Comparative effectiveness and safety of antibiotic prophylaxis during induction chemotherapy in children with acute leukaemia: a systematic review and meta-analysis.

BACKGROUND: Bacterial infections are common during induction therapy in children and adolescents with acute leukaemia and may cause infection-related mortality. AIM: To determine the efficacy and safety of prophylactic antibiotics in paediatric patients with acute leukaemia receiving induction chemotherapy. METHODS: From three English databases and four Chinese databases, we searched for randomized controlled trials (RCTs) and cohort studies that compared prophylactic antibiotics to placebo, no prophylaxis, or that compared one antibiotic versus another in paediatric patients with acute leukaemia undergoing induction chemotherapy. Two reviewers independently screened the studies, extracted data, and assessed the risk of bias using Cochrane Risk of Bias 2 tool and Newcastle-Ottawa Scale, and the certainty of evidence using Grading of Recommendations Assessment, Development, and Evaluation (GRADE). FINDINGS: Two RCTs and ten cohort studies were finally included. For children with acute lymphoblastic leukaemia, antibiotic prophylaxis, including levofloxacin, sulfamethoxazole-trimethoprim, or other antibiotics, probably reduced bacteraemia (risk ratio (RR): 0.44; 95% confidence interval (CI): 0.33-0.60; moderate certainty) without significantly increasing Clostridioides difficile infection (CDI) or invasive fungal infection. Levofloxacin reduced the CDI rate (RR: 0.08; 95% CI: 0.01-0.62; high certainty). Ciprofloxacin prophylaxis probably reduced infection-related mortality (RR: 0.12; 95% CI: 0.01-0.97; moderate certainty). In children with acute myeloid leukaemia, ciprofloxacin plus vancomycin may reduce febrile neutropenia (RR: 0.79; 95% CI: 0.66-0.94; low certainty). Individual studies indicated that prophylaxis increased antibiotic exposure but reduced non-preventive antibiotic exposure. CONCLUSION: In children with acute leukaemia undergoing induction therapy, antibiotic prophylaxis may improve the bacterial infection and mortality.

Predictive Value of Serum Creatinine/Cystatin C in Acute Ischemic Stroke Patients under Nutritional Intervention.

BACKGROUND AND PURPOSE: As a very common risk of adverse outcomes of the ischemic stroke patients, sarcopenia is associated with infectious complications and higher mortality. The goal of this retrospective study is to explore the predictive value of serum Cr/CysC ratio in acute ischemic stroke patients receiving nutritional intervention. METHODS: We reviewed adult patients with AIS from December 2019 to February 2020. Patients with acute kidney injury were excluded and all patients received nutritional intervention during a 3-month follow-up period. We collected baseline data at admission including creatinine and cystatin C. The primary poor outcome was major disability (modified Rankin Scale score ≥ 4) at 3 months after AIS. RESULTS: A total of 217 patients with AIS were identified for this study. Serum Cr/CysC ratio was significantly correlated with NIHSS at discharge, 1-month modified Rankin Scale score, and 3-month modified Rankin Scale score. During 3 months, 34 (15.70%) patients had a poor outcome after AIS and 11 (5.10%) patients died within 30 days. In multivariable logistic regression analyses, serum Cr/CysC ratio at admission was independently associated with 3-month poor outcomes (OR: 0.953, 95% CI: 0.921-0.986, p = .006) and 30-day mortality (OR: 0.953, 95% CI: 0.921-0.986, p = .006). CONCLUSION: As a blood biochemical indexes reflecting the muscle mass and aiding in risk stratification, Cr/CysC ratio at admission could be used as a predictor of 30-day mortality and long-term poor prognosis in AIS patients.

[Menopausal symptoms and quality of life of hormone receptor positive breast cancer patients at different endocrine therapy time].

