Evaluation of chronic lymphocytic leukemia by oligonucleotide-based microarray analysis uncovers novel aberrations not detected by FISH or cytogenetic analysis

<p>Abstract</p> <p>Background</p> <p>Cytogenetic evaluation is a key component of the diagnosis and prognosis of chronic lymphocytic leukemia (CLL). We performed oligonucleotide-based comparative genomic hybridization microarray analysis on 34 samples with CLL and known abnormal karyotypes previously determined by cytogenetics and/or fluorescence <it>in situ </it>hybridization (FISH).</p> <p>Results</p> <p>Using a custom designed microarray that targets >1800 genes involved in hematologic disease and other malignancies, we identified additional cryptic aberrations and novel findings in 59% of cases. These included gains and losses of genes associated with cell cycle regulation, apoptosis and susceptibility loci on 3p21.31, 5q35.2q35.3, 10q23.31q23.33, 11q22.3, and 22q11.23.</p> <p>Conclusions</p> <p>Our results show that microarray analysis will detect known aberrations, including microscopic and cryptic alterations. In addition, novel genomic changes will be uncovered that may become important prognostic predictors or treatment targets for CLL in the future.</p

Cognitive behaviour therapy plus aerobic exercise training to increase activity in patients with myotonic dystrophy type 1 (DM1) compared to usual care (OPTIMISTIC):Study protocol for randomised controlled trial

Peer reviewedPublisher PD

Cognitive behavioural therapy with optional graded exercise therapy in patients with severe fatigue with myotonic dystrophy type 1:a multicentre, single-blind, randomised trial

Background: Myotonic dystrophy type 1 is the most common form of muscular dystrophy in adults and leads to severe fatigue, substantial physical functional impairment, and restricted social participation. In this study, we aimed to determine whether cognitive behavioural therapy optionally combined with graded exercise compared with standard care alone improved the health status of patients with myotonic dystrophy type 1. Methods: We did a multicentre, single-blind, randomised trial, at four neuromuscular referral centres with experience in treating patients with myotonic dystrophy type 1 located in Paris (France), Munich (Germany), Nijmegen (Netherlands), and Newcastle (UK). Eligible participants were patients aged 18 years and older with a confirmed genetic diagnosis of myotonic dystrophy type 1, who were severely fatigued (ie, a score of ≥35 on the checklist-individual strength, subscale fatigue). We randomly assigned participants (1:1) to either cognitive behavioural therapy plus standard care and optional graded exercise or standard care alone. Randomisation was done via a central web-based system, stratified by study site. Cognitive behavioural therapy focused on addressing reduced patient initiative, increasing physical activity, optimising social interaction, regulating sleep–wake patterns, coping with pain, and addressing beliefs about fatigue and myotonic dystrophy type 1. Cognitive behavioural therapy was delivered over a 10-month period in 10–14 sessions. A graded exercise module could be added to cognitive behavioural therapy in Nijmegen and Newcastle. The primary outcome was the 10-month change from baseline in scores on the DM1-Activ-c scale, a measure of capacity for activity and social participation (score range 0–100). Statistical analysis of the primary outcome included all participants for whom data were available, using mixed-effects linear regression models with baseline scores as a covariate. Safety data were presented as descriptives. This trial is registered with ClinicalTrials.gov, number NCT02118779. Findings: Between April 2, 2014, and May 29, 2015, we randomly assigned 255 patients to treatment: 128 to cognitive behavioural therapy plus standard care and 127 to standard care alone. 33 (26%) of 128 assigned to cognitive behavioural therapy also received the graded exercise module. Follow-up continued until Oct 17, 2016. The DM1-Activ-c score increased from a mean (SD) of 61·22 (17·35) points at baseline to 63·92 (17·41) at month 10 in the cognitive behavioural therapy group (adjusted mean difference 1·53, 95% CI −0·14 to 3·20), and decreased from 63·00 (17·35) to 60·79 (18·49) in the standard care group (−2·02, −4·02 to −0·01), with a mean difference between groups of 3·27 points (95% CI 0·93 to 5·62, p=0·007). 244 adverse events occurred in 65 (51%) patients in the cognitive behavioural therapy group and 155 in 63 (50%) patients in the standard care alone group, the most common of which were falls (155 events in 40 [31%] patients in the cognitive behavioural therapy group and 71 in 33 [26%] patients in the standard care alone group). 24 serious adverse events were recorded in 19 (15%) patients in the cognitive behavioural therapy group and 23 in 15 (12%) patients in the standard care alone group, the most common of which were gastrointestinal and cardiac. Interpretation: Cognitive behavioural therapy increased the capacity for activity and social participation in patients with myotonic dystrophy type 1 at 10 months. With no curative treatment and few symptomatic treatments, cognitive behavioural therapy could be considered for use in severely fatigued patients with myotonic dystrophy type 1. Funding: The European Union Seventh Framework Programme

