Zum genetischen Risiko nach hochdosierter Radiojodtherapie unter Berücksichtigung der Gonadendosis

Ziel der vorliegenden Arbeit ist die Abschätzung des genetischen Risikos nach hochdosierter Radiojodtherapie unter besonderer Berücksichtigung der individuell erreichten Gonadendosis. Methode: Mittels eines Erhebungsbogens wurden die Daten von insgesamt 364 Patientinnen und Patienten mit einem differenzierten Schilddrüsenkarzinom im gebärbzw. zeugungsfähigen Alter bezüglich ihrer Nachkommen ausgewertet. 45 Patienten (41 Frauen und vier Männer) aus dieser Gruppe hatten insgesamt 56 Kinder. Der Verlauf von Schwangerschaft, Geburt und Kindesentwicklung wurde erfaßt. Ergebnisse: Im Rahmen der Therapie und Nachsorge waren insgesamt zwischen 4,144 und 35,15 GBq I-131 verabreicht worden; die individuell auf der Grundlage des MIRD-Modells errechnete Gonadendosis lag zwischen 0,2 und 2,2 Sv (im Mittel 0,51 Sv). Der Abstand zwischen der letzten I-131 Applikation und einer Geburt betrug mindestens 9 Monate und höchstens 14 Jahre. Bezüglich Schwangerschaftsverlauf und Geburt wurden zwei Frühaborte, eine Extrauteringravidität und eine Plazentainsuffizienz mit nachfolgender Frühgeburt ermittelt. In einem Fall trat eine chromosomale Translokation 7/14 als genetischer Defekt auf, die zur Interruptio führte. Die Entwicklung der ausgetragenen Kinder verlief bis auf das Auftreten einer Neurodermitis in zwei Fällen, multipler Allergien in einem anderen Fall und eines frühzeitigen Fontanellenverschlusses bei einem Kind unauffällig. Schlußfolgerung: Unter der Annahme einer Verdoppelung der Häufigkeit spontaner Mutationen bei einer erzielten Gonadendosis von 1 Sv erhöht sich das Risiko irgendeiner angeborenen Erkrankung bei unseren Patienten im Mittel rechnerisch um rund 13%; tatsächlich lag der Anteil genetischer Defekte in unserem Kollektiv mit 1,8% (1/57) im Bereich des natürlichen Risikos. Unter Berücksichtigung der Literatur ließ sich damit bisher bei insgesamt 408 Kindern keine Zunahme genetisch bedingter Erkrankungen oder angeborener Anomalien feststellen.

[Pediatric Morbidity of a Native American Village in French Guiana (2009-2016)]

The situation of the Amerindian village of Camopi in French Guiana is particular because of its geographical isolation and its socio-cultural environment. Does this unique context affect the morbidity of the children? This study describes the morbidity of children aged 0-5 years in Camopi. The study population included all the children living in Camopi, born between 01/01/2009 and 31/12/2013. Sociodemographic and medical data were collected from Child Health Record until 05/01/2016, with a maximum of five years. 149 children were included and received 5916 consultations during the period of study. ENT and upper respiratory diseases were the most frequent diseases that were followed by digestive disorders. Lower respiratory conditions were the leading cause of hospitalization. Tropical diseases were rare. Antibiotics were delivered in 32.5% of the consultations. The vaccination coverage exceeded 95% for BCG, DTP, HBVand yellow fever, remove than that of MMR which was little lower (89.9%) and only 4 children were vaccinated against pneumococcus. Despite the Amazonian context, the morbidity of Camopi's children mainly includes classic disorders. Traumas seem uncommon but can be violent. Facilitating access to rapid diagnostic tests, setting up protocols, and training staff could reduce the prescription of antibiotics.

