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Background Although Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) confers health benefits in peritoneal carcinomatosis (PC) treatment, it is associated with significant postoperative morbidity and mortality rate with increased length of hospital stay. The goal of this study is to determine whether a new comprehensive physiotherapy program including epidural loco-regional analgesia can improve the quality of care and patients recovery. Methods Between 2009 and 2013, 124 patients with PC were operated for CRS and HIPEC procedures. These patients were analyzed and divided in 2 groups by means of time. No Physio group included patients operated from 2009 to 2011 (n = 57) having a thoracic patient controlled epidural analgesia (PCEA) but no preoperative physiotherapy program. The Physio group included patients operated from 2012 to 2013 (n = 67) having both a PCEA with a preoperative physiotherapy program. Results The mortality rate was 1.6% (n = 2). The median length of stay in the intensive care unit (ICU) was lower in the Physio group, 2 days vs. 0 for No Physio group (p < 0.0001). The first time of mobilization after surgery was shorter in the Physio group (day 3 vs. 2, p = 0.0043). The overall satisfaction in the Physio group was achieved in 93% of patients, helping in decreasing fear of surgery and mobilization in 70% and 84% of cases respectively. Conclusion Our study demonstrates that a clear pre-operative information and education by a physiotherapist, associated with a PCEA-pain management significantly benefits the patient's post-operative recovery and reduces the length of stay in the ICU. [ABSTRACT FROM AUTHOR]

We have recently reported the crucial role of Galectin-3 (Gal3) in the progression of type 3 cardio-renal syndrome (CRS-3). Indeed, Gal3 overexpression after renal ischemia reperfusion (IRr) was associated with cardiac fibrosis and dysfunction, which were prevented by Gal3 pharmacological or genetic inhibition. Our present aim was to better define the initial role of kidney Gal3 for triggering CRS-3. A murine irradiated and graft model having IRr was used to differentiate the Gal3 expressed by tissue (WT irradiated mice grafted with Gal3-/- bone marrow (BM) cells, WTGal3-/-BM) from Gal3 expressed by immune cells (Gal3-/- irradiated mice grafted with WT BM cells: Gal3-/-WTBM) and were killed after 2 or 28 days. Cardiac and renal phenotypes were evaluated using echocardiography and real-time PCR. After IRr, WTGal3-/-BM exhibit normal cardiac phenotype whereas Gal3-/-WTBM developed cardiac dysfunction and high Fibronectin (Fn) mRNA expression (Fig. 1A). In contrast, WTGal3-/-BM showed short- and long-term kidney damages with increased renal NGAL mRNA level by day 2 and increased Fn mRNA by 28d (Fig. 1B). In kidney after IRr, the increased levels of endothelial marker transcripts (ICAM-1, VCAM-1) mainly in WTGal3-/-BM mice (Fig. 1C) suggested that tissue Gal3 expression is involved in the endothelial activation. After IRr the organ dysfunction varies according to the Gal3 cell type origin; kidney Gal3 plays a major role in renal damage, whereas Gal3 from infiltrated BM cells in the heart is deleterious for cardiac function. It remains now to define how tissue Gal3 acts and interacts with endothelial cells, to assess Gal3 as a key-point for CRS-3 understanding. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: Our objective was to evaluate the 3D power Doppler angiography (PDA) in terms of feasibility and ability to detect placental hypo-perfusion in an experimental rabbit model of intrauterine growth restriction (IUGR). Study design: 14 pregnant females were treated with NG-nitro-L-arginine methylester (L-NAME), a nitric oxide synthase inhibitor, from day 24 to day 28 of gestation, to induce an IUGR. Concomitantly, 8 pregnant rabbits were used as controls. On day 28, 3D power Doppler indices were quantified in each utero-placental unit. Morphological examination of the placentas for the control group (n = 4) and the L-NAME group (500 mg/day, n = 4) were performed with immunohistochemical staining to discriminate the fetal capillaries in the labyrinthine area. Results: A total of 180 live fetuses were obtained, 108 from the L-NAME group and 72 from the control group. G28 fetal weight was significantly lower in the L-NAME group than in the control group (27.40 ± 0.55 g vs 33.14 ± 0.62 g, p < 0.0001). In the L-NAME group the vascularization index (VI), flow index (FI) and vascularization flow index (VFI) were significantly lower than in the control group (2.6 [1.4; 6.0] vs 7.6 [3.5; 12.6], p < 0.05; 28.7 [26.5; 31.3] vs 32.9 [28.3; 38.1], p < 0.05; 0.8 [0.4; 1.8] vs 2.5 [1.1; 4.1], p < 0.05, for VI, FI and VFI, respectively). Morphological examinations revealed a substantial disorganization of the placental vascular architecture in the L-NAME group. Conclusion: This experimental study demonstrates that quantitative 3D PDA indices are sensitive enough to detect placental vascular insufficiency in an experimental rabbit model of IUGR. [Copyright &y& Elsevier]

