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Calcium-permeable AMPA-type glutamate receptors (CP-AMPARs) contribute to many forms of synaptic plasticity and pathology. They can be distinguished from GluA2-containing calcium-impermeable AMPARs by the inward rectification of their currents, which reflects voltage-dependent channel block by intracellular spermine. However, the efficacy of this weakly permeant blocker is differentially altered by the presence of AMPAR auxiliary subunits – including transmembrane AMPAR regulatory proteins, cornichons, and GSG1L – which are widely expressed in neurons and glia. This complicates the interpretation of rectification as a measure of CP-AMPAR expression. Here, we show that the inclusion of the spider toxin analog 1-naphthylacetyl spermine (NASPM) in the intracellular solution results in a complete block of GluA1-mediated outward currents irrespective of the type of associated auxiliary subunit. In neurons from GluA2-knockout mice expressing only CP-AMPARs, intracellular NASPM, unlike spermine, completely blocks outward synaptic currents. Thus, our results identify a functional measure of CP-AMPARs, that is unaffected by their auxiliary subunit content.

During surgery for advanced epithelial ovarian cancer (EOC), the most important prognostic factor is the absence of residual tumor. Invisible microscopic peritoneal metastasis (mPM) are not removed during surgery and can be responsible of peritoneal recurrences. The aim of this current systematic review is to assess the role of fluorescence in evaluating mPM in EOC. We performed a systematic review using bibliographic citations from PubMed, Clinical Trials.gov, Embase, Cochrane Library, and Web of Science databases. MeSH terms for fluorescence, EOC and peritoneal carcinomatosis were combined and not restricted to the English language. The final search was performed on September 1rst, 2021. The primary outcome was to determine the diagnostic accuracy of fluorescence. We also reviewed the different techniques used. Eighty-seven studies were identified. Of these, 10 were included for analysis. The sensitivity and specificity of fluorescence ranged between 66.7-100% and 54.2-100%, respectively. Most importantly, the negative predictive value (NPV) ranged from 90 to 100% Due to the heterogeneity of the studies, no consensus was reached concerning the optimal use of fluorescence in terms of type of dye, type and timing of injection and imager to use. No adverse event was reported. Fluorescence can safely be used in EOC to evaluate mPM with a high NPV. However, a randomized controlled trial is needed to homogenize current practice.

OBJECTIVE: To evaluate the effect of initial treatment regimen individualization, (Pro Re nata (PRN) or Treat-and-Extend (TAE)), according to macular neovascularization (MNV) subtype, on the functional and anatomical response in neovascular age-related macular degeneration (nAMD). The secondary objective is to compare the treatment burden between each MNV subtypes. METHODS: Consecutive treatment-naïve nAMD patients were retrospectively included. MNV subtype was graded by 2 independent blinded investigators on multimodal imaging. Functional and anatomical outcomes were analysed according to treatment regimen and MNV subtypes. RESULTS: A total of 281 eyes from 243 patients were included in the study. According to the treatment regimen, there was no significant difference in best-corrected visual acuity gain within the 2 first year of treatment for type 1 (p=0.106) and type 3 MNV (p=0.704). Conversely, there was a significant difference in favour of TAE regimen for type 2 (p=0.017) and type 4 MNV (p=0.047). Type 1 MNV had a higher proportion of visits with subretinal fluid (p=0.0007), but not with intraretinal fluid (p=0.22). The mean interval between the last 2 injections was significantly shorter for type 1 MNV (p=0.0045). CONCLUSION: The individualization of the initial treatment protocol according to MNV subtype can improve the functional outcome and may decrease the treatment burden.

Resume De nouvelles approches therapeutiques moleculaires ont vu le jour ces dernieres annees pour les cancers gynecologiques avances parmi lesquels les inhibiteurs de poly-ADP-ribose-polymerases (PARPi). Ceux-ci ont demontre une efficacite dans les cancers sereux de haut grade ovarien chez les patientes porteuses de mutation du gene de predisposition aux cancers notamment du sein et de l’ovaire BRCA. Les donnees cliniques et pre cliniques suggerent que l’activite des inhibiteurs de PARPi ne serait pas limitee aux tumeurs mutees BRCA et mettraient en jeu la voie de recombinaison homologue. Ces donnees soulevent la question de l’efficacite des PARPi dans les cancers de l’endometre et du col de l’uterus a des stades avances pour lesquels les options therapeutiques sont aujourd’hui limitees. A l’heure actuelle, il existe peu de donnees disponibles quant a l’activite des PARPi dans les cancers de l’endometre et du col de l’uterus mais certains resultats semblent prometteurs. Nous proposons dans cette revue une synthese des etudes disponibles concernant les PARPi dans le cancer de l’endometre et le cancer du col de l’uterus.

Background Lymphadenectomy is debated in patients with ovarian cancer. The aim of our study was to evaluate the impact of lymphadenectomy in patients with high-grade serous ovarian cancer receiving neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS). Methods A retrospective, unicentric study including all patients undergoing NACT and IDS was carried out from 2005 to 2018. Patients with and without lymphadenectomy were compared in terms of recurrence free survival (RFS), overall survival (OS), and complication rates. Results We included 203 patients. Of these, 133 had a lymphadenectomy (65.5%) and 77 had involved nodes (57.9%). Patients without a lymphadenectomy were older, had a more extensive disease and less complete CRS. No differences were noted between the lymphadenectomy and no lymphadenectomy group concerning 2-year RFS (47.4% and 48.6%, p = 0.87, respectively) and 5-year OS (63.2% versus 58.6%, p = 0.41, respectively). Post-operative complications tended to be more frequent in the lymphadenectomy group (18.57% versus 31.58%, p = 0.09). In patients with a lymphadenectomy, survival was significantly altered if the nodes were involved (positive nodes: 2-year RFS 42.5% and 5-year OS 49.4%, negative nodes: 2-year RFS 60.7% and 5-year OS 82.2%, p = 0.03 and p Conclusion Lymphadenectomy during IDS does not improve survival and increases post-operative complications.

