[Comparing outcomes of Immediate Breast reconstruction with and without use of radiotherapy]. / Comparaison des résultats de reconstruction mammaire immédiate par prothèse avec et sans radiothérapie.

BACKGROUND: Breast cancer and its treatment remains a public health problem. There is still a lack of epidemiological data concerning complications and aesthetic results bound to radiotherapy after an immediate breast reconstruction. The objective of this study was to compare outcomes of immediate breast reconstruction regardless to the use of radiotherapy (history of radiotherapy or adjuvant radiation therapy), in order to determine risk factor of complications and bad aesthetic results. METHODS: We conducted a retrospective study between January 2014 and December 2016 at the hospital "Gustave Roussy" in Paris, concerning breast cancer patients who needed immediate breast reconstruction after total mastectomy. The primary endpoint was to assess the failure rate of reconstruction and the aesthetic result, the secondary endpoint assessed the early and late rate of complications. We realized a multivariate analysis in order to identify risks factors that may predict complications. RESULTS: Three hundred and thirty three patients have been included: 157 in the "radiotherapy group" compared to 176 in the "no radiotherapy group". Preoperative characteristics were comparable. Average follow-up was between 1 and 3years without missing. Patients who benefited from radiotherapy had an equal risk failure of reconstruction. The subgroup analysis revealed non-significant differences: 12.7% failure rate reconstruction in the "radiotherapy group" vs. 12.5%. We could notify a better rate of "excellent results" in the "no radiotherapy group": 35% vs. 8.2%. Secondary outcomes were comparable. CONCLUSIONS: Radiotherapy related to immediate breast reconstruction didn't increase the failure rate of reconstruction or aesthetic results, comparatively to non-irradiated patients. It is therefore permissible to suggest an immediate breast reconstruction to any patients which would benefit from a total mastectomy followed by radiotherapy; in order to prevent them from a secondary breast reconstruction, who could be physically and psychologically more impactful.

[Evaluation of the management and conformity to clinical practice guidelines of soft tissues lesions. Study performed at the competence center of Lorraine area]. / Évaluation et impact du respect du référentiel ESMO sur la prise en charge des lésions des tissus mous, étude menée au centre de référence de Lorraine.

INTRODUCTION: Despite regular recommendations issued by the European Society for Medical Oncology (ESMO), patients faced still too often inadequate care with a direct influence on prognosis. METHODS: A retrospective study was carried out at the Competence center in Lorraine Area. Patients registered in the NetSarc database between 1st, 2010 and September 1st, 2016 were included. Compliance criteria were established using the latest ESMO 2014 referential. Two groups "conforming" and "non conforming" were analyzed. A first analyze about all of the soft tissue lesion and a second only about sarcomas. RESULTS: In total, 445 patients were eligible, 344 cases were treated according to the ESMO guidelines, giving a 77.3% conformity rate (95% CI: 73.4%, 81.2%). Compliance was better for the competence center than district hospitals (P<0.001), with compliance rates of 88.7%, and 51.6%, respectively. Among the 247 sarcomas, we found a R0 resection rate better according to the ESMO guideline, 55% against 18% (P<0.001). R1 rates were 34% vs. 56% and R2 11 vs. 26% disease free survival was not related significantly to the observance of recommendations in the univariate analysis. After adjustment on potential DFS prognostic factors, in the multivariate analysis, the results were similar. CONCLUSION: Compliance with the ESMO guidelines, through appropriate management, improves the quality of surgical excision for sarcomas and avoids non-corresponding surgical gestures.

GUEPAR hinge knee prosthesis.

Early and late results of the GUEPAR hinge knee prosthesis were evaluated on a series of 184 operations performed before January 1st, 1974. There were 3 immediate deaths and 26 before 5 years. Nineteen prostheses were removed. One hundred and twenty-six knees had degenerative osteoarthritis, 52 rheumatoid arthritis. Twenty-two had been operated on before. Patellar displacement, present in 27% of the cases, was the most frequent cause of complaint: pain or instability, proportional to the severity of displacement, made re-operation necessary in 10% of the patients. Addition of a patellar prosthesis was the most successful treatment as far as pain is concerned: it is probably advisable as a primary procedure. Deep infections occurred in 8.3% of the cases, infrequently after 2 years. Healing was obtained in all cases either by revision or by removal and arthrodesis: but functional results were poor except when fusion was achieved, in half of the cases of arthrodesis. Loosening occurred in 16% of the cases, mainly as a consequence of inadequate technique. It was frequently tolerated: re-operation was necessary in 6% of the total. Late functional results were evaluated in 99 cases with a follow-up of 5 to 8 years. Apart from loosening, the results did not deteriorate. Sixty percent were evaluated as excellent or good, 29% fair, and 11% poor. In consideration of these results, the choice of this prosthesis should be limited to special cases. To prevent complications, the use of a patellar prosthesis, of reinforced models and of cementing under pressure is advisable.

