Factors associated with pathological tumor stage and T3a upstage in clinical T1-2 renal cell carcinoma

INTRODUCTION

Considering the oncological outcomes, understanding the preoperative factors associated with and predicting advanced stage and T3a upstage will help in risk assessment and selection of the right treatment.

MATERIAL AND METHOD

Patients with postoperative pathology of Renal Cell Carcinoma (RCC) and stage T1-2 N0M0 were included in the study. Demographic and pathological characteristics of the patients, Neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and De Ritis- the ratio of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were recorded. Patients were classified according to T stage (T1-2 vs T3-4) and T3a upstage (T3a upstaged vs non-T3a upstaged).

RESULTS

A total of 289 patients participated in the study when inclusion and exclusion criteria were applied. No difference was found between the groups in terms of age, gender, body mass index, laterality, ABO blood group, Rh positivity and comorbidities. According to multivariate analysis, PLR, AST/ALT, Fuhrman grade, open radical nephrectomy (RN) and Clear Cell pathological subtype were found to be significant-independent factors in predicting advanced stage (T3-4) and T3a upstage (P<0.05).

CONCLUSION

It was found that higher PLR and AST/ALT ratios were associated with more advanced stage and postoperative T3a upstage in RCC patients. In addition, these patients more frequently had open RN and had higher Fuhrman grades, while the clear cell subtype was less common.

Treatment of advanced trigger finger by ulnar superficialis slip resection: Long-term outcome and predictive factors for poor prognosis

The aim of this study was to evaluate the outcome of ulnar superficialis slip resection and to determine predictive factors for poor prognosis in patients with advanced trigger finger. Over a 5-year-period, 55 patients (58 fingers) were included. After surgery, two groups were identified: group 1, with complete extension or <10° extension deficit in the proximal interphalangeal (PIP) joint (n = 27 fingers/27 patients); and group 2, with ≥10° residual PIP extension deficit (n = 31 fingers/28 patients). Factors associated with PIP extension deficit were assessed on logistic regression. There was a median extension gain of 20° (range, 10-30°) after surgery. The difference between pre- and post-operative extension deficits was significant (p < 0.001). There was no significant inter-group difference in DASH score (p > 0.9). Two predictive factors were found: >12 months' preoperative symptom duration (OR = 1.02; p = 0.045), and lack of self-rehabilitation (OR = 20; p < 0.001). Ulnar superficialis slip resection was effective in advanced trigger finger. Hand surgeons should operate early on these patients, and encourage self-rehabilitation. LEVEL OF EVIDENCE: 4.

[Suicidal behaviors in bipolar disorder type 1]

OBJECTIVES

Bipolar disorder is one of the most common and severe psychiatric conditions. It is frequently complicated by suicidal behaviors, and patients with BD are among those at higher risk of suicide. The aims of our study were to evaluate the predictive factors of suicidal behaviors in patients with BD type 1, through the assessment of their socio-demographic, clinical and evolutionary characteristics as well as to study the implications of the childhood traumas and impulsivity as predictive factors for suicidal behaviors in these patients with bipolar disorder.

METHODS

One hundred patients with bipolar disorder type 1were recruited in order to conduct a cross-sectional, analytical and comparative study. The recruitment involved a first group made up of 40 patients suffering from type 1 bipolar disorder with a history of suicidal acts. This group was compared with a second group made up of 60 patients with no history of attempted suicide. We used a pre-established collection sheet for collecting socio-demographic, clinical and therapeutic data. We also used the Childhood Trauma Questionnaire for the assessment of childhood adversities, the Barratt Impulsivity Scale in its eleventh version for the assessment of impulsivity levels and the Global Assessment of Functioning Scale for the evaluation of overall functioning.

RESULTS

The suicidal behaviors in patients with bipolar disorder were significantly associated with: female gender (P<0.001), professional instability (P=0.002), family history of BD (P=0.02), family history of other psychiatric disorders (P=0.003), frequency of depressive episodes (P=0.002), shorter remission (P=0.025), more subsyndromal symptoms (P=0.029), sexual abuse dimension (P=0.009), and a high level of impulsivity (P<0.001). The predictive factors for suicidal behaviors in multivariate analysis, after adjusting for the confounding variables were: childhood sexual abuse (P=0.01; adjusted OR 4.5; 95% CI 1.44-14.2), a high level of impulsivity (P=0.002; adjusted OR 6.6; 95% CI 2-20), a higher rate of depressive episodes (P=0.003; adjusted OR 5; 95% CI 1.69-14.2) and more subyndromal symptoms (P=0.007; adjusted OR 5.8; 95% CI 1.63-20).

CONCLUSIONS

Suicide prevention is an important mental health subject. It would be imperative to include systematic screening for childhood adversities and adequate management of bipolar disorder and impulsivity.

