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The aim of this study was to compare clinical characteristics and adipose/liver tissue histology analysis in HIV-infected and HIV-uninfected subjects undergoing bariatric surgery.This was a cross-sectional study of HIV-infected subjects undergoing single-port sleeve gastrectomy with prospective enrolment and frequency age (±5 years), sex, and body mass index (BMI, ± 5 kg/m2) matched on HIV-uninfected subjects.This study was conducted at a single clinical site at Pitié-Salpêtrière hospital-Paris-France comprising 19 HIV-uninfected and 21 HIV-infected subjects with plasma VL20 copies/mL, all with a BMI40 kg/m2 or35 kg/m2 with comorbidities. Histology of subcutaneous and visceral abdominal adipose tissue (SCAT/VAT) and liver biopsies was collected during single-port sleeve gastrectomy. Outcomes included anthropometric characteristics, comorbidities, cardiovascular parameters, adipose tissue, and liver histology.The age of HIV-infected participants was (median, interquartile range IQR) 48 y (42-51), with 76.2% females, a BMI of 41.4 kg/m2 (37.3-44.4), an antiretroviral duration of 16 y (8-21), current integrase strand transfer inhibitor (INSTI)-based regimen in 15 participants and non-INSTI regimen in 6 participants, and a CD4 count of 864/mm3 (560-1066). The age of controls was 43 y (37-51), with 78.9% females and a BMI of 39.2 kg/m2 (36.3-42.6). Anthropometric characteristics, comorbidities, and cardiovascular parameters did not differ according to HIV status and INSTI treatment. The number of macrophage crown-like structures in SCAT was lower in INSTI-treated participants than in HIV-uninfected participants (P = 0.02) and non-INSTI-treated HIV-infected subjects (P = 0.07). Hepatic steatosis and liver disease severity global score were lower in INSTI-treated participants than in non-INSTI-treated HIV-infected participants (P = 0.05 and P = 0.04, respectively).HIV-infected and HIV-uninfected subjects undergoing bariatric surgery presented a similar profile regarding anthropometric measures, cardiovascular parameters, and comorbidities. However, INSTI-treated participants presented milder SCAT and liver alterations than non-INSTI-treated participants.

A growing literature shows an improvement of chronic hepatitis C virus (HCV)-related depression after successful treatment with direct-acting antivirals. However, depression after HCV cure remains insufficiently documented in people living with HIV (PLWH) and HCV, a population with specific mental health challenges. This study aimed to (i) document the prevalence of moderate-to-severe depression (PHQ-9 score ≥10) across different age classes in HCV-cured PLWH; (ii) identify associated socio-behavioral correlates.Descriptive analyses were performed on data collected during a cross-sectional survey (February 2018 - May 2019) nested in a prospective, multicenter cohort of individuals living with HIV and HCV (ANRS CO13 HEPAVIH). Socio-behavioral correlates of moderate-to-severe depression were identified using logistic regression.Among the 398 HCV-cured individuals in the study sample (median age [IQR]: 56 [53-59] years; 73.1% men), 23.9% presented with moderate-to-severe depression (PHQ-9 score ≥10). Depressive symptom prevalence rates were as follows: anhedonia: 52.3%; feeling 'down' or feelings of hopelessness: 48.3%; sleeping problems: 65.7%; lack of energy: 70.3%; eating disorders: 51.2%; lack of self-esteem: 34.3%; difficulty concentrating: 34.9%; sluggishness (in movement and voice) or restlessness: 24.6%; suicidal ideation: 17.1%. No significant difference was detected across age classes. Female sex, unhealthy alcohol use, sedentary lifestyle, and unhealthy eating behaviors were associated with increased odds of moderate-to-severe depression.Depressive symptoms were common in this sample of HCV-cured PLWH. Unlike findings for the French general population, the prevalence of depression did not decrease with age class. Mental health remains a key issue for HIV-HCV-coinfected individuals, even after HCV cure, especially in women and in individuals with unhealthy behaviors.Despite potential improvements in mental health after successful treatment with direct-acting antivirals, many people living with HIV (PLWH) and hepatitis C virus (HCV) - even in older age classes - still face depressive symptoms after HCV cure. In this population, women and people reporting unhealthy alcohol use, sedentary lifestyle, or unhealthy eating behaviors are more prone to report depressive symptoms after HCV cure. Mental health and lifestyle-related issues should be integrated in a global care model for PLWH living with or having a history of hepatitis C.

