Retzius-sparing versus standard robot-assisted laparoscopic prostatectomy: A two-year patient-reported and oncological assessment.

PURPOSE: To evaluate the two-year functional and oncological outcomes of Retzius-sparing robot-assisted laparoscopic prostatectomy (rsRALP) and standard approach (sRALP). METHODS: A total of 200 consecutive patients who underwent either sRALP (n = 100) or rsRALP (n = 100) for clinically localized PCa at a single referral European center between 2015 and 2020 were identified from a prospectively cohort, as part of the Belgian Cancer Registry. Primary outcomes included functional outcomes and quality of life (QoL) using validated patient-reported outcome measures (PROMs) assessed at 1-, 3-, 12-, and 24-months post-surgery. Secondary outcomes comprised oncological outcomes reported as positive surgical margins (PSM) and 5-year biochemical recurrence (BCR). Kaplan-Meier analysis with log-rank test and multivariable Cox regression were used. RESULTS: The median follow-up was 60 months. No significant differences were observed between the surgical approaches in terms of patient and tumor characteristics. Urinary function and QoL were significantly better at each follow-up period (all p ≤ 0.01) with rsRALP, while sexual function was not significantly different 12 months after surgery. No significant difference in positive surgical margins rate was observed between surgical approaches (31% vs 32%, p = 0.9). Retzius-sparing RALP was associated with longer PSM lengths (5 mm vs 2.5 mm, p = 0.02), a higher multifocality rate (34% vs. 13%, p < 0.001), more occurrences in organ-confined disease (59% vs. 39%, p < 0.001) and at anterior locations (37% vs. 16%, p = 0.05). Five-year BCR-free survival was not significantly different, and surgical approach was not a predictor of BCR. CONCLUSIONS: The rsRALP approach significantly improves both early and short-term urinary function and QoL compared to sRALP. Despite being associated with worse PSM characteristics, no significant decrease in BCR-free survival was observed with rsRALP.

Viscosity of Suspensions of Strongly Bonded Spherical Particles of Nickel-Manganese-Cobalt Mixed Oxides (NMC) in Molten Poly(Ethylene Carbonate) for Batteries.

Ionically conductive polymers highly filled with active materials, such as metal oxides are increasingly studied for their potential use in all solid-state batteries. They offer the desirable processing ease of polymers for mass production despite interfacial issues that remain to be solved. In this study, it is shown that spherical particles of transition metal oxides can be introduced in co-polymers of alkene carbonate and ethylene oxide at loading close to the maximum packing fraction, without imparting the processability in the melt of the material. In particular, the viscosity does not show any yield stress and the increase of viscosity shows that the intrinsic viscosity of the filler does not match with the usual 2.5 value in the limit of the Einstein's equation. Conversely, rheological data show that the value is rather close to unity consistently with theoretical arguments that predicted that this scaling factor should be unity when particle rotation is precluded. In the present case, this behavior is attributed to strong bonding between polymer and filler that is proved by electronic microscopy and by dynamical mechanical spectroscopy showing a relaxation due to bound polymer.

Awareness of obstetric danger signs among pregnant women in the Democratic Republic of Congo: evidence from a nationwide cross-sectional study.

