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The main objective in this study was to determine the prevalence of Chronic Kidney Disease (CKD) in people with Type 2 Diabetes Mellitus (T2DM) in the Autonomous Community (AC) of Aragon (Spain) and to detect whether or not there is under-registration in the patient's history. As a secundary objetive, it was proposed to study the most relevant demographic and clinical characteristics of people with CKD. Observational and retrospective real world data study of the population over 18 years of age with a diagnosis of T2DM, between January 2017 and December 2021. A descriptive analysis of qualitative and quantitative variables, and a comparison using the parametric Student's t-test or the non-parametric Mann-Whitney U-test between both groups was performed. The prevalence of T2DM was 8.07 % and that of CKD 31.4 %, with an under-reporting of 47 %. The main risk factor associated with CKD was arterial hypertension (p<0.001), followed by dyslipidemia (p<0.001). The main treatment used for diabetes control was metformin, both in patients with and without CKD (p<0.001). A total of 56.81 % of people with T2DM and CKD did not undergo annual monitoring of their renal function (glomerular filtration rate) or determination of albuminuria. The prevalence of CKD increases in patients with T2DM (31.4 %), and in almost half of patients the diagnosis is not registered (47 %). This under-reporting delays the implementation of measures needed to prevent CKD progression. • We analyze the presence of CKD (chronic kidney disease) in people with diabetes. • Using big data of 90,700 diabetic patients, analyzing their CKD under-registration. • 31.4 % diabetic patients exhibit CKD, and 47 % of these cases are undiagnosed. • The primary risk factors associated with CKD are hypertension and dyslipidemia. • 56.8 % diabetic subjects with CKD did not undergo annual monitoring of their renal function. [ABSTRACT FROM AUTHOR]

Objective: This study sought to evaluate the implementation of the Ottawa 3DY Tool, a simple screening instrument for cognitive impairment, by front-line ED clinicians.Methods: We conducted a prospective cohort study in an academic ED. Patients ≥75 years underwent cognitive screening with the Ottawa 3DY by front-line nurses and physicians. Descriptive statistics were used to describe level of implementation and acceptability of the tool. Sensitivity and specificity was calculated using an Mini-Mental State Exam <25 as the cut-off for cognitive impairment. A weighted kappa was calculated to establish inter-rater agreement.Results: Cognitive screening was completed in 260/332 eligible patients (78.3%), who were 60% female and had a mean age of 83.7 years. Facilitators to screening: perceived importance and ownership of screening and feasibility of Ottawa 3DY. Barriers to screening were: over confidence in clinical judgement and perceived lack of patient benefit. Ottawa 3DY had a sensitivity of 84.6% (64.3-95.0) and specificity of 54.2% (39.3-68.4) when completed by nurses. When completed by emergency physicians, sensitivity was 78.9% (53.9-93.0) and specificity was 70.0% (45.7-87.2). Inter-rater agreement kappa score was 0.67.Discussion: This study demonstrated that incorporating the Ottawa 3DY tool into the routine evaluation of older ED patients by front-line ED clinicians is both feasible and effective. With its demonstrated good inter-rater reliability and moderate level of sensitivity and specificity when compared with the much longer MMSE, the routine adoption of this tool may help lead to improved recognition of cognitive impairment and ultimately patient and system outcomes. [ABSTRACT FROM AUTHOR]

Summary Background To evaluate the performance of CT-scans performed one week after pancreato-duodenectomy (PD) to detect severe postoperative complications requiring an invasive treatment. Patients and methods This monocentric retrospective study was conducted on data collected between 2005 and 2013. Patients undergoing PD underwent CT-scan with IV contrast at the end of the first postoperative week. The results of the CT-scans were analyzed to evaluate the usefulness of this procedure. The main assessment criterion was the occurrence of type-III complication (or greater) according to the Dindo-Clavien classification. Results In total, 138 patients were included. The mortality rate was 2.2%. The postoperative complication rate was 57.2%. The pancreatic fistula rate was 19.6%; 46 patients (33.3%) presented with a severe complication. A total of 138 CT-scans were analyzed: 44 (31.8%) were abnormal, 94 (68.2%) were normal. Among patients with abnormal CT-scans, 17 (39%) presented with a severe complication requiring an invasive treatment. Among the 94 patients with normal CT-scans, 14 patients (15%) presented a severe postoperative complication. Evaluation of the performance of the CT-scans at the end of the first postoperative week found a sensitivity of 55%, a specificity of 75%, a positive predictive value of 39%, and a negative predictive value of 85%. Conclusion Systematic CT-scans performed at the end of the first postoperative week do not effectively detect severe complications after PD and do not help to prevent them. [ABSTRACT FROM AUTHOR]

