Evaluating the safety of high-intensity focused ultrasound treatment for rectal endometriosis: results from a French prospective multicentre study including 60 patients.

STUDY QUESTION: Is increasing the intensity of high-intensity focused ultrasound (HIFU) by 30% in the treatment of rectal endometriosis a safe procedure? SUMMARY ANSWER: This study demonstrates the safety of a 30% increase in the intensity of HIFU in the treatment of rectal endometriosis, with no Clavien-Dindo Grade III complications overall, and namely no rectovaginal fistulae. WHAT IS KNOWN ALREADY: A feasibility study including 20 patients with rectal endometriosis demonstrated, with no severe complications, a significant improvement in digestive disorders, dysmenorrhoea, dyspareunia, and health status, although the volume of the endometriosis nodule did not appear to be reduced. STUDY DESIGN, SIZE, DURATION: A prospective multicentre cohort study was conducted between 2020 and 2022 with 60 patients with symptomatic rectal endometriosis. Following the failure of medical treatment, HIFU treatment was offered as an alternative to surgery. PARTICIPANTS/MATERIALS, SETTING, METHODS: As the main objective of this study was to examine safety, all adverse events observed during the 6 months of follow-up were analysed and graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) and Clavien-Dindo classifications. Secondary objectives included evaluating the evolution of symptoms using validated questionnaires: gynaecological and digestive pain symptoms with a visual analogue scale, health status with the Medical Outcomes Study 36-item Short Form (SF-36) questionnaire, average post-operative daily pain level, and analgesic medication required in the 10 days following treatment. MRI was also performed at Day 1 to detect early complications. Finally, we performed a blinded MRI review of the evolution of the nodule at 6 months post-treatment. MAIN RESULTS AND THE ROLE OF CHANCE: The procedure was performed under spinal anaesthesia for 30% of the patients. The median duration of treatment was 32 min. Fifty-five patients left the hospital on Day 1. MRI scans performed on Day 1 did not highlight any early-onset post-operative complication. Using the Clavien-Dindo classification, we listed 56.7% Grade I events, 3.4% Grade II events, and no events Grade III or higher. At 1, 3, and 6 months, all gynaecologic, digestive and general symptoms, as well as health status, had significantly improved. The evolution of the nodule was also significant (P < 0.001) with a 28% decrease in volume. LIMITATIONS, REASONS FOR CAUTION: The main objective was safety and not effectiveness. The study was not randomized and there was no control group. WIDER IMPLICATIONS OF THE FINDINGS: HIFU treatment for rectal endometriosis results in an improvement of symptoms with low morbidity; as such, for selected patients, it could be a valuable alternative to surgical approaches following the failure of medical treatment. STUDY FUNDING/COMPETING INTEREST(S): The study was funded by the company EDAP TMS. Professors Dubernard and Rousset are consultants for EDAP TMS. Dubernard received travel support from EDAP-TMS. Dr F. Chavrier received industrial grants from EDAP-TMS. He has developed a device for generating focused ultrasonic waves with reduced treatment time. This device has been patented by EDAP-TMS. Dr Lafon received industrial grants from EDAP-TMS; he declares that EDAP-TMS provided funding directly to INSERM to support a young researcher chair in therapeutic ultrasound, which is unrelated to the current study. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov identifier NCT04494568.

Low Tg, strongly segregated, ABA triblock copolymers: a rheological and structural study.

ABA triblock copolymers can form microphase separated structures where the B blocks form bridges between A domains, leading to reversible networks interesting for a variety of applications such as pressure sensitive adhesives or thermoplastic elastomers. However, a major drawback of these systems is their rapid loss of mechanical properties upon temperature increase. A potential way to circumvent this limitation would be to design ABA triblock copolymers that keep their microphase separation at high temperatures. In this paper, we report on all-soft ABA triblock copolymers having a poly(n-butyl acrylate) (PnBA) central block and poly(heptafluorobutyl acrylate) (PHFBA) outer blocks. By introducing fluorinated units, the incompatibility between the blocks is largely increased, allowing strong segregation between the block domains, which preserve the microphase separation up to high temperatures despite the low glass transition temperature of the blocks, as shown by temperature dependent SAXS measurements. We study the properties of different copolymers, with similar PHFBA volume fractions but different block lengths. Linear shear rheology measurements revealed the presence of a second, low frequency, plateau whose onset and length depend on the PnBA and PHFBA length, respectively. This plateau also persists up to higher temperatures for longer PHFBA blocks.

