[French version of The Ottawa Statement on the Ethical Design and Conduct of Cluster Randomized Trials, in a French law context]. / Version française des recommandations de la déclaration d'Ottawa sur la conception et la conduite éthique d'essais randomisés en clusters, dans le contexte législatif français.

INTRODUCTION: There is growing evidence on the ethical challenges raised by cluster randomized trials. This specificity is not reflected in the legal texts regulating research, which creates difficulties for researchers implementing these experimental designs. The Ottawa Statement (Weijer et al. 2012) aims to provide detailed guidance on the ethical design, conduct and assessment of cluster trials. More broadly aims to help research stakeholders and decision-makers to make informed ethical decisions regarding the particularity of these experimental designs. It seems that this international statement, written in English, is not sufficiently accessible to all of the French professionals involved in health research. The aim of this article is to provide these professionals with a contextualized and illustrated French translation of the "Ottawa statement". METHOD: . The "complex design" working group of the RECaP network (Research in Clinical Epidemiology and Public Health), carried out this work. A first version was discussed by the authors in several meetings. It was completed by contextual explanations and examples of French studies currently conducted by the authors. The final version was obtained by consensus and validated by the group. RESULTS: . This work reports 15 recommendations grouped into 7 key questions: How to justify cluster design? How to submit an article to an ethics committee? How to identify research participants? How and when to obtain informed consent? Who are the gatekeepers? How to assess benefits and harm? How to protect vulnerable participants? Each of these recommendations is specific to cluster trials. The recommendations are explained and detailed through concrete examples. CONCLUSION: Without interfering with current French laws, this work provides a framework for the organization, conduct and ethical assessment of cluster randomized trials in France. In the present-day context, it is essential that all concerned groups can base their decisions on recommendations in line with the elementary principles of health research ethics.

Patient navigation for colorectal cancer screening in deprived areas: the COLONAV cluster randomized controlled trial.

BACKGROUND: The objective of this study was to assess the effectiveness of a Patient Navigation Intervention targeting deprived patients for Colo-Rectal Cancer (CRC) screening participation. METHODS: A cluster randomized controlled trial was conducted in 5 districts. Peer Lay Patient Navigators were recruited to operate in deprived areas. Eligible participants had to be between 50 and 74 years old, live in these deprived areas and receive an invitation to the nationally organized Colo-Rectal Cancer (CRC) screening during the study period. The theory-driven navigation intervention was deployed for 18 months. A population Health Intervention Research assessment method was used to assess effectiveness and context interaction. The primary criterion was screening participation at 12 months. RESULTS: Twenty-four thousand two hundred eighty-one individuals were included inside 40 clusters. The increase in participation in the intervention group was estimated at 23%, (ORa = 1.23, CI95% [1.07-1.41], p = 0.003). For the subgroup of individuals who participated, the time delay to participating was reduced by 26% (ORa = 0.74, CI95% [0.57-0.96], p = 0.021). Main factors modulating the effect of the intervention were: closeness of navigator profiles to the targeted population, navigators' abilities to adapt their modus operandi, and facilitating attachment structure. CONCLUSION: The ColoNav Intervention succeeded in demonstrating its effectiveness, for CRC screening. Patient Navigation should be disseminate with broader health promotion goals in order to achieve equity in health care. TRIAL REGISTRATION: clinicaltrials.gov NCT02369757 24/02/2015.

Validation of a French version of the Sunnybrook facial grading system.

