Increased Fibrosis and Interstitial Fluid Pressure in Two Different Types of Syngeneic Murine Carcinoma Grown in Integrin β3-Subunit Deficient Mice

Stroma properties affect carcinoma physiology and direct malignant cell development. Here we present data showing that αVβ3 expressed by stromal cells is involved in the control of interstitial fluid pressure (IFP), extracellular volume (ECV) and collagen scaffold architecture in experimental murine carcinoma. IFP was elevated and ECV lowered in syngeneic CT26 colon and LM3 mammary carcinomas grown in integrin β3-deficient compared to wild-type BALB/c mice. Integrin β3-deficiency had no effect on carcinoma growth rate or on vascular morphology and function. Analyses by electron microscopy of carcinomas from integrin β3-deficient mice revealed a coarser and denser collagen network compared to carcinomas in wild-type littermates. Collagen fibers were built from heterogeneous and thicker collagen fibrils in carcinomas from integrin β3-deficient mice. The fibrotic extracellular matrix (ECM) did not correlate with increased macrophage infiltration in integrin β3-deficient mice bearing CT26 tumors, indicating that the fibrotic phenotype was not mediated by increased inflammation. In conclusion, we report that integrin β3-deficiency in tumor stroma led to an elevated IFP and lowered ECV that correlated with a more fibrotic ECM, underlining the role of the collagen network for carcinoma physiology

Simple scoring system to predict in-hospital mortality after surgery for infective endocarditis

BACKGROUND: Aspecific scoring systems are used to predict the risk of death postsurgery in patients with infective endocarditis (IE). The purpose of the present study was both to analyze the risk factors for in-hospital death, which complicates surgery for IE, and to create a mortality risk score based on the results of this analysis. METHODS AND RESULTS: Outcomes of 361 consecutive patients (mean age, 59.1\ub115.4 years) who had undergone surgery for IE in 8 European centers of cardiac surgery were recorded prospectively, and a risk factor analysis (multivariable logistic regression) for in-hospital death was performed. The discriminatory power of a new predictive scoring system was assessed with the receiver operating characteristic curve analysis. Score validation procedures were carried out. Fifty-six (15.5%) patients died postsurgery. BMI >27 kg/m2 (odds ratio [OR], 1.79; P=0.049), estimated glomerular filtration rate 55 mm Hg (OR, 1.78; P=0.032), and critical state (OR, 2.37; P=0.017) were independent predictors of in-hospital death. A scoring system was devised to predict in-hospital death postsurgery for IE (area under the receiver operating characteristic curve, 0.780; 95% CI, 0.734-0.822). The score performed better than 5 of 6 scoring systems for in-hospital death after cardiac surgery that were considered. CONCLUSIONS: A simple scoring system based on risk factors for in-hospital death was specifically created to predict mortality risk postsurgery in patients with IE

Les aventures de la Belgique

série historico-juridique de 5 émissions de 25 min sur la régionalisation de la Belgiqueinfo:eu-repo/semantics/publishe

Granulosa tumor: two spontaneous pregnancies after combined medico-surgical treatment: case report and review of the literature

Abstract Background Granulosa tumor is a rare tumor that arises from the mesenchyme and the sexual cord of the ovary. The prognosis is generally excellent, and treatment is mainly based on surgery, followed by chemotherapy depending on the extension of the disease. However, “the obstetrical prognosis” is compromised. Case presentation We report the case of a 32-year-old Caucasian patient who was diagnosed during a primary infertility assessment with an ultrasound image of a 39 mm organic left ovarian cyst confirmed on pelvic magnetic resonance imaging with infiltration of the uterosacral space. Tumor markers, including cancer antigen 125, alpha fetoprotein, and β-human chorionic gonadotropin, were normal. Histological study of biopsies of the ovarian lesion taken during exploratory laparoscopy confirmed the diagnosis of adult granulosa tumor. After a normal extension assessment including a thoracoabdominopelvic computed tomography scan and a positron emission tomography scan, the patient underwent complete conservative surgery and the disease was classified as stage Ic. Three cycles of adjuvant chemotherapy according to the “BEP” protocol combining bleomycin, etoposide, and cisplatin were performed after oocyte cryopreservation. After a 5-year follow-up period, the patient had no sign of tumor progression and had two spontaneous pregnancies, the first occurring 3 months after the end of chemotherapy and the second 14 months later. Conclusion Granulosa cell tumor remains a rare tumor whose management considerably compromises fertility and reduces the chances of having a spontaneous pregnancy. The particularity of our observation is that the diagnosis of the granulosa tumor was made following a primary infertility assessment and that the patient had two spontaneous pregnancies 3 months after the end of a medico-surgical treatment known to be very gonadotoxic