Resume Le statut ganglionnaire est le facteur pronostique le plus important chez les patientes atteintes d’un cancer du col uterin aux stades precoces. Le prelevement du ganglion sentinelle est une technique precise permettant d’evaluer le risque d’envahissement ganglionnaire en substitution aux curages pelviens systematiques. Une chirurgie ganglionnaire moins agressive permet de diminuer la morbidite induite par les curages pelviens, en particulier le risque de lymphœdeme des membres inferieurs. L’analyse histologique du ganglion sentinelle permet une ultrastadification qui identifie de faibles volumes tumoraux (cellules tumorales isolees et micrometastases). Sur le plan anatomique, la technique du ganglion sentinelle fournit des informations plus precises sur le drainage lymphatique des tumeurs du col en identifiant des nœuds lymphatiques en dehors des zones de curages classiques. La selection d’une population de patientes a faible risque d’atteinte ganglionnaire, une courbe minimale d’apprentissage et des regles simples garantissent un faible taux de faux negatifs. Plusieurs etudes ont montre que la technique du ganglion sentinelle est faisable, avec d’excellents taux de detection et de sensibilite. La technique combinee avec le technetium-99 et le bleu patente est largement utilisee mais la methode par fluorescence recemment introduite a montre de meilleurs taux de detection des ganglions sentinelles. Bien que les principales recommandations internationales recentes incitent a un prelevement du ganglion sentinelle en complement du curage pelvien, le prelevement exclusif du ganglion sentinelle n’est pas encore la reference, du au manque de donnees prospectives sur la survie sans recidive. Certains points sont encore discutes, tels que la valeur de l’examen extemporane du ganglion sentinelle et l’impact a long terme des micrometastases. L’essai prospectif randomise SENTICOL III devrait repondre a ces problematiques.

Objectives: Polypoidal choroidal vasculopathy is a common disease in Asia, but it has been less described in the Caucasian population. The aim of this real-life observational study was to describe the diagnostic and therapeutic practices as well as the prognosis in this population. Method: Fifty Caucasian patients with polypoidal choroidal vasculopathy were included in this study. All patients underwent angiography to confirm the diagnosis. Patients were divided into two treatment groups: patients of group 1 only received anti–vascular endothelial growth factor injections and those of group 2 required photodynamic therapy rescue in addition to intravitreal injections in case of suboptimal (anatomically or functionally) response. Clinical (visual acuity, fundus examination), paraclinical (retinal pigment epithelium detachment height and central retinal thickness on optical coherence tomography), and therapeutic (number of intravitreal injections) criteria were analyzed after 24 months. Results: Patient mean age was 73.9 ± 9.1 years, and half of the patients had age-related macular degeneration. In the whole cohort, the initial visual acuity was equivalent to the final visual acuity (59.9 ± 24.0 letters vs 62.5 ± 21.1 letters, p = 0.259). In group 1, the final visual acuity was significantly increased (from 56.9 ± 24.7 letters to 63.4 ± 21.6 letters, p = 0.016), while in group 2, it remained stable (from 61.7 ± 23.4 letters to 61.0 ± 21.4 letters, p = 0.249). The number of intravitreal injections was similar between both groups. Conclusion: In a Caucasian population, polypoidal choroidal vasculopathy seems to have a later onset. A non-standardized management allows stabilizing the functional prognosis. Patients requiring photodynamic therapy rescue have a poorer prognosis.

Purpose: The principal aim of this pilot study was to investigate the concordance between the different stages of Age-Related Macular Degeneration (AMD), as determined by the simplified classification of the Age Related Eye Disease Study Group (AREDS), and new evaluation criteria using a microperimetry system. Methods: A complete eye examination and a microperimetry MAIATM (Macular Integrity Assessment, CenterVue, Padova, Italy) examination was performed on 59 eyes with early, intermediate or advanced AMD. We analysed 19 evaluation criteria for every clinical group category. Results: There were 20 female and 12 male participants included with a median age of 74 years (min: 54, max: 87). Thirteen eyes (22%) were classified as category 1, 11 eyes (18.6%) as category 2, 17 eyes (28.8%) as category 3 and 18 eyes (30.6%) as category 4 AMD. All evaluated microperimetry criteria related to retinal sensitivity were found to have a statistically significant difference among the stages ( p Conclusions: The mean sensitivity and the categorized sensitivity (set to 25, 15 and 5 dB), the five higher and lower stimuli sensitivity appeared to be the most sensitive criteria to differentiate the four AMD categories. Microperimetry provides a new reproducible method of anatomical-functional macular analysis.

Background Homologous recombination deficiency is a marker of response to poly(ADP-ribose) polymerase inhibitors in different cancer types including ovary, prostate, and pancreatic cancer. To date, no report about poly(ADP-ribose) polymerase inhibitors has been published on cervical cancer. Case presentation Here we present the case of a patient with cervical cancer treated in this setting. A 49-year-old woman diagnosed with International Federation of Obstetricians and Gynecologists stage 2018 IIIC2 locally advanced undifferentiated cervical cancer received first-line chemoradiotherapy followed by carboplatin, paclitaxel, and bevacizumab with partial response. Because of a family history of cancers, the patient was tested and found positive for a pathogenic BRCA1 germline and somatic mutation, which motivated bevacizumab plus olaparib maintenance treatment. A simple hysterectomy was performed after 2 years stable disease; pathological report showed complete pathological response, and 12 months follow-up showed no recurrence. Conclusion Poly(ADP-ribose) polymerase inhibitors could be an alternative maintenance treatment for patients with persistent advanced cervical cancer previously treated with platinum, especially when familial history of cancers is reported. Clinical trials using poly(ADP-ribose) polymerase inhibitors for advanced cervical cancer are warranted.

Recent robust data allow for omitting lymph node dissection for patients with advanced epithelial ovarian cancer (EOC) and without any suspicion of lymph node metastases, without compromising recurrence-free survival (RFS), nor overall survival (OS), in the setting of primary surgical treatment. Evidence supporting the same postulate for patients undergoing complete cytoreductive surgery after neoadjuvant chemotherapy (NACT) is lacking. Throughout a systematic literature review, the aim of our study was to evaluate the impact of lymph node dissection in patients undergoing surgery for advanced-stage EOC after NACT. A total of 1094 patients, included in six retrospective series, underwent either systematic, selective or no lymph node dissection. Only one study reveals a positive effect of lymphadenectomy on OS, and two on RFS. The four remaining series fail to demonstrate any beneficial effect on survival, neither for RFS nor OS. All of them highlight the higher peri- and post-operative complication rate associated with systematic lymph node dissection. Despite heterogeneity in the design of the studies included, there seems to be a trend showing no improvement on OS for systematic lymph node dissection in node negative patients. A well-conducted prospective trial is mandatory to evaluate this matter.

