Surgical management of dysthyroid optic neuropathy: A systematic review

OBJECTIVE

There is currently no recommendation on the optimal surgical management for dysthyroid optic neuropathy (DON). The aim of this study is to systematically review the surgical management of DON and its outcome on visual acuity (VA).

DATA SOURCES

MEDLINE, Cochrane Library, and clinicaltrials.gov REVIEW METHODS: A systematic review of studies about the surgical management of DON was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Articles were included if preoperative and postoperative VA in logMAR (Logarithm of the Minimum Angle of Resolution) were available.

RESULTS

Fifteen articles were included in the study accounting for 669 orbits. The mean VA improvement was of 0.44 logMAR overall, 0.41 logMAR for 1-wall, 0.41 logMAR for 2-wall, and 0.55 logMAR for 3-wall decompressions. The mean reduction in exophthalmos was 4.9 mm overall, 4.3 mm for 1-wall, 4.54 mm for 2-wall, and 6.02 for 3-wall decompressions. The mean new onset diplopia (NOD) rate was 19.84% overall, 19,12% for 1-wall, 20.75% for 2-wall, and 19.83% for 3-wall decompressions.

CONCLUSION

The results are limited due to the high number of biases in the included studies. It seems that 3-wall decompression offers the best VA improvement and proptosis reduction although also the highest NOD and complications rate. Two-wall balanced decompression or 1-wall inferomedial decompression seems to be effective with less morbidity.

[Enhanced recovery after surgery in colorectal surgery]

Enhanced recovery after surgery (ERAS) in colorectal surgery consists of multidisciplinary, multimodal, and patient-centred care. The implementation of pre-, intra-, and post-operative measures mitigates the surgical stress, the inflammatory reaction, and their consequences. The elements of this protocol are evidence-based medicine. This allows improved and accelerated recovery. Consequently, ERAS reduces the incidence of medical complications by 50 %, including fewer infectious complications, and a possible positive impact on survival after oncologic surgery. Hospital length of stay is shortened. There is no contraindication to ERAS, which must be used for all patients undergoing colorectal surgery. Adaptation of the protocol will nevertheless be necessary in the event of urgent surgery.

Precise U-Pb age constrains on the Ediacaran biota in Podolia, East European Platform, Ukraine

The Neoproterozoic Era was characterized by rapidly changing paleogeography, global climate changes and especially by the rise and fall of the Ediacaran macro-biota. The correlation between disparate Ediacaran fossil-bearing localities and the tentative reconstruction of their paleoenvironmental and paleogeographic contexts are usually complicated by the lack of precise and accurate age data. For this reason, Neoproterozoic sedimentary sections associating Ediacaran biota fossils and fresh volcanic material are especially valuable for radioisotopic dating. Our research in the Podolya Basin, southwestern Ukraine, revealed the presence of four Neoproterozoic volcanic ash deposits (potassium-bentonite layers) within Ediacaran fossil-bearing siliciclastic rocks of the Mohyliv-Podilskyi Group. We used zircon U-Pb LA-ICPMS and CA-ID-TIMS methods to date two of those layers. The results indicate that a diverse assemblage of body and trace Ediacaran fossils occurred as early as 556.78 ± 0.18 million years (Ma) ago. By combining morphological evidence and new age determinations, we suggest a closer paleobiogeographical relationship between the Ukrainian Ediacaran assemblage and the Avalon paleocontinent than previously estimated.

Effects of Unilateral Ligamentoplasty on Spinal Development in the Growing Rabbit

Numerous models of scoliosis have been proposed, but few were characterized geometrically, easily reproductible and avalaible for testing orthopaedic procedures. Sixteen growing rabbits underwent unilateral ligamentoplasty of three lumbar vertebrae using screws in the vertebral body. Spinal modifications were evaluated at six and 12 weeks post-operatively by radiography, scannography and histology. The mean lateral deviation was found to be 21°± 3.1 at six weeks and 41.6 ± 6.6 at 12 weeks. Significant lordosis, cyphosis or vertebral rotation were not observed. Vertebral torsion was significative (p <0.005). Histological assessments of the modifications of paraspinal muscles, intervertebral discs and articular facets were performed for evaluation of consequences of surgery, spinal immobilization and deviation. We concluded that unilateral ligamentoplasty produce a reproductible model of lateral deviation of the spine in the growing rabbit.

This article analyses the spinal deformities obtained after unilateral ligamentoplasty of three lumbar vertebrae. A time-dependent lateral deviation and a vertebral torsion were found but significant lordosis, cyphosis or vertebral rotation were not observed. Paraspinal muscles, intervertebral discs and articular facets modifications are reported. Clinical relevance of these data are discussed.

