Incidence of persistent postoperative opioid use in patients undergoing ambulatory surgery: a retrospective cohort study.

The opioid crisis remains a major public health concern. In ambulatory surgery, persistent postoperative opioid use is poorly described and temporal trends are unknown. A population-based retrospective cohort study was undertaken in Ontario, Canada using routinely collected administrative data for adults undergoing ambulatory surgery between 1 January 2013 and 31 December 2017. The primary outcome was persistent postoperative opioid use, defined using best-practice methods. Multivariable generalised linear models were used to estimate the association of persistent postoperative opioid use with prognostic factors. Temporal trends in opioid use were examined using monthly time series, adjusting for patient-, surgical- and hospital-level variables. Of 340,013 patients, 44,224 (13.0%, 95%CI 12.9-13.1%) developed persistent postoperative opioid use after surgery. Following multivariable adjustment, the strongest predictors of persistent postoperative opioid use were pre-operative: utilisation of opioids (OR 9.51, 95%CI 8.69-10.39); opioid tolerance (OR 88.22, 95%CI 77.21-100.79); and utilisation of benzodiazepines (OR 13.75, 95%CI 12.89-14.86). The time series model demonstrated a small but significant trend towards decreasing persistent postoperative opioid use over time (adjusted percentage change per year -0.51%, 95%CI -0.83 to -0.19%, p = 0.003). More than 10% of patients who underwent ambulatory surgery experienced persistent postoperative opioid use; however, there was a temporal trend towards a reduction in persistent opioid use after surgery. Future studies are needed that focus on interventions which reduce persistent postoperative opioid use.

Stable Operation of a Free-Electron Laser Driven by a Plasma Accelerator.

The breakthrough provided by plasma-based accelerators enabled unprecedented accelerating fields by boosting electron beams to gigaelectronvolt energies within a few centimeters [1-4]. This, in turn, allows the realization of ultracompact light sources based on free-electron lasers (FELs) [5], as demonstrated by two pioneering experiments that reported the observation of self-amplified spontaneous emission (SASE) driven by plasma-accelerated beams [6,7]. However, the lack of stability and reproducibility due to the intrinsic nature of the SASE process (whose amplification starts from the shot noise of the electron beam) may hinder their effective implementation for user purposes. Here, we report a proof-of-principle experiment using plasma-accelerated beams to generate stable and reproducible FEL light seeded by an external laser. FEL radiation is emitted in the infrared range, showing the typical exponential growth of its energy over six consecutive undulators. Compared to SASE, the seeded FEL pulses have energies 2 orders of magnitude larger and stability that is 3 times higher.

Free-electron lasing with compact beam-driven plasma wakefield accelerator.

The possibility to accelerate electron beams to ultra-relativistic velocities over short distances by using plasma-based technology holds the potential for a revolution in the field of particle accelerators1-4. The compact nature of plasma-based accelerators would allow the realization of table-top machines capable of driving a free-electron laser (FEL)5, a formidable tool to investigate matter at the sub-atomic level by generating coherent light pulses with sub-ångström wavelengths and sub-femtosecond durations6,7. So far, however, the high-energy electron beams required to operate FELs had to be obtained through the use of conventional large-size radio-frequency (RF) accelerators, bound to a sizeable footprint as a result of their limited accelerating fields. Here we report the experimental evidence of FEL lasing by a compact (3-cm) particle-beam-driven plasma accelerator. The accelerated beams are completely characterized in the six-dimensional phase space and have high quality, comparable with state-of-the-art accelerators8. This allowed the observation of narrow-band amplified radiation in the infrared range with typical exponential growth of its intensity over six consecutive undulators. This proof-of-principle experiment represents a fundamental milestone in the use of plasma-based accelerators, contributing to the development of next-generation compact facilities for user-oriented applications9.

Long-term outcomes and safety after reirradiation in locally recurrent nasopharyngeal carcinoma in a non-endemic area.

