Search

The effect of treatment delay on survival in pancreatic ductal adenocarcinoma (PDAC) remains unclear. This study aimed to assess the prognostic impact of time to diagnosis and chemotherapy in advanced PDAC and factors influencing the time intervals. advanced PDAC patients receiving chemotherapy in five centers in the decade 2007–2016 were included. Key time points during care pathway from clinical presentation to beginning of chemotherapy were retrospectively collected. Multivariate Cox proportional hazard model was performed. A total of 409 patients were included (mean age 66.1 ± 10.3 years; 250 metastatic (61%); 139 received FOLFIRINOX chemotherapy (34%). The median overall survival (OS) was 7.2 months. The median times from first symptoms and from first specialist visit to the beginning of chemotherapy were respectively 100 days and 47 days. None of time intervals was significantly associated with OS. Significant prognostic factors were FOLFIRINOX chemotherapy (HR 0.6 [0.5–0.8]; P < 0.001), metastasis (HR 1.6 [1.3–2.0]; P = 0.001), WHO PS ≥ 2 (HR 1.6 [1.2–2.1]; P < 0.001) and acute pancreatitis as first symptom (HR 2.9 [1.7–4.9]; P < 0.001). Jaundice shortened time to diagnosis (P < 0.001). Acute pancreatitis (P < 0.001) and diabetes (P = 0.01) increased time to treatment. Wait times from clinical presentation to beginning of chemotherapy do not influence survival in advanced PDAC. [ABSTRACT FROM AUTHOR]

Cardiac amyloïdosis (CA) is an emerging disease in cardiology, especially the transthyretine form (TTR) in the elderly. However, data regarding prevalence of TTR-CA in patients with severe aortic stenosis (AS) remain scarce. To precise the prevalence of TTR-CA in patients refered for transcatheter aortic valve implantation (TAVI). All patients undergoing TAVI for severe AS between December 2020 and April 2021 in our center were screened for CA, using bone scintigraphy (BS) with HDP-99mTc before or after TAVI procedure. Cardiac fixation was ranked according to Perugini score (from 0 to III). Patients with Perugini score ≥ I on BS underwent seric and urine assay to rule out light chain amyloïdosis. Among the 50 patients included so far, mean age was 82 ±5.4 years, and 32 (64%) were male. Mean LVEF was 57 ±10%. Mean EuroScore II was 4.0 ±3.1, 42 (84%) had femoral access and 9 (18%) had already pacemaker (Table 1). Abnormal cardiac fixation on BS was observed in 4 patients (8.0%): 3 had Perugini I and 1 Perugini II. All were males. These 4 patients presented more abnormal cardiac parameters on ECG and echocardiography, such as: longer PR delay (208 ± 56 versus 151 ± 81 ms), wider QRS (143 ± 31 versus 113 ± 24 ms, P = 0.03) (Fig. 1B), lower ejection fraction (49 ± 9 versus 58 ± 10%) (Fig. 1A), higher left ventricule mass index (LVMi) (134 ±13 versus 120 ±34 g/m2) (Fig. 1C), lower voltage (1.45 versus 2.2 mV, P = 0.08) and lower voltage/mass ratio (11 ±2 versus 20 ±10 μV/g/m2, P = 0.07) (Fig. 1D). Patients with positive BS tend to have higher pacemaker implantation before TAVI (50% versus 15%, P = 0.08). Prevalence of TTR-CA was 8.0% in our population of AS patients treated with TAVI. All were male sex, and had more frequent conduction disorders, higher LVMi, lower LVEF and lower VMR. Those preliminary results need to be consolidated with the study completion. [ABSTRACT FROM AUTHOR]

Objectives: We sought to identify the technique yielding the best reproducibility from among various measures of native maximum abdominal aortic aneurysm (AAA) diameter with computed tomography angiography (CTA). Methods: Ten parameters of maximum diameter in 68 native AAA were measured double-blind by three radiologists on orthogonal planes, curved multiplanar reconstructions, and, finally, using semi-automated software. The semi-automated software creates the AAA lumen centreline and automatically provides cross sections perpendicular to this centreline. The maximum diameter in any direction is automatically calculated once the slice of interest has been selected. Intra- and inter-observer reproducibility and discordance >5 mm were analysed. Results: Intra-observer reproducibility was high. The limits of agreement were within the clinically accepted range [−5; +5 mm] in 27/30 (90%) comparisons. The method common to all three observers that yielded the lowest values was the semi-automated method. Inter-observer reproducibility was poorer. The limits were outside the clinically accepted range in 26/30 (87%) comparisons. The semi-automated method led to lower intra- (0%) and inter-observer (5.88%) discordances rates. Conclusion: Even using precise methodology, the reproducibility of maximum diameter measurements of native AAA on CTA may exceed recommended thresholds. The semi-automatic method yielded the lower discordance rates and provided a more relevant anatomical approach for measuring the maximum diameter of an AAA. [Copyright &y& Elsevier]

