Search

BackgroundPediatric renal trauma is rare and lacks sufficient population-specific data to generate evidence-based management guidelines. A nonoperative approach is preferred and has been shown to be safe. However, bleeding risk assessment and management of collecting system injury are not well understood. We introduce the Multi-institutional Pediatric Acute Renal Trauma Study (Mi-PARTS), a retrospective cohort study designed to address these questions. This article describes the demographics and contemporary management of pediatric renal trauma at Level I trauma centers in the United States.MethodsRetrospective data were collected at 13 participating Level I trauma centers on pediatric patients presenting with renal trauma between 2010 and 2019. Data were gathered on demographics, injury characteristics, management, and short-term outcomes. Descriptive statistics were used to report on demographics, acute management, and outcomes.ResultsIn total, 1,216 cases were included in this study. Of all patients, 67.2% were male, and 93.8% had a blunt injury mechanism. In addition, 29.3% had isolated renal injuries, and 65.6% were high-grade (American Association for the Surgery of Trauma Grades III-V) injuries. The mean Injury Severity Score was 20.5. Most patients were managed nonoperatively (86.4%), and 3.9% had an open surgical intervention, including 2.7% having nephrectomy. Angioembolization was performed in 0.9%. Collecting system intervention was performed in 7.9%. Overall mortality was 3.3% and was only observed in patients with multiple injuries. The rate of avoidable transfer was 28.2%.ConclusionThe management and outcomes of pediatric renal trauma lack data to inform evidence-based guidelines. Nonoperative management of bleeding following renal injury is a well-established practice. Intervention for renal trauma is rare. Our findings reinforce differences from the adult population and highlights opportunities for further investigation. With data made available through Mi-PARTS, we aimed to answer pediatric specific questions, including a pediatric-specific bleeding risk nomogram, and better understanding indications for interventions for collecting system injuries.Level of evidencePrognostic and Epidemiological; Level IV.

BackgroundTremor in Parkinson's disease (PD) is commonly seen in the upper extremities and can involve the lower extremities and mouth. We present a case of a patient with idiopathic PD who presented with abdominal tremor.Case reportA 40-year-old man with a 2-year history of subjective weakness and stiffness in the right arm and leg, followed by emergence of a right hand tremor, subsequently developed abdominal tremor. Patient experienced marked improvement of both abdominal and hand tremor and mobility of the right limbs with levodopa.DiscussionOur case report serves as the second only published report of abdominal tremor in an idiopathic PD patient.HighlightsTremor in Parkinson's disease (PD) commonly affects the upper and lower extremities and mouth. We describe a 40-year-old man with PD who developed abdominal tremor which was brought under control with levodopa. This case is one of only two published reports of abdominal tremor in PD.

Life-threatening "breakthrough" cases of critical COVID-19 are attributed to poor or waning antibody (Ab) response to SARS-CoV-2 vaccines in individuals already at risk. Preexisting auto-Abs neutralizing type I IFNs underlie at least 15% of critical COVID-19 pneumonia cases in unvaccinated individuals; their contribution to hypoxemic breakthrough cases in vaccinated people is unknown. We studied a cohort of 48 individuals (aged 20 to 86 years) who received two doses of a messenger RNA (mRNA) vaccine and developed a breakthrough infection with hypoxemic COVID-19 pneumonia 2 weeks to 4 months later. Ab levels to the vaccine, neutralization of the virus, and auto-Abs to type I IFNs were measured in the plasma. Forty-two individuals had no known deficiency of B cell immunity and a normal Ab response to the vaccine. Among them, 10 (24%) had auto-Abs neutralizing type I IFNs (aged 43 to 86 years). Eight of these 10 patients had auto-Abs neutralizing both IFN-α2 and IFN-ω, whereas two neutralized IFN-ω only. No patient neutralized IFN-β. Seven neutralized type I IFNs at 10 ng/ml and three at 100 pg/ml only. Seven patients neutralized SARS-CoV-2 D614G and Delta efficiently, whereas one patient neutralized Delta slightly less efficiently. Two of the three patients neutralizing only type I IFNs at 100 pg/ml neutralized both D614G and Delta less efficiently. Despite two mRNA vaccine inoculations and the presence of circulating Abs capable of neutralizing SARS-CoV-2, auto-Abs neutralizing type I IFNs may underlie a notable proportion of hypoxemic COVID-19 pneumonia cases, highlighting the importance of this particularly vulnerable population.

