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Few studies compared short-term androgen deprivation (STADT) with high-dose radiotherapy (STADT-RT) versus high dose radiotherapy (RT) alone in localized prostate cancer.

Le positionnement des implants d’une prothèse totale de hanche (PTH) est essentiel pour limiter les complications et optimiser les résultats fonctionnels. Dans une étude récente sur plus de 100 PTH posées par voie antérieure sur table orthopédique, nous avions constaté que l’antéversion moyenne de la cupule était plus importante (30°) que celle recommandée (20°). Pour expliquer ce phénomène, nous avons évoqué que le plan pelvien antérieur (PPA), défini par le plan passant par les épines iliaques antérosupérieures et la symphyse pubienne, qui sert de repère à la pose et au calcul de l’antéversion de la cupule n’était pas horizontal une fois le patient allongé sur la table orthopédique. Cette notion n’a pas été évaluée ; aussi, nous avons mené une étude prospective afin de : 1) mesurer la position du bassin sur table orthopédique ; 2) comparer à la position debout ; 3) évaluer son retentissement sur l’antéversion de la cupule.

There is an aging of the peripheral nervous system characterized by a decrease in sensory and motor nerve conduction, amplitudes of motor and above all sensory potentials, an abolition of the ankle jerk reflexes and an alteration of proprioceptive sensitivity in almost two-thirds of individuals over 65 years old. These anomalies tend to increase beyond 80 years. However, these signs of aging do not affect the quality of life of the subjects. The causes of peripheral neuropathies in the elderly differ little from those observed before age 65. Of course, hereditary causes are much less frequent, except cases with a late onset, now easily detectable, such as familial amyloidosis. In our climates and in the most developed countries, diabetes remains the most common cause, the prevalence of neuropathy increasing with age. The so-called idiopathic causes are also frequent and despite extensive investigations, nearly 20% of cases remain without etiological diagnosis, but this type of neuropathy is generally mild and not very progressive. The presence of peripheral neuropathy in the elderly can cause real problems in daily life, including the frequency of falls that can be responsible for deleterious bone damage.

Le maintien en emploi après un cancer fait partie des objectifs de la stratégie décennale cancer et du Plan national de santé au travail. Néanmoins, il se heurte à de nombreux obstacles liés aux conséquences de la maladie et des traitements, aux conditions du travail, et aux relations entre les acteurs. Il est recommandé d’intégrer les enjeux de travail dès le parcours de soins, pour mieux anticiper les enjeux. Le projet FASTRACS vise à développer, implanter et évaluer une intervention pour faciliter le maintien en emploi après un cancer du sein. L’objectif de cette communication est de décrire les contributions du partenariat chercheurs–acteurs dans la construction et l’implantation d’une intervention décloisonnant la prise en charge des femmes atteintes de cancer du sein.

Device‐encapsulated human stem cell‐derived pancreatic endoderm (PE) can generate functional β‐cell implants in the subcutis of mice, which has led to the start of clinical studies in type 1 diabetes. Assessment of the formed functional β‐cell mass (FBM) and its correlation with in vivo metabolic markers can guide clinical translation. We recently reported ex vivo characteristics of device‐encapsulated human embryonic stem cell‐derived (hES)‐PE implants in mice that had established a metabolically adequate FBM during 50‐week follow‐up. Cell suspensions from retrieved implants indicated a correlation with the number of formed β cells and their maturation to a functional state comparable to human pancreatic β cells. Variability in metabolic outcome was attributed to differences in number of PE‐generated β cells. This variability hinders studies on processes involved in FBM‐formation. This study reports modifications that reduce variability. It is undertaken with device‐encapsulated human induced pluripotent stem cell‐derived‐PE subcutaneously implanted in mice. Cell mass of each cell type was determined on intact tissue inside the device to obtain more precise data than following isolation and dispersion. Implants in a preformed pouch generated a glucose‐controlling β‐cell mass within 20 weeks in over 60% of recipients versus less than 20% in the absence of a pouch, whether the same or threefold higher cell dose had been inserted. In situ analysis of implants indicated a role for pancreatic progenitor cell expansion and endocrine differentiation in achieving the size of β‐ and α‐cell mass that correlated with in vivo markers of metabolic control. Stem Cells Translational Medicine2019;8:1296&1305 Device‐encapsulated human induced pluripotent stem cell‐derived pancreatic endoderm can generate a glucose‐controlling β‐cell mass in immune‐compromised mice. For a dose of 5 × 106cells, this involves pancreatic progenitor cell differentiation as well as a cell mass increase following an initial cell loss. Measurement of these processes inside the device allows selection of conditions that help achieve metabolic control.

