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Urinary incontinence after High Intensity Focused ultrasound (HIFU) is a poorly documented issue. To our knowledge, no study has evaluated the outcomes of artificial urinary sphincter (AUS) after HIFU. The aim of this study was to evaluate the functional outcomes of AUS for post-HIFU urinary incontinence.The charts of all male patients who underwent an AUS implantation between 2004 and 2020 in 13 centers were reviewed retrospectively. Only men with a history of HIFU were included. The primary endpoint was social continence at 3 months defined as wearing 0 to 1 pad per day.Out of 1318 procedures, nine men were implanted with an AUS after HIFU including four men with an history of pelvic irradiation: 3 pelvic radiation therapy and 1 prostatic brachytherapy. The patients were divided into two groups, 5 in the HIFU group without a history of pelvic irradiation, 4 patients in the HIRX group with a history of pelvic irradiation. The median age was 74 years (IQR 71-76). There was no perioperative complication. The median follow-up was 47.5 (IQR 25-85.5) months. Social continence at 3 months was 75% in the total cohort: 80% in the HIFU group and 67% in the HIRX group.AUS implantation may provide satisfactory long-term functional outcomes in the treatment of stress urinary incontinence resulting from HIFU. Larger series are needed to confirm these findings.4.

International audience; Recent developments in structural modeling techniques have dramatically increased the capability to incorporate fold related data into the modeling workflow. However, these techniques are lacking a mathematical framework for properly addressing structural uncertainties. Previous studies investigating structural uncertainties have focused on the sensitivity of the interpolator to perturbing the input data. These approaches do not incorporate conceptual uncertainty about the geological structures and interpolation process to the overall uncertainty estimate. In this work, we frame structural modeling as an inverse problem and use a Bayesian framework to reconcile structural parameters and data uncertainties. Bayesian inference is applied for determining the posterior probability distribution of fold parameters given a set of structural observations and prior distributions based on general geological knowledge and regional observations. This approach allows for an inversion of structural geology data, where each realisation can differ in the structural description of the fold geometries, instead of finding only a single best fit solution. We show that analysing the variability between the resulting models highlights uncertainties associated with the geometry of regional structures. These areas can be used to target where additional data would be most beneficial for improving the model quality and efficiently reducing structural uncertainty.

Background Several clinical pharmacy activities (CPA) were implemented in the rheumatology ward between March and April 2016: medical reconciliation at admission (MRA) and pharmaceutical analysis of prescriptions (PAP) for each patient at admission and then weekly. Purpose These CPA set up a strong link between the hospital and post-discharge sectors to ensure medicine continuity and to improve the quality of care of patients and avoid medical errors. Material and methods A pharmaceutical team (one resident and two interns) allowed quick and efficient implementation of these CPA. For the MRA, the pharmaceutical team performed a medication history prior to patient admission using several information sources (medical file, pharmacist, general physician, patient himself) to form the optimised medical report (OMR). Then, the admission script was compared with the OMR, and medical discrepancies (MD) were detected. Pharmacists and physicians analysed the MD to determine those to be documented or corrected. A level 3 PAP (according to the French Society of Clinical Pharmacy) was also performed by the pharmacy resident. Results 269 patients were admitted to the rheumatology ward between May and September 2016 (host capacity: 18 patients). 269 MRA (100% of admissions) were performed. 100 unintended MD were detected among 1934 MD and had mainly a ‘significant clinical impact’ (90%) according to the Hatoum Scale. 430 PAP were performed and 77 pharmaceutical interventions (PI) were made (1 PI every 9 prescriptions). Posology and treatment schedule were the most frequent types of PI (49%) and medicines from the ‘N’ ATC code (‘nervous system’) were mainly involved in these PI (68%). Conclusion Over these first 5 months of activity, unintended MD and PI have decreased. We can therefore assume that pharmacists are useful in clinical departments and these APC have to be kept. Furthermore, we can improve the quality and safety of care and reinforce the link between hospital and post-discharge sectors by setting up medical reconciliation at hospital discharge. No conflict of interest

