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To retrospectively evaluate the relief of pain after percutaneous image-guided cryoablation of symptomatic extraperitoneal endometriosis (EE). From 2017 to 2022, cryoablation of EE was performed at a single institution on a total of 47 lesions in 42 consecutive patients (median age, 37 years; interquartile range [IQR], 33–39.5 years). Patient and procedural characteristics were reviewed retrospectively. Tolerance and outcomes in terms of pain and patient satisfaction were evaluated. The median follow-up duration was 13.5 months (IQR, 1.1–37.7 months) after cryoablation. The median pain-free survival rate was 93.8% (95% confidence interval [CI], 77.3–98.4) at 6 months and 82.7% (95% CI, 58.8–93.5) after 12 months. Pain decreased from a median of 8/10 (IQR, 7–9) on the visual analog scale to 0/10 (IQR, 0–1) at the last follow-up (P <.0001). The median Patient Global Impression of Change score recorded at the last follow-up was 1/7 (IQR, 1–2). The efficacy rate of cryoablation to avoid secondary surgery was 92.8% (39/42) per patient and 93.6% (44/47) per nodule treated. Four patients (9.5%, 4/42) experienced an adverse event in the days following the procedure, and 1 patient (2%) experienced a severe adverse event. Percutaneous cryoablation is safe and effective in significantly reducing pain and obtaining local control of EE. [Display omitted] [ABSTRACT FROM AUTHOR]

This study compares morbidity and mortality associated with retroperitoneal and transperitoneal para-aortic lymphadenectomy (PAAL) for pretherapeutic nodal staging of locally advanced cervical cancers (FIGO IB3–IVA). Pre-, per- and postoperative data of patients treated for locally advanced stage cervical cancer between 1999 and 2018 in 12 French referral centers (FRANCOGYN Study Group) were retrospectively collected. The study was conducted using a sample of 448 patients, of whom 223 (49,8%) underwent retroperitoneal (group 1) and 225 (50,2%) had transperitoneal PAAL (group 2). No differences were noted concerning clinical and histological characteristics between the two groups. Among these 448 patients, 23 (5,1%) had an intraoperative complication (9 (2,0%) in group 1 and 14 (3,1%) in group 2, p = 0.28) and 47 (10,5%) had a postoperative complication (22 (4,9%) in group 1 and 25 (5,6%) in group 2, p = 0.44), only one of which required revision surgery but the patient died. The length of hospital stay was significantly shorter in group 1 than in group 2 (3.97 versus 4.88 days, p < 0.001). There was no significant difference in mortality between the two groups; 34 of 223 patients in group 1 (15.3%) and 40 of 225 patients in group 2 (15.6%) died (HR = 0.968, 95% CI [0.591–1.585]). There was no significant difference in recurrence-free or overall survival between the two groups. Retroperitoneal PAAL appears as a valuable and safety surgical route for nodal staging in locally advanced cervical cancer compared with standard transperitoneal PAAL. [ABSTRACT FROM AUTHOR]

Despite various surgical and nonsurgical strategies for abdominal wall endometriosis, the lack of definitive guidance on optimal treatment choice leads to clinical uncertainty. This review scrutinizes the safety and efficacy of abdominal wall endometriosis treatments to aid in decision-making. We performed a systematic literature review of PubMed, Embase, and Cochrane Library databases from 1947 until December 2023. A comprehensive literature search identified studies that assessed both surgical and nonsurgical interventions, including high-intensity focused ultrasound (HIFU), cryoablation, radiofrequency ablation, and microwave ablation. This review is registered in NIHR-PROSPERO (CRD 42023494969). Local tumor control (LTC), local pain relief (LPR), and adverse events (AE) were recorded. This review included 51 articles among 831 identified. All study designs were considered eligible for inclusion. A total of 2674 patients are included: 2219 patients (83%) undergoing surgery, and 455 (17%) undergoing percutaneous interventions (342 HIFU, 103 cryoablation, 1 radiofrequency ablation, 9 microwave ablation). Follow-up length was 18 months in median, ranging from 1 to 235 months. Overall LTC rates ranged from 86% to 100%. Surgical interventions consistently demonstrated the highest rate of LTC with a median rate of 100%, and LPR with a median rate of 98.2% (95% confidence interval [CI]: 93.9–97.7). HIFU showed median LTC and LPR rates, respectively of 95.65% (95% CI, 87.7–99.9) and 76.1% (95% CI, 61.8–90.4); and cryoablation of 85.7% (95% CI, 66.0–99.9) and 79.2% (95% CI, 67.4–91.03). Minor AE was reported after surgery in 17.5% of patients (225/1284) including 15.9% (199/1284) of mesh implantation; 76.4% (239/313) after HIFU; and 8.7% (9/103) after cryoablation. Severe AE was reported in 25 patients in the surgery group and 1 in the percutaneous group. The safety profile and efficacy of nonsurgical interventions support their clinical utility for management of abdominal wall endometriosis. [ABSTRACT FROM AUTHOR]

