Guidelines for May-Grünwald-Giemsa staining in haematology and non-gynaecological cytopathology: recommendations of the French Society of Clinical Cytology (SFCC) and of the French Association for Quality Assurance in Anatomic and Cytologic Pathology (AFAQAP).

OBJECTIVE: Since the guidelines of the International Committee for Standardisation in Haematology (ICSH) in 1984 and those of the European Committee for External Quality Assessment Programmes in Laboratory Medicine (EQALM) in 2004, no leading organisation has published technical recommendations for the preparation of air-dried cytological specimens using May-Grünwald-Giemsa (MGG) staining. DATA SOURCES: Literature data were retrieved using reference books, baseline-published studies, articles extracted from PubMed/Medline and Google Scholar, and online-available industry datasheets. RATIONALE: The present review addresses all pre-analytical issues concerning the use of Romanowsky's stains (including MGG) in haematology and non-gynaecological cytopathology. It aims at serving as actualised, best practice recommendations for the proper handling of air-dried cytological specimens. It, therefore, appears complementary to the staining criteria of the non-gynaecological diagnostic cytology handbook edited by the United Kingdom National External Quality Assessment Service (UK-NEQAS) in February 2015.

[Indoor tanning: motivations and beliefs among users and non-users in the population of Lille (Northern France)]. / Cabines de bronzage : étude des motivations et croyances des utilisateurs et non-utilisateurs dans la population lilloise.

BACKGROUND: Uncontrolled use of tanning beds is a major public health problem. The role of UV in skin carcinogenesis has in fact been clearly demonstrated. AIMS: The main purpose of the study was to assess the motivations and beliefs of the population concerning the use of indoor tanning. The secondary objectives were to compare the knowledge of users and non-users and to screen for addiction criteria among users. PATIENTS AND METHODS: This was a transversal descriptive study conducted between April and June 2013 in Lille town center. The motivations of the participants were determined using a multiple-choice questionnaire. A Likert scale was used to assess beliefs and an m-CAGE questionnaire was used to screen for addiction. RESULTS: Of the 200 respondents, 30% (n=60) had used tanning beds in a non-medical setting. The median age of first use was 23 years (15-59). 11.7% of respondents had started before the authorised age of 18 years. "To prepare the skin for exposure to the sun" was the main reason given (68.3%) for use of tanning beds. The population was aware that use of such apparatus favours onset of skin cancer and ageing of the skin. Users were more convinced than non-users that UV cabins "prepare the skin for exposure to the sun" (75% vs. 49.6%, P=0.0009) and that they "favour skin cancer" (56.9% against 36.2%, P=0.0444). Addictive behaviour was detected in 3.3% (2/60) of users. CONCLUSION: Users are aware of the carcinogenic risk of UV cabins but expose themselves to such risk, as they believe it prepares their skin for sun exposure.

[Radiological trap and oncological precautions in a patient who has undergone a permanent withdrawal of PIP breast implants]. / Piège radiologique et précautions carcinologiques chez une patiente ayant subi un retrait définitif de prothèses mammaires PIP.

We report the case of a 57-year-old patient who presented radiological images similar to ruptured breast implants one year after the supposed withdrawal of the latter. This woman had benefited for the first time from cosmetic PIP breast implants in 2000. Early in 2014, she requested the removal of the implants without renewal because she was feeling pain and functional discomfort. A few months after the operation, she consulted for breast swelling in the upper pole of the breast. Radiological assessment showed liquid formations compatible with the presence of implants. At our request, the rereading of the MRI by the radiologist definitively concluded on a bilateral seroma within the persistent fibrous capsule. In the absence of symptoms, clinical monitoring had been decided. But at the recrudescence of anaplastic large cell lymphoma cases associated with breast implants, a cytological sampling was intended. In case of cytological abnormality or recurrence of the seroma, a surgical procedure should be performed. In conclusion, the removal of a breast implant without capsulectomy may result in the formation of a seroma whose images resemble those of an implant. It is always worthwhile to provide precise clinical data to the radiologist in order to help him to make informed interpretations. Every serous effusion in a breast lodge having contained a silicone implant must evoke the diagnosis of anaplastic large cell lymphoma.