Time to removal of sutures from the palmar surface of the hand in dark-skinned patients: Results in a prospective cohort of 146 hands

The objective of this study was to estimate the time to removal of a suture from the palmar surface of a dark-skinned adult hand. A descriptive and analytical study included a cohort of 146 patients, 57% male, with a mean age of 37 ± 14 years, covering a period of 10 years. The mean time to removal of sutures on the palmar surface of the dark-skinned adult hands was 21 ± 2 days. Complete epithelialization of the suture path was the clinical indication for the ideal day for removal. After removal, closure was total in 90% of cases (132 hands) and partial in 9% (14 hands). The day of suture removal was significantly (p = 0.006) related to wound healing (complete closure). Eighty-five percent of patients without complete wound closure at suture removal had history of use of skin-lightening products. Tobacco use significantly lengthened time to suture removal (p < 0.001). There was a correlation between patient age and time to suture removal. On multivariate analysis, three factors were predictive of suture removal later than day 21: being a manual worker (44% of patients) (p 0.006), suture location in a palmar fold area (<0.001) and the age of patient, the 41-50 years (p = 0.001) and >50 years (p < 0.001).

[Patients treated with palbociclib and endocrine therapy for metastatic breast cancer: Can we predict the occurrence of severe early hematological toxicity?]

INTRODUCTION

The addition of palbociclib to endocrine therapy has been shown to improve progression free survival in hormone receptor positive metastatic breast cancer patients. This cyclin CDK4/6 inhibitor could expose patients to a grade 3-4 hematological toxicity, leading to treatment discontinuation or treatment interruption that is potentially associated with a lack of efficiency. The aim of this study was to identify predictive factors of severe early hematotoxicity (ESHT).

METHODS

This retrospective cohort study included patients who started palbociclib in the Institut Sainte Catherine between December 1, 2016 and January 1, 2019 for the treatment of metastatic breast cancer. Individual data and hematological toxicity were collected from electronic medical records. ESHT was defined as the occurrence, during the first 3 cycles, of grade 4 or grade 3 hematological toxicity requiring palbociclib dose reduction.

RESULTS

In total, 181 patients (180 females) were included; median age was 67 years. Forty-six patients (25.4%) experienced an ESHT. Predictive factors of ESHT in multivariate analysis were a performance status (PS) of 2 or more (P=0.024) and an history of radiotherapy of bone metastasis in the previous year (P=0.003). Before palbociclib initiation, a neutrophil count below 3.37g/L was predictive of ESHT with a sensibility of 76% and a specificity of 71%.

CONCLUSIONS

ECOG PS, bone radiotherapy within the year and low baseline neutrophils count are associated with ESHT in palbociclib-treated metastatic breast cancer patients. These elements could be useful for a careful monitoring leading to adapted therapy.

[Predictive factors for mandibular osteoradionecrosis after irradiation of head and neck cancers]

The identification of the different risk factors for mandibular osteoradionecrosis (ORN) must be done before and after the management of patients with head and neck cancer. Various clinical criteria for this severe radiation-induced complication are related to the patient (intrinsic radiosensitivity, malnutrition associated with thin weight loss, active smoking intoxication, microcapillary involvement, precarious oral status, hyposalivation) and/or related to the disease (oral cavity, large tumor size, tumor mandibular invasion). Therapeutic risk factors are also associated with a higher risk of ORN (primary tumor surgery, concomitant radio-chemotherapy, post-irradiation dental avulsion, preventive non-observance with the absence of stomatological follow-up and daily installation of gutters fluoride and, non-observance curative healing treatments). Finally, various dosimetric studies have specified the parameters in order to target the dose values distributed in the mandible, which increases the risk of ORN. An mean mandibular dose greater than 48-54Gy and high percentages of mandibular volume receiving 40 to 60Gy appear to be discriminating in the risk of developing an ORN.

Application of a multi-institutional nomogram predicting salvage whole brain radiation-free survival to patients treated with postoperative stereotactic radiotherapy for brain metastases

PURPOSE

The ultimate goal of stereotactic radiotherapy (SRT) of brain metastases (BM) is to avoid or postpone whole brain radiotherapy (WBRT). A nomogram based on multi-institutional data was developed by Gorovets, et al. to estimate the 6 and 12-months WBRT-free survival (WFS). The aim of the current retrospective study was to validate the nomogram in a cohort of postoperative BM patients treated with adjuvant SRT.

MATERIAL AND METHODS

We reviewed the data of 68 patients treated between 2008-2017 with postoperative SRT for BM. The primary endpoint was the WFS. The receiver operating characteristic curve and area under the curve (AUC) were calculated for both 6- and 12-months time points.

