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On October 15, 2021, the FDA approved atezolizumab as adjuvant therapy in patients with stage II to IIIA non–small cell lung cancer (NSCLC) whose tumors have programmed cell death ligand 1 (PD-L1) expression on ≥1% of tumor cells (TC), as detected by an FDA-approved test. The approval was based on results from the IMpower010 trial, in which 1,005 patients with NSCLC who had completed tumor resection and cisplatin-based adjuvant chemotherapy were randomly assigned 1:1 to receive atezolizumab for 16 cycles or best supportive care. The primary endpoint of disease-free survival (DFS) as assessed by investigator was tested hierarchically in the following analysis populations: stage II–IIIA NSCLC with PD-L1 expression on ≥1% of TCs (PD-L1 ≥ 1% TC); all randomly assigned patients with stage II–IIIA NSCLC; and the intent-to-treat population comprising all randomly assigned patients. At the prespecified interim DFS analysis, IMpower010 demonstrated a statistically significant and clinically meaningful improvement in DFS in the stage II–IIIA PD-L1 ≥ 1% TC analysis population, with an HR of 0.66 (95% confidence interval, 0.50–0.88; P = 0.004) favoring the atezolizumab arm. The safety profile of atezolizumab was generally consistent with known toxicities of anti–PD-(L) antibodies. The VENTANA PD-L1 (SP263) Assay (Ventana Medical Systems, Inc.) was contemporaneously approved as a companion diagnostic device to select patients with NSCLC who are PD-L1 ≥ 1% TC for adjuvant treatment with atezolizumab. Atezolizumab is the first immune checkpoint inhibitor approved by FDA for the adjuvant treatment of NSCLC.

Management of rectovaginal fistula (RVF) in Crohn’s disease (CD) is challenging. Available studies are heterogeneous and retrospective, with short-term follow-up. The aim of this study was to assess the overall long-term medico-surgical treatment results in women with RVF due to CD. A retrospective study was conducted on consecutive patients operated on for RVF in CD from September 1996 to November 2019 at a tertiary teaching hospital. All surgeries were classified as preliminary, closure, or salvage procedures. Primary outcome was fistula remission defined as the combination of fistula closure and no stoma, at least 6 months since last procedure. Thirty-two patients (median age 34 [range 21–55] years), with a median follow-up of 11.3 years (0–23.7) after first surgery, were included. Altogether, 138 procedures were performed; 36 (26%) preliminary, 80 (58%) closure, and 13 (9%) salvage procedures. RVF remission was obtained in 7/32 patients (22%). At the end of follow-up, a stoma was present in 13/32 patients (41%). The percentage of time on biologics was 86% for patients in remission, versus 36% for the others (p = 0.0057). After univariate analysis, only anti-TNF-α was significantly related to successful closure techniques (p = 0.007). The RVF remission rate in CD was low in the long term. However, patients underwent a succession of interventions, and the stoma rate was high. Combination of biologics with surgical management was crucial.

Background The estimated increase in prevalence of radiation enteropathy associated with a current scarcity of effective treatment options underline the need for the development of new therapies. Extracellular vesicles (EV), which are membrane-bound particles secreted by cells containing proteins, lipids and nucleic acids, have yielded promising preclinical results in various applications in regenerative medicine. Here, we aimed to investigate whether EV from adipose-derived stromal cells (ADSC) may present a therapeutic potential in the context of radiation colitis. Methods EV were produced from primary rat ADSC by exposure to a turbulent flow. Radiation colitis was induced by fractionated irradiation at a dose of 3x10Gy on a colorectal window (3x2cm) in male Sprague-Dawley rats (311-386g) at days 0, 2 and 4; following a pre-established protocol. Treatment was administered at days 11 and 15 through submucosal endoscopic injections of rat ADSC (n=9 rats, 2x106cells per dose), EV (n=9 rats, 1.06x1011 particles per dose), or an equivalent volume of saline (n=10 rats). The rats were sacrificed at day 17. Our primary endpoint was the extent of colonic epithelial injury at histological analysis (Table 1). Secondary endpoints included an endoscopic assessment of the severity of lesions at day 15 (Table 2) and an evaluation of macrophage infiltration in the colonic mucosa by CD68 immunohistochemistry. Comparisons of proportions were performed by the Chi-squared test followed by Fisher’s exact test. Results In the ADSC group, 1 rat died from anaesthesia complications. No other adverse effects were observed. No differences in total body weight evolution were observed between the groups. At day 15, a statistically significant decrease of the proportion of animals with moderate to severe lesions was evidenced by endoscopy in the EV group compared to the saline group (p=0.0031; Figure 1). No differences were observed between the other groups. Histological analysis of the colonic epithelial injury score evidenced a non-significant tendency towards a decreased length of high-grade lesions in the EV group (mean±standard deviation: 9180±3684µm; Figure 2) compared with the saline (11536±2711µm) and ADSC (11636±2815) groups. Similarly, CD68+ macrophage infiltration at the site of colonic mucosal lesions tended to be lower in the EV and ADSC groups compared to the saline group. Conclusion This proof-of-concept study seemed to demonstrate a beneficial effect of locally administered extracellular vesicles for the treatment of radiation colitis in the acute setting. A confirmation study in a larger animal cohort is underway, and further investigations focusing on dose effects or long-term effects on fibrosis are required to complete these preliminary results.