Racial differences in systemic sclerosis disease presentation: a European Scleroderma Trials and Research group study

Objectives. Racial factors play a significant role in SSc. We evaluated differences in SSc presentations between white patients (WP), Asian patients (AP) and black patients (BP) and analysed the effects of geographical locations.Methods. SSc characteristics of patients from the EUSTAR cohort were cross-sectionally compared across racial groups using survival and multiple logistic regression analyses.Results. The study included 9162 WP, 341 AP and 181 BP. AP developed the first non-RP feature faster than WP but slower than BP. AP were less frequently anti-centromere (ACA; odds ratio (OR) = 0.4, P &lt; 0.001) and more frequently anti-topoisomerase-I autoantibodies (ATA) positive (OR = 1.2, P = 0.068), while BP were less likely to be ACA and ATA positive than were WP [OR(ACA) = 0.3, P &lt; 0.001; OR(ATA) = 0.5, P = 0.020]. AP had less often (OR = 0.7, P = 0.06) and BP more often (OR = 2.7, P &lt; 0.001) diffuse skin involvement than had WP.AP and BP were more likely to have pulmonary hypertension [OR(AP) = 2.6, P &lt; 0.001; OR(BP) = 2.7, P = 0.03 vs WP] and a reduced forced vital capacity [OR(AP) = 2.5, P &lt; 0.001; OR(BP) = 2.4, P &lt; 0.004] than were WP. AP more often had an impaired diffusing capacity of the lung than had BP and WP [OR(AP vs BP) = 1.9, P = 0.038; OR(AP vs WP) = 2.4, P &lt; 0.001]. After RP onset, AP and BP had a higher hazard to die than had WP [hazard ratio (HR) (AP) = 1.6, P = 0.011; HR(BP) = 2.1, P &lt; 0.001].Conclusion. Compared with WP, and mostly independent of geographical location, AP have a faster and earlier disease onset with high prevalences of ATA, pulmonary hypertension and forced vital capacity impairment and higher mortality. BP had the fastest disease onset, a high prevalence of diffuse skin involvement and nominally the highest mortality

Evaluation de la personnalité, du coping et de la régulation émotionnelle de patients atteints de Dystrophie Myotonique de type 1 (DM1)