Triple-negative (TN) breast cancer represents one third of pregnancy-associated breast cancers (PABC). The aims of the current study were to describe oncological and obstetrical outcomes of patients with TN-PABC and to compare their prognosis with TN-non-PABC patients using a propensity score. Between January 2005 and December 2020, data of patients with histologically proven TN-PABC were collected and compared with data of TN-non-PABC patients under the age of 46 years diagnosed during the same period using a propensity score (PS). After PS matching (tumor size and lymph node involvement),there were 59 patients in each group. The median follow-up was 14 months (IQR 4.8–40.1) for the TN-PABC group and 60 months (IQR 30.7–101.4) for the TN-non-PABC group. Eight recurrences occurred in the TN-PABC group and 10 in the TN-non-PABC group (adjusted OR (AOR) = 0.60 (0.21–1.60), HR (Cox adjusted model- AHR) = 1.25 (0.53–2.94)). Two patients died in the TN-PABC group, and six in the TN-non-PABC group with an AOR = 0.23 (0.03–1.01) and an AHR = 0.58 (0.12–2.69). All the patients diagnosed during the second (n = 17) and third trimesters (n = 28) continued their pregnancies, with a median term at delivery of 38 WG (IQR 36–39). All patients gave birth to healthy newborns. Although the TN subtype is associated with poor prognosis in pregnant patients due to advanced stage at diagnosis and high lymph node involvement, our PS-matched case-control study showed that pregnancy per se does not worsen the prognosis in terms of recurrence-free and overall survival. • Triple-negative breast cancer are associated with poor prognosis. • Breast cancers occurring during pregnancy differ from those occurring in the post-partum period. • Pregnancy per se does not worsen the prognosis in triple-negative breast cancer. [ABSTRACT FROM AUTHOR]

Node involvement is one of the main prognostic factors for cervical cancer. Para-aortic lymph node (PALN) assessment is crucial for treating advanced cervical cancer, to define irradiation fields. Objective of this study was to develop a score predicting para-aortic lymph node involvement in patients with advanced cervical cancer. We performed a multicenter, retrospective, study on 9 French centers from 2000 to 2015, including patients with advanced squamous cell cervix carcinoma who had PALN status assessed by imaging and/or by surgery. Factors associated with a risk of PALN involvement were determined by univariate and multivariate analysis using a logistic regression model. A score was then developed and validated. A total of 1446 patients treated for cervical cancer were included. Of these, 498 had an advanced squamous cell cervical cancer. Ninety-one patients (18.3%) had positive PALN. After univariate and multivariate analysis, tumor size on pelvic MRI, initial SCC, and suspected pelvic node involvement on PET-CT were included in our score. This model allowed the population to be divided into 3 risk groups. Area under the ROC curve of the score was 0.81 (95%CI = 0.72–0.90). In the low-risk group, 9% (28/287) had PALN involvement, whereas in the high-risk group, 43% (22/51) had PALN involvement. We developed a simple score predicting PALN involvement in advanced cervical cancers. Three risk groups can be defined, and patients considered to be at low risk may avoid para-aortic staging as well as extensive field irradiation. [ABSTRACT FROM AUTHOR]

To evaluate the performances of systematic posttreatment pelvic magnetic resonance imaging (PPMRI) in predicting prognosis of patients treated with chemoradiation therapy (CRT) for locally advanced cervical cancer (LACC). Multi-institutional data from 216 patients presenting FIGO IB2-IIB cervical cancer for which PPMRI was performed following CRT were retrospectively reviewed. Incomplete response was defined as the identification of persistent lesion on PPMRI. Primary endpoints were patients' 5-year recurrence free (RFS) and overall (OS) survivals. Secondary endpoint was the identification of residual histologic disease on hysterectomy specimens when completion surgery was performed. PPMRI identified an incomplete response in 102 (47.2%) cases. A 70% or more reduction in tumor size on PPMRI was identified as the best predictive cut-off for recurrence (37.7% sensitivity and 78.7% specificity) and death (50% sensitivity and 77.9% specificity) with significant impact on those risks (HRa: 0.42; 95%CI: 0.23–0.77 and HRa: 0.18; 95%CI: 0.06–0.50, respectively). Completion hysterectomy was performed in 117 (54.4%) cases, with histologic residual disease in 55 (47.4%). PPMRI demonstrated 74.5% sensitivity and 50.8% specificity in predicting residual disease. Although survival of patients with complete response at PPMRI was not impacted by completion hysterectomy, it significantly increased 5-year RFS and OS of those with incomplete response: 38.7% vs. 65.3% (p < 0.001) and 63% vs. 82.9% (p = 0.038), respectively. A 70% or more reduction of in tumor size on PPMRI following CRT in patients with LACC is predictive of RFS and OS. PPMRI could help triaging patients who could benefit from completion hysterectomy. [ABSTRACT FROM AUTHOR]

Utilisées depuis l'Antiquité, les plantes aromatiques ont des propriétés thérapeutiques avérées. Les huiles essentielles soulagent de nombreux maux, que ce soit au niveau physique ou psychique. Le conseil en aromathérapie repose sur une écoute de qualité, puis sur des recommandations d'usage rigoureuses visant à ne pas nuire, mais à soigner et à accompagner au mieux. Used since antiquity, aromatic plants have proven therapeutic properties. Essential oils relieve many ailments, both physical or mental. Aromatherapy advice is based on quality listening, then on rigorous recommendations for use, aiming not to harm, but to heal and provide the best possible support. [ABSTRACT FROM AUTHOR]

