http://hdl.handle.net/2268/116 Chercher dans ce canal chercher http://orbi.ulg.ac.be/simple-search http://hdl.handle.net/2268/148088 Titre: Elévation faible d’hCG en dehors d’un contexte gravidique : à propos de deux cas et revue de la littérature <br/> <br/>Auteur, co-auteur: DE BACKER, Benjamin; GOFFIN, Frédéric; NISOLLE, Michelle; Minon, Jean-Marc <br/> <br/>Résumé: La découverte fortuite ou la persistance d’une positivité faible de l’hCG est une situation qui n’est pas inhabituelle et qui nécessite une démarche clinico-biologique pour éviter de mauvaises interprétations susceptibles de conduire à des attitudes diagnostiques ou thérapeutiques inappropriées. Lorsque toute forme de grossesse est écartée, une persistance d’hCG évoque chez beaucoup la présence d’un contexte tumoral. Cependant, la positivité des tests peut également être due à diverses causes bénignes. Deux cas sont décrits. Une première patiente a présenté des concentrations d’hCG faibles pendant plusieurs années, consécutivement à une fausse-couche. Après investigation, l’hypothèse retenue est celle d’une maladie trophoblastique gestationnelle quiescente. Chez une seconde patiente atteinte d’insuffisance rénale terminale, la positivité de l’hCG a été révélée préalablement à la réalisation d’un examen radiologique. Dans ce cas, l’origine serait l’accumulation d’hCG hypophysaire secondaire à la pathologie rénale. Ces cas illustrent l’importance d’une bonne compréhension des différentes causes d’élévation de l’hCG, qui sont revues dans cet article.; Unexpected finding or persistence of low human chorionic gonadotropin (hCG) levels is not a rare situation. It requires a clinico-biological approach in order to avoid misunderstandings that could lead to inappropriate diagnostic or therapeutic attitudes. Outside the context of a pregnancy, persistent low levels of hCG may be associated with various benign and malignant conditions, i.e. quiescent gestational trophoblastic disease (QTD), raised pituitary hCG or false positive elevation caused by circulating heterophile antibodies. We report the cases of two non-pregnant patients with low serum hCG. In the first case, hCG levels raised during several years following a spontaneous abortion. The likelihood of heterophilic antibodies interference was ruled out and extensive clinical investigation excluded the presence of a tumour. The diagnosis was QTD. In the second case, elevated hCG came to light as an incidental finding in a women with chronic renal failure and led the clinicians to question the laboratory. The cause was probably an increase in pituitary hCG consecutive to terminal renal failure. These cases illustrate the importance of understanding the biology of the hCG and the causes of its persistent low elevation, which are reviewed in this article. It is essential to demonstrate clinically the presence of a tumour in order to avoid unnecessary and ineffective chemotherapy and/or hysterectomy. http://hdl.handle.net/2268/147917 Titre: NEONATAL INVASIVE GROUP B STREPTOCOCCAL (GBS) INFECTIONS IN EUROPE <br/> <br/>Auteur, co-auteur: MELIN, Pierrette; Berner, Reinhard; Afshar, Baharak; Baldassarri, Lucilla; Detcheva, Antoaneta; de la Rosa, Manuel; Kunze, Mirjam; Kriz, Paula; Efstratiou, Androulla; Hufnagel, Markus; Kilian, Mogens; SEIDEL, Laurence; Telford, John <br/> <br/>Résumé: Objectives: To describe clinical characteristics and capsular type of GBS isolates responsible of invasive infections in infants from Belgium, Bulgaria, Czech-Republic, Denmark, Germany, Italy, Spain and United Kingdom, representing one of the main objectives of the DEVANI (DEsign of a Vaccine Against Neonatal Infections) project. Methods: Surveillance of invasive GBS infections in infants was performed from mid-2008 through December 2010. For each case, a standardized case report form was filled. Samples from cases were processed using local procedures. GBS isolates were characterised in national central labs using standardised