Value of ultrasonography as a marker of early response to abatacept in patients with rheumatoid arthritis and an inadequate response to methotrexate: results from the APPRAISE study

Objectives: To study the responsiveness of a combined power Doppler and greyscale ultrasound (PDUS) score for assessing synovitis in biologic-naïve patients with rheumatoid arthritis (RA) starting abatacept plus methotrexate (MTX). Methods: In this open-label, multicentre, single-arm study, patients with RA (MTX inadequate responders) received intravenous abatacept (∼10 mg/kg) plus MTX for 24 weeks. A composite PDUS synovitis score, developed by the Outcome Measures in Rheumatology–European League Against Rheumatism (OMERACT–EULAR)-Ultrasound Task Force, was used to evaluate individual joints. The maximal score of each joint was added into a Global OMERACT–EULAR Synovitis Score (GLOESS) for bilateral metacarpophalangeal joints (MCPs) 2–5 (primary objective). The value of GLOESS containing other joint sets was explored, along with clinical efficacy. Results: Eighty-nine patients completed the 24-week treatment period. The earliest PDUS sign of improvement in synovitis was at week 1 (mean change in GLOESS (MCPs 2–5): −0.7 (95% CIs −1.2 to −0.1)), with continuous improvement to week 24. Early improvement was observed in the component scores (power Doppler signal at week 1, synovial hyperplasia at week 2, joint effusion at week 4). Comparable changes were observed for 22 paired joints and minimal joint subsets. Mean Disease Activity Score 28 (C reactive protein) was significantly reduced from weeks 1 to 24, reaching clinical meaningful improvement (change ≥1.2) at week 8. Conclusions: In this first international prospective study, the composite PDUS score is responsive to abatacept. GLOESS demonstrated the rapid onset of action of abatacept, regardless of the number of joints examined. Ultrasound is an objective tool to monitor patients with RA under treatment. Trial registration number: NCT00767325

Death and the Societies of Late Antiquity

Ce volume bilingue, comprenant un ensemble de 28 contributions disponibles en français et en anglais (dans leur version longue ou abrégée), propose d’établir un état des lieux des réflexions, recherches et études conduites sur le fait funéraire à l’époque tardo-antique au sein des provinces de l’Empire romain et sur leurs régions limitrophes, afin d’ouvrir de nouvelles perspectives sur ses évolutions possibles. Au cours des trois dernières décennies, les transformations considérables des méthodologies déployées sur le terrain et en laboratoire ont permis un renouveau des questionnements sur les populations et les pratiques funéraires de l’Antiquité tardive, période marquée par de multiples changements politiques, sociaux, démographiques et culturels. L’apparition de ce qui a été initialement désigné comme une « Anthropologie de terrain », qui fut le début de la démarche archéothanatologique, puis le récent développement d’approches collaboratives entre des domaines scientifiques divers (archéothanatologie, biochimie et géochimie, génétique, histoire, épigraphie par exemple) ont été décisives pour le renouvellement des problématiques d’étude : révision d’anciens concepts comme apparition d’axes d’analyse inédits. Les recherches rassemblées dans cet ouvrage sont articulées autour de quatre grands thèmes : l’évolution des pratiques funéraires dans le temps, l’identité sociale dans la mort, les ensembles funéraires en transformation (organisation et topographie) et les territoires de l’empire (du cœur aux marges). Ces études proposent un réexamen et une révision des données, tant anthropologiques qu’archéologiques ou historiques sur l’Antiquité tardive, et révèlent, à cet égard, une mosaïque de paysages politiques, sociaux et culturels singulièrement riches et complexes. Elles accroissent nos connaissances sur le traitement des défunts, l’emplacement des aires funéraires ou encore la structure des sépultures, en révélant une diversité de pratiques, et permettent au final de relancer la réflexion sur la manière dont les sociétés tardo-antiques envisagent la mort et sur les éléments permettant d’identifier et de définir la diversité des groupes qui les composent. Elles démontrent ce faisant que nous pouvons véritablement appréhender les structures culturelles et sociales des communautés anciennes et leurs potentielles transformations, à partir de l’étude des pratiques funéraires.This bilingual volume proposes to draw up an assessment of the recent research conducted on funerary behavior during Late Antiquity in the provinces of the Roman Empire and on their borders, in order to open new perspectives on its possible developments. The considerable transformations of the methodologies have raised the need for a renewal of the questions on the funerary practices during Late Antiquity, a period marked by multiple political, social, demographic and cultural changes. The emergence field anthropology, which was the beginning of archaeothanatology, and then the recent development of collaborative approaches between various scientific fields (archaeothanatology, biochemistry and geochemistry, genetics, history, epigraphy, for example), have been decisive. The research collected in this book is structured around four main themes: Evolution of funerary practices over time; Social identity through death; Changing burial grounds (organisation and topography); Territories of the Empire (from the heart to the margins). These studies propose a review and a revision of the data, both anthropological and archaeological or historical on Late Antiquity, and reveal a mosaic of political, social, and cultural landscapes singularly rich and complex. In doing so, they demonstrate that we can truly understand the cultural and social structures of ancient communities and their potential transformations, based on the study of funerary practices

