This article illustrates the clinical practice of psycho-oncology in a paediatric onco-haematology department by young psychologists.To begin with,we look at the role of the psychologist in a somatic department.Creati...This article illustrates the clinical practice of psycho-oncology in a paediatric onco-haematology department by young psychologists.To begin with,we look at the role of the psychologist in a somatic department.Creativity in clinical work and the modulation of medical temporality.The aim here is to discuss the construction of the professional identity in relation to the construction of the therapeutic alliance with patients.Specifically,we will look at the relationship with creativity,which is necessary to support children and adolescents in their existential questioning.This work of creativity in the therapeutic alliance will be illustrated using two clinical cases that are particularly representative of clinical work centred on the relationship with finitude.展开更多
Endoscopy provides a direct evaluation of mucosal lesions in inflammatory bowel disease(IBD),permitting the description of elementary lesions,their surface extent and severity.The severity of mucosal lesions directly ...Endoscopy provides a direct evaluation of mucosal lesions in inflammatory bowel disease(IBD),permitting the description of elementary lesions,their surface extent and severity.The severity of mucosal lesions directly reflects disease activity and may help to identify an aggressive behavior of the disease.Several studies have recently pointed out the potential role of endoscopy in the prediction of IBD outcome.Indeed,severe endoscopic lesions in Crohn's disease(CD) patients,defined by deep and extensive ulcerations on at least one part of the colon,are associated with an increased risk of penetrating complication and surgery.Severe endoscopic lesions during severe attacks of ulcerative colitis(UC) are associated with an increased risk of colectomy in the short and long term.Severity of postoperative recurrence in CD may help to predict the risk of clinical relapse and need for further surgery.Achievement of mucosal healing,which can be obtained by administration of several types of drugs,is associated with a better outcome,less surgery and hospitalization.This review focuses on the assessment of endoscopic severity in CD and UC and on the impact of endoscopic severity on disease outcome.More specifically,we discuss how endoscopy can be used at different stages of IBD to predict the disease course and/or to adapt treatment strategies.展开更多
Gastric antral vascular ectasia(GAVE) may cause gastrointestinal bleeding(GIB). The treatment of GAVE relies on endoscopic approaches such as electrocoagulation(argon plasma coagulation, laser therapy, heater probe th...Gastric antral vascular ectasia(GAVE) may cause gastrointestinal bleeding(GIB). The treatment of GAVE relies on endoscopic approaches such as electrocoagulation(argon plasma coagulation, laser therapy, heater probe therapy, radiofrequency ablation), cryotherapy, and band ligation. In refractory cases, antrectomy may be considered. In the event of an associated cirrhosis and portal hypertension, it has been suggested that antrectomy could be an option, provided the mortality risk isn't considered too great. We report the case of a 67-year-old cirrhotic patient who presented with GAVE related GIB, unresponsive to multiple endoscopic treatments. The patient had a good liver function(model for end-stage disease 10). After a multidisciplinary meeting, a transjugular intrahepatic portosystemic shunt(TIPS) procedure was performed, in order to treat the cirrhosis associated ascites. The outcome was successful. An antrectomy was then performed, with no recurrence of GIB and no transfusion need during three months of follow up. In this case, the TIPS procedure achieved a complete ascites regression, allowing a safer surgical treatment of the GAVE-related GIB.展开更多
High dose radiation exposures involving medical treatments or accidental irradiation may lead to extended damage to the irradiated tissue. Alleviation or even eradication of irradiation induced adverse events is there...High dose radiation exposures involving medical treatments or accidental irradiation may lead to extended damage to the irradiated tissue. Alleviation or even eradication of irradiation induced adverse events is therefore crucial. Because developments in cell therapy have brought some hope for the treatment of tissues damages induced by irradiation, the Institute for Radiation and Nuclear Safety contributed to establish the clinical guidelines for the management of accidentally irradiated victims and to provide the best supportive care to patients all over the world. In the past 15 years, we contributed to develop and test cell therapy for protection against radiation side effects in several animalmodels, and we proposed mechanisms to explain the benefit brought by this new therapeutic approach. We established the proof of concept that mesenchymal stem cells (MSCs) migrate to damaged tissues in the nonobese diabetic/severe combined immunodeficiency immunotolerant mice model and in non-human primate after radiation exposure. We showed that the intravenous injection of MSCs sustains hematopoiesis after total body irradiation, improves wound healing after radiodermatitis and protects gut function from irradiation damages. Thanks to a tight collaboration with clinicians from several French hospitals, we report successful treatments of therapeutic/accidental radiation damages in several victims with MSC infusions for hematopoiesis correction, radio-induced burns, gastrointestinal disorders and protection homeostatic functions of gut management after radio-therapy.展开更多
The incidence of inflammatory bowel diseases(IBD)is rising worldwide.The therapeutic options for IBD are expanding,and the number of drugs with new targets will rapidly increase in coming years.A rapid step-up approac...The incidence of inflammatory bowel diseases(IBD)is rising worldwide.The therapeutic options for IBD are expanding,and the number of drugs with new targets will rapidly increase in coming years.A rapid step-up approach with close monitoring of intestinal inflammation is extensively used.The fear of side effects represents one the most limiting factor of their use.Despite a widespread use for years,drug induced liver injury(DILI)management remains a challenging situation with Azathioprine and Methotrexate.DILI seems less frequent with anti-tumor necrosis factor agents and new biologic therapies.The aim of this review is to report incidence,physiopathology and practical guidelines in case of DILI occurrence with the armamentarium of old and new drugs in the field of IBD.展开更多
The impact of a chronic disease such as inflammatory bowel disease (IBD) on sexual functioning and body image can significantly impair the quality of life of patients. This review considers the sexual and fertility as...The impact of a chronic disease such as inflammatory bowel disease (IBD) on sexual functioning and body image can significantly impair the quality of life of patients. This review considers the sexual and fertility aspects of IBD patients and their daily management. Modern IBD healthcare management should include appropriate communication on sexuality and consider psychological, physiological, and biological issues. Patients with IBD have less children than the general population, and voluntary childlessness is frequent. The most influential factors reported by IBD patients who experience fertility alteration are psychological and surgery-related problems. Pregnancy is a major concern for patients, and any pregnancy for IBD patients should be closely followed-up to keep the chronic disease in a quiescent state. Preconceptional consultation is of great help.展开更多
