Robot-based tele-echography: clinical evaluation of the TER system in abdominal aortic exploration

OBJECTIVE: The TER system is a robot-based tele-echography system allowing remote ultrasound examination. The specialist moves a mock-up of the ultrasound probe at the master site, and the robot reproduces the movements of the real probe, which sends back ultrasound images and force feedback. This tool could be used to perform ultrasound examinations in small health care centers or from isolated sites. The objective of this study was to prove, under real conditions, the feasibility and reliability of the TER system in detecting abdominal aortic and iliac aneurysms. METHODS: Fifty-eight patients were included in 2 centers in Brest and Grenoble, France. The remote examination was compared with the reference standard, the bedside examination, for aorta and iliac artery diameter measurement, detection and description of aneurysms, detection of atheromatosis, the duration of the examination, and acceptability. RESULTS: All aneurysms (8) were detected by both techniques as intramural thrombosis and extension to the iliac arteries. The interobserver correlation coefficient was 0.982 (P < .0001) for aortic diameters. The rate of concordance between 2 operators in evaluating atheromatosis was 84% +/- 11% (95% confidence interval). CONCLUSIONS: Our study on 58 patients suggests that the TER system could be a reliable, acceptable, and effective robot-based system for performing remote abdominal aortic ultrasound examinations. Research is continuing to improve the equipment for general abdominal use

TER: A Robot for Remote Ultrasonic Examination: Experimental Evaluations

This chapter: o Motivates the clinical use of robotic tele-echography o Introduces the TER system o Describes technical and clinical evaluations performed with TE

Targeted Therapy for Older Patients with Non-Small Cell Lung Cancer: Systematic Review and Guidelines from the French Society of Geriatric Oncology (SoFOG) and the French-Language Society of Pulmonology (SPLF)/ French-Language Oncology Group (GOLF)

Systematic molecular profiling and targeted therapy (TKI) have changed the face of Non-Small Cell Lung Cancer (NSCLC) treatment. However, there are no specific recommendations to address the prescription of TKI for older patients. A multidisciplinary task force from the French Society of Geriatric Oncology (SoFOG) and the French Society of Pulmonology/Oncology Group (SPLF/GOLF) conducted a systematic review from May 2010 to May 2021. Protocol registered in Prospero under number CRD42021224103. Three key questions were selected for older patients with NSCLC: (1) to whom TKI can be proposed, (2) for whom monotherapy should be favored, and (3) to whom a combination of TKI can be proposed. Among the 534 references isolated, 52 were included for the guidelines. The expert panel analysis concluded: (1) osimertinib 80 mg/day is recommended as a first-line treatment for older patients with the EGFR mutation; (2) full-dose first generation TKI, such as erlotinib or gefitinib, is feasible; (3) ALK and ROS1 rearrangement studies including older patients were too scarce to conclude on any definitive recommendations; and (4) given the actual data, TKI should be prescribed as monotherapy. Malnutrition, functional decline, and the number of comorbidities should be assessed primarily before TKI initiation. © 2022 by the authors. Licensee MDPI, Basel, Switzerland

Troublesome Heterotopic Ossification after Central Nervous System Damage: A Survey of 570 Surgeries

BACKGROUND: Heterotopic ossification (HO) is a frequent complication after central nervous system (CNS) damage but has seldom been studied. We aimed to investigate features of HO for the first time in a large sample and the rate of early recurrence of HO in terms of the time of surgery. METHODOLOGY/PRINCIPAL FINDINGS: We retrospectively analyzed data from an anonymous prospective survey of patients undergoing surgery between May 1993 and November 2009 in our institution for troublesome HO related to acquired neurological disease. Demographic and HO characteristics and neurological etiologies were recorded. For 357 consecutive patients, we collected data on 539 first surgeries for HO (129 surgeries for multiple sites). During the follow-up, recurrences requiring another surgery appeared in 31 cases (5.8% [31/539]; 95% confidence interval [CI]: 3.8%-7.8%; 27 patients). Most HO requiring surgery occurred after traumatic brain injury (199 patients [55.7%]), then spinal cord injury (86 [24.0%]), stroke (42 [11.8%]) and cerebral anoxia (30 [8.6%]). The hip was the primary site of HO (328 [60.9%]), then the elbow (115 [21.3%]), knee (77 [14.3%]) and shoulder (19 [3.5%]). For all patients, 181 of the surgeries were performed within the first year after the CNS damage, without recurrence of HO. Recurrence was not associated with etiology (p = 0.46), sex (p = 1.00), age at CNS damage (p = 0.2), multisite localization (p = 0.34), or delay to surgery (p = 0.7). CONCLUSIONS/SIGNIFICANCE: In patients with CNS damage, troublesome HO and recurrence occurs most frequently after traumatic brain injury and appears frequently in the hip and elbow. Early surgery for HO is not a factor of recurrence

Prognostic Value of Routinely Measured Inflammatory Biomarkers in Older Cancer Patients: Pooled Analysis of Three Cohorts