A new method of adhesive system application improves the bond strength between fiber post and root dentin.

This study evaluated a new method of adhesive system application on the bond strength between fiber post and root dentin using two adhesive systems. The canals of sixty bovine incisors were prepared and obturated. The roots were divided into six groups (n=10) according to the adhesive system (Clearfil SE - CSE and Single Bond Universal - SBU) and the application strategy (microbrush - MB; rotary brush - RB; and ultrasonic tip - US). The glass fiber posts were cemented with resin cement (RelyX ARC). The roots were sectioned perpendicularly to their long axis, and three slices per root were obtained. Previously to the push-out test, confocal laser scanning microscopy (CLSM) was performed to illustrate the interfacial adaptation of the cement to the root canal walls. Failure patterns were analyzed with 40x magnification. Shapiro-Wilk indicated a normal distribution of the data. The bond strength values were compared using one-way ANOVA and Tukey's tests. Student's T test analyzed the differences between the adhesive systems within each third and protocol. A significance level of 5% was used. CSE with RB showed higher mean bond strength values compared to MB (conventional technique) (P < 0.05). US application resulted in intermediate bond strength values for CSE (P > 0.05). The application of SBU using RB generated higher mean bond strength values compared to MB and US (P < 0.05). Adhesive failures were predominant (65.5%). CSE and SBU application with the new rotary brush improved the bond strength of fiber posts to root dentin compared to the conventional strategy.

[Laparoscopic ultrasound-guided radiofrequency ablation of uterine fibroid: A retrospective study]. / Myolyse des fibromes utérins par radiofréquence cœlioscopique sous contrôle échographique : à propos d'une série rétrospective.

OBJECTIVE: To assess clinical and radiological efficacy and safety of laparoscopic ultrasound-guided radiofrequency ablation of uterine leiomyomas. MATERIAL AND METHODS: Thirty-three patients with symptomatic uterine leiomyomas FIGO type 2 to 7, have undergone a laparoscopic ultrasound-guided radiofrequency ablation at Croix Rousse University Hospital Center (Hospices civils de Lyon) and at Saint-Vincent de Paul Hospital in Lille, between June 2020 and December 2022. The characteristics of each myoma and the symptoms were assessed with pelvic MRI and with Higham score, SSS and HRQL scores preoperatively and at 6 months. RESULTS: A total of 54 fibroids have been treated in 33 patients. We observed a significant decrease of the volume 6 months after the surgery, on average 21mL (55.97 vs. 74.37mL, 95% CI [7.13-34.88], P=0.001). The maximum diameter of each fibroid was also significantly reduced on average 11.78mm (41.89 vs. 52.06, 95% CI [8.83-14.73], P<0.05). We noticed a significant decrease of the NRS for dysmenorrhea on average 2.79 points (2.1 vs. 4.89, 95% CI [1.14-4.42], P<0.05). There was also a trend to improvement of menorrhagia, assess by Higham score. Indeed, 70.8% of the patients had menorrhagia. Menorrhagia was improved of 108,3 points with an average Higham score before surgery of 197.3 versus 87.9 after surgery (95% CI [47.9-168.8], P=0.001). Concerning UFS-QOL score: the symptom severity score (SSS) decreased on average 33 points, testifying of symptom improvement (27.04 vs. 60.89, 95% CI [22.92-43.39], P<0.001) and the HRQL score increased on average 20 points testifying quality of life improvement (65.57 vs. 42.7, 95% CI [15.83-37.85]. P<0.001). No severe adverse event has been reported. CONCLUSION: In this first French study about radiofrequency ablation. We confirm its efficiency for improvement of symptoms and quality of life but other study is mandatory to confirm the safety of this procedure in particular in patients with a wish to conceive.

Human infrastructures correspond to higher Adélie penguin breeding success and growth rate.