The popularity of laparoscopy to perform radical hysterectomy has massively increased over the last 2 decades. However, oncologic outcomes (overall and disease-free survival) have been found to be better in patients managed by laparotomy compared with laparoscopy, challenging this surgical route. Compared with laparotomy, vaginal access reduces postoperative morbidity, while avoiding potential cancer spread associated with laparoscopy. We describe the procedure of Schauta-Amreich radical vaginal hysterectomy with bilateral salpingo-oophorectomy, assisted laparoscopically, and associated with pelvic sentinel lymph node procedure in a 56-year-old woman with an International Federation of Gynecology and Obstetrics stage IB2 cervical epidermoid carcinoma. A sentinel lymph node procedure was first performed by laparoscopy. Radical hysterectomy was prepared through laparoscopy by dividing the infundibulopelvic, round, and broad ligaments. The procedure was continued by the vaginal route using the Schuchardt incision. We describe each step of the procedure and provide a video. Histology showed a margin-free resection in both the vagina and parametrium with negative sentinel lymph nodes. This description of the Schauta-Amreich radical vaginal hysterectomy technique with a video file could support the teaching of a procedure that may gain in popularity. [ABSTRACT FROM AUTHOR]

The prevalence of pregnancy-associated breast cancer is increasing. HER2-positive breast cancers typically have a poor prognosis. The objective of our study was to compare the prognosis of patients with HER2-positive breast cancer diagnosed during pregnancy (HER2-positive BCP) to young women diagnosed with HER2-positive breast cancer outside of pregnancy (HER2 non-BCP). Data of patients managed for invasive breast carcinoma between January 2005 and 2020 were retrospectively collected from the database of Tenon University Hospital (Paris, France), part of the "Cancer lié à la Grossesse" network. Fifty-one patients with HER2-positive BCP were matched on age at diagnosis with 51 HER2-positive non-BCP patients. Locally advanced disease with axillary lymph node involvement were frequent. Tumors were frequently aggressive with high grade (p = 0.57) and high Ki67 (p = 0.15). Among the HER2-positive BCP patients, the mean term at diagnosis was 19.3 week of gestation (WG). Eighty-four percent of the patients continued their pregnancy with a mean term at delivery of 34.2WG. Chemotherapy modalities differed between the two groups: neoadjuvant chemotherapy was more frequent in the HER2-positive BCP group (p = 0.03) and adjuvant chemotherapy more frequent in the HER2 non-BCP group (p = 0.009). The recurrence rate was 10% (n = 5) and 18% (n = 9) in the HER2-positive BCP and HER2 non-BCP groups, respectively, p = 0.25. Breast cancer-free survival was poorer in the HER2-positive BCP group with earlier recurrence, p = 0.008. No difference in type of recurrence was found between the groups (p = 0.58). This matched case-control study implies that patients with HER2-positive BCP still have a poorer prognosis than non-pregnant HER-positive patients. • Trastuzumab improved survival in HER2-positive patients with early, locally advanced and metastatic breast cancer. • Administration of trastuzumab is contraindicated during pregnancy. • Patients with HER2-positive breast cancer during pregnancy have a poorer prognosis than non-pregnant HER-positive patients. • The prognosis of patients with HER2-positive breast cancer is not related to the term of diagnosis. [ABSTRACT FROM AUTHOR]

The aim of this study was to identify prognostic factors of overall survival in patients with FIGO stage IIIc or IVa ovarian cancer (OC) treated by neo-adjuvant chemotherapy (NAC) followed by interval debulking surgery. Data from 483 patients with ovarian cancer were retrospectively collected, from January 1, 2000 to December 31, 2016, from the FRANCOGYN database, regrouping data from 11 centers specialized in ovarian cancer treatment. Median overall survival was determined using the Kaplan-Meier method. Univariate and multivariate analysis were performed to define prognostic factors of overall survival. The median overall survival was 52 after a median follow up of 30 months. After univariate analysis, factors significantly associated with decreased overall survival were; no pelvic and/or para-aortic lymphadenectomy (p = 0.002), residual disease (CC1/CC2/CC3) after surgery (p < 0.001), positive cytology after NAC (p < 0.001), omental disease after NAC (p = 0.002), no pathologic complete response (pCR) (p = 0.002). In multivariate analysis, factors significantly associated with decreased overall survival were; residual disease after surgery (HR = 1.93; CI95% (1.16–3.21), p = 0.01) and positive cytology after NAC (HR = 1.59; CI95% (1.01–2.55), p = 0.05). Patients with no residual disease after surgery had a median overall survival of 64 months versus 35 months for patients with residual disease. Patients with negative cytology after NAC had a median overall survival of 71 months versus 43 months for patients with positive cytology after NAC. In this first and largest French based retrospective study, complete cytoreductive surgery in ovarian cancer remains the main prognostic factor of overall survival. [ABSTRACT FROM AUTHOR]

The oleanolic acid (1), a natural pentacyclic triterpenoid, was quantitatively isolated from pomace olive (Olea europaea L.) under ultra-sonication conditions (6.8 g (3.4 mg/g DW)). Two series of oleanolic acid-1-phenyl-1 H -[1,2,3]triazol-4-ylmethylester 6a – g and new oleanolic acid-1-phenyl-1 H -[1,2,3]triazol-5-ylmethylester 7a – g congeners have been designed and synthesized in an attempt to develop potent anticancer and anti-inflammatory agents. A facile and regiospecific synthesis of 1,2,3-triazoles catalyzed by Cu(I) (CuAAC) or Ru(II) (RuAAC) and conducted under microwave conditions of oleanolic acid–alkyne derivative 5 with various aromatic azides 2a – g afforded a series of 1,4- and 1,5-triazolyl derivatives, respectively. Their structures were confirmed by using 1H NMR, 13C NMR, NOESY and HRMS analysis. Most of the compounds were evaluated for their anticancer and anti-inflammatory activities. Oleanolic acid 1 exhibited promising anticancer activity against murine breast (EMT-6) and human colon (SW480) cancer cells. Its derivatives 6b and 6c (1,4-regioisomers) and 7b (1,5-regioisomer) were found to be anti-cancer agents. On the other hand, only 6b displays anti-inflammatory activity. [ABSTRACT FROM AUTHOR]