Purpose. To examine choroidal neovascularization (CNV) characteristics in patients with exudative age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV), using swept-source optical coherence tomography angiography (SS-OCTA), and investigate agreement with OCT B-scan, fundus fluorescein angiography (FFA), and indocyanine green angiography (ICGA) by two different examiners. Methods. This is a retrospective multicentric study that involved patients with a history of AMD and PCV. Examiner A, who had access to OCTA, B-scan OCT, FFA, and ICGA imaging, had to differentiate between AMD and PCV, study the activity of AMD using Coscas’ criteria (active vs. quiescent), and categorize PCV subtypes, while examiner B had only access to OCTA. Then, the diagnostic concordance was assessed between both examiners. Results. A total of 27 patients (11 females (40.7%) and 16 males (59.3%), P = 0.231 ) were included in the analysis. Among those, 13 patients presented with neovascular AMD and 14 patients with PCV. There were 92.3% of correct answers regarding appropriate diagnosis and lesion characterization among AMD patients, against 61.5% of correct answers among PCV patients. The overall interrater reliability agreement between examiners, using Cohen’s kappa coefficient ( κ ) was 0.70 (0.5082-0.8916). Disagreement was found with one active AMD misdiagnosed as inactive AMD, three inactive PCV misdiagnosed as inactive AMD, and one inactive PCV misdiagnosed as active AMD. Conclusion. SS-OCTA alone remains limited in some specific phenotypes of PCV, which suggests the ongoing role of B-scan OCT associated with FFA and ICGA in the diagnosis of these conditions.

Acute kidney injury (AKI) is an infrequent complication of inflammatory bowel disease and can be exceptionally linked to interstitial nephritis secondary to anti-inflammatory drugs, such as Pentasa® (5-ASA).We present an case of an 80-year-old man who presented chronic diarrheas treated by Pentasa®. He developed AKI, evidenced by high plasma creatinine dosed in his local laboratory. At the hospital admission, plasma creatinine was exceptionally undetectable by the enzymatic method while Jaffe's method successfully determined it. Creatinine measurement by the enzymatic method was gradually restored during hospital stay, concomitant with the discontinuation of 5-ASA administration, suggesting that this drug could interfere with creatinine enzymatic assay. Creatinine enzymatic assays combine serial reactions. The last one called Trinder reaction, catalyzed by a peroxidase, uses HAll Trinder-dependent parameters should be interpreted with the patient's treatment knowledge, in particular salicylate derivatives.

Ever since the recent findings showing the lack of benefit of minimally invasive surgery (MIS) versus open surgery in early-stage cervical cancer, gynecologists have tried to explain these results. The primary objective of our study was to assess the impact of pre-operative conization on disease-free survival (DFS) in early-stage cervical cancer. The secondary objective was to analyze the peri-operative morbidity associated with a pre-operative conization. All patients undergoing a surgical management for early-stage squamous carcinoma or adenocarcinoma cervical cancer (IA1, IA2, IB1 and IB2 FIGO 2018) at a French university hospital from 2004 to 2018 were retrospectively included. We examined the association between conization and DFS using a Cox regression model. We also analyzed the morbidity associated with pre-operative conization. 48.4% (44/91) of the patients had a pre-operative conization (defined by a conization up to 90 days prior to surgery). 86.8% underwent MIS. There was a non-significant increase in the DFS with one patient presenting a recurrence in the conization group (2.3%) and six (12.8%) in the no conization group (log rank = 0.09). In univariate analysis, conization, definitive FIGO stage and pre-operative tumor size were associated with DFS (p

Objectives Subarachnoid haemorrhage (SAH) is characterised by 25% of mortality or induces long-term care. It needs immediate diagnosis with computed tomography (CT) scan. For the inconclusive CT scans, the detection of haem pigments can be performed in the cerebrospinal fluid (CSF). The reference method is spectrophotometry but it requires a large volume of CSF, and specific equipment. Sometimes, urine test strips are used as an alternative method for haem pigments detection. However, this method needs validation in SAH context. The aim of the study was to compare the performance of Multistix® urine test strips for haem pigments detection to the reference spectrophotometry and the final clinical SAH diagnosis. Methods We collected 136 CSFs sampled for suspected SAH. We detected haem pigments with urine test strips and spectrophotometry and compared performances for 100 samples. Results Urine tests strips displayed a high sensitivity (0.97) as compared to the reference spectrophotometry for haem pigments detection. Interestingly, absence of haem pigments fully correlated with absence of SAH. Conclusions Negative Multistix® urine test strips could help to exclude SAH diagnosis in combination with clinical data when a spectrophotometer is not available, or as a bedside diagnosis test.

International audience; Aim: Rectosigmoid resection is often performed during cytoreductive surgery for ovarian cancer, to achieve the goal of no residual tumour. Here, we evaluated the morbidity associated with rectosigmoid resection and the underlying risk factors. Methods: We retrospectively assessed consecutive patients managed with rectosigmoid resection during cytoreductive surgery for ovarian cancer at our centre in Paris, France, between 2005 and 2013. All previously identified risk factors were analysed. Major complications were defined as grade III-IV in the Clavien-Dindo classification. Results: Of 228 patients, 116 had primary and 112 interval surgery; 43/228 [18.9%]; experienced major complications, and these were more common after primary surgery [24.1% vs. 13.4%, p =.04]. The 69 patients who had rectosigmoid resection [33 primary vs. 36 interval surgery, p =.32] had a higher morbidity rate compared to the other patients [30.4% vs. 14.6%, p =.006]. The anastomotic leakage rate was 2.89%. By multivariate logistic regression, independent risk factors for morbidity were postmenopausal status [adjusted odds ratio (aOR), 13.7; 95% confidence interval (95%CI), 1.2;161.9], surgery after neoadjuvant chemotherapy [aOR, 4.4; 95%CI, 1.1;18.8], and peritoneal stripping of the left; paracolic gutter [aOR, 11.3; 95%CI, 2.3;54.3]. Conclusion: The morbidity of rectosigmoid resection during cytoreductive surgery for ovarian cancer seems acceptable. Ileostomy does not seem associated with a lower risk of major complications or adjuvant bevacizumab with a higher complication rate.