BACKGROUND: The aim of this study was to translate the Sunnybrook Facial Grading System and its specific criteria into French and validate its use by French-speaking physicians for facial palsy evaluation. MATERIAL AND METHODS: The original English version of the Sunnybrook Facial Grading System and its specific criteria was translated into French according to international standards. Twenty videos of patients with a wide range of facial palsy in terms of duration and severity were independently rated, twice each, by 6 physicians with varied experience in facial palsy care. Internal consistency and intra- and inter-rater reliability were analyzed. RESULTS: The French version of Sunnybrook Facial Grading System and its specific criteria both showed good internal consistency, with Cronbach alpha of 0.84 and 0.86 respectively. Inter-rater reliability was excellent in both sessions for the composite score, the score of symmetry at rest and during voluntary movement and synkinesis: intraclass correlation coefficient (ICC) between 0.77 and 0.98. Intra-rater reproducibility on the composite score and subscores was also excellent and comparable for expert, experienced and novice physicians, with an average ICC of 0.95. CONCLUSION: The French version of the Sunnybrook Facial Grading System and its specific criteria is reliable, reproducible and easy to use by French-speaking teams for facial palsy evaluation.

Musical Ear Syndrome: Prevalence and characteristics in cochlear implant bearers.

INTRODUCTION: Musical Ear Syndrome (MES) is an uncommon phenomenon described as the perception of auditory musical sensations not corresponding to any external stimulus. It seems to be more frequent in case of profound hearing loss. Our objective was to evaluate prevalence, characteristics and risk factors in a population of cochlear implant patients. METHODS: A retrospective study was conducted in cochlear implant patients, who were adult (>18 years) in 2020 and underwent cochlear implantation between 1993 and 2019. We analyzed the presence and characteristics of MES. RESULTS: 118 of the 358 patients (33%) perceived or had perceived auditory musical sensations: 71 (19.8%) before, 100 (28%) after, and 53 (14.8%) both before and after implantation. The musical auditory sensations were usually short and well-tolerated, resembling instrumental music, and occurring several times a day. Thirteen patients (11%) considered them intolerable. Fatigue was a triggering factor in 40 patients (33.9%). Personal and medical characteristics, type of implantation, make of implant, etiology and tinnitus did not emerge as risk factors. On the other hand, MES+ patients were significatively younger (56±17.4 years versus 61.9±17.9 years; P=0.0009). Despite the phenomenon, patients were satisfied with implant functioning and subjective auditory performance was not affected. CONCLUSION: Prevalence of Musical Ear Syndrome was high in cochlear implant patients, and especially in younger subjects. It is essential to improve knowledge of this phenomenon.

The influence of acute exercise on bone biomarkers: protocol for a systematic review with meta-analysis.

BACKGROUND: Bone is a plastic tissue that is responsive to its physical environment. As a result, exercise interventions represent a potential means to influence the bone. However, little is currently known about how various exercise and participant characteristics interact to influence bone metabolism. Acute, controlled, interventions provide an in vivo model through which the acute bone response to exercise can be investigated, typically by monitoring circulating bone biomarkers. Currently, substantial heterogeneity in factors such as study design, quality, exercise, and participant characteristics render it difficult to synthesize and evaluate the available evidence. Using a systematic review and meta-analytic approach, the aim of this investigation is to quantify the effect of an acute exercise bout on circulating bone biomarkers as well as examine the potential factors that may moderate this response, e.g., variation in participant, exercise, and sampling characteristics. METHODS: This protocol was designed in accordance with the PRISMA-P guidelines. Seven databases (MEDLINE, Embase, Sport Discus, Cochrane CENTRAL, PEDro, LILACS, and Ibec) will be systematically searched and supplemented by a secondary screening of the reference lists of all included articles. The PICOS (Population, Intervention, Comparator, Outcomes and Study Design) approach was used to guide the determination of the eligibility criteria. Participants of any age, sex, training, or health status will be considered for inclusion. We will select studies that have measured the bone biomarker response before and after an acute exercise session. All biomarkers considered to represent the bone metabolism will be considered for inclusion, and sensitivity analyses will be conducted using reference biomarkers for the measurement of bone resorption and formation (namely ß-CTX-1 and P1NP). Multi-level, meta-regression models within a Bayesian framework will be used to explore the main effect of acute exercise on bone biomarkers as well as potential moderating factors. The risk of bias for each individual study will be evaluated using a modified version of the Downs and Black checklist while certainty in resultant outcomes will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. DISCUSSION: A better understanding of the bone metabolic response to an acute bout of exercise has the potential to advance our understanding of the mechanisms through which this stimulus impacts bone metabolism, including factors that may moderate this response. Additionally, we will identify current gaps in the evidence base and provide recommendations to inform future research. SYSTEMATIC REVIEW REGISTRATION: This protocol was prospectively registered in the Open Science Framework Registry ( https://osf.io/6f8dz ).

