27 research outputs found
LâĂ©laboration dâune politique publique environnementale, le Bilan CarboneÂź - Entretien avec T. Gourdon (ADEME)
International audienc
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 MĂ©decine 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 oneâs 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 âs disease
Purpose:: Distinction between the impact of Parkinsonâs 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-ÎșB 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 vĂ©sicosphinctĂ©riens sont frĂ©quents dans les syndromes parkinsoniens, notamment la rĂ©tention urinaire chronique. En cas de rĂ©sidu significatif et symptomatique se pose le problĂšme de son traitement qui se rĂ©sume le plus souvent Ă la faisabilitĂ© ou non de la pratique des auto-sondages intermittents. Nous avons conduit une Ă©tude rĂ©trospective sur la faisabilitĂ© et les rĂ©sultats des auto-sondages dans cette population.MĂ©thodes: Ătude rĂ©trospective avec analyse qualitative et quantitative, clinique et instrumentale (urodynamique), des troubles vĂ©sicosphinctĂ©riens Ă type de rĂ©tention au cours des syndromes extrapyramidaux.RĂ©sultats: Au total, 42 patients avec syndrome parkinsonien et rĂ©alisant des auto-sondages intermittents ont Ă©tĂ© examinĂ©s. Vingt et un Ă©taient atteints dâune maladie de Parkinson idiopathique, 17 dâune atrophie multisystĂ©matisĂ©e, 1 dâun syndrome parkinsonien dâorigine vasculaire, 1 dâun syndrome parkinsonien dâorigine iatrogĂšne et 2 dâun syndrome extrapyramidal non Ă©tiquetĂ©. Tous avaient une rĂ©tention dâurine dĂ©finie par un rĂ©sidu post-mictionnel supĂ©rieur ou Ă©gal Ă cent cinquante millilitres. Tous Ă©taient symptomatiques et les symptĂŽmes rapportĂ©s Ă©taient une dysurie (30/42), une hyperactivitĂ© vĂ©sicale (20/42) et une incontinence urinaire dâeffort (6/42). La cystomanomĂ©trie mettait en Ă©vidence une hyperactivitĂ© dĂ©trusorienne (15/42), une dyssynergie vĂ©sicosphinctĂ©rienne (15/42), une hypocontractilitĂ© dĂ©trusorienne (14/42), une incompĂ©tence sphinctĂ©rienne (4/42) ou un dĂ©faut de compliance (3/42). Tous les patients maĂźtrisaient la technique des auto-sondages intermittents. Quatorze (33 %) ont arrĂȘtĂ© lâauto-sondage prĂ©cocement dans les mois qui suivaient lâapprentissage en raison du retentissement fonctionnel de la dĂ©gradation neurologique.Conclusion: MĂȘme si un tiers des patients abandonnent la rĂ©alisation des auto-sondages en raison de lâaggravation de la maladie neurologique, ces derniers restent la mĂ©thode de choix du traitement symptomatique de la rĂ©tention chronique du patient parkinsonien
Regulation of Monocarboxylate Transporter MCT1 Expression by p53 Mediates Inward and Outward Lactate Fluxes in Tumors
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