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JTA-004 est un traitement intra-articulaire innovant de l'arthrose du genou composé d'acide hyaluronique, de protéines plasmatiques et de clonidine. L'objectif de cette étude est d'étudier les effets de JTA-004 sur les symptômes de patients souffrant d'arthrose du genou et de les comparer aux effets d'une solution saline et de Synvisc-one®. KOA-2 est un essai clinique de phase III prospectif, randomisé, en double aveugle et contrôlé comparant les effets après 3 mois d'une mono-injection de JTA-004, de Synvisc-One® ou d'une solution saline. Des hommes et des femmes, âgés de 40 ans ou plus, diagnostiqués avec une arthrose primaire du genou et une réponse insuffisante aux analgésiques et/ou aux anti-inflammatoires non stéroïdiens ont été inclus dans l'étude. Le critère principal d'évaluation de l'efficacité de JTA-004 était le changement du score de douleur WOMAC® VA3.1 entre l'injection et 3 mois de suivi, en comparaison avec la solution saline. Les critères secondaires étaient : la douleur (EVA), les scores WOMAC fonction et raideur, la qualité de vie (EQ-5D-5L) et l'appréciation globale du patient sur sa maladie (PGA). Au total, 674 patients ont été inclus : 335 ont été injectés avec JTA-004, 170 avec Synvisc-One® et 169 avec une solution saline. Les caractéristiques de la population étaient : un âge moyen (SD) de 62,4 (9,0) ans, une proportion de femmes de 69,7 % et un IMC moyen (SD) de 29,78 (4,77) kg/m2. La douleur moyenne sur l'échelle EVA (SD) du genou cible était de 65,5 (13,9) mm. Au total, 374 (55,5 %) des 674 patients de l'étude avaient un score radiologique de Kellgren-Lawrence de grade 3 dans le genou cible. Sur le critère principal et l'ensemble des critères secondaires, JTA-004 et Synvisc-One® n'étaient pas plus efficace que la solution saline. JTA-004 était bien toléré. L'incidence, le type et la sévérité des effets secondaires étaient identiques dans les trois groupes. L'analyse post-hoc a démontré que JTA-004 (p = 0,031) et Synvisc-One® (p = 0,0096) réduisaient significativement plus le WOMAC douleur que la solution saline chez les patients avec le WOMAC douleur le plus élevé à l'inclusion (Q3). Par contre, JTA-004 n'était pas plus efficace que Synvisc-One®. JTA-004, mais pas Synvisc-One® ou la solution saline, diminuait significativement plus les sous-scores WOMAC® fonction et raideur chez les patients avec le taux de protéine c-réactive (CRP) le plus élevé à l'inclusion (Q3) par rapport à ceux avec un taux plus faible (Q1). JTA-004 et Synvisc-One® ne sont pas plus efficaces qu'une solution saline pour soulager les patients souffrant d'arthrose fémoro-tibiale. Cependant, chez les patients avec la CRP la plus élevée, JTA-004 est significativement plus efficace sur le statut algo-fonctionnel que chez les patients avec la CRP la plus basse. Bien que ces résultats doivent être confirmés, ils suggèrent que JTA-004 pourrait être utile pour soulager les patients exprimant un phénotype inflammatoire. [ABSTRACT FROM AUTHOR]

Objective: To study the feasibility of ultrasound-guided intervertebral disc (IVD) injection of contrast medium and methylene blue to aid in intraoperative identification of cervical IVD spaces in dogs., Methods: This was a single-center experimental cadaver study using randomly chosen skeletally mature dog cadavers from January 2, 2023, to March 23, 2023. For each cadaver, 1 cervical IVD was randomly selected. The ventral cervical region was ultrasonographically examined, pushing the trachea leftwards. A 50/50 contrast medium (iohexol, 300 mgI/mL) and methylene blue mixture was injected under ultrasound guidance in the IVD and ventral soft tissues. The x-rays and CT scans were performed before and after injection. Each cadaver was dissected using a ventral slot procedure. The cadavers and IVD characteristics, the success rate in ultrasonographically identifying the correct IVD space, time to injection, most caudal IVD space feasibly injectable, and semiquantitative imaging and surgical scores were recorded., Results: 20 canine cadavers were used. The IVD injections were successfully performed in the correct IVD space in all cadavers. The median time to injection was 3.95 minutes (Q1 to Q3, 3.22 to 5.88 minutes). The contrast medium was clearly visible on at least 1 radiographic projection in all but 1 case and on the CT in all cases. During surgical dissection, the dye was clearly visible in all but 1 case. The dogs' weight was significantly different between most caudal IVD spaces feasibly injectable., Conclusions: Ultrasonographical cervical IVD space identification and mixture injection are feasible and might help intraoperative cervical IVD space identification in dogs., Clinical Relevance: This technique could be used presurgically in patients with cervical IVD diseases.

