Risques en dermatologie interventionnelle chez les patients hémophiles ou atteints de la maladie de Willebrand

Publication date: Available online 14 November 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): M. Say, N. Dupin, N. Stieltjes, M.-F. Avril, S. Aractingi, J. Chanal
ContexteLa maladie de Willebrand (MW) et les hémophilies A (HA) et B (HB) représentent la majorité des déficits constitutionnels en facteurs de la coagulation (DCFC). La nature et la fréquence des complications qui peuvent survenir chez ces patients lors d'un geste de dermatologie interventionnelle (DI) ne sont pas connus. L'augmentation d'incidence des cancers cutanés et leur prise en charge chirurgicale nous ont amenés à nous interroger sur cette problématique.ButL'objectif de notre étude était de déterminer la fréquence des complications hémorragiques des actes de DI pratiqués chez des patients présentant un DCFC (Hémophilie ou MW).Patients et méthodesNous avons réalisé un recueil de données chez les patients présentant un DCFC et pris en charge pour un acte de DI au sein du service de dermatologie du centre hospitalier universitaire de Cochin à Paris.RésultatsQuatorze interventions ont été réalisées chez 8 patients. Trois complications de type hémorragique sont survenues (n=3/14 ; 21,4 %) : un hématome, un saignement tardif et un saignement immédiat. Aucune de ces complications n'a nécessité de reprise chirurgicale pour hémostase ni de réanimation.DiscussionLe taux de complications hémorragiques s'est révélé nettement supérieur à celui observé en population générale. Ces complications peuvent toutefois être considérées comme non graves, permettant de conserver un rapport bénéfice/risque favorable. La prise en charge de ces malades doit être multidisciplinaire et coordonnée avec le centre de références de l'hémophilie (CRH), afin d'établir un protocole de substitution en facteur de la coagulation (FC) adapté aux caractéristiques de la pathologie et au geste chirurgical.BackgroundVon Willebrand disease (VWD) and hemophilia A and B are the most common types of hereditary coagulation-factor deficiencies. The frequency and type of complications of skin surgery in these patients are unknown. The increasing incidence of skin cancer prompted us to reflect upon this issue. While the incidence of skin cancer is increasing, the complications of skin surgery or ablative laser treatment remain unknown in this population.AimThe aim of this study was to determine the frequency of bleeding complications during and after skin surgery in patients with a hereditary coagulation-factor deficiency (hemophilia or VWD).Patients and methodsWe conducted a retrospective study in patients with hemophilia A or B or VWD undergoing skin surgery or ablative laser treatment at the Dermatology Department of the Cochin Hospital in Paris, France.ResultsFourteen procedures were performed in 8 patients. Three episodes of bleeding occurred (n=3/14, 21.4%): one hematoma, one delayed bleed and one immediate bleed. None of these complications required surgical revision or resuscitation.DiscussionThe rate of hemorrhagic complications was higher than in the general population. However, these complications can be considered non-serious and the risk-benefit ratio remains favorable. Multidisciplinary management and coordination with the reference hemophilia center are mandatory in this population to establish a coagulation-factor (CF) substitution protocol suited to the disease characteristics and the surgical procedure.



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Risques en dermatologie interventionnelle chez les patients hémophiles ou atteints de la maladie de Willebrand

