QS9: Host Biofilm Interaction In Breast Implant Illness

Purpose: Breast Implant Illness (BII) is patient-described constellation of symptoms that are believed to be related to their breast implant. The symptoms described include fibromyalgia, chronic fatigue and a host of other symptoms that are often associated with autoimmune illnesses. In this work, we report that bacterial biofilm associated with breast implant, metabolize fatty acid oleic acid present in the breast tissue milieu to oxylipins, one such oxylipin identified from this study is (10S)-hydroxy-(8E)-octadecenoic acid (10-HOME). We hypothesize that immunomodulatory effects of oxylipin 10-HOME produced by biofilm present on the implant could be correlated with BII pathogenesis. Methods: Capsulectomy and breast implants from clinically indicated procedures for patients requesting prosthetic removal were collected using clinical parameters outlined in previous studies, and questionnaire screened for the commonly reported symptoms associated with BII. Predictive variables included age, diabetes status, co-morbidities, nature and duration of implant. Scanning electron microscopy (SEM), Wheat Germ Agglutinin (WGA) and 16SrRNA sequencing were used for bacterial biofilm bacterial identification. 10-HOME was quantitated through targeted and untargeted lipidomic analyses using LC-MS-MS. Results: Sixty eight Implant, associated capsules and breast tissue specimen were collected for BII (n=46) and two control groups, group I, (non-BII, n=14) patients with breast implants, no BII symptoms. Group II (normal tissue, n = 8), patients without an implant, whose breast tissue was removed due to surgical procedures. Bacterial biofilm was detected through SEM in both BII and non BII cohorts. However, WGA analysis (quantitative analysis) indicated increased abundance of biofilm in the BII cohort (n=7, p=0.0036). 16SrRNA (genomic) sequencing identified increased abundance of Staphylococcus epidermidis (Fisher’s exact test, p<0.001) in the BII group (63.04%) compared to non-BII group (14.3%) and the normal group. The BII group was 9.8 times significantly more likely to have Staphylococcus epidermidis colonization compared to the non-BII group (p=0.003, logistic regression), compared to normal, it is 17.4 times significantly more likely to have Staphylococcus epidermidis (p=0.0021). Elevated levels of 10-HOME BII compared to non-BII samples, (p < 0.0001) were observed through mass spectrometry. Positive correlation was observed between bacterial abundance and concentration of 10-HOME in BII subjects (R2=0.88). Similar correlation was observed in BII subjects with Staphylococcus epidermidis (R2=0.77). Conclusion: This study investigated the biofilm hypothesis of breast implant illness through a host-pathogen interaction. The breast microenvironment led to formation of biofilm derived 10-HOME from host oleic acid. The study provides the first evidence of a possible correlation between bacterial biofilm and biofilm derived 10-HOME in the context of 10-HOME. In consideration of reports of biofilm association with other metal implants, the findings of this study can possibly explain autoimmune response associated with those implants

Biofilm Derived Oxylipin Mediated Autoimmune Response in Breast Implant Subjects

Over 10 million women worldwide have breast implants for breast cancer/prophylactic reconstruction or cosmetic augmentation. In recent years, a number of patients have described a constellation of symptoms that are believed to be related to their breast implants. This constellation of symptoms has been named Breast Implant Illness (BII). The symptoms described include chronic fatigue, joint pain, muscle pain and a host of other manifestations often associated with autoimmune illnesses. In this work, we report that bacterial biofilm is associated with BII. We postulate that the pathogenesis of BII is mediated via a host-pathogen interaction whereby the biofilm bacteria Staphylococcus epidermidis interacts with breast lipids to form the oxylipin 10-HOME. The oxylipin 10-HOME was found to activate CD4+ T cells to Th1 subtype. An increased abundance of CD4+Th1 was observed in the breast tissue of BII subjects. The identification of a mechanism of immune activation associated with BII via a biofilm enabled pathway provides insight into the pathogenesis for implant-associated autoimmune symptoms

Brian G. Rogers, Proust et Barbey d'Aurevilly. Le dessous des cartes

Natta Marie-Christine. Brian G. Rogers, Proust et Barbey d'Aurevilly. Le dessous des cartes. In: Romantisme, 2002, n°115. De ceci à cela. pp. 126-128

Le vêtement dandy et la mode

Dandysme, mode et élégance au XIXe siècle Changement de mode Pour la plupart des contemporains de Barbey, le dandysme était avant tout une mode anglomane dont Brummell, son prince, s’était rendu célèbre par une irréprochable élégance et un art consommé de nouer sa cravate. Ce prince suscita des vocations, et eut une foule d’héritiers rarement dignes de leur modèle. On se moquait volontiers de ces dandys qui ne voyaient pas plus loin que le bout de leur canne, de ces cervelles vides, ancêtres ..