Background & Aims There is controversy over the ability of transjugular intrahepatic portosystemic shunts (TIPS) to increase survival times of patients with cirrhosis and refractory ascites. The high rate of shunt dysfunction with the use of uncovered stents counteracts the benefits of TIPS. We performed a randomized controlled trial to determine the effects of TIPS with stents covered with polytetrafluoroethylene in these patients. Methods We performed a prospective study of 62 patients with cirrhosis and at least 2 large-volume paracenteses within a period of at least 3 weeks; the study was performed at 4 tertiary care centers in France from August 2005 through December 2012. Patients were randomly assigned to groups that received covered TIPS (n = 29) or large-volume paracenteses and albumin as necessary (LVP+A, n = 33). All patients maintained a low-salt diet and were examined at 1 month after the procedure then every 3 months until 1 year. At each visit, liver disease–related complications, treatment modifications, and clinical and biochemical variables needed to calculate Child-Pugh and Model for End-Stage Liver Disease scores were recorded. Doppler ultrasonography was performed at the start of the study and then at 6 and 12 months after the procedure. The primary study end point was survival without a liver transplant for 1 year after the procedure. Results A higher proportion of patients in the TIPS group (93%) met the primary end point than in the LVP+A group (52%) ( P = .003). The total number of paracenteses was 32 in the TIPS group vs 320 in the LVP+A group. Higher proportions of patients in the LVP+A group had portal hypertension-related bleeding (18% vs 0%; P = .01) or hernia-related complications (18% vs 0%; P = .01) than in the TIPS group. Patients in LVP+A group had twice as many days of hospitalization (35 days) as the TIPS group (17 days) ( P = .04). The 1-year probability of remaining free of encephalopathy was 65% for each group. Conclusions In a randomized trial, we found covered stents for TIPS to increase the proportion of patients with cirrhosis and recurrent ascites who survive transplantation-free for 1 year, compared with patients given repeated LVP+A. These findings support TIPS as the first-line intervention in such patients. ClinicalTrials.gov ID: NCT00222014 . [ABSTRACT FROM AUTHOR]

The aim of this study was to develop and validate 2 different methods (enzymatic vs. time-resolved immunofluorometric assay [TR-IFMA]) for the detection and measurement of salivary α-amylase (s-α) in horses. The analytical validation of the enzymatic assay showed intra-assay and interassay coefficients of variation of 2.5% and 7.2%, respectively, and a limit of detection of 0.045 IU/L. On the other hand, the analytical validation of the TR-IFMA showed intra-assay and interassay coefficients of variation of 5.4% and 9.9%, respectively, and a limit of detection of 0.097 ng/mL. Both assays also demonstrated a high level of accuracy as determined by linearity under dilution. To check the presence of α-amylase in saliva of horses, 3 different models of physical exercises (exercise in a horse walker and 2 different types of dressage) were made in a total of 27 animals. Saliva samples were obtained before, immediately after, and 30 minutes after the physical exercise. Samples were measured by enzymatic assay and TR-IFMA, and both methods were able to detect the enzyme. Only the results of TR-IFMA showed a significant increase ( P < 0.05) in s-α concentration in saliva after the performance of one type of physical exercise and a significant decrease ( P < 0.05) in s-α concentration in saliva after the performance of other type of physical exercise, but these significances did not exist in the case of enzymatic measures in both types of exercises. Moreover, TR-IFMA had a lower interindividual variability than the enzymatic assay. Both assays validated in this study could measure s-α in saliva of horses in a reliable and robust way, showing the TR-IFMA advantages that could make this test a suitable alternative to enzymatic measures. [ABSTRACT FROM AUTHOR]