BACKGROUND: Left ventricular (LV) remodeling is a prognostically important development after acute myocardial infarction (AMI). We recently reported that vascular endothelial growth factor B (VEGFB) may be a potential new biomarker of LV remodeling. This potential biomarker was evaluated in the present study. METHODS AND RESULTS: Patients with AMI (n = 290) and healthy volunteers (n = 42) were included. Plasma VEGFB levels were assessed before discharge. LV remodeling was determined by echocardiography at 6 months' follow-up. Levels of VEGFB were elevated in AMI patients compared with healthy volunteers (1.5-fold; P = .001). Mean plasma levels of VEGFB were 64% higher (P < .001) in patients in whom LV end-diastolic volume (EDV) decreased during follow-up ([Delta]EDV <= 0; n = 144; reverse remodeling) compared with patients in whom [Delta]EDV increased ([Delta]EDV > 0; n = 146; remodeling). Using logistic regression models, independent relationships were found between VEGFB (odds ratio [OR] 0.8, 95% confidence interval [CI] 0.7-0.9; P = .0007) and infarct territory (OR 1.7, 95% CI 1.1-2.8; P = .02). Patients with anterior MI and low levels of VEGFB had the highest risk of remodeling. VEFGB outperformed N-terminal pro-B-type natriuretic peptide to predict LV remodeling, and low levels of VEGFB (<100 pg/mL) provided a specificity of 90%. Adding VEGFB to a clinical model involving age, sex, smoking habit, and infarct territory resulted in a net reclassification index of 11.7%. CONCLUSIONS: Plasma levels of VEGFB increase after AMI and correlate with preservation of cardiac function. Low levels of VEGFB accurately predict LV remodeling. Therefore, circulating VEGFB may have clinical utility in the identification of patients at high risk of remodeling after AMI. [ABSTRACT FROM AUTHOR]

Nous avons récemment démontré dans un modèle murin, que l'augmentation de l'expression de Gal3, secondaire à une ischémie-reperfusion rénale (IRr), était associée à la fibrose puis la dysfonction myocardique, prévenue lors d'une inhibition génétique ou pharmacologique de Gal3. L'objectif de notre travail est de définir le rôle initial de Gal3 tissulaire rénale à l'origine du syndrome cardiorenal-3 (SCR3). D'une part, un modèle de souris transgénique Gal3-/-, et d'autre part, un modèle de souris irradiées puis greffées était utilisé pour différencier l'expression tissulaire de Gal3 (souris sauvages greffées avec de la moelle osseuse (MO) Gal3-/- : WTGal3-/-MO) de la Gal3 exprimée par les cellules immunitaires (souris Gal3-/- greffées avec des cellules de MO sauvage: Gal3-/-W™O). Le phénotype puis les dommages cardiorénaux étaient évalués par échocardiographie, PCR quantitative et une analyse histologique après une IRr. Après une IRr les souris Gal3-/- présentaient moins de dysfonction cardiaque que les souris WT ; en revanche, les souris WTGal3-/-MO présentaient moins de dysfonctions cardiaques que les souris Gal3-/-W™O (Fig. 1). Les souris Gal3-/- présentaient moins de dommage rénaux que les souris WT, marqué par un expression des ARNm de NGAL et du score de lésions histologiques moins importante. Ceci s'accompagnait d'une augmentation moins importante des marqueurs de dysfonction endothéliale (ICAM-1, VCAM-1 et CD146). Les souris Gal3-/-W™O présentaient moins de dommage rénal et une expression des marqueurs endothéliaux plus faible que les WTGal3-/-MO (Fig. 1). Après une IRr, la dysfonction d'organe varie selon le type cellulaire d'expression de Gal3 ; lorsqu'elle est rénale, nous avons observé des dommages rénaux, alors que lorsqu'elle est immunitaire, elle est délétère pour la fonction myocardique. De plus l'expression tissulaire de Gal3 joue un rôle dans l'activation endothéliale dont l'interaction avec les cellules endothéliales reste à définir, ce qui représenterait la clé de voûte dans la compréhension du SCR3. [ABSTRACT FROM AUTHOR]

