Sarcopenia Trials in Specific Diseases: Report by the International Conference on Frailty and Sarcopenia Research Task Force.

Muscle atrophy occurs as a consequence of a number of conditions, including cancer, chronic obstructive pulmonary disease (COPD), diabetes mellitus, heart failure, and other chronic diseases, where it is generally a predictor of poor survival. It also occurs as a consequence of disuse and an age-related loss of muscle mass and strength (sarcopenia). The aims of the 2016, International Conference on Frailty and Sarcopenia Research (ICFSR) Task Force were to examine how these specific chronic conditions have been employed in treatment trials thus far and how future trials using these patient groups might be designed for efficient identification of effective sarcopenia interventions. Functional limitations assessed as gait speed, distance walked over a set time period, or other attributes of physical performance have been suggested as outcome measures in sarcopenia trials. Indeed, such measures have already been used successfully in a number of trials aimed at preventing disability in older adults.

[CONTRIBUTION OF CARDIAC CATHETERIZATION TO THE DIAGNOSIS AND TREATMENT OF CORONARY HEART DISEASE BEFORE AGE 40]. / APPORT DU CATHÉTÉRISME CARDIAQUE DANS LE DIAGNOSTIC ET LE TRAITEMENT DE LA MALADIE CORONARIENNE AVANT 40 ANS.

Coronary artery disease is the most frequent heart disease in our population. Its pathogenesis is well known and the first manifestation of the disease can occur in young adults. The main cause is atherosclerosis. The prevention and treatment of cardiovascular risk factors are key elements. The clinician's diagnosis is crucial before coronary arteriography, since the rate of percutaneous procedures decreases with the gravity of the starting diagnosis.

Registries and Cohorts to Accelerate Early Phase Alzheimer's Trials. A Report from the E.U./U.S. Clinical Trials in Alzheimer's Disease Task Force.

The EU/US/CTAD Task Force, an international collaboration of AD investigators from industry and academia, met in Barcelona, Spain, on November 4th, 2015, to explore existing and planned patient registries and other clinical trial infrastructure meant to expedite recruitment of large numbers of participants into clinical trials and improve their productivity. The Task Force identified a number of approaches currently being tested around the world, including the use of predictive algorithms to identify individuals likely to have prodromal or preclinical AD, the establishment of clinical trial networks to streamline trials, and reforming the informed consent process to make it less burdensome to both investigators and trial participants. Multi-national systems such as the European Prevention of Alzheimer's Dementia (EPAD) and the Global Alzheimer's Platform (GAP) offer value for sponsors, trial sites, and patients by optimizing efforts to find effective disease-modifying and symptomatic treatments.

[CT coronary angiography for the diagnosis of coronary heart disease]. / Contribution du scanner coronaire au diagnostic de maladie coronarienne.

Coronary computed tomography is an emerging technique for the diagnosis of coronary heart disease. Based on a clinical case, we discuss the diagnostic evaluation of chest pain and the role of coronary CT.

High prevalence of abdominal aortic aneurysm in patients with three-vessel coronary artery disease.

OBJECTIVES: Currently, the prevalence of abdominal aortic aneurysm (AAA) in patients with coronary artery disease (CAD) and the correlation between CAD severity and AAA prevalence are not clearly known. We conducted a prospective study to determine the prevalence of AAA in patients undergoing coronary angiography and to determine the risk factors and a coronary profile associated with AAA. METHODS: Over an 18-month period, abdominal aortic ultrasound was performed on 1,000 patients undergoing coronary angiography for suspected or known CAD, or prior to valve surgery. Clinical characteristics and coronary profile were collected from the patients. RESULTS: The overall number of previously repaired, already diagnosed, and new cases of AAA in the study population was 42, yielding a prevalence of 4.2%. Among the patients with newly detected AAAs, only two had an AAA diameter of >54 mm and were therefore treated surgically. In men aged ≥ 65 years, the prevalence reached 8.6%, while in men with three-vessel CAD it was 14.4%. Multivariate analysis showed that age ≥ 65 years (p = .003), male gender (p = .003), family history of AAA (p = .01), current smoking (p = .002), and three-vessel CAD (p < .001) were significantly associated with a higher prevalence of AAA. CONCLUSION: The prevalence of AAA was high in men aged ≥ 65 years and in those with three-vessel CAD regardless of age. While our findings do not prove the cost-effectiveness of screening for AAA in these high risk patients, they do support the usefulness of a quick ultrasound examination of the abdominal aorta during routine transthoracic echocardiography in such patients.

Is Alzheimer's Disease Drug Development Broken? What Must Be Improved.