Abstract Glass durability is one of the properties that can be affected by surface treatments such as coatings or chemical attacks. These treatments can be used to reduce the quantities of potentially toxic elements contained in glass that may be released in solution. Five surface treatments were selected: three different coatings (SnO2, TiO2, SiO2) and two acidic attacks (SO2 dealkalization and acid polishing). These treatments were performed on five glass compositions (soda-lime, borosilicate, barium silicate, opal, and lead crystal). Their effects on alteration rates and mechanisms were investigated through a single protocol (acetic acid 4%, 70 °C) simulating accelerated aging conditions for containers of beverages or food. The data collected over 1.3 years showed significant reduction of lead leaching with all treatments except acid polishing. The best reduction factor was obtained with SO2 dealkalization, which also demonstrated beneficial effects towards the retention of Ba by reducing the diffusion of alkalis.

IntroductionThe association between neuropathological changes and dementia among centenarians and nonagenarians remains unclear.MethodsWe examined brain tissue from 100 centenarians and 297 nonagenarians from The 90+ Study, a community-based longitudinal study of aging. We determined the prevalence of 10 neuropathological changes and compared their associations with dementia and cognitive performance between centenarians and nonagenarians.ResultsA total of 59% of centenarians and 47% of nonagenarians had at least four neuropathological changes. In centenarians, neuropathological changes were associated with higher odds of dementia and, compared to nonagenarians, the odds were not attenuated. For each additional neuropathological change, the Mini-Mental State Examination score was lower by 2 points for both groups.DiscussionNeuropathological changes continue to be strongly related to dementia in centenarians, highlighting the importance of slowing or preventing the development of multiple neuropathological changes in the aging brain to maintain cognitive health.HighlightsIndividual and multiple neuropathological changes are frequent in centenarians. These neuropathological changes are strongly associated with dementia. There is no attenuation of this association with age.

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

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

Objective:To determine prevalence of dementia-related neuropathologic changes and examine their association with dementia risk and severity in centenarians, and compare findings with nonagenarians from the same cohort.Background:Centenarians worldwide are projected to increase 50-fold by 2100 with dementia incidence estimated ~40%. Brain autopsy studies in this population are highly limited.Design/Methods:Participants were individuals who agreed to autopsy from The 90+ Study, a longitudinal study of aging. Cognitive diagnoses were assigned during a multidisciplinary conference blinded to autopsy results. Using standardized protocols, dementia-related neuropathologic changes (NCs) were assessed blinded to clinical information and dichotomized for analyses: +Alzheimer’s disease (AD) neuropathologic change (ADNC;intermediate/high), +cerebral amyloid angiopathy (moderate/severe), +arteriosclerosis (moderate/severe), +Lewy body disease (limbic/neocortical), +TDP-43 (hippocampal/cortical), +age-related tau astrogliopathy (ARTAG;present), +microinfarcts (≥2), and +hippocampal sclerosis (present). Mini-Mental State Exam (MMSE) scores nearest to death were used to examine dementia severity. Prevalence and associated odds of dementia were determined for each NC and for the presence of multiple NCs.Results:388 participants (100 centenarians and 288 nonagenarians) with completed brain autopsies were included. In centenarians, ADNC was most prevalent (75%; vs. 71% in nonagenarians), followed by arteriosclerosis (69%; vs. 55% in nonagenarians) and ARTAG (66%; vs. 60% in nonagenarians). In centenarians, arteriosclerosis (69%) and TDP-43 (39%) were significantly more prevalent compared to nonagenarians (55% and 28% respectively; P=0.01 and P=0.05 respectively). 83% centenarians had 2+NCs and number of NCs was strongly associated with dementia risk. Odds ratio increased from 2.9 (95% Confidence interval (CI):0.49–16.9) for 2NCs, to 12.7 (95%CI:2.34–68.31) for 3, and 63.8 (95%CI:8.78–463.67) for 4NCs. Number of NCs was also associated with dementia severity.Conclusions:Prevalence of dementia-related NCs is exceptionally high in centenarians and greater for arteriosclerosis and TDP-43 compared to nonagenarians. Multiple NCs are typical in centenarians and strongly associated with cognitive impairment, with risk and severity increasing with higher numbers of NCs.Disclosure: Mr. Neuville has nothing to disclose. Ms. Ho has nothing to disclose. The institution of Dr. Sajjadi has received research support from NIH. Dr. Biswas has received research support from European Union's Horizon 2020 research and innovation programme under the Marie Sklodowska-Curie Actions' fellowship (Grant agreement number 722046). The institution of Dr. Corrada has received research support from NIH. The institution of Dr. Kawas has received research support from NIH.

