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Background: There is no definitive evidence of the prognosis impact of histological variants (HVs) in patients who undergo surgical resection of a nonmetastatic renal cell carcinoma (nm-RCC) with venous tumor thrombus (TT). Objective: To investigate the impact of HVs on the prognosis of patients with nm-RCC with TT after radical surgery. Design, setting, and participants: Patients who underwent radical nephrectomy with the removal of the venous TT for an nm-RCC were included in a retrospective study. Outcome measurements and statistical analysis: Three groups were identified: clear cell (ccRCC), papillary (pRCC), and chromophobe (chRCC) RCC. The primary outcome measures (disease-free and overall survival [OS]) were assessed using the Kaplan-Meier method and compared using the log-rank test. Univariate and multivariate Cox proportional hazard models were used to study the impact of HVs on survival. Results and limitations: A total of 873 patients were included. The histological subtypes were distributed as follows: ccRCC in 780 cases, pRCC in 58 cases, and chRCC in 35 cases. At the time of data analysis, 612 patients were recurrence free and 228 had died. A survival analysis revealed significant differences in both OS and recurrence-free survival across histological subtypes, with the poorest outcomes observed in pRCC patients (p

Background: Human metapneumovirus (hMPV) is one of the leading respiratory viruses. This prospective observational study aimed to describe the clinical features and the outcomes of hMPV-associated lower respiratory tract infections in adult inpatients. Methods: Consecutive adult patients admitted to one of the 31 participating centers with an acute lower respiratory tract infection and a respiratory multiplex PCR positive for hMPV were included. A primary composite end point of complicated course (hospital death and/or the need for invasive mechanical ventilation) was used. Results: Between March 2018 and May 2019, 208 patients were included. The median age was 74 [62–84] years. Ninety-seven (47 %) patients were men, 187 (90 %) had at least one coexisting illness, and 67 (31 %) were immunocompromised. Median time between first symptoms and hospital admission was 3 [2–7] days. The two most frequent symptoms were dyspnea (86 %) and cough (85 %). The three most frequent clinical diagnoses were pneumonia (42 %), acute bronchitis (20 %) and acute exacerbation of chronic obstructive pulmonary disease (16 %). Among the 52 (25 %) patients who had a lung CT-scan, the most frequent abnormality was ground glass opacity (41 %). While over four-fifths of patients (81 %) received empirical antibiotic therapy, a bacterial coinfection was diagnosed in 61 (29 %) patients. Mixed flora (16 %) and enterobacteria (5 %) were the predominant documentations. The composite criterion of complicated course was assessable in 202 (97 %) patients, and present in 37 (18 %) of them. In the subpopulation of pneumonia patients (42 %), we observed a more complicated course in those with a bacterial coinfection (8/24, 33 %) as compared to those without (5/60, 8 %) (p = 0.02). Sixty (29 %) patients were admitted to the intensive care unit. Among them, 23 (38 %) patients required invasive mechanical ventilation. In multivariable analysis, tachycardia and alteration of consciousness were identified as risk factors for complicated course. Conclusion: hMPV-associated lower respiratory tract infections in adult inpatients mostly involved elderly people with pre-existing conditions. Bacterial coinfection was present in nearly 30 % of the patients. The need for mechanical ventilation and/or the hospital death were observed in almost 20 % of the patients.

