Prediction of the treatment outcome using machine learning with FDG-PET image-based multiparametric approach in patients with oral cavity squamous cell carcinoma.

AIM: To investigate the value of machine learning-based multiparametric analysis using 2-[18F]-fluoro-2-deoxy-d-glucose positron-emission tomography (FDG-PET) images to predict treatment outcome in patients with oral cavity squamous cell carcinoma (OCSCC). MATERIALS AND METHODS: Ninety-nine patients with OCSCC who received pretreatment integrated FDG-PET/computed tomography (CT) were included. They were divided into the training (66 patients) and validation (33 patients) cohorts. The diagnosis of local control or local failure was obtained from patient's medical records. Conventional FDG-PET parameters, including the maximum and mean standardised uptake values (SUVmax and SUVmean), metabolic tumour volume (MTV), and total lesion glycolysis (TLG), quantitative tumour morphological parameters, intratumoural histogram, and texture parameters, as well as T-stage and clinical stage, were evaluated by a machine learning analysis. The diagnostic ability of T-stage, clinical stage, and conventional FDG-PET parameters (SUVmax, SUVmean, MTV, and TLG) was also assessed separately. RESULTS: In support-vector machine analysis of the training dataset, the final selected parameters were T-stage, SUVmax, TLG, morphological irregularity, entropy, and run-length non-uniformity. In the validation dataset, the diagnostic performance of the created algorithm was as follows: sensitivity 0.82, specificity 0.7, positive predictive value 0.86, negative predictive value 0.64, and accuracy 0.79. In a univariate analysis using conventional FDG-PET parameters, T-stage and clinical stage, diagnostic accuracy of each variable was revealed as follows: 0.61 in T-stage, 0.61 in clinical stage, 0.64 in SUVmax, 0.61 in SUVmean, 0.64 in MTV, and 0.7 in TLG. CONCLUSION: A machine-learning-based approach to analysing FDG-PET images by multiparametric analysis might help predict local control or failure in patients with OCSCC.

[Data sources, the data used, and the modality for collection]. / Sources de données, données utilisées et modalité de recueil.

The hospital costing process implies access to various sources of data. Whether a micro-costing or a gross-costing approach is used, the choice of the methodology is based on a compromise between the cost of data collection, data accuracy, and data transferability. This work describes the data sources available in France and the access modalities that are used, as well as the main advantages and shortcomings of: (1) the local unit costs, (2) the hospital analytical accounting, (3) the Angers database, (4) the National Health Cost Studies, (5) the INTER CHR/U databases, (6) the Program for Medicalizing Information Systems, and (7) the public health insurance databases.

Determination of critical operational conditions favoring sulfide production from domestic wastewater treated by a sulfur-utilizing denitrification process.

The aim of this study was to determine the critical operational conditions leading to the generation of sulfide in a domestic wastewater treated by a sulfur-utilizing denitrification process. The influence of various important parameters on the reduction of the sulfates present in denitrified domestic wastewaters to sulfide was studied. Experiments were carried out in batch mode with denitrified domestic wastewaters containing various amounts of both organic matter and sulfates. Preliminary results showed that aqueous sulfide was generated for DOC and sulfate contents higher than 56 mg/L and 371 mg/L, respectively, while DOC and sulfate contents of 77 mg/L and 412 mg/L, respectively, were required to allow the release of gaseous H2S. Good correlations were also observed between gaseous sulfide production and the values of ORP and DOC, while the amounts of dissolved sulfide produced seemed to be correlated with the ORP values and the concentration of sulfates. Additional experiments were conducted using a Box-Behnken methodology to determine if the production of aqueous or gaseous sulfide can be predicted depending on the DOC (from 50 to 90 mg/L) and sulfate contents (from 160 to 380 mg/L) at various temperatures ranging from 5 to 25 °C. The highest sulfide generation (H2S(g) = 84.8 ppm and H2S(aq) = 2.42 mg/L) occurred at 25 °C with DOC and sulfate concentrations starting from 90 mg/L and 270 mg/L, respectively, indicating that the production of sulfides from denitrified domestic wastewaters required conditions not likely to occur at the effluent of a sulfur-based denitrification unit following secondary treatment.