Brian G. Rogers, Proust et Barbey d'Aurevilly. Le dessous des cartes

Natta Marie-Christine. Brian G. Rogers, Proust et Barbey d'Aurevilly. Le dessous des cartes. In: Romantisme, 2002, n°115. De ceci à cela. pp. 126-128

Politesse et polémique : La conversation de Barbey d’Aurevilly

Marie-Christine Natta «Politesse et polémique : la conversation de Barbey d’Aurevilly» Pour Barbey, causeur éblouissant, la conversation est à la fois le cadre privilégié de ses œuvres romanesques et une pratique mondaine paradoxale qu’il utilise comme un rempart contre la vague envahissante de la démocratie. À l’instar des causeurs d’Ancien Régime, il la déleste de toute érudition pesante et de tout esprit de sérieux malséant. Mais, romantique et dandy, Barbey subvertit les hauts principes de la civilité d’autrefois en laissant libre cours à la passion et au culte de soi qu’il exerce tantôt par un silence méprisant, tantôt par une verve intarissable. Plus qu’un échange, la conversation est avant tout pour lui un combat qui lui permet d’imposer spectaculairement sa présence.Natta Marie-Christine. Politesse et polémique : La conversation de Barbey d’Aurevilly. In: Littératures 58-59,2008. Barbey, polémiste. pp. 153-164

Rasch analysis of the Forgotten Joint Score in patients undergoing knee arthroplasty

PURPOSE: The purpose of this study was to test the hypothesis that the "Forgotten Joint Score" (FJS-12) is a unidimensional interval-level scale. Unidimensionality refers to measuring a single attribute, i.e., the single ability to forget the arthroplasty. If this property is not verified, the interpretation of the score can be confusing. Unidimensionality is an essential prerequisite of construct validity and required if FJS-12 response data are to be validly summated into a single score. Interval-level dimension is an essential prerequisite of the parametric statistics. Rasch analysis was used to test our study hypothesis. METHODS: The FJS-12 questionnaire was validated in 248 unilateral knee arthroplasty patients. Successive analyses were used to select items with good psychometric qualities to constitute the new "FJS". The external validity was assessed with the KUJALA questionnaire. RESULTS: Quantity of relevant items was greater than 50%. Of the 12 original items, nine showed disturbed thresholds, indicating that patients were unable to discriminate among the five levels for these items. The data set was reanalyzed using a four-level scale. The new analysis indicated that the internal consistency was good (r = 0.84). Three items did not fit with the model and they were removed. The nine items of the final scale defined a unidimensional and linear measure of the forgotten joint, and showed a continuous progression in their difficulty. The perception of difficulty was group-independent. The correlation coefficient was moderate between FJS and KUJALA score (r = 0.4). CONCLUSIONS: This new and items reduced FJS can be used in clinical practice with good psychometric qualities. It provides a reliable tool to follow up patient's evolution and document changes related to knee arthroplasty. This valid FJS is needed in evaluating patients' assessment, one indicator of quality of care. LEVEL OF EVIDENCE: III-Therapeutic

Effectiveness of a self-rehabilitation program to improve upper-extremity function after stroke in developing countries: A randomized controlled trial

ackground About two-thirds of stroke pa­tients pre­sent long-term up­per-limb im­pair­ment and lim­i­ta­tions of ac­tiv­ity, which con­sti­tutes a chal­lenge in re­ha­bil­i­ta­tion. This sit­u­a­tion is par­tic­u­larly true in de­vel­op­ing coun­tries, where there is a need for in­ex­pen­sive re­ha­bil­i­ta­tion so­lu­tions. Objective This study as­sessed the ef­fec­tive­ness of a self-re­ha­bil­i­ta­tion pro­gram in­clud­ing uni- or bi-man­ual func­tional ex­er­cises for im­prov­ing up­per-limb func­tion af­ter stroke with re­spect to the con­text in Benin, West Africa. Methods In this sin­gle-blind ran­dom­ized con­trolled trial, chronic stroke in­di­vid­u­als (>6 months post-stroke) per­formed a su­per­vised home-based self-re­ha­bil­i­ta­tion pro­gram for 8 weeks (in­ter­ven­tion group); the con­trol group did not re­ceive any treat­ment. Par­tic­i­pants were as­sessed be­fore treat­ment (T0), at the end of treat­ment (T1) and 8 weeks af­ter the end of treat­ment (T2). The pri­mary out­come was the man­ual abil­ity of the up­per limb, as­sessed with ABIL­HAND-Stroke Benin. Sec­ondary out­comes were grip force, mo­tor im­pair­ment (Fugl-Meyer As­sess­ment – Up­per Ex­trem­ity), gross man­ual abil­ity (Box and Block test, Wolf Mo­tor Func­tion test) and qual­ity of life (WHO­QOL-26). Results We in­cluded 28 in­di­vid­u­als in the in­ter­ven­tion group and 31 in the con­trol group. Ad­her­ence to the pro­gram was 83%. Af­ter 8 weeks of self-re­ha­bil­i­ta­tion, in­di­vid­u­als in the in­ter­ven­tion group showed sig­nif­i­cantly im­proved man­ual abil­ity and grip force as com­pared with the con­trol group (P < 0.001), with ef­fect size 0.75 and 0.24, re­spec­tively. In the in­ter­ven­tion group, the dif­fer­ence in av­er­age scores was 10% be­tween T0 and T1 and be­tween T0 and T2. Sub­scores of phys­i­cal and psy­cho­log­i­cal qual­ity of life were also sig­nif­i­cantly im­proved in the in­ter­ven­tion group. The other vari­ables re­mained un­changed. Conclusions A self-re­ha­bil­i­ta­tion pro­gram was ef­fec­tive in im­prov­ing man­ual abil­ity, grip force and qual­ity of life in in­di­vid­u­als with stroke in Benin. More stud­ies are needed to con­firm these re­sults in dif­fer­ent con­texts