Background Subcutaneous infliximab (IFX-SC) was launched in France for the treatment of patients with inflammatory bowel disease (IBD) in 2021. Real-life and pharmacokinetic (PK) data after switching from intravenous infliximab (IFX-IV) to IFX-SC are needed. The PEREM study is a French multicenter prospective cohort aiming to describe the persistence of IFX-SC after switch from IFX-IV. Methods IBD patients in steroid-free clinical remission [Harvey Bradshaw Index (HBI) ≤ 4 for Crohn's disease (CD) and partial Mayo score (PMS) ≤ 2 with each subscore ≤ 1 for UC] for at least 6 months on IFX-IV therapy were proposed to switch to IFX-SC as part of routine care. Patients were included in 40 centers between Oct 2021 and May 2022. Clinical scores (HBI, PMS), biological samples (CRP and fecal calprotectin - FC), PK and anti IFX antibodies (ATI) were evaluated 3, 6, 12 and 24 months after switch. In case of IFX-SC discontinuation, time and reason for withdrawal were documented. Safety and adverse events of interest were recorded. The primary endpoint was IFX-SC persistence at 12 months. As not all patients met this primary endpoint at the time of writing this abstract, we present here the results at 6 months (M6). Results Among the 444 patients included [44% female, median age: 37 years (Min, Max: 18-88), 72% Crohn's], 71% were receiving IFX-IV at a dose of 5 mg/kg every 8 weeks and 84% were treated on monotherapy. Among the 417 patients analyzed, five withdrew their consent before the M6 visit and 324 were assessed at M6; 25/324 (7.7%) discontinued IFX-SC before M6 (seven for relapse, twelve for intolerance, two for pregnancy, four for unknown reasons) including one (0.3%) switch back to IFX-IV. Rate of survival without IFX-SC discontinuation at M6 was 92.6% (95% CI 89.3-95.1). Among the patients evaluated at M6, median clinical scores did not vary between inclusion and M6: HBI from 0 (IQR: 0-1) to 0 (IQR: 0-1), PMS from 0 (IQR: 0-0) to 0 (IQR: 0-0), respectively. The median CF and CRP levels were respectively 52 μg/g (IQR: 19-142) at inclusion and 37 μg/g (IQR: 14-129) at M6, and 1 mg/L (IQR: 1-4) at inclusion and 1 mg/L (IQR 0-4) at 6 months. At baseline, median infliximab levels were 6.6 μg/mL (min, max: 0-29) and 20 μg/mL (min, max: 0.3- 79.2) at M6. No major safety signals were recorded. Conclusion In a national real-life multicenter cohort, rate of persistence of IFX-SC after 6 months was 92.6% in IBD patients switched in remission, without significant clinical or biological changes. Treatment switch was associated with an increase in IFX levels. These data are confirming the good efficacy and safety of IFX-SC after switch.

Background The prevalence of nonadherence to major treatments and the subsequent adverse outcomes in IBD patients during the first wave of COVID-19 pandemic remain scarce. Aim to investigate the risk of early disease relapse in a cohort of IBD patients under immunosuppressants and/or biologics who decided themselves to discontinue their IBD-related major treatments without previous medical advice during the first wave of COVID-19 pandemic. Methods All consecutive patients with inactive IBD under immunosuppressants and/or biologics who acknowledged having withdrawn their major therapy for IBD without previous medical advice during the first wave of COVID-19 (from March 2020 to December 2020) were enrolled. The primary endpoint was the survival rate without disease relapse. Kaplan-Meier curves were plotted for time from inclusion to IBD relapse and a logistic regression model with uni- and multivariate analyses was performed to identify predictors of relapse after drug discontinuation. Results During the study period, among the 862 IBD patients followed as outpatients either treated with infliximab or vedolizumab (outpatient clinics n= 368) or treated with oral azathioprine, adalimumab, golimumab or ustekinumab alone or in combination (n= 494), 54 patients (6.2 %) (42 CD, 12 UC, 28 F, median age 36 years) who had discontinued themselves their IBD-related major therapy without previous medical advice were included. The median duration of drug withdrawal was 7.0 weeks (range 2-24) and the median time to relapse was 9.0 weeks (range 4-20). The most treatments withdrawn were adalimumab (n=19), ustekinumab (n=19), azathioprine (n= 12), golimumab (n=1) and a lesser degree infliximab (n=7) eand vedolizumab (n=6). During the median follow-up period of 24 weeks (range 5-42), 22 out of 54 patients (40.7 %) who discontinued their IBD treatment experienced a relapse in whom 6 requiring administration of oral steroids, 4 hospitalization and 2 IBD-related surgery. By univariate analysis, past IBD related surgery was identified as the only predictor of disease relapse after drug withdrawal (OR=3.3 CI 95 % [1.08-10.38]. Conclusion In IBD patients, major treatment discontinuation by the patients themselves without medical advices during the first wave of pandemic Covid-19 including the lockdown was associated with a substantial risk of disease relapse occurring in around 4 out of 10 patients and subsequent further risk of need for steroids, hospitalization and surgery. Strategies targeting the adherence to therapy and patient’s informations about the real risks leading to drug discontinuation are of paramount interest, especially during health crisis to minimize such issues.

Background As a substantial proportion of patients with Crohn’s disease (CD) experiences a refractory disease course, immediate drug intensification may be an option to optimize the effectiveness of current biotherapies. Aim : to compare the one-year efficacy of immediate dose escalation of ustekinumab 90 mg to 4-weekly with that of 8-weekly dosing after intravenous (iv) induction in severe active CD patients. Methods The MUST (meta-optimization of Ustekinumab) study is a real-life multicenter observational French retrospective cohort study including patients with severe active CD. All patients from three academic IBD centers who received induction therapy with IV ustekinumab followed with subcutaneous (sc) UST 90 mg, either 4-weekly (MUST group) or 8-weekly (STD group) were included from Jan 2019 to Dec 2020. The choice of treatment regimen was left at the physician’s discretion. Severe active CD was defined by HBI > 16 and stool frequency (SF) ≥ 4 and abdominal pain (AP) ≥ 2 over one week and at least one objective evidence of inflammation (CRP ≥ 5 mg/L and/or FCal ≥ 250 μg/g and/or radiologic and/or endoscopic signs of disease activity). The primary endpoint was PRO-2 based clinical remission defined by SF≤2-8 and AP ≤1, and either FCal Results 203 adult patients were included, either in the MUST group (n = 59) or in the STD group (n = 144). Baseline patient demographics and disease characteristics were similar between groups. Median disease duration was 9 years (IQR: 5 – 14 yrs), 66% were females. Disease location according to the Montreal classification was L1 and L3 in 36% and 44 % of patients. All had previously been exposed to more than one biotherapy, 27% experienced perianal CD, and 35% had undergone previous CD-related surgery. At week 52, the adjusted difference between the two groups for the primary endpoint was 15.8% (95% confidence interval (CI) 0.21 – 0.94; p = 0.029) with significantly higher clinical remission in the MUST group. The adjusted difference for PRO-2 remission was 3.7% (CI 0.45 - 1.66; p = 0.64). All patients, except one in the STD group, were weaned off steroids at week 52. Endoscopic improvement was similar in both groups (61.9% vs. 61.5%, p=0.98). Adverse events were not significantly different in both arms (42.4% vs 34.7%, p=0.338). Conclusion In the treat-to-target era, our real-life study shows that immediate escalation of ustekinumab therapy to 4-weekly dosing could achieve higher clinical remission at one year than 8-weekly dosing in severe CD. These findings should be confirmed in a dedicated prospective randomized trial.

