Onco-Surgical Management of Liver Metastases from Colorectal Cancer

Metastatic disease is the main cause of death in patients with colorectal cancer and the most frequent location of metastases is in the liver. The treatment of liver metastases of colorectal origin is multimodal and should be based on a multidisciplinary team decision. A systematic review of the literature revealed that the number of liver metastases, their maximum size, CEA level, advanced age of the patients, and presence of extrahepatic disease are no longer contraindications to liver resection. The resectability rate of colorectal liver metastases increased from 10 to almost 40%, enabling 5-year overall survival rates higher than 30%. Short-term and long-term results achieved by simultaneous resection (SR) are similar to those achieved by staged resections in patients with synchronous colorectal liver metastases. Whenever possible, major hepatectomies should be replaced by ultrasound-guided limited liver resections, and primary tumor should be approached in a minimally invasive manner. Even initially unresectable colorectal liver metastases could be rendered resectable by an aggressive multimodal approach (“two-stage” hepatectomies, hepatectomy after portal vein embolization/ligation, resection after conversion chemotherapy, and hepatectomy associated with ablation). The presence of extrahepatic metastases is no longer a contraindication to liver resection, when extrahepatic disease is resectable. Repeat hepatectomy improves survival in patients with recurrent liver metastases

Aligned carbon nanotubes catalytically grown on iron-based nanoparticles obtained by laser-induced CVD

International audienceIron-based nanoparticles are prepared by a laser-induced chemical vapor deposition (CVD) process. They are characterized as body-centered Fe and Fe2O3 (maghemite/magnetite) particles with sizes ::;5 and 10 nm, respectively. The Fe particles are embedded in a protective carbon matrix. Both kind of particles are dispersed by spin-coating on SiO2/Si(1 0 0) flat substrates. They are used as catalyst to grow carbon nanotubes by a plasma- and filaments-assisted catalytic CVD process (PE-HF-CCVD). Vertically oriented and thin carbon nanotubes (CNTs) were grown with few differences between the two samples, except the diameter in relation to the initial size of the iron particles, and the density. The electron field emission of these samples exhibit quite interesting behavior with a low turn-on voltage at around 1 V/mm

Sur les modalités croire et savoir

Alexandrescu Sorin. Sur les modalités croire et savoir. In: Langages, 10ᵉ année, n°43, 1976. Modalités : logique, linguistique, sémiotique, sous la direction de Ivan Darrault. pp. 19-27

Generalized Riemann derivative

Initiated by Marshall Ash in 1966, the study of generalized Riemann derivative draw significant attention of the mathematical community and numerous studies where carried out since then. One of the major areas that benefits from these developments is the numerical analysis, as the use of generalized Riemann derivatives leads to solving a wider class of problems that are not solvable with the classical tools. This article studies the generalized Riemann derivative and its properties and establishes relationships between Riemann generalized derivative and the classical one. The existence of classical derivative implies the existence of the Riemann generalized derivative, and we study conditions necessary for the generalized Riemann derivative to imply the existence of the classical derivative. Furthermore, we provide conditions on the generalized Riemann derivative that are sufficient for the existence of the classical derivative

Surgical Options for Initially Unresectable Colorectal Liver Metastases

Although the frontiers of liver resection for colorectal liver metastases have broadened in recent decades, approximately 75% of these patients present with unresectable metastases at the time of their diagnosis. In the past, these patients underwent only palliative treatment, without the chance of a cure. In the previous two decades, several therapeutic strategies have been developed that render resectable those metastases that were initially unresectable, thus offering the chance of long-term survival and even a cure to these patients. The oncosurgical modalities that are available include liver resection following portal vein ligation/embolization, “two-stage” liver resection, one-stage ultrasonically guided liver resection, hepatectomy following conversion chemotherapy, and liver resection combined with thermal ablation. Moreover, in recent years, certain authors have recommended the revisiting of the concept of liver transplantation in highly selected patients with unresectable colorectal liver metastases and favorable prognostic factors. By employing such therapies, the number of patients with colorectal liver metastases who undergo a potentially curative treatment could increase to 40%. The safety profile of these approaches is acceptable (morbidity rates as high as 45%, mortality rates of less than 5%). Furthermore, the 5-year survival rates (approximately 30%) are significantly increased over those that were achieved with palliative treatment

Reflets (les fonctions de la représentation du miroir en peinture et en littérature)

