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Background: The aim of this brief communication is to highlight the potential bacteriological risk linked to the processes control of radiopharmaceutical preparations made in a radiopharmacy laboratory. Survival rate of Pseudomonas aeruginosa (ATCC: 27853) or Staphylococcus aureus (ATCC: 25923) or Staphylococcus epidermidis (ATCC: 1228) in multidose technetium-99 m solution was studied. Results: Depending on the nature and level of contamination by pathogenic bacteria, the lethal effect of radioactivity is not systematically observed. We found that P. aeruginosa was indeed affected by radioactivity. However, this was not the case for S. epidermidis, as the quantity of bacteria found in both solutions (radioactive and non-radioactive) was rapidly reduced, probably due to a lack of nutrients. Finally, the example of S. aureus is an intermediate case where we observed that high radioactivity affected the bacteria, as did the absence of nutrients in the reaction medium. The results were discussed in the light of current practices on the sterility test method, which recommends waiting for radioactivity to decay before carrying out the sterility test. Conclusion: In terms of patient safety, the results run counter to current practice and the latest EANM recommendation of 2021 that radiopharmaceutical preparations should be decayed before sterility testing. [ABSTRACT FROM AUTHOR]

Background: Despite the development of positron emission tomography (PET), single photon emission computed tomography (SPECT) still accounts for around 80% of all examinations performed in nuclear medicine departments. The search for new radiotracers or chelating agents for Technetium-99m is therefore still ongoing. O-TRENSOX and O-TRENOX two synthetic siderophores would be good candidates for this purpose as they are hexadentate ligands based on the very versatile and efficient 8-hydroxyquinoline chelating subunit. First, the radiolabeling of O-TRENOX and O-TRENSOX with 99mTc was investigated. Different parameters such as the quantity of chelating agent, type of reducing agent, pH and temperature of the reaction mixture were adjusted in order to find the best radiolabeling conditions. Then an assessment of the partition coefficient by measuring the distribution of each radiosynthesized complex between octanol and phosphate-buffered saline was realized. The complex's charge was evaluated on three different celluloses (neutral, negatively charged P81 and positively charged DE81), and finally in vivo studies with biodistribution and SPECT imaging of [99mTc]Tc-O-TRENOX and [99mTc]Tc-O-TRENSOX were performed. Results: The radiolabeling studies showed a rapid and efficient complexation of 99mTc with both chelating agents. Using tin pyrophosphate as the reducing agent and a minimum of 100 nmol of ligand, we obtained the [99mTc]Tc-O-TRENOX complex with a radiochemical purity of more than 98% and the [99mTc]Tc-O-TRENSOX complex with one above 97% at room temperature within 5 min. [99mTc]Tc-O-TRENOX complex was lipophilic and neutral, leading to a hepatobiliary elimination in mice. On the contrary, the [99mTc]Tc-O-TRENSOX complex was found to be hydrophilic and negatively charged. This was confirmed by a predominantly renal elimination in mice. Conclusions: These encouraging results allow us to consider the O-TRENOX/99mTc and O-TRENSOX/99mTc complexes as serious candidates for SPECT imaging chelators. This study should be continued by conjugating these tris-oxine ligands to peptides or antibodies and comparing them with the other bifunctional agents used with Tc. [ABSTRACT FROM AUTHOR]

Background: Artificial intelligence (AI) is rapidly infiltrating multiple areas in medicine, with gastrointestinal endoscopy paving the way in both research and clinical applications. Multiple challenges associated with the incorporation of AI in endoscopy are being addressed in recent consensus documents. Objectives: In the current paper, we aimed to map future challenges and areas of research for the incorporation of AI in capsule endoscopy (CE) practice. Design: Modified three-round Delphi consensus online survey. Methods: The study design was based on a modified three-round Delphi consensus online survey distributed to a group of CE and AI experts. Round one aimed to map out key research statements and challenges for the implementation of AI in CE. All queries addressing the same questions were merged into a single issue. The second round aimed to rank all generated questions during round one and to identify the top-ranked statements with the highest total score. Finally, the third round aimed to redistribute and rescore the top-ranked statements. Results: Twenty-one (16 gastroenterologists and 5 data scientists) experts participated in the survey. In the first round, 48 statements divided into seven themes were generated. After scoring all statements and rescoring the top 12, the question of AI use for identification and grading of small bowel pathologies was scored the highest (mean score 9.15), correlation of AI and human expert reading-second (9.05), and real-life feasibility-third (9.0). Conclusion: In summary, our current study points out a roadmap for future challenges and research areas on our way to fully incorporating AI in CE reading. [ABSTRACT FROM AUTHOR]

Introduction: Oral targeted therapies (OTTs) are widely used for cancer management. However, there is no consensus on OTT dose adaptation in older patients with cancer. Methods: This noninterventional, retrospective study was a real‐life assessment of dose adaptation for six OTTs (afatinib, everolimus, palbociclib, pazopanib, sorafenib and sunitinib), at baseline and during treatment, and the reasons for the changes, in ≥70‐year‐old patients treated between February 2016 and August 2019. Data were compared with univariate models fitted with all variables. Results: Among the 986 patients treated with OTT, the group of ≥70‐year‐old patients (n = 122) received afatinib (15.6%), everolimus (14.8%), palbociclib (50.8%), pazopanib (9.8%), sorafenib (5.8%) or sunitinib (3.2%). At baseline, the prescribed OTT dose was adapted (reduction) in 29% of ≥70‐year‐old patients (35/122). These 35 patients were significantly older (mean age 80 vs 74 years, P <.001), and more frequently had a performance status score ≥2 (P <.01) than the other patients (n = 87). In the standard dose group, higher toxicity grades (P =.18) and subsequent dose reduction (41% of patients, 36/87) tended to be more frequent compared with the baseline adapted dose group (26%, 9/35, P =.1). At the study end, 53% of patients in the whole cohort (65/122) were taking a lower dose than the recommended one. Conclusion: At OTT initiation, dose was adapted in 29% of older adults with cancer, rarely after a formal oncogeriatric evaluation (6.5% of all patients). In the absence of recommendations, clinical studies are needed to evaluate the efficacy and safety of baseline OTT dose reduction in older adults with cancer. [ABSTRACT FROM AUTHOR]

Background: Bubbles often mask the mucosa during capsule endoscopy (CE). Clinical scores assessing the cleanliness and the amount of bubbles in the small bowel (SB) are poorly reproducible unlike machine learning (ML) solutions. We aimed to measure the amount of bubbles with ML algorithms in SB CE recordings, and compare two polyethylene glycol (PEG)-based preparations, with and without simethicone, in patients with obscure gastro-intestinal bleeding (OGIB). Patients & Methods: All consecutive outpatients with OGIB from a tertiary care center received a PEG-based preparation, without or with simethicone, in two different periods. The primary outcome was a difference in the proportions (%) of frames with abundant bubbles (>10%) along the full-length video sequences between the two periods. SB CE recordings were analyzed by a validated computed algorithm based on a grey-level of co-occurrence matrix (GLCM), to assess the abundance of bubbles in each frame. Results: In total, 105 third generation SB CE recordings were analyzed (48 without simethicone and 57 with simethicone-added preparations). A significant association was shown between the use of a simethicone-added preparation and a lower abundance of bubbles along the SB (p = 0.04). A significantly lower proportion of "abundant in bubbles" frames was observed in the fourth quartile (30.5% vs. 20.6%, p = 0.02). There was no significant impact of the use of simethicone in terms of diagnostic yield, SB transit time and completion rate. Conclusion: An accurate and reproducible computed algorithm demonstrated significant decrease in the abundance of bubbles along SB CE recordings, with a marked effect in the last quartile, in patients for whom simethicone had been added in PEG-based preparations, compared to those without simethicone. [ABSTRACT FROM AUTHOR]

