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Il existe une grande variété de dysfonctions sexuelles (DS) chez les patients atteints de pathologies neurologiques. L'objectif de notre étude était de rapporter une mise au point sur les DS chez ces patients. Une revue de la littérature a été réalisée sur la base de données PubMed en novembre 2023 en utilisant les mots clés « sexuality », « male infertility » et « erectile dysfunction » associés aux mots clés « neurological », « spinal dysraphism », « spinal cord injury » « multiple sclerosis » et « Parkinson's disease ». Les DS sont classées en dysfonctions primaires (liées à l'atteinte du système nerveux altérant la réponse sexuelle), secondaires (liées à l'atteinte physique) ou tertiaires (liées aux troubles psychosociaux). La prise en charge doit être pluridisciplinaire et concerner l'ensemble de ces types de dysfonction. Pour les troubles du désir, des traitements hormonaux substitutifs ainsi que des psychothérapies pourront être proposés (hors AMM chez la femme). En cas de dysfonction érectile, le même panel de thérapeutique que chez l'homme non neurologique est possible. En cas de trouble de l'excitation chez la femme, des IPDE5, des lubrifiants pouvant être associés à des vibreurs ont montré leur efficacité. En cas de troubles de l'éjaculation, un traitement par midodrine et une prise en charge en centre de PMA peuvent être proposés. Les DS du patient neurologique sont à évaluer de façon pluridisciplinaire afin d'améliorer la qualité de vie des patients et de leur proposer une prise en charge adaptée à la pathologie neurologique. There are a wide variety of sexual dysfunctions (SD) in patients with neurological diseases. The aim of our study was to report an update on SD in these patients. A literature review was conducted on the PubMed database in November 2023 using keywords "sexuality", "male infertility" and "erectile dysfunction" associated with the keywords "neurological", "spinal dysraphism", "spinal cord injury", "multiple sclerosis", and "Parkinson's disease". SD are classified as primary dysfunctions (related to the involvement of the nervous system altering the sexual response), secondary (related to physical impairment) or tertiary (related to psycho-social disorders). Management must be multidisciplinary and concern all these types of dysfunction. For desire disorders, hormonal substitution treatments and psychotherapies may be offered. In case of erectile dysfunction, the same panel of therapeutics as in non-neurological patients is possible. In case of excitation disorder in women, IPDE5 and lubricants that can be associated with vibrators have shown their effectiveness. In case of ejaculation disorders, treatment with midodrine and treatment in a PMA center can be offered. The SD of the neurological patient are to be evaluated in a multidisciplinary way in order to improve the quality of life of the patients and to propose them a management adapted to the neurological pathology. [ABSTRACT FROM AUTHOR]

Copyright of Revista Española de Cardiología (18855857) is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Española de Cardiología (18855857) is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

• DD is frequent in patients with SAS, despite no or mild AS-related symptoms. • ASE/EACVI DD grades are associated with mortality in these patients. • PALS ≤ 14% refines the prognostic value of DD grades. • Patients with grade III or grade II DD and PALS ≤ 14% have a high mortality risk. • A comprehensive assessment of diastolic function is needed in patients with SAS. Diastolic dysfunction (DD) is common in severe aortic stenosis (AS) and preserved left ventricular ejection fraction (LVEF ≥ 50%). To determine the impact of American Society of Echocardiography/European Association of Cardiovascular Imaging-recommended DD grading and left atrial strain on mortality in a cohort of patients with severe AS and preserved LVEF. We studied patients with severe AS (aortic valve area indexed < 0.6 cm2/m2 and/or aortic valve area < 1 cm2), LVEF ≥ 50% and no or mild AS-related symptoms. The endpoint was all-cause mortality. A total of 387 patients (median age 76 years; 53% women) were studied. During a median follow-up of 57 (interquartile range 37; 83) months, 158 patients died. After adjustment for prognostic factors, patients with grade II or III DD had an increased mortality risk versus patients with grade I DD (adjusted hazard ratio (aHR) 1.62, 95% confidence interval (CI) 1.11–2.38; P = 0.013; aHR 4.73, 95% CI 2.49–8.99; P < 0.001; respectively). Adding peak atrial longitudinal strain (PALS) ≤ 14% to a multivariable model including DD grade improved predictive performance, with better global model fit, reclassification and discrimination. Patients with grade III DD or grade II DD + PALS ≤ 14% displayed an increased mortality risk versus patients with grade I DD + PALS > 14% (aHR 4.17, 95% CI 2.46–7.06; P < 0.0001). Those with grade I DD + PALS ≤ 14% or grade II DD + PALS > 14% were at intermediate risk (aHR 1.63, 95% CI 1.07–2.49; P = 0.024). Our results demonstrate the strong relationship between DD and mortality in patients with severe AS and preserved LVEF. Patients with grade III or grade II DD and impaired PALS are at very high risk. These data demonstrate the importance of a comprehensive assessment of diastolic function in patients with severe AS. [ABSTRACT FROM AUTHOR]

This study aimed to estimate the direct medical costs due to hospitalizations by COVID-19 in Colombia and to identify their cost drivers in Colombia. This is a retrospective cost-of-illness study of COVID-19 in Colombia. We estimated direct medical costs using data from patients insured to a Benefit Plan Administrator Company, between March 15, 2020 and May 29, 2020. Absolute and relative frequencies, averages, medians, and interquartile ranges (IQRs) were used to characterize the population and estimate the costs of hospitalized patients with COVID-19. We stratified the cost analysis by sex, age groups, comorbidities, and type of hospitalization (general ward and intensive care unit [ICU]). Cost drivers were calculated from a generalized linear model. We studied 113 confirmed patients, 51.3% men. On average, the hospital length of stay was 7.3 (± 6.2) days. A person hospitalized with COVID-19 reported median costs of $1688 (IQR 788-2523). In women, this cost was $1328 (IQR 463-2098); in men, this was 1.4 times greater. The median cost for ICU was $4118 (IQR 2069-5455), 3 times higher than those hospitalized only in the general ward. Admission to the ICU, having 1 comorbidity, length of stay, high blood pressure, having 5 comorbidities, and being treated in the city of Cartagena were statistically significant with direct medical costs. Our study provides an idea of the magnitude of costs needed to hospitalize a COVID-19 case in Colombia. Other studies in Colombia have assessed the costs of hospitalization for infectious diseases such as influenza, costs significantly lower than those described here. [ABSTRACT FROM AUTHOR]

