[Feasibility study: The medical imaging as a tool for therapeutic education in radiotherapy]. / Étude de faisabilité : l'utilisation de l'imagerie médicale en éducation thérapeutique en radiothérapie.

PURPOSE: Assess the feasibility of a randomized controlled trial (RCT) exploring the use of medical imaging as a therapeutic education (TPE) intervention in external radiation therapy. MATERIALS AND METHODS: Experimental feasibility trial of "RCT" type carried out in a single-center, between November 2019 and March 2020, following adult patients treated by thoracic radiotherapy. In addition to the information usually given, the experimental group benefited from an intervention consisting in the visualization of their own medical images using the open-source software "Stone of Orthanc". RESULTS: Forty-nine patients were recruited with a refusal rate of 8.16% (4/49). 20 patients were withdrawn from the study for health reasons (COVID), 10 for medical reasons. All the remaining 15 participants completed the process. Although not significant, the experimental group showed a median gain in the perception of knowledge compared to the control group (+ 1.9 (1.6 - 2.2)) vs (+ 1.4 (1.4 - 1.8)), as well as a decrease in scores related to anxiety (- 3.0 (-4.5 - (-2.0)) vs - 1.0 (-5.0 - 0.0)) and emotional distress ((- 5.0 (- 7.5 - (- 3.5)) vs (- 2.0 (- 5.0 - (- 1.0)) A significant reduction (p=0.043) is observed for the depression score ((- 2.0 (-3.0 - (-1.5)) vs (0.0 (0.0 - 0.0)). CONCLUSION: This study demonstrates the feasibility of the project, with promising preliminary results. Some adaptations in order to conduct a larger-scale RCT are highlighted.

[How to recognize a patient with palliative needs : a «surprise¼ question to prevent bad surprises]. / Comment reconnaître un patient en situation palliative ? Une question «surprise¼ pour ne plus se laisser surprendre.

Early discussion on palliative care with patients with advanced, progressive or terminal disease is difficult regardless patient's life expectancy. In Belgium, a Royal Decree sets the criteria to identify patients with palliative needs. For that purpose, the Palliative Care Indicators Tool (PICT) is proposed. This 3-step identification tool designed for physicians begins with the so-called surprise question, «Would you be surprised if your patient died in the next 6 to 12 months?¼. The second and third steps examine the fragility and incurability criteria, respectively. The surprise question intends to encourage the clinician to trust his/her intuition and to promote a reflection on patient's needs. The PICT facilitates communication between caregivers. Also, it makes possible early thinking about advanced care planning. Hence, it allows patients to receive palliative care in due time. In this paper, after reviewing the background of the surprise question, we shall examine the benefits and limitations of the surprise question.

Parler de soins palliatifs précocement chez les patients lorsqu'ils se trouvent à un stade avancé ou terminal d'une maladie grave, évolutive, mettant en péril le pronostic vital, quelle que soit son espérance de vie, reste difficile. La loi belge s'est dotée en octobre 2018 d'un arrêté royal proposant le PICT (Palliative Care Indicators Tool). Cette échelle d'identification, conçue en 3 étapes, débute par la question surprise : «Seriez-vous surpris si votre patient venait à décéder dans les 6 à 12 prochains mois??¼. La deuxième étape et la troisième étape déterminent respectivement les critères de fragilité et d'incurabilité. La question surprise encourage le clinicien à faire confiance à son intuition et valorise une réflexion centrée sur les besoins du patient. L'utilisation de l'outil PICT peut faciliter la communication entre soignants, permettre d'aborder plus tôt la réflexion autour de la planification anticipée des soins et offrira ainsi aux patients des soins palliatifs en temps opportun. Cet article présente l'historique de la question surprise ainsi que ses avantages et ses limites.

[Appropriate care at the end of life : insuring quality of life]. / Une bonne gestion de la fin de vie, ou le respect de la qualité de vie .

