Grecs et indigènes de la Catalogne à la mer Noire

Le programme de travail qui aboutit à ce livre s’inscrit dans le cadre du réseau d’excellence européen Ramses2, initié par la Maison méditerranéenne des sciences de l’homme. Une demi-douzaine de tables rondes ont réuni entre 2006 et 2008, d’un bout à l’autre de la Méditerranée (à Empúries, Aix-en-Provence, Palerme, Naples, Athènes), quelque soixante-dix chercheurs essentiellement français, italiens et espagnols, mais aussi anglais, grecs, bulgares, roumains, canadiens et russes. Il s’agissait d’étudier les rapports d’acculturation entre colons grecs et populations indigènes, en tenant compte des différences géographiques et chronologiques mais aussi de l’historiographie et des habitudes de recherche des diverses institutions. Les nombreuses communications qui ont jalonné les six tables rondes sont ici la plupart du temps précédées de textes introductifs. Une première partie, consacrée aux approches régionales, permet d’illustrer l’état de la recherche dans quelques régions choisies (autour d’Empuries, d’Himère, de Marseille, de Vélia, en Thrace et en mer Noire). La seconde partie, thématique, aborde un certain nombre de thèmes de recherche dans les régions précédentes, mais aussi dans d’autres régions du monde de la colonisation grecque. Le point de vue adopté dans ce livre est d’abord celui de la culture matérielle ; l’approche en est essentiellement archéologique. On se demandera par exemple quels sont les indices archéologiques qui permettent de dire si un site est habité par des Grecs, par des indigènes ou par une population “mixte”, et comment ces indices ont été appréciés selon les périodes et selon les régions. Beaucoup de communications présentent des synthèses régionales ou thématiques, mais une large place est faite également à des sites inédits, pour lesquels on n’a pas hésité à livrer une abondante documentation (plans, matériel de fouille). C’est en effet par le renouvellement de la documentation archéologique que nous pouvons espérer avancer dans la compréhension des rapports d’acculturation entre les colons grecs et les populations locales

Evaluation d'une stratégie pré-et-per-opératoire pour poser l'indication de curages ganglionnaires dans les cancers de l'endomètre

LE KREMLIN-B.- PARIS 11-BU Méd (940432101) / SudocSudocFranceF

Comparaison de la coelioscopie à la chirurgie robot-assistée dans la prise en charge des cancers de l endomètre

PARIS7-Xavier Bichat (751182101) / SudocSudocFranceF

Understanding SOS (Son of Sevenless)

International audienceSon of Sevenless (SOS) was discovered in Drosophila melanogaster. Essential for normal eye development in Drosophila, SOS has two human homologues, SOS1 and SOS2. The SOS1 gene encodes the Son of Sevenless 1 protein, a Ras and Rac guanine nucleotide exchange factor. This protein is composed of several important domains. The CDC25 and REM domains provide the catalytic activity of SOS1 towards Ras and the histone fold DH/PH (Dbl homology and Pleckstrin homology) domains function, in tandem, to stimulate GTP/GDP exchange for Rac. In contrast to Ras, there have been few studies that implicate SOS1 in human disease and, initially, less attention was given to this gene. However, mutations in SOS1 have been reported recently in Noonan syndrome and in type 1 hereditary gingival fibromatosis. Although, there have been very few studies that focus on the regulation of this important gene by physiological or exogenous factors, we recently found that the SOS1 gene was induced by the environmental toxin, dioxin, and that this effect was mediated by the aryl hydrocarbon receptor (AhR). These recent observations raise the possibility that alterations in the expression of the SOS1 gene and, consequently, in the activity of the SOS1 protein may affect toxicological endpoints and lead to clinical disease. These possibilities, thus, have stimulated much interest in SOS1 recently. In this article, we review the functions of SOS1 and the evidence for its roles in physiology and pathology across species

Is complete cytoreductive surgery feasible in this patient with ovarian cancer?