PURPOSE: To determine outcomes and toxicities after reirradiation for locally recurrent nasopharyngeal carcinoma (rNPC) and to apply a prognostic index in a non-endemic region. METHODS: We retrospectively reported progression-free survival (PFS), overall survival (OS), and treatment-related toxicities in patients treated with curative intent for locally rNPC. We applied the prognostic model for OS and grade 5 radiotherapy (RT)-related toxicities published by Li et al. and evaluated its prognostic accuracy by receiver operating characteristic (ROC) curve analysis. RESULTS: Between 2005 and 2018, 33 patients were treated for rNPC in our institution. Median follow-up was 60 months. The mean time to local recurrence was 75 months. Six (18%) patients had a persistent grade 3 toxicity from a previous RT course. The median re-RT dose was 66 Gy. After re-RT, 13 patients had local failure and 3 patients had metastatic recurrence. Median PFS was 18 months with a 5-year PFS rate of 29%. Median OS was 35 months with a 5-year OS rate of 37%. Grade 3 or higher toxicities rate was 74%. There were 21% grade 5 toxicities. The median time to a grade 5 toxicity was less than 6 months following re-RT. The prognostic nomogram was not predictive for OS or grade 5 toxicities. CONCLUSION: Reirradiation of rNPC is an effective treatment but is associated with a high rate of life-threatening toxicity. Stratification of patients based on their risk of developing severe toxicity is needed to select patients who will most likely benefit from re-RT.

Characterizing most irregular small-scale structures in turbulence using local Hölder exponents.

Two scalar fields characterizing respectively pseudo-Hölder exponents and local energy transfers are used to capture the topology and the dynamics of the velocity fields in areas of lesser regularity. The present analysis is conducted using velocity fields from two direct numerical simulations of the Navier-Stokes equations in a triply periodic domain. A typical irregular structure is obtained by averaging over the 213 most irregular events. Such structure is similar to a Burgers vortex, with nonaxisymmetric corrections. A possible explanation for such asymmetry is provided by a detailed time-resolved analysis of birth and death of the irregular structures, which shows that they are connected to vortex interactions, possibly vortex reconnection.

[Individualization of dose and fractionation of radiotherapy for head and neck cancers]. / Personnalisation de la dose et du fractionnement de la radiothérapie des cancers de la tête et du cou.

Head and neck cancers comprise a variety of tumours depending on the sub-site, for which target volumes and the prescribed doses need to be individualized according to each patient's history and presentation. This article aims at describing the main factors involved in decision-making regarding dose and volume, as well as ongoing research. Contouring and treatment guidelines, use of altered fractionation, major prognostic factors, the role of Human papillomavirus and of functional imaging will be presented and discussed.

Local estimates of Hölder exponents in turbulent vector fields.

It is still not known whether solutions to the Navier-Stokes equation can develop singularities from regular initial conditions. In particular, a classical and unsolved problem is to prove that the velocity field is Hölder continuous with some exponent h<1 (i.e., not necessarily differentiable) at small scales. Different methods have already been proposed to explore the regularity properties of the velocity field and the estimate of its Hölder exponent h. A first method is to detect potential singularities via extrema of an "inertial" dissipation D*=lim_{ℓ→0}D_{ℓ}^{I} that is independent of viscosity [Duchon and Robert, Nonlinearity 13, 249 (2000)0951-771510.1088/0951-7715/13/1/312]. Another possibility is to use the concept of multifractal analysis that provides fractal dimensions of the subspace of exponents h. However, the multifractal analysis is a global statistical method that only provides global information about local Hölder exponents, via their probability of occurrence. In order to explore the local regularity properties of a velocity field, we have developed a local statistical analysis that estimates locally the Hölder continuity. We have compared outcomes of our analysis with results using the inertial energy dissipation D_{ℓ}^{I}. We observe that the dissipation term indeed gets bigger for velocity fields that are less regular according to our estimates. The exact spatial distribution of the local Hölder exponents however shows nontrivial behavior and does not exactly match the distribution of the inertial dissipation.

Interactions between cancer-associated fibroblasts and tumor cells promote MCL-1 dependency in estrogen receptor-positive breast cancers.