Background Mucosae-associated lymphoid tissue (MALT) lymphomas are a rare and still poorly understood form of primary central nervous system lymphoma (PCNSL). The aim of this study was to better describe these tumors and their management, and to better appreciate their long-term prognosis after treatment. Material and Methods Adult immunocompetent patients with primary CNS MALT lymphoma (PCNSML) were retrospectively selected from the database on PCNSL of the Pitié-Salpêtrière Hospital. All cases had double-read for pathology. Results Eleven PCNSML representing 1.7% of the 662 PCNSL included in the database were selected, There were 9 women and two men, all immunocompetent. Their median age was 56 years (min 29; max 78). The median time from first symptoms to diagnosis was 13 months and the median KPS at diagnosis was 90. Location was dural in 8 cases, suggestive of meningioma in 7 cases and of subdural hematoma in 1 case, and parenchymal in 3 cases. The disease was unifocal/localized in 4 cases and multifocal/diffuse in 7 cases. In 3 cases, it was the second reading that allowed making the diagnosis. In first-line treatment, all patients received chemotherapy (CT): “systemic” CT, i.e usually used in systemic MALT lymphomas, in 7 cases (n=7) and “CNS” CT, i.e usually used in CNS lesions in 4 cases. CT was preceded by surgery in 4 cases. No patient received radiotherapy in first line. According to the IPCG (International PCNSL Collaborative Group) criteria, the overall response rate was 7/11 (64%). At latest news, 5 patients had a persistent contrast enhancement, stable without any treatment since a median of 57 months, raising the question of complete response despite persisting contrast enhancement. No patient developed neurotoxicity except for one of the 2 patients who subsequently received radiotherapy. The median follow-up was 109 months. The median progression-free survival was 78.0 months (95% CI [43.4;NA[) and the 10-year overall survival rate was 90% (95% CI [0.7;1[). Conclusion This series confirms the classical clinical and radiological presentation of PCNSML. Compared to the literature where the treatment was based on radiotherapy in almost two thirds of cases, the therapeutic approach presented here appears unconventional. This is the first series demonstrating that chemotherapy is an efficient treatment in PCNSML, with an excellent long-term outcome and the absence of neurotoxicity, and calling into question the relevance of the IPCG criteria for the evaluation of their therapeutic response.

International audience; No abstract available

Chronic enterovirus infections can occur in primary immunodeficiency with hypogammaglobulinemia. They usually associate meningitis and myofasciitis. Such infections have also been described in adults with rituximab-induced hypogammaglobulinemia.We report the case of a 33-year-old woman who was given rituximab for immune thrombocytopenia and developed rituximab-induced hypogammaglobulinemia (IgG 4.4g/L). One year after the last rituximab infusion, she developed lower limbs myofasciitis, followed two months later by a chronic lymphocytic meningitis. PCR in the serum and the cerebrospinal fluid at the time of the meningitis and the myofasciitis were positive to the same enterovirus (echovirus 11) while it was negative in the fascia biopsy. Under treatment with intravenous immunoglobulins, all symptoms and laboratory abnormalities improved and enterovirus PCR became negative.We report a case of chronic enterovirus infection associating meningitis and myofasciitis in an adult with rituximab-induced hypogammaglobulinemia. Outcome was favorable under treatment with intravenous immunoglobulins.

The Banff Working Group on Liver Allograft Pathology reviewed and discussed literature evidence regarding antibody-mediated liver allograft rejection at the 11th (Paris, France, June 5-10, 2011), 12th (Comandatuba, Brazil, August 19-23, 2013), and 13th (Vancouver, British Columbia, Canada, October 5-10, 2015) meetings of the Banff Conference on Allograft Pathology. Discussion continued online. The primary goal was to introduce guidelines and consensus criteria for the diagnosis of liver allograft antibody-mediated rejection and provide a comprehensive update of all Banff Schema recommendations. Included are new recommendations for complement component 4d tissue staining and interpretation, staging liver allograft fibrosis, and findings related to immunosuppression minimization. In an effort to create a single reference document, previous unchanged criteria are also included.

