To determine the risk of endometrial cancer (EC) and lymph node involvement in patients with a preoperative diagnosis of “AH-only” versus “AH - cannot rule out carcinoma” and to study the value of ...SLN mapping.
We reviewed all patients with a preoperative diagnosis of atypical hyperplasia, who underwent primary surgery with SLN mapping followed by pelvic lymphadenectomy. Sensitivity and negative predictive value (NPV) of SLN and rates of endometrial cancer were calculated.
Overall, 64/120 (53.3%) patients were found to have EC on final pathology: 58 stage IA, 3 IB, and 3 IIIC1. In patients with preoperative diagnosis of “AH”, 44.3% (31/70) had EC on final pathology compared to 66% (33/50) in patients with “AH - cannot rule out cancer” (p=0.02). Overall, 3.3% of the patients (4/120) had lymph node involvement. In patients with EC with a pre-operative diagnosis of “AH”, none had lymph node metastasis (0/31), compared to 12.1% (4/33) in patients with “AH - cannot rule out cancer” (p=0.06). Elevated preoperative CA125 levels (>25U/mL) were statistically associated with the risk of lymph node metastasis on final pathology (p=0.024). Unilateral and bilateral SLN detection occurred in 93.7% and 78.1% respectively. In patients with EC and bilateral SLN mapping, sensitivity and NPV were respectively 66.6% and 97.9%. There was one false negative (ITCs in non-SLN).
Our data indicate that the risk of lymph node involvement in patients with a preoperative diagnosis of “AH-only” is null. Lymph node assessment could be omitted in those patients. Conversely this risk is significant in patients with “AH - cannot rule out cancer”. SLN mapping could be a valuable staging procedure in these patients.
•Risk of endometrial cancer is higher with preop diagnosis of “AH-cannot rule out cancer”.•Lymph node metastasis, deep myometrial invasion and grade 2–3 disease are also higher.•SLN mapping may a be good compromise for lymph node staging in these cases.
Summary Background Concomitant chemoradiotherapy and accelerated radiotherapy independently improve outcomes for patients with locally advanced head and neck squamous-cell carcinoma (HNSCC). We aimed ...to assess the efficacy and safety of a combination of these approaches. Methods In our open-label phase 3 randomised trial, we enrolled patients with locally advanced, stage III and IV (non-metastatic) HNSCC and an Eastern Cooperative Oncology Group performance status of 0–2. We randomly allocated patients centrally with a computer program (with centre, T stage, N stage, and localisation as minimisation factors) in a 1:1:1 ratio to receive conventional chemoradiotherapy (70 Gy in 7 weeks plus three cycles of 4 days' concomitant carboplatin-fluorouracil), accelerated radiotherapy-chemotherapy (70 Gy in 6 weeks plus two cycles of 5 days' concomitant carboplatin-fluorouracil), or very accelerated radiotherapy alone (64·8 Gy 1·8 Gy twice daily in 3·5 weeks). The primary endpoint, progression-free survival (PFS), was assessed in all enrolled patients. This trial is completed. The trial is registered with ClinicalTrials.gov , number NCT00828386. Findings Between Feb 29, 2000, and May 9, 2007, we randomly allocated 279 patients to receive conventional chemoradiotherapy, 280 to accelerated radiotherapy-chemotherapy, and 281 to very accelerated radiotherapy. Median follow-up was 5·2 years (IQR 4·9–6·2); rates of chemotherapy and radiotherapy compliance were good in all groups. Accelerated radiotherapy-chemotherapy offered no PFS benefit compared with conventional chemoradiotherapy (HR 1·02, 95% CI 0·84–1·23; p=0·88) or very accelerated radiotherapy (0·83, 0·69–1·01; p=0·060); conventional chemoradiotherapy improved PFS compared with very accelerated radiotherapy (0·82, 0·67–0·99; p=0·041). 3-year PFS was 37·6% (95% CI 32·1–43·4) after conventional chemoradiotherapy, 34·1% (28·7–39·8) after accelerated radiotherapy-chemotherapy, and 32·2% (27·0–37·9) after very accelerated radiotherapy. More patients in the very accelerated radiotherapy group had RTOG grade 3–4 acute mucosal toxicity (226 84% of 268 patients) compared with accelerated radiotherapy-chemotherapy (205 76% of 271 patients) or conventional chemoradiotherapy (180 69% of 262; p=0·0001). 158 (60%) of 265 patients in the conventional chemoradiotherapy group, 176 (64%) of 276 patients in the accelerated radiotherapy-chemotherapy group, and 190 (70%) of 272 patients in the very accelerated radiotherapy group were intubated with feeding tubes during treatment (p=0·045). Interpretation Chemotherapy has a substantial treatment effect given concomitantly with radiotherapy and acceleration of radiotherapy cannot compensate for the absence of chemotherapy. We noted the most favourable outcomes for conventional chemoradiotherapy, suggesting that acceleration of radiotherapy is probably not beneficial in concomitant chemoradiotherapy schedules. Funding French Ministry of Health.
