A model-strengthened imaging biomarker for survival prediction in EGFR-mutated non-small-cell lung carcinoma patients treated with tyrosine kinase inhibitors

International audienceNon-small-cell lung carcinoma is a frequent type of lung cancer with a bad prognosis. Depending on the stage, genomics, several therapeutical approaches are used. Tyrosine Kinase Inhibitors (TKI) may be successful for a time in the treatment of EGFR-mutated non-small cells lung carcinoma. Our objective is here to propose a survival assessment as their efficacy in the long run is challenging to evaluate. The study includes 17 patients diagnosed as of EGFR-mutated non-small cell lung cancer and exposed to an EGFR-targeting TKI with 3 computed tomography (CT) scans of the primitive tumor (one before the TKI introduction and two after). An imaging biomarker based on the texture heterogeneity evolution between the first and the third exams is derived and computed from a mathematical model and patient data. Defining the overall survival as the time between the introduction of the TKI treatment and the patient death, we obtain a statistically significant correlation between the overall survival and our imaging marker (p = 0:009). Using the ROC curve, the patients are separated into two populations and the comparison of the survival curves is statistically significant (p = 0:025). The baseline exam seems to have a significant role in the prediction of response to TKI treatment. More precisely, our imaging biomarker defined using only the CT scan before the TKI introduction allows to determine a first classification of the population which is improved over time using the imaging marker as soon as more CT scans are available. This exploratory study leads us to think that it is possible to obtain a survival assessment using only few CT scans of the primary tumor

Dommage cardiaque chronique chez l'athlète compétiteur endurant sénior : analyse multimodale en imagerie cardiaque par résonance magnétique et échocardiographie d'effort

Il est bien établi qu’une pratique sportive modérée est bénéfique pour la santé, mais la question des bénéfices de l’activité physique pratiquée de façon très intensive et prolongée est plus débattue. En effet, l’hypothèse de cardiomyopathies induites par l’exercice a été récemment proposée, devant la découverte de fibrose myocardique, ou d’anomalies ventriculaires droite chez des sportifs sénior de haut niveau. L’existence de ces cardiopathies reste aujourd’hui controversée.L'objectif principal de ce travail était d’analyser le remodelage cardiaque chez des athlètes séniors endurants compétiteurs de haut niveau, en se focalisant sur la recherche de la fibrose myocardique. L'objectif secondaire était d’étudier les caractéristiques cardiaques électriques, fonctionnelles et structurelles bi-ventriculaires et bi-atriales de ces athlètes afin d’apporter de nouveaux éclairages dans la description du cœur d’athlète chez le sénior.Nous avons réalisé une étude de cohorte d’exposés / non exposés, comparant des athlètes séniors endurants compétiteurs aux sujets d’un groupe contrôle. Chaque sujet a bénéficié d’un électrocardiogramme, d’un prélèvement sanguin, d’une échographie cardiaque transthoracique d'effort, et d’une imagerie cardiaque par résonance magnétique.Trente-trois athlètes (47 ± 6 ans, 9,6 ± 1,7 heures hebdomadaires d’entrainement depuis 26 ± 6 ans) et 18 sujets contrôles (49 ± 7 ans) ont été inclus. Les athlètes présentaient des volumes bi-ventriculaires et bi-atriaux, un volume d’éjection systolique, et des valeurs de strain longitudinal bi-ventriculaire d’effort plus élevées que les sujets contrôles. Il n’a pas été retrouvé de fibrose myocardique chez les athlètes. Les valeurs de T1 mapping et de fraction de volume extracellulaire n’étaient pas significativement différentes pour les 2 groupes. Les valeurs de Troponine T et NT proBNP étaient normales pour tous les sujets. Contrairement aux sujets contrôles, les athlètes présentaient des troubles bénins de la conduction, et une bradycardie sinusale.L’exposition à un entrainement sportif important et à une pratique de compétition en endurance chez les athlètes de notre série était associée à un remodelage cardiaque adaptatif structurel, fonctionnel, et électrique s’inscrivant dans le cadre du cœur d’athlète. Nos données ne sont pas en faveur de l’existence d’une cardiomyopathie fibrosante induite par l’exercice, suggérant que le sport d’endurance de haut niveau, même pratiqué pendant plusieurs années avec des charges d’entrainement importantes, n’est pas délétère pour le cœur de l’athlète sénior