Rosai-Dorfman disease (RDD) was first described by the French pathologist Paul Destombes in 1965. It frequently affects children or young adults and is characterized by the presence of large histiocytes with emperipolesis. More than 50 years after this first description, the pathogenesis of this rare disease is still poorly understood. The revised classification of histiocytoses published in 2016 identified various forms of RDD, from familial RDD to IgG4-associated RDD. Almost 90% of the patients with RDD have cervical lymph nodes involvement although all the organs may virtually be involved. Outcomes are typically favorable. Treatments may be necessary in case of compression or obstruction, and are not well codified. The main therapeutic strategies rely on surgery, radiotherapy, steroids, immunosuppressive drugs or interferon-alpha and cladribine.

International audience; Background: Chromomycosis is a rare mycotic infection encountered in tropical and subtropical regions. The disease presents as a slowly-evolving nodule that can become infected with bacteria. Here, we describe a unique association of abscesses caused by a chromomycosis and Listeria monocytogenes in a kidney transplant recipient, and didactically expose how the appropriate diagnosis was reached.Case presentation: A 49-year old male originating from the Caribbean presented a scalp lesion which was surgically removed in his hometown where it was misdiagnosed as a sporotrichosis on histology, 3 years after he received a kidney transplant. He received no additional treatment and the scalp lesion healed. One year later, an abscess of each thigh due to both F. pedrosoi and L. monocytogenes was diagnosed in our institution. A contemporary asymptomatic cerebellar abscess was also found by systematic MRI. An association of amoxicillin and posaconazole allowed a complete cure of the patient without recurring to surgery. Histological slides from the scalp lesion were re-examined in our institution and we retrospectively concluded to a first localisation of the chromomycosis. We discuss the possible pathophysiology of this very unusual association.Conclusion: In this case of disseminated listeriosis and chromomycosis, complete cure of the patients could be reached with oral anti-infectious treatment only.

Kimura's disease (KD) is an angiolymphoid proliferative disorder of soft tissue with eosinophilia, with a predilection for head and neck regions in young Oriental men. Kidney disease is thought to be rare in KD. About a case of adult-onset nephrotic syndrome with minimal change disease, we comment Kimura's disease and its associated kidney damage. Kimura disease should be suspected and included in the diagnosis of adult-onset nephrotic syndrome with minimal change disease.

Resume Introduction La papulose lymphomatoide (PL) est une dermatose chronique evoluant par poussees. Elle est classee par le WHO-EORTC dans les lymphoproliferations T-cutanees primitives CD30+. L’atteinte muqueuse est rare (15 cas decrits). Nous rapportons 2 nouveaux cas de PL de la muqueuse buccale en absence d’atteinte cutanee. Observation Deux femmes âgees respectivement de 63 et 32 ans ont presente une ulceration buccale isolee douloureuse, a bords infiltres, a la tuberosite maxillaire pour l’une et a la face interne de joue pour l’autre. L’etat general etait conserve. L’immunohistochimie de biopsies a montre une PL de type A pour chacun des cas. Les lesions ont spontanement regresse. Discussion La PL est tres rare. Les atteintes buccales sont le plus souvent precedees de poussees cutanees. Elles sont toutes localisees a la langue et a la muqueuse labiale. Les localisations tuberositaire et jugale isolees n’avaient pas encore ete rapportees.

Neurological localizations of sarcoidosis are heterogeneous and may affect virtually every part of the central or peripheral nervous system. They are often the inaugural manifestation of sarcoidosis. The diagnosis may be difficult due to the lack of extra-neurological localization. Diagnosis may be discussed in the presence of an inflammatory neurological disease, in particular in case of suggestive radiological or biological pattern. Cerebrospinal fluid analysis shows lymphocytic pleiocytosis, often with low glucose level. The diagnosis relies on a clinical, biological and radiological presentation consistent with neurosarcoidosis, the presence of non-caseating granuloma and exclusion of differential diagnoses. Screening for other localizations of sarcoidosis, in particular cardiac disease may be obtained during neurosarcoidosis. The treatment of neurosarcoidosis relies on corticosteroids although immunosuppressive drugs are usually added because of the chronic course of this condition and to limit the side effects of steroids. Treatments and follow-up may be prolonged because of the high rate of relapses.

