Accuracy of Patient-Specific Instrumentation for Bone Tumor Resection within the pelvis: 1st study of 11 patients

Introduction Pelvic bone tumor resection is challenging due to complex geometry, limited visibility and restricted working space of the pelvis. Accurate resection in safe margin is required to reduce the risk of local recurrence. Computer-assisted preoperative planning and intraoperative navigation technologies have been developed for pelvic bone tumor surgeries, and clinical studies have already demonstrated the feasibility of achieving clinically adequate (tumor-free) resection margins [1]. Patient-specific instrumentation (PSI) technology has been developed and adapted to bone tumor surgery as a cheaper and less time-consuming alternative to intraoperative navigation. A recent experimental study has assessed an equivalent value-added of both PSI and navigation technologies in terms of the achieved surgical margins during simulated bone tumor resections of the pelvis [2]. The present study reports a series of 11 clinical cases of PSI-assisted bone tumor surgery within the pelvis, and assesses how accurately a preoperative resection strategy can be replicated intraoperatively with the PSI. Materials and methods The patient series consisted in 11 patients eligible for curative surgical resection of primary bone tumor of the pelvis. Eight patients had a bone sarcoma of iliac bone involving the acetabulum, two patients had a sacral tumor, and one patient had a chondrosarcoma of proximal femur with intra-articular hip extension. For all cases, magnetic resonance imaging (MRI) and computerized tomography (CT) were acquired preoperatively for diagnosis. The tumor volume was first delineated on the MRI. The set of MRI and CT images were fused to produce 3D models of bone and tumor volume (Figure (a)). Resection planning consisted in desired cut planes positioned close to the boundary of the tumor (from 1 up to 6 planes) defining the desired bone cutting with a safe margin defined by the surgeon from 3 up to 15 mm. PSI were designed in computer-aided design software according to the desired resection strategy and produced by additive manufacturing technology. PSI were designed to have bone-specific surfaces to fit in unique position on the bony structure of the patient. PSI were equipped with cylindric guides for 2-mm diameter Kirschner wires to be pinned on the bony structure and flat surfaces to materialize the desired cut planes. Intraoperatively, PSI were positioned freehand by the surgeon and fixed on the bone surface using the K-wires. Once the resection was achieved, both K-wires and PSI were taken off. The standard surgical approach has been used for each patient. Dissection of soft tissue for bone exposure was in accordance with the routine technique. There was no additional bone exposure to position the PSI. Histopathological analysis of the resected tumor specimens was performed to evaluate the safety of the achieved resection margins. Postoperative CT were acquired to assess the local control of the tumor. 3D bone models were reconstructed from the postoperative CT of the patient and registered with the corresponding preoperative bone model (Figure (b)). Two parameters were measured: achieved resection margin (RM) and location accuracy (L). RM was defined as the minimum distance (mm) between the achieved cut plane and the boundary of the tumor. Consequently, the error in the desired safe margin (ESM) was defined as the difference (mm) between RM and the desired safe margin. L was used in accordance with the ISO1101 standard [2] to evaluate accuracy between achieved and desired cut planes. L was defined as the maximum distance (mm) between the achieved cut plane and the desired cut plane. Results PSI were quick and easy to use with a positioning onto the bone surface in less than 5 minutes for all cases. The positioning of the PSI was considered unambiguous for all patients. Histopathological analysis classified all achieved resection margins as R0 (tumor-free), except for two patients. Patient #8 had an urgent morcelize

Ulvan Activates Chicken Heterophils and Monocytes Through Toll-Like Receptor 2 and Toll-Like Receptor 4

