Assessment of Diagnostic Strategy for Mucous Membrane Pemphigoid.

IMPORTANCE: An accurate diagnosis of mucous membrane pemphigoid (MMP) is essential to reduce diagnostic and therapeutic delay. OBJECTIVE: To assess the diagnostic accuracy of direct immunofluorescence microscopy on mucosal biopsy specimens and immunoserology in a large cohort of patients with suspected MMP. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study was carried out in a single tertiary care center for blistering diseases between January 2002 and March 2019. Eligible participants were patients with suspected MMP and paired data on at least a mucosal biopsy specimen for direct immunofluorescence microscopy (DIF) and indirect immunofluorescence microscopy (IIF) on a human salt-split skin substrate (SSS). In addition, an optional DIF test on a skin biopsy specimen and one or more performed routine immunoserologic tests were analyzed. Data analysis was conducted from April 2019, to June 2020. MAIN OUTCOMES AND MEASURES: Diagnostic accuracy of DIF, IIF SSS, and immunoblot for BP180 and BP230. RESULTS: Of the 787 participants, 121 (15.4%) received the diagnosis of MMP (50 men [41.3%], 71 women [58.7%]; mean [SD] age at diagnosis, 60.1 [17.7] years). Sixty-seven of the patients with MMP (55.4%) had monosite involvement, of which oral site was the most frequently affected (51 [42.1%]). No significant difference was found between the sensitivity of DIF on a perilesional buccal biopsy and a normal buccal biopsy (89.3% vs 76.7%). Three patients with solitary ocular involvement showed a positive DIF of only the oral mucosa. In 6 patients with a negative mucosal DIF, a skin biopsy confirmed diagnosis of MMP. Overall, IIF SSS was less sensitive (44.6%), but highly specific (98.9%). The sensitivity of immunoblot (66.1%) was higher compared to SSS, but with lower specificity (91.3%). CONCLUSIONS AND RELEVANCE: This comparative diagnostic accuracy study of a cohort of 787 patients found a high sensitivity of a mucosal DIF biopsy for diagnosis of MMP, and lower sensitivity of serologic analysis. A biopsy can be taken from either perilesional or normal buccal mucosa. An additional DIF biopsy of another mucosal site or of affected or unaffected skin may increase the diagnostic yield and is recommended in patients with negative DIF results and high clinical suspicion.

Gold nanoparticles assembled with dithiocarbamate-anchored molecular wires.

A protocol for the bottom-up self-assembly of nanogaps is developed through molecular linking of gold nanoparticles (AuNPs). Two π-conjugated oligo(phenylene ethynylene) molecules (OPE) with dithiocarbamate anchoring groups are used as ligands for the AuNPs. OPE-4S with a dithiocarbamate in each end of the molecule and a reference molecule OPE-2S with only a single dithiocarbamate end group. The linking mechanism of OPE-4S is investigated by using a combination of TEM, UV-Vis absorption and surface enhanced Raman spectroscopy (SERS) as well as studying the effect of varying the OPE-4S to AuNP concentration ratio. UV-Vis absorption confirms the formation of AuNP aggregates by the appearance of an extended plasmon band (EPB) for which the red shift and intensity depend on the OPE-4S:AuNP ratio. SERS confirms the presence of OPE-4S and shows a gradual increase of the signal intensity with increasing OPE-4S:AuNP ratios up to a ratio of about 4000, after which the SERS intensity does not increase significantly. For OPE-2S, no linking is observed below full coverage of the AuNPs indicating that the observed aggregate formation at high OPE-2S:AuNP ratios, above full AuNP coverage, is most likely of a physical nature (van der Waals forces or π-π interactions).

Is non-operative management of severe blunt splenic injury safer than embolization or surgery? Results from a French prospective multicenter study.