BACKGROUND: Poor awareness of obstetric danger signs is a major contributing factor to delays in seeking obstetric care and hence to high maternal mortality and morbidity worldwide. We conducted the current study to assess the level of agreement on receipt of counseling on obstetric danger signs between direct observations of antenatal care (ANC) consultation and women's recall in the exit interview. We also identified factors associated with pregnant women's awareness of obstetric danger signs during pregnancy in the Democratic Republic of Congo (DRC) METHODS: We used data from the 2017-2018 DRC Service Provision Assessment survey. Agreement between the observation and woman's recall was measured using Cohen's kappa statistic and percent agreement. Multivariable Zero-Inflated Poisson (ZIP) regression was used to identify factors associated with the number of danger signs during pregnancy the woman knew. RESULTS: On average, women were aware of 1.5 ± 1.34 danger signs in pregnancy (range: 0 to 8). Agreement between observation and woman's recall was 70.7%, with a positive agreement of 16.9% at the country level but ranging from 2.1% in Bandundu to 39.7% in Sud Kivu. Using multivariable ZIP analysis, the number of obstetric danger signs the women mentioned was significantly higher in multigravida women (Adj.IRR = 1.38; 95% CI: 1.23-1.55), in women attending a private facility (Adj.IRR = 1.15; 95% CI: 1.01-1.31), in women attending a subsequent ANC visit (Adj.IRR = 1.11; 95% CI: 1.01-1.21), and in women counseled on danger signs during the ANC visit (Adj.IRR = 1.19; 95% CI: 1.05-1.35). There was a regional variation in the awareness of danger signs, with the least mentioned signs in the middle and the most in the eastern provinces. CONCLUSIONS: Our findings indicated poor agreement between directly observed counseling and women's reports that counseling on obstetric danger signs occurred during the current ANC visit. We found that province of residence, provision of counseling on obstetric danger signs, facility ownership, gravidity and the number of ANC visits were predictors of the awareness of obstetric danger signs among pregnant women. These factors should be considered when developing strategies aim at improving women's awareness about obstetric danger signs in the DRC.

Liver stiffness measurement predicts long-term survival and complications in non-alcoholic fatty liver disease.

BACKGROUND AND AIMS: In non-alcoholic fatty liver disease (NAFLD), fibrosis is the strongest prognostic factor and can be assessed by non-invasive methods. We evaluated the ability of liver stiffness measurement (LSM) to predict overall survival and liver, cardiovascular and oncologic complications. METHODS: We prospectively collected data on 2251 consecutive NAFLD patients (mean age 59 years, male 53%, mean body mass index 28 kg/m2 ) in two centres. At inclusion, all patients had LSM, clinical and biological evaluation. During follow-up, we recorded cardiovascular events, cancers, liver complications, liver transplantation and death. The primary endpoint was overall survival. Survival curves according to LSM were first performed using Kaplan-Meier method for the primary endpoint, and Aalen-Johansen method for secondary outcomes to take into account competitive risks. In a second step, a Cox proportional hazard model analysis was done to identify independent predictors of overall survival. RESULTS: Median follow-up was 27 months [IQR: 25-38]. Fifty-five patients died and three patients had liver transplantation. Overall survival significantly decreased as baseline LSM increased. Twenty-one patients (0.9%) had a liver event, 142 (6.3%) developed cancer (excluding HCC) and 151 (6.7%) had a cardiovascular event during follow-up. By multivariable analysis, independent predictors of overall survival were as follows: baseline LSM (adjusted HR (aHR) = 2.85 [1.65-4.92], P = .0002), age (aHR = 1.11 [1.08-1.13], P < .0001) and male sex (aHR = 2.05 [1.17-3.57], P = .012). Patients with elevated LSM were also more likely to develop cardiovascular, and liver events but not other cancers. CONCLUSION: LSM can be used to predict survival, cardiovascular and liver complications in NAFLD patients.

A new dimension in patent foramen ovale size estimation.

BACKGROUND: Detailed multidimensional assessment of patent foramen ovale (PFO) size with transesophageal echocardiography (TOE) may help to determine PFO pathogenicity in cryptogenic stroke patients. We explored the potential additive value of Live xPlane and three-dimensional (3D) TOE anatomical PFO sizing techniques. METHODS: Imaging data of 45 patients who underwent a 3D TOE-assisted percutaneous PFO closure were studied. The two-dimensional (2D) PFO separation distance and right-to-left (RL) contrast shunt magnitude were assessed on preprocedural TOE recordings. Peri-procedural measurements of the triangular anatomical PFO opening (base, height, and area) were performed after positioning of a stiff guidewire (SW) through the PFO, using Live xPlane imaging and 3D Zoom mode. RESULTS: The PFO SW base appeared on average 5 times larger than the preprocedural 2D PFO separation (median difference [IQR] = 13[5] mm; P < .001). For a same PFO separation, the width of the PFO base may vary significantly. The PFO SW base was significantly larger in patients with a large versus a small-to-moderate PFO RL contrast shunt (18 vs 15 mm; P = .007) and in those with a spontaneous versus a provoked shunt (18 vs 14 mm; P = .003). CONCLUSION: Live xPlane and 3D Zoom TOE allow peri-procedural measurement of the largest dimension of a PFO, which is the PFO base. Patients with a large or spontaneous RL contrast shunt appear to have a larger PFO base. The anatomical PFO base dimension may be taken into account for optimization of device and patient selection strategies.