Responsiveness to invasive pathogens, clearance via the inflammatory response, and activation of appropriate acquired responses are all coordinated by innate host defenses. Toll-like receptor (TLR) ligands are potent immune-modulators with profound effects on the generation of adaptive immune responses. This property is being exploited in TLR-based vaccines and therapeutic agents in chickens. However, for administering the TLR agonist, all previous studies used in ovo, intra-muscular or intra-venous routes that cannot be performed in usual farming conditions, thus highlighting the need for TLR ligands that display systemic immune effects when given orally (per os). Here we have demonstrated that an ulvan extract of Ulva armoricana is able to activate avian heterophils and monocytes in vitro. Using specific inhibitors, we have evidenced that ulvan may be a new ligand for TLR2 and TLR4; and that they regulate heterophil activation in slightly different manner. Moreover, activation of heterophils as well as of monocytes leads to release pro-inflammatory cytokines, including interleukin1-β, interferon α and interferon γ, through pathways that we partly identified. Finally, when given per os to animals ulvan induces heterophils and monocytes to be activated in vivo thus leading to a transient release of pro-inflammatory cytokines with plasma concentrations returning toward baseline levels at day 3

Splenic Rupture and Malignant Mediterranean Spotted Fever

International audienc

Spontaneous virulence loss in natural populations of Listeria monocytogenes

International audienceThe pathogenesis of Listeria monocytogenes depends on the ability of this bacterium to escape from the phagosome of the host cells via the action of the pore-forming toxin listeriolysin O (LLO). Expression of the LLO-encoding gene (hly) requires the transcriptional activator PrfA, and both hly and prfA genes are essential for L. monocytogenes virulence. Here, we used the hemolytic activity of LLO as a phenotypic marker to screen for spontaneous virulence-attenuating mutations in L. monocytogenes. Sixty nonhemolytic isolates were identified among a collection of 57,820 confirmed L. monocytogenes strains isolated from a variety of sources (0.1%). In most cases (56/60; 93.3%), the nonhemolytic phenotype resulted from nonsense, missense, or frameshift mutations in prfA. Five strains carried hly mutations leading to a single amino acid substitution (G299V) or a premature stop codon causing strong virulence attenuation in mice. In one strain, both hly and gshF (encoding a glutathione synthase required for full PrfA activity) were missing due to genomic rearrangements likely caused by a transposable element. The PrfA/LLO loss-of-function (PrfA Ϫ /LLO Ϫ) mutants belonged to phylogenetically diverse clades of L. monocyto-genes, and most were identified among nonclinical strains (57/60). Consistent with the rare occurrence of loss-of-virulence mutations, we show that prfA and hly are under purifying selection. Although occurring at a low frequency, PrfA Ϫ /LLO Ϫ muta-tional events in L. monocytogenes lead to niche restriction and open an evolutionary path for obligate saprophytism in this facultative intracellular pathogen

Transcytosis of Listeria monocytogenes across the intestinal barrier upon specific targeting of goblet cell accessible E-cadherin

Listeria monocytogenes targets accessible E-cadherin expressed on mucus-producing goblet cells to invade the intestinal tissue

Recruitment of the Major Vault Protein by InlK: A Listeria monocytogenes Strategy to Avoid Autophagy

L. monocytogenes is a facultative intracellular bacterium responsible for listeriosis. It is able to invade, survive and replicate in phagocytic and non-phagocytic cells. The infectious process at the cellular level has been extensively studied and many virulence factors have been identified. Yet, the role of InlK, a member of the internalin family specific to L. monocytogenes, remains unknown. Here, we first show using deletion analysis and in vivo infection, that InlK is a bona fide virulence factor, poorly expressed in vitro and well expressed in vivo, and that it is anchored to the bacterial surface by sortase A. We then demonstrate by a yeast two hybrid screen using InlK as a bait, validated by pulldown experiments and immunofluorescence analysis that intracytosolic bacteria via an interaction with the protein InlK interact with the Major Vault Protein (MVP), the main component of cytoplasmic ribonucleoproteic particules named vaults. Although vaults have been implicated in several cellular processes, their role has remained elusive. Our analysis demonstrates that MVP recruitment disguises intracytosolic bacteria from autophagic recognition, leading to an increased survival rate of InlK over-expressing bacteria compared to InlK− bacteria. Together these results reveal that MVP is hijacked by L. monocytogenes in order to counteract the autophagy process, a finding that could have major implications in deciphering the cellular role of vault particles

Origin : a 60 GHz radio-over-fiber home area network project

International audience

Bone sarcomas: ESMO–EURACAN–GENTURIS–ERN PaedCan Clinical Practice Guideline for diagnosis, treatment and follow-up

Production costs have been covered by ESMO from central funds

Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome associated with COVID-19: An Emulated Target Trial Analysis.