Summary Aim The aim of this prospective, multicenter, randomized, placebo-controlled trial was to evaluate the efficacy of a commercial combination of simethicone and activated charcoal (Carbosylane®) on dyspeptic symptoms in patients consulting a general practitioner. Patients and methods A total of 132 patients were studied. Treatment duration was 3 months, followed by a 2 month follow-up period. Results At the end of the treatment period, the percentage of patients with a reduction of at least two points on the symptom intensity scale was significantly higher with Carbosylane® than with a placebo (P = 0.043). Compared with placebo, the intensity of three symptoms (abdominal fullness, bloating and the sensation of slow digestion) was significantly decreased after 90 days of Carbosylane® (P Conclusion Among patients consulting a general practitioner for dyspeptic syndrome, 3 months of treatment with Carbosylane® resulted in significant symptomatic improvement. The improvement was still evident 2 months after the end of treatment.

We investigate the initial–boundary value problem for the one-dimensional nonlinear Boussinesq equation inside domains with moving ends having both small increasing and decreasing displacements. Global solvability, uniqueness of solutions and the exponential decay to the energy are established provided the initial data are bounded in some sense.

Electron Microscopy and Plant Mycoplasma -like Agents (M L A)

A phytoplasma was discovered in diseased specimens of field-grown hortensia (Hydrangea spp.) exhibiting typical phyllody symptoms. PCR amplification of DNA using phytoplasma specific primers detected phytoplasma DNA in all of the diseased plants examined. No phytoplasma DNA was found in healthy hortensia seedlings. RFLP patterns of amplified 16S rDNA differed from the patterns previously described for other phytoplasmas including six isolates of foreign hortensia phytoplasmas. Based on the RFLP, the Japanese Hydrangea phyllody (JHP) phytoplasma was classified as a representative of a new subgroup in the phytoplasma 16S rRNA group I (aster yellows, onion yellows, all of the previously reported hortensia phytoplasmas, and related phytoplasmas). A phylogenetic analysis of 16S rRNA gene sequences from this and other group I phytoplasmas identified the JHP phytoplasma as a member of a distinct sub-group (sub-group Id) in the phytoplasma clade of the class Mollicutes. The phylogenetic tree constructed from 16S rRNA gene sequences was consistent with the hypothesis that the JHP phytoplasma and its closest known relatives, the Australian grapevine yellows (AUSGY), Phormium yellow leaf (PYL), Stolbur of Capsicum annuum (STOL) and Vergilbungskrankheit of grapevine (VK) share a common ancestor. The unique properties of the DNA from the JHP phytoplasma clearly establish that it represents a new taxon, 'Candidatus Phytoplasma japonicum'.

Restriction fragment length polymorphism and sequence analysis of PCR-amplified ribosomal DNA were used to identify and classify phytoplasmas associated with diseases of various wild and cultivated plants. The diseases examined were either not known before or the presumable causal agents were not yet identified and characterized or were only known from other geographic areas. New diseases examined were those causing virescence and phyllody of Bunias orientalis and Cardaria draba. Both were associated with strains of the aster yellows phytoplasma. The same type of aster yellows phytoplasma was also found to be associated with yellows and phyllody diseases of Portulaca oleracea, Stellaria media, Daucus carota ssp. sativus, and Cyclamen persicum. In German and French DNA samples from diseased Trifolium repens, the clover phyllody phytoplasma was identified, which could clearly be distinguished from other phytoplasmas of the aster yellows group. Strains of the stolbur phytoplasma were detected in big bud-affected tomatoes and almost exclusively in Convolvulus arvensis. In Cirsium arvense and Picris echioides two distinct phytoplasmas were identified which showed relationship to the sugarcane white leaf phytoplasma group but may represent a new group or subgroup. In Conyza (syn.: Erigeron) canadensis a phytoplasma of the X-disease group was detected. A strain from Gossypium hirsutum showed the same restriction profiles as the faba bean phyllody phytoplasma.

