Hydroxyapatite biomaterial implanted in human periodontal defects: an histological and ultrastructural study

The purpose of the present work was to study the response of human periodontium to hydroxyapatite biomaterial particles (180-200 µm). The biomaterial was implanted in two infraosseous periodontal defects (two patients) after clearing of the granulation tissue. At two months post-surgery, biopsies were studied using light and electron microscopy. No sign of inflammation was observed, the biomaterial aggregates were surrounded either by typical fibroblasts or larger phagocytotic cells with phagocytosis vesicles containing biomaterial crystals. These intracellular crystals were noticeably smaller than the nonphagocytized ones. Some of the phagocytized crystals showed morphological signs of intracellular dissolution. The spaces between the crystals constitutive of the aggregates were filled with organic substance containing collagen fibers.Le présent travail a pour but d’étudier la réponse du parodonte humain à des particules d’hydroxyapatite de 180 à 200 µm. Le biomatériau a été implanté dans deux poches parodontales infraosseuses (deux patients) après élimination du tissu de granulation. Deux mois après l’intervention, des biopsies ont été étudiées en microscopie photonique et en microscopie électronique. Aucun signe d’inflammation n’a été décelé, les agrégats de biomatériau sont bordés soit de fibroblastes, soit de cellules phagocytaires, de taille plus importante, avec des vésicules de phagocytose renfermant des cristaux de biomatériau. Ces cristaux intracellulaires sont notablement plus petits que les cristaux non phagocytés. La morphologie de certains cristaux phagocytés traduit l’existence d’une dissolution intracellulaire. Les espaces entre les cristaux constitutifs des agrégats sont comblés par une substance organique contenant des fibres de collagène

Sigmoid stricture associated with diverticular disease should be an indication for elective surgery with lymph node clearance

BACKGROUND: The literature concerning stricture secondary to diverticulitis is poor. Stricture in this setting should be an indication for surgery because (a) of the potential risk of cancer and (b) morbidity is not increased compared to other indications for colectomy. The goal of this report is to study the post-surgical morbidity and the quality of life in patients after sigmoidectomy for sigmoid stricture associated with diverticular disease. METHOD: This is a monocenter retrospective observational study including patients with a preoperative diagnosis of sigmoid stricture associated with diverticular disease undergoing operation between Jan 1, 2007 and Dec 31, 2013. The GastroIntestinal Quality of Life Index was used to assess patient satisfaction. RESULTS: Sixteen patients were included of which nine were female. Median age was 69.5 (46-84) and the median body mass index was 23.55kg/m(2) (17.2-28.4). Elective sigmoidectomy was performed in all 16 patients. Overall, complications occurred in five patients (31.2%) (4 minor complications and 1 major complication according to the Dindo and Clavien Classification); none resulted in death. Pathology identified two adenocarcinomas (12.5%). The mean GastroIntestinal Quality of Life Index was 122 (67-144) and 10/11 patients were satisfied with their surgical intervention. CONCLUSION: Sigmoid stricture prevents endoscopic exploration of the entire colon and thus it may prove difficult to rule out a malignancy. Surgery does not impair the quality of life since morbidity is similar to other indications for sigmoidectomy. For these reasons, we recommend that stricture associated with diverticular disease should be an indication for sigmoidectomy including lymph node clearance

Short-Term Outcomes of Colorectal Resection for Cancer in Elderly in the Era of Enhanced Recovery

BACKGROUND AND AIMS: Early rehabilitation protocols should be assessed in elderly. We aimed to study the outcomes of colorectal surgery and the observance of the modalities of an early rehabilitation protocol in patients over 80 years. MATERIAL AND METHODS: All consecutive patients who underwent surgery for colorectal cancer in our center over a 19-month period were included. All of these patients were managed using the same early rehabilitation protocol. Patients older than 80 were compared to younger patients. RESULTS: A total of 173 patients were included and 36 were ≥80 years (20.8%). Patients aged ≥80 years had a significantly higher ASA score and were operated on in emergency. In the peroperative period, patients aged ≥80 years were more likely to undergo laparotomy than patients <80 years in univariate analysis (p = 0.048), but in multivariate analysis, the choice for a laparoscopy was influenced by ASA score ≤2 (odds ratio = 3.55, 95% confidence interval = 1.67-7.58) and emergency surgery (odds ratio = 0.18, 95% confidence interval = 0.06-0.50). In the postoperative period, peristalsis stimulation and vascular catheter ablation were significantly better followed in Group 1 (p = 0.012 and 0.031). However, in multivariate analysis, age was not significantly associated with these parameters. Peristalsis stimulation was influenced by ASA score ≥2 (odds ratio = 4.27, 95% confidence interval = 1.18-15.37) and vascular catheter ablation was also influenced by ASA score ≤2 (odds ratio = 2.63, 95% confidence interval = 1.33-5.21). Emergency surgery had a strong trend to influence these parameters (p = 0.08). CONCLUSION: Although age or comorbidities may affect observance for certain modalities such as chewing gum use and vascular catheter ablation, an early rehabilitation protocol can be used after colorectal cancer surgery in patients ≥80 years old, where it would improve functional results and postoperative outcomes