Assessment of sulfide production risk in soil during the infiltration of domestic wastewater treated by a sulfur-utilizing denitrification process.

This study aimed to determine the potential of sulfide generation during infiltration through soil of domestic wastewater treated by a sulfur-utilizing denitrification process. Three types of soil with different permeability rates (K s = 0.028, 0.0013, and 0.00015 cm/s) were investigated to evaluate the potential risk of sulfur generation during the infiltration of domestic wastewater treated by a sulfur-utilizing denitrification system. These soils were thoroughly characterized and tested to assess their capacity to be used as drainages for wastewaters. Experiments were conducted under two operating modes (saturated and unsaturated). Sulfate, sulfide, and chemical oxygen demand (COD) levels were determined over a period of 100 days. Despite the high concentration of sulfates (200 mg/L) under anaerobic conditions (ORP = -297 mV), no significant amount of sulfide was generated in the aqueous (<0.2 mg/L) or gaseous (<0.15 ppm) phases. Furthermore, the soil permeability did not have a noticeable effect on the infiltration of domestic wastewater treated by a sulfur-utilizing denitrification system due to low contents of organic matter (i.e., dissolved organic carbon, DOC). The autotrophic denitrification process used to treat the domestic wastewater allowed the reduction of the concentration of biochemical oxygen demand (BOD5) below 5 mg/L, of DOC below 7 mg/L, and of COD below 100 mg/L.

[Cost comparison of open and robot-assisted partial nephrectomy in treatment of renal tumor]. / Comparaison médico-économique de la laparoscopie robot-assistée et de la lombotomie pour la réalisation de néphrectomies partielles pour cancer du rein.

INTRODUCTION: Robot-assisted partial nephrectomy rapidly took on among urologists, even though studies showing its superiority over other techniques are still scarce and its costs hard to evaluate, especially in the French medical system. OBJECTIVE: To evaluate the cost overrun of robot-assisted partial nephrectomy compared to that of open partial nephrectomy. EQUIPMENT AND METHODS: From January 2010 to December 2013, 77 patients underwent a partial nephrectomy, 46 of which by robot-assisted laparoscopy and the remaining 31 by lombotomy. The two groups were similar in composition. Economic data regarding the staff, the consumables and the premises involved have been analyzed. RESULTS: Costs are significantly higher in the NPR group (9253.21 euros vs. 7448.42 euros) due to higher consumable expenses as well as the costs pertaining to the amortization and maintenance of the robot. Yet, that difference tends to diminish as the duration of the experiment increases. No significant difference was found in warm ischemia times, operation duration and renal function a month after the operation. On the other hand, patients from the NPR group spent a significantly smaller amount of time in recovery room (159 minutes vs. 205 minutes, P=0.004), presented fewer complications and were discharged faster (6.1 days vs. 8.1 days, P=0.04). CONCLUSIONS: To be profitable for the hospital in the French GHS system, robot-assisted partial nephrectomy must take place in a complex where at least 300 robot-assisted interventions are performed annually, in the framework of a hospitalization lasting four days or less, the use of a single needle holder and no systematic use of a haemostatic agent. LEVEL OF EVIDENCE: 4.

[Diagnostic value of selective anorexia in pathological weight loss]. / Évaluation de l'apport diagnostique des anorexies sélectives au cours des amaigrissements pathologiques.