Microfluidic separation of magnetic nanoparticles on an ordered array of magnetized micropillars

Microfluidic separation of magnetic particles is based on their capture by magnetized microcollectors while the suspending fluid flows past the microcollectors inside a microchannel. Separation of nanoparticles is often challenging because of strong Brownian motion. Low capture efficiency of nanoparticles limits their applications in bioanalysis. However, at some conditions, magnetic nanoparticles may undergo field-induced aggregation that amplifies the magnetic attractive force proportionally to the aggregate volume and considerably increases nanoparticle capture efficiency. In this paper, we have demonstrated the role of such aggregation on an efficient capture of magnetic nanoparticles (about 80 nm in diameter) in a microfluidic channel equipped with a nickel micropillar array. This array was magnetized by an external uniform magnetic field, of intensity as low as 6-10 kA/m, and experiments were carried out at flow rates ranging between 0.3 and 30 μL/min. Nanoparticle capture is shown to be mostly governed by the Mason number Ma, while the dipolar coupling parameter α does not exhibit a clear effect in the studied range, 1.4 < α < 4.5. The capture efficiency Λ shows a strongly decreasing Mason number behavior, Λ∝Ma^{-1.78} within the range 32 ≤ Ma ≤ 3250. We have proposed a simple theoretical model which considers destructible nanoparticle chains and gives the scaling behavior, Λ∝Ma^{-1.7}, close to the experimental findings.

Identification of suitable endogenous controls for gene and miRNA expression studies in irradiated prostate cancer cells

This study aimed to to evaluate the stability of commonly used endogenous control genes for messenger RNA (mRNA) (N = 16) and miRNAs (N = 3) expression studies in prostate cell lines following irradiation. The stability of endogenous control genes expression in irradiated (6 Gy) versus unirradiated controls was quantified using NormFinder and coefficient of variation analyses. HPRT1 and 18S were identified as most and least stable endogenous controls, respectively, for mRNA expression studies in irradiated prostate cells. SNORD48 and miR16 miRNA endogenous controls tested were associated with low coefficient of variations following irradiation (6 Gy). This study highlights that commonly used endogenous controls can be responsive to radiation and validation is required prior to gene/miRNAs expression studies.

Knee arthroscopic surgery is beneficial to middle-aged patients with meniscal symptoms: a prospective, randomised, single-blinded study

OBJECTIVE

There is no evidence that a knee arthroscopy is more beneficial to middle-aged patients with meniscal symptoms compared to other treatments. This randomised controlled trial aimed to determine whether an arthroscopic intervention combined with a structured exercise programme would provide more benefit than a structured exercise programme alone for middle-aged patients with meniscal symptoms that have undergone physiotherapy.

METHOD

150 out of 179 eligible patients, aged 45 to 64 (mean:54 ± 5), symptom duration more than 3 months and standing X-ray with Ahlbäck grade 0, were randomised to: (1) a physiotherapy appointment within 2 weeks of inclusion that included instructions for a 3-month exercise programme (non-surgery group); or (2) the same as (1) plus, within 4 weeks of inclusion, knee arthroscopy for resection of any significant meniscal injuries (surgery group). The primary outcome was change in pain at 12 months, assessed with the Knee Injury and Osteoarthritis Outcome Score (KOOSPAIN).

RESULTS

In the Intention-To-Treat analysis, pain at 12 months was significantly lower in the surgery than in the non-surgery group. The change in KOOSPAIN was significantly larger in the surgery than in the non-surgery group (between-group difference was 10.6 points of change; 95% CI: 3.4 to 17.7, P = 0.004). The As-Treated analysis results were consistent with the Intention-To-Treat analysis results.

CONCLUSION

Middle-aged patients with meniscal symptoms may benefit from arthroscopic surgery in addition to a structured exercise programme. Patients' age or symptom history (i.e., mechanical symptoms or acute onset of symptoms) didn't affect the outcome.

TRIAL REGISTRATION

NCT01288768.

Étude de l’évolution des croyances au cours d’un traitement par stimulation magnétique transcrânienne (rTMS) chez des patients dépressifs

Introduction

La stimulation magnétique transcrânienne répétée (rTMS) est une technique thérapeutique non invasive de stimulation du cerveau, utilisée pour le traitement de la dépression résistante. Les études ont montré son efficacité sur la diminution de l’intensité de la dépression [1]. Mais, à ce jour, peu d’études se sont intéressées à l’évolution au cours de ce traitement, de facteurs psychologiques tels que les schémas dysfonctionnels représentés par les attitudes dysfonctionnelles [2] et les schémas précoces inadaptés [3] et qui sont impliqués dans la dépression.

Objectif principal

Déterminer s’il y a une évolution des schémas précoces inadaptés (Young, 1990, 1999) et des attitudes dysfonctionnelles [2] avec le traitement rTMS.

Méthodologie

Vingt-trois patients dépressifs traités par rTMS au cours d’une cure de 10 jours, avec ou sans traitement médicamenteux. En début et en fin de cure, puis un mois après la fin de la cure rTMS, ils ont rempli une batterie de questionnaires composés du MINI, du BDI-13, de l’HDRS, de la HAD, du STAI, de la DAS, de l’YSQ-S1 et de l’ESDV-5.

Résultats

La rTMS confirme son efficacité sur les symptômes anxio-dépressif. Les attitudes dysfonctionnelles diminuent significativement un mois après la cure rTMS. En revanche, les schémas précoces inadaptés restent stables. La qualité de vie n’augmente modestement qu’un mois après la cure rTMS.

Conclusion

Bien que la rTMS permette une diminution significative de l’intensité de la dépression et l’anxiété, une vulnérabilité psychologique est maintenue au travers de schémas dysfonctionnels. Une psychothérapie associée au traitement et visant le changement de ces pensées négatives semble nécessaire, notamment afin d’éviter les rechutes dépressives. D’autres études avec un plus grand échantillon devraient examiner l’impact de la rTMS sur certains facteurs psychologiques à court, moyen, et long terme.

