2021 innovations in pulmonology

 Charles Pilette, Thierry Pieters, Antoine Froidure Published in the journal : February 2022 Category : Pneumology

In pulmonology, the year 2021 was marked by significant progress towards personalized medicine, particularly in the fields of asthma, interstitial diseases, and bronchopulmonary cancer. In asthma, the advent of anti-IgE and anti-IL-5 (and soon anti-IL-4R) biologics rendered it possible to wean a substantial number of patients off oral corticosteroids, with additional beneficial effects on exacerbations or lung function (1). It has therefore become essential to refer patients with severe asthma, especially those being corticosteroid-dependent, to a specialized center (2), where the management can either confirm or infirm the indication for a biologic agent, meaning after excluding difficult asthma causes, and then implement, as necessary, a progressive weaning protocol of oral corticosteroids (3). The department has been participating to a large European study that is designed to better define the criteria for (non)response to these biological treatments (4). In interstitial diseases, a personalization of the diagnostic and therapeutic approach is currently underway by integrating all the clinical, radiological, and biological patient characteristics. A good example to mention was the identification of mutations in the telomerase complex genes, with relevant therapeutic implications in terms of responses to anti-fibrotic treatments (5) and adaptation of immunosuppressive treatments in the event of lung transplantation (6). The department was and still is involved in conducting phenotyping studies of interstitial diseases complicating inflammatory rheumatism, in collaboration with the rheumatology department, along with fundamental explorations in mucosal immunology (7). In lung cancer, clinical studies conducted in 2021 were aimed at refining the positioning of anti-PD1/PD-L1 immunotherapy in non-small-cell bronchial cancer, with our department participating in some of them in its cancer center. Finally, the department remained involved in the management of COVID patients, and as a reference center for immuno-allergological reactions and contraindications to vaccines, as well (8).

Read more

2021 innovations in orthopedic surgery and traumatology

 Maïte Van Cauter, Pierre Pirlot, Pierre-Philippe Guilmot, Loïc Thoreau, Maxime Bonnelance, Gautier Beckers, Hervé Poilvache, Daniel Morcillo, Vincent Druez, Jean-Emile Dubuc, Nadia Irda, Ludovic Kaminski, Simon Vandergugten, Alin Sirbu, Karim Tribak, Dan Published in the journal : February 2022 Category : Chirurgie orthopédique et traumatologie

The year 2021 enabled us to shed light on the impact of minimally-invasive techniques in hip arthroplasty surgery, continued progress in knee arthroplasty, place of unconventional strategies in the control of implant infections, and interest of a new surgical positioning for performing shoulder arthroscopy techniques.

The optimization of surgical techniques in hip arthroplasty renders it now possible to identify those patients for whom a postoperative blood control proves necessary but also, therefore, for optimizing the patients before the intervention in order to reduce the risk of postoperative anemia and transfusion requirement. The benefit of knee replacement surgery has so far not matched that of hip replacement. Nevertheless, the development of resurfacing strategies respecting the individual anatomy of the patient, supported by modern technology and particularly robotization and using custom-made implants, augurs well for significant progress. Infection is a serious complication of arthroplasty surgery. To the classic strategies were added new therapeutic approaches, such as two-stage surgery in one stage and a better definition of the place of long-term suppressive antibiotic therapy.

Finally, an optimal position for patients benefitting from shoulder arthroscopy is that in the supine position, avoiding the disadvantages of semi-sitting and lateral decubitus positions, with the first associated with increased anesthetic risks and the second with surgical difficulties in the event of conversion to an open approach, with a risk of injury to the brachial plexus.

Read more

2021 innovations in geriatric oncology

 Frank Cornélis, Pascale Cornette Published in the journal : February 2022 Category : Oncogériatrie

Geriatric assessment (GA) in elderly patients suffering from cancer was instrumental to a better understanding of patient health requirements. In 2021, two randomized clinical trials were published showing that the implementation of GA-guided interventions can be associated with decreased chemotherapy toxicity without compromising survival.

Read more

Novelties and innovations in neurosurgery: What conclusions can be drawn from the year 2021?

 Vincent Joris, Tévi Morel Lawson, Christian Raftopoulos Published in the journal : February 2022 Category : Neurochirurgie

The year 2021 saw a series of advances in neurosurgery.

Surgery for epilepsy that is refractory to medical treatment continues to be perfected with improved invasive assessments, as well as a refinement in surgical approaches aimed to limit neurological damage, while reducing the relevance of comitial seizures as much as possible.

Since the new classification based on molecular biology, brain tumor surgery has benefited from a better understanding of the natural evolution of these tumors.