PurposeProgress has been made in understanding trans health needs, but research priorities are often set by policy or healthcare professionals without trans input, which may not reflect public needs. Our study sought to identify trans health research priorities in France from both researchers and the trans community.MethodsExpert stakeholders (health and social sciences professionals, trans individuals, and their families) answered a three-round Delphi survey on trans health research priorities. The first round involved an open-ended questionnaire, analyzed qualitatively. In the second round, participants ranked research propositions from round one using a Likert scale. The study’s second phase involved a two-hour workshop with experts and trans individuals.Results53 participants (32% trans individuals/relatives, 60% health professionals) contributed 217 responses to open-ended questions, leading to 44 research priorities. After the two voting rounds, a total of five proposals reached a strong consensus cut-off and were considered as the main research priorities: evaluation of the effect of puberty blocker use in trans children and adolescents (95%), evaluation of the effect of supporting trans children and adolescents (92%), study of the support systems available for trans youth and their parents (86%), persistence of trans identity around puberty (prevalence, persistent persons characteristics) (86%), and needs assessment survey of the support for adolescents and their families (83%). Thirteen other proposals were considered moderate priorities.ConclusionThe main consensus in our French study concerned research on trans-youth care and support needs. Our results may guide further trans-health research that meets the public’s needs and desires.

Abstract Background Precise data about ATTR-CM incidence rates at national level are scarce. Consequently, this study aimed to estimate the annual incidence and survival of transthyretin amyloid cardiomyopathy (ATTR-CM) in France between 2011 and 2019 using real world data. We used the French nationwide exhaustive data (SNDS database) gathering in- and out-patient claims. As there is no specific ICD-10 marker code for ATTR-CM, diagnosis required both amyloidosis (identified by E85. ICD-10 code or a tafamidis meglumine delivery) and a cardiovascular condition (identified by ICD-10 or medical procedure codes related to either heart failure, arrhythmias, conduction disorders or cardiomyopathies), not necessarily reported at the same visit. Patients with probable AL-form of amyloidosis or probable AA-form of amyloidosis were excluded. Results Between 2011 and 2019, 8,950 patients with incident ATTR-CM were identified. Incidence rates increased from 0.6 / 100,000 person-years in 2011 to 3.6 / 100,000 person-years in 2019 (p

Abstract Background Data on ventilator associated pneumonia (VAP) in COVID-19 and influenza patients admitted to intensive care units (ICU) are scarce. This study aimed to estimate day-60 mortality related to VAP in ICU patients ventilated for at least 48 h, either for COVID-19 or for influenza, and to describe the epidemiological characteristics in each group of VAP. Design Multicentre retrospective observational study. Setting Eleven ICUs of the French OutcomeRea™ network. Patients Patients treated with invasive mechanical ventilation (IMV) for at least 48 h for either COVID-19 or for flu. Results Of the 585 patients included, 503 had COVID-19 and 82 had influenza between January 2008 and June 2021. A total of 232 patients, 209 (41.6%) with COVID-19 and 23 (28%) with influenza, developed 375 VAP episodes. Among the COVID-19 and flu patients, VAP incidences for the first VAP episode were, respectively, 99.2 and 56.4 per 1000 IMV days (p

Redox control of glasses is paramount both to their fusion process and to obtaining the desired properties of high technological glasses. However, the link between melting parameters, such as temperature, furnace atmosphere, or quenching rate, and the redox state of the final products is poorly understood. In this work, in situ x-ray absorption near-edge structure (XANES) data at Ce L3-edge data were acquired at high temperatures on cerium-containing sodium aluminosilicate glasses, allowing the determination of thermodynamic constants necessary to predict the cerium redox state over a wide temperature range (900–1500 °C). The results obtained were compared to the Raman spectra of samples quenched at different temperatures. Our findings demonstrate that the quench performed was fast enough to block the cerium oxidation state, meaning the redox measured at room temperature is representative of a high temperature state. This was further verified by room temperature Raman spectroscopy, where a relationship was found between the spectra and melting conditions. Wet chemical analysis, XANES at Ce L3-edge, Raman spectroscopy, and optical absorption spectroscopy were successfully used to determine the redox state of cerium in aluminosilicates. [ABSTRACT FROM AUTHOR]

Abstract Introduction Providing information on cancerous tissue samples during a surgical operation can help surgeons delineate the limits of a tumoral invasion more reliably. Here, we describe the use of metabolic profiling of a colon biopsy specimen by high resolution magic angle spinning nuclear magnetic resonance spectroscopy to evaluate tumoral invasion during a simulated surgical operation. Case presentation Biopsy specimens (n = 9) originating from the excised right colon of a 66-year-old Caucasian women with an adenocarcinoma were automatically analyzed using a previously built statistical model. Conclusions Metabolic profiling results were in full agreement with those of a histopathological analysis. The time-response of the technique is sufficiently fast for it to be used effectively during a real operation (17 min/sample). Metabolic profiling has the potential to become a method to rapidly characterize cancerous biopsies in the operation theater.