Selective inhibition of BCL-2 is expected to enhance therapeutic vulnerability in luminal estrogen receptor-positive breast cancers. We show here that the BCL-2 dependency of luminal tumor cells is nevertheless mitigated by breast cancer-associated fibroblasts (bCAFs) in a manner that defines MCL-1 as another critical therapeutic target. bCAFs favor MCL-1 expression and apoptotic resistance in luminal cancer cells in a IL-6 dependent manner while their own, robust, survival also relies on MCL-1. Studies based on ex vivo cultures of human luminal breast cancer tissues further argue that the contribution of stroma-derived signals to MCL-1 expression shapes BCL-2 dependency. Thus, MCL-1 inhibitors are beneficial for targeted apoptosis of breast tumor ecosystems, even in a subtype where MCL-1 dependency is not intrinsically driven by oncogenic pathways.

Epidemiology of systematic reviews in imaging journals: evaluation of publication trends and sustainability?

PURPOSE: To evaluate the epidemiology of systematic reviews (SRs) published in imaging journals. METHODS: A MEDLINE search identified SRs published in imaging journals from 1 January 2000-31 December 2016. Articles retrieved were screened against inclusion criteria. Demographic and methodological characteristics were extracted from studies. Temporal trends were evaluated using linear regression and Pearson's correlation coefficients. RESULTS: 921 SRs were included that reported on 27,435 primary studies, 85,276,484 patients and were cited 26,961 times. The SR publication rate increased 23-fold (r=0.92, p<0.001) while the proportion of SRs to non-SRs increased 13-fold (r = 0.94, p<0.001) from 2000 (0.10%) to 2016 (1.33%). Diagnostic test accuracy (DTA) SRs were most frequent (46.5%) followed by therapeutic SRs (16.6%). Most SRs did not report funding status (54.2%). The median author team size was five; this increased over time (r=0.20, p<0.001). Of the studies, 67.3% included an imaging specialist co-author; this decreased over time (r=-0.57, p=0.017). Most SRs included a meta-analysis (69.6%). Journal impact factor positively correlated with SR publication rates (r=0.54, p<0.001). Magnetic resonance imaging (MRI) and 'vascular and interventional radiology' were the most frequently studied imaging modality and subspecialty, respectively. The USA, UK, China, Netherlands and Canada were the top five publishing countries. CONCLUSIONS: The SR publication rate is increasing rapidly compared with the rate of growth of non-SRs; however, they still make up just over 1% of all studies. Authors, reviewers and editors should be aware of methodological and reporting standards specific to imaging systematic reviews including those for DTA and individual patient data. KEY POINTS: • Systematic review publication rate has increased 23-fold from 2000-2016. • The proportion of systematic reviews to non-systematic reviews has increased 13-fold. • The USA, UK and China are the most frequent published countries; those from the USA and China are increasing the most rapidly.

[New developments in the management of nasopharyngeal carcinoma]. / Nouveautés dans la prise en charge des carcinomes nasopharyngés.

Nasopharyngeal carcinoma is a rare condition, with less than 300 cases occurring per year in France. Its treatment can be difficult due to the importance of side effects, but tumor control is usually excellent following a well conducted chemoradiotherapy. This article summarizes the recent advances in nasopharyngeal cancer diagnosis, classification, treatment, surveillance and management of recurrences. Chemotherapy timing is discussed, along with arguments in favor of induction chemotherapy in locally advanced cases. As a survival advantage has been suggested for when patients are treated in high volume center it seems reasonable to refer these young patients for treatment to tertiary expert centers, especially given the low incidence of the disease.

Reporting bias in imaging: higher accuracy is linked to faster publication.