Palbociclib is a good candidate for therapeutic drug monitoring (TDM) due to its narrow therapeutic range and frequency of toxicities, particularly high-grade neutropenia. In this prospective, bicentric clinical trial, we evaluated the palbociclib exposure–toxicity relationship and determined the relevant sources of palbociclib pharmacokinetic variability, including drug–drug interactions (DDI). We followed 58 patients (mean age: 62.9 years) for 1 year. The geometric median of palbociclib plasma trough concentration (Ctrough) was 74.1 ng/mL. Neutropenia occurred in 70.7% of patients (high grade in 67.2% of patients). High-grade neutropenia occurrence during the first two palbociclib cycles was higher in patients with lower neutrophil count at initiation (p = 0.002). Palbociclib plasma Ctrough was correlated with high-grade neutropenia occurrence during the first two cycles (p = 0.024, OR 5.51). Co-treatment with agents that may interfere with palbociclib PK significantly influenced palbociclib Ctrough (p < 0.05). CYP3A4/P-glycoprotein inhibitors increased by 25% palbociclib Ctrough (p = 0.035), while antacids reduced it by 20% (p = 0.036). However, DDI did not have any significant effect on high-grade neutropenia occurrence (p > 0.05). This study confirms the major role of TDM to manage palbociclib safe use from the first week of treatment, particularly the significant incidence of hematological toxicity. Moreover, this first dedicated prospective study confirmed the importance of characterizing co-treatments to limit the DDI risk with oral-targeted therapies. [ABSTRACT FROM AUTHOR]

Purpose: Pharmacist consultation is unfrequently performed in oncology clinical trials that include patients who often have many co-treatments increasing the risk of drug-drug interactions (DDI). The aim of this study was to determine whether best possible medication history (BPMH) by hospital pharmacist at inclusion and therapeutic drug monitoring could be used for DDI risk evaluation and for current oral targeted therapy management.Methods: A prospective clinical trial (ALCINA 2, NCT04025541) was carried out in metastatic breast cancer cohort treated by palbociclib to conduct pharmacokinetics-toxicity correlation study. BPMH was prospectively performed by the hospital pharmacist at each trial inclusion, followed by a contact to the patient's community pharmacy to complete the collected data. Pharmacokinetic analysis was performed on blood samples collected at day 15 of cycle 1 of palbociclib treatment.Results: Pharmacist interventions indicated that at inclusion, current medications were incomplete for 63% of the enrolled patients (32/51). It allowed the real-time management of high-risk DDI detected in third of patients. The palbociclib Ctrough geometric median (min-max) was significantly higher in cohort with potential DDI [106 ng/mL (66.7-113)], than cohort without potential DDI [70.1 ng/mL (54.1-89.7)], p = 0.0284.Conclusion: This is the first prospective study evaluating the relevance of proactive BPMH by pharmacist with contact to the community pharmacy during the inclusion step of a clinical trial to ensure the efficacy and safety of the investigated drug. This investigation was thus able to highlight the statistically significant impact of these DDI on palbociclib plasma concentration variation during the clinical trial.Trial Registration: Clinicaltrials.gov identifier NCT04025541. [ABSTRACT FROM AUTHOR]

Background: Cleanliness scores in small-bowel capsule endoscopy (SBCE) have poor reproducibility. The aim of this study was to evaluate a neural network-based algorithm for automated assessment of small-bowel cleanliness during capsule endoscopy.Methods: 600 normal third-generation SBCE still frames were categorized as "adequate" or "inadequate" in terms of cleanliness by three expert readers, according to a 10-point scale, and served as a training database. Then, 156 third-generation SBCE recordings were categorized in a consensual manner as "adequate" or "inadequate" in terms of cleanliness; this testing database was split into two independent 78-video subsets for the tuning and evaluation of the algorithm, respectively.Results: Using a threshold of 79 % "adequate" still frames per video to achieve the best performance, the algorithm yielded a sensitivity of 90.3 %, specificity of 83.3 %, and accuracy of 89.7 %. The reproducibility was perfect. The mean calculation time per video was 3 (standard deviation 1) minutes.Conclusion: This neural network-based algorithm allowing automatic assessment of small-bowel cleanliness during capsule endoscopy was highly sensitive and paves the way for automated, standardized SBCE reports. [ABSTRACT FROM AUTHOR]

Résumé: L'endoscopie d'urgence s'adresse à des maladies graves à toute heure de prise en charge. Les indications sont essentiellement le traitement de l'hémorragie digestive et l'extraction des corps étrangers supérieurs. Mais elle peut aussi être nécessaire en cas de volvulus du sigmoïde et de syndrome d'Ogilvie résistant au traitement médical. La plupart des indications urgentes doivent conduire à une endoscopie dans les 24 heures mais, dans de rares cas, le délai doit être de moins de 12 heures voire de moins de 2 heures. Elle est souvent réalisée en dehors des heures ouvrables, la nuit, le week-end et les jours fériés. Elle doit cependant être réalisée dans de bonnes conditions avec une équipe entraînée. La bonne connaissance des indications des endoscopies d'urgence, ainsi que du délai et de ses modalités de réalisation est nécessaire à tout hépato-gastroentérologue pour prendre les bonnes décisions avec les correspondants urgentistes, réanimateurs, radiologues et chirurgiens et conduire à une prise en charge optimale du patient. Emergency endoscopy is mandatory at all times for critically ill patients. Emergency endoscopy is mainly performed for the management of digestive bleeding and for the extraction of foreign bodies. But it may also be necessary in case of sigmoid volvulus and Ogilvie syndrome resistant to medical treatment. Most urgent indications must lead to an endoscopy within 24 hours, and in rare cases within 12 hours or even less than 2 hours. It is therefore often be carried out outside working hours; at night, weekends and holidays. However, it should be performed by a properly trained team in an adequate environment. A knowledge of validated indications for emergency endoscopies, appropriate timing and procedures should therefore be mastered by any hepatogastroenterologist on duty, in order to take the appropriate decisions with emergency intensivists, radiologists and surgeons, and to obtain an optimal care for patients. [ABSTRACT FROM AUTHOR]

Pancreatic ductal adenocarcinoma (PDAC) is supported by a complex microenvironment whose physical contribution to chemoresistance could be overcome by ultrasound (US) therapy. This study aims to investigate the ability of US-induced inertial cavitation in association with chemotherapy to alter tumor cell viability via microenvironment disruption. For this purpose, we used a 3D-coculture PDAC model partially mimicking the tumor and its microenvironment. Coculture spheroids combining DT66066 cells isolated from KPC-transgenic mice and murine embryonic fibroblasts (iMEF) were obtained by using a magnetic nanoshuttle method. Spheroids were exposed to US with incremental inertial cavitation indexes. Conditions studied included control, gemcitabine, US-cavitation and US-cavitation + gemcitabine. Spheroid viability was assessed by the reduction of resazurin and flow cytometry. The 3D-coculture spheroid model incorporated activated fibroblasts and produced type 1-collagen, thus providing a partial miniature representation of tumors with their microenvironment. Main findings were: (a) Gemcitabine (5 μM) was significantly less cytotoxic in the presence of KPC/iMEFs spheroids compared with KPC (fibroblast-free) spheroids; (b) US-induced inertial cavitation combined with Gemcitabine significantly decreased spheroid viability compared to Gemcitabine alone; (c) both cavitation and chemotherapy affected KPC cell viability but not that of fibroblasts, confirming the protective role of the latter vis-à-vis tumor cells. Gemcitabine toxicity is enhanced when cocultured spheroids of KPC and iMEF are exposed to US-cavitation. Although the model used is only a partial representation of PDAC, this experience supports the hypothesis that US-inertial cavitation can enhance drug penetration and cytotoxicity by disrupting PDAC microenvironment. [ABSTRACT FROM AUTHOR]

