インドシアニングリーンを用いた，皮下乳腺全摘出術後の乳頭乳輪の血液灌流の測定

　The aim of this study is to investigate the blood supply of the normal nipple-areola complex (NAC) and the spared nipple-areola complex after a nipple-sparing mastectomy by the analysis of the fluorescence resulting from the indocyanine green dye (ICG) injection. At European Institute of Oncology (Milan, Italy), the nipple-sparing mastectomy is a subcutaneous mastectomy which spares a small glandular tissue underneath the areola to preserve the blood supply of the NAC, associated with intraoperative radiotherapy of the remaining glandular tissue. From December 2002 to July 2003 we performed the ICG analyses in 10 monolateral nipple-sparing mastectomy cases (10 healthy breasts and 10 postoperative breasts). In all cases, the resulting fluorescence was registered in three different zones: surrounding mammary skin, areola, and nipple. The slope of the each fluorescence curve was measured. On the healthy breast, the nipple showed a very high perfusion compared with other zones. On the contrary, after the mastectomy the fluorescent pattern was completely altered, being the perfusion of the nipple very low. The perfusion of the surrounding mammary skin was not so changed after surgery. Even more, the perfusion was superior than the healthy breast. In conclusion, these preliminary cases confirm the applicability of the ICG technique to evaluate the perfusion of the healthy and spared nipple-areola complex after surgery. In the future, we can apply this technique to estimate the future-results just after a nipple-sparing mastectomy to avoid NAC necrosis and hypoprojection of the nipple

autologous fat transplantation in patients with breast cancer silencing or fueling cancer recurrence

Abstract Lipotransfer can be considered a technical revolution in plastic surgery and widely performed for esthetic surgery. Recently the lipofilling has been indicated in breast reconstruction and deformity correction after breast conservative treatment. However, there is lack of understanding concerning the interactions between the potential tumor beds and the lipoaspirates grafts. Current literature underlines the efficacy of the technique as well as its safety. Nevertheless, many experimental studies provide data on the endocrine, paracrine, and autocrine activities of the transplanted fat tissues. Adipocyte, pre-adipocyte and progenitor cell secretions can stimulate angiogenesis and cell growth. The "tumor–stroma interaction" can potentially induce cancer reappearance by "fueling" dormant breast cancer cells in tumor bed. There is lack of translational research that proves this concern in clinical aspect. No study on the effects of lipotransfer on human cancer breast cells in vivo is available. We provide direct and indirect effects of lipotransfer in breast cancer patients, highlighting pro and con related issues. To confirm the safety of lipotransfer in breast cancer patients we need clinical studies with control group based on long term follow up

Thermal behavior of LV cables in presence of harmonic currents

International audienceThe proliferation of non-linear loads on public and industrial networks causes increases of harmonic current distortion. This paper deals with the thermal impact of harmonic distortion on LV cables, especially LV cables with neutral conductor. The thermal impact of harmonics is shown by measurements and FEM simulations on two different LV cable structures

Caractérisation photoélectrochimique des oxydes formés sur alliages base nickel en milieu primaire des réacteurs à eau pressurisée

Dans cette thèse, nous nous sommes intéressés aux propriétés semi-conductrices des oxydes formés sur les alliages base nickel en milieu primaire des REP. L'objectif étant de mettre en évidence les effets de la pression partielle en hydrogène, de la nature de l'alliage et de l'état de surface sur les types de semi-conductions et les énergies de bandes interdites. La technique photoélectrochimique a été employée pour caractériser ces propriétés semi-conductrices. D'autres techniques de caractérisation complémentaires ont été également utilisées telles que le MEB-FEG, la diffraction des rayons X, la spectroscopie Raman et l'XPS. Les essais de corrosion ont été effectués en milieu primaire simulé (autoclave en titane, température 325C, durée 500 heures). Des échantillons d'alliages 600 et 690 de polissage 1 m diamant, ont été oxydés aux P(H2) < 0,01 ; 0,3 et 6,5 bar. L'état de surface ne concernait que l'alliage 600 oxydé à P(H2) = 0,3 bar. Nous avons utilisé une nouvelle méthode d'ajustement numérique pour la détermination des gaps. Les résultats obtenus montrent que seule la pression d'hydrogène affecte le type de semi-conduction des oxydes présentés par les hautes énergies, il passe du type-n (P(H2) < 0,01) en type proche de l'isolant (P(H2) = 0,3 et 6,5 bar). Un comportement du type-n a été enregistré à basse énergie quels que soit les paramètres d'étude. Les énergies de bande interdites des oxydes NiO, Cr2O3 et NiFe2O4 ont été révélées.In this thesis, we are interested in semiconducting properties of oxides formed on nickel base alloys. The aim is to demonstrate the effects of hydrogen partial pressure, the nature of the alloy and the surface conditions on the semi-conduction type and the band gap energies. Photoelectrochemical technique was used to characterize the semiconducting properties. Other complementary techniques were also used such as FEG-SEM, X-ray diffraction, Raman spectroscopy and XPS. Corrosion tests were performed in simulated primary medium (titanium autoclave, temperature 325C, duration 500 hours). Samples of alloys 600 and 690 of 1 m diamond polishing were oxidized at P(H2) < 0,01 ; 0,3 et 6,5 bar. The surface conditions concerned only the alloy 600 oxidized at P(H2) = 0,3 bar. We used a new method for fitting energy spectra to obtain the band gap energies. The obtained results show that only the hydrogen pressure affects the semiconducting type of oxides presented by the high energies, it shift from n-type (P(H2) < 0,01 bar) to insulating type (P(H2) = 0,3 and 6,5 bar). An n-type behavior was recorded at low energy whatever the study parameters. Band gaps energies of NiO, Cr2O3 and NiFe2O4 were revealed.SAVOIE-SCD - Bib.électronique (730659901) / SudocGRENOBLE1/INP-Bib.électronique (384210012) / SudocGRENOBLE2/3-Bib.électronique (384219901) / SudocSudocFranceF

