Diaphragmatic weakness related to radiotherapy: 2 cases and a review.

Post-radiation diaphragmatic weakness have rarely been described. We report two cases of post-radiation diaphragmatic weakness from our center, and review the other published cases, computing clinical, electromyography and magnetic resonance imaging data. Including our two cases, seven cases of post-radiation diaphragmatic weakness have been described. Most occurred after mantle-field radiotherapy for Hodgkin lymphoma (5/7), often in associations with chemotherapy (4/7). Other radiations-induced complications were found (5/7) such as brachial plexopathy, cardiac involvement or hypothyroidy. When studied, phrenic nerve conduction studies revealed different profiles, from clearly abnormal responses to limit amplitudes. Imaging can be a useful diagnostic tool, displaying abnormalities with sharp limits matching the radiation field. Data is limited about long-term evolution. Presentation of post-radiation diaphragmatic weakness seems relatively homogeneous. We propose a diagnosis work-up for post-radiation diaphragmatic weakness, to exclude potentially treatable differential diagnoses.

Impact of cancer chemotherapy before ovarian cortex cryopreservation on ovarian tissue transplantation.

STUDY QUESTION: How efficacious is transplantation of ovarian cortex previously exposed to chemotherapy? SUMMARY ANSWER: Prior exposure to chemotherapy did not disrupt the function of cryopreserved ovarian tissue after transplantation. WHAT IS KNOWN ALREADY: Ovarian tissue cryopreservation (OTC) followed by ovarian tissue transplantation (OTT) is an efficacious technique for restoration of female fertility. At least 130 children have been born following this procedure. To date, little is known about the efficacy of OTT in patients exposed to cancer chemotherapy prior to OTC. STUDY DESIGN, SIZE, DURATION: This study evaluates the recovery of ovarian function and fertility in 31 consecutive patients who had received OTT, between 2005 and 2015. PARTICIPANTS/MATERIALS, SETTING, METHODS: Thirty one patients, wanting children, were transplanted with autologous ovarian cortex, among which 22 patients (71%) had been exposed to chemotherapy before OTC. Recovery of ovarian function was considered total once menstruation occurred. Ovarian function recovery (OFR), ovarian graft survival, and incidence of pregnancy were related to previous chemotherapy exposure, type of chemotherapy and graft characteristics (number of grafted fragments and follicular density). MAIN RESULTS AND ROLE OF CHANCE: The amount of ovarian tissue collected was the only parameter to show any significant change between patients with versus without previous chemotherapy. At 1 year after OTT, the cumulative incidence of OFR was 83% (93% in patients exposed to chemotherapy and 67% in others (P = 0.14)). A low follicular density (<0.3 foll/mm2) in the transplant and a low number of grafted fragments (<16) were significantly associated with a delayed OFR. Graft survival at 2 years after OTT was 77%. It was significantly lower in patients exposed to bifunctional alkylating agents before ovarian cryopreservation and in patients with a low follicular density. The proportion of women who succeeded in having at least one live birth was 23% in the total population, 0% (0/9) in the group 'no previous chemotherapy', and 32% (7/22) in the group 'previous chemotherapy'. The cumulative incidence of pregnancy (Kaplan-Meier) at 3 years after OTT was 36% overall and 49% in case of previous chemotherapy, with no difference related to previous chemotherapy exposure. In total there were 13 pregnancies and 8 births in 7 patients. LIMITATIONS, REASONS FOR CAUTION: The pathology in the two groups of patients was not comparable. In the group of patients who had chemotherapy before OTC, there were 95% of hematological malignancies. In the group of patients who did not have chemotherapy before OTC only 1 out of 9 patients had a malignant hematological disease while 44% had some pathology affecting the ovaries. Few women are available for study and only large changes are likely to have statistical significance. WIDER IMPLICATIONS OF THE FINDINGS: These results suggest that prior cancer chemotherapy should no longer be considered a limitation to cryopreservation of ovarian tissue and current recommendations in this regard should be revised. STUDY FUNDING/COMPETING INTEREST(S): This study was supported by the Agence de la Biomédecine (France's biomedical office). There are no competing interests to report. TRIAL REGISTRATION NUMBER: NCT02184806.

Unveiling Extreme Anisotropy in Elastic Structured Media.