OBJECTIVES: The objective of this study was to evaluate whether higher reported accuracy estimates are associated with shorter time to publication among imaging diagnostic accuracy studies. METHODS: We included primary imaging diagnostic accuracy studies, included in meta-analyses from systematic reviews published in 2015. For each primary study, we extracted accuracy estimates, participant recruitment periods and publication dates. Our primary outcome was the association between Youden's index (sensitivity + specificity - 1, a single measure of diagnostic accuracy) and time to publication. RESULTS: We included 55 systematic reviews and 781 primary studies. Study completion dates were missing for 238 (30%) studies. The median time from completion to publication in the remaining 543 studies was 20 months (IQR 14-29). Youden's index was negatively correlated with time from completion to publication (rho = -0.11, p = 0.009). This association remained significant in multivariable Cox regression analyses after adjusting for seven study characteristics: hazard ratio of publication was 1.09 (95% CI 1.03-1.16, p = 0.004) per unit increase for logit-transformed estimates of Youden's index. When dichotomizing Youden's index by a median split, time from completion to publication was 20 months (IQR 13-33) for studies with a Youden's index below the median, and 19 months (14-27) for studies with a Youden's index above the median (p = 0.104). CONCLUSION: Imaging diagnostic accuracy studies with higher accuracy estimates were weakly associated with a shorter time to publication. KEY POINTS: • Higher accuracy estimates are weakly associated with shorter time to publication. • Lag in time to publication remained significant in multivariate Cox regression analyses. • No correlation between accuracy and time from submission to publication was identified.

Production and characterization of monoclonal antibodies specific for canine CD138 (syndecan-1) for nuclear medicine preclinical trials on spontaneous tumours.

We isolated 11 antibodies specific for canine CD138 (cCD138) to validate the interest of CD138 antigen targeting in dogs with spontaneous mammary carcinoma. The affinity of the monoclonal antibodies in the nanomolar range is suitable for immunohistochemistry and nuclear medicine applications. Four distinct epitopes were recognized on cCD138 by this panel of antibodies. CD138 expression in canine healthy tissues is comparable to that reported in humans. CD138 is frequently expressed in canine mammary carcinomas corresponding to the human triple negative breast cancer subtype, with cytoplasmic and membranous expression. In canine diffuse large B-cell lymphoma, CD138 expression is associated with the 'non-germinal center' phenotype corresponding to the most aggressive subtype in humans. This homology of CD138 expression between dogs and humans confirms the relevance of tumour-bearing dogs as spontaneous models for nuclear medicine applications, especially for the evaluation of new tumour targeting strategies for diagnosis by phenotypic imaging and radio-immunotherapy.

Compton Scattered X-Gamma Rays with Orbital Momentum.

We study the possibility of producing x-gamma rays with orbital angular momentum by means of the inverse Compton backscattering between a high brightness electron beam and a twisted laser pulse. We use the classical electrodynamics retarded fields for evaluating the orbital angular momentum of the radiation and connecting it to that of the primary laser pulse. We then propose the dimensioning of a linearly polarized x-ray source with orbital angular momentum, starting from the parameters of operating Thomson setups.

Flow cytometry community fingerprinting and amplicon sequencing for the assessment of landfill leachate cellulolytic bioaugmentation.

Flow cytometry (FCM) is a high throughput single cell technology that is actually becoming widely used for studying phenotypic and genotypic diversity among microbial communities. This technology is considered in this work for the assessment of a bioaugmentation treatment in order to enhance cellulolytic potential of landfill leachate. The experimental results reveal the relevant increase of leachate cellulolytic potential due to bioaugmentation. Cytometric monitoring of microbial dynamics along these assays is then realized. The flow FP package is used to establish microbial samples fingerprint from initial 2D cytometry histograms. This procedure allows highlighting microbial communities' variation along the assays. Cytometric and 16S rRNA gene sequencing fingerprinting methods are then compared. The two approaches give same evidence about microbial dynamics throughout digestion assay. There are however a lack of significant correlation between cytometric and amplicon sequencing fingerprint at genus or species level. Same phenotypical profiles of microbiota during assays matched to several 16S rRNA gene sequencing ones. Flow cytometry fingerprinting can thus be considered as a promising routine on-site method suitable for the detection of stability/variation/disturbance of complex microbial communities involved in bioprocesses.

[Oral cavity cancers among young people: Clinical results and prognostic analysis]. / Cancers de la cavité buccale chez les sujets jeunes: résultats thérapeutiques et analyse de facteurs pronostiques.

