Étude comparative de la densité et du déplacement des Desmans des Pyrénées Galemys pyrenaicus (É. Geoffroy Saint-Hilaire, 1811) par une méthode non invasive

peer reviewe

Intérêt de l'IRM corps entier dans les gammapathies monoclonales de signification indéterminée. Une étude prospective sur 30 patients

PARIS-BIUM (751062103) / SudocCentre Technique Livre Ens. Sup. (774682301) / SudocSudocFranceF

Body composition and sarcopenia: The next-generation of personalized oncology and pharmacology?

International audienceBody composition has gained increasing attention in oncology in recent years due to fact that sarcopenia has been revealed to be a strong prognostic indicator for survival across multiple stages and cancer types and a predictive factor for toxicity and surgery complications. Accumulating evidence over the last decade has unraveled the "pharmacology" of sarcopenia. Lean body mass may be more relevant to define drug dosing than the "classical" body surface area or flat-fixed dosing in patients with cancer. Since sarcopenia has a major impact on patient survival and quality of life, therapeutic interventions aiming at reducing muscle loss have been developed and are being prospectively evaluated in randomized controlled trials. It is now acknowledged that this supportive care dimension of oncological management is essential to ensure the success of any anticancer treatment. The field of sarcopenia and body composition in cancer is developing quickly, with (i) the newly identified concept of sarcopenic obesity defined as a specific pathophysiological entity, (ii) unsolved issues regarding the best evaluation modalities and cutoff for definition of sarcopenia on imaging, (iii) first results from clinical trials evaluating physical activity, and (iv) emerging body-composition-tailored drug administration schemes. In this context, we propose a comprehensive review providing a panoramic approach of the clinical, pharmacological and therapeutic implications of sarcopenia and body composition in oncology

Psoas muscle index is not representative of skeletal muscle index for evaluating cancer sarcopenia

Abstract Background A common method for diagnosing sarcopenia involves estimating the muscle mass by computed tomography (CT) via measurements of the cross‐sectional muscle area (CSMA) of all muscles at the third lumbar vertebra (L3) level. Recently, single‐muscle measurements of the psoas major muscle at L3 have emerged as a surrogate for sarcopenia detection, but its reliability and accuracy remain to be demonstrated. Methods This prospective cross‐sectional study involved 29 healthcare establishments and recruited patients with metastatic cancers. The correlation between skeletal muscle index (SMI = CSMA of all muscles at L3/height2, cm2/m2) and psoas muscle index (PMI = CSMA of psoas at L3/height2, cm2/m2) was determined (Pearson's r). ROC curves were prepared based on SMI data from a development population (n = 488) to estimate suitable PMI thresholds. International low SMI cut‐offs according to gender were studied for males (<55cm2/m2) and for females (<39 cm2/m2). Youden's index (J) and Cohen's kappa (κ) were calculated to estimate the test's accuracy and reliability. PMI cut‐offs were validated in a validation population (n = 243) by estimating the percentage concordance of sarcopenia diagnoses with the SMI thresholds. Results Seven hundred and sixty‐six patients were analysed (mean age 65.0 ± 11.8 years, 50.1% female). Low SMI prevalence was 69.1%. Correlation between the SMI and PMI for the entire population was 0.69 (n = 731, P < 0.01). PMI cut‐offs for sarcopenia were estimated in the development population at <6.6cm2/m2 in males and at <4.8 cm2/m2 for females. The J and κ coefficients for PMI diagnostic tests were weak. The PMI cut‐offs were tested in the validation population where 33.3% of the PMI measurements were dichotomously discordant. Conclusions A diagnostic test employing single‐muscle measurements of the psoas major muscle as a surrogate for sarcopenia detection was evaluated but found to be unreliable. The CSMA of all muscles must be considered for evaluating cancer sarcopenia at L3

Étude comparative de la densité et du déplacement des Desmans des Pyrénées Galemys pyrenaicus (É. Geoffroy Saint-Hilaire, 1811) par une méthode non invasive

