Can 18F-FDG PET/CT findings be used to predict orbital tumor histology?

PURPOSE: To investigate whether 18F-FDG PET/CT might be useful to predict the histology of various orbital tumors based on the maximum standard uptake value (SUVmax) and the OMSUV (orbital max SUV)/MLSUV (mean liver SUV) ratio. PATIENTS AND METHODS: A retrospective single-center study was conducted between May 2019 and December 2020. Patients with an orbital mass who underwent preoperative 18F-FDG PET/CT followed by an orbital biopsy were included. Tumor histology was classified as follows: orbital inflammation, solid tumor, low-grade lymphoid tumor, and high-grade lymphoid tumor. Orbital tumors were also classified as indolent or aggressive. Data recorded included the orbital SUVmax, OMSUV/MLSUV ratio and additional extra-orbital SUV sites. RESULTS: Forty-five patients (24 men) were included. There were 15 (33.3%), 14 (31.1%), 9 (20%), and 7 (15.5%) cases of orbital inflammation, solid tumor, low-grade lymphoid tumor, and high-grade lymphoid tumor, respectively. No correlation was found between the OMSUV/MLSUV ratio and orbital SUVmax and tumor histology (Z = -0.77, Z = -0.6, Z = -1.6, and Z = 0.94, all P > 0.05, respectively). No correlation was found between the OMSUV/MLSUV ratio (Z = -1.42, P > 0.05) and orbital SUVmax (Z = -0.82, P > 0.05) and tumor aggressiveness (indolent versus aggressive). Subgroup analyses showed that SUVmax was predictive of lymphoma aggressiveness (P = 0.05) and was able to distinguish orbital cancers (all lymphomas+solid tumors) from benign tumors (P = 0.02). CONCLUSION: 18F-FDG PET/CT could not be used to predict the underlying orbital tumor histology. However, more aggressive tumors, especially high-grade lymphomas and cancers, tended to have a higher orbital SUVmax compared to indolent lesions.

[Impact of luteal phase support by human chorionic gonadotropin (hCG) in intrauterine inseminations]. / Impact du soutien de la phase lutéale par Human Chorionic Gonadotropine (hCG) dans les inséminations intra-utérines.

OBJECTIVES: The objective of our study is to evaluate the impact of luteal phase support by hCG in intrauterine inseminations preceded by ovarian gonadotropin stimulation. METHODS: A retrospective study was conducted at the CHU of Nice between March 1, 2016 and October 31, 2017. During this period, 300 intrauterine inseminations were included in data analysis. Ovarian stimulation was performed by gonadotropins and a GnRH antagonist was added, if needed. Following a modification of standard operative procedure in the department, patients who performed an intrauterine insemination from December 1, 2016 received luteal phase support with two injections of hCG 1500 IU, performed at three days of interval. Pregnancy and ovarian hyperstimulation syndrome were the primary and secondary study endpoints, respectively. RESULTS: Out of 300 inseminations included in the analysis, 144 were performed with luteal phase support and 156 without support. No statistically significant difference in pregnancy rate was observed between these two groups (19.4% of pregnancy in the luteal phase support group and 15.38% in the group without luteal phase support, P=0.353). No ovarian hyperstimulation syndrome occurred over the course of the study. CONCLUSION: Our study shows a slight improvement of pregnancy rate in the group subjected to luteal phase support by hCG after intrauterine insemination, but the benefit was not significant. A randomised prospective study based on a large cohort could help to assess the effect of luteal phase support during intrauterine inseminations.

Secondary Use of Recorded or Self-expressed Personal Data: Consumer Health Informatics and Education in the Era of Social Media and Health Apps.