Description of an outbreak of hemorrhagic fever with renal syndrome in the southern Jura Mountains, France, in 2021.

OBJECTIVE: The aim of our study was to describe the 2021 Hemorrhagic Fever with Renal Syndrome (HFRS) outbreak in the southern Jura Mountains. PATIENTS AND METHODS: We included all laboratory-confirmed cases of HFRS reported between April and September 2021 in the three local hospitals. RESULTS: A total of 90 patients were enrolled in the study: 73 hospitalized and 17 non-hospitalized patients. Transient myopia was only reported in non-hospitalized patients. Forty (44.4 %) patients underwent medical imaging before hantavirus diagnosis. Twenty-one patients (28.8 %) had a plasma creatinine level > 353.6 µmol/L, no patient developed severe metabolic disorder. Only one patient was dialyzed. A pacemaker was implanted before diagnosis of HFRS due to severe bradycardia in one patient. Sudden death was reported in one patient. CONCLUSION: This hantavirus epidemic led to numerous hospitalizations, one dialysis treatment, and one death. Early diagnosis by rapid test could avoid unnecessary investigations.

[Most common benign epithelial breast diseases: diagnosis, treatment and cancer risk]. / Les principales lésions mammaires épithéliales bénignes et à risque. Prise en charge diagnostique et thérapeutique.

As a consequence of breast imaging development and increased interventional radiology, benign epithelial breast diseases (BEBD) represent a growing percentage of breast pathology diagnoses. BEBD include numerous entities such as cysts, fibrosis, adenosis, duct ectasia, which require neither surgery nor follow-up. Some BEBD have to be individualized (radial scars, papillomas, complex sclerosing adenosis, lobular intraepithelial neoplasia, flat epithelial atypia, atypical hyperplasia), being preinvasive lesions or markers of increased breast cancer risk, or being associated with suspect radiological aspect. BEBD should be managed in a pluridisciplinar way and correctly diagnosed by percutaneous biopsies or surgical specimens. The goals of surgery vary according to lesions. It always allows a complete surgical specimen analysis and therefore a search for atypical or cancerous cells. Surgery can also have a preventive role by reducing the risk of potential malignant transformation. Finally, it enables in some cases the excision of a radiologically suspect mass. So the aim of this review is to give a clinical and morphological description of most common BEBD, underlying their cancer risk, specific diagnosis, therapeutic, follow-up and psychological repercussions.

Epidemiology of anthracycline cardiotoxicity in children and adults.

Anthracyclines, potent cytotoxic agents used to treat a broad spectrum of malignancies, are limited in their use by an attendant risk of cardiotoxicity. Malignancies affect all age ranges, and anthracyclines are used in all age ranges, thereby exposing a broad population of patients to the development of heart disease. For some treated patients, anthracyclines affect cardiac muscle, resulting in cardiomyopathy. The type and degree of cardiomyopathy, as well as when during or after treatment the condition occurs, are dependent on what risk factors are present. Age is a major risk factor. Children and adults may develop restrictive and dilated cardiomyopathy. The length of subsequent survival and amount of subsequent somatic growth may influence late anthracycline-associated cardiac outcome. Early cardiotoxicity, occurring during or within 1 year of completion of treatment, is the largest risk factor for the development of late cardiotoxicity, which occurs beyond a year of completion of treatment. Risk factors, which appear to be specific for early cardiotoxicity in children, include black race, trisomy 21, and the use of amsacrine therapy after anthracycline therapy. More cardiotoxic effects are seen in survivors of childhood cancer, the longer from completion of treatment a patient is followed. Cumulative as well as peak anthracycline doses affect adults and children alike, and cardiotoxicity occurs early and late. In adults, left ventricular contractility is affected by anthracyclines. Children may manifest impairment of left ventricular contractility and increased afterload due to thinning of left ventricular walls. Patients with an early presentation of depressed left ventricular contractility are likely to show progression of cardiac disease with time. In addition, female gender appears to affect early and late cardiotoxicity in both adults and children, although this risk factor has been described predominantly in the survivors of childhood cancer. Thus, although anthracycline chemotherapy has improved overall survivorship of patients with cancer, there is a significant risk of cardiotoxicity associated with this class of drugs.