RESULTS

After a median follow-up of 64 months, the 1-year cumulative incidence of local and distant brain relapse rates were 15% [95% CI=8-26%] and 34% [95% CI=24-48%], respectively. At recurrence, repeated SRT or salvage WBRT were applied in 33% and 57% cases, respectively. The WFS rates at 6 and 12 months were 88% [95% CI=81-97%] and 67% [95% CI=56-81%], respectively. Using the Gorovets nomogram, the 6 months rates were overestimated while they were accurate at 12 months. AUC values were 0.47 and 0.62 for the 6- and 12-months respectively. Overall, Harrell's concordance index was 0.54.

CONCLUSION

This nomogram-predicted well the 12 months WFS but its discriminative power was quite low. This underlines the limits of this kind of predictive tool and leads us to consider the use of big data analysis in the future.

Are routine cryoballoon procedural characteristics predictive of atrial arrhythmia recurrence in the long term?

BACKGROUND

Cryoballoon ablation is an effective procedure to treat atrial fibrillation (AF). However, AF recurrence rate at 1-year follow-up is approximately 20% despite improvements in ablation technique.

AIM

To find factors predictive of AF recurrence following a first pulmonary vein isolation procedure using a second-generation cryoballoon (PVI-2CB).

METHODS

This was an observational, retrospective, single-centre study. From June 2012 to April 2017, all patients who had a PVI-2CB procedure and a scheduled follow-up at Rouen University Hospital were included. The primary endpoint was atrial arrhythmia (AA) recurrence (e.g. AF, flutter or tachycardia), considering a blanking period of 2 months following the procedure. Secondary endpoints were procedural variables for each pulmonary vein (successful isolation, time to disconnection, total cryoballoon application time, number of cryoballoon applications, level of occlusion during cryoballoon application leading to successful disconnection and lowest temperature reached during successful cryoballoon application), occurrence of redo procedures, use of antiarrhythmic drugs and adverse events.

RESULTS

The initial population consisted of 239 patients; six were excluded for lack of procedural variable data, giving an analysed population of 233 patients. The AA recurrence rate was 36.9% (mean follow-up 25±14 months). Mean time to AA recurrence was 10±12 months. No procedural variable was found to be predictive of AA recurrence. Only major left atrial enlargement (defined as diameter>50mm or left atrial area>30cm² or left atrial volume>50mL/m²) was predictive (odds ratio 2.70, 95% confidence interval 1.54-4.72; P=0.001). Forty-one patients had redo procedures (17.6% of analysed population); in this subgroup, 75.6% had at least one pulmonary vein reconnected, mainly the right inferior pulmonary vein.

CONCLUSIONS

At long-term follow-up, up to one-third of patients had AA recurrence after PVI-2CB. Important atrial remodelling was the only factor predictive of AA recurrence, whereas no procedural variable was found to be predictive.

Radiation-induced lung toxicity predictors: Retrospective analysis of 90 patients treated with stereotactic body radiation therapy for stage I non-small-cell lung carcinoma

BACKGROUND

The main complication after hypofractionated radiotherapy for lung carcinoma is radiation-induced lung toxicity, which can be divided into radiation pneumonitis (acute toxicity, occurring within 6 months) and lung fibrosis (late toxicity, occurring after 6 months). The literature describes several predictive factors related to the patient, to the tumor (volume, central location), to the dosimetry and to biological factors.

MATERIALS AND METHODS

This study is a retrospective analysis of 90 patients treated with stereotactic body irradiation for stage I non-small-cell lung carcinoma between December 2010 and May 2015.

RESULTS

Radiation pneumonitis was observed in 61.5% of the patients who were mainly asymptomatic (34%). Chronic obstructive pulmonary disease was not predictive of radiation pneumonitis, whereas active smoking was protective. Centrally located tumors were not more likely to result in this complication if the radiation schedule utilized adapted fractionation. In our study, no predictive factor was identified. Whereas the mean lung dose was a predictive factor in 3D radiotherapy, the lung volume irradiated at high doses seemed to be involved in the pathogenesis after hypofractionated radiotherapy.

CONCLUSION

The discovery of predictive factors for radiation pneumonitis is difficult due to the rarity of this complication, especially with an 8×7.5Gy schedule. Radiation pneumonitis seems to be correlated with the volume irradiated at high doses, which is in contrast to the known knowledge about the organs in parallel. This finding leads us to raise the hypothesis that vessel damage, organs in series, occurring during hypofractionated radiotherapy could be responsible for this toxicity.

[Predictive factors for skeletal-related events in lung cancer]

INTRODUCTION

Skeletal-related events (SRE) are common in patients with bone metastatic lung cancer and have a negative impact on quality of life and survival. The objective of this study is to identify predictive factors for SRE occurrence among this population.

METHODS

We conducted a 3-year retrospective study including 100 lung cancer patients with bone metastasis.