Increased intracellular survival of Salmonella Typhimurium ST313 in HIV-1-infected primary human macrophages is not associated with Salmonella hijacking the HIV compartment.

BACKGROUND: Non-typhoidal Salmonella (NTS) causes a severe invasive syndrome (iNTS disease) described in HIV-positive adults. The impact of HIV-1 on Salmonella pathogenesis and the molecular basis for the differences between these bacteria and classical diarrhoeal S. Typhimurium remains unclear. RESULTS: Here, we show that iNTS-associated S. Typhimurium Sequence Type 313 (ST313) bacteria show greater intracellular survival in primary human macrophages, compared with a 'classical' diarrhoeal S. Typhimurium ST19 isolate. The increased intracellular survival phenotype of ST313 is more pronounced in HIV-infected macrophages. We explored the possibility that the bacteria take advantage of the HIV-associated viral-containing compartments created in human macrophages that have low pH. Confocal fluorescence microscopy and focussed ion beam-scanning electron microscopy tomography showed that Salmonella did not co-localise extensively with HIV-positive compartments. CONCLUSION: The capacity of ST313 bacteria to survive better than ST19 bacteria within primary human macrophages is enhanced in cells pre-infected with HIV-1. Our results indicate that the ST313 bacteria do not directly benefit from the niche created by the virus in HIV-1-infected macrophages, and that they might take advantage from a more globally modified host cell. SIGNIFICANCE: A better understanding of the interplay between HIV-1 and Salmonella is important not only for these bacteria but also for other opportunistic pathogens.

Patients' association programs for adolescents and young adults: The JAP study.

INTRODUCTION: A dozen innovative care clinics have recently opened in France to support the transition of adolescents with chronic conditions between pediatric and adult healthcare units through various interventions. Some patients' associations have set up specific programs for adolescents and young adults (AYAs) in order to facilitate the transition process, but they are not well-known among healthcare professionals. Our aim was to describe these programs and to evaluate the quality of their implementation and transferability into transition clinics. MATERIEL AND METHODS: We conducted semistructured interviews with representatives of associations that proposed interventions dedicated to AYAs with chronic conditions. We collected quantitative and qualitative data to describe these interventions. Descriptive statistics were run on quantitative data and a thematic analysis of the qualitative data was made. RESULTS: A questionnaire was sent to 55 associations, 19 (36%) of them had established programs and were contacted; interviews were conducted with 16 of them. Thirteen were national associations, 11 focused on a specific chronic disease, three supported multiple chronic conditions, and two were available to any AYA with chronic disease. Programs were mainly camps (n=5; from 2days to 3weeks) and workshops (n=5). Educational considerations and hobbies were more frequently discussed when peers were directly involved in the program. Stakeholders were mainly other patients and peers (9/16). Fourteen out of 16 were perceived as successful (perceived improvement in AYA quality of life and/or positive feedback). Twelve out of 16 associations thought that their program could be transferable to transition clinics and all were interested in collaboration. DISCUSSION: This work highlights five key points to be considered in the clinical care setting before building programs: unique tailoring and customization, complementarity with existing programs in patients' associations, viability based on peer involvement and evaluation, a common main goal, and using transition clinics' assets to direct AYAs towards the most suitable program.

Cochlear implantation in far-advanced otosclerosis: hearing results and complications.

