Pemphigus et herpès : enquête multicentrique et revue de la littérature

Publication date: Available online 14 June 2018
Source:Annales de Dermatologie et de Vénéréologie
Author(s): M. Merlant, V. Seta, P. Bernard, S. Fourati, J.-F. Meritet, P. Wolkenstein, N. Dupin, P. Joly, O. Chosidow, S. Ingen-Housz-Oro
IntroductionLa surinfection herpétique (SH) est une complication connue mais peu étudiée du pemphigus.ObjectifÉvaluer la fréquence et les circonstances de survenue des SH au cours du pemphigus.MéthodesÉtude rétrospective multicentrique incluant les cas de SH parmi les pemphigus nouvellement diagnostiqués entre 2008 et 2016. Les données cliniques, virologiques, immunologiques et thérapeutiques ont été colligées. Une revue de la littérature sur pemphigus et herpès a été effectuée.RésultatsParmi les 191 pemphigus, un prélèvement herpétique a été pratiqué chez 11 à 71 % des malades selon les centres. Ainsi, une SH a été démontrée chez 24 (12 femmes, âge médian 58 ans), soit une fréquence de SH de 0 à 42 % des patients prélevés selon les centres. Le pemphigus était un pemphigus vulgaire dans 21 cas et le site atteint était muqueux chez 19 malades. La SH était trouvée au moment du diagnostic de pemphigus dans 15 cas. La technique identifiant le virus était une PCR dans 23 des 24 cas (HSV1 dans 22 cas). Dix malades ont reçu par la suite un traitement antiviral préventif. Le suivi médian était de 36 mois (0–89 mois). Treize des 24 malades ont totalisé 23 rechutes de pemphigus. Un prélèvement herpétique a été réalisé lors de 19 rechutes, positif dans 6 cas (31,5 %).ConclusionNotre étude montre une variabilité de fréquence de la SH au cours du pemphigus, reflétant des pratiques de prélèvements différant selon les centres (systématique ou seulement si forte suspicion clinique). L'intérêt pronostique d'un dépistage systématique sur l'évolution du pemphigus reste à démontrer par une étude prospective.BackgroundAlthough herpes superinfection is a well-known complication of pemphigus, it has not been widely investigated.AimTo investigate the frequency and features of herpes infection in patients with ongoing pemphigus.Patients and methodsWe carried out a multicenter retrospective study between 2008 and 2016 in patients with newly diagnosed pemphigus presenting active herpes infection. Clinical, virological, immunological and therapeutic data were collated. We performed a literature review for pemphigus and herpes.ResultsAmong the 191 pemphigus patients, screening for herpes (PCR or culture) was carried out in 11 to 71 % of subjects, depending on the center in question. Twenty-four patients (12 women, mean age 58 years) presented at least one episode of herpes infection. The frequency of positivity ranged from 0 to 42 % by center. Twenty-one cases consisted of pemphigus vulgaris and infection occurred at a mucosal site in 19 patients. Herpes infection was identified at the time of diagnosis in 15 patients and 17 patients received no specific treatment for their pemphigus. The virus was identified using PCR in 23 cases. Ten patients subsequently received prophylactic treatment for herpes. The mean duration of follow-up was 36 months (0–89 months). Thirteen of the 24 patients had 23 relapses of pemphigus; PCR testing for herpes was performed 19 times and was positive in 6 cases (31.5 %).ConclusionOur study showed wide variation in the incidence of herpes superinfection in patients with pemphigus, reflecting the different screening approach at each center (being performed either routinely or only in the event of strong suspicion). The prognostic value of routine screening for herpes in patients with active pemphigus lesions remains to be demonstrated by further prospective investigations.



https://ift.tt/2HMlUki

Vitiligo sous inhibiteur de checkpoint

Publication date: Available online 14 June 2018
Source:Annales de Dermatologie et de Vénéréologie
Author(s): M. Amini-Adle, S. Dalle




