Jan Deprest

University of Leuven, Louvain, Flanders, Belgium

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Publications (765)2606.16 Total impact

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    ABSTRACT: The use of robot-assisted surgery (RAS) has gained popularity in the field of gynaecology, including pelvic floor surgery. To assess the benefits of RAS, we conducted a systematic review of randomized controlled trials comparing laparoscopic and robotic-assisted sacrocolpopexy. The Cochrane Library (1970–January 2015), MEDLINE (1966 to January 2015), and EMBASE (1974 to January 2015) were searched, as well as ClinicalTrials.gov and the International Clinical Trials Registry Platform. We identified two randomized trials (n = 78) comparing laparoscopic with robotic sacrocolpopexy. The Paraiso 2011 study showed that laparoscopic was faster than robotic sacrocolpopexy (199 ± 46 vs. 265 ± 50 min; p < .001), yet in the ACCESS trial, no difference was present (225 ± 62.3 vs. 246.5 ± 51.3 min; p = .110). Costs for using the robot were significantly higher in both studies, however, in the ACCESS trial, only when purchase and maintenance of the robot was included (LSC US$11,573 ± 3191 vs. RASC US$19,616 ± 3135; p < .001). In the Paraiso study, RASC was more expensive even without considering those costs (LSC US$ 14,342 ± 2941 vs. RASC 16,278 ± 3326; p = 0.008). Pain was reportedly higher after RASC, although at different time points after the operation. There were no differences in anatomical outcomes, pelvic floor function, and quality of life. The experience with RASC was tenfold lower than that with LSC in both studies. The heterogeneity between the two studies precluded a meta-analysis. Based on small randomized studies, with surgeons less experienced in RAS than in laparoscopic surgery, robotic surgery significantly increases the cost of a laparoscopic sacrocolpopexy. RASC would be more sustainable if its costs would be lower. Though RASC may have other benefits, such as reduction of the learning curve and increased ergonomics or dexterity, these remain to be demonstrated.
    No preview · Article · Jan 2016 · Gynecological Surgery
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    ABSTRACT: Congenital diaphragmatic hernia (CDH) is a malformation leading to pulmonary hypoplasia which can be treated in utero by fetal tracheal occlusion (TO). However the changes of gene expression induced by TO remain largely unknown but could be used to further improve the clinically used prenatal treatment of this devastating malformation. Therefore we aimed to investigate the pulmonary transcriptome changes due to surgical induction of diaphragmatic hernia (DH) and additional tracheal occlusion in the fetal rabbit model.Induction of DH was associated with 378 up-regulated genes compared to controls when allowing a false discovery rate (FDR) of 0.1 and a Fold Change (FC) of 2. Those genes were again down-regulated by consecutive TO. But DH+TO was associated with an up-regulation of 157 genes compared to DH and controls. When being compared to control lungs, 106 genes were down-regulated in the DH group and were not changed by TO. Therefore, the overall pattern of gene expression in DH+TO is more similar to the control group then to the DH group. In this study we further provide a database of gene expression changes induced by surgical creation of DH and consecutive TO in the rabbit model. Future treatment strategies could be developed using this dataset. We also discuss the most relevant genes that are involved in CDH.
    Preview · Article · Jan 2016 · Disease Models and Mechanisms
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    ABSTRACT: The fetal central nervous system can already be examined in the first trimester of pregnancy. Acrania, alobar holoprosencephaly, cephaloceles and spina bifida can confidently be diagnosed at that stage and should actively be looked for in every fetus undergoing first trimester ultrasound. For some other conditions, such as vermian anomalies and agenesis of the corpus callosum, markers have been identified, but the diagnosis can only be confirmed in the second trimester of gestation. For these conditions, data on sensitivity and more importantly specificity and false positives, are lacking and one should therefore be aware not to falsely reassure or scare expecting parents based on first trimester findings. This review summarizes the current knowledge of first trimester neurosonography in the normal and abnormal fetus and gives an overview of which diseases can be diagnosed. This article is protected by copyright. All rights reserved.
    No preview · Article · Jan 2016 · Prenatal Diagnosis
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    ABSTRACT: Introduction In this pooled study, we focused on the population pharmacokinetic profile of intravenous paracetamol metabolism and its covariates in young women, including during pregnancy and postpartum. Methods Population PK parameters using non-linear mixed effect modelling were estimated in a pooled dataset of plasma and urine PK studies in 69 young women [47 at delivery, 8/47 again 10–15 weeks after delivery (early postpartum), and 7/8 again one year after delivery (late postpartum), 22 healthy female volunteers with or without oral contraceptives]. Results Population PK parameters were estimated based on 815 plasma samples and 101 urine collections. Compared to healthy female volunteers (reference group) not on oral contraceptives, being at delivery was the most significant covariate for clearance to paracetamol glucuronide (F=2.03), while women in early postpartum had decreased paracetamol glucuronidation clearance (F=0.55). Women on contraceptives showed increased paracetamol glucuronidation clearance (F=1.46). The oestradiol level did not further affected this model. Being at delivery did not prove significant for clearance to paracetamol sulphate, but was higher in pregnant women who delivered preterm (<37 weeks, F=1.34) compared to term delivery and non-pregnant women. Finally, clearance of unchanged paracetamol was dependent on urine flow rate. Conclusions Compared to healthy female volunteers, the urine paracetamol glucuronidation elimination in young women is affected by pregnancy (higher), early postpartum (lower) or exposure to oral contraceptives (higher). This may be of relevance to predict variability in glucuronidation activity in young women and to predict fetal exposure to paracetamol and its metabolites.
    No preview · Article · Jan 2016 · Archives of Disease in Childhood