BACKGROUND: The prognostic assessment of older cancer patients is complicated by their heterogeneity. We aimed to assess the prognostic value of routine inflammatory biomarkers. METHODS: A pooled analysis of prospective multicenter cohorts of cancer patients aged >/=70 was performed. We measured CRP and albumin, and calculated Glasgow Prognostic Score (GPS) and CRP/albumin ratio. The GPS has three levels (0 = CRP /= 35 g/L, i.e., normal values; 1 = one abnormal value; 2 = two abnormal values). One-year mortality was assessed using Cox models. Discriminative power was assessed using Harrell's C index (C) and net reclassification improvement (NRI). RESULTS: Overall, 1800 patients were analyzed (mean age: 79 +/- 6; males: 62%; metastases: 38%). The GPS and CRP/albumin ratio were independently associated with mortality in patients not at risk of frailty (hazard ratio [95% confidence interval] = 4.48 [2.03-9.89] for GPS1, 11.64 [4.54-29.81] for GPS2, and 7.15 [3.22-15.90] for CRP/albumin ratio > 0.215) and in patients at risk of frailty (2.45 [1.79-3.34] for GPS1, 3.97 [2.93-5.37] for GPS2, and 2.81 [2.17-3.65] for CRP/albumin ratio > 0.215). The discriminative power of the baseline clinical model (C = 0.82 [0.80-0.83]) was increased by adding GPS (C = 0.84 [0.82-0.85]; NRI events (NRI+) = 10% [2-16]) and CRP/albumin ratio (C = 0.83 [0.82-0.85]; NRI+ = 14% [2-17]). CONCLUSIONS: Routine inflammatory biomarkers add prognostic value to clinical factors in older cancer patients

Traitement des fractures articulaires des doigts par un nouveau fixateur externe

Les fractures articulaires des doigts sont des traumatismes fréquents et graves. Ce sont les séquelles au niveau de l articulation interphalangienne proximale qui menacent le plus le pronostic fonctionnel du doigt et de la main. De nombreuses méthodes de traitement des fractures de l IPP sont publiées dans la littérature, leurs indications dépendent parfois de la sévérité de la fracture, souvent de l expérience du chirurgien. Le ligamentotaxis est une technique relativement récente de traitement des fractures articulaires digitales, si elle offre l espoir d un résultat correct, sa mise en application est délicate, elle dépend des opérateurs et reste confidentielle. Nous avons cherché à savoir si un nouveau fixateur externe dynamique appelé Ligamentotaxor® pouvait être utile dans le traitement de ces fractures, en étudiant si cette technique est fiable, simple et reproductible. Notre étude est multicentrique, elle porte sur 104 fractures articulaires digitales, dont 83 fractures de L IPP, provenant de 10 centres de SOS-main. Sur les 83 fractures de l IPP, il y avait au moins 76 fractures instables. 2 patients ont nécessité une arthrodèse. Concernant les 81 cas restants, après un recul de 15.6 mois, la mobilité est de 71, 8 en moyenne. 87% des patients sont satisfaits ou très satisfaits du résultat. Dans 85,5% des cas, la vie quotidienne du patient n est pas altérée. Notre série à des résultats proches de ceux de la littérature même si les séries publiées manquent d homogénéité. Cette technique est fiable, et ses résultats sont prédictibles. La comparaison des résultats entre les centres nous informe qu il s agit d une technique simple, car facile à appliquer et adaptable, et reproductible. Nous pensons qu il s agit d une technique intéressante pour le traitement des fractures articulaires instables des doigts.Joint fractures of the digits are frequent and severe injuries. The proximal interphalangeal joint fracture is more likely to lead to problems of decreased mobility. Different techniques of treatment have been described, depending either on the severity of the damage or on the surgeon s experience. Ligamentotaxis is a relatively new method for treating joint fractures of the fingers and can lead to satisfying results. However this is a technique which is not widely used because its practical application is complex and the technique of distraction depends on the surgeon. We tried to find out if a new external fixator called Ligamentotaxor® could help in the management of these fractures. Our study is based on 104 joint fractures of the digits, including 83 fractures of the proximal interphalangeal joint, coming from 10 Departments of Hand Surgery. Our study revealed that of 83 fractures of the interphalangeal joint, at least 76 were unstable. Two patients required arthrodesis because of a bad outcome. On the 81 fractures remaining, at final follow-up averaging 15.6 months, the active range of mobility averaged 71.8 degrees. 87% of patients were satisfied or very satisfied with the result. 85.7% of them didn t have any trouble in their daily activities. The results of our study are close to the results reported in the others series, considering the fact that all the publications are not homogeneous on the fracture type. Our technique is a reliable and predictible technique. On comparing the results of the Ligamentotaxor® between the different surgical teams, this proves that it is a simple, versatile and repeatable technique. We think this is an interesting method to treat unstable fractures of the finger joints.AMIENS-BU Santé (800212102) / SudocSudocFranceF

Le lambeau libre de fibula bifoliée pour la reconstruction des membres (à propos de 14 cas)

BORDEAUX2-BU Santé (330632101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Reconstruction osseuse post traumatique du membre inférieur (à propos de 50 cas traités en 15 ans)

BORDEAUX2-BU Santé (330632101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Lambeau fascio-cutané ante-brachial antérieur basé sur les perforantes distales de l'artère radiale (étude anatomique et application clinique)

TOURS-BU Médecine (372612103) / SudocSudocFranceF

Le karkade

MONTPELLIER-BU Pharmacie (341722105) / SudocSudocFranceF