International Guillain-Barré Syndrome Outcome Study (IGOS): protocol of a prospective observational cohort study on clinical and biological predictors of disease course and outcome in Guillain-Barré syndrome

Guillain-Barré syndrome (GBS) is an acute polyradiculoneuropathy with a highly variable clinical presentation, course, and outcome. The factors that determine the clinical variation of GBS are poorly understood which complicates the care and treatment of individual patients. The protocol of the ongoing International GBS Outcome Study (IGOS), a prospective, observational, multi-centre cohort study that aims to identify the clinical and biological determinants and predictors of disease onset, subtype, course and outcome of GBS is presented here. Patients fulfilling the diagnostic criteria for GBS, regardless of age, disease severity, variant forms, or treatment, can participate if included within two weeks after onset of weakness. Information about demography, preceding infections, clinical features, diagnostic findings, treatment, course and outcome is collected. In addition, cerebrospinal fluid and serial blood samples for serum and DNA is collected at standard time points. The original aim was to include at least 1000 patients with a follow-up of 1-3 years. Data are collected via a web-based data entry system and stored anonymously. IGOS started in May 2012 and by January 2017 included more than 1400 participants from 143 active centres in 19 countries across 5 continents. The IGOS data/biobank is available for research projects conducted by expertise groups focusing on specific topics including epidemiology, diagnostic criteria, clinimetrics, electrophysiology, antecedent events, antibodies, genetics, prognostic modelling, treatment effects and long-term outcome of GBS. The IGOS will help to standardize the international collection of data and biosamples for future research of GBS. ClinicalTrials.gov Identifier: NCT01582763

Meta-analyses of ataluren randomized controlled trials in nonsense mutation Duchenne muscular dystrophy.

Aim: Assess the totality of efficacy evidence for ataluren in patients with nonsense mutation Duchenne muscular dystrophy (nmDMD). Materials & methods: Data from the two completed randomized controlled trials (ClinicalTrials.gov: NCT00592553; NCT01826487) of ataluren in nmDMD were combined to examine the intent-to-treat (ITT) populations and two patient subgroups (baseline 6-min walk distance [6MWD] \u3e= 300-\u3c400 or \u3c400 m). Meta-analyses examined 6MWD change from baseline to week 48.Results:Statistically significant differences in 6MWD change with ataluren versus placebo were observed across all three meta-analyses. Least-squares mean difference (95% CI): ITT (n = 342), +17.2 (0.2-34.1) m, p = 0.0473; \u3e= 300-\u3c400 m (n = 143), +43.9 (18.2-69.6) m, p = 0.0008; \u3c400 m (n = 216), +27.7 (6.4-49.0) m, p = 0.0109. Conclusion: These meta-analyses support previous evidence for ataluren in slowing disease progression versus placebo in patients with nmDMD over 48 weeks. Treatment benefit was most evident in patients with a baseline 6MWD \u3e= 300-\u3c400 m (the ambulatory transition phase), thereby informing future trial design

Meta-analysis of muscle transcriptome data using the MADMuscle database reveals biologically relevant gene patterns

<p>Abstract</p> <p>Background</p> <p>DNA microarray technology has had a great impact on muscle research and microarray gene expression data has been widely used to identify gene signatures characteristic of the studied conditions. With the rapid accumulation of muscle microarray data, it is of great interest to understand how to compare and combine data across multiple studies. Meta-analysis of transcriptome data is a valuable method to achieve it. It enables to highlight conserved gene signatures between multiple independent studies. However, using it is made difficult by the diversity of the available data: different microarray platforms, different gene nomenclature, different species studied, etc.</p> <p>Description</p> <p>We have developed a system tool dedicated to muscle transcriptome data. This system comprises a collection of microarray data as well as a query tool. This latter allows the user to extract similar clusters of co-expressed genes from the database, using an input gene list. Common and relevant gene signatures can thus be searched more easily. The dedicated database consists in a large compendium of public data (more than 500 data sets) related to muscle (skeletal and heart). These studies included seven different animal species from invertebrates (<it>Drosophila melanogaster, Caenorhabditis elegans</it>) and vertebrates (<it>Homo sapiens, Mus musculus, Rattus norvegicus, Canis familiaris, Gallus gallus</it>). After a renormalization step, clusters of co-expressed genes were identified in each dataset. The lists of co-expressed genes were annotated using a unified re-annotation procedure. These gene lists were compared to find significant overlaps between studies.</p> <p>Conclusions</p> <p>Applied to this large compendium of data sets, meta-analyses demonstrated that conserved patterns between species could be identified. Focusing on a specific pathology (Duchenne Muscular Dystrophy) we validated results across independent studies and revealed robust biomarkers and new pathways of interest. The meta-analyses performed with MADMuscle show the usefulness of this approach. Our method can be applied to all public transcriptome data.</p

