Background:
Although the 6-min walk test (6MWT) is the gold standard for assessing exercise-induced impairment of gas exchange, it cannot easily be performed in a clinical office environment. The aim ...of this study was to compare the 1-min sit-to-stand test (1STST) with the 6MWT for the ability to assess exercise-induced oxygen desaturation in patients with interstitial lung diseases (ILDs).
Methods:
A total of 107 patients were enrolled and classified into three groups: sarcoidosis, fibrotic idiopathic interstitial pneumonia (f-IIP), and other forms of ILD. The 6MWT and 1STST were performed on the same day, and pulmonary function tests, pulse oxygen saturation (SpO2), and dyspnea and fatigue (modified Borg scale) were assessed. SpO2 desaturation was evaluated by intraclass correlation coefficient (ICC), Bland–Altman analysis, and kappa (κ) coefficient in the whole population and the patient subgroups.
Results:
The SpO2 nadir during the 1STST and 6MWT showed good consistency mean ± standard deviation: 92.5% ± 5% and 90% ± 7%, respectively; ICC 0.77, 95% confidence interval (CI) 0.71–0.83 and correlated strongly (r = 0.9, p < 0.0001). The frequency of patients with oxygen desaturation ⩾4% was also consistent for the two exercise tests (κ = 0.68, 95% CI 0.54–0.82). The number of repetitions in the 1STST correlated with the 6MWT distance (r = 0.5, p < 0.0001), but the dyspnea scores were higher during the 1STST than the 6MWT (p < 0.0001). These findings did not differ for the three patient subgroups.
Conclusion:
The 1STST can measure exercise-induced desaturation in ILD patients and could be used as an alternative test to the 6MWT in office practice.
The estimation of the postmortem interval (PMI) from skeletal remains represents a challenging task in forensic science. PMI is often influenced by extrinsic factors (humidity, dryness, scavengers, ...etc.) and intrinsic factors (age, sex, pathology, way of life, medical treatments, etc.). Raman spectroscopy combined with multivariate data analysis represents a promising tool for forensic anthropologists. Despite all the advantages of the technique, Raman spectra of skeletal remains are influenced by these extrinsic and intrinsic factors, which impairs precision and reproducibility. Both parameters have to reach a high level of confidence when such spectroscopy is used as a way to predict PMI. As a consequence, advanced multivariate data analysis is necessary to quantify the effect of all factors to improve the estimation of the PMI.
The objective of this work is to evaluate the effect of intrinsic and extrinsic factors on the Raman spectra of skeletal remains. We designed a protocol close to a real-world scenario. We used ANOVA-simultaneous component analysis (ASCA) to unmix and quantify the effect of 1 intrinsic (source body) and 1 extrinsic (burial time) factors on the Raman spectra. In our model, the burial time was found to generate the highest variability after the source body. ASCA showed that the variability due to the burial time has 2 mixed contributions. Seasonal variations are the first contribution. The second contribution is attributed to diagenesis. A decrease in the mineral bands and an increase in the organic bands are observed. The source body was also found to contribute to the variability in Raman spectra. ASCA showed that the source body induces variability related to the composition of bones. This quantification cannot be assessed by basic chemometrics methods such as PCA. The results of this study highlighted the need to use an advanced chemometric data analysis tool (like ASCA) combined with Raman spectroscopy to estimate the postmortem interval.
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•Raman spectroscopy as a promising tool to estimate postmortem interval.•Intrinsic and extrinsic factors affect Raman spectra.•Standard PCA does not yield an accurate estimation of the postmortem interval.•ASCA separates the effect of intrinsic and extrinsic factors.•Advanced chemometrics is needed to improve postmortem interval evaluation.
Abstract Objective Laparoscopic sacrocolpopexy (LSCP) learning is a challenge for unexperienced surgeons, since complications occurrence and anatomical results could depend from surgeon's experience. ...The aim of this study was to describe LSCP characteristics, perioperative complications and short term anatomical results when LSCP was performed by LSCP-experienced surgeons or trainees. Study design Patients who underwent LSCP in our surgical unit in the last ten years were included. Patients were excluded if laparotomy was performed without any laparoscopic time. Interventions were divided into LSCP experienced surgeons (who had performed at least 30 procedures) and trainees (residents, fellows, and surgeons with less than 30 procedures). Main outcomes were operative time, peroperative complications (included conversions to open or vaginal surgery, bladder and vaginal perforation, epigastric vessels injury and hemorrhage) early postoperative complications, mesh complications and anatomical results at three months. Results 492 patients were included, 108 in the trainee group and 384 in the LSCP-experienced group. Groups were comparable for demographics, preoperative clinical examination and surgery characteristics. Average operative time was significantly higher in trainees group than in LSCP-experienced group (251 versus 178 min ( p < 0.0001)). There was no difference in open surgery conversion rate (5.6% versus 3.9%, p = 0.42) or peroperative complication occurrence (4.7% versus 4.6%, p = 0.98). Bladder perforations were more frequent in trainee group but difference was not statistically significant (3.7% versus 1.3%, p = 0.11). 98% patients were assessed at three months. Overall anatomical success rate was 94.9%. There was no difference in anatomical failure rate between trainee group and LSCP experienced surgeons group (respectively 4.7% versus 5.2%, p = 0.82), neither in mesh complication rate (3.9% versus 2.8%, p = 0.77). Conclusion LSCP learning in an experimented surgical team induces high operative time, but remains safe for patient.