Behavior of nanoparticle clouds around a magnetized microsphere under magnetic and flow fields

When a micron-sized magnetizable particle is introduced into a suspension of nanosized magnetic particles, the nanoparticles accumulate around the microparticle and form thick anisotropic clouds extended in the direction of the applied magnetic field. This phenomenon promotes colloidal stabilization of bimodal magnetic suspensions and allows efficient magnetic separation of nanoparticles used in bioanalysis and water purification. In the present work, the size and shape of nanoparticle clouds under the simultaneous action of an external uniform magnetic field and the flow have been studied in detail. In experiments, a dilute suspension of iron oxide nanoclusters (of a mean diameter of 60 nm) was pushed through a thin slit channel with the nickel microspheres (of a mean diameter of 50 μm) attached to the channel wall. The behavior of nanocluster clouds was observed in the steady state using an optical microscope. In the presence of strong enough flow, the size of the clouds monotonically decreases with increasing flow speed in both longitudinal and transverse magnetic fields. This is qualitatively explained by enhancement of hydrodynamic forces washing the nanoclusters away from the clouds. In the longitudinal field, the flow induces asymmetry of the front and the back clouds. To explain the flow and the field effects on the clouds, we have developed a simple model based on the balance of the stresses and particle fluxes on the cloud surface. This model, applied to the case of the magnetic field parallel to the flow, captures reasonably well the flow effect on the size and shape of the cloud and reveals that the only dimensionless parameter governing the cloud size is the ratio of hydrodynamic-to-magnetic forces-the Mason number. At strong magnetic interactions considered in the present work (dipolar coupling parameter α≥2), the Brownian motion seems not to affect the cloud behavior.

Effect of hypoxia exposure on the recovery of skeletal muscle phenotype during regeneration

Hypoxia impairs the muscle fibre-type shift from fast-to-slow during post-natal development; however, this adaptation could be a consequence of the reduced voluntary physical activity associated with hypoxia exposure rather than the result of hypoxia per se. Moreover, muscle oxidative capacity could be reduced in hypoxia, particularly when hypoxia is combined with additional stress. Here, we used a model of muscle regeneration to mimic the fast-to-slow fibre-type conversion observed during post-natal development. We hypothesised that hypoxia would impair the recovery of the myosin heavy chain (MHC) profile and oxidative capacity during muscle regeneration. To test this hypothesis, the soleus muscle of female rats was injured by notexin and allowed to recover for 3, 7, 14 and 28 days under normoxia or hypobaric hypoxia (5,500 m altitude) conditions. Ambient hypoxia did not impair the recovery of the slow MHC profile during muscle regeneration. However, hypoxia moderately decreased the oxidative capacity (assessed from the activity of citrate synthase) of intact muscle and delayed its recovery in regenerated muscle. Hypoxia transiently increased in both regenerated and intact muscles the content of phosphorylated AMPK and Pgc-1α mRNA, two regulators involved in mitochondrial biogenesis, while it transiently increased in intact muscle the mRNA level of the mitophagic factor BNIP3. In conclusion, hypoxia does not act to impair the fast-to-slow MHC isoform transition during regeneration. Hypoxia alters the oxidative capacity of intact muscle and delays its recovery in regenerated muscle; however, this adaptation to hypoxia was independent of the studied regulators of mitochondrial turn-over.

Effect of hypoxia exposure on the phenotypic adaptation in remodelling skeletal muscle submitted to functional overload

AIM

To determine whether hypoxia influences the phenotypic adaptation of skeletal muscle induced by mechanical overload.

METHODS

Plantaris muscles of female rats were submitted to mechanical overload following synergist ablation. After 3 days of overload, rats were exposed to either hypobaric hypoxia (equivalent to 5500 m) or normoxia. Muscles were collected after 5, 12 and 56 days of overload (i.e. after 3, 9 and 53 days of hypoxia). We determined the myosin heavy chain (MHC) distribution, mRNA levels of myocyte-enriched calcineurin-integrating protein 1 (MCIP1) to indirectly assess calcineurin activity, the changes in oxidative capacity from the activities of citrate synthase (CS) and cytochrome c oxidase (COX), and the expression of regulators involved in mitochondrial biogenesis (Pgc-1α, NRF1 and Tfam) and degradation (BNIP-3).

RESULTS

Hypoxia did not alter the fast-to-slow MHC shift and the increase in calcineurin activity induced by overload; it only transiently slowed down the overload-induced transition in MHC isoforms. Hypoxia similarly decreased CS and COX activities in overloaded and control muscles. Nuclear respiratory factor 1 (NRF1) and transcription factor A (Tfam) mRNA and BNIP-3 protein were not influenced by hypoxia in overloaded muscles, whereas Pgc-1α mRNA and protein contents did not correlate with changes in oxidative capacity.

CONCLUSION

Hypoxia is not a critical stimulus to modulate the fast-to-slow MHC transition associated with overload. Thus, the impairment of the fast-to-slow fibre shift often observed during post-natal development in hypoxia could be explained by the lower voluntary locomotor activity associated with hypoxia. Hypoxia alters mitochondrial oxidative capacity, but this adaptive response is similar in overloaded and control muscles.

