Belgian Society Research Articles

Position statement on the management of the immune checkpoint inhibitor-induced colitis via multidisciplinary modified Delphi consensus

IntroductionThe use of immune checkpoint inhibitors (ICIs) in cancer immunotherapy has shown increased overall survival in a wide range of cancer types with the associated risk of developing severe immune-mediated adverse events, commonly involving the gastrointestinal tract. AimThe aim of this position statement is to provide an updated practice advice to the gastroenterologists and oncologists on the diagnosis and management of ICI-induced gastrointestinal toxicity. MethodologyThe evidence reviewed in this paper includes a comprehensive search strategy of English language publications. Consensus was reached using a three-round modified Delphi methodology and approved by the members of the Belgian Inflammatory Bowel Disease Research and Development Group (BIRD), Belgian Society of Medical Oncology (BSMO), Belgian group of Digestive Oncology (BGDO), and Belgian Respiratory Society (BeRS). ConclusionsThe management of ICI-induced colitis requires an early multidisciplinary approach. A broad initial assessment is necessary (clinical presentation, laboratory markers, endoscopic and histologic examination) to confirm the diagnosis. Criteria for hospitalisation, management of ICIs, and initial endoscopic assessment are proposed. Even if corticosteroids are still considered the first-line therapy, biologics are recommended as an escalation therapy and as early treatment in patients with high-risk endoscopic findings.

Assisted oocyte activation does not overcome recurrent embryo developmental problems.

Can recurrent embryo developmental problems after ICSI be overcome by assisted oocyte activation (AOA)? AOA did not improve blastocyst formation in our patient cohort with recurrent embryo developmental problems after ICSI. The use of AOA to artificially induce calcium (Ca2+) rises by using Ca2+ ionophores (mainly calcimycin and ionomycin) has been reported as very effective in overcoming fertilization failure after ICSI, especially in patients whose Ca2+ dynamics during fertilization are deficient. However, there is only scarce and contradictory literature on the use of AOA to overcome embryo developmental problems after ICSI, and it is not clear whether abnormal Ca2+ patterns during fertilization disturb human preimplantation embryo development. Moreover, poor embryo development after ICSI has also been linked to genetic defects in the subcortical maternal complex (SCMC) genes. This prospective cohort single-center study compared ICSI-AOA cycles and previous ICSI cycles in couples with normal fertilization rates (≥60%) but impaired embryonic development (≤15% blastocyst formation) in at least two previous ICSI cycles. In total, 42 couples with embryo developmental problems were included in this study from January 2018 to January 2021. Of the 42 couples included, 17 underwent an ICSI-AOA cycle consisting of CaCl2 injection and double ionomycin exposure. Fertilization, blastocyst development, pregnancy, and live birth rates after ICSI-AOA were compared to previous ICSI cycles. In addition, the calcium pattern induced by the male patient's sperm was investigated by mouse oocyte calcium analysis. Furthermore, all 42 couples underwent genetic screening. Female patients were screened for SCMC genes (TLE6, PADI6, NLRP2, NLRP5, NLRP7, and KHDC3L) and male patients were screened for the sperm-oocyte-activating factor PLCZ1. We compared 17 AOA cycles to 44 previous ICSI cycles from the same patient cohort. After AOA, a total fertilization rate of 68.95% (131/190), a blastocyst development rate of 13.74% (18/131), a pregnancy rate of 29.41% (5/17), and a live birth rate of 23.53% (4/17) were achieved, which was not different from the previous ICSI cycles (76.25% (321/421, P-value = 0.06); 9.35% (30/321, P-value = 0.18), 25.00% (11/44, P-value = 0.75), and 15.91% (7/44, P-value = 0.48), respectively). Calcium analysis showed that patient's sperm induced calcium patterns similar to control sperm samples displaying normal embryo developmental potential. Genetic screening revealed 10 unique heterozygous variants (in NLRP2, NLRP5, NLRP7, TLE6, and PADI6) of uncertain significance (VUS) in 14 females. Variant NLRP5 c.623-12_623-11insTTC (p.?) was identified in two unrelated individuals and variant NLRP2 c.1572T>C (p.Asp524=) was identified in four females. Interestingly, we identified a previously reported homozygous mutation PLCZ1, c.1499C>T (p.Ser500Leu), in a male patient displaying impaired embryonic development, but not showing typical fertilization failure. Our strict inclusion criteria, requiring at least two ICSI cycles with impaired embryo development, reduced cycle-to-cycle variability, while the requirement of a lower blastocyst development not influenced by a poor fertilization excluded couples who otherwise would be selective cases for AOA; however, these criteria limited the sample size of this study. Targeted genetic screening might be too restricted to identify a genetic cause underlying the phenotype of poor embryo development for all patients. Moreover, causality of the identified VUS should be further determined. Strong evidence for AOA overcoming impaired embryonic development is still lacking in the literature. Thus far, only one article has reported a beneficial effect of AOA (using calcimycin) compared to previous ICSI cycles in this patient population, whilst two more recent sibling-oocyte control studies (one using calcimycin and the other ionomycin) and our research (using ionomycin) could not corroborate these findings. Although no major abnormalities have been found in children born after AOA, this technique should be reserved for couples with a clear Ca2+-release deficiency. Finally, genetic screening by whole-exome sequencing may reveal novel genes and variants linked to embryo developmental problems and allow the design of more personalized treatment options, such as wild-type complementary RNA or recombinant protein injection. This study was supported by the Flemish Fund for Scientific Research (grant FWO.OPR.2015.0032.01 to B.H. and grant no. 1298722N to A.B.). A.C.B., D.B., A.B., V.T., R.P., F.M., I.D.C., L.L., D.S., P.D.S., P.C., and F.V.M. have nothing to disclose. B.H. reports a research grant from the Flemish Fund for Scientific Research and reports being a board member of the Belgian Society for Reproductive Medicine and the Belgian Ethical Committee on embryo research. NCT03354013.