3,6-Dimethyl-1-phenyl-1 H -pyrazolo[3,4- d ]pyrimidin-4(5 H)-one 3 was prepared by an intramolecular cyclization of N -(4-cyano-3-methyl-1-phenyl-1 H -pyrazol-5-yl) acetamide 2 in ethanol in the presence of piperidine. N -allylation and N -propargyl alkylation of N -substituted pyrazolo[3,4- d ] pyrimidin-4(5 H)-one 3 yielded the corresponding dipolarophiles 4 and 5 which afford by condensation with arylnitrile oxides in toluene the expected new isoxazolines 6 and isoxazoles 7 , respectively. On the other hand, the aminopyrazole 1 in refluxing with ethanol in the presence of sodium hydroxide afforded the corresponding carboxamide 8 , which then, was converted to its ethyl 3-methyl-4-oxo-1-phenyl-4,5-dihydro-1 H -pyrazolo[3,4- d ] pyrimidine-6-carboxylate 9 with neat diethyl oxalate. The dipolarophile 10 on regiospecific 1,3 -dipolar cycloaddition with arylnitrile oxides affords isoxazoles 11 and the unexpected deethoxycarbonylated isoxazoles 12. The target compounds were completely characterized by 1H NMR, 13C NMR, IR and HRMS. [ABSTRACT FROM AUTHOR]

In vulvar cancer, it is admitted that tumor-free margin distance is one of the most important element for locoregional control. It is currently recommended to surgically remove the tumor with at least an 8 mm tumor-free margin. The aim of this study was to evaluate the impact of tumor-free margin distance on recurrence and survival in vulvar cancer. From 2005 to 2016, 112 patients surgically treated for a vulvar squamous cell cancer were included in a retrospective multicenter study. Overall, disease-free and metastasis-free survivals were analyzed according to tumor-free margin distance. Patients were divided into three groups: group 1 (margin <3 mm, n = 47); group 2 (margin ≥3 mm to < 8 mm, n = 48) and group 3 (margin ≥8 mm, n = 17). During the study, 26,8% patients developed recurrence (n = 30) after a median of 8 months (1-69). Analysis of 5-year overall survival, as well as disease-free and metastasis-free survivals, did not reveal a difference between groups. We performed a subgroup analysis in patients with a tumor-free margin <8 mm (group 1 and 2). It showed that histological lesions observed closest to the edge of the specimen were more often invasive or in situ carcinoma lesions in group 1 than in group 2, in which VIN lesions were mainly observed at this location. After re-excision, no patients in group 1 and 50% (n = 2) patients in group 2 developed recurrence. This study did not reveal a significant impact of tumor-free margin distance on recurrence and survival in vulvar cancer. Moreover, the benefit of re-excision seems stronger when tumor-free margins are positive or very close (<3 mm), cases in which invasive or in situ lesions are often present closest to the edge of the specimen. [ABSTRACT FROM AUTHOR]

Pelvic and paraaortic lymphadenectomy are recommended for women with high-intermediate, high-risk and advanced endometrial cancer (EC). Lymphadenectomy is less frequently performed in elderly patients than in younger patients. We examined the survival of elderly women diagnosed with high-risk EC according to whether lymphadenectomy was performed or not. We selected women over 70 years with high-intermediate risk, high-risk or advanced EC from a multicenter retrospective cohort of women diagnosed between 2001 and 2013. Multivariate logistic regression models and Cox proportional hazards survival methods for overall survival (OS), disease-free survival (DFS) and cancer-specific survival (CSS) were used for analyses. 71 women had lymphadenectomy and were compared with the 213 who did not. Recurrence was similar in both groups (42% vs 33%, respectively, p = 0.17) but more deaths were reported in the group without lymphadenectomy (38% vs 23%, respectively, p < 0.001). There was no difference in adjuvant treatment in the two groups (17% vs 27%, respectively, p = 0.27). Elderly patients without lymphadenectomy had lower 3-year DFS (56% vs 71%, p = 0.076), CSS (67% vs 85%, p < 0.001) and OS (50% vs 71% p < 0.001). The Cox proportional hazard models showed independently poorer prognosis in women without lymphadenectomy (3.027, 95% CI 1.58–5.81, p < 0.001), histology type 2 (3.46, 95% CI 1.51–7.97, p = 0.003) and lymphovascular space involvement (3.47, 95% CI 1.35–8.98, p = 0.01) on 3-year CSS. No lymphadenectomy in elderly patients with high-risk or advanced EC is independently associated with poorer prognosis. Elderly patients with EC should benefit from lymphadenectomy when indicated. [ABSTRACT FROM AUTHOR]