Read more

2021 innovations in nephrology

 Valentine Gillion, Johann Morelle, Michel Jadoul, Nathalie Demoulin Published in the journal : February 2022 Category : Nephrology

In 2021, Kidney Disease: Improving Global Outcomes (KDIGO) published the updated guidelines concerning the management of glomerular diseases. Herein, we have briefly discussed several key points in regard to the management of the three most common glomerular diseases in adults. Next, we have reviewed the clinical benefits, considering both renal and cardiovascular perspectives, which were observed in Type 2 diabetics with chronic kidney disease (CKD), randomized to either finerenone or placebo. Based on these encouraging data, we can assume that this molecule will soon belong to the armamentarium deemed able to delay CKD progression in Type 2 diabetics. Lastly, we have discussed the results of a recent trial showing that chlorthalidone, a thiazide diuretic, proves to be still effective in Stage 4 CKD and this, in contrast to the prevalent dogma.

Read more

2021 Innovation in hematology

 Marie-Christiane Vekemans, Violaine Havelange, Eric Van Den Neste, Sarah Bailly, Catherine Lambert,Nicole Straetmans, Xavier Poiré, Stefan N. Constantinescu, Cédric Hermans Published in the journal : February 2022 Category : Hematology/Oncology

The year 2021 was rich in innovations in regard to both malignant and benign hematological diseases, with the most relevant of which discussed below.

- In recent years, the prognosis of multiple myeloma has been greatly improved, yet the disease remains as yet incurable. Current strategies aim to achieve optimal disease control at diagnosis using four-drug regimens designed to delay relapse, while in relapsed patients, innovative alternatives like immunotherapy are being employed to effectively re-arm the immune system, and this represents a real hope for patients suffering from this chronic disease.

- The management of chronic myeloid leukemia is still evolving. Since 2001, tyrosine kinase inhibitors have revolutionized its prognosis, but they are also responsible for toxicities. One of the current therapeutic goals is to achieve a sufficiently deep and prolonged response, thereby enabling tyrosine kinase inhibitors to be discontinued and remission maintained.

- Myelofibrosis is a myeloproliferative neoplasm with poor prognosis. The only curative treatment available to date is peripheral stem cell allograft, which can be applied at least for some patients. New therapeutic agents are currently being investigated, which are highly promising not only on account of their efficacy on symptoms and splenomegaly, but also for their potential anti-fibrotic and reducing effect on the mutated clone. Certain agents are in clinical assays in combination with JAK2 inhibitors.

- Several recent studies have suggested that CAR-Ts were likely to emerge as the second-line treatment of choice for patients suffering from aggressive lymphomas, while secondarily reducing the number of autologous stem cell transplants.

- Patients with acute myeloid leukemia and TP53-mutated myelodysplastic syndromes still represent a challenging population to treat with low and only short-lived response rates. The advent of APR-246, which restores TP53 activity, is likely to increase the number of responders among these very high-risk patients.

- Beyond its well-known involvement in heparin thrombocytopenia, platelet factor 4 (PF4) plays a major role in the very rarely observed thrombosis with thrombocytopenia occurring in association with COVID-19 adenoviral vector vaccines. Inhibition of FXI is expected to emerge as a promising anticoagulation strategy with reduced bleeding risk, while induction of antithrombin deficiency by interfering RNA is likely to prevent bleeding in hemophilia A and B patients, either with and without inhibitors.

- Concerning the management of immune thrombocytopenic purpura, targeted therapies are currently being favored owing to their lower toxicity and individualized platelet count targets.

Read more

Hepatology, endoscopy, and proctology: several outstanding events in 2021

 Nicolas Lanthier, Bénédicte Delire, Géraldine Dahlqvist, Marie Armelle Denis, Tom Moreels Published in the journal : February 2022 Category : Hépato-Gastro-Entérologie

The year 2021 saw several developments and advances in hepato-gastroenterology, particularly in regard to the general practitioner. In 2021, several simple non-invasive methods were made available and validated by the European scientific society for the study of the liver in order to assess liver fibrosis in at-risk individuals, including patients with metabolic syndrome or excessive alcohol consumption. Moreover, the criteria for reimbursement of certain medications against hepatitis B virus were reviewed. Indeed, these criteria no longer require a systematic liver biopsy while targeting even more patients at risk. Concerning the metabolic dysfunction-associated fatty liver disease, scientific studies with different types of diets were demonstrated to induce disease regression, with their potential advantages and disadvantages described. As a result, these diets can now be proposed by general practitioners. A lesser-known field of endoscopy has also been presented using motorized spiral enteroscopy, which is currently being employed at the Cliniques universitaires Saint-Luc. This technique is likely to improve both exploration and management of small bowel disease. Lastly, for practitioners often confronted with hemorrhoidal disease, recommendations for its management were drawn up and published by a group of Belgian proctologists.

Read more

What was new in 2021?

 Laurence de Montjoye, Axel De Greef, Alexia Degraeuwe, Evelyne Harkemanne, Romane Thirion, Laura Nobile, Pierre-Dominique Ghislain, Marie Baeck Published in the journal : February 2022 Category : Dermatology

Several innovations in dermatology in 2021 should be mentioned, particularly in the field of inflammatory and immunological diseases, such as atopic dermatitis, chronic urticaria, alopecia areata or Behçet's disease, but also in oncodermatology.