Is het chinolonengebruik in België gedaald door de gewijzigde terugbetalingsvoorwaarden van 2018?

Has the use of quinolones in Belgium decreased due to the introduction of reimbursement conditions in 2018? The substantial adverse drug reactions and contribution to antimicrobial resistance of quinolones implore public health initiatives to restrict the usage of these antibiotics. One such initiative in Belgium was to only reimburse quinolones under stringent conditions from May 2018 onwards. In this article, the authors aim to assess the effectiveness of this policy by charting the evolution of quinolone use. This study is based on reimbursement data of quinolones delivered to members of the Christian health insurance fund (CM) in public pharmacies from May 1, 2016 to April 30, 2021. The variables of interest are the number of users and the volume in defined daily dose (DDD). Diagnostic data about members with approval for reimbursement were obtained from the database of the CM, containing authorisations of reimbursement. 19% to 28% of the authorisations were justified as ‘exceptional’ situations without any specific diagnosis. The number of users of reimbursed quinolones decreased by 75% immediately after the implementation of the policy, although a decrease of only 36% was observed in the overall use of quinolones (reconstructed by means of statistics provided by the Belgian society of public pharmacists (APB)). The reimbursement policy in 2018 induced a substantial decrease (75%) in the use of reimbursed quinolones, but also a considerable increase in the use of non-reimbursed quinolones. Although the overall use still has decreased remarkably (36%) since the policy, the decrease was insufficient to reduce the use of quinolones to the objective of 5% of all prescribed antibiotics. In order to keep the quinolone use within reasonable bounds, the authors encourage education of health practitioners, dialogue between medical actors and sensibilisation of users. In addition, this study draws attention to the need for publicly available data on both reimbursed and non-reimbursed medication.

Belgian Society of Cardiology 42nd Annual Congress

Belgian Society of Cardiology 42nd Annual Congress

Annual meeting of the Royal Belgian Society of Laboratory Medicine: “Men’s health”

Article Annual meeting of the Royal Belgian Society of Laboratory Medicine: “Men’s health” was published on February 1, 2023 in the journal Clinical Chemistry and Laboratory Medicine (CCLM) (volume 61, issue 3).

Abstracts presented at the 26th Annual Congress of the Belgian Society of Internal Medicine, 9-10 December 2022, Dolce La Hulpe, La Hulpe, Belgium

Abstracts presented at the 26th Annual Congress of the Belgian Society of Internal Medicine, 9-10 December 2022, Dolce La Hulpe, La Hulpe, Belgium

Survey regarding prevention of surgical site infection after orthopaedic surgery in Belgium: are we on the right track?

