Impact de l'IMC sur la morbi-mortalité des hépatectomies par voie coelioscopique : étude tri-centrique

Introduction: Few data exist in the literature on laparoscopic hepatectomy’s morbidity and mortality in obese patients. Methods: From 1998 to 2018, 125 obese patients had laparoscopic hepatectomy in the Henri Mondor hospital and in the IMM and, from 2015 to 2019, 23 obese patients had laparoscopic hepatectomy in Caen. Preoperative data (age, BMI, comorbidities, ASA score), perioperative data (type of resection and conversion rate) and postoperative data (medical and surgical complications, revision surgery rate and Clavien-Dindo score) were studied. The objective was to compare post-operative outcomes (short and long) of the development of an innovative surgical technique in a center and then to compare this center to 2 others more experienced centers. The primary end point was the postoperative morbidity and mortality. Results: Morbidity and mortality, conversion and stays in intensive care unit rates are similar between the 2 different groups of patients. Medical complications rate is higher in the group “Caen”: 34,78% vs 11,2% (p<0,002). Revision surgery rate is higher in the group “Caen”: 8,7% vs 0,8% (p<0,01). Conclusion: Laparoscopic hepatectomy is a feasible, safe, standardized and reproductible technique.Introduction : peu de données existent dans la littérature sur la morbi-mortalité des hépatectomies par voie coelioscopique chez les patients obèses. Patients et méthodes : de 1998 à 2018, 125 patients obèses ont été opérés d’une hépatectomie coelioscopique à l’hôpital Henri Mondor et à l’IMM et, de 2015 à 2019, 23 patients obèses ont été opérés au CHU de Caen. Les données recueillies incluaient les données pré-opératoires (âge, IMC, antécédents, score ASA), les données péri-opératoires (type de résection, taux de conversion) et les données post-opératoires (complications médicales et chirurgicales, taux de reprise, score de Clavien). L’objectif de cette étude était d’évaluer les résultats post-opératoires à court et moyen terme de la mise en place d’une activité chirurgicale innovante au sein d’un établissement et de comparer secondairement ces résultats à deux autres centres plus expérimentés dans la prise en charge d’un groupe de patients particuliers : les obèses. Le critère de jugement principal était la morbi-mortalité post-opératoire. Résultats : la morbi-mortalité, les taux de conversion et de séjour en réanimation sont comparables entre les deux groupes. Le taux de complications médicales est plus élevé dans le groupe Caen : 34,78% vs 11,2% (p<0,002). Le taux de reprise chirurgicales est plus important dans le groupe Caen : 8,7% vs 0,8% (p<0,01). Conclusion : l'hépatectomie par voie coelioscopique est une technique faisable, sûre, standardisée et reproductible

Polarization of Brillouin scattered light in silica nanofibers

International audienceWe investigate both theoretically and experimentally the polarization properties of Brillouin light scattering in silica optical nanofibers. Our results show that while all hybrid acoustic waves scatter light without altering the state of polarization, one of the surface acoustic wave generates a depolarized Stokes light. Because of the slight ellipticity of the nanofiber, the surface wave is actually split into two torso-radial modes which give rise to polarization scrambling of the backward Brillouin Stokes signal. Our model also predicts that the polarization of the scattered light can be restored for one specific pump polarization

Immunohistochemistry, Molecular Biology, and Clinical Scoring for the Detection of Muir-Torre Syndrome in Cutaneous Sebaceous Tumors: Which Strategy?

International audienceBackground: Sebaceous neoplasms (SNs) always raise the possibility of an association with Muir-Torre syndrome (MTS) and permit to screen internal malignancies, colorectal and endometrial carcinomas, before they become symptomatic. Immunohistochemistry (IHC), molecular biology, and clinical examination are different approaches for detection of MTS. We conducted a retrospective analysis of non-selected SNs in order to determine the optimal tools to implement for MTS screening. Methods: Deficient MMR phenotype (dMMR) was determined by either IHC using antibodies directed to four mismatch repair (MMR) antigens on tissue microarray or molecular biology using pentaplex PCR. The Mayo Clinic risk score of MTS was calculated from medical records. Sensibility and specificity of each test for the detection of MTS were determined. Results: We included 107 patients, 8 with multiple SNs, for a total of 123 SNs (43 sebaceous adenomas, 19 sebaceomas, and 61 sebaceous carcinomas (SC)). Loss of at least one MMR protein was observed in 70.7% of tumors, while 48% had a microsatellite instable phenotype. Concordance between both techniques was 92.9%, with a 0.85 Cohen’s kappa coefficient. Nineteen patients (20.2%) had a ≥2 points Mayo Clinic risk score, one having a pMMR SC. Among the 13 patients with confirmed MTS, 2 had a low Mayo Clinic risk score (1 point). IHC had the highest sensitivity for MTS screening (100%) with a specificity of 34.1%, while a &gt;2-point Mayo Clinic risk score had a lower sensitivity (92%) but a higher specificity (89%). Conclusion: To detect MTS in SN patients, the first-line Mayo Clinic risk score followed by IHC appears to be the most accurate strategy with lower cost for society. This strategy should be adapted to the medico-economic resources of each country