Clinical comparison of acoustic and electronic stethoscopes and design of a new electronic stethoscope.

This clinical study was performed to evaluate the advantages and limitations of 3 acoustic stethoscopes and 3 electronic stethoscopes. It shows that it is possible to design a new electronic stethoscope by considering the advantages of both the acoustic and electronic stethoscopes.

Chair and bed rise performance in ADL-impaired congregate housing residents.

OBJECTIVES: To examine the ability of activity of daily living (ADL)-impaired older adults to successfully rise, and, when successful, the time taken to rise, from a bed and chair under varying rise task demands. SETTING: Seven congregate housing facilities SUBJECTS: Congregate housing residents (n = 116, mean age 82) who admitted to requiring assistance (such as from a person, equipment, or device) in performing at least one of the following mobility-related ADLs: transferring, walking, bathing, and toileting. METHODS: Subjects performed a series of bed and chair rise tasks where the rise task demand varied according to the head of bed (HOB) height, chair seat height, and use of hands. Bed rise tasks included supine to sit-to-edge, sit up in bed with hand use, and sit up in bed without hands, all performed from a bed where the HOB was adjusted to 0, 30, and 45 degrees elevations; roll to side-lying then rise (HOB 0 degrees); and supine to stand (HOB 0 degrees). Chair seat heights were adjusted according to the percent of the distance between the floor and the knee (% FK), and included rises (1) with hands and then without hands at 140, 120, 100, and 80% FK; (2) from a reclining (105 degrees at chair back) and tilting (seat tilted 10 degrees posteriorly) chair (100% FK); and (3) from a 80% FK seat height with a 4-inch cushion added, with and then without hands. Logistic regression for repeated measures was used to test for differences between tasks in the ability to rise. After log transformation of rise time, a linear effects model was used to compare rise time between tasks. RESULTS: The median total number of tasks successfully completed was 18 (range, 3-21). Nearly all subjects were able to rise from positions where the starting surface was elevated as long as hand use was unlimited. With the HOB at 30 or 45 degrees essentially all subjects could complete supine to sit-to-edge and sit up with hands. Essentially all subjects could rise from a seat height at 140, 120, and 100% FK as long as hand use was allowed. A small group (8-10%) of subjects was dependent upon hand use to perform the least challenging tasks, such as 140% FK without hands chair rise and 45 degrees sit up without hands. This dependency upon hand use increased significantly as the demand of the task increased, that is, as the HOB or seat height was lowered. Approximately three-quarters of the sample could not rise from a flat (0 degrees HOB elevation) bed or low (80% FK) chair when hand use was not allowed. Similar trends were seen in rise performance time, that is, performance times tended to increase as the HOB or chair seat elevation declined and as hand use was limited. Total self-reported ADL disability, compared to the single ADL transferring item, was a stronger predictor of rise ability and timed rise performance, particularly for chair rise tasks. CONCLUSIONS: Lowering HOB height and seat height increased bed and chair rise task difficulty, particularly when hand use was restricted. Restricting hand use in low HOB height or lowered seat height conditions may help to identify older adults with declining rise ability. Yet, many of those who could not rise under "without hands" conditions could rise under "with hands" conditions, suggesting that dependency on hand use may be a marker of progressive rise impairment but may not predict day-to-day natural milieu rise performance. Intertask differences in performance time may be statistically significant but are clinically small. Given the relationship between self-reported ADL disability and rise performance, impaired rise performance may be considered a marker for ADL disability. These bed and chair rise tasks can serve as outcomes for an intervention to improve bed and chair rise ability and might also be used in future studies to quantify improvements or declines in function over time, to refine physical therapy protocols, and to examine the effect of bed and chair design modifications on bed and chai

Task-specific resistance training to improve the ability of activities of daily living-impaired older adults to rise from a bed and from a chair.