Despite the growing evidence supporting the existence of CNS involvement in acute and chronic graft-versus-host disease (CNS-GvHD), the characteristics and course of the disease are still largely unknown. In this multicenter retrospective study, we analyzed the clinical, biological, radiological, and histopathological characteristics, as well as the clinical course of 66 patients diagnosed with possible CNS-GvHD (pCNS-GvHD), selected by predetermined diagnostic criteria. Results were then contrasted depending on whether pCNS-GvHD occurred before or after day 100 following allogeneic hematopoietic stem cell transplantation. Median time between hematopoietic stem cell transplantation and pCNS-GvHD onset was 149 days (IQ25-75 48-321), and pCNS-GvHD onset occurred before day 100 following transplantation in 44% of patients. The most frequent findings at presentation were cognitive impairment (41%), paresis (21%), altered consciousness (20%), sensory impairment (18%), and headache (15%). Clinical presentation did not significantly differ between patients with pCNS-GvHD occurring before or after day 100 following transplantation. Brain MRI found abnormalities compatible with the clinical picture in 57% of patients, while CT detected abnormalities in only 7%. Seven patients had documented spinal cord MRI abnormalities, all of them with pCNS-GvHD occurring after day 100 following transplantation. In the cerebrospinal fluid, white blood cell count was increased in 56% of the population (median 18 cells/μL). Histopathological analyses were performed on 12 specimens and were suggestive of pCNS-GvHD in 10. All compatible specimens showed parenchymal and perivascular infiltration by CD3+ and CD163+ cells. Immunosuppressive therapy was prescribed in 97% of patients, achieving complete clinical response in 27%, partial improvement in 47% and stable disease in 6%. Response to immunosuppressive therapy did not significantly differ between patients with pCNS-GvHD occurring before or after day 100 following transplantation. Clinical relapse was observed in 31% of patients who initially responded to treatment. One-year overall survival following pCNS-GvHD onset was 41%. Onset before day 100 following hematopoietic stem cell transplantation (HR [95%CI]: 2.1 [1.0-4.5]; P=0.041) and altered consciousness at initial presentation (HR [95%CI]: 3.0 [1.3-6.7]; P=0.0077) were associated with a reduced one-year overall survival probability. Among surviving patients, 61% had neurological sequelae. This study supports that immune-mediated CNS manifestations may occur following allo-HSCT. These can be associated with both acute and chronic GvHD and carry a grim prognosis. The clinical presentation as well as the radiological and biological findings appear variable., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Guarantors of Brain.)