Two thirds of node-positive breast cancer patients have limited pN1 disease and could benefit from a less extensive axillary lymph node dissection (ALND).172 breast cancers patients requiring an ALND were prospectively enrolled in the Sentibras Protocol of Axillary Reverse Mapping (ARM). Radioisotope was injected in the ipsilateral hand the day before surgery. ALND was standard. Removed lymph nodes were classified into non radioactive nodes and radioactive nodes (ARM nodes). Among ARM nodes, nodes located in the upper outer part of the axilla, above the second intercostal brachial nerve and lateral to the lateral thoracic vein were identified as "zone D ARM nodes". The main objective was: feasibility of identification of the zone D ARM nodes. Secondary objectives were: metastatic involvement and lymphedema rate.100% of patients had ARM nodes identified. The "zone D ARM nodes" were identified in 92% of cases. The rate of metastatic nodes was 60% in the all cohort, 31% in ARM nodes and 9% in zone D ARM nodes. Among those, metastatic rate was 6% in patients undergoing ALND for a positive sentinel node biopsy, 6% in case of primary ALND versus 14% after neo-adjuvant chemotherapy (p 0.05). After 34 months of median follow up, 27% of interviewed patients had a lymphedema.The ARM technique reliably identifies the "zone D ARM nodes". These nodes can also easily be identified using knowledge of axillary anatomy. In selected patients, a selective ALND sparing the zone D ARM nodes could be performed.

Introduction Complete removal of disease is the most important prognostic factor for patients with advanced epithelial ovarian carcinoma. However, the influence of carcinomatosis distribution on prognosis is unknown and the prognostic impact of implant size according to their location is poorly studied. Our objective was to assess the impact of peritoneal carcinomatosis quantitative and qualitative localizations on progression free survival (PFS) in patients with advanced epithelial ovarian carcinoma (AEOC) after complete cytoreductive surgery. Methods We conducted a monocentric cohort study, retrospective from October 2001 to July 2014. Inclusion criteria were high-grade AEOC patients without residual disease (CC0) after primary debulking surgery (PDS) or after interval debulking surgery (IDS) following neoadjuvant chemotherapy (NACT). Peritoneal carcinomatosis was assessed according to qualitative criteria and quantitative criteria. Results One hundred and one patients were included. Median PFS was 21·2 months and median OS was 62·2 months. On the whole population, involvement of adipocytes-enriched areas tended to be associated with a decreased PFS and was significantly associated with a decreased OS. Any localization was associated with PFS or OS in the “IDS” subgroup. In the “PDS” subgroup, PCI score and involvement of the right mesocolic area were associated with a decreased PFS. Conclusion Initial tumor load has not been found associated with PFS after complete surgery. Adipocytes-enriched areas and right mesocolic areas involvement were associated with poor prognosis in patients receiving primary debulking surgery. Larger-scale studies are needed to assess whether initial tumor load has a prognostic impact even after complete cytoreductive surgery is achieved.

OBJECTIVE The aim of this study was to determine the predictive factors of postoperative morbidity of patients who have undergone a radical trachelectomy (RT) for early-stage cervical cancer and to assess the oncologic outcomes. METHODS We retrospectively analysed the data of 2 prospective trials on sentinel node biopsy for cervical cancer (SENTICOL I and II). Patients having a RT for early-stage cervical cancer with negative sentinel lymph node and safe margins, were included. RESULTS Forty-nine patients met the inclusion criteria. Forty-five patients had a laparoscopic-assisted vaginal technique and 4 patients a total laparoscopic technique. The median age was 32 years (range, 22-46 years). 83.7% of patients had a stage IB1 disease. There were 63.3% squamous cell carcinomas and 34.7% adenocarcinomas. The median follow-up was 46 months (range, 1-85 months). Two patients (3.3%) had a severe postoperative complication (Clavien-Dindo ≥III and/or CTCAE ≥3). The main postoperative complications were urinary (28.6%), lymphovascular (26.5%) and neurologic (14.3%). On a multivariate analysis, postoperative complications were significantly associated with history of pelvic surgery and IB1 International Federation of Gynecology and Obstetrics stage. Inclusion in high surgical skills centers decrease the risk of postoperative complications. During the follow-up, 3 patients (6.1%) had a local recurrence and one patient died from a breast cancer. Between group with complications and group without any complications, overall survival and recurrence-free survival did not significantly differ at 5-year of follow-up. CONCLUSION RT has few severe postoperative complications and appears as a safe alternative to spare fertility of young patients. To guarantee best surgical outcomes, patients should be referred to expert center.

Objective The purpose of this study was to assess the postoperative morbidity after radical hysterectomy (RH) for early-stage cervical cancer and to determine risk factors of severe perioperative morbidity. Methods Data of two prospective trials on sentinel node biopsy for cervical cancer (SENTICOL I & II) were analysed. Patients having a radical hysterectomy were included between 2005 and 2012 from 25 French oncologic centers. Postoperative complications were prospectively recorded in a pre-specified analysis. Results 248 patients met the inclusion criteria. The median age was 44.5 years [25–85]. 88.7% of patients had a stage IB1 disease. There were 71.4% epidermoid carcinomas and 25% adenocarcinomas. 125 patients (50.4%) had a laparoscopic-assisted vaginal RH, 88 patients (35.5%) had a total laparoscopic RH, 26 patients (10.5%) had an open RH and 9 patients (3.6%) had a robotic-assisted RH. Sixteen patients (6.4%) had intraoperative complications. On a multivariate analysis, intraoperative complications were significantly associated with BMI >30 kg/m2. The urinary, lymphovascular and neurologic complications rates were respectively 34.3%, 20.6% and 19.8%. 31 patients (12.5%) had severe postoperative complications (Clavien-Dindo ≥ 3 or CTCAE ≥ 3). On multivariate analysis, severe postoperative complications were associated with parametrial involvement, preoperative brachytherapy and inclusion in low surgical skills center. Conclusions This study based on prospective data showed that RH has low severe postoperative complications. The main complications were urinary infections and lower limb lymphedema. Patients with early-stage cervical cancer should be referred to expert center to ensure best surgical outcomes.