Abstract Patterns of distant metastatic failure of endometrial cancer (EC) by specific anatomic site are not well described in the literature. In this manuscript, we evaluated the metastatic patterns of EC cancer and analysed the potential distribution of metastatic disease in this malignancy. Methods A total of 1444 women with EC were identified. Of which we extracted women with locoregional and distant recurrence or with distant recurrence alone. Women were scored based on first site of metastasis: multiple versus one site: bone, brain, lung, liver or sus diaphragmatic lymph nodes. Results 110 women developed distant metastatic disease with (n = 37(33.6%)) or without (n = 73(66.4%)) locoregional recurrence, including 39 women with exclusive first site of metastatic disease and 34 women with multiple sites of metastatic disease. When considering all women, the most common exclusive first site of metastasis was lung (42.8%). The median time to develop distant metastases was shorter after the completion of treatment for exclusive brain metastatic disease compared with other sites of metastatic− disease (7 months vs, 9 for lung, 10 for liver, 19 for bone and 27 months for sus-diaphragmatic LN; P = 0.004). The rate of 3-year overall survival was higher in the sus-diaphragmatic LN metastase group (83.3% vs 50.6% for lung, 37.3% for bone, 16.7% for brain and 0% for liver; P = 0.0059). Conclusion The present study has demonstrated the site-specific patterns of metastases. These data support current clinical practice of screening for site-specific metastatic disease after initial treatment of early stage EC based on concerning women-specific signs or symptoms. [ABSTRACT FROM AUTHOR]

Abstract Introduction Evidence-based data describing patterns of recurrence and prognosis in women with FIGO stage IB2 to IIB locally advanced cervical cancer (LACC) are scarce. The purpose of this study was to analyse patterns of recurrence in LACC and their correlation with prognosis, depending on FIGO stage, lymph node (LN) status and treatment modalities. The endpoints of this study were the type of recurrence (locoregional or distant, and time to recurrence), the recurrence free survival, the overall survival and the cumulative incidence for both locoregional and distant recurrence. Materials and methods Data of women with FIGO stage IB2 to IIB CC treated between April 1996 and May 2016 were retrospectively abstracted from nine French institutions. Results The median follow-up for the 501 women included was 35.6 months. Recurrences were observed in 158 (31.5%), with a mean time to recurrence of 20.7 months. Women with IIB CC had poorer prognosis, lower 3-year RFS and higher 3-year cumulative incidence of both locoregional and distant recurrences. Women with positive or unknown LN status had poorer prognosis with higher 3-year cumulative incidence of distant recurrence. Women who underwent concomitant chemo-radiotherapy ± vaginal brachytherapy had poorer prognosis, with lower 3-year RFS and higher 3-year cumulative incidence of distant recurrence. Conclusions Recurrence location and time to recurrence differ widely depending on the FIGO stage, LN status and treatment modalities, with potential impact on follow-up modalities and therapeutic approaches. [ABSTRACT FROM AUTHOR]

S'il est indéniable que les huiles essentielles suscitent un véritable engouement, il n'en demeure pas moins que l'aromathérapie ne doit laisser aucune place à l'improvisation. Un produit naturel n'est pas un produit inoffensif. Afin d'éviter les accidents, quelques règles de bon usage doivent être connues de l'équipe officinale. Although it is unquestionable that essential oils arouse a real interest, the fact remains that aromatherapy should leave no room for improvisation. A natural product is not a harmless product. In order to avoid accidents, a few rules of proper use must be known to the pharmacy team. [ABSTRACT FROM AUTHOR]

Abstract Introduction Pre-treatment evaluation of nodal status is crucial in women presenting with locally advanced cervical cancer (LACC). However, the prognostic impact of surgical staging remains to be proved, as published results comparing surgical versus radiological staging are contradictory. The aim of this study was to compare the prognosis of women with FIGO stage IB2–IIB CC who underwent surgical nodal staging including either exclusive para-aortic lymphadenectomy (PAL) or comprehensive pelvic + para-aortic lymphadenectomy (P-PAL). Materials and methods Data of 314 women with FIGO stage IB2 to IIB CC treated between January 2000 and January 2015 were retrospectively abstracted from nine French institutions. The prognosis and outcomes were compared by Propensity score (PS) matching (PSM) analysis. Results The median follow-up was 33 months (2–114). When comparing women who underwent PAL vs P-PAL, the recurrence rates were 26% (37/144) and 28% (41/144), respectively (p = 0.595). The respective 3-year recurrence free survival (RFS) for P-PAL and PAL were 72.9% (95% CI, 65.7–81.0) and 70.7% (95% CI, 62.4–80.2), (p = 0.394). The respective 3-year overall survival (OS) rates for P-PAL and PAL were 86.8% (95% CI, 81.1–92.9) and 78.6% (95% CI, 70.4–87.7) (p = 0.592). In the sub-group of women with lymph node metastases, RFS was improved for women who underwent P-PAL compared to those with exclusive PAL (p = 0.027), with no difference in OS (p = 0.187). Conclusions Comprehensive P-PAL does not seem to be of significant therapeutic benefit compared to exclusive PAL. [ABSTRACT FROM AUTHOR]

Abstract Purpose Predicting the pattern of recurrence can aid in the development of targeted surveillance and treatment strategies. The objectives of this study were to identify patterns of recurrence in women with operable endometrial cancer (EC) and to identify high-risk periods for recurrence in function of age. Patients and methods The data of 1153 women who received primary surgical treatment for stage I-III EC between January 2001 and December 2013 were abstracted from a prospectively maintained multicentre database. The time to first recurrence was calculated from the date of diagnosis, and the associated hazard function was examined to determine the peak risk period of recurrence. We categorized age at diagnosis as <65 and ≥ 65 years old and analysed the hazard rate (HR) by stratifying age groups. Results Women with EC aged ≥65 years maintain a significant recurrence rate during follow-up whatever the stratification (locoregional recurrence, distant recurrence, ESMO/ESGO/ESTRO subgroup). Multivariable Cox proportional hazard regression showed that the increased risk of recurrence of EC was associated with advanced age, advanced disease ESMO/ESGO/ESTRO subgroup but not with initial treatment received. Conclusion The annual HR of recurrence is not uniformly distributed over time but is dynamic and markedly determined by prognostic factors at diagnosis. [ABSTRACT FROM AUTHOR]