Severe forms of otosclerosis known as far-advanced otosclerosis (FAO) can lead to severe to profound sensorineural hearing loss and can justify cochlear implantation. Because of the pathophysiology of otosclerosis, patients implanted for FAO may experience an increased rate of complications, such as facial nerve stimulation or electrode dislocation, and may have poorer hearing outcomes than expected. This retrospective study aimed to compare cochlear implantation hearing outcomes, surgical difficulties and complications in FAO patients versus non-FAO patients. Moreover, we evaluated whether high resolution computed tomography (CT scan) findings were predictive of perioperative problems, complications and hearing outcomes. FAO patients were diagnosed based on medical history, examination and CT scan. Thirty-five ears from FAO patients were compared to 38 control ears. Audiometric results were assessed at least 12 months after implantation by pure tone average, speech reception threshold, monosyllabic and disyllabic word recognition score (WRS) and Central Institute for the Deaf (CID) sentences test. Complications and surgical difficulties were compiled. CT scan findings were categorised within 3 grades of otosclerotic extension. No significant difference was found between FAO and non-FAO hearing outcomes, except that monosyllabic WRS were lower for FAO patients, especially those who underwent previous stapedotomy. Facial nerve symptomatology occurred in 8.6% of FAO patients; among these, one required explantation-reimplantation surgery. 86% of FAO implanted patients had retrofenestral extension on CT. These were associated with poorer disyllabic WRS (51% vs 68%, p < 0.05) than those with only fenestral involvement. Although not significant, high grade of severity on CT tended to be associated with surgical difficulties and complications. Cochlear implantation in FAO patients is an effective treatment technique. Though the overall complication rate is low, it tends to be higher in cases of severe extension on CT. Patient counselling should be adjusted accordingly.

Autologous bilayered self-assembled skin substitutes (SASSs) as permanent grafts: a case series of 14 severely burned patients indicating clinical effectiveness.

Split-thickness skin autografts (AGs) are the standard surgical treatment for severe burn injuries. However, the treatment of patients with substantial skin loss is limited by the availability of donor sites for skin harvesting. As an alternative to skin autografts, our research group developed autologous self-assembled skin substitutes (SASSs), allowing the replacement of both dermis and epidermis in a single surgical procedure. The aim of the study was to assess the clinical outcome of the SASSs as a permanent coverage for full-thickness burn wounds. Patients were recruited through the Health Canada's Special Access Program. SASSs were grafted on debrided full-thickness wounds according to similar protocols used for AGs. The graft-take and the persistence of the SASS epithelium over time were evaluated. 14 patients received surgical care with SASSs. The mean percentage of the SASS graft-take was 98 % (standard deviation = 5) at 5 to 7 d after surgery. SASS integrity persisted over time (average follow-up time: 3.2 years), without noticeable deficiency in epidermal regeneration. Assessment of scar quality (skin elasticity, erythema, thickness) was performed on a subset of patients. Non-homogeneous pigmentation was noticed in several patients. These results indicated that the SASS allowed the successful coverage of full-thickness burns given its high graft-take, aesthetic outcome equivalent to autografting and the promotion of long-term tissue regeneration. When skin donor sites are in short supply, SASSs could be a valuable alternative to treat patients with full-thickness burns covering more than 50 % of their total body surface area.

The Development and Initial Validation of the Child Perceived Discrimination Questionnaire.

Perceived discrimination can affect psychological and physical health, starting in childhood. Yet, the measures that exist for measuring perceived discrimination among children have methodological limitations and structural/theoretical inconsistencies. The Child Perceived Discrimination Questionnaire (CPDQ) fills the gaps of the current measures by assessing two dimensions of everyday discrimination from both child and adult sources. To assess the reliability and validity of the CPDQ, we examined data from 163 participants, aged 9-11, 52.15% female, 57.67% Black. Results indicated that the CPDQ has good to excellent internal consistency and provided preliminary support for an a priori hypothesized factor structure. The CPDQ also discriminated between different race groups and demonstrated construct validity. Future research should seek additional evidence of reliability and validity for the CPDQ, though this preliminary evidence suggests that the CPDQ is appropriate for assessing perceived discrimination in children.