PURPOSE: Squamous cell carcinomas of the oral cavity occurring in young people represent a specific entity. Its management and prognosis are controversial. We performed a retrospective chart review of all patients aged less than 40 years old and treated at Gustave-Roussy Cancer Centre for a squamous cell carcinomas of the oral cavity between 1999 and 2011. METHODS: Patients and tumour characteristics, type of treatment and follow-up data were collected. Survival data were analysed according to the methods of Kaplan-Meier and both univariate and multivariate analyses were performed to look for prognostic factors regarding overall survival and progression-free survival. RESULTS: Sixty-three patients were identified. Median follow-up was 64 months. Most of the tumours were initially located in the mobile tongue (n=54, 85.7%). Overall 17 patients had died, including 15 from the treated cancer. Overall and progression-free survival rates at 5 years were respectively 79.6% and 68.6%. The corresponding 5 years local, regional and metastatic relapse free survival rates were 80%, 91% and 89% respectively. In the multivariate analysis only the absence of initial surgery (hazard ratio [HR]: 13.5 [2.0; 90.5]; P=0.007) was prognostic for overall survival, while alcohol abuse (HR: 0.37 [0.15; 0.9]; P=0.03) and the absence of surgery (HR: 13.6 [2.5; 74.2]; P=0.002) were associated with a decreased progression-free survival. A younger age (less than 30 year old) was not associated with the risk of recurrence or death. CONCLUSION: Survival rates and tumour control probabilities are relatively high among young patients suffering from squamous cell carcinomas of the oral cavity treated at a tertiary centre. The early identification of patients at risk of relapse is currently difficult. The balance between recurrence and treatment toxicity warrants further studies, both on the clinical level and for the development of prognostic biomarkers.

[Screening for the risk of allergy and prevention in French maternity units: A survey]. / Dépistage du risque d'allergie et prévention en maternité : enquête des pratiques AllerNaiss.

Allergy has been on the rise for half a century and concerns nearly 30% of children; it has now become a real public health problem. The guidelines on prevention of allergy set up by the French Society of Paediatrics (SFP) and the European Society of Paediatric Allergology and Clinical Immunology (ESPACI) are based on screening children at risk through a systematic search of the family history and recommend, for children at risk, exclusive breastfeeding whenever possible or otherwise utilization of hypoallergenic infant formula, which has demonstrated efficacy. The AllerNaiss practice survey assessed the modes of screening and prevention of allergy in French maternity units in 2012. The SFP guidelines are known by 82% of the maternity units that took part in the survey, and the ESPACI guidelines by 55% of them. A screening strategy is in place in 59% of the participating maternity wards, based on local consensus for 36% of them, 13% of the units having a written screening procedure. Screening is based on the search for a history of allergy in first-degree relatives (99%) during pregnancy (51%), in the delivery room (50%), and after delivery (89%). A mode of prevention of the risk of allergy exists in 62% of the maternity units, most often in writing (49%). A hypoallergenic infant formula is prescribed for non-breastfed children in 90% of the units. The survey shows that there is a real need for formalization of allergy risk screening and prevention of allergy in newborns in French maternity units.

Interventional oncology for liver and lung metastases from colorectal cancer: The current state of the art.

Interventional oncology is developing rapidly as a result of advances in imaging and medical devices. Although the treatments offered are recent and not yet fully validated in the guidelines, they allow non-invasive curative treatments to be offered to a growing number of patients. When it is used in a highly selected patients with less than three metastases under 2-3cm in size, percutaneous tumor ablation offers local efficacy similar to excision surgery with considerable sparing of the parenchyma, both for lung and liver metastases. Hepatic intra-arterial therapies (chemotherapy, radioembolization, and chemoembolization) are now "salvage" methods after chemotherapy has failed and are being assessed in earlier lines of treatment.

Coupling heat and chemical tracer experiments for estimating heat transfer parameters in shallow alluvial aquifers.

