Chemically Enhanced Convective Dissolution of CO_{2}

Convective dissolution, one of the main mechanisms for geological storage of CO_{2}, occurs when supercritical or gas CO_{2} dissolves partially into an aqueous solution, thus triggering downward convection of the denser CO_{2}-enriched liquid. Chemical reaction in the liquid can greatly enhance the process. Here, experimental measurements of convective flow inside a cylinder filled with a sodium hydroxide (NaOH) solution show that the plume's velocity can be increased tenfold as compared to a situation with no NaOH. This tremendous effect is predicted by a model with no adjusting parameters.

AB0410 EVOLUTION OF MONOCLONAL GAMMOPATHY OF UNDETERMINED SIGNIFICANCE IN PATIENTS TREATED WITH JAK INHIBITORS FOR RHEUMATIC DISEASES (JAKPIC STUDY)

Background

Monoclonal Gammopathy of Undetermined Significance (MGUS) is common in patients with inflammatory rheumatic diseases but there are scarce data regarding the effect of disease-modifying antirheumatic drugs (DMARDs) on this pre-malignant condition. Recently, preclinical data and phase I trial have shown efficacy of JAK inhibitors (JAKi) in multiple myeloma.

Objectives

We aimed to evaluate the impact of JAKi on MGUS when initiated for an active rheumatic disease.

Methods

Patients with monoclonal abnormality prior to JAKi initiation for an active rheumatic disease were identified through the MAJIK-SFR Registry, a french multicentre prospective study, and a call for observation via the “Club Rhumatismes et Inflammations”. Clinical and biological data were collected using a standardised case report form.

Results

Nineteen patients were identified, 10 women and 9 men, with a mean age of 65 years and a diagnosis of rheumatoid arthritis (n=14), psoriatic arthritis (n=3) or spondyloarthritis (n=2). The JAKi prescribed was baricitinib (n=8), tofacitinib (n=6) or upadacitinib (n=5), with a mean duration of 13 months.

Sixteen patients had individualized serum monoclonal protein (IgG Kappa n=9; IgG Lambda n=6; IgM Kappa n=3; IgA Lambda n=1) ranging from 0,16g/dL to 2,3g/dL. With a follow-up of 2 to 47 months, 8 of 16 patients experienced a decrease in serum monoclonal protein level and 8 had a stable serum monoclonal protein level. The maximal decrease observed was an initial IgG Kappa of 2.3g/dL decreasing to 0.2g/dL at month 14. During follow-up, two patients did not have any detectable serum monoclonal protein on serum electrophoresis (initial value of 5.2g/l and 1.6g/l), but still a positive immunofixation. One patient had bone marrow aspirate with 8% of plasma cells before JAKi introduction and 3% after 4 months of treatment.

Three patients did not have initial measurable spike but a positive immunofixation that became negative at month 8 and 11 (IgG Lambda, n=2) or stable (IgG Kappa, n=1).

Conclusion

This study brings reassuring and promising data on the MGUS evolution in patients treated with JAKi for rheumatic diseases, which may guide the choice of treatment in patients with both conditions.

References

[1]Berenson JR, To J, Spektor TM, et al. A Phase I Study of Ruxolitinib, Lenalidomide, and Steroids for Patients with Relapsed/Refractory Multiple MyelomaClin Cancer Res. 2020 May 15;26(10):2346-2353.

Acknowledgements

MAJIK-SFR Registry and Club Rhumatismes et Inflammations

Disclosure of Interests

None declared

[Chest radiological lesions in COVID-19 : from classical imaging to artificial intelligence]

In the course of the pandemic induced by the appearance of a new coronavirus (SARS-CoV-2; COVID-19) causing acute respiratory distress syndrome (ARDS), we had to rethink the diagnostic approach for patients suffering from respiratory symptoms. Indeed, although the use of RT-PCR remains the keystone of the diagnosis, the delay in diagnosis as well as the overload of the microbiological platforms have led us to make almost systematic the use of thoracic imaging for taking in charge of patients. In this context, thoracic imaging has shown a major interest in diagnostic aid in order to better guide the management of patients admitted to hospital. The most common signs encountered are particularly well described in thoracic computed tomography. Typical imaging combines bilateral, predominantly peripheral and posterior, multi-lobar, ground glass opacities. Of note, it is common to identify significant lesions in asymptomatic patients, with imaging sometimes preceding the onset of symptoms. Beyond conventional chest imaging, many teams have developed new artificial intelligence tools to better help clinicians in decision-making.