Abstract: Oxynitrides with the nominal composition LaTiO2N were prepared from a La2Ti2O7 precursor by thermal ammonolysis of the oxide under an NH3 flow for different durations t (4 – 30h). X-ray diffraction (XRD) indicated that phase-pure LaTiO2N samples were obtained when t ≥ 13h. The material was further characterised by scanning electron microscopy (SEM), surface area measurements based on the BET method, thermogravimetric analysis (TGA) and UV-visible diffuse reflectance spectroscopy (DRS). The powders displayed an increased crystallite size and a decreased surface area with increasing t. The ratio of N/(N+O) increased with t from 0.22 – 0.27. Correlated to this nitrogen increase, a small variation of the bandgap energy was observed from 2.19 to 2.12eV with t. All LaTiO2N samples oxidised H2O into O2 in the presence of an electron acceptor (Ag+). The O2 evolution was increased from 12μmol/h (t = 13h) to 22 – 24μmol/h (16h ≤t ≤ 30h). It was found that the nitrogen content and the amount of defects played a key role in the photocatalytic O2 evolution. [Copyright &y& Elsevier]

Abstract: Background: Although significant, the issue of health literacy (HL) among parents attending pediatric surgery outpatient clinics has received little attention. Purpose: The objectives of this study are to determine the HL skills of parents attending the pediatric surgery outpatient clinic at McMaster Children''s Hospital and to describe parent satisfaction with plain language materials. Methods: This cross-sectional study was conducted at the pediatric surgery outpatient clinic at McMaster Children''s Hospital. Using convenience sampling for 4 months, parents were recruited and interviewed regarding their demographic status. The Newest Vital Sign tool was used to assess HL. Feedback on the plain language education material was received. Results: Seventy-nine individuals were recruited, with a recruitment rate of 62%. Seventy-one percent had adequate HL. English as a first language and Canada as the place of birth were significantly correlated with adequate HL (r = 0.367, P < .001; r = 0.259, P < .05). Parents reported satisfaction with the plain language material, regardless of their HL level. Conclusion: Twenty-nine percent of parents showed inadequate HL, likely an underestimate owing to study limitations. Parents expressed satisfaction with the plain language material, emphasizing the need for clear, effective communication with patients and families. Future directions include evaluating staff knowledge of a universal precautions approach to health communication and the accessibility of plain language materials. [Copyright &y& Elsevier]

Abstract: Purpose: This scoping review assesses the literature and summarizes the current evidence on sclerotherapy for the treatment of lymphatic malformations in pediatric patients. Methods: A comprehensive search of published and unpublished literature was conducted using multiple databases. Title, abstract, and full-text screening was conducted by 2 independent clinicians. All discrepancies were resolved during consensus meetings. Results: A total of 182 articles were retrieved. Forty-four articles were removed as duplicates, and 11 articles were added after reviewing prominent studies. After full-text abstraction, 44 articles and 2 conference proceedings (N = 882 patients) were included in the final results. Twelve articles were classified as level II and 34 articles as level IV evidence. Picibanil (OK-432) was the primary agent used in most included studies. Postinjection symptoms with OK-432 were primarily fever, swelling, and erythema at the site. Life-threatening complications were uncommon and involved postinjection swelling of cervical lesions causing airway compromise. Conclusions: The literature regarding sclerotherapy for lymphatic malformations is of a low level of evidence and suffers from a lack of standardization. Randomized clinical trials focused on OK-432, bleomycin, or alcoholic solution of zein; standardized dosing protocols; and consistent and reliable outcome reporting will be necessary for further development of treatment guidelines. [Copyright &y& Elsevier]

Summary: The capacity of infection and the ability of Mycobacterium tuberculosis strains belonging to the Beijing family to spread rapidly probably result from genetic advantages and unidentified mechanisms of virulence not yet thoroughly investigated. Among the mechanisms proposed to be responsible for the varying virulence phenotypes of M. tuberculosis strains we find IS6110 insertions, genetic reorganizations and deletions, which have strong influences on fitness. Beijing family is one of the lineages with the highest number of copies of IS6110. By studying genetic markers characteristic for this lineage, here we have characterized the clinical isolate M. tuberculosis GC1237 strain responsible for important epidemic outbreaks in the Gran Canary Island. We have identified and analyzed each point of insertion of IS6110 using a bacterial artificial chromosome (BAC) library of this strain, in addition to the use of other approximations. Nineteen copies of IS6110 have been localized in GC1237 genome of which, four copies of IS6110 can act as a promoter and we have focused in the characterization of one copy located 31 bp upstream of the essential gene Rv2179c and compared to the reference strain H37Rv. [ABSTRACT FROM AUTHOR]

