The concordance between the volume hotspot and the grade hotspot: a 3-D reconstructive model using the pathology outputs from the PROMIS trial.

The rationale for directing targeted biopsy towards the centre of lesions has been questioned in light of prostate cancer grade heterogeneity. In this study, we assess the assumption that the maximum cancer Gleason grade (Gleason grade hotspot) lies within the maximum dimension (volume hotspot) of a prostate cancer lesion. 3-D histopathological models were reconstructed using the outputs of the 5-mm transperineal mapping (TPM) biopsies used as the reference test in the pilot phase of Prostate Mri Imaging Study (PROMIS), a paired validating cohort study investigating the performance of multi-parametric magnetic resonance imaging (MRI) against transrectal ultrasound (TRUS) biopsies. The prostate was fully sampled with 5 mm intervals; each core was separately labelled, inked and orientated in space to register 3-D cancer lesions location. The data from the histopathology results were used to create a 3-D interpolated reconstruction of each lesion and identify the spatial coordinates of the largest dimension (volume hot spot) and highest Gleason grade (Gleason grade hotspot) and assess their concordance. Ninety-four men, with median age 62 years (interquartile range, IQR= 58-68) and median PSA 6.5 ng ml(-1) (4.6-8.8), had a median of 80 (I69-89) cores each with a median of 4.5 positive cores (0-12). In the primary analysis, the prevalence of homogeneous lesions was 148 (76%; 95% confidence interval (CI) ±6.0%). In all, 184 (94±3.2%) lesions showed concordant hotspots and 11/47 (23±12.1%) of heterogeneous lesions showed discordant hotspots. The median 3-D distance between discordant hotspots was 12.8 mm (9.9-15.5). These figures remained stable on secondary analyses using alternative reconstructive assumptions. Limitations include a certain degree of error within reconstructed models. Guiding one biopsy needle to the maximum cancer diameter would lead to correct Gleason grade attribution in 94% of all lesions and 79% of heterogeneous ones if a true hit was obtained. Further correlation of histological lesions, their MRI appearance and the detectability of these hotspots on MRI will be undertaken once PROMIS results are released

Fast evolution of tropospheric Pb- and Zn-rich particles in the vicinity of a lead smelter

Dusts collected on air filters at a Pb–Zn refinery located in northern France were sampled in 1997, 1999 and 2002. The low temporal variability in major elements (Pb, Zn and S) abundances suggested chemical composition of particulate emissions was stable over time. In July 2001 and March 2002, atmospheric aerosols were sampled in the vicinity of the Pb–Zn refinery upwind and downwind from the smelters. Bulk concentrations of major elements (Al, Fe, Pb and Zn) and hydrosoluble ions (Na+, NH4+, Mg2+, K+, Ca2+, Cl– NO3– and SO42–) were, respectively, determined by atomic absorption spectrometry and ion chromatography. Elemental and molecular individual particle analyses were, respectively, performed by automated SEM–EDX and Raman microspectrometry. Continental air masses (campaign 2001) were characterized by low Na+ and high SO42–, NO3– and NH4+ contents upwind from the smelters. Individual particle analysis of Pb- and Zn-rich airborne particles collected downwind from the refinery indicated elemental associations and molecular speciation were similar to those obtained at the emission: Pb compounds were mainly identified as oxides, sulfates and oxy-sulfates whereas Zn compounds were identified as sulfides. Marine air masses (campaign 2002) were characterized by high Na+ contents upwind from the smelters. Individual particle analysis of Pb- and Zn-rich particles collected downwind from the refinery pointed out a systematic association with Na, not emitted by the refinery, suggesting internal mixing of marine aerosols with heavy-metals dusts emitted by the refinery. Such fast evolution of airborne particles chemical composition in the vicinity of the refinery was further proven by SEM–EDX and Raman microspectrometry mappings showing physical evolution by aggregation or coagulation of Zn- and Pb-rich particles with aged sea-salts

[Causes and differential diagnosis of flush.]

