Postoperative morbidity and mortality in patients with diabetes after colorectal surgery with an enhanced recovery program: A monocentric retrospective study.

BACKGROUND: Diabetes mellitus may increase the risk of adverse perioperative outcomes and prolong hospital stay. An enhanced recovery program (ERP) reduces surgical stress and its metabolic consequences, so attenuating the impact of preoperative risk factors. We tested the hypothesis that diabetes would have only a minor impact on outcome after colorectal surgery with an ERP. METHODS: The data for patients scheduled for colorectal surgery between 2015 and 2021, were analyzed (n=769). All the patients were managed with the same protocol. Demographic data, preoperative risk factors, postoperative complications, and length of stay were compared between patients with and without diabetes. RESULTS: In all, 124 patients (16.1%) had diabetes, of whom 30 (24.1%) required insulin. The following preoperative risk factors for postoperative complications were significantly more frequent in the patients with diabetes: age>70 years, ASA score ≥ III, renal failure, cardiac disease, BMI>30 kg/m2, anemia, and cancer as indication for surgery. Despite more risk factors, patients with diabetes did not experience more overall postoperative complications than controls (OR (95%IC): 0.9 [0.6-1.5], p=0.85). Length of hospital stay was not significantly longer in patients with diabetes than in those without (4 [2-7] vs. 3 [2-7] days; p=0.45). CONCLUSIONS: Despite more risk factors, patients with diabetes did not experience more complications or longer length of stay after colorectal surgery with an ERP. The multimodal, multidisciplinary approach of ERP to reducing surgical stress may thus help mitigate the reported deleterious effects of diabetes.

Leiomyosarcoma of the inferior nasal concha: a case report and literature review.

Leiomyosarcomas (LMSs) of the sinonasal tracts are rarely reported. We present a case of an LMS of the left inferior nasal concha, and discuss the management options with review of the literature. A 72-year-old female patient presented with epistaxis. Clinical examination and medical imaging showed a tumour arising from the left inferior nasal concha. An endoscopic resection was performed. Anatomopathological and immunohistochemical analyses revealed the tumour to be a grade 3 LMS with uncertain posterior margins. The patient was a Jehovah's Witness and refused more radical surgical resection due to religious beliefs; therefore, adjuvant conformal radiotherapy (60 Gy) was performed. LMS of the nasal cavity is a rare and locally aggressive tumour with a high tendency of recurrence, requiring radical surgical resection and long-term follow-up. The prognosis of a nasal cavity LMS is better than that of an LMS located in the paranasal sinuses.

Usefulness of delayed postcontrast magnetic resonance imaging in the detection of residual cholesteatoma after canal wall-up tympanoplasty.

OBJECTIVES/HYPOTHESIS: Imaging takes an increasing place in the follow-up of patients who have undergone surgery for cholesteatoma, with computed tomography (CT) as the first line imaging technique. However, in case of complete opacity of the tympanomastoid cavities, CT is not able to differentiate residual cholesteatoma from postoperative scar tissue. The aim of this study was to assess the usefulness of magnetic resonance imaging (MRI) using delayed postcontrast T1-weighted images for the detection of residual cholesteatoma after canal wall-up tympanoplasty (CWU) in cases where CT was not conclusive. STUDY DESIGN: Prospective study. METHODS: MRI, with delayed postcontrast T1-weighted images (30-45 minutes after contrast injection), was performed before revision surgery in 41 consecutive patients who had undergone CWU for cholesteatoma and presenting with a nonspecific complete opacity of the mastoid bowl on CT. In all the cases, imaging results were compared with operative findings at surgical revision. RESULTS: A residual cholesteatoma was found in 19 of 41 patients at revision surgery and was correctly detected on MRI in 17 patients. In the two remaining cases, cholesteatoma pearls smaller than 3 mm were not seen. There was no false-positive case. Statistics were as follows: sensitivity 90%; specificity 100%; positive predictive value 100%; negative predictive value 92%. CONCLUSION: When postoperative CT is not conclusive because of complete opacity of the tympanomastoid cavities, MRI with delayed postcontrast T1-weighted images is a reliable additional technique for the detection of a residual cholesteatoma when its diameter is at least 3 mm.

[Treatment of Bell's palsy with acyclovir and methylprednisolone]. / Traitement des paralysies faciales idiopathiques par méthylprednisolone et aciclovir.