PURPOSE OF THE STUDY: The management of the severe blunt splenic injuries remains debated. The aim of this study is to evaluate the morbidity and mortality of splenic injury according to severity and management (surgery, embolization, non-operative management [NOM]). METHODS: A prospective multicenter study was conducted including patients aged 16 years and older with diagnosed splenic injury. We evaluated severity according to the AAST classification, the presence of hemoperitoneum or a contrast blush on initial CT scan. The initial hemodynamic status, patients co-morbidities, the ISS (injury severity score), management and morbidity were also noted. RESULTS: Between May 2010 and May 2012, 91 patients were included. Thirty-seven patients (41%) had mild splenic injury (AAST I or II and a small hemoperitoneum) while 54 patients (59%) had severe splenic injury (AAST III or greater). The management included 18 splenectomies (20%), 15 embolizations (16%). Among 67 patients undergoing NOM without initial embolization, five (7%) developed secondary bleeding, five required surgery and nine underwent secondary embolization. No patient died and morbidity was 44% (n=40), 13% for mild injuries vs. 65% for severe injuries (P<0.01). For severe injuries, total morbidity was 58% after NOM, 73% after embolization and 70% after surgery. Specific morbidity related to the management was 10% after NOM vs. 47% after embolization (P=0.02). Specific morbidity after surgery was 15%. CONCLUSION: Embolization, because of its important specific morbidity, should not be performed as a prophylactic measure, but only in presence of clinical or laboratory signs of bleeding.

Carbide complexes as π-acceptor ligands.

The π-accepting character of a terminal carbide complex acting as a ligand is demonstrated experimentally and corroborates earlier theoretical predictions. As a result, coordination of a terminal ruthenium carbide complex to electron-rich metal centres is shown to provide a facile and versatile route to carbide-bridged heterometallic complexes. Synthesis, reactivity, spectroscopic and structural characterization are reported for heterobimetallic systems with auxiliary metals from groups 9-11: Rh(i), Ir(i), Pd(ii), Pt(ii), Ag(i), and Au(i) coordinated by [Ru(C)Cl2(PCy3)2] (RuC). This encompasses the first example of a homoleptic carbide-ligated transition metal complex: [{(Cy3P)2Cl2RuC}2Au]+. Kinetics of substitution on Pt(ii) by RuC ranks the carbide complex as having intermediate nucleophilicity. The 13C-NMR signals from the carbide ligands are significantly more shielded in the bridged heterobimetallic complexes than in the parent terminal carbide complex. Structurally, RuC forms very shorts bonds to the heterometals, which supports the notion of the multiple bonded complex acting as a π-backbonding ligand. Reactions are reported where RuC displaces CO coordinated to Rh(i) and Ir(i). A strong trans influence exerted by RuC indicates it to be a stronger σ-donor than CO. The geometries around the carbide bridges resemble those in complexes of electron-rich metals with carbonyl or bridging nitride-complex-derived ligands, which establishes a link to other strong π-acceptor ligands.

Ultrathin reduced graphene oxide films as transparent top-contacts for light switchable solid-state molecular junctions.

A new type of solid-state molecular junction is introduced, which employs reduced graphene oxide as a transparent top contact that permits a self-assembled molecular monolayer to be photoswitched in situ, while simultaneously enabling charge-transport measurements across the molecules. The electrical switching behavior of a less-studied molecular switch, dihydroazulene/vinylheptafulvene, is described, which is used as a test case.

End-to-end assembly of gold nanorods via oligopeptide linking and surfactant control.

We report two novel approaches for fabricating self-assembled chains of end-to-end linked Au nanorods separated by a nanogap. In one approach, bi-functional cysteine end-capped oligopeptides of different lengths are used as the linking agent. The widths of the produced nanogaps scale with the length and tertiary structure of the peptide linker. Functionalized oligopeptides containing an acetylene group are also employed as a linker, and the functional group is uniquely identified using surface-enhanced Raman spectroscopy. The development of an oligopeptide-linking platform is motivated by the ease of synthesis and high modularity of peptides; these features enable the possibility to integrate diverse functionality into molecular nanogap junctions - synthesized in water. The stepwise nanochain formation is followed via the evolution of the longitudinal plasmon absorption band in combination with transmission electron microscopy. The reaction rate and extent is tuned by controlling the concentration of the stabilizing CTAB surfactant in the solution. At very low surfactant concentrations, spontaneous end-to-end linking of the Au nanorods is observed even in the absence of linking peptide. The assembled AuNRs may act as next-generation electrodes in a platform for molecular electronics and synthetic biology.