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

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

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

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

Nursing education, like education in higher education, has made a gradual digital turn, combining face-to-face and distance learning phases, “supported” by an increasingly efficient technical and pedagogical environment. Our study aims to shed light on how trainers of six nursing schools in the same university area implemented this blended approach. Professional development is approached through the prism of trainers' experience and through the characterization of blended courses. This study reveals the profound meaning that trainers attribute to their profession. It underlines through the expression of their experience several obstacles and potentialities in this process.

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

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

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

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

Introduction: Characterisation of the recreational diving community could help to identify scuba divers at risk for accidents. Methods: We performed a cross-sectional evaluation in a federation for recreational scuba divers in Belgium (Duiken. Vlaanderen). Using binary logistic regression, factors predictive for accidents leading to hospitalisation were identified. Results: Of the 710 members, 210 (29.6%) participated in the survey, representing 140,133 dives. Age was > 50 years in 55% and the median (interquartile range [IQR]) number of dives was 380 (IQR 140--935). Cardiac (9.5%), orthopaedic (11.0%), ear-nose-throat (ENT, 10.5%) and allergic diseases (30.5%) were the top four morbidities. Twenty percent reported taking cardiovascular medication. Decompression accidents, barotrauma of the ear and musculoskeletal injuries were reported in 11.0, 11.9 and 11.0%. Fifty-five divers (26.2%) reported incidents not necessitating a medical intervention. For 36 divers (17.1%), medical interventions were necessary. Among these, 13 divers (6.2%) were hospitalised at least once and 12 (5.7%) of these needed hyperbaric oxygen therapy (HBOT). The absolute risk for hospitalisation or HBOT was 0.01% per dive. Age, advanced diving qualification, more dives annually, cardiac or ENT pathology and cardiac medication were significantly associated with an increased likelihood of hospitalisation resulting from diving accidents. In a multivariate risk model, ENT comorbidity (odds ratio [OR] 9.3; P = 0.006) and cardiac medication (OR 5.6; P = 0.05) predicted hospitalisation due to a diving accident. Conclusions: One in six recreational scuba divers required a medical intervention at least once during their career, while 6.2% were hospitalised or received HBOT. Ear nose and throat comorbidity and cardiac medication were strong predictors for accidents. These should be given sufficient weight in dive medical examination. [ABSTRACT FROM AUTHOR]