FDA's approval of cemiplimab-rwlc on February 22, 2021, follows prior approvals of pembrolizumab and atezolizumab for similar indications as first-line treatment for patients with programmed death ligand-1 (PD-L1)–high advanced non–small cell lung cancer (NSCLC). Approvals of these anti–PD-L1 agents were supported by statistically significant and clinically meaningful improvements in overall survival (OS) in international, multicenter, active-controlled randomized trials. In KEYNOTE-024, the OS HR was 0.60 [95% confidence interval (CI), 0.41–0.89; P = 0.005] favoring pembrolizumab over platinum-doublet chemotherapy. In IMpower110, the OS HR was 0.59 (95% CI, 0.40–0.89; P = 0.0106) favoring atezolizumab over platinum-doublet chemotherapy. In Study 1624, the OS HR was 0.68 (95% CI, 0.53–0.87; P = 0.0022) favoring cemiplimab-rwlc over platinum-doublet chemotherapy. The progression-free survival (PFS) effect sizes for these anti–PD-L1 antibodies were also comparable across their respective registrational trials, and their safety profiles were consistent with the anti–PD-L1 class adverse event profile. The consistent survival benefits and manageable toxicity profiles of these single-agent anti–PD-L1 antibodies have established them as important treatment options in the PD-L1–high NSCLC treatment landscape. FDA approvals of these anti–PD-L1 antibodies, based on their favorable benefit-risk profiles, present effective chemotherapy-free therapeutic options for patients with advanced PD-L1–high NSCLC in the United States.

Management of rectovaginal fistula (RVF) in Crohn's disease (CD) is challenging. Available studies are heterogeneous and retrospective, with short-term follow-up. The aim of this study was to assess the overall long-term medico-surgical treatment results in women with RVF due to CD.A retrospective study was conducted on consecutive patients operated on for RVF in CD from September 1996 to November 2019 at a tertiary teaching hospital. All surgeries were classified as preliminary, closure, or salvage procedures. Primary outcome was fistula remission defined as the combination of fistula closure and no stoma, at least 6 months since last procedure.Thirty-two patients (median age 34 [range 21-55] years), with a median follow-up of 11.3 years (0-23.7) after first surgery, were included. Altogether, 138 procedures were performed; 36 (26%) preliminary, 80 (58%) closure, and 13 (9%) salvage procedures. RVF remission was obtained in 7/32 patients (22%). At the end of follow-up, a stoma was present in 13/32 patients (41%). The percentage of time on biologics was 86% for patients in remission, versus 36% for the others (p = 0.0057). After univariate analysis, only anti-TNF-α was significantly related to successful closure techniques (p = 0.007).The RVF remission rate in CD was low in the long term. However, patients underwent a succession of interventions, and the stoma rate was high. Combination of biologics with surgical management was crucial.

Background Several therapeutic options are now available in ulcerative colitis after anti-TNF failure, but no data compared hitherto tofacitinib and vedolizumab. We compared the effectiveness of tofacitinib and vedolizumab in UC patients with prior exposure ≥ 1 anti-TNF. Methods In this multicentre retrospective study, we consecutively included all adult UC patients with partial Mayo score > 2, with ≥ 1 prior anti-TNF agent and started either tofacitinib (10mg b.i.d ± decreased to 5 mg b.i.d from week 8 (W8)) or vedolizumab (300 mg IV at W0-W2-W6 -W14 [± additional W10]) between January 2019 and June 2021. The primary endpoint was corticosteroid-free clinical remission or CFREM (partial Mayo score ≤ 2) at W16. Secondary endpoints were endoscopic improvement (CFREM + endoscopic Mayo score ≤ 1) and mucosal healing (CFREM + endoscopic and histological remission defined as Nancy index ≤ 1). All the comparisons were performed using propensity score analyses (inverse probability of treatment weighting) adjusted on gender, smoking, UC duration and extent, number of prior biologics or prior primary failure to biologics, concomitant 5-ASA, steroids or immunosuppressive agents, and disease severity. Results Overall, 400 patients will be included. Among the 200 first patients, 87 and 112 received tofacitinib and vedolizumab, respectively (one missing patient). Except for more pancolitis (54.0% vs 38.4%, p=0.028), less immunosuppressive therapies (4.6% vs 27.7%, p < 0.001), and higher rate of prior exposure ≥ 2 biologics (87.4% vs 37.5%, p < 0.001) in tofacitinib arm, baseline characteristics were similar across the two groups including concomitant 5-ASA (10.3% vs 18.8%) and steroids (23.0% vs 31.2%). Vedolizumab infusion at W10 was performed in 34.3% while 42.5% received tofacitinib 10 mg b.i.d until W16. CFREM was achieved in 54.2% and 42.5% in tofacitinib and vedolizumab, respectively p=0.089). The rate of CFREM at W16 was 57.4% vs 51.1% (p=0.77) after one biologic, 55.4% vs 41.8% (p=0.61) after 2 biologics, 56.9% vs 6.3% (p=0.007) after at least 3 biologics, and 59.0% vs 33.3% (p=0.17) in the subgroup with partial Mayo score ≥ 6, in tofacitinib and vedolizumab groups, respectively. Tofacitinib was more effective than vedolizumab to achieve CFREM at W16 in patients with primary failure to at least biologic (71.6% vs 30.8%, p=0.049). Among 177 patients, endoscopic improvement was higher in patients treated with tofacitinib (33.6 % vs 7.1%, p=0.048). Mucosal healing was observed in 6.4% vs 3.8% in tofacitinib and vedolizumab arms, respectively (p=0.27). Conclusion Tofacitinib and vedolizumab are effective after failure to anti-TNF agents. Tofacitinib seems to be more effective in case of primary failure to biologics and multiple therapeutic failure.

Toxoplasmosis is a potentially serious fetal infection associated with maternal seroconversion of toxoplasmosis during pregnancy. Follow-up and treatment vary between different countries. We present a case of congenital toxoplasmosis with unusual physiopathology and symptomatology. The mother was immunized before the beginning of pregnancy but immunosuppressive treatments for Crohn disease maintained during the pregnancy could explain toxoplasmosis reactivation in the mother and congenital toxoplasmosis. The baby presented reversible B lymphopenia and hypogammaglobulinemia.

Resume Objectifs Comparer l’efficacite d’une double maturation cervicale par agent mecanique et dinoprostone a une maturation par dinoprostone seule en cas de conditions locales tres defavorables. Methodes Etude retrospective monocentrique de type « avant-apres », entre le 1 er janvier 2008 et le 31 octobre 2013. Quatre-vingt-seize femmes presentant une grossesse unique en presentation cephalique, a terme, a membranes intactes avec une indication medicale de declenchement et un score de Bishop inferieur ou egal a 3 ont ete incluses et reparties en 2 groupes : patientes beneficiant d’une maturation cervicale par dinoprostone pendant 24 h (groupe prostaglandines seules, n = 38) et patientes beneficiant d’une maturation cervicale par double ballonnet pendant 12 h suivi de dinoprostone pendant 24 h (groupe ballonnet + prostaglandines, n = 58). Resultats Le taux d’accouchement par voie basse etait comparable entre les 2 groupes (51,7 % dans le groupe ballonnet + prostaglandines et 50 % dans le groupe prostaglandines seules ( p = 0,87)). Le score de Bishop apres maturation etait plus eleve dans le groupe ballonnet + prostaglandines (4,4 versus 2,4, p p = 0,0044). Il n’y avait pas de difference significative pour les complications maternelles et neonatales. Conclusion Une double maturation cervicale par agent mecanique et dinoprostone permet une amelioration du score de Bishop sans pour autant augmenter le taux d’accouchement par voie basse, chez des patientes avec un score de Bishop inferieur ou egal a 3.

