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Issard J, Vaudelin C, Imberton D, Vayssette A, Leroux M, Giol M, Khalife T, Camuset J, Debrosse D, Assouad J, Etienne H. In endometriosis-related pneumothorax surgery, presence of endometriotic nodules increases postoperative air leaks and long-term relapse. Eur J Obstet Gynecol Reprod Biol 2024; 296:1-5. [PMID: 38387250 DOI: 10.1016/j.ejogrb.2024.02.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 02/07/2024] [Accepted: 02/18/2024] [Indexed: 02/24/2024]
Affiliation(s)
- Justin Issard
- Department of Thoracic and Vascular Surgery, Hôpital Tenon, APHP, Paris.
| | - Clémence Vaudelin
- Department of Thoracic and Vascular Surgery, Hôpital Tenon, APHP, Paris
| | - Diane Imberton
- Department of Thoracic and Vascular Surgery, Hôpital Tenon, APHP, Paris
| | - Anna Vayssette
- Department of Thoracic and Vascular Surgery, Hôpital Tenon, APHP, Paris
| | - Marielle Leroux
- Department of Thoracic and Vascular Surgery, Hôpital Tenon, APHP, Paris
| | - Mihaela Giol
- Department of Thoracic and Vascular Surgery, Hôpital Tenon, APHP, Paris
| | - Theresa Khalife
- Department of Thoracic and Vascular Surgery, Hôpital Tenon, APHP, Paris
| | - Juliette Camuset
- Department of Thoracic and Vascular Surgery, Hôpital Tenon, APHP, Paris
| | - Denis Debrosse
- Department of Thoracic and Vascular Surgery, Hôpital Tenon, APHP, Paris
| | - Jalal Assouad
- Department of Thoracic and Vascular Surgery, Hôpital Tenon, APHP, Paris
| | - Harry Etienne
- Department of Thoracic and Vascular Surgery, Hôpital Tenon, APHP, Paris
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Betser L, Le Bras A, Etienne H, Roussel A, Bobbio A, Al-Zreibi C, Martinod E, Alifano M, Castier Y, Assouad J, Durand-Zaleski I, Mordant P. Outcomes and costs with the introduction of robotic-assisted thoracic surgery in public hospitals. J Robot Surg 2024; 18:124. [PMID: 38492119 DOI: 10.1007/s11701-024-01879-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 02/20/2024] [Indexed: 03/18/2024]
Abstract
Robotic-assisted thoracic surgery (RATS) is an effective treatment of non-small cell lung cancer (NSCLC) but the effects of its implementation in university hospital networks has not been described. We analyzed the early clinical outcomes, estimated costs, and revenues associated with three robotic systems implemented in the Paris Public Hospital network. A retrospective study included patients who underwent RATS for NSCLC in 2019 and 2020. Ninety-day morbidity, mortality, hospital costs, and hospital revenues were described. Economic analyses were conducted either from the hospital center or from the French health insurance system perspectives. Cost drivers were tested using univariate and multivariable analyses. Sensitivity analyses were performed to assess uncertainty over in-hospital length of stay (LOS), number of robotic surgeries per year, investment cost, operating room occupancy time, maintenance cost, and commercial discount. The study included 188 patients (65.8 ± 9.3 years; Charlson 4.1 ± 1.4; stage I 76.6%). Median in-hospital LOS was 6 days [5-9.5], 90-day mortality was 1.6%. Mean hospital expenses and revenues were €12,732 ± 4914 and €11,983 ± 5708 per patient, respectively. In multivariable analysis, factors associated with hospital costs were body mass index, DLCO, major complications, and transfer to intensive care unit. Sensitivity analyses showed that in-hospital LOS (€11,802-€15,010) and commercial discounts on the list price (€11,458-€12,732) had an important impact on costs. During the first 2 years following the installation of three robotic systems in Paris Public Hospitals, the clinical outcomes of RATS for NSCLC have been satisfactory. Without commercial discount, hospital expenses would have exceeded hospital revenues.Clinical registration number CNIL, N°2221601, CERC-SFCTCV-2021-07-20-Num17_MOPI_robolution.
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Affiliation(s)
- Léa Betser
- Department of Vascular Surgery, Thoracic Surgery, and Lung Transplantation, Bichat Hospital, 46 Rue Henri Huchard, 75018, Paris, France
- Hôpitaux de Paris, Paris, France
| | - Alicia Le Bras
- Clinical Research Unit Eco Ile de France, Hôtel-Dieu, Paris, France
- Hôpitaux de Paris, Paris, France
| | - Harry Etienne
- Department of Thoracic and Vascular Surgery, Hôpital Tenon, Paris, France
- Hôpitaux de Paris, Paris, France
| | - Arnaud Roussel
- Department of Vascular Surgery, Thoracic Surgery, and Lung Transplantation, Bichat Hospital, 46 Rue Henri Huchard, 75018, Paris, France
- Hôpitaux de Paris, Paris, France
| | - Antonio Bobbio
- Department of Thoracic Surgery, Hôpital Cochin, Paris, France
- Hôpitaux de Paris, Paris, France
| | - Charles Al-Zreibi
- Department of Thoracic Surgery, Hôpital Européen Georges Pompidou, Paris, France
- Hôpitaux de Paris, Paris, France
| | - Emmanuel Martinod
- Department of Thoracic and Vascular Surgery, Hôpital Avicenne, Bobigny, France
- Hôpitaux de Paris, Paris, France
| | - Marco Alifano
- Department of Thoracic Surgery, Hôpital Cochin, Paris, France
- Hôpitaux de Paris, Paris, France
| | - Yves Castier
- Department of Vascular Surgery, Thoracic Surgery, and Lung Transplantation, Bichat Hospital, 46 Rue Henri Huchard, 75018, Paris, France
- Hôpitaux de Paris, Paris, France
| | - Jalal Assouad
- Department of Thoracic and Vascular Surgery, Hôpital Tenon, Paris, France
- Hôpitaux de Paris, Paris, France
| | - Isabelle Durand-Zaleski
- Clinical Research Unit Eco Ile de France, Hôtel-Dieu, Paris, France
- Department of Public Health, Université Paris Est, Hôpital Henri Mondor, Créteil, France
- Hôpitaux de Paris, Paris, France
| | - Pierre Mordant
- Department of Vascular Surgery, Thoracic Surgery, and Lung Transplantation, Bichat Hospital, 46 Rue Henri Huchard, 75018, Paris, France.
- Hôpitaux de Paris, Paris, France.
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Etienne H, Goudou T, Assouad J. Atypical mutation of epidermal growth factor receptor in resected stage I non-small-cell lung cancers. Eur J Cardiothorac Surg 2024; 65:ezad428. [PMID: 38145494 DOI: 10.1093/ejcts/ezad428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 12/24/2023] [Indexed: 12/27/2023] Open
Affiliation(s)
- Harry Etienne
- Department of Thoracic and Vascular Surgery, Tenon Hospital, AP-HP, Sorbonne University, Paris, France
- Experimental and Clinical Respiratory Neurophysiology, Sorbonne University, INSERM, UMRS1158, Paris, France
| | - Tristan Goudou
- Department of Thoracic and Vascular Surgery, Tenon Hospital, AP-HP, Sorbonne University, Paris, France
- Experimental and Clinical Respiratory Neurophysiology, Sorbonne University, INSERM, UMRS1158, Paris, France
| | - Jalal Assouad
- Department of Thoracic and Vascular Surgery, Tenon Hospital, AP-HP, Sorbonne University, Paris, France
- Experimental and Clinical Respiratory Neurophysiology, Sorbonne University, INSERM, UMRS1158, Paris, France
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Etienne H, Pagès PB, Iquille J, Falcoz PE, Brouchet L, Berthet JP, Le Pimpec Barthes F, Jougon J, Filaire M, Baste JM, Anne V, Renaud S, D'Annoville T, Meunier JP, Jayle C, Dromer C, Seguin-Givelet A, Legras A, Rinieri P, Jaillard-Thery S, Margot V, Thomas PA, Dahan M, Mordant P. Impact of surgical approach on 90-day mortality after lung resection for nonsmall cell lung cancer in high-risk operable patients. ERJ Open Res 2024; 10:00653-2023. [PMID: 38259816 PMCID: PMC10801767 DOI: 10.1183/23120541.00653-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 11/15/2023] [Indexed: 01/24/2024] Open
Abstract
Introduction Non-small cell lung cancer (NSCLC) is often associated with compromised lung function. Real-world data on the impact of surgical approach in NSCLC patients with compromised lung function are still lacking. The objective of this study is to assess the potential impact of minimally invasive surgery (MIS) on 90-day post-operative mortality after anatomic lung resection in high-risk operable NSCLC patients. Methods We conducted a retrospective multicentre study including all patients who underwent anatomic lung resection between January 2010 and October 2021 and registered in the Epithor database. High-risk patients were defined as those with a forced expiratory volume in 1 s (FEV1) or diffusing capacity of the lung for carbon monoxide (DLCO) value below 50%. Co-primary end-points were the impact of risk status on 90-day mortality and the impact of MIS on 90-day mortality in high-risk patients. Results Of the 46 909 patients who met the inclusion criteria, 42 214 patients (90%) with both preoperative FEV1 and DLCO above 50% were included in the low-risk group, and 4695 patients (10%) with preoperative FEV1 and/or preoperative DLCO below 50% were included in the high-risk group. The 90-day mortality rate was significantly higher in the high-risk group compared to the low-risk group (280 (5.96%) versus 1301 (3.18%); p<0.0001). In high-risk patients, MIS was associated with lower 90-day mortality compared to open surgery in univariate analysis (OR=0.04 (0.02-0.05), p<0.001) and in multivariable analysis after propensity score matching (OR=0.46 (0.30-0.69), p<0.001). High-risk patients operated through MIS had a similar 90-day mortality rate compared to low-risk patients in general (3.10% versus 3.18% respectively). Conclusion By examining the impact of surgical approaches on 90-day mortality using a nationwide database, we found that either preoperative FEV1 or DLCO below 50% is associated with higher 90-day mortality, which can be reduced by using minimally invasive surgical approaches. High-risk patients operated through MIS have a similar 90-day mortality rate as low-risk patients.
