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The study aims to describe the course and management of non-infectious uveitis during pregnancy and postpartum period in European populations.A retrospective observational study in two tertiary centers in France was performed. Pregnant patients during the follow-up of a non-infectious uveitis as well as those with new-onset uveitis were included. The medical records were analyzed with a systematic collection of the characteristics of the uveitis, the treatment and evolution of the uveitis, and the course of the pregnancy including obstetric complications.Seventy-nine pregnancies in 59 women were included: 48 patients (68 pregnancies) were followed for uveitis and 11 had a new-onset uveitis diagnosis. Most patients had idiopathic uveitis (32.2%) or sarcoid uveitis (27.1%). Among the patients followed for uveitis at the time of conception, there were 18 relapses (26.5%) requiring treatment escalation. Relapses occurred mainly in the two first trimester (n = 12) or during the postpartum period (n = 5) and were significantly associated with an active uveitis at the time of conception (OR = 9.2, 95% CI [1.57-48.4], p = 0.01). The characteristics of the new-onset uveitis were similar to those already existing before pregnancy. Obstetric complications occurred in 25 pregnancies (31.6%), mainly gestational hypertension and gestational diabetes.The frequency of non-infectious uveitis relapses decreases as pregnancy progresses, in agreement with data from other non-European studies. However, multidisciplinary monitoring should be advised, especially to uncontrolled patients at the time of conception.

International audience; Primary antibody deficiency (PAD) is characterized by a defective immunoglobulin production and recurrent infections, mostly involving respiratory and gastrointestinal tracts. Chronic or recurrent diarrhea is reported in up to 23%. Campylobacter infection is a common cause of infectious diarrhea, reported in 1.2% to 7.5% of patients with common variable immunodefi-ciency (CVID), the most frequent PAD. The aim of this study was to describe Campylobacter infection in patients with PAD included in a large nationwide study and analyze factors associ-ated with susceptibility to this pathogen. The DEFI (DEFicit Immunitaire) study is an ongoing large cross-sectional French multicentric study of adults with PAD, with retrospective collection of clinical data. All patients with a history of bacteriologically documented Campylobacter infection were identified, and clinical data were collected for each episode. Factors associated with recurrent infection were assessed as oddsratio (OR) and 95% confidence interval (CI), calculated by means of simple regression analysis. In patients with available material, strains of each episode were characterized using molecular analysis and compared (Table E1, available in this article’s Online Repository at www.jaci-inpractice.org). A com-parison of immunodeficiency-related characteristics of patients with and without Campylobacter infection was performed in the homogeneous group of patients with CVID. The control group included patients with CVID from DEFI centers who confirmed that patients did not develop Campylobacter infection after enrollment (Figure E1, available in this article’s Online Repository at www.jaci-inpractice.org). After correction for multiple comparisons, P

Introduction Parmi les manifestations de la maladie thromboembolique veineuse (MTEV), entite regroupant thrombose veineuse proximale et embolie pulmonaire, on observe une thrombose de la veine cave inferieure (TVCI) dans 4 a 15 % des cas. C’est une localisation peu frequente et il existe a ce jour peu de series publiees sur le sujet. Le but de notre etude concernant la TVCI est de decrire les caracteristiques cliniques des patients, les caracteristiques de la maladie (etiologie, pronostic) et les traitements utilises. Materiels et methodes Nous avons realise une etude observationnelle, retrospective, bicentrique, controlee sur 2 centres hospitalo-universitaires francais entre mars 2010 et novembre 2017. Nous avons recueilli les donnees des patients atteints de TVCI (groupe TVCI issus des deux CHU) et les avons compares avec les donnees des patients atteints de maladie thromboembolique veineuse sans TVCI (groupe controle issu d’un seul CHU). Les donnees ont ete recueillies via le dossier patient informatise. Resultats 165 cas de patients porteurs de TVCI ont ete identifies (âge median 62 ans, 43 % de femmes) pour 727 patients atteints de maladie thromboembolique veineuse hors TVCI (âge median 69 ans, 54 % de femmes). La frequence de TVCI etait de 11 %. Les patients du groupe TVCI presentaient une embolie pulmonaire concomitante dans 35 % des cas. Il existait une pathologie associee a la thrombose chez 139 patients (84 %). Les principales causes de thromboses dans notre cohorte etaient l’existence d’une pathologie abdominale sous-jacente (71 %) et l’existence d’une neoplasie associee (62 %). La neoplasie n’etait presente que chez 140 patients soit 20 % du groupe controle (p Conclusion Cette cohorte de grande taille permet de preciser les determinants de la TVCI dans le spectre de la MTEV. La cause la plus frequente de thrombose de la veine cave inferieure est l’existence d’une neoplasie, principalement abdominale. A contrario, la place pour la recherche de syndrome des anticorps anti-phospholipides ou de thrombophilie acquise est limitee. La mortalite est plus importante en TVCI, probablement du fait de la neoplasie sous-jacente.