https://ift.tt/2JWmHo1

Pemphigus et herpès : enquête multicentrique et revue de la littérature

Publication date: Available online 14 June 2018
Source:Annales de Dermatologie et de Vénéréologie
Author(s): M. Merlant, V. Seta, P. Bernard, S. Fourati, J.-F. Meritet, P. Wolkenstein, N. Dupin, P. Joly, O. Chosidow, S. Ingen-Housz-Oro
IntroductionLa surinfection herpétique (SH) est une complication connue mais peu étudiée du pemphigus.ObjectifÉvaluer la fréquence et les circonstances de survenue des SH au cours du pemphigus.MéthodesÉtude rétrospective multicentrique incluant les cas de SH parmi les pemphigus nouvellement diagnostiqués entre 2008 et 2016. Les données cliniques, virologiques, immunologiques et thérapeutiques ont été colligées. Une revue de la littérature sur pemphigus et herpès a été effectuée.RésultatsParmi les 191 pemphigus, un prélèvement herpétique a été pratiqué chez 11 à 71 % des malades selon les centres. Ainsi, une SH a été démontrée chez 24 (12 femmes, âge médian 58 ans), soit une fréquence de SH de 0 à 42 % des patients prélevés selon les centres. Le pemphigus était un pemphigus vulgaire dans 21 cas et le site atteint était muqueux chez 19 malades. La SH était trouvée au moment du diagnostic de pemphigus dans 15 cas. La technique identifiant le virus était une PCR dans 23 des 24 cas (HSV1 dans 22 cas). Dix malades ont reçu par la suite un traitement antiviral préventif. Le suivi médian était de 36 mois (0–89 mois). Treize des 24 malades ont totalisé 23 rechutes de pemphigus. Un prélèvement herpétique a été réalisé lors de 19 rechutes, positif dans 6 cas (31,5 %).ConclusionNotre étude montre une variabilité de fréquence de la SH au cours du pemphigus, reflétant des pratiques de prélèvements différant selon les centres (systématique ou seulement si forte suspicion clinique). L'intérêt pronostique d'un dépistage systématique sur l'évolution du pemphigus reste à démontrer par une étude prospective.BackgroundAlthough herpes superinfection is a well-known complication of pemphigus, it has not been widely investigated.AimTo investigate the frequency and features of herpes infection in patients with ongoing pemphigus.Patients and methodsWe carried out a multicenter retrospective study between 2008 and 2016 in patients with newly diagnosed pemphigus presenting active herpes infection. Clinical, virological, immunological and therapeutic data were collated. We performed a literature review for pemphigus and herpes.ResultsAmong the 191 pemphigus patients, screening for herpes (PCR or culture) was carried out in 11 to 71 % of subjects, depending on the center in question. Twenty-four patients (12 women, mean age 58 years) presented at least one episode of herpes infection. The frequency of positivity ranged from 0 to 42 % by center. Twenty-one cases consisted of pemphigus vulgaris and infection occurred at a mucosal site in 19 patients. Herpes infection was identified at the time of diagnosis in 15 patients and 17 patients received no specific treatment for their pemphigus. The virus was identified using PCR in 23 cases. Ten patients subsequently received prophylactic treatment for herpes. The mean duration of follow-up was 36 months (0–89 months). Thirteen of the 24 patients had 23 relapses of pemphigus; PCR testing for herpes was performed 19 times and was positive in 6 cases (31.5 %).ConclusionOur study showed wide variation in the incidence of herpes superinfection in patients with pemphigus, reflecting the different screening approach at each center (being performed either routinely or only in the event of strong suspicion). The prognostic value of routine screening for herpes in patients with active pemphigus lesions remains to be demonstrated by further prospective investigations.



https://ift.tt/2HMlUki

Vitiligo sous inhibiteur de checkpoint

Publication date: Available online 14 June 2018
Source:Annales de Dermatologie et de Vénéréologie
Author(s): M. Amini-Adle, S. Dalle




https://ift.tt/2JWmHo1

An Automated Multiparametric MRI Quantitative Imaging Prostate Habitat Risk Scoring System for Defining External Beam Radiotherapy Boost Volumes

Publication date: Available online 13 June 2018
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Radka Stoyanova, Felix Chinea, Deukwoo Kwon, Isildinha M. Reis, Yohann Tschudi, Nestor A. Parra, Adrian L. Breto, Kyle R. Padgett, Alan Dal Pra, Matthew C. Abramowitz, Oleksandr N. Kryvenko, Sanoj Punnen, Alan Pollack
PurposeTo develop a prostate tumor habitat risk scoring (HRS) system based on multiparametric MRI (mpMRI) referenced to prostatectomy Gleason Score (GS) for automatic delineation of Gross Tumor Volumes (GTVs). A workflow for integration of HRS into radiotherapy (RT) boost volume dose escalation was developed in the framework of a Phase II randomized clinical trial (BLaStM).Materials and MethodsAn automated quantitative mpMRI based 10 point pixel by pixel method was optimized to prostatectomy GSs and volumes using referenced Dynamic Contrast Enhanced and Apparent Diffusion Coefficient sequences. The HRS contours were migrated to the planning CT for boost volume generation.ResultsThere were 51 regions of interest (ROIs) in 12 patients who underwent radical prostatectomy (RP) (26 with GS≥7 and 25 with GS6). The resultant heat maps showed inter- and intra-tumoral heterogeneity. The HRS6 level was significantly associated with RP ROIs (slope 1.09, r=0.767; p<.0001). For predicting the likelihood of cancer, GS≥7 and GS≥8, HRS6 AUCs were 0.718, 0.802 and 0.897, respectively. HRS was superior to the Prostate Imaging, Reporting and Diagnosis System 4/5 classification, wherein the AUCs were 0.62, 0.64 and 0.617, respectively (difference with HR6, p<.0001). HRS maps were created for the first 37 assessable patients on the BLaStM trial. There were an average of 1.38 habitat boost volumes per patient at a total boost volume average of 3.6 cc.ConclusionsAn automated quantitative mpMRI based method was developed to objectively guide dose escalation to high risk habitat volumes based on prostatectomy GS.