AIM: To investigate the feasibility and accuracy of cone beam computed tomography(CBCT) in assessing the ablation zone after liver tumor ablation.METHODS: Twenty-three patients(17 men and 6 women, range: 45-85 years o...AIM: To investigate the feasibility and accuracy of cone beam computed tomography(CBCT) in assessing the ablation zone after liver tumor ablation.METHODS: Twenty-three patients(17 men and 6 women, range: 45-85 years old, mean age 65 years) with malignant liver tumors underwent ultrasoundguided percutaneous tumor ablation [radiofrequency(n = 14), microwave(n = 9)] followed by intravenous contrast-enhanced CBCT. Baseline multidetector computed tomography(MDCT) and peri-procedural CBCT images were compared. CBCT image quality was assessed as poor, good, or excellent. Image fusion was performed to assess tumor coverage, and quality of fusion was rated as bad, good, or excellent. Ablation zone volumes on peri-procedural CBCT and post-procedural MDCT were compared using the nonparametric paired Wilcoxon t-test.RESULTS: Rate of primary ablation effectiveness was 100%. There were no complications related to ablation. Local tumor recurrence and new liver tumors were found 3 mo after initial treatment in one patient(4%). The ablation zone was identified in 21/23(91.3%) patients on CBCT. The fusion of baseline MDCT and peri-procedural CBCT images was feasible in all patients and showed satisfactory tumor coverage(at least 5-mm margin). CBCT image quality was poor, good, and excellent in 2(9%), 8(35%), and 13(56%), patients respectively. Registration quality between periprocedural CBCT and post-procedural MDCT images was good to excellent in 17/23(74%) patients. The median ablation volume on peri-procedural CBCT and post-procedural MDCT was 30 cm3(range: 4-95 cm3) and 30 cm3(range: 4-124 cm3), respectively(P-value > 0.2). There was a good correlation(r = 0.79) between the volumes of the two techniques. CONCLUSION: Contrast-enhanced CBCT after tumor ablation of the liver allows early assessment of the ablation zone.展开更多
Bacteria are known to communicate with each other and regulate their activities in social networks by secreting and sensing signaling molecules called autoinducers,a process known as quorum sensing(QS).This is a growi...Bacteria are known to communicate with each other and regulate their activities in social networks by secreting and sensing signaling molecules called autoinducers,a process known as quorum sensing(QS).This is a growing area of research in which we are expanding our understanding of how bacteria collectively modify their behavior but are also involved in the crosstalk between the host and gut microbiome.This is particularly relevant in the case of pathologies associated with dysbiosis or disorders of the intestinal ecosystem.This review will examine the different QS systems and the evidence for their presence in the intestinal ecosystem.We will also provide clues on the role of QS molecules that may exert,directly or indirectly through their bacterial gossip,an influence on intestinal epithelial barrier function,intestinal inflammation,and intestinal carcinogenesis.This review aims to provide evidence on the role of QS molecules in gut physiology and the potential shared by this new player.Better understanding the impact of intestinal bacterial social networks and ultimately developing new therapeutic strategies to control intestinal disorders remains a challenge that needs to be addressed in the future.展开更多
AIM:To evaluate the antiviral potency of a new antihepatitis C virus(HCV)antiviral agent targeting the cellular autophagy machinery.METHODS:Non-infected liver slices,obtained from human liver resection and cut in 350...AIM:To evaluate the antiviral potency of a new antihepatitis C virus(HCV)antiviral agent targeting the cellular autophagy machinery.METHODS:Non-infected liver slices,obtained from human liver resection and cut in 350μm-thick slices(2.7×106 cells per slice)were infected with cell culture-grown HCV Con1b/C3 supernatant(multiplicity of infection=0.1)cultivated for up to ten days.HCV infected slices were treated at day 4 post-infection with GNS-396 for 6 d at different concentrations.HCV replication was evaluated by strand-specific real-time quantitative reverse transcription-polymerase chain reaction.The infectivity titers of supernatants were evaluated by foci formation upon inoculation into naive Huh-7.5.1 cells.The cytotoxic effect of the drugs was evaluated by lactate dehydrogenase leakage assays.RESULTS:The antiviral efficacy of a new antiviral drug,GNS-396,an autophagy inhibitor,on HCV infection of adult human liver slices was evidenced in a dosedependent manner.At day 6 post-treatment,GNS-396 EC50 was 158 nmol/L without cytotoxic effect(compared to hydroxychloroquine EC50=1.17μmol/L).CONCLUSION:Our results demonstrated that our ex vivo model is efficient for evaluation the potency of autophagy inhibitors,in particular a new quinoline derivative GNS-396 as antiviral could inhibit HCV infection in a dosedependent manner without cytotoxic effect.展开更多
Radiotherapy may induce irreversible damage on healthy tissues surrounding the tumor. It has been reported that the majority of patients receiving pelvic radiation therapy show early or late tissue reactions of graded...Radiotherapy may induce irreversible damage on healthy tissues surrounding the tumor. It has been reported that the majority of patients receiving pelvic radiation therapy show early or late tissue reactions of graded severity as radiotherapy affects not only the targeted tumor cells but also the surrounding healthy tissues. The late adverse effects of pelvic radiotherapy concern 5% to 10% of them, which could be life threatening. However, a clear medical consensus concerning the clinical management of such healthy tissue sequelae does not exist. Although no pharmacologic interventions have yet been proven to efficiently mitigate radiotherapy severe side effects, few preclinical researches show the potential of combined and sequential pharmacological treatments to prevent the onset of tissue damage. Our group has demonstrated in preclinical animal models that systemic mesenchymal stromal cell(MSC) injection is a promising approach for the medical management of gastrointestinal disorder after irradiation. We have shown that MSCs migrate to damaged tissues and restore gut functions after irradiation.We carefully studied side effects of stem cell injection for further application in patients. We have shown that clinical status of four patients suffering from severe pelvic side effects resulting from an over-dosage was improved following MSC injection in a compationnal situation.展开更多
Hepatitis B and human immunodeficiency virus(HBV and HIV)infection share transmission patterns and risk factors,which explains high prevalence of chronic HBV infection in HIV infected patients.The natural course of HB...Hepatitis B and human immunodeficiency virus(HBV and HIV)infection share transmission patterns and risk factors,which explains high prevalence of chronic HBV infection in HIV infected patients.The natural course of HBV disease is altered by the HIV infection with less chance to clear acute HBV infection,faster progression to cirrhosis and higher risk of liver-related death in HIVHBV co-infected patients than in HBV mono-infected ones.HIV infected patients with chronic hepatitis B should be counseled for liver damage and surveillance of chronic hepatitis B should be performed to screen early hepatocellular carcinoma.Noninvasive tools are now available to evaluate liver fibrosis.Isolated hepatitis B core antibodies(anti-HBc)are a good predictive marker of occult HBV infection.Still the prevalence and significance of occult HBV infection is controversial,but its screening may be important in the management of antiretroviral therapy.Vaccination against HBV infection is recommended in non-immune HIV patients.The optimal treatment for almost all HIV-HBV co-infectedpatients should contain tenofovir plus lamivudine or emtricitabine and treatment should not be stopped to avoid HBV reactivation.Long term tenofovir therapy may lead to significant decline in hepatitis B surface Antigen.The emergence of resistant HBV strains may compromise the HBV therapy and vaccine therapy.展开更多
BACKGROUND Coronavirus disease(COVID)is a new and highly contagious infectious disease caused by the coronavirus(COVID-19 or severe acute respiratory syndrome coronavirus 2).There is limited data regarding the inciden...BACKGROUND Coronavirus disease(COVID)is a new and highly contagious infectious disease caused by the coronavirus(COVID-19 or severe acute respiratory syndrome coronavirus 2).There is limited data regarding the incidence and management of COVID-19 in immunocompromised patients’post-transplantation.In the pre-COVID-19 era,these patients were already at an increased risk of developing opportunistic infections.These often manifested with atypical symptoms.CASE SUMMARY We report another case of uneventful COVID-19 pneumonia in a 58-year old male who was 18 mo’post liver transplantation.He received tacrolimus monotherapy since July 2019.The clinical manifestations included only epigastric pain radiating to the right hypochondrium,nausea and vomiting.He had no fevers,cough,shortness of breath,anosmia or dysgeusia even if the chest computed tomography scan revealed an extension of the multiple patchy ground-glass density shadows to the upper lobe of the left lung too.He was hospitalised and received a course of oral chloroquine(200 mg×3 per day)for a period of 10 d.Interestingly,the COVID 19 infection was uneventful though there were no modifications to his tacrolimus dosing.He was successfully discharged.We performed subsequent follow-up via telemedicine.CONCLUSION In light of the current pandemic,it is even more important to identify how the liver recipient’s patients present and are managed,especially for immunosuppression treatment.展开更多