Objective: To summarize the state of the art during the year 2016 in the areas related to consumer health informatics and education with a special emphasis in secondary use of patient data. Methods: We conducted a systematic review of articles published in 2016, using PubMed with a predefined set of queries. We identified over 320 potential articles for review. Papers were considered according to their relevance for the topic of the section. Using consensus, we selected the 15 most representative papers, which were submitted to external reviewers for full review and scoring. Based on the scoring and quality criteria, five papers were finally selected as best papers Results: The five best papers can be grouped in two major areas: 1) methods and tools to identify and collect formal requirements for secondary use of data, and 2) innovative topics highlighting the interest of carrying on "secondary" studies on patient data, more specifically on the data self-expressed by patients through social media tools. Regarding the formal requirements about informed consent, the selected papers report a comparison of legal aspects in European countries to find a common and unified grammar around the concept of "data donation". Regarding innovative approaches to value patient data, the selected papers report machine learning algorithms to extract knowledge from patient experience and satisfaction with health care delivery, drug and medication use, treatment compliance and barriers during cancer disease, or acceptation of public health actions such as vaccination. Conclusions: Secondary use of patient data (apart from personal health care record data) can be expressed according to many ways. Requirements to allow this secondary use have to be harmonized between countries, and social media platforms can be efficiently used to explore and create knowledge on patient experience with health problems or activities. Machine learning algorithms can explore those massive amounts of data to support health care professionals, and institutions provide more accurate knowledge about use and usage, behaviour, sentiment, or satisfaction about health care delivery.

Creation of the First French Database in Primary Care Using the ICPC2: Feasibility Study.

The objective of our study was to assess the feasibility of gathering data stored in primary care Electronic Health records (EHRs) in order to create a research database (PRIMEGE PACA project). The software for EHR models of two office and patient data management systems were analyzed; anonymized data was extracted and imported into a MySQL database. An ETL procedure to code text in ICPC2 codes was implemented. Eleven general practitioners (GPs) were enrolled as "data producers" and data were extracted from 2012 to 2015. In this paper, we explain the ways to make this process feasible as well as illustrate its utility for estimating epidemiological indicators and professional practice assessments. Other software is currently being analyzed for integration and expansion of this panel of GPs. This experimentation is recognized as a robust framework and is considered to be the technical foundation of the first regional observatory of primary care data.

All that Glitters Is not Gold: Consumer Health Informatics and Education in the Era of Social Media and Health Apps. Findings from the Yearbook 2016 Section on Consumer Health Informatics.

OBJECTIVE: To summarize the state of the art published during the year 2015 in the areas related to consumer health informatics and education with a special emphasis on unintended consequences of applying mobile and social media technologies in that domain. METHODS: We conducted a systematic review of articles published in PubMed with a predefined set of queries, which lead to the selection of over 700 potential relevant articles. Section editors screened those papers on the title, abstract, and finally complete paper basis, taking into account the papers' relevance for the section topic. The 15 most representative papers were finally selected by consensus between the two section editors and submitted for full review and scoring to external reviewers and the yearbook editors. Based on the final scoring, section editors selected the best five papers. RESULTS: The five best papers can be grouped in two major areas: 1) Digital health literacy and 2) Quality and safety concerns. Regarding health literacy issues of patients with chronic conditions such as asthma, online interventions should rather focus on changing patient beliefs about the disease than on supporting them in the management of their pathology since personally controlled health management systems do not show expected benefits,. Nevertheless, encouraging and training chronic patients for an active online health information-seeking behaviour substantially decreases state anxiety level. Regarding safety and privacy issues, even recommended health-related apps available on mobile phones do not guarantee personal data protection. Furthermore, the analysis indicated that patients undergoing Internet interventions experienced at least one adverse event that might be related to treatment. At least, predictive factors have been identified in order to credit or not a health rumour. CONCLUSIONS: Trusting digital and connected health can be achieved if patients, health care professionals, and industrials build a shared model of health data management integrating ethics rules. Only increasing efforts in education with regards of digital health would help reach this goal., This would not resolve all frauds and security issues but at least improve their detection.

[Benefits and usability of a pharmaceutical record in medical practice. A survey of hospital doctors and pharmacists (MATRIX study)]. / Intérêt et utilisabilité du dossier pharmaceutique en pratique médicale. Enquête auprès de médecins et pharmaciens hospitaliers (étude MATRIX).

