Anal sphincter function as assessed by 3D high definition anorectal manometry

International audienc

Magnetic resonance imaging and clinical assessments for perianal Crohn's disease: gain and limits.

International audienceAssessment of perianal Crohn's disease remains challenging. European Crohn's and Colitis Organisation (ECCO) recommend magnetic resonance imaging (MRI) as a gold standard, but both accuracy and advantages remain limited compared to systematic clinical assessment. The aim of this study was to define their actual diagnostic value. We performed a retrospective analysis of a prospective database of consecutive patients with perianal Crohn's disease assessed by magnetic resonance imaging and clinical examination from 2006 to 2012. At each outpatient visit, perianal activity (Perianal Disease Activity Index) and perianal phenotype (Cardiff-Hughes classification) were noted. MRI was interpreted according to Cardiff-Hughes and Van Assche classifications. Overall, 122 combined evaluations were assessed in 70 patients. Radiological imaging failed to show superficial ulcerations in 20/21 patients (95%) and severe ulcerations in 13/15 patients (87%). It consistently failed to diagnose anal stenosis (n=21, 100%). For fistulising lesions, the global agreement between the two methods was 71/122 (58%) in assessing complex fistulas. Clinical assessment underestimated 44/68 (65%) of multiple or ramified fistula tracts. Clinical examination failed to diagnose half of the radiological abscesses. Current ECCO guidelines should be applied with some caution because of the low sensitivity of MRI for the diagnosis of non-fistulising perianal disease. Combining clinical and MRI assessments improves diagnostic accuracy

Anal Fistulas in Severe Perineal Crohn's Disease Mri Assessment in the Determination of Long-Term Healing Rates

International audienceBackground & aims - The European Crohn's and Colitis Organization recommends magnetic resonance imaging (MRI) of anal fistulas to decide on the drug/surgery strategy. No evidence is available on the long-term impact of MRI features on fistula healing. The aim of this study was to evaluate the benefit of combined drug/surgery strategies for the treatment of perianal Crohn's fistulas based on MRI factors at referral.Methods - The clinical event (anal abscess, new fistula tract, cellulitis), therapeutic intervention (introduction/optimization of immunosuppressant/biologics, anal surgery, intestinal resection, stoma), and MRI data were prospectively recorded for patients with Crohn's disease (CD) and anal fistulas. Healing was defined by fulfilment of all the following conditions: no discharge or pain, closure of the external opening of the fistula, no visible internal opening, no abscess, and no subsequent draining seton or drainage procedure performed during at least 1 year of follow-up.Results - Seventy CD patients with anal fistulas and MRI evaluations were followed for 70 months. The cumulative rates of fistula healing were 25%, 40%, 50%, and 70% at 12, 24, 36, and 72 months, respectively. Severe, complex, branched, and high fistulas were associated with a less favorable outcome. Surgical closure of the tract improved the healing rates better than treatment with biologics or thiopurines. Male sex, A1 luminal phenotype, and anal ulceration at referral were independently associated with a higher healing rate.Conclusions - Therapeutic strategies for perianal fistulizing CD require robust anatomical and healing evaluations. Combined strategies using biologics to improve both drainage and secondary closure of the fistula tracts merit further study.<br

Risk of Fecal Incontinence Following Receptive Anal Intercourse: Survey of 21,762 Men Who Have Sex With Men

International audienceBackground: The prevalence of receptive anal intercourse (RAI) is increasing. A few studies, with heterogeneous designs, have investigated the associated risk of fecal incontinence (FI).Aim: The primary objective of this study was to determine FI prevalence in a population of men who have sex with men (MSM) engaging in RAI. The secondary objective was to identify risk factors for severe FI.Methods outcomes: An online survey of 24,308 MSM was performed in 2019. Demographic and socioeconomic data were collected, together with information about RAI sexual practices, and FI defined by: "During the last month, have you experienced any involuntary leakage of stools?"Results clinical implications: In total, 1,734 (8%) of the 21,762 participants reported FI. Mean age was 35.3 years. The prevalence of FI was correlated with RAI frequency: 12.7% (if RAI ≥ 1 /wk) versus 5.7% (if no RAI). In multivariate analysis, the factors associated with FI were age (OR: 1.01), low socioeconomic status (OR 1.32 to 1.40), HIV-seropositivity (OR: 1.78), high RAI frequency (OR: 1.64), chemsex (OR: 1.67) and fist-fucking (OR: 1.61).Strengths and limitations: Main strengths of our study are population size and assessment of detailed modalities of sexual practices. Main limitations are the use of a convenience non-random sample and the assessment of FI only during the past month.Conclusion: This study of a large MSM population, highlights risk factors for FI among RAI practices: RAI ≥ 1 /wk, chemsex, fist-fucking, low socioeconomic status. Garros A, Bourrely M, Sagaon-Teyssier L, et al. Risk of Fecal Incontinence Following Receptive Anal Intercourse: Survey of 21,762 Men Who Have Sex With Men. J Sex Med 2021;18:1880-1890

Crystalline Structure of HfZrO Thin Films and ZrO2 / HfO2 bi-Layers Grown by AVD for MOS Applications

International audienceThe downscaling in CMOS transistors requires the introduction of new materials with a higher dielectric constant. The electrical properties of HfxZryOz films and ZrO2 / HfO2 bi-layers grown by Atomic Vapor Deposition were analyzed for their integration as gate oxides. While crystallinity of those layers was found to be dependent on their zirconium concentration, the electrical performance was shown to depend mainly on the growth temperature of the high-k films

Record RF Performance (ft=180GHz and fmax=240GHz) of a FDSOI NMOS processed within a Low Thermal Budget for 3D Sequential Integration

International audienceRecord RF Figure-Of-Merits (FoM) is highlighted for a 42nm NMOS transistor fully processed at Low Thermal Budget (LTB) (&lt;500&deg;C) needed for 3D Sequential Integration (3DSI). f T =180GHz &amp; f MAX =240GHz are reported at V DD =0.9V; which is actually very similar to performance of reference Si MOSfets processed with a Hot Thermal Budget (HTB) (Fig. 15). This excellent result was possible thanks to a careful optimization of the LTB process after an advanced characterization and modeling of key technological parameters such as mobility, Gate-Capacitance and Gate resistance</p

Record RF Performance (ft=180GHz and fmax=240GHz) of a FDSOI NMOS processed within a Low Thermal Budget for 3D Sequential Integration

International audienceRecord RF Figure-Of-Merits (FoM) is highlighted for a 42nm NMOS transistor fully processed at Low Thermal Budget (LTB) (&lt;500&deg;C) needed for 3D Sequential Integration (3DSI). f T =180GHz &amp; f MAX =240GHz are reported at V DD =0.9V; which is actually very similar to performance of reference Si MOSfets processed with a Hot Thermal Budget (HTB) (Fig. 15). This excellent result was possible thanks to a careful optimization of the LTB process after an advanced characterization and modeling of key technological parameters such as mobility, Gate-Capacitance and Gate resistance</p