Risk factors driving sex disparity in esophageal cancer are unclear. Recent molecular evidence suggests hormonal factors. We conducted a national descriptive epidemiological study to assess the hypothesis that estrogen exposure could explain the male predominance in observed esophageal adenocarcinoma incidence. We analyzed the esophageal cancer incidence trends by histology and sex from 1973 to 2008 in nine population-based cancer registries of the Surveillance, Epidemiology, and End Results (SEER) 9 Registry Database. We used age as a proxy for estrogen exposure in females. The collective age groups annual percentage change in esophageal adenocarcinoma for females is positive (0.03%; 95% confidence interval: 0.02, 0.03%) during the study period. Interestingly, the esophageal adenocarcinoma annual percentage change in incidence rates for females during the same time period is significantly negative from ages 50-54 to ages 60-64. Even though the incidence of esophageal adenocarcinoma rises in both males and females, the male-to-female ratio across age peaks in the 50-54 years then decreases. Furthermore, the esophageal adenocarcinoma age-adjusted incidence rate in postmenopausal females age 80 and above increases with age unlike their male counterparts. Taken together, these data support the hypothesis that the endocrine milieu in pre- and perimenopausal females serves as a protective factor against esophageal adenocarcinoma, and with loss of estrogen or because of the increasing time period away from estrogen exposure, the rate of esophageal adenocarcinoma incidence increases in the older postmenopausal female. Because females comprise the largest portion of the elderly population with esophageal adenocarcinoma, these findings are significant.

Zusammenfassung Die Entwicklung der DNA-Sequenzierungstechnologien stellt die humane Genomforschung vor große datenschutzrechtliche und ethische Herausforderungen. Der heute bereits mögliche tiefe Einblick in die genetische Ausstattung eines Menschen kann von enormer Bedeutung für dessen aktuelles und zukünftiges gesundheitliches Befinden sein. Genomische Daten lassen zudem Rückschlüsse auf die Identität und die genetischen Eigenschaften enger Blutsverwandter zu. Wegen ihres inhärenten Personenbezugs bedürfen genomische Daten somit eines besonders sorgfältigen Umgangs. Zentrale Elemente eines verantwortungsvollen Managements von Genomdaten im Rahmen von Forschungsprojekten sind neben der angemessenen Einwilligung der Teilnehmer auch die Anonymisierung/Pseudonymisierung der Daten und die Trennung der Datenhoheit. Außerdem müssen im Sinne der guten wissenschaftlichen Praxis Fristen und Verordnungen für die Aufbewahrung der Daten beachtet werden. Diese Aspekte werden im vorliegenden Artikel dargestellt und hinsichtlich ihrer praktischen Umsetzung diskutiert.

Objective: current evidence-bases recommendations do not recommend intensified infliximab (ifx) regimens for patients with severe IBD. Nethertheless, retrospective single-centers analysis observed markedly lower early surgical rate. Our aim was to evaluate the efficacy of metaoptimized ifx (Mifx), ie combined intensified induction and maintenance regimen as compared to a standard ifx (Sifx) schedule historical cohort on 1 year surgical rates and need to change therapy in severe hospitalized IBD patients.Methods: In this retrospective single center study, two cohorts of patients with CD and UC who were hospitalized at our single teaching hospital for an acute severe flare were identified from 20014 to 2016 (Mifx cohort) and 2007 to 2014 (Sifx cohort) were identified. Severe UC and CD were defined per clinical assessment with a Lichtiger Index > 12 for UC, a Harvey Bradshaw Index (HBI) > 12 for CD and according to ECCO classification. Results: 28 Mifx patients and 67 SIFX were included. A total of 5 of the 26 Mifx patients (18%) had a surgery, as compared with 10/64 Sifx (31%), patients with ifx metaoptimization had almost a two-fold chance of being surgery-free at 1 year while not reaching statistical significance (OR: 0.48 [95%CI: 0.16-1.42], p=0.18) Mifx patients had a three-fold chance to change their medical therapy at 1 year (25% ) as compared with Sifx patients (9%) (OR: 3.39 [95%CI: 1.02-11.22], p=0.05 ) The 1year infections rate was greater in Mifx patients (OR: 2.21 [95%CI: 0.61-7.95], p=0.11).Conclusion: Our underpowered data suggest that an ifx metaoptimization provides benefits in relation to 1-year surgery rates, but does not reduce need for biologics at that disease stage.

Background and purpose Long-term efficiency (> 5 years) of spinal cord stimulation for failed back surgery syndrome is poorly described in literature. The aims of our study were to evaluate the long-term efficiency and the quality of life of our series of patients with spinal cord stimulation for failed back surgery syndrome. Methods The data of 55 patients implanted successively in our institution between 1995 and 2005 for failed back surgery syndrome were collected retrospectively. We contacted them for a telephone survey focused on efficiency, quality of life and treatment satisfaction. Results An internal pulse generator was placed in 42 patients. Thirty-two of them were contacted to answer our survey with a mean follow-up of 8.3 years. Seventy-five percent of our population reported a pain decrease of greater or equal to 50%. The efficiency of percutaneous leads was reported as 50% for the quadripolars and 83% for the octopolars. The surgical leads evaluations were positive in 70% for 4 × 1 as well as for 4 × 2 leads. We observed a default of low back pain relief in 84% of patients with an incomplete pain relief (59%). The ability to sit, get out of the bed, and climb stairs increased in 75%. The walk was better in 82%. Decrease in drug consumption of greater or equal to 50% was observed in 66%. Conclusions Our retrospective study demonstrates a satisfaction of 75% of the patients after 8.3-years follow-up. Spinal cord stimulation is an effective treatment for refractory failed back surgery syndrome.

Fibromyalgia, chronic fatigue syndrome, and interstitial cystitis frequently overlap with irritable bowel syndrome (IBS). There is a positive correlation between the incidence of these comorbidities and increased health care seeking, reduction in quality of life, and higher levels of mood disorders, which raises the question of a common underlying pathophysiology. A possible central hypersensitization disorder seems to be particularly involved in the dysfunction of bidirectional neural pathways and viscerovisceral cross-interactions within the CNS, thus explaining these many extraintestinal manifestations in IBS.