OBJECTIVE: An open therapeutic trial was conducted in patients with Bell's palsy. Results were compared with data in the literature. MATERIALS AND METHODS: Between 1997 and 2000, 76 patients with Bell's palsy were treated with intravenous methylprednisolone (2 mg/kg/day) and acyclovir (5-10 mg/kg/8 hours) for 7 days. Treatment was initiated in all patients before the 14th day of illness. Severity of the palsy was scored on the first day of treatment and again one year later using the House and Brackman scale. RESULTS: Grade II or III palsy were observed in 38% of the patients at initial presentation, grades IV to VI in 62%. After treatment, 92% of the patients had reverted to grades I and II (good outcome) and only 8% had sequelae at 1-year follow-up. All patients with initial grade I or II recovered completely. For patients with grade IV, V, or VI complete recovery at 1 year was observed in 94, 86 and 50% respectively. CONCLUSION: Data in the literature suggest that corticosteroids should improve recovery in Bell's plasy. In our study, adjunction of acyclovir did not demonstrate any clear improvement in the cure rate. Benefit could depend on early prescription.

Cutting edge: STAT activation by IL-19, IL-20 and mda-7 through IL-20 receptor complexes of two types.

IL-10-related cytokines include IL-20 and IL-22, which induce, respectively, keratinocyte proliferation and acute phase production by hepatocytes, as well as IL-19, melanoma differentiation-associated gene 7, and AK155, three cytokines for which no activity nor receptor complex has been described thus far. Here, we show that mda-7 and IL-19 bind to the previously described IL-20R complex, composed by cytokine receptor family 2-8/IL-20Ralpha and DIRS1/IL-20Rbeta (type I IL-20R). In addition, mda-7 and IL-20, but not IL-19, bind to another receptor complex, composed by IL-22R and DIRS1/IL20Rbeta (type II IL-20R). In both cases, binding of the ligands results in STAT3 phosphorylation and activation of a minimal promoter including STAT-binding sites. Taken together, these results demonstrate that: 1) IL-20 induces STAT activation through IL-20R complexes of two types; 2) mda-7 and IL-20 redundantly signal through both complexes; and 3) IL-19 signals only through the type I IL-20R complex.

Cloning and characterization of IL-22 binding protein, a natural antagonist of IL-10-related T cell-derived inducible factor/IL-22.

The class II cytokine receptor family includes the receptors for IFN-alphabeta, IFN-gamma, IL-10, and IL-10-related T cell-derived inducible factor/IL-22. By screening genomic DNA databases, we identified a gene encoding a protein of 231 aa, showing 33 and 34% amino acid identity with the extracellular domains of the IL-22 receptor and of the IL-20R/cytokine receptor family 2-8, respectively, but lacking the transmembrane and cytoplasmic domains. A lower but significant sequence identity was found with other members of this family such as the IL-10R (29%), cytokine receptor family 2-4/IL-10Rbeta (30%), tissue factor (26%), and the four IFN receptor chains (23-25%). This gene is located on chromosome 6q24, at 35 kb from the IFNGR1 gene, and is expressed in various tissues with maximal expression in breast, lungs, and colon. The recombinant protein was found to bind IL-10-related T cell-derived inducible factor/IL-22, and to inhibit the activity of this cytokine on hepatocytes and intestinal epithelial cells. We propose to name this natural cytokine antagonist IL-22BP for IL-22 binding protein.

Interleukin 9 induces expression of three cytokine signal inhibitors: cytokine-inducible SH2-containing protein, suppressor of cytokine signalling (SOCS)-2 and SOCS-3, but only SOCS-3 overexpression suppresses interleukin 9 signalling.

Interleukin 9 (IL-9) is a cytokine preferentially produced by T helper type 2 lymphocytes and active on various cell types such as T- and B-lymphocytes, mast cells and haemopoietic progenitors. The IL-9 receptor (IL-9R) belongs to the haemopoietic receptor superfamily and its signal transduction involves mainly the Janus kinase/signal transducer and activator of transcription (JAK/STAT) pathway. Here we studied the implication of a novel family of suppressors of cytokine signalling (called CIS, for cytokine-inducible SH2-containing protein, and SOCS, for suppressor of cytokine signalling) in IL-9 signal attenuation. In BW5147 T-cell lymphoma, IL-9 induced the rapid expression of CIS, SOCS-2 and SOCS-3 with a peak after 2 h of stimulation. Using IL-9R mutants, we showed that STAT activation is required for CIS/SOCS induction: CIS and SOCS-2 expression was induced either via STAT1 and/or STAT3 or via STAT5 but only STAT1 and/or STAT3 were involved in SOCS-3 expression. The effect of these three proteins on IL-9 signal transduction was assessed by transient transfection in HEK-293 cells expressing the components of the IL-9 signalling pathway and a STAT-responsive reporter construct. These experiments showed that only SOCS-3 is able to inhibit IL-9-induced signal transduction; neither CIS nor SOCS-2 exerted any effect. Stable transfection of CIS and SOCS-3 in BW5147 lymphoma cells showed that only overexpression of SOCS-3 had an inhibitory activity on STAT activation, gene induction and the anti-apoptotic activity of IL-9. By contrast, CIS failed to affect the IL-9 response.