Sarcoidosis is a systemic granulomatous disorder of unknown cause. Apparition or flare of previously diagnosed sarcoidosis following hematopoietic stem cell transplantation (HSCT) has rarely been reported.We report a 62-year-old woman who presented a radiological flare of sarcoidosis post-autologous stem cell transplantation for a POEMS syndrome. Imaging findings and lymph node histology, which revealed non-caseating granuloma, were consistent with the sarcoidosis diagnosis. The patient was asymptomatic and was kept free of treatment.Sarcoidosis must be considered ahead of compatible clinicoradiological presentation occurring after HSCT. Sarcoidosis can mimic metastatic cancer or lymphatic relapse. Tissue biopsies and exclusion of differential diagnosis of granuloma diseases are warranted to confirm sarcoidosis diagnosis.

Nitrofurantoin is a commonly used drug which can have liver and pulmonary adverse effects. Among hepatic nitrofurantoin-induced adverse effects, autoimmune hepatitis is a rare complication which must not be mistaken as a toxic hepatitis.We report an 86-year-old woman who presented with acute hepatitis after a 3-month course of nitrofurantoin administration for urinary tract infections. She reported a previous hepatitis after treatment by nitrofurantoin twenty years before. Biological analysis showed polyclonal hypergammaglobulinemia, positive test for antinuclear antibodies and smooth muscle antibodies. Finally, liver histology showed lymphocytic infiltration, marked necrotic and inflammatory activity consistent with the diagnosis of autoimmune hepatitis. Nitrofurantoin was discontinued. Outcome of autoimmune hepatitis was good with corticosteroids and azathioprine but two months later, the patient died from a refractory global heart failure.Nitrofurantoin-induced autoimmune hepatitis is a severe condition which must be systematically discussed in patients taking nitrofurantoin who present with acute hepatitis. Hypergammaglobulinemia is an easily obtained blood marker, which can suggest this diagnosis. Treatment relies on nitrofurantoin eviction, corticosteroids and sometimes azathioprine. Outcome is usually favorable.

Objectifs Prise en charge diagnostique et therapeutique des pseudo-uveites associees au lymphome de type MALT. Patients et methodes Nous rapportons les cas de trois patients adresses pour une baisse visuelle profonde evoluant sur un mode aigu ou chronique. Ils presentaient tous une uveite ou une sclerite cortico-resistante. Il s’agissait respectivement d’une uveite posterieure associee a une infiltration retinochoroidienne, d’une sclerite anterieure associee a un syndrome d’effusion uveale et d’une pan-uveite bilaterale associee a des decollements sereux retiniens. Deux des patients avaient un antecedent de pathologie maligne systemique. Les trois patients ont eu un bilan etiologique complet. La recherche des etiologies infectieuses, auto-immunes ou malignes etait infructueuse mais l’imagerie orbitaire mettait en evidence un epaississement scleral posterieur. Resultats Le diagnostic de lymphome oculaire de type MALT a ete pose dans les trois cas apres biopsie des lesions sclerales. Les analyses immunohistochimiques mettaient en evidence un infiltrat lymphocytaire scleral de type CD20+ et CD5-. Les trois patients ont ete traites par cure de chimiotherapie associees a une radiotherapie. Les lesions ont ete stabilisees chez le premier patient alors qu’une amelioration de l’acuite visuelle de six lignes chez le deuxieme et une guerison totale chez le troisieme ont ete notees apres traitement. Discussion Les manifestations cliniques de cette atteinte oculaire semblent etre tres variees, mimant differents types d’uveite posterieure ou de sclerite. Dans ces trois cas, nous n’avons pas retrouve d’atteinte muqueuse associee. Le diagnostic repose entierement sur l’examen anatomopathologique. La recuperation visuelle rapide dans deux cas demontre l’importance d’un diagnostic precoce et d’un traitement specifique. Toute uveite posterieure totale, chronique et cortico-resistante impose une analyse radiologique specialisee suivie, le cas echeant, d’une biopsie orbitaire etagee.