What is known and Objective: Sunitinib pharmacokinetics can be influenced by the physio‐pathological conditions of individual patients. Therapeutic drug monitoring (TDM) helps to optimize efficacy and reduce the risk of adverse effects. We report on the use of Bayesian analysis to optimize sunitinib blood levels. Case Summary: We describe two patients with risk of sunitinib pharmacokinetic variability due to gastrectomy and ongoing haemodialysis, respectively. TDM and Bayesian estimation allowed maintaining their sunitinib pharmacokinetic profiles within the usual limits. What is new and conclusion: Our analysis showed that Bayesian analysis can be successfully applied for real‐time TDM to optimize sunitinib blood levels in patients with major comorbidities. [ABSTRACT FROM AUTHOR]

Artificial intelligence (AI) aims to simulate the human intelligence. It is a cognitive science which relies on neurobiology, logical and critical thinking (problem solving, deep learning, neural networks), computing sciences (calculation, internet), and on databases. Big data exploitation (epidemiology, predictive medicine) and "signals" analysis (EKG, EEG, imaging, pathology, dermatology, ophthalmology...) were the first successful application of AI in healthcare, followed by government approval. AI has a vast spectrum of potential applications in digestive endoscopy as well. AI can be used for screening, diagnosis, characterization, treatment, and prognosis evaluation, in a wide array of procedures. The quantity of published work in this field is thriving. Computer-assisted detection and characterization of colonic polyps for instance, were amongst the first successful applications of AI, and should be commercially available shortly. The automated reading of a capsule endoscopy, based on a network of machine learning systems, is also very demonstrative of what AI will be able to accomplish in the next future. It is believed that AI will significantly improve diagnostic performances and thus the quality of care. Today, endoscopists should not only promote this technological revolution, but also address new issues in the field of AI, regarding the respective roles of physicians (focused on ethics and patient-relations) and AI-machines (assistants vs autonomous), as well as responsibility (physicians vs. manufacturing companies), and reimbursement (physician vs manufacturing companies). [ABSTRACT FROM AUTHOR]

Résumé: Les personnes souffrant de maladie inflammatoire chronique de l'intestin (MICI) rapportent que leur santé sexuelle est souvent altérée et insuffisamment abordée lors des consultations médicales ; elles conçoivent moins d'enfants que la population générale. Cette revue vise à apporter au thérapeute une synthèse des outils et informations utiles concernant les dysfonctions de la sexualité et la fertilité des patients atteints de MICI. La dysfonction sexuelle est souvent associée à une altération de l'image corporelle et de la qualité de vie des patients ; ses mécanismes sont multiples. Des troubles anxio-dépressifs sont souvent intriqués. La fertilité est très voisine de celle de la population générale mais quelques cas particuliers doivent être connus des gastroentérologues. Une consultation pré-conceptionnelle apportant des informations simples au couple, répondant à ses questions et corrigeant éventuellement ses croyances erronées est d'une aide démontrée et le maintien de la rémission de la MICI (incluant l'utilisation des traitements médicamenteux) est un élément-clé. ..LAN-EN People with IBD report that their sexual health is often impaired and inadequately addressed during medical consultations; they conceive fewer children than the general population. This review aims to provide the therapist with a synthesis of useful tools and information regarding sexual dysfunction and fertility in IBD patients. Sexual dysfunction is often associated with impaired body image and quality of life for patients; its mechanisms are multiple. Anxio-depressive disorders are often entangled. Fertility is very close to that of the general population, but some special cases must be known to gastroenterologists. A pre-conception consultation providing simple information to the couple, answering their questions and possibly correcting their erroneous beliefs is of proven help and the maintenance of the remission of IBD (including the use of drug treatments) is a key element. [ABSTRACT FROM AUTHOR]

What is known and objective Neuroleptic malignant syndrome ( NMS) is a rare but severe adverse effect of antipsychotic drugs. Case description We report two cases of NMS highlighted by clinical pharmacists in an emergency unit during summer. One of them was fatal. Medication reconciliation processes performed at admission identified treatment with loxapine for one of them and with loxapine and clozapine for the other. Interview of the patients highlighted clinical symptoms suggesting NMS, allowing the pharmacists to alert the medical team. What is new and conclusion Adverse drug events may be severe and clinical pharmacists in emergency departments can help to detect them. [ABSTRACT FROM AUTHOR]

Agricultural is a major contributor to environmental resource management problems. Modelling the distribution of agricultural land use to evaluate current situations or scenarios is an important issue for policy-makers and natural resource managers. A promising approach is the use of bio-decisional models based on decision rules. However, at the regional scale, the large number of farmers makes it difficult to identify decision rules, and the diversity of farmers' decisions is rarely considered. To this end, we developed SIMITKO, a spatialised and stochastic bio-decisional model, able to simulate the spatial and temporal variability in farming practices. We focused on the choice of varietal earliness and sowing practices of maize ( Zea mays L.) in the Baïse sector (south-western France). Model development was based on statistical analyses of surveys of farmers’ practices to identify their current strategies, the best variables to describe the practices and the probabilities associated with the values of the variables for each strategy. We tested SIMITKO by simulating the dynamics of areas sown with maize. Comparing model predictions of practices to observed data showed generally good predictions of sowing dynamics but less satisfactory predictions of varietal earliness choices. Possible improvements are suggested. [ABSTRACT FROM AUTHOR]

Abstract: Natural-resource management that concerns multiple agents with a variety of interests can be facilitated by integrated assessment methods which include modelling and/or stakeholder participation. Integrated assessment methods are increasingly used for scenario approaches that enable policy-makers to explore possible futures and assess potential consequences of different policy or management strategies. The paper proposes a conceptual and operational framework to illustrate a scenario exercise, based on a previously developed model, by building on recently published progress on the participatory and model-based assessment approach. This framework focuses on information flows in two key operational phases, problem specification and adaptation of model outputs, where scientists and stakeholders interact. In both phases, transformation steps convert narrative information into a quantitative form (and vice-versa), thereby enabling scientists to apply computer models and decision-makers to get confident in model predictions. On the basis of four case studies aimed at solving complex water-resource management problems, we illustrate the difficulties, constraints and questions of each step of the proposed framework and present original solutions. This framework, which can be applied to all natural-resource management issues, clearly defines the step(s) at which each partner should be involved in a scenario exercise and his/her contribution. Consequently, by having greater foresight and transparency, the framework determines the nature of interactions between scientists and non-scientists. A posteriori, it also describes how a scenario exercise was conducted. [Copyright &y& Elsevier]

