[Contribution of technological aids to the extraction of orbital foreign bodies]

BACKGROUND

Removal of orbital foreign bodies is a surgical challenge. The purpose of this study is to report our experience in the removal of orbital foreign bodies and to evaluate the usefulness of various technological aids in their removal.

MATERIALS AND METHODS

We conducted a single-center retrospective study at Nice University Hospital (France) from January 2017 to December 2023. All patients undergoing surgery for an orbital foreign body during the study period were included. Data recorded included the nature of the orbital foreign body, its size, location, surgical route, outcome (success, partial success, failure), and technological aids used (intraoperative navigation, intraoperative imaging scope, orbital magnet). Concurrently, we designed a dedicated orbital magnet, which was tested in the anatomy laboratory and in two of our patients.

RESULTS

Six patients, all young men, were included during the study period. Removal was successful, partially successful, or unsuccessful in one-third of cases, respectively. Failure was associated with orbital foreign bodies located in the intraconal or posterior orbital space. Preoperatively, the use of a "low-artifact" scanner allowed us to better determine the exact size and shape of the orbital foreign body. Intraoperative navigation was not accurate enough, due to the mobility of the orbital bodies within the orbital fat. In our experience, intraoperative scope imaging was more accurate. The use of a dedicated orbital magnet was successfully tested in the anatomy laboratory and allowed the removal of a small orbital foreign body in one of our patients. Intraoperative surgical videos are provided.

CONCLUSION

Vegetal orbital foreign bodies must be systematically removed. Removal of non-vegetal orbital foreign bodies should be considered on a case-by-case basis based on their size, best assessed using a "low artifact" scanner, their location, and their intrinsic ferromagnetism. Intraoperative navigation does not appear useful, while intraoperative scope imaging does. A dedicated orbital magnet might be helpful in removing ferromagnetic orbital foreign bodies. However, an orbital magnet may be ineffective in removing intraorbital bullets, since they are made primarily of an alloy of copper and lead.

Indoor radon risk mapping of the Canary Islands using a methodology for volcanic islands combining geological information and terrestrial gamma radiation data

Within the framework of the recent approval of the National Plan Against Radon by the Council of Ministers of the Spanish Government, one of its five axes focuses on the delimitation of priority action areas. In line with this objective, this paper presents the indoor radon risk maps of the Canary Islands. Due to the volcanic origin of the Canary Islands, there is a great deal of geological heterogeneity in the soils on which buildings settle, making it very difficult to delimit radon-risk areas in the process of creating maps. Following a methodology developed in previous works for a study area formed of a set of representative municipalities, this paper presents radon risk maps of the Canary Islands based on lithostratigraphic information and high-resolution terrestrial gamma radiation maps. The goodness of fit of these maps is verified based on a statistical analysis of indoor radon concentration measurements carried out at representative building enclosures. In order to analyse the level of risk to the population, these maps were combined with built up areas (urban fabric) maps and estimations of the annual effective doses due to radon was obtained by applying a dosimetric model. This methodology improves the capability to delimit indoor radon risk areas, with a greater margin of safety. In this respect, it is estimated that areas classified as low risk have indoor radon concentrations 41 % below the current reference level of 300 Bq/m3 established by national regulations in compliance with the precepts laid down in the European EURATOM Directive.

Multiparametric analysis for the determination of radon potential areas in buildings on different soils of volcanic origin

The transposition of the European EURATOM directive into the regulations of the different member states of the European Union involved governments making great efforts to define priority action maps against indoor radon exposure in buildings over a short time period. In Spain, the Technical Building Code established 300 Bq/m³ as a reference level and set up a classification of municipalities in which remediation measures should be adopted for radon exposure in buildings. Oceanic volcanic islands, such as the Canary Islands, present high geological heterogeneity in a small space due to their volcanic origin. This variability poses a challenge to the elaboration of radiological risk maps, which makes it necessary to have a high density of data to collect local variations. This paper presents a methodology to obtain accurate radon risk maps based on geological criteria and terrestrial gamma radiation. The predictive efficiency of these maps is statistically verified using indoor radon concentration data measured in buildings. Other radiological variables, which are commonly used as criteria for radon risk prediction found in the literature, were also applied, such as the geogenic radon potential and the activity concentration of natural radioisotopes in soils. The higher resolution of the maps obtained allows for a more detailed classification of radon risk zones in the study area than the current risk maps published in the Spanish building regulations.

Pigmented demodicosis presenting as lentigo maligna diagnosed by reflectance confocal microscopy

The differential diagnosis between benign pigmented macules and lentigo maligna (LM) is clinically challenging. The presence of pigmented circles around hair follicles is an important dermoscopic clue for the diagnosis of LM. Here we report on a woman with a pigmented macule of the face with perifollicular circles for whom the diagnosis of LM was suspected. Instead, reflectance confocal microscopy diagnosed pigmented demodicosis, spared an unnecessary biopsy, and deciphered the mechanisms of hyperpigmentation.

The benefit of adopting Microultrasound in the prostate cancer imaging pathway: A lesion-by-lesion analysis: Biopsies prostatiques guidée par micro-échographie, quel bénéfice ? Une analyse lésion par lésion

INTRODUCTION

- Microultrasound (MicroUS) is a novel imaging modality relying on a high-frequency transducer which confers a three-fold improvement in spatial resolution as compared with conventional transrectal ultrasound. We evaluated the diagnostic value of MRI-MicroUS fusion biopsy and determined the additional benefit of employing MicroUS.