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Affiliation(s)
- Harry Etienne
- Department of Thoracic and Vascular Surgery, Hôpital Bichat, APHP, Paris, France
| | | | - Jules Iquille
- Department of Thoracic and Vascular Surgery, Hôpital Bichat, APHP, Paris, France
| | - Pierre Emmanuel Falcoz
- Department of Thoracic Surgery, Nouvel Hôpital Civil, CHU Strasbourg, Strasbourg, France
| | - Laurent Brouchet
- Department of Thoracic Surgery, Hôpital Larrey, CHU Toulouse, Toulouse, France
| | | | | | - Jacques Jougon
- Department of Thoracic Surgery, Hôpital Haut Lévêque, CHU Bordeaux, Bordeaux, France
| | - Marc Filaire
- Department of Thoracic Surgery, Centre Jean Perrin, Clermont-Ferrand, UK
| | - Jean-Marc Baste
- Department of Thoracic Surgery, Hôpital Charles-Nicolle, CHU Rouen, Rouen, France
- Department of Thoracic Surgery, Hôpital Robert Schuman, Vantoux, France
| | - Valentine Anne
- Department of Thoracic Surgery, Hôpital Arnault Tzanck, Mougins, France
| | - Stéphane Renaud
- Department of Thoracic Surgery, Hôpital Central, CHU Nancy, Nancy, France
| | - Thomas D'Annoville
- Department of Thoracic Surgery, Clinique du Millénaire, Montpellier, France
| | | | - Christophe Jayle
- Department of Thoracic Surgery, Hôpital La Mileterie, CHU Poitiers, Poitiers, France
| | - Christian Dromer
- Department of Thoracic Surgery, Polyclinique Nord-Aquitaine, Bordeaux, France
| | | | - Antoine Legras
- Department of Thoracic Surgery, Hôpital Trousseau, CHU Tours, Tours, France
| | - Philippe Rinieri
- Department of Thoracic Surgery, Clinique du Cèdre, Bois-Guillaume, France
| | | | | | | | - Marcel Dahan
- Department of Thoracic Surgery, Hôpital Larrey, CHU Toulouse, Toulouse, France
| | - Pierre Mordant
- Department of Thoracic and Vascular Surgery, Hôpital Bichat, APHP, Paris, France
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Simon L, Belaroussi Y, Vayssette A, Khalife T, Le Roux M, Debrosse D, Giol M, Assouad J, Etienne H. Role of RAPID score and surgery in the management of pleural infection: a single center retrospective study. J Thorac Dis 2023; 15:5340-5348. [PMID: 37969265 PMCID: PMC10636464 DOI: 10.21037/jtd-22-1599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 03/31/2023] [Indexed: 11/17/2023]
Abstract
Background The RAPID [Renal (urea level), Age, Pleural fluid purulence, source of Infection and Denutrition (albumin level)] score classifies patients with pleural infection according to mortality risk at 3 months. This study aims to assess the applicability of this score in a thoracic surgery department and to determine the impact of surgery in the management of pleural infection depending on the Rapid score. Methods In this single center retrospective study, patients managed for pleural infection, from January 1st 2013 to June 30th 2019, were included. The primary endpoint was the probability of survival at 6 months and 12 months depending on the RAPID score. Secondary endpoint was the probability of survival at 6 and 12 months in patients who had surgeries (surgical treatment group) and patients who didn't have surgery (medical treatment group). Results Seventy-four patients were included, with a median age of 54.5 years. According to the RAPID score, the low-, medium- and high-risk groups had 30, 30 and 14 patients respectively. The probability of survival at 6 and 12 months in the low- and medium-risk groups were both 0.967 [95% confidence index (CI95): 0.905-1] whereas, the probabilities of survival at 6 and 12 months in the high-risk group was significantly lower at 0.571 (CI95: 0.363-0.899) and 0.357 (CI95: 0.177-0.721) respectively (P<0.0001). The probabilities of survival at 6 months and 12 months in the medical treatment group was 0.875 (CI95: 0.786-0.974) and 0.812 (CI95: 0.704-0.931) respectively compared to the surgical treatment group where probabilities of survival at 6 and 12 months were both 0.923 (CI95: 0.826-1) (P=0.26). Conclusions In our study, patients with pleural infection, classified as high-risk according to the RAPID score, had a lower survival rate compared to low- and medium-risk patients. No difference in survival rate was found between patients classified as low- and medium-risk. In selected patients, surgical management seems to decrease mortality compared to exclusive medical management: this result should be confirmed in larger prospective studies.
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Affiliation(s)
- Laura Simon
- Department of Thoracic and Vascular Surgery, Tenon University Hospital, Sorbonne University, Paris, France
| | - Yaniss Belaroussi
- Department of Thoracic Surgery, Haut-Leveque Hospital Bordeaux University, University of Bordeaux, Bordeaux, France
| | - Anna Vayssette
- Department of Thoracic and Vascular Surgery, Tenon University Hospital, Sorbonne University, Paris, France
| | - Theresa Khalife
- Department of Thoracic and Vascular Surgery, Tenon University Hospital, Sorbonne University, Paris, France
| | - Marielle Le Roux
- Department of Thoracic and Vascular Surgery, Tenon University Hospital, Sorbonne University, Paris, France
| | - Denis Debrosse
- Department of Thoracic and Vascular Surgery, Tenon University Hospital, Sorbonne University, Paris, France
| | - Mihaela Giol
- Department of Thoracic and Vascular Surgery, Tenon University Hospital, Sorbonne University, Paris, France
| | - Jalal Assouad
- Department of Thoracic and Vascular Surgery, Tenon University Hospital, Sorbonne University, Paris, France
| | - Harry Etienne
- Department of Thoracic and Vascular Surgery, Tenon University Hospital, Sorbonne University, Paris, France
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Sarvan M, Etienne H, Bankel L, Brown ML, Schneiter D, Opitz I. Outcome Analysis of Treatment Modalities for Thoracic Sarcomas. Cancers (Basel) 2023; 15:5154. [PMID: 37958328 PMCID: PMC10649966 DOI: 10.3390/cancers15215154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 10/22/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Primary chest wall sarcomas are a rare and heterogeneous group of chest wall tumors that require multimodal oncologic and surgical therapy. The aim of this study was to review our experience regarding the surgical treatment of chest wall sarcomas, evaluating the short- and long-term results. METHODS In this retrospective single-center study, patients who underwent surgery for soft tissue and bone sarcoma of the chest wall between 1999 and 2018 were included. We analyzed the oncologic and surgical outcomes of chest wall resections and reconstructions, assessing overall and recurrence-free survival and the associated clinical factors. RESULTS In total, 44 patients underwent chest wall resection for primary chest wall sarcoma, of which 18 (41%) received surgery only, 10 (23%) received additional chemoradiotherapy, 7% (3) received surgery with chemotherapy, and 30% (13) received radiotherapy in addition to surgery. No perioperative mortality occurred. Five-year overall survival was 51.5% (CI 95%: 36.1-73.4%), and median overall survival was 1973 days (CI 95% 1461; -). As determined in the univariate analysis, the presence of metastasis upon admission and tumor grade were significantly associated with shorter survival (p = 0.037 and p < 0.01, respectively). Five-year recurrence-free survival was 71.5% (95% CI 57.6%; 88.7%). Tumor resection margins and metastatic disease upon diagnosis were significantly associated with recurrence-free survival (p < 0.01 and p < 0.01, respectively). CONCLUSION Surgical therapy is the cornerstone of the treatment of chest wall sarcomas and can be performed safely. Metastasis and high tumor grade have a negative influence on overall survival, while tumor margins and metastasis have a negative influence on local recurrence.
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Affiliation(s)
- Milos Sarvan
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, 8091 Zurich, Switzerland;
| | - Harry Etienne
- Department of Thoracic Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (H.E.); (D.S.)
| | - Lorenz Bankel
- Department of Medical Oncology, University Hospital Zurich, 8091 Zurich, Switzerland;
| | - Michelle L. Brown
- Department of Radiation Oncology, University Hospital Zurich, 8091 Zurich, Switzerland;
| | - Didier Schneiter
- Department of Thoracic Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (H.E.); (D.S.)
| | - Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (H.E.); (D.S.)
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Reimann L, Mayer L, Schneider SR, Schwarz EI, Müller J, Titz A, Furian M, Carta AF, Etienne H, Battilana B, Saxer S, Pfammatter T, Frauenfelder T, Opitz I, Ulrich S, Lichtblau M. Change in Right-to-Left Shunt Fraction in Patients with Chronic Thromboembolic Pulmonary Hypertension after Pulmonary Endarterectomy. J Cardiovasc Dev Dis 2023; 10:442. [PMID: 37998500 PMCID: PMC10672130 DOI: 10.3390/jcdd10110442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/06/2023] [Accepted: 10/20/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Pulmonary endarterectomy (PEA) is the treatment of choice for patients with chronic thromboembolic pulmonary hypertension (CTEPH) with accessible lesions. Breathing pure oxygen (hyperoxia) during right heart catheterization (RHC) allows for the calculation of the right-to-left shunt fraction (Qs/Qt). In the absence of intracardiac shunt, Qs/Qt can be used as a marker of ventilation-perfusion mismatch in patients with CTEPH. This study involved investigating Qs/Qt after PEA and its relation to other disease-specific outcomes. STUDY DESIGN AND METHODS This study is a retrospective study that focuses on patients with operable CTEPH who had Qs/Qt assessment during RHC before and 1 year after PEA. Additionally, 6 min walking distance (6MWD), WHO functional class (WHO-FC), and NT-proBNP were assessed to calculate a four-strata risk score. RESULTS Overall, 16 patients (6 females) with a median age of 66 years (quartiles 55; 74) were included. After PEA, an improvement in mean pulmonary artery pressure (38 [32; 41] to 24 [18; 28] mmHg), pulmonary vascular resistance (5.7 [4.0; 6.8] to 2.5 [1.4; 3.8] WU), oxygen saturation (92 [88; 93]% to 94 [93; 95]%), WHO-FC, and risk score was observed (all p < 0.05). No improvement in median Qs/Qt could be detected (13.7 [10.0; 17.5]% to 13.0 [11.2; 15.6]%, p = 0.679). A total of 7 patients with improved Qs/Qt had a significant reduction in risk score compared to those without improved Qs/Qt. CONCLUSION PEA did not alter Qs/Qt assessed after 1 year in operable CTEPH despite an improvement in hemodynamics and risk score, potentially indicating a persistent microvasculopathy. In patients whose shunt fraction improved with PEA, the reduced shunt was associated with an improvement in risk score.
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Affiliation(s)
- Lena Reimann
- Department of Pulmonology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Laura Mayer
- Department of Pulmonology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Simon Raphael Schneider
- Department of Pulmonology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Esther I. Schwarz
- Department of Pulmonology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Julian Müller
- Department of Pulmonology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Anna Titz
- Department of Pulmonology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Michael Furian
- Department of Pulmonology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Arcangelo F. Carta
- Department of Pulmonology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Harry Etienne
- Department of Thoracic Surgery, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Bianca Battilana
- Department of Thoracic Surgery, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Stéphanie Saxer
- Department of Pulmonology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
- Department of Health, Eastern Switzerland University of Applied Sciences, 9001 St. Gallen, Switzerland
| | - Thomas Pfammatter
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Thomas Frauenfelder
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Silvia Ulrich
- Department of Pulmonology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Mona Lichtblau
- Department of Pulmonology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
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Jungblut L, Etienne H, Zellweger C, Matter A, Patella M, Frauenfelder T, Opitz I. Swiss Pilot Low-Dose CT Lung Cancer Screening Study: First Baseline Screening Results. J Clin Med 2023; 12:5771. [PMID: 37762713 PMCID: PMC10531743 DOI: 10.3390/jcm12185771] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 08/29/2023] [Accepted: 08/31/2023] [Indexed: 09/29/2023] Open
Abstract
This pilot study conducted in Switzerland aims to assess the implementation, execution, and performance of low-dose CT lung cancer screening (LDCT-LCS). With lung cancer being the leading cause of cancer-related deaths in Switzerland, the study seeks to explore the potential impact of screening on reducing mortality rates. However, initiating a lung cancer screening program poses challenges and depends on country-specific factors. This prospective study, initiated in October 2018, enrolled participants meeting the National Lung Cancer Study criteria or a lung cancer risk above 1.5% according to the PLCOm2012 lung cancer risk-model. LDCT scans were assessed using Lung-RADS. Enrollment and follow-up are ongoing. To date, we included 112 participants, with a median age of 62 years (IQR 57-67); 42% were female. The median number of packs smoked each year was 45 (IQR 38-57), and 24% had stopped smoking before enrollment. The mean PLCOm2012 was 3.7% (±2.5%). We diagnosed lung cancer in 3.6% of participants (95%, CI:1.0-12.1%), with various stages, all treated with curative intent. The recall rate for intermediate results (Lung-RADS 3,4a) was 15%. LDCT-LCS in Switzerland, using modified inclusion criteria, is feasible. Further analysis will inform the potential implementation of a comprehensive lung cancer screening program in Switzerland.