PURPOSE: The diagnostic value of selective anorexia is debated. Some authors have suggested an association between meat aversion and cancer, but most do not use it as a diagnostic tool. We aimed to characterize anorexia of different diseases to search for an association between selective aversions and diagnostic groups. METHODS: All the patients admitted to three departments of a teaching hospital were included consecutively for 22months if they had more than 10 % weight loss in less than one year. Patients were excluded if history taking was not reliable, or if they suffered from anorexia nervosa. We compiled diagnoses at discharge and validated them six months later. We used logistic regression to identify independent factors associated with selective anorexia. RESULTS: Inclusion criteria were met in 106patients (female 44 %, median age 65years). Most frequent diagnoses were: cancer (36 %), infection (35 %), digestive diseases (19 %), non organic diseases (21 %). Recent selective anorexia was found in 46 % of the cases. It was significantly associated with female gender (P=0.002), marginally with young age (P=0.069) and long duration of weight loss (P=0.079). Opioid use at admission was negatively associated with selective anorexia (P=0.001). No specific diagnostic category was found to be associated. CONCLUSION: Selective anorexia does not appear to be a useful symptom to investigate pathological weight loss. It behaves more like a non-specific reactivation by current disease of earlier latent personal food aversions.

Clinical and Economic Evaluation of Absorbable Staple Line Buttressing in Sleeve Gastrectomy in High-Risk Patients.

BACKGROUND: Gastric leaks and bleeding are the most important complications after laparoscopic sleeve gastrectomy (LSG). The use of absorbable membranes as staple line reinforcement may decrease this risk. On the other hand, these materials bring additional costs and their economic impact is not well known. The purpose of this study was to assess the clinical and economic performance of one of the commercially available buttressing absorbable materials when treating a high-risk population. METHODS: A retrospective, observational, and comparative study was conducted at Montpellier University Hospital, France, between July 2013 and September 2014. Patients undergoing LSG, who were at a high risk for leaks and bleeding, were included and treated according to two groups: no buttressing (July 2013 to January 2014) and buttressing (February 2014 to September 2014). Clinical and economic outcomes were measured throughout the first 6 months. RESULTS: Two hundred two patients were included in the study: 116 during the no stapling reinforcement period and 86 during the buttressing period. Baseline characteristics were similar. There was no significant difference between the two groups regarding gastric leaks. However, buttressing reduced hemorrhagic complications (0 vs 8.6 %, p = 0.005) and decreased average total hospital costs for the first hospitalization (5768 vs 6025 €, p < 0.001), as well as 6-month total inpatient cost (5944 vs. 6246 €, p < 0.001). CONCLUSIONS: Staple line reinforcement with absorbable material reduces bleeding in high-risk population. Therefore, this type of material can also result in cost-savings.

[Home care for acute pulmonary embolism: Feasibility and general practitioner acceptability]. / Évaluation de l'acceptabilité du point de vue du médecin traitant et de la faisabilité de la prise en charge ambulatoire de l'embolie pulmonaire.

BACKGROUND: In France, initial management of pulmonary embolism (PE) is performed in the hospital setting. The latest international guidelines suggest that PE at low risk of mortality can be treated in the ambulatory care setting. This means that ambulatory care pathways and general practitioner (GP) opinions concerning such a change in practice need to be determined. OBJECTIVES: To determine: (1) rate of patients eligible for an ambulatory management of their PE and reasons for hospitalization of PE at low risk of mortality; (2) acceptability for GPs of PE home care and patient's desired care pathway. METHODS: Two-part prospective observational study conducted in Montpellier University Hospital from May 2012 to August 2013: (1) in-hospital study including all consecutive patients with non-hospital acquired PE; (2) telephonic survey on PE patient's ambulatory care pathway conducted among GPs. RESULTS: In-hospital study: 99.1% (n=211) of included patients were hospitalized and only 14.1% (n=30) had all criteria for home care. Patient's pathway survey: 68.3% (n=112) of GPs, particularly those aged 40-54 years and those who had already managed patients alone after hospital discharge, were in favour of home care for PE. One hundred and thirty-nine (84.8%) GPs wanted a collaborative management with an expert thrombosis physician and an outpatient follow-up visit at one week. CONCLUSION: Few patients managed at Montpellier University Hospital are eligible for ambulatory management of their PE. GPs have a favorable opinion of home care for PE if it is conducted in collaboration with an expert thrombosis physician.

Factors influencing the Zn and Mn extraction from pyrometallurgical sludge in the steel manufacturing industry.