Les auteurs proposent un nouvel instrument pour orienter, si necessaire, le patient douloureux chronique, vers une psychotherapie.

The aim of this prospective, multicenter, randomized, placebo-controlled trial was to evaluate the efficacy of a commercial combination of simethicone and activated charcoal (Carbosylane) on dyspeptic symptoms in patients consulting a general practitioner.A total of 132 patients were studied. Treatment duration was 3 months, followed by a 2 months follow-up period.At the end of the treatment period, the percentage of patients with a reduction of at least two points on the symptom intensity scale was significantly higher with Carbosylane than with a placebo (P=0.043). Compared with placebo, the intensity of three symptoms (abdominal fullness, bloating and the sensation of slow digestion) was significantly decreased after 90 days of Carbosylane (P0.05). At the end of the post-treatment follow-up, the percentages of patients with moderate or severe global complaints were 6.78% and 21.43% in the Carbosylane and placebo groups, respectively (P0.03).Among patients consulting a general practitioner for dyspeptic syndrome, 3 months of treatment with Carbosylane resulted in significant symptomatic improvement. The improvement was still evident 2 months after the end of treatment.

In France, a number of scientists from the fields of chemistry, physiology and surgery have been interested in anaesthesiology. Claude Bernard, who published in 1872 the most exhaustive studies on anaesthesia, was also interested from 1844 in drug curare. He created a methodology, studied pharmacology, including pharmacokinetics and demonstrated the specific action on motor nerves while muscle retained its irritability. It was however A. Vulpian who put forward the idea that curare does not affect the nerve itself but may act on a "linking substance" between nerve and muscle. In these times (1862), Rouget described the end apparatus at the nerve-muscle junction in a way which was finally accepted by German authors. Fifty years later, Couteaux achieved the microanatomic study of the end plate (1909). More recently (1972), Changeux and his team isolated the acetylcholine receptor from the electric organ of the torpedo fish.

Because limited experience of autologous transplantation in acute promyelocytic leukemia (APL) is available, its place in this disease after all-trans retinoic acid (ATRA) plus chemotherapy is unknown. The purpose of this study was to assess the safety and efficacy of autologous peripheral blood stem cell (PBSC) transplantation in APL patients who achieve a second complete remission (CR). The series included 22 adult patients who relapsed at a median time of 13.5 months (range: 6.2 – 52.9 months) and achieved a second CR. Induction therapy included oral ATRA therapy (45 mg/m2/day) until CR achievement followed by EMA chemotherapy combining etoposide (200 mg/m2/day) for 3 days, mitoxantrone (12 mg/m2/day) for 3 days, and cytarabine (500 mg/m2/day) for two sequences of 3 days. EMA was started on day 1 with ATRA in 6 cases because of initial white blood cell (WBC) counts > 5 G/l, or rapidly started in 6 other cases because WBC increased in order to prevent leukostasis. Severe infectious toxicity (WHO grade > 2) was observed in 12 cases during EMA. All patients were then theoretically scheduled for autologous PBSC transplantation. PBSC were collected in stable phase after administration of G-CSF (5 to 10 μg/kg/day) for 5 days. A median of 3 cytapheresis (range: 1–4) was performed. Actually, autologous transplantation was only carried out in 11 patients (10 from PBSC and 1 from bone marrow) aged from 27 to 65 years (median: 47 years). The reasons for not grafting were early relapse (2 patients), severe toxicity of EMA (5 cases), or failure of cytapheresis (4 patients). Eight of these patients received maintenance therapy consisting in mini-EMA, or methotrexate plus 6-mercaptopurine with or without ATRA. The 3 other patients did not receive any other treatment. Cyclophosphamide and total body irradiation (TBI) were used for pre-transplant conditioning in 8 cases. Busulfan and melphalan were administered as conditioning regimen in 2 patients, and busulfan combined with endoxan in one patient. Cryopreserved PBSC containing a median number of 43.9 × 104 CFU-GM/kg and of 5.04 × 106 CD34+ cells/ kg were reinfused at transplantation. The median number of days for granulocyte and platelet recovery was 12.5 days (range: 8–66 days) and 17 days (range: 13 – 210+ days). Median disease-free survival (DFS) of the entire cohort (intent-to-treat group) was 11.4 months, while that of patients effectively autografted was still not reached. Only 2 of the 11 patients who received autologous transplantation have relapsed at a median time of 7 months after transplantation. Preliminary results regarding detection of PML/RARa by a RT-PCR assay after autologous PBSC transplantation are encouraging. The 3 patients tested after PBSCT have negative RT-PCR determinations.