METHODS

- Retrospective analysis of consecutive treatment-naïve men undergoing MRI-MicroUS fusion biopsy between May 2018 and March 2019. Pre-biopsy MRI was systematically reviewed in a dedicated meeting where suspicious lesions PIRADS ≥ 3 were registered and uploaded in the ExactVu MicroUS device. MRI and MicroUS lesions were individually marked in a PIRADS v2 scheme. The biopsy protocol included MRI-MicroUS fusion and MicroUS targeted biopsies; systematic biopsies were performed at clinician's discretion. The diagnostic value was evaluated in terms of detection rate of clinically significant prostate cancer, defined as Gleason pattern ≥ 4 at histology.

RESULTS

- In all, 148 patients with a median age of 69 years (IQR 63-74) and median PSA density of 0.16 ng/ml/cc (0.10-0.23) were included. Clinically significant cancer was detected in 42.5% (63/148) patients. MRI detected 89 lesions in the peripheral zone; 73% (65/89) were visible on MicroUS. Clinically significant cancer was detected in 46.1% (30/65) MRI and MicroUS visible lesions, and in 4.2% (1/24) lesions only visible on mpMRI. MicroUS additionally identified 35 suspicious lesions non-visible on MRI of which clinically significant cancer was present in 25.7% (9/35).

CONCLUSION

- Adding MicroUS to the conventional pathway seems to increase the detection rate of clinically significant disease in unselected men undergoing biopsy. © 2022 Elsevier Masson SAS. All rights reserved.

WITHDRAWN: The benefit of adopting Microultrasound in the prostate cancer imaging pathway : A lesion-by-lesion analysis

INTRODUCTION

Microultrasound (MicroUS) is a novel imaging modality relying on a high-frequency transducer which confers a three-fold improvement in spatial resolution as compared with conventional transrectal ultrasound. We evaluated the diagnostic value of MRI-MicroUS fusion biopsy and determined the additional benefit of employing MicroUS.

METHODS

Retrospective analysis of consecutive treatment-naïve men undergoing MRI-MicroUS fusion biopsy between May 2018 and March 2019. Pre-biopsy MRI was systematically reviewed in a dedicated meeting where suspicious lesions PIRADS≥3 were registered and uploaded in the ExactVu MicroUS device. MRI and MicroUS lesions were individually marked in a PIRADS v2 scheme. The biopsy protocol included MRI-MicroUS fusion and MicroUS targeted biopsies; systematic biopsies were performed at clinician's discretion. The diagnostic value was evaluated in terms of detection rate of clinically significant prostate cancer, defined as Gleason pattern≥4 at histology.

RESULTS

In all, 148 patients with a median age of 69 years (IQR 63-74) and median PSA density of 0.16ng/ml/cc (0.10-0.23) were included. Clinically significant cancer was detected in 42.5% (63/148) patients. MRI detected 89 lesions in the peripheral zone; 73% (65/89) were visible on MicroUS. Clinically significant cancer was detected in 46.1% (30/65) MRI and MicroUS visible lesions, and in 4.2% (1/24) lesions only visible on mpMRI. MicroUS additionally identified 35 suspicious lesions non-visible on MRI of which clinically significant cancer was present in 25.7% (9/35).

CONCLUSION

Adding MicroUS to the conventional pathway seems to increase the detection rate of clinically significant disease in unselected men undergoing biopsy.

Methodology for determination of radon prone areas combining the definition of a representative building enclosure and measurements of terrestrial gamma radiation

The recommendations of the European Atomic Energy Community (EURATOM) have recently been incorporated into Spanish regulations in the Basic Document of Health Standards of the Technical Building Code (CTE), section HS6, on protection against radon exposure. This further accentuates the need to delimit radon prone areas as a strategy to address measures which minimise the effects of this gas on the population. In this research, measurements of terrestrial gamma radiation and indoor radon of dwellings have been carried out in the same location to delimit these risk areas. A new methodology has been developed including a definition of a Representative Building Enclosure (RBE) and it is proposed a Building Storey Index (I_BS) which allows normalizing measurements of indoor radon activity concentration taken in different levels from the ground to the RBE. The results show the need to consider the type of contact that exists between the building and the ground as a determining factor of radon risk. Terrestrial gamma radiation is used as a proxy for radioisotopic composition of soils to characterise the indoor radon risk at different geological formation.

Assessment of radon risk areas in the Eastern Canary Islands using soil radon gas concentration and gas permeability of soils

The Basic Safety Standard (BSS) Directive 2013/59/EURATOM of the European Union (EU) has stated the need for member states to establish national action plans to mitigate their general population's long-term risks of exposure to radon gas. Maps of radon-prone areas provide a useful tool for the development of such plans. This paper presents the maps of radon-prone areas in the Eastern Canary Islands (Gran Canaria, Fuerteventura and Lanzarote) obtained from assessment of Geogenic Radon Potential (GRP) distribution in the territory. GRP constitutes a magnitude that is contingent on both radon activity concentration and gas permeability of soils. An extensive campaign covering all geological formations of the Eastern Canary Islands was undertaken to locally sample these parameters. Geostatistical analysis of the spatial distribution of radon concentration in soils, permeability and GRP was performed on each of the islands, and the relationship between these magnitudes and the characteristic geological formations of the volcanic islands was investigated. Areas dominated by basic volcanic and plutonic rocks (originated by both recent and ancient volcanism) exhibit relatively low levels of radon in soils, and with the exception of specific cases of very high permeability, these areas are not classified as prone to radon risk according to international criteria. Areas in which intermediate or acidic volcanic and plutonic rocks predominate are characterised by greater radon activity concentration in soils, rendering them radon-prone. Given these results, Lanzarote is classified as an island with low radon risk all over its surface; Fuerteventura presents low-medium risk; and Gran Canaria contains extensive areas in the centre and north where the risk is medium or high. This classification is consistent with the risk maps obtained by National and European agencies from indoor radon measurements conducted on these islands.