Recommendations for obtaining unbiased chlorophyll estimates from in situ chlorophyll fluorometers: A global analysis of WET Labs ECO sensors

Chlorophyll fluorometers provide the largest in situ global data set for estimating phytoplankton biomass because of their ease of use, size, power consumption, and relatively low price. While in situ chlorophyll a (Chl) fluorescence is proxy for Chl a concentration, and hence phytoplankton biomass, there exist large natural variations in the relationship between in situ fluorescence and extracted Chl a concentration. Despite this large natural variability, we present here a global validation data set for the WET Labs Environmental Characterization Optics (ECO) series chlorophyll fluorometers that suggests a factor of 2 overestimation in the factory calibrated Chl a estimates for this specific manufacturer and series of sensors. We base these results on paired High Pressure Liquid Chromatography (HPLC) and in situ fluorescence match ups for which non-photochemically quenched fluorescence observations were removed. Additionally, we examined matches between the factory-calibrated in situ fluorescence and estimates of chlorophyll concentration determined from in situ radiometry, absorption line height, NASA’s standard ocean color algorithm as well as laboratory calibrations with phytoplankton monocultures spanning diverse species that support the factor of 2 bias. We therefore recommend the factor of 2 global bias correction be applied for the WET Labs ECO sensors, at the user level, to improve the global accuracy of chlorophyll concentration estimates and products derived from them. We recommend that other fluorometer makes and models should likewise undergo global analyses to identify potential bias in factory calibration

Two databases derived from BGC-Argo float measurements for marine biogeochemical and bio-optical applications

Since 2012, an array of 105 Biogeochemical-Argo (BGC-Argo) floats has been deployed across the world’s oceans to assist in filling observational gaps that are required for characterizing open-ocean environments. Profiles of biogeochemical (chlorophyll and dissolved organic matter) and optical (single-wavelength particulate optical backscattering, downward irradiance at three wavelengths, and photosynthetically available radiation) variables are collected in the upper 1000m every 1 to 10 days. The database of 9837 vertical profiles collected up to January 2016 is presented and its spatial and temporal coverage is discussed. Each variable is quality controlled with specifically developed procedures and its time series is quality-assessed to identify issues related to biofouling and/or instrument drift. A second database of 5748 profile-derived products within the first optical depth (i.e., the layer of interest for satellite remote sensing) is also presented and its spatiotemporal distribution discussed. This database, devoted to field and remote ocean color applications, includes diffuse attenuation coefficients for downward irradiance at three narrow wavebands and one broad waveband (photosynthetically available radiation), calibrated chlorophyll and fluorescent dissolved organic matter concentrations, and single wavelength particulate optical backscattering. To demonstrate the applicability of these databases, data within the first optical depth are compared with previously established bio-optical models and used to validate remotely derived bio-optical products. The quality-controlled databases are publicly available from the SEANOE (SEA scieNtific Open data Edition) publisher at https://doi.org/10.17882/49388 and https://doi.org/10.17882/47142 for vertical profiles and products within the first optical depth, respectively

Primary Tumor Versus Liver-First Approach for Synchronous Colorectal Liver Metastases: An Association Française de Chirurgie (AFC) Multicenter-Based Study with Propensity Score Analysis

