Laparoscopy in the acute abdomen.

Laparoscopy has become a routine procedure in the management of acute abdominal disease and can be considered both an excellent therapeutic and additional diagnostic tool in selected cases. However, a high level of expertise in laparoscopic and emergency surgery is required. Hemodynamic instability, huge abdominal distension, fecal peritonitis and perforated cancer are relative contraindications for the laparoscopic approach. In recent years, abdominal emergencies have increasingly been managed successfully by laparoscopy. In acute appendicitis, acute cholecystitis and perforated peptic ulcer, randomized controlled trials have proven that the laparoscopic approach is as safe and as effective as open surgery, with fewer complications and a quicker postoperative recovery. Other indications such as blunt and penetrating trauma to the abdomen, small bowel occlusion and perforated diverticular disease are under debate, indicating that more randomized controlled trials comparing laparoscopic and open surgery are still necessary

Novel Technique of Distal Roux-en-Y Gastric Bypass for Insufficient Weight Loss After Primary Procedure: Personal Experience and Primary Results at 12 Months.

In the literature, up to 20% of patients present a failure of weight loss after primary Roux-en-Y gastric bypass (RYGBP) or other restrictive procedures. Our aim is to describe the midterm results of our novel technique of distal Roux-en-Y gastric bypass (DRYGBP) as a revisional procedure. We performed our DRYGBP in 21 patients. The length of the common channel was 100 cm, whereas the lengths of the alimentary and the biliopancreatic limbs were 2/3 and 1/3 of the remaining bowel, respectively. We created 2 subgroups, a "revisional" group after failed restrictive procedures and a "distalization" group after failed RYGBP. The mean excess weight loss at 12 months in the "revisional" group (10 patients) was 67.8% and in the "distalization" group (11 patients) 57.1%. We did not experience any mortality nor severe morbidity rates. In our experience, our DRYGBP differentiated procedure seems to be effective at 12 months

Vers une horticulture à haute performance environnementale

UMR 1334 AGAP : Equipe AFEF ‘Architecture et Fonctionnement des Espèces fruitières’ ; Team AFFS ‘Architecture and Functioning of Fruit Species’ Contact: [email protected], [email protected] composé des articles suivants :- Vers une horticulture à haute performance environnementale : présentation de la séance- Les tendances et les enjeux de la filière fruits et légumes frais : introduction- Quel positionnement de la qualité à la croisée de l'environnement et de la nutrition- Systèmes de culture innovants et qualité des fruits en verger de pêchers- Cartographie des préférences des consommateurs européens et amélioration de la qualité de la tomate- Discussion- Conclusion.Séance de l’Académie d'Agriculture de France, 2011/03/16, Paris (France)International audienceL’organisation de la filière Fruits et Légumes (F&L) et son fonctionnement très complexes connaissent actuellement des changements importants nécessités par les évolutions des marchés et une demande sociétale forte, notamment au niveau de la qualité des F&L. Comment concilier qualités de ces produits et contraintes environnementales de plus en plus soutenues? Comment analyser les composantes de la qualité et leur perception par les consommateurs et les prendre en compte dans les programmes d’amélioration génétique? Telles sont les questions qui seront abordées dans cette séance consacrée aux enjeux futurs de la qualité des F&L

Tumoral acidosis promotes adipose tissue depletion by fostering adipocyte lipolysis

Objective: Tumour progression drives profound alterations in host metabolism, such as adipose tissue depletion, an early event of cancer cachexia. As fatty acid consumption by cancer cells increases upon acidosis of the tumour microenvironment, we reasoned that fatty acids derived from distant adipose lipolysis may sustain tumour fatty acid craving, leading to the adipose tissue loss observed in cancer cachexia. Methods: To evaluate the pro-lipolytic capacities of acid-exposed cancer cells, primary mouse adipocytes from subcutaneous and visceral adipose tissue were exposed to pH-matched conditioned medium from human and murine acid-exposed cancer cells (pH 6.5), compared to naive cancer cells (pH 7.4). To further address the role of tumoral acidosis on adipose tissue loss, a pH-low insertion peptide was injected into tumour-bearing mice, and tumoral acidosis was neutralised with a sodium bicarbonate buffer. Prolipolytic mediators were identified by transcriptomic approaches and validated on murine and human adipocytes. Results: Here, we reveal that acid-exposed cancer cells promote lipolysis from subcutaneous and visceral adipocytes and that dampening acidosis in vivo inhibits adipose tissue depletion. We further found a set of well-known prolipolytic factors enhanced upon acidosis adaptation and unravelled a role for β-glucuronidase (GUSB) as a promising new actor in adipocyte lipolysis. Conclusions: Tumoral acidosis promotes the mobilization of fatty acids derived from adipocytes via the release of soluble factors by cancer cells. Our work paves the way for therapeutic approaches aimed at tackling cachexia by targeting the tumour acidic compartment