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Affiliation(s)
- Lisa Jungblut
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
| | - Harry Etienne
- Department of Thoracic Surgery, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
| | - Caroline Zellweger
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
| | - Alessandra Matter
- Department of Thoracic Surgery, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
| | - Miriam Patella
- Department of Thoracic Surgery, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
| | - Thomas Frauenfelder
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
| | - Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
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Etienne H, Morris IS, Hermans G, Heunks L, Goligher EC, Jaber S, Morelot-Panzini C, Assouad J, Gonzalez-Bermejo J, Papazian L, Similowski T, Demoule A, Dres M. Diaphragm Neurostimulation Assisted Ventilation in Critically Ill Patients. Am J Respir Crit Care Med 2023; 207:1275-1282. [PMID: 36917765 PMCID: PMC10595441 DOI: 10.1164/rccm.202212-2252cp] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/14/2023] [Indexed: 03/15/2023] Open
Abstract
Diaphragm neurostimulation consists of placing electrodes directly on or in proximity to the phrenic nerve(s) to elicit diaphragmatic contractions. Since its initial description in the 18th century, indications have shifted from cardiopulmonary resuscitation to long-term ventilatory support. Recently, the technical development of devices for temporary diaphragm neurostimulation has opened up the possibility of a new era for the management of mechanically ventilated patients. Combining positive pressure ventilation with diaphragm neurostimulation offers a potentially promising new approach to the delivery of mechanical ventilation which may benefit multiple organ systems. Maintaining diaphragm contractions during ventilation may attenuate diaphragm atrophy and accelerate weaning from mechanical ventilation. Preventing atelectasis and preserving lung volume can reduce lung stress and strain and improve homogeneity of ventilation, potentially mitigating ventilator-induced lung injury. Furthermore, restoring the thoracoabdominal pressure gradient generated by diaphragm contractions may attenuate the drop in cardiac output induced by positive pressure ventilation. Experimental evidence suggests diaphragm neurostimulation may prevent neuroinflammation associated with mechanical ventilation. This review describes the historical development and evolving approaches to diaphragm neurostimulation during mechanical ventilation and surveys the potential mechanisms of benefit. The review proposes a research agenda and offers perspectives for the future of diaphragm neurostimulation assisted mechanical ventilation for critically ill patients.
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Affiliation(s)
- Harry Etienne
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
- Department of Thoracic Surgery, Tenon University Hospital, Paris, France
| | - Idunn S. Morris
- Interdepartmental Division of Critical Care Medicine and
- Department of Physiology, University of Toronto, Toronto, Ontario, Canada
- Division of Respirology, Department of Medicine, University Health Network, Toronto, Ontario, Canada
- Department of Intensive Care Medicine, Nepean Hospital, Kingswood, New South Wales, Australia
| | - Greet Hermans
- Medical Intensive Care Unit, Department of General Internal Medicine, University Hospital Leuven, Leuven, Belgium
- Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - Leo Heunks
- Department of Intensive Care, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Ewan C. Goligher
- Interdepartmental Division of Critical Care Medicine and
- Department of Physiology, University of Toronto, Toronto, Ontario, Canada
- Division of Respirology, Department of Medicine, University Health Network, Toronto, Ontario, Canada
- Toronto General Hospital Research Institute, Toronto, Ontario, Canada
| | - Samir Jaber
- Intensive Care and Anesthesiology Department, Saint Eloi Hospital, Montpellier, France
| | - Capucine Morelot-Panzini
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
- Service de Pneumologie
| | - Jalal Assouad
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
- Department of Thoracic Surgery, Tenon University Hospital, Paris, France
| | - Jésus Gonzalez-Bermejo
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
- Service de Soins de Suite Réadaptation
| | - Laurent Papazian
- Service de Médecine Intensive Reanimation, Centre Hospitalier de Bastia, Bastia, France
| | - Thomas Similowski
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
- Département R3S, and
| | - Alexandre Demoule
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
- Service de Médecine Intensive – Réanimation, Hopital Pitie Salpetriere, APHP, Sorbonne Universite, Paris, France; and
| | - Martin Dres
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
- Service de Médecine Intensive – Réanimation, Hopital Pitie Salpetriere, APHP, Sorbonne Universite, Paris, France; and
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10
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Etienne H, Fournel L, Mordant P, Delatour BR, Pfeuty K, Frey G, Seguin-Givelet A, Fourdrain A, Lancelin C, Berna P, Legras A, Alifano M, Bagan P, Assouad J. Anatomic lung resection after immune checkpoint inhibitors for initially unresectable advanced-staged non-small cell lung cancer: a retrospective cohort analysis. J Thorac Dis 2023; 15:270-280. [PMID: 36910122 PMCID: PMC9992580 DOI: 10.21037/jtd-22-704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 09/16/2022] [Indexed: 01/09/2023]
Abstract
Background Patients with initially unresectable advanced non-small cell lung cancer (NSCLC) might experience prolonged responses under immune checkpoint inhibitors (ICIs). In this setting, Multidisciplinary Tumor Board (MTB) seldomly suggest surgical resection of the primary tumor with the ultimate goal to eradicate macroscopic residual disease. Our objective was to report the perioperative outcomes of patients who underwent anatomic lung resection in these infrequent circumstances. Methods We set a retrospective multicentric single arm study, including all patients with advanced-staged initially unresectable NSCLC (stage IIIB to IVB) who received systemic therapy including ICIs and eventually anatomical resection of the primary tumor in 10 French thoracic surgery units from January 2016 to December 2020. Coprimary endpoints were in-hospital mortality and morbidity. Secondary endpoints were the rate of complete resection of the pulmonary disease, major pathologic response, risk factors associated with post-operative complications, and overall survival. Results Twenty-one patients (median age 64, female 62%) were included. Eighteen patients (86%) progressed after first line chemotherapy and received second line ICI. The median time between diagnosis and surgery was 22 months [interquartile range (IQR) 18-35 months]. Minimally-invasive approach was used in 10 cases (48%), with half of these requiring conversion to open thoracotomy. Nine patients (43%) presented early post-operative complications, and one patient died from broncho-pleural fistula one month after surgery. Rates of complete resection of the pulmonary disease and major pathologic response were 100% and 43%, respectively. In univariable analysis, diffusing capacity for carbon monoxide (DLCO) was the only factor associated with the occurrence of postoperative complications (P=0.027). After a median follow-up of 16.0 months after surgery (IQR, 12.0-30.0 months), 19 patients (90%) were still alive. Conclusions Anatomic lung resections appear to be a reasonable option for initially unresectable advanced NSCLC experiencing prolonged response under ICIs. Nonetheless, minimally invasive techniques have a low applicability and post-operative complications remains higher in patients who had lower DLCO values. The late timing of surgery may also contribute to complications.
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Affiliation(s)
- Harry Etienne
- AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Tenon, Service de Chirurgie Thoracique et Vasculaire, Paris, France
| | - Ludovic Fournel
- AP-HP, Groupe Hospitalier Universitaire APHP-Université Descartes, site Cochin, Service de Chirurgie Thoracique, Paris, France
| | - Pierre Mordant
- AP-HP, Groupe Hospitalier Universitaire APHP-Nord-Université de Paris, site Bichat-Claude Bernard, Service de Chirurgie Thoracique et Vasculaire, Paris, France
| | - Bertrand Richard Delatour
- Centre Hospitalier Universitaire de Rennes, Service de Chirurgie Cardiaque et Thoracique, Rennes, France
| | - Karel Pfeuty
- Centre Hospitalier Général de Saint-Brieuc, Service de Chirurgie Thoracique, Saint-Brieuc, France
| | - Gil Frey
- Centre Hospitalier Universitaire de Grenoble, Service de Chirurgie Thoracique, Grenoble, France
| | | | - Alex Fourdrain
- Centre Hospitalier Universitaire de Amiens, Service de Chirurgie Thoracique, Amiens, France
| | | | - Pascal Berna
- Centre Hospitalier Universitaire de Amiens, Service de Chirurgie Thoracique, Amiens, France
| | - Antoine Legras
- Centre Hospitalier Universitaire de Tours, Service de Chirurgie Thoracique et Vasculaire, Tours, France
| | - Marco Alifano
- AP-HP, Groupe Hospitalier Universitaire APHP-Université Descartes, site Cochin, Service de Chirurgie Thoracique, Paris, France
| | - Patrick Bagan
- Centre Hospitalier Général d'Argenteuil, Service de Chirurgie Thoracique et Vasculaire, Argenteuil, France
| | - Jalal Assouad
- AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Tenon, Service de Chirurgie Thoracique et Vasculaire, Paris, France
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11
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Etienne H, Kalt F, Park S, Opitz I. The oncologic efficacy of extended resections for lung cancer. J Surg Oncol 2023; 127:296-307. [PMID: 36630100 DOI: 10.1002/jso.27183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 01/12/2023]
Abstract
Extended lung resections for T3-T4 non-small-cell lung cancer remain challenging. Multimodal management is mandatory in multidisciplinary tumor boards, and here the determination of resectability is key. Long-term oncologic efficacy depends mostly on complete resection (R0) and the extent of N2 disease. The development of novel innovative treatments (targeted therapy and immune checkpoint inhibitors) sets interesting perspectives to reinforce current therapeutic options in the induction and adjuvant setting.
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Affiliation(s)
- Harry Etienne
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Fabian Kalt
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Samina Park
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
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Agrafiotis AC, Bourlon L, Etienne H, Le Roux M, Mazzoni L, Giol M, Debrosse D, Assouad J. Is surgical rib fixation in patients aged more than 65 years old associated with worse outcomes compared to younger patients? A retrospective single-center study. Acta Chir Belg 2022; 122:35-40. [PMID: 33146583 DOI: 10.1080/00015458.2020.1846939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND There is no robust data regarding rib fixation in elderly patients. The aim of this study is to compare the postoperative outcomes of patients aged less and more than 65 years old. METHODS Patients operated from January 2012 to December 2018 were retrospectively analyzed. The following data were collected: age, sex, comorbidities, smoking habit, Injury Severity Score (ISS), number of fractured ribs, indication for surgery, associated injuries, time from trauma to surgery, number of fixed ribs, intrathoracic injuries, duration of intubation, ICU stay, postoperative cardiopulmonary complications, blood transfusion, overall and 30-day mortality, length of stay. RESULTS There was no difference regarding the ISS (p = 0.09), the number of rib fractures (p = 0.291), the indication for surgery, the number of fixed ribs (p = 0.819), the ICU stay (p = 0.096), the postoperative intubation duration (p = 0.059), the cardiopulmonary complications (p = 0.273) and perioperative blood transfusions (p = 0.34). Elderly patients presented more postoperative cognitive complications (p < 0.001). There was no difference in terms of overall mortality (p = 0.06) and 30-day mortality (p = 0.69). Elderly patients stayed longer in the hospital (p < 0.001). CONCLUSIONS The outcomes of rib fixation in the elderly patients are comparable to younger patients. However, elderly patients experience more frequently postoperative cognitive complications and their hospitalizations are longer.