BACKGROUND: To evaluate the impact of the pharmaceutical patient record use in emergency, geriatric and anaesthesia and intensive care departments, an experimentation was launched in 2013 in 55 hospitals. The purpose of the study was to assess the opinions of physicians and pharmacists about the benefits and usability of the patient pharmaceutical record. METHODS: An e-mailed self-administered questionnaire was sent to all the pharmacists, anaesthesiologists, geriatricians and emergency physicians of the 55 hospitals involved in the patient pharmaceutical record experimentation. The questionnaire assessed the usability of the patient pharmaceutical record using the "System Usability Scale", as well as its use, its benefits and limitations perceived in clinical practice, and overall user satisfaction. Questionnaires were collected from November 2014 to January 2015. RESULTS: Ninety-six questionnaires were collected, from 47 hospitals, representing 86% of the hospitals involved in the experimentation. The patient pharmaceutical record was effectively operational in 36 hospitals. Data from 73 questionnaires filled by physicians and pharmacists with potential experience with the patient pharmaceutical record were used for evaluation. Forty-two respondents were pharmacists (57%) and 31 were physicians (43%), including 13 geriatricians, 11 emergency physicians and 7 anaesthesiologists. Patient pharmaceutical record overall usability score was 62.5 out of 100. It did not vary with the profession or seniority of the respondent. It was positively correlated with the frequency of use. More than half of respondents reported that they never or uncommonly used the patient pharmaceutical record. The length of access to data period was considered as insufficient. Main obstacles to more utilization of the patient pharmaceutical record were the lack of information about the dosage of dispensed drugs, the low number of patients in possession of their health card and the low number of patients with an activated patient pharmaceutical record. CONCLUSION: Two years after the beginning of the experiment aiming to broaden the access to the patient pharmaceutical record to physicians, these first evaluation results are encouraging. The evaluation of the consequences of the access to the patient pharmaceutical record for physicians remains necessary.

Health Social Media and Patient-Centered Care: Buzz or Evidence? Findings from the Section "Education and Consumer Health Informatics" of the 2015 Edition of the IMIA Yearbook.

OBJECTIVE: To summarize the 2014 state of the art in the areas related to consumer health informatics and social media. METHODS: We conducted a systematic review of articles published in 2014 in PubMed with a predefined set of queries. We identified 439 articles relevant for the review. The two section editors independently screened those papers taking into account their relevance to the topics covered by the section. In a second step, they jointly selected the 20 most representative papers as candidate best papers. Candidate best papers were then submitted for full review and scoring by external reviewers. Based on the scoring, section editors together with the IMIA Yearbook editorial board selected the four best papers published in 2014 in consumer health informatics. RESULTS: Helping patients acquire a healthier lifestyle is a crucial part of patient empowerment. In this line of work, new studies are exploring the efficacy of online health interventions for patient behavioral change. The special case of smoking cessation for consumers with low socio-economic status is particularly noticeable. Another study has explored how an online intervention can reduce the anxiety of women who experience an abnormal mammography. The team of PatientsLikeMe has studied how online support groups could play a role in the quality of life of organ transplant recipients. The patient perspective of online forums' users is also analyzed in the domain of anticoagulation therapy. CONCLUSIONS: Online health interventions, many of them using social media, have confirmed their potential to impact consumer behavioral change. However, there are still many methodological issues that need to be addressed in order to prove cost-effectiveness.

[Prosocial intervention in children and adolescents with autism spectrum disorder without intellectual disability: benefits of videotaping therapy sessions]. / Intervention pro-sociale chez l'enfant et l'adolescent avec trouble du spectre autistique sans déficit intellectuel : intérêt du support vidéo.