Publication date: Available online 14 November 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): M. Say, N. Dupin, N. Stieltjes, M.-F. Avril, S. Aractingi, J. Chanal
ContexteLa maladie de Willebrand (MW) et les hémophilies A (HA) et B (HB) représentent la majorité des déficits constitutionnels en facteurs de la coagulation (DCFC). La nature et la fréquence des complications qui peuvent survenir chez ces patients lors d'un geste de dermatologie interventionnelle (DI) ne sont pas connus. L'augmentation d'incidence des cancers cutanés et leur prise en charge chirurgicale nous ont amenés à nous interroger sur cette problématique.ButL'objectif de notre étude était de déterminer la fréquence des complications hémorragiques des actes de DI pratiqués chez des patients présentant un DCFC (Hémophilie ou MW).Patients et méthodesNous avons réalisé un recueil de données chez les patients présentant un DCFC et pris en charge pour un acte de DI au sein du service de dermatologie du centre hospitalier universitaire de Cochin à Paris.RésultatsQuatorze interventions ont été réalisées chez 8 patients. Trois complications de type hémorragique sont survenues (n=3/14 ; 21,4 %) : un hématome, un saignement tardif et un saignement immédiat. Aucune de ces complications n'a nécessité de reprise chirurgicale pour hémostase ni de réanimation.DiscussionLe taux de complications hémorragiques s'est révélé nettement supérieur à celui observé en population générale. Ces complications peuvent toutefois être considérées comme non graves, permettant de conserver un rapport bénéfice/risque favorable. La prise en charge de ces malades doit être multidisciplinaire et coordonnée avec le centre de références de l'hémophilie (CRH), afin d'établir un protocole de substitution en facteur de la coagulation (FC) adapté aux caractéristiques de la pathologie et au geste chirurgical.BackgroundVon Willebrand disease (VWD) and hemophilia A and B are the most common types of hereditary coagulation-factor deficiencies. The frequency and type of complications of skin surgery in these patients are unknown. The increasing incidence of skin cancer prompted us to reflect upon this issue. While the incidence of skin cancer is increasing, the complications of skin surgery or ablative laser treatment remain unknown in this population.AimThe aim of this study was to determine the frequency of bleeding complications during and after skin surgery in patients with a hereditary coagulation-factor deficiency (hemophilia or VWD).Patients and methodsWe conducted a retrospective study in patients with hemophilia A or B or VWD undergoing skin surgery or ablative laser treatment at the Dermatology Department of the Cochin Hospital in Paris, France.ResultsFourteen procedures were performed in 8 patients. Three episodes of bleeding occurred (n=3/14, 21.4%): one hematoma, one delayed bleed and one immediate bleed. None of these complications required surgical revision or resuscitation.DiscussionThe rate of hemorrhagic complications was higher than in the general population. However, these complications can be considered non-serious and the risk-benefit ratio remains favorable. Multidisciplinary management and coordination with the reference hemophilia center are mandatory in this population to establish a coagulation-factor (CF) substitution protocol suited to the disease characteristics and the surgical procedure.



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Type I interferon and proinflammatory cytokine levels in cerebrospinal fluid of newborns with rotavirus-associated leukoencephalopathy

Publication date: Available online 14 November 2017
Source:Brain and Development
Author(s): Kyung Yeon Lee, Chang Hoon Moon, Seong Hoon Choi
ObjectiveThe purpose of this study was to identify whether there is an increase in type I interferon and proinflammatory cytokine levels in the cerebrospinal fluid of newborns with rotavirus-associated leukoencephalopathy.MethodsLevels of type I interferons (interferon-alpha and interferon-beta) and proinflammatory cytokines (interleukin-6 and interferon-gamma) were measured in the cerebrospinal fluid of 23 newborns with rotavirus-associated leukoencephalopathy (patient group) and 39 infants under 90 days-of-age (control group).ResultsCerebrospinal fluid pleocytosis was not observed in either group. Cerebrospinal fluid interleukin-6 levels were significantly higher in the patient group (7.02 ± 5.88 pg/mL) than in the control group (1.14 ± 1.90 pg/mL) (p < .0001). The mean cerebrospinal fluid interferon-gamma levels of the patient group (24.43 ± 40.16 pg/mL) were also significantly higher than those of the controls group (0.0 ± 0.0 pg/mL) (p < .0001). Cerebrospinal fluid interferon-alpha was not detected in any patient (0%) from the patient group, but was detected in four (10.3%) of the controls. Interferon-beta was detected in only two patients (8.7%) from the patient group and in one (2.6%) of the controls. Cerebrospinal fluid interleukin-6 levels correlated positively with the extent of white matter lesions on diffusion-weighted magnetic resonance imaging (r = 0.607, p = .002).ConclusionsSignificant increases in proinflammatory cytokine levels accompanied by very low detection rates of type I interferon in cerebrospinal fluid indicate that rotavirus-associated leukoencephalopathy in newborns can be correlated with central nervous system inflammatory processes without direct virus invasion into the central nervous system.