Abstract Background Numerous studies reported genomic alterations in colorectal human tumors but few focused on rectal tumors with the specification of preoperative-treated or untreated tumors. The goals of this study were to list chromosome allelic imbalances and correlate their frequency with tumor progression and to identify potential molecular markers of progression in rectal chromosomally unstable tumors without preoperative treatment. Methods Genomic alterations of 57 rectal tumors assessed by allelotyping targeting 33 chromosomal loci, were clusterised and compared to those of 151 left colon tumors. Results Clustering separated the rectal tumors without preoperative treatment into three subtypes according to the allelic imbalance frequency and genomic alteration associations. The tumors without preoperative treatment displayed a significantly higher allelic imbalance frequency (54%) than the tumors with preoperative treatment (33%), suggesting that treatment could target highly altered tumor clones. Interestingly, the survival analysis identified three potential prognostic molecular survival markers, D1S197, D5S430, and D14S65, for tumors without preoperative treatment. Conclusion Based on the genomic status of 33 chromosomal loci, we observed that rectal tumors without preoperative treatment segregate according to the global allelic imbalance frequency but without correlation to the tumor progression. Moreover, the detailed associations of alterations in rectal tumors are different from those described in colon tumors suggesting that rectal and left tumors should be considered as separate entities. Finally, potential prognostic genomic molecular markers for survival are proposed which status could specify the clinical course of the tumors.

Glasses play a fundamental role in our daily lives at the economic, cultural, societal, energy and geological levels. Geological glasses testify to igneous activity of the Earth and represent an important material for tools and ornamental objects from the Paleolithic to the present day. Glasses are also used to manufacture technical materials, such as containers (dishes, glasses, jars, bottles ...), screens (television, computer, smartphone ...), fibers with multiple applications (reinforcement, information, transport, energy, health ...), to ensure the storage of domestic or nuclear waste and, more recently, biomaterials (dental or bone implants ...). Thus, silica-based glasses are at the heart of the history of the Earth and humanity. The variation in composition of natural and industrial glasses is vast but its structure is generally based on a tetrahedral frame of $\mathrm{SiO}_{4}$ units, the backbone of more than 90% of the glasses that surround us in our daily lives. Around this silica frame, other chemical elements are well constrained to form to form a single unit structure for use as network modifying elements, charge compensator, dyes, volatiles, and other substances. This article is a short introduction on glass.

The author of this opinion piece provides what he believes to be a definition of the present special education system at it's worst. Special education is described as a team of professionals gathered to plan for the individual. They assess, interpret, break down deficiencies into categories and divide those deficiencies to distribute among a variety of therapies and programs. The process has many names: Individualized Education Plan, Individualized Program Plan, or Personal Future Plan. The name changes, the process evolves, but the unconsciousness remains. The author states that the result, even if unintentional, is to break a whole child into perceived parts and cause the child to become known as those labeled imperfect fragments. The effect on the professional as an acquired assignment, is discussed which is often seen to be unsolvable and as a result harmful to both the professional and the student.

Before there were children with disabilities in typical schools in North America, there was only hope and need. Before the creation of highly specialized plans of education, individualized instruction techniques, methods of differentiating group instruction or regulations mandating the adherence to government regulations, there were only families, children with disabilities and institutions.