Progress of medical knowledge pushed the limits of medicine. This raises major ethical issues. The Belgian lawmaker, concerned to ensure the observance of Human Rights, attempted to regulate some of these issues. It remains essential to listen to the patient and to respect his/her will. Likewise, defining therapeutic goals based on patient's values and priorities is crucial until the end of patient's life.

: Les progrès scientifiques ont reculé les limites de la médecine. Ceci a conduit à d'importants débats éthiques. En Belgique, le législateur, soucieux du respect des Droits de l'Homme, a tenté de réglementer certaines pratiques. L'essentiel est d'écouter le patient et de respecter ses volontés. Il est capital de définir des objectifs thérapeutiques basés sur les valeurs et les priorités du patient, jusqu'à la fin de sa vie.

Identification of TB space-time clusters and hotspots in Ouest département, Haiti, 2011-2016.

BACKGROUND: Haiti has the highest incidence rate of TB in the Western Hemisphere, with an estimated 170 cases per 100,000 in 2019. Since 2010, control efforts have focused on targeted case-finding activities in urban areas, implementation of rapid molecular diagnostics at high-volume TB centers, and improved reporting. TB analyses are rarely focused on lower geographic units; thus, the major goal was to determine if there were focal areas of TB transmission from 2011 to 2016 at operational geographic levels useful for the National TB Control Program (PNLT). METHODS: We created a geocoder to locate TB cases at the smallest geographic level. Kulldorff's space-time permutation scan, Anselin Moran's I, and Getis-Ord Gi* statistics were used to determine the spatial distribution and clusters of TB. RESULTS: With 91% of cases linked using the geocoder, TB clusters were identified each year. Getis-Ord Gi* analysis revealed 14 distinct spatial clusters of high incidences in the Port-au-Prince metropolitan area. One hundred retrospective space-time clusters were detected. CONCLUSION: Our study confirms the presence of TB hotspots in the Ouest département, with most clusters in the Port-au-Prince metropolitan area. Results will help the PNLT and its partners better design case-finding strategies for these areas.

CONTEXTE: Haïti a le taux d'incidence le plus élevé de TB de l'hémisphère Ouest avec un nombre de cas estimé à 170 par 100 000 en 2019. Depuis 2010, les efforts de contrôle se sont focalisés sur des activités de recherche ciblée des cas dans les zones urbaines, la mise en œuvre de diagnostic moléculaire rapide dans des centres TB de grand volume et de meilleurs rapports. Les analyses TB sont rarement focalisées sur les unités géographiques; le but principal était de déterminer s'il existait des zones focales de transmission de la TB de 2011 à 2016 à des niveaux géographiques opérationnels utiles pour le Programme national de Lutte contre la TB (PNLT). MÉTHODES: Nous avons créé géocodeur pour localiser les cas de TB au plus petit niveau géographique. Le scan de permutation espace-temps de Kulldorff's, Anselin Moran's I et les statistiques de Getis-Ord Gi* ont été utilisés pour déterminer la distribution spatiale et les clusters de TB. RÉSULTATS: Avec 91% des cas liés avec le géocodeur, les clusters de TB ont été identifiés chaque année. L'analyse Getis-Ord Gi* a révélé 14 clusters spatiaux distincts d'incidence élevée dans la zone métropolitaine de Port-au-Prince. Cent clusters rétrospectifs espacetemps ont été détectés. CONCLUSION: Notre étude confirme la présence de hotspots TB dans la département Ouest, la majorité des clusters étant situés dans la zone métropolitaine de Port-au-Prince. Les résultats aideront le PNLT et ses partenaires à mieux affiner leurs stratégies de recherche des cas dans ces zones.

Outcomes, complications and risk factors following fluoroscopically guided transcondylar screw placement for humeral intracondylar fissure.