Infections opportunistes et sarcoïdose

National audienceIntroduction In spite of CD4+ T-lymphocytopenia and corticosteroids-induced immune suppression, the risk of opportunistic infection is not usually considered to be increased in sarcoidosis. Methods We describe 5 cases of opportunistic infection in patients with sarcoidosis and CD4+ T- lymphocytopenia. A systematic review of the literature was done. Results We describe 2 cases of chronic necroziting aspergillosis, one case of Mycobacterium avium complex pneumonia, one case of pneumocystis pneumonia, and one case of cryptoccocal meningitidis in five patients with sarcoidosis. Four patients were receiving corticosteroids at time of diagnosis. Four patients had CD4+ T-lymphocytopenia. In the literature, we documented 65 cases reports of sarcoidosis complicated by opportunistic infection. At the time of infection diagnosis, 36 patients were receiving corticosteroids. CD4+ T-lymphocytopenia was present in 5 of 11 reported cases. Cryptococcosis was the most common reported infection. Conclusion Opportunistic infectious complications are rare in patients with sarcoidosis. Opportunistic infections mainly occur in patients receiving corticosteroids, and with CD4+ T-lymphocytopenia. Except for cryptococcosis, sarcoidosis by itself does not appear to be a risk factor of opportunistic infection.Introduction Chez les patients atteints de sarcoïdose, malgré la fréquence de la lymphocytopénie T-CD4, et l'immunodépression induite par la corticothérapie, les infections opportunistes semblent rares. Méthodes Nous décrivons cinq cas de sarcoïdose compliquée d'infection opportuniste. Une recherche bibliographique des cas rapportés d'infection opportuniste chez des patients atteints de sarcoïdose, a été effectuée. Résultats Parmi les 5 cas d'infection opportuniste que nous décrivons, quatre (une aspergillose nécrosante chronique, une infection pulmonaire à mycobactérie atypique, une cryptococcose neuro-méningée, et une pneumocystose pulmonaire) sont survenus sous corticothérapie, et un seul (aspergillose nécrosante chronique) chez une patiente non traitée. Dans 4 cas, il existait une lymphocytopénie T-CD4 au moment du diagnostic de l'infection. Dans la littérature, parmi les 65 cas documentés de sarcoïdose compliquée d'infection opportuniste, 36 sont survenus chez des patients traités par corticoïdes. Une lymphocytopénie T-CD4 a été notée dans 5 cas (sur 11 documentés). La cryptococcose a été l'infection la plus fréquemment rapportée. Conclusion Les infections opportunistes sont rares au cours de la sarcoïdose, et surviennent principalement au cours d'un traitement par corticoïdes, dans un contexte de lymphocytopénie TCD4. Sauf peut-être pour la cryptococcose, la sarcoïdose en elle-même ne représente pas un facteur de risque infectieux