Health facility readiness and provider knowledge as correlates of adequate diagnosis and management of pre-eclampsia in Kinshasa, Democratic Republic of Congo.

BACKGROUND: Hypertensive disorders in pregnancy are the second most common cause of maternal mortality in the Democratic Republic of Congo (DRC), accounting for 23% of maternal deaths. This study aimed to assess facility readiness, and providers' knowledge to prevent, diagnose, and treat pre-eclampsia. METHODS: A facility-based cross-sectional study was conducted in 30 primary health centres (PHCs) and 28 referral facilities (hospitals) randomly selected in Kinshasa, DRC. In each facility, all midwives and physicians involved in maternal care provision (n = 197) were included. Data on facility infrastructure and providers' knowledge about pre-eclampsia were collected using facility checklists and a knowledge questionnaire. Facility readiness score was defined as the sum of 13 health commodities needed to manage pre-eclampsia. A knowledge score was defined as the sum of 24 items about the diagnosis, management, and prevention of pre-eclampsia. The score ranges from 0 to 24, with higher values reflecting a better knowledge. The Mann-Witney U test was used to compare median readiness scores by facility type and ownership; and median knowledge scores between midwives in hospitals and in PHCs, and between physicians in hospitals and in PHCs. RESULTS: Overall, health facilities had 7 of the 13 commodities, yielding a median readiness score of 53.8%(IQR: 46.2 to 69.2%). Although all provider groups had significant knowledge gaps about pre-eclampsia, providers in hospitals demonstrated slightly more knowledge than those in PHCs. Midwives in public facilities scored higher than those in private facilities (median(IQR): 8(5 to 12) vs 7(4 to 8), p = 0.03). Of the 197 providers, 91.4% correctly diagnosed severe pre-eclampsia. However, 43.9 and 82.2% would administer magnesium sulfate and anti-hypertensive drugs to manage severe pre-eclampsia, respectively. Merely 14.2 and 7.1% of providers were aware of prophylactic use of aspirin and calcium to prevent pre-eclampsia, respectively. CONCLUSION: Our study showed poor availability of supplies to diagnose, prevent and treat pre-eclampsia in Kinshasa. While providers demonstrated good knowledge regarding the diagnosis of pre-eclampsia, they have poor knowledge regarding its prevention and management. The study highlights the need for strengthening knowledge of providers toward the prevention and management of pre-eclampsia, and enhancing the availability of supplies needed to address this disease.

Proportion of pregnant women screened for hypertensive disorders in pregnancy and its associated factors within antenatal clinics of Kinshasa, Democratic Republic of Congo.