<strong>Background:</strong> <span "=""><span>Anticipating postoperative evolution in surgical patients is an important issue in our daily practice. We demonstrated in a previous...<strong>Background:</strong> <span "=""><span>Anticipating postoperative evolution in surgical patients is an important issue in our daily practice. We demonstrated in a previous study </span><span>that there were multiple predictors of postoperative outcome, including</span><span> American Society of Anesthesiologists status (ASA), transfusion, emergency, surgery and age. A secondary analysis describing intraoperative and postoperative outcomes was undertaken in children aged between 6 and 10 years old included in the initial study. </span><b><span>Objective: </span></b><span>To describe intraoperative and postoperative outcomes in children aged between 6 and 10 years old included in the initial cohort in abdominal surgery, neurosurgery and orthopedics. </span><b><span>Methods: </span></b><span>The secondary analysis of postoperative outcomes in children aged between 6 and 10 years old w</span></span><span>as</span><span "=""><span> retrospectively included in the initial study of 594 patients. The study was approved by the Ethics Committee. </span><b><span>Results: </span></b><span>There were 88 patients with a mean age of 98.7 ±</span></span><span "=""> </span><span "=""><span>13.8 months. The most common surgical interventions were scoliosis in 23 patients (26.1%), limb tumor resection in 8 patients (9.1%), femoral osteotomy in 6 patients (6.8%), intracerebral tumor resection in 6 patients (6.8%), intestinal resection in 5 patients (5.6%), Chiari’s malformation in 4 patients (4.5%), pelvic osteotomy in 4 patients (4.5%) and renal transplantation in 4 patients (4.5%). Most patients (45%) were American Society of Anesthesiologists grade 3 (ASA 3), and 13 (14.8%) were ASA grade 4. Twenty-two (25%) patients had intraoperative and/or postoperative complications (organ dysfunction or sepsis). Two patients (2.3%) had intraoperative hemorrhage, 1 patient (1.1%) had intraoperative difficult intubation, and 1 patient experienced intraoperative anaphy</span><span>laxis. Nine patients (10.2%) had postoperative neurologic failure, and 2</span><span> (2.3%) had postoperative cardio-circulatory failure. Three patients (3.4%) had postoperative septicemia, 2 patients (2.3%) had postoperative pulmonary and urinary sepsis, and 1 patient (1.1%) had postoperative abdominal sepsis. 3 patients (3.4%) had re-operations. 42</span></span><span "=""> </span><span>(47.7%) patients had intra-operative transfusion. There was 1 in-hospital death (1.1%). The median total length of hospital stay was 9 days [5</span><span "=""> </span><span>-</span><span "=""> </span><span "=""><span>16]. </span><b><span>Conclusion: </span></b><span>Twenty-five percent of the patients had intraoperative and/or postoperative complications, and most of them were ASA grade </span></span><span>3</span><span> 3. Integrating goal-directed therapies to optimize intraoperative management in these patients could be necessary to improve postoperative outcomes in surgical pediatric patients.展开更多
<b><span style="font-family:Verdana;">Background: </span></b></span><span><span><span style="font-family:""><span style="font-family:Ver...<b><span style="font-family:Verdana;">Background: </span></b></span><span><span><span style="font-family:""><span style="font-family:Verdana;">Scoliosis is among interventions with high postoperative com</span><span><span style="font-family:Verdana;">plication rates due to the characteristics of the surgery, where blood los</span><span style="font-family:Verdana;"></span><span style="font-family:Verdana;">s,</span></span><span style="font-family:Verdana;"> transfusion and fluid requirements can be increased. A monocentric retrospective observational study was undertaken earlier to determine predictors of intraoperative and postoperative outcomes in surgical patients. In this initial cohort, there were patients who underwent scoliosis surgery, and a secondary </span><span style="font-family:Verdana;">analysis to describe outcomes in these patients was realized and presented</span> <span><span style="font-family:Verdana;">here. </span><b><span style="font-family:Verdana;">Objective:</span></b><span style="font-family:Verdana;"> To describe intraoperative and postoperative outcomes in</span></span><span style="font-family:Verdana;"> patients under 18 years old in scoliosis surgery included in the initial study and </span><span style="font-family:Verdana;">to propose improvement </span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">and </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">implementation measures. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> A sec</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">ondary analysis of patients undergoing scoliosis surgery </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">from</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> 1 January 2014 to </span><span style="font-family:Verdana;">17 May 2017 was undertaken in our institution—Necker Enfants Malades</span> <span style="font-family:Verdana;">uni</span><span style="font-family:Verdana;">ver</span><span><span style="font-family:Verdana;">sity hospital. The study was approved by the Ethics Committee. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> There </span></span><span style="font-family:Verdana;">were 116 patients with a mean age of 147.5 ± 40.2 months. Twenty-eight pa</span><span style="font-family:Verdana;">tients </span><span style="font-family:Verdana;">(24.1%) presented intraoperative and/or postoperative complications. The most</span> <span style="font-family:Verdana;">common intraoperative complication was hemorrhagic shock in 3 patients </span><span style="font-family:Verdana;">(2.6%). The most common postoperative organ failure was neuro</span><span style="font-family:Verdana;">logic in seven patients (6%), respiratory in 3 patients (2.6%), car</span><span style="font-family:Verdana;">dio-circulatory in 2 patients (1.7%) and renal failure in </span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">1</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> patient (0.9%). The most common postoperative infection was surgical wound sepsis in 8 patients (6.9%), urinary sepsis in </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">3</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> patients (2.6%), and abdominal sepsis and septicemia in </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">2</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> patients (1.7%). </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">12</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> patients (10.3%) had reoperations. Fif</span><span style="font-family:Verdana;">ty-six patients (48.3%) had </span><span><span style="font-family:Verdana;">intraoperative transfusion. There was no in-hospital mortality. </span><b><span style="font-family:Verdana;">Conclusion:</span></b></span><span style="font-family:Verdana;"> The </span><span style="font-family:Verdana;">portion of patients with intraoperative and or postoperative complications </span><span style="font-family:Verdana;">was 24.1%, integrating goal-directed therapies in this surgical setting could improve postoperative outcomes.展开更多
<span style="font-family:Verdana;"> <strong>Background: </strong></span><span><span><span style="font-family:;" "=""><span style=&qu...<span style="font-family:Verdana;"> <strong>Background: </strong></span><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;">Femoral and pelvic osteotomies are potential hemorrhagic interventions where transfusion requirements can be necessary. </span><b><span style="font-family:Verdana;">Objective: </span></b><span style="font-family:Verdana;">We undertook a secondary analysis of patients who underwent femoral and pelvic osteotomy in the initial cohort. The objective of this secondary analysis was to describe intraoperative and postoperative outcomes and to describe intraoperative management in these patients in terms of blood product management and fluid and hemodynamic therapy with the aim of implementing optimization management protocols for postoperative outcome improvement. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> A secondary analysis of patients who underwent femoral and pelvic osteotomy surgery was included in the initial retrospective study. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">There were eighteen patients with a mean age of 104 ± 47.1 months. Four (22.2%) patients had intraoperative and/or postoperative complications. One patient (5.6%) had an intraoperative hemorrhagic shock, two patients (11.1%) had postoperative neurologic failure, and one patient (5.6%) had postoperative wound sepsis. The transfusion rate was 50% in nine patients. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Femoral and pelvic osteotomies are interventions where blood, transfusion and fluid requirements can be increased;thus, this implies the necessity of a global patient blood management protocol with point-of-care tests and fluid- and hemodynamic-guided protocols with validated tools in children for intraoperative and postoperative outcome optimization.</span></span></span></span>展开更多