Dihydropyridine receptor and ryanodine receptor gene expression in long-term denervated rat muscles.

Following disruption of the nerve supply, extensor digitorum longus (EDL) and soleus (SOL) muscles in rats are known to exhibit alterations in excitation-contraction coupling. After total RNA isolation from the denervated and the contralateral control muscles performed at 25 and 50 days following denervation, RNase protection assays were carried out with four cDNA probes specific for the skeletal and cardiac isoforms of both the DHPR alpha 1-subunit and the RyR. Longterm denervation increased the expression of the mRNA for skeletal DHPR and skeletal RyR in SOL muscle, but it also significantly increased the expression of the mRNA for the cardiac isoform of the DHPR alpha 1 subunit in EDL muscle

Des patients difficiles? Analyse qualitative des interactions médecins-patients dans le contexte de la maladie de Steinert

La maladie de Steinert, ou DM1, est une maladie neuromusculaire, génétique et rare impliquant de nombreuses fonctions et incluant des troubles cognitifs. Ces derniers sont fréquemment invoqués par les médecins pour expliquer les problèmes rencontrés lors des consultations avec ces « patients difficiles ». Néanmoins, la qualification de ces troubles reste sujette à débats. La recherche ASHAM visait à mieux comprendre les habitudes de vie et les conditions de prise en charge des personnes atteintes, à partir d’une étude qualitative auprès de patients et soignants. L’article propose d’analyser quatre situations types de consultations problématiques, chacune mettant en scène un hiatus existant entre l’expérience de vie des patients et l’évaluation médicale de la maladie. Patients et soignants ne disent ni ne qualifient de la même manière la maladie, et cette explicitation permet de remettre en contexte la notion de « patient difficile » au profit d’une responsabilisation collective. [Myotonic dystrophy type 1 (MD1) is a rare neuromuscular genetic disease affecting several functions and leading to cognitive impairments. Physicians often use these symptoms to explain the problems they face with these “difficult patients.” However, the classification of these disorders remains open to debate. ASHAM research aims to understand the daily lives of people with DM1, and the circumstances of their care and support, based on a qualitative study with patients and health professionals. The article proposes to analyze four typical situations of problematic consultations, each of them showing a disparity between the real-life experience of patients and the physicians’ assessments. Patients and health professionals do not describe or classify the disease in the same way. This explanation allows the notion of the “difficult patient” to be contextualized in favor of collective accountability.]</p

ASHAM Analyse sociologique des habitudes de vie des adultes atteints de Dystrophie myotonique de type 1 ou maladie de Steinert: Rapport de recherche dans le cadre du premier appel à projets de recherche 2012 Sciences humaines et sociales et maladies rares

Living habits for individuals suffering from a debilitating chronic disease are poorly known, yet essential for effective nursing care to be delivered in the long term. Myotonic dystrophy type 1 (DM1 or Steinert’s disease) is a particular chronic rare disease: it is genetic and progressive; it affects several functions and currently treatment for it is solely symptomatic. Amidst this complexity, it is relatively easy to cater for this clinical diversity in medical terms through multidisciplinary care, but it is more complicated object-side relationship. The objective of this qualitative study was to understand the change in living habits and the social determinants of coping strategies in men and women aged over 20 whose DM1 symptoms have appeared in adulthood. This is research in social sciences and nursing science based on a care issue and an ethno-sociological set of issue. The investigation has shown that patient’s behavior varies according to a set of combined determinants: age, social and professional situation, marital status, values and beliefs, living environment, and so on. Then, there is a large gap between medical representation of disease and day-to-day experience and social life of patients. The stations they passed during their life show various adaptation strategies. That gives us an opportunity to improve their support