Anthropogenic activities generate increasing disturbance in wildlife especially in extreme environments where species have to cope with rapid environmental changes. In Antarctica, while studies on human disturbance have mostly focused on stress response through physiological and behavioral changes, local variability in population dynamics has been addressed more scarcely. In addition, the mechanisms by which breeding communities are affected around research stations remain unclear. Our study aims at pointing out the fine-scale impact of human infrastructures on the spatial variability in Adélie penguin (Pygoscelis adeliae) colonies dynamics. Taking 24 years of population monitoring, we modeled colony breeding success and growth rate in response to both anthropic and land-based environmental variables. Building density around colonies was the second most important variable explaining spatial variability in breeding success after distance from skua nests, the main predators of penguins on land. Building density was positively associated with penguins breeding success. We discuss how buildings may protect penguins from avian predation and environmental conditions. The drivers of colony growth rate included topographical variables and the distance to human infrastructures. A strong correlation between 1-year lagged growth rate and colony breeding success was coherent with the use of public information by penguins to select their initial breeding site. Overall, our study brings new insights about the relative contribution and ecological implications of human presence on the local population dynamics of a sentinel species in Antarctica.

Do Osteobiologics Augment Fusion in Anterior Cervical Discectomy and Fusion Surgery Performed With Mechanical Interbody Devices (Polyether ether ketone, Carbon Fiber, Metal Cages) and is the Fusion Rate Comparable to that With Autograft? A Systematic Review.

STUDY DESIGN: Systematic Review of the Literature. OBJECTIVE: The purpose of this study was to perform a systematic review describing fusion rates for anterior cervical discectomy and fusion (ACDF) using autograft vs various interbody devices augmented with different osteobiologic materials. METHODS: A systematic review limited to the English language was performed in Medline, Embase and Cochrane library using Medical Subject Heading (MeSH) terms. Studies that evaluated fusion after ACDF using autografts and osteobiologics combined with PEEK, carbon fibre, or metal cages were searched for. Articles in full text that met the criteria were included in the review. The main outcomes evaluated were the time taken to merge, the definition of the fusion assessment, and the modality of the fusion assessment. The risk of bias of each article was assessed by the MINORS score or ROB 2.0 depending on the randomisation process. RESULTS: The total number of references reviewed was six hundred and eighty-two. After applying the inclusion criteria, 54 were selected for the retrieval of the full text. Eight studies were selected and included for final analysis in this study. Fusion rates were reported between 83.3% and 100% for autograft groups compared to 46.5% and 100% for various interbody device/osteobiological combinations. The overall quality of the evidence in all radiographic fusion studies was considered insufficient due to a serious risk of bias. CONCLUSION: Mechanical interbody devices augmented with osteobiologics performed similarly to autografts in terms of reliability and efficacy. Their time to fusion and fusion rate were comparable to autografts at the end of the final follow-up.

Comparison of complication rates between anterior versus posterior approaches for treating unstable Hangman's fracture. A systematic review and meta-analysis.

Study design: Systematic Review and Meta-analysis. Objective: To compare the complication rates associated with anterior and posterior approaches for the surgical treatment of unstable hangman's fractures. Methods: A systematic review and meta-analysis were performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in PubMed, Web of Science, and Scopus databases to identify comparative studies reporting complications of anterior versus posterior approaches for the treatment of unstable hangman's fractures. Results: The search yielded 1163 papers from which 5 studies were fully included. One hundred fifteen (115) patients were operated on using an anterior approach versus 65 through a posterior approach. The average complication rates for the anterior and posterior approaches were 26.1 % and 13.8 %, respectively. No complications following the anterior approach required pharmacological or surgical intervention (Clavien-Dindo, Grade 1), while 88.9 % of complications following the posterior approach did (Clavien-Dindo, Grade 2). Conclusion: No significant differences in the complication rates were found when comparing anterior versus posterior surgery for treating a C2 traumatic spondylolisthesis. However, most of the complications presented in the posterior surgery group were more severe.

Retrospective analysis of uterine involvement in low grade serous ovarian carcinoma.