INTRODUCTION: The category of pervasive developmental disorders (PDD) without intellectual disability (including Asperger syndrome and high-functioning autism) has increased steadily among individuals since the 1980s. Although some symptoms may decrease with age, functional disability persists and is largely related to abnormalities in social interaction. Within the framework of PDD without intellectual disability, improving social skills appears to be a primary target for intervention programs. Despite a recent increase in the number of studies on this topic, few validated programs are yet available for clinical settings. BACKGROUND: We have developed an intervention targeting the improvement of social skills from the analysis of video sequences. The goal of this intervention is to promote communication within the group through sharing their interests and emotions, and to enhance the understanding of social situations. In order to assess the efficiency of this intervention, we have conducted a prospective, open, and uncontrolled study. First, it aimed at assessing the immediate effect of our intervention on a single social skill (communication) in an experimental situation (in the group) and in an ecological situations (family and school). Second, this study aimed at assessing the effects of this intervention on the subjects' social adjustment. METHOD: This study included 16 individuals with high-functioning autism/Asperger syndrome. Participants were evaluated before and after a 6-month video-based training using measures of socio-communicative and adaptive skills. RESULTS: Results revealed a statistically significant increase in the communication skills not only in the group (15.5%), but also at home (13.7%) and at school (8.7%). The evaluation of socio-adaptive behavior indicates a statistically significant increase in communication (12%), family (7%) and social autonomy (8%), and leisure activities (8%). DISCUSSION: The communication and social adjustment scores obtained upon inclusion were low, despite low autistic intensity scores. However, the improvement at six months was significant for most studied variables. These results are consistent with our clinical findings and seem partly explained by the use of video supports as the mediator of exchanges within the group. However, because of some methodological limitations, the conclusions on the effects of the intervention should be nuanced. CONCLUSIONS: This type of intervention seems to be an interesting therapeutic indication for individuals with high-functioning autism/Asperger syndrome. The first results are encouraging, and all participants enjoyed attending the meetings. These conclusion elements encourage us to continue this intervention and to pursue further research by studying the impact on the individuals' quality of life.

Social media and patient health outcomes. Findings from the yearbook 2014 section on consumer health informatics.

OBJECTIVES: To provide a review of the current excellent research published in the field of Consumer Health Informatics. METHOD: We searched MEDLINE® and WEB OF SCIENCE® databases for papers published in 2013 in relation with Consumer Health Informatics. The authors identified 16 candidate best papers, which were then reviewed by four reviewers. RESULTS: Five out of the 16 candidate papers were selected as best papers. One paper presents the key features of a system to automate the collection of web-based social media content for subsequent semantic annotation. This paper emphasizes the importance of mining social media to collect novel data from which new findings in drug abuse research were uncovered. The second paper presents a practical method to predict how a community structure would impact the spreading of information within the community. The third paper presents a method for improving the quality of online health communities. The fourth presents a new social network to allow the monitoring of the evolution of individuals' health status and diagnostic deficiencies, difficulties or barriers in rehabilitation. The last paper reports on teenage patients' perception on privacy and social media. CONCLUSION: Selected papers not only show the value of using social media in the medical field but how to use these media to detect emergent diseases or risks, inform patients, promote disease prevention, and follow patients' opinion on healthcare resources.

Evidence-based Practice. Findings from the Section on Education and Consumer Health Informatics.

OBJECTIVES: To provide an overview of outstanding current research conducted in Education and Consumer Informatics. METHOD: Synopsis of the articles on education and consumer health informatics published in 2012 and selected for the IMIA Yearbook of Medical Informatics 2013. RESULTS: Architecture of monitoring or telehealth information systems for patients with chronic disease must include wireless devices to aid in the collection of personal data. Data acquisition technologies have an impact on patients' willingness to participate in telehealth programmes. Patients are more likely to prefer mobile applications over web-based applications. Social media is widely used by clinicians. Especially younger clinicians use it for personal purposes and for reference materials retrieval. Questions remain on optimal training requirements and on the effects on clinician behavior and on patient outcomes. A high level of e-Health literacy by patients will promote increased adoption and utilization of personal health records. CONCLUSION: The selected articles highlight the need for training of clinicians to become aware of existing telehealth systems, in order to correctly inform and guide patients to take part in telehealth systems and adopt personal healthcare records (PHR).

[Biometric and biomechanic analysis of lumbar posterior facets based on a CT-scan database]. / Analyse biométrique et biomécanique des articulaires lombaires postérieures au sein d'une base de données scanographique.

AIM OF THE STUDY: Our knowledge on anatomy of lumbar spine is based on few cadaver's study with old and few subjects. CT-scan is very precise for lumbar facet's morphology. We have analysed 400 subjects. The aim of this study is to measure different distances, angles and circles to better understand the mechanical function of the lumbar facets. PATIENTS AND METHODS: We have analysed 720 CT-scan. We had 217 men and 183 women with 59 years of mean age. We used native slices of 1.25 mm thick from L1 to S1. We created transversal plan and we put different mark point. We took their coordinates and we have calculated different distances, angles and mechanical circles. We have compared different axis of rotation of the facets. RESULTS: From L1 to S1, the facets goes near to the posterior wall and far from themselves. Moreover, the posterior angle between both facets increase down to the sacrum. The radius of the left side circle and the right one are very closed in 50% of the cases but the three radius are close only in 10% of cases. CONCLUSION: This study based on 400 subjects shows that there is not a unique axis of rotation for both lumbar posterior facets. We have had only 50% of symmetry between both sides whatever the level studied.

