Do Surgeons Anticipate Women’s Hopes and Fears Associated with Prolapse Repair? A Qualitative Analysis in the PROSPERE Trial

Women’s preoperative perceptions of pelvic-floor disorders may differ from those of their physicians. Our objective was to specify women’s hopes and fears before cystocele repair, and to compare them to those that surgeons anticipate. We performed a secondary qualitative analysis of data from the PROSPERE trial. Among the 265 women included, 98% reported at least one hope and 86% one fear before surgery. Sixteen surgeons also completed the free expectations-questionnaire as a typical patient would. Women’s hopes covered seven themes, and women’s fears eleven. Women’s hopes were concerning prolapse repair (60%), improvement of urinary function (39%), capacity for physical activities (28%), sexual function (27%), well-being (25%), and end of pain or heaviness (19%). Women’s fears were concerning prolapse relapse (38%), perioperative concerns (28%), urinary disorders (26%), pain (19%), sexual problems (10%), and physical impairment (6%). Surgeons anticipated typical hopes and fears which were very similar to those the majority of women reported. However, only 60% of the women reported prolapse repair as an expectation. Women’s expectations appear reasonable and consistent with the scientific literature on the improvement and the risk of relapse or complication related to cystocele repair. Our analysis encourages surgeons to consider individual woman’s expectations before pelvic-floor repair

Active chronic sarcoidosis is characterized by increased transitional blood B cells, increased IL-10-producing regulatory B cells and high BAFF levels.

BACKGROUND: Sarcoidosis is a multisystemic disease of unknown etiology characterized by a disproportionate Th1 granulomatous immune response in the organs involved. Plasmatic hypergammaglobulinemia and B cell accumulation in granulomatous lesions suggest the possible role of humoral immune responses in the pathogenesis of sarcoidosis. The purpose of this study is to describe B cell peripheral compartment in sarcoidosis. METHODOLOGY/PRINCIPAL FINDINGS: We analyzed blood B cell subsets and BAFF levels in 33 patients with chronic sarcoidosis (active sarcoidosis n = 18; inactive sarcoidosis n = 15) and 18 healthy donors. Active chronic sarcoidosis patients had significantly less circulating memory B cells (p<0.01), more transitional (p<0.01) and increased numbers of IL-10-producing regulatory B cells (p<0.05) compared with healthy donors and patients with inactive sarcoidosis. BAFF serum levels were significantly higher in patients with active sarcoidosis (p<0.01 versus healthy donors and inactive sarcoidosis patients) and strongly correlated with serum hypergammaglobulinemia (r = 0.53, p<0.01) and angiotensin converting enzyme levels (r = 0.61, p = <0.01). CONCLUSIONS/SIGNIFICANCE: These data show that there is an altered B cell homeostasis in active sarcoidosis and suggest BAFF antagonist drugs as potential new treatments of this disease

Sirolimus as combination rescue therapy with tumor necrosis alpha inhibitors for severe, refractory hidradenitis suppurativa

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Acropulpitis in systemic lupus erythematosus is associated with high type 1 interferon signature

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Increased naive and transitional but decreased memory blood B cells in active chronic sarcoidosis patients.

<p>(A) Representative flow cytometry dot plots of naive (CD27⁻IgD⁺) and memory (CD27⁺) B cell subsets among CD19⁺ B cells in a healthy control (healthy), active sarcoidosis patient (active) and inactive sarcoidosis patient (inactive). Numbers represent the percentage of the indicated B cell subset among CD19⁺ B cells. (B) Representative flow cytometry dot plots of the transitional (CD24^hiCD38^hi) B cell subset among CD19⁺ B cells in a healthy control, active sarcoidosis patient and inactive sarcoidosis patient. Numbers represent the percentage of the indicated B cell subset among CD19⁺ B cells. (C, D, E) Scatter plots showing the percentages (upper panel) and absolute numbers (lower panel) of naive (C), memory (D) and transitional (E) B cell subsets in the peripheral blood of the three subject groups as indicated. Each dot represents individual subjects, and horizontal bars represent the group means. The patients are described in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0043588#pone-0043588-t001" target="_blank">Table 1</a>. Significant differences between the means of the patient groups and healthy controls are indicated: NS, not significant; *p<0.05, **p<0.01.</p

Increased blood IL-10-producing B cells in patients with active chronic sarcoidosis.

<p>(A) Representative B cell cytoplasmic IL-10 expression of 15 healthy donors (healthy), 14 active sarcoidosis patients (active) and 11 inactive sarcoidosis patients (inactive). IL-10 production by B cells was induced by 72 hours of CpG stimulation, with PMA, ionomycin and monensin being added during the final 6 hours of culture. The percentages indicate IL-10⁺ B cell frequencies among CD19⁺ B cells. (B, C) IL-10⁺ B cell frequencies (B) and IL-10⁺ B cell absolute numbers (C) as in panel A, with each dot representing individual subjects. Horizontal bars represent group means. Significant differences between the means of patient groups and healthy controls are indicated: *p<0.05; **p<0.01.</p

Demographic, clinical and biological characteristics of 18 healthy donors and 18 active and 15 inactive chronic sarcoidosis patients.

<p>M = male, F = female, values are given as mean ± SEM,</p>**<p>p<0.01 and *p<0.05 compared with active sarcoidosis,</p>†<p>Visceral sarcoidosis lesions that occurred at any time of the patient’s history. Each organ defined was either clinically active at the time of inclusion in the active group or previously involved but not actively involved at the time of inclusion in the inactive group,</p>$<p>Upper respiratory tract sarcoidosis involvement was biopsy proved in 2/9 patients.</p

Increased serum BAFF levels in patients with active chronic sarcoidosis correlates with serum hypergammaglobulinemia.

<p>(A) Increased serum BAFF levels in active sarcoidosis patients. Scatter plots show the serum BAFF concentrations in 18 healthy donors (healthy), 18 active chronic sarcoidosis patients (active) and 15 inactive sarcoidosis patients (inactive). Each dot represents individual subjects, and horizontal bars represent the group means. Significant differences between the means of patient groups and healthy controls are indicated: **p<0.01. (B) BAFF levels correlate with serum hypergammaglobulinemia in sarcoidosis. The graph shows a linear regression analysis of BAFF levels (pg/ml) versus serum immunoglobulin levels (g/l) in sarcoidosis patients. Each dot represents individual subjects. The Pearson’s correlation coefficient is represented by “r”. The significance of the strength of the linear relationship is indicated: **p<0.01.</p

The spectrum of neutrophilic dermatoses associated with monoclonal gammopathy: Association with IgA isotype and inflammatory profile

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