For the past few years, advances have been made in atopic dermatitis leading to a better understanding of the pathogenesis, identification of comorbidities, and emergence of new biological treatments.

In the course of the year 2021, international guidelines for chronic urticaria clarified the classification and therapeutic management of this disease.

Treatment of patients with alopecia areata became more promising through the advent of Janus kinases inhibitors, leading to encouraging results.

Apremilast became a new treatment option being reimbursed for oral ulcers in Behçet's disease.

In onco-dermatology, several new developments in both diagnosis and management were made:

- Reflectance confocal microscopy is a non-invasive optical imaging technique that was made available for managing patients with suspected malignant skin lesions;

- Chlormethine, a local chemotherapy gel, was shown to be effective and is thus being reimbursed for treating cutaneous T-cell lymphoma mycosis fungoides type in adult patients;

- Simulated daylight-mediated photodynamic therapy is a new technique, which was made available for the therapeutic arsenal designed to manage transplant patients with actinic keratoses.

Read more

Medical treatment of chronic heart failure

 Agnès Pasquet, Anne Catherine Pouleur Published in the journal : February 2022 Category : Cardiology

During the year 2021, the European Society of Cardiology published new recommendations for the management of patients with chronic heart failure (1). Classically, patients with heart failure have previously been categorized according to the left ventricular ejection fraction (LVEF). Three different groups are currently recognized:

- Patients with reduced LVEF defined as LVEF ≤40%, which is referred to as heart failure with reduced Ejection Fraction).

- Patients with LVEF between 41% and 49%, i.e,. slightly reduced, which is referred to as heart failure with mildly reduced ejection fraction or HFrEF.

- Patients with signs or symptoms of heart failure with structural or functional cardiac abnormalities or elevated natriuretic peptides and an LVEF >50%, which is referred to as heart failure with preserved ejection fraction or HFpEF.

This article has reviewed the principles of pharmacological treatment pertaining to these three groups.

Read more

A rebuilt and revitalized team

 Véronique Deneys, Bénédicte Brichard*, Alice Brochier, Julien Cabo, Katherine Carkeek*, Virginie Chapelle, Corentin Deckers, Anabelle Decottignies*, Jean-Philippe Defour*, Antoine Froidure*, Thibaut Gervais, Claudine Guerrieri, Salwa Hamdash, Sarah Peerae Published in the journal : February 2022 Category : Biologie Hématologique

In 2021, a new wind of creativity and dynamism blew through the department owing to the arrival of two new medical staff members. In the special hematology laboratory, the diagnostic protocols in morphology and flow cytometry were reviewed, with the recommendations for the research and interpretation of schistocytes updated accordingly. The search for short telomere syndromes based on the Flow-Fish technique has taken off, with increasingly numerous clinical indications, including pulmonary fibrosis, bone marrow aplasia, and several others. The research outcomes are critical for both optimally managing patients and genetic counseling of families.

High-throughput sequencing (NGS) has been revolutionizing routine medical practice in hemato-oncology for several years now. This targeted sequencing has enabled the search for markers with diagnostic, prognostic, or therapeutic value, thereby opening the way to a more personalized medicine. The hematology molecular biology laboratory has kept on developing this technology. As a result, NGS can now be carried out there for all the hematological-oncological pathologies provided for in the RIZIV-INAMI agreement. Efforts are also being focused on further developing the RNA sequencing technique recommended since 1/1/2022 for two onco-hematological pathologies.

The HLA system plays a central role in human immunity, whereas it also constitutes a major obstacle to organ transplantation. The involvement of anti-HLA antibodies in early and late rejection is currently indisputable. Given this context, the leuko-platelet immunology laboratory implemented a new test for identifying clinically more relevant anti-HLA antibodies in order to facilitate graft allocation.

COVID-19 has not spared the hematological biology department, playing spoilsport at the Blood Bank. Indeed, not only were the transfusion needs of certain Sars-CoV-2-infected patients rather substantial, but the erythrocyte immunology laboratory was confronted with detecting virus-induced anti-erythrocyte autoantibodies, thereby interfering with routine tests while rendering the search for compatible blood at times even more complex.

One of the Transfusion Committee’s objectives in 2021 was to further develop "Patient Blood Management" (PBM) within the various departments at Cliniques universitaires Saint-Luc. The neonatology department was chosen to be the pilot department, with the intention to work on the second PBM pillar, meaning to minimize blood loss by reducing blood sampling in infants. A decision-making flowchart was established and presented to the pediatric medical and nursing teams prior to being implemented.

These different initiatives have been made possible only through the work of the different departmental teams, at all times seeking to fully respect the patient while offering them optimal care.

Read more