Summary Aim of the study We set out to develop and evaluate the morbidity of a non-invasive hyperthermic intraperitoneal chemotherapy (HIPEC) procedure in mice. HIPEC has been shown to improve overall survival in treating ovarian cancer with peritoneal carcinomatosis. However, related complications, toxicity and the lack of randomized trials limits its widespread use. To improve the surgical technique, there is a need for animal models that allow teams to work on large groups without burdensome logistics. Materials and methods To develop the model, we first determined optimal HIPEC conditions in 20 Black Six mice without carcinomatosis. To evaluate HIPEC morbidity, peritoneal carcinomatosis cells of ovarian origin were injected into the peritoneum of 10 pathogen-free Nude mice. The mice underwent HIPEC 21 days later under general anesthesia. An inflow catheter was introduced into the left hypochondria and an outflow catheter was introduced into the left iliac fossa. Bath infusion was oxaliplatin (920 mg/m 2 ) at 43 °C for 12 minutes. The mice were monitored and sacrificed two weeks after the procedure. Results No deaths were observed during the procedure and infusion was well tolerated throughout the HIPEC. One mouse died the day after the procedure. No major dehydration, hemoperitoneum or evisceration was observed. Conclusion This mouse model of closed abdomen HIPEC has limited morbidity and could be a useful model to study HIPEC regimens and its effects on peritoneal carcinomatosis. [ABSTRACT FROM AUTHOR]

Time from surgery to re-initiation of chemotherapy was 30 days in the CRS-only group and 33 in the CRS plus HIPEC group; 90% and 94% of patients respectively received the three cycles of postoperative chemotherapy originally envisaged (Level of evidence 1). The clear overall survival benefit observed in patients who underwent HIPEC in addition to CRS position HIPEC as a relevant treatment for patients with FIGO stage III ovarian cancer. [Extracted from the article]

Radiation therapy (with associated chemotherapy) is the standard treatment for nasopharyngeal carcinoma. Conformal intensity-modulated radiation therapy is a new and particularly interesting technique for these tumors, due to their complex volumes close to many critical organs. Better dosimetric results and improved protection of adjacent healthy tissue have been shown compared with conventional 2D or 3D radiation therapy, with significantly reduced side-effects, notably xerostomia. Excellent local control rates have been reported. [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.)

Abstract: Study Objective: To evaluate urologic complications after colorectal resection for endometriosis. Design: Cohort study (Canadian Task Force classification II-2). Setting: Tertiary referral university hospital and expert center in endometriosis. Patients: One hundred sixty-six women with colorectal endometriosis proven by transvaginal sonography and magnetic resonance imaging. Intervention: Open or laparoscopic colorectal resection for endometriosis. Measurements and Main Results: Forty-four patients (26.5%) experienced at least 1 urologic complication, including infection. Eight patients (4.8%) experienced postoperative symptomatic hydronephrosis requiring ureteral stent in 3 cases, a percutaneous nephrostomy in 1 case, and expectant management for the last 4. Urologic fistulas occurred in 5 patients (3%). Postoperative voiding dysfunction requiring self-catheterization was observed in 48 patients (28.9%). With univariate analysis, a relationship was found between voiding dysfunction and partial colpectomy (p = .001) and American Society of Reproductive Medicine total score (p = .02), and between the occurrence of urinary fistula and the use of prophylactic ureteral catheterization (p = .015) and parametrectomy (p = .02). A relationship was found between postoperative symptomatic hydronephrosis and the use of prophylactic ureteral catheterization (p = .003). Conclusion: Colorectal resection for endometriosis can lead to urologic complications, particularly for patients requiring partial colpectomy, of which patients need to be informed. [Copyright &y& Elsevier]

Abstract: In 2010, the French government created an agency for the coordination of research on energy (ANCRE –www.allianceenergie.fr). Nuclear energy lies of course within the scope of this agency. During its first year of activity, the agency fostered a reflection on the scientific and technical challenges tied to the development of nuclear energy. This work resulted in the production of several roadmaps, one for each major domain of nuclear R&D. A special effort was put on chemistry for nuclear energy, because this domain has been identified as a key for sustainable, clean and competitive nuclear systems. The elaboration of this roadmap was the occasion to gather the national community of nuclear chemists for a general reflection on the stakes in chemistry for nuclear energy, the main scientific problems, the tools available to solve them, and to agree on the R&D actions that should be taken in priority. [Copyright &y& Elsevier]

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.)