Pain assessment in Charcot-Marie-Tooth (CMT) disease.

OBJECTIVE: The objective of our study was to describe and evaluate the prevalence of chronic pain in persons with Charcot-Marie-Tooth (CMT) disease during a multidisciplinary consultation at the Center of Reference for Neuromuscular Diseases. METHODOLOGY: This prospective study was conducted between 2008 and 2010, it was a partnership between a Center of Reference for Neuromuscular Diseases (Centre de référence des maladies neuromusculaires [CRMD]) and a Department for the Assessment and Treatment of Pain (Département d'évaluation et de traitement de la douleur [DETD]). The evaluation consisted in a complete assessment of each patient during the first multidisciplinary consultation, with a previously established diagnosis validated by genetic testing, by various specialists: neurologist, PM&R physician, pain management specialist and physiotherapist. The evaluation tools used were Visual Analogical Scale (VAS), Hospital Anxiety and Depression Scale (HAD), DN4 scale, Neuropathic Pain Symptom Inventory (NPSI) (if DN4≥4), Pain Questionnaire of Saint Antoine (QDSA) (if DN4<4), body representation to define the painful areas, Overall Neuropathy Limitations Scale (ONLS), Medical Research Council scale (MRC), Short Questionnaire on Pain (QCD), VAS during transfers, self-care, getting dressed and physiotherapy sessions and quantified use of analgesics. RESULTS: A total of 50 patients were included (28 women, 22 men); two patients (one man and one woman) were discarded from the study because of missing pain assessment data. Mean age was 47years (R: 14-85), in average the symptoms had been present for the past 20years (R: 0.3-68), most patients had little impairment, the mean MRC was 53 (R: 36-60), with CMT1A being predominant (CMT1A: 76.9%, CMTX: 13.5%, CMT2: 5.8%, CMT4: 3.8%). It is noted that 65.4% of patients reported some pain with a mean duration of pain at 140months (R: 5-660). The mean VAS was 5.5 (R: 1-10), greater than 4 in 79.4% of cases, requiring the use of analgesics in 38.4% of cases (step 1: 60%, step 2: 40% on the WHO pain relief ladder). The predominant location of the pain was distal, peripheral and symmetric (64.7%); furthermore the feet were affected in 80% of cases. DN4 was positive in 40.6% of painful patients. In 62.5% of the cases, the pain did not have an underlying mechanical origin. The emotional impact remained quite modest (HAD: A=8; D=5). Patients with CMT1A seemed less affected by pain (P=0.03). CONCLUSION: This original study describes the pain in patients with CMT disease during a primary multidisciplinary consultation. We see that in 66% of cases, patients do report some pain, this pain is usually moderate, preferentially located in the extremities and is symmetric. In 62.5% of cases, the pain has a neuromuscular origin with a positive DN4 in 50% of cases in this etiology. In our study, patients with CMT1A report less pain than patients with other CMT types. This disease being quite rare (rare disease), the number of patients did not allow us to bring up statistically significant results. The pain must be thoroughly screened for because of its frequency in persons with CMT.

[Who are the recipients of labile blood products? A multicenter nation-wide study--a "donation day." Blood banks, health facilities]. / Qui sont les receveurs de produits sanguins labiles (PSL)? Une étude nationale multicentrique - un jour donné. Etablissement de transfusion sanguine (ETS) - établissements de santé (ES).