Ambient hypoxia enhances the loss of muscle mass after extensive injury

Hypoxia induces a loss of skeletal muscle mass and alters myogenesis in vitro, but whether it affects muscle regeneration in vivo following injury remains to be elucidated. We hypothesized that hypoxia would impair the recovery of muscle mass during regeneration. To test this hypothesis, the soleus muscle of female rats was injured by notexin and allowed to recover for 3, 7, 14, and 28 days under normoxia or hypobaric hypoxia (5,500 m) conditions. Hypoxia impaired the formation and growth of new myofibers and enhanced the loss of muscle mass during the first 7 days of regeneration, but did not affect the final recovery of muscle mass at 28 days. The impaired regeneration under hypoxic conditions was associated with a blunted activation of mechanical target of rapamycin (mTOR) signaling as assessed by p70(S6K) and 4E-BP1 phosphorylation that was independent of Akt activation. The decrease in mTOR activity with hypoxia was consistent with the increase in AMP-activated protein kinase activity, but not related to the change in regulated in development and DNA response 1 protein content. Hypoxia increased the mRNA levels of the atrogene muscle ring finger-1 after 7 days of regeneration, though muscle atrophy F box transcript levels remained unchanged. The increase in MyoD and myogenin mRNA expression with regeneration was attenuated at 7 days with hypoxia. In conclusion, our results support the notion that the enhanced loss of muscle mass observed after 1 week of regeneration under hypoxic conditions could mainly result from the impaired formation and growth of new fibers resulting from a reduction in protein synthesis and satellite cell activity.

Haloing in bimodal magnetic colloids: the role of field-induced phase separation

If a suspension of magnetic micrometer-sized and nanosized particles is subjected to a homogeneous magnetic field, the nanoparticles are attracted to the microparticles and form thick anisotropic halos (clouds) around them. Such clouds can hinder the approach of microparticles and result in effective repulsion between them [M. T. López-López, A. Yu. Zubarev, and G. Bossis, Soft Matter 6, 4346 (2010)]. In this paper, we present detailed experimental and theoretical studies of nanoparticle concentration profiles and of the equilibrium shapes of nanoparticle clouds around a single magnetized microsphere, taking into account interactions between nanoparticles. We show that at a strong enough magnetic field, the ensemble of nanoparticles experiences a gas-liquid phase transition such that a dense liquid phase is condensed around the magnetic poles of a microsphere while a dilute gas phase occupies the rest of the suspension volume. Nanoparticle accumulation around a microsphere is governed by two dimensionless parameters--the initial nanoparticle concentration (φ(0)) and the magnetic-to-thermal energy ratio (α)--and the three accumulation regimes are mapped onto a α-φ(0) phase diagram. Our local thermodynamic equilibrium approach gives a semiquantitative agreement with the experiments on the equilibrium shapes of nanoparticle clouds. The results of this work could be useful for the development of the bimodal magnetorheological fluids and of the magnetic separation technologies used in bioanalysis and water purification systems.

Drug-induced uveitis in aids patients: two case reports

Patients with acquired immunodeficiency syndrome (AIDS) can develop severe uveitis. Although infectious and autoimmune causes must always be considered, drug induced uveitis is also an important etiology. Herein, we present two case reports illustrating the classical presentation of rifabutin and cidofovir induced uveitis. The first case was a 33 year old woman with AIDS treated with anti-protease and anti-tuberculosis drugs (including rifabutin). She presented with a red painful right eye. There was a strong anterior segment inflammation with fibrinous exudates and a dense vitritis. Rifabutin was stopped and topical steroids and mydriatics were given. Intraocular inflammation and symptoms rapidly resolved. The second patient was a 36 year old woman who presented with a painful decrease of vision in her left eye. She was followed for bilateral CMV retinitis in the setting of AIDS and had recently received 2 systemic injections of cidofovir. Anterior segment inflammation with posterior synechiae in both eyes and folds of Descemet membrane in the left eye were noted. Intraocular pressure was 0 mmHg in the left eye and 10 mmHg in the right eye. Fundus examination disclosed CMV retinitis scars in the right eye and choroidal folds in the macula of the left eye. Cidofovir was discontinued and topical steroids and mydriatics started. Progressively the inflammation decreased and the intraocular pressure returned to normal levels. In conclusion, rifabutin and cidofovir are classical examples of drug induced uveitis with distinct characteristic clinical presentation. Recognition of those entities in AIDS patients can avoid useless and potentially invasive interventions in those fragile people.

Synthesis and magnetorheology of suspensions of submicron-sized cobalt particles with tunable particle size

Different samples of cobalt powder were synthesized. Particle size and shape were characterized using electron microscopy and light scattering. These measurements showed that the synthesized powders consisted of monodisperse spheres with average diameters ranging between 63 and 760 nm. These powders were used for the preparation of magnetorheological (MR) fluids by dispersing them in silicone oil. The MR properties of these MR fluids were investigated. It was found that particle size did not have much influence on the MR response of MR fluids, for average particle diameters larger than 100 nm. On the other hand, the MR response decreased appreciably when the average particle diameter was diminished below 100 nm; a theory based on the change of the shape of the aggregates with the size of the particles could explain these observations.