Natural radioactivity in algae arrivals on the Canary coast and dosimetry assessment

Nowadays, the use of wild and culture harvest seaweed in food industry is a booming productive sector. In this context, a radiological characterization of five globally common seaweed species that were collected in arrival on Gran Canaria coast was carried out. The studied algae species were Cymopolia barbata, Lobophora variegata, Sargassum vulgare, Dictyota dichotoma and Haliptilon virgatum. Radionuclides analysed by alpha and gamma spectrometry were ²³⁸U, ²³⁴U, ²³⁵U, ²¹⁰Po, ²³⁴Th, ²²⁶Ra, ²¹⁰Pb, ²²⁸Th, ²²⁴Ra, ⁴⁰K and ⁷Be. Activity concentrations, ratios, and concentration factors (CF) were determined for all samples collected. The CF in algae was higher for reactive-particle radionuclides (²¹⁰Po, ²³⁴Th, ²²⁸Th and ²¹⁰Pb) than for conservative ones (⁴⁰K and the uranium isotopes). ²¹⁰Po, ²²⁸Th and ²³⁴Th CF were one or two orders of magnitude higher than those recommended by the IAEA. L. variegata, C. barbata and S. vulgare showed a clear preference for ²¹⁰Pb and ²¹⁰Po, for uranium radioisotopes, and for ⁴⁰K and ²³⁴Th, respectively. A dosimetry assessment due to seaweed ingestion showed considerable values of annual committed effective dose for H. virgatum (605 ± 19 μSv/y), L. variegata (574 ± 17 μSv/y) and D. dichotoma (540 ± 30 μSv/y). Hence, this study suggests that an algae radiological characterization is recommended as part of the product valorising process.

Relationship between cervical muscle morphology evaluated by MRI, cervical muscle strength and functional outcomes in patients with degenerative cervical myelopathy

BACKGROUND

Cervical muscle alterations have been reported in patients with chronic neck pain, but the assessment of muscle morphology and strength has been overlooked in patients with degenerative cervical myelopathy (DCM).

OBJECTIVES

This study aimed to investigate the relationship between cervical muscle degenerative changes observed on MRI, muscle strength and symptoms severity in patients diagnosed with DCM.

DESIGN

Observational study.

METHODS

Cervical muscle measurements of total cross-sectional area (CSA), functional CSA (fat free area, FCSA) and ratio of FCSA/CSA (e.g. fatty infiltration) were obtained from T2-weighted axial MR images from C2-C3 to C6-C7 in 20 patients. Muscle strength was assessed manually using a microFET2 dynamometer. The association between cervical muscle morphology parameters, muscle strength, symptoms severity and functional status was investigated.

RESULTS

Greater mean CSA and FCSA was associated with greater overall muscle strength. The mean FCSA explained 37%, 76%, 39%, 20% and 65% of the total variance in flexion, extension, right-side bending, left-side bending and overall muscle strength, respectively. The mean ratio of FCSA/CSA was not significantly associated with cervical muscle strength in any direction. However, greater FCSA/CSA ratio (e.g. less fatty infiltration) was associated with lower disability score (p = 0.02, R² = 0.20).

CONCLUSIONS

Cervical muscle lean muscle mass was positively associated with cervical muscle strength in patients with DCM. Moreover, greater fatty infiltration in the cervical extensor muscles was associated with lower functional score. Such findings suggest that clinicians should pay greater attention to cervical muscle morphology and function in patients with DCM.

Atrophic scar formation in patients with acne involves long-acting immune responses with plasma cells and alteration of sebaceous glands

BACKGROUND

Possible outcomes of acne lesions are atrophic scars, which may cause serious psychological distress. Current treatments for postacne scarring often require invasive procedures. Pathophysiological studies on acne scarring have only investigated the first week of papule life.

OBJECTIVES

To study the pathophysiology of atrophic scar formation to identify molecular and cellular pathways that can lead to new therapies for the prevention of acne scarring.

METHODS

Large-scale gene expression profiling and immunohistochemistry analysis were performed on uninvolved skin and papules in both scar-prone (SP) and non-scar-prone (NSP) patients with acne, at different time points.

RESULTS

Gene expression and immunohistochemistry analyses showed a very similar immune response in 48-h-old papules in SP and NSP populations, characterized by elevated numbers of T cells, neutrophils and macrophages. However, the immune response only persisted in SP patients in 3-week-old papules, and was characterized by an important B-cell infiltrate. Transient downmodulation of sebaceous gland markers related to lipid metabolism was observed in 48-h-old papules in NSP patients, followed by normalization after 3 weeks. In contrast, in SP patients a drastic reduction of these markers persisted in 3-week-old papules, suggesting an irreversible destruction of sebaceous gland structures after inflammatory remodelling in SP patients with acne.