  • No preview · Article · Jan 2016 · Prenatal Diagnosis

  • No preview · Chapter · Dec 2015
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    Full-text · Dataset · Dec 2015
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    Full-text · Dataset · Dec 2015
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    Full-text · Dataset · Dec 2015
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    ABSTRACT: Background: There is relevant between individual variability in paracetamol clearance in young women. In this pooled study, we focused on the population pharmacokinetic profile of intravenous paracetamol metabolism and its covariates in young women. Methods: Population PK parameters using non-linear mixed effect modelling were estimated in a pooled dataset of plasma and urine PK studies in 69 young women [47 at delivery, 8/47 again 10-15 weeks after delivery (early postpartum), and 7/8 again 1 year after delivery (late postpartum), 22 healthy female volunteers with or without oral contraceptives]. Results: Population PK parameters were estimated based on 815 plasma samples and 101 urine collections. Compared to healthy female volunteers (reference group) not on oral contraceptives, being at delivery was the most significant covariate for clearance to paracetamol glucuronide (Factor = 2.03), while women in early postpartum had decreased paracetamol glucuronidation clearance (Factor = 0.55). Women on contraceptives showed increased paracetamol glucuronidation clearance (Factor = 1.46). The oestradiol level did not further affect this model. Being at delivery did not prove significant for clearance to paracetamol sulphate, but was higher in pregnant women who delivered preterm (<37 weeks, Factor = 1.34) compared to term delivery and non-pregnant women. Finally, clearance of unchanged paracetamol was dependent on urine flow rate. Conclusions: Compared to healthy female volunteers not on oral contraceptives, urine paracetamol glucuronidation elimination in young women is affected by pregnancy (higher), early postpartum (lower) or exposure to oral contraceptives (higher), resulting in at least a two fold variability in paracetamol clearance in young women.
    Preview · Article · Nov 2015 · BMC Anesthesiology

  • No preview · Article · Nov 2015 · Zeitschrift für Geburtshilfe und Neonatologie

  • No preview · Article · Nov 2015 · Zeitschrift für Geburtshilfe und Neonatologie
  • A Engels · M Carlon · L Joyeux · B Mori · W Merckx · J Deprest