Background: A high level of anti-BP180 antibodies on enzyme-linked immunosorbent assay and a persistent positive direct immunofluorescence at the end of treatment (immunologic tests, [ITs]) are predictors of relapse after treatment cessation (TC) in patients with bullous pemphigoid.Objective: To evaluate the real-life impact of the immunologic-based decision of TC on the 3- and 6-month relapse rates after TC in bullous pemphigoid.Methods: Retrospective multicentric study included patients followed almost 6 months after TC. Patients were classified according to whether the TC decision was in accordance with the results of ITs performed during the 3 months before TC, despite the results of ITs or without ITs performed.Results: We included 238 patients. Three months after TC, 36 patients showed relapse: 14 of 95 patients with TC in accordance with IT results (14.7%); 5 of 21 with TC despite ITs (23.8%); and 17 of 122 with TC without ITs (13.9%; P = .5). Six months after TC, the relapse rate was 18.9%, 28.6%, and 18.9% (P = .56), respectively, in the 3 groups.Limitations: The retrospective design and the limited follow up.Conclusion: In real-life practice, in bullous pemphigoid, the 3- and 6-month relapse rates were not significantly reduced with TC decision based on results of ITs as compared with a classic clinical-based decision. [ABSTRACT FROM AUTHOR]

Background: Danon disease (DD) is a rare X-linked dominant cardioskeletal myopathy caused by mutations in the lysosome-associated membrane protein-2 (LAMP-2) gene that is usually lethal without cardiac transplantation. The purpose of this study was to characterize post-transplant outcomes in a large cohort of patients with DD who underwent cardiac transplantation.Methods: The clinical phenotype and outcome data of patients with DD who underwent cardiac transplantation (n = 38; 19 males and 19 females) were obtained from 8 centers. Study outcomes included graft survival, defined as death or retransplantation, and episodes of acute cellular and antibody-mediated rejection and cardiac allograft vasculopathy at 1 year.Results: Median follow-up time after transplantation for the entire cohort was 4.4 years (IQR: 1.5-12.8 years). The median age at transplant for the cohort was 20.2 years (15.8-27.9 years), with no difference in age between sexes. Median pretransplant left-ventricular ejection fraction for the entire cohort was 30% (range 11%-84%). Males had higher pretransplant aspartate aminotransferase, alanine aminotransferase and creatine phosphokinase levels than females (P < 0.001). There were 2 deaths in the entire cohort and 2 retransplants. There was no difference in actuarial graft survival between males and females (P = 0.8965); the estimated graft survival was 87.1% (95%CI: 63.6%-95.9%) at 5 years. One episode (2.7%) of antibody-mediated rejection, grade 2, and 7 episodes (19%) of acute cellular rejection, grade 2 or 3, were reported in patients who survived to discharge (6 females and 1 male; P = 0.172).Conclusions: Heart transplantation outcomes are acceptable in DD with high probabilities of 5-year graft survival for males and females suggesting that cardiac transplantation is an effective treatment option for DD patients. [ABSTRACT FROM AUTHOR]

Chromium (III) tanned leather wastes were used to obtain gelatin, which was applied as a coating material for the synthesis of controlled urea release hydrogels. It was found that the hydrogel released its total urea content in 120 h in aqueous solution and that it promoted a significant difference in the growth of arugula seedlings. When compared with commercial gelatin, the hydrogels based on gelatin extracted from tannery waste had similar behavior, especially in the way urea was diffused to the external environment of the controlled release system, it can be characterized as a material of non-Fickian behavior during the swelling process and later, as a Fickian behavior, when it begins its process of degradation of the polymer matrix. In this way, this work demonstrates that it is possible to value a waste to obtain tools to promote a more sustainable agriculture. [Display omitted] • Use of a solid waste containing chromium (III) for a fertilizer hydrogel synthesis. • Promotion of circular economy by transform the waste into a new product. • Hydrogel coated with gelatin extracted from leather waste have the same behavior as those coated with commercial gelatin. • Hydrogel is a way to minimize nitrogen losses. [ABSTRACT FROM AUTHOR]

Limited aerobic capacity, low exercise tolerance, and frailty are highly prevalent in patients awaiting heart transplantation (HT) and tightly related to negatively impacting postoperative outcomes and healthcare resource consumption. Prehabilitation (prehab) has shown efficacy in improving functional status and preventing postoperative complications in selected high-risk surgical populations. However, the implementation of these programs feasibility and efficacy has not been evaluated in advanced heart failure patients. Prehab could be health resource-consuming and represent an economic burden. This study aimed to investigate the impact of prehab on HT postoperative outcomes and to evaluate the cost-effectiveness of a multimodal prehab program for HT candidates. Single-centre, ambispective cohort study including forty-six candidates for elective HT from 2017 to 2021 attending a multimodal prehab program (intervention) consisting of supervised exercise training, physical activity promotion, nutritional optimization, and psychological support. The postoperative outcomes and total cost of the prehab program (n=31) were compared with a group of twelve contemporaneous patients who did not join the program and those transplanted from 2014 to 2017 before the implementation of the program (n=51). Main postoperative measured outcomes: Comprehensive Complication Index (CCI), mechanical ventilation time, total hospitalization and intensive care length-of-stay, destination at discharge (home vs. rehabilitation facility), hospital readmissions at 30 days, and mortality at 30-days, 3-months, and 1-year. A prehab program cost analysis was performed. Healthcare use included HT surgical procedures, direct hospitalization (until discharge), and prehab costs. Data were obtained through micro-costing techniques according to resource use, combined with diagnostic-related centre-specific hospital fees. A bootstrapping approach was performed to control the skewness of the distribution. Thirty-one prehab patients underwent HT. Their postoperative outcomes were compared to the previously described control group. Significant improvements were observed in functional capacity (endurance time: 293 vs. 632s, p<0.001) and quality-of-life (Minnesota score: 58 vs. 47, p=0.046) after prehab. No exercise-related events were registered. Five candidates were eventually removed from the waitlist due to significant functional capacity improvement after prehab. Prehab cohort showed a lower rate and severity of postoperative medical complications (CCI 37 vs. 31, p=0.033), lower mechanical ventilation time (37 vs. 20 hours, p=0.032), ICU stay (7 vs. 5 days, p=0.01), total hospitalization stay (23 vs. 18 days, p=0.008) and less need for transfer to nursing/rehabilitation facilities after hospital discharge (31% vs. 3%, p=0.009). The mean cost per prehab program patient was 2,195€ mainly driven by supervised exercise training (1,971€). The healthcare-related mean cost for the HT index hospitalization, including the cost of the prehab program, did not show differences between groups (prehab: 56,503€ vs. control: 66,556€; p=0.12). The difference in costs was only statistically significant when removing the outliers from the analysis. Our findings support the beneficial impact of a multimodal prehabilitation intervention in the short-term postoperative outcomes of HT recipients without increasing direct healthcare costs, which may be interpreted as evidence of higher value for money (cost-effective intervention). [ABSTRACT FROM AUTHOR]