Objective: The endovascular management of aortic traumatic ruptures has been proposed as an alternative to classical surgical procedures. The aim of this work was to report the midterm results of the endovascular treatment of traumatic ruptures of the isthmic aorta. Methods: Between January 1996 and July 2005, endovascular repair of blunt traumatic aortic ruptures was performed in 33 patients (mean age, 40 ± 17 years). The stent grafts used were either Talent Medtronic (n = 27), Gore Excluder (n = 4), or Boston Vanguard (n = 2) grafts. Follow-up was 94.9% complete and averaged 32.4 ± 28.8 months (maximum, 8 years). Results: Stent graft deployment was successful in all cases without need for surgical conversion. Except for one iliac rupture, which was treated with an iliofemoral bypass during the same procedure, there was no major perioperative complication. The early complications consisted of 3 primary endoleaks (1 type I and 2 type IV), 1 transient paraparesis, 1 occlusion of the main left bronchus, 1 thrombosis, and 2 pseudoaneurysms of the brachial artery. All the primary endoleaks healed within the first month. No patient died, and no aortic reinterventions were performed. The midterm complications were a mild circumferential thrombus at the distal part of the stent graft and a fracture of the nitinol stent. Both complications were asymptomatic and were discovered on systematic computed tomographic scan examination. Actuarial freedom from complication at 1 year was 96.1% ± 3.8% and 85.5% ± 10.6% at 3 and 5 years, respectively. Conclusion: This study demonstrates that the endovascular treatment of blunt thoracic aortic traumatisms is a safe and effective therapeutic method without increased midterm morbidity and mortality rates. [Copyright &y& Elsevier]

Objective: We sought to determine the midterm results of endovascular repair of atherosclerotic aneurysms of the thoracic descending aorta by using second-generation, commercially available stent grafts. Methods: Between 1996 and 2005, 45 patients (mean age, 68 ± 11 years) with aneurysms of the descending thoracic aorta underwent endovascular repair. Aortic dissections, penetrating ulcers, and traumatisms were excluded. The mean follow-up was 24.7 ± 21.6 months (maximum, 6.7 years). Results: No patients died, and no conversion to surgical intervention was required during the procedures. Three (6.7%) patients died during the first month, and 6 (14.7%) died later on. The main complications were strokes (13.3%), vascular access complications (8.9%), aortic complications (6.6%), paraplegia (4.4%), and sudden deaths (4.4%). Nineteen (42%) primary endoleaks were encountered: 3 required reinterventions, 15 spontaneously thrombosed, and 1 patient died. Except for 2 sudden unexplained deaths, no aortic complications were observed after 1 month. Actuarial survival estimates at 1, 3, and 5 years were 87.6% ± 5.3%, 76.9% ± 7.4%, and 70.6% ± 9.2%, respectively. Actuarial freedom from death related to the treated aortic disease was 94.3% ± 4.0%, 94.3% ± 4.0%, and 86.4% ± 8.4% at 1, 3, and 5 years, respectively. Aspirin status of greater than 3 (P = .005), high aortic diameter (P = .007), and long covered lengths (P = .02) were determinant for mortality. Actuarial freedom from complication was 62.6% ± 7.7%, 58.9% ± 8.1%, and 58.9% ± 8.1% at 1, 3, and 5 years, respectively. The location of the aneurysm (P = .05) and a high aortic diameter (P = .04) were both determinants for endoleaks. Conclusions: Stent grafting of atherosclerotic aneurysm of the thoracic descending aorta is safe and effective. Further studies are mandatory to determine the most relevant indications and the long-term efficacy of such treatment. [Copyright &y& Elsevier]