CONCLUSIONS

Long-lived acne papules are characterized by a B-cell infiltrate. A relationship exists between the duration and severity of inflammation and the alteration of sebaceous gland structures, leading to atrophic scar formation in acne.

Lack of significant anti-inflammatory activity with clindamycin in the treatment of rosacea: results of 2 randomized, vehicle-controlled trials

Rosacea is a chronic inflammatory skin disease of the face. The objective of the studies described here was to evaluate the efficacy of clindamycin in the treatment of rosacea. Two multicenter, randomized, vehicle-controlled, phase 2 studies were conducted in participants with moderate to severe rosacea. Study A was a 12-week dose-comparison, 5-arm, parallel group comparison of clindamycin cream 1% or vehicle once or twice daily and clindamycin cream 0.3% once daily. Study B was a 2-arm comparison of twice daily clindamycin gel 1% versus vehicle gel. A total of 629 participants (study A, N=416; study B, N=213) were randomized. The results of these studies indicated that clindamycin cream 0.3% and 1% and clindamycin gel 1% were no more effective than the vehicle in the treatment of moderate to severe rosacea, suggesting clindamycin has no intrinsic anti-inflammatory activity in rosacea.

Influence of atomic kinetics in the simulation of plasma microscopic properties and thermal instabilities for radiative bow shock experiments

Numerical simulations of laboratory astrophysics experiments on plasma flows require plasma microscopic properties that are obtained by means of an atomic kinetic model. This fact implies a careful choice of the most suitable model for the experiment under analysis. Otherwise, the calculations could lead to inaccurate results and inappropriate conclusions. First, a study of the validity of the local thermodynamic equilibrium in the calculation of the average ionization, mean radiative properties, and cooling times of argon plasmas in a range of plasma conditions of interest in laboratory astrophysics experiments on radiative shocks is performed in this work. In the second part, we have made an analysis of the influence of the atomic kinetic model used to calculate plasma microscopic properties of experiments carried out on magpie on radiative bow shocks propagating in argon. The models considered were developed assuming both local and nonlocal thermodynamic equilibrium and, for the latter situation, we have considered in the kinetic model different effects such as external radiation field and plasma mixture. The microscopic properties studied were the average ionization, the charge state distributions, the monochromatic opacities and emissivities, the Planck mean opacity, and the radiative power loss. The microscopic study was made as a postprocess of a radiative-hydrodynamic simulation of the experiment. We have also performed a theoretical analysis of the influence of these atomic kinetic models in the criteria for the onset possibility of thermal instabilities due to radiative cooling in those experiments in which small structures were experimentally observed in the bow shock that could be due to this kind of instability.

Mapping natural radioactivity of soils in the eastern Canary Islands

The Canary Islands archipielago (Spain) comprises seven main volcanic islands and several islets that form a chain extending for around 500 km across the eastern Atlantic, between latitudes 27°N and 30°N, with its eastern edge only 100 km from the NW African coast. The administrative province of Las Palmas comprises the three eastern Canary Islands (Lanzarote, Fuerteventura and Gran Canaria). An extensive study of terrestrial gamma dose rates in surface soils has been carried out to cover the entire territory of the province (4093 km²). The average outdoor gamma dose rate in air at 1 m above ground is 73 nGyh^-1 at Gran Canaria, 32 nGyh^-1 at Fuerteventura, and 25 nGyh^-1 at Lanzarote. To complete the radiological characterization of this volcanic area, 350 soil samples at 0-5 cm depth were collected to cover all the geologic typologies of the islands. These samples were measured using high resolution gamma spectrometry to determine the activity concentrations of ²²⁶Ra, ²³²Th and ⁴⁰K. The average values obtained were 25.2 Bq/kg, 28.9 Bq/kg, and 384.4 Bq/kg, respectively. Maps of terrestrial gamma activity, effective dose, and activity concentrations of ²²⁶Ra, ²³²Th and ⁴⁰K for the region have been developed through the use of geostatistical interpolation techniques. These maps are in accord with the geology of the islands.

A simple methodology for characterization of germanium coaxial detectors by using Monte Carlo simulation and evolutionary algorithms

The determination in a sample of the activity concentration of a specific radionuclide by gamma spectrometry needs to know the full energy peak efficiency (FEPE) for the energy of interest. The difficulties related to the experimental calibration make it advisable to have alternative methods for FEPE determination, such as the simulation of the transport of photons in the crystal by the Monte Carlo method, which requires an accurate knowledge of the characteristics and geometry of the detector. The characterization process is mainly carried out by Canberra Industries Inc. using proprietary techniques and methodologies developed by that company. It is a costly procedure (due to shipping and to the cost of the process itself) and for some research laboratories an alternative in situ procedure can be very useful. The main goal of this paper is to find an alternative to this costly characterization process, by establishing a method for optimizing the parameters of characterizing the detector, through a computational procedure which could be reproduced at a standard research lab. This method consists in the determination of the detector geometric parameters by using Monte Carlo simulation in parallel with an optimization process, based on evolutionary algorithms, starting from a set of reference FEPEs determined experimentally or computationally. The proposed method has proven to be effective and simple to implement. It provides a set of characterization parameters which it has been successfully validated for different source-detector geometries, and also for a wide range of environmental samples and certified materials.

