Acute pancreatitis(AP)is a frequent disease with degrees of increasing severity responsible for high morbidity.Despite continuous improvement in care,mortality remains significant.Because hypovolemia,together with mic...Acute pancreatitis(AP)is a frequent disease with degrees of increasing severity responsible for high morbidity.Despite continuous improvement in care,mortality remains significant.Because hypovolemia,together with microcirculatory dysfunction lead to poor outcome,fluid therapy remains a cornerstone of the supportive treatment.However,poor clinical evidence actually support the aggressive fluid therapy recommended in recent guidelines since available data are controversial.Fluid management remains unclear and leads to current heterogeneous practice.Different strategies may help to improve fluid resuscitation in AP.On one hand,integration of fluid therapy in a global hemodynamic resuscitation has been demonstrated to improve outcomein surgical or septic patients.Tailored fluid administration after early identification of patients with high-risk of poor outcome presenting inadequate tissue oxygenation is a major part of this strategy.On the other hand,new decision parameters have been developed recently to improve safety and efficiency of fluid therapy in critically ill patients.In this review,we propose a personalized strategy integrating these new concepts in the early fluid management of AP.This new approach paves the way to a wide range of clinical studies in the field of AP.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
Alpha-thalassemia trait and sickle trait are not commonly considered risk factors of ischemic heart disease.We report the case of a non-atherosclerotic silent myocardial infarction in a 46-year-old woman,carrier of th...Alpha-thalassemia trait and sickle trait are not commonly considered risk factors of ischemic heart disease.We report the case of a non-atherosclerotic silent myocardial infarction in a 46-year-old woman,carrier of the alphathalassemia trait(homozygous deletion of locus-3.7) combined with sickle cell trait.While the patient was included as healthy volunteer for a metabolic study,we performed cardiac magnetic resonance imagery showing a left ventricle apicolateral myocardial infarction.Coronary computed tomography angiography showed normal coronary arteries with a coronary calcium score of 0.The patient was treated with low-dose aspirin in secondary prevention afterwards.This case allows us to discuss cardiovascular risk among patients presenting with both alpha-thalassemia trait and sickle cell trait and the indication of cardiac imagery in such patients even when considered as low-cardiovascular risk.展开更多
Dear Editor,Infertility affects about 48.5 million couples worldwide,and a male disorder is estimated to be a causative or contributing factor in 20%-50%of cases.^1 Notably,increasing data support the view that obese ...Dear Editor,Infertility affects about 48.5 million couples worldwide,and a male disorder is estimated to be a causative or contributing factor in 20%-50%of cases.^1 Notably,increasing data support the view that obese men are at higher risk of fertility disorders.^2 As is known,obesity is defined by an excess of white adipose tissue,currently recognized as being able to secrete many endocrinologically active molecules called adipokines.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
Epidemiological studies showed an association between menopause, weight gain and risk factors that identify the metabolic syndrome (MS). We evaluated body composition and metabolic risk factors in postmenopausal women...Epidemiological studies showed an association between menopause, weight gain and risk factors that identify the metabolic syndrome (MS). We evaluated body composition and metabolic risk factors in postmenopausal women addressed to a center for the assessment of nutritional status to lose weight by hypocaloric balanced diet. 161 postmenopausal women were enrolled. MS diagnosis was made applying IDF (International Diabetes Foundation) criteria. After the prescription of hypocaloric diet all subjects were controlled every 2 months. In patients suffering from MS (MS+) at the first visit, diagnosis of MS was reassessed when 10% weight loss was achieved. 70 women were MS+. Years since menopause, low instruction level, obesity and Visceral Adipose Tissue (VAT) were each associated with MS. Particularly, BMI ≥ 30 Kg/m2 (OR: 2.61;95% CI, 1.76 - 3.46) and VAT > 6.6 cm (OR: 3.49;95% CI, 2.52 - 4.46) resulted independent risk factors. The 30% of the whole sample dropped out, the reminders significantly reduced weight, waist circumference (Wc) and Fat Mass (p 0.01). The 35% of MS+ women achieved the 10% weight loss with significant reduction of VAT, Wc, fasting glucose, tryglicerides, blood pressure and resolution of MS in the 78% of them. The 43.5% of postmenopausal women addressed in one center for the assessment of nutritional status to follow a weight-loss nutritional program had the MS;visceral obesity was the strongest independent risk factor and hypocaloric balanced diet resulted a good strategy to lose weight and treat MS.展开更多
