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Pancreatic cancer is associated with a poor prognosis, mainly due to lymph node invasion and lymph node recurrence after surgical resection, even after extended lymphadenectomy. The peripancreatic lymphatic system is highly complex and the specific lymphatic drainage of each part of the pancreas has not been established. The aim of this study was to determine the lymphatic drainage pathways specific to each part of the pancreas on live pigs using Patent Blue. The pancreases of 14 live pigs were injected in different parts of the gland. The technique was efficient and reproducible. The diffusion patterns were similar for each location and were reported. Our results in pigs allowed us to define specific nodal relay stations and lymphatic drainage for each part of the pancreas and confirm that independent anatomical-surgical pancreatic segments can be described. It is interesting to note that lymphatic drainage for the upper part of the proximal part of pancreas (duodenal lobe) occurred on the left side of the portal vein. This suggests that lymph node resection during cephalic duodenopancreatectomy in humans should be extended to the left side of the mesenteric vein, and probably to the right side of the superior mesenteric artery, as recently suggested. These results could help surgeons perform safe anatomical-segmental pancreatic resections with accurate lymphadenectomies and improve survival in patients with pancreatic cancer. Based on these results we will perform an innovative prospective study. Patent Blue will be injected into different parts of the gland in patients operated for pancreatic resection, and lymphatic diffusion of the dye will be recorded in relation to their origin from the theoretical pancreatic segments (ClinicalTrials.gov Identifier: NCT03597230). [ABSTRACT FROM AUTHOR]

Background & Aim Some aspects of human embryogenesis and organogenesis remain unclear, especially concerning the development of the liver and its vasculature. The purpose of this study was to investigate, from a descriptive standpoint, the evolutionary morphogenesis of the human liver and its vasculature by computerized three-dimensional reconstructions of human embryos. Material & Methods Serial histological sections of four human embryos at successive stages of development belonging to three prestigious French historical collections were digitized and reconstructed in 3D using software commonly used in medical radiology. Manual segmentation of the hepatic anatomical regions of interest was performed section by section. Results In this study, human liver organogenesis was examined at Carnegie stages 14, 18, 21 and 23. Using a descriptive and an analytical method, we showed that these stages correspond to the implementation of the large hepatic vascular patterns (the portal system, the hepatic artery and the hepatic venous system) and the biliary system. Conclusion To our knowledge, our work is the first descriptive morphological study using 3D computerized reconstructions from serial histological sections of the embryonic development of the human liver between Carnegie stages 14 and 23. [ABSTRACT FROM AUTHOR]

Objectives: To develop a reliable and validated tool to evaluate technical resuscitation skills in a pediatric simulation setting.Study Design: Four Resuscitation and Emergency Simulation Checklist for Assessment in Pediatrics (RESCAPE) evaluation tools were created, following international guidelines: intraosseous needle insertion, bag mask ventilation, endotracheal intubation, and cardiac massage. We applied a modified Delphi methodology evaluation to binary rating items. Reliability was assessed comparing the ratings of 2 observers (1 in real time and 1 after a video-recorded review). The tools were assessed for content, construct, and criterion validity, and for sensitivity to change.Results: Inter-rater reliability, evaluated with Cohen kappa coefficients, was perfect or near-perfect (>0.8) for 92.5% of items and each Cronbach alpha coefficient was ≥0.91. Principal component analyses showed that all 4 tools were unidimensional. Significant increases in median scores with increasing levels of medical expertise were demonstrated for RESCAPE-intraosseous needle insertion (P = .0002), RESCAPE-bag mask ventilation (P = .0002), RESCAPE-endotracheal intubation (P = .0001), and RESCAPE-cardiac massage (P = .0037). Significantly increased median scores over time were also demonstrated during a simulation-based educational program.Conclusions: RESCAPE tools are reliable and validated tools for the evaluation of technical resuscitation skills in pediatric settings during simulation-based educational programs. They might also be used for medical practice performance evaluations. [ABSTRACT FROM AUTHOR]