Microscopic properties of xenon plasmas for density and temperature regimes of laboratory astrophysics experiments on radiative shocks

This work is divided into two parts. In the first one, a study of radiative properties (such as monochromatic and the Rosseland and Planck mean opacities, monochromatic emissivities, and radiative power loss) and of the average ionization and charge state distribution of xenon plasmas in a range of plasma conditions of interest in laboratory astrophysics and extreme ultraviolet lithography is performed. We have made a particular emphasis in the analysis of the validity of the assumption of local thermodynamic equilibrium and the influence of the atomic description in the calculation of the radiative properties. Using the results obtained in this study, in the second part of the work we have analyzed a radiative shock that propagated in xenon generated in an experiment carried out at the Prague Asterix Laser System. In particular, we have addressed the effect of plasma self-absorption in the radiative precursor, the influence of the radiation emitted from the shocked shell and the plasma self-emission in the radiative precursor, the cooling time in the cooling layer, and the possibility of thermal instabilities in the postshock region.

Measurement of the transverse target and beam-target asymmetries in η meson photoproduction at MAMI

We present new data for the transverse target asymmetry T and the very first data for the beam-target asymmetry F in the γ[over →]p[over →]→ηp reaction up to a center-of-mass energy of W=1.9  GeV. The data were obtained with the Crystal-Ball/TAPS detector setup at the Glasgow tagged photon facility of the Mainz Microtron MAMI. All existing model predictions fail to reproduce the new data indicating a significant impact on our understanding of the underlying dynamics of η meson photoproduction. The peculiar nodal structure observed in existing T data close to threshold is not confirmed.

Natural radioactivity measurements of beach sands in Gran Canaria, Canary Islands (Spain)

Concentrations of natural radionuclides (226)Ra, (232)Th, (40)K and man-made (137)Cs in most important tourist Gran Canaria beaches have been determined using a high-purity Germanium detector to analyse their radiological hazard. Average values of the activity concentrations of (226)Ra, (232)Th and (40)K were 17.6±1.4, 21.3±1.8 and 480±22 Bq kg(-1), respectively. Observed activity concentration values of (137)Cs were practically negligible from a radiological protection point of view. The results of this paper were compared with others published in the bibliography for beaches and coastal sediments of different countries. The mean external air absorbed dose rate was 43.9±2.8 nGyh(-1), which resulted in an outdoor annual effective dose below the world average. Also, the radium equivalent and the external hazard index were calculated. Results from Gran Canaria beaches showed the low levels of radioactivity, indicating no significant radiological risk related to human activities in the area.

New Measurement of the π0 radiative decay width

High precision measurements of the differential cross sections for π0 photoproduction at forward angles for two nuclei, 12C and 208Pb, have been performed for incident photon energies of 4.9-5.5 GeV to extract the π0→γγ decay width. The experiment was done at Jefferson Lab using the Hall B photon tagger and a high-resolution multichannel calorimeter. The π0→γγ decay width was extracted by fitting the measured cross sections using recently updated theoretical models for the process. The resulting value for the decay width is Γ(π0→γγ)=7.82±0.14(stat)±0.17(syst)  eV. With the 2.8% total uncertainty, this result is a factor of 2.5 more precise than the current Particle Data Group average of this fundamental quantity, and it is consistent with current theoretical predictions.

Feasibility of Sentinel Lymph Node Biopsy in Multiple Unilateral Synchronous Breast Cancer: Results of a French Prospective Multi-Institutional Study (IGASSU 0502)

Introduction: Controversy remains over whether to perform sentinel lymph node biopsy (SLNB) in multiple (multicentric or multifocal) unilateral synchronous breast cancer. Several small retro- or prospective studies, included pre- or post-operative (or both) multiple synchronous tumours (MST) have suggested that the test performance of SLNB is similar to that seen in unifocal disease. The purpose of this study was to evaluate the feasibility and accuracy of SLNB in preoperatively diagnosed invasive MST.Patients and Methods: The Interest of Axillary SLNB in Multiple Invasive Breast Cancer (IGASSU) study was a prospective multi-institutional study with initial breast surgery, SLNB, and systematic level I to II axillary lymph node dissection (ALND). Patients eligible for the IGASSU study had an operable invasive MST, defined as two or more physically separate invasive tumours in the same or different breast quadrant. The diagnosis of invasive MST was confirmed histologically in all patients by core needle biopsy before surgery. Detection of sentinel node was performed by using either blue patent or radiocolloide injection or both. Injection sites were subareolar.Statistical Analysis: Sensitivity (Se), negative predictive value (NPV), accuracy (A), false negative rate (FNR) and their 95%-confidence intervals (95%CI) were calculated with a classical 2x2 contingency table. A univariate analysis using odds ratio calculation was performed to identify the risk factors for false negative results.Results: Between March 1, 2006, and August 31, 2007, 216 patients were prospectively included from 16 institutions. Of these patients, 211 were evaluable. The SLNB identified rate were 93.4% (197/211). A mean number of 2.2 SLN (range, 1 to 8, ± 1.4) was successfully excised. The mean number of resected nodes in ALND was 12 (range, 1 to 39, ± 5.7). The FNR was 13.6% (14/103) [95%CI: 7- 20%], Se was 86 .4% (89/103) [95%CI: 79- 93%], NPV was 87% (94/108) [95%CI: 80-93%], A was 92.9% (183/197) [95%CI: 89- 96%]. For the 14 false-negative SN, all had ≤ 3 involved nodes in ALND. Table 1 shows patterns of management of the axilla.Table 1 ALND+ALND-Non-identified SLNB113Identified SLNB+4544Identified SLNB-1494 In a univariate analysis, tumour location (only external location vs other location) was the only clinico-pathological factor influencing the FNR (22% [11-33%] vs 7% [4-10%]), even then median aggregate histological tumour size was smaller in external tumours (17mm [range, 12-80] vs 34mm [range, 8- 90], p=0.016).Conclusion: With a FNR of 13.6% (95%CI: 7-20%), we do not recommend SLNB as a routine procedure for multiple unilateral synchronous breast cancer, even for small tumour foci.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 305.