Summary A disease of Populus nigra‘Italica’ associated with foliar yellowing, sparse foliage, stunting, dieback, and decline was observed in south-western Germany; a witches’ broom disease of Populus alba that is known in other countries was also detected in Hungary and Germany. The aetiology of the diseases was studied by fluorescence microscopy and polymerase chain reaction (PCR) amplification. Using fluorescence microscopy, phytoplasmas could be detected only in P. alba. However, most diseased trees of P. nigra‘Italica’ tested phytoplasma-positive by PCR. In some of the trees the phytoplasma numbers were so low that nested PCR was required to detect the infection. Very low phytoplasma numbers were also observed in diseased Populus tremula. The identity of phytoplasmas from P. nigra‘Italica’ sampled in Germany and France, P. alba and also P. tremula was examined by restriction fragment length polymorphism (RFLP) analysis of PCR-amplified ribosomal DNA. In all poplars, phytoplasmas of the aster yellows group were detected. However, three different RFLP groups were identified that consisted of (1) French strains from P. nigra‘Italica’, (2) German strains from P. nigra‘Italica’ and (3) strains from P. alba and P. tremula. The profile observed in the last group was probably the result of sequence heterogeneity in the two 16S RNA genes.

In order to assess the effects of tranexamic acid in comparison to the high dose regimen of aprotinin recommended by Royston and considered to be the reference in postoperative bleeding in cardiac surgery, 35 consecutive patients were randomised to two groups according to the product prescribed. The global postoperative bleeding was comparable in the two groups (p = 0.49). One surgical reoperation for haemostasis was required in the reference group. There was one case of renal failure in the same group due to cardiac failure. No thrombotic complications were observed. Platelet function, as judged by the bleeding time and platelet aggregation to ristocetin, was the same in the two groups. The D-dimers remained low in both groups, reflecting the absence of intravascular coagulation and fibrinolysis. Tranexamic acid was as effective and as safe as high dose aprotinin. These two substances, in addition to their fibrinolytic inhibitory activity, conserved platelet protection by blocking the action of plasmin. These results seem to justify the preventive use of tranexamic acid from the moment of skin incision, especially in reoperation.

At the end of cardiopulmonary bypass (CPB) diuresis and natriuresis are widely modified. Those are classically due to the CPB conditions (mean arterial pressure, non pulsatile flow, hypothermia, long duration ...). Previous studies showed no evidence of these modifications being due to variations of hormones such as vasopressin, renin or aldosterone. The atrial natriuretic factor, cardiac hormone mainly known for its natriuretic effect, would contribute to explain these facts. This study includes 17 patients NYHA I or II without any renal dysfunction or diabetes mellitus. They were scheduled for cardiac surgery under CPB (valvular replacement or aortocoronary bypass). Sampling times were: TO: after induction of anaesthesia and before surgical incision; T1: during steady CPB; T2: 30 min after CPB release. At each time were obtained: diuresis, osmolar and free water clearance, fractional excretion of sodium, haematocrit, plasma concentration of ANF (pANF), and right atrial pressure and capillar wedge pressure in case of aortocoronary graft. FeNa at the end of CPB is significantly linked to the osmolar clearance and the CPB duration. FeNa evolution is parallel with pFAN evolution. At the end of CPB pFAN is first linked to cardiac rate, then to CPB duration. Cardiac filling pressures after and before CPB are not different. pANF after CPB cannot be attributed to these pressures. Numerous factors are involved in the renal sodium elimination. An evident statistic link between pANF and FeNa is then difficult to demonstrate. Their parallel evolution is coherent and suggests that ANF is the main hormone of natriuresis at the end of CPB. ANF secretion factors at the end of CPB remain unclear. This study emphasizes the involvement of cardiac rate and CPB duration in pANF increase at the end of CPB.

