2019 innovations in urology

Emilie Delchambre, Marie-Camille Guerin, François Hervé Published in the journal : February 2020 Category : Urology

Patients with lower urinary tract symptoms often report a decrease in quality of life, with a diminished self-confidence leading to social isolation and depression. Their symptoms are related to the dysfunction of the lower urinary tract, including the detrusor or urinary sphincter, and concern the storage, emptying phase, or both.

The year 2019 has been characterized by scientific findings demonstrating the central effect of botulinum toxin after its injection in the detrusor of patients suffering from overactive bladder. New therapeutic targets have also been evaluated. The past year has emphasized the relevant role of psychological comorbidities in non-obstructive voiding disorders, and our treatment armamentarium has thus been improved. Finally, several multidisciplinary guidelines concerning the workout and treatment of nocturia have been established.

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Pulmonology in the era of 4P medicine

Charles Pilette, Antoine Froidure, Audrey Hanson, Thierry Pieters Published in the journal : February 2020 Category : Pneumology

Pulmonology has entered the era of so-called "4P" medicine, which is meant to be preventive, personalized, predictive, and participatory. Combating smoking and improving air quality are essential for the prevention of most respiratory diseases. The summary of innovations we offer in the fields of asthma, lung cancer, and interstitial lung disease clearly illustrates the concepts of predictive and personalized medicine. Health care now takes into account not only observable characteristics, such as asthma with sinus polyposis or non-small cell cancer, but also the mechanisms involved in their pathophysiology, such as eosinophils in asthma or PD1 / PD-L1 expression in lung cancer. All this underlies the concept of endotype. Finally, the patient is offered the appropriate treatment based on biomarkers. We also benefit from recent advances in genetics. In addition to the search for predictive rearrangements underlying the response to certain chemotherapies, the discovery of common genetic variants associated with pulmonary fibrosis will enable us to predict its evolution, or even more, prevent its occurrence by promoting preventive measures within risk groups. Finally, the inclusion of patients in the care process optimizes adherence to treatment and control of the disease, while feeding research in our University Clinics to better understand and treat medical conditions in the near future.

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2019 innovations in otology

Anaïs Grégoire, Monique Decat, Daniele De Siati, Naïma Deggouj Published in the journal : February 2020 Category : Otologie

Cochlear implants have been used for over 40 years for deeply deaf children and adults. In Belgium, their significant cost (approximately 20,000 €) is borne by INAMI: bilaterally up to 12 years and unilaterally beyond. Since December 1, 2019, patients with severe deafness; i.e., hearing thresholds of 70dB, have also been permitted to benefit from an implant.

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Innovations in pelvic gynecological oncology

Mathieu Luyckx, Violette Warzée, Jean-François Baurain, Filomena Mazzeo, Jean-Luc Squifflet Published in the journal : February 2020 Category : Onco-Gynécologie Pelvienne

The last two years have been prolific in pelvic gynecologic oncology, particularly for ovarian cancer, considering the results of large prospective randomized studies. The first, published in the NEJM by Van Driel et al. in January 2018, revealed for the first time the benefits of hyperthermic intraperitoneal chemotherapy (HIPEC) in the initial management of advanced ovarian cancers. These benefits involved both disease-free survival and overall survival without significantly increasing the surgery’s morbi-mortality. The second, also published in the NEJM in December 2018, demonstrated the undeniable benefits of PARP inhibitors (Olaparib) in the initial management of patients with advanced ovarian cancer carrying a BRCA 1 or 2 mutation. The third study, published in February 2019 by Harter et al., showed quite surprisingly that routine lymphadenectomy during cytoreductive surgery for advanced ovarian cancer (Stage IIB-IV) did not provide any benefits in terms of disease-free survival and overall survival. Even in the lymphadenectomy group, half of the patients exhibited lymphnode involvement. Finally, in September 2019, for two other PARP inhibitors tested in the initial management of advanced ovarian cancer, their indisputable usefulness was confirmed.

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2019 innovations in Neurology

Adrian Ivanoiu, Marianne de Tourtchaninoff, Susana Ferrao-Santos, Peter Y. K. Van den Bergh, Pietro Maggi, Bernard Hanseeuw, Louise-Amélie Cougnon, Olga Seminck, Nicolas Dubuisson Published in the journal : February 2020 Category : Neurology

The year 2019 has seen a series of relevant advances in the diagnosis and management of neurological diseases. This edition offers a review of current developments, placing them in their clinical context. As the field is wide, only certain aspects will be presented in more detail, depending on their clinical significance or the involvement of our neurologist team at UCLouvain in the research in question. Thus, we will reflect on the latest guidelines in terms of diagnosis and treatment of migraine, risk of sudden death in epileptic patients, and diagnosis of inflammatory neuropathy. These diagnoses are often not established, whereas effective treatments are available. Some of our young clinical fellow researchers will share current research lines on multiple sclerosis imaging, early Alzheimer's disease diagnosis, and ultrasound as a means of diagnosing peripheral neuropathies.

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2019 innovations in Nephrology

Eric Goffin, Sophie Coche, Laura Labriola, Corine Hubinont, Valentine Gillion, Nathalie Demoulin, Anne-Catherine Pouleur, Michel Jadoul Published in the journal : February 2020 Category : Nephrology

In 2019, we welcomed several major advances made in the management of kidney disease. We have decided to highlight herein two major developments. Firstly, pregnancy can now be considered in a patient upon chronic dialysis. Secondly, two new potassium binders are on the horizon, which is great news for patients with chronic kidney disease requiring renin angiotensin system (RAS) blockade.