BACKGROUND: There are few data on blood group(BG) types and types of pancreatic cancers. The aims of this study were to study BG types and BG-antigens in pancreatic intraductal papillary mucinous neoplasms(IPMNs). MET...BACKGROUND: There are few data on blood group(BG) types and types of pancreatic cancers. The aims of this study were to study BG types and BG-antigens in pancreatic intraductal papillary mucinous neoplasms(IPMNs). METHODS: BG type and tumor BG-antigen(glycoprotein) expression(studied by immunohistochemistry on tissue microarrays) were analyzed with regard to characteristics of 101 surgically resected pancreatic IPMNs. RESULTS: Non-O BG type predicted invasive carcinoma independently from high serum CA19-9 and male gender. BG type A was observed more frequently in women than in men. Chronic pancreatitis was more frequently seen in patients with BG type B or AB. Aberrant tumor expression(with regard to BG type) of loss of A antigen expression type occurred in 15.0% of IPMNs and of loss of B antigen expression type in 62.5% of IPMNs. Intraneoplasm BG-antigen expression was not related to dysplasia grade or invasion. CONCLUSION: The results of the study suggest that in pancreatic IPMN, non-O BG type predicted invasive carcinoma, whereas for intratumor BG-antigen expression no specific patterns were detected with regard to the progression of glandular epithelial dysplasia or invasion.展开更多
Metabolomics is defined as the quantitative measurement of the dynamic multiparametric metabolic response of living systems to pathophysiological stimuli or genetic modification.It is an"omics"technique that...Metabolomics is defined as the quantitative measurement of the dynamic multiparametric metabolic response of living systems to pathophysiological stimuli or genetic modification.It is an"omics"technique that is situated downstream of genomics,transcriptomics and proteomics.Metabolomics is recognized as a promising technique in the field of systems biology for the evaluation of global metabolic changes.During the last decade,metabolomics approaches have become widely used in the study of liver diseases for the detection of early biomarkers and altered metabolic pathways.It is a powerful technique to improve our pathophysiological knowledge of various liver diseases.It can be a useful tool to help clinicians in the diagnostic process especially to distinguish malignant and non-malignant liver disease as well as to determine the etiology or severity of the liver disease.It can also assess therapeutic response or predict drug induced liver injury.Nevertheless,the usefulness of metabolomics is often not understood by clinicians,especially the concept of metabolomics profiling or fingerprinting.In the present work,after a concise description of the different techniques and processes used in metabolomics,we will review the main research on this subject by focusing specifically on in vitro proton nuclear magnetic resonance spectroscopy based metabolomics approaches in human studies.We will first consider the clinical point of view enlighten physicians on this new approach and emphasis its future use in clinical"routine".展开更多
Parental imprinting is an epigenetic process leading to monoallelic expression of certain genes depending on their parental origin.Imprinting diseases are characterized by growth and metabolic issues starting from bir...Parental imprinting is an epigenetic process leading to monoallelic expression of certain genes depending on their parental origin.Imprinting diseases are characterized by growth and metabolic issues starting from birth to adulthood.They are mainly due to methylation defects in imprinting control region that drive the abnormal expression of imprinted genes.We currently lack relevant animal or cellular models to unravel the pathophysiology of growth failure in these diseases.We aimed to characterize the methylation of imprinting regions in dental pulp stem cells and during their differentiation in osteogenic cells(involved in growth regulation)to assess the interest of this cells in modeling imprinting diseases.We collected dental pulp stem cells from five controls and four patients(three with Silver-Russell syndrome and one with Beckwith-Wiedemann syndrome).Methylation analysis of imprinting control regions involved in these syndromes showed a normal profile in controls and the imprinting defect in patients.These results were maintained in dental pulp stem cells cultured under osteogenic conditions.Furthermore,we confirmed the same pattern in six other loci involved in imprinting diseases in humans.We also confirmed monoallelic expression of H19(an imprinted gene)in controls and its biallelic expression in one patient.Extensive imprinting control regions methylation analysis shows the strong potential of dental pulp stem cells in modeling imprinting diseases,in which imprinting regions are preserved in culture and during osteogenic differentiation.This will allow to perform in vitro functional and therapeutic tests in cells derived from dental pulp stem cells and generate other cell-types.展开更多
Diabetes,whether due to pancreatic beta cells insufficiency or peripheral resistance to insulin,has been suggested as a risk factor of developing severe acute respiratory disease coronavirus-2(SARS-CoV-2)infections.In...Diabetes,whether due to pancreatic beta cells insufficiency or peripheral resistance to insulin,has been suggested as a risk factor of developing severe acute respiratory disease coronavirus-2(SARS-CoV-2)infections.Indeed,diabetes has been associated with a higher risk of infections and higher risk of developing severe forms of coronavirus disease 2019(COVID-19)related pneumonia.Diabetic patients often present associated comorbidities such as obesity,hypertension and cardiovascular diseases,and complications of diabetes,including chronic kidney disease,vasculopathy and relative immune dysfunction,all of which make them more susceptible to infectious complications.Moreover,they often present lowgrade inflammation with increased circulating interleukin levels,endothelial susceptibility to inflammation and dysfunction,and finally,hyperglycemia,which increases this risk.Additionally,corticosteroids,which count among the few medications which showed benefit on survival and mechanical ventilation requirement in COVID-19 pneumonia in large randomized controlled trials,are associated to new onsets of diabetes,and metabolic disorders in patients with previous history of diabetes.Finally,SARS-CoV-2 via the alternate effects of the renin-angiotensin system,mediated by the angiotensin-converting-enzyme 2,was also associated with insulin resistance in key tissues involved in glucose homeostasis,such as liver,skeletal muscles,and adipose tissue;and also,with impaired insulin secretion by pancreaticβ-cells.In this work,we reviewed all elements which may help understand how diabetes affects patients with COVID-19,how treatments affect outcomes in patients with COVID-19,how they may cause new onsets of diabetes,and finally review how SARS-CoV-2 may inherently be a risk factor of developing diabetes,through immune-mediated diabetogenic mechanisms.展开更多
文摘This article illustrates the clinical practice of psycho-oncology in a paediatric onco-haematology department by young psychologists.To begin with,we look at the role of the psychologist in a somatic department.Creativity in clinical work and the modulation of medical temporality.The aim here is to discuss the construction of the professional identity in relation to the construction of the therapeutic alliance with patients.Specifically,we will look at the relationship with creativity,which is necessary to support children and adolescents in their existential questioning.This work of creativity in the therapeutic alliance will be illustrated using two clinical cases that are particularly representative of clinical work centred on the relationship with finitude.