OBJECTIVES: Low grade serous ovarian carcinoma (LGSOC) accounts for 2.5% of all ovarian carcinoma more affects younger women than high grade serous ovarian carcinoma. Hysterectomy is performed routinely for LGSOC treatment, but fertility sparring surgery (FSS) is feasible for some early stages. Currently, there is no study about uterine involvement in LGSOC. We evaluate uterine involvement in LGSOC patients and aim to identify pre-operative predictive factors. METHODS: Retrospective observational study of LGSOC patients treated between January 2000 and May 2022 in the Hospices Civils de Lyon. All cases were viewed, reviewed or approved by an expert pathologist. RESULTS: Among 535 serous ovarian carcinomas, 26 were included. Most patients (73 %) had FIGO III disease. Median OS was 115 months and median PFS was 42 months. Uterine involvement was found in 58 % patients who underwent hysterectomy (14/24), serosal involvement was the most frequent type of involvement (n = 13, 54 %). Myometrial involvement was found in 8 patients (33 %) and was associated with serosal involvement (7/8). Among patients with a macroscopic disease-free uterus during exploratory laparoscopy, 31 % had a microscopic serosal involvement. None patient with presumed early stage (FIGO I) were upstaged due to uterine involvement (serosal or myometrial). In patients with stage FIGO IIII, 72 % of uterine involvement were found. Univariate analysis did not show any predictive factor of myometrial involvement. There was no difference on OS nor PFS between patients with or without myometrial involvement. CONCLUSIONS: In early stages LGSOC, FSS may be considered for selected patients. In advanced stages, hysterectomy should be performed routinely, since no predictive factor for uterine involvement were identified.

Mastectomies for breast cancer: Comparison between peri-operative morbidity after simple mastectomy or after immediate breast reconstruction in a unicentric serie of 210 patients.

BACKGROUND: In breast cancer surgery, IBR (immediate breast reconstruction) is widely proposed to patients without indications of adjuvant treatments and without risk factors of surgical complications. New INCa's guidelines (2022) allow the expansion of IBR indications. OBJECTIVE: A retrospective, unicentric and safety study: post-operative complication rate after IBR in comparison with simple mastectomy (SM, reference treatment). MATERIEL AND METHOD: This retrospective study has included all major patients who have received mastectomy for breast cancer between 2016 and 2020 before application of new guidelines, in Hôpital de la Croix-Rousse, Lyon (France). They were distributed in two groups according to their surgery : IBR and SM. Usual risk factors of post-operative complications were collected (tabacco, obesity…). The primary endpoint was the occurrence of an early post-operative complication (within 3 months after surgery). Two secondary analysis focused on the impact of preoperative risk factors on complications, and the proportion of patients eligibled for an IBR among SM based on new INCA's guidelines. RESULTS: The study included 185 mastectomies: 153 SM, 32 mastectomies IBR.  IBR's patients presented less risk factors, and few indications of adjuvant treatments. The rate of major complications was identical in the two groups (14 % in SM group, 12 % in IBR group), and there were more minor complications in the SM group than in the IBR group (p 0,01). According to our study, the raw proportion of initially possible IBR was 68 % (36 % of breast reconstruction in this study). CONCLUSION: This analyse approve IBR in selected patients. In this context, INCa's guidelines (2022) can generalize IBR's proposal to patients. However, the analysis of pre-operative risk factors stay essential in medical care.

A new method of adhesive system application improves the bond strength between fiber post and root dentin

Abstract This study evaluated a new method of adhesive system application on the bond strength between fiber post and root dentin using two adhesive systems. The canals of sixty bovine incisors were prepared and obturated. The roots were divided into six groups (n=10) according to the adhesive system (Clearfil SE - CSE and Single Bond Universal - SBU) and the application strategy (microbrush - MB; rotary brush - RB; and ultrasonic tip - US). The glass fiber posts were cemented with resin cement (RelyX ARC). The roots were sectioned perpendicularly to their long axis, and three slices per root were obtained. Previously to the push-out test, confocal laser scanning microscopy (CLSM) was performed to illustrate the interfacial adaptation of the cement to the root canal walls. Failure patterns were analyzed with 40x magnification. Shapiro-Wilk indicated a normal distribution of the data. The bond strength values were compared using one-way ANOVA and Tukey's tests. Student's T test analyzed the differences between the adhesive systems within each third and protocol. A significance level of 5% was used. CSE with RB showed higher mean bond strength values compared to MB (conventional technique) (P < 0.05). US application resulted in intermediate bond strength values for CSE (P > 0.05). The application of SBU using RB generated higher mean bond strength values compared to MB and US (P < 0.05). Adhesive failures were predominant (65.5%). CSE and SBU application with the new rotary brush improved the bond strength of fiber posts to root dentin compared to the conventional strategy.