Thoracic outlet syndrome (TOS) is challenging to diagnose, as the physical findings and investigations lack sensitivity and/or specificity. Magnetic resonance imaging (MRI) with dynamic manoeuvres ...can rule out a tumour and detect anatomical abnormalities potentially responsible for compression. The objective of this study was to assess the sensitivity and specificity of MRI for identifying anatomical structures responsible for compression in TOS, using intra-operative findings as the diagnostic reference standard.
MRI is effective in diagnosing the source of compression in TOS, notably within the scalene triangle and at the pleural apex.
We retrospectively included 48 patients who underwent surgery for TOS after a work-up that included MRI (1.5-T, n=29 and 3-T, n=19). The MRI scans were reviewed for the study by a specialised radiologist who was unaware of the intra-operative findings. The sensitivity and specificity of MRI for diagnosing TOS were estimated using the intra-operative findings as the reference standard.
MRI identified a structure potentially responsible for TOS in 34 (71%) patients; thus, the false-negative rate was 14/48 (29%). The sensitivity of MRI was 28% for compression at the suspensory ligament of the pleural dome, 81% for hypertrophy of the anterior scalene muscle, and 50% for an accessory scalene muscle. For diagnosing a cervical rib, MRI had 100% sensitivity and 100% specificity.
MRI can contribute to the diagnosis of TOS. Specificity is sufficiently high to provide guidance for planning the surgical procedure. Sensitivity, however, is too low for MRI to be useful as a screening test. MRI should be used in combination with the clinical assessment and other investigations to assist in the diagnosis of TOS.
IV, retrospective cohort study.
Systemic sclerosis (SSc) is a severe and highly heterogeneous disease. The modified Rodnan skin score (mRSS) is a widely used tool for the assessment of the extent and degree of skin thickness. This ...study aimed to identify the classes of patients with early similar skin thickening trajectories without any a priori assumptions and study their associations with organ involvement and survival.
From the French SSc national cohort, patients with a disease duration of less than 2 years at inclusion and with at least 2 mRSS available within the first 4 years of follow-up were enrolled. Classes of patients with similar mRSS trajectories were identified based on a latent class mixed model. The clinical characteristics and survival rate were compared between the obtained classes.
A total of 198 patients fulfilled the inclusion criteria, with a total of 641 mRSS available. The median disease duration and follow-up were 0.8 (interquartile range 0.4; 1.2) and 6.3 (3.8; 8.9) years, respectively. Individual trajectories of mRSS were highly heterogeneous between patients. Models with 1-6 latent classes of trajectories were sequentially assessed, and the 5-class model represented the best fit to data. Each class was characterized by a unique global trajectory of mRSS. The median disease duration did not differ significantly between classes. Baseline organ involvement was more frequent in classes with significant change over time (classes 2-5) than in class 1 (low baseline mRSS without significant change over time). Using Cox regression, we observed a progressively increasing risk of death from classes 1 to 5.
Early identification of clinical phenotype based on skin thickening trajectories could predict morbi-mortality in SSc. This study suggested that mRSS trajectories characterization might be pivotal for clinical practice and future trial designs.
Purpose
The occurrence of arthralgia and myalgia during treatment with bevacizumab (Bev) has been described but not spontaneously reported. We aimed to evaluate the frequency of arthralgia in ...patients treated with Bev and identify the risk factors.
Methods
In this observational prospective study, a self-administered questionnaire was distributed to patients at the initiation of Bev and at 3 and 6 months of treatment. Bev (5–15 mg/kg) was administered every 2 or 3 weeks, with or without chemotherapy.
Results
A total of 71 patients (42 with colorectal cancer, 22 with ovarian cancer, and 7 with lung cancer) were enrolled from January to November 2018. All patients completed the questionnaire at initiation, while only 56 (78.9%) and 36 (50.7%) patients completed the questionnaire at 3 and 6 months, respectively. The frequency of joint pain was 29.6% before Bev treatment and increased to 41.8% and 50% at 3 and 6 months, respectively, without reaching significance. The evolution of pain was significant according to the Common Terminology Criteria for Adverse Events grades (
P
= 0.032). No significant increase in the impact of pain on instrumental or elementary activities was observed over time. The frequency of arthralgia significantly increased at 3 months in patients with ovarian cancer versus those with colorectal cancer (odds ratio: 19.50; 95% confidence interval 4.53–83.98;
P
< 0.001).
Conclusions
Bev‑including regimens tend to be associated with a significant increase in the frequency of arthralgia in women treated for ovarian cancer. Physicians should be aware of this side effect.
Clinical trial number
NCT03455907, date of registration: March 7, 2018.