During the years 1994-2001, a progressive decrease of the number of blood units transfused has been reported in France. In contrast, since 2002, there is an increasing number of blood units issuing (+7.6% between 2001 and 2006) and this must be investigated. On behalf of the French Society of Blood Transfusion, the "Recipients" working group promoted a nation wide survey with the support of the regional blood transfusion centres. This survey was aimed at describing the profiles of the transfused patients: socio-demographical patterns, and reasons of the blood transfusion (main and associated diagnoses). A cross-sectional survey was designed. All the patients who received a blood unit during a specific day were considered as the population of the study. They were identified by the regional transfusion centres by means of the "individual issuing form". Survey forms were fully filled for 90% of the patients. It has been considered as a good answer rate. Seven thousand four hundred and twenty-two blood units, delivered to 3450 patients were analyzed. Three groups of pathologies were found as a reason of transfusion: haematology-oncology (52.70% of the prescriptions) with 892 patients (27.8%) for haematological malignancies; surgical procedures (23.99%); intensive care and medicine procedures (21.92%). More than 50% of the recipients are 70 years old and more. This result is explained by the age distribution of inpatients. In a context of lack of donors and consequently difficulties to provide patients with optimal number of blood units, this study is helpful. Variability of blood unit issuings must be detected, analyzed and monitored in real time by the actors of the transfusion process, using computerized dashboards: the blood units provider (in order to adjust the strategy of blood units provision) and the health care establishment as well as care blood components prescribers (reasons of blood transfusion and evaluation of practices).

[Coordination of health vigilances: for a global management of hospital risks]. / La coordination des vigilances sanitaires : pour une gestion plus globale des risques hospitaliers.

The sanitary vigilances represent a permanent sanitary surveillance. They signal, enregister, treat and investigate the adverse events occurring through the use of health products. They assure the traceability of these health products and the management of the sanitary alerts. The sanitary vigilances are part of the sanitary security. They are optimized when coordinated and integrated to the global risk management process of the health care establishments.

Sex determination from the distal part of the femur in a French contemporary population.

Until now, determining the sex of a recently deceased individual using the measurement of the bicondylar breadth of the femur (also known as condylar width, epicondylar breadth and distal epiphyseal breadth) raised some concerns as to accuracy because no sample of contemporary French subjects was available. In this study, a sample of 88 female and male femurs taken from recently deceased elderly French people was studied. The bones were collected from subjects who had donated their bodies to the Medical School of Nice. The mean value of the male bicondylar breadth was found to be greater than that of females (84.3mm versus 74.8mm), confirming the sexual dimorphism of this parameter. Furthermore, the results showed a 95.4% accuracy rate for sexing individuals. To date, in the French population, as in some other samples, epicondylar breadth is the single most accurate measurement of sex determination, ahead even of head diameter. A discriminant function is presented to allow sex determination from remains of the distal femur. With regard to the data available in the literature, sexual dimorphism is probably the result of both genetic and environmental factors. The comparison of our results with those of other populations shows that there are inter-population variations of the bicondylar breadth, and also intra-population variations that account for the differences in the accuracy rate of this variable for the purposes of sex determination. These findings underscore the need to re-evaluate bone measurements within various contemporary populations.

[A structured ePortfolio to handle a programme of professional competences assessment in the area of transfusion medicine]. / Un portfolio électronique structuré pour la gestion et le suivi des dossiers d'évaluation des pratiques professionnelles en technique et médecine transfusionnelles.

In order to organize a nationwide program for the evaluation of professional practices in the area of blood transfusion, the French National Blood Transfusion Institute and the Nice-Sophia Antipolis University designed and implemented a web based service aimed at following-up and guiding the physicians involved in such an assessment program. The core component is a structured electronic portfolio (ePortfolio), the implementation of which was based on an object-oriented environment combined with a content management system. The modelling of the global evaluation system makes it possible to describe this type of portfolio according to six axes: an axis "objectives" (competencies accreditation); an axis "target" (heath care professionals); an axis "content" (numerical documents); an axis "structure" (matrix of answer defined in space and time); an axis "source" (single source peer-reviewed); an axis "level of evidence" (validation of the proof after its deposit by an identified and authenticated peer user, whole tracking of the exchanges and interactions between users and device).

[Transcatheter embolization for endoscopically unmanageable acute nonvariceal upper gastrointestinal hemorrhage]. / Traitement par embolisation endovasculaire d'hémorragies gastro-intestinales hautes non variqueuses et aiguës après échec du traitement endoscopique.