Radical hysterectomy (RH) is an effective treatment for early-stage cervical cancer IA2 to IIA1 but RH is often associated with several significant complications such as urinary, anorectal and sexual dysfunction due to pelvic nerve injuries. Pelvic autonomic nerves including the superior hypogastric plexus (SHP), hypogastric nerves (HN), pelvic splanchnic nerves (PSN), sacral splanchnic nerves (SSN), inferior hypogastric plexus (IHP) and efferent branches of the IHP. We aimed to precise the neuroanatomy of the female pelvis in order to provide key-points of surgical anatomy to improve NSRH for cervical cancer. The SHP could be injured during periaortic lymph node dissection and its preservation necessitates an approach on the right side of the aorta and a blunt dissection of the promontory before lomboaortic lymphadenectomy. Injuries to HN can occur during the resection of USL at the posterior pelvic wall and of rectovaginal ligaments and to preserve HN only the medial fibrous part of the uterosacral ligament should be resected. The middle rectal artery, the deep uterine vein and the ureter should be identified to preserve PSN and IHP during resection of paracervix. Vesical branches can be preserved by blunt dissection of the posterior layer of the vesicouterine ligament after identifying the inferior vesical vein. In most of cases, NSRH for cervical cancer can be performed. Anatomical landmarks as middle rectal artery, deep uterine vein, inferior vesical vein and ureter and the respect of nervous part of uterine ligament and of parametrium provide to surgeon a safe preservation of pelvic innervation without compromising oncological outcomes.

Resume But Aujourd’hui, les recommandations francaises et internationales different concernant la prise en charge du creux axillaire en cas de ganglion sentinelle (GS) metastatique dans le cancer du sein. Nous avons realise une enquete sur les pratiques francaises. Materiels et methodes Un questionnaire a ete envoye a 454 chirurgiens senologues entre juin 2014 et janvier 2015. Ce questionnaire comprenait des items sur : les indications de la biopsie du GS, la frequence du curage axillaire (CA) en cas de GS metastatique et les modalites de la radiotherapie en cas de GS metastatique sans CA. Resultats Au total, 169 chirurgiens (37 %) ont repondu au questionnaire. Vingt et un pour cent des chirurgiens ne font pas de CA en cas de macrometastase. Trente-deux pour cent ne font pas d’examen extemporane du GS. De plus, 8,4 % des praticiens realisent une biopsie du GS apres chimiotherapie neoadjuvante et 14 % dans le cas de tumeurs multicentriques, alors que cette derniere indication n’est pas recommandee. Dans le cas d’un GS metastatique sans CA complementaire, les champs d’irradiation sont etendus a l’aisselle dans 44 % des cas. Conclusion Des discordances significatives sont observees entre les pratiques et les recommandations nationales. La divergence entre les recommandations francaises et internationales conduit a des pratiques chirurgicales heterogenes.

Background Cardiac surgery-associated acute kidney injury (CSA-AKI) is a frequent complication. The current criteria to detect CSA-AKI rise only when organic dysfunction has occurred. The Doppler Renal Resistive Index (RRI) and the urinary G1 cell cycle arrest proteins (TIMP-2 and IGFBP7) have been advocated to predict CSA-AKI at an early stage after cardiac surgery. The primary objective was to determine the predictive value of these new markers to detect CSA-AKI after elective heart surgery in patients at risk to develop AKI. Methods In a prospective observational trial, we studied 50 patients scheduled for elective on-pump heart surgery at high risk for CSA-AKI. The primary outcome was the incidence of AKI according to the KDIGO criteria recording the urine output every hour until ICU discharge and measuring the serum creatinine levels on each postoperative day until the post-procedure peak values were reached or until the 7th postoperative day. The RRI and the urinary proteins [TIMP-2]*[IGFBP7] were measured concomitantly: before surgery, 1 hour (H1), 4-hour (H4), 12-hour (H12), and 24-hour (H24) after surgery. Results Thirty-seven patients (74%) developed CSA-AKI. Urinary [TIMP-2]*[IGFBP7] at H12 were significantly higher in patients that developed AKI (0.62, [interquartile] [0.20–1.18] vs. 0.30 [0.07–0.47] P = 0.044) with an area under the receiver-operating characteristic curve of 0.69 [0.53–0.84]. The best sensitivity (65%) and specificity (62%) was achieved for a cutoff value of 0.3 (ng.mL−1)2.1000−1. The H12 time-point was the only in which the RRI values measured showed a trend toward statistical significance in patients that developed AKI (0.72 (Standard deviation) ± (0.06) vs. 0.68 ± (0.07) P = 0.065). The combination of the two markers ([TIMP-2]*[IGFBP7] + RRI) at H12 showed an increased performance of the accuracy with an area under the receiver-operating characteristic curve of 0.78 [0.62–0.93]. Conclusions In a population at risk of developing CSA-AKI, neither the RRI nor urinary [TIMP-2]*[IGFBP7] detect CSA-AKI occurring in the first post-operative week within the first 24 postoperative hours.

Highly virulent Helicobacter pylori strains contain the cag pathogenicity island (cagPAI). It codes for about 30 proteins forming a type IV secretion system (T4SS) which translocates the pro-inflammatory protein CagA into epithelial host cells. While CagA and various other Cag proteins have been extensively studied, several cagPAI proteins are poorly characterized or of unknown function. CagN (HP0538) is of unknown function but highly conserved in the cagPAI suggesting an important role. cagM (HP0537) is the first gene of the cagMN operon and its product is part of the CagT4SS core complex. Both proteins do not have detectable homologs in other type IV secretion systems. We have characterized the biochemical and structural properties of CagN and CagM and their interaction. We demonstrate by circular dichroism, Multi-Angle Light Scattering (MALS) and small angle X-ray scattering (SAXS) that CagN is a folded, predominantly monomeric protein with an elongated shape in solution. CagM is folded and forms predominantly dimers that are also elongated in solution. We found by various in vivo and in vitro methods that CagN and CagM directly interact with each other. CagM self-interacts stably with a low nanomolar KD and can form stable multimers. Finally, in vivo experiments show that deletion of CagM reduces the amounts of CagN and other outer CagPAI proteins in H. pylori cells.