Breast-conserving surgery with or without radiotherapy vs mastectomy for ductal carcinoma in situ: French Survey experience

From March 2003 to April 2004, 77 physicians throughout France prospectively recruited 1289 ductal carcinoma in situ (DCIS) patients and collected data on diagnosis, patient and tumour characteristics, and treatments. Median age was 56 years (range, 30–84). Ductal carcinoma in situ was diagnosed by mammography in 87.6% of patients. Mastectomy, conservative surgery alone (CS) and CS with radiotherapy (CS+RT) were performed in 30.5, 7.8 and 61.7% of patients, respectively. Thus, 89% of patients treated by CS received adjuvant RT. Sentinel node biopsy (SNB) and axillary dissection (AD) were performed in 21.3 and 10.4% of patients, respectively. Hormone therapy was administered to 13.4% of the patients (80% tamoxifen). Median tumour size was 14.5 mm (6, 11 and 35 mm for CS, CS+RT and mastectomy, respectively, P<0.0001). Nuclear grade was high in 21% of patients, intermediate in 38.5% and low in 40.5%. Excision was considered complete in 92% (CS) and 88.3% (CS+RT) of patients. Oestrogen receptors were positive in 69.8% of assessed cases (31%). Treatment modalities varied widely according to region: mastectomy rate, 20–37%; adjuvant RT, 84–96%; hormone treatment, 6–34%. Our survey on current DCIS management in France has highlighted correlations between pathological features (tumour size, margin and grade) and treatment options, with several similar variations to those observed in recent UK and US studies.

Tolerance and consecutive patients adherence to hormonal treatment for early breast cancer

Abstract #1140

Body: For the past few years, Aromatase Inhibitors (AI) have been the standard hormonal treatment for menopausal women with breast cancer. Although the side effects described are as low as with Tamoxifen, tolerance is poor, and some patients wish to suspend treatment. A prospective observatory of patients under AI was initiated in our institution to assess patients' perception of side effects.&#x2028; Method: This monocentric prospective study was proposed to patients receiving AI treatment. After a medical visit, patients answered a specific questionnaire about their tolerance and including questions about their adherence to treatment: if necessary, reasons for stopping (either deliberate or not) were specified. The questionnaire was completed after the end of the medical visit and without the presence of the doctor. Medical evaluation of tolerance and cancer evolution was also collected. Statistical analyses were performed to test the correlation between patients' and physicians' perception according to side effects, patients' tolerance or desire to stop AI (Fischer test).&#x2028; Results: Of 450 post-menopausal patients included between Dec 2005 and Dec 2007, 300 were eligible for the adherence study. Median age was 59 years (range, 40-82) and cancer stages were: stage I: 40.5%, stage II: 46.8%, and stage III: 12.7%. Non menopausal women (2.3%) received gonadotropin-releasing hormone analogs. The three AI were Anastrozol (71.3% of cases), Letrozole (17.3%) and Exemestane (11.3%), Tamoxifen was initially prescribed to 30.8% of patients. Median follow-up was 23.1 months (range, 2.1-58.8) and the median number of questionnaires per woman was 1.46 (range, 1-5).&#x2028; Different side effects were reported; all declared symptoms were taken into account: insomnia (98.7%), arthralgia (85.3%), fatigue (72%), memory troubles (59.7%), concentration difficulties (55.3%), hot flushes (63.3%), decreased libido (56.7%), ocular troubles (50%), fracture (5%).&#x2028; Medical reports and patient responses were compared. Significant differences were seen in many items: arthralgia (85.3% vs. 49.3%, p&lt;0.001), fatigue (72% vs 17%, p=0.007), fracture (5% vs. 1%, p=0.04).&#x2028; Treatment adherence was high: at first medical visit (&gt; 3 months after the beginning of treatment) 81.4% of patients reported taking their treatment everyday (82.3% at second visit). But 6.1% decided to discontinue treatment (8.8% at the second visit). The main reasons were: bad tolerance (41.2%), recall of illness (17.6%) and lack of treatment information (17.6%).&#x2028; Discussion and Conclusions: Our results give evidence of the difficulty for the physicians to accurately determine patient's tolerance to a given treatment and consequently its observance. Adherence results appear better than in several previously published studies.&#x2028; This study was supported by grants from Astra Zeneca, Pfizer and Novartis.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 1140.

First step in management of weight gain induced by chemotherapy for early breast cancer