The purpose of this study was to establish the relative contribution of tumour stage, node stage, p53 gene status, p53 expression, and bcl-2 protein expression to tumour response to platin-fluorouracil chemotherapy in 141 patients with squamous-cell carcinomas of the head and neck. Tumour response was measured at the primary site after three cycles of chemotherapy. Exons 2–10 and the coding part of exon 11 were sequenced on both strands. Bcl-2 or p53 expression was detected by immunohistochemistry. Predictor variables of objective response (reduction of at least 50% of tumour size) were tested in univariate and multivariate analyses. P53 mutations were found in 52 patients (37%). Tumour cells expressed p53 in 84 cases (59%) and bcl-2 in 25 cases (18%). T1 or T2 stage (adjusted odds ratio, 3.3; 95% confidence intervall 1.3–8.7; P=0.01), N0 node stage (adjusted odds ratio, 2.7; 95% confidence interval 1.1–6.4; P=0.03), p53 wild-type gene (adjusted odds ratio, 4 .0; 95% confidence interval 1.7–9.5; P=0.002), and bcl-2 protein expression (adjusted odds ratio, 20; 95% confidence interval 2.3–170; P=0.006), were positively associated with tumour response. P53 protein expression was not predictive of response. In conclusion, tumour stage, node stage, p53 gene status, and bcl-2 expression are independent predictors of tumour response to platin-fluorouracil in patients with squamous-cell carcinomas of the head and neck. British Journal of Cancer (2002) 87, 1390–1395. doi:10.1038/sj.bjc.6600648 www.bjcancer.com © 2002 Cancer Research UK

Lymphomatoid Papulosis (LP) is a chronic dermatosis progressing by flare-up. According to the WHO-EORTC classification, LP is a form of CD30+ primitive cutaneous lympho-proliferation. Mucosal lesions are rare, with 15 published cases. We report two new cases of oral localizations, without any cutaneous involvement.Two women, 32 and 63 years old, presented with an isolated painful oral ulceration, of the maxillary tuberosity and of the inner side of the cheek respectively. The general state of health was preserved. Immunohistochimical analysis of the biopsies showed two Type A LPs. Lesions spontaneously resolved.Among the rare published cases, oral localization involved exclusively the tongue and the labial mucosa and almost all patients presented with previous cutaneous lesions. Isolated maxillary tuberosity or cheek involvements were not described yet.

Erdheim-Chester disease is a rare and orphan disease. Despite having been overlooked previously, numerous new cases have been diagnosed more recently. The number of Erdheim-Chester disease cases reported has increased substantially: more than 300 new cases have been published in the past 10 years. This situation is mainly a result of the generally better awareness among pathologists, radiologists, and clinicians of various aspects of this rare disease. The field has been particularly active in the last few years, with evidence of the efficacy of interferon-α, the description of a systemic pro-inflammatory cytokine signature, and most recently, reports of the dramatic efficacy of BRAF inhibition in severe, BRAF(V600E) mutation-associated cases of Erdheim-Chester disease. Also, BRAF mutations have been found in more than half of the patients with Erdheim-Chester disease who were tested. Detailed elucidation of the pathogenesis of the disease is likely to lead to the development of better targeted and more effective therapies.

Kimura's disease (KD) is an angiolymphoid proliferative disorder of soft tissue with eosinophilia, with a predilection for head and neck regions in young Oriental men. Kidney disease is thought to be rare in KD. About a case of adult-onset nephrotic syndrome with minimal change disease, we comment Kimura's disease and its associated kidney damage. Kimura disease should be suspected and included in the diagnosis of adult-onset nephrotic syndrome with minimal change disease.

Resume De recentes donnees histologiques, immunophenotypiques et genotypiques ont reduit le concept de maladie de Hodgkin (MDH) aux types 2 et 3 de la classification de Rye. Cette classification devrait etre revisee car il a ete montre que le type 1, a predominance lymphocytaire, inclut le paragranulome de Poppema et Lennert considere comme un lymphome de phenotype B, des cas confondus avec le lymphome non hodgkinien (LNH) B a grandes cellules riche en lymphocytes T et des cas qui devraient etre reclasses parmi les types 3, a cellularite mixte. De plus, la plupart des types 4 sont actuellement consideres comme des LNH anaplasiques. Les etudes immunophenotypiques et genotypiques sont en faveur de la nature heterogene des cellules de Reed-Sternberg et de Hodgkin (RSH) car celles-ci pourraient deriver de cellules lymphoides B, T ou nulle. Dans 50% des cas, les cellules RSH hebergent le genome du virus d'Epstein-Barr et expriment une proteine virale, la proteine de latence membranaire, qui pourrait jouer un role oncogenique dans la MDH. Enfin, les cellules RSH produisent de nombreuses cytokines qui pourraient stimuler leur proliferation et expliquer l'importance de la reaction tissulaire observee dans la MDH.