International audienceEspèce protégée et en régression sur l’ensemble de son aire de répartition, le Desman des Pyrénées Galemys pyrenaicus (É. Geoffroy Saint-Hilaire, 1811) reste une espèce mal connue malgré les programmes d’actions en faveur de sa conservation mis en œuvre en France depuis 2010. Le manque de connaissance sur la densité des populations et les déplacements des individus nous ont poussés à réaliser une étude de suivi de six populations de Desman répartie sur six sites pyrénéens connus pour abriter l’espèce. La méthode retenue pour cette étude a été l’analyse génétique des fèces nécessitant un protocole non invasif et moins coûteux que les captures ou les suivis par radiopistage. Certaines crottes ont permis de contacter des individus à plusieurs reprises et d’analyser leurs déplacements. L’individualisation des crottes a également permis d’estimer une densité minimale d’individus sur 1,5 km de cours d’eau prospecté réparti sur 3 km, ou encore sur des portions plus restreintes de 250 mètres. Ainsi, les résultats confirment la mobilité du Desman mais aussi son caractère nomade et non territorial. Un des sites n’a cependant pas pu rentrer dans l’analyse des données, car soumis à une pollution menant à la disparition de l’espèce pendant quelques années. Les analyses génétiques ont montré l’efficacité des prospections avec des résultats positifs au Desman pour chaque échantillon prélevé supposé appartenir à l’espèce. Cependant, ils confirment aussi la difficulté de détectabilité de l’espèce malgré sa présence et la nécessité de la prendre en compte, même si elle semble absente à un instant donné sur un site, notamment dans les projets d’aménagement de cours d’eau, afin de respecter la continuité écologique nécessaire à ses déplacements et aux mélanges génétiques des populations

Can dual-energy CT replace perfusion CT for the functional evaluation of advanced hepatocellular carcinoma?

International audienc

Myosteatosis as an independent risk factor for mortality after kidney allograft transplantation: a retrospective cohort study

Background Patients with end-stage renal disease may display both a loss of skeletal muscle mass and an increase in muscle fat deposits. We aimed to analyse the impact of low skeletal muscle mass index (SMI, surrogate marker of sarcopenia) and low muscle density (MD, surrogate marker of myosteatosis) on patient survival after kidney transplantation (KT). Methods In a retrospective cohort of 200 kidney transplant recipients (KTr), we measured on an unenhanced cross-sectional computed tomography scan taken at the level of the third lumbar vertebra within the previous year or at the time of KT, both SMI (muscle cross-sectional area normalized for height 2 , reported in cm 2 /m 2) and MD (mean attenuation of muscle cross-sectional area, expressed in Hounsfield units). We determined age-specific and sex-specific normality thresholds on 130 healthy subjects. The baseline factors associated with low MD were assessed by logistic regression analysis. Cox proportional hazard univariable and multivariable models were constructed to identify predictive factors of patient survival. Results Among the 200 patients of the cohort, 123 were male (62%), and mean age was 54.8 ± 13.8 years. A total of 181 KTr required renal replacement therapy before KT (91%), and 36 KTr (18%) received repeat kidney transplant after previous failed KT. Mean MD was 30.6 ± 9 HU in men and 29.7 ± 8.3 HU in women, whereas SMI was 49.7 ± 8.6 cm 2 /m 2 in men and 42.3 ± 7.3 cm 2 /m 2 in women. MD was below the 2.5th percentile for the healthy population in 49 KTr (25%), defining the myosteatosis group, while SMI was below the 2.5th percentile for the reference population in 10 KTr (5%). Independent risk factors for myosteatosis were two or more KT [adjusted odds ratio (aOR) 5.2, 95% confidence interval (95% CI): 2.22-12.4, P = 0.0001], a history of stroke (aOR 3.7, 95% CI: 1.30-10.7, P = 0.015), and body mass index > 25 kg/m 2 (aOR 2.94, 95% CI: 1.4-6.18, P = 0.004). Myosteatosis was independently associated with mortality [adjusted hazard ratio (aHR) 2.12, 95% CI: 1.06-4.24, P = 0.033], as were cardiovascular disease (HR 2.06, 95% CI: 1.02-4.15, P = 0.043) and age (aHR 1.06, 95% CI: 1.03-1.09, P = 0.0003). Low SMI was not associated with mortality. Conclusions Myosteatosis, which was more prevalent than low skeletal muscle mass, might be an important prognostic marker in patients undergoing KT

Predicting Difficult Laparoscopic Total Mesorectal Excision for Locally-advanced Mid-low Rectal Cancer: The EuMaRCS Score Validation

BACKGROUND/AIM: The European MRI and Rectal Cancer Surgery (EuMaRCS) score was proposed to identify preoperatively difficult laparoscopic total mesorectal excision (L-TME) for locally advanced rectal cancer (LARC). This study aimed to test EuMaRCS's validity. PATIENTS AND METHODS: Data were retrieved from a European multicenter database, including patients with mid/low LARC, treated with neoadjuvant chemoradiation therapy and L-TME with primary anastomosis. The EuMaRCS score was calculated on: BMI>30 (3 points), interspinous distance3 being associated with the best balance in sensitivity (82.6%) and specificity (66.1%). CONCLUSION: The EuMaRCS score represents a validated tool to predict preoperatively difficult L-TME in LARC patients