Are dietary reports in a case-control study on thyroid cancer biased by risk perception of Chernobyl fallout?

BACKGROUND: In retrospective case-control studies performed following nuclear tests or nuclear accidents, individual thyroid radiation dose reconstructions are based on fallout and meteorological data from the residential area, demographic characteristics, and lifestyle as well as dietary information. Collecting the latter is a controversial step, as dietary declarations may be affected by the subjects' beliefs about their risk behavior. This report analyses the potential for such bias in a case-control study performed in eastern France. METHODS: The study included 765 cases of differentiated thyroid carcinoma matched with 831 controls. Risk perceptions and beliefs of cases and controls were compared using Chi2 tests and differences in dietary reports were analyzed using a two-way ANOVA. RESULTS: In general, atmospheric pollution and living near a nuclear power plant were the two major risks that may influence thyroid cancer occurrence cited by cases and controls. When focusing in particular on the consequences of the Chernobyl accident, cases were more likely to think that the consequences were responsible for thyroid cancer occurrence than controls. Vegetable consumption during the two months after the Chernobyl accident was correlated with the status of subjects, but not to their beliefs. Conversely, consumption of fresh dairy products was not correlated with the status or beliefs of subjects. CONCLUSION: We found no evidence of systematic bias in dietary reports according to the status or beliefs held by subjects about the link between thyroid cancer occurrence and Chernobyl fallout. As such, these dietary reports may be used in further studies involving individual dosimetric reconstructions.

[Well-being in adulthood of patients with chronic conditions in childhood: The GEDEPAC-2 questionnaire]. / Bien-être à l'âge adulte des enfants atteints de maladies chroniques : le questionnaire GEDEPAC-2.

BACKGROUND: In France, chronic diseases affect 3 million children. In children with chronic conditions, long-term somatic outcome has been well described, but little is known about the psychosocial aspects of well-being. METHODS: Our aim was to build a self-administered questionnaire of global well-being in adults who had a chronic disease since or during childhood using a multidimensional and nonspecific approach. The questionnaire was constructed by a multidisciplinary group (epidemiologists, clinicians, sociologist, statistician). Items were built in compliance with reference data from the French general population (national surveys, free access) to allow comparative analysis adjusted for age and sex (and eventually other confounding factors) by indirect standardization (qualitative variables) or Z-scores (quantitative variables). RESULTS: The GEDEPAC-2 includes 108 items exploring 11 domains: education, employment, housing, material security, social links, civic engagement, leisure, environment, physical health/risky behavior, health-related quality of life and sex life. Factual questions and satisfaction scales jointly explore social well-being. Quality of life is analyzed in terms of physical quality of life, mental quality of life, fatigue and burden of treatment by 3 questionnaires validated in French (SF-12; MFI-20; Burden of Treatment Questionnaire). Experience of transition from pediatric to adult healthcare is described in 21 items. Paper and electronic versions were developed. CONCLUSION: Built in a multidimensional approach to well-being and in line with the available reference data, GEDEPAC-2 will facilitate the implementation of future studies on impact in adulthood of chronic disease in childhood.

2-µm Ho emitter-based coherent DIAL for CO(2) profiling in the atmosphere.

We report on the use of a thulium-fiber-pumped holmium-based emitter in a coherent differential absorption lidar (CDIAL) experiment for high time and space resolution of CO(2) absorption field in the atmosphere. The 2-µm high-power dual-wavelength single-mode Q-switched Ho:YLF oscillator delivers 10-mJ pulses with a duration of 40 ns at 2 kHz. Both short pulse duration and high repetition rate were chosen to increase the DIAL precision and time and space resolution in coherent detection. The CDIAL provides 150-m range and 15-min time-resolved CO(2) absorption coefficient with a calculated instrumental error of 0.5% at 500 m and less than 2% at 1 km. Dry-air CO(2) mixing ratio estimates from the DIAL system are compared with simultaneous in situ gas analyzer measurements during a 20-h-long experiment.