Si l’etat nutritionnel des patients avec MICI est le plus souvent proche de la normale en dehors des poussees et chez les patients qui n’ont pas subi une resection etendue du grele dans la maladie de Crohn (MC), une denutrition severe peut etre observee au cours des poussees, a fortiori en cas de grele court (< 1 m) dans la MC. La severite de cette denutrition depend de plusieurs facteurs (nature, etendue, anciennete, duree de la poussee et activite de la MICI ; malabsorption des sels biliaires ; pullulation microbienne du grele ; fistules ; diminution des apports alimentaires et augmentation des depenses energetiques; malabsorption intestinale; enteropathie exsudative ; complications iatrogenes). Cette denutrition, souvent ignoree et qui peut se majorer pendant l’hospitalisation, doit etre evaluee de facon systematique et simple (interrogatoire et examen clinique, poids et calcul de l’indice de masse corporel, bilan biologique, calcul d’indices de denutrition). A l’issue de cette evaluation nutritionnelle, le traitement de cette denutrition doit etre discute, pouvant aller d’une dietetique simple plus ou moins associee a des complements nutritionnels hyperenergetiques et hyperproteiques a une prise en charge par nutrition artificielle de type enterale (a privilegier) ou parenterale selon la gravite de la denutrition et/ou l’etat clinique. La responsabilite des aliments dans le declenchement des MICI et la survenue des poussees inflammatoires n’est pas clairement etablie. Les recommandations dietetiques au cours de la MC et de la rectocolite sont tres proches. Lors des phases aigues de la maladie, le regime esidus eduire les symptomes digestifs (diarrhees, douleurs abdominales). Une fois la crise passee, la reintroduction progressive des « fibres tendres » et du lactose (s’il est encore absent) est recommandee. Il est conseille de diversifier l’alimentation petit a petit, pour tester la tolerance digestive et revenir ensuite a une alimentation la plus normale et diversifiee possible. En cas de corticotherapie prolongee, le regime sans sel strict n’est pas justifie.

Background Acceptance of a lower transfusion trigger in the perioperative period requires study of the effects of anesthetic depth on the tolerance to acute isovolemic anemia. Anesthetic agents with negative effects on the cardiovascular system may exert proportionately greater depressant effects on cardiac output response than on tissue oxygen demand, reducing tolerance to acute isovolemic anemia. Methods In the first study, animals were anesthetized with halothane (n = 14; 23.8 +/- 4.8 kg, mean +/- SD). In a second study, animals were anesthetized with ketamine (n = 14; 24.3 +/- 4.7 kg). In each study, dogs were randomly allocated to receive either low or high concentrations of anesthetic. Oxygen delivery and oxygen consumption were determined from independent measurements during a stepwise isovolemic hemodilution protocol. In each dog, critical oxygen delivery was determined from a plot of oxygen consumption versus oxygen delivery using a least-sum-of-squares technique. Critical hemoglobin (hemoglobin) was determined from a plot of hemoglobin versus oxygen consumption using the same method. Results With both agents, the higher anesthetic concentration was associated with decreased oxygen consumption, resulting in a lower critical oxygen delivery. However, critical hemoglobin was significantly higher in the animals receiving the higher anesthetic dosage (1.5 vs. 1.0 minimum alveolar concentration of halothane: 4.1 +/- 1.3 vs. 2.3 +/- 0.5 g/dl, P < 0.05; high- vs. low-dose ketamine: 3.7 +/- 1.4 vs. 2.5 +/- 0.6 g/dl, P < 0.05). This was related to a marked blunting of the cardiac output response to hemodilution in the animals receiving the higher anesthetic dosage. Conclusions Increased anesthetic depth with halothane or ketamine resulted in a decreased tolerance to acute anemia, as reflected by a significant increase in critical hemoglobin concentration.

A solid-phase synthesis of benzimidazole N -oxides was developed while attempting to synthesize 1,5-benzodiazepine-2,4-diones. The key step of the synthesis involves the reduction of an arylnitro to a hydroxyamino intermediate which subsequently condenses with an internal carbonyl group to give a benzimidazole N -oxide. A library of nine benzimidazole N -oxides was prepared on SynPhase™ Lanterns using this reduction–cyclization methodology.

Solid-phase synthesis is greatly dependent on the solid support. Here, we report the use of a new hydrophilic grafted surface on SynPhase lanterns in solid-phase organic chemistry. A convenient and facile solid-phase synthesis of disubstituted 1,4-benzodiazepine-2-ones on polyamide SynPhase lanterns is described. The key step of the synthesis involved a reduction-cyclization of a nitroaryl methyl ester with a mixture of tin(II) chloride dihydrate and ammonium acetate in water and ethanol at elevated temperature to give the desired target compounds. A library of 21 disubstituted 1,4-benzodiazepine-2-ones was prepared.

Our studies examined the acute toxicity, the natural bioactive compounds contained in the aqueous leaf extract (ESera) and its actions on the electrocardiogram. They were therefore aimed to confirm the use in traditional medicine for the treatment of cardiovascular diseases and childbirth complications. After the revelation of the phytochemical compounds in S. radiatum leaves by general reactions, the determination of LD50 of acute toxicity in mice was achieved after treatment with the aqueous leaf extract (ESera). ESera was administrated intraveinously to the animal via the saphenous vein for ECG registration. The phytochemical analysis revealed the presence of quinones, tannins, alkaloids, sterols, terpens, polyphenols, saponosides and reducing compounds. Short treatments (24 hours) of mice with the leaves aqueous extract gave LD50 values of 169.7 ± 15 mg/kg of b.w. and of 184.2 ± 21 mg/kg of b.w., respectively by the method of Miller and Tainter and the method of Dragstedt and Lang. ESera induced negative inotrope and chronotrope actions on the global electric activity of rabbit. In Conclusion: 1. The aqueous leaf extract has a low toxicity which permits its uses by populations. 2. As shown by the electrocardiac investigation and the phytochemical study of the leaves, S. radiatum could have many pharmacological properties justifying its traditional use to treat many diseases including cardiovascular diseases and childbirth complications.

We describe here the case of a patient affected with pre-eclampsia and who had idiopathic facial palsy and HELLP syndrome during the puerperium. It developed favourably with a treatment associated with an antihypertensive medicine, corticoid therapy and ophtalmological care. There is an association between pre-eclampsia and idiopathic facial palsy during pregnancy. This can be explained by identical physiopathological mechanisms. Facial palsy generally appears in the course of the third trimester of pregnancy or during the early puerperium. The prognosis is usually good and does not seem to be influenced by pregnancy. When idiopathic facial palsy appears during pregnancy, evidence of pre-eclampsia must be looked for.