Improving athletes' perspectives of sport psychology consultation: a controlled evaluation of two interview methods.

Although investigations have consistently demonstrated the effectiveness of sport psychology interventions, these methods have been underutilized by athletes. In this study, 124 athletes completed the athletes' Attitudes Toward Seeking Sport Psychology Consultation Questionnaire (ATSSPCQ) and were subsequently randomly assigned to receive one of the two semistructured interview formats. One interview focused on discussing the athlete's experiences in sports, and the other focused on delineating sport psychology and its potential benefits to the athlete. Upon being interviewed, athletes were readministered the ATSSPCQ. Discussing sport psychology and its personal benefits was more effective in enhancing athletes' perception of need for sport psychology than discussing sport experiences. However, neither interview format enhanced athletes' perceptions of openness to discuss personal issues with a sport psychology consultant and tolerance of stigma associated with sport psychology consultation. Indeed, participants who received the discussion of sports intervention reported a significant decrease in personal openness to discuss personal issues relevant to sports psychology from pre- to postintervention. Intervention effects were similar for male and female athletes. Study implications and future directions are discussed in light of these results.

Efficient metallo-ene reactions in organoaqueous phase.

[reaction: see text] The easily prepared catalyst systems PdCl(2), RhCl(2)(COD)(2), NiCl(2).6H(2)O, or Ni(COD)(2)/TPPTS have been found to form a C-C bond in organoaqueous medium. Intramolecular metallo-ene reactions have been efficiently realized. Metal selectivity has been discovered.

Stereoselective synthesis of iso-dolaproine via dynamic kinetic resolution.

[see reaction]. An efficient multigram-scale synthesis of optically pure Boc-(2S,3R,4S)-iso-dolaproine is reported using dynamic kinetic resolution (DKR). The catalytic asymmetric hydrogenation of ethyl (4S)-3-(2'-pyrrolidinyl)-3-oxo-2-methyl propanoate hydrochloride using in situ generated Ru[(S)-MeO-BIPHEP]Br2 catalyst affords the anti beta-hydroxy alpha-methyl ester quantitatively. The two new stereogenic centers are simultaneously controlled with high diastereoselectivity.

Asymmetric synthesis of hydroxylated pyrrolizidine, indolizidine, and (+)-alpha-conhydrine via ruthenium-catalyzed hydrogenation.

The enantioselective ruthenium promoted hydrogenation of beta-keto ester, derived from (S)- or (R)-proline and (S)-pipecolic acid, provided a new efficient route to hydroxylated pyrrolizidine or indolizidine ring systems in diastereomeric excesses up to 99%. A practical synthesis of (+)-alpha-conhydrine is also reported.

[Urodynamic exploration in functional micturition disorders in children]. / Exploration urodynamique des troubles mictionnels fonctionnels de l'enfant.

Urodynamic investigation in paediatric patients is presented. The practical aspects and usefulness of each method are discussed in the cases of functional micturition disorders based upon the most significant results from the literature and the author's experience. Urodynamic investigation in children provides a pathophysiological explanation of bladder-sphincter dysfunction and guidelines for appropriate treatment.

[Natural remedies for vaginal infections]. / Remedios naturales para infecciones vaginales.

AIDS: Vaginal infections, affecting half of all women, are more severe in women with AIDS. The infection vulva vaginitis, caused by candida, may require medical attention. The doctor performs a pelvic exam and examines vaginal fluids under a microscope. Antibiotics, diet, or a suppressed immune system can increase candida yeast presence. Sweets should be avoided, as well as foods high in leavening, such as bread, cheese, fruit, or alcoholic beverages. Vegetables, grains, rice and wheat can be added to the diet. Eating a half-cup of yogurt daily will help maintain a proper level of yeast. Acidophilus capsules can be taken two or three times daily to relieve digestive problems. Raw or cooked garlic can be used as a vaginal suppository at night. Pau D'arco, the bark of a South American tree, is also anti-yeast. Boil for ten to twenty minutes, and take a teaspoon two or three times a day. Tea, or vinegar and water, can be used as a douche. Some women get relief by adding a half-cup of white vinegar to their bath. Do not wash genitals with soap and do not use sanitary napkins or tampons. Visit a doctor if the condition persists.^ieng

[Complications in root canal therapy]. / Complicaties bij de kanaalbehandeling.

Several factors prior to, during and after treatment may complicate root canal therapy. In this article several of these complications are discussed together with their possible solutions to these problems.