type-specific (Ia, Ib-IX) latex agglutination and molecular typing methods. Results: Data on 188 infants with invasive infection were analysed: 144 (60.6%) early onset diseases (EOD) and 74 (39.4%) late onset diseases (LOD). In EOD, mean/median ages at onset were 14/0 hours and the male:female ratio was 1.25. The predominant manifestation at onset was respiratory distress (42% cases); 83% cases were associated with sepsis/bacteremia, 15% with pneumonia and 6% with meningitis. Late-prenatal screening cultures were obtained from 51% of cases’ mothers and only half of these were positive for GBS. Non-elective C-section, intrapartum fever and rupture of membrane (>18h) were more frequent in EO-cases’ mothers versus healthy babies’ GBS-positive mothers. The major serotypes were III (43%), V (21%) and Ia (18%). In LOD, mean/median ages at onset were 42/34 days and the male:female ratio was 0.9. The predominant characteristic at onset was fever (62% cases); 70% cases were associated with sepsis and 30% with meningitis. Very rare manifestations were osteomyelitis and cellulitis. Serotype III was highly predominant (80.6%) followed mainly by Ia (12.5%). Death rates were 4.7/1.5% in EOD/LOD. Conclusions: Clinical presentations were associated with age at onset of infection. Serotype III predominated in neonatal infections. Prenatal screening was not universal neither sensitive. Study funded through the European Commission Seventh Framework. http://hdl.handle.net/2268/147904 Titre: Group B streptococci, a European perspective with results of the DEVANI project <br/> <br/>Auteur, co-auteur: MELIN, Pierrette <br/> <br/>Résumé: In 2011, neonatal group B streptococcal (GBS) diseases remain a global public health concern. Where consensus guidelines to detect and treat intrapartum women with GBS colonization have been widely adopted, incidence of neonatal early onset disease (EOD) has dramatically declined, however despite preventive strategies cases still occur. The strategy was not expected to prevent all cases and there are challenges and limitations to this preventive approach. The best strategy for European countries is still a matter of debate and intrapartum antimicrobial prophylaxis (IAP) is not widely recommended. To adopt the best preventive strategy, we first need better data assessing more accurately the true burden of GBS diseases in the different countries. Furthermore, as the current screening-based strategy for prevention is highly effective but imperfect, given the challenges, limitations and potential complications of maternal IAP, a new approach is still needed. Maternal immunization against GBS is an attractive alternative for the prevention of not only neonatal diseases but also stillbirths and maternal diseases. Vaccines against GBS may likely become the most effective and sustainable long-term preventive strategy. But the development of vaccines with global relevance has been hampered by changes in the distribution of GBS serotypes of strains causing diseases over time and in different parts of the world. A multivalent vaccine to cover against the more prevalent serotypes suitable for European populations might not be suitable for Asian or African populations. To overcome type-specificity, new developments target vaccines based on conserved surface antigenic proteins, such as Sip protein located at the cell surface of all GBS and on immunogenic proteins from GBS pili. A pilus-based GBS vaccine is appealing and could become a globally relevant reality. The DEVANI (DEsign of a Vaccine Against Neonatal Infections) programme funded through the European Commission Seventh Framework was launched on 1 January 2008 with the key objective being the assessment of European GBS epidemiology to facilitate the design of a new vaccine that will confer neonatal immunity through a durable maternal immune response. A major component was to undertake pan European surveillance of maternal colonisation, maternal GBS antibody