Disability and functioning in primary and secondary hip osteoarthritis in Benin

Background: In Africa, primary hip osteoarthritis seems to be less frequent than in Europe. Sickle cell disease is responsible for aseptic osteonecrosis of the femoral head associated with secondary hip osteoarthritis. Very little evidence is available on the influence of aetiology (primary and secondary) and radiographic status on pain and disability in a Beninese population with hip osteoarthritis. Objectives: The aim of this study was to compare the impacts of aetiology and radiographic status on pain, disability and quality of life in a Beninese population with hip osteoarthritis. Method: This was a descriptive cross-sectional study, including participants recruited in the Clinic of Physical Medicine and Rehabilitation at the National Teaching Hospital in Cotonou. Assessment was based on the International Classification of Functioning, Disability and Health model. The main outcomes were severity of osteoarthritis, pain, range of motion, muscle strength, gait speed and quality of life. Statistical comparisons between the aetiologies were performed using a t-test or rank sum test. One-way analysis of variance was used to test the effect of radiographic status. Results: Forty-nine participants (26 women and 23 men; mean age [standard deviation] 40.5 [17.9] years) were recruited. According to the aetiology (59.2% and 40.8% of primary and secondary osteoarthritis, respectively), there were no significant differences for any of the outcomes. Grades I, II, III and IV osteoarthritis were observed in 22.4%, 14.3%, 26.5% and 36.7% of the participants, respectively. Participants with grade IV osteoarthritis were more affected than those with grades I, II and III based on the Kellgren and Lawrence classification. Conclusion: Aetiology did not influence pain, gait speed or quality of life. Participants with grade IV osteoarthritis had more pain, were more limited in walking and had a more impaired quality of life

Disability and functioning in primary and secondary hip osteoarthritis in Benin

Background: In Africa, primary hip osteoarthritis seems to be less frequent than in Europe. Sickle cell disease is responsible for aseptic osteonecrosis of the femoral head associated with secondary hip osteoarthritis. Very little evidence is available on the influence of aetiology (primary and secondary) and radiographic status on pain and disability in a Beninese population with hip osteoarthritis. Objectives: The aim of this study was to compare the impacts of aetiology and radiographic status on pain, disability and quality of life in a Beninese population with hip osteoarthritis. Method: This was a descriptive cross-sectional study, including participants recruited in the Clinic of Physical Medicine and Rehabilitation at the National Teaching Hospital in Cotonou. Assessment was based on the International Classification of Functioning, Disability and Health model. The main outcomes were severity of osteoarthritis, pain, range of motion, muscle strength, gait speed and quality of life. Statistical comparisons between the aetiologies were performed using a t-test or rank sum test. One-way analysis of variance was used to test the effect of radiographic status. Results: Forty-nine participants (26 women and 23 men; mean age [standard deviation] 40.5 [17.9] years) were recruited. According to the aetiology (59.2% and 40.8% of primary and secondary osteoarthritis, respectively), there were no significant differences for any of the outcomes. Grades I, II, III and IV osteoarthritis were observed in 22.4%, 14.3%, 26.5% and 36.7% of the participants, respectively. Participants with grade IV osteoarthritis were more affected than those with grades I, II and III based on the Kellgren and Lawrence classification. Conclusion: Aetiology did not influence pain, gait speed or quality of life. Participants with grade IV osteoarthritis had more pain, were more limited in walking and had a more impaired quality of life