Abstract: Introduction: This paper evaluates the role of an acquisition parameter, the frame cycle time “FCT”, in the performance of an aS500-II EPID. Materials and methods: The work presented rests on the study of the Varian EPID aS500-II and the image acquisition system 3 (IAS3). We are interested in integrated acquisition using asynchronous mode. For better understanding the image acquisition operation, we investigated the influence of the “frame cycle time” on the speed of acquisition, the pixel value of the averaged gray-scale frame and the noise, using 6 and 15MV X-ray beams and dose rates of 1–6Gy/min on 2100 C/D Linacs. Results: In the integrated mode not synchronized to beam pulses, only one parameter the frame cycle time “FCT” influences the pixel value. The pixel value of the averaged gray-scale frame is proportional to this parameter. When the FCT <55ms (speed of acquisition V f/s >18 frames/s), the speed of acquisition becomes unstable and leads to a fluctuation of the portal dose response. A timing instability and saturation are detected when the dose per frame exceeds 1.53MU/frame. Rules were deduced to avoid saturation and to optimize this dosimetric mode. Conclusion: The choice of the acquisition parameter is essential for the accurate portal dose imaging. [Copyright &y& Elsevier]

Abstract: Aim: We sought to determine whether survivors of sudden death without structural heart disease have beat-to-beat electrocardiographic (ECG) characteristics at the microvolt and at the millisecond level that differ from normal subjects. Methods: We studied patients at our implantable cardioverter defibrillator clinic who had been resuscitated from ventricular fibrillation with no evidence of underlying structural heart disease. Continuous 10-minute high-resolution unfiltered digital surface ECGs at 1000-Hz sampling rate were acquired in these subjects and in a group of healthy volunteers. We then analyzed different parameters of beat-to-beat variations in duration, amplitudes and vectors of the QRS complex, and the T wave using a locally developed program (Comparative Analysis of ECGs, Vectocardiograms, and their Interpretation with Auto-Reference to the patient) and compared them between the 2 groups. Results: Thirteen patients (7 men; age, 46 ± 16 years) were studied. Standard ECGs were unremarkable in 7 patients and suggestive of Brugada syndrome in the 6 others. The control group consisted of 23 age- and sex-matched subjects (13 men; age, 41 ± 10 years). Although the QRS parameters showed only few differences between the 2 groups, there were several differences in parameters evaluating repolarization. Conclusion: High-resolution ECGs show distinct beat-to-beat variations in parameters of repolarization in survivors of sudden death without structural heart disease, as compared with normal subjects. These findings may reflect increased electrical instability and should be evaluated for stratifying arrhythmic risk in asymptomatic individuals. [Copyright &y& Elsevier]

Copyright of EMC-Cardiologie-Angeiologie 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.)

Objective: Surgical management of deep endometriosis is associated with a high incidence of lower urinary tract dysfunction. The aim of the current systematic review and meta-analysis was to assess the rates of voiding dysfunction according to colorectal shaving, discoid excision, and segmental resection for deep endometriosis.Data Sources: We performed a systematic review using bibliographic citations from PubMed, Clinical Trials.gov, Embase, Cochrane Library, and Web of Science databases. Medical Subject Headings terms for colorectal endometriosis and voiding dysfunction were combined and restricted to the French and English languages. The final search was performed on August 28, 2019. The outcome measured was the occurrence of postoperative voiding dysfunction.Methods Of Study Selection: Study Quality Assessment Tools were used to assess the quality of included studies. Studies rated as good and fair were included. Two reviewers independently assessed the quality of each included study, discrepancies were discussed; if consensus was not reached, a third reviewer was consulted.Tabulation, Integration and Results: Out of 201 relevant published reports, 51 studies were ultimately reviewed systematically and 13 were included in the meta-analysis. Rectal shaving was statistically less associated with postoperative voiding dysfunction than segmental colorectal resection (Odds ratio [OR] 0.34; 95% confidence intervals [CI], 0.18-0.63; I2 = 0%; p <.001) or discoid excision (OR 0.22; 95% CI, 0.09-0.51; I2 = 0%; p  <.001). No significant difference was noted when comparing discoid excision and segmental colorectal resection (OR 0.74; 95% CI, 0.32-1.69; I2 = 29%; p = .47). Similarly, rectal shaving was associated with a lower risk of self-catheterization >1 month than segmental colorectal resection (OR 0.3; 95% CI, 0.14-0.66; I2 = 0%; p = .003). This outcome was no longer significant when comparing discoid excision and segmental colorectal resection (OR 0.72; 95% CI, 0.4-1.31; I2 = 63%; p = .28).Conclusion: Colorectal surgery for endometriosis has a significant impact on urinary function regardless of the technique. However, rectal shaving causes less postoperative voiding dysfunction than discoid excision or segmental resection. [ABSTRACT FROM AUTHOR]

New lupeol long-chain alkanoic ester 1 and lupeol β-hydroxy fatty acid esters 2c , d (laevigatins I and II) in a mixture with the previously isolated procrims a and b ( 2a,b ) were isolated together with lupeol 3 and lupeol acetate 4 from the latex of Periploca laevigata collected in Tunisia . Their structures were elucidated by extensive spectroscopic methods including 1D ( 1 H, 13 C and DEPT 135), 2D-NMR experiments, ( 1 H– 1 H COSY and NOESY), EI–MS, MALDI-TOF and GC analysis. Anti-acetylcholinesterase activity of most isolated compounds was evaluated and showed that lupeol ( 3 ) was the best inhibitor of AChE. [ABSTRACT FROM AUTHOR]