Periodic structures can be engineered to exhibit unique properties observed at symmetry points, such as zero group velocity, Dirac cones, and saddle points; identifying these and the nature of the associated modes from a direct reading of the dispersion surfaces is not straightforward, especially in three dimensions or at high frequencies when several dispersion surfaces fold back in the Brillouin zone. A recently proposed asymptotic high-frequency homogenization theory is applied to a challenging time-domain experiment with elastic waves in a pinned metallic plate. The prediction of a narrow high-frequency spectral region where the effective medium tensor dramatically switches from positive definite to indefinite is confirmed experimentally; a small frequency shift of the pulse carrier results in two distinct types of highly anisotropic modes. The underlying effective equation mirrors this behavior with a change in form from elliptic to hyperbolic exemplifying the high degree of wave control available and the importance of a simple and effective predictive model.

Pisotriquetral joint disorders: an under-recognized cause of ulnar side wrist pain.

Pisotriquetral joint disorders are often under-recognized in routine clinical practice. They nevertheless represent a significant cause of ulnar side wrist pain. The aim of this article is to present the main disorders of this joint and discuss the different imaging modalities that can be useful for its assessment.

Vitamin D nutritional status and bone turnover markers in childhood acute lymphoblastic leukemia survivors: A PETALE study.

BACKGROUND: The remarkable progress in the treatment of childhood acute lymphoblastic leukemia (cALL) has led to a survival rate reaching 90%. This success story is unfortunately linked to increased risk of impaired skeletal mass accumulation during childhood and adolescence, predisposing the patients to osteoporosis and pathological fractures at adulthood. OBJECTIVE: This study aims at characterizing the vitamin D status and bone health biomarkers in a well-characterized cohort of cALL survivors. RESULTS: Food frequency questionnaires reveal that (i) the total vitamin D intake varies greatly (44-2132 IU/d), (ii) only 16.8% of the participants consume vitamin D supplements, and (iii) 74% of survivors' intakes are below the Recommended Daily Intakes (400 IU/d). For the 42 participants taking vitamin D supplements, the median (2.5-97.5%iles) intake is 600 IU/d (21.2-1972 IU/d). Sixteen participants are vitamin D deficient (<30 nM) and 66 insufficient (≥30 - <50 nM). Serum 24,25(OH)2D3 concentrations are directly related to those of 25OHD3, and those of 3-epi-25OHD3 below the Lower Limit of Quantification in most samples. The participants' serum concentrations of cross-linked C-telopeptide of type-I collagen and intact amino-terminal pro-peptide of type-I collagen decrease steadily with age, leveling at adulthood, and are at all times higher in males. CONCLUSION: The present study shows that the prevalence of vitamin D insufficiency or deficiency is not greater in cALL survivors compared to the general Canadian population despite low vitamin D food and supplement intakes. Furthermore, there seem to be no overt imbalance in the gender- and age-adjusted serum bone turnover marker concentrations.

[Effect of women's weight on the success rate of in vitro fertilization]. / Influence du poids sur les taux de succès en fécondation in vitro.

OBJECTIVE: To examine the effect of women's weight on the success rate of in vitro fertilization. PATIENTS AND METHODS: Single centre retrospective study of a continuous series of 846 patients who underwent 1444 in vitro fertilization or ICSI cycles. The outcomes of each cycle was analysed as a function of the woman's body mass index (BMI). Three groups were defined: (1) underweight (BMI<18 kg/m2, n=68 cycles, 43 women), (2) normal BMI (18 < or =BMI<25, n=1045 cycles, 607 women), (3) overweight or obese women (IMC > or =25, n=331 cycles, 196 women). MAIN OUTCOME MEASUREMENT: Live birth rate per cycle. RESULTS: In group 3, the live birth rate per cycle (10,6% [95% confidence interval: 7,3-13,9]) was significantly lower than in group 2 (16,6% [14,3-18,8]). There was a non-significant trend towards a decreased live birth rate in group I (11,8% [4,1-19,4]). In group 3, the cancellation rate (30,8% [25,8-35,8]) was significantly greater than in group 2 (19,6% [17,2-22]), the pregnancy per oocyte pick-up rate was lower (19,9% versus 24,6%) and the early miscarriage rate was increased (26,9% versus 15,7%) without reaching statistical significance. DISCUSSION AND CONCLUSION: The live birth rate was decreased among overweight or obese women. This could be mediated by impairment of response to ovarian stimulation, oocyte quality, or implantation abnomalies.

