L’élaboration d’une politique publique environnementale, le Bilan Carbone® - Entretien avec T. Gourdon (ADEME)

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Comparaison de l'échodoppler hépatique et de l'examen histologique pour l'évaluation de la fibrose hépatique (à propos de 92 patients alcooliques)

NICE-BU Médecine Odontologie (060882102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Adherence to Anticholinergic Therapy and Clean Intermittent Self-Catheterization in Patients With Multiple Sclerosis

International audiencePurposeTo evaluate adherence to anticholinergic therapy (AT) and clean intermittent self-catheterization (CISC) in patients with multiple sclerosis (MS) and to identify factors associated with poor adherence.MethodsThis single-center study prospectively included 49 patients suffering from MS who had been prescribed AT and/or CISC. Adherence was evaluated using a self-report questionnaire. The Expanded Disability Status Scale (EDSS), Patient Global Impression of Improvement, Mini-Mental State Examination, Urinary Symptom Profile, and Hospital Anxiety and Depression (HAD) instruments were administered, and the number of daily anticholinergic pills and/or catheterizations was noted. Whether patients were receiving concomitant intradetrusor botulinum toxin injections was assessed, as were barriers to treatment, side effects, number of spontaneous micturitions, reasons for the prescription, satisfaction, and difficulties.ResultsOnly 38% of patients were adherent to AT. Experiencing side effects was related to nonadherence (P=0.02). Only 29% of patients were adherent to CISC. More intense voiding dysfunction (P<0.001), a higher frequency of CISC (P=0.03), and a higher EDSS score (P=0.02) were associated with better adherence. Conversely, the HAD score (P<0.001), depression (P<0.001), the persistence of spontaneous micturition (P<0.001), a blocking sensation during catheterization (P=0.04), and the need to adapt one’s posture or gesture to perform catheterization (P=0.04) were associated with poorer adherence.ConclusionsAdherence to AT and CISC was poor in patients with MS suffering from bladder dysfunction. Several factors related to nonadherence were identified in this study, and addressing these factors might help to improve treatment adherence

Assessment of voiding difficulties in men with idiopathic Parkinson ’s disease

Purpose:: Distinction between the impact of Parkinson’s disease (PD) or age-related lower urinary tract disorders such as benign prostatic hyperplasia (BPH) can be difficult in patients reporting voiding difficulties (VD). This study aimed to describe the causes of VD in men with PD, and to compare clinical and urodynamic parameters according to the mechanism. Materials and Methods:: This retrospective study included men with PD reporting VD, for whom pressure-flow studies were performed. Findings of urodynamics, voiding cystourethrogram (VCUG), and prostatic weight were collected. BPH was defined as a prostatic weight >30 cc. Urodynamic obstruction and underactivity were defined using the Bladder Outlet Obstruction Index >40 and the Bladder Contractility Index <100 respectively. Results:: Forty-one patients were included (median age 70 (IQR: 66-74)). Twenty-nine (71%) had bladder obstruction. The maximum flow rate was lower (6.8 ± 2.6 ml/s vs 13.6 ± 2.3 ml/s; p<0.001) and the post-void residual was higher in the obstructed group (99 ± 133 ml vs 9 ± 16 ml; p = 0.002). Ten patients (24%) had detrusor underactivity.Among patients with obstruction, eighteen (62%) had BPH and seven (24%) did not. Eleven obstructed patients underwent a VCUG: only one patient among the seven with BPH presented incomplete bladder neck opening compared to six among the seven patients without BPH (p = 0.02). Conclusion:: VD in patients with PD is more frequently related to bladder outlet obstruction. BPH is the primary cause, but tight bladder neck and detrusor underactivity, probably secondary to PD, must be considered. Thus, a detailed assessment of urinary disorders in this population is crucial