文摘Endoscopy provides a direct evaluation of mucosal lesions in inflammatory bowel disease(IBD),permitting the description of elementary lesions,their surface extent and severity.The severity of mucosal lesions directly reflects disease activity and may help to identify an aggressive behavior of the disease.Several studies have recently pointed out the potential role of endoscopy in the prediction of IBD outcome.Indeed,severe endoscopic lesions in Crohn's disease(CD) patients,defined by deep and extensive ulcerations on at least one part of the colon,are associated with an increased risk of penetrating complication and surgery.Severe endoscopic lesions during severe attacks of ulcerative colitis(UC) are associated with an increased risk of colectomy in the short and long term.Severity of postoperative recurrence in CD may help to predict the risk of clinical relapse and need for further surgery.Achievement of mucosal healing,which can be obtained by administration of several types of drugs,is associated with a better outcome,less surgery and hospitalization.This review focuses on the assessment of endoscopic severity in CD and UC and on the impact of endoscopic severity on disease outcome.More specifically,we discuss how endoscopy can be used at different stages of IBD to predict the disease course and/or to adapt treatment strategies.
文摘Gastric antral vascular ectasia(GAVE) may cause gastrointestinal bleeding(GIB). The treatment of GAVE relies on endoscopic approaches such as electrocoagulation(argon plasma coagulation, laser therapy, heater probe therapy, radiofrequency ablation), cryotherapy, and band ligation. In refractory cases, antrectomy may be considered. In the event of an associated cirrhosis and portal hypertension, it has been suggested that antrectomy could be an option, provided the mortality risk isn't considered too great. We report the case of a 67-year-old cirrhotic patient who presented with GAVE related GIB, unresponsive to multiple endoscopic treatments. The patient had a good liver function(model for end-stage disease 10). After a multidisciplinary meeting, a transjugular intrahepatic portosystemic shunt(TIPS) procedure was performed, in order to treat the cirrhosis associated ascites. The outcome was successful. An antrectomy was then performed, with no recurrence of GIB and no transfusion need during three months of follow up. In this case, the TIPS procedure achieved a complete ascites regression, allowing a safer surgical treatment of the GAVE-related GIB.
文摘High dose radiation exposures involving medical treatments or accidental irradiation may lead to extended damage to the irradiated tissue. Alleviation or even eradication of irradiation induced adverse events is therefore crucial. Because developments in cell therapy have brought some hope for the treatment of tissues damages induced by irradiation, the Institute for Radiation and Nuclear Safety contributed to establish the clinical guidelines for the management of accidentally irradiated victims and to provide the best supportive care to patients all over the world. In the past 15 years, we contributed to develop and test cell therapy for protection against radiation side effects in several animalmodels, and we proposed mechanisms to explain the benefit brought by this new therapeutic approach. We established the proof of concept that mesenchymal stem cells (MSCs) migrate to damaged tissues in the nonobese diabetic/severe combined immunodeficiency immunotolerant mice model and in non-human primate after radiation exposure. We showed that the intravenous injection of MSCs sustains hematopoiesis after total body irradiation, improves wound healing after radiodermatitis and protects gut function from irradiation damages. Thanks to a tight collaboration with clinicians from several French hospitals, we report successful treatments of therapeutic/accidental radiation damages in several victims with MSC infusions for hematopoiesis correction, radio-induced burns, gastrointestinal disorders and protection homeostatic functions of gut management after radio-therapy.
文摘The incidence of inflammatory bowel diseases(IBD)is rising worldwide.The therapeutic options for IBD are expanding,and the number of drugs with new targets will rapidly increase in coming years.A rapid step-up approach with close monitoring of intestinal inflammation is extensively used.The fear of side effects represents one the most limiting factor of their use.Despite a widespread use for years,drug induced liver injury(DILI)management remains a challenging situation with Azathioprine and Methotrexate.DILI seems less frequent with anti-tumor necrosis factor agents and new biologic therapies.The aim of this review is to report incidence,physiopathology and practical guidelines in case of DILI occurrence with the armamentarium of old and new drugs in the field of IBD.
文摘The impact of a chronic disease such as inflammatory bowel disease (IBD) on sexual functioning and body image can significantly impair the quality of life of patients. This review considers the sexual and fertility aspects of IBD patients and their daily management. Modern IBD healthcare management should include appropriate communication on sexuality and consider psychological, physiological, and biological issues. Patients with IBD have less children than the general population, and voluntary childlessness is frequent. The most influential factors reported by IBD patients who experience fertility alteration are psychological and surgery-related problems. Pregnancy is a major concern for patients, and any pregnancy for IBD patients should be closely followed-up to keep the chronic disease in a quiescent state. Preconceptional consultation is of great help.