STAT5 activation is required for interleukin-9-dependent growth and transformation of lymphoid cells.

Interleukin-9 (IL-9) is a growth factor for T cells and various hematopoietic and lymphoid tumor cells. IL-9 signaling involves activation of Janus kinase (JAK)1 and JAK3 kinases, and signal transducer and activator of transcription (STAT)1, STAT3 and STAT5. Using a dominant negative form of STAT5 (STAT5delta), we demonstrated that this factor is an important mediator of IL-9-dependent Ba/F3 cell growth. Mutation of the STAT binding site of the IL-9 receptor (tyr116phe) results in an important decrease in STAT activation and inhibition of proliferation in the presence of IL-9. A small number of cells escape this inhibition, and IL-9-dependent cell lines could be derived. The selected cells required activation of STAT5 for growth, which was blocked by STAT5delta expression and enhanced by overexpression of wild-type STAT5. In contrast to parental cells, Ba/F3-Phe116 cells growing in the presence of IL-9 further progress to cytokine-independent tumorigenic clones. These tumorigenic clones exhibited a strong cytokine-independent activation of JAK1 and STAT5, which most likely supports their proliferation. Transfection of a constitutively activated variant of STAT5 promoted the growth of wild-type Ba/F3 cells in the absence of cytokine. Finally, the expression of the proto-oncogene pim-1 was correlated with STAT5 activation and cell growth. Our data suggest that STAT5 is an important mediator of IL-9-driven proliferation and that dysregulation of STAT5 activation favors tumorigenesis of lymphoid cells.

Positive pressure generation by pneumatic and electronic O2 regulators: a bench experimental evaluation.

BACKGROUND: The introduction of advanced anti-G protection into agile fast fighter aircraft may result in the regular use of positive pressure breathing (PPB) for G protection by aircrew. Since PPB results in an external additional work of breathing (WoB), we compared the mechanical performance of the pneumatic and electronic O2 regulators designed for "Mirage 2000" and "Rafale" aircraft. HYPOTHESIS: Since mask pressure is regulated by the electronic device in relation to flow, mask pressure will remain constant throughout the respiratory cycle, so that PPB-related additional WoB will be less with the electronic regulator. METHODS: In a bench dynamic study performed with a sinusoidal pump, we measured variations in mask pressure (deltaP) and calculated WoB at 0, 3 and 6 kPa of PPB (0, 30 and 60 cm H2O, respectively), for 0.5, 1 and 2 L of volume and for 10, 15 and 20 cycles per minute of respiratory rate. RESULTS: We found that, compared with the pneumatic device, inspiratory and expiratory WoB with the electronic device were respectively lower by approximately 25% (p < 0.05) and by approximately 10% (NS) at 3 and 6 kPa of PPB, for all respiratory conditions. Nevertheless, we also observed remaining variations in mask pressure with the electronic regulator, due to complex impedance of the inspiratory circuit, since the device uses the pressure measured into the regulator. CONCLUSIONS: We concluded that the electronic control of mask pressure is relatively efficient but that the device would be improved by placing the site of the pressure measurement into the mask.

Effects of chest wall counterpressures on lung mechanics under high levels of CPAP in humans.

We assessed the respective effects of thoracic (TCP) and abdominal/lower limb (ACP) counterpressures on end-expiratory volume (EEV) and respiratory muscle activity in humans breathing at 40 cmH2O of continuous positive airway pressure (CPAP). Expiratory activity was evaluated on the basis of the inspiratory drop in gastric pressure (DeltaPga) from its maximal end-expiratory level, whereas inspiratory activity was evaluated on the basis of the transdiaphragmatic pressure-time product (PTPdi). CPAP induced hyperventilation (+320%) and only a 28% increase in EEV because of a high level of expiratory activity (DeltaPga = 24 +/- 5 cmH2O), contrasting with a reduction in PTPdi from 17 +/- 2 to 9 +/- 7 cmH2O . s-1 . cycle-1 during 0 and 40 cmH2O of CPAP, respectively. When ACP, TCP, or both were added, hyperventilation decreased and PTPdi increased (19 +/- 5, 21 +/- 5, and 35 +/- 7 cmH2O . s-1 . cycle-1, respectively), whereas DeltaPga decreased (19 +/- 6, 9 +/- 4, and 2 +/- 2 cmH2O, respectively). We concluded that during high-level CPAP, TCP and ACP limit lung hyperinflation and expiratory muscle activity and restore diaphragmatic activity.