RESULTS FROM A NEW METHOD TO ASSESS THE OCCUPATIONAL LENS DOSE IN INTERVENTIONAL RADIOLOGY

Interventional radiology procedures have always been of particular concern because of the potential high dose to the workers. Special attention has recently been given to the lens dose: in 2011 the ICRP issued the recommendation 'Statement on Tissue Reactions' where a new limit of 20 mSv in a year, averaged over defined periods of 5 years, is given. Due to the impossibility of measuring the dose directly on the eye, there is not still a general consensus on a standardized methodology to assess the lens dose, which should be at the same time reliable, robust and simple to implement in practice. The procedure described here aims to assess the lens dose using the Hp(0.07) equivalent dose measured with a dosimeter worn at chest level above the lead apron, through a correlation with the total KAP per procedure and considering the type of the protection tools used during each procedure: glasses (with lateral shields), ceiling screen, both or neither of them and the frequency of their use.

Rh nanoparticles from thiolate dimers: selective and reusable hydrogenation catalysts in ionic liquids

Thiolate-capped RhNPs in imidazolium-based ionic liquids were synthesized from [Rh(μ-SR)(COD)]₂ dimmers under H₂ pressure without external addition of ligand stabilizers, preserving thiolate integrity on the nanoparticle surface. This nanoparticulated systems showed a remarkable selectivity that led to their application in the one pot reductive N-alkylation to produce amines.

[The importance of the thickness of the bone in osteocartilaginous autografts of the rabbit knee]

This experimental study is complementary to the clinical series of cartilaginous autografts in the knee for medial condylar necrosis. The aim was to determine the viability of the articular cartilage in a series of grafts with variable thickness of the underlying spongy bone.The study was done on 36 adult rabbits and the cartilage was studied by biochemical, histochemical and ultrastructural methods. The results are conclusive. The earliest abnormal signs in the first few weeks affect the thinnest grafts of 4 mm whereas the 12 mm thickness grafts hardly show any lesions.It is therefore possible to use large autogenic grafts for osteocartilaginous defects provided the proportion between the area of the articular surface and the underlying spongy bone of the graft is at least 1/4. Under these circumstances, cartilaginous deterioration will be avoided and reduce long term degeneration.

Comparison of 12-month anatomic and functional results between Z6 femtosecond laser-assisted and manual trephination in deep anterior lamellar keratoplasty for advanced keratoconus

The management of severe keratoconus requires corneal transplantation, for which the gold standard is deep anterior lamellar keratoplasty (DALK), preserving the healthy Descemet's membrane and endothelium. The safety and reproducibility of corneal cuts have been improved by the evolution of femtosecond lasers in refractive surgery, and femtosecond laser in DALK would seem to provide the same advantages over the manual method. In our retrospective study, we compare functional and anatomical results of femtosecond-assisted DALK versus manual trephination DALK in patients with keratoconus in stage 4 of the Krumeich classification. It is a retrospective study including all patients with stage 4 keratoconus who underwent femtosecond laser-assisted DALK between November 2012 and November 2015 in Nantes university medical center. We compared those patients to a group of patients who underwent manual DALK in the same period, paired by age and maximal keratometry. We assessed visual acuity, pachymetry, endothelial cell density (specular microscopy), and keratometry before surgery and at 4, 8 and 12 months of follow-up. Laser settings and intraoperative complications were recorded. Nineteen patients underwent surgery by femtosecond-assisted DALK, 6 women and 12 men with average age 30.2±10.8 years at transplantation. They were paired with a group of 17 patients who underwent manual DALK in order to compare results. Before surgery, mean visual acuity in the femtosecond group was 0.90 logMAR versus 0.89 logMAR in the manual group, showing no statistically significant difference (P=0.96). Both groups were similar in terms of preoperative age, mean keratometry, pachymetry and endothelial cell density. Average visual acuity post-surgery was 0.27; 0.26; and 0.14 logMAR for femtosecond DALK versus 0.27; 0.17 et 0.25 for manual DALK at 4, 8 and 12 months follow-up respectively, showing no statistically significant difference. After surgery, at 4, 8 and 12 months, mean pachymetry was similar in both groups, and average endothelial cell density was 2390 cells/mm² for femto DALK versus 2531 cells/mm² for manual DALK at 12 months of follow-up, showing no statistically significant difference (P=0.5726). The rate of Descemet's membrane microperforations during the procedure was low and similar for both groups. Our study allows for a 12-month follow-up, with assessment of visual recovery, anatomic result and endothelial safety in a series of 19 femtosecond laser-assisted DALK with no statistical significant difference versus the manual trephination group. Femtosecond laser allows for increased reproducibility of the DALK procedure without reducing adverse effects during surgery. Femtosecond laser seems to improve the technique of the DALK procedure, and future developments could improve the reproducibility of DALK even further. A medical economics study would be necessary to determine the cost-effectiveness of femtosecond laser-assisted DALK.