Geothermal energy systems, closed or open, are increasingly considered for heating and/or cooling buildings. The efficiency of such systems depends on the thermal properties of the subsurface. Therefore, feasibility and impact studies performed prior to their installation should include a field characterization of thermal properties and a heat transfer model using parameter values measured in situ. However, there is a lack of in situ experiments and methodology for performing such a field characterization, especially for open systems. This study presents an in situ experiment designed for estimating heat transfer parameters in shallow alluvial aquifers with focus on the specific heat capacity. This experiment consists in simultaneously injecting hot water and a chemical tracer into the aquifer and monitoring the evolution of groundwater temperature and concentration in the recovery well (and possibly in other piezometers located down gradient). Temperature and concentrations are then used for estimating the specific heat capacity. The first method for estimating this parameter is based on a modeling in series of the chemical tracer and temperature breakthrough curves at the recovery well. The second method is based on an energy balance. The values of specific heat capacity estimated for both methods (2.30 and 2.54MJ/m(3)/K) for the experimental site in the alluvial aquifer of the Meuse River (Belgium) are almost identical and consistent with values found in the literature. Temperature breakthrough curves in other piezometers are not required for estimating the specific heat capacity. However, they highlight that heat transfer in the alluvial aquifer of the Meuse River is complex and contrasted with different dominant process depending on the depth leading to significant vertical heat exchange between upper and lower part of the aquifer. Furthermore, these temperature breakthrough curves could be included in the calibration of a complex heat transfer model for estimating the entire set of heat transfer parameters and their spatial distribution by inverse modeling.

[Stereotactic body radiation therapy in the management of liver tumours]. / Place de la radiothérapie stéréotaxique dans la prise en charge des tumeurs hépatiques.

Stereotactic radiotherapy is a high-precision technique based on the administration of high doses to a limited target volume. This treatment constitutes a therapeutic progress in the management of many tumours, especially hepatic ones. If surgery remains the standard local therapy, stereotactic radiotherapy is first dedicated to inoperable patients or unresectable tumours. Patients with moderately altered general status, preserved liver function and tumour lesions limited in number as in size are eligible to this technique. Results in terms of local control are satisfying, regarding primary tumours (notably hepatocellular carcinomas) as metastases stemming from various origins. If treatment protocols and follow-up modalities are not standardized to this day, iconographic acquisition using four-dimensional computed tomography, target volumes delineation based on morphological and/or metabolic data, and image-guided radiotherapy contribute to an oncologic efficacy and an improved sparing of the functional liver. The purpose of this literature review is to report the results of the main works having assessed stereotactic radiotherapy in the management of primary and secondary liver tumours. Technical particularities of this radiation modality will also be described.

[Implementation of a scale on stone baskets]. / Implementierung einer Skala auf Steinfangkörben.

BACKGROUND: Complications after endoscopic retrieval of kidney and ureter stones are obviously related to the size of the stones as well as the experience of the surgeon and other factors. During the procedure it is sometimes difficult for surgeons to estimate stone size and therefore give prognostic advises. The visual perception of the stone size depends on the shape, colour, distance to the renoscope and dilatation of the ureter. This is the so-called binding problem, because shape, color and direction of motion are processed separately by different population of optical neurons. In order to establish a better prognostic ratio, especially for less experienced surgeons we established an intraoperative semi-quantitative measurement of the stone size supported by a stone basket. MATERIALS AND METHODS: We modified the tipped nitinol stone baskets from the company Urotech with diameters of 2.5, 3.0 and 4 Ch. The handle of this basket has a spring mechanism, which automatically closes the basket and provides a predefined fixation force of the stones within the basket. On the handle we established a non-linear scale in mm by grabbing standardized balls or standardized screws. RESULTS: The scales are nonlinear because of the nonlinear relation between the diameter of the stone and the distance of the slider. Also the scales differ in between the basket size, because of the different strain conditions due to the different wire sizes and materials or the spring and basket. CONCLUSIONS: This scale could be an important orientation for a surgeon during endourological procedures to estimate stone sizes. It could be used also for the documentation of the size of fragments after an endourologic lithotripsy and could help in the decision for or against an extraction. Finally it could be very interesting for other disciplines like gastroenterology. The scale should be validated in further clinical trials.