The synthesis and pharmacological evaluation of new series of 4-((3-aryl-4,5-dihydroisoxazol-5-yl)methoxy)-2H-chromen-2-ones 3a – f prepared by cycloaddition reaction using various arylnitrile oxides with the suitable 4-(allyloxy)-2H-chromen-2-one 2a are described. The 2-methyl-2,3-dihydrothieno[3,2-c]chromen-4-one 8 was also synthesized due to chemospecificity by the thio - Claisen rearrangement of 4-(allylthio)-2H-chromene-2-thione 7a . We also describe the new heterocyclic compounds 4-(R-thio)-2H-chromene-2-thiones 7a – d , 4-(2-thioxo-2H-chromen-4-ylthio) 5 and 4,4′-thiobis (2H-chromen-2-one) 6 which were prepared by a classical and PTC alkylation of 4-mercapto-2H-chromene-2-thione 4 with allylic halides. [ABSTRACT FROM AUTHOR]

Objectives To provide an updated synthesis on the efficacy of IPost on accurate surrogate markers of IS. Background Infarct size (IS) is a major determinant of patient outcome after acute ST-segment elevation myocardial infarction (STEMI). Interventions aiming at reducing reperfusion injury such as cardiac ischemic postconditioning (IPost) may reduce IS and improve clinical outcomes. IPost, was shown to be feasible in patients with STEMI treated by primary percutaneous coronary intervention (PPCI). Methods We performed a meta-analysis of randomized controlled trials that evaluated the efficacy of IPost in STEMI patients undergoing PPCI. Main outcome was the area under the curve (AUC) of serum CK release (CK-AUC). Secondary outcomes were other surrogate biomarkers of IS, complete ST-segment resolution (cSTR), direct measure of IS by single-photon emission computed tomography (SPECT) or estimate of the IS by cardiac magnetic resonance (CMR). Results Eleven studies were selected including 1313 STEMI patients undergoing PPCI with or without IPost. Compared to control, we observed a significant reduction of CK-AUC (SMD –2.84, 95%CI-5.43 to –0.25 IU/L, p=0.03). Other surrogate markers like CMR (SMD –0.36, 95%CI [–0.88, 0.15], p=0.16) showed a non-significant IS reduction in the IPost group. Conclusions This meta-analysis dealing with accurate surrogates of IS such as CK-AUC suggests that IPost reduces IS. These results should be interpreted cautiously because of limited samples sizes. Whether this translates into cardiac function and patient’s prognosis improvement still needs to be demonstrated in larger prospective sufficiently powered randomized controlled studies. Abstract 0057 – Figure: Forest plots of biologic surrogates of infarct size [ABSTRACT FROM AUTHOR]

Objective The objective of the study was to externally validate and assess the robustness of 2 nomograms designed to predict the probability of lymphatic dissemination (LD) for patients with early-stage endometrioid endometrial cancer. Study Design Using a prospective multicenter database, we assessed the discrimination, calibration, and clinical utility of 2 nomograms in patients with surgically treated early-stage endometrioid endometrial cancer. Results Among the 322 eligible patients identified, the overall LD rate was 9.9% (32 of 322). Predictive accuracy according to discrimination was 0.65 (95% confidence interval, 0.61–0.69) for the full nomogram and 0.71 (95% confidence interval, 0.68–0.74) for the alternative nomogram. The correspondence between observed recurrence rate and the nomogram predictions suggests a moderate calibration of the nomograms in the validation cohort. Conclusion The nomograms were externally validated and shown to be partly generalizable to a new and independent patient population. Although these tools provide a more individualized estimation of LD, additional parameters are needed to allow higher accuracy for counseling patients in clinical practice. [ABSTRACT FROM AUTHOR]

Objective: The objective of the study was to describe the surgical anatomy of infraureteral parametrium. Study Design: Findings of laparoscopic dissections during 12 type III radical hysterectomies were compared with findings obtained by bilateral pelvic dissections of 5 fresh and 5 embalmed female cadavers and to magnetic resonance imaging of 10 healthy controls. Results: Two anatomical entities of the parametrium were distinguished: (1) the lateral mesometrium corresponding to the blade containing vessels and lymph nodes of the uterus; and (2) the infraureteral parametrium extending dorsally from cervix and vagina. The lateral paracervix classically described under the ureter was never identified. Infraureteral parametrium appeared as a fibrous tissue extending in a lateral, dorsal, and caudal direction on both sides of the rectum and very close to the pelvic plexus. Conclusion: Our results attest to the absence of infraureteral parametrium, raising the issue of the surgical relevance of radical hysterectomy classification and the redefinition of the concept of radical hysterectomy. [Copyright &y& Elsevier]

Objective: The aim of this study was to assess hourly fetal urine production rates (HFUPRs) and establish a nomogram by measuring bladder volumes with 3-dimensional ultrasound. Study Design: Fetal urine bladder volume was estimated in 167 normal singleton pregnancies with neither oligohydramnios nor polyhydramnios, at a gestational age of 20-41 weeks. HFUPR was estimated in a regression analysis that included at least 3 volumes calculated during the filling phase with the Virtual Organ Computed-aided AnaLysis (VOCAL) technique. We estimated interoperator variability for HFUPR less than 10 mL/h and HFUPR greater than 10 mL/h. Results: Fetal urine production rates at 25, 30, 35, and 40 weeks were 7.5, 22.2, 56.1, and 125.1 mL/h, respectively. The intraclass correlation coefficients for interoperator variability were 99.2% for HFUPR less than 10 mL/hour and 97.1% for HFUPR greater than 10 mL/h. Conclusion: Prenatal measurement of HFUPR with 3-dimensional VOCAL ultrasound is reproducible and may help to determine the cause and prognosis of amniotic fluid volume abnormalities. [Copyright &y& Elsevier]