Granulomas are compact structures formed in tissues by the immune system in response to aggressions. The
formation of granulomas using circulating mononuclear cells is an innovative method to easily ...assess the immune response of patients. Monitoring the efficiency of mononuclear cells from patients to form granulomas
would help improve their therapeutic management. Circulating mononuclear cells from 23 elderly patients with sepsis and 24 elderly controls patients were incubated with Sepharose beads coated with either BCG or
extracts. The formation of granulomas was measured over 9 days. Most healthy elderly patients (92%) were able to form granulomas in response to BCG and
extracts compared to only 48% of infected elderly patients. Undernutrition was significantly associated with impaired granuloma formation in healthy and infected patients. Granulomas typically comprise epithelioid cells and multinucleated giant cells, however, these cells were not detected in samples obtained from patients unable to form granulomas. We also found that the impairment of granuloma formation was associated with reduced production of tumor necrosis factor without overproduction of interleukin-10. Finally, all genes specifically modulated in granulomatous cells were down-modulated in patients with defective granuloma formation. TNFSF10 was the only M1 gene markedly upregulated in patients who did not form granulomas. Our study suggest that defective granuloma formation may be a measurement of altered activation of immune cells which can predispose to nosocomial infections in elderly patients.
Social isolation potentiates the risk of death by cancer in the older cancer patient population. The PREDOMOS study investigates the impact of establishing a Program of Social intervention associated ...with techniques of Domotic and Remote assistance on the improvement of quality of life of older isolated patients, treated for locally advanced or metastatic cancer. This paper updates the pilot trial protocol.
The original protocol was published in Trials, accessible at https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-017-1894-7 . This update reports on the eligibility criteria expansion and on the adjunction of a cost-utility analysis. We widened the eligible population to patients with locally advanced or metastatic cancer including malignant hemopathies (except acute myeloid leukemia) and to patients in the first and second lines of oncologic treatment. We restricted the inclusion to patients with a Mini Mental State Examination score strictly over 24. In addition to the secondary outcomes outlined in the protocol, a medico-economic analysis has been added to evaluate both the health benefits and costs of the two strategies and calculate the incremental cost-utility ratio of the innovative program assessed, compared to the standard practice.
ClinicalTrials.gov, NCT02829762 . Registered on 29 June 2016.
Gemcitabine-induced severe pulmonary toxicity Barlési, Fabrice; Villani, Patrick; Doddoli, Christophe ...
Fundamental & clinical pharmacology,
February 2004, Volume:
18, Issue:
1
Journal Article
Peer reviewed
Gemcitabine is a relatively new deoxycytidine analog (2′,2′‐difluorodeoxycytidine) with structural similarities to cytosine arabinoside (Ara‐C). Activity of gemcitabine is demonstrated in the ...treatment of many solid tumors, like pancreas, ovarian and nonsmall cell lung cancer (NSCLC). Although gemcitabine is considered as a drug with a good safety profile, cases of gemcitabine‐induced severe pulmonary toxicity (GISPT) were reported as for Ara‐C. We performed a systematic review of reported cases on the GISPT. Twenty‐nine clinical trials especially interesting NSCLC patients (21) and 21 reported cases recording 40 patients were analyzed. The incidence of the GISPT varies from 0 to 5%. The clinical presentation is a subacute clinical syndrome and is frequently nonspecific. The predominant radiographic pattern on chest X‐ray are reticulo‐nodular interstitial infiltrates. It was postulated that the physio‐pathological mechanism of the GISPT was an inflammatory reaction of the alveolar capillary wall cytokine‐mediated, which created an abnormal permeability of its membrane. After the differential diagnosis were ruled out, the discontinuation of the drug and the early initiation of steroids and diuretics are the most frequently performed treatments. Under these conditions, the outcome was favorable in a delay of few days generally for a majority of patients but 20% of patients died. Some risk factors, as a previous pulmonary disease or a previous thoracic irradiation, for the occurrence of the GISPT were proposed. GISPT is rare but sometimes fatal. Its a necessity to increase awareness about it to enhanced an early and suitable management of patients developing such a toxicity after gemcitabine administration.
Summary
We assessed if antiresorptive treatment can prevent aromatase inhibitor–induced bone loss in patients with early breast cancer. We observed that patients who did not receive antiresorptive ...treatment had a 20.8-fold increase in risk of bone loss after 24 months of aromatase inhibitors therapy.
Purpose
This study aimed to describe changes in femoral and lumbar bone mineral density (BMD) after 24 months of aromatase inhibitors (AIs) and antiresorptive treatment in postmenopausal women with estrogen receptor–positive breast cancer.
Methods
Prospective, longitudinal study in a real-life setting with a 2-year follow-up. Patients underwent a complete baseline bone assessment including clinical assessment, biological evaluation, BMD measurement, and spine X-ray. Antiresorptive treatment was prescribed to patients with a
T
-score < − 2 or a
T
-score < − 1.5 SD with additional osteoporosis risk factors. A follow-up bone assessment was carried out after 24 months.