OBJECTIVES: To describe the surgical technique and complications for fluoroscopically guided transcondylar screw placement for humeral intracondylar fissure in dogs. MATERIALS AND METHODS: A retrospective review was undertaken of cases from two hospitals where identical surgical technique was employed. Factors were analysed for any association with postoperative complications. RESULTS: Sixty-two dogs (82 elbows) were reviewed for which the postoperative complication rate was 45%; a total of 15% of cases required revision surgery. Complications were more likely in cases operated on earlier in the case series and with increasing dog bodyweight. Both increasing surgical time and being a neutered female were protective against postoperative complications. CLINICAL SIGNIFICANCE: Fluoroscopically guided transcondylar screw placement for humeral intracondylar fissure is associated with a high postoperative complication rate (45%) with 15% of cases requiring revision surgery.

Review of dietary supplements for the management of osteoarthritis in dogs in studies from 2004 to 2014.

Osteoarthritis (OA) is a chronic, painful, degenerative and inflammatory disease that affects the synovial joints and leads finally to the loss of mobility. It is highly prevalent in dogs. Nowadays, no cure exists, and the pharmacological treatment is limited to clinical signs alleviation. Some positive beneficial effects have been highlighted with dietary supplements in the course of dog OA. The goals of this narrative review are to summarize the scientific data available in the literature on dietary supplements assessed in dog OA and to discuss some trails about how to improve several aspects of research and issues with dietary supplements, such as bioavailability and dosage regimen. Chondroitin sulphate, glucosamine, undenaturated type II collagen, avocado-soya bean unsaponifiables, curcumin and polyunsaturated fatty acids were studied in dog OA and therefore discussed in the present review. Most of them showed anticatabolic and anti-inflammatory effects. Unfortunately, few data exist concerning their pharmacokinetics. Their bioavailability is low, but new formulations are developed to enhance their gastrointestinal absorption. The clinical relevance of these new formulations compared to native forms should be demonstrated in good clinical trials. Even if further investigations are needed, dietary supplements should be considered in OA management.

[MANAGEMENT OF NON-SMALL CELL LUNG CANCER]. / PRISE EN CHARGE DU CANCER BRONCHIQUE NON À PETITES CELLULES.

Already known as the first cause of mortality in men, non-small cell lung cancer (NSCLC) is nowadays a major cause of cancer-related death in women. Its approach relies on a thorough locoregional and extra-thoracic assessment allowing a precise staging which not only has prognostic value, but also determines the therapeutic options. This review presents the current multidisciplinary strategy agreement or the treatment of NSCLC.

Complications and outcome of a new modified Maquet technique for treatment of cranial cruciate ligament rupture in 82 dogs.

OBJECTIVES: To describe the complications, short and long-term outcome and owner satisfaction of dogs with cranial cruciate ligament rupture treated with a recently described new osteotomy for the modified Maquet technique (N-MMT). MATERIALS AND METHODS: Medical records and radiographs of 82 dogs (84 stifles) were reviewed. Details regarding short-term outcome and complications were recorded from the medical records. Long-term follow-up information was obtained by telephone interview. Historical data and complications were statistically analysed. RESULTS: Major complications occurred in 34/84 stifles. Intra-operative complications occurred in 26/84 stifles, all of which were fissures or fractures of the cortical hinge. Twenty-one of these fractures or fissures were repaired with a figure-of-eight wire. The second most common major complication was late meniscal tears in 3/84 stifles. One dog sustained a complete tibial fracture. Non-displaced fracture of the cortical hinge was the most common postoperative minor complication, which occurred in 5/84 stifles. The median preoperative lameness score was 3 out of 6. Final in-hospital re-evaluation of limb function was available in 58 dogs. The median lameness score at that time was 0 out of 6. Development of osteotomy related complications was not associated with a significant change in the postoperative lameness score. CLINICAL SIGNIFICANCE: Subjectively assessed clinical outcome with the N-MMT was good to excellent in this cohort of dogs. However, a high rate of intra- and postoperative complications of the N-MMT procedure was also present in these dogs.

[Which is the place of the human being inside the recommendations, multidisciplinary oncological meetings, and treatment plan?]. / Quelle est la place de l'humain au sein des recommandations, des concertations oncologiques multidisciplinaires et du projet thérapeutique?

