Malignant epithelial tumors (carcinomas) are the most common ovarian cancers and also the most lethal gynecological malignancies. Based on histopathology and molecular genetic alterations, ovarian ...carcinomas are divided into five main types high-grade serous (70%), endometrioid (10%), clear-cell (10%), mucinous (3%), and low-grade serous carcinomas (<5%) that account for over 95% of cases. These types are essentially distinct diseases, as indicated by differences in epidemiological and genetic risk factors, precursor lesions, patterns of spread, and molecular events during oncogenesis, response to chemotherapy, and prognosis. For a successful specific treatment, reproducible histopathological diagnosis of the tumor cell type is critical. The five tumor types are morphologically diverse and resemble carcinomas of the uterus. Actually, recent investigations have demonstrated that a substantial number of cancers, traditionally thought to be primary ovarian tumors (particularly serous, endometrioid, and clear-cell carcinomas), originate in the fallopian tube and the endometrium and involve the ovary secondarily. This presentation summarizes recent advances in the molecular pathology which have greatly improved our understanding of the biology of ovarian carcinoma and are also relevant to patient management.
Nocardia, a Gram-positive bacterium, is responsible for rare and severe infections. Accurate microbiological data are essential to guide antibiotic treatment. Our primary objective was to describe ...species identification and results of antimicrobial susceptibility testing (AST) for Nocardia isolates analysed over a 6-year period. Secondary objectives were to study temporal trends in species distribution and AST results.
We retrospectively analysed results from Nocardia isolates sent between January 2010 and December 2015 to a French laboratory dedicated to Nocardia (Observatoire Français des Nocardioses). Species identification was obtained by amplification and sequencing of a 600-bp fragment of the 16S rRNA gene (for all isolates) and of hsp65 (when required). AST was performed using disk diffusion.
We included 793 Nocardia isolates, mostly from the lungs (53.8%). The most frequent species were Nocardia farcinica (20.2%), Nocardia abscessus complex (19.9%) and Nocardia nova complex (19.5%). The proportion of N. farcinica increased significantly over time from 13% in 2010 to 27.6% in 2014. Linezolid, amikacin, trimethoprim-sulfamethoxazole, minocycline and imipenem were the most frequently identified active antibiotics with, respectively, 0% (0/734), 2.9% (21/730), 5.4% (40/734), 9.4% (69/734) and 19.5% (143/732) of isolates not susceptible. Nocardia farcinica was frequently not susceptible to cefotaxime (118/148, 79.7% of the isolates), but only about 5% of Nocardia cyriacigeorgica and N. abscessus complex isolates were not susceptible to cefotaxime.
In this first epidemiological study of Nocardia isolated from human samples in France, N. farcinica was the species most frequently identified and its prevalence increased over time.
Hemorrhage is the leading cause of death in severe trauma injuries. When organs or tissues are subjected to prolonged hypoxia, danger signals-known as damage-associated molecular patterns (DAMPs)-are ...released into the intercellular environment. The endothelium is both the target and a major provider of damage-associated molecular patterns, which are directly involved in immuno-inflammatory dysregulation and the associated tissue suffering. Although damage-associated molecular patterns release begins very early after trauma, this release and its consequences continue beyond the initial treatment. Here we review a few examples of damage-associated molecular patterns to illustrate their pathophysiological roles, with emphasis on emerging therapeutic interventions in the context of severe trauma. Therapeutic intervention administered at precise points during damage-associated molecular patterns release may have beneficial effects by calming the inflammatory storm triggered by traumatic hemorrhagic shock.
Chagas disease has been increasingly diagnosed in non-endemic countries. This is a prospective observational study performed at the Tropical Medicine Units of the International Health Program of the ...Catalan Health Institute, Barcelona (PROgrama de Salud Internacional del Instituto Catalán de la Salud, PROSICS Barcelona, Spain), that includes all patients with Chagas disease who attended from June 2007 to May 2012. Clinical and epidemiological data were collected. Overall, 1274 patients were included, the mean age of the patients was 37.7 years, 67.5% were women and 97% came from Bolivia. Thirteen patients had immunosuppressive conditions. The prevalence of cardiac involvement was 16.9%, lower than in previous studies performed in endemic areas (20–60%). Cardiac alterations were found in 33.8% of symptomatic and 14.1% of asymptomatic patients. The prevalence of digestive involvement was 14.8%. The rate of digestive involvement is very different among previous studies because of different diagnostic tools and strategies used. Barium enema alterations were found in 21.4% of symptomatic and 10.3% of asymptomatic patients, and oesophageal alterations were found in 3.7% of symptomatic and in 2.3% of asymptomatic patients. As shown in previous studies, Chagas disease in non-endemic countries affects younger patients and has lower morbidity.
Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an innovative procedure in the treatment of noncompressible truncal hemorrhage. However, readily available fluoroscopy remains a ...limiting factor in its widespread implementation. Several methods have been proposed to perform REBOA without fluoroscopic guidance, and these methods were adapted predominantly from the military theater.
To develop a method for performing REBOA in a civilian population using a standardized distance from a set point of entry.
A retrospective study of whole-body computed tomographic (CT) scans from a cohort of 280 consecutive civilian trauma patients from University Hospitals of Lyon, France, was used to calculate the endovascular distances from both femoral arteries at the level of the upper border of the symphysis pubis to aortic zone I (descending thoracic aorta) and zone III (infrarenal aorta). These whole-body CT scans were performed between 2013 and 2015. Data were analyzed from July 16 to December 7, 2015.
Two segments (1 per zone) common to all CT scans were isolated, and their location, length, prevalence in the cohort, and predicted prevalence in the general population were calculated by inverting 99% certainty tolerance limits.
Among the 280 trauma patients (140 men and 140 women) in this study, the mean (SD) height was 170.7 (8.7) cm, and the mean (SD) age was 38.8 (16.5) years. The common segment in zone I (414-474 mm) existed in all CT scans. The common segment in zone III (236-256 mm) existed in 99.6% and 97.9% of CT scans from the right and left femoral arteries, respectively. These segments are expected to exist in 98.7% (zone I) and 94.9% (zone III) of the general population.
Target distances for blind placement of REBOA exist with more than 94% prevalence in a civilian population. These findings support the expanded use of REBOA in emergency department and prehospital settings. Validation for safety and efficacy on cadaveric and clinical models is necessary.
An optical access network transceiver based on a reflective semiconductor optical amplifier operating as modulator and photodetector is demonstrated. Device characterization and modulation/detection ...tests show the system proper operation at 1.25 Gb/s to 30-km reach. This optical network unit design is a simple and capable solution for future fiber-to-the-home networks.
Introduction L’étude des enfants et adolescents participant aux séjours en Maisons Sanitaires de l’AJD a montré au cours des dix dernières années une forte augmentation des schémas multi-injections ...et de la pompe, mais peu de changement de l’HbA1c. L’objectif de cette étude est de réévaluer la corrélation entre schémas thérapeutiques et HbA1c, avec un dosage centralisé de l’HbA1c, et d’analyser la corrélation avec le niveau de connaissance du diabète et la qualité de vie. Patients et méthodes Sur 715 jeunes de plus de 8 ans, venus en séjour AJD pendant l’été 2009, 446 âgés de 12,5+/−2,4 ans, ont donné leur consentement de participation. Les données suivantes ont été collectées : sexe, âge, ancienneté du diabète, taille, poids, BMI, schéma de traitement, HbA1c déclarée, questionnaire d’admission, auto-questionnaires de connaissance de l’AJD et de qualité de vie d’Ingersoll et Marrero (version courte du Hvidoere Study Group), dosage centralisé de l’HbA1c. Analyses statistiques : analyse de variance, Chi-2, analyses multi-variées. Résultats Par rapport aux années antérieures, la fréquence de traitement par pompe est beaucoup plus élevée (28 %), alors que celle des multi-injections est légèrement plus basse (48 %) et celle des 2–3 injections (15 %) ou des insulines mixtes (3,5 %) diminue encore fortement. L’HbA1c moyenne (8,3+/−1,5 %) reste inchangée sur une période d’observation de 12 ans, mais la fréquence des HbA1c > 9 % et > 10 % diminue, de 33 à 24 % et de 16 à 10 %. L’HbA1c est plus basse avec la pompe (7,9+/−0,9 %) qu’avec le basal bolus (8,1+/−1,1 %) ou les autres schémas (8,2+/−1,1 %). L’HbA1c est corrélée au niveau de connaissance du diabète, chez les jeunes de plus de 14 ans mais pas chez les plus jeunes. Les scores de qualité de vie (perception de santé et parents) sont fortement corrélés à l’HbA1c, pas à l’âge et au schéma thérapeutique. Conclusion L’HbA1c des jeunes ayant un diabète de type 1 est plus fortement corrélée à la qualité de vie qu’à la connaissance du diabète et aux schémas thérapeutiques.
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