responses and neonatal diseases in eight European countries. Through 2009 and 2010, all Belgian laboratories sending any neonatal GBS invasive isolate to the National Reference Centre for GBS were invited to bring their contribution to this project. Belgium, Bulgaria, Czech Republic, Denmark, Germany, Italy, Spain and the United Kingdom established specific GBS screening studies during 2008/10. Maternal vaginal/rectal swabs and sera were taken between 34-37 weeks gestation and processed using a standardised microbiological screening protocol. Samples from neonatal cases were processed using local procedures. For each pregnant woman and each case of GBS neonatal disease, standardized case report forms were filled. GBS isolates were characterised using standardised serological and molecular typing methods for detection of all ten GBS capsular polysaccharide types (Ia to IX). Furthermore all the collected isolates were screened by multiplex PCR and FACS analysis to evaluate respectively gene presence and surface-exposure of pili. And clonal analysis of these isolates was performed using multi-locus sequence typing (MLST). The main microbiological results of this pan European surveillance are following. Carriage rates among pregnant women in all countries ranged from 8% to 26%. The most common GBS capsular types were III (33%), Ia (25%) and V (8%). Among GBS from EOD, the major serotypes were III (43%), V (21%) and Ia (18%). In contrast among GBS isolated from neonatal late onset disease (LOD), serotype III was highly predominant (80.6%) followed mainly by Ia (12.5%). Analysis of the pattern of pili genes showed that all isolates contained at least one gene coding for pili. The most common gene patterns found were PI-2a alone, PI 1+2a and PI 1+2b, while the PI-2b gene alone was very rare. The most prominent result was that a majority of isolates from neonatal infections carried the PI-1+2b gene pattern, while the most common pattern among pregnant women was PI-1+2a. Most of analyzed strains express at least one pilus on their surface. The clonal analysis showed that 66 sequence types were found to belong to nine clonal complexes (CC). Among these nine CCs, five were prevailing and covered 92 % of GBS isolates tested. The GBS population in pregnant women was found to be more heterogeneous than the GBS isolated from neonatal infection cases. Among neonatal isolates, the most frequent CC was CC17 (43 %) known as a highly virulent clone. Among participating countries, there were no significant differences in the occurrence of clonal complexes. The analysis of the levels of specific antibodies as surrogate markers of protection is still ongoing. More detailed and additional results as the main conclusions will be presented. http://hdl.handle.net/2268/147903 Titre: GBS colonization and screening in pregnancy: how does it work in Europe? <br/> <br/>Auteur, co-auteur: MELIN, Pierrette <br/> <br/>Résumé: In Europe, as in North America, GBS infections among infants are associated to high morbidity and mortality even if some differences exist between different European countries. During the past two decades, major initiatives have been proposed to prevent early onset GBS disease (EOD) and they are still subject of controversy. Several European countries have issued guidelines for the prevention of neonatal GBS diseases, either universal screening-based or risk-based strategy, others have no official guidelines at all. In countries having guidelines, despite considerable efforts and economic resources spent on intrapartum antimicrobial prophylaxis for GBS EOD, cases continue to occur. Among these cases there are a lot of missed opportunities to administer IAP but there are also false negative screening. Therefore in the setting of a maternal GBS-screening program and successful implementation of the strategy, efforts to improve screening for GBS status remain important. The natural reservoir for GBS is the gastrointestinal tract