A thorough evaluation of the functional outcomes resulting from supra-pubic phalloplasty (SPP) assessing different aspects of the phalloplasty technique has not been reported. To report the outcomes on sexuality, urinary function, satisfaction, and regrets following SPP performed at our centre. All consecutive patients who underwent the three-step technique of pre-expanded SPP between 2007 and 2018 and who had at least one year of follow-up. Questionnaires were sent to analyse several domains of penile reconstruction: sexuality, urinary function, perceived sensitivity, and satisfaction. Sexuality was evaluated using the Self-Esteem And Relationship (SEAR) questionnaire. Urinary function was analysed based on the urethral stricture surgery patient-reported outcome measures (USS-PROM) questionnaire. A total of 77 patients were included, 92.2% were transmen, and 33 (42.9%) responded to the questionnaire. Urethral lengthening (UL) was performed in 28 (36.4%) procedures, and erectile prosthesis was implanted in 42 patients (54.5%). The mean length of the neophallus was 15.3 cm (standard deviation [SD] 2.6), and the mean girth was 11.8 cm (SD 2.1). The mean total SEAR score (/100) was 73.8 (SD 26.7). The mean six-item lower urinary tract symptom score (/24) was 8.4 (SD 4.6). The standing position was the usual voiding position reported by 11 patients (73.3%). Pre-expanded SPP is a robust technique that can achieve substantial flap dimensions, leading to high satisfaction with neophallus appearance and the choice of the phalloplasty technique. Overall, sexual outcomes are mostly favourable. UL is feasible and effective in terms of voiding in a standing position. [ABSTRACT FROM AUTHOR]

Mise à jour des recommandations de prise en charge des tumeurs germinales du testicule. Revue exhaustive de la littérature effectuée sur PubMed depuis 2022 concernant le diagnostic, le traitement et le suivi des tumeurs germinales du testicule (TGT), et la tolérance des traitements. Le niveau de preuve des références a été évalué. Le bilan initial d'un patient atteint d'une tumeur germinale du testicule repose sur un examen clinique, une évaluation biologique (par le dosage de marqueurs sériques AFP, hCG totale, LDH) et radiologique (échographie scrotale et tomodensitométrie thoracoabdominopelvienne [TAP]). L'orchidectomie par voie inguinale est la première étape thérapeutique : elle permet le diagnostic histologique, définit le stade local, et les facteurs de risque évolutifs pour les tumeurs germinales non séminomateuses (TGNS) de stades I. Pour les patients atteints d'un séminome pur de stade I, le risque évolutif compris entre 15 et 20 % fait privilégier la surveillance chez des patients compliants ; la chimiothérapie adjuvante par carboplatine AUC 7 est une option ; les indications de radiothérapie lomboaortiques sont limitées. Pour les patients atteints d'une TGNS de stade I, différentes options sont envisageables entre une surveillance ou une stratégie adaptée au risque (surveillance ou 1 cycle de bléomycine étoposide cisplatine [BEP] en fonction de la présence ou non d'emboles vasculaires au sein de la tumeur). Le curage ganglionnaire rétropéritonéal de stadification a une place très limitée. Le traitement des TGT métastatiques est une chimiothérapie par BEP en l'absence de contre-indication à la bléomycine dont le nombre de cycles est défini selon les groupes pronostiques de l'International Germ Cell Cancer Consortium Group (IGCCCG). La radiothérapie lombo-aortique est encore un standard dans les tumeurs germinales séminomateuses (TGS) de stade IIA. À l'issue de la chimiothérapie, l'évaluation de la taille des masses résiduelles doit être réalisée par un scanner TAP pour les TGNS : un curage ganglionnaire rétropéritonéal est recommandé pour toute masse résiduelle supérieure à 1 cm, ainsi que l'exérèse de tous les autres sites métastatiques. Pour les TGS, une réévaluation par TEP-18FDG est nécessaire pour préciser l'indication chirurgicale des masses résiduelles > 3 cm. La chirurgie reste rare dans ces situations. Le respect des recommandations de prise en charge des TGT permet d'obtenir un taux de survie spécifique excellent de 99 % pour les stades I et de plus de 85 % pour les stades métastatiques. To update the guidelines for the management of germ cell tumours of the testis. Comprehensive PubMed review from 2022 on the diagnosis, treatment and follow-up of testicular germ cell tumours (TGT), as well as safety of treatments. The level of evidence of the studies was assessed. The initial assessment of a patient with a germ cell tumour of the testis is based on a clinical examination, biological evaluation (by measuring the serum markers AFP, total hCG, and LDH) and radiological evaluation (scrotal ultrasound and thoraco-abdomino-pelvic computed tomography [TAP]). Inguinal orchiectomy is the first therapeutic step, as it allows histological diagnosis and defines the local stage and risk factors for progression in stage I nonseminomatous germ cell tumours (NSGCTs). For patients with pure stage I seminoma, the risk of progression is between 15 % and 20 %, so surveillance is preferred in compliant patients; adjuvant chemotherapy with carboplatin AUC 7 is an option; and the indications for lumbo-aortic radiotherapy are limited. For patients with stage I NSGCT, various options exist, namely, surveillance or a risk-adapted strategy (surveillance or 1 cycle of BEP [bleomycin etoposide cisplatin] depending on the presence or absence of vascular emboli within the tumour). Retroperitoneal lymph node dissection for staging has a very limited role. Treatment of metastatic GCT consists of chemotherapy with BEP in the absence of contraindication to bleomycin, the number of cycles of which is defined according to the prognostic groups of the International Germ Cell Cancer Consortium Group (IGCCCG). Lumbo-aortic radiotherapy is still the standard treatment for stage IIA seminomatous germ cell tumours (SGCTs). At the end of chemotherapy, the size of any residual mass should be assessed via a TAP scan for NSGCTs, with retroperitoneal lymph node dissection recommended for any residual mass greater than 1 cm, along with removal of all other metastatic sites. For SGCT, reassessment via 18FDG PET scans is necessary to determine the surgical indication for residual masses > 3 cm. Surgery remains rare in these situations. Adherence to the recommendations for the management of GCT results in excellent specific survival rates of 99 % for patients with stage I disease and over 85 % for patients with metastatic disease. [ABSTRACT FROM AUTHOR]