We have recently reported the crucial role of Galectin-3 (Gal3) in the progression of type 3 cardio-renal syndrome (CRS-3). Indeed, Gal3 overexpression after renal ischemia reperfusion (IRr) was associated with cardiac fibrosis and dysfunction, which were prevented by Gal3 pharmacological or genetic inhibition. Our present aim was to better define the initial role of kidney Gal3 for triggering CRS-3. A murine irradiated and graft model having IRr was used to differentiate the Gal3 expressed by tissue (WT irradiated mice grafted with Gal3-/- bone marrow (BM) cells, WTGal3-/-BM) from Gal3 expressed by immune cells (Gal3-/- irradiated mice grafted with WT BM cells: Gal3-/-WTBM) and were killed after 2 or 28 days. Cardiac and renal phenotypes were evaluated using echocardiography and real-time PCR. After IRr, WTGal3-/-BM exhibit normal cardiac phenotype whereas Gal3-/-WTBM developed cardiac dysfunction and high Fibronectin (Fn) mRNA expression (Fig. 1A). In contrast, WTGal3-/-BM showed short- and long-term kidney damages with increased renal NGAL mRNA level by day 2 and increased Fn mRNA by 28d (Fig. 1B). In kidney after IRr, the increased levels of endothelial marker transcripts (ICAM-1, VCAM-1) mainly in WTGal3-/-BM mice suggested that tissue Gal3 expression is involved in the endothelial activation. After IRr the organ dysfunction varies according to the Gal3 cell type origin; kidney Gal3 plays a major role in renal damage, whereas Gal3 from infiltrated BM cells in the heart is deleterious for cardiac function. It remains now to define how tissue Gal3 acts and interacts with endothelial cells, to assess Gal3 as a key-point for CRS-3 understanding. [ABSTRACT FROM AUTHOR]

Introduction: Placental dysfunction is known to be a major cause of pregnancy complications, such as perinatal loss, preeclampsia, and intrauterine growth restriction (IUGR). Inadequate remodeling of the spiral arteries resulting in decreased blood flowto the placenta has been implicated in the pathophysiology of preeclampsia and IUGR. 3D power Doppler angiography (PDA) is a noninvasive and safe way to study blood flow within an organ or region of interest. The aim of this study was to evaluate PDA as a method to quantify placental perfusion in a pharmacological rabbit model of vascular IUGR induced by inhibition of NO synthesis. Objectives: Our objective was to evaluate the 3D power Doppler angiography (PDA) in terms of feasibility and ability to detect placental hypo-perfusion in an experimental rabbit model of intrauterine growth restriction (IUGR). Methods: Fourteen pregnant females were treated with NG-nitro-L-arginine methylester (L-NAME), a nitric oxide synthase inhibitor, from day 24 to day 28 of gestation, to induce an IUGR. Concomitantly, 8 pregnant rabbits were used as controls. On day 28, 3D power Doppler indices were quantified in each uteroplacental unit. Results: A total number of 180 live fetuses were obtained, 180 from the L-NAME group and 72 from the control group. G28 fetal weight was significantly lower in the L-NAME group than in the control group (27.40±0.55g vs 33.14±0.62g, p <0.0001). In the L-Name group the vascularization index (VI) was significantly lower than in the control group (2.6 [1.4;6.0] vs 7.6 [3.5;12.6], p <0.05). Similar results were obtained for the Flow Index (FI) and the Vascularization Flow Index (VFI). The number of fetuses considered as small for gestational age (SGA;weight<10th centile) was significantly higher in the L-NAME group than in the control group (47/108 vs 7/72, p <0.0001). The VI was significantly lower in the SGA group than in the eutrophic group (3.46 [0.46;5.9] vs 7.50 [4.22;10.9] p <0.05). Similar results were obtained for FI and VFI. Conclusions: This experiment study demonstrates that quantitative 3D PDA indices are sensitive enough to detect placental vascular insufficiency in an experimental model of IUGR. [Copyright &y& Elsevier]

Summary: In cases of serious bleeding postpartum, resuscitation and surgical techniques are complementary and should be adapted to both the etiology and severity of bleeding. In extremely severe cases, the performance of a hysterectomy should not be delayed. For women with stable hemodynamic status, so-called “conservative” surgical techniques can instead be used. In this study, we describe and discuss the indications and feasibility of various techniques of vascular ligation. Uterine mattress suture compression techniques and abdomino-pelvic packing are also described. When conservative management is feasible, the first line approach should be bilateral distal ligation of the uterine arteries: this simple and low-risk technique is immediately effective in 80% of cases. If bleeding persists, uterine devascularization can be completed by a triple ligation as described by Tsirulnikov, with or without supplemental proximal ligation of the uterine arteries. This procedure should be performed in preference to the so-called “stepwise ligation sequence”, which involves ligation of the ovarian pedicles and poses a risk of subsequent ovarian failure. Bilateral hypogastric artery ligation is also an effective and widely used first-line technique for experienced surgeons. This approach is technically challenging for less-experienced surgeons and is reserved for cases of failed triple ligation. [Copyright &y& Elsevier]