Etat de la question Le lupus erythemateux systemique (LES) est une maladie auto-immune rare impactant lourdement la qualite de vie (QdV) des patients. La plupart des etudes longitudinales precedentes portaient sur des questionnaires generiques et ne detaillaient pas l’influence du type de poussee clinique sur l’evolution de la QDV. Notre etude avait pour objectif d’evaluer l’evolution de la qualite de vie specifique dans les 18 mois suivant une poussee clinique, a l’aide d’une approche basee sur la theorie de reponse aux items. Materiel et methodes La cohorte prospective longitudinale francaise EQUAL est constituee de patients atteints de LES suivis pendant deux ans. La QDV specifique selon le LupusQol et le SLEQOL a ete recueillie tous les trois mois. L’activite lupique selon le SELENA-SLEDAI (SFI) et le SELENA-SLEDAI revise (SFI-R) a ete evaluee tous les six mois. La reponse aux items des questionnaires specifiques LupusQoL et SLEQOL par des patients dans les 18 mois (a 6, 12 et 18 mois apres une poussee) suivant une poussee clinique a ete comparee a celle des patients sans poussee grâce a un modele lineaire logistique a hypotheses assouplies pour les dimensions de chaque questionnaire. Resultats Entre decembre 2011 et juillet 2015, 336 patients ont ete inclus (89,9 % de femmes). Les domaines du LupusQol et du SLEQOL concernant la qualite de vie physique (sante physique, fonctionnement physique et douleur) etaient les plus impactes par les poussees osteoarticulaires et cutanees (perte d’independance, ralentissement moteur, difficulte a la marche, impact de la douleur sur les activites, le sommeil, la mobilite, inquietude lie a la douleur articulaire, sentiment de gene pour les autres et de tristesse). Les items impactes par la poussee cutanee concernaient egalement les problematiques d’image de soi. Les poussees neurologiques ou psychiatriques impactaient plus severement la qualite de vie specifique. La qualite de vie des patients est modifiee jusqu’a 18 mois apres une poussee. Conclusion Les resultats d’analyse selon la theorie de reponse aux items permettent de reperer les items qui representent le mieux l’evolution de la qualite de vie des patients. Les items portant sur la sante physique et sur la douleur sont les plus sensibles aux variations de QDV apres une poussee osteoarticulaire ou cutanee, indiquant que cette preoccupation des patients s’ameliore dans les six a 18 mois apres une poussee.

Background: Preclinical and retrospective clinical data suggest that ≥3T is a biomarker for poor prognosis and resistance to paclitaxel in breast cancer (BC). Preclinical studies have demonstrated that Ixa has activity in ≥3T over-expressing xenograft models resistant to taxanes and Ixa has shown clinical activity in BC patients with high ≥3T mRNA levels [Horak et al., J Clin Oncol 27:15s, 2009 (suppl; abstr 3587]. Dako and BMS have developed an IHC assay for detection of ≥3T to explore the potential of ≥3T as a biomarker to select BC patients that may benefit from Ixa. A neoadjuvant BC study comparing ixa to weekly paclitaxel employs this assay to assess ≥3T expression levels in patients’ tumor samples. Here we describe the application and initial validation testing of the assay in BC tumor samples. Methods: An IHC assay employing a murine monoclonal anti-≥3T antibody (TUJ1) was developed to assess ≥3T expression in formalin-fixed paraffin-embedded tissue specimens. Banked specimens for initial testing included 233 cases of invasive BC. Results: Patterns of ≥3T staining were typically homogeneous cytoplasmic staining with normal tissue elements such as endothelial cells and nerve cells serving as internal positive controls. Staining intensity was scored as 0, 1+, 2+ or 3+ with 0 being no visible staining and 2+ being equal to that of the internal positive control. Tumors with ≥50% cells staining ≥2+ were defined as positive for ≥3T based on previous published studies. Of the 233 breast tumors, 81 (35%) were positive and 152 (65%) were negative for ≥3T expression. HER2 status was defined for 128 of these specimens, with 37 of them (29%) found to be HER2 positive. Comparison of the samples with defined HER2 status demonstrated similar patterns of ≥3T expression, with 15 (40.5%) of the HER2+ samples being positive for ≥3T and 31 (34.1%) of HER2- specimens expressing elevated levels of ≥3T. In pathologist training exercises the inter-reader and intra-reader agreement of ≥3T scoring exceeded 85%. Antigen stability has been confirmed and other assay validation efforts are ongoing. Conclusions: These findings are consistent with previously reported data on ≥3T expression in breast cancer, and support the use of this ≥3T IHC assay in studies with ixabepilone. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P4-08-06.

