Locally unresectable differentiated thyroid cancer: outcomes and perspectives.

PURPOSE: Differentiated thyroid cancer (DTC) patients with an unresectable primary tumor cannot benefit from curative surgery, and radioiodine treatment for locoregional and distant disease is not possible with the thyroid gland still in place. Due to local invasion, these patients cannot be included in clinical trials, so that treatment options are limited. The aim of this study was to describe the characteristics and the prognosis of patients with these locally unresectable DTC. PATIENTS AND METHODS: A retrospective and multicentric analysis of consecutive cases of unresectable DTC diagnosed between 2000 and 2015 was performed. RESULTS: The study population consisted in 22 patients, 13 females (59%); median age: 77 years (range: 52-91). Thyroid tumors were papillary in six, follicular in seven, Hürthle cell in one and poorly differentiated in eight patients. Patients were treated with external beam radiation therapy (EBRT) (57%), locoregional therapy of distant metastases (41%), cytotoxic chemotherapy (38%) and tyrosine kinase inhibitors (TKIs) (33%). TKI treatment resulted in median disease control duration of 7 months with a grade 3-4 toxicity rate of 44%. Only one patient had a total thyroidectomy after neo-adjuvant EBRT. The 1, 3 and 5-year cumulative survival rate was 81%, 27.7% and 21.5%, respectively. The cause of death was DTC in 11 cases (local progression in 7), and to other causes in 7 cases; no patient died from treatment toxicity. CONCLUSIONS: Clinical trials and approved treatments are lacking for unresectable DTC. TKI treatment may allow prolonged disease control with acceptable toxicity.

A MOOC About Bariatric Surgery Improves Knowledge and Promotes Patients' Soft Skills.

The ASMBS recommends that patients should be provided with educational materials to improve informed consent about bariatric surgery. Massive online open courses (MOOCs) are learning sources which are free, online, and available to people in remote situations. A French language MOOC regarding preparation for obesity surgery targets patients, as well as HCP, and people curious about this treatment. The patients' knowledge and skills after completion of the 5-week learning sessions (evaluated with semi-direct interviews) improved. Soft skills such as feeling empowered to ask questions to their HCP and explaining their plan to their relatives improved. This study suggests that MOOC can be a resource to improve knowledge and soft skills in patients for a better consent to surgery and follow-up.

Prognostic significance of visible cardiophrenic angle lymph nodes in the presence of peritoneal metastases from colorectal cancers.

BACKGROUND: Visible cardiophrenic angle lymph nodes (CPALN) (enlarged or not), detected on CT scan are correlated with the presence of peritoneal metastases (PM), and contribute to the diagnosis of PM in colorectal cancer patients. OBJECTIVE: To study whether visible CPALN exert a prognostic impact on survival after complete cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (CCRS + HIPEC) treating PM. PATIENTS AND METHODS: From 1999 to 2010, 114 patients with colorectal cancer and PM were treated with CCRS + HIPEC. CPALN were depicted in 64% of cases. The impact of visible CPALN on survival was investigated retrospectively. RESULTS: The mean peritoneal cancer index (PCI) score was 9.2, 21% of the patients had presented with associated liver metastases, and 71% of the women with ovarian metastases. Median follow-up was 3.9 years. Visible CPALN had no impact on OS nor on DFS, unlike the PCI score which was unequivocably the most potent prognostic factor in the multivariate analysis. CONCLUSION: Although some arguments might suggest that CPALN are malignant, paradoxically, we found that visible CPALN did not exert a positive nor a negative impact on survival after CCRS + HIPEC. SYNOPSIS: Visible cardiophrenic angle lymph nodes (CPALN) on CT-scan are strongly associated with the presence of peritoneal metastases. But this study demonstrates that the presence of CPALN has no prognostic impact after optimal cytoreductive surgery plus HIPEC.

Value of cardiophrenic angle lymph node for the diagnosis of colorectal peritoneal carcinomatosis.

BACKGROUND: Cardiophrenic angle lymph nodes (CPALN) have been reported in patients with abdominopelvic malignancies. We aimed to assess whether the presence of CPALN is associated with peritoneal carcinomatosis (PC) in colorectal cancer. PATIENTS AND METHODS: Between 2007 and 2011, 550 patients with colorectal cancer, including 165 (30%) with PC, had undergone surgery with complete peritoneal exploration. We retrospectively reviewed preoperative CT scans for the presence of CPALN and assessed its association with confirmed PC by univariate and multivariate analyses. RESULTS: CPALN were present in 123 (75%) patients with PC, but absent in 263 (68%) patients without PC (Se: 0.72; Sp: 0.68; PPV: 0.49; NPV: 0.85; [OR], 3.3; p<0.001). PC was the only factor independently associated with CPALN in the multivariate analysis. CPALN was not correlated with the presence of liver metastases. 99 of the 165 patients with PC (62%) had visible signs of PC on CT scan. Among the remaining 66 patients, CPALN were the only potential sign of PC in 41 (62%), (Se 0.62, Sp 0.68, PPV 0.24, and NPV 0.92). CONCLUSION: The detection of CPALN on CT may be of valuable help for the diagnosis of PC in patients with CRC.