Objective: To evaluate the uptake of perinatal HIV preventive interventions by the risk of perinatal HIV transmission in mother-infant pairs in a high-HIV prevalence area in the US.Study Design: This was a retrospective cohort study of mother-infant pairs with perinatal HIV exposure during 2013-2017 managed at a subspecialty pediatric HIV program in Washington, DC. We collected demographic data, maternal HIV history, delivery mode, maternal and infant antiretroviral drug (ARV) use, and infant HIV test results. We compared the uptake of recommended preventive interventions in low-risk (ie, mothers on antiretroviral therapy [ART] with viral suppression) and high-risk (mothers without ART or viral suppression) mother-infant pairs using the Pearson chi-square, Fisher exact, and Wilcoxon rank-sum tests and logistic regression.Results: We analyzed 551 HIV-exposed infants (HEIs) and 542 mothers living with HIV. The majority of mothers received ARVs (95.5%), had HIV RNA ≤1000 copies/mL before delivery (81.9%), and received intrapartum zidovudine (ZDV; 65.5%). The majority of all HEIs were low risk (82.6%) and received postpartum ARVs (98.9%). Among the low-risk infants, 53.2% were delivered via cesarean delivery (CD), and 62.9% and 96.5% were administered intrapartum and postpartum ZDV, respectively. Among high-risk infants, 84.4% were delivered via CD, 78.1% received intrapartum ZDV, and 62.5% received combination ART. Nine high-risk infants acquired HIV perinatally.Conclusion: In an area of high HIV prevalence in the US, a large proportion of low-risk HEIs received intrapartum ZDV and were delivered via CD. We also observed missed opportunities for the prevention of perinatal HIV transmission. [ABSTRACT FROM AUTHOR]

Patients with neurogenic bowel dysfunction (NBD) suffer severe constipation and/or fecal incontinence that are very difficult to treat. Most medication-based and interventional treatments have been unsuccessful. The goal of this study was to assess the medium-term effectiveness of the Malone procedure in all patients with NBD, as an alternative to colostomy. In this retrospective single-center study, 23 patients who underwent Malone's surgical treatment were analyzed. The main criteria were the usage of antegrade colonic enemas (ACE) after Malone's procedure at the most recent follow-up and comparison of quality of life scores before and after surgery. The post-procedure mortality was zero, but an overall morbidity of 60% was observed, including minor complications (Clavien 1, 2) in 56%. The median follow-up was 33 months. At the most recent follow-up, the utilization rate of the neo-appendicostomy for ACE was 69.6%; 76.9% of the patients using ACE reported improvement in quality of life scores. Secondary colostomy was performed in 21.7% for functional failure of the Malone procedure. The Malone procedure is a reliable technique that can be used in the therapeutic strategy for managing NBD patients with incontinence/constipation refractory to usual treatments. It should be considered as a therapeutic step to take before resorting to colostomy. [ABSTRACT FROM AUTHOR]

To evaluate intra-abdominal pressure changes during hip arthroscopy and define its relationship with other patient related variables. A prospective multicenter study evaluating intra-abdominal pressure (IAP) in patients undergoing arthroscopic treatment of femoroacetabular impingement was performed. The IAP was measured indirectly by a bladder catheter (AbViser Autovalve Intra-abdominal pressure monitor) and documented every 30 minutes during the entire procedure. The following risk factors were analyzed: traction time, duration surgery, previous abdominal surgery, capsule repair, psoas tenotomy, and surgical approach. One hundred and five patients with symptomatic femoroacetabular impingement that underwent hip arthroscopy met the inclusion criteria. There were significant differences in the IAP between the preoperative measurement of IAP and the IAP at different time points during surgery (P <.01). The IAP increased continuously from the commencement of surgery (considered as time point from portal establishment) until the first 60 minutes. After first 60 minutes of surgery, the IAP did not increase significantly. There were no significant associations between increased IAP and the risk factors analyzed. IAP increases significantly during the first 60 minutes of hip arthroscopy; it then stabilizes for the duration of surgery before decreasing just after the completion of surgery. The highest recorded IAP was not associated with additional complications. No symptomatic intra-abdominal hypertension was documented. Finally, patient- and procedure-specific risk factors did not predict changes in IAP. Systemic monitoring of IAP during the hip arthroscopy procedure can easily and effectively be done, allowing the surgeon to early detect any significant change. Level IV, therapeutic case series. [ABSTRACT FROM AUTHOR]

The anaerobic digestion sector is undergoing worldwide expansion, and alternatives of using digestate as substrate for microalgae cultivation in order to improve the profitability and environmental impact of biogas plants are important. This work investigates the feasibility of growing Arthrospira platensis (A. platensis) on diluted liquid anaerobic digestates using geothermal water (GW) as alternative source of water. To this purpose, digestates from four industrial biogas plants were collected and used to carry out A. platensis cultivation assays. In the first part of the study, a screening experiment was performed to determine the ideal dilution factor suitable for A. platensis growth using each individual anaerobic digestate diluted with demineralized water (DW). Depending on the type of digestate, the most appropriate dilution factors ranged from 2× to 60× corresponding to optimal initial ammonium and turbidity values of 40–95 mgN.L−1 and 10–70 NTU, respectively. These dilution factors were consequently used to investigate the opportunity to substitute DW by GW for the culture of A. platensis. No significant changes were observed in the growth profiles when DW was replaced by GW for the four digestates tested. Regarding the final concentration reached by the different digestates, values ranged from 0.58 to 0.77 g dry matter.L−1 with DW as compared to values from 0.53 to 0.66 g dry matter.L−1 with GW. Experimental findings also showed the strong nutrient bioremediation potential of A. platensis culture, with removal efficiencies ranging from 96 to 97 %, 78 to 100 %, 45 to 66 % for N-NH 4 +, P-PO 4 3− and K+, respectively. These promising results indicate that geothermal water could be used as substitute to fresh water for diluting anaerobic digestates and cultivating A. platensis , in a more sustainable way compared to conventional culture approaches using fresh water. [Display omitted] • Four anaerobic liquid digestates were used as culture media for A. platensis growth. • Dilution of anaerobic digestates with geothermal water was investigated. • No changes in growth profiles were observed when geothermal replaced demineralized water. • Up to 97 % of N-NH 4 +, 100 % of P-PO 4 3− and 66 % of K+ were removed from the digestates. [ABSTRACT FROM AUTHOR]

Copyright of Revista Española de Cardiología (18855857) is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Background Essential tremor (ET) is one of the most common movement disorders of adults, characterized by postural and kinetic tremor. With drug treatment only partially efficient, new treatments are being developed. Objectives The goal of this study was to demonstrate the feasibility of non-thermal focused-ultrasound (FUS) to induce tremor-suppression in an ET rat model. Methods Harmaline-induced tremor rats were treated with FUS along the inferior olivary (IO) system. EMG was recorded continuously during treatment in order to quantify FUS-induced tremor suppression. T2-weighted MRI was performed immediately following treatment and periodically thereafter. Results FUS treatment at an intensity of 27.2 W/cm2 (Isppa) induced significant reduction of tremor in 12 out of 13 ET rats. Tremor frequency was reduced from 6.2 ± 2.8 to 2 ± 1 Hz, p < 0.0003. In 6 of the 12 responding rats, tremor was completely suppressed. Response duration was 70 ± 61s, on average. FUS induced motor response, depicted as movement of the tail and/or the limbs synchronized with the FUS sonication, was also demonstrated both in ET rats and in naïve rats when treated in the medulla oblongata region. Conclusions These results demonstrate the feasibly for obtaining significant tremor reduction or tremor suppression induced by non-thermal, non-invasive, reversible focused-ultrasound. Highlights • Non-thermal focus ultrasound (FUS) was applied to tremoring rats. • Non-thermal focus ultrasound reduced Harmaline-induced tremor in 12/13 rats. • In 6 of the 12 responding rats, tremor was completely suppressed by FUS. • Treatment duration was 52 s whole response duration was 70 ± 61 s on average. • FUS induced motor response synchronized with the FUS sonication. [ABSTRACT FROM AUTHOR]