Lower Urinary Tract Symptoms in Elderly Population With Multiple Sclerosis

Purpose The aim of this study is to compare the clinical and urodynamic characteristics of urinary disorders in multiple sclerosis (MS) patients in a geriatric population with a nongeriatric population. Methods This study was conducted retrospectively between 2010 and 2016. Each patient with MS aged 65 and older was matched with 2 patients with MS aged less than 65 in sex, form of MS, and Expended Disability Status Scale (EDSS). Demographic data, urinary symptoms, treatment, quality of life, repercussion of lower urinary tract symptoms on daily life activities and psychological state and urodynamic parameters were collected. Differences between the 2 populations were evaluated using Student test, chi-square, or Fischer tests. Results Twenty-four patients with MS aged 65 and older (mean age, 69.8 years) were matched with 48 patients aged less than 65 years (mean age, 49.4 years). Maximum urethral closure pressure was lower in the elderly population than in the nongeriatric population (mean±standard deviation [SD]: 35.6±18.5 cm H2O vs. 78.2±52.3 cm H2O, P<0.001). In the male population, there was no statistical difference in any other clinical or urodynamic endpoints. In the female population, voiding symptoms was more described in the nongeriatric population (Urinary Symptom Profile low stream: 3.4±3.5 vs. 1.7±2.4, P=0.04), geriatric population had less urinary treatment (P=0.05). LUTS had less impact on quality of life (Qualiveen: 1.4±1.0 vs. 2.1±0.9, P=0.02) on the geriatric population than in the nongeriatric of female MS patients. Conclusions Geriatric population of MS has few differences of urinary disorders compared to a nongeriatric population with EDSS, sex, and MS form equal. However, the psychological impact of these urinary disorders is less important in female geriatric population

Regulation of monocarboxylate transporter MCT1 expression by p53 mediates inward and outward lactate fluxes in tumors

The monocarboxylate transporter MCT family member MCT1 can transport lactate into and out of tumor cells. While most oxidative cancer cells import lactate through MCT1 to fuel mitochondrial respiration, the role of MCT1 in glycolysis-derived lactate efflux remains less clear. In this study we identified a direct link between p53 function and MCT1 expression. Under hypoxic conditions, p53 loss promoted MCT1 expression and lactate export produced by elevated glycolytic flux, both in vitro and in vivo. p53 interacted directly with the MCT1 gene promoter and altered MCT1 mRNA stabilization. In hypoxic p53-/- tumor cells, NF-κB further supported expression of MCT1 to elevate its levels. Following glucose deprivation, upregulated MCT1 in p53-/- cells promoted lactate import and favored cell proliferation by fuelling mitochondrial respiration. We also found that MCT1 expression was increased in human breast tumors harboring p53 mutations and coincident features of hypoxia, with higher MCT1 levels associated with poorer clinical outcomes. Together, our findings identify MCT1 as a target for p53 repression and they suggest that MCT1 elevation in p53-deficient tumors allows them to adapt to metabolic needs by facilitating lactate export or import depending on the glucose availability