Laparoscopic right hemicolectomy (LRH) can be performed with an intracorporeal anastomosis (IA) or extracorporeal anastomosis (EA). It is not clear which technique is best. This study evaluated the ...impact of each anastomosis technique on perioperative safety and postoperative evolution.
We performed a retrospective study at a tertiary colorectal surgery center. All patients who had an elective LRH from 2015 to 2019 were analyzed according to the anastomosis technique used.
In total, 285 patients were included in the study. IA was performed in 64 patients (22.5%). Mean operative time was longer in the patients with IA (IA, 160±31 minutes vs. EA, 138±42 minutes; P<0.001). No differences were observed in intraoperative complications, time to first bowel movement, length of stay, reoperation, or rehospitalization. Time to first flatus was longer in the patients with IA (P=0.049). At 30 days after surgery, there were no differences in the frequency of anastomotic leak (IA, 0% vs. EA, 2.3%; P=0.59), bleeding (IA, 3.1% vs. EA, 2.7%; P>0.99), or intraabdominal abscess (IA, 0% vs. EA, 0.5%; P>0.99). During follow-up, we noted more incisional hernias in patients with EA (IA, 1.6% vs. EA, 11.3%; P=0.01) and a trend toward more hernia in patients with EA in multivariate analysis (hazard ratio, 7.13; P=0.06). Anastomosis technique had no influence on recurrence.
For LRH, both IA and EA are safe, with a low incidence of complications when performed by experienced surgeons. IA may be associated with a lower incidence of incisional hernia.
Backgound
Hyperoxemia is common and associated with poor outcome during veno-arterial extracorporeal membrane oxygenation (VA ECMO) support for cardiogenic shock. However, little is known about ...practical daily management of oxygenation. Then, we aim to describe sweep gas oxygen fraction (F
S
O
2
), postoxygenator oxygen partial pressure (P
POST
O
2
), inspired oxygen fraction (F
I
O
2
), and right radial arterial oxygen partial pressure (P
a
O
2
) between day 1 and day 7 of peripheral VA ECMO support. We also aim to evaluate the association between oxygenation parameters and outcome. In this retrospective multicentric study, each participating center had to report data on the last 10 eligible patients for whom the ICU stay was terminated. Patients with extracorporeal cardiopulmonary resuscitation were excluded. Primary endpoint was individual mean F
S
O
2
during the seven first days of ECMO support (F
S
O
2
mean (day 1−7)
).
Results
Between August 2019 and March 2022, 139 patients were enrolled in 14 ECMO centers in France, and one in Switzerland. Among them, the median value for F
S
O
2
mean (day 1−7)
was 70 57; 79 % but varied according to center case volume. Compared to high volume centers, centers with less than 30 VA-ECMO runs per year were more likely to maintain F
S
O
2
≥ 70% (OR 5.04, CI 95% 1.39; 20.4,
p
= 0.017). Median value for right radial P
a
O
2
mean (day 1−7)
was 114 92; 145 mmHg, and decreased from 125 86; 207 mmHg at day 1, to 97 81; 133 mmHg at day 3 (
p
< 0.01). Severe hyperoxemia (i.e. right radial P
a
O
2
≥ 300 mmHg) occurred in 16 patients (12%). P
POST
O
2
, a surrogate of the lower body oxygenation, was measured in only 39 patients (28%) among four centers. The median value of P
POST
O
2
mean (day 1−7)
value was 198 169; 231 mmHg. By multivariate analysis, age (OR 1.07, CI95% 1.03–1.11,
p
< 0.001), F
S
O
2
mean (day 1−3)
(OR 1.03 1.00-1.06,
p
= 0.039), and right radial P
a
O
2
mean (day 1−3)
(OR 1.03, CI95% 1.00-1.02,
p
= 0.023) were associated with in-ICU mortality.