[Exploration of urethral strictures : place of urethrocystography]

Stricture of the male urethra is a frequent and regularly iatrogenic pathology in industrialized countries. The urologist's surgical arsenal is wide and the choice of an operative technique is made at the end of an assessment where urethrocystography is the main radiological examination. The conditions to achieve the examination, its different stages, the normal aspects and anatomical variants as well as the limitations to its interpretation, should therefore be known by the urologist and the radiologist, in order to assess correctly this pathology.

[Cystic nephroma : a rare kidney neoplasm]

Cystic nephroma is a rare kidney neoplasm belonging to the entity of cystic tumours. It is a slow-growing tumour, which develops insidiously, sometimes reaching a considerable size. The diagnosis is more often accidental (except for mass syndrome in children). It is a benign tumour that may be treated by partial sparing nephrectomy. Malignant degeneration is few and far between. However, no medical examination can confirm the diagnosis before surgery. On medical imaging, the tumour enhances after contrast injection and there will always be a doubt about the benignity. Furthermore, percutaneous biopsy of the mass is not contributory to the diagnosis. This means that it is not easy to propose a conservative surgical treatment, even though this remains the best way to deal with such a tumour.

[Exploring focal liver lesions with contrastenhanced ultrasonography]

Noninvasive diagnosis of focal liver lesions is usually based on unenhanced ultrasonography, computed tomography, or magnetic resonance. Contrast-enhanced ultrasonography (CEUS) can be used among the other imaging modalities in evaluating these lesions. The technique requires the intravenous injection of contrast media. Ultrasound contrast agents are very safe and the technique doesn't involve any radiation. A large body of evidence supports and clarifies the role of CEUS in evaluating focal liver lesions. Hemangiomas, focal nodular hyperplasia, focal fatty change will be diagnosed in a majority of cases and CEUS is also helpful in distinguishing malignant from benign lesions.

Increased risk of mortality in systemic sclerosis-associated digital ulcers: a systematic review and meta-analysis

BACKGROUND

Survival can be threatened in certain forms of systemic sclerosis (SSc) so clear prognostic factors are needed.

OBJECTIVES

The aim of this meta-analysis was to assess the association between the presence of digital ulcers (DUs) and mortality in SSc.

METHODS

We performed a systematic review and meta-analysis in the Pubmed and Scopus databases from the earliest records to May 2017. Two research strategies were performed: « systemic sclerosis » and « digital ulcers » (strategy A); « systemic sclerosis » and « mortality » (strategy B). The primary outcome was the mortality associated with the presence of DUs in patients with SSc.

RESULTS

The literature search identified 1473 citations. Fifty-nine studies were examined for full text. Ten articles were included for the meta-analysis. SSc patients with DUs had an increased pooled mortality risk: RR = 1.53 (IC 95%: [1.23-1.90]).

CONCLUSIONS

This meta-analysis revealed a higher mortality in SSc patients with associated DUs. Having DUs may be a predictive factor of developing organ involvement such as pulmonary or cardiovascular events that could be associated with poor survival. It suggests that early screening of DUs in SSc patients is important to identify patients most at risk of poor survival.

WITHDRAWN: A single center experience in resectable pancreatic ductal adenocarcinoma : the limitations of the surgery-first approach. Critical review of the literature and proposals for practice update

The article has been withdrawn at the request of the authors and editor because of incorrect authorship, which is considered a form of unethical publication. The Publisher apologizes for any inconvenience this may cause.

[Multidisciplinary management of alveolar echinococcosis : Echino-Liege Working Group]

Alveolar echinococcosis is a zoonotic disease due to the tapeworm Echinococcus multilocularis. The definitive host is the red fox. Until recently, Belgium was considered a country at very low risk for alveolar echinococcosis. However, recent studies carried out in southern Belgium have revealed, through post-mortem examination, high prevalences (up to 62 %) in foxes. Cats and dogs can act as definitive hosts. Human are accidentally infected by ingestion of food contaminated by the feces. After a long incubation period, invasive hepatic lesions may appear, as well as extra-hepatic lesions. The disease may be fatal. The diagnosis is based on imaging techniques, serology and nucleic acid detection in tissues. Early diagnosis may allow surgical removal of the lesion associated with at least 2 years of albendazole postoperative treatment. In case of contraindication to surgery, a long term treatment with albendazole is necessary. Liver transplantation is sometimes necessary. This article presents the epidemiologic, clinical, diagnostic and therapeutics features of this zoonotic disease.