Objective: To explore the menopausal symptoms and quality of life of hormone receptor positive (HR+ ) breast cancer patients at different endocrine therapy time. Methods: The HR+ breast cancer patients who were pathologically confirmed from 2011 to 2017 in the Sichuan Cancer Hospital were divided into three groups according to endocrine therapy time (<12 months, 12~36 months, >36 months) and analyzed by a cross-sectional study. The Menopausal symptoms and quality of life of these patients were measured using the modified Kupperman scale and the functional assessment of cancer therapy-breast cancer (FACT-B) scale. The differences of menopausal symptoms among different time groups and drug groups were analyzed by Chi-square test. The differences of quality of life and the effects of menopausal symptoms on quality of life were tested by covariance and multiple linear regression analyses. Results: The average score of menopausal symptom of 167 patients was 14.5±7.6 and the prevalence rate was 87.4% (146/167). Among all of the menopausal symptoms, the prevalence rate of insomnia was the highest (73.7%, 123/167). Besides insomnia and excitement, hot flashes was more prevalent in selective estrogen receptor modulator (SERM) users (64.8%, 79/122) , while osteoarthritis was more prevalent in aromatase inhibitor (AI) users (62.2%, 28/45). The total score of FACT-B of Patients was 104.5±15.5, and the compliance rate was up to 89.8% (150/167). However, the condition of each dimension was different, the compliance rates of social/ family and functional dimension were lowest, which were 73.0% (122/167) and 50.9% (85/167), respectively. The menopausal symptoms of patients at different time groups were 15.0±1.3, 14.0±6.9, 14.5±7.4, respectively, and the total score of FACT-B of patients at different time groups were 102.7±17.8, 105.0±12.9, 105.6±16.7, respectively, without significant differences (both P>0.05). Multiple linear regression analysis showed that menopausal symptoms impaired the quality of life of SERM users during the endocrine therapeutic period. The standardized regression coefficients of three time groups were -0.67, -0.30, -0.50, respectively, with the lowest effect on 12~36 months group. Conclusion: HR+ breast cancer patients will have a poor function recovery and social/ family return, who need more attention. Menopausal symptoms are common problems during endocrine therapy, and active measures should be taken to improve patients' quality of life.

[Pulmonary Metastase of a Knee Mycetoma in Senegal]. / Métastase pulmonaire d'un mycétome du genou au Sénégal.

Mycetoma is transmitted by thorns infected. The commonest site for mycetoma is the foot. The primary pulmonary are rare and usually secondary to other primary site. We report a case of pulmonary fungal mycetoma secondary to primary site in the knee. We do a review of the literature and we discuss the way of dissemination.

Le mycétome se transmet principalement par piqures d'épines d'arbustes infectés. Les localisations primitives au niveau du pied sont les plus fréquentes. Les localisations pulmonaires sont exceptionnelles et secondaires à des localisations périphériques primitives. Nous rapportons un cas de localisation pulmonaire d'un mycétome fongique secondaire à une localisation au niveau du genou, puis nous faisons une revue de la littérature et nous discutons de la voie de dissémination.

[Efficacy and mechanism of loading dose clopidogrel in patients with transient ischemic attack and minor stroke].

