Gut microbiota analysis reveals a marked shift to bifidobacteria by a starter infant formula containing a synbiotic of bovine milk-derived oligosaccharides and Bifidobacterium animalis subsp. lactis†CNCM I-3446.

Non-digestible milk oligosaccharides were proposed as receptor decoys for pathogens and as nutrients for beneficial gut commensals like bifidobacteria. Bovine milk contains oligosaccharides, some of which are structurally identical or similar to those found in human milk. In a controlled, randomized double-blinded clinical trial we tested the effect of feeding a formula supplemented with a mixture of bovine milk-derived oligosaccharides (BMOS) generated from whey permeate, containing galacto-oligosaccharides and 3'- and 6'-sialyllactose, and the probiotic Bifidobacterium animalis subsp. lactis (B. lactis) strain CNCM I-3446. Breastfed infants served as reference group. Compared with a non-supplemented control formula, the test formula showed a similar tolerability and supported a similar growth in healthy newborns followed for 12 weeks. The control, but not the test group, differed from the breast-fed reference group by a higher faecal pH and a significantly higher diversity of the faecal microbiota. In the test group the probiotic B. lactis increased by 100-fold in the stool and was detected in all supplemented infants. BMOS stimulated a marked shift to a bifidobacterium-dominated faecal microbiota via increases in endogenous bifidobacteria (B. longum, B. breve, B. bifidum, B. pseudocatenulatum).

Three-dimensional rotational angiography in the assessment of the angioarchitecture of brain arteriovenous malformations.

BACKGROUND AND PURPOSE: The angioarchitecture of brain arteriovenous malformations (BAVM) still remains a complex subject of study despite advances in medical imaging techniques. For this reason, the present study aimed to assess whether or not 3D rotational angiography (3DXA) might improve the assessment of BAVM. PATIENTS AND METHODS: Included prospectively were 72 patients who had undergone conventional digital subtraction angiography (DSA) and 3DXA for pretherapeutic assessment of BAVM prior to radiosurgery. Dimensional criteria, arterial-feed patterns, venous drainage, points of weakness and vascular densities (VD) of the nidus and shunt zone were studied. RESULTS: 3DXA detected all arteriovenous shunts by revealing abnormal venous enhancement. Post-processing tools similar to CT and MRI may also be used to make complex 3D reconstructions. In addition, the technique provided significant help for volumetric estimations, extraction of arterial feeders and origins of draining veins, and analysis of the 3D conformation of the nidus. Furthermore, 3DXA detected significantly more points of weakness, such as intranidus aneurysms and venous anomalies (P<0.005). In 65% of cases, a gradient of vascular enhancement intensity was found between the arteries and draining veins surrounding or comprising the nidus. VD, or the percentages of space occupied by the enhanced vascular elements, was evaluated in both the nidus and shunt zone. VD in the shunt zone was highest in untreated patients with no history of bleeding (P<0.005). CONCLUSION: 3DXA offers a useful approach to BAVM exploration and can improve our knowledge of lesional angioarchitecture, necessary for the planning of therapeutic strategies.

[Diagnosis and management of vascular anomalies]. / Diagnostic et prise en charge des anomalies vasculaires.

Vascular anomalies are a complex pathological group. They are especially difficult to study because of confusion in the terminology used. The classification developed by the International Society for the Study of Vascular Anomalies (ISSVA) in 1996 allows using a common scientific language. There are two groups of lesions: vascular tumor and vascular malformation. The management of these anomalies is difficult and must involve an interdisciplinary approach including specialists in plastic surgery, radiology, pediatry and dermatology. We propose a simplified approach for the management of these pathologies. This approach is coming from the experience of Marseille (France) multidisciplinary team.

[Vascular anomalies: information documents]. / Les anomalies vasculaires : fiches d'information.

Vascular anomalies are a complex pathological group. They are composed of hemangiomas and other vascular tumors and congenital vascular malformations: venous, lymphatic, arteriovenous and capillary malformations. The management of these anomalies is difficult and must involve an interdisciplinary approach. To help patients to understand their pathology, we have made some information documents.

