107 research outputs found
Grossesse molaire partielle avec fĆtus diploĂŻde vivant: Ă propos dâun cas et revue de la littĂ©rature
La mĂŽle hydatiforme partielle (MHP) fait partie des maladies trophoblastiques gestationnelles. AppelĂ©e Ă©galement mĂŽle embryonnĂ©e, il sâagit dâun Ćuf humain pathologique comportant des villositĂ©s en transformation vĂ©siculaire, mais conservant une forme placentaire reconnaissable et une cavitĂ© amniotique avec un fĆtus. La circonstance diagnostique la plus commune Ă©tant le tableau dâavortement spontanĂ© au premier trimestre. Rarement les mĂŽles partielles persistent au-delĂ du premier trimestre et sont alors source de complications maternelles et fĆtales et de confusion diagnostique. Lâorigine gĂ©nĂ©tique des MHP correspond Ă une conception triploĂŻde avec un lot chromosomique supplĂ©mentaire dâorigine paternelle. La coexistence dâun fĆtus de caryotype normal avec une MHP est une situation exceptionnelle. Nous rapportons un cas rare de grossesse molaire partielle avec fĆtus vivant diploĂŻde Ă 27 semaines dâamĂ©norrhĂ©e (SA) chez une femme ĂągĂ©e de 36 ans dont le diagnostic est portĂ© Ă lâoccasion dâune menace dâaccouchement prĂ©maturĂ©e associĂ©e Ă un placenta prĂŠvia
Evaluation de la sexualité chez des femmes atteintes dŽun cancer du sein aprÚs traitement: à propos de 100 cas
Le cancer du sein est le cancer féminin le plus fréquent. Plusieurs stratégies de traitement sont utilisées : la chimiothérapie, la radiothérapie, la chirurgie et enfin lŽhormonothérapie. Chacun de ces traitements est susceptible dŽaltérer la sexualité des patientes à court ou à long terme. LŽobjectif de notre étude est dŽévaluer la sexualité des femmes atteintes d'un cancer du sein aprÚs traitement. Un devis descriptif quantitatif a été réalisé auprÚs de 100 patientes suivies pour un cancer mammaire non métastasique en activité sexuelle, rencontrées à la consultation de gynécologie de lŽhÎpital Farhat Hached de Sousse. La collecte des données a été réalisé par une fiche de renseignement et à lŽaide de deux échelles validées :RSS (Relation Ship and Sexuality) et BESAA (Body EsteemScale For Adolescents and Adults) afin dŽévaluer la sexualité et lŽimage du corps. La moyenne dŽùge était 53,8 ans. Environ la moitié des patientes (48%), avaient une vie sexuelle altérée par la maladie. La fréquence des rapports, le désir sexuel et la capacité dŽatteindre lŽorgasme a été diminué respectivement chez 65, 45 et 54 patientes. Le score global des 3 dimensions de lŽimage du corps était de 49,4. Les femmes ùgées entre 35 et 39 ans développaient significativement plus de peur du rapport sexuel (p=0,002) et moindre de fréquence sexuelle (p=0,004). Une formation adéquate et accentuée sur la prise en charge des femmes ayant un cancer ainsi que leurs problÚmes sexuels et un travail multidisciplinaire permettent dŽaméliorer lŽétat psychologique des femmes
Reperfusion therapy in renal dysfunction patients presenting with STEMI: Which is better in the Tunisian context?
BackgroundPatients with renal insufficiency experience worse prognosis after STEMI. Current guidelines do not clearly draw specific strategies for renal dysfunction (RD) patients, and most clinical trials exclude them from the study population.Aim of the studyTo compare primary PCI (PPCI) and thrombolysis (using Strepokinase) results as well as in-hospital mortality after successful reperfusion between patients with or without RD.MethodsFrom January 1995 to October 2011, 1388 patients admitted for STEMI were enrolled in the MIRAMI (MonastIRâs Acute Myocardial Infarction) registry. Two reperfusion groups were identified: PPCI (315 patients) and thrombolysis (379 patients). Patients who underwent rescue PCI were excluded. Due to lacking clearance data, we used a serum creatinine level >130ÎŒmol/l to define RD patients. We compared in each reperfusion group: (1) The success of revascularization (TIMI III flow restoring with <20% residual stenosis after PPCI, pain relief with ST regression >50% 60min after thrombolysis) and (2) the in-hospital mortality rate after reperfusion success between the RD patients (RD+) and normal renal function patients (RDâ).ResultsNinety patients (13%) had RD, 50% of which underwent PPCI, and 50% received thrombolytics. Among RD+ and RD- groups, baseline characteristics were similar between the two reperfusion groups.In the PPCI group, although TIMI flow was similar before angioplasty (p=0.82), TIMI III restoring was significantly lower in the RD+ group (78.6% vs 91.8%, p=0.013). Suboptimal result was also higher in the RD+ group (13.6% vs 2.7%, p<0.001), but ST regression after TIMI III achievement was similar in the 2 groups (p=0.43) reflecting probably no microvascular damage.In the thrombolysis group, successful reperfusion was also significantly lower when RD exists (58% vs 74%, p=0.03).After successful reperfusion, in-hospital mortality is higher among RD+ patients in the PPCI group (33.3% vs 4.3%, p<0.001), whereas it is similar after successful thrombolysis (2.6% vs 0%, p=0.42).ConclusionRD reduces either PPCI or thrombolysis success, with no proven microvascular damage after PPCI. In-hospital prognosis is however worse in RD group only after successful PPCI, but not after successful Streptokinase thrombolysis
