Robot-assisted laparoscopy for deep infiltrating endometriosis: a retrospective French multicentric study (2008-2019) using the Society of European Robotic Gynecological Surgery endometriosis database.

OBJECTIVE: This study aimed at assessing perioperative results of robot-assisted laparoscopy (RAL) in the context of deep infiltrating endometriosis (DIE). METHODS: This retrospective French multicentric study included all patients with DIE who underwent surgical treatment managed by RAL (Da Vinci® System). From November 2008 to June 2019, patients were included in a single European database, in Robotic Assisted Laparoscopic Gynecologic Surgery, with Society of European Robotic Gynecological Surgery collaboration. Patients had different DIE sites as follows: gynecological, urological, or digestive, or combinations of these. Surgical procedures and perioperative complications were evaluated. To assess complications, patients were divided into the following four groups according to surgical procedure and DIE site: gynecological only; gynecological and urological; gynecological and digestive; and gynecological, urological, and digestive. RESULTS: A total of 460 patients treated at one of eight health-care facilities from November 2008 to June 2019 were included. Median operative time was 245 min (IQR 186-320), surgeon console time was 138 ± 75 min and estimated blood loss was 70.0 mL ± 107 mL. Among this patient sample, 42.1% had a multidisciplinary surgical approach with a digestive or urology surgeon in addition to gynecology surgeon (25.5% and 16.6% of cases, respectively). Among those with intraoperative complications (n = 25, 5.4%) were primarily conversion to laparotomy (n = 6, 2.0%), transfusion (n = 2, 0.6%), and organ wounds (n = 8, 1.7%). Overall, 5.6% had severe postoperative complications (Clavien-Dindo classification ≥ Grade 3). CONCLUSION: This is among the largest published series addressing RAL for DIE. Interest in this procedure appears promising, with no observed increases in blood loss or in peri- or post-operative complications. DIE laparoscopic surgery can require complex surgical procedures performed by multidisciplinary surgical teams. Thus, it may be one of the best candidates for RAL within gynecology surgery.

Effect of temperature on ultrasound-assisted electroless nickel-boron plating.

Electroless nickel-boron coatings have several advantages over electroplated nickel and electroless nickel-phosphorous: they are harder than both other coatings and, as all electroless coatings, can be applied easily to complex shapes and all substrates, even non conducting ones, contrary to electroplated coatings. Preliminary testing has proved that ultrasound assistance helps improve their properties by increasing the plating rate while conserving the properties of the coating. In this study, the effect of plating temperature on mechanically agitated and ultrasonic assisted electroless nickel-boron deposition was investigated: deposition was performed in two different configurations: one with a classical mechanical agitation at 300 rpm and the other employing ultrasound at a frequency of 35 kHz. In addition, different temperatures in the 80-95 °C range were tested. The increase of plating rate previously observed was confirmed and it was possible to lower slightly plating temperature while conserving plating efficiency, which decreases evaporation of the solution. Morphological, mechanical, corrosion and wear characterization were performed on the coatings, as well as tribocorrosion studies in an alkaline environment (0.1 M NaCl). Ultrasound-assisted coatings presented tribocorrosion behaviour that was similar or better than the standard ones.

[Focus on mucinous adenocarcinoma of the uterine cervix]. / Les adénocarcinomes mucineux du col utérin.

Cancer of the uterine cervix is the fourth most common cancer in women worldwide, and the fourth leading cause of cancer death in women. Squamous cell carcinoma is the first type of cervical cancer (about 75% of cases), and adenocarcinoma the second. Adenocarcinoma of the uterine cervix were redefined in the 2014 WHO classification. Endocervical adenocarcinoma, usual type, is the mose common. Mucinous adenocarcinoma were classified by this classification into different subtypes: gatric type, intestinal type and signet-ring cell type. This literature review shows the caracteristics of these various subtypes of cervical cancer, little known. These are physiopathological, clinical, cytological histological, pronostic caracteristics, and their treatments.

Fundus autofluorescence in retinal artery occlusion: A more precise diagnosis.