OBJECTIVES: Evaluate the efficacy of endovascular embolization for patients with endoscopically unmanageable acute nonvariceal upper gastrointestinal hemorrhage as well as the factors that may influence mortality. MATERIALS AND METHODS. Retrospective study over a 4-year period including a historical cohort of 37 consecutive patients (22 men), with a mean age of 69.2 years (range, 22-93 years). In most cases (54%), the hemorrhage stemmed from a gastrointestinal ulcer. Technical, primary clinical, and secondary clinical success rates, as well as complication rates, were calculated. Several clinical and angiographic parameters were compared to the early mortality rate using Kruskal-Wallis or Fisher tests. RESULTS: Technical, primary clinical, secondary clinical success rates, and complication rates were, respectively, 89.2%, 83.8%, 88.9%, and 10.8%. The early mortality rate was 32.4%. The APACHE II and IGS II scores were strongly correlated with mortality (p=0.001 and p=0.003, respectively). CONCLUSION: Endovascular embolization in patients with endoscopically unmanageable acute nonvariceal upper gastrointestinal hemorrhage is effective. However, the mortality rate remains high because of the changes in the clinical condition of these patients.

Tissue-specific differential antitumour effect of molecular forms of fractalkine in a mouse model of metastatic colon cancer.

BACKGROUND AND AIMS: Fractalkine, a chemokine that presents as both a secreted and a membrane-anchored form, has been described as having tumour-suppressive activities in standard subcutaneous models. Here, we investigate the antitumour effect of fractalkine, in its three molecular forms, in two orthotopic models of metastatic colon cancer (liver and lung) and in the standard subcutaneous model. METHODS: We have developed models of skin tumours, liver and pulmonary metastasis and compared the extent of tumour development between C26 colon cancer cells expressing either the native, the soluble, the membrane-bound fractalkine or none. RESULTS: The native fractalkine exhibits the strongest antitumour effect, reducing the tumour size by 93% in the skin and by 99% in the orthotopic models (p<0.0001). Its overall effect results from a critical balance between the activity of the secreted and the membrane-bound forms, balance that is itself dependent on the target tissue. In the skin, both molecular variants reduce tumour development by 66% (p<0.01). In contrast, the liver and lung metastases are only significantly reduced by the soluble form (by 96%, p<0.002) whereas the membrane-bound variant exerts a barely significant effect in the liver (p = 0.049) and promotes tumour growth in the lungs. Moreover, we show a significant difference in the contribution of the infiltrating leukocytes to the tumour-suppressive activity of fractalkine between the standard and the orthotopic models. CONCLUSIONS: Fractalkine expression by C26 tumour cells drastically reduces their metastatic potential in the two physiological target organs. Both molecular forms contribute to its antitumour potential but exhibit differential effects on tumour development depending on the target tissue.

[Prevalence of pressure sores in a university hospital in 2003]. / L'escarre à l'hôpital en 2003: enquête de prévalence un jour donné.

BACKGROUND: To determine the prevalence of pressure sores in a university hospital and to assess the risk of developing a pressure sore. METHODS: A one-day survey was performed in all hospitalized patients, day hospital excepted. The Garches scale was used to assess the severity of pressure sores and the Braden scale was used to measure the patient's risk for the development of pressure ulcers. RESULTS: One thousand six hundred and eleven patients were included, mean age was 62+/-23 years and 53.3% were over 65 years old. In hospitalized patients, 64% were in acute care, 29% in intermediate medicine and long-term care and 7% in intensive care units. We have found 675 pressure sores in 268 patients, mean age of 76 years; 263 decubitus ulcers were acquired during hospitalization. The most frequent sites were heels (46%) and sacrum (26%). Stage 1 pressure ulcers showed 33% of the total. The total prevalence was 16.6%, 95% CI (14.9-18.6), the hospital acquired pressure sores prevalence was 7.5%, all stages included. A Braden score less than or equal to 15 was found in 29.1% of hospitalized patients. Standard mattresses were used in 37% of patients with pressure sores. Multivariate analysis showed that age and a Braden score less than or equal to 15 were significantly associated with pressure sores. CONCLUSION: Pressure sores are still an important problem in hospital; occurrence must be considered as an iatrogenic event and management requires a multidisciplinary approach.