Background Tesetaxel is an orally administered taxane that, unlike IV analogs, is not a Pgp substrate (a primary mechanism of taxane resistance). This novel agent has a long plasma T½ (∼180 h), allowing administration once every 3 weeks (Q3W). Tesetaxel is particularly active in breast and gastric cancers, with response rates of 50% and 20%, respectively, in 1st-line metastatic breast and 2nd-line gastric cancer. Among > 500 pts treated to date, no hypersensitivity reactions have occurred, and neurotoxicity has been distinctly uncommon. In Western pts, the maximally tolerated dose (MTD) of tesetaxel is 27 mg/m2 Q3W, and neutropenia is dose limiting. We conducted a phase I intersubject dose-escalation study to evaluate safety and PK in Japanese pts. Methods Eligibility criteria included age ≥ 20 years, advanced or metastatic solid tumors, ECOG PS ≤ 1, and adequate organ function. Tesetaxel 24 mg/m2 was given on day 1 of a 21-day cycle to the first cohort. The dose was escalated to 27 mg/m2 and 31 mg/m2 in successive cohorts absent dose-limiting toxicity (DLT). Serial blood samples were obtained for PK analysis and assayed by HPLC. Results Twelve pts (9 men, 3 women; age 39-74 yr) were enrolled (3 each in the 24 and 31 mg/m2 cohorts and 6 in the 27 mg/m2 cohort). Most pts were heavily pretreated; the median number of prior chemotherapy regimens was 4. Neutropenia ≥ grade 3 occurred in 1 pt in the 24 mg/m2 and 27 mg/m2 cohorts and 2 pts in the 31 mg/m2 cohort. DLT (febrile neutropenia) was observed in 1 pt at the 31 mg/m2 dose. Mean PK data (see table) were similar in Western and Japanese pts, with an expected dose-dependent increase in exposure. Dose level Patients (n) Cmax Tmax AUC0-168 h 24 mg/m2 Western (11) 29.7 2.5 594 Japanese (3) 29.0 2.7 658 27 mg/m2 Western (7) 31.2 2.1 869 Japanese (3) † 46.6 4.7 818 * 31 mg/m2 Japanese (3) 57.0 2.0 1036 † Results of PK analyses for last 3 pts enrolled not yet available * Dose not studied in Western pts Conclusion This study indicates that tolerability and PK of tesetaxel is similar in Western and Japanese pts. Final data will be presented. Disclosure T. Cousin: I am an employee of Genta Incorporated, the company that is developing tesetaxel. All other authors have declared no conflicts of interest.

A case of cardiomyopathy secondary to an unrecognised pheochromocytoma is reported. It was cured by successful outset with congestive cardiac failure with an ejection fraction of 11%. Following medical treatment including a beta-blocker and converting enzyme inhibitors, the situation remained so disturbing that cardiac transplant was envisaged. It was nevertheless decided to first remove the tumour, with mechanical circulatory assistance cover if necessary. Surgical excision proved to be relatively easy. Cardiac failure disappeared clinically within a few days, though a degree of myocardial impairment revealed by paraclinical investigations persisted after ten months. The pathophysiology, beneficial effect of beta-blockers and the SvO2 usefulness blood during the perioperative period are discussed. The prognosis of the cardiomyopathy, considered up to the present to be uncertain, new seems favourable once it is possible to completely excise the tumour.