Remote sensing based identification of environmental risk factors associated with West Nile disease in horses in Camargue, France.

Geographic information system and remote sensing technologies were used to identify landscape features associated with risk of West Nile virus transmission as defined by the presence of confirmed horse cases. SPOT-4 images of Camargue area were used to generate a map of landscape categories of epidemic foci and the geographic information system was employed to determine the proportion of landscape components surrounding 10 horse case sites and 17 control sites. The spatio-temporal analysis of the cases outbreak gave the best results for a spatial window of 9 km and a temporal window of 18 days. Two clusters were identified (relative risk=3.35), both in the wet area of Camargue, near the town "Les Saintes Maries de la Mer". The first one was 4 km radius, the second 9 km. The relationships between the presence of cases and proportions of landscape categories were analyzed using generalized linear model. The best model indicated that rice fields and dry bushes, wet "sansouire" and open water were the major components of the landscape that were associated with the presence of West Nile virus cases.

Spontaneous nano-emulsification: Process optimization and modeling for the prediction of the nanoemulsion's size and polydispersity.

The aim of the present study was to optimize the size and polydispersity of a lipid nanoemulsion as a function of the oil (Labrafac® WL1349), surfactant (Kolliphor® HS 15) and cosurfactant (Span® 80) phase composition and temperature. The nanoemulsions were prepared using a low-energy self-emulsification method. The Z-average diameter and the polydispersity index (PDI) were modeled with mixture experiments. Nanoemulsions from 20nm to 120nm with PDI<0.2 were obtained at the three different tested temperatures (30°C, 50°C and 90°C). The nanoemulsion size was able to be controlled with the oil, surfactant and cosurfactant concentrations. Interestingly, the smallest PDIs were obtained at 30°C, and the cosurfactant concentration was able to be adjusted to optimize the formulation and to obtain nanoemulsions in the 20-120nm range with a PDI smaller than 0.14. These nanoemulsions have shown a good stability at 4°C in storage conditions and at 37°C in diluted conditions.

Correlation between primary flat foot and lower extremity rotational misalignment in adults.

PURPOSE: The goal of this study was to identify rotational abnormalities of the lower limb in adult patients with primary symptomatic flatfoot. MATERIALS AND METHODS: From September 2009 to May 2012, 24 patients (12 women, 12 men; mean age: 40 years) were prospectively included in the study. Each patient underwent radiographs of the flat foot and weight-bearing upright EOS® examination. Three-dimensional reconstructions of the lower extremities were performed with derived measurements (length, hip and knee parameters, rotations). A total of 31 symptomatic primary flat feet (bilateral flat foot, n=7 patients; unilateral flat foot, n=17 patients) were studied and compared to 30 control subjects matched for age and gender. A comparison between the two groups was made with the Student t-test. RESULTS: No significant differences were found between patients and control subjects on the coronal and sagittal planes. Similarly, no significant differences were observed between the 2 groups for rotation of the lower limbs (femoral torsion, tibial torsion, tibiofemoral rotation). CONCLUSION: There are no rotational abnormalities of the lower extremities in adult patients with primary symptomatic flat foot.

[Variations in cyclic AMP level and specific activities of adenylate cyclase and cyclic AMP phosphodiesterase during the cell cycle of an Actinomycete (author's transl)]. / Variations du taux D'AMP cyclique et des activités spécifiques de l'adénylate cyclase et de l'AMP cyclique-phosphodiestérase pendant le cycle cellulaire d'un actinomycéte.