Nowadays, the cancer patient has access to a highly technical, more and more targeted and increasingly individualized medicine. And the human being in that matter ? Numerous tools have been developed to help physicians and caregivers to reconcile contemporary medicine and the rights of the patient. Among these are multidisciplinary oncology meetings and treatment guidelines published by national and international scientific societies. The patients care must be cross-disciplinary and evidence-based. This shared decision-making process should at the end be in accordance with the wishes of the patient. This approach should allow him/her to maintain autonomy and be the main actor in the decision-making process.

[Multidisciplinary treatment of glioblastoma]. / Le traitement multidisciplinaire du glioblastome.

Glioblastoma is a primary brain tumor that occurs most often in elderly patients. Despite improved management, the prognosis of this cancer remains poor. This review describes the multidisciplinary management of the patient with glioblastoma. It includes surgery, radiation therapy and chemotherapy.

[The challenge of local control in unresectable locally advanced non-small cell lung cancer]. / Le défi du contrôle local dans le cancer pulmonaire, non à petites cellules, localement avancé, non opérable.

Non-small cell lung cancer (NSCLC) is common. Approximately one out of every five patients with NSCLC has locally advanced disease that is surgically unresectable. For these patients, the disease has a poor prognosis characterized by a high rate of local disease progression or recurrence despite attempts at chemo- and radiation therapy. The purpose of this review is to describe the heterogeneity of this group of patients, to clarify the terms of the combination of chemotherapy and radiotherapy and to clarify the efficacy of modern radiotherapy techniques to increase local control.

Biomechanical testing of a ß-tricalcium phosphate wedge for advancement of the tibial tuberosity.

OBJECTIVES: to evaluate in vitro the strength of different compositions of beta-tricalcium phosphate (ß-TCP) wedges in comparison with titanium foam and cages. To study the response to cyclic loading of the strongest ß-TCP wedge, titanium foam and titanium cage. METHODS: Compression test: Twenty-five tibiae were prepared for tibial tuberosity advancement using the modified Maquet technique. Five groups were defined depending on the material used to maintain the tibial tuberosity: Group 1=titanium cage; Group 2=wedges of porous titanium foam with 50% porosity (OrthoFoam®); Group 3=blocks of biphasic synthetic bone (60% hydroxyapatite [HAP] and 40% ß-TCP, porosity 80%); Group 4=blocks of biphasic synthetic bone (60% HAP and 40% ß-TCP, porosity 70%) and Group 5=blocks of biphasic synthetic bone (65% HAP and 35% ß-TCP, porosity 60%). Loads to failure were calculated for each implant. Cyclic study: Five additional tibiaes of group 1, 2 and 5 were fatigue tested from 100 to 500 N at a rate of 4 Hz for 200,000 cycles or until failure. RESULTS: Compression test: For the five groups, the mean load at failure was 1895 N, 1917 N, 178 N, 562 N and 1370 N respectively. Cyclical study: All samples in the three groups tested withstood 200,000 cycles without failure. CLINICAL SIGNIFICANCE: The ideal implant to maintain tibial tuberosity advancement after the modified Maquet technique would be absorbable and allow osteoconduction and osteoinduction. As such, ß-TCP wedges have many advantages and our study shows that they can withstand loads in the patellar tendon up to 500 N over 200,000 cycles in vitro and deserve more investigation.

Mechanical testing of a new osteotomy design for tibial tuberosity advancement using the Modified Maquet Technique.