RATIONALE: Whether COVID patients may benefit from extracorporeal membrane oxygenation (ECMO) compared with conventional invasive mechanical ventilation (IMV) remains unknown. OBJECTIVES: To estimate the effect of ECMO on 90-Day mortality vs IMV only Methods: Among 4,244 critically ill adult patients with COVID-19 included in a multicenter cohort study, we emulated a target trial comparing the treatment strategies of initiating ECMO vs. no ECMO within 7 days of IMV in patients with severe acute respiratory distress syndrome (PaO2/FiO2 <80 or PaCO2 ≥60 mmHg). We controlled for confounding using a multivariable Cox model based on predefined variables. MAIN RESULTS: 1,235 patients met the full eligibility criteria for the emulated trial, among whom 164 patients initiated ECMO. The ECMO strategy had a higher survival probability at Day-7 from the onset of eligibility criteria (87% vs 83%, risk difference: 4%, 95% CI 0;9%) which decreased during follow-up (survival at Day-90: 63% vs 65%, risk difference: -2%, 95% CI -10;5%). However, ECMO was associated with higher survival when performed in high-volume ECMO centers or in regions where a specific ECMO network organization was set up to handle high demand, and when initiated within the first 4 days of MV and in profoundly hypoxemic patients. CONCLUSIONS: In an emulated trial based on a nationwide COVID-19 cohort, we found differential survival over time of an ECMO compared with a no-ECMO strategy. However, ECMO was consistently associated with better outcomes when performed in high-volume centers and in regions with ECMO capacities specifically organized to handle high demand. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Study of the role of PAR-2 in cutaneous neurogenic inflammation