Cette étude se propose la recherche d'un paradigme anti-mimétique de l'art dans les expressions du miroir déformant et des cas particuliers de la réflexion non-mimétique depuis l'Antiquité jusqu'à la fin du XVe siècle. Nous avons choisi de situer notre recherche dans les espaces culturels grec et romain pour l'Antiquité et dans la culture italienne et française pour le Moyen Age et la première Renaissance. Comme il s'agit d'une étude pluridisciplinaire, nous avons analysé les occurrences du miroir déformant dans la littérature, la philosophie, la théorie de l'art, la peinture, mais aussi dans les sciences: l'optique et la catoptrique, en privilégiant surtout le dialogue entre le texte et l'image. En considérant le miroir déformant comme le symbole du paradigme anti-mimétique de l'art, nous avons suivi ses expressions selon quatre niveaux. Le premier est consacré à l'importance accordée par l'optique et la catoptrique à l'instrument spéculaire et en particulier à l'étude des lois de la réflexion dans les miroirs déformants. Le deuxième niveau, le niveau symbolique, est représenté par l'analyse des occurrences du miroir déformant et des cas particuliers de la réflexion non-mimétique dans la philosophie, la littérature et la peinture, en fonction de quelques thèmes et motifs liés à la spécularité. Le troisième niveau, celui esthétique, repose sur l'analyse des théories artistiques en suivant les deux paradigmes de l'art: la mimésis et l'anti-mimésis. Les fonctions de la représentation spéculaire en peinture constituent le dernier niveau de cette recherche où nous avons insisté surtout sur la déformation de l'image reflétée et sur son rôle méta-pictural.This is a study of the anti-mimetic paradigm of art using the expressions of the distorted mirror and the specific cases of the non-mimetic reflection since Antiquity until the end of the 15th century. We have decided to place our research of the Antiquity in the Greek and Roman cultural spaces and of the Middle Ages and Early Renaissance in the Italian and French cultural spaces. In accordance with our multidisciplinary study, we have analysed the various occurrences of the distorted mirror in the areas of literature, philosophy, art theory, and painting, as well as in sciences, such as optics and catoptrics. By considering the distorted mirror as the symbol of the anti-mimetic paradigm of art, we have followed its expressions according to four perspectives. The first perspective considers the importance given by optics and catoptrics to the specular instrument and, in particular, to the study of the laws of reflection for the distorted mirrors. The second perspective, the symbolic one, is represented by the analysis of the occurrences of the distorted mirror and of the specific cases of the non-mimetic reflection in philosophy, literature and painting, and more specifically of some of the themes and motives related to the mirror. With the third perspective, the aesthetical one, we analysed the artistic theories, in particular the ones that consider the specular metaphor, by following the two paradigms of art: mimesis and anti-mimesis. The functions of the specular representation in paintings constitute the last level of our research where we have focused especially on the distortion of the reflected image and on its meta-pictorial role.LYON3-Bibliothèques (693872102) / SudocSudocFranceF

Surgical Options for Peritoneal Surface Metastases from Digestive Malignancies—A Comprehensive Review

The peritoneum is a common site for the dissemination of digestive malignancies, particularly gastric, colorectal, appendix, or pancreatic cancer. Other tumors such as cholangiocarcinomas, digestive neuroendocrine tumors, or gastrointestinal stromal tumors (GIST) may also associate with peritoneal surface metastases (PSM). Peritoneal dissemination is proven to worsen the prognosis of these patients. Cytoreductive surgery (CRS), along with systemic chemotherapy, have been shown to constitute a survival benefit in selected patients with PSM. Furthermore, the association of CRS with hyperthermic intraperitoneal chemotherapy (HIPEC) seems to significantly improve the prognosis of patients with certain types of digestive malignancies associated with PSM. However, the benefit of CRS with HIPEC is still controversial, especially due to the significant morbidity associated with this procedure. According to the results of the PRODIGE 7 trial, CRS for PSM from colorectal cancer (CRC) achieved overall survival (OS) rates higher than 40 months, but the addition of oxaliplatin-based HIPEC failed to improve the long-term outcomes. Furthermore, the PROPHYLOCHIP and COLOPEC trials failed to demonstrate the effectiveness of oxaliplatin-based HIPEC for preventing peritoneal metastases development in high-risk patients operated for CRC. In this review, we discuss the limitations of these studies and the reasons why these results are not sufficient to refute this technique, until future well-designed trials evaluate the impact of different HIPEC regimens. In contrast, in pseudomyxoma peritonei, CRS plus HIPEC represents the gold standard therapy, which is able to achieve 10-year OS rates ranging between 70 and 80%. For patients with PSM from gastric carcinoma, CRS plus HIPEC achieved median OS rates higher than 40 months after complete cytoreduction in patients with a peritoneal cancer index (PCI) ≤6. However, the data have not yet been validated in randomized clinical trials. In this review, we discuss the controversies regarding the most efficient drugs that should be used for HIPEC and the duration of the procedure. We also discuss the current evidence and controversies related to the benefit of CRS (and HIPEC) in patients with PSM from other digestive malignancies. Although it is a palliative treatment, pressurized intraperitoneal aerosolized chemotherapy (PIPAC) significantly increases OS in patients with unresectable PSM from gastric cancer and represents a promising approach for patients with PSM from other digestive cancers

Structuri Hibride în artă

LYON3-Bibliothèques (693872102) / SudocSudocFranceF