Abstract: Psychiatric units for adolescents often deal with the flights of their young patients. Objectives: To research the commonalities of the adolescent runaways and how the act of running away is carried out. Methods: Surveys of the runaways from the House of Adolescents of Reims from 2009 to 2010. Formation and comparison of two groups (runaways and non-runaways) matched up by their psychopathology and dates of hospitalization. Studied criteria: factors of the adolescents (age, sex, schooling, housing situation, family structure, mode and duration of hospitalization) and characteristics of the runaways’ incidents (trigger factor, duration, destination, how they returned…). Analysis of data: Quantitative variables described using average and standard deviation, qualitative variables using frequency and percentages. Use of Wilcoxon tests and Chi2 or Fisher Exact tests according to the conditions of application. Significance threshold retained: 0.05. Results: In total: 157 hospitalizations between 2009 and 2010, 26 runaway incidents (16.5%) and 17 runaways. Average age of runaways: 14.5 years old, 65% male. Conclusion: No significant difference in the studied variables between the adolescent runaways and non-runaways. Runaway incidents of hospitalized adolescents are fairly infrequent (26) in regards to the number of hospitalizations (157), neither leading to major risky behavior (94%) nor to an interruption of treatment (87.5%). Interesting to consider them as positive events occurring during the course of hospitalization, playing a therapeutic lever role and allowing for eventual family engagement. [Copyright &y& Elsevier]

Abstract: The aim of the study was to determine predictive factors of epidemic extended spectrum beta-lactamase-producing Escherichia coli acquisition. All patients presenting any type of culture positive for ESBL-producing E. coli between November 2006 and October 2007 were included. An epidemic case was defined as a patient colonized with a clonal strain having epidemiological link with an another patient harbouring the same strain. Clinical and administrative data were recorded. Groups were compared by univariate and multivariate analysis using SAS software. Were included in this study 148 patients: 60 epidemic and 88 sporadic cases. Multivariate analysis showed several predictive factors of epidemic strain acquisition: female gender, high Charlson index, treatment by amoxicillin or ticarcillin–clavulanic acid, admission to emergency unit and hospitalisation in a high number of different care units. Identification of predictive factors of epidemic ESBL-producing E. coli strains acquisition may help to limit cross transmission of such strains. [Copyright &y& Elsevier]

• We present a prospective study evaluating the impact of tobacco on severe acute toxicities during radiotherapy for head and neck cancers. • For secondary endpoints, association was found in the multivariate analysis between grade 3–4 acute toxicities and concurrent chemotherapy, 2.12 Gy fractionation dose, V30 oral cavity, BMI and alcohol exposure. • Current smokers during radiotherapy showed a tendency to present more grade 3–4 acute toxicities, but the association was not statistically significant. The association between smoking and acute radiation toxicities of head and neck cancer (HNC) is currently unproven. The aim of the study was to compare the occurrence of acute severe toxicity between active and non-active smokers treated for HNC by radiotherapy. A prospective monocentric cohort study included patients treated by (chemo)radiotherapy for HNC from January 2021 to January 2023. Smoking status was recorded. Patients underwent a medical exam weekly during the radiotherapy to report acute toxicities according to the Common Terminology Criteria for Adverse Effects system version 5.0. Primary endpoint was the occurrence of at least one grade ≥ 3 acute toxicity among mucositis, dysphagia and dermatitis. Among the 102 patients included, 27.4 % were active smokers, 58.8 % were former smokers and 13.7 % had never smoked. Regarding toxicity, 23.5 % (n = 24) patients experienced severe mucositis, 37.2 % (n = 38) severe dysphagia, 13.7 % (n = 14) severe dermatitis and 54.9 % (n = 56) experienced at least one of them. Occurrence of severe acute toxicity was not statistically associated with smoking during radiotherapy (64.3 % among active smokers versus 51.3 % among non-active smokers; p = 0.24). On multivariate analysis, concurrent chemotherapy (87.5 % vs 65.2 %; OR = 5.04 [1.64–15.52]; p = 0.004) and 2.12 Gy versus 2 Gy fractionation schedule (64.3 % vs 41.3 %; OR = 2.53 [1.09–5.90]; p = 0.03) were significantly associated with severe acute toxicity. This study did not find an association between smoking during radiotherapy for HNC and occurrence of severe acute toxicities. [ABSTRACT FROM AUTHOR]

Introduction Medical care and treatments of patients suffering from slowly-progressive neuromuscular disease (NMD) mainly aim to improve health-related quality of life (HRQOL). To date there is no French HRQOL-measurement tool specifically designed for these patients. Recent works allowed developing a new questionnaire of 26 items named “Quality of Life in Neuromuscular Diseases” (QoL-NMD). It is structured in 3 domains and was constructed using focus groups: Delphi method and exploratory statistical analysis. Our objectives are to validate QoL-NMD using an independent sample and to calibrate the scoring system. Methods The QOL-NMD and a validated questionnaire (WHOQOL-BREF) were administered to 153 patients recruited in 8 tertiary hospitals dedicated to NMD. Confirmatory statistical analysis included methods derived from both Items Response Theory (IRT) and Classical Test Theory. Results Data confirmed the results of the exploratory analysis. The 3 domains of QoL-NMD met IRT assumptions (i.e. unidimensionality, parameter invariance and monotonicity) and showed adequate psychometric properties (Cronbach > 0.7, H > 0.3, test-retest ICC > 0.7). Each domain was calibrated using a parametric IRT model. Comparison to WHOQOL-BREF allowed investigating similarities, discrepancies and putting forward QoL-NMD psychometric superiority. Conclusion This study led to the validation and calibration of a new HRQOL questionnaire specifically designed for NMD patients. It can now be used in various clinical settings. QoL-NMD has been translated and culturally adapted to English but still require a psychometric validation abroad. [ABSTRACT FROM AUTHOR]

