Depuis une décennie, le péritoine est considéré comme un organe à part entière. Une meilleure compréhension de l’anatomie, du rôle et de la physiopathologie du péritoine a permis de faire des ...avancées sur les plans diagnostique et thérapeutique des métastases péritonéales d’origine colorectale (MPCCR). Le seul traitement curatif des MPCCR repose sur la cytoréduction complète associée à une chimiothérapie systémique ± chimiothérapie hyperthermique intrapéritonéale après discussion en réunion de concertation pluridisciplinaire spécialisée en maladies péritonéales (réseau RENAPE). Nous allons aborder, dans cet article, les points importants permettant de diagnostiquer et de prendre en charge les MPCCR à visée curative.
On closer inspection, the peritoneum is definitively an organ with a very complex anatomy. Understanding its anatomy/physiology and the mechanism of peritoneal dissemination from the primary tumor plays a key role in the prevention, early detection and management of colorectal peritoneal metastasis (cPM). Cytoreductive surgery combined with preoperative chemotherapy and/or hyperthermic intraperitoneal chemotherapy with Mitomycin became a curative option for cPM in selected patients. In this article, we will discuss diagnosis and management of cPM in curative context.
Background and Aims:
Pancreatic neuroendocrine tumors (PNET) arise from uncontrolled proliferation of neuroendocrine cell and further genetic alterations that may induce hormone secretion such as ...glucagon/insulin/gastrin/VIP. Their incidence is rapidelly growing, especially because of the frequent incidental diagnosis of small asymptomatic non-functionnal neuroendocrine tumors with the widespread use of cross-sectional imaging. The vast majority of pancreatic neuroendocrine tumors are sporadic but up to 5%–10% of them arise from genetic syndromes, the main one being Multiple Endocrine Neopalsm type 1 (MEN1). Appropriate management of patients with PNET is a complex challenge for surgeons, and require extensive medical collaboration. This review aims to summarize major and recent updates regarding the medico-surgical management of PNETs.
Material and Methods:
Review of pertinent English language literature.
Results:
This article provides a concise summary of the clinical presentation, diagnosis, surgical management, alternative treatments and follow up of PNETs.
Conclusion:
PNET are a rare, heterogeneous group of neoplasms with a generally favorable prognosis at least compared to pancreatic adenocarcinoma. Surgical resection is the cornerstone of their management, particularly for localized disease, and should always be discussed in multidisciplinary tumor board.
Interference effects are included in the x-ray coherent scattering models used in Monte Carlo codes by modifying each material form factor through a proper interference function, which is obtained ...directly from the measured scattering pattern. This approach is effective for non-biological materials, but it is impractical for biological tissues, due the wide composition variability they can feature. Instead, a given biological sample can be considered as a proper mixture of four basis materials: fat, water, collagen and calcium hydroxyapatite. The sample form factor can then be obtained through a weighted mean of the form factors of the basis materials, which include interference effects. Here, we fully demonstrate the validity of the proposed segmentation method by applying it to 31 biological tissue samples whose form factors are available in the literature. The segmentation, namely the determination of the optimal weight of the basis components, was carried out through a multiple linear regression or, in some cases, by using a controlled trial and error sequence. The form factors of the basis materials were extracted from previous works and elaborated to include more scattering features. In particular, they were interpolated at a denser grid. Furthermore, the data measured separately in wide angle and small angle regimes, for fat and collagen, were merged. In general, a very good agreement was obtained between the original sample and the calculated mixture, being the mean relative difference of their scattering profiles and their attenuation coefficients ∼10%. The segmentation method is fully supported by our extension to the Geant4 model of x-ray coherent scattering, which was used to compare simulated scatter distributions with known experimental data. The developed Geant4 code and a series of molecular form factors, including those of the basis materials, are freely downloadable from a dedicated web repository.
•Synthetic mammography is superior to digital mammography in microcalcs contrast.•The contrast of microcalcs on synthetic images is on average 48 % higher.•Contrast enhancement is achieved regardless ...the size and breast glandularity.•Structure noise suppression increases microcalcs’ contrast on synthetic images.•A quantitative evaluation can better address the role of synthetic mammography.