Conclusion
In a multicentric cohort of cardiogenic shock supported by VA ECMO, the median value for F
S
O
2
mean (day 1−7)
was 70 57; 79 %. P
POST
O
2
monitoring was infrequent and revealed significant hyperoxemia. Higher F
S
O
2
mean (day 1−3)
and right radial P
a
O
2
mean (day 1−3)
were independently associated with in-ICU mortality.
To determine the validity of sentinel lymph node (SLN) biopsy with ICG in endometrial cancer and to evaluate the factors associated with poor mapping or false negative.
We reviewed all patients who ...underwent primary surgery for endometrial carcinoma with SLN mapping using ICG followed by pelvic lymphadenectomy from February 2014 to December 2015. SLNs were ultrastaged on final pathology. Patients' demographics, surgical approach and histopathological factors were prospectively collected. Detection rate, sensitivity and negative predictive value (NPV) were calculated and univariate analysis was performed to evaluate factors associated with failed bilateral detection of SLNs.
A total of 119 patients were included. The overall and bilateral detection rates were 93% and 74%. Sensitivity and NPV were 100% in patients with bilateral detection; 95% and 99% respectively in cases with at least unilateral detection. Advanced FIGO stage (III or IV) was the only factor related to failed bilateral detection (p = 0.01). In 14 hemi-pelvis, the specimen labelled as SLN did not contain nodal tissue on final pathology (only lymphatic channels), which represented 37% of the “failed detection” cases. One false negative occurred in a patient with an ipsilateral clinically suspicious enlarged lymph node.
ICG is an excellent tracer for SLN mapping in endometrial cancer. Advanced FIGO stage correlated with failed bilateral detection (p = 0.01). Suspicious lymph nodes should be removed regardless of the mapping. Care should be taken to ensure that SLN specimen actually contains nodal tissue and not only swollen lymphatic channels, as this represents a significant cause of failed SLN mapping.
•ICG has excellent SLN detection rate, sensitivity and NPV in endometrial cancer.•With the use of ICG, swollen green lymphatics can be mistaken for lymph nodes and contribute to failed detection.•Spy and CSF mode, ex-vivo palpation of the nodes, frozen section and vigilance can reduce the rate of failed mapping.
Plant diversification through crop rotation or agroforestry is a promising way to improve sustainability of agroecosystems. Nonetheless, criteria to select the most suitable plant communities for ...agroecosystems diversification facing contrasting environmental constraints need to be refined. Here, we compared the impacts of 24 different plant communities on soil fertility across six tropical agroecosystems: either on highly weathered Ferralsols, with strong P limitation, or on partially weathered soils derived from volcanic material, with major N limitation. In each agroecosystem, we tested several plant communities for diversification, as compared to a matching low diversity management for their cropping system. Plant residue restitution, N, P and lignin contents were measured for each plant community. In parallel, the soil under each community was analyzed for organic C and N, inorganic N, Olsen P, soil pH and nematode community composition. Soil potential fertility was assessed with plant bioassays under greenhouse controlled climatic conditions.
Overall, plant diversification had a positive effect on soil fertility across all sites, with contrasting effects depending on soil type and legumes presence in the community. Communities with legumes improved soil fertility indicators of volcanic soils, which was demonstrated through significantly higher plant biomass production in the bioassays (+18%) and soil inorganic N (+26%) compared to the low diversity management. Contrastingly, communities without legumes were the most beneficial in Ferralsols, with increases in plant biomass production in the bioassays (+39%), soil Olsen P (+46%), soil C (+26%), and pH (+5%). Piecewise structural equation models with Shipley's test revealed that plant diversification impacts on volcanic soil fertility were related to soil N availability, driven by litter N. Meanwhile, Ferralsols fertility was related to soil P availability, driven by litter P. These findings underline the importance of multifactorial and multi-sites experiments to inform trait-based frameworks used in designing optimal plant diversification in agroecological systems.
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•We compared plant diversification impacts on soil fertility across 6 agroecosystems.•Benefits of plant diversification depended on both legume presence and soil type.•Legume-based diversification was mostly beneficial on the younger soils.•Ferralsols' fertility was improved with plant communities' litter P content.•Plant communities' traits were linked with diversification impacts on contrasting soils.
Poncin, la Châtelarde Faure-Boucharlat, Élise; Vicherd, Georges; Ayala, Grégoire ...