and is likely the source for vaginal colonization. Among pregnant women, GBS carriage rate in the vaginal and rectal flora ranges from 10% up to 30%. Critical factors that influence the accuracy of detecting GBS maternal colonization are the choice of the body sites sampled, the timing of sampling and the use of selective culture media. The evolution of the different culture options to improve the GBS-screening strategy will be reviewed. If the optimal time for performing antenatal cultures is between 35 to 37 weeks’ gestation, as GBS carriage is highly variable, the predictive values of GBS antenatal cultures are not always as good predictors of the maternal GBS status at presentation for delivery as expected. Potential alternative to antenatal GBS-screening culture is the identification of GBS colonization at presentation for delivery. Use of a reliable, sensitive, easy to use rapid test should be cost effective leading to the prevention of more EOGBS cases while reducing the number of unnecessarily IAP. Advances of polymerase chain reaction (PCR) and fluorescence labeling technologies has provided new detection tools for bacterial identification. Therefore, commercialization of rapid detection of GBS through real-time PCR offers the potential for GBS detection among women without prenatal care or those in whom no antenatal culture was collected. However questions of costs and logistics remain unanswered. Could such rapid intrapartum test replace existing screening strategies or could it be used in conjunction with them? Colonizing rates and recommended screening procedures existing through Europe will be reviewed. http://hdl.handle.net/2268/147897 Titre: GBS AND THE NEONATE: PREVENTION STRATEGIES <br/> <br/>Auteur, co-auteur: MELIN, Pierrette <br/> <br/>Résumé: Streptococcus agalactiae, or group B streptococcus (GBS), remains the leading cause of neonatal sepsis and meningitis, early onset and late onset diseases (EOD, LOD). Where consensus guidelines to detect and treat intrapartum women with GBS colonization have been widely adopted, incidence of neonatal EOD has dramatically declined. In response to both successful impacts on the incidence of GBS-EOD and analyses of missed opportunities, the first American guidelines for prevention issued in the 90s have since been adapted in several stages to improve their efficacy. In some countries in Europe, nationwide guidelines, whether screening-based or risk-based, for the prevention of neonatal GBS diseases have also been issued and adopted, with the expected impact on incidence of GBS-EOD. In spite of universal screening, in spite of the great progress that has been made, GBS-EOD continues to occur and the GBS burden remains a significant public health issue. Continuous efforts to improve screening for GBS status continue to be important and may be able to take advantage of new rapid diagnostic technologies. The current screening-based strategy for prevention is highly effective but imperfect. Given the challenges, limitations and potential complications of maternal intrapartum prophylaxis, a new approach is still needed. Maternal immunization against GBS is an attractive alternative for the prevention of not only neonatal diseases but also stillbirths and maternal diseases. Vaccines against GBS may likely become the most effective and sustainable long-term preventive strategy. http://hdl.handle.net/2268/144687 Titre: Role of Gamma Delta T cells in HPV-induced Cancer Progression <br/> <br/>Auteur, co-auteur: Van hede, Dorien; Bastin, Renaud; Francis, Floriane; Bisig, Bettina; Arrese Estrada, Jorge; Renoux, Virginie; Dortu, Estelle; Langers, Inge; Delvenne, Philippe; Vermijlen, David; Jacobs, Nathalie http://hdl.handle.net/2268/144675 Titre: Role of γδ T cells in HPV-induced cancer progression <br/> <br/>Auteur, co-auteur: Van hede, Dorien; Bastin, Renaud; Francis, Floriane; Bisig, Bettina; Arrese Estrada, Jorge; Renoux, Virginie; Dortu, Estelle; Langers, Inge; Delvenne, Philippe; Jacobs, Nathalie