During the decade from 2002 to 2012, 99.6% of the 244 agents tested for efficacy in slowing the progression of Alzheimer's' disease (AD) failed to achieve their primary endpoints. At a CTAD symposium on November 14, 2013, in San Diego, USA, an international group of AD researchers met to discuss the evolution of trials over the past 10 years and proposed a number of changes intended to streamline and enhance the efficiency of clinical trials. Approximately 1,031 AD trials were conducted between 2000 and 2012. The number of patients per trial site tended to decrease over time necessitating a larger number of sites. The use of biomarkers for enrichment purposes, or as measures of target engagement or surrogate outcomes, results in higher screen failure and drop-out rates, adding to trial duration and/or costs. Present disease modifying AD trials ask for increasing logistical and technical requirements, necessitating the creation of highly specialized trial facilities and limiting the participation of smaller sites. Due to heavy administrative and regulatory task, only about 13% of the team's time is used for the essential recruitment. Proposals and perspectives: Strategies suggested to improve the efficiency of recruitment include establishing "ready to go cohorts" in advance of trials using biomarkers and clinical measures. Simplification and harmonization of administrative procedures, including harmonization of certification procedures, are urgently needed. Alternative approaches, such as using the Internet to screen volunteers for possible inclusion needs to be evaluated. The AD drug development enterprise from discovery through clinical trials requires re-examination and re-organization if new drugs are to be delivered to patients in a timely way.

Identification of protein biomarkers associated with cardiac ischemia by a proteomic approach.

Angina is chest pain induced by ischemia of the heart muscle, generally due to obstruction or spasm of the coronary arteries. People that suffer from average to severe cases of angina have an increased percentage of death before the age of 55, usually around 60%. Therefore, prevention of major complications, optimizing diagnosis, prognosis and therapeutics are of primary importance. The main objective of this study was to uncover biomarkers by comparing serum protein profiles of patients suffering from stable or unstable angina and controls. We identified by non-targeted proteomic approach and confirmed by the means of independent techniques, the differential expression of several proteins indicating significantly increased vascular inflammation response, disturbance in the lipid metabolism and in atherogenic plaques stability.

Neutron diffraction study of the non-Fermi liquid compound CeNiGa2: magnetic behaviour as a function of pressure and temperature.

The magnetic symmetry and structure of the non-Fermi liquid heavy fermion compound CeNiGa2 has been determined by neutron powder diffraction. The orthorhombic CeNiGa2 compound orders antiferromagnetically below 4.4(2) K at ambient pressure with a magnetic moment magnitude of µCe = 0.80(4) µB for moments aligned along the c-axis. The magnetic (Shubnikov) space group is C2cm'm'm. The nature of the magnetic order of CeNiGa2 is further elucidated by neutron diffraction at elevated pressures up to 4.5 kbar, allowing for the confirmation of a critical pressure PC of about 4.2(2) kbar above which the magnetic moment ordering is suppressed.

[Multimodal cardiovascular imaging before aortic valve transcatheter replacement]. / L'imagerie cardiovasculaire multimodalités avant l'implantation d'une prothèse valvulaire aortique par voie percutanée.

Calcified aortic valve stenosis is the most frequent valvular heart disease in developed countries with a very poor outcome when symptoms develop. However, several of these patients are denied for surgery. The main reasons are their advanced age (elderly patient), co-morbidities, technical limitations and a very high surgical risk. It is currently possible to propose a Transcatheter Aortic Valve Implantation (TAVI). After selection of candidates, the feasibility of the intervention is analysed. The size of the aortic bioprosthesis must be selected according to the cardiac anatomy. Several cardiac imaging modalities (echocardiography, computed tomography and cardiac MRI) can be used to identify unsuitable situations. Heavy calcifications or tortuosity can thwart the retrograde approach use. The sub-clavian arteries (for the CoreValve) and trans-apical approach (for the Edwards-Sapien) constitute alternatives ways.

[Wellens syndrome: a poorly known yet significant electrocardiographic entity]. / Une entité electrocardiographique peu connue, mais pourtant importante aux urgences ... le syndrome de Wellens.

We report the case of a 54-year-old patient admitted to an emergency department, because of a thoracic pain suspicious for angina pectoris. Although the patient had become asymptomatic on admission, his electrocardiogram presented abnormalities (biphasic T waves in V1 to V4 ) which prompted a diagnosis of unstable angina.This electrocardiophic pattern is known as Wellens' syndrome.

[Interventional options in modern treatment of hypertrophic obstructive cardiomyopathy]. / Options interventionnelles en matière de traitement moderne de la cardiomyopathie hypertrophique obstructive.

Obstructive hypertrophic cardiomyopathy is a complex pathology. The understanding of its physiopathology and, notably, of the SAM phenomenon (Systolic Anterior Motion), is crucial for all available treatments. Amongst the most efficient therapies, one can cite the septal myectomy and its most recent technical updates, as well as the alcohol septal ablation. The choice between these two methods depends on the general state of the patient, the thickness of the interventricular septum and the coronary anatomy of the patients.

[Adherence to antiplatelet therapy in patients with coronary artery disease]. / Adhésion thérapeutique aux antiagrégants chez le patient coronarien.