Real-life study of the role of high-flow nasal cannula for bronchiolitis in children younger than 3 months hospitalised in general pediatric departments.

We aimed to describe the real-life role of high-flow nasal cannula (HFNC) for bronchiolitis in infants under 3 months of age admitted to three general pediatric departments during the 2017-2018 epidemic period. We retrospectively assessed the clinical severity (Wang score) for every 24-h period of treatment (H0-H24 and H24-H48) according to the initiated medical care (HFNC, oxygen via nasal cannula, or supportive treatments only), the child's discomfort (EDIN score), and transfer to the pediatric intensive care unit (PICU). A total of 138 infants were included: 47±53 days old, 4661±851.9 g, 70 boys (50.7%), 58 with hypoxemia (42%), Wang score of 6.67±2.58, 110 (79.7%) staying for 48 consecutive hours in the same ward. During the H0-H24 period, only patients treated with HFNC had a statistically significant decrease in the severity score (n=21/110; -2 points, P=0.002) and an improvement in the discomfort score (n=15/63; -3.8 points, P<0.0001). There was no difference between groups during the H24-H48 period. The rate of admission to the PICU was 2.9% for patients treated for at least 24 h with HFNC (n=34/138, 44% with oxygen) versus 16.3% for the others (P=0.033). Early use of HFNC improves both clinical status and discomfort in infants younger than 3 months admitted for moderately severe bronchiolitis, whatever their oxygen status.

[Delayed myocardial enhancement: Optimizing the MR imaging protocol]. / Comment j'optimise la technique d'IRM à la recherche d'un rehaussement tardif?

The purpose of this article is to 1) review the basic models characterizing myocardial enhancement on MR and CT, 2) review the main characteristics of available iodinated and Gadolinium-based contrast agents and, 3) review the literature on emerging MR contrast agents to assess myocardial viability. The intensity of enhancement following infarction is the result of two processes: 1) the increased interstitial space (15 + or - 2% in normal myocardium and 80 + or - 3% in necrotic tissue) secondary to cell necrosis and 2) perfusion abnormalities secondary to absent revascularization or impaired microvascularization. The equation described by Kety was used to create models of contrast material kinetics within myocardium or enhancement of the different components of the myocardium (viable myocardium, necrosed myocardium, fibrosis, with no-reflow zone, hibernating or stunned myocardium).

[Urokinase in the management of occluded PICC lines]. / Utilisation de l'urokinase dans le traitement des occlusions de PICC-lines.

PURPOSE: To determine the efficacy and safety of urokinase in the management of occluded PICC lines. MATERIALS AND METHODS: A total of 587 PICC lines were placed over an 11 month period. During this period, 28 PICC lines (4.8%) became occluded: 12 occluded PICC lines were successfully managed by simple flushing with normal saline while 16 PICC lines were thrombolyzed with urokinase. RESULTS: After urokinase, 93.8% (15/16) of occluded PICC lines were completely patent. A single infusion of urokinase, 20,000 IU over 30 minutes, was used in all cases. No secondary occlusion or complication was noted after urokinase. CONCLUSION: Urokinase is effective and safe to restore patency to occluded PICC lines. The procedure is simple, and could be performed at the bedside by nursing staff after medical prescription. It is an alternative to over the wire PICC line exchange, that could reduce the risk of complication related to manipulations, patient discomfort and cost.

Prostatic artery embolization using three-dimensional cone-beam computed tomography.