Resumo Este estudo avaliou o efeito de um novo método para aplicação do sistema adesivo na resistência de união entre pino de fibra e dentina radicular usando dois sistemas adesivos. Os canais de sessenta incisivos bovinos foram preparados e obturados. As raízes foram divididas em seis grupos (n=10) de acordo com o sistema adesivo (Clearfil SE - CSE e Single Bond Universal - SBU) e com a estratégia de aplicação (microbrush - MB, escova rotatória - RB e inserto ultrassônico - US). Os pinos de fibra foram cimentados utilizando cimento resinoso (RelyX ARC). As raízes foram seccionadas perpendicularmente ao seu longo eixo e três fatias foram obtidas. Previamente ao teste de push-out, foi realizada microscopia de varredura confocal a laser para ilustrar a adaptação interfacial do cimento às paredes do canal radicular. Os padrões de falha foram analisados com magnificação de 40x. O teste de Shapiro-Wilk indicou distribuição normal dos dados. Os valores de resistência de união foram comparados usando o teste ANOVA de uma via e post hoc de Tukey. As diferenças entre os sistemas adesivos em cada terço e de acordo com cada protocolo foram analisadas pelo teste T de Student. O nível de significância foi de 5%. CSE aplicado com RB apresentou maiores valores médios de resistência de união do que quando aplicado com MB (técnica convencional) (P<0,05). Aplicação com US apresentou valores intermediários de resistência de união para o CSE (P>0,05). A aplicação do SBU utilizando RB gerou maiores valores médios de resistência de união comparados com MB e US (P<0,05). Falhas adesivas foram predominantes (65,5%). A aplicação do CSE e SBU com a nova escova rotatória melhorou a resistência de união dos pinos de fibra à dentina radicular comparados com a estratégia convencional.

Complementary and Integrative Medicine: a plea for a better resource allocation by the SwissDRG grouping algorithm.

No abstract available.

Effects of a physical activity and endometriosis-based education program delivered by videoconference on endometriosis symptoms: the CRESCENDO program (inCRease physical Exercise and Sport to Combat ENDOmetriosis) protocol study.

BACKGROUND: Endometriosis is a chronic disease characterized by growth of endometrial tissue outside the uterine cavity which could affect 200 million women (The term "woman" is used for convenience. Individuals gendered as man or as nonbinary can also suffer from this disease) worldwide. One of the most common symptoms of endometriosis is pelvic chronic pain associated with fatigue. This pain can cause psychological distress and interpersonal difficulties. As for several chronic diseases, adapted physical activity could help to manage the physical and psychological symptoms. The present study will investigate the effects of a videoconference-based adapted physical activity combined with endometriosis-based education program on quality of life, pain, fatigue, and other psychological symptoms and on physical activity. METHODS: This multicentric randomized-controlled trial will propose to 200 patients with endometriosis to be part of a trial which includes a 6-month program with 45 min to more than 120 min a week of adapted physical activity and/or 12 sessions of endometriosis-based education program. Effects of the program will be compared to a control group in which patients will be placed on a waiting list. All participants will be followed up 3 and 6 months after the intervention. None of the participants will be blind to the allocated trial arm. The primary outcome measure will be quality of life. Secondary outcomes will include endometriosis-related perceived pain, fatigue, physical activity, and also self-image, stereotypes, motivational variables, perceived support, kinesiophobia, basic psychological need related to physical activity, and physical activity barriers. General linear models and multilevel models will be performed. Predictor, moderator, and mediator variables will be investigated. DISCUSSION: This study is one of the first trials to test the effects of a combined adapted physical activity and education program for improving endometriosis symptoms and physical activity. The results will help to improve care for patients with endometriosis. TRIAL REGISTRATION: ClinicalTrials.gov, NCT05831735 . Date of registration: April 25, 2023.

Anterior sacrospinous ligament fixation by the vaginal route in ten steps.