Educational trajectories after childhood cancer: When illness experience matters.

With the increase in survival from childhood cancer, research has increasingly focused on the educational and professional achievements of childhood cancer survivors. Yet, if large-scale studies provide an acute description of the current situation of childhood cancer survivors, little is known about their trajectories and the social processes shaping these trajectories. Using a qualitative methodology, drawing from a life course perspective, this study sought to describe the role of childhood cancer and its side effects in educational trajectories, as perceived by the participants. We investigated related processes of social adjustment to cancer, that is to say, choices or decisions that survivors related to the illness in the making of their career plans. Eighty long-term French childhood cancer survivors participating in the Euro2K longitudinal study were interviewed through in-depth, face-to-face interviews undertaken in 2011-2012. There were various types of impact described by respondents of the diagnosis of cancer on their trajectories. These varied according to gender. In women, childhood cancer tended to result in poor educational achievement, or in steering the individual towards a health care or child care occupation. This was justified by a desire to return the support that had been offered to them as patients. In men, however, childhood cancer led to a shift in career plans, because of physical sequelae, or because of concerns about their future health. Paradoxically, this limitation had a positive impact in their occupational achievement, as most of these men disregarded blue-collar jobs and chose more qualified white-collar occupations. Overall, findings suggest that childhood cancer influenced educational trajectories and, thus, socioeconomic status in adulthood, through mechanisms embedded in gender norms. These mechanisms could explain gender inequalities in educational achievement after childhood cancer reported in large-scale cohort studies.

[Pregnancy and substance use in France: a literature review]. / Grossesse et usage de substances psychoactives en France. Synthèse de la littérature.

OBJECTIVES: Substance use during pregnancy is an important public health issue. It requires identifying at-risk populations and risk perception among women. MATERIALS AND METHODS: A literature review was conducted. It included French studies conducted since 2000 on substance use during pregnancy (tobacco, alcohol, marijuana, psychotropic drugs) and risk perception. RESULTS: In France, in 2010, 24% of pregnant women smoke--17% in the 3rd trimester. Depending on studies, the prevalence of alcohol use ranged from 12 to 63% and binge drinking ranged from 1 to 7%; daily drinking was below 0.5%. Marijuana use ranged from 1 to 3%, and psychotropic drugs ranged from 2 to 4%. Little research has been dedicated to risk perception. Studies show a lack of awareness about the equivalence of risks between fermented and distilled beverages and about the risks of moderate smoking during pregnancy. CONCLUSION: Data is lacking to characterize at-risk populations and mechanisms underlying risky behaviors.

Use of new synthetic talc as reinforcing nanofillers for polypropylene and polyamide 6 systems: thermal and mechanical properties.

New layered synthetic nanotalc prepared at a lab-scale by a conventional hydrothermal process and commercial natural fine talc were used in order to establish a comparative study in terms of their contributions on the improvement of the final properties of two different polymers: a nonpolar polyolefin matrix and a polyamide. All samples were prepared by melt extrusion in a co-rotating microcompounder. The surface properties of talc - surface energy and isoelectric point - were probed. The particles' crystalline structure and the distribution/dispersion within the polymer matrix were performed using transmission electron microscopy and X-ray diffraction. The effect of talc particles on the crystallinity, the thermal and mechanical properties was highlighted as a function of the surface properties of talc. In the case of talc-filled PP systems, it seems that the incorporation of both natural and synthetic talc greatly improves the thermal stability of polypropylene matrix. The highest elastic modulus was obtained in presence of highly nucleating natural talc. Oppositely, the best ductility was observed for the synthetic talc-filled PP systems. For PA6/talc nanocomposites, a remarkable improvement in the dispersion of talc layers was shown and a significant increase in Young's modulus was determined due to the closer affinity between the hydrophilic nanotalc lamellae and the polar PA6 matrix.

The PREGVAXGRIP study: a cohort study to assess foetal and neonatal consequences of in utero exposure to vaccination against A(H1N1)v2009 influenza.