PURPOSE: The purpose of this study was to report the use of three-dimensional (3D) cone-beam computed tomography (CBCT) for prostatic artery embolization (PAE) in patients with benign prostatic hypertrophy (BPH). MATERIALS AND METHODS: Twenty-three consecutive men who underwent PAE using 3D CBCT from June 2016 to September 2018, were retrospectively included in this observational single-center study. There were 23 men with a mean age of 73±12 (SD) years (range: 52-94years) with moderate to severe lower urinary tract symptoms (mean international prostate symptom score, 21±5.7 [SD]; range: 9-30) due to BPH (mean prostate weight, 100g±63 [SD]; range: 30-250g). PAEs were analyzed with respect to procedure time, fluoroscopy time, technical success, complications and dosimetric indices. RESULTS: The mean catheterization time of the prostatic artery from the internal iliac artery was 17.3±12.5 (SD) min (range: 8-57min) on the right side and 23.6±14.9 (SD) min (range: 6-54min) on the left side. A technical success was achieved in 21 patients (21/23; 91%). PAE was bilateral in 14 patients (14/21; 66%) and unilateral in 7 patients (7/21; 33%). No occurrence of non-target embolization was reported. The mean dose area product was 146.7±47.9 (SD) Gy.cm2 (range: 54-254Gy.cm2) and mean cumulative air kerma was 771.4±333.3 (SD) mGy; range: 280-1560 mGy. The mean fluoroscopy time was 42.3±23.1 (SD) min (range: 19.4-118.2min). CONCLUSION: 3D CBCT is a useful tool to identify the prostatic arteries and facilitates catheterization of prostatic arteries with an acceptable level of radiation exposure.

[Virtual interventional radiology: evaluation of performances as a function of experience]. / Réalité virtuelle en radiologie vasculaire interventionnelle: évaluation des performances de l'opérateur selon son niveau d'expérience.

PURPOSE: To determine the value of an angioplasty simulation to differentiate the users based on their level of experience. To determine the perceived usefulness of an angioplasty simulation program. MATERIALS AND METHODS: Forty-six radiologists performed a renal angioplasty on a VIST simulator (Mentice Corporation, Gothenburg, Sweden); the procedure was completed by 41 radiologists. The radiologists were divided into two groups based on the level of experience. Quantitative variables analyzed included procedure duration time and fluoroscopy time. The radiologists then completed a questionnaire evaluating the simulation program. RESULTS: Radiologists with more than 2 years of clinical experience (n=14) performed the procedures faster (20.4 min vs 27.4 min, p<0.01) using less fluoroscopy time (7.8 min vs 11.2 min, p<0.05) than others. Radiologists performing more than 2 procedures per month (n=14) performed the procedures faster (19.4 min vs 27.9 min, p<0.01) using less fluoroscopy time (7.4 min vs 11.3 min, p<0.05) than other (n=27). The participating radiologists indicated that the simulation was realistic. CONCLUSION: Procedure duration time and duration of fluoroscopy were criteria able to differentiate the users based on their level of experience. The educational value of the simulation program was perceived as helpful by the users.

In Vivo Feasibility of Arterial Embolization with Permanent and Absorbable Suture: The FAIR-Embo Concept.

PURPOSE: Arterial embolization has been shown to be effective and safe for the management of bleeding, especially for postpartum and pelvic traumatic bleeding. We propose to evaluate the proof of concept of feasibility and effectiveness of arterial embolization with absorbable and non-absorbable sutures in a porcine model. MATERIALS AND METHODS: In the acute setting (n = 1), several different arteries (mesenteric, splenic, pharyngeal, kidney) were embolized using non-absorbable sutures (NAS): Mersutures™ braided sutures (polyethylene terephthalate). In the chronic setting (n = 3), only lower pole renal arteries were embolized. On the right side, NAS was used, whereas on the left side embolization was realized with absorbable suture (AS): Vicryl® braided suture (polyglactin 910). The chronic group was followed for 3 months. The pigs received contrast-enhanced CT the day before embolization (D-1), after the embolization (D0), at 1 month and 3 months after embolization (M1 and M3); digital subtraction angiography (DSA) was done at D0 and M3 and histological analysis at M3. RESULTS: All vascular targets were effectively embolized without any pre- or postoperative complications. Both DSAs and CTs at M3 showed a 100% recanalization rate for the AS embolization and a partial reversal rate for the NAS embolization. A renal hypotrophy in the embolized region was observed during both the M1 and M3 scans for both sutures (AS and NAS) with a clear hypotrophy for the NAS embolized kidney. CONCLUSION: Embolization by AS and NAS (FAIR-Embo) is a feasible and effective treatment which opens up the possibility of global use of this inexpensive and widely available embolization agent.