International audienceBackground Post-operative residual tumor size is the main prognostic factor in advanced epithelial ovarian cancer. Our objective was to develop a score for predicting the feasibility of complete cytoreductive surgery in patients with advanced epithelial ovarian cancer. Material and methods Using data from a retrospective cohort of 123 patients with advanced ovarian cancer, we developed a score for predicting complete cytoreductive surgery, by performing multiple logistic regression after a jackknife procedure. Results Three criteria were independently associated with incomplete cytoreductive surgery confirmed by surgery: age >60 years (adjusted odds ratio [aOR], 6.37; 95% confidence interval [95%CI], 1.9–21.3), diaphragmatic carcinomatosis by computed tomography (aOR, 3.34; 95%CI, 1.1–9.9), and a Peritoneal Cancer Index >10 by diagnostic laparoscopy (aOR, 3.8; 95%CI, 1.4–10.2). A 10-point score was developed based on these three criteria. The area-under-the-curve of the score was 0.76 (95%CI, 0.67–0.86). The score discriminated between groups with low and high risks of incomplete cytoreductive surgery (4.4% [95% CI, 0–10.5] and 42.9% [95% CI, 26.3–59.4], respectively). Using a cutoff of 4, sensitivity of the score was 92.8% (95%CI, 83.2–100) and specificity was 77% (95%CI, 67.1–84.9) for predicting incomplete cytoreductive surgery. Conclusion This easy-to-calculate score may prove useful to identify patients with ovarian peritoneal carcinomatosis in whom complete cytoreductive surgery is feasible

Complications of lymphadenectomy for gynecologic cancer

International audienceIntroduction: Symptomatic postoperative lymphocysts (SPOLs) and lower-limb lymphedema (LLL) are probably underestimated complications of lymphadenectomy for gynecologic malignancies. Here, our objective was to evaluate the incidence and risk factors of SPOLs and LLL after pelvic and/or aortocaval lymphadenectomy for gynecologic malignancies. Methods: Single-center retrospective study of consecutive patients who underwent pelvic and/or aortocaval lymphadenectomy for ovarian cancer, endometrial cancer, or cervical cancer between January 2007 and November 2008. The incidences of SPOL and LLL were computed with their 95% confidence intervals (95%CIs). Multivariate logistic regression was performed to identify independent risk factors for SPOL and LLL. Results: We identified 88 patients including 36 with ovarian cancer, 35 with endometrial cancer, and 17 with cervical cancer. The overall incidence of SPOL was 34.5% (95%CI, 25-45) and that of LLL was 11.4% (95% confidence interval [95%CI], 5-18). Endometrial cancer was independently associated with a lower risk of SPOL (adjusted odds ratio [aOR], 0.09; 95%CI, 0.02-0.44) and one or more positive pelvic nodes with a higher risk of SPOL (aOR, 4.4; 95%CI, 1.2-16.3). Multivariate logistic regression failed to identify factors significantly associated with LLL. Conclusion: Complications of lymphadenectomy for gynecologic malignancies are common. This finding supports a more restrictive use of lymphadenectomy or the use of less invasive techniques such as sentinel node biopsy

Diagnostic accuracy of hand-assisted laparoscopy in predicting resectability of peritoneal carcinomatosis from gynecological malignancies

International audienceObjectives Residual disease after excision surgery is the main prognostic factor in advanced ovarian cancer. Open surgery can delay neoadjuvant chemotherapy initiation. Therefore, a minimally invasive method for evaluating resectability would be of great interest. Aim of our study is to evaluate a new technique for assessing the extent of peritoneal carcinomatosis, combining manual palpation and standard laparoscopy. Methods Prospective single-center study from October 2008 to January 2010. Patients with peritoneal carcinomatosis from gynecological malignancies were investigated by standard laparoscopy followed by laparoscopy plus manual palpation using Lapdisc® (Ethicon Inc.), at 43 abdominopelvic sites. When both techniques indicated resectability, standard cytoreduction surgery was performed via a midline laparotomy. The Fagotti, modified Fagotti, and Sugarbaker scores were computed. The diagnostic performance of each evaluation criterion was assessed by computing sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the receiver-operating characteristic curves (ROC-AUCs). Results Of the 29 included patients, 18 (62.1%) were considered to have resectable disease. Fourteen (14/18, 77.8%) had macroscopically complete cytoreduction. With Lapdisc®, sensitivity was 100%, specificity 73.3%, PPV 77.8%, NPV 100%, and ROC-AUC 0.87. Corresponding values were as follows: laparoscopy, 100%, 40%, 60.9%, 100%, and 0.70; Fagotti and modified Fagotti scores, 100%, 46.7%, 63.6%, 100%, and 0.73; Sugarbaker score, 64.3%, 93.3%, 90%, 73.7%, and 0.79. The ROC-AUCs showed significantly better performance of Lapdisc® than of standard laparoscopy (P = 0.008). Conclusion Hand-assisted laparoscopy may perform better than laparoscopy alone for predicting the resectability of peritoneal carcinomatosis by increasing the number of sites evaluated