http://hdl.handle.net/2268/144671 Titre: Role of γδ T cells in HPV-induced cancer progression <br/> <br/>Auteur, co-auteur: Van hede, Dorien; Bastin, Renaud; Francis, Floriane; Bisig, Bettina; Arrese Estrada, Jorge; Renoux, Virginie; Dortu, Estelle; Langers, Inge; Delvenne, Philippe; Vermijlen, David; Jacobs, Nathalie http://hdl.handle.net/2268/144669 Titre: γδ T cells could promote cancer progression of HPV-induced lesions <br/> <br/>Auteur, co-auteur: Van hede, Dorien; Bastin, Renaud; Francis, Floriane; Bisig, Bettina; Arrese Estrada, Jorge; Renoux, Virginie; Dortu, Estelle; Langers, Inge; Boniver, Jacques; Delvenne, Philippe; Vermijlen, David; Jacobs, Nathalie http://hdl.handle.net/2268/144354 Titre: CERTOLIZUMAB PEGOL DID NOT RESULT IN A DECREASE IN SEMEN QUALITY IN HEALTHY VOLUNTEERS: RESULTS FROM A PHASE 1 STUDY <br/> <br/>Auteur, co-auteur: Perrier d'Hauterive, Sophie; KESSELER, Sophie; RUGGERI, Philippe; TIMMERMANS, Marie; GASPARD, Olivier; Kumke, T; Parker, G http://hdl.handle.net/2268/143951 Titre: Prise en charge des pathologies gynécologiques bénignes par chirurgie robotique <br/> <br/>Auteur, co-auteur: BRENEZ, Anne; PETIT, Philippe; DECHENNE, Valérie; Nisolle, Michelle http://hdl.handle.net/2268/143674 Titre: Phenotypical and genotypical surveillance of macrolide and lincosamide resistance in group B streptococcus in Belgium <br/> <br/>Auteur, co-auteur: DESCY, Julie; ACKERMANS, Yanick; BOREUX, Raphaël; MEEX, Cécile; Rémont, Leslie; Rodriguez Cuns, Grisel; MELIN, Pierrette <br/> <br/>Résumé: Background: Constant increase of erythromycin (E) and clindamycin (C) resistance (R) has been observed worldwide among isolates of group B streptococci (GBS). In Belgium, through the 2000s, E R increased rapidly from 10% to up to 30%. Therefore phenotypical and molecular surveillance of E and C R has to be conducted. Methods: 275 clinical isolates (N1) were obtained from a Belgian surveillance for invasive GBS disease in newborns (59 isolates with 32 early- and 27 late-onset diseases) and adults (216 strains) during 2008 to 2011 and 53 isolates (N2) from vagino-rectal colonization in pregnant women in 2010. E and C MICs were determined by using Etest® (EUCAST interpretive criteria). Furthermore, for the E R isolates, the inducible (iMLS), constitutive (cMLS) and M phenotypes were assessed by a double disk diffusion test; the distribution of genes encoding RNA methylases and efflux pumps was investigated by PCR. Results: Of the N1 and N2 isolates, 92 (33.5%) and 15 (28.3%) were respectively R to E, with a higher rate among serotype V (p <0.001) and serotype IV (p <0.05). Among these 107 E-R isolates, 100 (93.5%) exhibited the MLS phenotype (R to E and CC): 73 were cMLS with E MIC50 >256 mg/L and 27 iMLS with E MIC50/MIC90 12/>256 mg/L. The M phenotype (R to E and S to C) was expressed by 7 (6.5%) of E R isolates with E MIC50/MIC90 4/12 mg/L. One colonizing strain presented a newly described resistance mechanism in GBS: the L phenotype (S to E and R to C) with a C MIC at 8 mg/L. For cMLS, the most common E R genotype was ermB (66%) (p <0.05) followed by ermTR (29%) and ermB+ermTR (5%). All iMLS isolates harbored an ermTR gene except 3 (2 with ermB, 1 with both ermB and ermTR); and all M phenotype were positive for mefA/B gene. Conclusions:1) In Belgium, by year 2010, prevalence of macrolides R in GBS exceeded 30%, 2) MLS R phenotypes (target-site modification) were the majority mechanism; M phenotype (efflux R mechanism) was also prevalent. 