A single center experience in resectable pancreatic ductal adenocarcinoma : the limitations of the surgery-first approach. Critical review of the literature and proposals for practice update

BACKGROUND AND STUDY AIMS

The current standard of care for resectable pancreatic ductal adenocarcinoma (PDAC) is surgery-first followed by adjuvant chemotherapy. We review our single center experience in a PDAC cohort managed by the surgery-first strategy. We then compare our data to those of Belgian and international literature.

PATIENTS METHODS

We reviewed a series of 83 consecutive resectable patients with PDAC, treated by the surgery-first approach in a Belgian Academic Hospital between 2007 and 2013. The outcomes were assessed with univariate and multivariate Cox regression analysis. Kaplan-Meier curves were drawn according to patient groups.

RESULTS

For the entire population, the median survival (MS) was 18.4 months; the 1-year relapse-free survival was 56%, and the 5-year overall survival (OS) was 13%. The size of the primary tumor larger than 3 cm (OS, HR = 1.76, p = 0.033) and vascular resection (DFS, HR = 2.1, p = 0.024) were the single independent prognostic factors in the multivariate analysis of this cohort. Only 69% of the patients received adjuvant chemotherapy, and more than 75% of them demonstrated no chance of survival beyond 3 years because they harbored poor prognostic factors, recognized only postoperatively.

CONCLUSIONS

Our results and those published in the literature brought to light the limited perspectives of the surgery-first strategy in a population of apparently resectable pancreatic cancers. In comparison, data from reported neo-adjuvant series deserve our interest to bring this strategy upfront in selected patients in the context of close observational monitoring and randomized trials. The actual standard of care for resectable PDAC is surgery-first followed by adjuvant chemotherapy. The performance of this strategy relies on the dedicated imaging that does not accurately recognize the limits of the tumor and the high prevalence of adverse prognostic factors. Moreover, pancreatectomy remains associated with high postoperative complication rates and the poor completion of adjuvant therapy. This translates into poor long-term survival figures. In our series the MS was 18.4 months and 5-year OS was 13%. The disease-free survival (DFS) was 15.6 months, 1 and 3-year DFS were 56 and 26%, respectively. The variables that significantly correlated with OS in univariate analysis are tumor size and lymph node involvement. Regarding DFS, vascular resection was the only significant factor. In the multivariate analysis, the only significant factor related to OS remained the tumor size >3 cm in greatest diameter. Vascular resection remained significant for DFS. 31% of the patients did not receive any chemotherapy at all before the 6-month period following resection. The rates of complete resections compared favorably with those of a surgery-first strategy with no excess of operative mortality, complications and early relapse rates. The advantages of a chemotherapy-first approach, eventually combined with chemo-radiotherapy, are to offer higher combined therapy completion rates and improve the level of free resection margins, lymph node involvement and patient selection. The advent of safe, more potent chemotherapy combinations has the potential to further improve survival when administered upfront.

[How I explore … Crohn's disease by various imaging modalities]

Crohn's disease is a chronic inflammatory condition characterized by recurrent and/or chronic lesions, leading to cumulative structural bowel damage. It is established that the correlation between symptoms and intestinal lesions is weak. Therefore, monitoring by frequent cross-sectional imaging is proposed to assess the disease activity. There is no consensus about the preferred imaging option. Priority is given to non-radiating modalities, such as ultrasonography and MRI. Tomodensitometry will be reserved for emergency cases. Ultrasonography can be useful, in emergency as well as for the monitoring of lesions of known topography. Entero-MRI is henceforth considered the standard imaging technique for the diagnosis and follow-up of Crohn's disease. Its high contrast resolution allows an accurate assessment of disease activity, therapeutic efficacy, cumulative structural bowel damage and complications.

[Point-of-care ultrasound in emergency department : a case report of acute dyspnea during pregnancy]

On the basis of the case report of a pregnant woman with acute pleuritis, this article describes the diagnostic modalities of dyspnea during pregnancy. The utility and effectiveness of bedside ultrasound examination by the emergency physician («POCUS») are reviewed in view of recent literature data. The ultrasound in this case is considered to be the extension of physical examination aiming at providing answers with immediate clinical relevance.

[STRICTURING CROHN'S DISEASE: CLINICAL FEATURES, DIAGNOSIS AND TREATMENT]

Crohn's disease (CD) is a chronic inflammatory bowel disease which mainly affects young people. This disease evolves in successive steps and is often complicated by strictures which express characteristic signs of occlusive syndrome, more often in case of ileal than colonic involvement. The nature and localisation of strictures should be precisely defined by different techniques like endoscopy, entero-(colo)-scanner or entero-(colo)-MRI. This work-up is essential to best adapt the therapeutic care. Indeed, the fibrosing evolution of inflammatory strictures causes medical treatment's failure which may lead to endoscopic dilatation or surgical resection. To avoid this negative evolution, it is mandatory to adopt early therapeutic strategy to control inflammation.

[AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE: HOW AND WHY SHOULD WE IDENTIFY THE PATIENTS "RAPIDLY PROGRESSING" TO END-STAGE RENAL DISEASE?]

Autosomal dominant polycystic kidney disease (ADPKD) is a common inherited disease characterised by the progressive development of multiple and bilateral cysts in kidneys and other organs. Most patients with ADPKD will develop, sooner or later, end-stage renal disease (ESRD). The morbidity and mortality associated with ESRD prompt physicians to identify early ADPKD patients considered as "rapid progressors", who have the greatest risk to rapidly develop ESRD. The rate of progression can be assessed by clinical--especially with the "predicting renal outcome in polycystic kidney disease score" (PROPKD-Score)-, biological (a decline of the glomerular filtration rate (GFR) of 4.4-5.9 ml/min/year and/or the doubling of serum creatinine within a 36-month period), or radiological criteria (total kidney volume (TKV) adjusted for the size > 600 cc/m and/or TKV annual growth rate > 5 %). Nowadays, there is no curative treatment for ADPKD. However, vasopressin-2 receptor antagonists, such as tolvaptan, appear to slow down the growth of renal cysts and the slope of GFR decline. The current management of ADPKD patients is mostly based on correcting the risk factors for progression, i.e. encouraging (over)-hydration, normalizing blood pressure, stimulating smoking cessation.

[ABOUT JUVENILE NASOPHARYNGEAL ANGIOFIBROMA]

We report the case of a young man with a juvenile nasopharyngeal angiofibroma. In this paper, we will first remind the clinical signs of this pathology and its radiological appearance (localisation and extensions). Then we will explain how radioembolisation techniques were used to facilitate the surgical intervention. Finally we will discuss the histology of this tumor.

[Evolution in the therapeutic strategy of localized resectable pancreatic ductal adenocarcinoma]

Pancreatic ductal adenocarcinoma is characterized by a high rate of early metastatic relapse. Surgical resection is still recognized as the cornerstone upfront therapy. However, reported 5 years survival rates are inferior to 20-25% even when surgery is followed by chemotherapy. Margins involvement on the surgical specimen (50 to 85%) and lymph node involvement (around 70%) both strongly impact survival. Median survivals are close to those of locally advanced diseases treated by chemotherapy or chemoradiotherapy, 15 to 16 months. This review focuses on adverse prognostic factors, post-operative outcomes and their impact on multimodality therapy completion rates and survivals in patients undergoing upfront surgery. Current data and emerging results from neoadjuvant series could lead to a change in the therapeutic strategy.

Persisting signs of disease activity at Magnetic Resonance Enterocolonography predict clinical relapse and disease progression in quiescent Crohn's disease

INTRODUCTION

Deep remission including clinical remission and tissue healing has been advocated as the therapeutic target in Crohn's disease. Yet, the definition of deep remission remains unclear. The aim of this study was to assess the persisting lesions at magnetic resonance enterocolonography (MREC) in clinically quiescent Crohn's disease as well as their relapse predictive value.

METHODS

we performed a prospective monocentre cohort study. We included patients with clinical remission. At baseline, these patients had blood tests, the measurement of fecal calprotectin and underwent a MREC. They were then followed up clinically for a minimum of 1 year. A relapse was defined by a HBI > 4 with an increase of at least 3 points. Correlations between clinical, demographic, biological parameters and MREC signs were assessed as well as the time-to-relapse predictive value of the studied variables.

RESULTS

Twenty seven patients were recruited. Fourteen out of 27 had persisting disease activity at MREC. MREC signs only partly correlated with biomarkers. Ten out of 27 patients relapsed over a median follow up of 25 months. In univariate analysis, relative contrast enhancement of the most affected segment (HR: 2.56; P = 0.046), ulcers (HR: 12.5; P = 0.039), fistulas (HR: 14.1; P = 0.009) and target sign (HR: 3.63; P = 0.049) were associated with relapse. In multivariate analysis, fistula was the only one.

CONCLUSIONS

Half of the patients with clinically quiescent Crohn's disease had persisting signs of disease activity at MREC. These signs predicted time-to-relapse.