Abstract Several typologies of urban surface properties have been proposed, in recent years, for urban heat island studies and climate modeling. Some were specifically developed for cities and urban climate issues, like the Urban Climate Zones, and the more recent Local Climate Zones. The initial objective of this paper is to evaluate the capacity of these two typologies to identify thermal environments in and around cities, and to determine which typology best captures the daily spatio-temporal patterns of surface and urban canopy heat islands. To simulate urban climate with a model, LULC data based on a given typology are required. To avoid circularity, we combined the Corine Land Cover database, with data for the whole of Europe, and the BD TOPO database, for France, to form a new tool, CLC_USGS, which we used as input for the WRF limited-area model, with a 150-m grid resolution. The capacity of each typology to identify coherent thermal zones was estimated for Dijon, a medium-sized French city, during a three-week heat wave, over a 24-hour period, in conditions favorable to urban heat island development. The comparison was based on hourly air temperatures directly output from the WRF model, those obtained from the purpose-built MUSTARDijon 47-sensor meteorological network, and NDVI values and land surface temperatures estimated from Landsat images for 11 July 2015 at 1030 UTC. Typical diurnal variations and spatial contrasts of surface and air temperatures were identified in both simulations and observations. As both typologies show significant capacity for identifying thermally coherent intra-urban areas, this study suggests that they could both be useful for urban climate applications. The typology that is most generally applicable in worldwide contexts is Local Climate Zones. [ABSTRACT FROM AUTHOR]

Settled dust can function as a pollutant sink for compounds, such as polycyclic aromatic hydrocarbons (PAHs) and metal(loid)s (MMs), which may lead to health issues. Thus, dust represents a hazard specifically for young children, because of their vulnerability and hand-to-mouth behavior favoring dust ingestion. The aim of the present study was to explore the influence of the season and the microenvironment on the concentrations of 15 PAHs and 17 MMs in indoor and outdoor settled dust in three preschools (suburban, urban, and industrial). Second, the potential sources and health risks among children associated with dust PAHs and MMs were assessed. Third, domestic factors (risk perception, knowledge and parental style) were described to explore protective parental behaviors toward dust hazards. The suburban preschool had the lowest concentrations of dust PAHs and MMs, while the industrial and urban preschools had higher but similar concentrations. Seasonal tendencies were not clearly observed. Indoor dusts reflected the outdoor environment, even if specific indoor sources were noted. Source analysis indicated mainly vehicular emissions, material release, and pyrogenic or industrial sources. The non-cancer health risks were non-existent, but potential cancer health risks (between 1.10−6 and 1.10−4) occurred at all sampling locations. Notably, the highest cancer risk was observed in a playground area (>1.10−4) and material release should be further addressed. Whereas we assessed higher risk indoors, parents perceived a higher risk in the open-air environment and at the preschool than at home. They also perceived a lower risk for their own children, revealing an optimism bias, which reduces parental anxiety. [Display omitted] • Dust PAHs and metal(loid)s content varied spatially, but little seasonally. • Input of PAHs and metal(loid)s was higher in industrial or urban schools. • PAHs and metal(loid)s came mainly from materials, industry, and traffic. • Playground areas had unacceptable levels of cancer risk due to metal(loid)s. • Parents believed the risk of exposure was higher in open air situation than indoor. [ABSTRACT FROM AUTHOR]

Highlights • Standard tests and protocols are recommended for studying chemobrain in animals. • Preclinical research is needed into non-cognitive factors (e.g., stress) in chemobrain. • Animal models of chemobrain must take into account the effects of drugs and disease. • Identifying biological and cognitive mechanisms is a priority for chemobrain research. • Preclinical research has a role in developing treatment programs for chemobrain. Abstract Cancer survivors who undergo chemotherapy for non-CNS tumours often report substantial cognitive disturbances that adversely affect quality of life, during and after treatment. The neurotoxic effects of anti-cancer drugs have been confirmed in clinical and pre-clinical research. Work with animals has also identified a range of factors and underlying mechanisms that contribute to chemotherapy-induced cognitive impairment. However, there is a continuing need to develop standard cognitive testing procedures for validation and comparison purposes, broaden the search for biological and neurochemical mechanisms, and develop improved animal models for investigating the combined effects of treatment, the disease, and other potential factors (e.g., age, stress). In this paper, a working group, formed under the auspices of the International Cognition and Cancer Task Force, reviews the state of pre-clinical research, formulates strategic priorities, and provides recommendations to guide animal research that meaningfully informs clinical investigations. [ABSTRACT FROM AUTHOR]

Objective When treated with anticancer therapies, a number of issues are raised for older patients such as physical needs (coping with symptoms and side-effects) or psychological needs. Geriatric tailored interventions addressing these needs may be effective in terms of improving quality of life of our patients. Methods A systematic review was performed in September 2017 in MEDLINE. All reports assessing older patients with cancer care needs in the context of anticancer systemic therapy were reviewed. Results A total of 357 articles were analyzed. From these, 35 studies were included in the analysis. Compared to younger patients, the elderly had less supportive care needs. While older patients asked for less information than their younger counterparts, they still requested information on diagnosis, seriousness of the disease, chances of cure, spread of the disease, recovery, courses of illness, possible consequences, treatment procedures, treatment options, possible side effects and how to deal with them, and what they could do in daily life. When taking into consideration the various needs as assessed by the “Supportive Care Needs Survey”, physical and daily living were the most frequently reported needs with emphasis on nutrition, coping with physical symptoms, dealing with side effects of treatment, and performing usual physical tasks and activities. Conclusion Information demand seemed moderate but a great deal of attention was paid to nutrition and well-being. [ABSTRACT FROM AUTHOR]