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Oxidative stress in adult growth hormone deficiency: different plasma antioxidant patterns in comparison with metabolic syndrome

Abstract

Background and aims

Growth hormone deficiency (GHD) is a condition associated with increased cardiovascular risk and insulin-resistance. Oxidative stress (OS) could be a mechanism underlying both these phenomena. In order to investigate plasma antioxidant defenses in such condition, we evaluated adults with GHD, compared with controls and metabolic syndrome patients (MetS), studying plasma total antioxidant capacity (TAC) and coenzyme Q10 (CoQ10, lipophilic antioxidant) levels, both in its oxidized and reduced forms, correlating this data with metabolic and hormonal pattern.

Materials and methods

In this case-control study, 51 GHD, 36 controls, and 35 MetS were enrolled. An evaluation of hormonal and metabolic parameters was performed. TAC was measured using the system metmyoglobin -H₂0₂ and the chromogen ABTS, whose radical form is spectroscopically revealed; latency time (LAG) in the appearance of ABTS^● is proportional to antioxidant in sample. CoQ10 was assayed by electrochemical method.

Results

Despite HOMA index was higher in both GHD and MetS (2.2 ± 0.3 and 3.1 ± 0.3 vs. 1.2 ± 0.2 in controls), only in MetS we observed lower LAG levels (64.5 ± 3.1 s vs. 82.8 ± 5.8 in GHD and 80.6 ± 6.6 in controls), suggesting an increased consumption of antioxidants. LAG significantly correlated with uric acid only in MetS (r ² = 0.65, p < 0.001), suggesting a different pattern of antioxidants. CoQ10 exhibited a trend toward lower levels in GHD, although not significant.

Conclusions

Our data indicate that GHD, although sharing with MetS various metabolic features, including increased HOMA levels, showed a different pattern of plasma antioxidants, suggesting inadequate reactivity toward radical production rather than an antioxidants consumption as in MetS.

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Tumor Acidosis and Hypoxia Differently Modulate the Inflammatory Program: Measurements In Vitro and In Vivo

Publication date: December 2017
Source:Neoplasia, Volume 19, Issue 12
Author(s): Anne Riemann, Sarah Reime, Oliver Thews
Inflammatory mediators produced by the tumor cells are of importance for immune response but also for malignant progression. The aim of the study was to analyze the expression of monocyte chemoattractant protein-1, interleukin-6 (IL-6), tumor necrosis factor-α, inducible isoform of nitric oxide synthase (iNOS), cyclooxygenase-2, and osteopontin in vitro in two different tumor cell lines under hypoxia (pO2≈1.5 mmHg) and/or acidosis (pH=6.6) for up to 24 hours since hypoxia and acidosis are common characteristics of solid tumors. Additionally, the same tumor cell lines implanted in vivo were made hypoxic and acidotic artificially for 24 hours, after which the cytokine expression was measured. Finally, the activation of ERK1/2 and p38 by acidosis/hypoxia and their impact on cytokine expression were studied. The results indicate that acidosis and hypoxia have fundamentally different (often opposing) effects on cytokine expression. In addition, these effects were tumor cell line specific. When combining hypoxia and acidosis, the overall changes reflect an additive effect of both conditions alone, indicating that hypoxia and acidosis act by independent mechanisms. The in vivo changes corresponded well with the results obtained in the isolated tumor cells. Only iNOS expression was downregulated in vivo but increased in cell culture. For IL-6 expression, the acidosis-induced changes were dependent on ERK1/2 activation. In conclusion, it was demonstrated that the environmental pO2 and pH strongly affect the expression of inflammatory mediators in tumor cells. In vivo, most of the inflammatory mediators were downregulated, which could limit the activation of immune cells and by this foster the immune escape of tumors.