Objective: To assess outcome, safety and possible mechanism of loading dose clopidogrel in patients with transient ischemic attack (TIA) and minor stroke. Methods: We reviewed patients with confirmed TIA and minor stroke admitted between July 2016 and December 2017 into the First Affiliated Hospital of Soochow University. Loss-of-function allele carriers of CYP2C19 were included and randomly divided into loading dose group (first dose of 300 mg clopidogrel) and standard dose group (first dose of 75 mg clopidogrel), 100 mg aspirin was gave at the same time, followed by aspirin 100 mg/d plus clopidogrel 75 mg/d maintaining for 20 days. Platelet aggregation (maximum aggregation ratio, MAR) induced by Adenosine diphosphate (ADP) was examined before and 3 days after administration. The National Institutes of Health Stroke Scale (NIHSS) score method was employed to assess the NIHSS scores before and after treatment in each group of patients; the modified Rankin Scale (mRS) was used to assess the 3-month functional outcome. Results: There was no significant difference in baseline data between the two groups (P>0.05).The proportion of early neurological function improvement in the two groups was 75.0% and 54.8%, and the difference was statistically significant (χ(2)=4.498, P=0.034). The 3-month prognosis was 79.5% and 61.3%, and the difference was statistically significant (χ(2)=4.000, P=0.045). Adverse events: 1 case in the loading dose group, 1 case in the standard dose group, the difference was not statistically significant (2.3% vs 1.6%, χ(2)=0.061, P=0.806). After 3 days of antiplatelet therapy, the MAR of the loading dose group decreased (11%±8%), and the MAR of the standard dose group decreased (9%±4%), the difference was statistically significant (P=0.013).In the loading dose group, there were 32 (72.7%)CYP2C19*2 carriers and 42 (95.5%)CYP2C19*2+*3 carriers; early neurological function improvement in 33 cases, accounting for 93.8% and 76.2%, respectively, and the difference was statistically significant (χ(2)=4.122, P=0.042). There were 35 patients with good prognosis in 3 months, accounting for 96.9% and 81.0%, respectively. The difference was statistically significant (χ(2)=4.310, P=0.038); MAR of CYP2C19*2 carrier was decreased (15%±5%), and MAR of CYP2C19*2+*3 carrier was decreased (12%±8%). The difference was statistically significant (P=0.039). Conclusions: Loading dose clopidogrel can improve the clinical prognosis of minor stroke/TIA without increasing the risk of bleeding. Loading dose clopidogrel may improve the prognosis of minor stroke/TIA by decreasing MAR of CYP2C19*2 carriers.

[Recidives of Mycetoma after Amputation in Dakar (Senegal)]. / Récidives de mycétome après amputation à Dakar (Sénégal).

The treatment of fungal mycetoma is essentially surgical. This carcinological-like surgery consists of amputation in case of bone involvement. The recurrences after amputation are rare and address the problem of the operative indication. We report 5 cases of recurrence of fungal black-grain mycetoma after amputation of leg or thigh. Case 1: a 52-year-old patient with a mycetoma of the knee evolving for 8 years. There is no history of surgery. A thigh amputation with ganglion dissection is performed. One year after the surgical procedure, the patient presents a recurrence on the amputation stump and on the lymph node dissection site. An indication of hip disarticulation is made and performed 17 months after amputation. Case 2: a 25-year-old patient who has a black-grain mycetoma of the foot with osteitis evolving since 10 years. A leg amputation was performed. The patient had a recurrence at the popliteal level at 15 months postoperatively. An indication of amputation of the thigh is posed and refused by the patient. Case 3: a30-year-old woman with black-grain mycetoma of the knee with bone involvement for more than 10 years. A thigh amputation was performed and at nine months postoperativeshe presented a recurrence in the amputation stump. She was lost of sight despite the decision of surgical revision. Case 4: a 43-year-old patient operated on his foot and leg mycetoma at least 5 timesbefore amputation in 2000. The recurrence occurred one year after amputation. 18 years after amputation, a new surgical procedure was difficult due to extension of the lesions in the pelvis. Case 5: a 50-year-old female patient operated in Mauritania in 2012 (thigh amputation for mycetoma of the knee). She presented a recurrence on the amputation stump in 2018. An indication of disarticulation of the hip was posed and refused by the patient. These recurrences were testified by to the persistence of grains on the preserved segment. They pose the problem of the level of amputation and therefore of preoperative planning. Good preoperative planning allows optimization of the surgical procedure and avoids certain recurrences.

La chirurgie constitue le temps essentiel du traitement des mycétomes fongiques. Elle consiste en une amputation en cas d'atteinte osseuse. Nous avons observé 5 cas de récidives après amputation pour mycétome. Il s'agit dans tous les cas de patients présentant des mycétomes à grain noir avec atteintes osseuses. Les récidives sont survenues à moins de 18 mois de l'amputation faisant parler de reprise évolutive et posant le problème du niveau de l'amputation.

[Applying decision trees to establish risk rating model of breast cancer incidence based on non-genetic factors among Southwest China females].