Background: Mucociliary clearance (MCC) impairment can be due to mucus abnormalities or to a ciliary dysfunction, which can be innate, or secondary to infection and/or inflammation. In cystic fibrosis (CF), it is well documented that MCC is impaired due to mucus abnormalities, but little is known concerning ciliary beating. This study aimed to confirm that ciliary dyskinesia is present in CF, and if this might be innate or secondary to the chronic infection and/or inflammation., Methods: Ciliated epithelial samples were obtained by nasal brushing from 51 CF patients, and from 30 healthy subjects. Ciliary beating was evaluated using digital high-speed videomicroscopy at 37 °C, allowing to evaluate ciliary beat frequency (CBF) and the percentage of abnormal beat pattern (CBP); this was repeated after air-liquid interface (ALI) cell culture., Results: Ciliary dyskinesia was higher in CF patients than in healthy subjects, with a lower CBF and a higher percentage of abnormal CBP. Ciliary dyskinesia, already present in childhood, normalized after ALI cell culture. A chronic airway colonization did not worsen ciliary dyskinesia., Conclusions: We showed that, in CF, a ciliary dyskinesia, present from childhood, might contribute to the impaired MCC. Our results also found that the abnormal ciliary beating was not associated with a chronic infection, and resolved after ALI cell culture, suggesting that ciliary dyskinesia in CF is not innate, and might be secondary to chronic inflammation., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Anne-Lise Poirrier reports a relationship with GSK that includes: consulting or advisory and speaking and lecture fees. Anne-Lise Poirrier reports a relationship with Sanofi that includes: consulting or advisory and speaking and lecture fees. Renaud Louis reports a relationship with GSK that includes: consulting or advisory, funding grants, and speaking and lecture fees. Renaud Louis reports a relationship with AstraZeneca that includes: consulting or advisory, funding grants, and speaking and lecture fees. Renaud Louis reports a relationship with Chiesi that includes: funding grants and speaking and lecture fees. Florence Schleich reports a relationship with GSK that includes: consulting or advisory, funding grants. Florence Schleich reports a relationship with AstraZeneca that includes: consulting or advisory, funding grants. Florence Schleich reports a relationship with ALK that includes: consulting or advisory. Florence Schleich reports a relationship with Novartis that includes: consulting or advisory. Celine Kempeneers reports a relationship with Sanofi that includes: consulting or advisory., (Copyright © 2024. Published by Elsevier B.V.)

Multicomponent mind-body interventions are increasingly studied in oncology to improve patients' quality of life (QOL). However, the respective usefulness of each of their components or their long-term use by the participants are rarely assessed. In this study, 95 women with different cancer diagnoses participated in a self-hypnosis and self-care group. Different questionnaires were administrated before (T1), right after (T2), 3 to 4 months after (T3), and 1 year after (T4) the intervention. After the intervention, 97.5% of the participants regularly practiced any kind of relaxation ( vs . 50% at baseline), especially hypnosis. The different components of the intervention (i.e., being in a group, hypnosis exercises during the sessions and at home, self-care tasks, and discussions during the group sessions) were all considered to be very useful (M = 6.91-7.75/10). One year after the intervention, the 10 most used techniques were mainly concrete activities to take care of oneself. This intervention seems very relevant for women who had cancer. Our results allow a first reflection about the mechanisms of action of our intervention. Registration: ClinicalTrials.gov (NCT03144154). Registered on the 1 st of May 2017.

