[The roles of patients in healthcare provision, training and research: A French perspective]. / Rôles des patients dans le système de santé, la formation et la recherche en santé : une perspective française.

In 2002, patients were transformed into users of the French health system. As this opinion piece demonstrates, in 2021 they may at least potentially participate more actively than before. They can convey their knowledge of a disease and its treatments, and voluntarily share their experience. They can intervene in user representation and therapeutic patient education, the objective being to increase the autonomy of one and all, patients and public, in the training of professionals, clinical research and evolution of the health system. The rationale for the involvement of patients and their roles in provision of care, training and clinical research are analyzed from a French perspective. The obstacles to overcome and improvements to be achieved are reviewed, the objective being to promote enhanced health democracy through increased patient engagement. In 2021, however, the role of patients in the design and implementation of therapeutic patient education (TPE) and in the development of medical studies curricula remains limited if not restricted; this is due not only to a lack of information, but also to the resistance of health professionals and universities. Patients could and should assume a major role, fostering evolution toward a more just and effective health care system.

Sexual function after vaginal erbium laser: the results of a large, multicentric, prospective study.

The aim of this multicentric, prospective study was to evaluate the effects of vaginal erbium laser (VEL-SMOOTH®) on sexual function in postmenopausal women suffering from the genitourinary syndrome of menopause (GSM). This study was performed on an outpatient basis without anesthesia or drug use before or after the intervention, using an erbium laser (XS Fotona Smooth®, Fotona, Ljubljana, Slovenia) in 1081 postmenopausal women (age 54.3 ± 3.9 years) treated with up to three laser applications every 30 days. Patients were assessed using the Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale-Revised (FSDS-R). No adverse events were recorded during the study. The FSDS-R scores (n = 554), from basal values of 25.5 ± 3.5, were 11.5 ± 3.0, 10.5 ± 3.5 and 11.5 ± 3.5 at the 4-, 12- and 24-week follow-ups, respectively (p < 0.01 vs. corresponding basal values). Individual FSFI domain scores (n = 569) significantly (p < 0.001) increased after VEL-SMOOTH® treatment and remained significantly higher up to the 24th week after the end of treatment. The total scores, from basal values of 15.5 ± 1.5, were 27.5 ± 2.5, 27.6 ± 2.7and 27.0 ± 3.5 at the 4-, 12- and 24-week follow-ups, respectively (p < 0.01 vs. corresponding basal values). Albeit not randomized, this large, prospective study shows that VEL-SMOOTH® treatment may improve sexual function in postmenopausal women suffering from GSM.

Remission of acromegaly after treatment withdrawal in patients controlled by cabergoline alone or in combination with octreotide: results from a multicenter study.

PURPOSE: Remission of acromegaly has been reported after somatostatin analogs withdrawal, but not after withdrawal of combination therapy with cabergoline, and only in case reports of patients controlled by cabergoline alone. METHODS: To establish the remission rates (normal IGF-1 for age/sex: IGF-1 ≤ 1.00 xULN) after withdrawal of combined treatment with octreotide LAR and cabergoline and of cabergoline alone, we prospectively studied 16 patients with acromegaly controlled by those treatments in the preceding 2 years as part of a larger study on remission of acromegaly after withdrawal of different medical treatments. RESULTS: Among 97 patients with controlled acromegaly included in the entire study, only 16 patients had been on combination therapy (n = 12) or cabergoline alone (n = 4). At 8 weeks after treatment withdrawal, three patients (19%) were in remission (short-term remission). At 60 weeks (long-term remission), IGF-1 levels were still in the normal range in two patients (12.5%) and remained normal up to 108 weeks after treatment withdrawal (last visit). One patient had been treated with cabergoline alone and another one with combination of octreotide and cabergoline before treatment withdrawal. CONCLUSION: Remission of acromegaly after treatment withdrawal seems to be uncommon in patients controlled by cabergoline, either as monotherapy or in combination with octreotide. In the future, larger studies and/or meta-analysis will be necessary to accurately establish the remission rates of acromegaly after withdrawal of cabergoline with or without somatostatin analogs.

Rationale and design for the Vaginal Erbium Laser Academy Study (VELAS): an international multicenter observational study on genitourinary syndrome of menopause and stress urinary incontinence.