Purpose: To describe abnormal dark (hyposignal) and white (hypersignal) lesions observed on optical coherence tomography angiography in central serous chorioretinopathy. Methods: Prospective, multicenter, and descriptive study including patients with active or quiescent central serous chorioretinopathy. All patients had undergone a complete ophthalmic examination. Results: Abnormal dark lesions were detected as “dark spots” and “dark areas” on optical coherence tomography angiography. A “dark spot” could correspond to six different abnormalities: pigment epithelium detachment, subretinal deposit, “Lucency” within surrounding subretinal fibrin, choroidal cavitation, choroidal excavation, and choroidal fluid. A “dark area” could be related to a serous retinal detachment or choriocapillary compression. Abnormal white lesions were also detected: A “white spot” could correspond with the leaking point on fluorescein angiography or with hyper-reflective dots; A “white filamentous pattern” at the Brüch’s membrane level corresponded to abnormal choroidal neovascular vessels. Conclusion: A semiology is described using optical coherence tomography angiography in central serous chorioretinopathy as abnormal dark and white lesions. Multimodal imaging is mandatory in addition to optical coherence tomography angiography to diagnose non-neovascular retinal and choroidal central serous chorioretinopathy lesions. However, optical coherence tomography angiography alone is helpful in detecting choroidal neovascular membrane in central serous chorioretinopathy.

Purpose. To identify spectral-domain optical coherence tomography (SD-OCT) predictive morphological features for the outcome of Ranibizumab therapy for neovascular age-related macular degeneration (AMD). Methods. This is a retrospective multicentric study that involved 64 eyes with naïve AMD. Patients who received three monthly intravitreal injections of Ranibizumab were stratified into (1) “responders” [≥ 5 letters gain on Early Treatment Diabetic Retinopathy Study (ETDRS) scale] and (2) “nonresponders” (< 5 letters gain). Best-corrected visual acuity (BCVA) and SD-OCT morphological features were compared at baseline and one month after three consecutive injections of Ranibizumab. Univariate and multivariate analyses were carried out to correlate these morphological features with the change in BCVA. Results. Among the 64 patients enrolled, 40 (62.5%) were “responders” and 24 (37.5%) “nonresponders”. Age, sex, and BCVA were comparable between both groups. A multivariate correlational analysis found that subfoveal choroidal thickness (SFCT) and the presence of pigment epithelial detachment (PED) > 250 μm at baseline were two independent prognostic indicators of final BCVA. No other SD-OCT morphological studied features seem to affect final BCVA after Ranibizumab treatment. Conclusion. SFCT and the presence of PED > 250 μm are two significant biomarkers that may predict improvement after Ranibizumab therapy for AMD. These markers may guide ophthalmologists' treatment decision under financial constraints and limited time.

Au tout debut des annees 2000 est nee au Danemark, dans un contexte de violences racistes, une initiative qui porte le nom original, voire antinomique, de « Human library ». On utilise les expressions « bibliotheque humaine » ou « bibliotheque vivante » pour designer cet evenement dans la langue francaise. Les bibliotheques vivantes ont pour objectif la lutte contre les stereotypes et les prejuges, et pour mot d’ordre le slogan « take out your prejudice ». Comme dans la bibliotheque tradition...

Background Acute kidney injury (AKI) is a frequent complication after a transcatheter aortic valve implantation (TAVI). Biomarkers such as urinary G1 cell cycle arrest proteins (TIMP-2 and IGFBP7) and sonographic evaluation (Doppler Renal Resistive Index [RRI]) have been advocated to predict AKI at an early stage after a TAVI-procedure. The primary aim was to determine the predictive value of these markers to detect AKI after a TAVI-procedure at an early phase. Patients and methods In a prospective observational study, 62 consecutive patients were scheduled for a TAVI. AKI was assessed based on the KDIGO criteria. Biomarkers and RRI were measured concomitantly before TAVI, at the first micturition post-implantation and the first micturition on the morning after the procedure. Results Twenty-two patients (35%) developed AKI. On the first day after the TAVI-procedure, urinary TIMP-2 and IGFBP7 concentrations increased significantly in patients who developed AKI (0.1, [interquartile] [0.1–0.35] to 0.40 [0.10–1.00] vs. 0.2 [0.1–0.5] to 0.10 [0.10–0.20], P = 0.012) with an area under the receiver-operating characteristic curve of 0.71 [0.55–0.83]. Sensitivity was 0.57 and specificity was 0.83 for a cut-off value of 0.35. No significant increases in RRI were found in patients who developed AKI. Conclusions Based on the current guidelines for the diagnosis of AKI, the urinary proteins TIMP-2 and IGFBP7 do not detect AKI at an early stage accurately in patients undergoing a TAVI-procedure.

Dyspnea is a multidimensional symptom, but this multidimensionality is not considered in most dyspnea questionnaires. The Dyspnea-12 takes a multidimensional approach to the assessment of dyspnea, specifically the sensory and the affective response. The objective of this study was to translate into Spanish and validate the Dyspnea-12 questionnaire.The original English version of the Dyspnea-12 questionnaire was translated into Spanish and backtranslated to analyze its equivalence. Comprehension of the text was verified by analyzing the responses of 10 patients. Reliability and validation of the questionnaire were studied in an independent group of COPD patients attending the pulmonology clinics of Hospital Universitario Marqués de Valdecilla, diagnosed and categorized according to GOLD guidelines.The mean age of the group (n=51) was 65 years and mean FEV1 was 50%. All patients understood all questions of the translated version of Dyspnea-12. Internal consistency of the questionnaire was α=0.937 and intraclass correlation coefficient was=.969; P.001. Statistically significant correlations were found with HADS (anxiety r=.608 and depression r=.615), mMRC dyspnea (r=.592), 6MWT (r=-0.445), FEV1 (r=-0.312), all dimensions of CRQ-SAS (dyspnea r=-0.626; fatigue r=-0.718; emotional function r=-0.663; mastery r=-0.740), CAT (r=0.669), and baseline dyspnea index (r=-0.615). Dyspnea-12 scores were 10.32 points higher in symptomatic GOLD groups (B and D) (P.001).The Spanish version of Dyspnea-12 is a valid and reliable instrument to study the multidimensional nature of dyspnea.