An Access Control Model for Web Databases
International audienceThe majority of today's web-based applications are based on back-end databases to process and store business information. Containing valuable business information, these systems are highly interesting to attackers and special care needs to be taken to prevent them from malicious accesses. In this paper, we propose (RBACâ+â), an extension of the NIST RBAC (Role-Based Access Control) standard with the notions of application, application profile and sub-application session to distinguish end users that execute the same application, providing them by only the needed roles and continuously monitoring them throughout a whole session. It is based on business application logic rather than primitive reads and writes to enhance the ability of detecting malicious transactions. Hence, attacks caused by malicious transactions can be detected and canceled timely before they succeed
Sex-dependent least toxic timing of irinotecan combined with chronomodulated chemotherapy for metastatic colorectal cancer : randomized multicenter
The least toxic time (LTT) of irinotecan varied by up to 8 hours according to sex and genetic background in mice. The translational relevance was investigated within a randomized trial dataset, where no LTT stood out significantly in the whole population.
130 male and 63 female eligible patients with metastatic colorectal cancer were randomized to receive chronomodulated Irinotecan with peak delivery rate at 1 of 6 clock hours staggered by 4 hours on day 1, then fixedâtime chronomodulated FluorouracilâLeucovorinâOxaliplatin for 4 days, q3 weeks. The sexâspecific circadian characteristics of grade (G) 3â4 toxicities were mapped with cosinor and time*sex interactions confirmed with Fisher's exact test.
Baseline characteristics of male or female patients were similar in the six treatment groups. Main grade 3â4 toxicities over six courses were diarrhea (males vs females, 39.2%; vs 46.0%), neutropenia (15.6% vs 15.0%), fatigue (11.5% vs 15.9%), and anorexia (10.0% vs 7.8%). They were reduced following irinotecan peak delivery in the morning for males, but in the afternoon for females, with statistically significant rhythms (P < .05 from cosinor) and sex*timing interactions (Fisher's exact test, diarrhea, P = .023; neutropenia, P = .015; fatigue, P = .062; anorexia, P = .032). Irinotecan timing was most critical for females, with grades 3â4 ranging from 55.2% of the patients (morning) to 29.4% (afternoon) for diarrhea, and from 25.9% (morning) to 0% (afternoon) for neutropenia.
The study results support irinotecan administration in the morning for males and in the afternoon for females, in order to minimize adverse events without impairing efficacy
Early tumour response as a survival predictor in previously- treated patients receiving triplet hepatic artery infusion and intravenous cetuximab for unresectable liver metastases from wild-type KRAS colorectal cancer
Relevance of a mobile internet platform for capturing inter- and intrasubject variabilities in circadian coordination during daily routine : pilot study
Background:
Experimental and epidemiologic studies have shown that circadian clocks disruption can play an important role in the development of cancer and metabolic diseases. The cellular clocks outside the brain are effectively coordinated by the body temperature rhythm. We hypothesized that concurrent measurements of body temperature and rest-activity rhythms would assess circadian clocks coordination in individual patients, thus enabling the integration of biological rhythms into precision medicine.
Objective
The objective was to evaluate the circadian clocksâ coordination in healthy subjects and patients through simultaneous measurements of rest-activity and body temperature rhythms.
Methods
Non-invasive real-time measurements of rest-activity and chest temperature rhythms were recorded during the subjectâs daily life, using a dedicated new mobile e-health platform (PiCADo). It involved a chest sensor that jointly measured accelerations, 3D-orientation and skin surface temperature every 1-5 min, and relayed them out to a mobile gateway via Bluetooth-Low-Energy. The gateway tele-transmitted all stored data to a server via GPRS every 24 h. The technical capabilities of PiCADo were validated in 55 healthy subjects and 12 cancer patients, whose rhythms were e-monitored during their daily routine for 3-30 days. Spectral analyses enabled to compute rhythm parameters values, with their 90% confidence limits, and their dynamics in each subject.