L’inflammation neurogène cutanée (INC) est une inflammation de la peau induite par l’activation des fibres nerveuses intra-épidermiques qui secrètent des neuropeptides tels que la substance P (SP). L’INC est impliquée dans des dermatoses inflammatoires prurigineuses comme le psoriasis, la dermatite atopique (DA) et le syndrome de Netherton (SN). Un nouveau concept émerge, suggérant que les kératinocytes sont également des acteurs majeurs de l’INC. Le récepteur activé par des protéases de type 2 (PAR-2) est fortement incriminé dans l’INC associée à ces dermatoses, ce qui permet de comprendre les voies du prurit non-histaminergique. Les enjeux thérapeutiques sont de taille puisqu’il n’existe actuellement aucun traitement efficace permettant la prise en charge spécifique du prurit histamino-indépendant au cours des dermatoses prurigineuses associées à l’INC.Bien que le rôle de PAR-2 dans la sécrétion de neuropeptides à partir des neurones sensoriels soit clairement établi, son implication dans la modulation de gènes pouvant contribuer à l’entretien ou l’amplification de l’INC reste méconnue. Le rôle inflammatoire de PAR-2 a également été démontré sur des kératinocytes cultivés en monocouche via la sécrétion de cytokines par des mécanismes dépendants du Ca2+. La surexpression de PAR-2 et la perte d’expression de certains canaux calciques impliqués dans sa réponse calcique dans les kératinocytes différenciés suggèrent des mécanismes d’action de PAR-2 différents pour ceux-ci. Dans le but d’étudier le rôle pro-inflammatoire de PAR-2 au cours des dermatoses prurigineuses, nous avons analysé l’effet de son activation sur des monocultures de neurones sensoriels issus de ganglions rachidiens dorsaux (GRD) de rat et de kératinocytes humains différenciés (DhPK), en criblant l’expression de médiateurs de l’inflammation. Pour approfondir, les voies calciques de PAR-2 sous-jacente à la modulation d’expression dans les kératinocytes différenciés, des expériences d’imagerie calcique ont été réalisées et différents antagonistes ont été utilisés pour analyser les acteurs impliqués.Dans le cadre d’un partenariat avec les laboratoires dermatologiques d’Uriage, nous avons testé les effets de l’eau thermale d’Uriage sur la modulation de gènes induite par PAR-2 dans les DhPK. Nous avons également utilisé une lignée de PC12 différenciables en neurones par le NGF afin de les utiliser comme alternatives des neurones sensoriels issus des GRD de rat pour l’étude de l’INC.L’ensemble des résultats obtenus au cours du criblage des gènes modules par PAR-2 confirme le rôle pro-inflammatoire de PAR-2 dans les neurones sensoriels de rat et dans les DhPK. La découverte d’une nouvelle voie calcique de PAR-2 dans les DhPK offre de nouvelles pistes thérapeutiques pour les dermatoses prurigineuses telles que le psoriasis, la DA et le NS. Les résultats obtenus avec l’eau thermale d’Uriage peuvent présenter une perspective thérapeutique pour les patients souffrants de dermatoses prurigineuses réfractaires aux traitements conventionnels. L’utilisation d’une lignée neuronale comme lesPC12 pour l’étude de l’INC serait une alternative utile dans le développement des tests cosmétiques avec les industriels pour notre laboratoire.Cutaneous neurogenic inflammation (CNI) is an inflammation of the skin induced by the activation of intraepidermal nerve fibers that release neuropeptides such as substance P (SP). CNI is involved in pruritic inflammatory skin disorders such as psoriasis, atopic dermatitis (AD) and Netherton syndrome (NS). A new concept is growing, suggesting that keratinocytes could also trigger INC. The proteases activated receptor 2 (PAR-2) is strongly incriminated in CNI associated with these dermatoses, which allow to understand the histamine-independent itching pathways. The therapeutic stakes are high since there is currently no effective treatment allowing the specific management of histamine-independent pruritus during skin disorders associated with CNI.Although the role of PAR-2 in the secretion of neuropeptides from sensory neurons is clearly established, its involvement in the modulation of genes involved in the maintenance or amplification of CNI remains unknown. The inflammatory role of PAR-2 on keratinocytes has also been demonstrated through the production of cytokines in a Ca2+-dependent mechanisms. The overexpression of PAR-2 and the loss of ORAI1 expression, a calcium channel following keratinocytes differentiation suggest different signaling pathways downstream to PAR-2 activation between undifferentiated and differentiated keratinocytes.In order to study the pro-inflammatory role of PAR-2 during pruritic dermatoses, we analyzed the effect of its activation on rat primary sensory neurons from dorsal spinal ganglia (DRG) and on differentiated human primary keratinocytes (DhPK) by screening the expression of inflammatory mediators. To deepen the Ca2+ pathways underlying PAR-2-mediated inflammatory mediator modulation in DhPK, we performed Ca2+ imaging experiments and different antagonists were used to analyze the involvement of intracellular actors. In a partnership with the dermatological laboratories of Uriage, we tested the effects of Uriage thermal water on PAR-2-induced gene modulation in DhPK. We also used a PC12 cell line differentiable in neurons by the NGF in order to use them as alternatives of rat primary sensory neurons from DRG for the study of INC. We also used a PC12 cell line differentiable in neurons by the NGF use them as alternatives of rat primary sensory neurons from DRG for the study of INC.The results obtained during the screening of the PAR-2-modulated genes confirmed the proinflammatory role of PAR-2 in rat primary sensory neurons and in DhPK. The discovery of a new PAR-2-mediated Ca2+ pathway in DhPK offers new therapeutic pathways for pruritic dermatoses such as psoriasis, AD and NS. The results obtained with the thermal water of Uriage can present a therapeutic perspective for patients suffering from pruritic dermatoses refractory to conventional treatments. The use of a neuronal cell line as the PC12 for the study of INC would be an useful alternative in the development of cosmetic tests