Abstract #6139

Adjuvant therapies for breast cancer are often associated with weight gain (WG). Overweight, obesity and WG have deleterious consequences for quality of life and probably for breast cancer evolution.&#x2028; This french monocentric prospective study aimed to determine the incidence of overweight, obesity and WG during and one year after adjuvant chemotherapy (CT) for early breast cancer. Secondary goals were to examine the observance of national nutritional recommendations for healthy living, to observe their effects on WG prevention and to estimate patients needs for dietetic management.&#x2028; Method : Patients younger than 66 years candidates for adjuvant CT for early breast cancer underwent dietary evaluation at the beginning of CT and were informed of the benefits of WG prevention, healthy diet and living habits. Written recommendations are given. A dietetic follow-up was systematically proposed. Weight, Body Mass Index (BMI) and nutritional habits over the last year before diagnosis, and at 6 and 12 months after chemotherapy were recorded. Statistical analysis is performed to test the association between WG and initial parameters (alpha level 5%).&#x2028; Results: Of 272 consecutive patients recruited from Oct 2004 to Oct 2006, 242 are evaluated at 6 months and 233 after 1 year. The mean age was 51 years ; 44.1% were not menopausal before chemotherapy. TNM classification was as follows: T0: 15%, T1: 41%, T2: 32%, T3: 9%, T4: 3% and N+: 68%. Chemotherapy regimes were based on doxorubicin for 40% of cases, on taxanes for 1.5% and both for 58.5% . Hormonal therapy was provided to 74.85% of the patients. The average weight before chemotherapy was 65.9 kg (44-117); 25.7% of patients were overweight (25&lt;BMI&lt;30) and 15.1% obese (BMI&gt;30). A third experienced WG during the year before diagnosis. Six months after CT, 52.1% patients had gained weight (&lt;5% body weight for 59%, but &gt;10% for 7.1%) and 29.8 % had lost weight. At one year, WG affected 59.7% of the patients. The average of WG is 5.88% of body weight and 14.4% of the patients gained more than 10%. WG before diagnosis seems to be the only factor associated with post CT absence of weight gain (OR 0.542, IC 95% [0.308-0.954], p= 0.0338). Only 43 women (16%) asked for dietetic follow-up, which induced weight loss for 57%. Health recommendations of the national program of nutrition and health (PNNS in France) were observed by 36.1% of the patients at the beginning of treatment, versus 43.5% at 6 months and 52.1% at one year.&#x2028; Discussion and conclusions :&#x2028; This study confirms the high rate of patients gaining weight after chemotherapy. Nutritional information alone is not sufficient, and appropriate healthy program (nutritional follow up and physical activities) must be proposed to limit weight gain and avoid possible consequences on disease free survival and further co morbidities.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 6139.

Alteration textures in terrestrial volcanic glass and the associated bacterial community

Alteration textures were examined in subglacial (hyaloclastite) deposits at Valafell, Southern Iceland. Pitted and 'elongate' alteration features are observed in the glass similar to granular and tubular features reported previously in deep-ocean basaltic glasses, but elongate features generally did not have a length to width ratio greater than five. Elongate features were found in only 7% of surfaces. Crystalline basalt clasts, which are incorporated into the hyaloclastite, did not display elongate structures. Pitted alteration features were poorly defined in crystalline basalt, comprising only 4% of the surface compared to 47% in the case of basaltic glass. Examination of silica-rich glass (obsidian) and rhyolite similarly showed poorly defined pitted textures that comprised less than 15% of the surface and no elongate features were observed. These data highlight the differences in alteration textures between terrestrial basaltic glass and previously studied deep-ocean and subsurface basaltic glass, and the important role of mineralogy in controlling the type and abundance of alteration features. The hyaloclastite contains a diverse and abundant bacterial population, as determined by 16S rDNA analysis, which could be involved in weathering the glass. Despite the presence of phototrophs, we show that they were not involved in the production of most alteration textures in the basaltic glass materials we examined.

[Patients' preferences and decision-making: state of the art and applications in cancer]

BACKGROUND

This paper deals with the physician-patient encounter. In France, the current legal framework allows patients to be informed (patients' rights to health information) and to participate to decisions regarding their own health. In such a context, this paper aims to give the reader the broad key components of the so-called 'patient treatment preferences elicitation process' in breast cancer, our research area.

METHODS AND RESULTS

We first present the general context, with a definition of the different physician-patient models. We then present decision aids, tools that aim to provide high-quality information to patients in the decision-making process. Finally, based on our previous studies and on examples drawn from the international literature, we present the empirical process of patients' preferences elicitation, which not only increases patients' knowledge of and satisfaction with the decision made, but also allows patients to be part of their disease management.

CONCLUSION

Far from being a phenomenon in the air supported by a legal system, this method developed in the 90s allows patients and more generally healthcare users to be autonomous without constraining them to a choice.

Validation of a haemoglobin dilution method for estimation of blood loss

BACKGROUND AND OBJECTIVES

Analysis of haemoglobin (Hb) dilution after bleeding is a simple, inexpensive and non-invasive method to estimate blood loss. Blood volume is estimated, taking sex, weight and height into account. The Hb concentration before and after blood loss is analysed and, from the difference, the blood loss volume can be calculated assuming a normovolemic subject. Although widely used this method has never been validated.

MATERIAL AND METHODS

The Hb concentration of 21 blood donors was analysed before and up to 4 days after a standard blood donation and in another 18 blood donors the Hb concentration was analysed before and on day 4, 6, 8, 11 and 14 after blood donation. The blood volume of each donor was calculated and the donated blood volume was estimated by weighing. We calculated the blood loss by the Hb dilution method and compared the calculated value with the donated blood volume.

RESULTS

The mean donated blood volume was 442 +/- 10 ml, whereas the mean calculated blood loss was 152 +/- 214 ml using the Hb concentration of the first day after donation and 301 +/- 145 ml with the Hb concentration of day 6 after blood donation after which no further Hb decrease was observed. The directly measured Hb concentration was always higher than the calculated/expected Hb concentration based on the blood donation volume.

CONCLUSIONS

The Hb dilution method underestimates the true blood loss by more than 30% after a moderate blood loss of approximately 10% of the total blood volume.