Purpose Ig4-related disease is a recently defined entity characterized by a mono or multi organ lymphoplasmocytic infiltrate with IgG4+staining (IgG4+/IgG+ cell ratio>40%), associated with fibrosis or sclerosis and elevated IgG4 serum rate over 135mg/dL. Purpose is to determine the ophthalmological and histological features of IgG4-RD, and to analyse the outcome under treatment. Methods Patients with biopsy-proven IgG4-RD, seen between 2009 and 2011 in a single tertiary center, were retrospectively reviewed. Clinical manifestations, biological and radiological results, histological features and outcome under treatment were analyzed. Results Three caucasian women were included. Mean age was 58 years (range :50-63). One patient presented with unilateral painful propotosis, associated with third and fifth cranial nerve palsy. One patient had recurrent anterior scleritis, and one patient presented with chronic conjonctival inflitration. None of them had extra-ocular involvement (FDG-PET-scan). Other inflammatory conditions were ruled out. Histopathology demonstrated lymphoplasmocytosic proliferation with expression of IgG4+ plasma cells over 40%. IgG4 serum rate was elevated in one case. All patients primary responded to corticosteroids but 2 of them required the adjunction of an immusuppressive drug(fibrosis or relapse).third one presented with epithelial carcinoma. Conclusion IgG4-RD is a new and rare entity, challenging to diagnose in case of isolated orbital involvement or in atypical features, such as conjonctivitis and scleritis Histopathology is the gold-standard for diagnosis if appropriate staining is performed. Treatment is controvertial : corticosteroids are the mainstay, but many cases require associated immunosuppressors.

Churg Strauss syndrome (CSS) is a systemic vasculitic disorder characterized by granulomatous inflammation affecting small to medium-sized blood vessels. Although the cause of CSS remains unknown, ...

The detection and typing of human papillomaviruses on cervical smears were performed by means of a new application of the polymerase chain reaction allowing easier and faster detection of the amplification product. This application consisted of a combination of two series of amplifications and the use of primers labelled with biotin and with 125 iodine on a reporter group for the second amplification. The final amplification product was detected by counting the radioactivity after incubation of the media in avidin-coated tubes. This test was compared with conventional methods of detection by electrophoresis and Southern blot and its specificity was confirmed. The study of a series of 52 patients demonstrated a higher prevalence of type 16 in relation to type 6/11 and 18 and a correlation between the degree of dysplasia and the frequency of oncogenic types 16 and 18. This new application could facilitate studies of the prevalence of HPV in large series of cervical smears.

FibroTest has been validated for the diagnosis of liver fibrosis in patients with chronic hepatitis C.To compare FibroTest with a new proteome-based model for the prediction of advanced liver fibrosis.Sera from 191 consecutive patients with simultaneous liver biopsy and FibroTest on fresh sera were used for retrospective mass spectrometry analysis. A new fibrosis index was constructed combining proteomic peaks, selected on differential expression according to fibrosis stages in logistic regression analyses. The main end point was the diagnosis of advanced fibrosis on liver biopsy.Eight out of 1000 peaks were selected for the construction of the proteomic index. The area under the receiver operating curve (AUROC) of the proteomic index was 0.88 (95% CI: 0.82-0.92), significantly greater than the FibroTest AUROC of 0.81 (95% CI: 0.74-0.86; P = 0.04); the AUROC of the proteomic and FibroTest combination was 0.88 (95% CI: 0.83-0.92). Seven of the eight selected peaks were highly associated with the FibroTest score, with different patterns of association with the five components of FibroTest.A proteomic index combining eight peaks had an excellent accuracy value for the diagnosis of advanced fibrosis in patients with chronic hepatitis C. However, despite a statistical significance, the small improvement delivered by proteomics impairs clinical applications because of its cost and its variability compared with the well validated FibroTest.