In this laboratory study, a process has been developed for selectively leaching zinc and manganese from pyrometallurgical sludge produced in the steel manufacturing industry. In the first part, the yield of Zn extraction was studied using four factors and four levels of the Box-Behnken response surface design. The optimum conditions for the step of Zn leaching were determined to be a sulfuric acid concentration of 0.25 mol/L, a pulp density of 10%, an extraction temperature of 20 °C, and three stages of leaching. Under such conditions, 75% of the Zn should be leached. For Mn leaching, the optimum conditions were determined to be a sulfuric acid concentration of 0.25 mol/L, a Na2S2O5/Mn stoichiometry of 1, a leaching time of 120 min and two leaching steps. In this case, 100% of the Mn should be leached.

[Association of air-pollution with acute myocardial infarction: A case-crossover study]. / Association entre pollution atmosphérique et infarctus du myocarde sur base de la méthode cas-croisé.

BACKGROUND: A large number of studies have demonstrated an association between ambient air pollutant exposures and acute myocardial infarctions (AMI). Case-crossover methods are frequently used for analyzing the acute health effects of air pollution. Nevertheless, only a few studies controlled for potential confounders like other air pollutants and temperature. METHODS: The defined geographic entity for the collection of acute myocardial infarctions was composed of 15 municipalities in Charleroi. Charleroi is a relatively highly polluted region in Wallonia, the South of Belgium. The analyses presented hereafter concern patients in the 25-74 years age range over time from 1999 to 2009. Ambient concentrations of PM10, O3, NO2, CO and temperature were available from stationary monitors during this time period. A time-stratified case-crossover approach was applied. Season stratified analysis and analysis matching for environmental confounders were also performed. RESULTS: A total of 3303 AMIs were analyzed during the study period. For the entire year, O3 was significantly associated with AMI, OR=1.028 (CI95%: 1.003-1.054). The highest associations (for a 10 µg.m(-3) rise in pollutant levels) between air pollution and myocardial infarction were observed for PM10 and O3 during the warm period, OR=1.086 (CI95%: 1.020-1.151) and 1.064 (CI95%: 1.024-1.105), respectively. Matching cases and controls for temperature produced weaker association between O3 and AMI (OR=1.003, CI95%: 0.974-1.032). In contrast, this matching had no effect on the association between PM10 and AMI. The adjustment for NO2 concentration decreased the association between PM10 and AMI. CONCLUSIONS: The results of this study reinforce the evidence of the short-term effects of air pollution on acute myocardial infarction, especially during the warm season. This also suggests that the case-crossover method is a suitable tool in studying the association between acute events and air pollution. Controlling for potential environmental confounding effects is also feasible with this method.

Stent retrievers in acute ischemic stroke: complications and failures during the perioperative period.

BACKGROUND AND PURPOSE: Stent retriever-assisted thrombectomy promotes high recanalization rates in acute ischemic stroke. Nevertheless, complications and failures occur in more than 10% of procedures; hence, there is a need for further investigation. MATERIALS AND METHODS: A total of 144 patients with ischemic stroke presenting with large-vessel occlusion were prospectively included. Patients were treated with stent retriever-assisted thrombectomy ± IV fibrinolysis. Baseline clinical and imaging characteristics were incorporated in univariate and multivariate analyses. Predictors of recanalization failure (TICI 0, 1, 2a), and of embolic and hemorrhagic complications were reported. The relationship between complication occurrence and periprocedural mortality rate was studied. RESULTS: Median age was 69.5 years, and median NIHSS score was 18 at presentation. Fifty patients (34.7%) received stand-alone thrombectomy, and 94 (65.3%) received combined therapy. The procedural failure rate was 13.9%. Embolic complications were recorded in 12.5% and symptomatic intracranial hemorrhage in 7.6%. The overall rate of failure, complications, and/or death was 39.6%. The perioperative mortality rate was 18.4% in the overall cohort but was higher in cases of failure (45%; P = .003), embolic complications (38.9%; P = .0176), symptomatic intracranial hemorrhages (45.5%; P = .0236), and intracranial stenosis (50%; P = .0176). Concomitant fibrinolytic therapy did not influence the rate of recanalization or embolic complication, or the intracranial hemorrhage rate. Age was the only significant predictive factor of intracranial hemorrhage (P = .043). CONCLUSIONS: The rate of perioperative mortality was significantly increased in cases of embolic and hemorrhagic complications, as well as in cases of failure and underlying intracranial stenoses. Adjunctive fibrinolytic therapy did not improve the recanalization rate or collateral embolic complication rate. The rate of symptomatic intracranial hemorrhage was not increased in cases of combined treatment.