Myotonic Dystrophy type 1 (DM1) is a neuromuscular disease with multiple impairments leading to blunted affect, apathy, hypersomnia, fatigue, social cognition deficit and theory of mind deficit. In this research, personality traits, coping, and emotion regulation of 60 DM1 patients were assessed. All this information will help us design DM1 adapted psychological care.Regarding personality, our main result is that patients show similar N scores to the healthy control group despite our expectations (high scores in relation with the severity of the disease and its complications). In the light of our coping results, it seems that DM1 patients are using a large variety of coping strategies. However, apathy and reduced motivation constitute obstacles for coping strategies. Finally, apathy and fatigue do not influence emotion regulation in our sample DM1. Furthermore, Cognitive reevaluation strategy seems preserved from the disease’s consequences. This strategy might be an important advantage in the preservation of quality of life in DM1, despite the disease progression. A DM1 specific Cognitive Behavioral Therapy showed promising results. Other psychotherapeutic approaches could be explored, namely Acceptance and Commitment Therapy.Le Dystrophie Myotonique de type 1 (DM1) est une maladie neuromusculaire aux atteintes multiples qui induisent notamment de l’émoussement affectif, de l’apathie, de l’hypersomnolence, de la fatigue, ainsi qu’un déficit de cognition sociale et de théorie de l’esprit. Nous avons évalué les traits de personnalité, le coping et la régulation émotionnelle de 60 patients atteints de DM1. In fine, il s’agissait de proposer, à partir de ces éléments, une prise en charge psychothérapeutique adaptée à leurs besoins. Concernant la personnalité, le résultat le plus frappant concerne la dimension N. Contrairement à ce que nous attendions (des scores élevés du fait de la maladie et de ses répercussions), les patients inclus dans notre échantillon obtiennent des scores similaires à ceux de notre groupe contrôle tout-venant. Nos résultats relatifs au coping témoignent d’une utilisation variée des 10 stratégies que nous avons évaluées. Toutefois, l’apathie et la motivation réduite ressortent comme des obstacles qui limiteraient leur mise en place pour faire face à la DM1. Enfin, l’apathie et la fatigue ne semblent pas influencer la régulation émotionnelle dans notre échantillon. De plus, la stratégie Réévaluation cognitive ne semble pas être impactée par la maladie, ce qui pourrait se révéler un atout important dans la préservation de la qualité de vie des patients malgré la progression de leurs atteintes. En termes de psychothérapie, une Thérapie Comportementale et Cognitive a été développée spécifiquement pour ces patients et apporte des résultats prometteurs. D’autres pistes de psychothérapies pourraient être intéressantes à explorer, notamment la thérapie d’acceptation et d’engagement

Personality, coping, and emotion regulation assessment in patients with Myotonic Dystrophy type 1 (DM1)

Le Dystrophie Myotonique de type 1 (DM1) est une maladie neuromusculaire aux atteintes multiples qui induisent notamment de l’émoussement affectif, de l’apathie, de l’hypersomnolence, de la fatigue, ainsi qu’un déficit de cognition sociale et de théorie de l’esprit. Nous avons évalué les traits de personnalité, le coping et la régulation émotionnelle de 60 patients atteints de DM1. In fine, il s’agissait de proposer, à partir de ces éléments, une prise en charge psychothérapeutique adaptée à leurs besoins. Concernant la personnalité, le résultat le plus frappant concerne la dimension N. Contrairement à ce que nous attendions (des scores élevés du fait de la maladie et de ses répercussions), les patients inclus dans notre échantillon obtiennent des scores similaires à ceux de notre groupe contrôle tout-venant. Nos résultats relatifs au coping témoignent d’une utilisation variée des 10 stratégies que nous avons évaluées. Toutefois, l’apathie et la motivation réduite ressortent comme des obstacles qui limiteraient leur mise en place pour faire face à la DM1. Enfin, l’apathie et la fatigue ne semblent pas influencer la régulation émotionnelle dans notre échantillon. De plus, la stratégie Réévaluation cognitive ne semble pas être impactée par la maladie, ce qui pourrait se révéler un atout important dans la préservation de la qualité de vie des patients malgré la progression de leurs atteintes. En termes de psychothérapie, une Thérapie Comportementale et Cognitive a été développée spécifiquement pour ces patients et apporte des résultats prometteurs. D’autres pistes de psychothérapies pourraient être intéressantes à explorer, notamment la thérapie d’acceptation et d’engagement.Myotonic Dystrophy type 1 (DM1) is a neuromuscular disease with multiple impairments leading to blunted affect, apathy, hypersomnia, fatigue, social cognition deficit and theory of mind deficit. In this research, personality traits, coping, and emotion regulation of 60 DM1 patients were assessed. All this information will help us design DM1 adapted psychological care.Regarding personality, our main result is that patients show similar N scores to the healthy control group despite our expectations (high scores in relation with the severity of the disease and its complications). In the light of our coping results, it seems that DM1 patients are using a large variety of coping strategies. However, apathy and reduced motivation constitute obstacles for coping strategies. Finally, apathy and fatigue do not influence emotion regulation in our sample DM1. Furthermore, Cognitive reevaluation strategy seems preserved from the disease’s consequences. This strategy might be an important advantage in the preservation of quality of life in DM1, despite the disease progression. A DM1 specific Cognitive Behavioral Therapy showed promising results. Other psychotherapeutic approaches could be explored, namely Acceptance and Commitment Therapy