OBJECTIVES: To determine the effect of a 12-week intervention to improve the ability of disabled older adults to rise from a bed and from a chair. DESIGN: Subjects were randomly allocated to either a 12-week task-specific resistance-training intervention (training in bed- and chair-rise subtasks, such as sliding forward to the edge of a chair with the addition of weights) or a control flexibility intervention. SETTING: Seven congregate housing facilities. PARTICIPANTS: Congregate housing residents age 65 and older (n = 161, mean age 82) who reported requiring assistance (such as from a person, equipment, or device) in performing at least one of the following mobility-related activities of daily living: transferring, walking, bathing, and toileting. MEASUREMENTS: At baseline, 6 weeks, and 12 weeks, subjects performed a series of bed- and chair-rise tasks where the rise task demand varied according to height of the head of the bed, chair seat height, and use of hands. Outcomes were able or unable to rise and, if able, the time taken to rise. Logistic regression for repeated measures was used to test for differences between tasks in the ability to rise. Following log transformation of rise time, a linear effects model was used to compare rise time between tasks. RESULTS: Regarding the maximum total number of bed- and chair-rise tasks that could be successfully completed, a significant training effect was seen at 12 weeks (P = .03); the training effect decreased as the total number of tasks increased. No statistically significant training effects were noted for rise ability according to individual tasks. Bed- and chair-rise time showed a significant training effect for each rise task, with analytic models suggesting a range of approximately 11% to 20% rise-time (up to 1.5 seconds) improvement in the training group over controls. Training effects were also noted in musculoskeletal capacities, particularly in trunk range of motion, strength, and balance. CONCLUSIONS: Task-specific resistance training increased the overall ability and decreased the rise time required to perform a series of bed- and chair-rise tasks. The actual rise-time improvement was clinically small but may be useful over the long term. Future studies might consider adapting this exercise program and the focus on trunk function to a frailer cohort, such as in rehabilitation settings. In these settings, the less challenging rise tasks (such as rising from an elevated chair) and the ability to perform intermediate tasks (such as hip bridging) may become important intermediate rehabilitation goals.

Liposomal mediated transfection of mature rat astrocytes in vitro: a comparison of ten reagents.

Ten cationic liposomes were tested for their ability to transfect mature, astrocyte monolayers in vitro using the eucaryotic expression vector plasmid p cytomegalovirus (CMV)-beta. Liposomal agents were examined for optimum length of exposure and optimum cDNA/lipid ratios. Lipofectin demonstrated the highest transfection efficiencies of all agents tested (3.3%). When examined at 3 days following transfection, 24-h exposures yielded higher efficiencies compared to 6 h exposures (1.9%, P=0.07). Although expression appeared to decline by up to 80%, positive cells were still detected up to 2 weeks after transfection with all reagents. Lipofectin represents a useful tool for transfecting mature astrocytes for investigation of gene transfer in vitro.

Low frequency analysis of opening sound for detection of single leg separation of Björk-Shiley Convexo-Concave heart valves.

The aim of the study was to evaluate the potential of low frequency analysis of valve opening sounds in order to detect the presence of single leg separation of the outlet strut of Björk-Shiley convexo-concave (BSCC) valves. Single leg separation is believed to precede outlet strut fracture. Phonocardiograms (PCG) of 28 patients with BSCC mitral valves were recorded and filtered to limit the frequency bandwidth between 90 and 1400 Hz (-20 dB). Twenty-four patients had BSCC valves that were presumably unimpaired and four patients had BSCC valves with single leg separation. Spectral analysis consisted of computing the power spectrum for 30 opening sounds for each patient using a fast Fourier transform (FFT) algorithm on an IBM-PC compatible computer. For each patient, the power spectra of the selected opening sounds were averaged and normalized in amplitude on a 0-100% linear scale. A ratio of the high to the low frequency area of the averaged power spectra was computed and evaluated as a diagnostic feature to identify the valves with single leg separation. Six cut-off frequencies serving to distinguish between high and low frequency areas of the spectra were tested: 400, 450, 500, 550, 600, and 650 Hz. The results showed that the high-to-low frequency area ratios tested were all able to identify valves with single leg separation. The correct classification performance was 96.4%. The sensitivity to detect valves with single leg separation was 75% and the specificity was 100%. The positive predictive value was 100% and the negative predictive value 96%. The study confirmed the potential of low frequency analysis of valve opening sounds to detect single leg separation of the outlet strut of BSCC valves implanted in humans.

Artificial neural networks in computer-assisted classification of heart sounds in patients with porcine bioprosthetic valves.