At regional scale issues such as diffuse pollution, water scarcity and pollen transfer are closely related to the diversity and location of cropping systems because agriculture interacts with many other activities. Although sustainable land use solutions for territorial development and natural resource management are needed, very few agro-environmental studies account for both the coherence and the spatial variability of cropping systems. The originality of this article is to review methods that describe and locate cropping systems within large areas. We mainly based our analysis on four case studies using the concept of cropping systems on a regional scale, but differing in their objectives and extents. We found that describing and locating cropping systems in space meets not only decision-making stakes but also a scientific stake that allows multi-simulations over large areas when models require cropping system information. Simulation models are indeed necessary when the study aims at estimating cropping system externalities. Then, the involved process determines the extent, and the model determines the support unit, unless socio-economic considerations prevail. In this case, as well as when no model is involved, it is often considerations related to stakeholders that determine extent and support unit choices. On a regional scale, the cropping system must be described by only a few variables whose selection depends on the study objective and the involved processes. Collecting cropping system information for all support units is often simplified by identifying determining factors of cropping systems. However, obtaining deterministic relations between easily accessible factors and cropping system variables is not always possible, and sometime accessing modalities of determining factors for all support units is also difficult. We found that describing and locating cropping systems relied very much on expertise and detailed survey data. The development of land management practice monitoring would facilitate this description work. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To describe the management of patients with atrial fibrillation (AF) and to study consistency with guidelines on management of AF. Patients and methods: Observational study on a random sample of cardiologists from a French national database. Each cardiologist had to recruit the first five patients meeting inclusion criteria (patients diagnosed with AF between January 2004 and one month before inclusion and accepting the collection of their medical data). Results: Between December 2006 and January 2207, 1789 patients aged 71 on average have been recruited by 481 cardiologists. Fifty-one percent were diagnosed with paroxysmal, 15% with persistent and 33% with permanent AF. Restoration of sinus rhythm was preferred in forms considered as paroxysmal or persistent forms whereas control of the ventricular rate was more frequent in AF considered as permanent. Overall, therapeutic guidelines are applied in practice, despite a frequent use of amiodarone in patients with no associated heart disease. Prevention of thromboembolism was observed in 88% of the patients. Conclusions: FACTUEL is the biggest observational study on AF ever conducted in France. The therapeutic strategies used by the cardiologists are consistent with the objectives of preventing thromboembolism and controlling heart rhythm and/or rate. In most cases, the treatment used is consistent with the therapeutic guidelines. [Copyright &y& Elsevier]

Artificial intelligence (AI) has shown promising results in digestive endoscopy, especially in capsule endoscopy (CE). However, some physicians still have some difficulties and fear the advent of this technology. We aimed to evaluate the perceptions and current sentiments toward the use of AI in CE. An online survey questionnaire was sent to an audience of gastroenterologists. In addition, several European national leaders of the International CApsule endoscopy REsearch (I CARE) Group were asked to disseminate an online survey among their national communities of CE readers (CER). The survey included 32 questions regarding general information, perceptions of AI, and its use in daily life, medicine, endoscopy, and CE. Among 380 European gastroenterologists who answered this survey, 333 (88%) were CERs. The mean average time length of experience in CE reading was 9.9 years (0.5–22). A majority of CERs agreed that AI would positively impact CE, shorten CE reading time, and help standardize reporting in CE and characterize lesions seen in CE. Nevertheless, in the foreseeable future, a majority of CERs disagreed with the complete replacement all CE reading by AI. Most CERs believed in the high potential of AI for becoming a valuable tool for automated diagnosis and for shortening the reading time. Currently, the perception is that AI will not replace CE reading. [ABSTRACT FROM AUTHOR]

Agriculture is a major consumer of water, with up to 88% of the total water consumption in summer in irrigated regions, either in France or, for instance, in Australia. Good water management therefore requires an accurate estimation of regional water demand by agriculture, which depends on both soil and weather conditions and on farmers' practices. We studied the farmers' practices that influence maize irrigation: sowing and the choice of cultivar in regard to its earliness. Specifically, we aimed to identify geo-referenced indicators that could be used to estimate the spatial and temporal distribution of the various combinations of sowing date, sowing density, sown area and maize earliness. The study was conducted in a 500-km2irrigated area in south-western France. We first conducted a quantitative analysis of postal survey data to identify environmental factors and farm descriptors that could determine sowing practices and the choice of earliness of cultivar. We then interviewed a group of farmers to find out the main constraints relevant to the sowing date and earliness of cultivar. We identified variables that can be used as indicators of the spatial variability of the studied practices. Our results show that the spatial distribution of sowing date and cultivar earliness over a region can be estimated from climatic descriptors of the area and structural farm characteristics. The first factor allows estimation of tactical variables, the sowing starting date and the cultivar earliness groups, while the second allows estimation of sowing and earliness choice strategies. This is one of the first studies identifying on a regional scale geo-referenced indicators of a crop management system, and the first that provides a conjunctive estimation of sowing and earliness choice practices on a regional scale. This study suggests that for estimating any crop management system, it is helpful to treat strategic and tactical variables separately. [ABSTRACT FROM AUTHOR]

Abstract: Four trials were conducted to study the grain magnesium (Mg), zinc (Zn) and iron (Fe) concentrations in bread wheat (Triticum aestivum L.). These trials used different sources of genotypes, including old French landraces, a worldwide germplasm collection and elite breeding lines or modern cultivars, grown in different environments. Mg concentration ranged from 600 to 1400ppm in modern material, and reached 1890ppm in some exotic genotypes. There was a negative correlation between grain yield and Mg concentration, but despite this dilution effect enough variability remains useful for selection purposes. Analysis of variance showed high genotype effects and Spearman rank correlations indicated moderate genotype by environment (G×E) interactions, so breeding for high Mg concentration can reasonably be envisaged. Zn concentration generally ranged from 15 to 35ppm, but increased to 43ppm in some genetic resources. Variation in Zn was also partly explained by a dilution effect. There was a significant effect of genotype, but also high G×E interactions, which would make direct selection more difficult than for Mg. However, as Zn and Mg concentrations appeared to be positively correlated, Zn concentration should respond favorably to selection for high Mg concentration. Fe concentration ranged from 20 to 60ppm, and reached 88ppm in non-adapted material. There were no significant genotype effects, very high G×E interactions, and the trait was poorly correlated to other mineral concentrations. Breeding for high Fe concentration will thus probably prove illusory. [Copyright &y& Elsevier]

Abstract: Lutein and its stereo-isomer zeaxanthin, are the major carotenoids of wheat grain and function as antioxidants in plants as well as in humans. Dietary intake and serum levels of these xanthophylls have been correlated with a beneficial impact on the development of cataracts, age-related maculopathy and other degenerative diseases. The objective of the present study was to explore the genetic variability of carotenoid concentration and oxidase activity among cultivated diploid (einkorn, T. monococcum L.), tetraploid (durum wheat, T. turgidum L. subsp. durum (Desf.) Husn.) and hexaploid (bread wheat, Triticum aestivum L.) wheat species and bread wheat varieties. Varietal mix of the three cultivated wheat species and 48 varieties of bread wheat adapted to north-western European conditions were analysed. The carotenoid concentration of the wholemeal flour of the three wheat species was determined by high performance liquid chromatography. The extractable activities of lipoxygenase (LOX) and peroxidase, involved in the degradation of carotenoid pigments during the kneading step of bread making, were also determined for the varietal mix of the three cultivated wheat species. For the three cultivated wheat species, lutein was the major carotenoid and only traces of zeaxanthin were detected, confirming previous results obtained for durum and bread wheat. Lutein concentration was significantly different among the three wheat species, and averaged 5.75±0.17, 3.32±0.18, and 1.24±0.17μgg−1 DM for einkorn, durum and bread wheat, respectively. The LOX activity of the three wheat species was negatively correlated to the total carotenoid concentration, and was 3-times lower in einkorn (11.91±1.56nkatg−1) than in durum wheat (33.61±1.59nkatg−1), which was 2.5-times lower than in bread wheat (84.7±7.72nkatg−1). The peroxidase activity was not significantly different among the three wheat species. Einkorn appears to be a parent of interest for breeding, since it presents a high carotenoid concentration to LOX activity ratio, a selection criteria that predicts an optimal conservation of carotenoid pigments in bread. Total carotenoid concentration of the 48 bread wheat varieties was assessed spectrophotometrically after calibration against HPLC determination. The results show significant varietal variation of the total carotenoid concentration, ranging from 0.43±0.01μgg−1 DM (cv. Panifor) to 1.74±0.07μgg−1 DM (cv. Apache). Therefore, grain selection could be used to increase the nutritional value of wheat products. [Copyright &y& Elsevier]