Background: It has been shown that vagal nerve stimulation (VNS) can affect body mass. The aim of this study was to evaluate effect of VNS on body mass, body composition, metabolic rate, and plasma leptin and IGF-I levels. Methods: Eight female pigs were included in the study. Under general anesthesia, a bipolar electrode was implanted on the anterior vagal nerve by laparoscopy. Group A was treated by VNS, and group B was the control. After 4 weeks, stimulation was discontinued in group A and started in group B. The following parameters were evaluated: body mass, body composition, metabolic rate, plasma leptin and IGF-1 levels and intramuscular fat content (IMF). Results: VNS attenuated body weight gain (2.28 ± 3.47 kg vs 14.04 ± 6.75 kg; P = .0112, for stimulation and nonstimulation periods, respectively), backfat gain (0.04 ± 0.26 mm vs 2.31 ± 1.12 mm) and IMF gain (−3.76 ± 6.06 mg/g MS vs 7.24 ± 12.90 mg/g MS; P = .0281). VNS resulted in lower backfat depth/loin muscle area ratio (0.33 ± 0.017 vs 0.38 ± 0.35; P = .0476). Lower plasma IGF-I concentration was found after VNS (−3.67 ± −11.55 ng/mL vs 9.86 ± 10.74 ng/mL; P = .0312). No significant changes in other parameters were observed. Conclusions: VNS affects body weight mainly at the expense of body fat resources; however, metabolic rate is not affected. [Copyright &y& Elsevier]

Objective: The study’s objective was to comparatively evaluate surgery and stent-graft repair of acute or subacute traumatic aortic rupture. Methods: A total of 76 patients (14–76 years old; mean, 37 years; male/female ratio, 63/11) with a traumatic aortic injury were admitted to our hospital between 1981 and 2003. Six patients died within 1 to 9 days of another associated severe traumatic lesion. The 70 remaining patients were divided according to the type of rupture repair. In group 1, 35 patients were treated surgically: 28 with immediate repair and 7 with delayed repair (average time interval 66 days, 5–257 days). In group 2, 29 patients were treated with stent grafting of the aortic isthmus. In group 3, 6 patients with minor aortic lesions were treated medically with a close follow-up. Results: In the 28 patients treated surgically in the emergency department, the mortality and paraplegia rates were 21% and 7%, respectively. No death or paraplegia was observed in the group with delayed surgical repair. With stent grafting, complete exclusion of the pseudoaneurysmal sac was observed in all patients. Except for 1 iliac rupture treated during the same procedure, there was no major morbidity or mortality during the mean follow-up of 46 months (13–90 months). No major complication was observed in group 3. Conclusions: In stable rupture of the aorta, initial conservative treatment is safe and allows management of the major associated lesions. Stent grafting of the aortic isthmus is a valuable therapeutic alternative to surgical repair, especially in patients considered high risk for conventional thoracotomy. [ABSTRACT FROM AUTHOR]

Endovascular treatment of aortic disease has emerged as an alternative mode of treatment that is particularly attractive for patients with severe comorbidities who would not be ideal candidates for open surgery. Actually, short-term morbidity and mortality rates, of large series, compare favorably with those from surgery, and stent-graft placement is proving to be a safe, minimally invasive, and effective treatment for thoracic aortic diseases. However, although endoluminal interventions are minimally invasive, they are associated with complications, as are surgical methods. In this article, indications, technical aspects, and results of endovascular TAA repairs will be reviewed. We will also examine the advantages and limitations of stent-graft treatment. Finally, we will discuss the management of complications following aortic stent-graft implantation. We intentionally do not cover the topic of thoracic dissection, as it is being covered in another article in this volume. [Copyright &y& Elsevier]

Purpose Volumetric modulated arc therapy (VMAT) is a technique widely used in prostate cancer nowadays, which decreases the delivery time and the dose in the organs at risk. The goal of this work is to achieve a higher dose gradient between the PTV and rectum, meanwhile, decrease the optimization time in our treatment planning system (TPS). Methods Our TPS is Eclipse (Varian Medical System, Palo Alto, California). The VMAT optimizer is Progressive Resolution Optimizer (PRO v13.06.26) and the calculation algorithm is Anisotropic Analytical Algorithm (AAA v13.06.26). Instead the initial state of the multi-leaf collimator (MLC) given by the optimizer, we try to find one more adapted to the organs delimited by the physician. To obtain this initial state, an arc therapy treatment was generated fitting the MLC to the PTV in the beam’s eye view (BEV) with a 5 mm of margin and protecting the rectum without margin, as well. We propose to use this arc therapy plan as an initial plan when optimization starts and only perform the last stages of VMAT optimization, assigning priority only to the objectives of the PTV and the bladder. Results Our group has used this method for more than 20 concomitant and single volume treatments. We have compared the results of our method with those obtained by the usual method of optimization. In both cases, we delivered the dose with a single arch. The coverage of the PTV is similar in both solutions, but the protection of the rectum in low and medium doses is notably better with our technique. The MLC transitions between adjacent Gantry angles become smoother using our solution. The differences between the dose to the bladder and to the femoral heads in both methods are not remarkable. The time used to perform an optimization with the new technique is significantly lower. Conclusions The proposed method increases the protection of the rectum in prostate treatments, decreases the optimization time and simplifies the table of restrictions in the optimizer. [ABSTRACT FROM AUTHOR]