IMPORTANCE: Retinal artery occlusion (RAO) is a medical emergency associated with a high risk of cerebral vascular accident and other cardiovascular events. Among patients with non-arteritic RAO, a retinal embolus is observed in approximately 40% of cases. Fundus examination and retinography are not reliable to predict the nature of the emboli. OBSERVATIONS: We report three consecutive cases of central and branch RAO that were investigated with fundus autofluorescence, fluorescein angiography and color retinal photographs. All patients underwent complete neurological and cardiovascular workups, with brain imaging, cardiac Doppler ultrasound, carotid Dopplers and Holter ECG's, to determine the underlying mechanism of retinal embolism. In the three cases, aged 77.7±4 years (2 women and 1 man), fundus autofluorescence demonstrated hyperautofluorescent emboli. In two cases, it allowed visualization of emboli that were not detected with fundus examination or retinography. The cardiovascular work-up demonstrated atheromatous carotid or aortic plaques in all patients. In one case, it permitted the diagnosis of RAO. Two of the three cases were considered to be of atherosclerotic origin and one of undefined origin. CONCLUSION AND RELEVANCE: Fundus autofluorescence may help to detect and characterize retinal emboli. Since lipofuscin, which is present in large quantity in atherosclerotic plaques, is the main fluorophore detected with fundus autofluorescence, this non-invasive and simple examination may give information about the underlying mechanism of retinal embolism, and thus impact the etiologic assessment of RAO. Additional studies are necessary to confirm this potential role of autofluorescence.

Electroless deposition of nickel-boron coatings using low frequency ultrasonic agitation: Effect of ultrasonic frequency on the coatings.

The effect of ultrasound on the properties of Nickel-Boron (NiB) coatings was investigated. NiB coatings were fabricated by electroless deposition using either ultrasonic or mechanical agitation. The deposition of Ni occurred in an aqueous bath containing a reducible metal salt (nickel chloride), reducing agent (sodium borohydride), complexing agent (ethylenediamine) and stabilizer (lead tungstate). Due to the instability of the borohydride in acidic, neutral and slightly alkaline media, pH was controlled at pH 12±1 in order to avoid destabilizing the bath. Deposition was performed in three different configurations: one with a classical mechanical agitation at 300rpm and the other two employing ultrasound at a frequency of either 20 or 35kHz. The microstructures of the electroless coatings were characterized by a combination of optical Microscopy and Scanning Electron Microscope (SEM). The chemistry of the coatings was determined by ICP-AES (Inductively Coupled Plasma - Atomic Emission Spectrometry) after dissolution in aqua regia. The mechanical properties of the coatings were established by a combination of roughness measurements, Vickers microhardness and pin-on-disk tribology tests. Lastly, the corrosion properties were analysed by potentiodynamic polarization. The results showed that low frequency ultrasonic agitation could be used to produce coatings from an alkaline NiB bath and that the thickness of coatings obtained could be increased by over 50% compared to those produced using mechanical agitation. Although ultrasonic agitation produced a smoother coating and some alteration of the deposit morphology was observed, the mechanical and corrosion properties were very similar to those found when using mechanical agitation.

On the use of speciation techniques and ab initio modelling to understand tetravalent actinide behavior in a biological medium: An(IV)DTPA case.

In the case of an accidental nuclear event, contamination of human bodies by actinide elements may occur. Such elements have the particularity to exhibit both radiological and chemical toxicities that may induce severe damages at several levels, depending on the biokinetics of the element. In order to eliminate the actinide elements before they are stored in target organs (liver, kidneys, or bone, depending on the element), sequestering agents must be quickly injected. However, to date, there is still no ideal sequestering agent, despite the recent interest in this topic due to contamination concerns. DTPA (diethylene triamine pentaacetic acid) is currently generating interest for the development of oral or alternative self-administrable forms. Although biokinetics data are mostly available, molecular scale characterization of actinide-DTPA complexes is still scarce. Nevertheless, strong interest is growing in the characterization of An(IV)DTPA(-) complexes at the molecular level because this opens the way for predicting the stability constants of unknown systems or even for developing new analytical strategies aimed at better and more selective decorporation. For this purpose, Extended X-ray Absorption Fine Structure (EXAFS) and Ab Initio Molecular Dynamics (AIMD) investigations were undertaken and compared with capillary electrophoresis (CE) used in a very unusual way. Indeed, it is commonly believed that CE is incapable of extracting structural information. In capillary electrophoresis, the electrophoretic mobility of an ion is a function of its charge and size. Despite very similar ratios, partial separations between An(IV)DTPA(-) species (An(IV) = Th, U, Np, Pu) were obtained. A linear relationship between the electrophoretic mobility and the actinide--oxygen distance calculated by AIMD was evidenced. As an example, the interpolated U-O distances in U(IV)DTPA(-) from CE-ICPMS experiments, EXAFS, AIMD, and the relationship between the stability constants and the ratio z/dAn-O, are all in agreement. This results in the capability to evaluate the stability constants for the formation of Pa(IV)DTPA(-), Am(IV)DTPA(-) or Bk(IV)DTPA(-).