To verify that the rate of post operative infections is higher with homologous transfusion rather than without, 86 coronary artery bypass patient charts were retrospectively studied. Inclusion criteria were those of the autologous transfusion group. Four groups were defined : Gr 1 : No transfusion. Gr 2: Autotransfusion. Gr 3: Allotransfusion. Gr 4: Autotransfusion who also received homologous blood products. Although not significant, the bacterial infection rate was twofold higher in the Gr 3, than in the autologous group and was almost four times higher and significant (p0.01) when patients who received homologous blood products were compared to those who did not. These preliminary results lead us to enlarge our autotransfusion program and us encourage, to search for the cause of the decreased infection rate after autologous transfusion by prospective studies.

8531 Background: Oblimersen (OBL) is a Bcl-2 targeted phosphorothioate antisense that enhances antitumor activity of alkylating agents in preclinical studies. A prior phase III study of dacarbazine...

In order to assess the validity of antifibrinolytic treatments in cardiac surgery, three successive controlled randomized double-blind studies were carried out in patients undergoing a first (n = 60) or repeat surgical procedure because of a valvular or coronary disease. The first study aimed at stating the value of low doses of aprotinin compared with "classical" ones and a placebo. The second study was planned to compare tranexamic acid with low-dosed aprotinin and a placebo. The last study applied to reiterated procedures and compared tranexamic acid with classical and reduced aprotinin dosages, without a placebo group. Effects were estimated on postoperative bleeding, blood transfusions, platelets function and possible complications such as thrombosis or seric creatinine elevation. A reduced bleeding was observed in the non-placebo groups of studies I and II. The 3d study did not show any significant differences in this respect between the three methods. Tranexamic acid was found as effective as aprotinin on platelets function. No significant changes of seric creatinine was observed from preoperative to 4th postoperative day. A valvular non-obstructive thrombosis occurred on the second postoperative week in the tranexamic acid group.

The pharmacokinetics of propofol administered in continuous infusion was studied in 10 patients without left ventricular insufficiency during extracorporeal circulation (ECC) with hemodilution, for aortocoronary bypass. After a dosage of 1.5 mg.kg-1 during anaesthetic induction, the blood level was 4,800 micrograms.l-1. Under continuous infusion levels remained very high: they decreased by 40% during EEC induction and rose more than 10% when artificial ventilation started again. These modifications can be explained by physiological variations induced by EEC (non pulsated flow, redistribution, vasoconstriction, hemodilution, hypothermia) and they lead to adapt dosages in this type of anaesthesia.

The authors report here a first experiment of anaesthesia in a medicine unit. 29 anaesthesias were performed for 22 patients classed ASA II and III. The indications were nurses dressing for trophic troubles related to extremely painful vascular diseases. The whole treatment was realised in the medicine ward. Anaesthesia consists first in morphine injection as a premedication then several injections of propofol and alfentanil combined. The heart beat frequency was still and the blood pressure never lowered more than 10% of the preoperative level. No incident occurred. The awaking was of good value and without discomfort. The usual autonomy is regain in 2 hours after anaesthesia. This type of anaesthesia offers a new approach of painful cares and through a better dressing should lower the hospital stay.

Two cases of paralysis of the diaphragm occurring after puncture of the internal jugular vein are reported. Both were old cancer patients, requiring an internal jugular venous catheter for intravenous feeding. Although the catheter was easily placed in both cases, the diagnosis of diaphragmatic paralysis was made postoperatively. The first patient remained asymptomatic, despite paradoxical breathing when lying supine; there was no change in her condition up to her death 4 months later. The second patient became increasingly breathless, with hypoxia and hypercapnia, during recovery from a gastrostomy under general anaesthesia. She required artificial ventilation, from which she could not be weaned and died 25 days later. A lesion of the phrenic nerve is possible when placing an internal jugular venous catheter, because they are closely related behind the sternocleidomastoid muscle. In the opposite to compression by a haematoma, or transient blockade following local anaesthetic infiltration, such a direct injury may be irreversible.