Sentinel node biopsy appears as a promising technique for the assessment of nodal disease in early cervical cancers. Selection of a population with a low risk of nodal metastasis, a minimal training, and simple rules allow a low false negative rate. Sentinel node biopsy provides supplementary information, such as anatomical information (nodes outside of routine lymphadenectomy areas) and histological information (isolated tumors cells and micrometastases).

International audience; In the weeks following the attacks in January 2015 against Charlie Hebdo and Hyper Cacher, French libraries reacted with speed, intensity , and emotion to the events by, among other things, displaying posters, making acquisitions, and holding exhibitions and debates. The events spawned by the attacks were politically charged. While the attacks challenged the sanctity of freedom of speech in France, the ensuing rallies in protest against them questioned both French unity and the notions of mobilization and engagement in an era that we had come to consider depoliticized. Further, the French na

Hollow capsules with dimensions below 1 μm have recently attracted much attention due to their potential applications as catalysts as well as biomedical and pharmaceutical vectors for controlled drug delivery. Among them, hollow zeolites are particularly interesting because they possess (i) a crystalline structure, which greatly improves their hydrothermal and chemical stability as compared to amorphous silica analogs and (ii) a microporous network that acts as a shape-selective membrane. Moreover, their properties can be continuously tuned by changing their composition, in particular the framework aluminum content. In this perspective review, we examine the recent progress in the development of synthetic methods for the preparation of hollow zeolite and zeotype structures, from templating routes providing large polycrystalline capsules to controlled dissolution methods leading to nanometer-sized hollow single crystals. The applications of these materials will be illustrated and discussed, namely their ma...

International audience; Purpose:To determine the rate of reticular pseudodrusen (RPD) in age-related macular degeneration using multimodal imaging, including color fundus photography, the blue channel image of fundus photography, infrared reflectance, fundus autofluorescence, multicolor imaging, and spectral domain optical coherence tomography, as well as to compare the sensitivities and specificities of these modalities for detecting RPD.Methods:This prospective study included 243 eyes from 125 consecutive patients with age-related macular degeneration. They underwent fundus examination including color fundus photography, blue channel, infrared reflectance, fundus autofluorescence, multicolor imaging, and spectral domain optical coherence tomography in both eyes. To be considered as having RPD, eyes had to have reticular patterns on spectral domain optical coherence tomography in a large studied cube of 30 degrees x 25 degrees or on infrared reflectance with at least one other examination.Results:The mean age of the 125 patients was 81.1 years (8.1). Eighty-six patients (68.8%) were diagnosed with RPD. Spectral domain optical coherence tomography, infrared reflectance, and multicolor imaging had the highest sensitivity (99.3, 84.6, and 87.1%, respectively) and specificity (100%). The color fundus photography, blue channel, and fundus autofluorescence had lower sensitivity to detect RPD.Conclusion:Reticular pseudodrusen is frequently associated with soft drusen in patients with age-related macular degeneration. As RPD may be rarely located only in the perifoveal area, spectral domain optical coherence tomography with a larger cube (30 x 25 degrees) than that usually used (20 x 20 degrees) had the highest sensitivity and specificity to detect RPD and is recommended to optimize the rate of detection.

Background Conservative treatment of lower pole breast cancer in small or medium sized breasts could be attended with poor cosmetic outcomes. The purpose of this study was to assess the results of the “Crescent” Oncoplastic technique in this indication. Material and methods Prospective study in 54 breast cancer patients undergoing the technique. Results Post-operative recovery was uneventful except 1 hematoma and 6 breast seromas. With a mean follow-up period of 45 months (range 27–64), no local recurrence s was detected. Five patients had fat necrosis. Cosmetic results were assessed as being excellent (39%), good (35%), fair (20%) and mediocre (6%). Conclusion We therefore advise this technique as a first step oncoplastic surgery technique for tumors situated near the inframammary fold. We also recommend the systematic check of the final cosmetic results in the standing position in order to obtain the best possible results.

Resume La chirurgie robotisee connait un essor important depuis quelques annees. Elle est aujourd’hui une voie d’acces majeure en chirurgie urologique, notamment pour la chirurgie prostatique. Son developpement en gynecologie est plus recent. Les interventions en chirurgie oncologique gynecologique representent une part importante des indications potentielles. La chirurgie robotisee est notamment frequemment utilisee pour la prise en charge des cancers de l’endometre. Cependant, aucun essai therapeutique n’a ete publie a ce jour et seules des series mono- ou multicentriques pour la plupart retrospectives sont disponibles. Il semble interessant dans ce contexte d’effectuer une revue de la litterature pour rassembler les informations issues de ces differentes etudes. La faisabilite semble bonne et l’apprentissage rapide (environ 20 cas). Les durees operatoires sont plus longues qu’avec la laparotomie, mais equivalentes ou plus courtes qu’avec la cœlioscopie classique. Le temps d’installation du robot allonge la duree totale de l’intervention, mais semble diminuer dans des valeurs acceptables avec une courbe d’apprentissage des equipes paramedicales. Les pertes sanguines et les taux de transfusion sont significativement reduits en comparaison a la laparotomie, mais aussi a la cœlioscopie pour certains auteurs. Le taux global de complication semble plus faible. Les douleurs postoperatoires et les durees de sejour ou de convalescence sont moindres qu’avec la laparotomie et parfois la cœlioscopie. La limite principale a la diffusion de cette technique reste la disponibilite du robot liee a son cout. Les limites de la chirurgie robotisee commencent a etre mise en evidence par les equipes les plus entrainees.

