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Poitiers, France

Bensadoun R.-J.,CHU de Poitiers | Nair R.G.,Griffith University
Current Opinion in Oncology | Year: 2012

Purpose of review: To discuss the promising state of the art low-level laser therapy (LLLT) for preventive and therapeutic usage in oral mucositis due to cancer therapy. Recent findings: Photomedicine using LLLT is very effective with intraoral and extraoral devices in the management of oral mucositis, based on several studies including randomized control studies. A systematic review identified 33 relevant articles that were subjected to meta-analysis based on which laser parameters in routine practice are being defined. Meta-analysis showed that LLLT reduced risk of oral mucositis with relative risk (RR) 2.45 [confidence interval (CI) 1.85-3.18], reduced duration, severity of oral mucositis and reduced number of days with oral mucositis (4.38 days, P=0.0009). RR was similar between the red (630-670 nm) and infrared (780-830 nm) LLLT. Pain-relieving effect based on the Cohen scale was at 1.22 (CI 0.19-2.25). Summary: No adverse side effects of LLLT were reported; hence, we recommend red or infrared LLLT with diode output between 10-100 mW, dose of 2-3J/cm 2/cm 2 for prophylaxis and 4J/cm 2 (maximum limit) for therapeutic effect, application on single spot rather than scanning motion. Lesions must be evaluated by a trained clinician and therapy should be repeated daily or every other day or a minimum of three times per week until resolution. There is moderate-to-strong evidence in favor of LLLT at optimal doses as a well tolerated, relatively inexpensive intervention for cancer therapy-induced oral mucositis. It is envisaged that LLLT will soon become part of routine oral supportive care in cancer. © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Fakhouri F.,Nantes University Hospital Center | Roumenina L.,French Institute of Health and Medical Research | Provot F.,Lille University Hospital Center | Sallee M.,Marseille University Hospital Center | And 8 more authors.
Journal of the American Society of Nephrology | Year: 2010

In contrast to pregnancy-associated thrombotic thrombocytopenic purpura, the pathogenesis and presentation of pregnancy-associated atypical hemolytic uremic syndrome (P-aHUS) remain ill-defined. We conducted a retrospective study to assess the presentation and outcomes of patients presenting with P-aHUS and the prevalence of alternative C3 convertase dysregulation. P-aHUS occurred in 21 of the 100 adult female patients with atypical HUS, with 79% presenting postpartum. We detected complement abnormalities in 18 of the 21 patients. The outcomes were poor: 62% reached ESRD by 1 month and 76% by last follow-up. The risk for P-aHUS was highest during a second pregnancy. Thirty-five women, 26 (74%) of whom had complement abnormalities, had at least one pregnancy before the onset of a non-pregnancy-related aHUS. Outcomes did not differ between patients with pregnancy-related and non-pregnancy-related aHUS. Mutations in the SCR19-20 domains of factor H were less frequent in P-aHUS patients compared with non-pregnancy-related aHUS. Pregnancies in female patients with complement abnormalities (n = 44) were complicated by fetal loss and preeclampsia in 4.8% and 7.7%, respectively. Better understanding of complement dysregulation in pregnancy complications is essential, especially to guide development of pharmacologic agents to modulate this system. Copyright © 2010 by the American Society of Nephrology.

Withdrawal of nutrition/hydration is a legal and ethical decision in adults. It is very rarely practiced in children in France, due to the fear of letting a child die from hunger and thirst. Several pediatric issues make this decision a complex one. The root of the decision should be the best interest of the child, knowing that the subjective feelings of the family should also be addressed. The physiologic dependence of the infant on environment for food and water is indistinctly superimposed on the means involved for sustaining nutrition during a disease. Nutrition/hydration is synonymous to life and the oral character is linked to pleasure. Thus, the wish to withdraw nutrition/hydration can be considered as a decision to deliberately provoke death. Given the child's lack of autonomy and the fact that the child can be harmed with a chronic disease at birth, make the ethical approach to the decision more complex. Death is the unavoidable result of the decision of withdrawal of nutrition/hydration, but the patient may not suffer from hunger and thirst during the remaining days. Particular attention should be devoted to the prevention of pressure ulcers and use of analgesic drugs in the setting of renal failure. The presumption of an important moral suffering of the family and/or the treating team should balance the choice of this option among other end-of-life decisions in children. © 2009 Elsevier Masson SAS. All rights reserved.

Tougeron D.,CHU de Poitiers | Tougeron D.,French Institute of Health and Medical Research | Tougeron D.,Laboratoire inflammation | Fauquembergue E.,French Institute of Health and Medical Research | Latouche J.-B.,French Institute of Health and Medical Research
Bulletin du Cancer | Year: 2013

Immune response has a crucial role in the control of tumoral progression in colorectal cancer (CRC). A close link between the rate of tumor infiltrating lymphocytes and prognosis has been found. Indeed, recent studies have shattered our dogmas as the rate of tumor infiltrating lymphocytes seems to be a better prognostic factor than TNM classification. This review is focused on immune response in CRC. Specific cell-mediated immunity is important for the control of tumoral growth. Specific T cell activation is induced by tumoral antigens process by dendritic cells. Among the numerous tumoral antigens that could induce an immune response in CRC, the carcinoembryonic antigen is the most studied but its immunogenicity remains low. In CRC with microsatellite instability, several immunogenic neo-antigens have been identified and could explain the high level of tumor infiltrating lymphocytes and the better prognosis of this type of tumour. However, CRC can escape immune response by immune response modulation or tumoral cells modifications conducting to immune resistance. These data should be considered for the treatment of CRC or the development of immunotherapy strategies. © John Libbey Eurotext.

Lionet A.,Lille University Hospital Center | Kandel C.,Nantes University Hospital Center | Bourdon F.,Clinique du Bois | Gnemmi V.,Lille University Hospital Center | And 3 more authors.
American Journal of Kidney Diseases | Year: 2015

C3 glomerulopathy (C3G) is a prototypic complement-mediated kidney disease. Rapidly progressive forms of C3G usually respond poorly to conventional treatments. We report on the efficacy of the terminal complement inhibitor eculizumab in 3 adult patients with rapidly progressive C3G. In all 3 patients, serum creatinine levels had increased by >50% in the 2 months preceding initiation of eculizumab treatment despite the use of conventional immunosuppressive drugs and/or plasma exchanges in 2 of these individuals. Of note, 2 patients had long-standing nephrotic syndrome. Kidney biopsy performed prior to eculizumab treatment disclosed marked glomerular inflammatory changes and increased C5b-9 deposition in all patients. Eculizumab use was associated with significant improvement in kidney function, with estimated glomerular filtration rates of patients increasing 22 to 38 mL/min/1.73 m2. Eculizumab use also was associated with remission of nephrotic syndrome in the 2 affected patients, an effect observed as early as one week after treatment initiation. Repeat kidney biopsy disclosed regression of glomerular inflammatory changes and decreases in glomerular staining for C5b-9 in all patients. These results warrant further assessment of eculizumab for treatment of rapidly progressive forms of C3G with markedly increased glomerular C5b-9 deposits. © 2015 National Kidney Foundation, Inc.

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