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The risk factors related to bruxism in children: A systematic review and meta-analysis

Publication date: February 2018
Source:Archives of Oral Biology, Volume 86
Author(s): Huaqi Guo, Tongxia Wang, Xiaohong Niu, Hui Wang, Weihan Yang, Jie Qiu, Lan Yang
ObjectiveThis systematic review was performed to determine the risk factors related to bruxism in children.DesignThis systematic review was conducted with reporting in agreement to the PRISMA statement and according to guidelines from the Cochrane Handbook for Systematic Reviews of Interventions. We conducted a systematic search of seven online databases, with the last search updated on 1st October 2016. The seven databases were Pubmed, Embase, Cochrane Library database, Web of Science, CNKI, CBM, and WF. The included trial type were RCT, cohort studies, and case-control studies, and bruxism symptoms were assessed by questionnaires and examinations. Eighteen out of the 5637 initially identified studies met the inclusion and exclusion criteria.Resultsgender, age, gene, mixed position, anxiety, the nervous, secondhand smoke, high psychological reactions, responsibility, move a lot during sleep, sleeps with mouth open, snores loudly, restless sleep, sleep hours, sleep with light on, noise in room, headache, biting, cheeks tonus, perioral musculature participation, conduct problems, peer problems, emotional symptoms, mental health problems, birth weight, occupation of family head, maternal marital status, hyperactivity, family income seemed to have statistical significance from the present systematic review and meta-analysis.ConclusionsThe risk factors related to bruxism were as follows: Male, gene, mixed position, moves a lot, anxiety, the nervous, psychological reactions, responsibility, secondhand smoke, snore loudly, restless sleep, sleep with light on, noise in room, "sleep hours, ≤8h", headache, objects biting, conduct problems, peer problems, emotional symptoms and mental health problems.



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The chemokine receptor type 4 antagonist, AMD3100, interrupts experimental tooth movement in rats

Publication date: February 2018
Source:Archives of Oral Biology, Volume 86
Author(s): Kasumi Hatano, Yuji Ishida, Hiroyuki Yamaguchi, Jun Hosomichi, Jun-ichi Suzuki, Risa Usumi-Fujita, Yasuhiro Shimizu, Naoki Shibutani, Sawa Kaneko, Takashi Ono
ObjectiveThe aim of this study was to clarify the role of the stromal cell-derived factor-1 (SDF-1)/C-X-C chemokine receptor type 4 (CXCR4) axis in osteoclast accumulation, and the influence of orthodontic tooth movement (OTM) under mechanical force application to periodontal tissues, by administration of the CXCR4 antagonist AMD3100.DesignThe upper right first molar (M1) of rats was moved mesially with a 10-g force titanium-nickel closed coil spring. Rats were treated with phosphate-buffered saline or AMD3100 (5mg/kg), which is a SDF-1 antagonist. After 0, 1, 3, and 7days, alveolar bones in all groups were examined at each time point by micro-computed tomography and histological analysis.ResultsTooth movement was decreased significantly in the AMD3100-treated group at 1, 3, and 7days after beginning OTM. The numbers of tartrate-resistant acid phosphatase-positive multinucleated cells in the periodontal ligament around the maxillary M1 were decreased significantly in the treated as compared to the control group on Days 1 and 3.ConclusionAdministration of AMD3100 decreases OTM and osteoclast accumulation in rat molars under orthodontic force application. These findings suggest that the SDF-1/CXCR4 axis plays an important role in alveolar bone metabolism during OTM.



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