Background: Whether echocardiography platform and analysis software impact left ventricular (LV) volumes, ejection fraction (EF), and stroke volume (SV) by transthoracic tridimensional echocardiography (3DE) has not yet been assessed. Hence, our aim was to compare 3DE LV end-diastolic and end-systolic volumes (EDV and ESV), LVEF, and SV obtained with echocardiography platform from 2 different manufacturers.Methods: 3DE was performed in 84 patients (65% of screened consecutive patients), with equipment from 2 different manufacturers, with subsequent off-line postprocessing to obtain parameters of LV function and size (Philips QLAB 3DQ and General Electric EchoPAC 4D autoLVQ). Twenty-five patients with clinical indication for cardiac magnetic resonance imaging served as a validation subgroup.Results: LVEDV and LVESV from 2 vendors were highly correlated (r = 0.93), but compared with 4D autoLVQ, the use of Qlab 3DQ resulted in lower LVEDV and LVESV (bias: 11 mL, limits of agreement: -25 to +47 and bias: 6 mL, limits of agreement: -22 to +34, respectively). The agreement between LVEF values of each software was poor (intraclass correlation coefficient 0.62) despite no or minimal bias. SVs were also lower with Qlab 3DQ advanced compared with 4D autoLVQ, and both were poorly correlated (r = 0.66). Consistently, the underestimation of LVEDV, LVESV, and SV by 3DE compared with cardiac magnetic resonance imaging was more pronounced with Philips QLAB 3DQ advanced than with 4D autoLVQ.Conclusions: The echocardiography platform and analysis software significantly affect the values of LV parameters obtained by 3DE. Intervendor standardization and improvements in 3DE modalities are needed to broaden the use of LV parameters obtained by 3DE in clinical practice. [ABSTRACT FROM AUTHOR]

Copyright of Archives of Cardiovascular Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Archives of Cardiovascular Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction Pancreatic adenocarcinoma affects mainly older patients. Surgery is indicated for localized tumors while chemotherapy alone is proposed in advanced or metastatic tumors. Objective To evaluate the feasibility of standard of care oncologic treatments in this population, the accuracy of the geriatric evaluation to predict the ability of patients to tolerate the recommended treatments and to identify specific geriatric prognosis factors. Methods We included, between 2007 and 2014, all consecutive patients over 70 years of age with a pathologically diagnosed pancreatic cancer. The patients underwent a comprehensive geriatric assessment before therapeutic decision in a multidisciplinary team meeting. We analyzed factors independently associated with all-cause mortality with Cox survival analysis. Results Seventy-three patients (median age = 77.9 years) were prospectively included. Among them, 42 patients underwent surgery whereas the 31 other patients not eligible for surgical treatment received chemotherapy ( n  = 22) or best supportive care alone ( n  = 9). Almost 62% of operated patients received adjuvant chemotherapy. In the non-surgical group, a mean of 9 cycles of palliative chemotherapy per patients were administrated. Median overall survival was 21.3 months in the surgical group and 6.1 months in the palliative group ( p  = 0.0001). Most of oncologic parameters were found to be independent survival predictors. Age was not associated with the survival, but a significant impact of Lawton ' s Instrumental Activities of Daily Living (IADL) impairment (IADL<4) (HR = 5.0, p  = 0.047), Cumulative Index Rating Scale-Geriatric (CIRS-G) ≥2 (HR = 19, p  = 0.035) and weight loss >10% (HR = 4.6, p = 0.03) on survival was detected. Surgery was the only factor independently predictive of survival in multivariate analysis ( p  < 0.001). Conclusion Almost 90% of selected older pancreatic patients with cancer (64 out of 73 patients) may benefit from the same standard treatments as younger patients. IADL impairment of patients, CIRS-G ≥2, and weight loss >10% constitute survival prognostic factors which should be added to the oncological criteria in the therapeutic decision-making process. [ABSTRACT FROM AUTHOR]

Copyright of Archives of Cardiovascular Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Proges en Urologie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Archives of Cardiovascular Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Résumé Cet article étudie les représentations que les professionnels du monde judiciaire se font des personnes placées sous main de justice (PPSMJ) dont ils ont la charge. Une comparaison selon les institutions concernées est pertinente dans la mesure où les missions des policiers, des psychiatres, des CPIP et des travailleurs sociaux diffèrent et donc leur relation avec les PPSMJ n’est pas de même nature. Une enquête de terrain réalisée à l’aide d’entretiens semi-directifs qui ont fait l’objet d’analyses de discours et de contenu permet de rendre compte des particularités liées aux interactions sociales menées par ces différents professionnels. Schématiquement, les policiers manifestent une mise à distance des PPSMJ, les psychiatres, respectueux du secret médical sont centrés sur la PPSMJ en tant que source de son traitement, les CPIP hésitent entre leur rôle social et leur rôle répressif et les travailleurs sociaux, très investis dans la relation avec les PPSMJ dont ils ont la charge, évacuent les causes de leur désocialisation. Les représentations que ces différents professionnels se font des PPSMJ font apparaître la nécessité de comparer ces représentations avec les attentes des PPSMJ dont ils s’occupent de manière à proposer des préconisations pour réduire les écarts et améliorer ainsi la relation entre les différents protagonistes de l’interaction. The present article studies the representation of the persons under the hand of justice by the legal professionals in charge. A comparison among the concerned establishments has been made. We assume that the relationships with the offenders vary depending on whether it is with policemen, psychiatrists, probation officers or social workers, as their duties with the delinquents are different. A field study has been carried out with the help of semi-structured interviews that we used for discourse and content analysis allowing us to reveal the characteristics of the social interactions by vocations. Generally speaking, policemen tend to keep distance from the offenders; while psychiatrist, abide by medical confidentiality, are focused on therapy. Probation officers are in-between their social and repressive roles; whereas social workers put a lot into the relationship with the offenders they are in charge of, leaving behind the reason of their marginalization. The representations of the offenders made by the different workers reveal the need for a comparison of the depiction of these workers and the expectations of the offenders they are dealing with; so as to propose recommendations to reduce the highlighted gap between them and in order to improve the relationship with the different players of the interaction. [ABSTRACT FROM AUTHOR]

Background: Among a group of therapies collectively known as energy psychology (EP), emotional freedom techniques (EFT) is the most widely practiced. Clinical EFT is an evidence-based practice combining elements of cognitive and exposure therapies with the manual stimulation of acupuncture points (acupoints). Lacking is a recent quantitative meta-analysis that enhances understanding of the variability and clinical significance of outcomes after clinical EFT treatment in reducing depression.Methods: All studies (2005-2015) evaluating EFT for sufferers of depression were identified by electronic search; these included both outcome studies and randomized controlled trials (RCTs). Our focus was depressive symptoms as measured by a variety of psychometric questionnaires and scales. We used meta-analysis to calculate effect sizes at three time points including posttest, follow-ups less than 90 days, and follow-ups more than 90 days.Results: In total, 20 studies were qualified for inclusion, 12 RCTs and 8 outcome studies. The number of participants treated with EFT included N = 461 in outcome studies and N = 398 in RCTs. Clinical EFT showed a large effect size in the treatment of depression in RCTs. At posttest, Cohen׳s d for RCTs was 1.85 and for outcome studies was 0.70. Effect sizes for follow-ups less than 90 days were 1.21, and for ≥ 90 days were 1.11. EFT were more efficacious than diaphragmatic breathing (DB) and supportive interview (SI) in posttest measurements (P = .06 versus DB, P < .001 versus SI), and sleep hygiene education (SHE) at follow-up (P = .036). No significant treatment effect difference between EFT and eye movement desensitization and reprocessing (EMDR) was found. EFT were superior to treatment as usual (TAU), and efficacious in treatment time frames ranging from 1 to 10 sessions. The mean of symptom reductions across all studies was -41%.Conclusions: The results show that Clinical EFT were highly effective in reducing depressive symptoms in a variety of populations and settings. EFT were equal or superior to TAU and other active treatment controls. The posttest effect size for EFT (d = 1.31) was larger than that measured in meta-analyses of antidepressant drug trials and psychotherapy studies. EFT produced large treatment effects whether delivered in group or individual format, and participants maintained their gains over time. This meta-analysis extends the existing literature through facilitation of a better understanding of the variability and clinical significance of depression improvement subsequent to EFT treatment. [ABSTRACT FROM AUTHOR]