Early cardiovascular events in women with a history of gestational diabetes mellitus

International audienceBackground: The effect of gestational diabetes mellitus (GDM) on cardiovascular diseases (CVD) is not assessed within the first 10 years postpartum, regardless of subsequent diabetes. The aim of this study was to determine the risk of CVD events related to GDM within 7 years of postpartum.Methods: This nationwide population-based study of deliveries in 2007 and 2008 with a follow-up of 7 years was based on data from the French medico-administrative database. Two groups were formed: women with a history of GDM and women without GDM or previous diabetes. CVD included angina pectoris, myocardial infarction, stroke, heart bypass surgery, coronary angioplasty, carotid endarterectomy and fibrinolysis. Hypertensive disease was assessed separately. Determinants studied included age, obesity, subsequent diabetes mellitus and hypertensive diseases during pregnancy. Adjusted odds ratios for outcomes were calculated using multiple logistic regressions.Results: The hospital database recorded 1,518,990 deliveries in 2007 and 2008. Among these, 62,958 women had a history of GDM. After adjusting for age, DM, obesity and hypertensive disorders in pregnancy, GDM was significantly associated with a higher risk of CVD (adjusted Odds Ratio aOR = 1.25 [1.09-1.43]). Considering each variable in a separate model, GDM was associated with angina pectoris (aOR = 1.68 [1.29-2.20]), myocardial infarction (aOR = 1.92 [1.36-2.71]) and hypertension (aOR = 2.72 [2.58-2.88]) but not with stroke.Conclusions: A history of GDM was identified as a risk factor of CVD, especially coronary vascular diseases, within the 7 years postpartum. A lifestyle changes from postpartum onwards can be recommended and supported

Transcatheter tricuspid valve implantation: A multicentre French study

SummaryBackgroundTranscatheter valve-in-valve (VIV) implantation in failing bioprosthesis is an emerging field in cardiology.AimTo report on a French multicentre experience and a literature review of tricuspid VIV implantation.MethodsWe approached different institutions and collected 10 unpublished cases; a literature review identified 71 patients, including our 10 cases. Clinical aspects and haemodynamic data are discussed.ResultsAmong our 10 unpublished cases, the reason for implantation was significant tricuspid stenosis (n=4), significant tricuspid regurgitation (n=1) or mixed lesion (n=5). Implantation was performed under general anaesthesia at mean age 28±17 years. The 22mm Melody valve was implanted in seven patients; the Edwards SAPIEN valve was implanted in three patients. The procedure succeeded in all cases, despite two embolizations in the right cardiac chambers; in both cases, the valve was stabilized close to the tricuspid annulus using a self-expandable stent, before implantation of a second Edwards SAPIEN valve. Functional class improved in all but one case. Mean diastolic gradient decreased from 9±2.45mmHg to 3.65±0.7mmHg (p=0.007); no more than trivial regurgitation was noticed. Among the published cases, the Melody valve was implanted in 41 patients, the Edwards SAPIEN valve in 29 patients and the Braile valve in one patient. Short-term results were similar for our 10 cases, but mid-term results are not yet available.ConclusionsTricuspid VIV implantation using the Melody or Edwards SAPIEN valves is a feasible and effective procedure for selected patients with failing bioprosthesis