Background: The best surgical treatment for hyperthyroidism caused by Graves’ disease remains a controversial subject. Methods: Seven hundred fourteen consecutive patients underwent total or near-total thyroidectomy for Graves’ disease in a 13-year period. In a first analysis, postoperative rates of suffocating hematoma, wound infection, recurrent laryngeal nerve (RLN) palsy, hypoparathyroidism, and persistence or recurrence of hyperthyroidism, were studied and compared with the same parameters in 4,426 patients who underwent bilateral thyroid gland resection for other conditions. A second analysis identified factors associated with postoperative complications among Graves’ disease patients. Results: Comparing Graves’ disease patients with patients who had bilateral thyroid resection for other conditions, the transient morbidity rate was 13.3% versus 8.2% (p < 0.0001), with 10.2% versus 5.0% (p < 0.0001) hypoparathyroidism, 2.2% versus 1.7% (p = 0.35) RLN palsy, 1.7% versus 0.9% (p < 0.05) suffocating hematoma, and 0.3% versus 0.4% (p = 0.67) wound infection, respectively. Permanent morbidity rate was 2% versus 2.2% (p = 0.72), including 0.4% versus 0.6% RLN palsy and 1.5% versus 1.7% hypoparathyroidism. Among the Graves’ disease patients, univariate analysis revealed that those who experienced postoperative complications had a higher weight resected thyroid gland (odds ratio = 1.5; 95% CI, 1.0–2.3) and a higher rate of total thyroidectomy (24.4% versus 19.5%, odds ratio = 2.2; 95% CI, 1.4–3.4) than patients without complications. In the multivariable model, these two factors remained independent. There was no recurrence of hyperthyroidism with a median followup of 6.7 years (interquartile range 4.1 to 10.1 years). Persistent hyperthyroidism developed in three patients. Conclusions: Total or near-total thyroidectomy is an effective and safe treatment for Graves’ disease when performed by an experienced surgeon. [Copyright &y& Elsevier]

Bread is one of the most widely consumed staple foods worldwide. White-wheat bread, largely consumed in France, is made from highly refined flour, which leads to a low nutrient density. Due to a highly porous structure and gelatinised starch, it is easily broken down during digestion, leading to a rapid increase of glucose released into the bloodstream. Low glycaemic responses are considered favourable to health, especially against a background of diabetes. Literature reports show that selection of raw material is an essential factor in decreasing the glycaemic index (GI) of white bread. There are two means of decreasing the rate of starch degradation: either (i) slowing gastric emptying rate and/or glucose diffusion–absorption through the intestinal mucosa, which can be achieved by incorporating soluble fibre or organic acid in bread, or (ii) limiting starch accessibility to α-amylase by using high-amylose cereal varieties and/or incorporating intact cereal grains. Studies on cereal products show that preservation of the food structure during digestion seems to be a more important GI-reducing factor than the degree of starch crystallinity or the presence of soluble fibre. Thus, we should look to produce bread with a more compact food structure or higher density, which is the case in leavened wholewheat bread or bread with intact cereal grains. The baking process should also be improved to achieve this goal, by using, for example, a reduced kneading time or less yeast than usual. [ABSTRACT FROM AUTHOR]

Abstract: Accurate estimation of regional water demand by agriculture, mainly consumed by farmers for irrigation, is a key requirement for water management. It depends on the farmers’ irrigation practices which itself depend on the farmers’ irrigation strategies. Describing irrigation strategies over a region is rather difficult due to the large number and the diversity of farmers. We seek whether it is possible to characterise irrigation strategies from easily accessible farm characteristics data at the regional scale. For that purpose, we investigated the relationships between maize irrigation strategies and three farming sub-systems: the production system, the water resource system and the irrigation equipment system. Based on a 56-farmers survey of maize irrigation strategies carried out in two different areas in south-western France, we firstly created typologies from the three farming sub-systems and from irrigation strategies and, in a second step, analysed the links between the different typologies. Multivariate analyses, cluster analyses, linear regressions and regression trees were used for that purpose. Only two types of irrigation strategies were found that could not be fully explained by the three sub-systems typologies. However, the theoretical irrigation capacity explains a part of the irrigation strategies. Such data can be obtained at a wide geographical scale from administrative data bases. Strategic management of irrigation is similar amongst farmers in a given area while more operational actions differ from farmer to farmer. Standardisation of strategies due to county-based advice is then discussed. [Copyright &y& Elsevier]

The European Myocardial Infarct Amiodarone Trial (EMIAT) investigated the effects of amiodarone versus placebo in patients after myocardial infarction who had left ventricular ejection fraction ≤40% and were ≤75 years of age. The present substudy examined whether ventricular repolarization (VR) dynamicity could differentiate patients who died from cardiac death from their matched survivors in this EMIAT population. In addition, we assessed whether VR dynamicity could differentiate patients who died from arrhythmic cardiac death (ACD) and from non-ACD. VR dynamicity (determined from Holter''s recordings at baseline) was compared before antiarrhythmic therapy in 118 patients who had cardiac death and 118 matched survivors according to age, gender, left ventricular ejection fraction, and subsequent administration or nonadministration of amiodarone. VR dynamicity was compared within the cardiac death group between the 59 patients who died from ACD and the 59 who died from non-ACD. VR dynamicity was expressed as the slope of the linear regression between QTo (measured automatically) and stable RR intervals. Patients who died were found to have a significant steeper rate dependence of QTo intervals during the 3 periods than their matched survivors. In multivariate analysis, the QTo/RR nocturnal interval appeared to be the best independent predictor of cardiac death. In addition, patients who died from ACD were found to have a significant steeper rate dependence of QTo intervals during the morning period than those who died from non-ACD. In the multivariate analysis, the QTo/RR morning interval remained the best independent predictor of ACD. Thus, in the EMIAT trial, evaluation of QT dynamicity is a strong predictor of cardiac death. In addition, QT dynamicity could predict the occurrence of ACD in cases of cardiac death. [Copyright &y& Elsevier]