Myofibroblastoma and Darier Ferrand’s dermatofibrosarcoma are rare entities that are similar both in terms of clinical morphological characteristics and histological characteristics. We report the case of a 49-year-o...Myofibroblastoma and Darier Ferrand’s dermatofibrosarcoma are rare entities that are similar both in terms of clinical morphological characteristics and histological characteristics. We report the case of a 49-year-old non-menopausal woman with a history of right breast lumpectomy. Supported by the Chompret criteria, an oncogenetic consultation was performed. Clinical examination revealed a firm 25 mm mass on the medial part of the left breast with skin involvement. A biopsy was performed and analysis result came back in favor of a cellular type myofibroblastoma showing a fibrous component consisting of spindle cells with a herringbone arrangement. Anatomopathological results concluded to a dermatofibrosarcoma of Darier Ferrand while immunohistochemistry stated a tumor population strongly positive for CD34 expression. The search for a rearrangement of the collagen type I alpha 1 gene (COL1A1) by fluorescence in situ hybridization (FISH) was positive. The diagnosis of Dermatofibrosarcoma of Darier Ferrand can be suspected on imaging and confirmed by histology. Surgical treatment of Darier Ferrand dermatofibrosarcoma consists of wide excision of the lesions with margins greater than 2 cm, on which the prognosis mainly depends. Micrographic surgery and oncoplastic breast surgery are of major interest in this location.展开更多
Microneedles(MNs)are a prospective system in cancer immunotherapy to overcome barriers regarding proper antigen delivery and presentation.This study aims at identifying the potential of MNs for the delivery of Peptide...Microneedles(MNs)are a prospective system in cancer immunotherapy to overcome barriers regarding proper antigen delivery and presentation.This study aims at identifying the potential of MNs for the delivery of Peptide-coated Conditionally Replicating Adenoviruses(PeptiCRAd),whereby peptides enhance the immunogenic properties of adenoviruses presenting tumor associated antigens.The combination of PeptiCRAd with MNs containing polyvinylpyrrolidone and sucrose was tested for the preservation of structure,induction of immune response,and tumor eradication.The findings indicated that MN-delivered PeptiCRAd was effective in peptide presentation in vivo,leading to complete tumor rejection when mice were pre-vaccinated.A rise in the cDC1 population in the lymph nodes of the MN treated mice led to an increase in the effector memory T cells in the body.Thus,the results of this study demonstrate that the combination of MN technology with PeptiCRAd may provide a safer,more tolerable,and efficient approach to cancer immunotherapy,potentially translatable to other therapeutic applications.展开更多
文摘Acute pancreatitis(AP)is a frequent disease with degrees of increasing severity responsible for high morbidity.Despite continuous improvement in care,mortality remains significant.Because hypovolemia,together with microcirculatory dysfunction lead to poor outcome,fluid therapy remains a cornerstone of the supportive treatment.However,poor clinical evidence actually support the aggressive fluid therapy recommended in recent guidelines since available data are controversial.Fluid management remains unclear and leads to current heterogeneous practice.Different strategies may help to improve fluid resuscitation in AP.On one hand,integration of fluid therapy in a global hemodynamic resuscitation has been demonstrated to improve outcomein surgical or septic patients.Tailored fluid administration after early identification of patients with high-risk of poor outcome presenting inadequate tissue oxygenation is a major part of this strategy.On the other hand,new decision parameters have been developed recently to improve safety and efficiency of fluid therapy in critically ill patients.In this review,we propose a personalized strategy integrating these new concepts in the early fluid management of AP.This new approach paves the way to a wide range of clinical studies in the field of AP.
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.
文摘Alpha-thalassemia trait and sickle trait are not commonly considered risk factors of ischemic heart disease.We report the case of a non-atherosclerotic silent myocardial infarction in a 46-year-old woman,carrier of the alphathalassemia trait(homozygous deletion of locus-3.7) combined with sickle cell trait.While the patient was included as healthy volunteer for a metabolic study,we performed cardiac magnetic resonance imagery showing a left ventricle apicolateral myocardial infarction.Coronary computed tomography angiography showed normal coronary arteries with a coronary calcium score of 0.The patient was treated with low-dose aspirin in secondary prevention afterwards.This case allows us to discuss cardiovascular risk among patients presenting with both alpha-thalassemia trait and sickle cell trait and the indication of cardiac imagery in such patients even when considered as low-cardiovascular risk.
