Minimal information for studies of extracellular vesicles 2018 (MISEV2018):a position statement of the International Society for Extracellular Vesicles and update of the MISEV2014 guidelines

The last decade has seen a sharp increase in the number of scientific publications describing physiological and pathological functions of extracellular vesicles (EVs), a collective term covering various subtypes of cell-released, membranous structures, called exosomes, microvesicles, microparticles, ectosomes, oncosomes, apoptotic bodies, and many other names. However, specific issues arise when working with these entities, whose size and amount often make them difficult to obtain as relatively pure preparations, and to characterize properly. The International Society for Extracellular Vesicles (ISEV) proposed Minimal Information for Studies of Extracellular Vesicles (“MISEV”) guidelines for the field in 2014. We now update these “MISEV2014” guidelines based on evolution of the collective knowledge in the last four years. An important point to consider is that ascribing a specific function to EVs in general, or to subtypes of EVs, requires reporting of specific information beyond mere description of function in a crude, potentially contaminated, and heterogeneous preparation. For example, claims that exosomes are endowed with exquisite and specific activities remain difficult to support experimentally, given our still limited knowledge of their specific molecular machineries of biogenesis and release, as compared with other biophysically similar EVs. The MISEV2018 guidelines include tables and outlines of suggested protocols and steps to follow to document specific EV-associated functional activities. Finally, a checklist is provided with summaries of key points

Implementing an osteoporosis refracture prevention (ORP) service for South Western Sydney

Aim: To implement a patient centred re-fracture prevention service in Liverpool Hospital. This includes identification, assessment and treatment of all patients >50 years old presenting to Liverpool Hospital with a minimal trauma fracture. Method: Prior to the implementation, the Fracture Liaison Coordinator (FLC) conducted site visits across NSW and attended several FLC Network Meetings. By collaborating with the Emergency Department, we developed a system enabling a weekly report to be generated listing all patients aged >50 years who have sustained a fracture. We initially found the proportion of patients who had completed bone mineral density (BMD) testing prior to medical review was very low (20%). Various factors were identified including the culturally diverse population (25% of patients required interpreters) and long waiting times for booking radiology appointments in the public hospital. A public/private partnership was established with a local private rheumatology service to provide quick access to bone mineral density testing. The private BMD provider proactively contacted patients where necessary and offered an appointment within 1 week, including offering interpreter services. Results: To date, 246 patients have been seen by the FLC and rheumatologist. 88% of patients were prescribed pharmacotherapy to reduce fracture risk. Reasons for not starting treatment included medical contraindications and patient preference. The development of a public/private partnership with a local Liverpool Rheumatology clinic improved our BMD completion rates at the initial medical officer review appointment from 20% to 75%. Conclusions: The Liverpool Hospital ORP service has grown significantly over the last 12 months. We provide holistic patient-centred care with a multidisciplinary treating team. Initiating a private/public partnership significantly improved access to bone mineral density testing. Future work will focus on expanding the service to capture all minimal trauma fractures in South-West Sydney

Maintien thérapeutique à deux ans de l’abatacept en pratique courante. Résultats de la cohorte française de l’étude ACTION

International audienceObjectifsLa cohorte des patients français inclus dans l’étude ACTION (2010–2013) a été analysée. Cette étude en vie réelle, prospective, portait sur des patients atteints de polyarthrite rhumatoïde modérée à sévère, ayant initié un traitement par abatacept intraveineux.MéthodesLe maintien thérapeutique de l’abatacept à 2 ans a été analysé chez 455 patients selon : la ligne de traitement, l’IMC et le statut sérologique du facteur rhumatoïde (FR) et des anticorps antipeptides citrullinés (ACPA).RésultatsÀ 2 ans, le taux global de maintien thérapeutique (IC 95 %) était de 44 % et plus élevé chez les patients naïfs de traitement biologique comparativement aux patients en échec à au moins un agent biologique, mais non significatif (48,1 % vs 41,8 %). Ce taux a été évalué en fonction de l’IMC chez 444 patients, il est de 45,5 % sans surpoids, 48,9 % avec surpoids, 36,6 % avec obésité ; sans différence significative entre sous-groupes. Ce taux a été évalué chez 390 patients en fonction du statut FR et ACPA, il est de 45,7 % pour les FR+ et ACPA+, 43,8 % pour les FR+ ou ACPA+ et de 39,1 % pour les FR− et ACPA− ; sans différence significative entre sous-groupes.ConclusionLes données de la cohorte française d’ACTION ont confirmé l’intérêt de l’abatacept, avec un maintien thérapeutique à 2 ans de 44 %. Dans cette analyse, le maintien thérapeutique n’a pas été influencé par la ligne de traitement, l’IMC et le statut sérologique