Thermodynamics and structure of actinide(IV) complexes with nitrilotriacetic acid.

Nitrilotriacetic acid, commonly known as NTA (N(CH(2)CO(2)H)(3)), can be considered a representative of the polyaminocarboxylic family. The results presented in this paper describe the thermodynamical complexation and structural investigation of An(IV) complexes with NTA in aqueous solution. In the first part, the stability constants of the An(IV) complexes (An = Pu, Np, U, and Th) have been determined by spectrophotometry. In the second part, the coordination spheres of the actinide cation in these complexes have been described using extended X-ray absorption fine structure spectroscopy and compared to the solid-state structure of (Hpy)(2)[U(NTA)(2)] x (H(2)O). These data are further compared to quantum chemical calculations, and their evolution across the actinide series is discussed. In particular, an interpretation of the role of the nitrogen atom in the coordination mode is proposed. These results are considered to be model behavior of polyaminocarboxylic ligands such as diethylenetriamine pentaacetic acid, which is nowadays the best candidate for a chelating agent in the framework of actinide decorporation for the human body.

Generation and characterization of human smooth muscle cell lines derived from atherosclerotic plaque.

The study of atherogenesis in humans has been restricted by the limited availability and brief in vitro life span of plaque smooth muscle cells (SMCs). We describe plaque SMC lines with extended life spans generated by the expression of the human papillomavirus (HPV)-16 E6 and E7 genes, which has been shown to extend the life span of normal adult human aortic SMCs. Resulting cell lines (pdSMC1A and 2) demonstrated at least 10-fold increases in life span; pdSMC1A became immortal. The SMC identity of both pdSMC lines was confirmed by SM22 mRNA expression. pdSMC2 were generally diploid but with various structural and numerical alterations; pdSMC1A demonstrated several chromosomal abnormalities, most commonly -Y, +7, -13, anomalies previously reported in both primary pdSMCs and atherosclerotic tissue. Confluent pdSMC2 appeared grossly similar to HPV-16 E6/E7-expressing normal adult aortic SMCs (AASMCs), exhibiting typical SMC morphology/growth patterns; pdSMC1A displayed irregular cell shape/organization with numerous mitotic figures. Dedifferentiation to a synthetic/proliferative phenotype has been hypothesized as a critical step in atherogenesis, because rat neonatal SMCs and adult intimal SMCs exhibit similar gene expression patterns. To confirm that our pdSMC lines likewise express this apparent plaque phenotype, osteopontin, platelet-derived growth factor B, and elastin mRNA levels were determined in pdSMC1A, pdSMC2, and AASMCs. However, no significant increases in osteopontin or platelet-derived growth factor B expression levels were observed in either pdSMC compared with AASMCs. pdSMC2 alone expressed high levels of elastin mRNA. Lower levels of SM22 mRNA in pdSMC1A suggested greater dedifferentiation and/or additional population doublings in pdSMC1A relative to pdSMC2. Both pdSMC lines (particularly 1A) demonstrated high message levels for matrix Gla protein, previously reported to be highly expressed by human neointimal SMCs in vitro. These results describe 2 novel plaque cell lines exhibiting various features of plaque SMC biology; pdSMC2 may represent an earlier plaque SMC phenotype, whereas pdSMC1A may be representative of cells comprising an advanced atherosclerotic lesion.

Human cytomegalovirus IE2 86-kilodalton protein binds p53 but does not abrogate G1 checkpoint function.