    No preview · Article · Nov 2015 · Zeitschrift für Geburtshilfe und Neonatologie
  • Julio Jimenez · Jute Richter · Jaan Toelen · Jan Deprest
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    ABSTRACT: Objective: The objective of this study is to identify and systematically review in vivo animal studies on antenatal medical interventions to prevent bronchopulmonary dysplasia. Methods: An automated literature search was conducted using MEDLINE (Pubmed) and Embase including all studies using Medical Subject Headings (MeSH) and keywords following a step-by-step approach. All in vivo prenatal intervention studies in animal models mimicking key aspects of the pathophysiology of bronchopulmonary dysplasia were included. In view of relevance of the findings, an additional criterion was that outcomes at 48 h of life or beyond were available. The PRISMA statement concerning systemic reviews was applied and a quality checklist developed by the CAMARADES group was used. Results: In total, 518 abstracts were identified yet only eight studies were eligible for further analysis. Four studies involved administration of glucocorticoids, the other studies described therapy with epidermal growth factor, interleukin 1b, beta-naphthoflavone, or vitamin D. Outcomes were survival, pulmonary histology, lung function, and/or biochemical analysis. Conclusions: Though many in vivo experimental studies in animal models for bronchopulmonary dysplasia have been done, only few have looked into the effect of prenatal interventions and measured outcomes after at least 48 h of life. Most involve the use of antenatal glucocorticoids, although still only four.
    No preview · Article · Oct 2015 · Journal of Maternal-Fetal and Neonatal Medicine
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    ABSTRACT: Image guidance plays a central role in minimally invasive fetal surgery such as photocoagulation of inter-twin placental anasto-mosing vessels to treat twin-to-twin transfusion syndrome (TTTS). Fe-toscopic guidance provides insufficient sensitivity for imaging the vascu-lature that lies beneath the fetal placental surface due to strong light scattering in biological tissues. Incomplete photocoagulation of anasta-moses is associated with postoperative complications and higher perinatal mortality. In this study, we investigated the use of multi-spectral photoacoustic (PA) imaging for better visualization of the placental vas-culature. Excitation light was delivered with an optical fiber with dimensions that are compatible with the working channel of a fetoscope. Imaging was performed on an ex vivo normal term human placenta collected at Caesarean section birth. The photoacoustically-generated ultrasound signals were received by an external clinical linear array ultrasound imaging probe. A vein under illumination on the fetal placenta surface was visualized with PA imaging, and good correspondence was obtained between the measured PA spectrum and the optical absorption spectrum of deoxygenated blood. The delivery fiber had an attached fiber optic ultrasound sensor positioned directly adjacent to it, so that its spatial position could be tracked by receiving transmissions from the ultrasound imaging probe. This study provides strong indications that PA imaging in combination with ultrasonic tracking could be useful for detecting the human placental vasculature during minimally invasive fetal surgery.
    Full-text · Article · Oct 2015 · Lecture Notes in Computer Science
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    ABSTRACT: Segmentation of the placenta from fetal MRI is critical for planning of fetal surgical procedures. Unfortunately, it is made difficult by poor image quality due to sparse acquisition, inter-slice motion, and the widely varying position and orientation of the placenta between pregnant women. We propose a minimally interactive online learning-based method named Slic-Seg to obtain accurate placenta segmentations from MRI. An online random forest is first trained on data coming from scribbles provided by the user in one single selected start slice. This then forms the basis for a slice-by-slice framework that segments subsequent slices before incorporating them into the training set on the fly. The proposed method was compared with its offline counterpart that is with no retraining, and with two other widely used interactive methods. Experiments show that our method 1) has a high performance in the start slice even in cases where sparse scribbles provided by the user lead to poor results with the competitive approaches, 2) has a robust segmentation in subsequent slices, and 3) results in less variability between users.
    Full-text · Conference Paper · Oct 2015
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    ABSTRACT: Objective: We first aimed to investigate in vivo thrombin generation induced by fetoscopy, and second we used term membrane explants for measurement of thrombin generation, thrombin receptor location and induction of selected matrix metalloproteinases (MMPs) in tissue culture. Materials and methods: In vivo study (37 cases): samples of amniotic fluid were taken at the beginning and end of fetoscopy (mean gestational age 26.7 weeks) and analyzed by ELISA for thrombin-antithrombin complexes. In vitro study: fetal membranes were put in culture and punctured for measurement of thrombin generation by calibrated automated thrombography and ELISA. Induction of MMP-9 and MMP-2 was analyzed by zymography. PAR-1 was localized by immunohistochemistry. Results: No significant increase in thrombin-antithrombin was measured in amniotic fluid obtained during fetoscopy. In vitro, thrombin generation induced by needle trauma of membrane cultures is correlated to the amount of plasma. Activity of MMP-9 but not MMP-2 was elevated in cultured membranes but could not be inhibited by a thrombin inhibitor. On histology, the thrombin receptor PAR-1 was located in the chorion and decidua, but not in the amnion. Discussion: Despite the influence of thrombin on punctured fetal membranes in vitro, the role of thrombin in iatrogenic preterm premature rupture of membranes is questionable.
    No preview · Article · Oct 2015 · Fetal Diagnosis and Therapy

