Acute respiratory distress in relation to COVID-19 and beyond

Charles Pilette, Grégory Reychler, Nicolas Audag, Anne-Claire Latiers, Stéphanie Quennery, William Poncin, Gimbada Mwenge, Giuseppe Liistro, Charlotte Smetcoren, Frank Aboubakar, Sophie Gohy, Silvia Berardis, Antoine Froidure Published in the journal : February 2021 Category : Pneumology

In 2020, COVID-19 mobilized pulmology experts along with other colleagues specializing in infectious diseases, emergency physicians, as well as intensivists. This occurred within a concerted effort, especially with the aim to reach a consensus in managing the infectious and inflammatory diseases at Cliniques Universitaires Saint-Luc. The physiotherapy team was mobilized from the very first hours of the pandemic; they were indeed involved in optimizing respiratory care for these patients. Original work and the "field" experience of our physicians and physiotherapists turned out to be instrumental in clarifying essential concerns. These latter included the best interface for delivering high-flow oxygen therapy, as well as the usefulness of supplying positive pressure continuous positive airway pressure (CPAP) to numerous patients with severely hypoxemic SARS-CoV-2 pneumonia, in addition to defining the most appropriate aerosol therapy in this pandemic context.

The follow-up of chronic respiratory disease-affected patients represented another challenge. Indeed, we were obliged to implement alternative methods, including teleconsultations, which particularly applied to the first CONIV-19 wave. Nevertheless, the year 2020 witnessed the arrival on the European market of targeted cystic fibrosis therapies as well as self-injectable biologics for severe Type 2 asthma, along with the multidisciplinary management of the ever-increasing number of cases suffering from diffuse interstitial pathologies. Notably, our department distinguished itself through original COVID-19 studies that were conducted in respiratory disease (cystic fibrosis, severe asthma patients) patient cohorts. Another distinctive feature pertaining to our department was the shedding light on the aging mechanisms involved in certain genetic pulmonary fibrosis forms, as well as on telomere length regulation, the latter being a risk factor for COVID-19 severity. Lastly, while lung cancers remain at the top of the "serial killer" list, these gloomy statistics are likely to change in the near future, owing to the progress made in molecular biology. This progress enables us today, and will do it even more tomorrow, to initiate and implement a personalized medicine management for certain cancer types.

These clinical and research transfer activities clearly demonstrate the pulmologists’ desire to work at the patient's bedside, in an effort to offer him the most appropriate specific care, in line with our academic hospital’s missions. This latter includes an active contribution to further developing medical and scientific knowledge in this field. Notably, this issue is at the heart of the 2020 news.

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2020 innovations in Nephrology

Hélène Georgery, Fabienne Oguz, Nathalie Demoulin, Michel Jadoul, Arnaud Devresse, Johann Morelle Published in the journal : February 2021 Category : Nephrology

In 2020, a large-sized randomized study provided reassuring results about the cardiovascular safety of febuxostat, a xanthine oxidase inhibitor used for the treatment of symptomatic hyperuricemia.

The cardiovascular and renal benefits of sodium-glucose co-transporter 2 (SGLT-2) inhibitors were confirmed in 2020, and their indications even extended. Notably, the DAPA-CKD trial demonstrated that dapagliflozin is strongly nephroprotective in both proteinuric diabetics and non-diabetics. Thus, the standard of care for managing these patients is likely to soon include an SGLT2- inhibitor in addition to an angiotensin converting enzyme inhibitor or angiotensin II receptor blocker.

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Management of relapsed/refractory diffuse large B-cell lymphomas in 2020 in Belgium. A 1-year experience with tisa-cel (Kymriah®), the first anti-CD19 CAR-T cell to be reimbursed

Sarah Bailly, Xavier Poiré, Nicole Straetmans, Violaine Havelange, Marie-Christiane Vekemans, Eric Van Den Neste Published in the journal : February 2021 Category : Hematology/Oncology

Recently, the management of relapsed/refractory diffuse large B-cell lymphoma has been revolutionized by the introduction of of anti-CD19 CAR-T cells. These treatments have been available in Belgium since mid-2019.

What to remember after one year of experience?