RESULTS

Eighty-two patients presented at least one SRE (69.5% at baseline). The median occurrence for SRE was 4.5 months and severe bone pain was the most common SRE (56%). The alkaline phosphatase serum level>120IU/L (hazard ratio [sHR]=2.8; 95% confidence interval (CI) [1.5-5.4]; P=0.002) and calcemia>2.6mmol/L ([sHR]=9.7; 95% CI [5.1-18.4]; P<0.001) were identified as risk factors for SRE occurrence while the presence of an initial SRE was associated with a decrease of this risk ([sHR]=0.2; 95% CI [0.1-0.4]; P<0.001).

CONCLUSION

The elevated alkaline phosphatase serum level and hypercalcemia are risk factors for SRE occurrence in bone metastatic lung cancer patients and should be used as biomarkers to adapt current medical practice for these patients.

[Long term renal function outcomes and predictive factors of chronic renal failure after living kidney donation]

INTRODUCTION

Living donor kidney transplants give the best results in term of renal function and are the principal solutions for the transplant shortage. However, donors selection and kidney function evaluation after surgery are essential. The objective of this study was to evaluate the prevalence and to identify the predictive factors of chronic renal failure for the donor, after living donor nephrectomy.

MATERIALS AND METHODS

It was a retrospective and monocentric study, including all the patients who underwent a living donor nephrectomy from 2007 to 2015 at the hospital of the Conception in Marseille. The primary study endpoint was renal function mesured by the glomerular filtration rate (GFR in mL/min) at 1 year and 5 years after surgery. The identification of moderate kidney failure predictive factors was achieved by an univariate and a multivariate analysis under Cox model.

RESULTS

Ninety-one patients were included. There was 40,7 % of men and media nage was 49 years (21; 70). Median pre-operative GFR was 94mL/min (67; 160). Median follow-up was 24 months (1; 120). Post operative GFR at 1 month, 1 year and 5 years was respectively 63mL/min (33; 90), 65mL/min (38; 107) and 67mL/min (56; 126) ans significantly lower than pre operative GFR (respectively P<0,001, P<0,001 et P=0,005). The prevalence of moderate kidney failure at 1 month, 1 year and 5 years was respectively 43,1 %, 33,3 % ans 25 %. In univariate and multivariate analysis, the only parametre significantly associated with a 1 year GFR>60mL/min wasp re operative GFR>90mL/min OR 3,61 IC95 % (1,27; 10,28) P=0,02.

CONCLUSION

Living donor nephrectomy leads to an important medium to long term loss of renal function. Donors with pre operative GFR<90mL/min should benefit from a rigorous supervision and nephrological care.

LEVEL OF EVIDENCE

3.

[Results and compliance of transcutaneous tibial nerve stimulation on overactive bladder syndrome in patients with Parkinson's disease. Retrospective Study.]

PURPOSE

To investigate efficiency and tolerance of transcutaneous tibial nerve stimulation (TNS) in the overactive bladder syndrome in patients with Parkinson's disease (PD), and to identify predictive factors for compliance.

METHODS

We conducted a retrospective monocentric study with a cohort of 17 patients with PD who have used TNS for an overactive bladder syndrome. The efficiency of the treatment was evaluated on the clinical improvement felt (rated out of ten). Patients were classified as « adopters » if they continued using TNS for at least one year after beginning the treatment or as « non adopters » if they stopped. Patients characteristics were evaluated for their predictive value for compliance with TNS.

RESULTS

Out of 17 patients, there were 9 women and 8 men, median age 66 years (55-77), median history for Parkinson's disease 8 years (1-22) and for urinary symptoms 3 years (1-10). Subjective efficiency was seen in 10 patients (59%), on nocturia and/or urinary incontinence for 9 patients (mean efficiency 5.75/10 and median efficiency 6.5/10). Three patients found TNS not effective, and four patients didn't use it long enough to evaluate. Two patients had side effects and stopped the TNS (feeling of electricity and restless leg syndrome). 7 patients were classified as « adopters » and 10 patients as « non adopters » after one year. Most evaluated characteristics proved not to be of predictive value for compliance with TNS except nocturia and pollakiuria (P=0.03 and P=0.05).

CONCLUSION

Our study seems to reveal TNS is particularly effective on nocturia and urge. Moreover, nocturia and pollakiuria appear to be predictive factors for SNT compliance. Nocturia could be a prominent symptom in SNT's prescription. But studies with more patients should be conducted for obtain better patient selection in TNS.

LEVEL OF EVIDENCE

IV.

[Radiation-induced lung toxicity predictors after stereotactic radiation therapy for non-small cell lung carcinoma stage I]

In case of refusal or contraindication for surgical management of a stage I non-small cell lung carcinoma, the validated alternative therapy is stereotactic irradiation. This technique reaches an equivalent tumour control rate than surgery and significantly higher than conventional radiotherapy. One of the dreaded complications is radiation induced lung toxicity (radiation pneumonitis and lung fibrosis), especially when it is symptomatic, occurring in about 10 % of cases. This article is a literature review of this complication's predictive factors.