[FROM EVIDENCE-BASED MEDICINE TO PERSONALIZED MEDICINE IN CROHN'S DISEASE]

The therapeutic armamentarium in Crohn's disease includes mesalazine, steroids (including topical drugs), anti-metabolites (purines, methotrexate), anti-TNFα antibodies and, more recently, selective inhibitors of lymphocytes homing (vedolizumab). The efficacy of these drugs has been shown in pivotal phase 3 placebo-controlled trials and meta-analyses. However, the use of these drugs in routine practice still remains ill-defined. Those are rather the cohort studies, natural history data and therapeutic strategy trials that help the clinician to determine, for each individual patient, the treatment leading to an optimal benefit/risk profile, aiming at moving from evidence-based medicine towards personalized medicine.

Depth of remission in Crohn's disease patients seen in a referral centre : associated factors and impact on disease outcome

INTRODUCTION

Our goals were to assess the prevalence of biological and tissue remission in routine practice in Crohn's disease, and to evaluate the correlation between biological or tissue remission and clinical or demographic characteristics as well as their impact on disease outcome.

METHODS

We performed a retrospective monocenter study. Biological remission was defined by a CRP < 5 mg/I. Tissue remission was defined by the absence of ulcer at endoscopy and/or absence of signs of acute inflammation at MRI. Association with demographic, clinical and laboratory markers was studied by logistic regression models and rates of relapses, hospitalizations and surgeries were compared using the logrank test.

RESULTS

Among the 263 patients included, 147 were in clinical remission; 102/147 (69%) were in biological remission. Fifty-six patients also had morphological evaluation: 37 (66%) were in tissue remission. Biological remission was associated with older age, higher hemoglobin and lower BMI. Tissue remission was associated with older age, lower platelets count, absence of previous surgery, and the use of immunosuppressant. Time-to-relapse was significantly longer in patients with biological remission and in patients with tissue remission as compared to patients without biological or tissue remission.

CONCLUSIONS

Among the patients in clinical remission seen as outpatients, two thirds were either in biological and/or tissue remission. Biological and/or tissue remission was associated with a better outcome than clinical remission alone.

[Functional imaging and radiotherapy]

Medical imaging plays a crucial role in the diagnosis, staging and therapeutic strategy of oncologic patients. The development of medical imaging over the last decade has allowed significant progresses in radiotherapy. Indeed, medical imaging is now considered the corner stone of radiotherapy. The main challenge for the radiation oncologist consists in the tumour identification with a view to irradiate the tumour at a curative dose while avoiding healthy tissues. To achieve these goals, the radiotherapist daily uses anatomical imaging such as computed tomography (CT) or magnetic resonance imaging (MRI). Since several years now, the development of functional imaging such as positron emission tomography (PET) combined with CT or functional MRI has opened new perspectives in the management of oncologic diseases. Indeed, these imaging techniques offer new information on tumour metabolism that may be taken into account to plan the radiotherapy treatment. This article illustrates the different imaging techniques used in radiotherapy and the role of functional imaging for establishing new therapeutic strategies in radiation oncology.

[Iodinated contrast media and iodine allergy: myth or reality?]

The term "iodine allergy" is an old phrase that refers to a reaction to iodinated contrast media. After a brief review of definitions, pathophysiological mechanisms and risk factors of this clinical entity, management is urged immediate and delayed according to the most recent recommendations from the literature. We underline that iodine allergy, as such, does not really exist.

[Crohn's disease and MRI: assessment of inflammatory activity and tissue damage]

Crohn's disease is an inflammatory bowel disease that affects mainly young people and includes periods of remission interspersed with occasional flare-ups. Entero-MR (Magnetic Resonance) is a non-radiating and a non-invasive tomography imaging technique. Entero-MR has recently proven its ability to assess inflammatory activity and structural damage of the bowel in Crohn's disease which are fundamental elements in the therapy planning. These considerations explain why entero-MR is playing an increasing role in the evaluation of Crohn's disease.

[Fifteen years of use of anti-TNF antibodies in moderate to severe Crohn's disease: how to make the best of this experience]

After fifteen years of use, the anti-TNF antibodies have become the corner stone of the treatment of moderate and severe Crohn's disease. The skill acquired over the years through experimental trials and clinical experience leads to increased therapeutic efficacy and minimized risks. These antibodies are introduced increasingly earlier in Crohn's disease as well as in a broader range of patients, aiming at changing the natural history of the diseases by avoiding the development of intestinal tissue damage and complications.