Background: Aging is frequently associated with impairments of the musculoskeletal system and many elderly people experience joint discomfort or pain which might reduce their ability to move and consequently alter their quality of life. A beneficial effect of fish cartilage hydrolysate (FCH) on pain and joint function has recently been shown in an ACLT/pMMx osteoarthritis rat model., Methods: We therefore performed an exploratory, non-comparative, multi-centric clinical trial including 33 subjects with moderate knee joint discomfort and loss of functionality to investigate the efficacy of FCH on their algo-functional status. We further determined the potential health benefit of FCH in an original clinical ex vivo study investigating the role of FCH human metabolites on primary human chondrocytes., Results: FCH significantly improved knee pain and function, as assessed by the Knee injury and Osteoarthritis Outcome Score (KOOS). Moreover, FCH significantly reduced pain at rest and while walking, and patient global assessment (PGA), as assessed by the Visual Analogue Scale (VAS), and improved patients' quality of life (SF-36). FCH metabolites decreased the synthesis of catabolic factors (MMP-13) and pro-inflammatory mediators (NO, PGE2) and limited the inhibitory effect of IL-1β on the synthesis of cartilage matrix components (GAG and collagen)., Conclusions: Thus, these data provide insights on the mode of action of FCH in humans and contribute to explain how FCH may relieve pain and improve joint function in subjects with knee discomfort. Although these preliminary data need to be confirmed in a randomized controlled trial, they strongly support the potential health benefit of such an active ingredient., Trial Registration: The study was registered on clinicaltrials.gov with the identifier NCT04420091 (09/06/2020)., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Primary ciliary dyskinesia is a heterogeneous, inherited motile ciliopathy in which respiratory cilia beat abnormally, and some ultrastructural ciliary defects and specific genetic mutations have been associated with particular ciliary beating alterations. Ciliary beating can be evaluated using digital high-speed videomicroscopy (DHSV). However, normal reference values, essential to assess ciliary beating in patients referred for a PCD diagnostic, vary between centres, as minor variations in protocols might influence ciliary beating. Consequently, establishment of normal values is essential for each PCD diagnostic centre. We aimed to evaluate whether delay after sampling, and temperature for conservation of respiratory ciliated samples, might modify assessments of ciliary beating. In total, 37 healthy nasal brushing samples of respiratory ciliated epithelia were collected. Video sequences were recorded at 37 °C immediately using DHSV. Then, the samples were divided and conserved at 4 °C or at room temperature (RT). Ciliated beating edges were then recorded at 37 °C, at 3 h and at 9 h post sampling. In six samples, recordings were continued up to 72 h after sampling. Ciliary beating was assessed manually by ciliary beat frequency (CBF M ) and ciliary beat pattern (CBP). A semi-automatic software was used for quantitative analysis. Both CBF and CBP evaluated manually and by a semi-automated method were stable 9 h after sampling. CBF M was higher when evaluated using samples stored at RT than at 4 °C. CBP and the semi-automated evaluation of ciliary beating were not affected by storage temperature. When establishing normal references values, ciliary beating can be evaluated at 37 °C up to 9 h after nasal brushing, but the storage temperature modifies ciliary beating and needs to be controlled.

Objectives: The effect and safety of Nasafytol ® , a food supplement combining curcumin, quercetin, and Vitamin D, on hospitalized COVID-19-positive patients as support to standard of care were to be assessed., Methods: This exploratory, open-label, randomized, controlled trial was carried out among hospitalized adults with COVID-19 infection. Participants were randomly assigned to receive Nasafytol ® or Fultium ® control. The improvement of the clinical condition and occurrence of (serious) adverse events were evaluated. The study was registered on clincaltrials.gov with the identifier NCT04844658., Results: Twenty-five patients received Nasafytol ® , and 24 received Fultium ® . Demographic characteristics were well balanced between the groups. On day 14 (or at hospital leave if < 14 days), no difference was observed between groups regarding their clinical condition, fever, or the need of oxygen therapy. At day 7, however, 19 participants had been discharged from the hospital in the Nasafytol ® arm compared to 10 participants in the Fultium ® arm. No participants were transferred to the ICU or died in the Nasafytol ® arm, vs. 4 transfers and 1 death in the Fultium ® arm. The clinical condition of participants in the Nasafytol ® arm had improved, as evidenced by a decrease in the COVID-19 WHO score. Interestingly, five SAEs occurred with Fultium ® , while no SAE was observed with Nasafytol ® ., Conclusion: Supplementation with Nasafytol ® , in addition to standard-of-care treatment, led to a faster discharge from the hospital, improved clinical conditions of participants, and a reduced risk of serious outcomes, including transfer to the intensive care unit or death, in patients hospitalized with COVID-19., Competing Interests: YH is the founder and president of Artialis SA, a spin-off company of the University of Liège. YH has also received consulting and speaker fees from Tilman SA, Nestlé, Laboratoire Expanscience, Heel, Megalab, Genequine, LABHRA, and Biose. MU, BC, JH, and SP are employees of Artialis SA. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Gérain, Uebelhoer, Costes, Herman, Pietri, Donneau, Monseur and Henrotin.)