[Predictive factors of seclusion duration in patients hospitalized in psychiatry settings. A prospective multisite study in the DTRF Paris-Sud]

INTRODUCTION

In psychiatric inpatient settings seclusion is a last resort to ensure the safety of the patient, other patients, and staff from disturbed behaviors. Despite its major interest for patients, seclusion could negatively impact treatment adherence and patient/staff relationships. Indeed, some secluded patients report a feeling of guilt during the measure and do not consider seclusion to be a healthcare intervention. To be more beneficial and to reduce the feeling by patients of being forced, seclusions should be as short and rare as possible. In other words, measures to reduce seclusion are available and have been clearly identified. Such measures could be applied, in the first instance, in patients with longer duration. In this way, the aim of this study was to investigate predictive factors of a seclusion of long duration.

METHODS

Our study was based on the dataset of the EPIC study, an observational prospective French multicenter study of seclusion and restraint. The EPIC study occurred in seven French psychiatric hospitals in the southern region of Paris. Inclusions were realized for 73days and allowed a data collection of 302 seclusion measures. Of these measures 236 were effectively a seclusion in a standardized room. Because the median duration was 7days, we defined two groups of patients: duration<7days and duration ≥ 7 days. Our variable to be explicated was duration ≥ 7 days. Explicative variables available in EPIC study were age, sex, forced hospitalization, autoagressivity, heteroagressivity, use of sedative treatment (oral or intramuscular), history of seclusion and patient diagnoses. We used bivariate and multivariate analyses to explore the association between a seclusion duration ≥ 7 days and explicative variables. Diagnoses were classified as psychotic disorders, mood disorders and others diagnoses. To be included in multivariate logistic regressions, diagnoses were treated as dummy variables (mood disorder vs psychotic disorders; psychotic disorders vs others; mood disorders vs others). Statistical analyses were performed using SPSS software 20.0 and R 3.4.0.

RESULTS

Of the 236 measures of seclusion the mean age was 38.2 (±12.8), 196 (83%) patients were forcibly hospitalized prior to their seclusion, 147 (62%) had a diagnosis of psychotic disorder, 43 (18%) a diagnosis of mood disorder and 33 (14%) an "other diagnosis". Mean duration was 10.2 (1.5) days and median was 7.1 days. One hundred and thirty-five (47%) patients were in the group of duration ≥ 7 days. In bivariate analyses, variables associated with a duration ≥ 7 days were: being in forced hospitalization prior to the seclusion (P=0.04), administration of a sedative treatment (P=0.01) and against the group of others diagnoses the diagnosis of mood disorders (P<0.0005) and psychotic disorders (P=0.001). Multivariate analyses showed that, against the group of other diagnoses, the group of psychotic disorders [OR=3.3, CI 95% (1.3-8.4), P=0.01], the group of mood disorder [OR=2.7, CI 95% (1.4-4.9), P=0.002] and administration of sedative treatment [OR=8.1, CI 95% (2.0-32.5), P=0.003] were significantly associated with a duration ≥ 7 days. These results were independent from other confusion variables. Considering the hospitalization status, psychotic disorders was the only diagnosis which showed an association between duration ≥ 7 days and forced hospitalization [OR=2.9 CI 95% (1.1-7.8), P=0.03].

CONCLUSION

Our study highlighted two profiles of higher risk to remain ≥ 7days in seclusion. The first one is patients with a diagnosis of mood disorder who needed sedative treatment. The second one is patients with a diagnosis of psychotic disorder who needed sedative treatment and forced hospitalized before seclusion. Thus, these two profiles could be a good target to practice, in the first instance, measures to reduce seclusion duration in psychiatry settings.

Incidence, indications and predicting factors of permanent pacemaker implantation after transcatheter aortic valve implantation: A retrospective study

BACKGROUND

As the number of transcatheter aortic valve implantation (TAVI) procedures is constantly increasing, it is important to consider common complications, such as pacemaker (PM) implantation, and their specific risk factors.

AIMS

Echocardiographic, computed tomography and electrocardiographic data were analysed to determine the predicting factors, if any, associated with PM implantation.

METHODS

This retrospective study included patients referred to Nancy University Hospital for a TAVI procedure from January 2013 to December 2015. Both Medtronic CoreValve and Edwards SAPIEN valves were implanted. Patients with preprocedurally implanted PMs and/or referred from another institution were excluded.