BACKGROUND: Screening for hypertensive disorders in pregnancy (HDP) is clinically important for identifying women at high risk, and planning early preventative interventions to improve pregnancy outcomes. Several studies in developing countries show that pregnant women are seldom screened for HDP. We conducted a study in Kinshasa, DR Congo, in order to assess the proportion of pregnant women screened for HDP, and to identify factors associated with the screening. METHODS: We conducted a facility-based cross-sectional study in a random sample of 580 pregnant women attending the first antenatal visit. Data collection consisted of a review of antenatal records, observations at the antenatal care services, and interviews. A pregnant woman was considered as screened for HDP if she had received the tree following services: blood pressure measurement, urine testing for proteinuria, and HDP risk assessment. Multivariable logistic regression, with generalized estimating equations, was used to identify factors associated with the screening for HDP. RESULTS: Of the 580 pregnant women, 155 (26.7%) were screened for HDP, 555 (95.7%) had their blood pressure checked, 347(59.8%) were assessed for risk factors of HDP, and 156 (26.9%) were tested for proteinuria. After multivariable analysis, screening for HDP was significantly higher in parous women (AOR = 2.09; 95% CI, 1.11-3.99; P = 0.023), in women with a gestational age of at least 20 weeks (AOR = 5.50; 95% CI, 2.86-10.89; P = 0.002), in women attending in a private clinic (AOR = 3.49; 95% CI, 1.07-11.34; P = 0.038), or in a hospital (AOR = 3.24; 95% CI, 1.24-8.47; P = 0.017), and when no additional payment was required for proteinuria testing at the clinic (AOR = 2.39; 95% CI, 1.14-5.02; P = 0.021). CONCLUSION: Our results show that screening for HDP during the first antenatal visit in Kinshasa is not universal. The factors associated with screening included maternal as well as clinics' characteristics. More effort should be made both at maternal and clinic levels to improve the screening for HDP in Kinshasa.

Effects of Precompetitive Preparation Period on the Isokinetic Muscular Characteristics in World Class Handball Players.

Maurelli, O, Bernard, PL, Dubois, R, Ahmaidi, S, and Prioux, J. Effects of precompetitive preparation period on the isokinetic muscular characteristics in world class handball players. J Strength Cond Res 33(4): 1065-1074, 2019-The aim of this study was to describe the effects of 8 weeks of precompetitive preparation period (Pc2P) on the isokinetic muscular characteristics in world-class handball players. Nineteen male professional players (age, 26.6 ± 5.4 years) participated in the study. Two bilateral isokinetic tests of knee joint flexors (H; hamstring) and extensors (Q; quadriceps) were performed before and after Pc2P to determine the peak torque (PT), the mean power (MP), and the ratios (agonist-antagonist, dominant-nondominant, and combined). For the PT, Q at low angular velocity (60°·s) in concentric mode revealed no significant increase for the dominant or nondominant legs. For H, results showed a significant increase for both legs (p < 0.001). At the higher angular velocity (240°·s), Q was significantly increased for the dominant (p < 0.005) and nondominant (p < 0.002) legs and also H for both sides (p < 0.001). Eccentric mode (30°·s) showed a significant increase for dominant (p < 0.005) and nondominant (p < 0.01) legs. For MP, results showed significant increase at low angular velocity (p < 0.003) and high angular velocity (p < 0.01) for both legs. In eccentric mode, values showed a significant increase after Pc2P for dominant (p < 0.001) and nondominant (p < 0.02) legs. The ratios showed significant increase for the agonist-antagonist ratio at 60°·s for dominant leg (p < 0.003) and the nondominant leg (p < 0.01). At 240°·s, the values showed a significant difference for both side (p < 0.02). From an injury risk perspective, in addition to optimizing performance, these results demonstrated that 8 weeks of Pc2P increased the maximum strength and muscle power of international handball players, even if the ratios of the knee joint muscles did not change during this period.

Effects of the Competitive Season on the Isokinetic Muscle Parameters Changes in World-Class Handball Players.