The aim of this work was to compare, in a clinical study, digital mammography and synthetic mammography imaging by evaluating the contrast in microcalcifications of different sizes.
A retrospective review of microcalcifications from 46 patients was undertaken. A Hologic 3-Dimensions mammography system and a HD Combo protocol was used for simultaneous acquisition of the digital and synthetic images. Microcalcifications were classified in accordance with their size, and patient breast images were classified in accordance with their density as adipose, moderately dense and dense. The contrast of the microcalcifications was measured and the contrast ratio between synthetic and digital images was compared. An additional qualitative assessment of the images was presented to correlate the conspicuity of the microcalcifications with the suppression of the structure noise.
Microcalcifications in adipose background always exhibit a comparable or better contrast on synthetic images, regardless their size. For moderately dense background, synthetic images show a better contrast in 91.2 % of cases for small microcalcifications and in 90.9 % of cases for large microcalcifications. For a dense background, better contrast is seen in 89.5 % of cases for small microcalcifications, and in 85.7 % of cases for large microcalcifications. The contrast ratio increases with increasing breast glandularity. The suppression of structure noise also contributes to the enhancement of microcalcifications in the synthetic images.
Synthetic mammography imaging is superior to digital mammography imaging in terms of microcalcification contrast, regardless their size and breast density.
Vitamin D is an anti-inflammatory nutrient and a determinant of bone health. Some prospective studies suggest that maternal vitamin D status is positively associated with offspring bone mass. We ...found that serum concentrations of lipopolysaccharide (LPS), an inflammatory molecule related to adiposity, insulin resistance and bone resorption, is lower in healthy mouse offspring exposed to high dietary vitamin D during pregnancy and lactation. LPS reaches the circulation via the gut. This study investigated whether maternal vitamin D programs metabolic, gut and bone health of male offspring in an obesogenic environment.
C57BL/6J dams received an AIN-93G diet with high (H) or low (L) vitamin D during pregnancy and lactation. At weaning, offspring remained on their dam's vitamin D level (LL or HH) or were switched (LH or HL) and fed a high fat (44.2%) and sucrose (19.8%) diet. Glucose response, adiposity, systemic inflammation (LPS, cytokines), intestinal permeability and mass, strength and microarchitecture of trabecular and cortical bone were assessed in 7-month-old male offsprings.
Higher maternal dietary vitamin D resulted in lower intestinal permeability (fecal albumin, P=0.010) and benefited trabecular but not cortical bone structure at the distal femur (higher trabecular number, P=0.022; less trabecular separation, P=0.015) and lumbar vertebra 2 (bone volume/total volume%, P=0.049). Higher maternal and offspring vitamin D resulted in lower fasting glucose (HH versus LL, P=0.039) and serum LPS concentrations (dam diet, P=0.011; pup diet, P=0.002). Higher offspring vitamin D resulted in lower epididymal fat pad relative weight (P=0.006). The serum concentrations of IL-6 and TNF-α did not differ among groups.
Maternal dietary vitamin D beneficially programs intestinal permeability and systemic LPS concentration, which is accompanied by stronger trabecular bone in an obesogenic environment. Thus, the gut may mediate vitamin D effects. Moreover, optimizing vitamin D in early life may be critical for later health.
We developed a mathematical model of the cerebral venous outflow for the simulation of the average blood flows and pressures in the main drainage vessels of the brain. The main features of the model ...are that it includes a validated model for the simulation of the intracranial circulation and it accounts for the dependence of the hydraulic properties of the jugular veins with respect to the gravity field, which makes it an useful tool for the study of the correlations between extracranial blood redistributions and changes in the intracranial environment. The model is able to simulate the average pressures and flows in different points of the jugular ducts, taking into account the amount of blood coming from the anastomotic connections; simulate how the blood redistribution due to change of posture affects flows and pressures in specific points of the system; and simulate redistributions due to stenotic patterns. Sensitivity analysis to check the robustness of the model was performed. The model reproduces average physiologic behavior of the jugular, vertebral, and cerebral ducts in terms of pressures and flows. In fact, jugular flow drops from ∼11.7 to ∼1.4 ml/s in the passage from supine to standing. At the same time, vertebral flow increases from 0.8 to 3.4 ml/s, while cerebral blood flow, venous sinuses pressure, and intracranial pressure are constant around the average value of 12.5 ml/s, 6 mmHg, and 10 mmHg, respectively. All these values are in agreement with literature data.