The paper describes the design, training and testing of a three-layer feed-forward back-propagation neural network for the classification of bioprosthetic valve closure sounds. Forty-seven patients with a porcine bioprosthetic valve inserted in the aortic position were involved in the study. Twenty-four of them had a normal bioprosthetic valve, and the other 23 had a degenerated valve. Five features extracted from the Fourier spectra and 12 linear predictive coding (LPC) coefficients of the sounds were used separately as the input of two neural-network classifiers. The performance of the classifiers was tested using the leave-one-out method. Results show that correct classifications were 85 per cent using the spectral features, and 89 per cent using the LPC coefficients. The study confirms the potential of artificial networks for the classification of bioprosthetic valve closure sounds. Clinical use of this method, however, still requires further investigation.

The embryology of congenital heart defects.

The embryological development of the heart is an awesome and complex process. The heart is formed from groups of cells that coalesce into sheets of tissue. These sheets fuse to form a tube that grows into the atria and ventricles. The twists and turns of the developing heart tissue and the simultaneous septation of atria, ventricles, and truncus, along with a shifting of the atrioventricular canal and conus then position the portions of the heart in alignment to allow normal blood flow. Errors at any stage of embryological formation can result in specific congenital defects. Understanding the development of the heart in utero can provide the pediatric nurse a basis for understanding the physiological effects of embryological failures that result in congenital heart defects in the infant and child.

[Unilateral gigantomastia of pregnancy: case-report of a giant breast hamartoma]. / Gigantomastie unilatérale gravidique: à propos d'un cas d'hamartome géant.

Breast hamartoma is a benign tumour consisting of fat, fibrous and glandular tissue. A young woman in her 19th week of pregnancy underwent exceptional surgery for a unilateral gigantomastia secondary to a rapid-growth giant hamartoma during her second pregnancy. Rigourous clinical and ultrasonographic examinations were performed followed by multiple biopsies. The decision to perform surgery was guided by the risk to skin integrity and of tumour infarct. Our report provides detailed information on gestational benign breast tumours, on the specificities of medical imaging and breast surgery in pregnant patients.

[MRI-guided breast microbiospy or macrobiopsy: which is the best option for a small tumor?]. / Micro- ou macrobiopsie mammaire guidée par IRM : quel est le meilleur choix pour une petite tumeur ?

The choice of the optimum therapeutic strategy for breast cancer depends on the histological diagnosis of the sample obtained by biopsy. The microbiopsy is the preferred method as it provides an accurate diagnosis of the histological type as well as the main prognostic factors, whilst being simple, fast and inexepensive. However, some infraclinic breast tumors are not accessible by conventional guidance due to excessive depth inside the breast, their small size or technical inability to image them by mammography or ultrasonography. In those cases, the MRI guidance may help to perform the biopsy. Most MRI biopsies are made by large-core needle that are known to alter the histological structure of the tumor and to disturb the anatomopatholgical analysis (size and surgical margin). Those are very important elements to know before treatment. Our case report details an original technique of MRI microbiopsy of a deep 4mm opacity found on the occasion of a patient's mammography. The operative specimen revealed an invasive ductal carcinoma of 4mm diameter which scored III on the Elston and Ellis scale (oestrogen and progesterone receptors tested negative and HER-2 was over-expressed). It was associated with a high grade in situ ductal carcinoma. No systemic treatment was prescribed due to the small size of the carcinoma. The development of partially or totally amagnetic microbiopsy pistols would help perform microbiopses guided by MRI.

[Diabetic mastopathy: a recurrent benign breast disease]. / La mastopathie diabétique : une lésion mammaire bénigne sujette à récidive.

Diabetic mastopathy is an uncommon benign entity occurring in young women with type 1 diabetes. Its clinical and radiological signs are not specific and often mimic a breast carcinoma. However, the benign nature of this lesion is easily recognized on histological examination, visualizing dense keloid-like fibrosis, lymphocytic lobulitis and ductitis with lymphocytic perivascular inflammation, with or without epithelioid-like fibroblasts. Surgery can generally be avoided. The evolution of this entity is characterized by the risk of local growth, bilateralisation or recurrence after surgical treatment. We present a case in which the core biopsy allowed the diagnosis of a diabetic mastopathy and we discuss its clinical, diagnostic, pathological and therapeutic particularities.