Incidence and determinants of spinal cord ischaemia in stent-graft repair of the thoracic aorta.

OBJECTIVES: Endovascular repair of descending thoracic aortic lesions is associated with a substantial risk of perioperative spinal cord ischaemia (SCI) which may lead to permanent paraplegia. We performed a retrospective analysis of our experience in the endovascular treatment of descending thoracic aortic lesions to define the incidence of SCI and to identify factors that contributed to its development. METHODS: 67 consecutive patients underwent stent graft repair for descending thoracic aortic lesions including degenerative aneurysm (n=19), type B dissection (acute n=2, chronic n=15), traumatic rupture (acute n=14, chronic n=4), penetrating aortic ulcer (n=5), anastomotic false aneurysm (n=4), mycotic aneurysm (n=3) and embolic aortic lesion (n=1) between June 2000 and June 2005. All procedures were performed with the patient under general anaesthesia and strict blood pressure monitoring. No patient had intra-operative monitoring of spinal evoked potential or cerebrospinal fluid (CSF) drainage to prevent SCI. Neurological evaluation was realized after recovery from general anaesthesia. Fifteen factors, including nature of aortic disease, length of aortic coverage, number of stent-grafts, coverage of the distal third of the thoracic aorta and subclavian artery coverage, were investigated as possible predictors of postoperative SCI. RESULTS: Five patients (7.5%) had postoperative neurological deficits (immediate n=2, delayed n=3) referable to SCI. Univariate analysis showed that length of aortic coverage (p<0.001) and number of stent-grafts deployed (p=0.02) were significant predictors of SCI. Multivariate logistic regression analysis showed that length of aortic coverage was the only independent significant predictor of SCI. ROC curve analysis revealed 205mm of aortic length coverage as the threshold for increased risk of postoperative SCI (p=0.001), with specificity and sensitivity of 95.2 and 80% respectively. CONCLUSION: In our study, length of aortic coverage is the only independent predictive factor of SCI after endovascular treatment with 205mm as a threshold for increased risk. Hence, methods to prevent SCI, especially those aimed at restoration of an adequate spinal cord perfusion pressure, should be offered to patients requiring extensive coverage of the descending thoracic aorta.

[Nasopharyngeal carcinoma]. / Cancer du nasopharynx.

Nasopharyngeal carcinoma is relatively common. Undifferentiated Carcinomas of Nasopharyngeal Type (UNCT) are endemic Epstein-Barr virus (EBV)-related tumors. They are mainly radiosensitive. The role of imaging is to assess locoregional extension, TNM classification and adjust the radiation fields. MRI is essential to determine the initial extension. CT is useful to confirm the presence of bone involvement and evaluate nodal status. MRI and CT are necessary for the post-treatment follow-up.

[Cervical lymph nodes]. / Adénopathies cervicales.

Imaging plays a chief role in the care and monitoring of patients in cervico-facial oncology. The radiologist must know the anatomy of different lymph nodes as well as signs of malignancy (hypertrophy, enhancement, necrosis, capsular rupture, etc.). CT is still the first-line examination because of its high reliability, its accessibility and its ability to make an assessment of the upper aero digestive ways at the same time. Ultrasound is very accuracy, and allows the realization of cytoponction, but does not provide a complete exploration of the neck. MRI does not appear to be indicated for the first intention, but the new rapid sequences (STIR, diffusion) seem interesting. The PET-CT is useful in post-therapeutic management of patients, and probably in the initial staging, but its accessibility is poor.

[Peripherally inserted central catheters (PICC): a promising technique]. / Cathéters centraux insérés par voie périphérique: une technique prometteuse.

To describe technical features and benefits from PICC lines.

[Prospective evaluation of PICC line related complications]. / Evaluation prospective des complications des PICCs.