[Particle pollution effects on the risk of cardiovascular diseases]. / Effets de la pollution particulaire sur le risque de maladies cardiovasculaires.

The effects of air pollution on health are quite well-documented and the influence of particulate pollution on morbidity and mortality from myocardial infarction and stroke is increasingly evident. The objective of this literature review is to identify and synthesize articles on the impact of air pollution by PM10 and PM2.5 of myocardial infarction and stroke. A total of 14 studies were reported on the effects of PM10 and five on the effects of PM2.5. Nine out of 14 studies for PM10 and two studies of five for PM2.5 have found a significant association with myocardial infarction and/or stroke. Particle composition according to location, study period and population must be considered in interpreting the results on the health effects of air pollution. The integration of these elements is important for decision making in tune with social and economic conditions specific to each environment.

Can the PFDI (Pelvic Floor Distress Inventory) or PFIQ (Pelvic Floor Impact Questionnaires) be used to predict outcome in pelvic reconstructive surgery?

OBJECTIVE: To determine a syndrome score threshold on PFDI or PFIQ predictive of a significant improvement in post-operative functional results. DESIGN: A retrospective case review (Canadian Task Force Classification II-2). SETTING: University and research hospital. POPULATION: Women diagnosed with pelvic organ prolapse and repaired with synthetic vaginal mesh. METHODS: Quality of life was arbitrarily considered to have improved significantly if the score decreases by more than 50% between pre-operatively and 36 months post-operatively. We investigated the pre-operative cut-off score predictive of no quality of life improvement at M36 from a prospective trial for surgical pelvic organ prolapse treatment. RESULTS: The most accurate pre-operative cut-off score predicting a failure to improve quality of life at 36 months post-operatively was 62/300 (PFDI Score). This cut-off value had a positive predictive value of 83.6% and specificity of 62.1%. No significant threshold was obtained from the PFIQ score. CONCLUSION: The intensity of symptoms before surgery may interfere as a predictive factor for outcome.

Partially hydrolyzed guar gum characterization and sensitive quantification in food matrices by high performance anion exchange chromatography with pulsed amperometric detection--validation using accuracy profile.

Interest concerning functional ingredients and especially dietary fibres has been growing in recent years. At the same time, the variety of ingredient accepted as dietary fibres and their mixing at low level in complex matrices have considerably complicated their quantitative analysis by approved AOAC methods. These reasons have led to the specific development of an innovative analytical method performed by high-performance anion-exchange chromatography (HPAEC) with pulsed amperometric detection (PAD) to detect and quantify partially hydrolyzed guar gum (PHGG) in fruit preparation and dairy matrices. The analytical methodology was divided in two steps which could be deployed separately or in conjunction. The first, consists in a complete characterization of PHGG by size exclusion chromatography (SEC) with multi-angle light scattering and refractive index detection and HPAEC-PAD to determine its physico-chemical properties and galactomannans content, and the second step is the development of a new HPAEC-PAD method for PHGG direct quantification in complex matrices (dairy product). Validation in terms of detection and quantification limits, linearity of the analytical range, average accuracy (recovery, trueness) and average uncertainty were statistically carried out with accuracy profile. Overall, this new chromatographic method has considerably improved the possibility to quantify without fractionation treatment, low level of dietary fibres emerging from specific galactomannans, in complex matrices and many foodstuffs.

Complications after conservative treatment of blunt liver trauma in children.