RESULTS

Of 208 TAVI patients, 23 had a pre-existing PM and were excluded. A new PM was required in 38 patients (20.5%). Pre-existing right bundle branch block (RBBB), the use of the Medtronic CoreValve and large prostheses were identified as predictors of PM implantation (P=0.0361, P=0.0004 and P=0.0019, respectively). Using logistic regression, predictors of PM implantation included first-degree atrioventricular block (odds ratio 3.7, 95% confidence interval 1.5-9.1; P=0.0054) and large aortic annulus diameter in echocardiography (odds ratio 1.2, 95% confidence interval 1-1.4; P=0.0447), with a threshold of 24.1mm. For the combination of preTAVI PR duration >220ms and QRS duration >120ms, the positive predictive value for PM implantation reached 80%.

CONCLUSION

Use of the Medtronic CoreValve, RBBB and first-degree atrioventricular block are major risk factors for post-TAVI PM implantation. In addition, large aortic annulus and large valvular prosthesis are independent risk factors for PM implantation. The combination of preTAVI prolonged PR interval and increased QRS duration could be used as a marker for periprocedural PM implantation.

[Predictors of prolonged ICU stay following elective adult cardiac surgery: Monocentric retrospective study on 5 and half years]

AIM

The aim of our study was to identify predictors for prolonged ICU stay following elective adult cardiac surgery under cardiopulmonary bypass.

PATIENTS AND METHODS

A retrospective study was conducted during 5 years and a half period. Were included, patients age≥18 years old, underwent elective cardiac surgery under cardiopulmonary bypass. Patients who died within 48hours of surgery were excluded. Prolonged ICU stay was defined as stay in the ICU for 48hours or more.

RESULTS

During the review period, 610 patients were included. One hundred and sixty-four patients have required a prolonged ICU stay (26.9 %). In multivariate analysis, 5 predictors were identified: ejection fraction<30 % (OR 19.991, IC 95 % [1.382-289.1], P=0.028], pulmonary hypertension (OR 2.293, IC 95 % [1.058-4.973], P=0.036), prolonged ventilation (≥12hours) (OR 4.026, IC 95 % [2.407-6.733], P<0.001). Number of blood units transfused (OR 1.568, IC 95 % [1.073-2.291], and postoperative acute renal failure (OR 2.620, IC 95 % [1.026-6.690], P=0.044]. Prolonged ICU stay is significantly associated with prolonged hospital stay (17 days vs 13 days ; P<0.001) and higher in hospital mortality (22 % vs. 3 %, P<0.001).

CONCLUSION

The identification of these patients at risk of prolonged ICU stay is crucial. It will aid to plan prophylactic measures to optimize their support.

Predictors of response to repetitive transcranial magnetic stimulation (rTMS) in the treatment of major depressive disorder

Repetitive transcranial magnetic stimulation (rTMS), based on the principle of electromagnetic induction, consists of applying series of magnetic impulses to the cerebral cortex so as to modulate neurone activity in a target zone. This technique, still experimental, could prove promising in the field of psychiatry, in particular for the treatment of major depressive disorder. It is important for the clinician to be able to assess the response potential of a given patient to rTMS, and this among other things requires relevant predictive factors to be available. This review of the literature aims to determine and analyse reported predictive factors for therapeutic response to rTMS treatment in major depressive disorder. Different parameters are studied, in particular age, the severity of the depressive episode, psychological dimensions, genetic factors, cerebral blood flows via cerebral imagery, and neuronavigation. The factors found to be associated with better therapeutic response were young age, low level of severity of the depressive episode, motor threshold intensity over 100%, more than 1000 stimulations per session, more than 10 days treatment, L/L genotype on the 5-HTTLPR transporter gene, C/C homozygosity on the promotor regions of the 5-HT1A receptor gene, Val/Val homozygosity on the BDNF gene, cordance analyses by EEG, and finally the accurate localisation provided by neuronavigation. The authors conclude that investigations in larger patient samples are required in the future, and that the work already achieved should provide lines of approach for the coming experimental studies.

[Cardiac permanent pacemaker after transcatheter aortic valve implantation: A predictive and scientific review]

Transcatheter aortic valve implantation (TAVI) is nowadays a worldwide technique in the field of treating aortic stenosis. One of the main side effects linked to the technique are mostly attached to rhythm disturbances, such as atrioventricular (AV) and intraventricular blocks. Consequently, a pacemaker implantation is often required. That implantation rate is estimated between 8 and 30%, depending on the valve chosen. Thanks to main meta analysis on the subject, it has been managed to isolate the following risks factors for AV block development: preoperative right bundle branch block (RBBB: the most powerful element), complete AV block during the procedure, male gender, a so-called porcelain aorta, the absence of previous valvular surgery, the aortic annulus size (i.e when that size is inferior to the valve's one) and the QRS duration after the procedure (the superior threshold has been set at 128ms for the Corevalve). The currently recommendations advice to implant a pacemaker are as followed: high grade AV block (in the main studies, the implantation occurs within the 5 days after the TAVI), complete and transient AV block during the TAVI, second degree AV block and RBBB associated with first degree AV block. Our article aims to review the arrhythmic issues of TAVI.

