Clinical Pathway Evaluation for Left and Sigmoid Colectomy in Abdominal Surgery

At the end of 2008, a new left colon clinical pathway was implemented in our hospital and set up by a multidisciplinary team, monitored by a clinical pathway coordinator. Our aim was to evaluate the quality of left and sigmoid colectomy management, to simplify the clinical pathway and to assess its impact on the patient, the medical and nursing staffs. A sample of 290 patients with benign or malignant disease requiring a laparoscopic of laparotomy left colon resection (mainly sigmoid) was included in this clinical pathway during the years 2009–2017. Our analysis focused particularly on the compliance with the protocol, the pain felt, the suture leak rate, the hospital stay, the re-hospitalization rate and redo surgery within 30 days. Our work leads to the conclusion that the introduction of a clinical pathway, when it is well prepared and brings together all the implicated persons with the same goal, is feasible with convincing results. These are directly beneficial to the patient and to the quality of its management

Utilisation cérébrale du glucose dans la paralysie supranucléaire progressive et dans la dégénérescence strio-nigrique. Etude par scanner à positons.

Dix-huit études du métabolisme cérébral du glucose ont été réalisées chez des sujets atteints du syndrome "Parkinson Plus", au moyen de la tomographie par émission de positrons (TEP) et du traceur [18F]Fluorodeoxyglucose (FDG). Neuf patients étaient atteints de paralysie supranucléaire progressive. Chez 7 d'entre eux, il existait une distribution spécifique des altérations métaboliques, caractérisée par une atteinte prédominante du cortex frontal, alors que le métabolisme du glucose était diffusément diminué chez 1 sujet et normal dans 1 cas. Dans les 7 cas d'hypométabolisme frontal, les aires motrices et prémotrices étaient plus affectées que les zones paralimbiques et préfrontales. Bien que cette image métabolique soit typique de l'affection, aucune corrélation nette entre les anomalies métaboliques et les résultats des tests neuropsychologiques n'a pu être mise en évidence. Neuf études ont été effectuées chez 7 patients présentant un syndrome extrapyramidal évolutif, pharmacologiquement résistant, ayant conduit au diagnostic probable de dégénérescence nigrostriée. Un hypométabolisme hautement significatif (3 SD) a été démontré chez tous les sujets au niveau du putamen et du noyau caudé et, dans une moindre mesure, dans le cortex moteur/prémoteur et préfrontal. Les analyses en résonance magnétique ont mis en évidence la présence de dépôts ferriques anormaux dans le putamen, en l'absence d'anomalies corticales. Ces résultats suggèrent que la méthode TEP/FDG fournit un index de la fonction cérébrale résiduelle dans des zones en dégénérescence et permet de détecter les répercussions fonctionnelles à distance, résultant de déafférentation. Dans le cadre des syndromes parkinsoniens, les images obtenues au moyen de la TEP sont d'un intérêt diagnostique direct. La présence d'un hypométabolisme dans le striatum pourrait expliquer la résistance à la L-dopa et constituer un élément de mauvais pronostic

Rectal cancer treatment in a teaching hospital

Background: Rectal adenocarcinomas surgery morbidity and mortality might be impaired by neoadjuvant therapy. We performed this retropsective study to be compared with the PROCARE study running afterwards. Methods: We performed a retrospective study of 95 patients operated on for rectal denocarcinoma in a single institution during the period 2007-2009. We used logistic regression to estimate the relationship between possible predictive parameters of AL. Results: The laparoscopic approach is favored in 63.1% of the cases with a conversion rate of 11.6%, mainly in man (6 out of 7). For low rectal cancer though, laparotomy was the first choice (92.3%). From a carcinological point of view, laparoscopy allowed a complete tumor resection according to the PME (n=27) and TME (n=26) standards. Multivariate analysis revealed that women, lower BMI, lower rectum tumor, laparoscopic surgery, neoadjuvant treatment and anal suture were associated with higher risk of AL. The mean hospital stay was 15.4 days (3 – 46 days). In-hospital mortality was 3.1%. Adjuvant chemotherapy was completed in 42.1% of the patients. Despite these treatments, we registered a recurrence rate of 26.6%. Of these, 72% were distally localized and 12% exclusively locally. Among the patients operated on by laparoscopy, there was one local recurrence and one local with distant metastases (3.7%). The one- and three-years survival rates were 91.5% and 80.4% respectively. Conclusions: Our study showed a higher rate of AL than expected (18%). In our series recorded in PROCARE-Home, our leak rate has dropped to 10%. It may be indicating a positive effect of PROCARE

Identification of a novel family of proteins in snake venoms. Purification and structural characterization of nawaprin from Naja nigricollis snake venom

10.1074/jbc.M305322200Journal of Biological Chemistry2784140097-40104JBCH

Elafin, an Elastase-specific Inhibitor, Is Cleaved by Its Cognate Enzyme Neutrophil Elastase in Sputum from Individuals with Cystic Fibrosis*

Elafin is a neutrophil serine protease inhibitor expressed in lung and displaying anti-inflammatory and anti-bacterial properties. Previous studies demonstrated that some innate host defense molecules of the cystic fibrosis (CF) and chronic obstructive pulmonary disease airways are impaired due to increased proteolytic degradation observed during lung inflammation. In light of these findings, we thus focused on the status of elafin in CF lung. We showed in the present study that elafin is cleaved in sputum from individuals with CF. Pseudomonas aeruginosa-positive CF sputum, which was found to contain lower elafin levels and higher neutrophil elastase (NE) activity compared with P. aeruginosa-negative samples, was particularly effective in cleaving recombinant elafin. NE plays a pivotal role in the process as only NE inhibitors are able to inhibit elafin degradation. Further in vitro studies demonstrated that incubation of recombinant elafin with excess of NE leads to the rapid cleavage of the inhibitor. Two cleavage sites were identified at the N-terminal extremity of elafin (Val-5—Lys-6 and Val-9—Ser-10). Interestingly, purified fragments of the inhibitor (Lys-6—Gln-57 and Ser-10—Gln-57) were shown to still be active for inhibiting NE. However, NE in excess was shown to strongly diminish the ability of elafin to bind lipopolysaccharide (LPS) and its capacity to be immobilized by transglutamination. In conclusion, this study provides evidence that elafin is cleaved by its cognate enzyme NE present at excessive concentration in CF sputum and that P. aeruginosa infection promotes this effect. Such cleavage may have repercussions on the innate immune function of elafin

Controversies around epithelial–mesenchymal plasticity in cancer metastasis

Experimental evidence accumulated over decades has implicated epithelial–mesenchymal plasticity (EMP), which collectively encompasses epithelial–mesenchymal transition and the reverse process of mesenchymal–epithelial transition, in tumour metastasis, cancer stem cell generation and maintenance, and therapeutic resistance. However, the dynamic nature of EMP processes, the apparent need to reverse mesenchymal changes for the development of macrometastases and the likelihood that only minor cancer cell subpopulations exhibit EMP at any one time have made such evidence difficult to accrue in the clinical setting. In this Perspectives article, we outline the existing preclinical and clinical evidence for EMP and reflect on recent controversies, including the failure of initial lineage-tracing experiments to confirm a major role for EMP in dissemination, and discuss accumulating data suggesting that epithelial features and/or a hybrid epithelial–mesenchymal phenotype are important in metastasis. We also highlight strategies to address the complexities of therapeutically targeting the EMP process that give consideration to its spatially and temporally divergent roles in metastasis, with the view that this will yield a potent and broad class of therapeutic agents.See 'additional link' for access to a free to read version of the article.</p