OBJECTIVES: To evaluate the mechanical properties of the distal cortical hinge associated with a new osteotomy design for the Modified Maquet Technique (MMT). STUDY DESIGN: Ex vivo mechanical study. METHODS: The osteotomy was started 10 mm caudal to the tibial tuberosity and extended over 150% of the length of the tibial crest; it was slightly curved distally to stay at a distance of 2 to 4 mm from the cranial cortex, according to the body weight. Ninety-six tibiae were tested in advancement, and 60 tibiae were axially loaded perpendicular to the tibial plateau, until failure of the crest. Desired advancement was measured using the common tangent method in 60 tibiae. Angle of opening, thickness, and area of the cortical hinge were recorded. RESULTS: Desired advancement of 6 mm, 9 mm, 12 mm and 15 mm was recorded in 16, 12, 18 and 14 tibiae respectively. Mean maximal advancement in these bones was 15.6 ± 6.4 mm, 20.8 ± 5.2 mm, 21.3 ± 5.2 mm and 22.7 ± 5.2 mm respectively. The desired advancement was reached in all but one tibia. Advancement was mainly influenced by the angle of opening and the stiffness of the cortical hinge. Mean ultimate load to failure was 6.12 ± 2.4 times the body weight. It was significantly associated with the body weight, thickness, and area of the cortical hinge. CLINICAL RELEVANCE: Mean maximal advancement was higher than clinically required without occurrence of fissure or fracture. Ultimate load to failure and maximal advancement could be predicted using calculated formulae.

[Does Radiotherapy have a role in end-of-life care?]. / Y a-t-il une place pour la radiothérapie en fin de vie?

Up to 50% of cancer patients will receive radiation therapy as a part of their treatment. Radiation may be delivered with curative or palliative intent, according to the extent of disease, the patient's performance status and his wishes. The aim of palliative radiotherapy is to locally control primary tumor or metastasis and, thus, to slow down the disease. Another purpose is to decrease symptoms as part of the supportive care in the end of life. The total dose, the dose per fraction and the technique of irradiation used vary with the treatment aim. Indications of radiotherapy in the end of life are reviewed in this paper

Mechanical testing of a modified stabilisation method for tibial tuberosity advancement.

OBJECTIVES: This in vitro study evaluated three modified techniques of tibial tuberosity advancement (TTA). Loads to failure were calculated for each technique. METHODS: A 9 mm TTA procedure was performed in the tibiae of dogs weighing between 32 and 38 kg. In group 1 (n = 12), the distal part of the tibial crest was left attached to the tibia by the cranial cortex, and a figure-of-eight wire was added for stabilisation. In group 2 (n = 12), the tibial crest was left attached but no additional device was used for stabilisation. In group 3 (n = 12), the tibial crest was completely separated from the tibia and fixed by a figure-of-eight wire so that, in this group, only the wire opposed avulsion of the tibial crest. Unidirectional axial force was applied via the patella to determine the maximal load to failure of the model. RESULTS: There was no significant difference between group 1 and group 2. These two groups both had a significantly stronger construct than that of group 3. CLINICAL SIGNIFICANCE: We described modifications to the TTA procedure without plate fixation that warrant clinical investigation. When the crest is broken during its advancement, the tension sustained by the repair is significantly weaker from a biomechanical point of view and the use of such a repair clinically is not recommended by the authors.

[Ductal carcinoma in situ (DCIS): can radiotherapy be avoided?]. / Carcinome intracanalaire (in situ) du sein: pouvons-nous raisonnablement éviter la radiothérapie pour certaines patientes opérées?

There is a never ending discussion on the need for radiotherapy after conservative breast surgery for DCIS (Ductal Carcinoma In Situ). It is true that adjuvant irradiation does not yield any difference in overall survival in the published randomized trials. However, postoperative irradiation after breast conserving surgery (BCS) has been shown to significantly reduce ipsilateral breast event (IBE), whether this is a DCIS recurrence or a recurrence with an invasive component. The real question is to define if there is a subgroup of patients for whom radiotherapy can be withheld without taking any significant local risk. Nowadays, we are not able to define such a subgroup as the possible selection criteria to avoid radiotherapy have never been validated within a well designed prospective randomized trial. Therefore, we think that there is no available evidence to avoid radiotherapy after BCS for DCIS. However, radiotherapy is not indicated after mastectomy.

Growth rate of Ulva rigida in different Mediterranean eutrophicated sites.