Physical interactions between human cytomegalovirus (HCMV) immediate-early (IE) proteins and key cell cycle regulatory proteins have been suggested as a mechanism whereby this herpesvirus modifies cellular control of proliferation. Observed similarities to interactions of other DNA virus proteins (human papillomavirus type 16 E6 and E7, simian virus 40 large T antigen, and adenovirus type 5 E1A and E1B) with cell cycle modulatory proteins such as p53 and Rb have suggested that HCMV IE proteins may likewise alter the G1-to-S phase transition. The IE2 region gene product IE86 has been shown to specifically bind p53, potentially modifying p53 G1 checkpoint function. To examine this possibility, p53-mediated G1 arrest in the presence of IE86 was assessed. Retroviral constructs were created to facilitate the stable expression of IE86 and IE72, another IE protein implicated in HCMV-mediated alteration of cell cycle progression. Western analysis and immunoprecipitation confirmed IE protein expression and binding of IE86 to p53, respectively. Chloramphenicol acetyltransferase assays examining the ability of IE86 to repress activity from the HCMV major IE promoter or activate the HCMV early promoter for the 2.2-kb class of RNAs demonstrated the functional integrity of the IE86 protein. Induction of DNA damage in normal, uninfected fibroblasts (FB) or FB expressing IE86 by actinomycin D (Act D) resulted in increased p53 levels, a predominance of the hypophosphorylated form of Rb, and increased expression of both p21(CIP1/WAF1) and mdm-2. Fluorescence-activated cell sorting revealed that both uninfected and IE86-expressing FB experienced dramatic G1 arrest following exposure to Act D. The clear demonstration of these p53-dependent responses in the presence of IE86 indicates that binding to this viral protein does not compromise the ability of p53 to elicit growth arrest following DNA damage.

Vascular cell interactions modulate the expression of endothelin-1 and platelet-derived growth factor BB.

Endothelin (ET)-1 and platelet-derived growth factor (PDGF) BB are important regulators of vascular cell growth and contractile function. We tested the hypothesis that interactions between endothelial cells (ECs) and vascular smooth muscle cells (VSMCs) regulate the expression of these two factors. Bovine and rat cocultures of EC-VSMC that allowed cell contact and exchange of soluble mediators were studied. In bovine cocultures, ET-1 and PDGF B transcription decreased. Minimum levels of transcription were 39 +/- 9% of control for ET-1 and 31 +/- 6% of control for PDGF B. In contrast, steady-state mRNA levels transiently increased in coculture; maximum mRNA levels were 579 +/- 248 and 267 +/- 41% of control for ET-1 and PDGF B, respectively. ET-1 and PDGF BB protein levels were decreased in bovine cocultures. The amount of ET-1 in cocultures was 51% less and the amount of PDGF BB was 25% less than that in homotypic cultures. In rat cocultures, ET-1 protein levels were transiently increased compared with homotypic cultures; the maximum difference was 99 +/- 26%. These results indicate that EC-VSMC interactions regulate ET-1 and PDGF BB expression in EC-VSMC cocultures via multiple mechanisms. Furthermore, the interactive regulation appears to be species specific. These data suggest a novel mechanism for the regulation of these two vasoactive factors that may play an important role in cardiovascular physiology and/or pathology.

Decreased phosphorylation of four 20-kDa proteins precedes staurosporine-induced disruption of the actin/myosin cytoskeleton in rat astrocytes.

The changes in protein phosphorylation and cytoskeletal structure preceding the dramatic morphological changes in staurosporine-treated rat astrocytes were examined, and the dependence of these effects on protein kinase C (PKC) was studied. Fluorescence and photoelectron microscopy revealed that a 20-min exposure to the kinase inhibitor staurosporine at 100 nM substantially decreased the thickness and linear appearance of actin microfilament bundles (stress fibers) prior to major changes in cell shape, while 60 min of staurosporine depleted virtually all microfilament bundles and caused arborization and contraction of the cell body. The distribution of myosin light chain (MLC) labeling within the cytoplasm was also dramatically altered by staurosporine, progressing from a linear punctate pattern coincident with the linear pattern of filamentous actin to a diffuse pattern in cells in which microfilament dissolution was taking place. Two-dimensional gel analysis of astrocyte phosphoproteins demonstrated 50-80% reduction of 32P incorporation into four 20-kDa spots, one of which was recognized by an antibody to MLC, following a 15-min treatment with 100 nM staurosporine. Depletion of functinal PKC from astrocytes by a 24-h exposure to phorbol myristate acetate prior to staurosporine exposure did not reduce the extent of the cytoskeletal alterations or alter the decrease in protein phosphorylation. Two other protein kinase inhibitors which affect astrocyte morphology, H-7 and the MLC kinase inhibitor ML-9, were also observed to disrupt microfilament bundles with accompanying decreases in 32P incorporation into these same phosphoproteins, whereas the more selective PKC inhibitor Ro 31-8220 did not do either. The early onset of decreased phosphorylation of the 20-kDa proteins supports a direct relationship between the rapid dissociation of myosin light chain from actin microfilament bundles, the disruption of actin patterns, and the subsequent morphological alterations. These data also suggest that staurosporine and H-7 may exert their effects via a pathway involving inhibition of MLC kinase.