Prevention strategies are essential to reduce the rate of surgical site infection (SSI) in orthopaedic surgery. Members of the Royal Belgian Society for Orthopaedic Surgery and Traumatology (SORBCOT) and the Belgische Vereniging voor Orthopedie en Traumatologie (BVOT) were asked to answer a 28-question questionnaire on the internet about the application of surgical antimicrobial prophylaxis measures and to compare them with current inter- national recommendations. 228 practicing orthopedic surgeons responded to the survey from different regions (Flanders, Wallonia and Brussels), different hospitals (university, public and private), different levels of experience (< 5 years, 5 to 10 years and > 10 years) and different subspecialties (lower limb, upper limb and spine). Regarding the questionnaire: 7% systematically perform a dental check-up. 47.8% of the participants never carry out a urinalysis, 41.7% when the patient presents symptoms and 10.5% carry it out systematically. 2.6% systematically propose a pre-operative nutritional assessment. 5.3% of respondents suggest stopping biotherapies (Remicade®, Humira®, rituximab®, etc.) before an operation and 43.9% do not feel comfortable with this type of treatment. 47.1% suggest smoking cessation before the operation and 22% of them advise smoking cessation for a period of 4 weeks. 54.8% never carry out MRSA screening. 68.3% systematically per- formed hair removal, 18.5% when the patient had hirsutism. Among them, 17.7% use shaving with razors. Alcoholic Isobetadine is the most used product with 69.3% when disinfecting the surgical site. 42.1% of the surgeons chose a delay between the injection of antibiotic prophylaxis and the incision of less than 30 minutes, 55.7% between 30 and 60 minutes and 2.2% between 60 and 120 minutes. However, 44.7% did not wait for the injection time to be respected before incising. An incise drape is used in 79.8% of cases. The response rate was not influenced by the surgeon's experience. Most international recommendations in terms of prevention of surgical site infection are correctly applied. However, some bad habits are maintained. These include the use of shaving for depilation and the use of non-impregnated adhesive drapes. Practices that could be improved include management of treatment in patients with rheumatic diseases, a 4-week smoking cessation period, and treating positive urine tests only when symptomatic.

2022 Annual Meeting of the Belgian Society of Radiology (BRS) – Young Radiologist Section (YRS)

The annual meeting of the Belgian Society of Radiology (BSR) will take place on the 19th of November in the heart of Brussels at Passage 44. For the 8th time the BSR and the Young Radiologist Section (YRS) of the BSR are joining forces to organize an exciting and interesting day filled with high-quality educational lectures. This year’s topic will focus mainly on head and neck imaging, with a touch of neuroradiology.

Changes in anticancer treatment plans in patients with solid cancer hospitalized with COVID-19: analysis of the nationwide BSMO-COVID registry providing lessons for the future

Solid cancer is an independent prognostic factor for poor outcome with COVID-19. As guidelines for patient management in that setting depend on retrospective efforts, we here present the first analyses of a nationwide database of patients with cancer hospitalized with COVID-19 in Belgium, with a focus on changes in anticancer treatment plans at the time of SARS-CoV-2 infection. Nineteen Belgian hospitals identified all patients with a history of solid cancer hospitalized with COVID-19 between March 2020 and February 2021. Demographic, cancer-specific and COVID-specific data were pseudonymously entered into a central Belgian Society of Medical Oncology (BSMO)-COVID database. The association between survival and primary cancer type was analyzed through multivariate multinomial logistic regression. Group comparisons for categorical variables were carried out through a Chi-square test. A total of 928 patients were registered in the database; most of them were aged ≥70 years (61.0%) and with poor performance scores [57.2% Eastern Cooperative Oncology Group (ECOG) ≥2]. Thirty-day COVID-related mortality was 19.8%. In multivariate analysis, a trend was seen for higher mortality in patients with lung cancer (27.6% versus 20.8%, P= 0.062) and lower mortality for patients with breast cancer (13.0% versus 23.3%, P= 0.052) compared with other tumour types. Non-curative treatment was associated with higher 30-day COVID-related mortality rates compared with curative or no active treatment (25.8% versus 14.3% versus 21.9%, respectively, P < 0.001). In 33% of patients under active treatment, the therapeutic plan was changed due to COVID-19 diagnosis, most frequently involving delays/interruptions in systemic treatments (18.6%). Thirty-day COVID-related mortality was not significantly different between patients with and without treatment modifications (21.4% versus 20.5%). Interruption in anticancer treatments at the time of SARS-CoV-2 infection was not associated with a reduction in COVID-related mortality in our cohort of patients with solid cancer, highlighting that treatment continuation should be strived for, especially in the curative setting.