Teaser

Prostate multiparamateric MRI has a high sensitivity and specificity for identifying tumor regions in the prostate; but, there is subjectivity in defining high risk 3D volumes that could be boosted, as opposed to entire prostate dose escalation. Registering to prostatectomy Gleason score, a habitat risk score based on pixel by pixel quantitative diffusion and perfusion was developed and then applied to guiding radiotherapy boost volumes in the background of a randomized Phase II clinical trial.


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Heterogeneity in Clinical, Endoscopic, and Histologic Outcome Measures and Placebo Response Rates in Clinical Trials of Eosinophilic Esophagitis: A Systematic Review

Publication date: Available online 14 June 2018
Source:Clinical Gastroenterology and Hepatology
Author(s): Christopher Ma, Bram D. van Rhijn, Vipul Jairath, Tran M. Nguyen, Claire E. Parker, Seema S. Aceves, Glenn T. Furuta, Sandeep K. Gupta, David A. Katzka, Ekaterina Safroneeva, Alain M. Schoepfer, Alex Straumann, Jonathan M. Spergel, Rish K. Pai, Brian G. Feagan, Ikuo Hirano, Evan S. Dellon, Albert J. Bredenoord
Background & AimsAgents are being developed for treatment of eosinophilic esophagitis (EoE). However, it is not clear what outcome measures would best determine the efficacy and safety of these agents in clinical trials. We performed a systematic review of outcomes used in randomized placebo-controlled trials of EoE and we estimate the placebo response and rates of remission.MethodsWe searched MEDLINE, Embase, CENTRAL, ClinicalTrials.gov, and the EU Clinical Trials Register from inception through February 20, 2018 for randomized controlled trials of pharmacologic therapies for EoE. Efficacy outcome definitions, measurement tools, and the proportion of patients responding to placebo were collected and stratified by based on histologic, endoscopic, and patient-reported outcomes.ResultsWe analyzed data from 22 placebo-controlled trials, comprising 1112 patients with EoE. Ten additional active registered trials were identified. Most published trials evaluated topical corticosteroid therapy (13/22, 59.1%). Histologic outcomes measuring eosinophil density and patient-reported outcomes were reported in 21/22 published trials (95.5%). No consistently applied definitions of histologic or patient-reported response or remission were identified. Endoscopic outcomes were described in 60% (12/20) of published trials. The EoE Endoscopic Reference Score is the most commonly applied tool for describing changes in endoscopic appearance. The median histologic response to placebo was 3.7% (range 0%-31.6%) and the median rate of remission in patients given placebo was 0.0% (range 0%-11.0%). The median patient-reported response to placebo was 14.4% (range 8.6%-77.8%) and rate of remission in patients given placebo was 26.2% (range 13.2%-35.7%).ConclusionsIn a systematic review of the literature, we found that no standardized definitions of histologic, endoscopic, or patient-reported outcomes are used to determine whether pharmacologic agents produce a response or remission in patients with EoE. A core outcome set is needed to reduce heterogeneity in outcome reporting and facilitate trial interpretation and comparison of results from trials.



https://ift.tt/2yc89fa

Brain Activity and Network Interactions in the Impact of Internal Emotional Distraction

Abstract

Emotional distraction may come from the external world and from our mind, as internal distraction. Although external emotional distraction has been extensively investigated, less is known about the mechanisms associated with the impact of internal emotional distraction on cognitive performance, and those involved in coping with such distraction. These issues were investigated using a working memory task with emotional distraction, where recollected unpleasant autobiographical memories served as internal emotional distraction. Emotion regulation was manipulated by instructing participants to focus their attention either on or away from the emotional aspects of their memories. Behaviorally, focusing away from emotion was associated with better working memory performance than focusing on the recollected emotions. Functional MRI data showed reduced response in brain regions associated with the salience network, coupled with greater recruitment of executive prefrontal and memory-related temporoparietal regions, and with increased frontoparietal connectivity, when subjects focused on nonemotional contextual details of their memories. Finally, temporal dissociations were also identified between regions involved in self-referential (showing faster responses) versus context-related processing (showing delayed responses). These findings demonstrate that focused attention is an effective regulation strategy in coping with internal distraction, and are relevant for understanding clinical conditions where coping with distressing memories is dysfunctional.

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