La laparoscopie, une voie d’abord privilégiée pour la chirurgie des cancers en gynécologie

International audienceLa chirurgie mini-invasive par laparoscopie permet un traitement efficace et rigoureux dans lescancers gynécologiques (ovaires, endomètre, col utérin). Lorsqu’elle est possible, cette techniquedoit être privilégiée face à la laparotomie pour tous les gestes chirurgicaux réalisés à viséethérapeutique et diagnostique. Elle permet une courte convalescence, limitant le délai pour débuterdes traitements adjuvants, ce qui est un facteur pronostique importan

Outcomes of robotic surgery for endometrial cancer in elderly women

International audienceIntroduction: Few data have been reported on robot-assisted surgery in elderly. The objectives were to compare feasibility, complication data, and survival of patients under and upper the age of 70 who are managed for endometrial cancer by robot-assisted laparoscopy.Materials and methods: This is a retrospective comparative single-center study including patients treated between January 2007 and December 2016. Patients were divided into 2 groups: less than 70 years and greater than or equal to 70 years. The primary endpoint was the rate of complications. The secondary endpoints were conversion rate and follow-up.Results: 148 patients were included: 86 under 70 (group A) and 62 aged 70 and over (group B). More adhesiolysis was performed in group B (p < .01); the pelvic and para-aortic lymph node dissection rates were not different between both groups (p = .2 and p = .9). The operating times were significantly longer in group B (220.1 vs. 234.4 min, p = .02). The conversion rate was similar between the 2 groups (p = .7). The tumors were endometrioid adenocarcinomas for 77.9 and 66.7% respectively (p = .2), with grade 3 tumors more represented in older patients (24.4% vs. 48.4%, p < .01). There were more tumors at high risk of recurrence after 70 years (33.7 vs. 45.2%, p = .04). No significant difference was found for postoperative complications. There was no difference in overall survival (p = .7) or progression-free survival (p = .2). Undertreated women rate was similar in both groups (p = .1).Conclusion: Robotic surgery appears feasible and reproducible and could bring a benefit and allow optimal surgery without increasing the morbidity in the management of endometrial cancers whatever the age is

Impact of mixtures of persistent organic pollutants on breast cancer aggressiveness

Introduction: Breast cancer (BC) is frequent with a poor prognosis in case of metastasis. The role of the environment has been poorly evaluated in its progression. We searched to assess whether a mixture of pollutants could be responsible of BC aggressiveness. Methods: Patients undergoing surgery for their BC were prospectively included in the METAPOP cohort. Forty-two POPs were extracted, among them 17 dioxins (PCDD/F), 16 polychlorobiphenyls (PCB), 8 polybromodiphenylethers (PBDE) and 2,2′,4,4′,5,5′-hexabromobiphenyl (PBB153) were measured in the adipose tissue surrounding the tumor. BC aggressiveness was defined using tumor size and metastasis (distant or lymph nodes). Two complementary models were used to evaluate the impact of the mixture of pollutants: the BKMR (Bayesian Kernel machine regression) and WQS (weighted quantile sum regression) models. The WQS estimates the weight (positive or negative) of a certain chemical based on its quantile and the BKMR model applies a kernel-based approach to estimate posterior inclusion probabilities. The sub-group of patients with a body mass index (BMI) > 22 kg/ m2 was also analyzed. Results: Ninety-one patients were included. Of these, 38 patients presented a metastasis, and the mean tumor size was 25.4 mm. The mean BMI was 24.5 kg/m2 (+/- 4.1). No statistical association was found in the general population. However, in patients with a BMI > 22 kg/ m2, our mixture was positively associated with tumor size (OR: 9.73 95 %CI: 1.30–18.15) and metastasis (OR = 3.98 95 %CI = 1.09–17.53) using the WQS model. Moreover, using the BKMR model on chemical families, dioxin like chemicals and PCDD were associated with a higher risk of metastasis. Discussion: These novel findings identified a mixture associated with breast cancer aggressiveness in patients with a BMI > 22 kg/ m2