Liver fetuin-A in activated macrophages is a key feature of nonalcoholic steatohepatitis in mice and humans

Background and aims: Fetuin-A, a plasma multifunctional protein known to play a role in insulin resistance, is usually presented as a liver secreted protein. However, fetuin-A adipose tissue production has been also described. Here, we evaluated fetuin-A production by the liver and the adipose tissue during NAFLD-NASH development. Methods: Male foz -/- mice fed a normal diet (ND) or a HFD for 4 (short term HFD or SHFD), 12 (long term HFD or LHFD) or 30 weeks (very long term HFD or VLHFD) were used to induce early steatosis, marked steatosis or definite fibrosing NASH, respectively. Fetuin-A was evaluated by ELISA, PCR, Western-blot and immunofluorescence in those animals and in NAFLD-NASH patients undergoing bariatric surgery (n=5) and from the hepatology clinic (n=49). Fetuin-A was also quantified in hepatocyte and adipocyte cell culture experiments. Results: Foz -/- mice fed a SHFD developed liver steatosis and increased circulating levels of fetuin-A compared to ND fed mice. On liver slides, fetuin-A and steatosis were mainly located in the centrilobular region. In LHFD mice, macrophage activation was observed within the liver together with elevated fasted plasma glucose, raised fetuin-A blood levels and localization of fetuin-A immunostaining in steatotic hepatocytes. VLHFD mice were characterized by the occurrence of NASH. Fetuin-A was located at this time-point not only in steatotic hepatocytes but also in some macrophages forming lipogranuloma. A high quantity of fetuin-A protein was present within the adipose tissue. However, compared to the adipose tissue, liver fetuin-A mRNA expression was significantly higher. In humans, fetuin-A was located in steatotic hepatocytes in NAFLD-NASH patients and within some lipogranuloma and macrophage clusters in NASH patients. Circulating fetuin-A was significantly correlated with blood glucose levels rather than with NASH severity in terms of fibrosis. Liver m-RNA expression was 5000 times increased compared to adipose tissue mRNA expression. In cell culture, fetuin-A was evidenced only in the supernatant of hepatocytes but not in the supernatant of adipocytes. Conclusion: Fetuin-A is produced by steatotic hepatocytes at early time points in NAFLD and correlates with insulin resistance both in mice and humans. In NASH, fetuin-A also co-localizes with activated liver macrophages. Future experiments on foz -/- mice will help to progress in the role of fetuin-A on NASH pathogenesis and macrophage activation

Early Versus Late Oral Refeeding After Pancreaticoduodenectomy for Malignancy: a Comparative Belgian-French Study in Two Tertiary Centers.

In the era of fast-track surgery, because pancreaticoduodenectomy (PD) carries a significant morbidity, surgeons hesitate to begin early oral feeding and achieve early discharge. We compared the outcome of two different approaches to the postoperative management of PD in two tertiary centers. Of patients having undergone PD for malignancy from 2008 to 2017, 100 patients who received early postoperative oral feeding (group A) were compared to 100 patients from another center who received early enteral feeding and a delayed oral diet (group B). Surgical indication and approach and type of pancreatic anastomosis were similar between both groups. Postoperative outcomes were retrospectively reviewed. Patient characteristics were similar between both groups, except significantly more neoadjuvant treatment in group A (A = 20% vs. B = 9%, p < 0.01). Mortality rates were 3% and 4% in groups A and B, respectively (p = 0.71). The rate of severe postoperative morbidity was significantly lower in group A (13% vs. 26%, p = 0.02), resulting in a lower reoperation rate (p < 0.01). Delayed gastric emptying and clinically relevant pancreatic fistula were similar between both groups but chyle leaks were more frequent in group A (10% vs. 3%, p = 0.04). The median hospital stay was shorter in group A (16 vs. 20 days, p < 0.01). In the present study, early postoperative oral feeding after PD was associated with a shorter hospital stay and did not increase severe postoperative morbidity or the rate of pancreatic fistula. However, it resulted in more chyle leaks and did not prevent delayed gastric emptying