[Vagus nerve stimulation for intractable epilepsy: A retrospective bicentric cohort study of 101 patients operated on between 1999 and 2010]

BACKGROUND

Vagus nerve stimulation is an adjunctive palliative therapy for refractory epilepsy.

MATERIAL AND METHODS

We reviewed the clinical and surgical records of patients who had a VNS implantation for intractable epilepsy between the years 1999 and 2010 at two institutions, Bordeaux and Toulouse University Hospitals.

RESULTS

A total of 101 patients were included of whom 57 were male. Median age at epilepsy onset was 7.5 years, inter quartile range (IQR) [2.5-12.5] and the median time between epilepsy onset and VNS implantation was 21.1 years, IQR [11.9-29.5]. At the end of the study, 85 patients were alive with a functional VNS. Survival probability of having a functional VNS at 1, 2 and 5 years were respectively: 99%, IC95% [97.1,100]; 96.49%, IC95% [92.7,100] and, 88.2%, IC95% [79.9,97.4]. Among the patients, 41.6% demonstrated a seizure decrease of more than 50%. The mean number of seizures was reduced by 5.7 per week. We failed to demonstrate any factor affecting the outcome.

CONCLUSION

The VNS can decrease the seizure frequency but, also reduce their intensity and had a favourable effect on the patients mood. Morbidity is low and the therapeutic effect of the stimulation is sustainable. The indication of the VNS should be discussed earlier in the evolution of a nonsurgical and severe epilepsy.

[Predictive factors and prognostic consequences of perioperative complications of radical cystectomies for urothelial carcinoma in patients of 80 years or more]

OBJECTIVE

To define the predictive factors and the prognostic consequences of perioperative complications occurrence while radical cystectomies for urothelial carcinoma treatment in patients older than 80 years.

MATERIAL AND METHOD

Retrospective analysis of clinical and biological preoperative data and outcome of eighty patients of 80 years or more, treated with radical cystectomy between 1990 and 2010 in one centre. Perioperative complications were graded according to the classification from Clavien-Dindo.

RESULTS

Twenty-eight patients (35%) had a single perioperative complication and nineteen (24%) had multiple (≥2) perioperative complications. Overall survival of patients with multiple perioperative complications was significantly lower than that of patients who had no complications (Log-rank P=0.0004). The occurrence of multiple perioperative complications was associated with Charlson and ASA scores, with pelvic irradiation and induction chemotherapy histories. However, in multivariate analysis, only the existence of respiratory comorbidity was an independent risk factor for the occurrence of multiple perioperative complications.

CONCLUSIONS

The occurrence of multiple perioperative complications was associated with reduced overall survival in elderly patients after radical cystectomy. The existence of respiratory comorbidity was the only independent risk factor for the occurrence of multiple perioperative complications.

LEVEL OF EVIDENCE

5.

[Surgery for pulmonary metastases from colorectal cancer: Predictive factors for survival]

INTRODUCTION

Colorectal cancer is the 3rd commonest cause of death from cancer: 5% of patients will develop lung metastases. The management of oligometastatic disease is based on the objective of optimal local control.

STATE OF THE ART

To date, no results from randomized control trials support the resection of pulmonary metastases in oligometastastic colorectal cancer patients. However, numerous series, mainly retrospective, report long-term survival for highly selected patients, with 5-year survival ranging from 45 to 65% in the most recent series. The consensual predictive factors of a good prognosis are: a disease free-interval>36 months, a number of metastases≤3, a normal level of carcino-embryonic antigen and the absence of hilar or mediastinal lymph node involvement.

PERSPECTIVES

Around 20 to 40% of patients will develop recurrence, probably linked to the presence of undetectable micrometastases. Therefore, experimental work is being undertaken to develop new treatment techniques such as isolated lung perfusion, radiofrequency ablation and stereotactic radiation therapy.

CONCLUSION

Highly selected patients suffering from colorectal cancer lung metastases could benefit from resection with improved survival and disease-control.

[Difficulties and limitations in conducting translational research in thoracic oncology. A practical example]

INTRODUCTION

In a first study, we identified signatures of 3 mRNAs (semaphorin 3D [SEMA3D], cytokeratin 16 [KRT16] and UL16 binding protein 2 [ULBP2]) associated to response to a cisplatin-vinorelbin chemotherapy and to survival of advanced non-small cell lung cancers (NSCLC).

MATERIAL AND METHODS

The aim of this study was to develop immunohistochemistry tests for KRT16, ULBP2 and SEMA3D and to test proteins expression for prediction of response and survival in biopsies of the same patients.