OBJECTIVES: Multicenter studies comparing the reverse strategy (RS) with the classical strategy (CS) for the management of stage IVA liver-only colorectal cancer (CCR) are scarce. The aim of this study was to compare long-term survival and recurrence patterns following use of the CS and RS. METHOD: This retrospective multicenter review collected data from all consecutive patients with stage IVA liver-only CCR who underwent staged resection of CCR and liver metastases (LM) at 24 French hospitals between 2006 and 2013 and were retrospectively analyzed. Patients who underwent simultaneous liver and CCR resection, those with synchronous extrahepatic metastasis, and those who underwent emergent CCR resection were excluded. Overall survival (OS) and recurrence-free survival (RFS) rates and recurrence patterns were investigated before and after propensity score matching (PSM). RESULTS: A total of 653 patients were included: 587 (89.9%) in the CS group and 66 (10.1%) in the RS group. Compared with the CS patients, RS patients were more likely to have rectal cancer (43.9 vs. 24.9%; p = 0.006), larger liver tumor size (52.5 ± 38.6 vs. 39.6 ± 30 mm; p = 0.01), and more positive lymph nodes (62.1 vs. 44.8%; p = 0.009). OS was not different between the two groups (75 vs. 72% at 5 years; p = 0.77), while RFS was worse in the RS group (24 vs. 33% at 5 years; p = 0.01). Time to recurrence at any site (1.8 vs. 2.4 years, p = 0.024) and intrahepatic recurrence (1.7 vs. 2.2 years, p = 0.014) were significantly shorter in the RS group than in the CS group. After PSM (63 patients in each group), no significant difference was found between the two groups in OS (p = 0.35), RFS (p = 0.62), time to recurrence at any site (p = 0.19), or intrahepatic recurrence (p = 0.13). CONCLUSIONS: In this study, approximately 10% of patients with CCR and synchronous LM were offered surgery with the RS. Both strategies ensured similar oncological outcomes

Gastrointestinal motility has more of an impact on postoperative recovery than you might expect

International audiencePURPOSE: While patient’s reported autonomy (PRA) may help the physician to adapt the day of discharge, the link between postoperative ileus and length of stay and PRA is not known. The aim of this study was to evaluate the evolution of the PRA score during the postoperative period and to determine the factors possibly influencing such an evolution. METHODS: This retrospective study on a prospective database took place in a single centre over 14 months. PRA was defined by the by using part I of the Groningen Activity Restriction Scale known as activity of daily life [from 9 (best) to 45 (worst)]. RESULTS: Among the 101 patients operated on for elective or emergent colorectal surgery, 80% of the patients had recovered their preoperative PRA (±5 points) before discharge and maintained their PRA during the 2 days preceding discharge. While PRA was significantly decreased by surgery (P<0.0001), each postoperative day allowed for its progressive recovery. Interestingly, the day of recovery of GI transit was associated with a significant increase of PRA (-6.96 points, P<0.0001). Despite high variability of baseline autonomy level, patients presented very similar recovery processes, which were represented by very low slope variability in the linear mixed model. Laparoscopy reduced the decrease of postoperative PRA (P=0.03) while ASA score>2 increased PRA (P=0.03). Age, emergency surgery and the occurrence of postoperative morbidity did not affect postoperative autonomy. Finally, enhanced recovery programs (ERP) tended to improve postoperative autonomy recovery (P=0.09). CONCLUSION: PRA may be used as a means of optimising a patient’s day of discharge following colorectal surgery

c-JUN gene induction and AP-1 activity is regulated by a JNK-dependent pathway in hypoxic HepG2 cells.

Hypoxia is an important pathophysiological stress that occurs during blood vessel injuries and tumor growth. It is now well documented that hypoxia leads to the activation of several transcription factors which participate in the adaptive response of the cells to hypoxia. Among these transcription factors, AP-1 is rapidly activated by hypoxia and triggers bFGF, VEGF, and tyrosine hydroxylase gene expression. However, the mechanisms of AP-1 activation by hypoxia are not well understood. In this report, we studied the events leading to AP-1 activation in hypoxia. We found that c-jun protein accumulates in hypoxic HepG2 cells. This overexpression is concomitant with c-jun phosphorylation and JNK activation. Moreover, we showed that AP-1 is transcriptionally active. We also observed that AP-1 transcriptional activity is inhibited by a MEKK1 dominant negative mutant. Moreover, the MEKK1 dominant negative mutant as well as deletion of the AP-1 binding sites within the c-jun promoter inhibited the c-jun promoter activation by hypoxia. All together, these results indicate that, in hypoxic HepG2 cells, AP-1 is activated through a JNK-dependent pathway and that it is involved in the regulation of the c-jun promoter, inducing a positive feedback loop on AP-1 activation via c-jun overexpression