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Affiliation(s)
| | - Lucie Bourlon
- Department of Thoracic Surgery, Tenon University Hospital, Paris, France
| | - Harry Etienne
- Department of Thoracic Surgery, Tenon University Hospital, Paris, France
| | - Marielle Le Roux
- Department of Thoracic Surgery, Tenon University Hospital, Paris, France
| | - Lucia Mazzoni
- Department of Thoracic Surgery, Tenon University Hospital, Paris, France
| | - Mihaela Giol
- Department of Thoracic Surgery, Tenon University Hospital, Paris, France
| | - Denis Debrosse
- Department of Thoracic Surgery, Tenon University Hospital, Paris, France
| | - Jalal Assouad
- Department of Thoracic Surgery, Tenon University Hospital, Paris, France
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Etienne H, Dres M, Piquet J, Wingertsmann L, Thibaudeau O, Similowski T, Gonzalez-Bermejo J, Assouad J. Phrenic nerve stimulation in an ovine model with temporary removable pacing leads. J Thorac Dis 2022; 14:2748-2756. [PMID: 36071760 PMCID: PMC9442545 DOI: 10.21037/jtd-21-1944] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 04/08/2022] [Indexed: 12/03/2022]
Abstract
Background The objective of this study was to assess the feasibility and safety of a novel, removable, surgically implanted, temporary neurostimulation approach involving the distal portion of the phrenic nerve. Methods Temporary phrenic nerve pacing electrodes were implanted surgically using an ovine model (4 animals). The primary endpoint was the ability to successfully match the animal’s minute-ventilation upon implantation of both phrenic nerve pacers on day 1. Secondary endpoints were successful phrenic neurostimulation by both electrodes 15 and 30 days after initial implantation. We also assessed safe removal of the electrodes at 15 and 30 days after implementation. Results In 3 of 4 animals, electrodes were successfully implanted in both right and left phrenic nerves. On day 1, median ventilation-minute induced by neurostimulation was not significantly different from baseline ventilation-minute [4.9 L·min−1 (4.4–5.5) vs. 4.4 L·min−1 (4.3–5.2); P=0.4] after 15 minutes. Neurostimulation was still possible 15 and 30 days after implementation in all left side phrenic nerves. On the right side, stimulation was possible at all times in 1 animal but not in the remaining 3 animals for at least one time point, possibly due to lead displacement. Analysis of pathology after percutaneous electrode removal showed integrity of the distal portion of all phrenic nerves. Conclusions Efficient temporary neurostimulation through the distal portion of the phrenic nerve was possible at baseline. The main complication was the displacement of electrodes on the right phrenic nerve on two occasions, which was due to the anatomy of the ovine model. It compromised diaphragm pacing on day 15 and day 30. The electrodes could be safely removed percutaneously without damage to the phrenic nerves.
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Affiliation(s)
- Harry Etienne
- Experimental and Clinical Respiratory Neurophysiology, INSERM, UMRS1158, Sorbonne University, Paris, France
- Department of Thoracic Surgery, Tenon University Hospital, Paris, France
| | - Martin Dres
- Experimental and Clinical Respiratory Neurophysiology, INSERM, UMRS1158, Sorbonne University, Paris, France
- Department of Pulmonary Intensive Care Medicine, Pitie-Salpetriere University Hospital, Paris, France
| | - Julie Piquet
- Surgical Research Laboratory, Carpentier Foundation, Paris, France
| | | | | | - Thomas Similowski
- Experimental and Clinical Respiratory Neurophysiology, INSERM, UMRS1158, Sorbonne University, Paris, France
- Department R3S, Pitie-Salpetriere University Hospital, Paris, France
| | - Jesus Gonzalez-Bermejo
- Experimental and Clinical Respiratory Neurophysiology, INSERM, UMRS1158, Sorbonne University, Paris, France
- Department of Pulmonary and Neuro-respiratory Rehabilitation, Pitie-Salpetriere University Hospital, Paris, France
| | - Jalal Assouad
- Experimental and Clinical Respiratory Neurophysiology, INSERM, UMRS1158, Sorbonne University, Paris, France
- Department of Thoracic Surgery, Tenon University Hospital, Paris, France
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14
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Etienne H, Assouad J. [Thoracic surgery and co-morbid patients]. Rev Mal Respir 2021; 38:743-753. [PMID: 34215483 DOI: 10.1016/j.rmr.2021.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 04/15/2021] [Indexed: 11/15/2022]
Abstract
Patients undergoing lung resection are often active or former smokers who have chronic disease related to tobacco (coronary artery disease, chronic obstructive bronchitis, arteritis of the inferior limbs…). Those co-morbidities increase the operative risk for surgery in which morbi-mortality is relevant. On top of this, we are witnessing an increasing number of non-small cell lung cancers in an aging population that might show signs of frailty. The challenge for the surgeon is to identify early those co-morbid and/or frail patients by using predictive scores like Thoracoscore, mFI (modified frailty index) or MSK-F1 (Memorial Sloan-Kettering Frailty Index). Screening for those high-risk patients implies adapting surgical management through a multidisciplinary approach. That is the objective of co-managment, which allows geriatricians and surgeons to collaborate, or enhanced recovery after surgery which is more accessible to all group ages. The objective of this article is to review the management of co-morbid patients in thoracic surgery, by detailing certain predictive scores available and the multidisciplinary approaches developed to treat the patients screened.
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Affiliation(s)
- H Etienne
- Service de chirurgie thoracique et vasculaire, centre hospitalier universitaire Tenon, 4, rue de la Chine, 75020 Paris, France.
| | - J Assouad
- Service de chirurgie thoracique et vasculaire, centre hospitalier universitaire Tenon, 4, rue de la Chine, 75020 Paris, France.
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Leclère JB, Fournel L, Etienne H, Al Zreibi C, Onorati I, Roussel A, Castier Y, Martinod E, Le Pimpec-Barthes F, Alifano M, Assouad J, Mordant P. Maintaining Surgical Treatment of Non-Small Cell Lung Cancer During the COVID-19 Pandemic in Paris. Ann Thorac Surg 2021; 111:1682-1688. [PMID: 33038341 PMCID: PMC7543779 DOI: 10.1016/j.athoracsur.2020.08.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/18/2020] [Accepted: 08/24/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) outbreak was officially declared in France on March 14, 2020. The objective of this study is to report the incidence and outcome of COVID-19 after surgical resection of non-small cell lung cancer in Paris Public Hospitals during the pandemic. METHODS We retrospective analyzed a prospective database including all patients who underwent non-small cell lung cancer resection between March 14, 2020, and May 11, 2020, in the 5 thoracic surgery units of Paris Public Hospitals. The primary endpoint was the occurrence of SARS-CoV-2 infection during the first 30 days after surgery. RESULTS Study group included 115 patients (male 57%, age 64.6 ± 10.7 years, adenocarcinoma 66%, cT1 62%, cN0 82%). During the first month after surgery, 6 patients (5%) were diagnosed with COVID-19. As compared with COVID-negative patients, COVID-positive patients were more likely to be operated on during the first month of the pandemic (100% vs 54%, P = .03) and to be on corticosteroids preoperatively (33% vs 4%, P = .03). Postoperative COVID-19 was associated with an increased rate of readmission (50% vs 5%, P = .004), but no difference in 30-day morbidity (for the study group: grade 2, 24%; grade 3, 7%; grade 4, 1%) or mortality (n = 1 COVID-negative patient, 0.9%). Immediate oncologic outcomes did not differ significantly between groups (R0 resection 99%, nodal upstaging 14%, adjuvant chemotherapy 29%). CONCLUSIONS During the COVID-19 pandemic, surgical treatment of non-small cell lung cancer was associated with a rate of postoperative COVID-19 of 5% with a significant impact on readmissions but not on other outcomes studied.
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Affiliation(s)
- Jean-Baptiste Leclère
- Department of Vascular Surgery, Thoracic Surgery, and Lung Transplantation, Hôpital Bichat, Université de Paris, Paris, France
| | - Ludovic Fournel
- Department of Thoracic Surgery, Hôpital Cochin, Université de Paris, Paris, France
| | - Harry Etienne
- Department of Thoracic and Vascular Surgery, Hôpital Tenon, Sorbonne Université, Paris, France
| | - Charbel Al Zreibi
- Department of General Thoracic Surgery, Oncology, and Lung Transplantation, Hôpital Européen Georges-Pompidou, Université de Paris, Paris, France
| | - Ilaria Onorati
- Department of Thoracic and Vascular Surgery, Hôpital Avicenne, Université Sorbonne Paris Nord, Paris, France
| | - Arnaud Roussel
- Department of Vascular Surgery, Thoracic Surgery, and Lung Transplantation, Hôpital Bichat, Université de Paris, Paris, France
| | - Yves Castier
- Department of Vascular Surgery, Thoracic Surgery, and Lung Transplantation, Hôpital Bichat, Université de Paris, Paris, France
| | - Emmanuel Martinod
- Department of Thoracic and Vascular Surgery, Hôpital Avicenne, Université Sorbonne Paris Nord, Paris, France
| | - Françoise Le Pimpec-Barthes
- Department of General Thoracic Surgery, Oncology, and Lung Transplantation, Hôpital Européen Georges-Pompidou, Université de Paris, Paris, France
| | - Marco Alifano
- Department of Thoracic Surgery, Hôpital Cochin, Université de Paris, Paris, France
| | - Jalal Assouad
- Department of Thoracic and Vascular Surgery, Hôpital Tenon, Sorbonne Université, Paris, France
| | - Pierre Mordant
- Department of Vascular Surgery, Thoracic Surgery, and Lung Transplantation, Hôpital Bichat, Université de Paris, Paris, France.
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Abstract
Principles of surgical training have not changed, but methods of training are evolving very fast. Online tools are being adopted in both knowledge and skills training for surgical residents. As a result, to evaluate the outcome of these tools, online assessment is also developing. Knowledge resources are very diverse ranging from lectures, webinars, surgical videos to three-dimensional planning and printing. Skills resources include virtual reality simulators, remote skills training and interdisciplinary teamwork. Assessment of E-learning tools can be performed using online questions, task-based simulations, branching scenarios and online interviews/discussions. In thoracic surgery, video assisted thoracic surgery (VATS) lobectomy simulator has been developed and it appears to be an important tool for minimally invasive thoracic surgery education. Training programs incorporate e-Learning in their curriculum and online training and assessment will become an important part of thoracic surgical training as well.
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Affiliation(s)
| | - Jalal Assouad
- Sorbonne University, Tenon University Hospital, Department of Thoracic and Vascular Surgery, Paris, France
| | - Harry Etienne
- Sorbonne University, Tenon University Hospital, Department of Thoracic and Vascular Surgery, Paris, France
| | - Xavier Benoit D'Journo
- Aix-Marseille University, Thoracic surgery department, North Hospital, Marseille, France
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17
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Berna P, Quesnel C, Assouad J, Bagan P, Etienne H, Fourdrain A, Le Guen M, Leone M, Lorne E, Nguyen YNL, Pages PB, Roz H, Garnier M. Guidelines on enhanced recovery after pulmonary lobectomy. Anaesth Crit Care Pain Med 2021; 40:100791. [PMID: 33451912 DOI: 10.1016/j.accpm.2020.100791] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To establish recommendations for optimisation of the management of patients undergoing pulmonary lobectomy, particularly Enhanced Recovery After Surgery (ERAS). DESIGN A consensus committee of 13 experts from the French Society of Anaesthesia and Intensive Care Medicine (Soci,t, franOaise d'anesth,sie et de r,animation, SFAR) and the French Society of Thoracic and Cardiovascular Surgery (Soci,t, franOaise de chirurgie thoracique et cardiovasculaire, SFCTCV) was convened. A formal conflict-of-interest policy was developed at the onset of the process and enforced throughout. The entire guidelines process was conducted independently of any industry funding. The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide assessment of quality of evidence. METHODS Five domains were defined: 1) patient pathway and patient information; 2) preoperative management and rehabilitation; 3) anaesthesia and analgesia for lobectomy; 4) surgical strategy for lobectomy; and 5) enhanced recovery after surgery. For each domain, the objective of the recommendations was to address a number of questions formulated according to the PICO model (Population, Intervention, Comparison, Outcome). An extensive literature search on these questions was carried out and analysed using the GRADE® methodology. Recommendations were formulated according to the GRADE® methodology, and were then voted by all experts according to the GRADE grid method. RESULTS The SFAR/SFCTCV guideline panel provided 32 recommendations on the management of patients undergoing pulmonary lobectomy. After two voting rounds and several amendments, a strong consensus was reached for 31 of the 32 recommendations and a moderate consensus was reached for the last recommendation. Seven of these recommendations present a high level of evidence (GRADE 1+), 23 have a moderate level of evidence (18 GRADE 2+ and 5 GRADE 2-), and 2 correspond to expert opinions. Finally, no recommendation was provided for 2 of the questions. CONCLUSIONS A strong consensus was expressed by the experts to provide recommendations to optimise the whole perioperative management of patients undergoing pulmonary lobectomy.