Results
All the individuals displayed a dominant circadian rhythm in activity with maxima occurring from 12:09 to 20:25. This was not the case for the dominant temperature period, which clustered around 24 h for 51 out of 67 subjects (76%), and around 12 h for 13 others (19%). Statistically significant sex- and age- related differences in circadian coordination were identified in the non-cancerous subjects, based upon the range of variations in temperature rhythm amplitudes, maxima (acrophases), and phase relations with rest-activity. The circadian acrophase of chest temperature was located at night for the majority of people, but it occurred at daytime for 26% (14/55) of the non-cancerous people and 33% (4/12) of the cancer patients, hence supporting important inter-subject differences in circadian coordination. Sex, age and cancer significantly impacted on the circadian coordination of both rhythms, based on their phase relationships.
Conclusions
Complementing rest-activity with chest temperature circadian e-monitoring revealed striking inter-subject differences regarding human circadian clocks coordination and timing during daily routine. To further delineate the clinical importance of such finding, the PiCADo platform is currently applied for both the assessment of health effects resulting from atypical work schedules, and the identification of the key determinants of circadian disruption in cancer patients
Efficacy and Safety of Hepatic Arterial Infusion of Fluorouracil with Leucovorin as Salvage Treatment for Refractory Liver Metastases from Colorectal Cancer
Circadian rest-activity rhythm as an objective biomarker of patient-reported outcomes in patients with advanced cancer
Background
Psychosocial symptoms often cluster together, are refractory to treatment, and impair healthârelated quality of life (HRâQoL) in cancer patients. The contribution of circadian rhythm alterations to systemic symptoms has been overlooked in cancer, despite a causal link shown under jet lag and shift work conditions. We investigated whether the circadian restâactivity rhythm provides a reliable and objective estimate of the most frequent patientâreported outcome measures (PROMs).
Methods
Two datasets were used, each involving concomitant 3âday time series of wrist actigraphy and HRâQoL questionnaires: EORTC QLQâC30 was completed once by 237 patients with metastatic colorectal cancer; MD Anderson Symptom Inventory (MDASI) was completed daily by 31 patients with advanced cancer on continuous actigraphy monitoring, providing 1015 paired data points. Circadian function was assessed using the clinically validated dichotomy index I < O. Nonparametric tests compared PROMs and I < O. Effect sizes were computed. Sensitivity subgroup and temporal dynamics analyses were also performed.
Results
I < O values were significantly lower with increasing symptom severity and worsening HRâQoL domains. Fatigue and anorexia were worse in patients with circadian disruption. The differences were both statistically and clinically significant (P < 0.001; d â„ 0.33). Physical and social functioning, and global quality/enjoyment of life were significantly better in patients with robust circadian rhythm (P < 0.001; d â„ 0.26). Sensitivity analyses validated these findings.
Conclusion
Objectively determined circadian disruption was consistently and robustly associated with clinically meaningfully severe fatigue, anorexia, and interference with physical and social functioning. This supports an important role of the circadian system in the determination of cancer patientsâ HRâQoL and symptoms that deserves therapeutic exploitation
Multicentre, interventional, single-arm study protocol of telemonitored circadian rhythms and patient-reported outcomes for improving mFOLFIRINOX safety in patients with pancreatic cancer (MultiDom, NCT04263948)
Introduction: Circadian clocks regulate cellular proliferation and drug effects. Tolerability and/or efficacy of anticancer therapies have been improved by their administration according to circadian rhythms, while being predicted by circadian robustness. The combination of leucovorin, fluorouracil, irinotecan and oxaliplatin (mFOLFIRINOX) is a standard treatment for pancreatic ductal adenocarcinoma (PDAC), that generates grades 3â4 adverse events in the majority of patients and an estimated 15%â30% emergency admission rate. The MultiDom study evaluates whether mFOLFIRINOX safety can be improved using a novel circadian-based telemonitoring-telecare platform in patients at home. The detection of early warning signals of clinical toxicities could guide their early management, possibly preventing emergency hospital admissions. Methods and analysis: This multicentre, interventional, prospective, longitudinal, single-arm study hypothesises that the mFOLFIRINOX-related emergency admission rate will be 5% (95% CI 1.7% to 13.7%), among 67 patients with advanced PDAC. Study participation is 7 weeks for each patient, including a reference week before chemotherapy onset and 6 weeks afterwards. Accelerometry and body temperature are measured q1-min using a continuously worn telecommunicating chest surface sensor, daily body weight is self-measured with a telecommunicating balance and 23 electronic patient-reported outcomes (e-PROs) are self-rated using a tablet. Hidden Markov model, spectral analyses and other algorithms automatically compute physical activity, sleep, temperature, body weight change, e-PRO severity and 12 circadian sleep/activity parameters, including the dichotomy index I<O (% activity âin-bedâ below median activity âout-of-bedâ), once to four times daily. Health professionals access visual displays of near-real time parameter dynamics and receive automatic alerts, with trackable digital follow-up. Ethics and dissemination: The study has been approved by the National Agency for Medication and Health Product Safety (ANSM) and Ethics Committee West V (2 July 2019; third amendment, 14 June 2022). The data will be disseminated at conferences and in peer-reviewed journals and will support large-scale randomised evaluation. Trial registration numbers: NCT04263948 and ID RCB-2019-A00566-51
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