Resume Introduction Plusieurs auteurs ont evalue la relation entre l’expression de la β-tubuline de classe III et le devenir des patients porteurs d’un cancer du poumon non a petites cellules (CPNPC) traites par des agents antitubulines (AAT). Etat des connaissances Un haut niveau d’expression de β-tubuline de classe III a ete correle avec une moindre reponse ou une survie plus courte chez les patients presentant un CPNPC avance traite par taxanes et vinorelbine. Deux etudes ont montre que les patients traites par paclitaxel dont les tumeurs exprimaient un haut niveau de β-tubuline de classe III avaient une moindre reponse et une survie plus vite, tandis que cette variable n’avait pas de valeur predictive chez les patients ne recevant pas d’AAT. A l’oppose, l’analyse des tumeurs des patients operes porteurs d’un CPNPC de l’essai JBR-10 a montre que la chimiotherapie par cisplatine/vinorelbine semblait neutraliser la valeur pronostique negative de l’expression de β-tubuline de classe III et que le benefice de la chimiotherapie etait plus important pour les patients ayant un haut niveau d’expression. Perspectives Dans le CPNPC avance, un haut niveau d’expression de β-tubuline de classe III pourrait orienter le choix de la chimiotherapie vers un protocole sans taxanes. Les epothilones apparaissent potentiellement interessantes dans ce contexte. Conclusions L’expression de la β-tubuline de classe III emerge comme un marqueur de resistance aux taxanes dans le CPNPC avance, ainsi qu’un marqueur pronostic pour le devenir des patients ayant une maladie localisee.

Les carcinomes de primitif inconnu (CAPI) constituent un groupe de tumeurs heterogenes, avec des histoires naturelles extremement variables, mais dans l’ensemble associeesa unpronostic sombre. En raison de leur similitude de presentation avec des situations pour lesquelles la tumeur primitive est connue, certains sous-groupes anatomocliniques, dits de pronostic favorable, meritent d’etre individualises dans la mesure ou ils justifient une demarche therapeutique susceptible d’amener des remissions prolongees. Pour les autres patients, les principaux facteurs independants de mauvais pronostic identifies dans les analyses multifactorielles sont le statut de performance (PS) superieur ou egal a 2, l’existence de metastases hepatiques, l’existence d’une elevation des lactates-deshydrogenases (LDH) ou d’une hypoalbuminemie. Leur connaissance est importante pour optimiser l’interpretation des essais therapeutiques et prendre au quotidien les decisions therapeutiques.