To compare the efficiency of a double cervical ripening (mechanical agent and dinoprostone) to a dinoprostone-only ripening in women with an unfavourable cervix.In a retrospective study from January 2008 to October 2013, 96 patients were included with the following criteria: pregnancies over 37 weeks, singleton, vertex presentation, medical indication for induction of labor, no premature rupture of membranes and very unfavourable cervix (Bishop score ≤ 3). Patients were classified into 2 groups: intravaginal dinoprostone for 24h (prostaglandin group, n=38) and double-balloon device for 12h followed by intravaginal dinoprostone for 24h (balloon+prostaglandin group, n=58).There was no difference in vaginal delivery rates between the 2 groups (balloon+prostaglandin group 51.7%, prostaglandin group 50%, P=0.87). The Bishop score after cervical ripening was significantly higher in the balloon+prostaglandin group (4.4 versus 2.4, P0.0001), but the interval between the induction and the delivery was longer (33.6h versus 24.9h, P=0.0044). There was no significant difference for maternal and neonatal complications.A double cervical ripening (with mechanical agent and dinoprostone) allows the Bishop score to be improved without increasing the rate of vaginal delivery, for patients with a Bishop score ≤ 3.

Biotin−avidin immobilization can be a useful tool in structure–function studies of hormone receptors. A crucial step is the preparation of a specifically biotinylated hormone that is able to bind to its receptor while leaving the biotin group free for interaction with avidin. The receptor for relaxin, an ovarian peptidic hormone produced during pregnancy, has not yet been isolated. We therefore undertook to prepare a specifically monobiotinylated rat relaxin for use in ligand-searching strategies. Rat relaxin is a convenient analogue because reliable bioassays exist, thus allowing assessment of the effect of N-biotinylation on bioactivity. To help improve the yield of the two-chain, three-disulfide bond rat relaxin, 2-hydroxy-4-methoxybenzyl (Hmb) backbone protection was used during the solid-phase assembly of the B-chain to help prevent any possible chain aggregation. As a final step, while the protected peptide was still on the resin, the biotin label was introduced at the N-terminus of the B-chain using standard coupling protocols. The chain combination with the A-chain was accomplished in reasonable yield. Secondary structural measurements demonstrated that the biotin caused the starting B-chain to adopt a more ordered conformation. The labelled synthetic relaxin exhibited similar circular dichroism spectra to native and synthetic single B-chain peptides. In addition, the biotinylated relaxin showed no significant difference in its chronotropic activity in the rat isolated heart assay compared with the native peptide. Biosensor studies showed that antibody recognition was retained upon attachment of the synthetic relaxin to the streptavidin-derivatized surface.

The ‘template-assembled synthetic protein’ (TASP) concept provides a simple and elegant approach for the preparation of analogues that retain key structural elements. We have synthesized TASP molecules containing the putative active site of relaxin, a peptide that has similar structural features to insulin but a markedly different biological role. Two types of chemoselective thiol ligation strategies (thioether and thiazolidine) were used and compared. The synthetic pendant peptides contain an essential region for bioactivity that is located in the α-helical region of the relaxin B-chain. Depending on whether the thioether or the thiazolidine chemistry was used to attach the peptides to the template, the reacting amino acid was placed either at the C-terminus or N-terminus, respectively, thus allowing the choice of orientation relative to the carrier molecule. The template molecule consists of a decapeptide with two proline–glycine turns and four evenly spaced lysine residues that were functionalized with the appropriate chemical moiety. This allowed reaction with the appropriately derivatized peptides in solution. To improve the template ligation step using the thioether approach, a pendant peptide C-terminal cysteamine residue was used to reduce potential steric hindrance during conjugation. The design of the peptides as well as the synthetic strategy resulted in the acquisition of mimetics showing weak non-competitive and weak competitive antagonist properties. Copyright © 2000 European Peptide Society and John Wiley & Sons, Ltd.

Base-induced aspartimide (cyclic imide) and subsequent base adduct formation in the Fmoc-solid phase synthesis of sensitive sequences are serious side reactions that are difficult to both anticipate and control. The effect of extended treatment of piperazine as Nα-Fmoc deprotection reagent on two sensitive peptide sequences was examined. For comparison, other bases were also investigated, including piperidine, 1-hydroxypiperidine, tetrabutylammonium fluoride, and 1,8-diazabicyclo[5.4.0]undec-7-ene. The results showed that all bases induced varying degrees of both aspartimide and, in some cases, base adduct formation, although piperazine caused the least side reaction. Use ofN-(2-hydroxy-4-methoxybenzyl) peptide backbone amide protection was confirmed to confer complete protection against side reaction. In the absence of such protection, for all bases, the use of 1-hydroxybenzotriazole as additive had some, but not complete, beneficial effect in further reducing side reaction. Best results were obtained with piperazine containing 0.1M 1-hydroxybenzotriazole indicating that this reagent merits serious consideration for Nα-deprotection in the Fmoc-solid phase synthesis of base-sensitive sequences. A further advantage of this reagent is that it causes little racemisation of resin-bound C-terminal cysteine, an occasionally serious base-mediated problem in Fmoc-solid phase assembly.

Le traitement de fond de l'asthme modere de l'enfant repose sur un traitement anti-inflammatoire inhale, le plus souvent par corticoides. La mauvaise coordination main—inspiration etant un obstacle pragmatique bien connu a la bonne utilisation des systemes d'inhalation, un essai comparant deux systemes d'inhalation palliant cette mauvaise coordination a ete mene chez des enfants. Cet essai, ouvert, randomise en groupes paralleles compare l'efficacite, la tolerance et l'acceptabilite de la beclomethasone 1 000 μg/j delivree en deux prises, soit par Autohaler ™ , soit par un aerosol-doseur conventionnel couple a une chambre d'inhalation. Cent vingt-neuf enfants âges de 5 a 15 ans, presentant un asthme persistant leger a modere evoluant depuis plus de six mois, ont ete inclus lors de cette etude menee par 33 pneumologues et/ou pediatres francais. Ces enfants etaient traites par corticoides inhales a posologie stable depuis au moins quatre semaines avant l'inclusion et presentaient des difficultes a utiliser les aerosol-doseurs standards. Le volume expiratoire maximal par seconde (VEMS) etait superieur a 60 % de la valeur theorique et il existait une reversibilite de l'obstruction bronchique apres inhalation de beta-2 mimetiques (amelioration du VEMS ≥ 12 %). Apres tirage au sort, 62 enfants ont ete inclus dans le groupe Autohaler ™ et 67 enfants dans le groupe aerosol-doseur standard couple a une chambre d'inhalation. L'efficacite est significative et comparable dans les deux groupes avec notamment une amelioration significative du VEMS ( p ™ ( p = 0,001) avec un nettoyage plus facile ( p = 0,001). Cet avantage pragmatique s'accompagne d'une meilleure reconnaissance par les enfants de la realite du traitement avec une meilleure perception du passage de la bouffee, pour le systeme Autohaler ™ ( p = 0,001).