The genitourinary syndrome of menopause (GSM) and stress urinary incontinence (SUI) are common clinical challenges for women's health and quality of life. The laser treatment and particularly the vaginal erbium laser (VEL) may provide a new non-invasive treatment for both GSM and SUI. However, the estimation of the ultimate results of different laser treatments may be altered by different issues, such as patient selection, concomitant treatments, and long-term effect of vaginal laser thermotherapy. In the present paper, we present the protocol for a large multicenter study on the evaluation of the efficacy and safety of VEL for the treatment of GSM and SUI, the Vaginal Erbium Laser Academy Study (VELAS). This study will evaluate the effects of three laser applications in 1500 postmenopausal women. Subjective and objective symptoms will be evaluated prior to the first laser treatment with follow-up visits after 4 weeks from the last laser application, and subsequently after every 3 months for 1 year. Findings from the VELAS have the potential to affect clinical care practice and health decisions for millions of women world-wide for a non-hormonal treatment for GSM and a non-invasive treatment of SUI.

Electroencephalographic staging of hepatic encephalopathy by an artificial neural network and an expert system.

AIM OF THE STUDY: To provide an objective EEG assessment of hepatic encephalopathy (HE), we set up and tested an entirely automatic procedure based on an artificial neural network-expert system software (ANNESS). PATIENTS AND METHODS: A training set sample of 50 EEG (group A) and a test sample of 50 EEG (group B) of 100 cirrhotic patients were considered. The EEGs had been visually classified by an expert electroencephalographer, using a modified five-degree Parsons-Simith classification of HE. The efficiency of the ANNESS, trained in group A, was tested in group B. RESULTS: Both the ANNESS and the visually-based classifications were found to be correlated to liver insufficiency, as assessed by the Child-Pugh score (Spearman's coefficient rho=0.485, P<0.0001; rho=0.489, P<0.0001, respectively) and by the biochemical indexes of hepatic function (bilirubin: rho=0.31 vs. 0.27; albumin: rho=-0.13 vs. -0.18; prothrombin time rho=-0.35 vs. -0.52). The classifications were found to be correlated to each other (rho=0.84 P<0.0001, Cohen's kappa=0.55). However, the ANNESS overestimated grade 2 EEG alterations. CONCLUSION: An ANNESS-based classification of EEG in HE provided data comparable with a visually-based classification, except for mild alterations (class 2) that tended to be overestimated. Further optimization of automatic EEG staging of HE is desirable, as well as a prospective clinical evaluation.

An artificial intelligence approach to classify and analyse EEG traces.

We present a fully automatic system for the classification and analysis of adult electroencephalograms (EEGs). The system is based on an artificial neural network which classifies the single epochs of trace, and on an Expert System (ES) which studies the time and space correlation among the outputs of the neural network; compiling a final report. On the last 2000 EEGs representing different kinds of alterations according to clinical occurrences, the system was able to produce 80% good or very good final comments and 18% sufficient comments, which represent the documents delivered to the patient. In the remaining 2% the automatic comment needed some modifications prior to be presented to the patient. No clinical false-negative classifications did arise, i.e. no altered traces were classified as 'normal' by the neural network. The analysis method we describe is based on the interpretation of objective measures performed on the trace. It can improve the quality and reliability of the EEG exam and appears useful for the EEG medical reports although it cannot totally substitute the medical doctor who should now read the automatic EEG analysis in light of the patient's history and age.

[Late post-traumatic diaphragmatic hernia: unusual cause of colonic occlusion]. / Ernia diaframmatica post-traumatica tardiva: una rara causa di occlusione colica.

Traumatic diaphragmatic rupture is not an uncommon problem, particularly in the last few years because of the increasing number of road accidents, improved diagnostic techniques and resuscitation techniques after serious traumas. In a certain number of cases, post-traumatic diaphragmatic hernias may become clinically manifest only months or years after thoracic or abdominal trauma and are still a challenge to surgeons because of the vague clinical symptoms and the diagnostic difficulties involved. The Authors report a case of acute colon occlusion due to diaphragmatic hernia 24 months after thoraco-abdominal trauma. None of the radiological or endoscopic examinations demonstrated the presence of diaphragmatic hernia. Laparoscopy showed a diaphragmatic rupture with incarceration of the left colonic segment. The laparoscopic procedure was converted for technical reasons and the diaphragmatic defect was closed with a primary suture.

