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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2019 innovations in geriatry

François-Xavier Sibille, Catherine Pétein, Perrine Evrard, Ariane Mouzon, Stefanie Thevelin, Marie de Saint-Hubert, Anne Spinewine Published in the journal : February 2020 Category : Geriatry

Deprescription is the process of stopping, reducing, or switching an inappropriate medication to another deemed more appropriate, which is supervised by a healthcare professional (either a physician, pharmacist, or nurse) in order to improve health and reduce costs. It has gradually become a major topic in the (appropriate) prescription domain, especially in the elderly and end-of-life patients.

While its global security and benefits are commonly accepted, routine implementation and optimization still needs to be further investigated in many research paths. We will first review the viewpoints of actors involved in the deprescribing process, namely patients and relatives, as well as health care professionals. Evidences concerning a specific medication class, benzodiazepine receptor agonists, will be reviewed. Finally, the article will outlinehow deprescription can be implemented in nursing home residents and end-of-life patients.

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Endoscopic ultrasound-guided radiofrequency ablation, insulinoma

Raluca Maria Furnica, Ivan Borbath, Bernard Vandeleene, Dominique Maiter, Pierre Deprez Published in the journal : February 2020 Category : Endocrinologie et Nutrition

Endoscopic utrasound-guided ablation: an interesting alternative in the treatment of benign localized insulinomas Endoscopic ultrasound-guided radiofrequency (RF) is an innovative technique that may represent an interesting and less invasive alternative for the radical treatment of patients with a benign insulinoma. Since June 2018, we have been able to treat at the Cliniques universitaires Saint-Luc four patients with a localized benign insulinoma using a Starmed RF electrode (Taewong). The effectiveness of the treatment was evident immediately after the procedure in all patients. Among all pancreatic neuroendocrine tumors, insulinomas are probably the best indication for endoscopic ultrasound-guided RF ablation due to their small size and low malignant potential, as well as the technique’s relative safety.

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2019 innovations in orthopaedic surgery and traumatology

Xavier Libouton, Nathalie Pireau, Simon Vandergugten, Vincent Cunin, Jean-Emile Dubuc, Philippe Mahaudens, Nadia Irda, Maïte Van Cauter, Ludovic Kaminski, Karim Tribak, Dan Putineanu, David Mathieu, Daniel Morcillo, Loic Thoreau, Alin Sirbu, Vincent D Published in the journal : February 2020 Category : Chirurgie orthopédique et traumatologie

The year 2019 has provided us three major themes: the contribution of 3D imaging in the planning of shoulder replacements, joint reconstruction of the elbow by mirrored osteoarticular graft, and finally scoliosis surgery by modulation of growth, without vertebral fusion. Shoulder disease is one of the most common conditions involving the musculoskeletal system, affecting about half of the patients with musculoskeletal complaints. Gleno-humeral osteoarthritis, whatever its etiology, may justify prosthetic replacement. However, the fate of these implants does not attain the survival rates of prosthetic hip and knee implants. The severity of bone loss, particularly within the scapula, and the difficulty of precisely orientating implants both account for a large part of common and too early failures. Planning surgery using planning software from 3D reconstruction scans can anticipate these problems and enable us to establish an appropriate surgical strategy.

The fate of elbow replacements remains limited over time, especially in the young and active subject. Using osteochondral reconstruction allows us to postpone arthroplasty for several years. The need for perfect joint congruence is currently made possible via mirror planning from the healthy joint and selection of the most appropriate allograft based on scanner imaging. Surgery is made possible by the surgeon's provision of cutting guides for the injured joint and allograft, ensuring accurate correction, in accordance with preoperative planning.

Scoliosis mainly affects a young population, tending to worsen with growth. Until now, surgery has been aimed at restoring the spine’s sagittal balance by fusion of the bony segments to prevent further deformation. This strategy has implemented constraints on the spine segments left free of instrumentation and bone fusion with potentially secondary discoradicular pathologies at these levels. The concept of using residual spine growth to correct deformation has recently been introduced. Rather than permanently fusing the column, the material is positioned to slow the growth on the curvature’s convex side and let the concave side continue to grow and correct the deformation. This is growth modulation. In this configuration, the column is no longer blocked and retains its flexibility.

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