New reliability problems rise for microsensors working in harsh environments: e.g., polycrystalline silicon piezoresistive gauges can be deteriorated in many applications, thus leading to a decrease of the sensor lifetime. In order to investigate these problems, polysilicon gauges highly doped with boron were processed, and accelerated corrosion tests were realized in different atmospheres. Two different runs were processed in order to distinguish the effect of corrosion on polysilicon only from the effect on the whole gauge. Electrical characterization of the gauges was then performed. The static characterization shows that only the thermal budget is responsible for the degradation of polysilicon resistivity. On the dynamic point of view, the 1/ f noise developed by the gauges was found to be very sensitive to the kind of atmosphere and also to the thermal budget. Chlorine reveals to be very corrosive for polysilicon even at only 5% mixture with air or argon. Kinetics of the chemical reactions seems to be attainable from 1/ f noise measurements.

The electrical characteristics and the low frequency noise of Schottky contacts on n-type Si(100) have been systematically measured. The thin films were deposited by reactive magnetron sputtering at room temperature. Based on a model of a parallel combination of an ideal diode of current and a generation-recombination diode of current , we have extracted the contribution of both diodes to the measured total current I. Treating the two components and as different noise generators, we have analysed the observed white noise at high frequencies and the excess current noise at lower frequencies. The white noise is explained by using a pure shot noise for the component , by applying Gupta's general theorem on noise in non-linear driven devices for the component and by considering an additional noise generator with a Nyquist-type intensity. The excess current noise is explained by a model based on fluctuations of the generation-recombination current only. Analysis of the versus I data allowed us to determine the interface state density.

We have explored systemic and regional tolerance to haemodilution during anaesthesia with two different synthetic colloids. Eighteen dogs undergoing mechanical ventilation during anaesthesia with ketamine were submitted to progressive normovolaemic haemodilution with either gelatin (GEL; n = 9) or hydroxyethylstarch (HES; n = 9) administered on a 1:1 ratio. Systemic oxygen delivery was calculated from measurement of thermodilution cardiac output and arterial oxygen content, while systemic oxygen consumption was determined from expired gas analysis. Mesenteric oxygen delivery and consumption were determined using ultrasonic flow measurements, and arterial and mesenteric venous oxygen contents. The critical haemoglobin concentration (i.e. the haemoglobin value below which oxygen consumption becomes oxygen delivery dependent) was mean 3.6 (SD 0.8) g dl-1 in the GEL and 3.5 (1.5) g dl-1 in the HES group. The mesenteric critical oxygen extraction ratio (O2ER) (GEL 50.1 (12.1)%; HES 48.5 (13.4)%) was significant lower than the systemic critical O2ER (GEL 66.1 (8.4)%; HES 67.7 (7.1)%). There were no significant differences between the GEL and HES groups for any of these variables, or in the amount of colloid administered. During the study, oxygen delivery decreased almost linearly with reduction in haemoglobin, indicating a lack of cardiac output response to anaemia during ketamine anaesthesia.

Resume Une crue artificielle est realisee sur un troncon de ruisseau du bassin versant du Mercube (Haute-Savoie, France) afin de rendre compte du role du reseau hydrographique dans la transmission et l’emission de particules et de phosphore. Seul le phosphore d’origine diffuse est concerne. Cette experimentation se deroule en injectant de l’eau naturellement marquee par une teneur elevee en sulfates et chargee de suspensions. Elle met en evidence (1) les zones de stockage et de relargage des matieres en suspension dans le reseau hydrographique, (2) l’importance de l’effet piston sur le renouvellement des eaux en crue et (3) la capture du phosphore soluble au cours du transfert. L’augmentation du debit liee a l’onde de pression met en mouvement les sediments deposes au fond du lit. De ce fait, le phosphore est emis a l’exutoire d’abord lieaux particules remises en suspension, puis associea l’eau injectee. La contribution du reseau hydrographique a l’emission de phosphore n’est pas negligeable. Le meme phenomene se retrouve dans une crue reelle d’intensitecomparable.

Background "Rush to surgery" among patients with worse symptoms, delays related to morbidity, and inclusion of patients with advanced disease in study populations have produced a mixed picture of importance of time to treatment to survival of non-small cell lung cancer. Our objective was to assess the contribution of diagnosis to first surgery interval to survival among patients diagnosed in the community with early-stage non-small cell lung cancer. Methods Patients with early-stage lung cancer (N = 174) at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins who were diagnosed and treated from 2003 to 2009 and followed through 2011 made up a prospective study of overall survival. Diagnosis to first surgery interval was examined overall, as 2 segments (referral interval and treatment interval), as short and longer intervals, and as a continuous variable. Results The majority of patients were female (55%) and aged more than 65 years (61%). The average mean referral and treatment delays were 61.2 and 5.9 days, respectively. Cox method hazard analysis revealed that older age (years) at diagnosis (hazard ratio [HR], 1.02; 95% confidence interval [CI], 1.00-1.05), stage IIB (HR, 2.17; 95% CI, 1.12-4.21), large (>4 cm) (HR, 3.68; 95% CI, 1.05-12.93) or unknown tumor size (HR, 4.45; 95% CI, 1.21-16.38), and weeks from diagnosis to first surgery interval (HR, 1.04; 95% CI, 1.00-1.09) predicted worse overall survival. The threshold period of less than 42 days from diagnosis to surgery did not reach statistical significance. Conclusions Patients seem to benefit from rapid reduction of tumor burden with surgery. Reasons for delay were not available. Nevertheless, referral delay experienced in the community is unduly long. In addition to patient choices, an unconscious patient or physician bias that lung cancer is untreatable or an inevitable consequence of smoking may be operating and needs further investigation.

The exposure of dermal equivalent, i.e., fibroblasts cultured in a 3-dimensional collagen matrix to realistic doses of UVA (< or = 200 kJ/m2), results in a lipid peroxidation process as evidenced by the release of thiobarbituric acid-reactive substances in the supernatant. This peroxidative process is shown to be associated with the presence of fibroblasts and is inhibited by preincubation with vitamin E, the well-known chain-breaking antioxidant. Moreover, the UVA irradiation triggers cytotoxic effects which can also be reversed by preincubation with vitamin E. While the peroxidation extent is similar for fibroblasts cultured in monolayers or in dermal equivalent, the cytotoxic response to UVA is more pronounced in dermal equivalent.