Fatigue, bruit moteur et précision de la motricité humaine

MONTPELLIER-BU Médecine UPM (341722108) / SudocMONTPELLIER-BU Médecine (341722104) / SudocSudocFranceF

Neuromuscular adaptations after a rehabilitation program in patients with chronic low back pain: case series (uncontrolled longitudinal study).

International audienceBACKGROUND: To investigate the impact of a short-term multimodal rehabilitation program for patients with low back pain (LBP) on trunk muscle reflex responses and feedforward activation induced by postural perturbations. METHODS: Case series (uncontrolled longitudinal study). Thirty chronic patients with LBP (21 women and 19 men, mean age 42.6 +/- 8.6 years, mean weight 73 +/- 14 kg, mean height 174 +/- 10 cm) were included. The intervention consisted in a 5-day program including therapeutic education sessions (360 min), supervised abdominal and back muscle strength exercises (240 min), general aerobic training (150 min), stretching (150 min), postural education (150 min) and aqua therapy (150 min). Feedforward activation level and reflex amplitude determined by surface electromyographic activity triggered by postural perturbations were recorded from abdominal and paraspinal muscles in unexpected and expected conditions. Subjects were tested before, just after and again one month after the rehabilitation program. RESULTS: No main intervention effect was found on feedforward activation levels and reflex amplitudes underlining the absence of changes in the way patients with LBP reacted across perturbation conditions. However, we observed a shift in the behavioral strategy between conditions, in fact feedforward activation (similar in both conditions before the program) decreased in the unexpected condition after the program, whereas reflex amplitudes became similar in both conditions. CONCLUSIONS: The results suggest that a short-term rehabilitation program modifies trunk behavioral strategies during postural perturbations. These results can be useful to clinicians for explaining to patients how to adapt to daily life activities before and after rehabilitation

Absence of cardiac damage induced by long-term intensive endurance exercise training: A cardiac magnetic resonance and exercise echocardiography analysis in masters athletes

Objectives: It is under debate whether the long-term practice of intensive endurance exercise induces chronic cardiac damage such as myocardial fibrosis and ventricle contractile dysfunction. Multimodality analysis was performed to evaluate myocardial damage induced by long term intensive endurance training in master athletes. Methods: Thirty-three asymptomatic endurance master athletes (47 ± 6 year-old, 9,6 ± 1,7 h training/week for 26 ± 6 years), were compared to 18 sedentary controls (49 ± 7 year-old). They underwent a CMR protocol including 4 chambers morphological and late gadolinium-enhancement (LGE) analysis, left (LV) and right ventricular (RV) T1 mapping and calculation of cardiac extracellular volume (ECV). A maximal exercise echocardiography with left and right ventricular longitudinal global strain (LGS) analysis was performed. Cardiac biomarkers of fibrosis (high sensitive cardiac Troponin T, N-Terminal pro brain natriuretic peptide, N-terminal propeptide of procollagen type I and N-terminal propeptide of procollagen type III) were analysed. Results: Athletes had larger left and right atrial volume, LV and RV end diastolic volume and increased LV and RV mass compared to controls. LGE was not found in athletes. Native T1 values of LV and RV were not significantly different in athletes compared with controls. ECV was normal in both groups (21,5%± 1,6% [18.3 – 23%] in athletes, 22%± 2,2% [18.5 – 27%] in controls). LV and RV peak exercise LGS values were higher in athletes. Cardiac biomarkers levels were normal. Conclusion: Despite significant physiological cardiac remodelling, consistent with previous descriptions of athlete's heart, there was no evidence of myocardial fibrosis or exercise left or right ventricular dysfunction or cardiac fibrosis in endurance athletes. Our results are not supporting the hypothesis of deleterious cardiac effects induced by long term and intensive endurance exercise training

Meeting Abstract: P311

International audienc

Wearable cardioverter defibrillator: Bridge or alternative to implantation?