Modeling of population kinetics of plasmas that are not in local thermodynamic equilibrium, using a versatile collisional-radiative model based on analytical rates

We discuss the modeling of population kinetics of nonequilibrium steady-state plasmas using a collisional-radiative model and code based on analytical rates (ABAKO). ABAKO can be applied to low-to-high Z ions for a wide range of laboratory plasma conditions: coronal, local thermodynamic equilibrium or nonlocal thermodynamic equilibrium, and optically thin or thick plasmas. ABAKO combines a set of analytical approximations to atomic rates, which yield substantial savings in computer running time, still comparing well with more elaborate codes and experimental data. A simple approximation to calculate the electron capture cross section in terms of the collisional excitation cross section has been adapted to work in a detailed-configuration-accounting approach, thus allowing autoionizing states to be explicitly included in the kinetics in a fast and efficient way. Radiation transport effects in the atomic kinetics due to line trapping in the plasma are taken into account via geometry-dependent escape factors. Since the kinetics problem often involves very large sparse matrices, an iterative method is used to perform the matrix inversion. In order to illustrate the capabilities of the model, we present a number of results which show that the ABAKO compares well with customized models and simulations of ion population distribution. The utility of ABAKO for plasma spectroscopic applications is also outlined.

Presynaptic action of neurotensin on dopamine release through inhibition of D(2) receptor function

Background

Neurotensin (NT) is known to act on dopamine (DA) neurons at the somatodendritic level to regulate cell firing and secondarily enhance DA release. In addition, anatomical and indirect physiological data suggest the presence of NT receptors at the terminal level. However, a clear demonstration of the mechanism of action of NT on dopaminergic axon terminals is lacking. We hypothesize that NT acts to increase DA release by inhibiting the function of terminal D2 autoreceptors. To test this hypothesis, we used fast-scan cyclic voltammetry (FCV) to monitor in real time the axonal release of DA in the nucleus accumbens (NAcc).

Results

DA release was evoked by single electrical pulses and pulse trains (10 Hz, 30 pulses). Under these two stimulation conditions, we evaluated the characteristics of DA D₂ autoreceptors and the presynaptic action of NT in the NAcc shell and shell/core border region. The selective agonist of D₂ autoreceptors, quinpirole (1 μM), inhibited DA overflow evoked by both single and train pulses. In sharp contrast, the selective D₂ receptor antagonist, sulpiride (5 μM), strongly enhanced DA release triggered by pulse trains, without any effect on DA release elicited by single pulses, thus confirming previous observations. We then determined the effect of NT (8–13) (100 nM) and found that although it failed to increase DA release evoked by single pulses, it strongly enhanced DA release evoked by pulse trains that lead to prolonged DA release and engage D₂ autoreceptors. In addition, initial blockade of D₂ autoreceptors by sulpiride considerably inhibited further facilitation of DA release generated by NT (8–13).

Conclusion

Taken together, these data suggest that NT enhances DA release principally by inhibiting the function of terminal D₂ autoreceptors and not by more direct mechanisms such as facilitation of terminal calcium influx.

A nomogram predictive of non-sentinel lymph node involvement in breast cancer patients with a sentinel lymph node micrometastasis

PURPOSE

Predictive factors of non-sentinel lymph node (NSN) involvement at axillary lymph node dissection (ALND) have been studied in the case of sentinel node (SN) involvement, with validation of a nomogram. This nomogram is not accurate for SN micrometastasis. The purpose of our study was to determine a nomogram for predicting the likelihood of NSN involvement in breast cancer patients with a SN micrometastasis.

METHODS

We collated 909 observations of SN micrometastases with additional ALND. Characteristics of the patients, tumours and SN were analysed.

RESULTS

Involvement of SN was diagnosed 490 times (53.9%) with standard staining (HES) and 419 times solely on immunohistochemical analysis (IHC) (46.1%). NSN invasion was observed in 114 patients (12.5%), whereas 62.3% (71) had only one NSN involved and 37.7% (43) two or more NSN involved. In multivariate analysis, significant predictive factors were: tumour size (pT stage < or = 10 mm or >11 and < or = 20 or >20 mm [odds ratio (OR) 2.1 and 3.43], micrometastases detected by HES or IHC [OR 1.64], presence or absence of lymphovascular invasion (LVI) [OR 1.76], tumour histological type mixed or not [OR 2.64]. The rate and probability of NSN involvement with the model are given for 24 groups, with a representation by a nomogram.

CONCLUSION

One group, corresponding to 10.1% of the patients, was associated with a risk of NSN involvement of less than 5%, and five groups, corresponding to 29.8% of the patients, were associated with a risk < or = 10%. Omission of ALND could be proposed with minimal risk for a low probability of NSN involvement.