Current procedures of water management often use simple models and parameterisation to predict demand that may fail in years with extreme climatic and hydrological conditions. The simulation platform ADEAUMIS, presented in a companion paper (), was developed to improve decision-making in strategic water management. In order to estimate irrigation demand over large areas, it includes a spatial data base and a bio-decisional model. The main variables of the data base are irrigated area, weather data and agricultural practices (crops, sowing dates, varieties and irrigation decision rules). ADEAUMIS was applied in the Baïse sector, in south-western France, in 1998 and 2000.This paper presents an evaluation of ADEAUMIS. Firstly, the operational validation was conducted. Estimated and true input variables and predicted and observed output variables of the bio-decisional model of ADEAUMIS were compared. Secondly, its credibility was evaluated by the water manager by comparing ADEAUMIS with the current decision support system (DSS) (called RIO), in order to determine if the new platform allows better decisions. The operational validation raises the problem of the quality of validation data.For the 2 years of simulation, data on water consumption and electricity use (for pumping) were used to construct the reference curve of water withdrawal during the irrigation season. This reference curve was compared to the estimations of ADEAUMIS. There was good agreement for irrigation demand over the whole region for one of the three methods used to estimate irrigated area. The quality and spatial coverage of the water withdrawal reference curve and of independent estimations of irrigated area, used as validation data, are discussed. It seems that a better fit to the reference curve could be obtained by improving the set of decision rules used to reproduce the average irrigation practice of the region, in particular the rules for starting irrigation and the rule for delaying irrigation following rainfall.ADEAUMIS was evaluated as a decision tool on a year (1998) for which RIO failed in the sense that decisions regarding water deliveries or restrictions were difficult to make. Better decisions would have been made with ADEAUMIS. This led the water manager to consider ADEAUMIS as satisfactory for strategic water management The major contribution of ADEAUMIS, compared to RIO, is the better estimation of the temporal dynamics of irrigation. This is due to the use of a crop model with current year climatic data and the representation of irrigation practices. [Copyright &y& Elsevier]

In most countries, planning and management of water resources has become a very important issue. Part of this problem, accurate estimation of water demand by agriculture is a key need for water management. In south-western France, the main water manager (CACG) uses a decision support system (DSS) called RIO, based on a simple representation of the agricultural and physical system. This DSS is satisfactory for average years but fails in years characterised by extreme weather conditions. To improve RIO, the ADEAUMIS simulation platform has been developed.ADEAUMIS is a bio-decisional model linked to a spatialised input data base. The bio-decisional model works on a daily time step and includes a model of plant development coupled with a model of action. The database includes information relative to irrigated area, weather and agricultural practices. Soil information has been shown to be unnecessary. The methods used to collect these data had to respect the operational constraints of the water manager, namely early delivery and cheap acquisition. At the present stage of development, one method per type of input data is used except for the estimation of irrigated area where one can choose between three different methods. Irrigation demand is calculated for individual simulation units and then aggregated over the study area.Applied to the Baïse sector of the Neste system for 2 years, 1998 and 2000, ADEAUMIS showed its ability to simulate a realistic dynamics of water withdrawal over the region, but also its great sensitivity to estimation of irrigated area. This platform, developed for strategic water management, could be easily used for real-time water management or planning. Extending the objective from quantitative to qualitative water management would certainly require more complex modelling. [Copyright &y& Elsevier]

LEENHARDT, A., et al.: Study of Precursors of Ventricular Tachycardia from Data Stored in the Memory of a Dual Chamber Implantable Cardioverter Defibrillator. --> This study was performed to examine precursors of ventricular tachyarrhythmias in patients who experienced a sustained ventricular tachyarrhythmia and received appropriate therapy by ICD. From an overall consecutive population of 77 patients, 18 patients (1 woman,mean age 61.7 ± 10.8 years) were selected for having experienced a sustained ventricular tachyarrhythmia and received at least one appropriate ICD therapy preceded by 20 minutes of internal information. The number of premature ventricular complexes (PVCs)/min for each of the 20 minutes preceding the onset of ventricular tachyarrhythmia, the shortest coupling intervals between PVC and normal sinus beat, and the presence of short‐long‐short (SLS) interval sequences were examined. Data were stratified according to underlying disease, left ventricular ejection fraction, rate of ventricular tachyarrhythmia, and antiarrhythmic therapy. One hundred twenty‐eight episodes of spontaneous ventricular tachyarrhythmia were retrieved. Rapid ventricular tachyarrhythmia (>160 beats/min) were preceded by a significantly greater mean number(3.71 ± 6.36)of PVCs than slower ventricular tachyarrhythmia (≤160 beats/min)(0.63 ± 0.88, P = 0.0004). The mean shortest PVC coupling interval was significantly shorter in patients with(588 ± 99 ms)versus without(643 ± 111 ms, P = 0.03)ischemic heart disease, before episodes of rapid(527 ± 55 ms)versus slower(636 ± 105 ms, P = 0.0001)ventricular tachyarrhythmia, and in the absence(538 ± 80 ms)versus the presence(620 ± 105 ms, P = 0.006)of amiodarone. SLS sequences preceded 29% of rapid ventricular tachyarrhythmic episodes, versus 8% of the slower ventricular tachyarrhythmia(P < 0.01). Significant differences were found in the characteristics of PVCs preceding ventricular tachyarrhythmic episodes in accordance to their rate and the underlying cardiomyopathy. Though insufficient in isolation, these findings may be helpful when combined with other observations to develop preventive algorithms, or to refine the programming of implantable devices. (PACE 2003; 26[Pt. I]:1454–1460) [ABSTRACT FROM AUTHOR]

Summary Because of its high density of negatively charged phosphate groups, phytic acid (PA) forms very stable complexes with mineral ions rendering them unavailable for intestinal uptake. Indeed, the first step in mineral absorption requires that the mineral remains in the ionic state. As the PA content of the diet increases, the intestinal absorption of zinc, iron and calcium decreases. The inhibitory effects of PA on magnesium or copper are more controversial. Nevertheless, PA does not occur alone in foods and is often consumed with various compounds. Phytates are always present in vegetal matrix composed of fibres, minerals, trace elements and other phytomicronutrients. Thus, in order to evaluate mineral absorption from phytate-rich products, all components of diet and food interactions should be considered and it is hard to predict mineral bioavailability in such products by using only the phytate content. [ABSTRACT FROM AUTHOR]

Accurate prediction of water demand by agriculture is a key point of water management. Current procedures of water management often use simple models and parameterisation to predict demand, that may fail in particular climatic situations. In a particular area of south-western France, it is suspected that such failure was due to poor estimation of sowing dates. To solve this problem, a model was developed to estimate the spatial and temporal distribution of summer crop sowing dates. This paper presents the development and the test of the model. The model (SIMSEM) is based on a farm typology, a soil water balance model and supplemental expert knowledge. Although many inaccuracies remain, the distributions predicted compared fairly well to observed distributions obtained from a field survey. The model improved estimated sowing dates compared to the method currently used in water management calculations. The use of SIMSEM to provide information about sowing dates seems helpful for better predicting water demand, as shown by tests performed for the critical 1998 year where the current procedure failed. [Copyright &y& Elsevier]

Objective: To improve the preoperative selection for operation of patients with solitary thyroid nodules. Design: Prospective cohort study. Setting: University hospital, France. Patients: 155 consecutive patients who presented with solitary thyroid nodules and were operated on. Interventions: Clinical examination, ultrasound examination, fine needle aspiration biopsy, followed by total thyroid lobectomy with frozen section and final histological examination. Main outcome measure: Correct prediction of thyroid carcinoma or benign adenoma. Results: A logistic regression analysis indicated that absence of rim (p < 0.002), solid and hypoechoic feature (p < 0.003) and malignant or suspicious fine needle aspiration biopsy results (p < 0.0001) were significantly associated with malignancy. Selection for operation by the logistic model would save 40 of 73 patients from operation and 40 of 59 from unnecessarily radical operation. It would detect a similar number of cancers as a strategy based solely on fine needle aspiration cytology. Conclusions: A combination of the available diagnostic methods provides substantial benefit in the preoperative selection of patients with an isolated thyroid nodule. [ABSTRACT FROM AUTHOR]