L'objectif de cette publication est de rappeler la conduite à tenir initiale face à un incidentalome surrénalien et le cas échéant d'établir la prise en charge carcinologique d'une tumeur maligne de la surrénale. Le groupe de travail multidisciplinaire a actualisé les recommandations sur la prise en charge carcinologique d'un incidentalome surrénalien, établies par le CCAFU en 2022, en s'appuyant sur une revue exhaustive de la littérature effectuée sur PubMed. Si la majorité des masses surrénaliennes sont bénignes et non fonctionnelles, il est important de les investiguer, du fait du potentiel endocrinien grave et de certains cancers. Les tumeurs malignes de la surrénale (TMS) sont essentiellement des carcinomes corticosurrénaliens (CCS), des phéochromocytomes malins (PCM) et des métastases surrénaliennes (MS). Le bilan de malignité d'un incidentalome surrénalien inclut une anamnèse complète, un examen physique, une évaluation biochimique/hormonale pour rechercher une sécrétion hormonale infraclinique. Des hypothèses diagnostiques sont parfois disponibles dès ce stade mais c'est l'imagerie morphologique et fonctionnelle et l'analyse histologique qui permettront de clore le bilan de malignité et de poser le diagnostic carcinologique. Les CCS et les PCM sont surtout sporadiques mais une origine héréditaire est toujours possible. Un CCS est suspecté en préopératoire mais le diagnostic de certitude est histologique. Le diagnostic de PCM est plus délicat et se base sur la clinique, la biologie et l'imagerie. Le diagnostic de certitude de MS passe par une biopsie percutanée. À l'issue, les dossiers doivent obligatoirement être discutés au sein du réseau COMETE — cancers de la surrénale. The objective of this publication is to recall the initial work-up when faced with an adrenal incidentaloma and, if necessary, to establish the oncological management of an adrenal malignant tumor. The multidisciplinary working group updated French urological guidelines about oncological assessment of the adrenal incidentaloma, established by the CCAFU in 2022, based on an exhaustive literature review carried out on PubMed. Although the majority of the adrenal masses are benign and non-functional, it is important to investigate them, as a percentage of these can cause serious endocrine diseases or be cancers. Malignant adrenal tumors are mainly represented by adrenocortical carcinomas (ACC), malignant pheochromocytomas (MPC) and adrenal metastases (AM). The malignancy assessment of an adrenal incident includes a complete history, a physical examination, a biochemical/hormonal assessment to look for subclinical hormonal secretion. Diagnostic hypotheses are sometimes available at this stage, but it is the morphological and functional imaging and the histological analysis, which will make it possible to close the malignancy assessment and make the oncological diagnosis. ACC and MPC are mainly sporadic but a hereditary origin is always possible. ACC is suspected preoperatively but the diagnosis of certainty is histological. The diagnosis of MPC is more delicate and is based on clinic, biology and imagery. The diagnosis of certainty of AM requires a percutaneous biopsy. At the end, the files must be discussed within the COMETE — adrenal cancer network. [ABSTRACT FROM AUTHOR]