The growth of juvenile populations of Ulva rigida C. Agardh was measured by means of immersion in in situ cages against environmental parameters (temperature, incident light, salinity, dissolved inorganic nitrogen and dissolved reactive phosphorus) in four different eutrophicated southern sites: Channel of the Thau lagoon (France), Lido, Sacca Sessola and Fusina stations (Venice lagoon, Italy). The growth curves as a function of temperature showed that, in all cases, the maximal temperature for Ulva growth was 17 degrees C (limitation in growth below 7 degrees C and above around 25 degrees C). The growth analysis of these four sites showed seasonal differences. In the least eutrophicated and calmest Lido station, grazing and dissolved reactive phosphorus (seven times lower at Lido than at Thau) played a key role. At Thau and Fusina, which are eutrophicated and turbid environments, the incident light had a strong impact on growth. Sacca Sessola, with an intermediate position between the above two mentioned situations, showed the highest growth rate. The values and relative growth rate (RGR) curves of the Mediterranean and open-sea northern sites are discussed. In particular, the temperature defines the type of growth curve (unimodal or bimodal) and the incident light is responsible for the low Mediterranean RGR values (<10% day(-1)).

Value of FDG-PET in detecting residual or recurrent nonsmall cell lung cancer.

In order to evaluate the usefulness of 18-fluorodeoxyglucose (FDG) positron emission tomography (PET) in the assessment of therapeutic effects, a study was performed before and after therapy in 126 patients with non-small cell lung cancer (NSCLC) codified stage I to stage IIIB. Treatment with an early curative result was given in 58 patients, whereas in 68 cases it was limited to palliation. During the treatment follow-up period (8-40 months), each patient was evaluated every 3 months by clinical examination and < or =6 months by imaging techniques (PET and computed tomography (CT)). A diagnosis of persistent or recurrent tumour was established by means of pathological analysis in 31 patients and by clinical evolution and subsequent imaging progression in 29 other patients. PET showed increased FDG uptake in all cases (n = 60) of persistent or recurrent tumour, whereas CT was nonspecific in 17 cases. Conversely, there were five false positive cases via PET imaging and three via CT. In detecting residual or recurrent NSCLC, PET had a sensitivity of 100% and specificity of 92%, whereas CT had a sensitivity and specificity of 71% and 95% respectively. In conclusion, 18-fluorodeoxyglucose positron emission tomography correctly identified response to therapy in 96% (121 of 126) of patients. Positron emission tomography appears to be more accurate (p = 0.05) than conventional imaging in distinguishing persistent or recurrent tumour from fibrotic scar in patients undergoing treatment for non-small cell lung cancer.

Fluorine-18 deoxyglucose positron emission tomography for the detection of bone metastases in patients with non-small cell lung cancer.

Despite advances in morphological imaging, some patients with lung cancer are found to have non resectable disease at surgery or die of recurrence within a year of surgery. At present, metastatic bone involvement is usually assessed using bone scintigraphy, which has a high sensitivity but a poor specificity. We have attempted to evaluate the utility of the fluorine-18 deoxyglucose positron emission tomography (FDG PET) for the detection of bone metastasis. One hundred and ten consecutive patients with histological diagnosis of non-small cell lung cancer (NSCLC) who underwent both FDG PET and bone scintigraphy were selected for this review. In this group, there were 43 patients with metastatic disease (stage IV). Among these, 21 (19% of total group) had one or several bone metastases confirmed by biopsy (n = 8) or radiographic techniques (n = 13). Radionuclide bone scanning correctly identified 54 out of 89 cases without osseous involvement and 19 out of 21 osseous involvements. On the other hand, FDG PET correctly identified the absence of osseous involvement in 87 out of 89 patients and the presence of bone metastasis in 19 out of 21 patients. Thus using PET there were two false-negative and two false-positive cases. PET and bone scanning had, respectively, an accuracy of 96% and 66% in the evaluation of osseous involvement in patients with NSCLC. In conclusion, our data suggest that whole-body FDG PET may be useful in detecting bone metastases in patients with known NSCLC.