In a previous systematic review and meta-analysis of studies reporting associations between hyper-/hypothyroidism and breast cancer incidence published through 29 January 2019, we identified a higher risk with diagnosed hyperthyroidism compared to euthyroidism, but no association with diagnosed hypothyroidism. This 2-year updated meta-analysis aims to investigate the role of menopause in this association and the dose– response relationship with blood levels of thyroid-stimulating hormone (TSH) and thyroid hormones. After the exclusion of studies with only mortality follow-up, with thyroid dysfunction evaluated as a cancer biomarker or after prior breast cancer diagnosis, we reviewed 25 studies that were published up to 01 December 2021 and identified in MEDLINE, the COCHRANE library, Embase, or Web of Science; of these, 9 were included in the previous meta-analysis. Risk estimates from 22 of the 25 studies were included in the meta-analysis and pooled using random-effects models. Compared to euthyroidism, hyperthyroidism and hypothyroidism diagnoses were associated with higher (pooled risk ratio (RR): 1.12, 95% CI: 1.06–1.18, 3829 exposed cases) and lower risks (RR = 0.93, 95% CI: 0.86–1.00, 5632 exposed cases) of breast cancer, respectively. The increased risk after hyperthyroidism was greater among postmenopausal women (RR = 1.19, 95% CI 1.09–1.30) and the decreased risk after hypothyroidism was more pronounced among premenopausal women (RR = 0.69, 95% CI 0.53–0.89). Among women with no prior history of thyroid disease, every 1 mIU/L increase in TSH level was associated with a 0.8% (95% CI > 0–1.5%) lower risk of breast cancer. In conclusion, this meta-analysis supports an association between thyroid hormone levels and breast cancer risk, which could be modified by menopausal status. [ABSTRACT FROM AUTHOR]

Objective: Thyroid cancers are on the rise, but the associated vital prognosis and long-term survival rates are very good. Therefore, treated patients' quality of life and psychological well-being are important considerations. The treatment usually involves surgery and radioactive iodine (radioiodine) ablation. This study aims to investigate potential effects of radioiodine ablation therapy on health-related quality of life, anxiety and depression symptoms, and nutritional status at 6 months post-therapy. Methods: This study included 136 patients diagnosed with thyroid cancer. Absorbed doses to the salivary glands were estimated from dosimeters worn by patients. Patient health-related quality of life, psychological status and nutritional status were assessed before and 6 months after therapy using standardized questionnaires (including SF-36, Hospital Anxiety and Depression (HAD) scale). Statistical analyses included random-effects logistic and linear regressions adjusted for potential confounders. Results: While no significant association was found between radioiodine exposure and anxiety or depression symptoms, or nutritional status, a significant increase in the SF-36 role physical sub- score was observed in relation with the salivary gland dose (β= 6.54, 95%CI 2.71;10.36 for a 1-Gy increase). Conclusions: The findings suggest an improved physical health-related quality of life, namely reduced pain and functional impairment, 6 months after radioiodine therapy in thyroid cancer patients. No significant association was found between radioiodine exposure and mental health-related quality of life, anxiety or depression scores nor nutritional status. This study does not provide any evidence that radioiodine therapy has a potentially adverse effect on patient health-related quality of life. [ABSTRACT FROM AUTHOR]

Context : Lymph node metastasis (N1) is a prognostic factor for disease recurrence in papillary thyroid carcinoma (PTC) patients. Skip metastasis is defined as only lateral N1 with negative central lymph nodes (LNs). Objective: The aim of this study was to explore the outcome of PTC patients with skip N1. Patients and design: All patients who underwent a total thyroidectomy with ipsilateral central and lateral LN dissection for PTC from 1999 to 2019 in a high-volume endocrine surgery centre were included in this study. Main outcome measure: Demographic and outcomes—recurrence and disease-specific survival (DSS)—were compared between three groups: N1a (central N1 only), N1b-CL (central and lateral N1), and N1b-Skip (lateral N1 without central LN involvement). Results: During the study period, 3046 patients had surgery for PTC, including 1138 with N1 (37%, 860 women, mean age: 44.8 years) comprising 474 N1a (42%), 513 N1b-CL (45%), and 151 N1b-Skip (13%). The median follow-up was 74 months (range 12–216 months). The recurrence rate in the N1b-Skip group was 13% (20/151) and 10% (47/474) in the N1a group. This was significantly lower than that in the N1b-CL group (27%, 140/513) (p < 0.0001). DSS at 10 years was 99% for group N1a, 98% for the N1b-CL, and 99% in the N1b-Skip group. Conclusion: The recurrence rate of N1b-Skip patients was lower than that of N1b-CL patients and similar to that of N1a patients. This result could be used as an indication for the modality of radioiodine therapy, and for the pattern of follow-up procedures. [ABSTRACT FROM AUTHOR]

• HPLC-MS/MS assay for palbociclib and ribociclib concomitant quantification in plasma. • Quantification of palbociclib exposure in patients with metastatic breast cancer. • Perspective therapeutic drug monitoring in patients treated with CDK4/6 inhibitors. • Impact of drug-drug interactions on palbociclib plasma concentration. The CDK4/6 inhibitors palbociclib and ribociclib are kinase inhibitors used in association with hormonal therapy for the management of patients with metastatic breast cancer. Like most kinase inhibitors, therapeutic drug monitoring may be used for personalize their dosage. To this aim, we developed and validated a sensitive and specific HPLC-MS/MS method for palbociclib and ribociclib quantification in blood samples. We then quantified exposure to palbociclib (plasma trough concentration; C trough) in a real-life cohort of patients with locally invasive or metastatic breast cancer (n = 18) at day 15 of the first cycle of palbociclib treatment to characterize palbociclib concentration at steady state (Clinicaltrials.gov identifier NCT04025541, IdRCB n° 2018-A00064-51, 03/07/2018). The geometric mean (± standard deviation [min-max]) of palbociclib plasma C trough was 88.58 ng/mL (± 26.4 [46.5 ng/mL – 133 ng/mL]) at day 15. Some covariates, such as drug-drug interactions, could explain the concentration variations observed in our Caucasian cohort. These first results in real-life settings obtained with our HPLC-MS/MS method give important information on palbociclib monitoring and pharmacokinetic variability. [ABSTRACT FROM AUTHOR]

The article discusses the use of stented aortic matrices for tracheal reconstruction in advanced thyroid cancer. The study reports on the outcomes of 12 patients who underwent this procedure and found it to be a safe and effective treatment option for previously unresectable malignancies. The patients had favorable long-term results with no tracheal recurrence and a good quality of life. However, the study acknowledges limitations such as a small sample size and a lack of comparison to non-surgical methods. The authors plan to conduct a larger, randomized trial in the future. [Extracted from the article]

Purpose: The coronavirus disease 2019 (COVID-19) pandemic reshaped the usual risk: benefit equilibrium that became a trade-off between the infection exposure risk for the patient (and for staff) and the risk associated with delaying or cancelling the nuclear medicine examination. This study aimed at quantifying the impact of the first COVID-19 lockdown in France on nuclear medicine examination volume together with volume of examination cancellation and non-attendance. Methods: We retrospectively assessed the volume of planned examinations from 1 month before to 1 month after the first lockdown in French high-volume nuclear medicine departments (NMD) sharing the same information management system including both university hospitals, UH (n = 7), and cancer centres, CC (n = 2). Results: The study enrolled 31,628 consecutive patients referred for a nuclear medicine examination performed or not (NMEP or NMEnP). The total volume of NMEP significantly dropped by 43.4% between the 4 weeks before and after the starting of the lockdown. The comparison of the percentage of NMEP and NMEnP between UH and CC is significantly different (p < 0.001). The percentage of NMEP during the study was 67.9% in UH vs 84.7% in CC. Percentages of NMEnP in UH and CC were due respectively to cancellation by the patient (14.9 vs 7.4%), cancellation by the NMD (9.5 vs 3.4%), cancellation by the referring physician (5.1 vs 4.4%) and non-attender patients (2.7 vs 0.2%). Conclusion: The study underlines the public health issue caused by COVID-19 above the pandemic itself and should be useful in preparing for potential resource utilisation and staffing requirements. [ABSTRACT FROM AUTHOR]