Case volume and mortality in haematological patients with acute respiratory failure

High case volume is associated with improved survival in medical and surgical conditions. The present study sought to determine whether intensive care unit (ICU) case volume was associated with survival of critically ill patients with haematological malignancies and acute respiratory failure (ARF). A regional database containing data from 1,753 haematological patients with ARF admitted to 28 medical ICUs from 1997 to 2004 was used. Multivariate analysis using mixed models was performed to adjust for severity of illness and other confounding factors, including a propensity score that incorporates differences between ICUs with different case volumes. The three case volume tertiles were: low volume (<12 admissions per year), intermediate volume (12-30 admissions per year), and high volume (>30 admissions per year). In univariate analyses, ICU case volume was not associated with ICU mortality. After adjusting for prognostic factors for ICU mortality and the propensity score, patients in high-volume ICUs had lower mortality than other patients. A case volume increase of one admission per year led to a significant mortality reduction with an odds ratio of 0.98 (95% confidence limits 0.97-0.99). Mortality was independently associated with severity of organ dysfunction. In intensive care units admitting larger numbers of critically ill haematological patients with acute respiratory failure, mortality was lower than in other intensive care units. The mechanisms of the relationship between volume and outcome among haematological patients with acute respiratory deserve additional studies.

Dressings for acute and chronic wounds: a systematic review

OBJECTIVE

To critically review the literature on the efficacy of modern dressings in healing chronic and acute wounds by secondary intention.

DATA SOURCES

Search of 3 databases (MEDLINE, EMBASE, and the Cochrane Controlled Clinical Trials Register) from January 1990 to June 2006, completed by manual research, for articles in English and in French.

STUDY SELECTION

The end points for selecting studies were the rate of complete healing, time to complete healing, rate of change in wound area, and general performance criteria (eg, pain, ease of use, avoidance of wound trauma on dressing removal, ability to absorb and contain exudates). Studies were selected by a single reviewer. Overall, 99 studies met the selection criteria (89 randomized controlled trials [RCTs], 3 meta-analyses [1 of which came from 1 of the selected systematic reviews], 7 systematic reviews, and 1 cost-effectiveness study).

DATA EXTRACTION

The RCTs, meta-analyses, and cost-effectiveness studies were critically appraised by 2 reviewers to assess the clinical evidence level according to a modification of Sackett's 1989 criteria. Ninety-three articles were finally graded.

DATA SYNTHESIS

We found no level A studies, 14 level B studies (11 RCTs and 3 meta-analyses), and 79 level C studies. Hydrocolloid dressings proved superior to saline gauze or paraffin gauze dressings for the complete healing of chronic wounds, and alginates were better than other modern dressings for debriding necrotic wounds. Hydrofiber and foam dressings, when compared with other traditional dressings or a silver-coated dressing, respectively, reduced time to healing of acute wounds.

CONCLUSIONS

Our systematic review provided only weak levels of evidence on the clinical efficacy of modern dressings compared with saline or paraffin gauze in terms of healing, with the exception of hydrocolloids. There was no evidence that any of the modern dressings was better than another, or better than saline or paraffin gauze, in terms of general performance criteria. More wound care research providing level A evidence is needed.

Consensus panel recommendations for chronic and acute wound dressings

OBJECTIVE

To seek a consensus on recommendations that would help health professionals choose appropriate wound dressings in daily practice, since a systematic review found only limited evidence to support reported indications for modern wound dressings.

PARTICIPANTS

A steering committee selected a panel of 27 experts with no declared conflicts of interest from lists of nursing staff and physicians (specialists or general practitioners) with long-standing experience of wound care. The lists were put forward by 15 French learned societies.

EVIDENCE

The panelists received a recent systematic review of the literature, a classification of indications established by a working group, and definitions for the dressings.

CONSENSUS PROCESS

The steering committee designed questionnaires on chronic wounds and on acute wounds including burns for each of the 2 panels. The consensus method was derived from the nominal group technique adapted by RAND/UCLA. Panelists rated the relevance of each possible dressing-indication combination on the basis of the published evidence and their own experience. After the first round of rating, they met to discuss results and propose recommendations before taking part in a second round of rating. The working group peer reviewed the final recommendations.

CONCLUSIONS

A strong consensus was reached for use of the following combinations: for chronic wounds, (1) debridement stage, hydrogels; (2) granulation stage, foam and low-adherence dressings; and (3) epithelialization stage, hydrocolloid and low-adherence dressings; and for the epithelialization stage of acute wounds, low-adherence dressings. For specific situations, the following dressings were favored: for fragile skin, low-adherence dressings; for hemorrhagic wounds, alginates; and for malodorous wounds, activated charcoal.

Guidelines for doctors attending detainees in police custody: a consensus conference in France

Medical practice in police custody needs to be harmonized. A consensus conference was held on 2-3 December 2004 in Paris, France. The health, integrity, and dignity of detainees must be safeguarded. The examination should take place in the police station so that the doctor can assess the conditions in which the detainee is being held. If the minimum conditions needed for a medical examination are not available, the doctor may refuse to express an opinion as to whether the detainee is fit to be held in custody or may ask for the detainee to be examined in a hospital. Doctors are subject to a duty of care and prevention. They should prescribe any ongoing treatment that needs to be continued, as well as any emergency treatment required. Custody officers may monitor the detainee and administer medication. However, their role should not be expected to exceed that required of the detainee's family under normal circumstances and must be specified in writing on the medical certificate. Doctor's opinion should be given in a national standard document. If the doctors consider that the custody conditions are disgraceful, they may refuse to express an opinion as to whether the detainee is fit for custody.