A Review of Psychopathology Features, Personality, and Coping in Myotonic Dystrophy Type 1

International audienceBackground: The last literature review on psychopathological features in Myotonic Dystrophy type 1 had been conducted by Ambrosini and Nurnberg in 1979. Since that date, many researches had been carried out.Objective: The aim of this study is (i) to systematically obtain and evaluate the relevant literature on psychopathological features, personality, and coping in individuals with adult phenotypes of Myotonic Dystrophy type 1. (ii) To summarize current research findings and draw conclusions for future research.Methods: A systematic search was conducted on Pubmed, PubPsych, PsycInfo, Science Direct, and Scopus covering the period of January 1979 to July 2017.Results: In view of our literature review, patients show mild psychopathological problems, such as interpersonal difficulties, lack of interest, dysphoria, concern about bodily functioning, and hypersensibility. However, they do not experience more psychiatric disorder in comparison to the general population, except for personality disorders and depression. We discussed problems concerning depression's assessment tool. Patients also present symptoms of several personality disorders: avoidant personality disorder was the most common. Finally, coping strategies relative to limitations resulting from their disease have a negative impact on their quality of life.Conclusions: In conclusion, Myotonic Dystrophy type 1 patients did not present homogeneous psychopathological and psychological features. However, based on tendencies observed among Myotonic Dystrophy type 1 patients, elements to conceptualize their social difficulties are provided

Guide pratique pour élaborer un programme de TMF et son manuel associé : Des choix théoriques au contenu des séances (chap. 10)

International audienc

Patients and Parents’ Experience of Multi-Family Therapy for Anorexia Nervosa: A Pilot Study

International audienceBackground: Family therapy is considered as the gold standard in treatment of adolescents with anorexia nervosa (AN). Among the different types of family therapy, multi-family therapy (MFT) is increasingly used for treating AN, and shows promising results. In this article, our focus relied on the patients’ and their parents’ perceptions of the effectiveness and the underlying mechanisms of the MFT. Methods: The present pilot exploratory qualitative study included two focus groups conducted using a semi-structured approach: one with the adolescents ( n = 3), and another with one or two of their parents ( n = 4 mothers; n = 2 fathers). The subjects discussed were the changes observed in both AN symptoms and family interactions following therapy, and the mechanisms underlying these changes. We crossed the perspectives of the adolescents and of the parents on these two points. Results: Qualitative analysis revealed that while both adolescents and parents had difficulties relating the changes they observed in the last year to MFT, they were able to say that the group cohesion had several positive effects and that their family dynamics had improved. In the light of analysis the adolescents perceived more improvements related eating disorders symptoms than their parents did, while parents were concerned about a negative effect of MFT on their children. Discussion: While both patients and parents perceived improvements in both AN symptoms and family interactions in the past year, it was not clear if they considered MFT to have led to these improvements. FG also explored the MFT mechanisms underlying changes. Both adolescents and their parents stressed the beneficial effects of identification to others members of the group and shared experience to overcome social isolation. Parents also mentioned the sympathy they felt for each other. The idea that they give a central place to families in the therapy was also described by the families