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Surgical planning using 3D modeling and 3D printing of the liver: progress made in managing patients with multiple colorectal cancer-related metastases

Douglas Lacomblez, MD1, Mike Salavracos, MD1, Etienne Danse, MD, PhD1, Laurent Coubeau, MD2 Published in the journal : February 2021 Category : Chirurgie et Transplantation Abdominale

We herein describe a pilot project that involves liver surgeons and radiologists and concerns the modeling of three-dimensional objects for liver surgery planning. The model is being applied to patients suffering from metastatic colorectal liver disease, with the object extrapolated from conventional imaging examinations being printed in three dimensions and used intraoperatively, with the ultimate aim to improve the spatial visualization of tumors in relation to vascular and biliary hepatic structures.

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Lyumjev®: a new rapid insulin formulation

Michel P. Hermans Published in the journal : February 2021 Category : Diabétologie

Insulin URLi (Lyumjev®) is a novel formulation of insulin lispro that was developed to more closely mimic the physiological secretion of prandial insulin, owing to its faster action and shortened duration of effect. URLi was recently marketed in Belgium and is intended for adult diabetics. Compared to lispro, its use is associated with decreased postprandial glycemic excursions in both Type 1 and Type 2 diabetic patients. When used in multiple injection regimens, URLi was demonstrated to increase diurnal time in range compared to lispro, in addition to reducing the time spent in hypoglyaemia in patients using insulin pumps.

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Enhanced recovery after surgery, esophagectomy, prehabilitation

Yannick Deswysen Published in the journal : February 2021 Category : Chirurgie oeso-gastrique

The Enhanced Recovery After Surgery (ERAS®) program constitutes a real improvement in perioperative care. This evidence-based concept has been proven to reduce the impact of surgery on the patient, thereby decreasing potential complications. The beneficial effects have been demonstrated in different clinical situations, although they are particularly relevant for patients with multiple co-morbidities undergoing major surgery. The ERAS is, therefore, fully applicable to esophageal surgery.

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2020 innovations in orthopedic surgery and traumatology

Xavier Libouton*, Nathalie Pireau*, Robin Evrard*, Emmanuel Thienpont*, Daniel Morcillo, Loic Thoreau, Maïte Van Cauter, Vincent Druez, Jean-Emile Dubuc, Maxime Bonnelance, Nadia Irda, Ludovic Kaminski, Simon Vandergugten, Alin Sirbu, Karim Tribak, Dan Pu Published in the journal : February 2021 Category : Chirurgie orthopédique et traumatologie

Four themes were emphasized in the year 2020, including new perspectives in knee arthroplasty surgery, contribution of 3D metal printing in developing implants for sarcoma surgery, usefulness of lateralization of the rotation center in reverse prosthetic shoulder surgery, and, lastly, contribution of microsurgery in bone defects. Nevertheless, 20% of patients still experience an unsatisfactory outcome following knee arthroplasty. Advances in tribology and implant fixation have rendered it possible to deviate from a purely mechanical approach and develop new resurfacing strategies that respect the patient's native anatomy. These advances are aimed at a kinematic alignment that is capable of recreating the natural joint movement with its ligament balance. This has resulted in developing personalized implants and ultra-precise positioning techniques, which are assisted by navigation and robot.

In oncological surgery, certain tumor resections are associated with difficult reconstructions, especially within the pelvis, as these resections are accompanied by a high rate of complications and mechanical failures. Metal 3D printing technology has rendered it possible to design porous titanium implants, which basically mirror the substance loss. Their stable fixation can already been anticipated at the design stage, thereby facilitating the reconstruction process and offering lasting mechanical perspectives. The performance of a reverse shoulder arthroplasty, which is indicated in osteoarthritis associated with a cuff tear, results in a medialization of the glenohumeral rotation center. This medialization results in a conflict with the scapula and progressive loosening of joint replacement. Metallic augmentation or bone grafting techniques enable lateralization of the rotation center, thereby preventing these complications.

Finally, when facing vast bone-tissue defects with a significant functional impact, the use of autologous vascularized grafts of different types represents a surgical solution that is still constantly evolving, including the recent contribution of super microsurgery.