Introduction and hypothesis
There is a lack of knowledge concerning long-term reoperation and complications after laparoscopic sacrocolpopexy (LSCP). We analyzed the rates and indications and ...potential risk factors for reoperation after LSCP in a large series of consecutive patients.
Methods
This was a single-center, retrospective study including all patients who underwent LSCP between 2003 and 2013. Data regarding pelvic organ prolapse (POP), surgical modalities and perioperative complications were collected. Patients were then contacted by telephone or postal letter in 2014. The main outcome criteria were grade III Dindo classification complications: reoperation for POP recurrence, mesh complications, and urinary incontinence (UI).
Results
Between January 2003 and December 2013, a total of 464 consecutive patients (mean age, 59 years) underwent LSCP. Almost all (99.1 %) patients presented with POP ≥ grade 3 (POP-Q classification). Long-term evaluations were completed for 391 (84.1 %) patients. The median follow-up was 53.5 ± 28.2 months. The global reoperation rate was 12.5 %. The main reoperation indications were UI-related surgery in 21 patients (5.5 %), POP recurrence surgery in 20 patients (5.1 %), and mesh-related surgery in 11 patients (2.8 %). Multivariate analysis showed that older age at the time of initial surgery and concomitant subtotal hysterectomy were significant protective factors against global reoperation (HR = 0.606, CI 95 % 0.451–0.815 and 0.367, CI 95 % 0.193–0.698 respectively) and reduced the risk of POP recurrence surgery.
Conclusion
Prolapse recurrence and mesh-related surgery occurred in 5.1 and 2.8 % of patients respectively, 4 years after laparoscopic sacrocolpopexy. Age and concomitant subtotal hysterectomy could play a role in the incidence of long-term reoperation.
To evaluate the impact of body mass index (BMI) on sonographic measurement of head perineum distance (HPD) before operative vaginal delivery (OVD).
This was a single-center retrospective cohort study ...(Lille, France) conducted from March 1, 2019 to October 31, 2020 including all singleton and OVD. HPD measurement was systematically performed without and with compression on the perineum soft tissues. The level of station was defined by vaginal examination and three maternal BMI groups were defined (normal BMI <24.9 kg/m
vs overweight 25-29.9 kg/m
vs obese ≥30 kg/m
). HPD measures were compared between BMI groups and compression, in distinct level of station, using a two-factor analysis of variance including BMI groups, the compression, and the interaction term BMI group compression.
A total of 775 women were included: 488 with normal BMI, 181 overweight patients and 106 obese patients. The measurement of HPD before OVD without and with compression on the soft tissues was significantly different between the BMI groups only in the lower part, particularly between normal BMI and obese patients (mean difference (95% CI): 6.6 mm (4.0 to 9.2) without compression; 3.8 (1.1 to 6.4) with compression).
The values of HPD without and with compression on the soft tissues on the maternal perineum were different according to the maternal BMI concerning lower part station. Thus, it seems important to define thresholds of HPD measures corresponding to each head station levels according to maternal BMI.
Infertility associated with endometriosis can be explained by several non-exclusive mechanisms. The oocyte plays a crucial role in determining embryonic competence and this is particularly relevant ...for in vitro fertilization (IVF) outcomes. According to some authors, the morphology of oocytes could also be a non-invasive marker of oocyte quality. The aim of this study was to evaluate the relationship between endometriosis and oocyte morphology after controlled ovarian stimulation for intracytoplasmic sperm injection (ICSI) on a large oocyte cohort.
Single-center comparative retrospective study in the academic In Vitro Fertilization (IVF) unit of the Lille University Hospital. A total of 596 women treated for IVF-ICSI with ejaculated spermatozoa for sperm alterations were included. They were classified as endometriosis (n = 175) or control groups (n = 401). The morphological evaluation of 2,016 mature oocytes from 348 cycles of patients with endometriosis was compared with that of 4,073 mature oocytes from 576 control cycles. The main outcome measures were Average Oocyte Quality Index (AOQI) and metaphase II oocyte morphological scoring system (MOMS). Comparison of groups was carried out by a mixed linear model and by a generalized estimation equation model with a "patient" random effect to consider that a patient might have several attempts.
No difference in AOQI and MOMS scores was found between endometriosis and control women (adjusted p = 0.084 and 0.053, respectively). In case of endometriosis, there were significantly fewer metaphase II oocytes retrieved, embryos obtained, grade 1 embryos and number of cumulative clinical pregnancies compared to controls. In the endometriosis group, endometriosis surgery was associated with a reduced number of mature oocytes retrieved, and the presence of endometrioma(s) was associated with some abnormal oocyte shapes. Nevertheless, no difference concerning the AOQI and MOMS scores was found in these subgroups.
Endometriosis does not have a negative impact on oocytes' morphology in IVF-ICSI.
On December 16, 2019, the Institutional Review Board of the Lille University Hospital gave unrestricted approval for the anonymous use of all patients' clinical, hormonal and ultrasound records (reference DEC20150715-0002).
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