Mise à jour des recommandations de prise en charge du pénis. Revue exhaustive de la littérature effectuée sur PubMed depuis 2022 concernant le diagnostic, le traitement et le suivi des tumeurs du pénis. Le niveau de preuve des références a été évalué. Au total 95 % des cancers du pénis infiltrants sont des carcinomes épidermoïdes, dont un tiers en rapport avec une infection à Human Papillomavirus (HPV). L'examen clinique permet d'identifier la taille de la lésion, sa localisation, sa proximité avec le méat urétral, son infiltration en profondeur. L'interrogatoire doit évaluer les fonctions urinaire et sexuelle. L'IRM est l'imagerie de référence pour le bilan local. Les tumeurs du pénis sont classées en faible risque (≤ pT1a et bien différencié G1), de risque intermédiaire (pT1a G2), à haut risque (≥ pT1b, ou G3, ou contingent sarcomatoïde). L'évaluation ganglionnaire du cancer du pénis est fondamentale. La technique du ganglion sentinelle est recommandée pour l'évaluation des patients cN0 ayant une tumeur de risque intermédiaire ou plus. La TEP 18FDG est recommandée chez le patient cN+. La chirurgie est le traitement de référence localement et est fonction de la taille, de la localisation et du grade de la tumeur. Un traitement topique ou par curiethérapie peut être indiqué dans certains cas. Un curage inguinal radical (CIR) est recommandé pour les stades cN1/cN2. Une chimiothérapie néoadjuvante est recommandée pour les stades cN3, associée à un CIR chez les patients répondeurs. Les formes métastatiques peuvent faire l'objet de chimiothérapie palliative, et d'immunothérapie dans le cadre d'un essai clinique. Le traitement du cancer du pénis est essentiellement chirurgical plus ou moins associé à une chimiothérapie en cas d'extension ganglionnaire. Le facteur pronostique principal est l'atteinte ganglionnaire justifiant une prise en charge diagnostique et thérapeutique précoce des aires inguinales. To update recommendations for the management of penile lesion. Comprehensive review from 2022 of the literature performed on PubMed since 2022 concerning the diagnosis, treatment and follow-up of penile tumors. The level of evidence of the references was assessed. A total of 95 % of invasive infiltrating penile cancers are squamous cell carcinomas, a third of which are related to Human Papillomavirus (HPV) infection. Clinical examination can help identify the size of the lesion, its location, its proximity to the urethral meatus, and its deep infiltration. Questioning should assess urinary and sexual function. MRI is the gold standard reference imaging tool for local assessment. Penile tumors are classified as low-risk (≤ pT1a and well-differentiated G1), intermediate-risk (pT1a G2) and), high-risk (≥ pT1b, or G3, or sarcomatoid contingent). Lymph node assessment in penile cancer is fundamental. The sentinel node technique is recommended for the evaluation of cN0 patients with tumors of intermediate risk or higher. 18FDG PET is recommended for cN+ patients. Surgery is the gold standard for local treatment and depends, depending on the tumour size, location and grade of the tumor. Topical treatment or brachytherapy may be indicated in some certain cases. Topical treatment or brachytherapy may be indicated in certain cases. Radical inguinal lymphadenectomy (RIL curettage (RIC) is recommended for stages cN1/cN2. Neoadjuvant stages. Neo-adjuvant chemotherapy is recommended for cN3 stages, combined with RILRIC in responders. Metastatic forms may be treated with palliative chemotherapy, and immunotherapy as part of a clinical trial. Treatment of penile cancer is essentially surgical, with or without chemotherapy in the case of lymph node involvement extension. The main prognostic factor is lymph node involvement, which justifies early diagnostic and therapeutic management of the inguinal areas. [ABSTRACT FROM AUTHOR]