[Russian intra vehicular space suit and cold protection]. / Scaphandre spatial intra-vehiculaire russe et protection contre le froid.

During space flights, astronauts use equipment allowing protection against many environmental factors. During tests realised in Russia, space suit efficiency was evaluated particularly concerning cold protection capacity in cold water (3 degrees C) and in cold air (-30 degrees C). Obtained results prove that this equipment allows to prevent hypothermia in cold water and ensure thermal comfort in cold air.

Increase of LBNP tolerance using elastic compression stockings.

BACKGROUND: Astronauts returning from spaceflight are affected by reduced orthostatic tolerance resulting from exposure to weightlessness. There are some countermeasures currently in use to improve cardiovascular performance of returning astronauts, while there are others that are being tested in flight and in ground-based investigations. This paper presents a study on the use of elastic compression stockings to reduce leg blood capacity (LBC) which is believed to be one of the determinants of orthostatic tolerance. METHODS: The data are from 6 healthy men with a mean age of 36 +/- 5 (SE) yr. Assessment of the effectiveness of stockings in improving orthostatic tolerance is based on a presyncopal-limited lower body negative pressure (LBNP) test, consisting of successive 3 min exposures to negative pressures of -20 hPa (-15 mmHg), -40 hPa (-30 mmHg), and decrements in steps of 10 hPa (7.5 mmHg) from then on until termination of the test. RESULTS: Results show an increase in the maximal level of LBNP tolerated (88 hPa or 66 mmHg for control vs. 108 hPa or 81 mmHg for stockings; p = 0.018) as well as in the cumulative stress index (CSI) (1122 hPa-min or 842 mmHg-min for control vs. 1734 hPa-min or 1300 mmHg-min for stockings; p = 0.029). CONCLUSIONS: The improvement of LBNP tolerance with elastic compression stockings coupled with their ease of use support the need for further experimental studies for evaluating their potential as a countermeasure for astronauts after return from spaceflight.

Effect of zolpidem on sleep and ventilatory patterns at simulated altitude of 4,000 meters.

The purpose of this study was to assess the effect of zolpidem 1 0 mg, a new imidazopyridine hypnotic drug, on sleep and respiratory patterns at a simulated altitude of 4,000 meters. Eight male subjects spent three nights in a decompression chamber. The first study night was spent at the ambient pressure corresponding to sea level. The two other nights were spent at a simulated altitude of 4,000 meters with either zolpidem or a placebo in random order according to a double-blind, crossover design. All subjects showed periodic breathing (PB) during sleep at simulated high altitude. Furthermore, altitude was associated with decreases in total sleep time (TST), slow-wave sleep (SWS), and REM sleep, and with significant increases in Stage 1 duration and in the arousal index. Most arousals were synchronous with the hyperpneic phase of PB. The main finding of our study is that zolpidem improved sleep characteristics at high altitude, inducing a decrease in sleep onset latency (placebo, 22 +/- 12 min versus zolpidem, 10 +/- 6 min), an increase in SWS duration (placebo, 46 +/- 28 min versus zolpidem, 69 +/- 28 min), and a reduction in the arousal index during SWS (placebo, 7.4 +/- 4.1 per h versus zolpidem: 2.4 +/- 1.0 per h). Furthermore, none of the respiratory parameters were significantly affected by zolpidem in any sleep stage. In conclusion, zolpidem improved sleep quality at high altitude without adversely affecting respiration.

From health locus of control to immune control: internal locus of control has a buffering effect on natural killer cell activity decrease in major depression.

Decreased immunity in depressive as compared with control subjects has been well documented, although some depressed patients have severe alterations whereas others have milder ones or not at all. Since for equal severities of depression, there may be individual differences in the degree of perceived control over one's condition, we investigated the interaction of perceived control with immunological variations. Immune function (T and B lymphocytes, lymphocyte proliferation and natural killer cell activity (NKCA)) were evaluated in 34 adult major depressives and in 18 healthy controls. Lymphocyte proliferation did not differ between the two groups, but NKCA was significantly lower in the depressed patient group. Among the depressed subjects, those who experienced less subjective control also showed significantly lower NKCA. An internal locus of control appears to act as a buffer against the decrease in cellular immunity observed in major depression. Further studies should focus on methods of coping and on degree of perceived control rather than on diagnostic and nosographic variables alone.