[Clinical case of the month. Portal venous gas due to a hydrogen peroxide colic enema]

Portal venous gas is a worrying radiological sign that was described for the first time in 1955 among newborn children suffering from necrotizing enterocolitis. It was often related to mesenteric ischemia which mortality remains very high. Now, as radiological explorations increase, portal venous gas is more and more described in less pejorative contexts, such as hydrogen peroxide intoxication. It is what happened to our patient who underwent a hydrogen peroxide colic enema followed by a major and transient portal venous gas onset. This solved quickly and spontaneously.

Ruptured hepatocellular carcinoma following transcatheter arterial chemoembolization

Transcatheter arterial chemoembolization (TACE) is known to be an effective palliative treatment in unresectable hepatocellular carcinoma (HCC). Although TACE can control tumour growth and palliate the patients, complications of TACE with significant morbidity are well known and adversely affect the outcome of patients. Necrotic tumor rupture is a serious complication of TACE and has a high mortality rate. We report a case of ruptured HCC followingTACE in a 78-year-old male patient who subsequently developed peritonitis and pneumoperitoneum. This case gives us the opportunity to underline the importance of such complications and demonstrates the utility of CT imaging for diagnosis and management of patients with ruptured HCC.

[Clinical case of the month. Cystic lymphangioma of the mesentery]

Cystic lymphangioma of the mesentery is a benign condition, probably of malformative origin, and frequently appearing in infancy. Its symptomatology can be very polymorphic. Its diagnosis is suspected by ultrasonography and computed tomography, and definitely confirmed by pathology. About a recent case of cystic lymphangioma of the mesentery diagnosed and operated on at the university hospital of Liège in an adult patient, the authors review its classification and its therapeutic strategy. Surgical resection is indicated in symptomatic cystic lymphangioma.

[Pseudoaneurysm of the left gastric artery]

We report the case of a 65-year-old man admitted for an upper-GI hemorrhage. A CT scan performed with vascular reconstructions demonstrated a pseudoaneurysm of the left gastric artery. Proximal vascular control of the celiac axis was obtained by balloon occlusion with a Fogarty balloon inserted retrograde via the femoral artery: the pseudoaneurysm was then successfully controlled with direct suture.

[Epiploic appendagitis, an ignored diagnosis]

Epiploic appendagitis is the term used to describe the inflammation of an epiploic appendage. These small masses of fat distributed along the colon, from the caecum to the recto-sigmoid junction can inflammate by torsion, spontaneously or secondarily with the inflammation of an anatomical structure in the neighbourhood. Symptomatology may mimic retro-caecal appendicitis or diverticulitis and the diagnosis by CT avoids unnecessary surgery or hospitalization. Indeed, under conservative treatment by AINS and analgesics, symptomatology regresses in about five days. In this article, we relate the case of a patient with a typical clinical presentation, to remind the elements of this pathological entity.

[Palliative management of hepatocarcinoma with sorafenib (Nexavar). Results of the SHARP study (sorafenib hepatocarcinoma assessment randomized protocol trial)]

Curative management of early-stage hepatocarcinoma may include partial hepatic resection, liver transplantation or tumoral necrosis using radiofrequency ablation or alcoholisation. Until recently, no efficient therapeutic mean was available for advanced hepatocarcinoma. Sorafenib (Nexavar, Bayer) is a multikinase inhibitor that decreases tumoral proliferation and angiogenesis, and increases apoptosis in many cancer models. The results of a phase 3 randomized, multicentric, study, entitled SHARP, have now demonstrated that sorafenib increases survival in patients with advanced hepatocarcinoma developed in Child A cirrhosis. Mean survival gain was a little less than 3 months, without any radiologic response or improvement in the delay before symptomatic progression of the disease. The monthly cost of sorafenib is a little more than 5,000 euros. It is now crucial to evaluate the potential role of sorafenib in adjuvant therapy after liver resection or radiofrequency ablation of hepatocarcinoma. The CHU of Liège is taking part to a randomized, multicentric study evaluating the use of sorafenib after liver resection or radiofrequency ablation for hepatocarcinoma. Another future evaluation could be the association of sorafenib with other antitumoral agents.

[Isolated spontaneous dissection of the superior mesenteric artery: a case report]

We report the case of a 38-year-old man admitted at the emergency department for abdominal pain of abrupt onset. Computed tomographic examination revealed a spontaneous isolated dissection of the superior mesenteric artery and an anevrysm of the coeliac artery caused by the arcuate ligament. Outcome was favorable under conservative medical treatment and a three months follow-up was uneventful. This observation offers the opportunity to present recent insights concerning this pathology.