The financial burden of pursuing a medical education continues to grow, with the average medical student now owing over $240,000 in total student loan debt by the time they graduate. This burden peaks at a time when trainees are making some of the most consequential decisions of their careers. Additionally, many students are simultaneously making important financial decisions related to personal aspirations, all before a drastic change in earning potential once they begin practicing as attending physicians. Medical trainees’ financial stress is linked to specialty choice, mental quality of life, and physician burnout, with additional implications of such stress for patient health and safety. 1 – 3 Despite these issues, there are few examples of medical schools providing direct personal finance education to their students. Given the lack of personal finance education opportunities for medical students, the authors designed and implemented a medical student–specific personal finance curriculum at their home institution in conjunction with the Association of American Medical Colleges’ (AAMC) Financial Information, Resources, Services, and Tools program. The curriculum, which is primarily delivered through interactive lectures, covers topics ranging from the basics of saving and investment to clinicians’ potential future roles as administrators and innovators. The authors (1) present details regarding the creation of their personal finance education program; (2) invite fellow medical trainees and their respective institutions to start their own personal finance education programs or add similar curriculum to their health sciences coursework; and (3) call for recommendations by the American Medical Association (AMA) and AAMC in support of formal personal finance instruction for medical students on a national level.

LaF3 is commonly added to oxide glass, in particular to silica, to form oxyfluoride glass. After appropriate thermal treatment at a temperature lower than 800 °C, usually, glass ceramics are obtained. Recently, LaF3 nanoparticles have been used as precursors to obtain amorphous nanoparticles of undefined composition in optical fiber. However, fiber fabrication necessitates temperature much higher (typically up to 2000 °C) than the one required for bulk glass. In this article, we report on the reactivity of fluoride ions in LaF3 with SiO2 and GeO2 (a common dopant used to dope optical fiber) powders at high temperature. TGA, EDX-SEM, XRD and Raman analyses were performed. Above 1000 °C, LaF3 starts to react, preferentially with SiO2, to form SiF4 gaseous species. The remaining lanthanum ions form La2Si2O7 and La2Ge2O7 phases. These results could contribute to improve material development for the fiber optics community.

BackgroundBefore starting surgery for the resection of an intracranial tumor, its outlines are typically marked on the skin of the patient. This allows for the planning of the optimal skin incision, craniotomy, and angle of approach. Conventionally, the surgeon determines tumor borders using neuronavigation with a tracked pointer. However, interpretation errors can lead to important deviations, especially for deep-seated tumors, potentially resulting in a suboptimal approach with incomplete exposure. Augmented reality (AR) allows displaying of the tumor and critical structures directly on the patient, which can simplify and improve surgical preparation.MethodsWe developed an AR-based workflow for intracranial tumor resection planning deployed on the Microsoft HoloLens II, which exploits the built-in infrared-camera for tracking the patient. We initially performed a phantom study to assess the accuracy of the registration and tracking. Following this, we evaluated the AR-based planning step in a prospective clinical study for patients undergoing resection of a brain tumor. This planning step was performed by 12 surgeons and trainees with varying degrees of experience. After patient registration, tumor outlines were marked on the patient's skin by different investigators, consecutively using a conventional neuronavigation system and an AR-based system. Their performance in both registration and delineation was measured in terms of accuracy and duration and compared.ResultsDuring phantom testing, registration errors remained below 2.0 mm and 2.0° for both AR-based navigation and conventional neuronavigation, with no significant difference between both systems. In the prospective clinical trial, 20 patients underwent tumor resection planning. Registration accuracy was independent of user experience for both AR-based navigation and the commercial neuronavigation system. AR-guided tumor delineation was deemed superior in 65% of cases, equally good in 30% of cases, and inferior in 5% of cases when compared to the conventional navigation system. The overall planning time (AR = 119 ± 44 s, conventional = 187 ± 56 s) was significantly reduced through the adoption of the AR workflow (p < 0.001), with an average time reduction of 39%.ConclusionBy providing a more intuitive visualization of relevant data to the surgeon, AR navigation provides an accurate method for tumor resection planning that is quicker and more intuitive than conventional neuronavigation. Further research should focus on intraoperative implementations.