Objective: To estimate incident probability and establish risk rating model of breast cancer incidence under different combinations of non-genetic factors among Southwest China females, applying the decision trees. Methods: From 2014 to 2015, a total of 783 cases, which were pathologically diagnosed as primary breast cancer, were sequentially collected from West China Hospital of Sichuan University, Sichuan Cancer Hospital and Sichuan Province People's Hospital. 3, 879(excluding 36 samples with missing data) controls were randomly selected and matched by area of residence and age. Classification and regression tree (CART) algorithm was applied to construct breast cancer risk rating model according to non-genetic factors. 5 test sets were randomly selected for model validation. Results: BI-RADS classes, menopausal status, age, history of benign breast disease, menarche age, age of first delivery and number of live births were identified as risk factors and included in the risk rating model of breast cancer incidence. Among these factors, BI-RADS classes, menopausal status and age were the most important. The risk rating model developed were vitrificated by 5 test sets, and the average sensitivity, positive predictive value, accuracy were 95.60%, 92.26%, 97.93%, respectively. Conclusions: Breast cancer risk rating model constructed by decision trees was valid and reliable. The model could be used as the basic tool of breast cancer risk assessment among Southwest China females.

[Association of plasma leptin levels and soluble leptin receptor with breast cancer].

Objective: To explore the association between plasma leptin (LEP) levels, soluble leptin receptor(SLR), free leptin index and breast cancer. Methods: 245 new female cases of primary breast cancer confirmed by histopathology examination were sequentially recruited into the study. A total of 245 age-matched healthy women were enrolled as controls during the same period. A standardized questionnaire was used to collect the demographic information of the subjects. Blood samples were collected and the levels of LEP and SLR in plasma were measured by enzyme linked immunosorbent assay. The differences of LEP, SLR and FLI expression between control and cases group, as well as different breast cancer subtypes and TNM stages were compared using t-test and ANOVA after stratification by menopause status. Multivariate logistic regression was used to explore the contributions of the three indexes to the risk of breast cancer. Results: Females in both cases and control group were (50.7 ± 9.4) years old. The level of SLR and FLI (P(50)(P(25),P(75))) in premenopausal women were 18.4 (11.2, 28.7), 0.5 (0.4, 0.6) µg/L in case group and 27.7 (19.2, 43.4), 0.3 (0.3, 0.4) µg/L in control group (P<0.001). While the level of postmenopausal women in case group were 20.3 (12.8, 31.8), 0.5 (0.4, 0.6) µ g/L (P<0.001), and 30.1 (18.8, 40.5), 0.3 (0.3, 0.5) µg/L in control group (P<0.001), respectively. After adjustment for confounding factors and BMI, the relationship between FLI and breast cancer remained significant for both pre- and postmenopausal women while the association between SLR and breast cancer was significant only in premenopausal women. Compared with the lowest level of SLR, higer levels of SLR is associated with a reduced risk of breast cancer (premenopausal women, OR=0.10, 95% CI: 0.04-0.29, P(trend)<0.001). Compared with the lowest level of FLI, FLI at higher levels is associated with an increased risk of breast cancer (premenopausal women, OR=7.14, 95% CI: 2.86-17.83, P(trend)<0.001; postmenopausal women, OR=8.10, 95% CI: 2.85-22.98, P(trend)<0.001). No significant association between LEP and breast cancer or association between the three indexes and breast cancer subtypes and TNM stages was found (P>0.05). Conclusion: SLR may be a protective factor for breast cancer while FLI may increase the risk of breast cancer.

Résultats de la technique de Mac Intosh au Fascia Lata Modifiée par Jaeger dans les instabilités antérieures chroniques du genou