International audienceThe implantable cardioverter-defibrillator (ICD) is effective to prevent sudden cardiac death (SCD) in selected patients with heart disease known to be at high risk for ventricular arrhythmia. Nevertheless, this invasive and definitive therapy is not indicated in patients with potentially transient or reversible causes of sudden death, or in patients with temporary contra-indication for ICD placement. The wearable cardioverter defibrillator (WCD) is increasingly used for SCD prevention both in patients awaiting ICD implantation or with an estimated high risk of ventricular arrhythmia though to be transient. We conducted a review of current clinical uses and benefits of the WCD, and described its technical aspects, limitations and perspectives

Use of morselized allografts for acetabular reconstruction during THA revision: French multicenter study of 508 cases with 8 years’ average follow-up

International audienceBackgroundIn the context of acetabular reconstruction, bone defects can be filled with processed or unprocessed bone allografts. Published data are often contradictory on this topic and few studies have been done comparing processed allografts to fresh-frozen ones. This led us to conduct a large study to measure the factors impacting the survival of THA revision: (1) type of allograft and cup, (2) technical factors or patient-related factors.HypothesisAcetabular reconstruction can be performed equally well with frozen or processed morselized allografts.Materials and methodsThis retrospective, multicenter study of acetabular reconstruction included 508 cases with a minimum follow-up of 5 years. The follow-up for the frozen grafts was shorter (7.86 years ± 1.89 [5–12.32]) than that of the processed grafts (8.22 years ± 1.77 [5.05–15.48]) (p = 0.029). However, the patients were younger at the time of the primary THA procedure in the frozen allograft group (51.5 years ± 14.2 [17–80]) than in the processed group (57.5 years ± 13.0 [12–94]) (p < 0.001) and were also younger at the time of THA revision (67.8 years ± 12.2 [36.9–89.3] versus 70 years ± 11.7 [25–94.5]) (p = 0.041).ResultsThere were more complications overall in the frozen allograft group (46/242 = 19.0%) than the processed allograft group (35/256 = 13.2%) (p = 0.044) with more instances of loosening in the frozen group (20/242 [8.2%]) than in the processed group (6/266 [3.3%])(p = 0.001). Conversely, the dislocation rate (16/242 = 6.6% vs. 17/266 = 6.4%) (p = 0.844) and infection rate (18/242 = 7.4% vs. 15/266 = 5.7%) (p = 0.264) did not differ between groups. The subgroup analysis reveal a correlation between the occurrence of a complication and higher body mass index (BMI) (p = 0.037) with a higher overall risk of complications in patients with a BMI above 30 or under 20 (p = 0.006) and a relative risk of 1.95 (95% CI: 1.26–2.93). Being overweight was associated with a higher risk of dislocation (relative risk of 2.46; 95% CI: 1.23–4.70) (p = 0.007). Loosening was more likely to occur in younger patients at the time of the procedure (relative risk of 2.77; 95% CI: 1.52–6.51) (p = 0.040) before 60 years during the revision. Lastly, patients who were less active preoperatively based on the Devane scale had an increased risk of dislocation (relative risk of 2.51; 95% CI: 1.26–8.26) (p = 0.022).DiscussionOur hypothesis was not confirmed. The groups were not comparable initially, which may explain the differences found since the larger number of loosening cases in the frozen allograft group can be attributed to group heterogeneity. Nevertheless, morselized allografts appear to be suitable for acetabular bone defect reconstruction. A randomized study would be needed to determine whether frozen or processed allografts are superior.Level of evidenceIII, comparative retrospective study