Background: Landmark reports have suggested that patients with QRS widening immediately after cardiac resynchronization therapy (CRT) experienced less frequently reverse left ventricular remodeling during follow-up.Objective: We sought to investigate the relationship between postoperative QRS widening relative to baseline and mortality in a prospective cohort of heart failure patients receiving CRT.Methods: A 12-lead electrocardiogram was recorded for 237 heart failure patients (New York Heart Association class II to IV, left ventricular ejection fraction ≤35%, and QRS width ≥120 ms) before and immediately after CRT device implantation. The relationships between QRS widening, all-cause and cardiovascular mortality, and echocardiographic response to CRT were studied.Results: During a median follow-up of 24 months, 39 patients died. Fifty patients (21%) experienced QRS widening after CRT [QRS(+) group]. During follow-up, all-cause mortality was higher in QRS(+) patients than in QRS(-) patients (36-month survival free from death 81% ± 7% vs 64% ± 16%; log rank, P = .029). After adjustment for important prognostic confounders, QRS(+) patients remained associated with an excess overall mortality (adjusted hazard ratio [HR] 2.67; 95% confidence interval 1.07-6.65; P = .035) and cardiovascular mortality (adjusted hazard ratio 3.63; 95% confidence interval 1.13-11.65; P = .03). QRS(+) patients were less frequent responders to CRT than were QRS(-) patients (20 [47%] vs 136 [83%]; P < .0001).Conclusion: Postoperative QRS widening relative to baseline after CRT is associated with a considerable increased mortality risk during follow-up. Whether QRS narrowing should be achieved to optimize CRT placement, and thereby increase the rate of CRT responders and improve outcome, deserves further research. [ABSTRACT FROM AUTHOR]

Our work addresses the influence of the growing adoption of information and communication technologies (ICT) for campaigning purposes on the evolving dynamics of information flows from the eminently social beings that candidates are. Our approach combines an analysis of contents to technological and methodological concerns. The breadth of these objectives as well as the amount of data to be considered pointed to a need for collaboration between several researchers for sharing out tasks and bringing together expertise from various disciplines. This paper presents results concerning three of the data collections life cycle phases: collection, cleaning, and storage. The result is a data collection ready to be analysed for different purposes. In particular, in our experimental validation it has been used for comparing political campaigns behaviour in France and the United Kingdom during the European elections in 2015. [ABSTRACT FROM AUTHOR]

Unlabelled: The use of rodents in preclinical studies has contributed greatly to our understanding of the pathophysiology of chronic neuropathic pain. These animal models are limited because of their poor clinical translation. We developed a pig model for chronic pain caused by surgically induced peripheral neuritis trauma (PNT). Seventy-five percent of the animals exhibited mechanical and tactile allodynia, which are indicative of painful neuropathy, by day 28 after surgery. Importantly, the PNT-injured pigs retained their ability to walk or to stand on their injured leg. Messenger RNA analysis of acute inflammatory cytokines calcitonin gene-related peptide and brain-derived neurotrophic factor at the site of injury suggests transient inflammation followed by a persistent high level of neurologic markers. Gabapentin and morphine effectively inhibited hypersensitivity to von Frey filaments and to feather stimuli, and reversed spontaneous pain-related behavior in a dose-related manner. No analgesic effect was detected in PNT-injured pigs after treatment with aprepitant, similar to observations in humans and contrary to observations in rodents. In conclusion, PNT-induced trauma in pigs may comprise a valid preclinical model for the study of the chronification of peripheral nerve injury and for the study of new pain therapies.Perspective: This article presents the characterization of a new peripheral neuritis trauma (PNT) model in pigs. The pig PNT model could help close the translational gap between preclinical and clinical responses and may contribute to improved efficacy or safety of candidate drugs. [ABSTRACT FROM AUTHOR]

Copyright of Archives of Cardiovascular Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Persistent occiput posterior and occiput transverse positions are the most common malpositions of the fetal head during labor and are associated with prolonged second stage of labor, cesarean deliveries, instrumental deliveries, severe perineal tears, postpartum hemorrhage, and chorioamnionitis. Manual rotation is one of several strategies described to deal with these malpositions.Objective: This study aimed to determine if the trial of prophylactic manual rotation at the early second stage of labor is associated with a decrease in operative deliveries (instrumental and/or cesarean deliveries).Study Design: We conducted a multicenter, open-label, randomized controlled trial in 4 French hospitals. Women with singleton term pregnancy and occiput posterior or occiput transverse position confirmed by ultrasound at the early second stage of labor and with epidural analgesia were eligible. Women were randomly assigned (1:1) to either undergo a trial of prophylactic manual rotation of occiput posterior or occiput transverse position (intervention group) or no trial of prophylactic manual rotation (standard group). The primary outcome was operative delivery (instrumental and/or cesarean deliveries). The secondary outcomes were length of the second stage of labor, maternal complications (postpartum hemorrhage, operative complications during cesarean delivery, episiotomy and perineal tears), and neonatal complications (Apgar score of <5 at 10 minutes, arterial umbilical pH of <7.10, neonatal injuries, neonatal intensive care unit admission). The main analysis was focused on intention-to-treat analysis.Results: From December 2015 to December 2019, a total of 257 women (mean age, 30.4 years; mean gestational age, 40.1 weeks) were randomized: 126 were assigned to the intervention group and 131 were assigned to the standard group. Operative delivery was significantly less frequent in the intervention group compared with the standard group (29.4% [37 of 126] vs 41.2% [54 of 131]; P=.047; differential [intervention-standard] [95% confidence interval] = -11.8 [-15.7 to -7.9]; unadjusted odds ratio [95% confidence interval] = 0.593 [0.353-0.995]). Women in the intervention group were more likely to have a significantly shorter second stage of labor.Conclusion: Trial of prophylactic manual rotation of occiput posterior or occiput transverse positions during the early second stage of labor was statistically associated with a reduced risk of operative delivery. This maneuver could be a safe strategy to prevention operative delivery. [ABSTRACT FROM AUTHOR]