Impaired antifungal effector activity but not inflammatory cell recruitment in interleukin-6-deficient mice with invasive pulmonary aspergillosis.

A murine model of infection, in which immunocompetent or immunosuppressed interleukin-6-deficient (IL-6(-/-)) mice were infected intranasally with Aspergillus fumigatus conidia and were monitored for parameters of fungal colonization and innate and adaptive immunity, was used to assess the role of IL-6 in invasive pulmonary aspergillosis (IPA). The results indicate that IL-6(-/-) mice were more susceptible than wild-type mice to IPA. Susceptibility was associated with increased inflammatory pathology, decreased antifungal effector functions of phagocytes, and impaired development of protective type 1 responses. Exposure to exogenous IL-6 restored antifungal effector activity.

[Small bowel diverticula in adults: clinical and therapeutic features. Report of 2 cases and review of the literature]. / I diverticoli del tenue nell'adulto. Aspetti clinici e terapeutici. Presentazione di 2 casi e revisione della letteratura.

The true diverticula of the small bowell are a very rare observation in clinical practice; they have a malformative origin and, occasionally, are acquired, contrary to what observed in the colon, where they are frequently an acquired pathology. They can involve the small bowel as a single lesion (Meckel's diverticulum), or as a segmentary disease (duodenal diverticula), or as a diffused diverticulosis. Generally they are asymptomatic and rarely they produce a true pathology. The symptomatic disease is primarily found in pediatric age and it requires a surgical procedure. This makes even more rare the diverticular pathology in the adult. The authors report 1 case of intestinal occlusion due to ileoileo-colic invagination arising from a Meckel's diverticulum and 1 case of intestinal occlusion in presence of a severe and acute diffuse diverticulosis of the small bowell, both in adult patients.

Interleukin 18 restores defective Th1 immunity to Candida albicans in caspase 1-deficient mice.

Caspase 1, formerly designated interleukin 1beta (IL-1beta)-converting enzyme, processes pro-IL-1beta and pro-IL-18 to yield active cytokines that play a pivotal role in inflammation and cell activation. We show here the effect of caspase 1 deficiency on the inflammatory and adaptive immune responses to the fungus Candida albicans. Caspase 1 deficiency did not affect susceptibility to primary systemic infection with the fungus, as revealed by survival and fungal growth. However, Th1-mediated resistance to reinfection was greatly impaired in caspase 1-deficient mice, and this correlated with low-level production of IL-12 and gamma interferon. Early in infection, production of these cytokines and that of tumor necrosis factor alpha, IL-6, and, interestingly, IL-1beta occurred normally in caspase 1-deficient mice, while that of IL-18 was severely impaired. Exogenous administration of IL-18, more than IL-12, restored the Th1-mediated resistance to the infection. We conclude that, while caspase 1 is not indispensable for release of mature IL-1beta in candidiasis, the caspase 1-dependent production of IL-18 may represent an important and novel pathway for the expression of sustained Th1 reactivity to the fungus.

[Role and limitations++ of the urease test on gastric biopsy for Helicobacter pylori infection. Study of 50 cases]. / Ruolo e limiti del test all'ureasi su biopsie gastriche per l'infezione da Helicobacter pylori. Studio su 50 casi.

The authors after a review of the international literature, analyzed 50 cases of gastroduodenal pathology submitted to endoscopy and biopsy. The biopsy was analyzed with the CP test. The analysis of results of CP test and local endoscopic status offers useful indications for therapy. The authors consider and assess the data of this epidemiological study.

[An infrequent cause of upper digestive hemorrhage: gastric leiomyoma]. / Una causa non frequente di emorragia digestiva alta: il leiomioma gastrico.

Following a brief review of the forms of benign tumors originating at the smooth muscles of the stomach, a case of bleeding gastric leiomyoma treated with gastric resection is reported.

On radiation-induced extraskeletal osteosarcoma: report of a case.

A case of extraskeletal osteogenic sarcoma arising in the soft tissues of the lower portion of the anterior abdominal wall (subumbelical region) is reported. The tumor developed in an area that had received telecobaltherapy 2 years 8 months previously (total skin dose of 9,000 rads delivered in 45 exposures over two separate periods of 106 and 141 days), after surgical treatment for a Stage I carcinoma of the uterine cervix. The clinical description and histopathology of this unusual neoplasm are presented, and the literature is reviewed.