Abstract: Neodynium-doped zirconolite was fabricated by hydrolysing a mixture of alkoxide with nitrate solutions followed by a series of drying, calcination, pressing and sintering steps. The material obtained was essentially zirconolite (99.5vol% Ca0.8Nd0.2ZrTi1.8Al0.2O7) with a minor ZrTiO4 phase (0.5vol%). The microstructure and composition of the zirconolite was characterised, before and after durability experiments, by SEM/EDS, SIMS, AFM and TEM. Chemical durability testing was carried out using the standard MCC-2 test at 150°C for a series of four test durations - 1, 7, 28 and 84 days. The pH of the leachates was fairly constant with time (pH 5), and elemental releases reached apparent steady-state conditions within the first day of leaching. Thermodynamic calculations indicated that attainment of these steady-state conditions at this point could not be explained by thermodynamic equilibrium being reached between the leachates and the primary zirconolite phase. However, thermodynamic equilibrium between a possible layer of secondary hydroxides or a decalcified zirconolite and the leachates could explain the steady state of Ti, Zr and Al releases. Moreover, it is suggested that the steady-state conditions achieved by Nd, theoretically undersaturated in the leachates, is due to adsorption of Nd to this secondary layer, and is not a result of precipitation of a hydroxide form. Anatase, commonly observed during leaching of zirconotitanates, is also theoretically undersaturated in the leachates. When observed, it is possibly a product of local condensation of the hydroxide layer and not due to simply a dissolution/precipitation process. SEM and AFM investigations confirmed the formation of a passivation layer on the surface of the zirconolite. The layer was of the order of 10nm, in accordance with the thickness calculated from leachate results. [Copyright &y& Elsevier]

Abstract: The clinical reliability of 3-D ultrasound imaging (3-DUS) in quantification of abdominal aortic aneurysm (AAA) was evaluated. B-mode and 3-DUS images of AAAs were acquired for 42 patients. AAAs were segmented. A 3-D-based maximum diameter (Max3-D) and partial volume (Vol30) were defined and quantified. Comparisons between 2-D (Max2-D) and 3-D diameters and between orthogonal acquisitions were performed. Intra- and inter-observer reproducibility was evaluated. Intra- and inter-observer coefficients of repeatability (CRs) were less than 5.18 mm for Max3-D. Intra-observer and inter-observer CRs were respectively less than 6.16 and 8.71 mL for Vol30. The mean of normalized errors of Vol30 was around 7%. Correlation between Max2-D and Max3-D was 0.988 (p < 0.0001). Max3-D and Vol30 were not influenced by a probe rotation of 90°. Use of 3-DUS to quantify AAA is a new approach in clinical practice. The present study proposed and evaluated dedicated parameters. Their reproducibility makes the technique clinically reliable. [Copyright &y& Elsevier]

Abstract: In this paper, we present the critical experiment performed in March 2008 in the high-flux reactor (HFR) to reproduce physical conditions similar to the core light water introduction accident. We present the HFR, the context of the study and two Monte Carlo models: TRIPOLI4 – JEFF3.1 and MCNP – ENDF/BVII. All comparisons between calculations and experimental results show, within both models, that the safety rods efficiencies, in AIC alloy, are always underestimated in normal as well as in accidental configuration of the reactor. [Copyright &y& Elsevier]

Introduction: L’ostéoporose idiopathique juvénile (OIJ) est une pathologie rare. L’objectif de ce travail était d’en préciser la présentation clinique et l’évolution notamment depuis l’introduction du traitement par bisphosphonates. Patients et Méthodes: Nous avons mené une étude rétrospective multicentrique incluant 24 enfants. La rémission a été définie par l’absence de douleur, de fractures et l’amélioration de la densité minérale osseuse (DMO) après 3 ans de traitement. Résultats: La médiane d’âge était de 12 ans, 6/14 enfants avaient des antécédents familiaux d’ostéoporose. Le motif de consultation était la déminéralisation osseuse, les fractures répétées, les douleurs dues aux tassements vertébraux. Dix/24 patients ont été traités par bisphosphonates. Le nombre de patients en rémission était plus important dans le groupe traité par bisphosphonates (75 % vs 35 %) mais non significatif, et le gain de z-score était plus important dans le groupe traité (+1,6DS vs +0,18DS). Cinq enfants gardaient des séquelles importantes quelque soit le traitement. Conclusion: Les données de notre étude laissent suspecter une prédisposition génétique dans l’OIJ. L’utilisation des bisphosphonates doit être prudente, mais discutée en cas d’atteinte sévère avec baisse importante de la DMO. [ABSTRACT FROM AUTHOR]