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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]

Objectives X-linked hypophosphatemia (XLH) is characterized by increased concentrations of circulating fibroblast growth factor 23 (FGF-23) resulting in phosphate wasting, hypophosphatemia, atypical growth plate and bone matrix mineralization. Epidemiologic studies suggest a relationship between FGF-23, obesity, and metabolic dysfunction. The prevalence of overweight and obesity is high in children with XLH. We aimed to evaluate the prevalence of obesity and metabolic complications in adults with XLH. Methods We conducted a prospective cohort study in adult XLH patients from a single tertiary referral center. The proportion of patients with a BMI >25 kg/m2 was the main outcome measure. Body fat mass percentage (FM%) and adipose tissue surfaces were secondary outcome measures. Glucose homeostasis (plasma glucose and insulin concentrations after fasting and 2 hours after an oral glucose tolerance test) was explored in a subgroup of patients and compared with age-, sex-, and BMI-matched healthy controls. Results Among 113 evaluated patients, 85 (75%) were female and 110 (97%) carried a PHEX mutation. Sixty-three (56%) patients were overweight or obese, with a median BMI of 25.3 [IQR, 22.7; 29.2] kg/m2. BMI was correlated with FM%, abdominal and thigh subcutaneous and intra-abdominal adipose tissue surfaces. The prevalence of impaired fasting glucose, impaired glucose tolerance, and diabetes was not different between XLH patients and matched controls. Conclusion The prevalence of overweight and obesity is high among XLH patients and is associated with excess fat mass. However, the prevalence of glucose homeostasis abnormalities is not increased in patients compared to healthy controls, suggesting that metabolically healthy overweight or obesity predominates. [ABSTRACT FROM AUTHOR]

The sharp increase in and volatility of fossil fuel prices, due in particular to the Russian–Ukrainian conflict, is a powerful incentive for cities to accelerate their energy transition. Yet urban authorities have limited power over the construction of energy policies and the management of networks, and they remain dependent on remote and mainly carbon-intensive imported sources of energy. The recovery of waste heat from waste incineration or industrial emissions and its use in heating networks represents a solution for cities to control part of their energy supply, to develop their own capacities for action and to implement local transition strategies, in addition to the development of renewable energies. Based on the analysis of four case studies in France between 2019 and 2022, in the context preceding the current energy crisis, this article examines how cities are trying to develop waste heat recovery and the role this energy resource plays in the decarbonisation of urban energy systems. The analysis highlights that the emergence of these projects is more broadly part of the renegotiation dynamics of energy, ecological and economic relationships between cities and industries, and that their implementation results in the construction of new urban energy nexuses. The use of waste heat makes it possible to improve the energy efficiency of industrial and urban energy systems, sometimes significantly, but it must be seen as a transitional solution because it can temporarily increase cities' dependency on high-carbon and energy-inefficient industrial activities. [ABSTRACT FROM AUTHOR]