PURPOSE: To report the occurrence of complications following placement of peripherally inserted central catheters (PICC). Materials and methods. A total of 127 PICC lines were placed in 115 patients for TPN (n=54), long-term antibiotics (n=29), chemotherapy (n=14) or miscellaneous intravenous therapy (n=18). RESULTS: All PICC lines were successfully inserted. PICC lines were used for a mean duration of 16 days (1-166 days). The following complications were recorded: occlusion (7%), rupture (1.6%), accidental withdrawal (2.4%), infection (3.1%) and venous thrombosis (2.4%). CONCLUSION: PICC lines are a simple, safe and effective alternative to conventional central venous catheters. The occurrence of complications, typically "mechanical", must be reduced and prevented by strict management of this type of central line by the treating team.

Transarterial chemoembolization (TACE) in the management of hepatocellular carcinoma: Results of a French national survey on current practices.

PURPOSE: To report current practices of transarterial chemoembolization (TACE) by interventional radiologists (IR) for hepatocellular carcinoma (HCC) through a French national survey. MATERIALS AND METHODS: An electronic survey was sent by e-mail to 232 IRs performing TACE in 32 private or public centers. The survey included 66 items including indications for TACE, technical aspects of TACE, other locally available treatments for HCC, follow-up imaging and general aspects of interventional radiology practices. RESULTS: A total of 64 IRs (64/232; 27%) answered the survey. Each IR performed a mean of 49±45 (SD) TACE procedures per year. Marked variations in indications for TACE in HCC were observed. Six percent of IRs (4/64) treated only patients with Barcelona Clinic Liver Cancer (BCLC) stage B HCC. Antibioprophylaxis was not used by 43/64 of IRs (67%). The number of HCC nodules was considered to select conventional TACE versus drug-eluting beadsTACE (DEB-TACE) by 17/49 IRs (35%) followed by patient performance status and Child-Pugh score by 6/49 IRs (12%). Seventy-three percent of IRs (45/62) treated nodules selectively in patients with unilobar disease with cTACE. Thirty-three percent of IRs (21/64) planned systematically a second TACE session. Doxorubicin was the most frequently used drug (52/64; 81%) and 15/64 IRs (23%) used gelatine sponge as the only embolic agent. For DEB-TACE, 100-300µm beads were used by 26/49 IRs (53%) and no additional embolization was performed by 19/48 IRs (39%). Monopolar radiofrequency technique was widely available (59/63; 94%) compared to selective internal radiation therapy (37/64; 58%). Magnetic resonance imaging was used for follow-up by 13/63 IRs (20%). CONCLUSION: Current practices of TACE for HCC varied widely among IRs suggesting a need for more standardized practices.

[Uterine artery embolisation to treat severe haemorrhage following legal abortion]. / Embolisation des artères utérines après hémorragie sévère compliquant une IVG à 12 SA.

The aim of this paper is to present a case of hemorrhagic complication following a legal abortion treated with uterine embolisation. A 45-year-old woman, with a history of one caesarean section and seven legal induced abortions, requested legal induced abortion at 12 weeks of amenorrhea. Legal induced abortion was performed as a day case using vacuum aspiration with a plastic cannula under general anaesthesia. Severe haemorrhage, with an estimated blood loss of 800 ml, occurred during the procedure. Bleeding was not related to cervical laceration, incomplete abortion, or uterine perforation. Surgical conservative procedures and intravenous use of sulprostone (Nalador) failed to control haemorrhage. The patient underwent uterine artery embolisation with Curaspon, a porcine-derived gelfoam, used for the temporary occlusion of the visceral arteries. Successful hemostasis was obtained. The patient presented no complication related to the procedure. Severe haemorrhage following legal induced procedure is rarely reported. Emergency arterial embolisation may offer an effective modality of treatment.

[Anatomic variants of the biliary tree with MR Cholangiography: feasibility and surgical applications]. / Variations anatomiques des voies biliaires en cholangio-IRM: faisabilité et intérêt chirurgical.