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Affiliation(s)
- Pascal Berna
- Department of Thoracic Surgery, Amiens University Hospital, 80000 Amiens, France
| | - Christophe Quesnel
- Sorbonne Universit,, APHP, DMU DREAM, Service d'Anesth,sie-R,animation et M,decine P,riop,ratoire, H"pital Tenon, 75020 Paris, France
| | - Jalal Assouad
- Department of Thoracic Surgery, Tenon University Hospital, Sorbonne Universit,, 75020 Paris, France
| | - Patrick Bagan
- Department of Thoracic and Vascular Surgery, Victor Dupouy Hospital, 95100 Argenteuil, France
| | - Harry Etienne
- Department of Thoracic Surgery, Tenon University Hospital, Sorbonne Universit,, 75020 Paris, France
| | - Alex Fourdrain
- Department of Thoracic Surgery, Amiens University Hospital, 80000 Amiens, France
| | - Morgan Le Guen
- D,partement d'Anesth,sie, H"pital Foch, Universit, Versailles Saint Quentin, 92150 Suresnes, France; INRA UMR 892 VIM, 78350 Jouy-en-Josas, France
| | - Marc Leone
- Aix Marseille Universit, - Assistance Publique H"pitaux de Marseille - Service d'Anesth,sie et de R,animation - H"pital Nord - 13005 Marseille, France
| | - Emmanuel Lorne
- Departement d'Anesth,sie-R,animation, Clinique du Mill,naire, 34000 Montpellier, France
| | - Y N-Lan Nguyen
- Anaesthesiology and Critical Care Department, APHP Centre, Paris University, 75000 Paris, France
| | - Pierre-Benoit Pages
- Department of Thoracic Surgery, Dijon Burgundy University Hospital, 21000 Dijon, France; INSERM UMR 1231, Dijon Burgundy University Hospital, University of Burgundy, 21000 Dijon, France
| | - Hadrien Roz
- Unit, d'Anesth,sie R,animation Thoracique, H"pital Haut Leveque, CHU de Bordeaux, 33000 Bordeaux, France
| | - Marc Garnier
- Sorbonne Universit,, APHP, DMU DREAM, Service d'Anesth,sie-R,animation et M,decine P,riop,ratoire, H"pital Tenon, 75020 Paris, France.
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Etienne H, Hamdi S, Le Roux M, Camuset J, Khalife-Hocquemiller T, Giol M, Debrosse D, Assouad J. Artificial intelligence in thoracic surgery: past, present, perspective and limits. Eur Respir Rev 2020; 29:29/157/200010. [PMID: 32817112 DOI: 10.1183/16000617.0010-2020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 02/11/2020] [Indexed: 12/15/2022] Open
Abstract
Artificial intelligence (AI) technology is becoming prevalent in many areas of everyday life. The healthcare industry is concerned by it even though its widespread use is still limited. Thoracic surgeons should be aware of the new opportunities that could affect their daily practice, by direct use of AI technology or indirect use via related medical fields (radiology, pathology and respiratory medicine). The objective of this article is to review applications of AI related to thoracic surgery and discuss the limits of its application in the European Union. Key aspects of AI will be developed through clinical pathways, beginning with diagnostics for lung cancer, a prognostic-aided programme for decision making, then robotic surgery, and finishing with the limitations of AI, the legal and ethical issues relevant to medicine. It is important for physicians and surgeons to have a basic knowledge of AI to understand how it impacts healthcare, and to consider ways in which they may interact with this technology. Indeed, synergy across related medical specialties and synergistic relationships between machines and surgeons will likely accelerate the capabilities of AI in augmenting surgical care.
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Affiliation(s)
- Harry Etienne
- AP-HP, Dept of Thoracic and Vascular Surgery, Tenon University Hospital, Paris, France .,Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Sarah Hamdi
- Dept of Thoracic and Vascular Surgery, Le Raincy-Montfermeil Hospital, Montfermeil, France
| | - Marielle Le Roux
- AP-HP, Dept of Thoracic and Vascular Surgery, Tenon University Hospital, Paris, France
| | - Juliette Camuset
- AP-HP, Dept of Thoracic and Vascular Surgery, Tenon University Hospital, Paris, France
| | | | - Mihaela Giol
- AP-HP, Dept of Thoracic and Vascular Surgery, Tenon University Hospital, Paris, France
| | - Denis Debrosse
- AP-HP, Dept of Thoracic and Vascular Surgery, Tenon University Hospital, Paris, France
| | - Jalal Assouad
- AP-HP, Dept of Thoracic and Vascular Surgery, Tenon University Hospital, Paris, France.,Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
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Etienne H, Journé C, Rouchaud A, Senemaud J, Louedec L, Pellenc Q, Coscas R, Gouya L, Dupont S, Michel JB. Persistence of Intraluminal Thrombus Makes Saccular Aneurysm More Biologically Active than Fusiform in an Experimental Rat Model. J Vasc Res 2020; 57:164-176. [PMID: 32222706 DOI: 10.1159/000506159] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 01/26/2020] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Saccular aneurysms are thought to have a worse prognosis than fusiform aneurysms in humans, due to hemodynamic reasons. However, data comparing hemodynamic and biology in saccular and fusiform aneurysms are lacking. The main objective was to evaluate the impact of aneurysm morphology on intra-luminal thrombus (ILT) formation and activity. METHODS Forty Lewis rats were ran-domly divided into 2 groups of 20: "saccular" (Group A) and "fusiform" (Group B) aneurysms. Decellularized thoracic aortas from guinea pigs were xenografted to create saccular or fusiform aneurysms. Final imaging evaluation of the aneurysms was carried out during the third week, by quantitative Doppler ultrasound and magnetic resonance imaging. Assays of myeloperoxidase (MPO), platelet factor 4 (PF4), advanced oxidation protein products (AOPPs) iron and matrix metallopeptidase-9 (MMP-9) were performed as biological criteria. RESULTS Quantitatively, saccular aneurysms are characterized by a more thicker ILT, lower inflow velocities and more important relative backflow velocities as compared to fusiform aneurysms. Compared to fusiform, saccular aneurysms released significantly more MPO (p = 0.004), PF4 (p = 0.02), AOPPs (p < 0.002), iron (p < 0.0001) and MMP-9 (p < 0.04). CONCLUSION Experimental saccular and fusiform aneurysms show differential specific hemodynamics, which seem to impact the histology and the biology of the ILT in each type of aneurysm.
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Affiliation(s)
- Harry Etienne
- UMR 1148, Inserm-Denis Diderot University, Hôpital Xavier Bichat, Paris, France,
| | - Clément Journé
- UMR 1148, Inserm-Denis Diderot University, Hôpital Xavier Bichat, Paris, France.,UMS 34, Fédération de Recherche en Imagerie Multimodalités, Paris, France
| | - Aymeric Rouchaud
- Université Limoges, CNRS, XLIM, UMR 7252, Limoges, France.,Department of interventional neuroradiology, CHU Dupuytren, Limoges, France
| | - Jean Senemaud
- UMR 1148, Inserm-Denis Diderot University, Hôpital Xavier Bichat, Paris, France.,Department of Vascular, Thoracic Surgery and Lung Transplantation, Hôpital Xavier Bichat, Paris, France
| | - Liliane Louedec
- UMR 1148, Inserm-Denis Diderot University, Hôpital Xavier Bichat, Paris, France
| | - Quentin Pellenc
- UMR 1148, Inserm-Denis Diderot University, Hôpital Xavier Bichat, Paris, France.,Department of Vascular, Thoracic Surgery and Lung Transplantation, Hôpital Xavier Bichat, Paris, France
| | - Raphaël Coscas
- Department of Vascular Surgery, Ambroise Paré University Hospital, AP-HP, Boulogne-Billancourt, France
| | - Laurent Gouya
- Paris Diderot University, INSERM U1149, Hème, fer et pathologies inflammatoires, Assistance Publique des Hôpitaux de Paris, Hôpital Louis Mourier, Paris, France
| | - Sébastien Dupont
- UMR 1148, Inserm-Denis Diderot University, Hôpital Xavier Bichat, Paris, France
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Agrafiotis AC, Etienne H, Le Roux M, Mazzoni L, Giol M, Debrosse D, Assouad J. A Single-Center Experience of Osteosynthesis Material Infection after Rib Fixation for Blunt Trauma. Thorac Cardiovasc Surg 2020; 68:357-360. [PMID: 32005045 DOI: 10.1055/s-0039-3401043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION There is no data regarding the incidence and treatment of deep infection affecting the surgical implants after rib fixation. The aim of this study is to share our experience in the management of infected material after surgical rib fixation. METHODS The medical records of operated patients from January 2012 to December 2018 were retrospectively analyzed. RESULTS Three patients out of 87 (3.44%) developed an infection. One patient was treated conservatively and two patients were operated for hardware removal. CONCLUSIONS The lack of evidence prompts for the design of surgical databases to share experience and enhance available data.
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Affiliation(s)
| | - Harry Etienne
- Department of Thoracic Surgery, Tenon University Hospital, Paris, France
| | - Marielle Le Roux
- Department of Thoracic Surgery, Tenon University Hospital, Paris, France
| | - Lucia Mazzoni
- Department of Thoracic Surgery, Tenon University Hospital, Paris, France
| | - Mihaela Giol
- Department of Thoracic Surgery, Tenon University Hospital, Paris, France
| | - Denis Debrosse
- Department of Thoracic Surgery, Tenon University Hospital, Paris, France
| | - Jalal Assouad
- Department of Thoracic Surgery, Tenon University Hospital, Paris, France
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21
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Breitler JC, Djerrab D, Leran S, Toniutti L, Guittin C, Severac D, Pratlong M, Dereeper A, Etienne H, Bertrand B. Full moonlight-induced circadian clock entrainment in Coffea arabica. BMC Plant Biol 2020; 20:24. [PMID: 31941456 PMCID: PMC6961272 DOI: 10.1186/s12870-020-2238-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 01/03/2020] [Indexed: 05/31/2023]
Abstract
BACKGROUND It is now well documented that moonlight affects the life cycle of invertebrates, birds, reptiles, and mammals. The lunisolar tide is also well-known to alter plant growth and development. However, although plants are known to be very photosensitive, few studies have been undertaken to explore the effect of moonlight on plant physiology. RESULTS Here for the first time we report a massive transcriptional modification in Coffea arabica genes under full moonlight conditions, particularly at full moon zenith and 3 h later. Among the 3387 deregulated genes found in our study, the main core clock genes were affected. CONCLUSIONS Moonlight also negatively influenced many genes involved in photosynthesis, chlorophyll biosynthesis and chloroplast machinery at the end of the night, suggesting that the full moon has a negative effect on primary photosynthetic machinery at dawn. Moreover, full moonlight promotes the transcription of major rhythmic redox genes and many heat shock proteins, suggesting that moonlight is perceived as stress. We confirmed this huge impact of weak light (less than 6 lx) on the transcription of circadian clock genes in controlled conditions mimicking full moonlight.