Effect of process parameters and post-treatments on the mechanical static and fatigue properties of SLM AlSi10Mg alloy

Metal additive manufacturing and in particular selective laser melting (SLM) is a very promising production method. SLM alloy AlSi10Mg, as a common lightweight structural alloy, has already drawn the attention of the aerospace industry due to its good strength-to-weight ratio. Its high strength (resulting from the very fine Si network formed during rapid cooling) compared to cast alloys of the same composition is clearly an asset of the technology. However, when aiming at reaching the requirements of highly demanding structural applications, the fatigue life of SLM AlSi10Mg does not reach the performances met by wrought aluminium alloys. The poor fatigue resistance in the as-built condition is attributed to residual stresses, high surface roughness and process-induced porosities favouring early fatigue crack initiation. In the frame of an industrial case study of aircraft conventional part replacement by a 3D printed one, a characterisation campaign has been led about the microstructure and the mechanical behaviour of SLM AlSi10Mg alloy. Cubic and cylindrical specimens have been fabricated and various process parameters (layer thickness, orientation,…) and post-treatments (stress relief, shot-peening, hot isostatic pressing,…) have been studied. Both static mechanical tests and fatigue tests were performed and coupled with an in-depth characterisation of the corresponding microstructures. The effect of the various post-treatments on the improvement of fatigue life is finally discussed

HSP110 as a Diagnostic but Not a Prognostic Biomarker in Colorectal Cancer With Microsatellite Instability

Determination of microsatellite instability (MSI) using molecular test and deficient mismatch repair (dMMR) using immunohistochemistry (IHC) has major implications on colorectal cancer (CRC) management. The HSP110 T 17 microsatellite has been reported to be more monomorphic than the common markers used for MSI determination. Large deletion of HSP110 T 17 has been associated with efficacy of adjuvant chemotherapy in dMMR/MSI CRCs. The aim of this study was to evaluate the interest of HSP110 deletion/expression as a diagnostic tool of dMMR/MSI CRCs and a predictive tool of adjuvant chemotherapy efficacy. All patients with MSI CRC classified by molecular testing were included in this multicenter prospective cohort ( n = 381). IHC of the 4 MMR proteins was carried out. HSP110 expression was carried out by IHC ( n = 343), and the size of HSP110 T 17 deletion was determined by PCR (n = 327). In the 293 MSI CRCs with both tests, a strong correlation was found between the expression of HSP110 protein and the size of HSP110 T 17 deletion. Only 5.8% of MSI CRCs had no HSP110 T 17 deletion ( n = 19/327). HSP110 T 17 deletion helped to re-classify 4 of the 9 pMMR/MSI discordance cases as pMMR/MSS cases. We did not observe any correlation between HSP110 expression or HSP110 T 17 deletion size with time to recurrence in patients with stage II and III CRC, treated with or without adjuvant chemotherapy. HSP110 is neither a robust prognosis marker nor a predictor tool of adjuvant chemotherapy efficacy in dMMR/MSI CRC. However, HSP110 T 17 is an interesting marker, which may be combined with the other pentaplex markers to identify discordant cases between MMR IHC and MSI

Effect of Hydroxyethyl Starch vs Saline for Volume Replacement Therapy on Death or Postoperative Complications Among High-Risk Patients Undergoing Major Abdominal Surgery The FLASH Randomized Clinical Trial

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Nebulised liposomal-amphotericin-B as maintenance therapy in ABPA: a randomised, multicentre, trial

International audienceBackground In allergic bronchopulmonary aspergillosis (ABPA), prolonged nebulised antifungal treatment may be a strategy for maintaining remission. Methods We performed a randomised, single-blind, clinical trial in 30 centres. Patients with controlled ABPA after a 4-month attack treatment (corticosteroids and itraconazole) were randomly assigned to nebulised liposomal-amphotericin-B or placebo for 6 months. The primary outcome was occurrence of a first severe clinical exacerbation within 24 months following randomisation. Secondary outcomes included the median time-to-first severe clinical exacerbation, number of severe clinical exacerbations per patient, ABPA-related biological parameters. Results Among 174 enrolled patients with ABPA from March 2015 through July 2017, 139 were controlled after 4-month attack treatment and were randomised. The primary outcome occurred in 33 (50.8%) of 65 patients in nebulised liposomal-amphotericin-B group and 38 (51.3%) of 74 in placebo group (absolute difference −0.6%, 95% CI −16.8% to +15.6%, odds ratio 0.98, 95% CI 0.50 to 1.90; p=0.95). The median time-to-first severe clinical exacerbation was longer in liposomal-amphotericin-B group, 337 days (IQR, 168 to 476) versus 177 (64 to 288). At the end of maintenance therapy, total immunoglobulin-E and Aspergillus precipitins were significantly decreased in nebulised liposomal-amphotericin-B group. Conclusions In ABPA, maintenance therapy using nebulised liposomal-amphotericin-B did not reduce the risk of severe clinical exacerbation. The presence of some positive secondary outcomes creates clinical equipoise for further research