Les biopsies spléniques radiologiques sont considérées comme des gestes à haut hémorragiques, conduisant parfois à réaliser de splénectomie d'hémostase en urgence. Sa réalisation n'est donc pas de pratique courante et nécessite une expertise radiologique. Nous présentons un cas original de découverte d'une mélioïdose disséminée découverte a l'occasion d'une biopsie splénique radioguidée. Un patient de 62 ans, diabétique de type 2, vivant entre la Thaïlande et la France est hospitalisé pour toux et douleurs basithoracique gauche depuis 9 mois. Il a perdu 15 kg en 1 an. Il est apyrétique, mais a eu de la fièvre intermittente il y a quelques mois. Il a eu 2 accidents de scooter compliqués de fractures de côtes à gauche il y a 1 an et demi. Il a réalisé en Thaïlande un TDM abdominal retrouvant une lésion splénique de 7,6 × 6,2 × 6,8 cm, un épanchement pleural gauche avec atélectasie du lobe inférieur gauche semblant communiquer avec la rate au travers du diaphragme. Il n'a pas de syndrome inflammatoire biologique. Les hémocultures sont stériles. Sérologie VIH, VHB, VHC négative. Sérologies parasitaires dont hydatidose et ecchinococose négatives. L'immunophénotypage lymphocytaire ne retrouve pas de clone suspect. L'ETO dédouane une endocardite. L'hypothèse de l'hématome splénique est écartée après relecture scannographique, du fait de la perforation diaphragmatique atypique et l'absence de signe de résorption. La lésion splénique est hétérogène et pseudo tissulaire. La rate est ascensionnée, collée au diaphragme rendant la splénectomie difficile du fait des risques d'adhérence. La lésion pulmonaire ne semble pas accessible par voie endobronchique et nécessite une thoracotomie. Le TEP TDM montre une hyperfixation intense d'une condensation postérobasale gauche, et de deux lésions intraspléniques confluentes. Nous réaliserons une biopsie splénique radiologique (8 carottes faites au pistolet à biopsie de 18G). Il n'y a pas de complication post geste immédiat ou à distance. La culture bactériologique et mycobactériologique sont négatives, et une PCR et culture Burkholderia reviennent positives. Le patient est traité par CEFTAZIDIME 2g × 3/j puis par BACTRIM FORTE 3 × /j pour une durée totale de 6 mois pour cette infection a Burkholderia pseudomallei splénique et pulmonaire. L'évolution clinique à 6 mois est satisfaisante avec une diminution de la taille des lésions. La décision de réalisation de la PCR Burkholderia est motivée par la connaissance de l'épidémiologie infectieuse Thailandaise. La mélioidose est une infection a Burkholderia pseudomallei , (BGN aérobies, non sporulés, non fermentants) endémique d'Asie du Sud Est mais émergente dans les pays occidentaux (considérée comme éradiquée depuis 1945). L'infection est associée à une blessure, à l'ingestion ou à l'inhalation de bactéries en aérosol [1]. En 2018, le taux de mortalité globale était de 30 à 35 % chez les patients admis dans les hôpitaux en Thaïlande [1]. La prévalence était de 36,8 pour 100 000 patients hospitalisés [1]. Ce BGN se culture sur les géloses MacConkey, au sang et au chocolat. Les tests PCR auraient une sensibilité de 94 %, une spécificité de 83 % (réaction croisée faussement positive avec plusieurs espèces de Burkholderia) [1]. La CEFTAZIDIME et le MEROPENEM sont les antibiotiques utilisés initialement, puis le COTRIMOXAZOLE (TMP-SMX), la DOXYCYCLINE et l'AMOXYCILLINE-ACIDE CLAVULANIQUE pour le relai oral et la prophylaxie post-exposition [2]. L'imagerie thoracique retrouve habituellement des lésions nodulaires multiples en cas de dissémination hématogéne ou des lésions abcédées excavées pseudo tuberculeuses. Les autres localisations sont les abcès hépatiques et spléniques. Le diabète est un facteur de risque de mélioïdose avec un risque relatif d'hospitalisation liée à l'infection de 2,2 (IC à 99 %, 2,10 à 2,23) [3]. En Thaïlande, le taux de récidive est estimé à 6 % [1] , conduisant à rallonger les traitements et les prophylaxies secondaires. La mélioïdose est une pathologie émergente dans les pays occidentaux du fait des migrations de population. Notre CHU bénéficie de l'expertise de radiologues entraînés dans la réalisation de biopsie splénique. Cette technique a permis un diagnostic de pathologie inédite dans les pays occidentaux sans recours d'une alternative chirurgicale invasive. [ABSTRACT FROM AUTHOR]