Resume Objectif Etudier la correlation entre la nature des tumeurs ovariennes presumee selon les criteres echographiques de Timmerman et le diagnostic final histologique. Patientes et methodes Nous avons effectue une etude prospective durant une periode de 4 ans, portant sur des patientes porteuses de tumeurs ovariennes explorees par echographie pelvienne. Les differentes tumeurs ont ete classees selon les criteres de Timmerman, presumant de leur caractere benin ou malin, permettant de determiner l’efficience de ce score. La reference diagnostique etait l’examen histologique final. La sensibilite et la specificite de ces criteres ont ete calculees avec leurs intervalles de confiance a 95 %. Resultats Cent vingt-deux patientes presentant une tumeur ovarienne ont ete incluses entre janvier 2002 et decembre 2005. Parmi ces tumeurs, 88,5 % (108 sur 122) etaient benignes et 11,5 % (14 sur 122) malignes ou a la limite de la malignite. Les criteres de classification etudies etaient applicables pour 89,3 % (109 sur 122) des tumeurs de notre serie. La sensibilite des criteres echographiques dans notre etude est de 73 % (IC 95 % [45–100]) et la specificite de 97 % (IC 95 % [94–100]). Discussion et conclusion La plupart de tumeurs annexielles peut etre classee selon les criteres echographiques de Timmerman avec une bonne specificite pour eliminer leurs caracteres malins ou a la limite de la malignite. Les tumeurs ne pouvant pas etre classees selon ce score devront etre orientes vers un echographiste plus experimente.

Single crystals of the title compound, C(17)H(16)N(2)O(3), were obtained by gas diffusion. The observed diffraction pattern is compatible with a superposition of reflections from two monoclinic unit cells with the space group C2/c. The two cells share the a and b axes but not the c axis. Both structures contain layers parallel to (001), with molecules connected by intermolecular N-H···O=C hydrogen bonds. The bonding between adjacent layers is weak. Layer displacements result in a crystal structure containing two closely related polymorphic domains. The structure of one polymorph can be derived from the structure of the other if subsequent layers are displaced by (a/4, b/4, 0) for odd-numbered layers and by (a/4, -b/4, 0) for even-numbered layers. Three different crystals were analysed and their observed diffraction patterns were similar, showing all three crystals to contain the polymorphic domain structure.

Lymph node metastases in cervical and endometrial cancer are major prognostic factors. Lymph-nodal involvement determines adjuvant therapy. As imagery is not reliable to diagnose lymph node status, pelvic +/- para-aortic lymphadenectomy remains the gold standard. These surgical procedures are, however, responsible for specific morbidity: lymphocele and lymphedema. Sentinel lymph node procedure could avoid lymphadenectomy and their complications in cervical and endometrial cancer with good negative predictive values. We present actual indications, procedure and results of sentinel lymph node procedures in cervical and endometrial cancer.

Resume Le cancer de l’endometre est une tumeur de bon pronostic, souvent diagnostiquee a un stade precoce. Neanmoins, il existe, parmi les stades I, 5 a 20 % d’envahissements ganglionnaires. La connaissance du statut ganglionnaire apporte une information pronostique essentielle. Celle-ci est malheureusement mal evaluee par le bilan preoperatoire et la lymphadenectomie a visee pronostique apparait donc justifiee. En revanche, le benefice therapeutique des curages pelviens et lomboaortiques est controverse. Les derniers essais randomises ne retrouvent pas d’impact sur la survie pour les patientes a bas niveau de risque d’envahissement ganglionnaire. Ainsi, dans ce groupe de patientes, le curage ne devrait plus etre considere comme une pratique systematique. Neanmoins, le groupe a haut risque semble, lui, beneficier non seulement du curage pelvien, mais egalement lomboaortique, en raison de la possibilite d’envahissement lomboaortique isole.

Single crystals of the title compound, C(9)H(10)N(3)O(3)(+).Cl(-).H(2)O, were obtained by recrystallization from hydrochloric acid. The cations stack along the crystallographic a direction. The 2,3-dioxo-1,4-dihydroquinoxaline group shows a significant deviation from planarity [r.m.s. deviation from the best plane = 0.063 (2) A]. Hydrogen bonding links the cations, chloride anions and water molecules to form an extended three-dimensional architecture.

Les SOR 2007 du cancer de l’ovaire placent la chirurgie d’intervalle apres chimiotherapie neo-adjuvante comme une option apres le standard de l’effort chirurgical premier chaque fois que la cytoreduction complete est possible [1]. L’essai randomise de l’EORTC a demontre qu’il n’y avait pas de difference de survie entre les 2 bras chirurgie premiere ou chimiotherapie neo-adjuvante. Il est discute de la prise en charge premiere d’un cancer de l’ovaire dans les limites des connaissances d’aujourd’hui.

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 38 - N° 7 - p. 537-544

Poly[triaqua-mu(4)-fumarato-cobalt(II)], [Co(C(4)H(2)O(4))(H(2)O)(3)](n), (I), contains two symmetry-independent octahedrally coordinated Co(2+) ions, both on inversion centers. One Co(2+) ion is coordinated by two water molecules and four fumarate dianions, whereas the other Co(2+) ion is surrounded by four water molecules and two fumarate dianions. Each fumarate dianion is bonded to three Co(2+) ions, leading to a two-dimensional structure. The fumarate dianions are nonplanar; the angle between the planes of the two carboxylate groups is 54.9 (2) degrees. The cobalt(II) fumarate layers are connected by hydrogen bonding into a three-dimensional network. Compound (I) is not isostructural with calcium(II) fumarate trihydrate [Gupta et al. (1972). Acta Cryst. B28, 135-139]. In poly[mu(4)-fumarato-dimethanolcobalt(II)], [Co(C(4)H(2)O(4))(CH(4)O)(2)](n), (II), the Co(2+) ions are octahedrally coordinated by four fumarate dianions and two methanol molecules, leading to a three-dimensional structure. The fumarate group is planar. The Co(2+) ions and the fumarate dianions both lie on inversion centers. Additionally, the one-dimensional structure of catena-poly[[[tetraaquacobalt(II)]-mu(2)-fumarato] monohydrate], {[Co(C(4)H(2)O(4))(H(2)O)(4)].H(2)O}(n), (III), was redetermined at a higher resolution, and the space group C2/c was confirmed.

Malignant nonepithelial ovarian tumours represent less than 20% of ovarian cancers in adults. Apart from haematological tumours, there are mainly germ cell tumours and sex cordstromal ovarian tumours. These tumours affect young women and are diagnosed in early stages associated with a good prognosis. The management of malignant nonepithelial ovarian tumours is difficult because they are rare and because we have to propose an appropriate oncological treatment, preserving fertility for these women of child-bearing age. We propose an update on recent data in the literature, focusing on management.