Limits on spin-independent interactions of weakly interacting massive particles with nucleons from the two-tower run of the cryogenic dark matter search

We report new results from the Cryogenic Dark Matter Search (CDMS II) at the Soudan Underground Laboratory. Two towers, each consisting of six detectors, were operated for 74.5 live days, giving spectrum-weighted exposures of 34 (12) kg d for the Ge (Si) targets after cuts, averaged over recoil energies 10-100 keV for a weakly interacting massive particle (WIMP) mass of 60 GeV/c2. A blind analysis was conducted, incorporating improved techniques for rejecting surface events. No WIMP signal exceeding expected backgrounds was observed. When combined with our previous results from Soudan, the 90% C.L. upper limit on the spin-independent WIMP-nucleon cross section is 1.6 x 10(-43) cm2 from Ge and 3 x 10(-42) cm2 from Si, for a WIMP mass of 60 GeV/c2. The combined limit from Ge (Si) is a factor of 2.5 (10) lower than our previous results and constrains predictions of supersymmetric models.

First results from the Cryogenic Dark Matter Search in the Soudan Underground Laboratory

We report the first results from a search for weakly interacting massive particles (WIMPs) in the Cryogenic Dark Matter Search experiment at the Soudan Underground Laboratory. Four Ge and two Si detectors were operated for 52.6 live days, providing 19.4 kg d of Ge net exposure after cuts for recoil energies between 10 and 100 keV. A blind analysis was performed using only calibration data to define the energy threshold and selection criteria for nuclear-recoil candidates. Using the standard dark-matter halo and nuclear-physics WIMP model, these data set the world's lowest exclusion limits on the coherent WIMP-nucleon scalar cross section for all WIMP masses above 15 GeV/c2, ruling out a significant range of neutralino supersymmetric models. The minimum of this limit curve at the 90% C.L. is 4 x 10(-43) cm2 at a WIMP mass of 60 GeV/c2.

Pain hypersensitivity in patients with functional gastrointestinal disorders: a gastrointestinal-specific defect or a general systemic condition?

Visceral hypersensitivity was shown in patients with functional gastrointestinal disorders (FGID). The mechanisms underlying this sensory dysfunction remain undetermined. The initial hypothesis of a generalized reduction in pain tolerance was rejected by further studies that suggested a normal tolerance to somatic stimuli and led to the generally accepted assumption that pain intolerance is specific and exclusive for visceral stimuli in these patients. We wanted to revisit this theory by examining whether patients with FGID reported perception and tolerance to somatic pain differently from normal subjects and whether the response to somatic pain stimulus was correlated to gastrointestinal symptoms or psychological status or distress. Thirty-three patients with FGID (Rome II criteria)(F/M: 26/7; mean age 48+/-9.9) and 33 normal controls (F/M: 24/9; mean age 44.1+/-6.8) were asked to immerse their nondominant hand into 4 degrees C water for as long as possible (maximum 120 sec). Time before appearance of: (1) discomfort, (2) pain, and (3) withdrawing of the hand were noted. The intensity of pain was rated on a visual analog scale from 0 to 100. Self-report questionnaires were used to assess the severity of gastrointestinal symptoms (St-Luc GI index) and the psychological distress (SCL-90) in the patient group. Data are expressed in seconds as mean +/- SEM. Discomfort sensory thresholds were similar in controls and FGID patients (28+/-3 and 24+/-2, respectively; NS) whereas pain and withdrawing were significantly lower in FGID (41+/-3 and 76+/-6 sec) than in controls (62+/-6 and 102+/-4; P < 0.05). Pain intensity was similar in both groups (64+/-4 vs 67+/-3; NS). Female patients showed lower sensory thresholds than male patients and control females (pain thresholds: 39.8+/-3.4 vs 67.8+/-16.7 and vs 56.8+/-8.7; P < 0.05). Sensory thresholds were not different in subgroups of patients with FGID (irritable bowel syndrome and functional dyspepsia). No correlation was shown between sensory thresholds and gastrointestinal index or SCL 90-test. In conclusion, FGID patients showed a threshold to painful somatic stimulus that was lower than in normal subjects. These findings suggest that patients with FGID may have hyperalgesia and low pain tolerance that is not limited to the viscera, but that is part of a systemic general condition.