The influence of surface forces on shear-induced tracer diffusion in mono and bidisperse suspensions

The shear-induced self-diffusivity of tracer particles of radius a (t) = lambda a in a suspension of particles having a radius, a, is calculated by Stokesian dynamics for different values of the size ratio, lambda , both in 2 and 3 dimensions in the binary-collision regime. The self-diffusion is found to decrease strongly when the size ratio becomes quite different from unity. On the other hand, for the same average distance of contact between two spheres, the presence of a soft force always increases greatly the diffusion compared to the effect of a hard shell which is used to model the roughness. This is particularly true for tracer particles smaller than the bath particles, where the shear-induced diffusion can be increased by many order of magnitudes in the presence of a soft force. For suspensions of monodisperse particles we show that, for low volume fraction, the diffusion coefficient is much smaller than the one predicted by the binary collision model, due to the existence of a layered structure. On the contrary at higher volume fraction, many-body collisions strongly enhance the diffusion and it appears that the value of the diffusion is quite sensitive to the presence of clusters of particles which are themselves determined by the range of interparticle forces.

Long-term results after primary repair or non-surgical treatment of anterior cruciate ligament rupture: a randomized study with a 15-year follow-up

We investigated the long-term outcome of 100 patients 15 years after having been randomly allocated to primary repair (augmented or non-augmented) or non-surgical treatment of an anterior cruciate ligament (ACL) rupture. The subjective outcome was similar between the groups, with no difference regarding activity level and knee-injury and osteoarthritis outcome score but with a slightly lower Lysholm score for the non-surgically treated group. This difference was attributed to more instability symptoms. The radiological osteoarthritis (OA) frequency did not differ between surgically or non-surgically treated patients, but if a meniscectomy was performed, two-thirds of the patients showed OA changes regardless of initial treatment of the ACL. There were significantly more meniscus injuries in patients initially treated non-surgically. One-third of the patients in the non-surgically treated group underwent secondary ACL reconstruction due to instability problems. In this study, ACL repair itself could not reduce the risk of OA nor increase the subjective outcome scores. However, one-third of the non-surgical treated patients were later ACL reconstructed due to instability. The status of the menisci was found to be the most important predictor of developing OA. Early ACL repair and also ACL reconstruction can reduce the risk of secondary meniscus tears. Indirectly this supports the hypothesis that early stabilization of the knee after ACL injury is advantageous for the long-term outcome.

Distribution of promoter hypermethylation in epithelial cells collected by endobronchial brushes of patients (pts) with non- small cell lung cancer (NSCLC) and controls

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Background: Epigenetic gene silencing by promoter hypermethylation is an early event in NSCLC development. Exposure to tobacco smoke may explain random occurrence of hypermethylation events throughout the bronchial epithelium of pts with NSCLC. We assessed the methylation status of 11 genes in brushes sampled in 3 well-defined endobronchial locations in pts with NSCLC and in brushes of controls. Methods: In pts with NSCLC we collected bronchial brushes of 1) tumor, 2) normal appearing bronchus 2–3 cm proximally of tumor, and 3) main bronchus of contralateral lung. Also, we collected a brush of the normal appearing main bronchus of controls. Methylation status of RASSF1A, GATA4, GATA5, SFRP1, RARβ2, DAPK, MGMT, p16(INK4A), p14, CHFR, and APC was determined in all samples using quantitative methylation specific PCR. Genes were considered hypermethylated if the gene/actin ratio was higher than gene-specific cut-off values previously defined in NSCLC tissue (A). Alternatively, cut-off values were defined by ratios for which no hypermethylation was observed in controls (B). Results: Ten pts with NSCLC (5 adeno, 4 large cell, 1 neuro-endocrine carcinoma) and 24 controls (20 asthma, 4 COPD) were included. Median packyears of pts 32 (range 20–60), of controls 6 (0–70). Six pts had one or more hypermethylated genes in their tumor brush using cut-off A and eight pts using B. Hypermethylation of genes in proximal or contralateral locations was only observed if the same gene was also hypermethylated in tumor brush. No hypermethylation was observed controls. Total sensitivity was 60% (A) and increased to 80% in B, while specificity remained 100%. RASSF1A showed the highest single gene sensitivity (40%). Presence of hypermethylation in pts was not associated with number of packyears (p=0.61/0.53) or histological subtype (p=0.39/0.28) for cut-off A or B, respectively. Conclusions: Hypermethylation events were observed in up to 80% of bronchial tumor brushes of NSCLC pts. Hypermethylation comes from tumor cells and not from normal bronchial epithelium near or distant to the primary tumor.

No significant financial relationships to disclose.

Effects of autologous platelet lysates on ceramic particle resorption and new bone formation in critical size defects: The role of anatomical sites

This study investigated the effects of rabbit autologous platelet lysates (APL) on the performance of fillers consisting of calcium carbonate ceramic particles (CP) pertinent to new bone formation and repair. Critical-size defects in rabbit femurs and calvaria were filled with CP alone, CP plus APL, and CP plus APL with or without thrombin (THR). After 6 weeks, resorption of CP occurred under all conditions tested in the present study. Compared with respective CP alone controls, addition of APL resulted in significantly higher ceramic resorption, as evidenced by decreased ceramic particle diameter (p < 0.01) and number (p < 0.01) at both defect sites. The presence of THR prevented reduction of both CP diameter and number in the femoral defect sites. Addition of APL to the CP resulted in a significant (p < 0.03) decrease in new bone area at the calvarial sites, but not at the femoral sites; moreover, when THR was added to the CP plus APL fillers, bone formation in the femoral defects was significantly (p < 0.05) reduced. In addition to differences in the respective anatomical and cellular milieu, the biochemical events induced by mechanical loading at the femurs may explain the reduced ceramic particle resorption as well as the enhanced new bone formation when compared with the results obtained at the calvarial defect sites.