Spontaneous intracranial hypotension (SIH) is a well-known, but under- or misdiagnosed, condition caused by cerebrospinal fluid leak resulting from idiopathic dural breach. Blind lumbar epidural blood patch is an effective treatment in most cases, but occasionally, even targeted epidural blood patch fails to lead to improvement. In these cases, the cerebrospinal fluid leak is usually repaired surgically, especially for large dural breaches (>5 mm), once the site has been identified by imaging techniques (magnetic resonance myelography/computed tomography [CT] myelography/isotopic transit). We describe a less invasive percutaneous technique consisting of direct puncture into the epidural space with a 25-G needle to access the injection site under CT control. We report 2 cases with good technical and clinical outcome after 1 and 8 years of follow-up (clinical evaluation and brain imaging control by CT). The technique we describe here is of high interest in refractory SIH or for the serious form of the disease, before considering surgical repair. Further prospective studies are required to provide general guidelines in treatment options for patients with SIH. [ABSTRACT FROM AUTHOR]

Résumé: Au cours de la maladie d’Alzheimer (MA), l’incapacité à maîtriser la dimension temporelle de la vie quotidienne est une source majeure de handicap. En l’absence d’outil validé existant, la présente recherche vise à contribuer à la compréhension des troubles de l’appropriation de la temporalité de la vie quotidienne chez une population de patients aux stades légers à modérés de la MA. Pour ce faire, nous avons élaboré puis administré une batterie de 12 estimations de durée de tâches quotidiennes à 440 témoins et 22 patients. Cette tâche apparaît préservée et indépendante chez les patients des processus cognitifs évalués, dont ceux impliqués par le test de l’horloge. La dépression n’influence pas cette estimation de durée. Ce type d’estimation de durée met en jeu des processus cognitifs préservés liés à la mémoire procédurale des scripts sur lesquels une approche de réhabilitation ultérieure pourrait se fonder. [ABSTRACT FROM AUTHOR]

Abstract: Brain imaging studies have revealed frontal disruption during aging and parieto-temporal disruption during Alzheimer’s disease (AD). The present study aims at developing a specific method based on precise anatomical landmarks for assessing the integrity all along the course of the cingulum bundle, so as to determine if it presents the classical aging and AD dissociation. Five regions of interest (ROIs) were placed on fractional anisotropy (FA) maps all along the cingulum in 15 young (Gyoung), 15 70-year-old (Gold), and 15 AD subjects (Galz). An age-related decrease of FA occurred in the anterior part of the bundle. Moreover, a specific alteration of the supero-posterior region of the cingulum during AD was observed since mean FA values as well as mean number of fibers were significantly decreased in Galz compared to Gold and Gyoung. This multiple ROIs placement allows for revealing distinctive alterations of the cingulum bundle during aging and AD, which could constitute the anatomical basis for the distinctive functional disconnection recently described in the literature using functional connectivity at rest. [Copyright &y& Elsevier]

Background Syringomyelia due to intracranial hypotension is rarely described. As a consequence, intracranial hypotension is less recognized as a potential cause of syringomyelia or mistaken with Chiari type 1 malformation. The pathogeny is poorly understood, and we lack diagnostic and therapeutic strategies for this particular setting. Case Description We describe a 45-year-old patient who developed syringomyelia after about 10 years of undiagnosed intracranial hypotension caused by traumatic C6 cerebrospinal fluid (CSF) leak. Surgical closing of the leak was required to treat intracranial hypotension after failure of conservative measures and blind epidural patches. It led to a marked improvement of cerebral and spinal signs. We discuss the pathogeny of syringomyelia caused by intracranial hypotension and highlight a mechanical theory of hyperpressure against the cervical spine due to blockage of CSF flow by descent of cerebellar tonsils at the foramen magnum level. We describe discriminating clinical and radiologic signs to differentiate intracranial hypotension from Chiari type 1 malformation and discuss mechanisms and causality relating trauma and intracranial hypotension. Conclusions Syringomyelia can be a consequence of long-term progression of intracranial hypotension, which must be differentiated from Chiari type 1 malformation. In our case, resolution was achieved by detecting and closing the CSF leak causing the intracranial hypotension. Reports of similar cases are necessary to understand the origin of CSF leak in traumatic intracranial hypotension and assess the best therapeutic strategy. [ABSTRACT FROM AUTHOR]