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Virtual reality training after suffering from a vascular cerebral accident

Gauthier Everard, Charlotte Pietteur, Gaëtan Stoquart, Thierry Lejeune Published in the journal : February 2021 Category : Médecine Physique et Réadaptation

After stroke, patients may present with motor and cognitive impairments that lead to a reduced quality of life. Rehabilitation therefore represents a major challenge for these patients. Recently, new emerging technologies have contributed to intensifying the rehabilitation program, including virtual reality. Virtual reality allows for providing real-time feedbacks, promoting the use of the affected limb, and including specific and varied exercises. Moreover, combined with serious games, virtual reality adds a motivating and playful feature to the rehabilitation program. Results of these last years should encourage the implementation of virtual reality as a therapy complement.

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2020 innovations in metabolic fatty liver disease, hepatocellular carcinoma, cholestatic pruritus, encephalopathy, and inflammatory bowel diseases

Nicolas Lanthier, Ivan Borbath, Géraldine Dahlqvist, Bénédicte Delire, Olivier Dewit Published in the journal : February 2021 Category : Hépato-gastroentérologie

We herein present several relevant developments in the hepato-gastroenterology field during the year 2020. An expert consensus has resulted in a clearer nomenclature for “non-alcoholic” fatty liver disease, which is now referred to as "metabolic" liver disease and clearly defined using positive criteria. In fibrosing steatohepatitis, lanifibranor, which is a triple agonist of the three isoforms of the peroxisome proliferator-activated receptor (PPAR α, δ, γ), has demonstrated clear superiority over placebo in terms of disease resolution, fibrosis regression, and metabolic profile improvement. For patients with advanced hepatocellular carcinoma, the combined approach of atezolizumab (anti-programmed death-ligand 1 [anti-PD-L1]) and bevacizumab (anti–vascular endothelial growth factor [anti-VEGF) is a huge improvement and sets a new standard treatment in first-line. In cholestatic pruritus cases, fibrates are deemed to exert beneficial effects on the symptoms. Rifaximin, a broad-spectrum and, poorly absorbed antibiotic, has been demonstrated to be effective for preventing hepatic encephalopathy. This agent is now reimbursed when given in combination with lactulose. For inflammatory bowel diseases, ustekinumab (anti-interleukin [IL]12-IL23) is also now reimbursed in ulcerative colitis cases, and infliximab (anti-tumor necrosis factor [TNF]) as well as vedolizumab (anti-integrin) can be administered subcutaneously. Lastly, inflammatory bowel disease patients were proven not to exhibit any increased risk of coronavirus infection or developing severe COVID-19. In spite of their immunosuppressive therapy, these patients can (and should) benefit from the currently available vaccines.

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Innovations 2020 in hemostasis and thrombosis

Cédric Hermans, Amandine Hansenne, Catherine Lambert Published in the journal : February 2021 Category : Hémostase – Thrombose

The year 2020 was rich in developments and innovations in the field of thrombotic and hemorrhagic disorders. With respect to both its complex physiopathology and its multifaceted antithrombotic treatment, the coagulopathy linked to COVID-19 has aroused major interest that is far from being exhausted. Direct oral anticoagulants (DOACs) continue to be developed and validated, particularly in cancer-related venous thromboembolic diseases and for managing heparin-induced thrombocytopenia. The data on the DOAC use in early pregnancy appear reassuring. While these agents should indeed be avoided during pregnancy, the available data do not justify voluntary pregnancy termination as based on DOAC exposure alone. Mortality in catastrophic anti-phospholipid syndrome (CAPS) is likely to be significantly reduced when two antibodies, consisting of eculizumab and rituximab, are incorporated into the treatment regimen. As regards congenital hemophilia, the publication of new international recommendations by the World Federation of Hemophilia has attracted a great deal of attention, as have new therapeutic advances, including the validation of an ultra-long half-life FVIII concentrate (BIV001). Emicizumab is a bispecific antibody mimicking the action of FVIII that appears to be very promising. In addition to this drug’s use in managing congenital hemophilia A, it is also indicated in managing acquired hemophilia A.

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