文摘Dear Editor,Infertility affects about 48.5 million couples worldwide,and a male disorder is estimated to be a causative or contributing factor in 20%-50%of cases.^1 Notably,increasing data support the view that obese men are at higher risk of fertility disorders.^2 As is known,obesity is defined by an excess of white adipose tissue,currently recognized as being able to secrete many endocrinologically active molecules called adipokines.
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Epidemiological studies showed an association between menopause, weight gain and risk factors that identify the metabolic syndrome (MS). We evaluated body composition and metabolic risk factors in postmenopausal women addressed to a center for the assessment of nutritional status to lose weight by hypocaloric balanced diet. 161 postmenopausal women were enrolled. MS diagnosis was made applying IDF (International Diabetes Foundation) criteria. After the prescription of hypocaloric diet all subjects were controlled every 2 months. In patients suffering from MS (MS+) at the first visit, diagnosis of MS was reassessed when 10% weight loss was achieved. 70 women were MS+. Years since menopause, low instruction level, obesity and Visceral Adipose Tissue (VAT) were each associated with MS. Particularly, BMI ≥ 30 Kg/m2 (OR: 2.61;95% CI, 1.76 - 3.46) and VAT > 6.6 cm (OR: 3.49;95% CI, 2.52 - 4.46) resulted independent risk factors. The 30% of the whole sample dropped out, the reminders significantly reduced weight, waist circumference (Wc) and Fat Mass (p 0.01). The 35% of MS+ women achieved the 10% weight loss with significant reduction of VAT, Wc, fasting glucose, tryglicerides, blood pressure and resolution of MS in the 78% of them. The 43.5% of postmenopausal women addressed in one center for the assessment of nutritional status to follow a weight-loss nutritional program had the MS;visceral obesity was the strongest independent risk factor and hypocaloric balanced diet resulted a good strategy to lose weight and treat MS.
文摘Myofibroblastoma and Darier Ferrand’s dermatofibrosarcoma are rare entities that are similar both in terms of clinical morphological characteristics and histological characteristics. We report the case of a 49-year-old non-menopausal woman with a history of right breast lumpectomy. Supported by the Chompret criteria, an oncogenetic consultation was performed. Clinical examination revealed a firm 25 mm mass on the medial part of the left breast with skin involvement. A biopsy was performed and analysis result came back in favor of a cellular type myofibroblastoma showing a fibrous component consisting of spindle cells with a herringbone arrangement. Anatomopathological results concluded to a dermatofibrosarcoma of Darier Ferrand while immunohistochemistry stated a tumor population strongly positive for CD34 expression. The search for a rearrangement of the collagen type I alpha 1 gene (COL1A1) by fluorescence in situ hybridization (FISH) was positive. The diagnosis of Dermatofibrosarcoma of Darier Ferrand can be suspected on imaging and confirmed by histology. Surgical treatment of Darier Ferrand dermatofibrosarcoma consists of wide excision of the lesions with margins greater than 2 cm, on which the prognosis mainly depends. Micrographic surgery and oncoplastic breast surgery are of major interest in this location.
基金support from the Research Council Finland(grant No.331151,HAS)UMCG Research Funds(HAS)+6 种基金the Finnish Cultural Foundation(CD)provided by the European Research Council(ERC)under the Horizon 2020 framework(grant No.681219,VC)the Magnus Ehrnrooth Foundation(project No.4706235,VC)the Jane and Aatos Erkko Foundation(project No.4705796,VC)the Finnish Cancer Foundation(project No.4706116,VC)the Helsinki Institute of Life Science(HiLIFE)(project No.797011004,VC)the Digital Precision Cancer Medicine Flagship iCAN(VC),and the GeneCellNano Flagship(VC).
文摘Microneedles(MNs)are a prospective system in cancer immunotherapy to overcome barriers regarding proper antigen delivery and presentation.This study aims at identifying the potential of MNs for the delivery of Peptide-coated Conditionally Replicating Adenoviruses(PeptiCRAd),whereby peptides enhance the immunogenic properties of adenoviruses presenting tumor associated antigens.The combination of PeptiCRAd with MNs containing polyvinylpyrrolidone and sucrose was tested for the preservation of structure,induction of immune response,and tumor eradication.The findings indicated that MN-delivered PeptiCRAd was effective in peptide presentation in vivo,leading to complete tumor rejection when mice were pre-vaccinated.A rise in the cDC1 population in the lymph nodes of the MN treated mice led to an increase in the effector memory T cells in the body.Thus,the results of this study demonstrate that the combination of MN technology with PeptiCRAd may provide a safer,more tolerable,and efficient approach to cancer immunotherapy,potentially translatable to other therapeutic applications.