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Affiliation(s)
- J-C Breitler
- CIRAD, UMR IPME, F-34398, Montpellier, France.
- UMR IPME, Univ. Montpellier, CIRAD, IRD, F-34394, Montpellier, France.
- INECOL, Clúster BioMimic, 34394, Xalapa Enríquez, Ver, Mexico.
| | - D Djerrab
- CIRAD, UMR IPME, F-34398, Montpellier, France
- UMR IPME, Univ. Montpellier, CIRAD, IRD, F-34394, Montpellier, France
| | - S Leran
- CIRAD, UMR IPME, F-34398, Montpellier, France
- UMR IPME, Univ. Montpellier, CIRAD, IRD, F-34394, Montpellier, France
| | - L Toniutti
- CIRAD, UMR IPME, F-34398, Montpellier, France
- UMR IPME, Univ. Montpellier, CIRAD, IRD, F-34394, Montpellier, France
| | - C Guittin
- UMR IPME, Univ. Montpellier, CIRAD, IRD, F-34394, Montpellier, France
| | - D Severac
- CNRS, Montpellier GenomiX, c/o Institut de Génomique Fonctionnelle, 141 rue de la Cardonille, Cedex 34, Montpellier, France
| | - M Pratlong
- CNRS, Montpellier GenomiX, c/o Institut de Génomique Fonctionnelle, 141 rue de la Cardonille, Cedex 34, Montpellier, France
| | - A Dereeper
- UMR IPME, Univ. Montpellier, CIRAD, IRD, F-34394, Montpellier, France
| | - H Etienne
- CIRAD, UMR IPME, F-34398, Montpellier, France
- UMR IPME, Univ. Montpellier, CIRAD, IRD, F-34394, Montpellier, France
| | - B Bertrand
- CIRAD, UMR IPME, F-34398, Montpellier, France
- UMR IPME, Univ. Montpellier, CIRAD, IRD, F-34394, Montpellier, France
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Etienne H, Journé C, Dupont S, Louedec L, Delbosc S, Rouchaud A, Coscas R, Michel JB. Comparative Study of Hemodynamics and Pathological Consequences of Saccular Versus Fusiform Experimental Aortic Aneurysms. Eur J Vasc Endovasc Surg 2019. [DOI: 10.1016/j.ejvs.2019.06.634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Coscas R, Dupont S, Mussot S, Louedec L, Etienne H, Massy Z, Jacob MP, Michel JB. Exploring Antibody-Dependent Adaptive Immunity Against Aortic Extracellular Matrix Components in Experimental Aortic Aneurysms. Eur J Vasc Endovasc Surg 2019. [DOI: 10.1016/j.ejvs.2019.06.633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Fournel L, Etienne H, Mansuet Lupo A, Damotte D, Rouquette A, Revel MP, Guinet C, Alifano M, Regnard JF. Correlation between radiological and pathological features of operated ground glass nodules. Eur J Cardiothorac Surg 2019; 51:248-254. [PMID: 28186249 DOI: 10.1093/ejcts/ezw294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 06/13/2016] [Accepted: 07/11/2016] [Indexed: 12/21/2022] Open
Affiliation(s)
- Ludovic Fournel
- Department of Thoracic Surgery, Cochin Hospital of Paris, Assistance Publique des Hôpitaux de Paris, René Descartes University, Paris, France
| | - Harry Etienne
- Department of Thoracic Surgery, Cochin Hospital of Paris, Assistance Publique des Hôpitaux de Paris, René Descartes University, Paris, France
| | - Audrey Mansuet Lupo
- Department of Pathology, Cochin Hospital of Paris, Assistance Publique des Hôpitaux de Paris, René Descartes University, Paris, France
| | - Diane Damotte
- Department of Pathology, Cochin Hospital of Paris, Assistance Publique des Hôpitaux de Paris, René Descartes University, Paris, France
| | - Alexandra Rouquette
- Department of Biostatistics, Hôtel-Dieu Hospital of Paris, Assistance Publique des Hôpitaux Paris, René Descartes University, Paris, France
| | - Marie-Pierre Revel
- Department of Radiology, Cochin Hospital of Paris, Assistance Publique des Hôpitaux de Paris, René Descartes University, Paris, France
| | - Claude Guinet
- Department of Radiology, Cochin Hospital of Paris, Assistance Publique des Hôpitaux de Paris, René Descartes University, Paris, France
| | - Marco Alifano
- Department of Thoracic Surgery, Cochin Hospital of Paris, Assistance Publique des Hôpitaux de Paris, René Descartes University, Paris, France
| | - Jean-François Regnard
- Department of Thoracic Surgery, Cochin Hospital of Paris, Assistance Publique des Hôpitaux de Paris, René Descartes University, Paris, France
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Etienne H, Agrafiotis AC, Masmoudi H, Assouad J. Postero-apical thoracic schwannoma with cervical extension resected by complete video-assisted thoracoscopic surgery. Monaldi Arch Chest Dis 2019; 89. [PMID: 31148605 DOI: 10.4081/monaldi.2019.1073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 05/15/2019] [Indexed: 11/22/2022] Open
Abstract
Schwannomas or neurilemmomas are benign tumors developed from the peripheral nervous system. Complete video-assisted thoracic surgery (cVATS) has set itself over the years as the preferred approach for the removal of small mediastinal neurogenic tumors. However, in case of apical location, complete VATS seems challenging because of proximity with the subclavian artery and/or elements of the brachial plexus. In case of a cVATS procedure, some authors prefer enucleation instead of resection, with a higher risk of relapse. We present two cases of cVATS resection of thoracic apical schwannomas.
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Affiliation(s)
- Harry Etienne
- Department of Thoracic Surgery, Tenon University Hospital, Paris.
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Etienne H, Mercier O, Le Pavec J, Fabre D, Mussot S, Mitilian D, Fadel E. Lobar Lung Transplantation from Brain-dead Donors in Pulmonary Hypertension. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Etienne H, Fabre D, Gomez Caro A, Kolb F, Mussot S, Mercier O, Mitilian D, Stephan F, Fadel E, Dartevelle P. Tracheal replacement. Eur Respir J 2018; 51:51/2/1702211. [DOI: 10.1183/13993003.02211-2017] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 11/29/2017] [Indexed: 11/05/2022]
Abstract
Tracheal reconstruction is one of the greatest challenges in thoracic surgery when direct end-to-end anastomosis is impossible or after this procedure has failed. The main indications for tracheal reconstruction include malignant tumours (squamous cell carcinoma, adenoid cystic carcinoma), tracheoesophageal fistula, trauma, unsuccessful surgical results for benign diseases and congenital stenosis. Tracheal substitutes can be classified into five types: 1) synthetic prosthesis; 2) allografts; 3) tracheal transplantation; 4) tissue engineering; and 5) autologous tissue composite. The ideal tracheal substitute is still unclear, but some techniques have shown promising clinical results. This article reviews the advantages and limitations of each technique used over the past few decades in clinical practice. The main limitation seems to be the capacity for tracheal tissue regeneration. The physiopathology behind this has yet to be fully understood. Research on stem cells sparked much interest and was thought to be a revolutionary technique; however, the poor long-term results of this approach highlight that there is a long way to go in this research field. Currently, an autologous tissue composite, with or without a tracheal allograft, is the only long-term working solution for every aetiology, despite its technical complexity and setbacks.
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Ouede R, Masmoudi H, Etienne H, Assouad J. [Bronchial carcinoid tumor and recurrent pneumothoraxes]. Rev Pneumol Clin 2017; 73:263-266. [PMID: 29031965 DOI: 10.1016/j.pneumo.2017.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 08/01/2017] [Accepted: 08/16/2017] [Indexed: 06/07/2023]
Abstract
Pneumothorax is a rare clinical manifestation of lung cancer. It can exceptionally reveal a bronchial carcinoid tumor. We present the case of a 27-year-old woman in whom recurrent pneumothoraxes were the clinical manifestation of a bronchial carcinoid tumor. The interest for chest computed tomography and bronchoscopy to identify etiology of secondary pneumothoraxes will be discussed.
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Affiliation(s)
- R Ouede
- Service de chirurgie thoracique, hôpital Tenon, 4, rue de Chine, 75020 Paris, France
| | - H Masmoudi
- Service de chirurgie thoracique, hôpital Tenon, 4, rue de Chine, 75020 Paris, France
| | - H Etienne
- Service de chirurgie thoracique, hôpital Tenon, 4, rue de Chine, 75020 Paris, France.
| | - J Assouad
- Service de chirurgie thoracique, hôpital Tenon, 4, rue de Chine, 75020 Paris, France
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Masmoudi H, Etienne H, Sylvestre R, Evrard D, Ouede R, Le Roux M, Giol M, Assouad J. Three Hundred Fifty-One Patients With Pneumothorax Undergoing Uniportal (Single Port) Video-Assisted Thoracic Surgery. Ann Thorac Surg 2017; 104:254-260. [PMID: 28410634 DOI: 10.1016/j.athoracsur.2017.01.054] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 01/01/2017] [Accepted: 01/11/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Video-assisted thoracic surgery (VATS) is usually performed using three ports. Uniportal VATS has not yet been widely developed. We report our single institution experience in uniportal VATS for the surgical management of 351 patients with pneumothorax. METHODS Between November 2009 and February 2016, we conducted a study in 351 patients treated for pneumothorax using uniportal VATS. Resection of apical bullae associated with partial pleurectomy, pleural abrasion, or talc effusion was performed. RESULTS The mean age was 29.6 ± 10.1 years. Surgical indications were mainly persistence or recurrence of pneumothorax. Sixty-seven patients (19%) presented with complications. At the 30-day control, 60.1% of patients were asymptomatic; 85% of patients were satisfied with the single small scar. The recurrence rate was 3.6% at 24 ± 13 months. CONCLUSIONS Uniportal VATS is feasible, safe, and reproducible in the treatment of pneumothorax. Morbidity is similar to multiport VATS. The recurrence rate is comparable with best results after multiport VATS or thoracotomy. Patients were satisfied with the single small scar.
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Affiliation(s)
- Hicham Masmoudi
- Department of Thoracic Surgery, Tenon Hospital, Paris, France.
| | - Harry Etienne
- Department of Thoracic Surgery, Tenon Hospital, Paris, France
| | | | - Diane Evrard
- Department of Thoracic Surgery, Tenon Hospital, Paris, France
| | - Raphaël Ouede
- Department of Thoracic Surgery, Tenon Hospital, Paris, France
| | | | - Mihaela Giol
- Department of Thoracic Surgery, Tenon Hospital, Paris, France
| | - Jalal Assouad
- Department of Thoracic Surgery, Tenon Hospital, Paris, France
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Sénémaud J, Caligiuri G, Etienne H, Delbosc S, Michel JB, Coscas R. Translational Relevance and Recent Advances of Animal Models of Abdominal Aortic Aneurysm. Arterioscler Thromb Vasc Biol 2017; 37:401-410. [DOI: 10.1161/atvbaha.116.308534] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Accepted: 12/21/2016] [Indexed: 01/11/2023]
Abstract
Human abdominal aortic aneurysm (AAA) pathophysiology is not yet completely understood. In conductance arteries, the insoluble extracellular matrix, synthesized by vascular smooth muscle cells, assumes the function of withstanding the intraluminal arterial blood pressure. Progressive loss of this function through extracellular matrix proteolysis is a main feature of AAAs. As most patients are now treated via endovascular approaches, surgical AAA specimens have become rare. Animal models provide valuable complementary insights into AAA pathophysiology. Current experimental AAA models involve induction of intraluminal dilation (nondissecting AAAs) or a contained intramural rupture (dissecting models). Although the ideal model should reproduce the histological characteristics and natural history of the human disease, none of the currently available animal models perfectly do so. Experimental models try to represent the main pathophysiological determinants of AAAs: genetic or acquired defects in extracellular matrix, loss of vascular smooth muscle cells, and innate or adaptive immune response. Nevertheless, most models are characterized by aneurysmal stabilization and healing after a few weeks because of cessation of the initial stimulus. Recent studies have focused on ways to optimize existing models to allow continuous aneurysmal growth. This review aims to discuss the relevance and recent advances of current animal AAA models.