Current practice in antireflux and hiatal hernia surgery: exploration of the Belgian field

Background In Belgium, no publicly available information exists on the spread, quality, results nor follow-up of antireflux and hiatal hernia surgery, in contrast to the recently centralized esophageal cancer surgery. The aim of this study was to create a snap shot of the current practice in Belgium. Methods An online questionnaire was distributed among all members of the Royal Belgian Society for Surgery in autumn 2021. A total of 33 questions spread over four sections were asked, covering demographics, current practice (case load, case mix, indications, preoperative workup, patient information, average length of stay, follow up, quality of life (QOL)), operative techniques and future thoughts. Results Twenty-four surgeons completed the questionnaire. Surgical indications are discussed multidisciplinary and based on guidelines in 67%. Workup includes endoscopy, pH-monitoring and manometry in 100%. Barium swallow, impedance and gastric emptying tests were added in respectively 83%, 42% and 13%. Symptom or QOL scores were used in 17%. About 81% are performed as primary surgery, 18% redo surgery and 1% resections. Laparoscopic procedures are reported in 99%: Nissen(-Rosetti) 79%, Toupet/Lind 15%, partial gastrectomy 5% and Collis gastroplasty 1%. Discharge is planned on POD1 in 42% and on POD2 in 54%. 50% performs follow-up < 1 year. Interest in further clinical research collaboration was expressed in 92%. Conclusion Antireflux and hiatal hernia surgery is not standardized in Belgium. There is an evident variety in clinical practice, but this questionnaire shows similarity amongst respondents regarding workup and surgical approach. There is a willingness for future research collaborations.

Dappere Russen, wrede Chinezen en beate missionarissen

Brave Russians, cruel Chinese and pious missionaries. Yulij Lukyanovich Yelets and the phenomenon of illustrated lectures in the Belgian belle époque This contribution sheds light on the rhetorical use of the projection lantern in the Belgian public lecture circuit at the turn of the twentieth century by means of a microstoria. By analysing a lantern lecture delivered by the Russian writer and lieutenant colonel Yulij Lukyanovich Yelets (1862-1932), presented to the Royal Geographical Society of Antwerp (KAGA) on 9 October 1903, we question how Yelets’ public performance was rhetorically constructed through word and lantern images. Through an in-depth exploration of the social and intellectual biography of Yelets, insight is gained into how lecturers and organisations found each other in the Belgian belle époque, and what the underlying reasons for lantern performances like these might have been. The content of Yelets’ lecture concerned a topic that strongly touched on much more widely spread sentiments and sensitivities in Belgian society at the time, namely the Chinese Boxer Rebellion (1899-1901) and the related ‘yellow peril’. It will be argued that public illustrated lectures fulfilled an important social role in the communication of new ideas, knowledge, or, in the case of Yelets, popular geopolitical ideas and stereotypes. Public lectures were seldom at the basis of these popular or (scientific) ideas, but they did contribute, in their own way, to the public opinion surrounding them and to their broader dissemination and communication.

399. CURRENT PRACTICE IN ANTIREFLUX AND HIATAL HERNIA SURGERY: EXPLORATION OF THE BELGIAN FIELD

Abstract In Belgium no publicly available information exists on the spread, quality, results nor follow-up of antireflux and hiatal hernia surgery, in contrast to the recently centralized esophageal cancer surgery. However, in some countries a plea is rising to perform this benign esophageal surgery in high volume centers. The aim of this study was to create a snap shot of the current practice in Belgium. An online questionnaire was distributed among all members of the Royal Belgian Society for Surgery in autumn 2021. A total of 33 questions spread over four sections were asked, covering demographics, current practice (case load, case mix, indications for surgery, preoperative workup, patient information, average length of stay, follow up, quality of life (QOL)), operative techniques (approach, type of procedure, crural reinforcement) and future thoughts (opinion on the future of antireflux and hiatal hernia surgery in Belgium). Twenty-four surgeons completed the questionnaire. Surgical indications are discussed multidisciplinary and based on guidelines in 67%. Workup includes endoscopy, pH-monitoring and manometry in 100%. Barium swallow, impedance and gastric emptying tests were added in respectively 83%, 42% and 13%. Symptom or QOL scores were used in 17%. 81% are performed as primary surgery, 18% redo surgery and 1% resections. Laparoscopic procedures are reported in 99%: Nissen(−Rosetti) 79%, Toupet/Lind 15%, partial gastrectomy 5% and Collis gastroplasty 1%. Discharge is planned on POD1 in 42% and on POD2 in 54%. 50% performs follow-up &amp;lt;1 year. Interest in further clinical research collaboration was expressed in 92%. Antireflux and hiatal hernia surgery is not standardized in Belgium. There is an evident variety in clinical practice, but this questionnaire shows similarity amongst respondents regarding workup and surgical approach. Further research collaborations are possible in the future.