The variations in the concentrations of intra- and extracellular cyclic AMP and in he specific activities of adenylate cyclase (EC 4.6.1.1) and cyclic AMP phosphodiesterase (EC 3.1.4.17) have been monitored in synchronized cultures of Nocardia restricta, a prokaryote belonging to the group of Actinomycetes. At the beginning of the cell cycle, during a first period of RNA and protein synthesis, there is an increasing synthesis of adenylate cyclase which can be suppressed in the presence of chloramphenicol or rifampicin. Simultaneously, the specific activity of cyclic AMP phosphodiesterase decreases and the concentrations of intra- and extracellular cyclic AMP rise. After the end of DNA replication, during a second period of RNA and protein synthesis, the specific activity of cyclic AMP phosphodiesterase increases; during the same time, the specific activity of adenylate cyclase and the level of intracellular cyclic AMP drop. It appears that the overall metabolism of cyclic AMP is coordinated so that the cyclic AMP level will be high at the beginning of DNA replication and will fall thereafter. The results are discussed in comparison with known data about the variations of cyclic AMP during the cell cycle of mammalian cells in cultures.

[Prenatal ultrasound diagnosis of neuroblastoma]. / Neuroblastomes de diagnostic échographique anténatal.

With the progress of foetal ultrasonography, diagnosis of foetal tumors can be made before birth. We report five cases of prenatally detected neuroblastoma of the adrenal glands. Diagnosis was made during the third trimester in all cases. At birth no clinical sign related to the tumor was present, and urinary catecholamines were within normal ranges. On ultrasound scans the tumor was cystic in 1 case, solid in 2 cases and of mixed echogenicity in 2 cases. All children were operated on without pre or postoperative chemotherapy. In each setting the tumor was a stage I neuroblastoma according to the Evans classification. All children are alive and disease-free with a follow-up of 32 months at 14 years.

Imaging features of lower limb malformations above the foot.

Lower limb malformations are generally isolated or sporadic events. However, they are sometimes associated with other anomalies of the bones and/or viscera in patients with constitutional syndromes or disorders of the skeleton. This paper reviews the main imaging features of these abnormalities, which generally exhibit a broad spectrum. This paper focuses on several different bone malformations: proximal focal femoral deficiency, congenital short femur and femoral duplication for the femur, tibial hemimelia (aplasia/hypoplasia of the tibia) and congenital bowing for the tibia, fibular hemimelia (aplasia/hypoplasia) for the fibula, and aplasia, hypoplasia and congenital dislocation for the patella.

[Demonstration, kinetic study and solubilization of particular adenylate cyclase from Nocardia restricta]. / Mise en évidence, études cinétiques et solubilisation de l'adénylate cyclase particulaire de Nocardia restricta.

An adenylate cyclase (EC r.6.1.1.) was found in cell-free extracts of several Nocardia species. The enzyme from Nocardia restricta has been specially studied. It is a membrane enzyme which exhibits a strong specific activity, one hundred times greater than that of mammals. It has an optimal pH of 8.5 in Tris buffer and an absolute requirement for divalent ions, Mg++ or Mn++ (Mn++ ions are the most efficient). The kinetic properties of this adenylate cyclase are similar to those that could be expected of an allosteric enzyme having, as a substrate, the ATP-Mg++ complex and, as an activator, free Mn++ ions. Ca++ ions are activators: they set up the maximum velocity without modification of the KM. GTP is a competitive inhibitor (KI = 5.10(-5) M). Fluoride ions have no detectable effect on activity. Non-ionic detergents, Lubrol WX and Triton X 100, are inhibitors of the enzyme which has been partially solubilized by repeated freezing and thawing, following by brief ultra-sonic treatment. Catalytic sites are not modified after the solubilization, but cooperative effects between moles of substrate ATP-Mn++ are diminished: the KM becomes smaller and the sigmoidal shape of the curve v = f (ATP-Mn++) is attenuated.

The use of gonadotropin-releasing hormone analogs for in vitro fertilization: comparison between the standard form and long-acting formulation of D-Trp-6-luteinizing hormone-releasing hormone.

The introduction of luteinizing hormone-releasing hormone (LH-RH) analogs into treatment schemes for the stimulation of ovulation has enabled the authors' in vitro fertilization (IVF) team to overcome two problems; they can now suppress spontaneous LH peaks and program their activity. Two hundred and five IVF cycles were investigated. The agent used was D-Trp-6-LH-RH, either in a sustained release formulation (112 cases, group 1) or in a standard form (93 cases, group 2). The quantity of human menopausal gonadotropin (hMG) necessary for adequate ovarian stimulation was much lower when the standard form of the analog was used. The number of oocytes recovered per puncture was greater in group 1 (7.6 compared with 5.1), but the difference was not significant when considering the number of embryos (2.4 compared with 2.1). The corrected pregnancy rate (with allowance for progressive introduction of freezing from the third embryo onwards) was identical in both groups. The authors conclude that systems in which LH-RH analogs are employed have a clear advantage over the classical treatment with clomiphene citrate/hMG, and that the immediate-action formulation of D-Trp-6-LH-RH is preferable.