Auto-sondages intermittents et rétentions urinaires des syndromes parkinsoniens

International audienceINTRODUCTION: Lower urinary tract symptoms are common in Parkinson diseases, especially chronic urinary retention. In case of significant and symptomatic postvoid residual, a specific treatment is necessary in order to empty the bladder and nowadays the gold standard of such neurogenic bladder is based on self-intermittent-catheterizations, if possible at all. We carried out a retrospective study about feasibility and outcomes of self-intermittent-catheterizations in this population.METHODS: Retrospective study with qualitative and quantitative, clinical and instrumental (urodynamic) assessment, of lower urinary tract symptoms as urinary retention in extrapyramidal syndromes.RESULTS: Overall, 42 patients with parkinsonian syndrome performing self-intermittent-catheterization were assessed. Twenty-one had idiopathic Parkinson's disease, 17 multiple system atrophy, 1 vascular Parkinson, 1 iatrogenic Parkinson and 2 not yet determined parkinsonian syndromes. All the patients had urinary retention characterized by a postvoiding residual volume more than 150mL. All the patients were symptomatic and reported voiding dysfunction (30/42), overactive bladder syndrome (20/42), stress urinary incontinence (6/42). The cystometry showed detrusor overactivity (15/42), bladder-sphincter dyssynergia (15/42), detrusor underactivity (14/42), sphincter deficiency (4/42) or bladder compliance alteration (3/42). Each patient have learned and well controlled self-intermittent-catheterization technique. Fourteen (33%) stopped self-intermittent-catheterization prematurely in the following months because of functional impact of neurological worsening.CONCLUSION: Even if one third of the patients had stopped self-intermittent-catheterization because of neurological deterioration, this technique remains the gold standard for the treatment of urinary chronic retention in parkinsonian patients.Introduction: Les troubles vésicosphinctériens sont fréquents dans les syndromes parkinsoniens, notamment la rétention urinaire chronique. En cas de résidu significatif et symptomatique se pose le problème de son traitement qui se résume le plus souvent à la faisabilité ou non de la pratique des auto-sondages intermittents. Nous avons conduit une étude rétrospective sur la faisabilité et les résultats des auto-sondages dans cette population.Méthodes: Étude rétrospective avec analyse qualitative et quantitative, clinique et instrumentale (urodynamique), des troubles vésicosphinctériens à type de rétention au cours des syndromes extrapyramidaux.Résultats: Au total, 42 patients avec syndrome parkinsonien et réalisant des auto-sondages intermittents ont été examinés. Vingt et un étaient atteints d’une maladie de Parkinson idiopathique, 17 d’une atrophie multisystématisée, 1 d’un syndrome parkinsonien d’origine vasculaire, 1 d’un syndrome parkinsonien d’origine iatrogène et 2 d’un syndrome extrapyramidal non étiqueté. Tous avaient une rétention d’urine définie par un résidu post-mictionnel supérieur ou égal à cent cinquante millilitres. Tous étaient symptomatiques et les symptômes rapportés étaient une dysurie (30/42), une hyperactivité vésicale (20/42) et une incontinence urinaire d’effort (6/42). La cystomanométrie mettait en évidence une hyperactivité détrusorienne (15/42), une dyssynergie vésicosphinctérienne (15/42), une hypocontractilité détrusorienne (14/42), une incompétence sphinctérienne (4/42) ou un défaut de compliance (3/42). Tous les patients maîtrisaient la technique des auto-sondages intermittents. Quatorze (33 %) ont arrêté l’auto-sondage précocement dans les mois qui suivaient l’apprentissage en raison du retentissement fonctionnel de la dégradation neurologique.Conclusion: Même si un tiers des patients abandonnent la réalisation des auto-sondages en raison de l’aggravation de la maladie neurologique, ces derniers restent la méthode de choix du traitement symptomatique de la rétention chronique du patient parkinsonien

Semi-automatic PD-L1 Characterization and Enumeration of Circulating Tumor Cells from Non-small Cell Lung Cancer Patients by Immunofluorescence

International audienceCirculating tumor cells (CTCs) derived from the primary tumor are shed into the bloodstream or lymphatic system. These rare cells (1-10 cells per mL of blood) warrant a poor prognosis and are correlated with shorter overall survival in several cancers (e.g., breast, prostate and colorectal). Currently, the anti-EpCAM-coated magnetic bead-based CTC capturing system is the gold standard test approved by the U.S. Food and Drug Administration (FDA) for enumerating CTCs in the bloodstream. This test is based on the use of magnetic beads coated with anti-EpCAM markers, which specifically target epithelial cancer cells. Many studies have illustrated that EpCAM is not the optimal marker for CTC detection. Indeed, CTCs are a heterogeneous subpopulation of cancer cells and are able to undergo an epithelial-to-mesenchymal transition (EMT) associated with metastatic proliferation and invasion. These CTCs are able to reduce the expression of cell surface epithelial marker EpCAM, while increasing mesenchymal markers such as vimentin. To address this technical hurdle, other isolation methods based on physical properties of CTCs have been developed. Microfluidic technologies enable a label-free approach to CTC enrichment from whole blood samples. The spiral microfluidic technology uses the inertial and Dean drag forces with continuous flow in curved channels generated within a spiral microfluidic chip. The cells are separated based on the differences in size and plasticity between normal blood cells and tumoral cells. This protocol details the different steps to characterize the programmed death-ligand 1 (PD-L1) expression of CTCs, combining a spiral microfluidic device with customizable immunofluorescence (IF) marker set