While many studies have documented the intentions for the COVID-19 vaccine booster, few have explored the change from intention to final decision. This study explores the COVID-19 booster intentions and the change from intention to decision in a primo-vaccinated university population, with a distinction between staff members and students. It looks at the sociodemographic and medical characteristics, health literacy, personal COVID-19 infection and vaccination history, and attitudes/intentions regarding the booster, among the 1030 participants (64.4% staff members, 61.3% female, median age 36.0 years). Of the 8.7% who were initially hesitant, 72.7% ultimately got a booster and 27.3% did not. Another 84.2% intended to get a booster and 7.1% did not. Among the latter two groups, 88.9% maintained their intention and 11.1% changed their minds. The determinants associated with the intentions were health literacy and previous intentions regarding the COVID-19 primo-vaccination. The determinants associated with the change to non-vaccination were a previous COVID-19 infection, a past COVID-19 primo-vaccination intention, and a neutralizing antibody level. The results point to an opening for the support in decision-making, with a significant percentage of the study population potentially changing their mind between intention and final decision; this process should start early and be tailored to the individual's COVID-19 history. A personalized approach seems necessary in order to ensure that individuals make an informed choice., Competing Interests: The authors declare no conflict of interest.

Objectives: Due to the persistent primary care physicians shortage and the substantial increase in their workload, the organization of primary care calls during out-of-hours periods has become an everyday challenge. The SALOMON algorithm is an original nurse telephone triage tool allowing to dispatch patients to the best level of care according to their conditions. This study evaluated its reliability and criterion validity in rea-life settings., Methods: In this 5-year study, out-of-hours primary care calls were dispatched into four categories: Emergency Medical Services Intervention (EMSI), Emergency Department referred Consultation (EDRC), Primary Care Physician Home visit (PCPH), and Primary Care Physician Delayed visit (PCPD). We included data of patients' triage category, resources, and destination. Patients included into the primary care cohort were classified undertriaged if they had to be redirected to an emergency department (ED). Patients from the ED cohort were considered overtriaged if they did not require at least three diagnostic resources, one emergency-specific treatment or any hospitalization. In the ED cohort, only patients from the University Hospitals were considered., Results: 10,207 calls were triaged using the SALOMON tool: 19.2% were classified as EMSI, 15.8% as EDRC, 62.8% as PCPH, and 2.2% as PCPD. The triage was appropriate for 85.5% of the calls with a 14.5% overtriage rate. In the PCPD/PCPH cohort, 96.9% of the calls were accurately triaged and 3.1% were undertriaged. SALOMON sensitivity and specificity reached 76.6% and 98.3%, respectively., Conclusion: SALOMON algorithm is a valid triage tool that has the potential to improve the organization of out-of-hours primary care work.

Objectives: The aim of this study was to assess the predictive value of the Vandenberg and Kuse Mental Rotation Test (MRT) on performance of novice medical students for manipulation of a nasal endoscope on a cadaveric model., Material and Method: We randomly selected 39 medical students who had never handled a nasal endoscope and subjected them to the MRT. General information including experience in manual, technical, or surgical activities and testing of anatomical knowledge were collected to exclude possible confounding factors. They were then asked to perform series of cadaveric model exercises using a nasal endoscope. Their cadaver performance was evaluated by 2 blinded observers, using a standardized scale., Results: We found that medical students with higher mental rotation skills had significantly increased endoscopic sinus performance ( P = .0002 using multivariate regression adjusted for specialty choice, previous surgical exposure, and anatomy knowledge). Higher anatomy knowledge was also associated with better endoscopic sinus performance ( P = .0141). Other parameters had no impact on endoscopic sinus performance measured by the endoscopic scale ( P > .05)., Conclusion: The score obtained on the MRT was correlated with the practical performance of manipulating the nasal endoscope in cadaver. It could therefore be a useful spatial ability tool for directing targeted training in rhinology.