Résumé Les patients atteints d'un carcinome hépatocellulaire inscrits sur liste d'attente de transplantation hépatique requièrent le plus souvent un traitement local afin de limiter tout risque de croissance de la tumeur. Les traitements classiquement utilisés sont la thermoablation par radiofréquence percutanée ou la chimioembolisation transartérielle. En raison de la taille ou de la topographie de la lésion, il arrive qu'aucune de ces deux techniques ne soit réalisable. La radiothérapie en conditions stéréotaxiques s'est récemment développée dans la prise en charge des carcinomes hépatocellulaires localisés en alternative aux thérapies focales utilisées jusqu'à présent. Les données publiées sur la faisabilité et l'efficacité de cette technique récente avant transplantation sont très limitées. Nous rapportons ici le cas d'une patiente de 43 ans en situation de réponse histologique complète sur explant après irradiation hépatique stéréotaxique et discutons les principales données publiées relatives à la place de cette technique dans la prise en charge du carcinome hépatocellulaire en traitement d'attente avant transplantation hépatique. Abstract Patients with hepatocellular carcinoma who are on liver transplant waiting list usually require local treatment to limit any risk of tumour growth. Historically percutaneous radiofrequency ablation or transarterial chemoembolization represented the major therapeutic alternatives. Depending on the size, or the topography of the lesion these two techniques may not be feasible. Radiation therapy under stereotactic conditions has recently emerged in the management of localized hepatocellular carcinoma as an alternative to the focused therapies performed to date. We herein report the case of a 43-year-old patient harbouring a complete histological response on explant after liver stereotactic irradiation and discuss its role in the management of hepatocellular carcinoma before liver transplantation. [ABSTRACT FROM AUTHOR]

LNE has ability to calibrate gas micro-flow rates using the dilution method for nitrogen flow rates in the range from 2 µg/s to 200 µg/s or helium ones in the range 0.75–30 µg/s. In addition, a primary constant pressure flowmeter for leak rate measurements from 0.05 µg/s to 35 µg/s is also available. This equipment will be used to validate the dilution method below 30 µg/s. In order to compare these reference facilities, LNE is developing a micro-flow transfer standard (µFTS) in collaboration with ATEQ France, a manufacturer of control equipment for leak testing. The flowmeter consists mainly of an array of three stainless steel capillaries designed to cover the ranges from 0.035 µg/s to 0.35 µg/s, 0.35 µg/s to 3.5 µg/s and 3.5 µg/s to 35 µg/s for nitrogen (0.1–100 ml/h). A dynamic model of the µFTS determines the mass flow rate from the input pressure, the differential pressure of the capillary, the gas temperature, viscosity and density and the length and radius of the capillary. A comparison of both reference methods is carried out with the µFTS from 0.35 µg/s to 35 µg/s. [ABSTRACT FROM AUTHOR]

Abstract: The measurement of blood pressure by mercury sphygmomanometer and auscultation is one of the oldest methods, and it is still widely used in health services. Nowadays, the usage of inexpensive electronic oscillometric devices for home and clinical use has increased dramatically. The purpose of this paper is to verify the reliability of such devices. Until now, automated pressure devices have been evaluated by a clinical study utilizing the auscultatory method, which has the disadvantage of resulting in uncertainties related to the perception of Korotkoff sounds. Therefore, it is necessary to establish a full calibration chain based on invasive pressure measurements in order to evaluate the performance of automated pressure devices and to ensure their traceability. [Copyright &y& Elsevier]