International audience; BACKGROUND:In 2014, the European Society for Immune Deficiencies (ESID) revised the common variable immunodeficiency (CVID) diagnosis criteria by incorporating new clinical and biological markers. The new definition appeared more restrictive but had not yet been evaluated in a large cohort of patients.OBJECTIVE:The objective of this study was to evaluate the impact of this new definition in a large cohort of patients with primary hypogammaglobulinemia.METHODS:Evaluation of 3 different CVID definitions (ESID/Pan-American Group for Immunodeficiency [PAGID] 1999, ESID 2014, DEFI 2015) in 521 patients included in the French DEFI study with a diagnosis of primary hypogammaglobulinemia.RESULTS:Using the ESID/PAGID 1999 definition, 351 patients were classified as CVID. The new ESID 2014 definition excluded 62 (18%) patients. Most of them (n = 56; 90%) had a less severe disease, whereas 6 (10%) presented with a severe disease with major T-cell defect. We propose different criteria (occurrence of opportunistic infection or very low naive CD4+ T-cell count) to define this population with severe T-cell defect. Sixty-two patients fulfilled these criteria, represented 20% of the initial CVID population but accounted for 77% of the deaths, with a 5-year overall survival of 67.6% (95% confidence interval, 51.0-79.6), and were considered as late onset combined immunodeficiency (LOCID).CONCLUSIONS:The new ESID definition for CVID still fails to exclude a large number of patients with severe T-cell defect. We propose a new definition (DEFI 2015) that excluded more patients with a T-cell defect and consider these patients as LOCID. This population has a poor outcome and should be considered as a distinct group requiring specific care.

Summary Background Kawasaki-like syndrome (KLS) is rare in adults; one third of these patients are infected by Human immunodeficiency virus (HIV). Our study reports cases of KLS occurring in HIV-positive adults and reviews the literature to compare their characteristics with HIV-negative adults and children with Kawasaki disease (KD). Methods Report of cases and review of the literature. Results Amongst 20 cases reviewed, including 4 who were managed at our institution, KLS was associated with severe immunosuppression and a high HIV viral load. There was frequent co-infection by hepatitis viruses. Desquamation and liver abnormalities were more frequent in HIV-negative adults whereas headaches and gastrointestinal disorders more common in HIV-positive adults. Intravenous immunoglobulin was effective therapy. Relapse was more frequent among HIV-positive patients. No cardiovascular complications or deaths occurred. Conclusions Advanced immunosuppression due to HIV may predispose to KLS. The differential diagnosis that must be considered includes drug hypersensitivity reactions and staphylococcal infections.

Ectopic adrenocorticotropic (ACTH) syndrome is a rare condition, generally due to lung or carcinoid tumors. 18-fluorodeoxy-glucose positron emission tomography ((18)FDG-PET) can be useful where conventional localization techniques often fail. A 50-year-old man presented with sudden diffuse oedema, hypokaliemic alkalosis, Diabetes mellitus and high serum levels of ACTH and cortisol. Ectopic ACTH syndrome was confirmed leading to ketoconazole treatment. Chest-computed tomography only revealed an aspecific anterior mediastinal nodule that was hypermetabolic on the whole body-(18)FDG-PET. A thymic tumor was suspected and the patient had a thymectomy that revealed an atypical carcinoid tumor with pleural carcinosis. The postoperative course was favorable with clinical and biochemical remission of neoplastic Cushing's syndrome.

In 2002, the French Federation of Comprehensive Cancer Centers published clinical practice guidelines (CPGs) for the management of carcinomas of unknown primary (CUP).A controlled "before-after" study at two centers (experimental in Lyon, France and control in Edmonton, Canada) to assess the impact of CPGs on CUP management. Fifty-CUP patients treated in 2000-2001, i.e. before CPG publication, and 50 patients treated in 2003-2004, were analyzed for both centers.In both groups, compliance for diagnostic workup was the same before or after CPGs publication. Non-adenocarcinoma histology and performance status (PS)2 were independent factors for CPGs compliance. In the experimental group, 75% of patients underwent inappropriate investigations. The proportion of patients from this group with unfavourable clinicopathologic entity and PSor = 1, who received cisplatin-based chemotherapy did not significantly change (2000-2001: 27% vs. 2003-2004: 37.5%; P = 0.45). However, most patients treated in the pre period received organ-specific regimens, while most patients treated in the post period received taxane or gemcitabine-based regimens. Patients from the control group generally received taxane/carboplatin.Our study show that simply distributing CUP CPGs did not change practice and underline the necessity to disseminate and implement CPGs, both to oncologists and organ-specialist physicians.