Selective reduction in multifetal pregnancies: technical and psychological aspects.

OBJECTIVE: To evaluate efficiency and safety of a very early transvaginal selective reduction procedure in multifetal pregnancies. DESIGN: Prospective study. SETTING: Obstetric and Gynecology Department, University of Paris VI. PATIENTS: Twenty-two patients with multifetal pregnancies: 14 triplets, 8 quadruplets, and 1 quintuplet. INTERVENTION: Selective embryonic reduction was performed at 7 weeks of amenorrhea under general anesthesia by transvaginal embryo puncture and aspiration. Two embryos were left in place. MAIN OUTCOMES: Pregnancy outcome (immediate or delayed complication, term of delivery, newborns) and psychological impact. RESULTS: No complication occurred. The 22 patients now have delivered at 36.5 weeks of amenorrhea, on average giving birth to 44 neonates with no congenital malformation. If the procedure generates anxiety, it is nevertheless perceived as necessary for the successful outcome of the pregnancy. CONCLUSION: Early mechanical transvaginal embryo reduction performed at 7 weeks of amenorrhea, leaving two embryos is, in our opinion, a simple and safe procedure with no affect on remaining fetuses. It is necessary when there are four or more embryos, and it should also be proposed for triplets. In these circumstances, patients saw reduction as a necessary procedure.

PIP: This study sought to evaluate the efficiency and safety of a very early transvaginal selective reduction procedure in multifetal pregnancies. The Obstetric and Gynecology Department of the University of Paris VI was the site of this prospective study which included 22 patients--14 sets of triplets, 8 sets of quadruplets, and 1 set of quintuplets. Selective embryonic reduction was performed at 7 weeks of amenorrhea under general anesthesia by transvaginal embryo puncture and aspiration. 2 embryos were left in place. The main outcomes measured were pregnancy outcome (immediate or delayed complications, term of delivery, newborns), and psychological impact. No complications occurred and the 22 patients have now delivered at 36.5 weeks of amenorrhea, giving birth, on the average to 44 neonates with no congenital malformations. If the procedure has generated anxiety, it has nevertheless been perceived as necessary for the successful outcome of these pregnancies. Early mechanical transvaginal embryo reduction performed at 7 weeks amenorrhea and leaving 2 embryos intact is, according to these authors, a simple and safe procedure with no effects on the remaining fetuses. It is essential when there are 4 or more embryos and it should be proposed for triplets. Under these circumstances, the patients also saw the necessity of the procedure.

Assisted reproductive technology and superfetation: a case report.

This observation reports a case of human superfetation. Fertilizable oocytes and embryos were obtained after ovarian stimulation in a women already several weeks pregnant. Spontaneous monofetal pregnancy had normal development and the embryos obtained after in vitro fertilization were actually frozen.

How many embryos should be transferred in in vitro fertilization? A prospective randomized study.

OBJECTIVE: To maintain the rate of pregnancy, while suppressing high rank multiple pregnancies by limiting the number of fresh embryos transferred after IVF, in a population selected for potential success. DESIGN: A prospective, randomized study. SETTING: Département de Gynécologie Obstétrique, Centre Hospitalo Universitaire, Paris VI, France. PATIENTS: There were two groups of 28 couples. Women were < or = 35 years of age, with > or = 70% cleavage rate and at least four morphologically regular embryos. INTERVENTION: On the day of ET, either four fresh embryos were transferred (group 1) or two fresh embryos were transferred and two were frozen for later transfer (group 2). MAIN OUTCOME: Pregnancy rate and multiple pregnancy. RESULTS: The pregnancy rate was the same in the two groups with one-third of the high rank pregnancies in group 1 and no pregnancies in group 2. CONCLUSION: Only two fresh embryos need to be transferred in this selected population.