Background: In chronic pain, it seems that the effect of cognitive-behavioral therapy (CBT) is boosted when it is combined with hypnosis. The aim of this study was to assess the efficacy of self-hypnosis combined with self-care (i.e., a type of CBT) compared to music/self-care, self-care and psychoeducation/CBT and to evaluate their long-term effects., Methods: An open label randomized clinical trial enrolled patients with chronic pain and was carried out at the University Hospital of Liège (Belgium). Patients were randomized into four groups: self-hypnosis/self-care, music/self-care, self-care, psychoeducation/CBT (7 monthly sessions of 2 hours). Two follow-up sessions were delivered at 6- and 12-month. Levels of pain, fatigue intensity, anxiety, depression, insomnia severity, disability, health locus of control, mental and physical quality of life and attitudes (control, disability, harm, emotion, medical cure, medication, solicitude) towards pain were assessed before and after the treatments, and at follow-up., Results: 203 patients were randomized: 52 in self-hypnosis/self-care, 59 in music/self-care, 47 in self-care, and 45 in psychoeducation/CBT. No group effect was found. A significant time effect was showed. Directly after the treatment, all groups decreased in pain attitudes and physical quality of life. Perceived control increased. At 6-month, all patients kept their levels of physical quality of life and perceived control, and showed decrease in pain intensity, harm, emotion and medical cure. At 12-month, scores that had change previously remained ameliorated, a decrease in insomnia severity and an increase in internal locus of control were observed., Conclusions: The present findings are encouraging as they display long-term beneficial effects of complementary biopsychosocial-based treatments in chronic pain. It seems that patients continued to apply the learnt strategies as improvements were observed one year after the treatments had ended., Competing Interests: The authors have declared that no competing interests exist.

Unlabelled: This study compares ultrasonographic prediction of prostatic volume and surgical exerese. A total of 200 prostates have been measured by the same echographist, operated upon by the same surgeon, and stratified for histology, surgical technique and weight. Adopting the general formula: Surgical volume = D1 x D2 x D3/x the surgical volume is calculated by a simplified and complete definition for a denominator giving the most accurate prediction., Conclusions: a. the glands of more than 60 cc could be calculated by the classical formula of ellipsoid pi x D1 x D2 x D3/6, simplified to D1 x D2 x D3/2, with a 21% standard deviation error from the surgical volume; b. medium-sized prostates (20-60 cc) could be calculated by the formula: D1 x D2 x D3/3 with a 21% standard deviation; c. prostates smaller than 20 cc, a series which included all reoperations for remnants or recurrence, could be calculated with the same proposed formula with a 22% standard deviation, while the classical ellipsoid formula led to a 56% standard deviation error. No mathematical formula based only on three prostatic diameters is reliable to assess true parenchymal weight.

In 10 cases of obstetric and surgical necrosis of the urethra and in one of congenital aplasia, the canal was reconstructed using as an intermediate layer the roots of the clitoris, freed and applied. In the ten cases in which treatment has been completed, continence was restored in 8, either with one operation only (3 cases), or with the addition of various procedures for suspension of the bladder neck using autografts (5 cases).

This technique has been applied to 224 female patients over 9 years with a mean follow-up to the last control of 2 years 3 months. The sub-urethral fold of the fascia, the inferior and infero-lateral aspects of the urethra are dissected, the length and the width of the tube are restored by direct resuture, the sub-urethral fascia is doubled by overlapping. No suspension nor foreign tissue. Genito-urinary ptosis is treated by the same time. Application to stress incontinence, diverticulae, abscesses, periurethritis and a few cases of non malignant pathology. In stress incontinence, selected by suprapubic expression test, full success in 76.3%, primary failure in 5.4% and imperfect result with no permanent or necessary padding in 18.2%. In these imperfect results and failures as well as in periurethral pathology the importance of relapsing inferior of the low tract suggests that sexual infections be more investigated and that mechanical causes of infection, such as reflux be more operated on. On the 224 cases, 1 fistula and 1 urethral avulsion, in particular conditions which do not affect the general principle. No fistula in 12 cases of urethral diverticulae and abscesses. The suprapubic expression test in simple and valuable in selecting before and testing after operation the static mechanical incontinence.

Ingested asbestos is mainly excreted in the urine. Marked impregnation of bladder neck in a patient working in an asbestos factory was diagnosed initially as a tuberculosis lesion on the granulomatous histologic appearance. Asbestos fibers were counted by electron microscopy. This appears to be the first case of this type reported and possible causal relations and histopathologic findings are discussed. Also reported is a patient with prostatic cancer, and chronic pulmonary asbestosis, treated by adenomectomy using an upper approach 15 years previously. The cancer was of the prostate transitional cell type. A causal relation could not be proved but other such cases should be investigated, to determine a possible link between the lesion and industrial fibers.