Pelvic organ prolapse (POP) is a common condition affecting women, characterized by the descent of pelvic organs such as the vagina and uterus. While POP may not always cause symptoms, it can significantly impact a woman's quality of life. Diagnosis is typically made through clinical examination, and treatment options range from pelvic-floor physical therapy to surgery. Anterior sacrospinous ligament fixation (ASSLF) has emerged as a viable technique for treating apical prolapse vaginally. This procedure involves attaching the cervix or vaginal vault to the sacrospinous ligament, providing satisfactory results in the short term. Compared to the posterior approach, ASSLF shows similar efficacy, shorter operative time, and potentially fewer complications. Vaginal surgery offers advantages such as lower morbidity and cost, ability to address other pelvic conditions simultaneously, and suitability for managing recurrences. The presented case involves a 72-year-old woman with stage 3 cystocele, stage 3 hysterocele, stage 1 rectocele, and severe voiding dysfunction. After unsuccessful attempts with a pessary, surgical intervention becomes necessary. An instructive video article has been created to standardize the essential steps of ASSLF and facilitate resident education. The video demonstrates ten surgical steps, including installation/exposure, anterior vaginal wall infiltration, median anterior colpotomy, vesico-vaginal dissection, paravesical dissection, sacrospinous ligament suture, cystocele correction, colpotomy and vaginal wall repair, uterine anterior isthmus suture and sacrospinous ligament fixation, and colporrhaphy final closure. In conclusion, POP is a prevalent condition that can be effectively managed through techniques like ASSLF. Vaginal surgery offers several advantages, and proper training and standardization of surgical steps contribute to successful outcomes and resident education.

Mercury contamination in the tropical seabird community from Clipperton Island, eastern Pacific Ocean.

Mercury (Hg) pollution is a global problem affecting remote areas of the open ocean, but the bioaccumulation of this neurotoxic pollutant in tropical top predators remains poorly documented. The objective of this study was to determine Hg contamination of the seabird community nesting on Clipperton Island using blood and feathers to investigate short and longer-term contamination, respectively. We examined the significance of various factors (species, sex, feeding habitat [δ13C] and trophic position [δ15N]) on Hg concentrations in six seabird species. Among species, Great Frigatebirds had the highest Hg concentrations in blood and feathers, boobies had intermediate values, and Brown Noddies and Sooty Terns the lowest. At the interspecific level, although δ13C values segregated boobies from frigatebirds and noddies/terns, Hg concentrations were explained by neither δ13C nor δ15N values. At the intraspecific level, both Hg concentrations in blood and feathers show relatively small variations (16-32 and 26-74%, respectively), suggesting that feeding ecology had low seasonal variation among individuals. Despite most species being sexually dimorphic, differences in Hg contamination according to sex was detected only in Brown Boobies during the breeding period. Indeed, female Brown Boobies feed at a higher trophic level and in a different area than males during this period, resulting in higher blood Hg concentrations. The present study also shows that most of the seabirds sampled at Clipperton Island had little or no exposure to Hg toxicity, with 30% in the no risk category and 70% in the low risk category.

Investigating two consecutive catastrophic breeding seasons in a large king penguin colony.

Large-scale breeding failures, such as offspring die-offs, can disproportionately impact wildlife populations that are characterized by a few large colonies. However, breeding monitoring-and thus investigations of such die-offs-is especially challenging in species with long reproductive cycles. We investigate two unresolved dramatic breeding failures that occurred in consecutive years (2009 and 2010) in a large king penguin Aptenodytes patagonicus colony, a long-lived species with a breeding cycle lasting over a year. Here we found that a single period, winter 2009, was likely responsible for the occurrence of breeding anomalies during both breeding seasons, suggesting that adults experienced poor foraging conditions at sea at that time. Following that unfavorable winter, the 2009 breeding cohort-who were entering the late stage of chick-rearing-immediately experienced high chick mortality. Meanwhile, the 2010 breeding cohort greatly delayed their arrival and egg laying, which would have otherwise started not long after the winter. The 2010 breeding season continued to display anomalies during the incubation and chick-rearing period, such as high abandonment rate, long foraging trips and eventually the death of all chicks in winter 2010. These anomalies could have resulted from either a domino-effect caused by the delayed laying, the continuation of poor foraging conditions, or both. This study provides an example of a large-scale catastrophic breeding failure and highlights the importance of the winter period on phenology and reproduction success for wildlife that breed in few large colonies.

Intramedullary histoplasmosis of the thoracic cord as an isolated lesion: A rare case report and literature review.

Background: Disseminated histoplasmosis involving the central nervous system occurs in 5-10% of cases. However, intramedullary spinal cord lesions are extremely rare. Here, 45-year-old female with a T8-9 intramedullary lesion did well following surgical extirpation. Case Description: For 2 weeks, a 45-year-old female experienced progressive lower back pain, paresthesias, and paraparesis. The magnetic resonance imaging showed an intramedullary expansive lesion at the T8-T9 level that markedly enhanced with contrast. Surgery, consisting of T8-T10 laminectomies performed using neuronavigation, an operating microscope, and intraoperative monitoring, revealed a well-demarcated lesion that proved to be a focus of histoplasmosis; it was readily completely excised. Conclusion: Surgery is the gold standard for treating spinal cord compression attributed to intramedullary histoplasmosis unresponsive to medical management.