The effect of maternal linseed supplementation and/or lamb linseed supplementation on muscle and subcutaneous adipose tissue fatty acid composition of indoor lambs.

Eighty eight lambs were used in a 2×2 factorial arrangement 1) to investigate the effect of maternal dietary linseed supplementation and/or lamb linseed supplemented concentrate on growth performance, carcass fat quality and fatty acid (FA) composition of muscle and dorsal adipose tissue of indoor lambs 2) to study the relationships between subcutaneous fat quality and FA composition. Feeding linseed to ewes increased C18:3 n-3 (ALA) proportion in milk and therefore the ALA supply to suckling lambs. However, ALA and n-3 polyunsaturated FA (n-3 PUFA) proportions in lamb tissues were not affected. Feeding linseed to lambs during the post-weaning period significantly increased the proportions of ALA and n-3 PUFA in tissues. Softer and more colored fat was associated with a decrease in even medium-chain saturated FA and increases in odd and methyl FA proportions but not with ALA proportion in subcutaneous adipose tissue.

New insights into the influence of breed and time of the year on the response of ewes to the 'ram effect'.

Exposure of anoestrous ewes to rams induces an increase in LH secretion, eventually leading to ovulation. This technique therefore is an effective, low-cost and hormone-free way of mating sheep outside the breeding season. However, the use of this technique is limited by the variability of the ewes' responses. In this study, our objective was to understand more completely the origins of this variability and to determine the relative roles of breed, the point in time during anoestrus and the depth of anoestrus on the response to the 'ram effect'. In the first experiment, the pattern of anoestrus on the basis of the concentration of progesterone determined weekly, was determined in four breeds including two less seasonal (Mérinos d'Arles and Romane), one highly seasonal (Mouton Vendéen) and one intermediate (Île-de-France) breeds. Anoestrus was longer and deeper in Mouton Vendéen and Île-de-France than in Romane or Mérinos d'Arles. In the second experiment, we used the same four breeds and tested their hypophyseal response to a challenge with a single dose of 75 ng gonadotrophin-releasing hormone (GnRH) in early, mid and late anoestrus, and then we examined their endocrine and ovarian responses to the 'ram effect'. Most (97%) ewes responded to GnRH and most (93%) showed a short-term increase in LH pulsatility following the 'ram effect'. The responses in both cases were higher in females that went on to ovulate, suggesting that the magnitude of the hypophyseal response to a GnRH challenge could be a predictor of the response to the 'ram effect'. As previously observed, the best ovarian response was in Mérinos d'Arles at the end of anoestrus. However, there was no relationship between the proportion of females in the flock showing spontaneous ovulation and the response to the 'ram effect' of anoestrous ewes from the same flock.

[Slow progression of a ground glass lesion - need for long term vigilance]. / Un nodule en verre dépoli d'évolution très lente: savoir rester vigilant!

INTRODUCTION: The identification of a ground-glass opacity on chest CT is a frequent problem because of the number of exams performed. OBSERVATION: We report the case of a man of 66 years with a very slowly increasing ground-glass opacity during 5 years. Although the lesion was negative for positron emission tomography and because of its increasing size and the appearance of a solid part, our patient underwent surgery. The final diagnosis was stage I adenocarcinoma. CONCLUSIONS: The management of a ground glass opacity differs from solid nodules of the lung. The rate of malignancy is high in the published studies, especially in south-east Asia. PET is not as useful as for solid nodules. Long term follow up is necessary because of the long doubling time in these neoplasms.

Effect of level of linseed on fatty acid composition of muscles and adipose tissues of lambs with emphasis on trans fatty acids.