Visual Overview—
An online visual overview is available for this article.
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Affiliation(s)
- Jean Sénémaud
- From the UMR 1148, Inserm-Paris7 - Denis Diderot University, Xavier Bichat Hospital, Paris, France (J.S., G.C., H.E., S.D., J.-B.M., R.C.); UMR 1173, Inserm-Paris11 - Faculty of Health Sciences Simone Veil, Versailles Saint-Quentin-en-Yvelines University, Paris-Saclay University, Montigny-le-Bretonneux, France (R.C.); Department of Vascular Surgery, Ambroise Paré University Hospital, AP-HP, Boulogne-Billancourt, France (R.C.); and UMR 1018, Inserm-Paris11 - CESP, Versailles Saint-Quentin-en-Yvelines
| | - Giuseppina Caligiuri
- From the UMR 1148, Inserm-Paris7 - Denis Diderot University, Xavier Bichat Hospital, Paris, France (J.S., G.C., H.E., S.D., J.-B.M., R.C.); UMR 1173, Inserm-Paris11 - Faculty of Health Sciences Simone Veil, Versailles Saint-Quentin-en-Yvelines University, Paris-Saclay University, Montigny-le-Bretonneux, France (R.C.); Department of Vascular Surgery, Ambroise Paré University Hospital, AP-HP, Boulogne-Billancourt, France (R.C.); and UMR 1018, Inserm-Paris11 - CESP, Versailles Saint-Quentin-en-Yvelines
| | - Harry Etienne
- From the UMR 1148, Inserm-Paris7 - Denis Diderot University, Xavier Bichat Hospital, Paris, France (J.S., G.C., H.E., S.D., J.-B.M., R.C.); UMR 1173, Inserm-Paris11 - Faculty of Health Sciences Simone Veil, Versailles Saint-Quentin-en-Yvelines University, Paris-Saclay University, Montigny-le-Bretonneux, France (R.C.); Department of Vascular Surgery, Ambroise Paré University Hospital, AP-HP, Boulogne-Billancourt, France (R.C.); and UMR 1018, Inserm-Paris11 - CESP, Versailles Saint-Quentin-en-Yvelines
| | - Sandrine Delbosc
- From the UMR 1148, Inserm-Paris7 - Denis Diderot University, Xavier Bichat Hospital, Paris, France (J.S., G.C., H.E., S.D., J.-B.M., R.C.); UMR 1173, Inserm-Paris11 - Faculty of Health Sciences Simone Veil, Versailles Saint-Quentin-en-Yvelines University, Paris-Saclay University, Montigny-le-Bretonneux, France (R.C.); Department of Vascular Surgery, Ambroise Paré University Hospital, AP-HP, Boulogne-Billancourt, France (R.C.); and UMR 1018, Inserm-Paris11 - CESP, Versailles Saint-Quentin-en-Yvelines
| | - Jean-Baptiste Michel
- From the UMR 1148, Inserm-Paris7 - Denis Diderot University, Xavier Bichat Hospital, Paris, France (J.S., G.C., H.E., S.D., J.-B.M., R.C.); UMR 1173, Inserm-Paris11 - Faculty of Health Sciences Simone Veil, Versailles Saint-Quentin-en-Yvelines University, Paris-Saclay University, Montigny-le-Bretonneux, France (R.C.); Department of Vascular Surgery, Ambroise Paré University Hospital, AP-HP, Boulogne-Billancourt, France (R.C.); and UMR 1018, Inserm-Paris11 - CESP, Versailles Saint-Quentin-en-Yvelines
| | - Raphaël Coscas
- From the UMR 1148, Inserm-Paris7 - Denis Diderot University, Xavier Bichat Hospital, Paris, France (J.S., G.C., H.E., S.D., J.-B.M., R.C.); UMR 1173, Inserm-Paris11 - Faculty of Health Sciences Simone Veil, Versailles Saint-Quentin-en-Yvelines University, Paris-Saclay University, Montigny-le-Bretonneux, France (R.C.); Department of Vascular Surgery, Ambroise Paré University Hospital, AP-HP, Boulogne-Billancourt, France (R.C.); and UMR 1018, Inserm-Paris11 - CESP, Versailles Saint-Quentin-en-Yvelines
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Janssens J, Lu D, Ni B, Chadwick W, Siddiqui S, Azmi A, Etienne H, Jushaj A, van Gastel J, Martin B, Maudsley S. Development of Precision Small-Molecule Proneurotrophic Therapies for Neurodegenerative Diseases. Vitam Horm 2016; 104:263-311. [PMID: 28215298 DOI: 10.1016/bs.vh.2016.10.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Age-related neurodegenerative diseases, such as Alzheimer's disease, will represent one of the largest future burdens on worldwide healthcare systems due to the increasing proportion of elderly in our society. As deficiencies in neurotrophins are implicated in the pathogenesis of many age-related neurodegenerative disorders, it is reasonable to consider that global neurotrophin resistance may also become a major healthcare threat. Central nervous system networks are effectively maintained through aging by neuroprotective and neuroplasticity signaling mechanisms which are predominantly controlled by neurotrophin receptor signaling. Neurotrophin receptors are single pass receptor tyrosine kinases that form dimeric structures upon ligand binding to initiate cellular signaling events that control many protective and plasticity-related pathways. Declining functionality of the neurotrophin ligand-receptor system is considered one of the hallmarks of neuropathological aging. Therefore, it is imperative to develop effective therapeutic strategies to contend with this significant issue. While the therapeutic applications of cognate ligands for neurotrophin receptors are limited, the development of nonpeptidergic, small-molecule ligands can overcome these limitations, and productively regulate this important receptor system with beneficial effects. Using our advanced knowledge of the high-dimensionality complexity of receptor systems, the future generation of precision medicines targeting these systems will be an attainable goal.
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Affiliation(s)
- J Janssens
- Translational Neurobiology Group, University of Antwerp, Antwerpen, Belgium
| | - D Lu
- Receptor Pharmacology Unit, National Institute on Aging, National Institutes of Health, Baltimore MD United States
| | - B Ni
- Receptor Pharmacology Unit, National Institute on Aging, National Institutes of Health, Baltimore MD United States
| | - W Chadwick
- Receptor Pharmacology Unit, National Institute on Aging, National Institutes of Health, Baltimore MD United States
| | - S Siddiqui
- Receptor Pharmacology Unit, National Institute on Aging, National Institutes of Health, Baltimore MD United States
| | - A Azmi
- Translational Neurobiology Group, University of Antwerp, Antwerpen, Belgium
| | - H Etienne
- Translational Neurobiology Group, University of Antwerp, Antwerpen, Belgium
| | - A Jushaj
- Translational Neurobiology Group, University of Antwerp, Antwerpen, Belgium
| | - J van Gastel
- Translational Neurobiology Group, University of Antwerp, Antwerpen, Belgium
| | - B Martin
- Metabolism Unit, National Institute on Aging, National Institutes of Health, Baltimore MD United States
| | - S Maudsley
- Translational Neurobiology Group, University of Antwerp, Antwerpen, Belgium; Receptor Pharmacology Unit, National Institute on Aging, National Institutes of Health, Baltimore MD United States.
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Etienne H, Touma J, Becquemin JP. Unusual Acute Onset of Abdominal Aortic Endograft Infection by Propionibacterium acnes after Coil Embolization for Type II Endoleak. Ann Vasc Surg 2016; 35:204.e9-204.e11. [DOI: 10.1016/j.avsg.2016.01.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 01/03/2016] [Accepted: 01/03/2016] [Indexed: 10/21/2022]
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Alpizar E, Dechamp E, Lapeyre-Montes F, Guilhaumon C, Bertrand B, Jourdan C, Lashermes P, Etienne H. Agrobacterium rhizogenes-transformed roots of coffee (Coffea arabica): conditions for long-term proliferation, and morphological and molecular characterization. Ann Bot 2008; 101:929-40. [PMID: 18316320 PMCID: PMC2710235 DOI: 10.1093/aob/mcn027] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2007] [Revised: 01/09/2008] [Accepted: 01/31/2008] [Indexed: 05/21/2023]
Abstract
BACKGROUND AND AIMS The aims of this study were to set up proliferation conditions for hairy roots of Coffea arabica regenerated after transformation by Agrobacterium rhizogenes strain A4-RS, and to carry out the morphological and molecular characterization of hairy root clones maintained over the long term. METHODS Auxin supply, light conditions and sucrose concentration were modified with the aim of establishing efficient root proliferation conditions. The morphological variability among 62 established hairy root clones was phenotyped by scanning the roots and analysing the images using 'whinRHIZO' software procedures. PCR analysis of integration in transformed root cells of rol and aux oncogenes from the T-DNA of the Ri plasmid was used to study the molecular variability among clones. KEY RESULTS Auxin supply was necessary to obtain and stimulate growth and branching, and IBA applied at 0.5 microm was the most efficient auxin. Significant differences were shown among the 62 clones for total root length and for the percentage of fine roots. These variables were stable across subcultures and could hence be used for efficient characterization of hairy root clones. The majority of hairy root clones (86 %) exhibited non-significant phenotype differences with non-transformed roots. Eight clones were significantly different from the non-transformed controls in that they possessed a low proportion of fine roots. Two other hairy root clones grew significantly faster than the other clones. The PCR analysis revealed a low variability in the integration of rol and aux oncogenes in transformed root cells. The T(R)-DNA was never integrated as aux1 and aux2 genes were not found, although rolB and rolC genes from the T(L)-DNA were always present. CONCLUSIONS The discovery of low morphological variability among coffee hairy roots together with the identification of morphological variables allowing easy identification of phenotypically altered clones represent two important results. They make hairy roots a possible, and efficient, tool for functional-genomic studies of coffee root genes.