PURPOSE: To assess the usefulness of MR Cholangiography for evaluation of anatomic variants of the biliary tree before biliary surgery. MATERIALS AND METHODS: Our study group consisted of 45 consecutive patients (29 males, 16 females; mean age 57 years), who were referred for MR evaluation of malignant (n=26) and benign (n=19) cholangiopancreatic diseases. MR Cholangiography studies were independently reviewed by two radiologists. RESULTS: Anatomic variants of the biliary tree were observed in 9 patients (20%); 6 variants involved the biliary confluence and 4 the cystic duct (one patient had both). Anatomic variants involved principally the right posterior duct: 1 (2,2%) drainage of right posterior duct into left hepatic duct; 2 (4,4%) triple confluence of right posterior duct, right anterior duct, and left hepatic duct, and 3 (6,6%) aberrant drainage of right posterior duct into common hepatic duct. Observed cystic duct anomalies included: 2 (7,44%) low insertion of the cystic duct into the common hepatic duct and 3 (11,1%) medial insertion of the cystic duct into the common hepatic duct. CONCLUSION: MR Cholangiography accurately shows anatomic variants of the biliary tree. Noninvasive preoperative evaluation of the biliary anatomy may be important for the detection of anatomic variants that may increase the complexity of hepatic surgical procedures and biliary interventions.

[Radiation-induced carotid stenosis: A personnalized approach]. / Sténose carotidienne post-irradiation cervicale : une approche personnalisée.

INTRODUCTION: Surgical treatment of radio-induced carotid stenosis (RICS) is challenging and burdened by an elevated risk of local complications. Carotid artery stenting (CAS) may be a suitable alternative. The best approach is yet to be defined. We reviewed the results of both techniques following selection based on better-suitability characteristics (anatomic and clinical). METHODS: We retrospectively reviewed 38 patients treated for 43 RICS from a group of 1230 patients who had carotid interventions between 2008 and 2015 (5 bilateral). Primary endpoints were morbidity and mortality at 30 days (transient ischemic attack, stroke, myocardial infarction, or death). Secondary endpoints were technical success, wound complications, cranial nerve injury (CNI), restenosis (≥50%) and recurrent symptoms. RESULTS: RICS was symptomatic in 6 patients in the OR group and 3 in the CAS group. Lesions in the OR group were longer (P=0.02) and more calcified (P=0.08). Technical success rate was 100%. Cranial nerve injury rate was 14.2% (3/21). All injuries were completely resolved within several weeks. In the CAS group, technical success rate was 95% (21/22) with the one failure due to a residual stenosis exceeding 30%. Periprocedural stroke rates were 0% and 4.5% in the OR and CAS groups respectively (0/21 vs 1/22, P=0.32). There were no early deaths. Mean follow-up was 19.1 months (3-75). The restenosis rate was 9.5% (2/21) in the OR group and 9% (2/22) in the CAS group. CONCLUSION: Our results do not support a preferred treatment strategy. The choice of treatment should be considered on an individual basis.

Embolization of ovarian vein for pelvic congestion syndrome with ethylene vinyl alcohol copolymer (Onyx®).

PURPOSE: To evaluate the safety and efficacy of pelvic embolization using ethylene vinyl alcohol copolymer (Onyx®) for pelvic congestion syndrome. MATERIAL AND METHODS: Between March 2012 to September 2016, 17 women (mean age, 44.7± 12.2 (SD) years; range: 34-71years) presenting with pelvic congestion syndrome were evaluated for transvenous embolization with Onyx®. Pelvic congestion syndrome was initially diagnosed by clinical examination and the results of transvaginal Doppler ultrasound and further confirmed by pelvic venography. Primary and secondary clinical efficacy was defined respectively by the resolution of the symptoms after embolization and at the end of the follow-up, irrespective to the number of embolization procedures. RESULTS: Technical efficacy of embolization was 100% with no significant complications during and after embolization. After a mean follow-up time of 24.2 months (range: 6-69months) a primary and secondary clinical efficacy of 76.4% (13/17 women) and 94.1% (16/17 women) respectively were observed. Four women (23.5%) underwent a second embolization procedure with one woman requiring a third embolization procedure. These additional embolization procedures were associated with direct puncture of vulvar varices for sclerotherapy in two women. Five women (29%) had recurrent symptoms 21 months post-treatment (7-42months). CONCLUSION: Pelvic embolization using ethylene vinyl alcohol copolymer (Onyx®) has a favorable clinical success for pelvic congestion syndrome.