Pregnancy, which is in fact rare in women with end-stage kidney failure, is associated with increased feto-maternal morbidity. Recent data, along with our own experience, highlight that pregnancy can now be considered in women on maintenance hemodialysis, who are ready to perform intensive home hemodialysis, along with a strict and regular obstetrical follow-up.

Hyperkalemia is common in chronic kidney disease patients, especially in those under RAS blockade, and can be life-threatening. Since the old K-binders have limited efficacy and are poorly tolerated, RAS blockade is frequently discontinued in such patients. Nevertheless, two new K-binders are on the horizon. The first one, patiromer, has been reimbursed since 2019 for the treatment of chronic hyperkalemia. The other one, sodium cyclosilicate of zirconium (SZC), has been approved for use in Europe, though this drug is not yet reimbursed in Belgium. We briefly review these molecules’ efficacy and safety and discuss their role in maintaining RAS blockade, especially in CKD patients with proteinuria or heart failure.

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2019 innovations In hepato-gastroenterology and hepatic transplantation surgery

Géraldine Dahlqvist, Bénédicte Delire, Olivier Dewit, Laurent Coubeau, Yves Horsmans, Nicolas Lanthier, Tom Moreels Published in the journal : February 2020 Category : Hépato-gastroentérologie

Overall, 30% and 3% of the Belgian population suffer from fatty liver and its severe form, non-alcoholic steatohepatitis (NASH), respectively. To date, there is no pharmacological treatment in the NASH field. Nevertheless, encouraging results have been described with obeticholic acid in a Phase 3 study. As a consequence, obeticholic acid is considered a promising therapeutic strategy. In the area of chronic inflammatory bowel disease, tofacitinib (Xeljanz®) is reimbursed since September 2019 in case of first-line treatment failure in ulcerative colitis patients, providing new perspectives to patients affected by this disease. Poorly known 10 years ago, the hepatitis E virus has recently gained interest. In Europe and more particularly in Belgium, genotype 3 is responsible for the majority of cases. Hepatitis E virus infection should be checked for in each acute hepatitis case. The disease can be more severe in two sub-populations, namely patients suffering from chronic liver disease that can decompensate in this context and immunocompromised patients in whom the infection can become chronic. Great advances in the field of enteroscopy were also confirmed in 2019, due to the techniques enabling the biliopancreatic system to be accessed in patients with an altered anatomy of the upper digestive tract (gastric bypass,etc.) or through the use of motorized spiral enteroscopy. All of these techniques are employed at the Cliniques universitaires Saint-Luc. Finally, the last part of this review will be devoted to liver transplantation and the UCL-ALDAPT clinical study, whose objective is to assess the validity of a 2-stage total hepatectomy surgical procedure associated with a left-liver transplantation, so as to minimize risks in adult-to-adult living donor liver transplantation.

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New hemophilia treatments

Cédric Hermans Published in the journal : February 2020 Category : Hémostase

The current treatment of hemophilia relies on intravenous administration, repeated several times a week, of clotting factor VIII (FVIII) or factor IX (FIX) concentrates, either derived from plasma or produced by biotechnology. This preventive treatment is burdensome, expensive, and only allows for transient and partial corrections of the clotting factor deficiencies. Moreover, it is associated with the risk of developing neutralizing antibodies, termed inhibitors.

The FVIII and IX concentrates with a longer half-life, such as a bispecific monoclonal antibody mimicking the action of FVIII, as well as various strategies modifying the physiological regulation of coagulation, whilst being administered subcutaneously, represent new treatment options, either already validated or being evaluated. The first results of gene therapy studies also look very promising.

These developments offer patients with hemophilia new perspectives of treatment, if not cure, which this article proposes to review.

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From immunotherapy, the new therapeutic pillar, to allogeneic hematopoietic stem cell transplantation

Xavier Poiré, Nicole Straetmans, Sarah Bailly, Marie-Christiane Vekemans Published in the journal : February 2020 Category : Hematology/Oncology

In this article focused on innovations in onco-hematology are highlighted the successes of immunotherapy, as well as current challenges of allogeneic hematopoietic stem cell transplantation.

The treatment of hematological malignancies has traditionally been dominated by chemotherapy or radiotherapy. The discovery of the cytogenetic and molecular bases of these diseases has paved the way for targeted therapies; more recently, the field of immunotherapy has emerged with the development of CAR-Ts, BiTEs, immunoconjugates, and checkpoint inhibitors. These innovations have enabled us to better understand the complex interactions between a patient's immune system and potential tumor cells. However, the idea of exploiting the patient's immune system in an attempt to control his disease is not a recent concept, since allogeneic haematopoietic stem cell transplantation is based on the principle of using graft’s T lymphocytes to eliminate the recipient's tumor cells.

To date, allogeneic hematopoietic stem cell transplantation remains a mainstay of therapeutic weapons in hematology. Moreover, there is a great deal of research being done to improve outcomes. In order to reduce the risk of relapse without increasing toxicity, conditioning regimens with reduced toxicity are becoming a new standard. Graft-versus-host disease would be better prevented by administering post-transplant cyclophosphamide. Finally, numerous post-transplant relapses are the consequence of immune escape. A better understanding of their mechanisms likely opens the way to new therapeutic strategies.

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Advances made in fertility preservation in women

Camille Hossay, Marie-Madeleine Dolmans Published in the journal : February 2020 Category : Gynécologie

In 2019, major advances have been made in the field of fertility preservation in women. Our research mainly focused on improving ovarian tissue cryopreservation and transplantation, and the development of an artificial ovary.

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