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Affiliation(s)
- E. Alpizar
- Centre de Coopération Internationale en Recherche Agronomique pour le Développement–Département des Systèmes Biologiques (CIRAD-BIOS). UMR-RPB, 911 Avenue Agropolis, BP 64501, 34394 Montpellier, France
| | - E. Dechamp
- Centre de Coopération Internationale en Recherche Agronomique pour le Développement–Département des Systèmes Biologiques (CIRAD-BIOS). UMR-RPB, 911 Avenue Agropolis, BP 64501, 34394 Montpellier, France
| | - F. Lapeyre-Montes
- CIRAD-BIOS, UMR-DAP, Plateau d'histologie et d'imagerie cellulaire végétale (PHIV), Avenue Agropolis, 34398 Montpellier, Cedex 5, France
| | - C. Guilhaumon
- Centre de Coopération Internationale en Recherche Agronomique pour le Développement–Département des Systèmes Biologiques (CIRAD-BIOS). UMR-RPB, 911 Avenue Agropolis, BP 64501, 34394 Montpellier, France
| | - B. Bertrand
- Centre de Coopération Internationale en Recherche Agronomique pour le Développement–Département des Systèmes Biologiques (CIRAD-BIOS). UMR-RPB, 911 Avenue Agropolis, BP 64501, 34394 Montpellier, France
| | - C. Jourdan
- CIRAD – Tree-Based Planted Ecosystems Unit, TA 80/01, Avenue Agropolis, 34398 Montpellier, Cedex 5, France
| | - P. Lashermes
- Institut de Recherche pour le Développement (IRD). UMR-RPB, IRD, 911 Av. Agropolis, BP 64501, 34394, Montpellier, Cedex 5, France
| | - H. Etienne
- Centre de Coopération Internationale en Recherche Agronomique pour le Développement–Département des Systèmes Biologiques (CIRAD-BIOS). UMR-RPB, 911 Avenue Agropolis, BP 64501, 34394 Montpellier, France
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Bores D, Chapelotte I, Chevalier M, Etienne H, Houmenou K, Jandar N, Jean RM, Ramirez P, Saint-Amaux C, Samathi G, Sebire D, Lorange R. [Nursing care during a total hip prosthesis implantation]. Rev Infirm 2007:28-9. [PMID: 17566503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
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Alpizar E, Dechamp E, Espeout S, Royer M, Lecouls AC, Nicole M, Bertrand B, Lashermes P, Etienne H. Efficient production of Agrobacterium rhizogenes-transformed roots and composite plants for studying gene expression in coffee roots. Plant Cell Rep 2006; 25:959-67. [PMID: 16596429 DOI: 10.1007/s00299-006-0159-9] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2006] [Accepted: 03/16/2006] [Indexed: 05/07/2023]
Abstract
The possibility of rapid validation and functional analysis of nematode resistance genes is a common objective for numerous species and particularly for woody species. In this aim, we developed an Agrobacterium rhizogenes-mediated transformation protocol for Coffea arabica enabling efficient and rapid regeneration of transformed roots from the hypocotyls of germinated zygotic embryos, and the subsequent production of composite plants. The A. rhizogenes strain A4RS proved to be the most virulent. High transformation efficiencies (70%) were obtained using a 2-week co-cultivation period at a temperature of 15-18 degrees C. Using a p35S-gusA-int construct inserted in the pBIN19 binary plasmid, we could estimate that 35% of transformed roots were GUS positive (co-transformed). Using the GUS assay as visual marker, 40% composite plants bearing a branched co-transformed rootstock could be obtained after only 12 weeks without selection with herbicides or antibiotics. Transgenic coffee roots obtained with A. rhizogenes did not exhibit the 'hairy' disturbed phenotype and were morphologically similar to normal roots. PCR analyses demonstrated that all co-transformed roots were positive for the expected rolB and gusA genes. Transformed and non-transformed root systems from both susceptible and resistant varieties were inoculated with Meloidogyne exigua nematode individuals. Inoculation of composite plants from the Caturra susceptible variety resulted in the normal development of nematode larvae. Numbers of extracted nematodes demonstrated that transformed roots retain the resistance/sensibility phenotype of varieties from which they are derived. These results suggest that composite plants constitute a powerful tool for studying nematode resistance genes.
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Affiliation(s)
- E Alpizar
- Centre de Coopération Internationale en Recherche Agronomique pour le Développement, Département des Cultures Pérennes (CIRAD-CP), UMR-DGPC, Résistance des Plantes, Montpellier, France
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Etienne H, Bertrand B. Somaclonal variation in Coffea arabica: effects of genotype and embryogenic cell suspension age on frequency and phenotype of variants. Tree Physiol 2003; 23:419-426. [PMID: 12642244 DOI: 10.1093/treephys/23.6.419] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
We determined how age of embryogenic cell suspensions affects somaclonal variation in five F1 hybrids of Coffea arabica L. Batches of plants were produced either directly from embryogenic callus, or after 3, 6, 9 and 12 months of embryogenic cell suspension culture. Seven phenotypic variants were characterized. Based on vigor and productivity of the regenerated plants, we classified the variants in order of increasing severity of physiological disorders as: Juvenile leaf color, Giant, Dwarf, Thick leaf (Bullata), Variegata, Angustifolia, and Multi-stem. The Dwarf, Angustifolia and Multi-stem variants were the most frequent among the regenerated plants (1.4, 4.8 and 2.9%, respectively). The frequency (f) of variants increased exponentially with the age (t) of the embryogenic suspension, in accordance with the function f = 0.99e(0.267t). For all genotypes, somaclonal variation was low (1.3%) in plants produced from embryogenic callus or 3-month-old cell suspensions and increased in frequency with increasing suspension age (6, 10 and 25% in plants produced from cell suspensions aged 6, 9 and 12 months, respectively). Large differences in somaclonal variation among genotypes were found only in plants produced from 12-month-old cell suspensions. For two genotypes, the oldest suspensions produced a majority of somaclonal variants (80-90%), whereas somaclonal variation ranged between 8 and 18% in the other genotypes. Cell suspension age and genotype also affected the type of variant produced. The severity of somaclonal variations increased with cell suspension age. For all genotypes combined, the Angustifolia variant was the most common. The other somaclonal variations were specific to certain genotypes or distributed randomly among the genotypes.
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Affiliation(s)
- H Etienne
- Laboratorio de Biotecnología, CATIE, Apartado 11, 7170 Turrialba, Costa Rica.
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Kettaneh A, Tourret J, Stimemann J, Fain O, Eclache V, Stefanizzi S, Etienne H, Hubert G, Ingibse M, Dahmouni K, Mouas H, Thomas M. Troubles du goût quantitatifs et qualitatifs : fréquence et facteurs associés en médecine interne. Rev Med Interne 2001. [DOI: 10.1016/s0248-8663(01)80067-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Etienne H, Bertrand B. Trueness-to-type and agronomic characteristics of Coffea arabica trees micropropagated by the embryogenic cell suspension technique. Tree Physiol 2001; 21:1031-8. [PMID: 11560816 DOI: 10.1093/treephys/21.14.1031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Trueness-to-type and agronomic characteristics of trees of four coffee (Coffea arabica L.) F(1) hybrid clones derived from embryogenic cell suspensions were compared with those of trees produced from in vitro microcuttings. Three types of variants were observed among the 644 trees derived from embryogenic suspensions. Total frequency of the variants was 2.1% for trees originating from embryogenic cell suspensions, whereas no variant was found among the trees produced from microcuttings. The variant known as "thick leaf" had thick leaves, many abnormally starry flowers and low yields of large fruit. The "dwarf" variant was characterized by slow growth and small fruit. The "dwarf peaberry" variant had abnormal seeds in a single cavity, in addition to the "thick leaf" and "dwarf" characteristics. Compared with normal trees, the variants differed in leaf density and number of chloroplasts per guard cell. The variants aside, there were no differences in the main agronomic characteristics between trees produced from embryogenic suspensions and those produced from microcuttings. For all four clones, the trees had vegetative characteristics, productivity, fertility, and bean biochemical, mineral and organoleptic characteristics that were identical to those of the controls. We conclude that it is possible to generate coffee trees commercially with normal agronomic performance from embryogenic suspensions, because the frequency with which somaclonal variants occur is limited.
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Affiliation(s)
- H Etienne
- Centre de Coopération Internationale en Recherche Agronomique pour le Développement-Cultures Pérennes (CIRAD-CP), CIRAD, TA 80 / PS3, Boulevard de la Lironde, 34398 Montpellier Cedex 5, France
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Etienne-Barry D, Bertrand B, Vasquez N, Etienne H. Direct sowing of Coffea arabica somatic embryos mass-produced in a bioreactor and regeneration of plants. Plant Cell Rep 1999; 19:111-117. [PMID: 30754735 DOI: 10.1007/s002990050720] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The effect of germination conditions on the morphology of Coffea arabica L. somatic embryos mass-produced in a 1-l temporary immersion bioreactor (RITA®) was studied with emphasis on direct sowing in soil. Using germinated embryos, direct sowing resulted in a highly successful conversion of embryos into plants. A culture density above 1600 embryos per 1-l bioreactor positively affected embryo morphology by causing higher embryonic axis elongation (+4-5 mm). At this density, the addition of a high concentration of sucrose (234 mM) 2 weeks before sowing promoted an increase in effective plant conversion in soil (78%) and a vigorous vegetative growth of the resulting plants. Furthermore, direct sowing reduced handling time to 13% and shelving area requirements to 6.3% of the values obtained by conventional acclimatization of plants developed on gel media.
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Affiliation(s)
- D Etienne-Barry
- Laboratorio de biotecnología, CATIE, 7170 Turrialba, Costa Rica, , , , , , CR
| | - B Bertrand
- CIRAD-CP/PROMECAFE/IICA, Ap. 55, 2200 San José, Costa Rica, , , , , , CR
| | - N Vasquez
- Laboratorio de biotecnología, CATIE, 7170 Turrialba, Costa Rica, , , , , , CR
| | - H Etienne
- CIRAD-CP/PROMECAFE/CATIE, Apartado 11, CATIE 7170 Turrialba, Costa Rica e-mail: Fax: +506-556-09-38, , , , , , CR
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Teisson C, Alvard D, Berthouly B, Côte F, Escalant J, Etienne H, Lartaud M. SIMPLE APPARATUS TO PERFORM PLANT TISSUE CULTURE BY TEMPORARY IMMERSION. ACTA ACUST UNITED AC 1996. [DOI: 10.17660/actahortic.1996.440.91] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Blanc P, Etienne H, Daujat M, Fabre I, Zindy F, Domergue J, Astre C, Saint Aubert B, Michel H, Maurel P. Mitotic responsiveness of cultured adult human hepatocytes to epidermal growth factor, transforming growth factor alpha, and human serum. Gastroenterology 1992; 102:1340-50. [PMID: 1532370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
The present study was undertaken to evaluate the ability of human hepatocytes to respond in culture to various mitotic agents including epidermal growth factor (EGF), transforming growth factor alpha (TGF-alpha), or serum from patients with fulminant hepatitis. Human hepatocytes were maintained in culture on collagen-coated plates in a chemically and hormonally defined serum-free medium at low cell density. Twelve hours after plating, cultures were treated with increasing amounts of EGF (1-100 ng/mL), TGF-alpha (1-100 ng/mL), or human serum (1%-10%) for 0-96 hours. Proliferative response was assessed by determining against time the rate of DNA synthesis by [3H]thymidine incorporation in DNA, the labeling index, the expression of cyclin A, the amount of DNA, and the number of cells. The rate of DNA synthesis reached a maximum after 48 hours of treatment with 20 ng/mL EGF, 40 ng/mL TGF-alpha, or 5%-10% of human serum (fulminant hepatitis); the average increase with respect to untreated cells was 4.35 times with EGF, 5.4 times with TGF-alpha, and 4-6 times with serum from patients with fulminant hepatitis. The maximum expression of cyclin A coincided with the maximum of DNA synthesis. After 72 hours of treatment with EGF or human serum (fulminant hepatitis), the amount of DNA increased by 75%-100% (P less than 0.001) and the number of cells by 50% (P less than 0.001). These results show that adult human hepatocytes respond to mitogens, as expected from previous studies on animal hepatocytes, and provide experimental basis for future investigations in the field of human liver regeneration.
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Affiliation(s)
- P Blanc
- INSERM U-128, CNRS, Montpellier, France
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Blanc P, Etienne H, Daujat M, Fabre I, Pichard L, Domergue J, Joyeux H, Fourtanier G, Maurel P. Antiproliferative effect of FK 506 and cyclosporine on adult human hepatocytes in culture. Transplant Proc 1991; 23:2821-4. [PMID: 1721288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- P Blanc
- INSERM U128, Montpellier, France
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Korenman IM, Etienne H, Eddy CW, Eds F, Samuel BL, Shockey HH, Cattelain E, Chabrier P, Pemberton MH, Nyssens P, Wladimirow LW, Lobanow LN, Scholes SR. Phosphate. Anal Bioanal Chem 1938. [DOI: 10.1007/bf01602303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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