ESHRE survey results and good practice recommendations on managing chromosomal mosaicism.

How should ART/preimplantation genetic testing (PGT) centres manage the detection of chromosomal mosaicism following PGT? Thirty good practice recommendations were formulated that can be used by ART/PGT centres as a basis for their own policy with regards to the management of 'mosaic' embryos. The use of comprehensive chromosome screening technologies has provided a variety of data on the incidence of chromosomal mosaicism at the preimplantation stage of development and evidence is accumulating that clarifies the clinical outcomes after transfer of embryos with putative mosaic results, with regards to implantation, miscarriage and live birth rates, and neonatal outcomes. This document was developed according to a predefined methodology for ESHRE good practice recommendations. Recommendations are supported by data from the literature, a large survey evaluating current practice and published guidance documents. The literature search was performed using PubMed and focused on studies published between 2010 and 2022. The survey was performed through a web-based questionnaire distributed to members of the ESHRE special interest groups (SIG) Reproductive Genetics and Embryology, and the ESHRE PGT Consortium members. It included questions on ART and PGT, reporting, embryo transfer policy and follow-up of transfers. The final dataset represents 239 centres. The working group (WG) included 16 members with expertise on the ART/PGT process and chromosomal mosaicism. The recommendations for clinical practice were formulated based on the expert opinion of the WG, while taking into consideration the published data and results of the survey. Eighty percent of centres that biopsy three or more cells report mosaicism, even though only 66.9% of all centres have validated their technology and only 61.8% of these have validated specifically for the calling of chromosomal mosaicism. The criteria for designating mosaicism, reporting and transfer policies vary significantly across the centres replying to the survey. The WG formulated recommendations on how to manage the detection of chromosomal mosaicism in clinical practice, considering validation, risk assessment, designating and reporting mosaicism, embryo transfer policies, prenatal testing and follow-up. Guidance is also provided on the essential elements that should constitute the consent forms and the genetic report, and that should be covered in genetic counselling. As there are several unknowns in chromosomal mosaicism, it is recommended that PGT centres monitor emerging data on the topic and adapt or refine their policy whenever new insights are available from evidence. Rather than providing instant standardized advice, the recommendations should help ART/PGT centres in developing their own policy towards the management of putative mosaic embryos in clinical practice. This document will help facilitate a more knowledge-based approach for dealing with chromosomal mosaicism in different centres. In addition to recommendations for clinical practice, recommendations for future research were formulated. Following up on these will direct research towards existing research gaps with direct translation to clinical practice. Emerging data will help in improving guidance, and a more evidence-based approach of managing chromosomal mosaicism. The WG received technical support from ESHRE. M.D.R. participated in the EQA special advisory group, outside the submitted work, and is the chair of the PGT WG of the Belgian society for human genetics. D.W. declared receiving salary from Juno Genetics, UK. A.C. is an employee of Igenomix, Italy and C.R. is an employee of Igenomix, Spain. C.S. received a research grant from FWO, Belgium, not related to the submitted work. I.S. declared being a Co-founder of IVFvision Ltd, UK. J.R.V. declared patents related to 'Methods for haplotyping single-cells' and 'Haplotyping and copy number typing using polymorphic variant allelic frequencies', and being a board member of Preimplantation Genetic Diagnosis International Society (PGDIS) and International Society for Prenatal Diagnosis (ISPD). K.S. reported being Chair-elect of ESHRE. The other authors had nothing to disclose. This Good Practice Recommendations (GPR) document represents the views of ESHRE, which are the result of consensus between the relevant ESHRE stakeholders and are based on the scientific evidence available at the time of preparation. ESHRE GPRs should be used for information and educational purposes. They should not be interpreted as setting a standard of care or be deemed inclusive of all proper methods of care, or be exclusive of other methods of care reasonably directed to obtaining the same results. They do not replace the need for application of clinical judgement to each individual presentation, or variations based on locality and facility type. Furthermore, ESHRE GPRs do not constitute or imply the endorsement, or favouring, of any of the included technologies by ESHRE.