The area under the receiver operating characteristic (ROC) curve is widely used as an estimate of the diagnostic value for fibrosis markers. Biopsy length and fragmentation are known as risk factors of false positive or false negative of biopsy but their quantitative impact on area under the receiver operating characteristic curve variability has not been assessed.To assess these relationships to better compare the fibrosis markers.The area under the ROC curves of FibroTest for the diagnosis of fibrosis was estimated in patients with chronic hepatitis C using an integrated database including 1312 patients with FibroTest and biopsy. To take into account the biopsy length, we used two adjustment factors: one in which an observed area under the ROC curve could be adjusted according to the relative area under the receiver operating characteristic curve of a biopsy of a given length vs. the entire liver and one taking into account the prevalence of each fibrosis stage defining advanced and non-advanced fibrosis.The mean biopsy length was smaller for cirrhosis (F4, 16 mm) vs. F3, (18 mm, P=0.01) and F0 (19 mm, P=0.01). The mean number of fragments was higher for cirrhosis (F4=4.1 fragments) vs. all the other stages (F0=1.9, F1=1.9, F2=1.9, F3=2.3; P0.001 vs. F4). The FibroTest area under the ROC curves for the diagnosis of advanced fibrosis, adjusted for stages' prevalence, ranged from 0.80 to 0.98 depending on biopsy length and fragmentation, respectively.The comparison of the area under the ROC curves of fibrosis markers should take into account the biopsy length and fragmentation.

In non-alcoholic fatty liver disease, histological lesions display a significant sampling variability that is ignored when interpreting histological progression during natural history or therapeutic interventions.To provide a method taking into account sampling variability when interpreting crude histological data, and to investigate how this alters the conclusions of available studies.Natural history studies detailing histological progression and therapeutic trials were compared with the results of a previously published sampling variability study.Natural history studies showed an improvement in steatosis, which was significantly higher than expected from sampling variability (47% vs. 8%, P0.0001). In contrast, no study showed a change in activity grade or ballooning higher than that of sampling variability. There was only a marginal effect on fibrosis with no convincing demonstration of a worsening of fibrosis, a conclusion contrary to what individual studies have claimed. Some insulin sensitizing drugs and anti-obesity surgery significantly improved steatosis, while most did not significantly impact on fibrosis or activity.Sampling variability of liver biopsy is an overlooked confounding factor that should be considered systematically when interpreting histological progression in patients with non-alcoholic fatty liver disease.

Objectifs Evaluer l’effet de l’exposition au laser Ho:YAG sur l’œil d’un modele animal ex vivo et l’action protectrice des lunettes dediees a cet effet. Methodes L’experience a consiste en l’application d’une energie laser Ho:YAG par une fibre laser de 275 um pendant une duree de une ou cinq secondes a differents parametres (0,5 J–20 Hz, 1 J–10 Hz et 2 J–10 Hz) et differentes distances (0,3, 5, 8, 10 et 20 centimetres) au centre de la pupille d’yeux de porcs (yeux recueillis sur animaux abattus) ( Fig. 1 A et B). Ce schema experimental a ete repete avec l’utilisation : – de lunettes protectrices ; – de lunettes de vue ; – d’aucun dispositif entre la fibre laser et la pupille. Les effets du laser ont ete analyses par histologie. Le meme schema experimental a ete reproduit sur du papier thermique. Resultats Un total de 78 yeux a ete utilise dont 6 en tant que controle. Les lesions corneennes induites par l’energie laser n’ont ete observees qu’en l’absence d’utilisation des lunettes protectrices. Celles-ci allaient de la brulure superficielle a la necrose complete de la zone concernee et etaient directement correlees a l’intensite de l’energie du pulse, au temps d’exposition et inversement correlees avec la distance fibre laser-pupille. Lorsque la fibre etait placee a 5 centimetres ou plus de la cornee, aucune lesion n’a ete constatee quels que soient les parametres laser utilises et le temps d’exposition. Des resultats similaires ont ete observes avec l’utilisation du papier thermique ( Fig. 2 ). Aucune lesion cristallinienne et retinienne n’a ete notee dans tous les yeux utilises et ce avec ou sans utilisation de lunettes protectrices. Conclusion Le laser Ho:YAG peut creer des lesions limitees uniquement a la cornee et ce en cas de haute energie, de distance inferieure a 5 centimetres entre la fibre et l’œil et en l’absence de port de lunettes protectrices. Ces lunettes protegent de tout risque lesionnel quel que soit le reglage laser utilise.