Infections opportunistes et sarcoïdose

National audienceIntroduction In spite of CD4+ T-lymphocytopenia and corticosteroids-induced immune suppression, the risk of opportunistic infection is not usually considered to be increased in sarcoidosis. Methods We describe 5 cases of opportunistic infection in patients with sarcoidosis and CD4+ T- lymphocytopenia. A systematic review of the literature was done. Results We describe 2 cases of chronic necroziting aspergillosis, one case of Mycobacterium avium complex pneumonia, one case of pneumocystis pneumonia, and one case of cryptoccocal meningitidis in five patients with sarcoidosis. Four patients were receiving corticosteroids at time of diagnosis. Four patients had CD4+ T-lymphocytopenia. In the literature, we documented 65 cases reports of sarcoidosis complicated by opportunistic infection. At the time of infection diagnosis, 36 patients were receiving corticosteroids. CD4+ T-lymphocytopenia was present in 5 of 11 reported cases. Cryptococcosis was the most common reported infection. Conclusion Opportunistic infectious complications are rare in patients with sarcoidosis. Opportunistic infections mainly occur in patients receiving corticosteroids, and with CD4+ T-lymphocytopenia. Except for cryptococcosis, sarcoidosis by itself does not appear to be a risk factor of opportunistic infection.Introduction Chez les patients atteints de sarcoïdose, malgré la fréquence de la lymphocytopénie T-CD4, et l'immunodépression induite par la corticothérapie, les infections opportunistes semblent rares. Méthodes Nous décrivons cinq cas de sarcoïdose compliquée d'infection opportuniste. Une recherche bibliographique des cas rapportés d'infection opportuniste chez des patients atteints de sarcoïdose, a été effectuée. Résultats Parmi les 5 cas d'infection opportuniste que nous décrivons, quatre (une aspergillose nécrosante chronique, une infection pulmonaire à mycobactérie atypique, une cryptococcose neuro-méningée, et une pneumocystose pulmonaire) sont survenus sous corticothérapie, et un seul (aspergillose nécrosante chronique) chez une patiente non traitée. Dans 4 cas, il existait une lymphocytopénie T-CD4 au moment du diagnostic de l'infection. Dans la littérature, parmi les 65 cas documentés de sarcoïdose compliquée d'infection opportuniste, 36 sont survenus chez des patients traités par corticoïdes. Une lymphocytopénie T-CD4 a été notée dans 5 cas (sur 11 documentés). La cryptococcose a été l'infection la plus fréquemment rapportée. Conclusion Les infections opportunistes sont rares au cours de la sarcoïdose, et surviennent principalement au cours d'un traitement par corticoïdes, dans un contexte de lymphocytopénie TCD4. Sauf peut-être pour la cryptococcose, la sarcoïdose en elle-même ne représente pas un facteur de risque infectieux

P2857 Quantifying drivers of antimicrobial resistance in a large network of hospital wards: a meta-population approach.

International audienceBackground: Antimicrobial resistance is a major threat. The prevalence of multidrug resistant organisms(MDROs) in hospital wards depends both on the local antibiotic selection pressure and MDRO introduction from other wards or the community. Understanding the relative contribution of these factors is essential for designing effective antimicrobial stewardship and infection control strategies. Here we adopt a metapopulation approach to compare the impacts of local selection and inter-ward introduction on the prevalence of various MDROs and their non-MDR counterparts.Materials/methods: Data were collected from October 2016 to October 2017 from 523 wards in 4 hospital groups in Lyon, France. We considered six bacterial groups: cephalosporin-resistant Escherichia coli and Enterobacter cloacae and carbapenem-resistant Pseudomonas aeruginosa, and their non-MDR variants. The main model outcome was the number of patients infected by each bacterial group in each ward. Local selection pressure was estimated from the number of delivered defined daily doses of antibiotics. As a proxy for inter-ward introduction, we counted patients transferred from wards harbouring the same bacterial group. We used a modified Hanski metapopulation model with Poisson regression controlling for sampling bias, to examine associations of the prevalence of each bacterial group with antibiotic consumption and patient transfers.Results: Antibiotic consumption consistently predicted prevalence (P0.05).Conclusions: The impact of antibiotic consumption on MDRO prevalence strongly outweighs that of inter-ward introduction. The lack of impact of introduction on E.cloacae prevalence suggests that the selection of both MDR and non-MDR variants occurs locally in individual wards and is strongly dependent on antibiotic consumption. Hence, patient isolation might be less effective for controlling E. cloacae spread compared to P. aeruginosa or E. coli. Controlling resistance requires adapting strategies to each bacterial taxon