Impact Factor JUMPS After the 2020 COVID-19 Pandemic: A Retrospective Study in Radiology, Nuclear Medicine & Medical Imaging Journals.

One of the most widely applied methods for evaluating a research paper's quality is the impact factor (IF). The term JUMPS was applied to the IF in an article published in PubMed in 2021, describing an increase of more than 40% of IF. In this study, we aimed to compare the growth rate of IF JUMPS in Radiology, Nuclear Medicine & Medical Imaging in the last 6 years. This retrospective study calculated the growth rate (JUMP) in IF from 2015 to 2020. We used the Friedman and Wilcoxon signed ranks tests to calculate the statistically significant difference in IF from 2015 to 2020 and the 2019 to 2020 difference. We classified JUMPS in negative growth rate, quartiles, and journals with >100%. Three journals had more than 100% IF growth rate during 2020 ( Zeitschrift fur Medizinische Physik , Journal of the Belgian Society of Radiology , and Ultrasound Quarterly ). A 76% to 100% growth rate was observed in another 4 journals (3.2%), and 8 journals (6.3%) depicted a 51% to 75% percentage of change. Repeated measures analyses showed a significant difference ( P < 0.001). During the COVID-19 pandemic, several journals in the Radiology, Nuclear Medicine & Medical Imaging category increased their IF by 50%. Knowing the growing trends in this category might supplement the assessment of target journals for authors looking to submit their works.

PRECISION: the Belgian molecular profiling program of metastatic cancer for clinical decision and treatment assignment

PRECISION is an initiative from the Belgian Society of Medical Oncology (BSMO) in collaboration with several stakeholders, encompassing four programs that aim to boost genomic and clinical knowledge with the ultimate goal to offer patients with metastatic solid tumors molecularly guided treatments. The PRECISION 1 study has led to the creation of a clinico-genomic database. The Belgian Approach for Local Laboratory Extensive Tumor Testing (BALLETT) and GeNeo studies will increase the number of patients with advanced cancer that have comprehensive genotyping of their cancer. The PRECISION 2 project consists of investigator-initiated phase II studies aiming to provide access to a targeted drug for patients whose tumors harbor actionable mutations in case the matched drug is not available through reimbursement or clinical trials in Belgium.

Editorial introductions.

Editorial introductions.

Endocrine outcome and seminal parameters in young adult men born with hypospadias: A cross-sectional cohort study.

SummaryBackgroundHypospadias affects around 1/200 newborn males. Intrauterine testicular dysfunction may underlie a subset of cases. The long-term endocrine and reproductive outcomes in these men remain largely unknown.MethodsCross-sectional study in Ghent and Vienna University Hospitals to assess the endocrine and seminal parameters of young adult men (16–21 years) born with non-syndromic hypospadias (NSH) (n = 193) compared to healthy typical males (n = 50). Assessments included physical exam, semen analysis, hormone assays and exome-based gene panel analysis (474 genes).FindingsAll participants had experienced a spontaneous puberty, in spite of higher LH and INSL3 levels than typical males. Oligo- or azoospermia was observed in 32/172 (18·6%; 99%-CI: 12·2–27·4%) of NSH men; but in 5/16 (31·3%; 99%-CI: 11·1;62·4%) of complex NSH men and in 13/22 (59·1%; 99%-CI: 33·2–80·7%) of those born small for gestational age (SGA). No (likely) pathogenic coding variants were found in the investigated genes. Suboptimal statural growth affected 8/23 (34·8%; 99%-CI: 15·4–61·0%) of men born SGA with NSH.InterpretationSpermatogenesis is significantly compromised in NSH men, especially in those born SGA or those with complex NSH. Long-term andrological follow-up is recommended, including end-pubertal semen analysis. No clear monogenic causes could be demonstrated in our cohort even in proximal or complex NSH. Being born SGA with NSH is frequently associated with poor catch-up growth, requiring growth hormone therapy in some.FundingResearch grants from the European Society of Paediatric Endocrinology, the Belgian Society of Pediatrics, the Belgian Society of Pediatric Endocrinology and Diabetology and the Research Foundation Flanders (FWO).