Clinical benefit of antiplatelet therapy is established for cardiovascular disease and percutaneous coronary intervention (PCI). Dual antiplatelet therapy is used to optimize platelet inhibition. However, cardiovascular events still occur. Aspirin/clopidogrel resistance and poor compliance are the main factors implied in recurrent events. Compliance to dual antiplatelet therapy is particularly relevant during the first 6 months following acute coronary syndromes and PCI. Furthermore, several studies have shown association between antiplatelet resistance and poor compliance. Additionally, late (1 month to 1 year) and very late (> 1 year) stent thromboses are intimately linked to interruption of antiplatelet treatment. In this article we review the latest data about compliance, resistance and recommendations regarding antiplatelet therapy.

[Implementation of reperfusion therapy in ST segment elevation myocardial infarction (STEMI). A policy statement from the Belgian Society of Cardiology and its working group of acute cardiology and interventional cardiology]. / Mise en pratique du traitement de reperfusion dans les infarctus du myocarde avec élévation du segment ST (STEMI). Recommandations actualisées de la Société Belge de Cardiologie et de ses groupes de travail: le Groupe Interdisciplinaire de Cardiologie Aiguë (BIWAC) et le Groupe de Cardiologie Interventionnelle (BWGIC).

Myocardial infarction remains a major healthcare problem. Reperfusion therapy has been shown to influence favourably short- and long-term patient survival. The authors reviewed the data of early recognition of STEMI (ST Elevation Myocardial Infarction), the reperfusion modalities including a flowchart management, as proposed by the Belgian working groups (BIWAC and BWGIC), and the lessons learned from European and American registries. Primary PCI often remains the treatment of choice. A national policy is still required to implement the guidelines and improve clinical practice for our STEMI patients.

[Implementation of reperfusion therapy in ST segment elevation myocardial infarction (STEMI). A policy statement from the Belgian Society of Cardiology and its working group of acute cardiology and interventional cardiology]. / Mise en pratique du traitement de reperfusion dans les infarctus du myocarde avec élévation du segment ST.

Myocardial infarction remains a major healthcare problem. Reperfusion therapy has been shown to influence favourably short- and long-term patient survival. The authors reviewed the data of early recognition of STEMI (ST Elevation Myocardial Infarction), the reperfusion modalities including a flowchart management, as proposed by the Belgian working groups (BIWAC and BWGIC), and the lessons learned from European and American registries. Primary PCI often remains the treatment of choice. A national policy is still required to implement the guidelines and improve clinical practice for our STEMI patients.

[Prevention of restenosis and of cardiac events after coronary angioplasty in diabetics]. / Prévention de la resténose et des accidents cardiaques après angioplastie coronaire chez le diabétique.

Various systemic pharmacological approaches have been evaluated to reduce the risk of restenosis and clinical complications after coronary angioplasty, with or without stent, a main objective in the high risk diabetic population. The aim of the present paper is to describe the effects of the main pharmacological classes on the risk of restenosis, the need for new revascularisation procedures and the incidence of major clinical events (MACE: death, myocardial infarction, revascularisation). We will analyse successively the role of antiplatelet agents, omega 3 fatty acids, statins, anti-inflammatory compounds, immunomodulators, anti-oxidants and inhibitors of the renin-angiotensin system. Whenever possible, we will focus our attention on the results obtained in the diabetic population.

[Elevation of cardiac biomarkers after strenuous physical exertion]. / Elévation des biomarqueurs cardiaques après un effort physique intense.

We present the case of a patient who felt faint after a strenuous exercise. A coronary angiography was performed because of an elevated level of troponin, but it failed to demonstrat any significant coronary stenosis. We discuss the effect of strenuous exercise on cardiac biomarkers. Most previous published studies involved young trained populations. The frequency of these abnormalities in older, less trained people is unknown. Moreover, the possible impact of these abnormalities on mid- or long-term outcome is a matter of debate. Seniors practising intensive sport activities should systematically be submitted to a cardiological evaluation.

[Monoclonal antibodies in cardiology]. / Anticorps monoclonaux en cardiologie.

Clinical efficacy of antiplatelet agents administration to reduce ischemic complications has supported the concept of atherothrombosis and plaque rupture. Specifically, administration of monoclonal antibody against platelet membrane receptor glycoprotein IIb/IIa was shown to be highly effective whenever percutaneous intervention is performed in the setting of unstable coronary syndrome. The in-hospital use of glycoprotein IIb/IIIa is unanimously recommended in these situations.

[Incidence of restenosis and cardiac events after coronary angioplasty in diabetic patients: reduction by systemic pharmacological approaches]. / Risque de resténose et d'evénements cardiaques après angioplastie coronaire chez le patient diabétique: réduction par des approches pharmacologiques systémiques.

Various systemic pharmacological approaches have been evaluated to reduce the risk of restenosis after coronary angioplasty, with or without stent, in the general population and in diabetic patients who are at increased risk for such complication. The aim of the present paper is to describe the effects of the main pharmacological classes on the risk of restenosis, the need for new revascularisation procedures and the incidence of major clinical events (MACE: death, myocardial infarction, revascularisation). We will analyse the role of antiplatelet agents, omega-3 fatty acids, statins, anti-inflammatory compounds, immunomodulators, anti-oxidants, glitazones and, finally, classical antidiabetic drugs such as metformin and insulin. Whenever possible, we will focus our attention on the results obtained in the diabetic population.