Locus of control and metabolic control.

Previous studies designed to establish in diabetic patients the relationship between metabolic control and locus of control are controversial. The aim of the present study was to find answers to the following questions: is there a link between an internal locus of control and improved metabolic control? Is this true for type I and type II diabetic subjects? Is this improved metabolic control linked directly, or even indirectly, with the locus of control by types of behaviour, such as for example a greater desire for information concerning the disease (knowledge) and closer adherence to doctors' recommendations (compliance)? Sixty-one patients (36 type I and 25 type II) on insulin therapy were compared according to the type of their locus of control using two different questionnaires (Rotter and Wallston). The extent of their knowledge about diabetes was also assessed; self-monitoring of blood glucose (SMBG) was considered to be a measure of compliance, while the HbA1 level was considered to be an indicator of metabolic control. The study compared the influence of the type of locus of control on the various parameters. The results indicate that, irrespective of the questionnaire, type I "internals" exhibited better metabolic control (p < 0.05) than type I "externals", even with a lower level of knowledge of diabetes (p < 0.01) and less frequent SMBG (p < 0.05). However, the benefits of internality as regards metabolic control were not as great when this internality was extreme.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical trials of antidepressants: the hidden face: where locus of control appears to play a key role in depression outcome.

It remains difficult to determine in what measure improvements observed in clinical trials of anti-depressants may be attributable to the psychological predispositions of the subjects. The present article focuses on the effect of a psychological variable, the Health Locus of Control, which measures the extent of a subject's belief that he is in control over his own health. The hypothesis is that depressed subjects whose locus of control is internal, i.e. who perceive themselves to be in control, rather than external, i.e. control perceived as being in others or just chance, will improve more markedly and consistently on the Hamilton Depression Rating Scale, across a number of clinical trials. Forty-nine depressive patients undergoing treatment with four different compounds were included, after a week's placebo run-in period, in a classical 42-day follow-up study comprising visits on days -7, 0, 10, 21; and 42. Interactions between the type of locus of control and the clinical course were investigated by MANOVA. Results show that with a classical design of clinical trials of antidepressants, locus of control plays a significant role if it is internal (P < 0.001) in consolidating the improvement process, and that this is true irrespective of type of antidepressant. The relationship between the concept of locus of control and placebo effect is discussed.

Hepatic [14C]aminopyrine demethylation capacity after portocaval shunting. Comparative study in patients with and without arterialization of portal vein.

The [14C]aminopyrine breath test (ABT) was used before and after surgical portocaval shunting in 29 cirrhotic patients, 15 with arterialization of the portal vein and 14 without. These two subgroups were comparable with regard to age, prothrombin time, serum albumin, serum total bilirubin concentrations, Child classification, and preoperative ABT. After portocaval shunt, a striking reduction in ABT values was observed after 6 and 12 months (90.7 +/- 8.0%, P < 0.05 and 77.3 +/- 7.5%, P < 0.005, respectively). No further decrease was observed between 12 and 24 months. The microsomal function was reduced to a greater extent in patients with postnecrotic cirrhosis (55 +/- 4.8%, P < 0.01) than in those with alcoholic cirrhosis (84.8 +/- 10.4%, P < 0.05). Arterialization of the portal stump of the portal vein did not prevent the reduction in hepatocellular function. No significant change in prothrombin time, serum albumin, or bilirubin concentrations was observed during the follow-up period in any of the groups. Overall, preoperative ABT was significantly higher in those surviving one year (0.29 +/- 0.12% administered dose) than in those who died within this time period (0.12 +/- 0.01%, P < 0.005). This observation suggests that portocaval anastomosis induces an early decrease in microsomal function that is not prevented by arterialization of the portal vein. It also suggests that ABT might be helpful in selecting patients for shunt surgery.

[Mammographic aspects of Aschoff's proliferative centres]. / Aspects mammographiques des centres prolifératifs d'Aschoff.

The pseudotumoral feature of radial scar cause considerable diagnostic problems mammographically and at the extemporaneous examination. From a series of 28 cases, the authors confront their experience with classical mammographic data and emphasize: the difficulty in analysing the central area of the radiating structure, the possibility of glandular retraction, the relationship between spicules and radiolucent linear structures. These radiological criterias do not allow us to affirm the diagnosis. Extraction with histological examination of the operatory fragment is the only attitude.