Prion diseases are characterized by the presence of an abnormal isoform of the cellular prion protein (PrPc) whose physiological role still remains elusive. To better understand the function of PrPc, it is important to identify the different subcellular localization(s) of the protein and the different partners with which it might be associated. In this context, the PrPc-lectins interactions are investigated because PrPc is a sialoglycoprotein which can react with lectins which are carbohydrate-binding proteins. We have previously characterized a nuclear lectin CBP70 able to recognize N-acetyl-beta-D-glucosamine residues in HL60 cells. Using confocal immunofluorescence, flow-cytofluorometry, and Western-blotting, we have found that PrPc is expressed in the nucleus of the NB4 human promyelocytic leukemia cell line. It was also found that the lectin CBP70 is localized in NB4 cell nuclei. Moreover, several approaches revealed that PrPc and CBP70 are colocalized in the nucleus. Immunoprecipitation experiments showed that these proteins are coprecipitated and interact via a sugar-dependent binding moiety. In conclusion, PrPc and CBP70 are colocalized in the nuclear compartment of NB4 cells and this interaction may be important to better understand the biological function and possibly the conversion process of PrPc into its pathological form (PrPsc).

The subcellular plurilocalization of some lectins (galectin-1, galectin-3, galectin-10, calreticulin, etc.) is an intriguing problem, implying different partners according to their localization, and involvement in a variety of cellular activities. For example, the well-known lectin, galectin-3, a lactose-binding protein, can act inside the nucleus in splicing events, and at the plasma membrane in adhesion, and it was demonstrated that galectin-3 interacts in the cytoplasm with Bcl-2, an antiapoptotic protein. Some years ago, our group isolated a nuclear lectin CBP70, capable of recognizing N-acetylglucosamine residues. This lectin, first isolated from the nucleus of HL60 cells, was also localized in the cytoplasm. It has been demonstrated that CBP70 is a glycosylated lectin, with different types of glycosylation, comparing cytoplasmic and nuclear forms. In this article, we have studied the localization of CBP70 in undifferentiated HL60 cells by electron microscopy, immunofluorescence analysis, and subcellular fractionation. The results obtained clearly demonstrated that CBP70 is a plurilocalized lectin that is found in the nucleus, at the endoplasmic reticulum, the Golgi apparatus, and mitochondria, but not at the plasma membrane. Because CBP70, a nuclear glycoprotein, was found to be associated also with the endoplasmic reticulum and the Golgi apparatus where the glycosylation take place, it raised the question: where does the glycosylation of nuclear proteins occur?

Some years ago, a lectin designated CBP70 that recognized glucose (Glc) but had a stronger affinity for N-acetylglucosamine (GlcNAc), was first isolated from HL60 cell nuclei. Recently, a cytoplasmic form of this lectin was described, and one 82 kDa nuclear ligand was characterized for the nuclear CBP70. In the present study, the use of Pronase digestion and the trifluoromethanesulphonic acid (TFMS) procedure strongly suggest that the nuclear and the cytoplasmic CBP70 have a same 23 kDa polypeptide backbone and, consequently, could be the same protein. In order to know the protein better and to obtain the best recombinant possible in the future, the post-translational modification of the nuclear and cytoplasmic CBP70 was analyzed in terms of glycosylation. Severals lines of evidence indicate that both forms of CBP70 are N- and O-glycosylated. Surprisingly, this glycosylation pattern differs between the two forms, as revealed by beta-elimination, hydrazinolysis, peptide-N-glycosydase F (PNGase F), and TFMS reactions. The two preparations were analyzed by affinity chromatography on immobilized lectins [Ricinus communis-l agglutinin (RCA-I), Arachis hypogaea agglutinin (PNA), Galanthus nivalis agglutinin (GNA), and wheat germ agglutinin (WGA)] and by lectin-blotting analysis Sambucus nigra agglutinin (SNA), Maackia amurensis agglutinin (MAA), Lotus tetragonolobus (Lotus), succinylated-WGA, and Psathyrella velutina agglutinin (PVA)]. Both forms of CBP70 have the following sugar moities: terminal beta Gal residues, Gal beta 1-3 GalNAc, Man alpha 1-3 Man, sialic acid alpha 2-6 linked to Gal or GalNAc; and sialic acid alpha 2-3 linked to Gal. However, only nuclear CBP70 have terminal GlcNAc and alpha-L-fucose residues. All these data are consistent with the fact that different glycosylation pattern found for each form of CBP70 might act as a complementary signal for cellular targeting.