Vivre à la campagne au Moyen Âge,
06/2016
Book Chapter
1. Le site de Poncin, La Châtelarde, dans son environnement Département : Ain Commune : Poncin Lieu-dit : La Châtelarde Numéro de site : 01 303 002 Coordonées Lambert : Xa : 837 300 Ya : 2125.860Xb : ...837.370 Yb : 2125.970 Altitude NGF : 257 m Cadre d’intervention : Autoroute A 40 : aménagements de chantier Responsables d’opérations : G. Vicherd, H. De Klijn. L. Françoise dit Miret et L. Olivier Date d’intervention : 1981-1984 Surface explorée : 17 000 m2 Surface fouillée : 1 000 m2 (fouille ...
To evaluate the effect of anaesthesia and ICU sedation with sevoflurane to protect the myocardium against ischemia-reperfusion injury associated to cardiac surgery assessed by troponin release.
We ...performed a prospective, open-label, randomized study in cardiac surgery with cardiopulmonary bypass. Patients were randomized to an algorithm-based intervention group and a control group. The main outcome was the perioperative kinetic of cardiac troponin I (cTnI). The secondary outcomes included composite endpoint, GDF-15 (macrophage inhibitory cytokine-1) value, arterial lactate levels, and the length of stay (LOS) in the ICU.
Of 82 included patients, 81 were analyzed on an intention-to-treat basis (intervention group: n = 42; control group: n = 39). On inclusion, the intervention and control groups did not differ significantly in terms of demographic and surgical data. The postoperative kinetics of cTnI did not differ significantly between groups: the mean difference was 0.44 ± 1.09 μg/ml, P = .69. Incidence of composite endpoint and GDF-15 values were higher in the sevoflurane group than in propofol group. The intervention and control groups did not differ significantly in terms of ICU stay and hospital stay.
The use of an anaesthesia and ICU sedation with sevoflurane was not associated with a lower incidence of myocardial injury assessed by cTnI. Sevoflurane administration was associated with higher prevalence of acute renal failure and higher GDF-15 values.
Metallic nanoparticles (MNPs) produced by green synthesis using plant extracts have attracted huge interest in the scientific community due to their excellent antibacterial, antifungal and ...antibiofilm activities. To evaluate these pharmacological properties, several methods or protocols have been successfully developed and implemented. Although these protocols were mostly inspired by the guidelines from national and international regulatory bodies, they suffer from a glaring absence of standardization of the experimental conditions. This situation leads to a lack of reproducibility and comparability of data from different study settings. To minimize these problems, guidelines for the antimicrobial and antibiofilm evaluation of MNPs should be developed by specialists in the field. Being aware of the immensity of the workload and the efforts required to achieve this, we set out to undertake a meticulous literature review of different experimental protocols and laboratory conditions used for the antimicrobial and antibiofilm evaluation of MNPs that could be used as a basis for future guidelines. This review also brings together all the discrepancies resulting from the different experimental designs and emphasizes their impact on the biological activities as well as their interpretation. Finally, the paper proposes a general overview that requires extensive experimental investigations to set the stage for the future development of effective antimicrobial MNPs using green synthesis.
•A variety of paraneoplastic syndromes can be associated with gynecological cancers.•These syndromes can affect all systems, and may lead to severe complications.•A systematic literature search ...identified those related to gynecologic oncology.•This article provides a summary and up-to-date information about each syndrome.
A number of paraneoplastic syndromes have been described with gynecological cancers. These syndromes are induced by substances secreted by the tumor or by an immune response triggered by the cancer. Each system of the human body can be affected by different syndromes. Indeed, paraneoplastic syndromes occurring from tumors of the gynecologic tract were found to involve the nervous, ophthalmologic, dermatologic, rheumatologic, endocrine, hematologic and renal systems. These syndromes can manifest before, at the time, or after the diagnosis of cancer. They can also occur at the time of a recurrence. Knowledge about these syndromes is important for physicians caring for patients with cancers, as they can result in severe morbidity and must be treated appropriately.
Literature regarding paraneoplastic syndromes associated with tumors of the female genital tract is scattered and the subject has not been reviewed recently. A systematic literature search was thus conducted to identify paraneoplastic syndromes associated with gynecologic cancers. This review focuses on the cancers involved with each paraneoplastic syndrome, and on their pathophysiology, clinical manifestations, possible complications, outcomes, and treatments. As the mainstay of treatment in these conditions is often to address the underlying tumor, it is of upmost importance that physicians be aware of these rare cancer manifestations.
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