BACKGROUND: Nonoperative treatment is the gold standard approach to treat blunt liver trauma (BLT) in hemodynamically stable children. The purpose of this study was to evaluate the incidence, risk factors, timing for appearance, diagnostic modalities, management and outcome of hepatic complications secondary to such approach. METHODS: This retrospective study included children admitted at Montpellier University Hospital for BLT over a 10-year period. All hemodynamically stable children were initially conservatively treated. RESULTS: A total of 51 children underwent nonoperative treatment for BLT during the study period. The success rate was 94.1% (48/51). Three patients (5.9%) presented 13 complications related to hepatic injuries and required secondary surgical treatment. These 3 patients presented grade 3 or higher liver lesions. Others factors identified as predictive of complications included initial hemodynamic instability (responding to the first resuscitative measures), presence of peritoneal irritation at first examination, severe hemoperitoneum, an initially low haemoglobin level (< 8.5 g/dl) and need for important transfusions during the first 48h (> 10 cc/kg). The median interval for appearance of complications was 19 days after injury (range 1-60 days). Complications were successfully treated using minimally invasive techniques in 69.2% of cases (9/13). The rest of the complications (30.8% : 4/13) were surgically treated. All children included in our study had favourable outcomes (follow-up 1-54 months). CONCLUSIONS: This series fully validates conservative approach of BLT in hemodynamically stable children. Complications of such approach are uncommon; many can be successfully treated using minimally invasive techniques with very satisfying results.

Intra-reader reliability of FDG PET volumetric tumor parameters: effects of primary tumor size and segmentation methods.

OBJECTIVE: To establish the effects of size and segmentation methods on intra-reader reliability of primary tumor metabolic tumor volume (MTV) and total glycolytic activity (TGA) in human solid tumors. METHODS: This is a retrospective study of 121 patients who had a baseline FDG PET/CT scan for oncologic staging. Volumetric parameter readings were performed in random order on two separate occasions, 12 weeks apart, by the same reader. The MTV and TGA were segmented using gradient and fixed maximum standardized uptake value (SUVmax) threshold methods. Intra-reader reliability was established by the intraclass correlation coefficient (ICC) and Bland-Altman analysis. RESULTS: The biases for MTV were 2.95, 14.76 and 11.13% for gradient segmentation, 38 and 50% SUVmax fixed threshold segmentations, respectively (p < 0.0001). For TGA, the corresponding biases were 0.76, 10.36 and 7.46% (p < 0.0001). There were no statistically significant differences in the biases between the first and second reads for MTV segmented for small and large volume tumors by the gradient method (p < 0.34) or 50% SUVmax threshold segmentation (p < 0.08). However, there were statistically significant differences in the corresponding biases for the 38% SUVmax threshold segmentation (p < 0.04). There were no statistically significant differences in the biases between the first and second reads for TGA segmented for small and large volume tumors (p < 0.98). CONCLUSION: Intra-reader reliability for primary tumor FDG MTV and TGA is affected by the tumor size and segmentation methods. The segmentation bias was smaller for gradient method than percentage fixed threshold method for MTV. The segmentation biases were smaller for TGA than MTV.

[Robot-assisted laparoscopic myomectomy: comparison with abdominal myomectomy]. / La myomectomie par cœlioscopie avec assistance robotique: comparaison avec la laparotomie.

OBJECTIVE: To compare morbidity of robot-assisted laparoscopic myomectomy versus those performed by laparotomy. PATIENTS AND METHODS: It reports a monocentric retrospective case matched analysis enrolling 22 patients (six laparotomic and 16 robot-assisted laparoscopic myomectomies), needing a surgical treatment for at least one myoma oversizing 6cm. RESULTS: Both patient groups were comparable regarding their age, their weight and myoma's size. There were more complications in the laparotomy group in comparison with the robotic group (66.7%, versus 0%; P=0.002). Average intraoperative blood losses were respectively 397±377mL versus 387±349mL (P=0.71) and length of stay 7.2±0.8 days versus 3.9±2.8 days (P<0.001). None of the robot-assisted laparoscopic myomectomy needed any conversion to laparotomy. CONCLUSION: Robot-assisted laparoscopic myomectomy seems to be feasible for heavy fibroids, with a lower morbidity in comparison with laparotomy. These results must be confirmed by several wider prospective studies.