Alzheimer's disease: an epidemiological analysis over the number of hospitalizations and deaths in Brazil.

BACKGROUND: Alzheimer's disease (AD) is a neurodegenerative condition characterized by impaired cognitive function. It results in high morbidity, including a large number of hospitalizations, and mortality, generating high costs to health systems. OBJECTIVE: The present epidemiological analysis evaluated the number of hospitalizations and deaths by AD as the main diagnosis in Brazil between 2010 and 2020. This endeavor should contribute to a better understanding of the disease and its implications. METHODS: The present analytical, observational, longitudinal, and retrospective study used data extracted from the Department of Informatics of the Brazilian Unified Health System (DATASUS, in the Portuguese acronym). The variables include the number of hospitalizations, the total cost spent, the average cost per hospitalization, the average length of hospital stay, the number of deaths during hospitalization, the mortality rate per hospitalization, sex, age group, region, and race. RESULTS: From 2010 to 2020, there were 188,811 deaths and 13,882 hospitalizations for AD, with a total expenditure of BRL 25,953,019.40 in hospitalizations. The average length of hospital stay was 25 days. Over the considered period, mortality, the number of hospitalizations, and the total cost increased while the average length of stay decreased. CONCLUSION: From 2010 to 2020, AD represented a large portion of hospital admissions, generating a significant cost to the health system and a large number of deaths. These data are important to undertake joint efforts to prevent hospitalizations of these patients in order to minimize impacts on the health system.

ANTECEDENTES: A doença de Alzheimer (DA) é uma doença neurodegenerativa caracterizada pelo comprometimento da função cognitiva. Resulta em uma alta taxa de morbimortalidade, por meio de um número significativo de óbitos e internações, gerando um alto custo ao sistema de saúde. OBJETIVO: Realizar uma análise epidemiológica, utilizando as variáveis citadas abaixo, por DA como principal diagnóstico, no Brasil, entre 2010 e 2020, a fim de contribuir para um melhor entendimento da doença e suas implicações. MéTODOS: Estudo analítico, observacional, longitudinal e retrospectivo. Os dados foram extraídos do Departamento de Informática do Sistema Único de Saúde (DATASUS). As variáveis utilizadas foram número de internações, custo total gasto, custo médio por internação, tempo médio de internação, número de óbitos nas internações, taxa de mortalidade por internação, número de óbitos absolutos, sexo, faixa etária, região e raça. RESULTADOS: De 2010 a 2020, foram registrados 188.811 óbitos e 13.882 internações por DA, com um gasto total de R$ 25.953.019,40 em internações. O tempo médio de permanência no hospital foi de 25 dias. Em 11 anos, houve aumento da mortalidade, internações e custo total; por outro lado, o tempo médio de permanência, no mesmo período, diminuiu. CONCLUSãO: A DA, nos anos avaliados, representa uma parcela significativa das internações hospitalares, gerando um custo significativo ao sistema de saúde, além do número de óbitos. Estes dados são importantes para gerar esforços conjuntos para evitar internações desses pacientes, a fim de minimizar o impacto no Sistema de Saúde.

Impact of cervical excisional dimensions on endocervical margins status in adenocarcinoma in situ of the uterine cervix: A multicenter study from the FRANCOGYN group.