Dynamic MR longitudinal R1 relaxometry after administration of a gadolinium contrast bolus (Gd-DTPA) has been used for in vivo measurements of the extracellular volume fraction (v) and the capillary permeability (k min−1) in rabbit muscles to distinguish between red slow- and white fast-twitch muscle fiber types. For this purpose a protocol imaging sequence has been used which allows fast R1 measurements during the contrast agent uptake. Physiological tissue parameters, k and v, were obtained by computing procedures assuming a simplified monoexponential plasma model. These were shown to be about twice as large in the slow-twitch semimembranosous proprius muscle (SP), containing 100% oxidative type-I fiber, that in the fast-twitch rectus femorus muscle (RF), containing only 6% type-I fiber type.The capillary permeability has been found to be 0.25 ± 0.02 min−1 for the (SP) and 0.10 ± 0.01 min−1 for the (RF). Similarly, the extracellular volume fractions were 0.189 ± 0.015 and 0.082 ± 0.006 respectively, in close agreement with literature data and experimental results obtained by invasive radionuclide measurements. For the pool of the 10 studied animals, no significant variation among animals was observed in the extracellular volume fraction and the capillary permeability for the different muscle fiber types.The dynamic relaxometry method used is easy to implement on conventional MR imagers and has potential applications in muscle diseases. The method has also potential applications for tissue characterization based on extracellular volume and capillary permeability quantification. In particular, the method can be used for the evaluation of tumors and their responses to therapies. [Copyright &y& Elsevier]

La radiothérapie en conditions stéréotaxiques s'est récemment développée dans la prise en charge des tumeurs hépatiques primitives localisées, carcinome hépatocellulaire ou cholangiocarcinome, en alternative aux autres thérapies focales. L'objectif de ce travail était l'évaluation du contrôle local, de la survie sans progression, de la survie globale ainsi que de la toxicité de la radiothérapie en conditions stéréotaxiques des tumeurs hépatiques primitives. Tous les patients pris en charge par radiothérapie en conditions stéréotaxiques entre avril 2015 et septembre 2018 dans notre centre pour un carcinome hépatocellulaire ou un cholangiocarcinome ont été inclus dans cette étude. La radiothérapie était délivrée en arcthérapie dynamique avec asservissement respiratoire sur un accélérateur TrueBeam Novalis STX. Le contrôle local était évalué selon les Modified Response Evaluation Criteria in Solid Tumors (mRECIST) (relecture centralisée), la toxicité selon les Common Terminology Criteria for Adverse Effects. L'analyse de la survie a été réalisée avec la méthode de Kaplan-Meier. Parmi les 55 patients traités, 49 avaient un carcinome hépatocellulaire et six un cholangiocarcinome. La taille médiane des lésions était de 35 mm (extrêmes : 13-115 mm). La dose médiane prescrite dans le volume cible prévisionnel était de 50 Gy (extrêmes : 30–55 Gy) en trois ou cinq fractions. La dose équivalente biologique (BED 10 , avec un rapport α/β de 10 Gy) médiane était de 100 Gy (extrêmes : 48–151 Gy). Après un suivi médian de 15 mois, le taux de contrôle local à 1 an était de 81 % (intervalle de confiance à 95 % [IC 95 %] : 64–90 %). Les taux de survie sans progression et de survie globale à 1 an étaient respectivement de 49 % (extrêmes : 34–62 %) et 83 % (extrêmes : 69–91 %). Le diamètre de la lésion inférieur à 5 cm et une BED 10 supérieure ou égale à 100 Gy étaient associés à une meilleure probabilité de survie sans progression. Quatre patients (7 %) ont souffert d'une toxicité tardive de grade 3–4. Nos résultats sont concordants avec les données publiées de la littérature, confirmant que la radiothérapie en conditions stéréotaxiques est une technique efficace et bien tolérée. Des données prospectives sont nécessaires afin de préciser sa place dans la stratégie thérapeutique en association ou comme alternative aux autres traitements locaux. [ABSTRACT FROM AUTHOR]