International audience: The flush is a transient and recurrent erythema of the upper region of the body, due to a sudden arterial dilatation. First, physicians should confirm the flush and ascertain the location and timing of skin manifestations. The rapid onset and location of the skin rash to the face and anterior chest are the main characteristics of flush. In most of the cases, the flush is emotional, but this should remain a diagnosis of exclusion, as flush may be the presenting manifestation of many systemic or neoplastic disorders. Therefore, a comprehensive diagnostic work-up is necessary, including clinical, biological, and imaging testing. Neoplastic and endocrine causes of flush include VIPoma, carcinoid syndrome, medullary thyroid cancer, mastocytosis, renal cell carcinoma, and pheochromocytoma. Mast cell activation syndrome has been recently described, but it remains a diagnosis of exclusion. This review will first present the different causes of flush, and then will propose a diagnostic algorithm for the physician

Speciation of lead in ambient air dust combining individual particle analysis by ESEM-EDS, micro-Raman, micro-PIXE and bulk analysis by ICP-MS and selective chemical extractions

In order to determine the speciation of lead in ambient air dust, a combination of two complementary levels of investigation is used. The first one consists in a quantitative bulk analysis of the samples by applying selective chemical extractions followed by ICP-MS analysis. The second one is an individual particle analysis done by ESEM-EDS, micro-PIXE and micro-Raman. This paper presents the results from initial studies aiming to demonstrate the relevance of our methodology. Primary information about the main physico-chemical species of lead found in ambient air particulate matter, collected in the vicinity of a lead and zinc smelter, are given

Magnetic resonance image–guided focused ultrasound robotic system for transrectal prostate cancer therapy

Background: A magnetic resonance image (MRI) guided robotic device for focussed ultrasound therapy of prostate cancer (PC) was developed. The device offers movement in 5 degrees of freedom (DOF) and uses a single-element transducer that operates at 3.2 MHz, has a diameter of 25 mm and focuses at 45 mm. Methods: The MRI compatibility of the system was evaluated in a 1.5 T scanner. The ability of the transducer to create lesions was evaluated in laboratory and MRI settings, on ex vivo pork tissue and in vivo rabbit thigh tissue. Results: Cavitational and thermal lesions were created on the excised pork tissue. In vivo experiments proved the efficacy of the system in ablating muscle tissue without damaging intervening areas. Conclusions: The MRI compatible robotic system can be placed on the table of any commercial MRI scanner up to 7 T. The device has the ability of future use for transrectal focal therapy of PC with the patient in supine position

Vie r\ue9elle apr\ue8s l\u2019implantation d\u2019une neuromodulation sacr\ue9e : taux, raisons et facteurs de risque d\u2019interruption du suivi \ue0 mi-parcours

Abstract: Objectives. - To evaluate follow-up after implantation of a sacral nerve modulation implantable pulse generator (IPG) and to investigate the reasons and risk factors for follow-up discontinuation. Materials and methods. - All patients who underwent an IPG implantation to treat lower urinary tract symptoms between 2014-2019 within 6 hospital centers located in the district of "Hauts-de-France" (France) were systematically called during the year 2020 for a standardized (tele)consultation. Patients were divided into 3 distinct profiles according to the regularity of their 5-year postoperative follow-up: "Regular follow-up", "Irregular follow-up" and "Lost to follow-up". The primary outcome was the change in the annual proportion of the 3 follow-up profiles over the 5 years following IPG implantation. As secondary outcomes we described the reasons reported for follow-up discontinuation and looked for risk factors associated with. Results. - Overall, 259 patients were included. At the time of data collection, after a mean follow-up of 28.4 (+/- 19.8) months, 139 patients (53.7%) had a "Regular follow-up", 54 (20.8%) had an "Irregular follow-up" and 66 (25.5%) were "Lost to follow-up". The proportion of patients with a "Regular follow-up" decreased year by year, representing only 46.2% of patients at five-years. 175 patients (67.6%) underwent a standardized (tele)consultation. In multivariate analysis, only "lack of knowledge of the follow-up protocol" was statistically associated with follow-up discontinuation (OR = 5.16; 95% CI [2.12-13.57]). Conclusion. - The proportion of patients followed up after IPG implantation decreased steadily over the years, often related to a lack of therapeutic education. Level of evidence.- 4. (c) 2023 Elsevier Masson SAS. All rights reserved