Laparoscopic ovariectomy by single-port access for ovarian ă cryopreservation

International audiencePurpose The aim of this study is to assess the feasibility of ă ovariectomy by single-port access laparoscopy for cryopreservation. ă Methods Observational prospective monocentric study including patients ă referred for an ovariectomy for ovarian tissue cryopreservation ă underwent ovariectomy by single-port access laparoscopy. Feasibility, ă intra-and post-operative complications, and quality of the ovarian ă tissue collected were reported. ă Results Height patients were included. No conversion to standard ă laparoscopy or laparotomy was performed and no intra-or post-operative ă complications were reported. Median duration of surgery was 35 min ă (30-60). The quality of all the ovarian tissue collected was correct, ă and cryopreservation was possible for all patients. ă Conclusions Ovariectomy for cryopreservation by laparoscopy with SPA ă seems feasible. The advantages of this technique are particularly ă interesting in these patients who require the least aggressive surgical ă technique possible and a rapid convalescence

Factors influencing sexual function in women with genital prolapse

Background. To evaluate the impact of the different types of genital prolapse and associated factors, on sexual quality of life in women presenting a genital prolapse. Design and methods. Forty-four women were included in this prospective observational study. We collected clinical data. Genital prolapse was quantified according to the Pelvic Organ Prolapse Quantification scale (POP-Q). Sexual function was evaluated using a validated questionnaire (PISQ-12). Statistical analysis between POP-Q stages, clinical characteristics and PISQ-12 scores was undertaken. Results. A history of abdominal surgery significantly decreases the sexual quality of life (P=0.03). PISQ-12 scores were poorly affected by the type and the severity of genital prolapse. Conclusions. The only factor influencing sexual quality of life was a history of previous abdominal surgery. The type and severity of genital prolapse did not influence sexual function. These results must be confirmed further studies with a higher sample size

Hysterectomy for benign disease: clinical practice guidelines from the ă French College of Obstetrics and Gynecology

International audienceObjective: The objective of the study was to draw up French College of ă Obstetrics and Gynecology (CNGOF) clinical practice guidelines based on ă the best available evidence concerning hysterectomy for benign disease. ă Methods: Each recommendation for practice was allocated a grade, which ă depends on the level of evidence (clinical practice guidelines). ă Results: Hysterectomy should be performed by a high-volume surgeon (>10 ă hysterectomy procedures per year) (grade C). Stimulant laxatives taken ă as a rectal enema are not recommended prior to hysterectomy (grade C). ă It is recommended to carry out vaginal disinfection using ă povidone-iodine solution prior to hysterectomy (grade B). Antibiotic ă prophylaxis is recommended during hysterectomy, regardless of the ă surgical approach (grade B). The vaginal or laparoscopic approach is ă recommended for hysterectomy for benign disease (grade B), even if the ă uterus is large and/or the patient is obese (grade C). The choice ă between these two surgical approaches depends on other parameters, such ă as the surgeon's experience, the mode of anesthesia, and organizational ă constraints (duration of surgery and medical economic factors). Vaginal ă hysterectomy is not contraindicated in nulliparous women (grade C) or in ă women with previous cesarean section (grade C). No specific hemostatic ă technique is recommended with a view to avoiding urinary tract injury ă (grade C). In the absence of ovarian disease and a personal or family ă history of breast/ovarian carcinoma, the ovaries should be preserved in ă premenopausal women (grade B). Subtotal hysterectomy is not recommended ă with a view to reducing the risk of peri-or postoperative complications ă (grade B). ă Conclusion: The application of these recommendations should minimize ă risks associated with hysterectomy. (C) 2016 Elsevier Ireland Ltd. All ă rights reserved