Sleep deprivation reveals altered brain perfusion patterns in somnambulism

BACKGROUND: Despite its high prevalence, relatively little is known about the pathophysiology of somnambulism. Increasing evidence indicates that somnambulism is associated with functional abnormalities during wakefulness and that sleep deprivation constitutes an important drive that facilitates sleepwalking in predisposed patients. Here, we studied the neural mechanisms associated with somnambulism using Single Photon Emission Computed Tomography (SPECT) with 99mTc-Ethylene Cysteinate Dimer (ECD), during wakefulness and after sleep deprivation. METHODS: Ten adult sleepwalkers and twelve controls with normal sleep were scanned using 99mTc-ECD SPECT in morning wakefulness after a full night of sleep. Eight of the sleepwalkers and nine of the controls were also scanned during wakefulness after a night of total sleep deprivation. Between-group comparisons of regional cerebral blood flow (rCBF) were performed to characterize brain activity patterns during wakefulness in sleepwalkers. RESULTS: During wakefulness following a night of total sleep deprivation, rCBF was decreased bilaterally in the inferior temporal gyrus in sleepwalkers compared to controls. CONCLUSIONS: Functional neural abnormalities can be observed during wakefulness in somnambulism, particularly after sleep deprivation and in the inferior temporal cortex. Sleep deprivation thus not only facilitates the occurrence of sleepwalking episodes, but also uncovers patterns of neural dysfunction that characterize sleepwalkers during wakefulness

immediate breast reconstruction with prostheses after conservative treatment plus intraoperative radiotherapy long term esthetic and oncological outcomes

Abstract Electron intraoperative radiotherapy (ELIOT) has been introduced for breast conservative treatment (BCT) with promising oncological outcome. Thus, immediate breast reconstruction with prosthesis after BCT became possible due to minimal radiation effect on local tissue from ELIOT. We reported oncological and esthetical results of 29 BCT patients who had immediate implant reconstruction plus 21 Gy-ELIOT as the sole radiation treatment. All patients had prosthesis in ipsilateral breast and had simultaneous contralateral augmentation for symmetrical procedure. The average age was 52.3 years. There were stage Ia thirteen cases, stage Ib seven cases, stage IIa six cases and stage IIIb one case and two cases of intraepithelial neoplasia. From 54.2 (36–88) months follow up, the capsular contracture grading in the reconstructed breast from ELIOT-side is comparable with non-irradiated contralateral side. There was one patient who developed local recurrence (LR) and later on dead with breast related event (LR = 0.76% per year). There was no primary ipsilateral carcinomas and distant metastasis

A Novel Indole-3-propanamide Exerts Its Immunosuppressive Activity by Inhibiting JAK3 in T Cells

ABSTRACT We previously identified an indole-3-propanamide derivative, 3-[1-(4-chlorobenzyl)indol-3-yl]-N-(pyridin-4-yl)propanamide (AD412), as a potential immunosuppressive agent. Here, we document that AD412 inhibited the proliferative response of CD3/CD28-stimulated human T cells without inhibiting their interleukin 2 (IL-2) production and also inhibited the proliferation of CTL-L2 cells in response to IL-2. These results prompted us to analyze the effect of our compound on the three main signaling pathways coupled to the IL-2 receptor. We provide evidence that AD412 inhibited the JAK1/3-dependent phosphorylations of Akt, STAT5a/b, and ERK1/2 in IL-2-stimulated CTL-L2 cells. In contrast, AD412 had little effect on the JAK1/2-dependent INF-␥-induced phosphorylation of STAT1 in U266 cells. This suggested a preferential inhibition of JAK3 over JAK1 or JAK 2 activities by AD412 that was confirmed by in vitro kinase assays with purified JAK2 and JAK3 kinases. In addition, we provide evidence that the inhibition of IL-2 response by AD412 was not due to inhibition of IL-2R␣ up-regulation because neither AD412 nor JAK3 inhibitors described previously [4-[(3-bromo-4-hydroxyphenyl)amino]-6,7-dimethoxyquinazoline (WHI-P154) and ␣-cyano-(3,4-dihydroxy)-N-benzylcinnamid (AG-490)] significantly inhibited IL-2-induced IL-2R␣ overexpression. Finally, we further document the immunosuppressive activity of AD412 in vivo by showing that its administration per os significantly prolonged heart allograft graft survival. This molecule may thus represent an interesting lead compound to develop new immunosuppressive agents in the field of transplantation and autoimmune diseases