Effect of microstructure on the mechanical properties of Haversian cortical bone

The mechanical properties of cortical bone have been extensively studied at the macrostructural scale. However, knowledge of the macroscopic mechanical properties is not sufficient to predict local phenomena, such as damage or bone remodeling, both of which are dependent on local mechanical behavior. The objective of this study is to quantify the mechanical properties of cortical bone at several length scales, with emphasis on the microstructure of Haversian systems. Samples of mature bovine cortical bone, with a Haversian microstructure, were obtained from the posterior area of the mid-femoral diaphysis. A nanoindentation technique was used to measure the local Young's modulus. The distribution of the bone mineral content was obtained by backscattered electron imaging using a scanning electron microscope. A novel compression device employing microextensometry techniques was developed to quantify local strains. Digital image correlation was performed on the microstructure imaged by optical microscopy during compression tests. This study demonstrated that the local Young's modulus and strain were heterogeneous at the scale of an osteon. For both properties, the ratio between the maximum and minimum values was approximately two. The local Young's modulus and bone-mineral content were reasonably correlated (r2 = 0.75; P < 0.0001), but this was not the case for the distribution of local strains versus bone mineral content (r2 = 0.395; P < 0.0001). Hence, local strains cannot be described simply in terms of the bone mineral content, as the Haversian canal and osteonal microstructure have a major influence on these properties. In conclusion, the microstructure must be considered in evaluating the local strain and stress fields of cortical bone.

[Mammary implants and breast cancer]

Many publications deal with the impact of cosmetic breast implants to increase the breast cancer occurence or to delay its diagnosis. We first try to express the clinical and radiological differences in the implanted breast. The diagnostical and therapeutical difficulties were developped to the different technics of imagery, biopsy and specific management of the treatment. On one hand, the litterature revue does not show any significant difference in tumoral stage and nodal status between augmented and nonaugmented women eventhough the mammography sensibility is not as optimal. On the other hand, the global mortality of the augmented population is higher but it appears that this phenomenon could be link to their way of life and is totally independant of breast cancer. Finally, if the diagnosis and the treatment are more complex, the women survival is not altered by breast augmented surgery.

A new numerical concept for modeling hydroxyapatite in human cortical bone

This research presents a new modelling procedure which allows the computation of the physical properties of the human cortical bone, considered as a strongly heterogeneous medium consisting of bony architecture and the physical properties of the two basic components: the collagen and the hydroxyapatite (Hap). The numerical simulations are based on the homogenisation theory, however, since the size of the Hap crystals are small compared to the size of a collagen stick, a new entity (the elementary volume of mineral content (EVMC)) is defined at the nanoscopic scale. This model permits the testing of all the possible structural configurations that may be present and suggests that the anisotropy of the bone is not only induced by the haversian structure but by the properties of the Hap crystals and their special organisation.

Effect of different sterilization processing methods on the mechanical properties of human cancellous bone allografts

Use of new sterilization methods applied to human bone is likely to affect both the mechanical and biological properties of human cancellous grafts. The mechanical properties of the transplanted bone inevitably determine the short- and mid-term results of the orthopedic procedure performed. The aim of this study was to compare, under similar conditions, the mechanical effects of gamma irradiation, lipid extraction, and treatment with 6M urea on trabecular bone samples, through conventional mechanical tests and measurement of the ultrasound wave propagation rate. Deteriorations measured for gamma irradiation and lipid extraction were low: 2.4% and 2.5%, respectively, for ultrasound propagation wave measurements. They were clearly significant for protocol including 6M urea, corresponding to a loss of 30% in values measured in the control sample for the stress to failure, inciting prudence when grafted bone is used for support in orthopedic assembly. High consistency in the results obtained between travel time of the ultrasound wave, easily done, and measurement of stress to failure through conventional tests, favor the use of ultrasound protocol, described as a quality test performed on bone grafts in the tissue bank before distribution and implantation.

Expression of anti human IL-4 and IL-6 scFvs in transgenic tobacco plants

The two murine single-chain Fv (scFv) genes against human interleukin IL-4 and IL-6 cytokines were cloned in a plant expression vector (pGEJAE1) and mobilized to Agrobacterium tumefaciens. Tobacco leaf discs were co-cultured with Agrobacterium and transferred to selective media for regeneration. The tobacco in vitro plants produced scFvs against human IL-4 and IL-6. Only 8% of transformed plants expressing anti-IL-4 scFv were obtained versus 76% of transformed plants expressing anti-IL-6 scFv. In addition, some plants producing anti-IL-4 and anti-IL-6 scFvs aged more rapidly in in vitro conditions and in greenhouse pots than did control plants. Western blot analysis showed that the transformed Nicotiana tabacum plants contained proteins with an apparent molecular mass on electrophoresis of ca. 32 kDa, corresponding to the predicted size of the scFvs. As entire plant root seemed to accumulate more scFv than did leaves, we decided to continue working with isolated roots. Anti-IL-6 scFvs were detected in cultivated roots and their culture media. Functional anti-IL-6 scFv accounted for 0.16-0.18% of total soluble proteins. The affinity of the anti-IL-6 scFv produced in plants and measured by Biacore was similar to that of scFv produced in Escherichia coli. The high levels of antibody accumulation in isolated roots and secretion into the medium demonstrate the potential for producing recombinant protein in bioreactor systems.