Coronary angiography is clinically used worldwide to diagnose diseases of coronary arteries. Despite its effectiveness, this technique is quite invasive and it is associated with significant risks ...due to the arterial catheterisation needed to inject the contrast agent. A valid alternative is using the K-edge subtraction (KES) method, which is based on the subtraction of two images acquired at energies bracketing the K-edge of the contrast element. The enhanced sensitivity of KES allows the intravenous injection of the contrast agent, thus reducing the risks of catheterisation. This technique can be effectively implemented by using intense and quasi-monochromatic x-ray beams. Synchrotron radiation has been proven to work well for this purpose, but its cost and size prevent a widespread clinical application. Inverse Compton sources are among the most promising innovative sources of intense and quasi-monochromatic x-rays. These sources are intrinsically more compact than those based on synchrotron radiation. In this work, the potential application of inverse Compton radiation to KES angiography is investigated. To this purpose, after a short review of the physics behind the inverse Compton process, an analytical framework is described. The proposed model is based on the application of the KES algorithm to calculate the SNR of details inside a suitable mathematical phantom. That allowed us to identify the characteristics of an inverse Compton source required for KES imaging. In particular, it was estimated that a photon fluence of 10
ph mm
is necessary to detect signals of clinical interest. Novel sources based on inverse Compton promise to achieve this requirement with an acquisition time of few hundreds of ms. This feature, together with compactness, broad two-dimensional radiation field, absence of harmonic contamination and the ability to deliver high photon fluxes also at high energies, makes this kind of sources promising for KES angiography and other diagnostic applications.
True coincidence summing (TCS) correction factors were determined for
152
Eu volume sources used for γ-ray efficiency calibration as the ratio of full energy peak efficiency (
ε
) simulated by MCNP5 ...code to the apparent full energy peak efficiency (
ε
app
) determined experimentally. The results were compared to those calculated by TrueCoinc software and then validated using certified environmental radioactive samples. The dependance of
152
Eu and
133
Ba TCS factors on volume sample and matrix was investigated. Finally, as our n-type HPGe detector is very sensitive to low energy photons, the contribution of the γ–X coincidence summing to TCS factors for
152
Eu and
133
Ba sources in volume soil samples was studied.
Breaking bad news (BN) is difficult and necessitates targeted training. To be effective, training may call for High Fidelity Simulation (HFS). This prospective study was conducted to objectively ...assess the impact of HFS as a tool conducive to the development of clinical competence in situations involving the delivery of bad news.
This feasibility study was conducted from January to May 2021 and included students in medical oncology and digestive surgery. The subjective and objective impacts of HFS were evaluated by means of a self-administered questionnaire and a wristband, Affect-tag, which recorded several indicators: emotional power (EP), emotional density (DE) and cognitive load (CL) in students undergoing training.
Forty-six (46) students with a median age of 25 years (21–34 years) were included. While the participants were effectively and emotionally involved in the HFS training, they were not completely overwhelmed by their emotions, a possible occurrence in this type of program. After two training programs, the students presented with lower EP (P<0.001) and higher DE (P=0.005), while their CL remained stable (P=0.751). The information given in the self-administered questionnaires and the evaluations by outside professionals (actor, nurse, psychologist…) highlighted improved skills.
Taking into account the emotional parameters observed and the questionnaires collected, HFS can be considered as a suitable and effective tool in the breaking of bad news.
This study investigates the impact of aggregate and pipe cooling systems on concrete behaviour at a mesoscale level. Firstly, a Chemo-Thermo-Mechanical model is developed to investigate the initial ...stress state of early age hydration concrete followed by a mechanical analysis of the consequences brought by this initial state. Pipe and aggregate cooled concrete samples have been subjected to tensile and cyclic loadings. The results have been discussed in terms of damage and crack openings. It has been concluded that early age hydration modifies the initial conditions of any concrete structures. Regarding the cyclic behaviour, initial state due to the hydration process leads to permanent displacements corresponding to damage and cracking. The cooling methods improve the mechanical behaviour of concrete.
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