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

Abstract Objective To investigate the progression of neural and motor features of Parkinson's disease in a longitudinal study, after washout of medication and bilateral subthalamic nucleus deep brain stimulation (STN DBS). Methods Participants with clinically established Parkinson's disease underwent bilateral implantation of DBS leads (18 participants, 13 male) within the STN using standard functional frameless stereotactic technique and multi‐pass microelectrode recording. Both DBS leads were connected to an implanted investigative sensing neurostimulator (Activa™ PC + S, Medtronic, PLC). Resting state STN local field potentials (LFPs) were recorded and motor disability, (the Movement Disorder Society‐Unified Parkinson's Disease Rating Scale – motor subscale, MDS‐UPDRS III) was assessed off therapy at initial programming, and after 6 months, 1 year, and yearly out to 5 years of treatment. The primary endpoint was measured at 3 years. At each visit, medication had been held for over 12/24 h and DBS was turned off for at least 60 min, by which time LFP spectra reached a steady state. Results After 3 years of chronic DBS, there were no increases in STN beta band dynamics (p = 0.98) but there were increases in alpha band dynamics (p = 0.0027, 25 STNs). Similar results were observed in a smaller cohort out to 5 years. There was no increase in the MDS‐UPDRS III score. Interpretation These findings provide evidence that the beta oscillopathy does not substantially progress following combined STN DBS plus medication in moderate to advanced Parkinson's disease.

Abstract Rationale Acute respiratory failure (ARF) in patients admitted to the intensive care unit (ICU) with known or de novo small-vessel vasculitis (Svv) may be secondary to the underlying immune disease or to other causes. Early identification of the cause of ARF is essential to initiate the most appropriate treatment in a timely fashion. Methods A retrospective multicenter study in 10 French ICUs from January 2007 to January 2018 to assess the clinical presentation, main causes and outcome of ARF associated with Svv, and to identify variables associated with non-immune etiology of ARF in patients with known Svv. Results During the study period, 121 patients [62 (50–75) years; 62% male; median SAPSII and SOFA scores 39 (27–52) and 6 (4–8), respectively] were analyzed. An immune cause was identified in 67 (55%), and a non-immune cause in 54 (45%) patients. ARF was associated with several causes in 43% (n = 52) of cases. The main immune cause was diffuse alveolar hemorrhage (DAH) (n = 47, 39%), whereas the main non-immune cause was pulmonary infection (n = 35, 29%). The crude 90-day and 1-year mortality were higher in patients with non-immune ARF, as compared with their counterparts (32% and 38% vs. 15% and 20%, respectively; both p = 0.03), but was marginally significantly higher after adjusted analysis in a Cox model (p = 0.053). Among patients with a known Svv (n = 70), immunosuppression [OR 9.41 (1.52–58.3); p = 0.016], and a low vasculitis activity score [0.84 (0.77–0.93)] were independently associated with a non-immune cause, after adjustment for the time from disease onset to ARF, time from respiratory symptoms to ICU admission, and severe renal failure. Conclusions An extensive diagnosis workup is mandatory in ARF revealing or complicating Svv. Non-immune causes are involved in 43% of cases, and their short and mid-term prognosis may be poorer than those of immune ARF. Readily identified predictive factors of a non-immune cause could help avoiding unnecessary immunosuppressive therapies.