BACKGROUND: In October 2009, in the context of an A(H1N1)v2009 influenza pandemic, a vaccination campaign was launched in France, in which one of the priority groups was pregnant women, on account of the high risk of developing complications following infection by this virus. OBJECTIVE: The aim of this multicentric, prospective, observational study was to assess safety and pregnancy outcomes in a cohort of pregnant women when receiving the A(H1N1)v2009 influenza pandemic vaccine. METHODS: This was a prospective study that followed up pregnant women recruited mainly in vaccination centres and maternity departments. Following the expected delivery date, follow-up data were collected concerning the delivery, the infant, and, if appropriate, the reasons why the pregnancy did not reach its term. RESULTS: Between 1 November 2009 and 31 March 2010, 2,415 pregnant women were included at the time of vaccination; 97.6 % of women received a vaccine without adjuvant and 2.4 % received an adjuvanted vaccine. Ninety-two (3.9 %) women were vaccinated during the first trimester of pregnancy, 1,090 (46.5 %) during the second trimester, and 1,162 (49.6 %) during the third trimester. One hundred and thirty-three adverse events (5.5 % of women) were reported, of which 12 were unexpected or serious. There were 2,246 (93.0 %) known pregnancy outcomes with 12 spontaneous abortions (0.5 %), 6 stillbirths (0.3 %), and 4 therapeutic abortions (0.2 %). There were 65 neonates with congenital anomalies, among which 31 were major. But only one congenital malformation (1.4 %) was reported for the 92 women vaccinated in their first trimester. Of the women, 93.3 % were delivered full term and 6.7 % preterm. For 96 (4.2 %) neonates, a disorder was reported in the neonatal period and 130 (5.6 %) were transferred to the neonatology department. CONCLUSIONS: This study suggests that exposure to the A(H1N1)v2009 pandemic influenza vaccine during pregnancy does not increase the risk of adverse pregnancy outcomes. However, because of the relatively small number of women exposed during the first trimester, other studies are needed to exclude an increased risk of malformation.

[Pelvic and spinal MR follow-up of multiple myeloma patients after high-dose chemotherapy and autologous peripheral blood stem cell transplant]. / Suivi par IRM pelvi-rachidienne d'une cohorte de patients atteints de myélome multiple, traités par chimiothérapie à haute dose et autogreffe de cellules souches périphériques.

PURPOSE: To evaluate the changes of bone marrow lesions on pelvic and spinal MR in patients with multiple myeloma after high-dose chemotherapy and autologous peripheral blood stem cell transplant. PATIENTS AND METHODS: Pelvic and spinal MR examinations were obtained at presentation (myeloma diagnosis) and 1 year after transplant in 20 patients that were part of a group of 39 patients enrolled in a prospective study. The type of marrow replacement (classified in stages with stage 0: normal; stage 1: salt and pepper; stage 2: focal infiltration; stage 3: diffuse infiltration), the number and size of marrow lesions and the number of vertebral compression fractures were recorded. We have compared the findings prior to and following transplant, with correlation to the response to treatment and the use of biphosphonates. RESULTS: The type of marrow replacement was improved following transplant in 65% of patients (not statistically significant). The number and size of nodules > 20 mm showed significant reduction (p = 0.0224 and p = 0.0237 respectively). Lesions on MR improved in 50% of patients with good response and 75% of patients with poor response to treatment. Patients receiving biphosphonates showed more vertebral compression fractures. CONCLUSION: The evolution of marrow replacing lesions on MR is discordant compared to the biological and clinical response to treatment. Pelvic and spinal MR evaluation at the time of diagnosis does not appear to be a good predictive factor of response to treatment. Biphosphonates do not appear to prevent new vertebral compression fractures. Pelvic and spinal MR provides interesting data in the follow-up of patients with myeloma following autologous transplant, especially in the local evolution of marrow replacing lesions, but our results do not justify its use in routine clinical practice.