Altered angiogenesis in low birth weight individuals: a role for anti-angiogenic circulating factors

International audienceObjective: Low birth weight (LBW) is a risk factor for hypertension at adulthood. Endothelial progenitor cells (EPCs) dysfunction has been characterized in LBW neonates. We hypothesized that changes in soluble, plasma pro-or anti-angiogenic factors are associated with EPCs dysfunction and impaired angiogenesis in LBW neonates. Method: Venous umbilical cord blood was collected from 42 normal, term neonates and 75 LBW neonates. Cord blood endothelial colony forming cells (ECFC) from control patients were cultured in the presence of 10% of serum obtained from both groups. Results: The proliferation and the migration of ECFC were significantly reduced when cultured with 10% of serum of LBW neonates compared to serum of control neonates. Matrigel invasion assay was not significantly altered. Umbilical vein plasma VEGF concentration was significantly reduced in LBW neonates while that of sVEGFR and PF4 were significantly higher. Addition of VEGF corrected the inhibitory effect of LBW serum on normal ECFC proliferation. Conclusions: Serum obtained from LBW babies contains factors that exhibit an antiangiogenic effect on ECFC proliferation and migration. VEGF/sVEGF/PF4 pathway seems to be involved in the EPCs dysfunction in LBW neonates

Safety of surgery in patients with rheumatoid arthritis treated with tocilizumab: data from the French (REGistry -RoAcTEmra) Regate registry

International audienceTo investigate the frequency and risk factors of postoperative complications in RA patients treated with tocilizumab (TCZ).METHODS: the French registry REGATE recruited 1496 RA patients receiving TCZ in routine care. Data from patients treated with TCZ who underwent surgery were reviewed. Frequency of post-surgery complications was collected and compared in patients with and without complications in order to identify factors associated with complications. Similar analysis was performed in patients with postoperative infection.RESULTS: we identified 167 patients who underwent 175 surgical procedures including 103 orthopaedic surgeries (58.9%). The patients were mainly women (84%) with a mean disease duration of 14.96±11.29 years. The mean delay between surgery and the last TCZ infusion was 4.94±1.74 weeks. Fifteen patients experienced 15 complications (8.6%) with 10 severe infections including 5 surgical site infections (33.3%). There was no significant difference between patients with and without complications. In multivariate analysis, previous treatment with rituximab in the previous year tended to be associated with postoperative complications (OR: 3.27, IC95% 0.92–11.49, p=0.06). Concerning postoperative infections, diabetes mellitus tended to be associated with this complication (OR: 3.73, IC95% 0.88–15.79, p=0.06) in multivariate analysis.CONCLUSIONS: in RA patients treated with TCZ in perfusion, the rate of surgical complications was low: 8.6%. The median time between surgery and last infusion was relatively short according to half-life of TCZ but did not influence the rate of postoperative complications

Safety of surgery in patients with rheumatoid arthritis treated with tocilizumab: data from the French (REGistry -RoAcTEmra) Regate registry

International audienceTo investigate the frequency and risk factors of postoperative complications in RA patients treated with tocilizumab (TCZ).METHODS: the French registry REGATE recruited 1496 RA patients receiving TCZ in routine care. Data from patients treated with TCZ who underwent surgery were reviewed. Frequency of post-surgery complications was collected and compared in patients with and without complications in order to identify factors associated with complications. Similar analysis was performed in patients with postoperative infection.RESULTS: we identified 167 patients who underwent 175 surgical procedures including 103 orthopaedic surgeries (58.9%). The patients were mainly women (84%) with a mean disease duration of 14.96±11.29 years. The mean delay between surgery and the last TCZ infusion was 4.94±1.74 weeks. Fifteen patients experienced 15 complications (8.6%) with 10 severe infections including 5 surgical site infections (33.3%). There was no significant difference between patients with and without complications. In multivariate analysis, previous treatment with rituximab in the previous year tended to be associated with postoperative complications (OR: 3.27, IC95% 0.92–11.49, p=0.06). Concerning postoperative infections, diabetes mellitus tended to be associated with this complication (OR: 3.73, IC95% 0.88–15.79, p=0.06) in multivariate analysis.CONCLUSIONS: in RA patients treated with TCZ in perfusion, the rate of surgical complications was low: 8.6%. The median time between surgery and last infusion was relatively short according to half-life of TCZ but did not influence the rate of postoperative complications