High-performance InGaAs/InAlAs/InP Hall sensors with high magnetic sensitivity, good linearity, low temperature coefficient and high resolution are reported. These sensors use the properties of a two-dimensional electron gas and the benefit of pseudomorphic material, in which both the alloy composition and the built-in strain offer additional degrees of freedom for band structure tailoring. With the described growth optimization of pseudomorphic heterostructures by molecular beam epitaxy, a high electron mobility of 13 000 at room temperature has been obtained. A physical model of the structure including a self-consistent description of the coupled Schrodinger and Poisson equations has been developed to better understand the influence of the design of the heterostructure on its electronic properties. These results have been used in order to optimize the structure design. A magnetic sensitivity of with a temperature coefficient of between and has been obtained, and high signal-to-noise ratios corresponding to minimal magnetic field of at 100 Hz and at 1 kHz have been measured.

The noise properties of polysilicon emitter bipolar transistors are studied. The influences of the various chemical treatments and annealing temperatures, prior and after polysilicon deposition, on the noise magnitude are shown. The impact of hot-electron-induced degradation and post-stress recovery on the base and collector current fluctuations are also investigated in order to determine the main noise sources of these devices and to gain insight into the physical mechanisms involved in these processes. >

International audience; In this work, we propose solutions based on band-gap engineering of III-V heterostructures to develop new types of magnetic sensors using the properties of a two-dimensional electron gas and the benefit of strain in pseudomorphic channels. First, the optimization of the growth of pseudomorphic In0.75Ga0.25As/In0.52Al0.48As heterostructures by molecular beam epitaxy is described. A low sheet electron density of 9.84×1011 cm−2 and a high mobility of 13 000 cm2 V−1 s−1 at room temperature have been obtained. A physical model of the structure including a self-consistent description of the coupled Schrödinger and Poisson equations has been developed for a better understanding of the influence of the heterostructure design on its electronic properties. A sensitivity of 580 V A−1 T−1 with a temperature coefficient of −550 ppm °C−1 between −80 and 85 °C is obtained. High signal-to-noise ratios corresponding to minimal detectable fields of 350 nT Hz−1/2 at 100 Hz-1/2 and 120 nT Hz−1/2 at 1 kHz have been measured.

The effects of 14-day trandolapril or enalapril treatment of spontaneously hypertensive rats (SHRs) were studied on blood pressure and angiotensin-converting enzyme (ACE) activity measured ex vivo in various organs. Both ACE inhibitors caused dose-dependent decreases in blood pressure and ACE activity, trandolapril being 30- and 400- to 1,000-fold more active than enalapril on blood pressure and ACE activity, respectively. However, comparison of ACE inhibitory activities of the diacid forms of trandolapril and enalapril, i.e., trandolaprilat and enalaprilat, measured in vitro on various tissues, showed that trandolaprilat was only three- to fivefold more active than enalaprilat. To understand the reasons for such discrepancies between ex vivo effects of ACE inhibitors and in vitro actions of their diacid metabolites, we measured the lipophilicities of the compounds and investigated the possibility that trandolapril could display an ACE inhibitory effect by itself. Trandolaprilat was found to be far more lipophilic than enalaprilat, as shown by reverse-phase high-performance liquid chromatography studies performed at pH 7.4 (log kw7.4 = 1.487 vs. 0.108). In addition, trandolapril was practically as active in vitro as its diacid metabolite (IC50 = 2.5 vs. 1.35 nM) in inhibiting ACE activity in the aorta, whereas enalapril was practically devoid of any effect (IC50 = 240 nM). Measurements of relative affinities of inhibitors or metabolites for purified human renal ACE showed that trandolapril displayed about 20% of the affinity of its diacid metabolite (IC50 = 15 vs. 3.2 nM); enalaprilat affinity (34 nM) was within the same range as those of trandolapril and trandolaprilat, whereas enalapril displayed a very low affinity for the purified enzyme (IC50 = 50 microM).(ABSTRACT TRUNCATED AT 250 WORDS)

Long-Term Therapy With Bevacizumab in a Patient With Glanzmann’s Thrombasthenia and Recurrent Digestive Bleeding due to Gastrointestinal Angiodysplastic Lesions

Long-term efficiency (5 years) of spinal cord stimulation for failed back surgery syndrome is poorly described in literature. The aims of our study were to evaluate the long-term efficiency and the quality of life of our series of patients with spinal cord stimulation for failed back surgery syndrome.The data of 55 patients implanted successively in our institution between 1995 and 2005 for failed back surgery syndrome were collected retrospectively. We contacted them for a telephone survey focused on efficiency, quality of life and treatment satisfaction.An internal pulse generator was placed in 42 patients. Thirty-two of them were contacted to answer our survey with a mean follow-up of 8.3 years. Seventy-five percent of our population reported a pain decrease of greater or equal to 50%. The efficiency of percutaneous leads was reported as 50% for the quadripolars and 83% for the octopolars. The surgical leads evaluations were positive in 70% for 4 × 1 as well as for 4 × 2 leads. We observed a default of low back pain relief in 84% of patients with an incomplete pain relief (59%). The ability to sit, get out of the bed, and climb stairs increased in 75%. The walk was better in 82%. Decrease in drug consumption of greater or equal to 50% was observed in 66%.Our retrospective study demonstrates a satisfaction of 75% of the patients after 8.3-years follow-up. Spinal cord stimulation is an effective treatment for refractory failed back surgery syndrome.

The results are presented of a comparison of the properties of Si and GaAs multidrain field-effect transistors, also named MAGFETs, the basic structures of which consist of lateral symmetrical drains with, or without, a central drain. The relative drain-current sensitivity of GaAs-MESFETs can reach 50–60%/T, which is a rather high value compared with 5–10%/T obtained with Si-MOSFETs. Lateral drains can also be used as Hall probes; the corresponding sensitivities are 40 mV/T for Si-MOSFETs and 180 mV/T for GaAs-MESFETs (with I = 200 μA).

New results obtained with multidrain MOSFET magnetic-field sensors (commonly named MAGFETs) are presented. The dependence of the sensitivity and noise characteristics on the device geometries and dimensions and on contact positions has been investigated experimentally. From these results, it appears that the resolution is better when the MAGFET is used as a Hall-MOS sensor rather than as a multidrain magnetotransistor. Although the 1/f noise in MOS devices has a rather high level, a very good value of 150 nT/√Hz has been obtained for the minimum detectable magnetic field.