Human body surface area: measurement and prediction using three dimensional body scans

The development of three dimensional laser scanning technology and sophisticated graphics editing software have allowed an alternative and potentially more accurate determination of body surface area (BSA). Raw whole-body scans of 641 adults (395 men and 246 women) were obtained from the anthropometric data base of the Civilian American and European Surface Anthropometry Resource project. Following surface restoration of the scans (i.e. patching and smoothing), BSA was calculated. A representative subset of the entire sample population involving 12 men and 12 women (G24) was selected for detailed measurements of hand surface area (SAhand) and ratios of surface area to volume (SA/VOL) of various body segments. Regression equations involving wrist circumference and arm length were used to predict SAhand of the remaining population. The overall [mean (SD)] of BSA were 2.03 (0.19) and 1.73 (0.19) m2 for men and women, respectively. Various prediction equations were tested and although most predicted the measured BSA reasonably closely, residual analysis revealed an overprediction with increasing body size in most cases. Separate non-linear regressions for each sex yielded the following best-fit equations (with root mean square errors of about 1.3%): BSA (cm2) = 128.1 x m0.44 x h0.60 for men and BSA = 147.4 x m0.47 x h0.55 for women, where m, body mass, is in kilograms and h, height, is in centimetres. The SA/VOL ratios of the various body segments were higher for the women compared to the men of G24, significantly for the head plus neck (by 7%), torso (19%), upper arms (15%), forearms (20%), hands (18%), and feet (11%). The SA/VOL for both sexes ranged from approximately 12.m-1 for the pelvic region to 104-123.m-1 for the hands, and shape differences were a factor for the torso and lower leg.

Mini mutagenicity test: a miniaturized version of the Ames test used in a prescreening assay for point mutagenesis assessment

The bacterial reverse mutagenicity test on Salmonella typhimurium, known as the Ames test, is widely used by regulatory agencies, academic institutions and chemical companies to assess the mutagenic potential of raw compounds. Several attempts have been made to miniaturise the Ames test in order to fit the industrial constraint of screening more products at the low quantities available. The major limitation of these miniaturised versions of the Ames test lies in the impossibility to work with all the six strains used in the regular Ames test, especially with those showing a low spontaneous revertant frequency. We describe here a mini version of the regulatory Ames test protocol that allows a significant reduction of the quantity of test substance needed (300 mg) but remains applicable to all Salmonella strains used in the regulatory protocol. In a preliminary study, 10 in-house chemical compounds have been evaluated in the Mini Mutagenicity Test (MMT) together with some positive control substances. A first set of historical data obtained in 1999 as well as the predictivity and the sensitivity of the MMT are presented and compared to those of the regular Ames test.

[Vitamin D concentrations in blood and skin phototype in a general adult population in France]

INTRODUCTION

A link between bone mineral density and skin color has been reported recently, and pigmentation has been shown to affect cutaneous vitamin D production. In the present study, we investigated the relationship between phototype, global self assessed sun exposure, geographical location and vitamin D serum levels in 1191 French adults.

METHODS

Three multiple linear regression analyses were performed. The two first analyses to test separately the effect of phototype, and the effect of sun exposure on the vitamin D levels. Then, a third model was constructed, using both factors and geographical location.

RESULTS

When the factors were analyzed separately, individuals with lower phototype showed significantly lower levels of vitamin D than those with darker phototype, as well as, individuals with lower sun exposure showed significantly lower levels of vitamin D than those with higher sun exposure. However in the global model, which takes into account phototype and sun exposure simultaneously together with the region of residence, the vitamin D status was no longer linked with the phototype, but with sun exposure and geographical location.

CONCLUSION

Since phototype and global self-assessment of sun exposure were positively linked, our data suggest that lower vitamin D levels in fair-skinned individuals are due to their sun exposure behavior.

Performance of a 2D image-based anthropometric measurement and clothing sizing system

Two-dimensional, image-based anthropometric measurement systems offer an interesting alternative to traditional and three-dimensional methods in applications such as clothing sizing. These automated systems are attractive because of their low cost and the speed with which they can measure size and determine the best-fitting garment. Although these systems have appeal in this type of application, not much is known about the accuracy and precision of the measurements they take. In this paper, the performance of one such system was assessed. The accuracy of the system was analyzed using a database of 349 subjects (male and female) who were also measured with traditional anthropometric tools and techniques, and the precision was estimated through repeated measurements of both a plastic mannequin and a human subject. The results of the system were compared with those of trained anthropometrists, and put in perspective relative to clothing sizing requirements and short-term body changes. It was concluded that image-based systems are capable of providing anthropometric measurements that are quite comparable to traditional measurement methods (performed by skilled measurers), both in terms of accuracy and repeatability.