Results
Among 328 patients referred to our center, 168 patients (67.7 ± 10.6 years) were included in our study, and 144 were eligible for antiresorptive treatment. After 24 months, patients receiving antiresorptive treatment experienced a significant increase of + 6.28% in femoral-BMD (F-BMD) and + 7.79% in lumbar-BMD (L-BMD). This increase was not significantly different between osteoporotic and osteopenic patients. Conversely, patients not receiving antiresorptive treatment presented significant F-BMD and L-BMD loss regardless of the baseline BMD.
In the multivariate logistic model, the lack of antiresorptive treatment was the only predictive factor for major femoral bone loss with a 20.83 odds ratio (CI95%:4.2–100,
p
< 0.001).
Conclusion
This real-life study confirmed that antiresorptive treatment significantly increases femoral and lumbar BMD regardless of the baseline BMD in postmenopausal patients receiving AIs for early breast cancer. Patients who did not receive antiresorptive treatment had a 20.8-fold increased risk of major bone loss. Nevertheless, the best threshold to adopt for starting antiresorptive agents remains undetermined.
GPs are confronted with therapeutic dilemmas in treating patients with multimorbidity and/or polypharmacy when unfavourable medication risk-benefit ratios (RBRs) conflict with patients' demands.
To ...understand GPs' attitudes about prescribing and/or deprescribing medicines for patients with multimorbidity and/or polypharmacy, and factors associated with their decisions.
Cross-sectional survey in 2016 among a national panel of 1266 randomly selected GPs in private practice in France.
GPs' opinions and attitudes were explored using a standardised questionnaire including a case vignette about a female treated for multiple somatic diseases, sleeping disorders, and chronic pain. Participants were randomly assigned one of eight versions of this case vignette, varying by patient age, socioprofessional status, and stroke history. Backward selection was used to identify factors associated with GPs' decisions about drugs they considered inappropriate.
Nearly all (91.4%) responders felt comfortable or fairly comfortable deprescribing inappropriate medications, but only 34.7% decided to do so often or very often. In the clinical vignette, most GPs chose to discontinue symptomatic medications (for example, benzodiazepine, paracetamol/tramadol) because of unfavourable RBRs. When patients asked for ketoprofen for persistent sciatica, 94.1% considered this prescription risky, but 25.6% would prescribe it. They were less likely to prescribe it to older patients (adjusted odds ratio AOR 0.48, 95% confidence interval CI = 0.36 to 0.63), or those with a stroke history (AOR 0.55, 95% CI = 0.42 to 0.72).
In therapeutic dilemmas, some GPs choose to prioritise patients' requests over iatrogenic risks. GPs need pragmatic implementation tools for handling therapeutic dilemmas, and to improve their skills in medication management and patient engagement in such situations.
The Chibanis represent the population of aging former immigrant workers who arrived in France in the 1970s in order to take up employment. Most of them still live in immigrant hostels, which are not ...appropriate for an older population. This anthropological study was conducted on Chibanis living in an immigrant hostel in the 15th arrondissement of Marseille. The objectives were to assess the medical, economic, and social characteristics of this population, to understand their access to health care, and to measure their adherence to the prevention actions of an association. 67 Chibanis aged 65 and over were included, with a median age of 77: 91% had access to a general practitioner, and 86.6% had more than two chronic diseases. More than half of the Chibanis complained of dental problems, and 20% complained of ophthalmological problems. Only 32.8% of the Chibanis included agreed to follow-up care with the nurses from the association. The population of Chibanis are isolated geographically from their families, live in poor socio-economic conditions, and often have insufficient medico-social coverage. They must “manage” their chronic diseases, as well as costly health problems such as dental or ophthalmic diseases. Improving care pathways for this population requires us to identify their specificities and all the factors hindering prevention actions.
Background
Sarcopenia is a muscle disease defined by a loss of muscle strength associated to a decrease in skeletal muscle mass. In addition to aging, many factors may contribute to sarcopenia as ...cancer and/or androgen deprivation therapy (ADT).
Objectives
The aims of this study are to describe the prevalence of sarcopenia in older prostate cancer patients before initiation of treatment with ADT and radiotherapy, and to evaluate the impact of ADT on the occurrence or aggravation of sarcopenia in this population.
Design
Longitudinal study.
Participants and setting
Sarcopenia was prospectively evaluated in 31 consecutive patients aged 70 to 88 years, referred in one hospital unit of south eastern France, for a comprehensive geriatric assessment (CGA) before cancer treatment initiation.
Measurements and results
CGA, measures of muscle strength and physical performances were performed at baseline (T0) and at the end of cancer treatment (T1). Appendicular skeletal muscle mass was measured by Dual-energy X-ray absorptiometry (DXA) at the end of treatment. At T0, 8 patients (among 31) had a probable sarcopenia according to European consensus, and 18 had altered physical performance. At T1, 15 patients (among 19) had abnormal one leg balance test. Finally, only one patient had a sarcopenia confirmed by DXA.
Conclusion
This preliminary study showed a high prevalence of muscle disorders before initiation of ADT in a population of elderly cancer prostate patients with intermediate frailty status, and an increased risk of falls at the end of ADT. This highlighted the importance of screening for sarcopenia before treatment initiation, to prevent the occurrence or aggravation of sarcopenia by possible adjustment of treatment, and implementation of appropriate exercise and nutrition interventions.
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