RESULTS

We were not able to reproduce by the protein expression study the signature predicting response to chemotherapy in advanced NSCLC.

CONCLUSION

We highlight the difficulties of translational research in thoracic oncology emphasizing the complexity in obtaining adequate tissue samples and the difficulties in conduction and transposing in routine practice high throughput technique for transcriptomic analyses.

[Predictors of failed trial of labor in obese nulliparous]

OBJECTIVES

To identify predictors of failed trial of labour (TOL) in obese nulliparous at term.

PATIENTS AND METHODS

Retrospective study about 213 nulliparous with a body mass index (BMI) greater than 30kg/m(2) who delivered a vertex singleton after 37 weeks of gestation (WG). Planned caesarean sections were excluded. Maternal, sonographic, per-partum and neonatal characteristics were analyzed according to the mode of entry into labor and delivery route. Univariate and multivariate logistic regression analysis were performed.

RESULTS

The cesarean delivery rate was 28%. Induction of labor (aOR=4.3 [1.8-10.7]), prolonged pregnancy (aOR=10.8 [1.7-67.6]), macrosomia (aOR=5.6 [1.1-27.3]), meconium-stained amniotic fluid (aOR: 2.57 [1.03-6.42]), use of trinitrine (aOR=5.5 [1.39-21.6]) and neonatal head circumference greater than 35cm (aOR=3.1 [1.2-8.0]) were predictors of failed TOL. There was no significant correlation between failed TOL and preconceptional BMI. Univariate analysis revealed an association between excessive weight gain and failed TOL.

DISCUSSION AND CONCLUSION

Predictors of failed TOL are the same in obese and non-obese women. Preconceptional BMI does not predict failed TOL in this nulliparous obese population.

[Is obesity a barrier to kidney transplantation?]

INTRODUCTION

Kidney transplantation is the most suitable of ESRD care. The proportion of obese people is increasing in the general population and patients with kidney impairment. It is important to assess the impact of obesity on surgical complications of kidney transplantation. The aim of this retrospective study was to signify the correlation between obesity and the occurrence of postoperative urological complications during the first year.

METHODS

We conducted a retrospective study from March 1999 to December 2009. We conducted a chart review of patients undergoing kidney transplantation. The kidneys were taken from cadaveric donors. Data collected included age, weight, height, preoperative BMI; causal nephropathy, smoking, hypertension, diabetes, anticoagulation therapy. Intraoperative data included operative time (DO), cold ischemia. Urological complications were recorded during the first year after the kidney transplantation (vascular anastomotic strictures, ureterovesical stenosis, lymphorrheas, pyelonephritis, hematoma, wound infection). Statistical analysis consisted of a t-test for independent samples and univariate and multivariate logistic regression for the occurrence of complications.

RESULTS

Four hundred and twenty-two patients were transplanted in total. We excluded 20 patients. BMI and duration of surgery patients with complications were significantly different from those of patients with no complications (P=0.016 and P=0.039, respectively). Obese (n=48) had more diabetes (12.5% versus 3.7%, P=0.014), were more often smoking (35.4% versus 22%, P=0.012), had a longer DO (203.64minutes versus 182.46minutes, P=0.006), and complications (62.5% versus 50.28%, P=0.03) than patients with a BMI <30 (n=354). After adjusting for age, smoking, DO, diabetes and BMI showed that only BMI was an independent predictor of the occurrence of postoperative complications with P=0.048 and RR=1.058 [CI: 1 to 1.119]. However, there was no more transplantectomy obese (P=0.911).

CONCLUSION

Our study showed that there is a significant risk of surgical complications after kidney transplantation in obese patients. But ultimately, this does not affect graft survival because there are no more transplantectomies or return to dialysis.

LEVEL OF EVIDENCE

5.

[Prevalence of burnout among obstetrics and gynecology residents]

OBJECTIVES

Prevalence assessment of burnout among obstetrics and gynecology residents and predisposing factors.

PATIENTS AND METHODS

Multicentric cross-sectional survey based on a questionnaire sent by email to the residents including demographics data and Maslach Burnout Inventory.

RESULTS

Mean burnout scores were 19.67±10.19 for emotional exhaustion, 33.94±5.01 for personal accomplishment and 8.72±6.10 for depersonalization, corresponding to a moderate burnout for each category. High scores of burnout were seen on 19.45 % of residents for emotional exhaustion, 33.33 % for depersonalization and 11.11 % for personal accomplishment. 36.11 % of residents showed evidence of high burnout in emotional exhaustion or depersonalization, and 5.55 % in the three dimensions. The number of semesters is correlated with depersonalization (P=0.01).

CONCLUSION

There is a strong personal accomplishment among obstetrics and gynecology residents; however, burnout and emotional exhaustion remains a reality during obstetrics and gynecology residency.