文摘AIM: To investigate the feasibility and accuracy of cone beam computed tomography(CBCT) in assessing the ablation zone after liver tumor ablation.METHODS: Twenty-three patients(17 men and 6 women, range: 45-85 years old, mean age 65 years) with malignant liver tumors underwent ultrasoundguided percutaneous tumor ablation [radiofrequency(n = 14), microwave(n = 9)] followed by intravenous contrast-enhanced CBCT. Baseline multidetector computed tomography(MDCT) and peri-procedural CBCT images were compared. CBCT image quality was assessed as poor, good, or excellent. Image fusion was performed to assess tumor coverage, and quality of fusion was rated as bad, good, or excellent. Ablation zone volumes on peri-procedural CBCT and post-procedural MDCT were compared using the nonparametric paired Wilcoxon t-test.RESULTS: Rate of primary ablation effectiveness was 100%. There were no complications related to ablation. Local tumor recurrence and new liver tumors were found 3 mo after initial treatment in one patient(4%). The ablation zone was identified in 21/23(91.3%) patients on CBCT. The fusion of baseline MDCT and peri-procedural CBCT images was feasible in all patients and showed satisfactory tumor coverage(at least 5-mm margin). CBCT image quality was poor, good, and excellent in 2(9%), 8(35%), and 13(56%), patients respectively. Registration quality between periprocedural CBCT and post-procedural MDCT images was good to excellent in 17/23(74%) patients. The median ablation volume on peri-procedural CBCT and post-procedural MDCT was 30 cm3(range: 4-95 cm3) and 30 cm3(range: 4-124 cm3), respectively(P-value > 0.2). There was a good correlation(r = 0.79) between the volumes of the two techniques. CONCLUSION: Contrast-enhanced CBCT after tumor ablation of the liver allows early assessment of the ablation zone.
基金by Fondation pour la Recherche Médicale,No.EQU202003010171Association François Aupetit,No.AHLs 2019 and No.AHLs 2021+1 种基金Fondation pour la Recherche Médical FRM,No.ECO201806006843(to Coquant G)and CORDDIM,Ile-de-France Region(to Aguanno D).
文摘Bacteria are known to communicate with each other and regulate their activities in social networks by secreting and sensing signaling molecules called autoinducers,a process known as quorum sensing(QS).This is a growing area of research in which we are expanding our understanding of how bacteria collectively modify their behavior but are also involved in the crosstalk between the host and gut microbiome.This is particularly relevant in the case of pathologies associated with dysbiosis or disorders of the intestinal ecosystem.This review will examine the different QS systems and the evidence for their presence in the intestinal ecosystem.We will also provide clues on the role of QS molecules that may exert,directly or indirectly through their bacterial gossip,an influence on intestinal epithelial barrier function,intestinal inflammation,and intestinal carcinogenesis.This review aims to provide evidence on the role of QS molecules in gut physiology and the potential shared by this new player.Better understanding the impact of intestinal bacterial social networks and ultimately developing new therapeutic strategies to control intestinal disorders remains a challenge that needs to be addressed in the future.
基金Supported by The Institut National de la Sante et de la Recherche Medicale(INSERM,France)the personal support of Professor Jean-Francois Delfraissy as Director of the French Agency,Agence Nationale de Recherches sur le Sida et les hepatites virales(ANRS)
文摘AIM:To evaluate the antiviral potency of a new antihepatitis C virus(HCV)antiviral agent targeting the cellular autophagy machinery.METHODS:Non-infected liver slices,obtained from human liver resection and cut in 350μm-thick slices(2.7×106 cells per slice)were infected with cell culture-grown HCV Con1b/C3 supernatant(multiplicity of infection=0.1)cultivated for up to ten days.HCV infected slices were treated at day 4 post-infection with GNS-396 for 6 d at different concentrations.HCV replication was evaluated by strand-specific real-time quantitative reverse transcription-polymerase chain reaction.The infectivity titers of supernatants were evaluated by foci formation upon inoculation into naive Huh-7.5.1 cells.The cytotoxic effect of the drugs was evaluated by lactate dehydrogenase leakage assays.RESULTS:The antiviral efficacy of a new antiviral drug,GNS-396,an autophagy inhibitor,on HCV infection of adult human liver slices was evidenced in a dosedependent manner.At day 6 post-treatment,GNS-396 EC50 was 158 nmol/L without cytotoxic effect(compared to hydroxychloroquine EC50=1.17μmol/L).CONCLUSION:Our results demonstrated that our ex vivo model is efficient for evaluation the potency of autophagy inhibitors,in particular a new quinoline derivative GNS-396 as antiviral could inhibit HCV infection in a dosedependent manner without cytotoxic effect.
文摘Radiotherapy may induce irreversible damage on healthy tissues surrounding the tumor. It has been reported that the majority of patients receiving pelvic radiation therapy show early or late tissue reactions of graded severity as radiotherapy affects not only the targeted tumor cells but also the surrounding healthy tissues. The late adverse effects of pelvic radiotherapy concern 5% to 10% of them, which could be life threatening. However, a clear medical consensus concerning the clinical management of such healthy tissue sequelae does not exist. Although no pharmacologic interventions have yet been proven to efficiently mitigate radiotherapy severe side effects, few preclinical researches show the potential of combined and sequential pharmacological treatments to prevent the onset of tissue damage. Our group has demonstrated in preclinical animal models that systemic mesenchymal stromal cell(MSC) injection is a promising approach for the medical management of gastrointestinal disorder after irradiation. We have shown that MSCs migrate to damaged tissues and restore gut functions after irradiation.We carefully studied side effects of stem cell injection for further application in patients. We have shown that clinical status of four patients suffering from severe pelvic side effects resulting from an over-dosage was improved following MSC injection in a compationnal situation.
文摘Hepatitis B and human immunodeficiency virus(HBV and HIV)infection share transmission patterns and risk factors,which explains high prevalence of chronic HBV infection in HIV infected patients.The natural course of HBV disease is altered by the HIV infection with less chance to clear acute HBV infection,faster progression to cirrhosis and higher risk of liver-related death in HIVHBV co-infected patients than in HBV mono-infected ones.HIV infected patients with chronic hepatitis B should be counseled for liver damage and surveillance of chronic hepatitis B should be performed to screen early hepatocellular carcinoma.Noninvasive tools are now available to evaluate liver fibrosis.Isolated hepatitis B core antibodies(anti-HBc)are a good predictive marker of occult HBV infection.Still the prevalence and significance of occult HBV infection is controversial,but its screening may be important in the management of antiretroviral therapy.Vaccination against HBV infection is recommended in non-immune HIV patients.The optimal treatment for almost all HIV-HBV co-infectedpatients should contain tenofovir plus lamivudine or emtricitabine and treatment should not be stopped to avoid HBV reactivation.Long term tenofovir therapy may lead to significant decline in hepatitis B surface Antigen.The emergence of resistant HBV strains may compromise the HBV therapy and vaccine therapy.