3) E and C susceptibility testing and surveillance are mandatory to guide prophylaxis and treatment of serious GBS infections in penicillin-allergic patients (at high risk for anaphylaxis) but also to identify emergence of newly acquired resistance mechanisms such as the L phenotype. http://hdl.handle.net/2268/143546 Titre: Isoform 111 of vascular endothelial growth factor (VEGF111) improves angiogenesis of ovarian tissue xenotransplantation <br/> <br/>Auteur, co-auteur: Labied, Soraya; Delforge, Yves; Blacher, Silvia; Munaut, Carine; Signolle, Nicolas; Colige, Alain; Janssen, Lauriane; HENRY, Laurie; Perrier d'Hauterive, Sophie; JOUAN, Caroline; Kirschvink, Nathalie; Noël, Agnès; Nisolle, Michelle; Foidart, Jean-Michel http://hdl.handle.net/2268/143545 Titre: Does vascular endothelial growth factor improve ovarian tissue recovery after cryopreservation? <br/> <br/>Auteur, co-auteur: Henry, Laurie; Fransolet, Maïté; Labied, Soraya; Blacher, Silvia; Munaut, Carine; Colige, Alain; Kirschvink, N; Noël, Agnès; Nisolle, Michelle; Foidart, Jean-Michel http://hdl.handle.net/2268/143457 Titre: Adverse obstetrical outcomes after treat- ment of precancerous cervical lesions : a Belgian multicenter study <br/> <br/>Auteur, co-auteur: Simoens, C; GOFFIN, Frédéric; Simon, P; Barlow, P; Antoine, J; Foidart, Jean-Michel; Arbijn, M http://hdl.handle.net/2268/143456 Titre: Lymphadénectomie para-aortique par laparoscopie assistée par robot dans le bilan des cancers du col utérin localement avancés. Étude belge multicentrique. <br/> <br/>Auteur, co-auteur: Merindol, C; GOFFIN, Frédéric; Vergote, I; Vandromme, J; Degueldre, M; PETIT, Philippe; Leunen, K; Fastrez, M http://hdl.handle.net/2268/143455 Titre: Indicateurs de qualité de prise en charge du cancer du corps de l’utérus : méthodologie et liste pour le projet EFFECT <br/> <br/>Auteur, co-auteur: Bouche, G; WERBROUCK, J; De Jonge, E; Jacomen, G; D'Hondt, V; Denys, H; VAN LIMBERGEN, E; VANDERMEERSCH, B; DE SCHUTTER, H; VAN EYCKEN, L; GOFFIN, Frédéric; Amant, F http://hdl.handle.net/2268/143454 Titre: The prospective Belgian experience of robot-assisted management of apparent early-stage endometrial cancer : relation between surgical outcomes and obesity. <br/> <br/>Auteur, co-auteur: GOFFIN, Frédéric; Traen, K; Segaert, A; TIMMERMANS, Marie; Voorhoof, L; Fastrez, M; Nisolle, Michelle; Vergote, I. http://hdl.handle.net/2268/143453 Titre: Surgical outcomes of women withe endometrial cancer after introducing a robotic programm <br/> <br/>Auteur, co-auteur: LAMBERT, Marie; DELBECQUE, Katty; DE CUYPERE, Marjolein; TIMMERMANS, Marie; Nisolle, Michelle; Kridelka, Frédéric; GOFFIN, Frédéric http://hdl.handle.net/2268/143449 Titre: High-risk human papillomavirus infection of the genital tract of women with a previous history or current high-grade vulvar intraepithelial neoplasia <br/> <br/>Auteur, co-auteur: Goffin, Frédéric; Mayrand, Marie-Hélène; Gauthier, Philippe; Alobaid, A.; Lussier, C.; Provencher, D.; Drouin, P.; Franco, Edouardo; Coutlée, F. <br/> <br/>Résumé: Human papillomavirus (HPV) infection is associated with high-grade vulvar intraepithelial neoplasia (VIN-3). The prevalence of anogenital HPV infection in women with previously treated VIN-3 has not been documented yet. This cross-sectional study compared high-risk HPV DNA detection rates in women with past (n = 30) and current (n = 22) VIN-3 to those without current or past VIN (n = 86). HPV DNA was detected in vulvar and cervical samples with Hybrid Capture 2 (HC-2). Smoking was associated in multivariate analysis with current VIN-3 (odds ratio (OR) 8.3, 95% confidence interval (CI) 2.0-8.2) and any VIN-3 history (OR 6.5, 95% CI 2.5-16.5). High-risk HPV DNA was found on the vulva of 64%, 33%, and 20% of women with current VIN-3, past VIN-3, and without previous or current VIN, respectively. After controlling for age and smoking, high-risk HPV vulvar infection was associated with cervical high-risk HPV infection (OR 8.6, 95% CI 2.8-26.5; P = 0.001). After controlling for age, HPV infection was more often multifocal in women with current VIN-3 compared to women with previous but no current VIN-3 lesion (OR 17.6, 95% CI 1.4-227.2). Multifocal vulvar HPV infection was detected in women with previous or active VIN-3. Longitudinal studies are required to determine if the multifocality of HPV infection on the vulva could explain the high recurrence rate of VIN-3.