Two-year abatacept retention rate in clinical practice in the French ACTION cohort

International audienceObjectives: Abatacept retention rates were evaluated in the French cohort in the prospective ACTION study (2010-2013), which included patients with moderate-to-severe rheumatoid arthritis managed in everyday clinical practice and started on intravenous abatacept therapy.Methods: Two-year abatacept retention rates were evaluated in 455 patients classified according to treatment line, body mass index (BMI), and status for rheumatoid factor (RF) and anti-citrullinated peptide antibody (ACPA).Results: After 2 years, the overall abatacept retention rate was 44%. The retention rate was non-significantly higher in the patients with vs. without a history of unresponsiveness to at least one biologic (48.1% vs. 41.8%, respectively). No significant retention rate differences were found across BMI categories (444 patients; <25, 45.5%; ≥25 to <30, 48.9%; and ≥30, 36.6%). Neither were any significant differences demonstrated according to RF and ACPA status (RF+ and ACPA+, 45.7%; RF+ or ACPA+, 43.8%; and FR- and ACPA-, 39.1%).Conclusion: The 44% 2-year retention rate in the French ACTION cohort supports the usefulness of abatacept therapy. In this study, retention was not associated with treatment line, BMI, or antibody status

Efficacy and safety of Hylan G-F 20 in shoulder osteoarthritis with an intact rotator cuff. Open-label prospective multicenter study

International audienceObjective: To evaluate the feasibility, safety, and symptomatic efficacy of intra-articular Hylan G-F 20 in patients with shoulder osteoarthritis and an intact rotator cuff. Methods: Open-label, prospective, multicenter study in patients with pain scores on a visual analog scale (VAS) between 40/100 and 90/100. An intra-articular injection of 2 ml of Hylan G-F 20 was given under fluoroscopic guidance. A second injection was given after 1, 2, or 3 months in the event of inadequate pain relief. The primary evaluation criterion was the VAS pain score 3 months after the first injection. Follow-up was 6 months. Results: Of 39 included patients, 33 received a first injection and, among these, 16 received a second injection; 29 patients completed the study. No serious or severe treatment-related adverse events were recorded. There were 10 mild or moderate adverse events in eight patients. The mean VAS pain score decreased from 61.2 mm at baseline to 37.1 mm after 3 months (P < 0.001), and the decrease was larger in the subgroup that required a single injection. Conclusion: This prospective study shows that treatment with one or two intra-articular injections of Hylan GF 20 in patients who have shoulder osteoarthritis and an intact cuff is feasible, safe, and probably effective. Viscosupplementation using Hylan G-F 20 may constitute a helpful treatment option in patients who have shoulder osteoarthritis with an intact rotator cuff. (C) 2009 Societe francaise de rhumatologie. Published by Elsevier Masson SAS. All rights reserved

Establishing baseline absolute risk of subsequent fracture among adults presenting to hospital with a minimal-trauma-fracture

Background: One in three women and one in five men are expected to experience a minimal-trauma-fracture after the age of 50-years, which increases the risk of subsequent fracture. Importantly, timely diagnosis and optimal treatment in the form of a fracture liaison service (FLS), has been shown to reduce this risk of a subsequent fracture. However, baseline risk of subsequent fracture among this group of FLS patients has not been well described. Therefore, this study aims to estimate absolute risk of subsequent fracture, among women and men aged 50-years or more, presenting to hospital with a minimal-trauma-fracture. Methods: Women and men aged 50-years or more with a minimal-trauma-fracture, presenting to hospitals across the South Western Sydney Local Health District between January 2003 and December 2017 were followed to identify subsequent fracture presentations to hospital. Absolute risk of subsequent fracture was estimated, by taking into account the competing risk of death. Results: Between January 2003 and December 2017–15,088 patients presented to the emergency departments of the five hospitals in the SWSLHD (11,149, women [74%]), with minimal-trauma-fractures. Subsequent fractures identified during the follow-up period (median = 4.5 years [IQR, 1.6–8.2]), occurred in 2024 (13%) patients. Death during the initial hospital stay, or during a subsequent hospital visit was recorded among 1646 patients (11%). Women were observed to have 7.1% risk of subsequent fracture after 1-year, following an initial fracture; and, the risk of subsequent fracture after 1-year was 6.2% for men. After 5-years the rate among women was 13.7, and 11.3% for men, respectively. Cumulative risk of subsequent fracture when initial fractures were classified as being at proximal or distal sites are also presented. Conclusion: This study has estimated the baseline risk of subsequent fracture among women and men presenting to hospital with minimal trauma fractures. Importantly, this information can be used to communicate risk to patients deciding to attend an osteoporosis refracture prevention clinic, and highlight the need for screening, and initial of treatment when indicated, once a minimal-trauma-fracture has occurred