文摘BACKGROUND Coronavirus disease(COVID)is a new and highly contagious infectious disease caused by the coronavirus(COVID-19 or severe acute respiratory syndrome coronavirus 2).There is limited data regarding the incidence and management of COVID-19 in immunocompromised patients’post-transplantation.In the pre-COVID-19 era,these patients were already at an increased risk of developing opportunistic infections.These often manifested with atypical symptoms.CASE SUMMARY We report another case of uneventful COVID-19 pneumonia in a 58-year old male who was 18 mo’post liver transplantation.He received tacrolimus monotherapy since July 2019.The clinical manifestations included only epigastric pain radiating to the right hypochondrium,nausea and vomiting.He had no fevers,cough,shortness of breath,anosmia or dysgeusia even if the chest computed tomography scan revealed an extension of the multiple patchy ground-glass density shadows to the upper lobe of the left lung too.He was hospitalised and received a course of oral chloroquine(200 mg×3 per day)for a period of 10 d.Interestingly,the COVID 19 infection was uneventful though there were no modifications to his tacrolimus dosing.He was successfully discharged.We performed subsequent follow-up via telemedicine.CONCLUSION In light of the current pandemic,it is even more important to identify how the liver recipient’s patients present and are managed,especially for immunosuppression treatment.
文摘<strong>Background:</strong> <span "=""><span>Anticipating postoperative evolution in surgical patients is an important issue in our daily practice. We demonstrated in a previous study </span><span>that there were multiple predictors of postoperative outcome, including</span><span> American Society of Anesthesiologists status (ASA), transfusion, emergency, surgery and age. A secondary analysis describing intraoperative and postoperative outcomes was undertaken in children aged between 6 and 10 years old included in the initial study. </span><b><span>Objective: </span></b><span>To describe intraoperative and postoperative outcomes in children aged between 6 and 10 years old included in the initial cohort in abdominal surgery, neurosurgery and orthopedics. </span><b><span>Methods: </span></b><span>The secondary analysis of postoperative outcomes in children aged between 6 and 10 years old w</span></span><span>as</span><span "=""><span> retrospectively included in the initial study of 594 patients. The study was approved by the Ethics Committee. </span><b><span>Results: </span></b><span>There were 88 patients with a mean age of 98.7 ±</span></span><span "=""> </span><span "=""><span>13.8 months. The most common surgical interventions were scoliosis in 23 patients (26.1%), limb tumor resection in 8 patients (9.1%), femoral osteotomy in 6 patients (6.8%), intracerebral tumor resection in 6 patients (6.8%), intestinal resection in 5 patients (5.6%), Chiari’s malformation in 4 patients (4.5%), pelvic osteotomy in 4 patients (4.5%) and renal transplantation in 4 patients (4.5%). Most patients (45%) were American Society of Anesthesiologists grade 3 (ASA 3), and 13 (14.8%) were ASA grade 4. Twenty-two (25%) patients had intraoperative and/or postoperative complications (organ dysfunction or sepsis). Two patients (2.3%) had intraoperative hemorrhage, 1 patient (1.1%) had intraoperative difficult intubation, and 1 patient experienced intraoperative anaphy</span><span>laxis. Nine patients (10.2%) had postoperative neurologic failure, and 2</span><span> (2.3%) had postoperative cardio-circulatory failure. Three patients (3.4%) had postoperative septicemia, 2 patients (2.3%) had postoperative pulmonary and urinary sepsis, and 1 patient (1.1%) had postoperative abdominal sepsis. 3 patients (3.4%) had re-operations. 42</span></span><span "=""> </span><span>(47.7%) patients had intra-operative transfusion. There was 1 in-hospital death (1.1%). The median total length of hospital stay was 9 days [5</span><span "=""> </span><span>-</span><span "=""> </span><span "=""><span>16]. </span><b><span>Conclusion: </span></b><span>Twenty-five percent of the patients had intraoperative and/or postoperative complications, and most of them were ASA grade </span></span><span>3</span><span> 3. Integrating goal-directed therapies to optimize intraoperative management in these patients could be necessary to improve postoperative outcomes in surgical pediatric patients.
文摘<b><span style="font-family:Verdana;">Background: </span></b></span><span><span><span style="font-family:""><span style="font-family:Verdana;">Scoliosis is among interventions with high postoperative com</span><span><span style="font-family:Verdana;">plication rates due to the characteristics of the surgery, where blood los</span><span style="font-family:Verdana;"></span><span style="font-family:Verdana;">s,</span></span><span style="font-family:Verdana;"> transfusion and fluid requirements can be increased. A monocentric retrospective observational study was undertaken earlier to determine predictors of intraoperative and postoperative outcomes in surgical patients. In this initial cohort, there were patients who underwent scoliosis surgery, and a secondary </span><span style="font-family:Verdana;">analysis to describe outcomes in these patients was realized and presented</span> <span><span style="font-family:Verdana;">here. </span><b><span style="font-family:Verdana;">Objective:</span></b><span style="font-family:Verdana;"> To describe intraoperative and postoperative outcomes in</span></span><span style="font-family:Verdana;"> patients under 18 years old in scoliosis surgery included in the initial study and </span><span style="font-family:Verdana;">to propose improvement </span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">and </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">implementation measures. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> A sec</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">ondary analysis of patients undergoing scoliosis surgery </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">from</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> 1 January 2014 to </span><span style="font-family:Verdana;">17 May 2017 was undertaken in our institution—Necker Enfants Malades</span> <span style="font-family:Verdana;">uni</span><span style="font-family:Verdana;">ver</span><span><span style="font-family:Verdana;">sity hospital. The study was approved by the Ethics Committee. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> There </span></span><span style="font-family:Verdana;">were 116 patients with a mean age of 147.5 ± 40.2 months. Twenty-eight pa</span><span style="font-family:Verdana;">tients </span><span style="font-family:Verdana;">(24.1%) presented intraoperative and/or postoperative complications. The most</span> <span style="font-family:Verdana;">common intraoperative complication was hemorrhagic shock in 3 patients </span><span style="font-family:Verdana;">(2.6%). The most common postoperative organ failure was neuro</span><span style="font-family:Verdana;">logic in seven patients (6%), respiratory in 3 patients (2.6%), car</span><span style="font-family:Verdana;">dio-circulatory in 2 patients (1.7%) and renal failure in </span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">1</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> patient (0.9%). The most common postoperative infection was surgical wound sepsis in 8 patients (6.9%), urinary sepsis in </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">3</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> patients (2.6%), and abdominal sepsis and septicemia in </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">2</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> patients (1.7%). </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">12</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> patients (10.3%) had reoperations. Fif</span><span style="font-family:Verdana;">ty-six patients (48.3%) had </span><span><span style="font-family:Verdana;">intraoperative transfusion. There was no in-hospital mortality. </span><b><span style="font-family:Verdana;">Conclusion:</span></b></span><span style="font-family:Verdana;"> The </span><span style="font-family:Verdana;">portion of patients with intraoperative and or postoperative complications </span><span style="font-family:Verdana;">was 24.1%, integrating goal-directed therapies in this surgical setting could improve postoperative outcomes.