Objectif: Il existe plusieurs techniques de reconstruction des ruptures anciennes du ligament croisé antérieur du genou. Le but de cette étude était d'évaluer à moyen terme les résultats de la technique de Mac Intosh au fascia lata modifiée par Jaeger. Matériel et méthodes: Dans cette étude rétrospective réalisée entre janvier 2005 et décembre 2013, 56 genoux (56 patients) ont été opérés par la technique de Jaeger à ciel ouvert pour des ruptures anciennes du ligament croisé antérieur. Elle a concerné des adultes jeunes masculins. Cinquante (89%) patients étaient sportifs. Un patient avait une arthrose débutante classée stade 2 Alhbäck modifiée. L'évaluation fonctionnelle des résultats a été faite selon le score IKS (globale, genou et fonction). L'examen clinique était basé sur la mobilité du genou, le test de Lachman-Trillat, et la recherche du ressaut. Le positionnement du tunnel tibial a été analysé à la radiographie. Le stade arthrosique a été apprécié selon les critères d'Alhbäck modifié . La ligamentisation du transplant à l'IRM a été étudiée chez quatre patients. Résultats: Au recul moyen de 7 ans, 85% des patients étaient satisfaits du résultat fonctionnel avec un score IKS genou de 96,1 en moyenne, un score IKS fonction de 100, et un score IKS global de 196,1. La mobilité était complète sans flessum résiduel. Le test de Lachman-Trillat était négatif (n= 38 ; 68%). Il était positif avec arrêt dur (n=16 ; 29%) et retardé (n=2 ; 3%). Le ressaut rotatoire a été neutralisé chez tous les patients. L'angle tibial moyen de face était de 61°. Il n'y avait pas de ballonisation des tunnels. Cinquantedeux (93%) patients étaient classés Alhbäck 1 et quatre (7%) Alhbäck 2. La ligamentisation a été constante à l'IRM. Conclusion: La ligamentoplastie du croisé antérieur au fascia lata modifiée par Jaeger donne de bons résultats fonctionnels et anatomiques avec une réduction significative de l'apparition de l'arthrose secondaire

Traitement des fractures ouvertes Gustilo IIIB du tiers distal de la jambe

Objectif: Déterminer les modalités thérapeutiques et préciser l'évolution du traitement des fractures ouvertes stade IIIB de Gustilo du tiers distal de la jambe. Patients et méthodes: Il s'agissait d'une étude rétrospective continue de patients opérés entre Janvier 2008 et Mai 2013. Treize patients totalisant 13 lésions stade IIIB de Gustilo du tiers distal de la jambe ont été concernés. La perte de substance exposant le tibia était contemporaine du traumatisme (n=7) et secondaire à une chute d'escarres (n=6). Le traitement réalisé a été étudié. L'évaluation des résultats était basée sur le délai et la qualité de la cicatrisation et de la consolidation osseuse. Résultats: Une antibiothérapie et une sérovaccination antitétanique ont été instituées pour tous les patients. Le délai moyen du traitement chirurgical était de 7heures. Le traitement consistait en un parage, une réduction de la fracture, et une ostéosynthèse par un fixateur externe. La couverture de la perte substance cutanée par un lambeau a été réalisée dans un délai moyen de 16 jours. La cicatrisation était obtenue chez tous les patients dans un délai moyen de 52 jours. La consolidation était effective chez 12 patients. Conclusion: Le traitement des fractures ouvertes IIIB de Gustilo du tiers distal de la jambe a reposé sur l'antibiothérapie, le parage, l'ostéosynthèse et la couverture cutanée par lambeau. Le fixateur externe était l'implant de choix. La cicatrisation a été obtenue chez tous les patients

Traitement des fractures complexes des plateaux tibiaux par la méthode d'Ilizarov

Objectif: Evaluer les résultats du traitement des fractures complexes des plateaux tibiaux opérés par la méthode d'Ilizarov. Matériel et méthodes: Une étude rétrospective continue de patients admis entre janvier 2010 et décembre 2014 a été réalisée. Quatorze fractures complexes des plateaux tibiaux classées type V (n=4) et type VI (n=10) selon Schatzker ont été traitées. Les critères de Duparc et Cavagna et Lysholm ont été utilisés pour évaluer respectivement les résultats anatomiques et fonctionnels au recul moyen de 34 mois. Résultats: Toutes les fractures ont consolidé dans un délai moyen de 118 jours. Tous les patients avaient un bon résultat anatomique. Le score fonctionnel était bon (n=12) et moyen (n=2). Conclusion: La méthode d'Ilizarov est une technique fiable dans le traitement des fractures complexes des plateaux tibiaux. Son faible risque infectieux justifie sa vulgarisation dans les pays à ressources limitées