La patología mamaria de la adolescente está dominada por las anomalías morfológicas y el fibroadenoma. La exploración física a menudo es suficiente para su diagnóstico. La rareza de la patología maligna a esta edad permite tranquilizar, casi siempre, a la adolescente y a su familia desde el primer examen. La ecografía es el mejor examen complementario. Es indispensable antes de cualquier tratamiento quirúrgico. La mamografía no está indicada en la adolescencia. Las anomalías morfológicas están representadas por las anomalías de número (politelia, polimastia), de volumen (hipertrofia mamaria, hipotrofia mamaria, amastia), las asimetrías y las anomalías de forma (mamas tuberosas, síndrome de Poland). A menudo, tienen un fuerte impacto emocional y requieren un tratamiento adecuado, sin posponer la edad de la cirugía si la paciente lo espera. El fibroadenoma es el principal tumor de la adolescencia. El diagnóstico es clínico. En el caso más frecuente de un fibroadenoma simple, no es necesario ningún tratamiento. En cambio, el fibroadenoma gigante debe ser objeto de una exéresis quirúrgica, y la poliadenomatosis, de un tratamiento hormonal. La patología inflamatoria se debe a la sobreinfección de una ectasia galactófora. El tratamiento a menudo es médico. Las indicaciones operatorias indiscutibles durante la adolescencia son el fibroadenoma gigante y los tumores malignos. Las otras peticiones deben discutirse caso por caso, según la forma clínica y la repercusión psicológica. La cirugía se difiere hasta la madurez física (normalidad y estabilidad del peso, fin del crecimiento mamario) y psicológica, en la medida de lo posible, para limitar los problemas cicatriciales y para favorecer la estabilidad del resultado.

To compare the effectiveness of peripheral nerve stimulation utilizing a subcutaneous lead implant technique—subcutaneous nerve stimulation (SQS) plus optimized medical management (SQS + OMM arm) vs. optimized medical management alone (OMM arm) in patients with back pain due to failed back surgery syndrome. Patients were recruited from 21 centers, in Europe, Israel, and Australia. Eligible patients were randomized (1:1) to SQS + OMM or OMM arms. Those in the SQS arm were implanted with a neurostimulator and up to two subcutaneous percutaneous cylindrical leads in the area of pain. Patients were evaluated pre‐randomization and at one, three, six, and nine months post‐randomization. The primary endpoint was the proportion of subjects with a ≥50% reduction in back pain intensity (“responder”) from baseline to nine months. Secondary outcomes included proportion of responders with a ≥50% reduction in back pain intensity at six months and ≥30% reduction at nine months, and the mean change from baseline in back pain intensity at six and nine months between the two arms. Due to the slow rate of recruitment, the study was terminated early with 116 subjects randomized. A total of 33.9% (19/56, missing: n= 20 [36%]) of subjects in the SQS + OMM arm and 1.7% (1/60, missing: n= 24 [40%]) in the OMM arm were responders at Month 9 (p< 0.0001). Secondary objectives showed a significant difference in favor of SQS + OMM arm. The results indicate that the addition of SQS to OMM is more effective than OMM alone in relieving low back pain at up to nine months.

Peripheral nerve stimulation (PNS) has emerged as a minimally invasive percutaneous procedure addressing neuropathic pain. However, the percutaneous cylindrical lead ultrasound-guided implantation procedure requires expertise that limits widespread PNS utilization. To overcome these challenges, a microinvasive endoscopy device has very recently been developed, enhancing the precision of PNS implantation by providing accurate visualization of the targeted nerve. We aimed to determine the feasibility, safety, clinical effectiveness, and energy consumption of PNS therapy by means of ultrasound guidance combined with microendoscopy.

Introduction: Extra-articular hip resection may be necessary in cases of malignant tumour of the pelvic bone or of the proximal femur invading the hip joint. When the tumour is in the proximal femur, it is possible to resect the acetabulum en bloc by performing a periacetabular osteotomy, but this creates a discontinuity in the pelvic ring with difficult reconstruction and diminished function. Several techniques described recently seek to be as sparing as possible on the pelvic bone by preserving the posterior column or both columns in order to facilitate reconstruction and improve function. However, these still require complex reconstructions and can necessitate intra-pelvic dissection.Technique: We describe here an extra-articular hip resection technique for tumours of the proximal femur invading the joint, with maintenance of pelvic continuity by preserving both columns and the quadrilateral plate of the acetabulum, without intra-pelvic dissection, that can be performed on patients in whom the medial wall of the acetabulum is thick enough. Our preliminary assessments have included studies on dry bone and imaging analyses. The technique was first tested on a single cadaver pelvis (encompassing 2 hips) and subsequently performed on a patient with a pathological fracture of the femoral neck due to osteosarcoma secondary to Paget’s disease.Conclusions: Further clinical applications are essential to evaluate the overall effectiveness, safety and impact on patient functionality of this experimental technique.

•Nonspecific neck pain patients can be classified based on pain mechanisms.•The proposed classification strategy has clinically acceptable interrater reliability.•The classification holds the potential to guide physical therapy interventions.•Validity testing is the necessary next step to justify this approach for clinical use.

La douleur neuropathique reste très difficile à soulager avec un impact considérable sur la qualité de vie. Au même titre qu’une optimisation pharmacologique adaptée, la prise en charge des douleurs neuropathiques relève souvent de l’algologie interventionnelle incluant les blocs neurolytiques. Les blocs neurolytiques sont indiqués dans les douleurs neuropathiques focalisées intraitables, dans la prise en charge de la spasticité et en oncologie. Ils utilisent plusieurs agents « lytiques » qu’ils soient chimiques, physiques ou thermiques. Les blocs neurolytiques ne peuvent s’inscrire que dans une prise en charge globale avec une évaluation des facteurs de vulnérabilité psychosociaux et un suivi rapproché et individualisé. Ils nécessitent dans la plupart des cas des blocs anesthésiants diagnostiques et sélectifs. La place des blocs neurolytiques peut être pensée et intégrée dans un schéma multimodal dès l’élaboration initiale du projet thérapeutique d’un patient souffrant d’une douleur neuropathique focalisée.