662-P: Glycemic Variability Patterns Strongly Correlate with Partial Remission Status in Children with Newly Diagnosed Type 1 Diabetes

Residual β-cell secretion is commonly used as primary endpoint of β-cell mass prevention trials. Recently, peak C-peptide was challenged as a clinically relevant marker of β-cell function considering its poor integration of insulin sensitivity and β-cell glucose responsiveness. In our DIATAG study, we evaluated the correlations between metrics of glycemic variability (GV) and markers of diabetes control (i.e. A1C, insulin daily dose, insulin dose-adjusted A1C [IDAA1C]) to identify whether GV indexes may overcome residual β-cell secretion estimates (BSE) in the evaluation of glucose homeostasis during the first year of type 1 diabetes (e.g. remission period) . Data from 78 new-onset type 1 diabetes pediatric patients were collected from diabetes onset (Δ) and cross-sectionally compared using adjusted mixed-effects models at Δ+3, +12 months for BSE (n=119) and Δ+3, +6, +9, +12 months for glucose control and CGM metrics (n=169) . BSE demonstrated weak-to-moderate correlations with clinical parameters and CGM metrics (r2= 0.05-0.25; p&amp;lt;0.05) . CGM metrics strongly correlated with clinical parameters (r2 &amp;gt;0.52; p&amp;lt;0.05) and were sufficient to distinguish remitters from non-remitters (i.e. IDAA1C respectively &amp;lt;9 or ≥9) . Moreover, CGM metrics from remitters exhibited specific nycthemeral patterns characterized by increased glycemic stability (in 63-160 mg/dL range) across days in the early morning period and decreased grade II hypoglycemia during the day (p&amp;lt;0.01) . Using hierarchical clustering on 46 CGM metrics and clinical parameters (n=169) , we identified four unique glucotypes (p&amp;lt;0.001) during the first year of diabetes that allowed better segregation of intermediate values of IDAA1C from Δ+3 months (38% in Group 1, 26% in Group 2, 29% in Group 3, 7% in Group 4) . We conclude that a combination of CGM metrics and clinical parameters unraveled key clinical milestones of glucose homeostasis and remission status during the first year of type 1 diabetes. Disclosure O.G. Polle: None. A.A. Delfosse: None. M. Martin: None. I. Gies: None. M. Iebrethon: None. J. Louis: None. N. Seret: None. L. Gatto: None. Funding Fond National de la Recherche Scientifique (FRIA grant, FSR starting grant) Belgian Society for Pediatric Endocrinology and Diabetology (BESPEED) Société Francophone du Diabète (SFD)

Catholic Charity and Public Poor Relief in Nineteenth-century Belgium: Reconquest, Competition, Complementarity, Superiority

Abstract The compatibility of public poor relief with private, in particular faith-based, charity is a long-debated issue. Our contribution offers a historical reflection by analysing the evolving discourses of Catholic charity in nineteenth-century Belgium. We highlight its somewhat ambiguous self-imagery and evaluate its (un)willingness to cooperate with official provisions. Belgian Catholics at first sought to complement and even to infiltrate the public structures created under French rule, but rising ideological tensions on the issue in Belgian society from 1850 onwards made them realise that the clock couldn’t be turned back. A further expansion or more pronounced agency of public provisions, however, was considered unwanted and unnecessary. The Belgian Church eagerly defended the pre-eminence of private charity provisions, considering them to be more community-embedded, encompassing, efficient, flexible and innovative. Religious charity was portrayed as morally pre-eminent, much more committed and interpersonal, with strong connotations of vocation, pastorate, penance and salvation emerging from its transcendental perspective. Given this mindset, it was far from self-evident that a division of tasks with public poor relief should be sought. While nineteenth-century Belgian Catholics repeatedly made public appeals for pragmatism and cooperation, the continued expansion of their charitable networks and the associated discourses reveal an inherently competitive strategy and a continuous, even growing conviction that upheld the superiority of private initiative.

Belgian Society of Cardiology 41st Annual Congress

Belgian Society of Cardiology 41st Annual Congress