Maurelli, O, Bernard, PL, Dubois, R, Ahmaidi, S, and Prioux, J. Effects of the competitive season on the isokinetic muscle parameters changes in world-class handball players. J Strength Cond Res 33(10): 2778-2787, 2019-The aim of this study is to investigate the effects of the competitive season on isokinetic muscular parameters of the lower limbs in world-class handball players. Nineteen, male, world-class, handball players (age, 26.6 ± 5.4 years) participated in the study. Two bilateral isokinetic tests of knee joint flexors (H; hamstring) and extensors (Q; quadriceps) were performed in the beginning and end of the competitive season to determine the peak torque (PT), the mean power, and agonist-antagonist ratio, dominant-nondominant ratio (DNDR), and combined ratio. The results showed a significant decrease in PT values at low angular velocity (60°·s) in concentric mode for Q on dominant leg (p < 0.001). The other PT values for dominant and nondominant legs at low and high angular velocities (240°·s) and in eccentric mode (30°·s) were not significantly different for Q and H. For mean power, values did not change at 60°·s. At 240°·s, we found a significant decrease in H for dominant leg (p < 0.001) but not for nondominant leg. In eccentric mode, the results showed a significant increase on both legs (p < 0.001). For the ratios, values significantly decreased for DNDR at 60°·s for Q (p < 0.03) and for agonist/antagonist ratio at 240°·s for the dominant leg (p < 0.01). The present results highlight the importance of integrating regular strength training sessions during the competitive season in world-class handball players. Accordingly, this study should help trainers to modify their planning to maximize strength and power qualities of the lower limbs of their players in addition to avoiding injuries.

First trimester isolated maternal hypothyroxinaemia: adverse maternal metabolic profile and impact on the obstetrical outcome.

BACKGROUND: Isolated maternal hypothyroxinaemia (IH) is defined as low maternal FT4 (<5th percentile) and normal thyroid-stimulating hormone. There is concern on its potential negative effects on the mother and offspring. OBJECTIVE: We aimed to evaluate the prevalence of IH and to assess the consequences of hypothyroxinaemia on the maternal and foetal outcomes. SUBJECTS AND METHODS: From a total of 1300 consecutive pregnant women recruited during the prenatal screen (mean gestational age, 11·8 weeks), thyroid function parameters were assessed in 879 women. After exclusion of women with T4 supplements, with twin pregnancies and with diabetes, data from 783 women were included. Maternal and neonatal outcomes in 55 selected women with IH and negative thyroid auto-antibodies without thyroid disorders or pregnancy achieved through assisted reproductive techniques were compared with a selected euthyroid control group (N = 165). RESULTS: Among the 783 non diabetic singleton pregnant women, 68 women (8·7%) were identified with IH. When compared to the selected euthyroid controls, selected women with hypothyroxinaemia had significantly increased body mass index (BMI) in preconception (P = 0·003), in the first trimester (P = 0·004) and at the time of delivery (P = 0·001). At term, foetal breech presentation and caesarean section rate were significantly higher (P = 0·006 and P = 0·026, respectively) than in the euthyroid controls. A significant increase in macrosomia was also noted (P = 0·026). CONCLUSION: The prevalence of hypothyroxinaemia in early pregnancy was of 8·7%. IH is associated with an increased maternal BMI and is related with a risk of breech presentation, a significant increase in macrosomia and caesarean sections. Screening should consider overweight as risk factor for hypothyroxinaemia.

Prediction of hepatocellular carcinoma recurrence after liver transplantation: Comparison of four explant-based prognostic models.

AIM: Discordance between pre-LT imaging and explanted liver findings have been reported after liver transplantation (LT) for hepatocellular carcinoma (HCC), suggesting the need of reassessing the risk of HCC recurrence post-LT. Our aims were to compare pre-LT imaging and explants features and to test the performances of four explant-based predictive models of recurrence in an external cohort. METHODS: Staging according to pre-LT imaging and explant features were compared. Four explants-based models were retrospectively tested in a cohort of 372 patients transplanted for HCC in 19 French centres between 2003 and 2005. Accuracies of the scores were compared. RESULTS: Pre-LT imaging underestimated tumour burden in 83 (22.7%) patients according to Milan criteria. The highest AUCs for prediction of 5-years recurrence were observed in the "Up to seven" (0.7915 [95% CI: 0.7339-0.849]) and Decaens models (0.747 [95% CI: 0.6877-0.806]), with two levels of risk: low (10%) and high (>50%). Chan and Iwatsuki models identified 3 and 4 levels of risk, but had lower AUCs (0.68 and 0.70) respectively. Accuracy of the "Up to seven" model was superior to the Decaens model (P=.034), which was superior to the Chan model (P=.0041) but not to the Iwatsuki model (P=.17). CONCLUSION: Pre-LT imaging underestimates tumour burden, and prediction of recurrence should be reassessed after LT. The explant-based "Up to seven" and Decaens models provided the best accuracy for prediction of 5-year recurrence, identifying only two levels of risk. New models are needed to further refine the prediction of recurrence after LT.