The hypothalamus is key in the control of energy balance. However, strategies targeting hypothalamic neurons have failed to provide viable options to treat most metabolic diseases. Conversely, the role of astrocytes in systemic metabolic control has remained largely unexplored. Here, we show that obesity promotes anatomically restricted remodeling of hypothalamic astrocyte activity. In the paraventricular nucleus (PVN) of the hypothalamus, chemogenetic manipulation of astrocytes results in bidirectional control of neighboring neuron activity, autonomic outflow, glucose metabolism, and energy balance. This process recruits a mechanism involving the astrocytic control of ambient glutamate levels, which becomes defective in obesity. Positive or negative chemogenetic manipulation of PVN astrocyte Ca2+ signals, respectively, worsens or improves metabolic status of diet-induced obese mice. Collectively, these findings highlight a yet unappreciated role for astrocytes in the direct control of systemic metabolism and suggest potential targets for anti-obesity strategy. [Display omitted] • Diet-induced obesity induces astrocytic Ca2+ signal remodeling in the hypothalamus • PVN astrocytes can control PVN parvocellular neuronal firing • PVN astrocytes bidirectionally affect systemic metabolism in obese mice • Astrocytic control of extracellular glutamate is impaired in obesity Herrera Moro Chao et al. show that obesity promotes anatomically restricted remodeling of hypothalamic astrocyte activity. In the paraventricular nucleus of the hypothalamus (PVN), chemogenetic manipulation of astrocytes results in bidirectional control of neighboring neuron activity, autonomic outflow, glucose metabolism, and energy balance through the control of ambient glutamate levels. [ABSTRACT FROM AUTHOR]

Background: Uncertain fetal head engagement represents 4% of obstetrical situations associated with an increased risk of postpartum hemorrhage, notably in cases of cesarean delivery and increased neonatal impairment owing to failed vaginal instrumental delivery. In this obstetrical condition, cesarean delivery is recommended, but vaginal delivery is possible in two-thirds of the cases. During the second stage of labor, the descent of the fetal head can be assessed by sonography, particularly by measuring the angle of progression.Objective: To evaluate, after a prolonged second stage of labor, the impact of measuring the angle of progression in addition to a digital examination on cesarean delivery rates when fetal head engagement remains uncertain.Study Design: This open multicenter randomized pragmatic trial included women at term with a singleton cephalic fetus in a clinical occiput anterior position after a prolonged 2-hour second stage of labor with uncertain fetal head engagement. After inclusion in the study, an independent investigator performed ultrasound systematically to confirm the occiput anterior position and measured the angle of progression at the climax of Valsalva pushing. This operator did not participate in labor management. In the study group but not in the control group, the angle of progression was communicated to the obstetrician in charge of labor management. Obstetricians were encouraged to attempt vaginal birth if the angle of progression was >120°. The primary outcome was the cesarean delivery rate. Secondary outcomes were operative delivery rate (cesarean delivery and operative vaginal delivery), maternal complications (third and fourth-degree perineal tears, failed vaginal instrumental delivery, postpartum hemorrhage, hysterectomy), and neonatal outcomes (Apgar score <5 at 10 minutes, umbilical arterial pH <7.10, neonatal wounds, neonatal intensive care unit admission).Results: A total of 45 women were included in the study. Occiput anterior position was confirmed in 33 women: 16 in the study group and 17 in the control group. Women's characteristics at baseline were similar between the groups. The median (range) angles of progression were similar: 138.4° (15) and 140.3° (16.9) in the study and control group, respectively. Cesarean delivery rates were 12.5% in the study group and 41.1% in the control group (P=.06). Secondary outcomes were similar between the 2 groups. No failed vaginal instrumental delivery was reported.Conclusion: Measurement of the angle of progression in addition to digital examination when fetal head engagement remained uncertain showed promising results in decreasing cesarean delivery rates. A larger multicenter randomized controlled trial is needed to confirm these results. [ABSTRACT FROM AUTHOR]

Over a four-month period, ten patients were suspected of having acquired nosocomial infection to P. aeruginosa in the ear, nose, and throat department. Environmental and clinical isolates were compared. Only water from a drinking water fountain was contaminated by P. aeruginosa. This isolate and those of three patients had indistinguishable random amplified polymorphic DNA profiles. These patients had serious oncology diseases. The drinking water fountain was used for their alimentation by percutaneous endoscopic gastrostomy and was the origin of the outbreak. Another type of drinking fountain with a terminal ultraviolet treatment was installed, following which no new infections linked to drinking water were identified. [ABSTRACT FROM AUTHOR]

Summary Feeding behavior is exquisitely regulated by homeostatic and hedonic neural substrates that integrate energy demand as well as the reinforcing and rewarding aspects of food. Understanding the net contribution of homeostatic and reward-driven feeding has become critical because of the ubiquitous source of energy-dense foods and the consequent obesity epidemic. Hypothalamic agouti-related peptide-secreting neurons (AgRP neurons) provide the primary orexigenic drive of homeostatic feeding. Using models of neuronal inhibition or ablation, we demonstrate that the feeding response to a fast ghrelin or serotonin receptor agonist relies on AgRP neurons. However, when palatable food is provided, AgRP neurons are dispensable for an appropriate feeding response. In addition, AgRP-ablated mice present exacerbated stress-induced anorexia and palatable food intake—a hallmark of comfort feeding. These results suggest that, when AgRP neuron activity is impaired, neural circuits sensitive to emotion and stress are engaged and modulated by food palatability and dopamine signaling. [ABSTRACT FROM AUTHOR]

Background Although the risk of cholelithiasis (CL) increases in patients after Roux-en-Y gastric bypass (RYGB), no prospective study has yet assessed the incidence of CL after sleeve gastrectomy (SG). Objectives To compare, prospectively, the incidence and predictive factors for CL after both procedures. Methods A postoperative abdominal ultrasound follow-up was proposed to all patients with an intact gallbladder and who underwent RYGB or SG in Hôpital Louis Mourier from 2008 onward. Results At least one ultrasound was performed on one hundred and sixty patients between 6 and 12 months postsurgery, 43 after SG and 117 after RYGB. Age, gender, initial body-mass index, co-morbidities were similar in both groups. Weight loss (WL) at 6 months was significantly lower after SG than after RYGB (26.9±9.2 and 31.3±7.5 kg, respectively = .001). The incidences of CL after SG and RYGB were similar (28% versus 34% respectively, P = .57). Most cases of CL occurred in the first year post surgery. During the follow-up, 12% and 13% of patients who underwent SG and RYGB, respectively, became symptomatic. WL of>30 kg at 6 months was a risk factor for CL after bariatric surgery, but we did not find any preoperative predictive factor for gallstone formation. Conclusions Despite lower WL after SG, the incidence of CL after SG and RYGB was similar at 2 years. Our results suggest that rapid WL is the main element leading to gallstone formation after both procedures. [ABSTRACT FROM AUTHOR]