The effects of linseed content in concentrates on the fatty acid (FA) composition of adipose tissues and muscles of lambs were studied in a 2×4 design: males (M) vs. females (F) and linseed content (0%, L0, 3%, L3, 6%, L6, 9%, L9). FA proportions were determined both on a DB-wax and on a CP-Sil column in perirenal (PR), dorsal subcutaneous (SC) adipose tissue and in longissusmus dorsi muscle (IM). No effects of linseed contents in the diet on growth performances either in male or female lambs were observed. Linseed supplementation tended to decrease the fatness score. The proportion of linolenic acid increased linearly with the linseed content in the diet, from: 0.6, 0.5, and 0.5% for L0 to 1.9, 1.6, and 1.3% for L9, in PR, SC and IM, respectively. The increase in n-3 PUFA and in total PUFA was similar to that of linolenic acid. The n-6:n-3 ratio decreased from 5.7, 5.3 and 5.8 for L0 to 1.8, 1.7 and 2.7 for L9, in PR, SC and IM, respectively. There was no change in the proportion of docosahexaenoic acid with linseed supplementation. The proportions of C18:1trans-10 and C18:1trans-11 did not vary in PR, SC and IM with linseed supplementation. The total proportion of trans-octadecenoic acid was high in each tissue type and group of lambs. C18:1trans-10 represented about half of the total trans-octadecenoic isomers. With an increase in linolenic acid, most cis- and trans-octadecenoic isomers also increased, but trans-10 and trans-11 isomers did not and cis-9 and cis-11 isomers decreased. With linseed supplementation there was a decrease in the Δ9 desaturase indices in SC.

Raman investigation of calcium carbonate bone substitutes and related biomaterials.

The interaction between biomaterials used in surgical procedures and the host bone is not yet perfectly understood. It appears that these problems may have been encountered because of insufficient characterisation of the basic component used in the synthesis of such biomaterials. Calcium carbonate (CaCO3) is interesting for bone filling or regeneration procedures because of its resorbability. The aim of this work is to compare different CaCO3 biomaterials and their basic source with the help of microRaman spectroscopy. Bionacre and Biocoral are analysed. The main bands of carbonate internal modes are observed around 1084-86 and 704-12 cm-1. In the lattice modes region, for both Biocoral and synthetic aragonite, two bands at 206 and 155 cm-1 are observed. The eggshell, oyster shell and synthetic calcite samples exhibit bands at 281 and 155 cm-1. Three bands are present at 280, 206 and 155 cm-1 on the Bionacre sample. The 206 and the 280 cm-1 bands are due to aragonite and calcite forms respectively. Therefore it appears to be a mixture of aragonite and calcite whereas Biocoral is pure aragonite. Additional Raman investigations should be of great interest in evaluating the structural modifications and their influence on the biological behaviour of these biomaterials. Lity index, the percentage of prematurity and of low birth weight are the indices of national health status.

Effects of dental plaque antiseptic decontamination on bacterial colonization and nosocomial infections in critically ill patients.

OBJECTIVES: To document in intensive care unit (ICU) patients the effect of dental plaque antiseptic decontamination on the occurrence of plaque colonization by aerobic nosocomial pathogens and nosocomial infections. DESIGN: Single-blind randomized comparative study. SETTING: A 16-bed adult intensive care unit in a university hospital. PATIENTS: Patients consecutively admitted in the ICU with a medical condition suggesting an ICU stay of 5 days and requiring mechanical ventilation. INTERVENTIONS: After randomization, the treated group received dental plaque decontamination with 0.2% chlorhexidine gel, three times a day during the ICU stay. The control group received standard oral care. SPECIFIC MEASUREMENTS: Dental status was assessed by the Caries-Absent-Occluded index; the amount of dental plaque was assessed by a semi-quantitative plaque index. Bacterial sampling of dental plaque, nasal and tracheal aspirate, blood, and urine cultures were done on days 0, 5, 10, and every week. MAIN RESULTS: Sixty patients were included; 30 in the treated group and 30 in the control one (mean age: 51 +/- 16 years; mean Simplified Acute Physiological Score II: 35 +/- 14 points). On admission, no significant differences were found between both groups for all clinical and dental data. Compared with the control group, the nosocomial infection rate and the incidence densities related to risk exposition were significantly lower in the treated group (18 vs 33% days in the ICU and 10.7 vs 32.3% days of mechanical ventilation; P < 0.05). These results were consistent with a significant preventive effect of the antiseptic decontamination (Odds Ratio: 0.27; 95% CI: 0.09; 0.80) with a 53% relative risk reduction. There was a trend to a reduction of mortality, length of stay, and duration of mechanical ventilation. CONCLUSIONS: An antiseptic decontamination of dental plaque with a 0.2% chlorhexidine gel decreases dental bacterial colonization, and may reduce the incidence of nosocomial infections in ICU patients submitted to mechanical ventilation.