Isolated bilateral transverse agenesis of the distal segments of the lower limbs at the level of the knee joint in a human fetus.

Congenital limb anomalies occur in Europe with a prevalence of 3.81/1,000 births and can have a major impact on patients and their families. The present study concerned a female fetus aborted at 23 weeks of gestation because she was affected by non-syndromic bilateral absence of the zeugopod (leg) and autopod (foot). Autopsy of the aborted fetus, X-ray imaging, MRI, and histochemical analysis showed that the distal extremity of both femurs was continued by a cartilage-like mass, without joint cavitation. Karyotype was normal. Moreover, no damaging variant was detected by exome sequencing. The limb characteristics of the fetus, which to our knowledge have not yet been reported in humans, suggest a developmental arrest similar to anomalies described in chicks following surgical experiments on the apical ectodermal ridge of the lower limbs.

Using biophysical models to manage nitrogen pollution from agricultural sources: Utopic or realistic approach for non-scientist users? Case study of a drinking water catchment area in Lorraine, France.

The objectives of this comparison of two biophysical models of nitrogen losses were to evaluate first whether results were similar and second whether both were equally practical for use by non-scientist users. Results were obtained with the crop model STICS and the environmental model AGRIFLUX based on nitrogen loss simulations across a small groundwater catchment area (<1 km(2)) located in the Lorraine region in France. Both models simulate the influences of leaching and cropping systems on nitrogen losses in a relevant manner. The authors conclude that limiting the simulations to areas where soils with a greater risk of leaching cover a significant spatial extent would likely yield acceptable results because those soils have more predictable leaching of nitrogen. In addition, the choice of an environmental model such as AGRIFLUX which requires fewer parameters and input variables seems more user-friendly for agro-environmental assessment. The authors then discuss additional challenges for non-scientists such as lack of parameter optimization, which is essential to accurately assessing nitrogen fluxes and indirectly not to limit the diversity of uses of simulated results. Despite current restrictions, with some improvement, biophysical models could become useful environmental assessment tools for non-scientists.

Effectiveness of telaprevir or boceprevir in treatment-experienced patients with HCV genotype 1 infection and cirrhosis.

BACKGROUND & AIMS: We investigated the effectiveness of the protease inhibitors peginterferon and ribavirin in treatment-experienced patients with hepatitis C virus (HCV) genotype 1 infection and cirrhosis. METHODS: In the Compassionate Use of Protease Inhibitors in Viral C Cirrhosis study, 511 patients with HCV genotype 1 infection and compensated cirrhosis who did not respond to a prior course of peginterferon and ribavirin (44.3% relapsers or patients with viral breakthrough, 44.8% partial responders, and 8.0% null responders) were given either telaprevir (n = 299) or boceprevir (n = 212) for 48 weeks. We assessed percentages of patients with sustained viral responses 12 weeks after therapy and safety. This observational study did not allow for direct comparison of the 2 regimens. RESULTS: Among patients given telaprevir, 74.2% of relapsers, 40.0% of partial responders, and 19.4% of null responders achieved SVR12. Among those given boceprevir, 53.9% of relapsers, 38.3% of partial responders, and none of the null responders achieved SVR12. In multivariate analysis, factors associated with SVR12 included prior response to treatment response, no lead-in phase, HCV subtype 1b (vs 1a), and baseline platelet count greater than 100,000/mm(3). Severe adverse events occurred in 49.9% of cases, including liver decompensation, severe infections in 10.4%, and death in 2.2%. In multivariate analysis, baseline serum albumin level less than 35 g/L and baseline platelet counts of 100,000/mm(3) or less predicted severe side effects or death. CONCLUSIONS: Relatively high percentages of real-life, treatment-experienced patients with HCV genotype 1 infection and cirrhosis respond to the combination of peginterferon and ribavirin with telaprevir or boceprevir. However, side effects are frequent and often severe. Baseline levels of albumin and platelet counts can be used to guide treatment decisions. ClinicalTrials.gov number: NCT01514890.