文摘<span style="font-family:Verdana;"> <strong>Background: </strong></span><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;">Femoral and pelvic osteotomies are potential hemorrhagic interventions where transfusion requirements can be necessary. </span><b><span style="font-family:Verdana;">Objective: </span></b><span style="font-family:Verdana;">We undertook a secondary analysis of patients who underwent femoral and pelvic osteotomy in the initial cohort. The objective of this secondary analysis was to describe intraoperative and postoperative outcomes and to describe intraoperative management in these patients in terms of blood product management and fluid and hemodynamic therapy with the aim of implementing optimization management protocols for postoperative outcome improvement. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> A secondary analysis of patients who underwent femoral and pelvic osteotomy surgery was included in the initial retrospective study. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">There were eighteen patients with a mean age of 104 ± 47.1 months. Four (22.2%) patients had intraoperative and/or postoperative complications. One patient (5.6%) had an intraoperative hemorrhagic shock, two patients (11.1%) had postoperative neurologic failure, and one patient (5.6%) had postoperative wound sepsis. The transfusion rate was 50% in nine patients. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Femoral and pelvic osteotomies are interventions where blood, transfusion and fluid requirements can be increased;thus, this implies the necessity of a global patient blood management protocol with point-of-care tests and fluid- and hemodynamic-guided protocols with validated tools in children for intraoperative and postoperative outcome optimization.</span></span></span></span>
文摘BACKGROUND: There are few data on blood group(BG) types and types of pancreatic cancers. The aims of this study were to study BG types and BG-antigens in pancreatic intraductal papillary mucinous neoplasms(IPMNs). METHODS: BG type and tumor BG-antigen(glycoprotein) expression(studied by immunohistochemistry on tissue microarrays) were analyzed with regard to characteristics of 101 surgically resected pancreatic IPMNs. RESULTS: Non-O BG type predicted invasive carcinoma independently from high serum CA19-9 and male gender. BG type A was observed more frequently in women than in men. Chronic pancreatitis was more frequently seen in patients with BG type B or AB. Aberrant tumor expression(with regard to BG type) of loss of A antigen expression type occurred in 15.0% of IPMNs and of loss of B antigen expression type in 62.5% of IPMNs. Intraneoplasm BG-antigen expression was not related to dysplasia grade or invasion. CONCLUSION: The results of the study suggest that in pancreatic IPMN, non-O BG type predicted invasive carcinoma, whereas for intratumor BG-antigen expression no specific patterns were detected with regard to the progression of glandular epithelial dysplasia or invasion.
文摘Metabolomics is defined as the quantitative measurement of the dynamic multiparametric metabolic response of living systems to pathophysiological stimuli or genetic modification.It is an"omics"technique that is situated downstream of genomics,transcriptomics and proteomics.Metabolomics is recognized as a promising technique in the field of systems biology for the evaluation of global metabolic changes.During the last decade,metabolomics approaches have become widely used in the study of liver diseases for the detection of early biomarkers and altered metabolic pathways.It is a powerful technique to improve our pathophysiological knowledge of various liver diseases.It can be a useful tool to help clinicians in the diagnostic process especially to distinguish malignant and non-malignant liver disease as well as to determine the etiology or severity of the liver disease.It can also assess therapeutic response or predict drug induced liver injury.Nevertheless,the usefulness of metabolomics is often not understood by clinicians,especially the concept of metabolomics profiling or fingerprinting.In the present work,after a concise description of the different techniques and processes used in metabolomics,we will review the main research on this subject by focusing specifically on in vitro proton nuclear magnetic resonance spectroscopy based metabolomics approaches in human studies.We will first consider the clinical point of view enlighten physicians on this new approach and emphasis its future use in clinical"routine".
基金financially supported with a grant from the Sociéte Francaise d’Endocrinologie et Diabétologie pédiatrique and the experiments were supported by the ANR-18-CE12-022。
文摘Parental imprinting is an epigenetic process leading to monoallelic expression of certain genes depending on their parental origin.Imprinting diseases are characterized by growth and metabolic issues starting from birth to adulthood.They are mainly due to methylation defects in imprinting control region that drive the abnormal expression of imprinted genes.We currently lack relevant animal or cellular models to unravel the pathophysiology of growth failure in these diseases.We aimed to characterize the methylation of imprinting regions in dental pulp stem cells and during their differentiation in osteogenic cells(involved in growth regulation)to assess the interest of this cells in modeling imprinting diseases.We collected dental pulp stem cells from five controls and four patients(three with Silver-Russell syndrome and one with Beckwith-Wiedemann syndrome).Methylation analysis of imprinting control regions involved in these syndromes showed a normal profile in controls and the imprinting defect in patients.These results were maintained in dental pulp stem cells cultured under osteogenic conditions.Furthermore,we confirmed the same pattern in six other loci involved in imprinting diseases in humans.We also confirmed monoallelic expression of H19(an imprinted gene)in controls and its biallelic expression in one patient.Extensive imprinting control regions methylation analysis shows the strong potential of dental pulp stem cells in modeling imprinting diseases,in which imprinting regions are preserved in culture and during osteogenic differentiation.This will allow to perform in vitro functional and therapeutic tests in cells derived from dental pulp stem cells and generate other cell-types.
文摘Diabetes,whether due to pancreatic beta cells insufficiency or peripheral resistance to insulin,has been suggested as a risk factor of developing severe acute respiratory disease coronavirus-2(SARS-CoV-2)infections.Indeed,diabetes has been associated with a higher risk of infections and higher risk of developing severe forms of coronavirus disease 2019(COVID-19)related pneumonia.Diabetic patients often present associated comorbidities such as obesity,hypertension and cardiovascular diseases,and complications of diabetes,including chronic kidney disease,vasculopathy and relative immune dysfunction,all of which make them more susceptible to infectious complications.Moreover,they often present lowgrade inflammation with increased circulating interleukin levels,endothelial susceptibility to inflammation and dysfunction,and finally,hyperglycemia,which increases this risk.Additionally,corticosteroids,which count among the few medications which showed benefit on survival and mechanical ventilation requirement in COVID-19 pneumonia in large randomized controlled trials,are associated to new onsets of diabetes,and metabolic disorders in patients with previous history of diabetes.Finally,SARS-CoV-2 via the alternate effects of the renin-angiotensin system,mediated by the angiotensin-converting-enzyme 2,was also associated with insulin resistance in key tissues involved in glucose homeostasis,such as liver,skeletal muscles,and adipose tissue;and also,with impaired insulin secretion by pancreaticβ-cells.In this work,we reviewed all elements which may help understand how diabetes affects patients with COVID-19,how treatments affect outcomes in patients with COVID-19,how they may cause new onsets of diabetes,and finally review how SARS-CoV-2 may inherently be a risk factor of developing diabetes,through immune-mediated diabetogenic mechanisms.