Role of catecholamines in regulation by feeding of energy balance following chronic exercise in rats.

Two experiments examined the contribution of the two catecholamines--epinephrine (EPI) and norepinephrine (NE)--to the control of food intake and body weight gain in male rats during chronic exercise. Urinary excretion of both catecholamines rose significantly and was positively correlated to food intake inhibition (NE, n = 54, r = 0.394, p less than 0.01; EPI, n = 54, r = 0.428, p less than 0.01). Oral ingestion of the non-selective beta-adrenoceptor blocking drug, pindolol, abolished the food intake reduction induced by exercise. Furthermore, rats that were treated with pindolol gained weight at a higher rate than untreated rats. These findings are consistent with the idea that catecholamines contribute to post-exercise inhibition of food intake and reduction of body weight in male rats. However, the exact physiological mechanism of catecholamine-induced decrease in food intake remains to be elucidated.

[Concentration of the atrial natriuretic factor in the atria and blood plasma in the development of hypertension in spontaneously hypertensive rats]. / Kontsentratsiia predserdnogo natriiureticheskogo faktora v predserdiiakh i plazme krovi v razvitii gipertenzii u spontanno gipertenzivnykh krys.

The contribution of atrial natriuretic factor to the development of spontaneous arterial hypertension was investigated in rats (the SHR line). Prehypertensive atrial and plasma levels of a natriuretic factor were similar in SHR to those of the control WKY rats. In fully-developed hypertension, the factor content decreases in left-atrial wall and increases in the plasma. It is assumed that elevated arterial blood pressure affects myo-endocrine left-atrial cells, leading to hypersecretion of the natriuretic factor. This kind of secretory response might be an adaptive/compensatory mechanism of blood pressure control.

Antibacterial activity of gutta-percha cones attributed to the zinc oxide component.

Growth of several species of bacteria was inhibited by the presence of endodontic gutta-percha cones. Microbiologic analysis, measurement of osmolarity, microscopy, x-ray diffraction analysis, and scanning electron micrography were used to identify the biologically active component that slowly leaches from gutta-percha cones. This component is zinc oxide in the form of small solid particles, from which active, soluble Zn2+ ion is mobilized by hydrolysis. A hypothesis on the "depot" effect of the ZnO particles is formulated, and is used to discuss some earlier reported literature on toxic and antibacterial activity of zinc oxide-containing materials. It is concluded that zinc oxide is not to be considered an inert compound. Its widespread uses in medicine and dentistry seem to reside in its "inert," biocompatible, and astringent properties mainly. The biologically active role of zinc oxide, however, merits further investigation.

Evidence for antibacterial activity of endodontic gutta-percha cones.

In the presence of endodontic gutta-percha cones, several species of bacteria were killed in vitro. Silver points, when compared with gutta-percha cones, were not or were considerably less effective against the target organism. Staphylococcus aureus, in our assay system. Growth of bacteria in serum could be abolished by the mere presence of gutta-percha, especially when time was allowed for previous contact between the serum and the cones. It is concluded that gutta-percha cones possess a slowly acting, relatively weak, but, in our opinion, significant inherent antimicrobial property.

[GUEPAR hinge knee prosthesis (author's transl)]. / Prothèse totale à charnière du genou GUEPAR. Expérience avec cinq ans de recul.

Early and late results of Guepar hinge knee prosthesis have been evaluated on a serie of 184 operations performed before January 1st 1974. There were 3 immediate deaths and 26 before 5 years. 19 prosthesis were removed. 126 knees had degenerative osteoarthritis, 52 rheumatoid arthritis. 22 had been operated on before. Patellar displacement, present in 27 p. 100 of the cases was the most frequent cause of complaint: pain or instability, proportional to the severity of displacement made reoperation necessary in 10 p. 100 of the patients. Addition of a patellar prosthesis was the most successful treatment as far as pain is concerned: it is probably advisable as a primary procedure. Deep infections occurred in 8,3 p. 100 of the cases, unfrequently after 2 years. Healing was obtained in all cases either by revision or by removal and arthrodesis: but functional results were poor except when fusion was achieved, in half of the cases of arthrodesis. Loosening occurred in 16 p 100 of the cases mainly as the consequence of insufficient technique. It was frequently tolerated: reoperation was necessary in 6 p. 100 of the total. Late functional results were evaluated in 99 cases with a follow-up of 5 to 8 years. Apart from loosening, the results did not deteriorate. 60 p. 100 are evaluated as excellent or good, 29 p. 100 fair, and 11 p. 100 bad. With due consideration of these results election of this prosthesis should be limited to special cases. To prevent complications, the use of a patellar prosthesis, of reinforced models, and of cementing under pressure is advisable.