Anomalies of the placenta and umbilical cord in twin gestations.

The frequency of twin gestations has increased over the last few decades, mainly due to maternal age at childbearing, and the use of assisted reproductive technologies. Twins are at higher risk of aneuploidy, structural anomalies, and placental abnormalities. Some of the placental and umbilical cord abnormalities found in twin gestations are nonspecific and can be found in singleton gestations (ie, placenta previa, placental abruption, single umbilical artery, velamentous cord insertion, vasa previa, etc). However, other anomalies are unique to twin gestations, and are mainly associated with monochorionic twins-these include intraplacental anastomosis and cord entanglement. Most of these conditions can be diagnosed with ultrasound. An accurate and early diagnosis is important in the management of twin gestations. Determination of chorionicity, amnionicity, and the identification of placental anomalies are key issues for the adequate management of twin pregnancies. Pathologic placental examination after delivery can help in assessing the presence of placental and umbilical cord abnormalities, as well as providing information about chorionicity and gaining insight into the potential mechanisms of disease affecting twin gestations.

Radiofrequency ablation versus surgical resection for hepatocellular carcinoma within the Milan criteria: A study of 281 Western patients.

OBJECTIVES: The aim of this study was to compare survival between radiofrequency ablation (RFA) and surgical resection (SR) in patients with hepatocellular carcinoma (HCC) within Milan criteria. METHODS: From January 2004 to December 2013 we consecutively and retrospectively included all patients with first occurrence of HCC within Milan criteria receiving SR or RFA as first-line treatment. The cumulative overall survival (OS) and disease-free survival (DFS) were compared after inverse probability weighting (including confounding factor). RESULTS: A total of 281 patients (RFA 178, SR 103) were enrolled. In multivariate Cox regression RFA and SR were not independent predictors of survival or recurrence. The respective weighted 5 years OS and DFS for patients with propensity scores between 0.1-0.9 in the SR and RFA groups were 54-33% and 60-16.9%, P = 0.695 and P = 0.426, respectively. Local tumour progression rate did not differ according to treatment (P = 0.523). Major complication rate was higher in the SR group, P = 0.001. Hospitalisation duration was lower in the RFA group (mean 2.19 days, range 2-7) than in the SR group (mean 10.2 days, range 3-30), P < 0.001. CONCLUSION: This large Western study has shown that OS and DFS did not differ after RFA (using mainly multipolar devices) and SR, for HCC within the Milan criteria in a European population, with a shorter hospitalisation time and a lower complication rate for RFA.

Influence of repeated effort induced by a 6-min walk test on postural response in older sedentary women.

According to the latest recommendations, adults should exercise regularly at moderate intensity to improve aerobic fitness and body composition. However, it is unknown whether aerobic exercise at submaximal intensity has detrimental effects on balance in older sedentary adults. We explored the effects of two 6-min walk tests (6MWTs) on the postural responses in 49 sedentary women between 60 and 76 years old. We assumed that an increase in the center of pressure (COP) fluctuations or a loss in the complexity of the COP time series would be a sign of a deleterious effect on balance. We used kinematic stabilometric parameters, recurrence quantification analysis (RQA) and the central tendency measure (CTM). We refer to the measures obtained through RQA and CTM methods by dynamical measures. Repeated-measures analysis of variance showed no significant differences between the three sets of postural kinematic measures (before vs. after the first vs. after the second 6MWT). However, we observed significant differences between the three sets for the CTM measure in the antero-posterior direction (p < 0.002), RQA determinism in the medio-lateral (ML) direction (p < 0.0001), and RQA entropy in the ML direction (F = 5.93; p < 0.004).Our results indicate that the effects of moderate-intensity walking exercise on posture are not revealed by classical postural kinematic measures but only by dynamical measures. The loss of complexity in the COP time series observed after both the first and second 6MWTs may indicate presymptomatic deterioration in the postural adaptive capabilities of sedentary older women.