The association between physical activity and cognition in men with and without HIV infection

OBJECTIVES

HIV-associated neurocognitive disorders are highly prevalent, and physical activity (PA) is a modifiable behaviour that may affect neurocognitive function. Our objective was to determine the association between PA and neurocognitive function and the effect of HIV on this association.

METHODS

PA was assessed in the Multicenter AIDS Cohort Study with the International Physical Activity Questionnaire. A neuropsychological test battery assessed global impairment and domain-specific impairment (executive function, speed of processing, working memory, learning, memory, and motor function) every 2 years. Semiannually, the Symbol Digit Modalities Test and Trail Making Test Parts A and B were performed. Adjusted logistic regression models were used to assess the PA-neurocognitive function association. Using longitudinal data, we also assessed the PA category-decline of neurocognitive function association with multivariate simple regression.

RESULTS

Of 601 men, 44% were HIV-infected. Low, moderate, and high PA was reported in 27%, 25%, and 48% of the HIV-infected men vs. 19%, 32% and 49% of the HIV-uninfected men, respectively. High PA was associated with lower odds of impairment of learning, memory, and motor function [odds ratio (OR) ranging from 0.52 to 0.57; P < 0.05 for all]. The high PA-global impairment association OR was 0.63 [95% confidence interval (CI) 0.39, 1.02]. Among HIV-infected men only, across multiple domains, the high PA-impairment association was even more pronounced (OR from 0.27 to 0.49). Baseline high/moderate PA was not associated with decline of any domain score over time. HIV infection was marginally associated with a higher speed of decline in motor function.

CONCLUSIONS

A protective effect of high PA on impairment in neurocognitive domains was observed cross-sectionally. Longitudinal PA measurements are needed to elucidate the PA-neurocognitive function relationship over time.

Two-photon controlled sol–gel condensation for the microfabrication of silica based microstructures. The role of photoacids and photobases

Two-photon excitation of photobases is used to induce pH changes and control the condensation step of the sol–gel process at the focal point of a laser beam in a confocal configuration.

Aminophosphine ligands as a privileged platform for development of antitumoral ruthenium(ii) arene complexes

The potential utility of aminophosphine ligands in both high-throughput testing and rational design of new anticancer metallodrugs.

New oral targeted therapies for metastatic breast cancer disrupt the traditional patients' management-A healthcare providers' view

Although a cure still cannot be expected for metastatic breast cancer, thanks to progressive advances in treatments, life expectancy has been increasing over the past 15 years. This study aims to present the impact on the organisation of patients' management of newly released oral targeted therapies dedicated to metastatic breast cancer and the obstacles to their diffusion. Our work is based on the analysis of 40 semi-structured interviews, conducted with oncology healthcare professionals in three regions of France (2015-2016). It shows three main results. First, the prescription of an oral targeted therapy requires greater collaboration between healthcare professionals than traditional intravenous oncology drugs, which may be challenging. Second, there remain many barriers to the dissemination of oral targeted therapies. Third, taking an oral targeted therapy keeps the patient away from the hospital facility and asks for a strong therapeutic alliance. The management of oral targeted therapies is time-consuming for medical oncologists and disrupts the traditional care pathway. The multiplication of actors involved in patients' management reinforces the slowdown in the deployment and acceptance of therapeutic innovations. More players equal a higher risk of slowdown. Questioning and re-designing hospital organisation and management modalities towards this type of care are critical.