[Laparoscopy-assisted vaginal pelvic exenteration]

OBJECTIVE

The aim of the study was to evaluate the feasibility, morbidity and survival outcome of laparoscopy-assisted vaginal pelvic exenteration.

PATIENTS AND METHODS

Since 2000, 7 en-bloc pelvic exenteration combining a vaginal or perineal approach and laparoscopic approach have been performed in our cancer center associated with complex laparoscopic reconstruction. All patients but one received previous irradiation. Two patients underwent a total pelvic exenteration; three patients an anterior and middle exenteration; two patients a middle and posterior exenteration. Urinary system was reconstructed with an ileal loop in one case, with a hand-assisted laparoscopic Miami pouch in four cases. Reconstruction of the vagina was performed with an omental cylinder in three cases, with a gluteal thigh flap in one case. A colorectal anastomosis was performed in three patients, one patient had an end colostomy. A mini-laparotomy conversion was necessary in one case because of a pelvic side involvement to perform an intraoperative irradiation.

RESULTS

Mean time of the procedure was 6.5 hours with peroperative bleeding less than 500 cm3. Four patients presented minor complications. No revision of the Miami pouch was necessary. Mean length of hospital stay was 27 days. The four patients with a Miami pouch were able to self catheterize at the time of discharge. Mean follow-up was 14 months. Four patients died of the disease (three were metastatic). One patient presented a local recurrence. Two patients are free of disease.

DISCUSSION AND CONCLUSION

Laparoscopic or laparoscopy-assisted vaginal pelvic exenteration followed by reconstruction is feasible with curative intent in selected patients.

[Transient ischemic stroke]

According to the new definition proposed by the TIA working group, transient ischemic stroke (TIA) is "a brief episode of neurologic dysfunction caused by focal brain or retinal ischemia, with clinical symptoms typically lasting less than one hour, and without evidence of acute infarction." Patient presenting with a TIA should be investigated and treated urgently because the risk of ischemic stroke is about 10% at one month with 50% of these events occurring during the first 48 hours. Atherosclerosis, cardioembolism and small vessel disease account for the majority of TA. Aspirin should be started as soon as possible after brain imaging has been performed. Other treatment such as oral anticoagulants or carotide surgery may be necessary, depending on the result of the electronical work up.

Membranous nephropathy and cancer: Epidemiologic evidence and determinants of high-risk cancer association

The association between membranous nephropathy (MN) and cancer is often mentioned in textbooks but poorly substantiated, and the characteristics of cancer-associated MN are unknown. To address these questions, we studied a cohort of 240 patients with MN, among them 24 had malignancy at the time of renal biopsy or within a year thereafter. The incidence of cancer was significantly higher in these patients than in the general population (standardized incidence ratio 9.8 [5.5-16.2] for men and 12.3 [4.5-26.9] for women). The frequency of malignancy increased with age. At the time of diagnosis, clinical presentation did not differ between the patients with cancer-associated MN and those with idiopathic MN, but smoking was more frequent among patients with cancer. Analysis of renal biopsies revealed that the number of inflammatory cells infiltrating the glomeruli was significantly higher in patients with cancer-associated MN (P = 0.001). The best cutoff value for distinguishing malignancy-related cases from controls was eight cells per glomerulus. Using this threshold led to a diagnosis of cancer-associated MN with a specificity of 75% and a sensitivity of 92%. In patients with cancer-associated MN, there was a strong relationship between reduction of proteinuria and clinical remission of cancer (P < 0.001). In conclusion, our study provides epidemiologic evidence of an excess of cancer risk in patients with MN. It also shows that age, smoking, and the presence of glomerular leukocytic infiltrates strongly increase the likelihood of malignancy in MN patients.

[Laparoscopic surgery in gynaecological tumors]

The use of laparoscopic staging and/or surgery in the field of gynaecological oncology was pioneered in the late 80's and the first reports were published in the early 90's. The issue has been initially most controversial, and is still debated, with some justification considering the possible adverse consequences of surgical mismanagement of gynaecologic malignancy. Since then, a number of papers have confirmed the absence of significant adverse effects on survival after laparoscopic diagnosis or surgery in gynaecological cancers. New developments cover virtually all the basic techniques in cancer surgery, including major exenterative surgery. The use of extraperitoneal technique for aortic dissections is emerging as a new tool. New indications, such as radical vaginal trachelectomy (Dargent operation), radical parametrectomy, pelvic sentinel node identification, decisional laparoscopy in adnexal malignancies, or the use of pretherapeutic surgical staging of uterine cancers, have been developed in direct relation with the use of laparoscopic techniques. Worldwide interest clearly demonstrates that laparoscopic techniques must now be part of the armamentarium of the gynaecologic oncologist. Postoperative morbidity and recurrence risk do not seem to be affected. Cost-efficiency of laparoscopic procedures is based on the reduction of hospital stay and recovery time, particularly in obese patients. Combined training in gynaecologic oncology and in laparoscopic and/or vaginal surgery is more than ever mandatory to reduce the operating time, which is becoming similar to laparotomy in experiences hands, and avoid the risk of inadequate staging or management of pelvic malignancies.

Clinical practice guidelines: medical follow-up of patients with asthma--adults and adolescents

The follow-up of patients with asthma should focus on asthma control (disease course over a number of weeks).