  • No preview · Article · Oct 2015 · Journal of Pediatric Gastroenterology and Nutrition
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    ABSTRACT: Objectives: Mesenchymal stem cells derived from human amniotic fluid (hAFSCs) are a promising source for cellular therapy, especially for renal disorders, as a subpopulation is derived from the fetal urinary tract. The purpose of this study was to evaluate if hAFSCs with a renal progenitor phenotype demonstrate a nephroprotective effect in acute ischemia reperfusion (I/R) model and prevent late stage fibrosis. Methods: A total of 45 male 12-wk-old Wistar rats were divided into three equal groups;: rats subjected to I/R injury and treated with Chang Medium, rats subjected to I/R injury and treated with hAFSCs and sham-operated animals. In the first part of this study, hAFSCs that highly expressed CD24, CD117, SIX2 and PAX2 were isolated and characterized. In the second part, renal I/R injury was induced in male rats and cellular treatment was performed 6 hours later via arterial injection. Functional and histological analyses were performed 24 hours, 48 hours and 2 months after treatment using serum creatinine, urine protein to creatinine ratio, inflammatory and regeneration markers and histomorphometric analysis of the kidney. Statistical analysis was performed by analysis of variance followed by the Tukey's test for multiple comparisons or by nonparametric Kruskal-Wallis followed by Dunn. Statistical significance level was defined as p <0.05. Results: hAFSCs treatment resulted in significantly reduced serum creatinine level at 24 hours, less tubular necrosis, less hyaline cast formation, higher proliferation index, less inflammatory cell infiltration and less myofibroblasts at 48h. The treated group had less fibrosis and proteinuria at 2 months after injury. Conclusion: hAFSCs contain a renal progenitor cell subpopulation that has a nephroprotective effect when delivered intra-arterially in rats with renal I/R injury, and reduces interstitial fibrosis on long term follow-up.
    Full-text · Article · Sep 2015 · PLoS ONE
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    ABSTRACT: Lung hypoplasia in congenital diaphragmatic hernia (CDH) is a life-threatening birth defect. Severe cases can be offered tracheal occlusion to boost prenatal lung development, though defining those to benefit remains challenging. Metabonomics of 1H NMR spectra collected from amniotic fluid (AF) can identify general changes in diseased versus healthy fetuses. AF contains lung secretions, hence, might reflect pulmonary characteristics among general markers of disease in CDH fetuses. AF from 81 healthy and 22 CDH fetuses was collected. NMR spectroscopy was performed at 400 MHz to compare AF from fetuses with CDH against controls. Several advanced feature extraction methods based on statistical tests which explore spectral variability, similarity and dissimilarity were applied and compared. This resulted in the identification of 30 spectral regions, which accounted for 80% variability between CDH and controls. Combination with automated classification discriminates AF from CDH versus healthy fetuses with 86% accuracy. Within the identified spectral regions isoleucine, leucine, valine, pyruvate, GABA, glutamate, glutamine, citrate, creatine, creatinine, taurine and glucose were the most concentrated metabolites. As the metabolite pattern of AF changes with fetal development, we have excluded metabolites with a high age-related variability and repeated the analysis with twelve spectral regions, which has resulted in similar classification accuracy. From this analysis, it was possible to distinguish between AF from fetuses with CDH from healthy controls independent of gestational age dependent metabolic changes.
    No preview · Article · Sep 2015 · Journal of Proteome Research