Covered vs. uncovered stents for transjugular intrahepatic portosystemic shunt: a randomized controlled trial.

BACKGROUND & AIMS: The first studies comparing covered stents (CS) and bare stents (BS) to achieve Transjugular Intrahepatic Portosystemic Shunt (TIPS) were in favor of CS, but only one randomized study has been performed. Our aim was to compare the primary patency of TIPS performed with CS and BS. METHODS: The study was planned as a multicenter, pragmatic (with centers different in size and experience), randomized, single-blinded (with blinding of patients only), parallel group trial. The primary endpoint was TIPS dysfunction defined as either a portocaval gradient ⩾12mmHg, or a stent lumen stenosis ⩾50%. A transjugular angiography with portosystemic pressure gradient measurement was scheduled every 6months after TIPS insertion. RESULTS: 137 patients were randomized: 66 to receive CS, and 71 BS. Patients who were found to have a hepato-cellular carcinoma, or whose procedure was cancelled were excluded, giving a sample of 129 patients (62 vs. 67). Median follow-up for CS and BS were 23.6 and 21.8months, respectively. Compared to BS, the risk of TIPS dysfunction with CS was 0.60 95% CI [0.38-0.96], (p=0.032). The 2-year rate of shunt dysfunction was 44.0% for CS vs. 63.6% for BS. Early post TIPS complications (22.4% vs. 34.9%), risk of hepatic encephalopathy (0.89 [0.53-1.49]) and 2-year survival (70% vs. 67.5%) did not differ in the two groups. The 2-year cost/patient was 20k€ [15.9-27.5] for CS vs. 23.4k€ [18-37] for BS (p=0.52). CONCLUSIONS: CS provided a significant 39% reduction in dysfunction compared to BS. We did not observe any significant difference with regard to hepatic encephalopathy or death.

Long term results of liver transplantation for Wilson's disease: experience in France.

BACKGROUND & AIMS: Liver transplantation (LT) is the therapeutic option for severe complications of Wilson's disease (WD). We aimed to report on the long-term outcome of WD patients following LT. METHODS: The medical records of 121 French patients transplanted for WD between 1985 and 2009 were reviewed retrospectively. Seventy-five patients were adults (median age: 29 years, (18-66)) and 46 were children (median age: 14 years, (7-17)). The indication for LT was (1) fulminant/subfulminant hepatitis (n = 64, 53%), median age = 16 years (7-53), (2) decompensated cirrhosis (n = 50, 41%), median age = 31.5 years (12-66) or (3) severe neurological disease (n = 7, 6%), median age = 21.5 years (14.5-42). Median post-transplant follow-up was 72 months (0-23.5). RESULTS: Actuarial patient survival rates were 87% at 5, 10, and 15 years. Male gender, pre-transplant renal insufficiency, non elective procedure, and neurological indication were significantly associated with poorer survival rate. None of these factors remained statistically significant under multivariate analysis. In patients transplanted for hepatic indications, the prognosis was poorer in case of fulminant or subfulminant course, non elective procedure, pretransplant renal insufficiency and in patients transplanted before 2000. Multivariate analysis disclosed that only recent period of LT was associated with better prognosis. At last visit, the median calculated glomerular filtration rate was 93 ml/min (33-180); 11/93 patients (12%) had stage II renal insufficiency and none had stage III. CONCLUSIONS: Liver failure associated with WD is a rare indication for LT (<1%), which achieves an excellent long-term outcome, including renal function.