OBJECTIVE: Excisional procedures have a central role in the management of adenocarcinoma in situ of the cervix (AIS). We aimed to evaluate the relationship between the excisional specimen dimensions and the endocervical margin status. METHODS: We conducted a multicentric retrospective study in seven French centers. All cases with proven AIS on a colposcopic biopsy and undergoing an excisional procedure afterwards were included in the analysis. We evaluated the impact of excision length, along with the lateral and anteroposterior diameters on the endocervical margin status. An additional subgroup analysis of the impact of maternal age on endocervical margin status was also conducted. RESULTS: Of the 101 cases of AIS diagnosed on initial biopsy, 95 underwent a primary excisional procedure, among which 80% (n = 76/95) had uninvolved endocervical margins and 20% (n = 19/95) had positive endocervical margins. The excisional specimen length was not significantly related to the endocervical margin status. Conversely, both lateral and antero-posterior diameters were significantly correlated with the negative endocervical margins status: OR = 1,19, 95% CI [1.03, 1.40], p = 0.025, for the lateral diameter and OR = 1.34, 95% CI [1.14, 1.64], p = 0.001 for the antero-posterior diameter. The median lateral diameter was 20 mm, IQR (18, 24) in case of endocervical negative margins vs. 18 mm IQR (15, 24) in case of positive endocervical margins (p = 0.039), and the median anteroposterior diameter was 17 mm IQR (15, 20) in case of negative endocervical margins vs 14 mm IQR (11, 15) in case of positive endocervical margins (p = 0.004), respectively.  Additionally, in patients over 45 years old, endocervical margin were more likely to be positive despite similar excisional dimensions (7/17 (41%) of positive endocercival margins before 45 years old vs 12/78 (15%) after, p = 0.039) CONCLUSIONS: Endocervical margin statues were significantly related to the transverse diameters (lateral and anteroposterior diameters), but not to the excision specimen length. Reducing the excised length may lead to fewer post-procedure complications but would still allow to obtain a large proportion of negative endocervical margins.

Alzheimer's disease: an epidemiological analysis over the number of hospitalizations and deaths in Brazil / Doença de Alzheimer: análise epidemiológica frente ao número de internações e óbitos no Brasil

Abstract Background Alzheimer's disease (AD) is a neurodegenerative condition characterized by impaired cognitive function. It results in high morbidity, including a large number of hospitalizations, and mortality, generating high costs to health systems. Objective The present epidemiological analysis evaluated the number of hospitalizations and deaths by AD as the main diagnosis in Brazil between 2010 and 2020. This endeavor should contribute to a better understanding of the disease and its implications. Methods The present analytical, observational, longitudinal, and retrospective study used data extracted from the Department of Informatics of the Brazilian Unified Health System (DATASUS, in the Portuguese acronym). The variables include the number of hospitalizations, the total cost spent, the average cost per hospitalization, the average length of hospital stay, the number of deaths during hospitalization, the mortality rate per hospitalization, sex, age group, region, and race. Results From 2010 to 2020, there were 188,811 deaths and 13,882 hospitalizations for AD, with a total expenditure of BRL 25,953,019.40 in hospitalizations. The average length of hospital stay was 25 days. Over the considered period, mortality, the number of hospitalizations, and the total cost increased while the average length of stay decreased. Conclusion From 2010 to 2020, AD represented a large portion of hospital admissions, generating a significant cost to the health system and a large number of deaths. These data are important to undertake joint efforts to prevent hospitalizations of these patients in order to minimize impacts on the health system.

Resumo Antecedentes A doença de Alzheimer (DA) é uma doença neurodegenerativa caracterizada pelo comprometimento da função cognitiva. Resulta em uma alta taxa de morbimortalidade, por meio de um número significativo de óbitos e internações, gerando um alto custo ao sistema de saúde. Objetivo Realizar uma análise epidemiológica, utilizando as variáveis citadas abaixo, por DA como principal diagnóstico, no Brasil, entre 2010 e 2020, a fim de contribuir para um melhor entendimento da doença e suas implicações. Métodos Estudo analítico, observacional, longitudinal e retrospectivo. Os dados foram extraídos do Departamento de Informática do Sistema Único de Saúde (DATASUS). As variáveis utilizadas foram número de internações, custo total gasto, custo médio por internação, tempo médio de internação, número de óbitos nas internações, taxa de mortalidade por internação, número de óbitos absolutos, sexo, faixa etária, região e raça. Resultados De 2010 a 2020, foram registrados 188.811 óbitos e 13.882 internações por DA, com um gasto total de R$ 25.953.019,40 em internações. O tempo médio de permanência no hospital foi de 25 dias. Em 11 anos, houve aumento da mortalidade, internações e custo total; por outro lado, o tempo médio de permanência, no mesmo período, diminuiu. Conclusão A DA, nos anos avaliados, representa uma parcela significativa das internações hospitalares, gerando um custo significativo ao sistema de saúde, além do número de óbitos. Estes dados são importantes para gerar esforços conjuntos para evitar internações desses pacientes, a fim de minimizar o impacto no Sistema de Saúde.