The ratio of acceleration time to ejection time (AT/ET) is a simple and reproducible echocardiographic parameter that integrates AS severity and its consequences on the LV. The prognostic impact of AT/ET on outcome in patients with SAS and no or mild symptoms has not been investigated. This study sought to determine the prognostic impact of AT/ET on mortality in patients with severe aortic stenosis (SAS), preserved left ventricular ejection fraction (LVEF) and no or only mild symptoms. Three hundred and fifty-three patients [median age 79 (71–85), 46% women] with high gradient [mean pressure gradient ≥ 40 mmHg and/or aortic peak jet velocity (Vmax)≥4 m/s] SAS, LVEF ≥ 50% and no or only mild AS symptoms were studied. Patients were retrospectively stratified by AT/ET ≤ or > 0.35. Survival analyses were carried out to study the impact of AT/ET on all-cause mortality. During a median follow-up of 39 (23–62) months, 70 patients died. AT/ET > 0.35 was associated with a considerable increased mortality risk after adjustment for established prognostic factors in SAS when the entire follow up (medical and/or surgical management) was considered [adjusted HR 2.54 (95%CI,1.47–4.37); P < 0.001] but also under medical management [adjusted HR 3.29 (95%CI, 1.70–6.39); P < 0.001]. In addition, AT/ET > 0.35 improved the predictive performance of multivariable models including established risk factors in SAS as indicated by better global model fit, reclassification, and discrimination. After propensity score matching (n = 236), increased risk of mortality persisted for patients with AT/ET > 0.35 compared with those with AT/ET ≤ 0.35 [adjusted HR 2.67 (95% CI, 1.45–4.92); P = 0.002] (Fig. 1). AT/ET > 0.35 is a strong predictor of outcome in patients with SAS and no or only mild symptoms and identifies a subgroup of patients at higher risk of death who may derive benefit from earlier aortic valve replacement. [ABSTRACT FROM AUTHOR]

Pancreatic body and tail adenocarcinoma is a tumor of silent evolution, showing up as advanced disease at diagnosis in the majority cases. A 60-year-old man, presenting a solid expansive lesion (3.1 × 2.8 cm) in the body of the pancreas, by imaging exams. There was 50% involvement of the celiac trunk at the level of the it's bifurcation and suspected peripancreatic lymph nodes. Clinical staging was cT4N1M0. After neoadjuvant chemotherapy (NQT), there was a small reduction of the tumor to 3.0 × 2.6 cm, an important decreasing of the celiac trunk involvement (25%), and also a reduction in the levels of C19–9 from 650 U/mL to 358 U/mL. Further on, the patient underwent a Robotic Modified Appleby procedure, without intra and postoperative complications. Locally advanced pancreatic tumors should be referred to NQT, and those with good response might benefit to radical surgery. The modified Appleby technique - distal pancreatectomy with splenectomy and celiac trunk resection – is the procedure of choice when there is involvement of celiac trunk, but concern must be given to the liver vascularization. The use of robotic system on pancreatic surgery is emerging, but still, there is lower data regarding its safety in major pancreatic procedures. The use of neoadjuvant therapy is recommended to assess the in vivo response, improve oncological results and increase negative margins. Pre-operative imaging is mandatory for surgical planning. The robotic modified Appleby procedure is feasible and safe, with reduced of intraoperative blood loss and transfusion rate, corroborating the literature. • 30% of pancreatic cancer presents as locally advanced disease at diagnosis with invasion to vascular structures. • Arterial involvement is the biggest challenge for oncological resection, and involvement of the celiac axis or its branches can make curative resection impossible • Robotic systems have been used in pancreatic surgery, but there is fewer data regarding feasibility and safety in major procedures. • Preoperative radiology is crucial to assess the response to neoadjuvant therapy and allows for the analysis of vascular anatomy. [ABSTRACT FROM AUTHOR]

Objectives Our aim was to identify “correctable abnormalities” using conventional grayscale and blood-pool Doppler echocardiography and evaluate their ability to predict both response and midterm survival. Background Identification of mechanical abnormalities that may be corrected with cardiac resynchronization therapy (CRT) is useful for predicting echocardiographic response at 1-year follow-up. Methods A total of 200 CRT patients were included. Clinical evaluation and echocardiography were performed before and after CRT to assess the presence of the mechanical abnormalities of interest (septal flash, abnormal ventricular filling, or exaggerated interventricular dependence). Response to CRT was defined as a reduction in left ventricular (LV) end-systolic volume (ESV) ≥15%. Four subgroups of extent of response were defined: LVESV reduction >26.68% (extensive remodeling); LVESV reduction 6.8% to 26.68% (slight remodeling); LVESV reduction <6.8% (no remodeling) and clinical response; and LVESV reduction <6.8% without clinical response or the occurrence of death or heart transplantation. Midterm cardiovascular survival was evaluated (mean follow-up 38 ± 19 months). Results The presence of a correctable abnormality was independently associated with a better rate (odds ratio: 0.03 [95% confidence interval (CI): 0.01 to 0.10], p < 0.001) and extent of response to CRT (n = 59 [96.7%] for the extensive remodeling subgroup vs. n = 53 [85.5%] for the slight remodeling subgroup vs. n = 19 [47.5%] for the no remodeling with clinical response subgroup vs. n = 17 [45.9%] for the no remodeling without clinical response subgroup, p = 0.0001), as well as with increased midterm survival (hazard ratio: 0.11 [95% CI: 0.2 to 0.6]). Other independent predictors included creatinine level and LV end-systolic diameter for response; New York Heart Association functional class IV, creatinine, LV end-systolic diameter, and transmurality index for extent of response; and New York Heart Association functional class IV for cardiovascular mortality. Conclusions The presence of a correctable abnormality evaluated by conventional echocardiography is associated with LV reverse remodeling and better survival at midterm follow-up. Clinical characteristics and myocardial viability also have an influence. [ABSTRACT FROM AUTHOR]

The arcuate nucleus (ARC) of the hypothalamus is particularly regarded as a critical platform that integrates circulating signals of hunger and satiety reflecting energy stores and nutrient availability. Among ARC neurons, pro-opiomelanocortin (POMC) and agouti-related protein and neuropeptide Y (NPY/AgRP neurons) are considered as two opposing branches of the melanocortin signaling pathway. Integration of circulating signals of hunger and satiety results in the release of the melanocortin receptor ligand α-melanocyte-stimulating hormone (αMSH) by the POMC neurons system and decreases feeding and increases energy expenditure. The orexigenic/anabolic action of NPY/AgRP neurons is believed to rely essentially on their inhibitory input onto POMC neurons and second-orders targets. Recent updates in the field have casted a new light on the role of the ARC neurons in the coordinated regulation of peripheral organs involved in the control of nutrient storage, transformation and substrate utilization independent of food intake. [ABSTRACT FROM AUTHOR]