Publication Stats

12k Citations
2,606.16 Total Impact Points

Institutions

  • 1995-2015
    • University of Leuven
      • • Department of Development and Regeneration
      • • Faculty of Medicine
      • • Department of Human Genetics
      Louvain, Flanders, Belgium
    • Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center
      Torrance, California, United States
  • 1970-2015
    • Universitair Ziekenhuis Leuven
      • Department of Gynaecology and obstetrics
      Louvain, Flanders, Belgium
  • 2000-2014
    • The Catholic University of America
      Washington, Washington, D.C., United States
  • 2009-2012
    • Catholic University of Louvain
      Лувен-ла-Нев, Walloon, Belgium
    • University of Leipzig
      • Klinik und Poliklinik für Kinderchirurgie
      Leipzig, Saxony, Germany
    • Leiden University
      Leyden, South Holland, Netherlands
  • 1999-2012
    • Universitair Ziekenhuis Ghent
      Gand, Flemish, Belgium
  • 2010
    • Cliniques Universitaires Saint-Luc
      • Division of Obstetrics
      Bruxelles, Brussels Capital Region, Belgium
  • 2007-2009
    • Hospital Clínic de Barcelona
      • Servicio de Medicina Materno Fetal
      Barcino, Catalonia, Spain
    • King's College Hospital NHS Foundation Trust
      Londinium, England, United Kingdom
    • University of Amsterdam
      Amsterdamo, North Holland, Netherlands
  • 2008
    • Leiden University Medical Centre
      • Department of Pediatrics
      Leyden, South Holland, Netherlands
    • St. Michael's Hospital
      Toronto, Ontario, Canada
    • University of Maryland, Baltimore
      Baltimore, Maryland, United States
  • 2006-2007
    • King's College London
      • Division of Asthma, Allergy and Lung Biology
      Londinium, England, United Kingdom
    • University of Glasgow
      Glasgow, Scotland, United Kingdom
    • University of Texas Health Science Center at San Antonio
      • Department of Obstetrics and Gynecology
      San Antonio, Texas, United States
    • University of Cincinnati
      Cincinnati, Ohio, United States
  • 2005
    • University of Zurich
      Zürich, Zurich, Switzerland
    • University Hospital Vall d'Hebron
      Barcino, Catalonia, Spain
  • 2001-2005
    • ՊԵՐԻՆԱՏՈԼՈԳԻԱՅԻ, ՄԱՆԿԱԲԱՐՁՈՒԹՅԱՆ ԵՎ ԳԻՆԵԿՈԼՈԳԻԱՅԻ ԻՆՍՏԻՏՈՒՏ
      Ayrivan, Yerevan, Armenia
  • 2004
    • Hannover Medical School
      Hanover, Lower Saxony, Germany
    • Wayne State University
      • Department of Obstetrics and Gynecology
      Detroit, Michigan, United States
    • University of Massachusetts Boston
      Boston, Massachusetts, United States
  • 1995-2004
    • Universitair Psychiatrisch Centrum KU Leuven
      Cortenberg, Flanders, Belgium
  • 2003
    • Fukushima Medical University
      Hukusima, Fukushima, Japan
    • Boston University
      Boston, Massachusetts, United States
    • Harbor-UCLA Medical Center
      Torrance, California, United States
  • 2002
    • The University of Edinburgh
      Edinburgh, Scotland, United Kingdom
  • 1998
    • Universität Bremen
      Bremen, Bremen, Germany
    • McGill University
      • Department of Surgery
      Montréal, Quebec, Canada
  • 1997
    • West Georgia Obstetrics and Gynecology
      Georgetown, Georgia, United States
  • 1996
    • Rhode Island Hospital
      Providence, Rhode Island, United States