Purpose: To ensure the safe use of oral anticancer drugs, oncology pharmacy consultations (OPCs) have been established in France. They are conditioned by the needs, expectations, and involvement of the patients in their care. Thus, it is essential to elicit their preferences. The discrete-choice experiment (DCE) is a method recommended by the ISPOR for such a task. The “selection and validation of attributes and their values” step is fundamental in this process. In this context, the aim of this study was to present our research approach to identify and validate the attributes that characterize an OPC and their values. Methods: Due to the lack of relevant published data in the literature, the focus-group method was used in accordance with good research practices for the application of conjoint-analysis of the ISPOR. The two-round Delphi method was used to validate the attributes and their values identified by the focus-group method. Results: The focus-group method enabled identification of nine attributes. Thirty-seven healthcare professionals at a national level, including 30 pharmacists and seven physicians, were selected to take part in the Delphi procedure. Seven attributes (frequency, planification, operation mode, duration, content, written support, and report) and their values were thus validated. Conclusion: Based on these results, the next step will be to elicit patient preferences for OPCs and to then shed light on the issues of pharmaceutical support for patients by comparing their preferences with those of informal caregivers and, in particular, those of the healthcare professionals involved in their care. [ABSTRACT FROM AUTHOR]

Gastrointestinal angiodysplasia are the most common vascular lesions of the digestive tract. Risk factors include age, aortic stenosis (Heyde syndrome), chronic renal failure, cirrhosis and von Willebrandt's disease. Diagnosis is often made in the setting of occult or overt gastrointestinal bleeding. Due to their preferential location in the jejunum and colon, most lesions are diagnosed during upper endoscopy or colonoscopy. In cases where small bowel bleeding is suspected, capsule endoscopy is the gold standard diagnostic exam. A meta-analysis has recently shown that its diagnostic yield is optimal within 48 hours following an overt bleeding episode, and it is recommended to respect this time frame (European Guidelines). Capsule endoscopy is ideal in terms of patient tolerance. However, it is tedious and time-consuming to interpret and requires expertise. In the recent years artificial intelligence applied to capsule endoscopy has developed significantly. Its contribution is now major, with improved diagnostic yield and reduced interpretation time. Argon plasma coagulation during endoscopy is the first-line treatment for gastrointestinal angiodysplasia. Deep enteroscopy is the preferred procedure for ablation of small bowel angiodysplasia. Motorized spiral enteroscopy has enabled easier access to deep small bowel lesions and a shorter procedure time, since it was first used in 2016. However, it has been withdrawn from the market since July 2023, given the occurrence of serious adverse events (perforations). More centres should be equipped with double-ballon enteroscopes in France. The recent results from the randomized controlled OCEAN trial confirm that long-acting release somatostatin analogues (Octreotide) significantly reduce transfusion needs when endoscopic treatment has failed. Thalidomide is also an interesting treatment option, as demonstrated in a randomized control trial published in November 2023, with a reduced recurrence rate of bleeding after 4 months of treatment and during the following year. In the specific case of Heyde syndrome, percutaneous aortic valve replacement (TAVI) also reduces transfusion requirements. [ABSTRACT FROM AUTHOR]

In Europe, where marine envenomations are usually not severe, some rare stings may require medical management; for example, weever fish stings, inducing numerous marine envenomations on the European coasts (these accidents lead to frequent consultations during the summer season in the French poison centers). The authors report the case of a 37-year-old man, without a previous clinical history, who was treated in an emergency unit for a weever fish sting on the scalp after a headlong fall in the sand. This observation was characterized by the unusual localization of the venom injection, and by the clinical feature of persistence of symptoms despite therapeutic treatment. [ABSTRACT FROM AUTHOR]

Background: Understanding of changes in salivary and lacrimal gland functions after radioactive iodine therapy (131I-therapy) remains limited, and, to date, no studies have evaluated dose–response relationships between absorbed dose from 131I-therapy and dysfunctions of these glands. This study investigates salivary/lacrimal dysfunctions in differentiated thyroid cancer (DTC) patients six months after 131I-therapy, identifies 131I-therapy-related risk factors for salivary/lacrimal dysfunctions, and assesses the relationships between 131I-therapy radiation dose and these dysfunctions. Methods: A cohort study was conducted involving 136 DTC patients treated by 131I-therapy of whom 44 and 92 patients received 1.1 and 3.7 GBq, respectively. Absorbed dose to the salivary glands was estimated using a dosimetric reconstruction method based on thermoluminescent dosimeter measurements. Salivary and lacrimal functions were assessed at baseline (T0, i.e., immediately before 131I-therapy) and six months later (T6) using validated questionnaires and salivary samplings, with and without stimulation of the salivary glands. Statistical analyses included descriptive analyses and random-effects multivariate logistic and linear regressions. Results: There was no difference between T0 and T6 in the level of parotid gland pain, nor was there difference in the number of patients with hyposalivation, but there were significantly more patients with dry mouth sensation and dry eyes after therapy compared with baseline. Age, menopause, depression and anxiety symptoms, history of systemic disease, and not taking painkillers in the past three months were found to be significantly associated with salivary or lacrimal disorders. Significant associations were found between 131I-exposure and salivary disorders adjusted on the previous variables: for example, per 1-Gy increase in mean dose to the salivary glands, odds ratio = 1.43 [CI 1.02 to 2.04] for dry mouth sensation, ß = −0.08 [CI −0.12 to −0.02] mL/min for stimulated saliva flow, and ß = 1.07 [CI 0.42 to 1.71] mmol/L for salivary potassium concentration. Conclusions: This study brings new knowledge on the relationship between the absorbed dose to the salivary glands from 131I-therapy and salivary/lacrimal dysfunctions in DTC patients six months after 131I-therapy. Despite the findings of some dysfunctions, the results do not show any obvious clinical disorders after the 131I-therapy. Nevertheless, this study raises awareness of the risk factors for salivary disorders, and calls for longer follow-up. Clinical Trials Registration: Number NCT04876287 on the public website (ClinicalTrials.gov). [ABSTRACT FROM AUTHOR]

Viewing the landscape as a spatialized social-ecological system allows identification of specific management challenges: integration of multiple views, multiple levels of organization, complex spatial-temporal patterns and uncertainties. Multi-criteria assessments (MCAs), which allow the comparison of alternative actions when multiple interests collide, are considered adequate to support landscape management. However, there is no consensus about how they should be applied and can integrate both multiple views and spatial dimension. We conducted an extensive quantitative and qualitative literature review targeting MCAs with a participatory and spatial approach. Our results suggest that (1) for sustainability assessments, participatory and spatial approaches endorse different rationales and hybrid methods are not so common; (2) within those methods, only scenario-selection methods (as opposed to design methods) can integrate spatially-explicit, spatially-implicit, place-specific, and overall values; and (3) current applications, which aggregate values ignoring their spatial and social distribution, do not coincide with the nature of landscape-management challenges. In addition, they give little importance to the structuration of information and to collective deliberation. We conclude that, in the absence of a good match between spatiality and participation, MCAs should, for now, be handled as insightful but distorted tools to explore and structure landscape-level management problems. [ABSTRACT FROM AUTHOR]