Band and port-related morbidity after bariatric surgery: an underestimated problem.

OBJECTIVE: To evaluate the magnitude of the morbidity related to the system used for gastric banding Methods Between January 1997 and December 2004, 286 consecutive patients underwent laparoscopic gastric banding (LAGB) in one center. We used 4 models of LapBand 9.75, 10, 11 and Vanguard with pars flacida route. Recalibration of band was performed in our consultation unit without systematic radiologic control. We considered four kinds of complication: port displacement, port rupture, band rupture and others problems. RESULTS: The mean follow up was 3.3+/-2.8 years with a median 2.9 years. Complications occurred within a mean time of 2.2+/-1.9 years. For the models vanguard and size 11, there were no rupture and 15 (27.7%) displacements whereas for size 9.75 and 10 there were 39 ruptures (14.7%) and 15 (5.6%) displacements. Types of complications were related to the bands used i.e. more port displacements for the models vanguard and size 11 and more band and port ruptures for the models size 9.75 and 10. But when we considered the respective follow up according to the type of band these differences were no longer significant. Moreover rupture rate was significantly high but decreased after March 2002 because of changing of junction between port and catheter. Mean excess weight loss (35.2+/-27.7%) was not different in group whether the patients were reoperated or not. CONCLUSION: Band and port related morbidity is an important aspect of bariatric surgery. We have to pay attention to material evolution and to our follow up for calibration. Some new recent technical advancement could improve the management of these patients.

[Major digestive surgery in octogenarians. A prospective study of 54 cases]. / La chirurgie digestive lourde après 80 ans. Etude rétrospective de 54 cas.

OBJECTIVE: The interest in geriatric surgery is on the increase because of the ageing of the population. Our study reviewed the results of a non- specialised unit. Method 54 octogenarians underwent digestive surgery including visceral resection. Cancer predominated the indications (80%). RESULTS: The patients exhibited cardiovascular (87%), endocrine (18.5%) or neuropsychiatric (29.6%) disorders with 75% scoring ASA III or IV. Morbidity was of 81.5% with 20% of specifically surgical complications and a 40.2% rate of cardiovascular complications. Post-surgical mortality was of 7.4% and the survival rate at 2 years was of 44.4%. The treating physicians judged that in 65% of patients the intervention had improved the initial status of the patient and had stabilised the disease in 35% of cases. The percentage of patients living at home declined from 83.3% before the intervention to 64.8% after the intervention. Only 2 out of the 9 patients having undergone stomy of the colon following colectomy continued to improve. CONCLUSION: This study underlines the interest of major surgery in octogenarians, including in units non-specialised in geriatric surgery.

[Evaluation of laparoscopic bariatric surgery using the BAROS score]. / Evaluation de la chirurgie coelioscopique de l'obésité par le score BAROS.

AIM OF THE STUDY: Mid-term assessment of laparoscopic adjustable silicon gastric banding (Lap-Band) by a specific score. PATIENTS AND METHODS: One hundred consecutive patients received by mail 12 to 54 months after laparoscopic adjustable gastric banding a questionnaire including the Bariatric Analysis and Reporting Outcome System (BAROS) which is the only specific and validated instrument for measuring the quality of life after bariatric surgery. This score includes five categories of results (failure, fair, good, very good, excellent). It uses three major fields: the quality of life, excess weight loss, and medical comorbidities evaluation. RESULTS: Seventy three patients answered back with a mean follow up of 24.6 +/- 10 months. Forty six (2/3) had lost more than 50% of their weight excess. Sixty six experienced an improvement of their medical conditions following surgery. Final results were good or excellent for 60 patients (82% of those who answered back). Failure was reported in 7 patients (2 "sweet eaters" and 2 pouch dilatations) which needed a surgical treatment. CONCLUSION: This evaluation based on the BAROS confirms its validation in France and the good mid-term results of bariatric surgery based on the Lap-Band.

[Do bipolar scissors increase postoperative adhesions? An experimental double-blind randomized trial]. / Les ciseaux bipolaires augmentent-ils les adhérences postopératoires? Etude expérimentale randomisée en double aveugle.

AIM: The use of bipolar scissors (PowerStar) which has been suggested to reduce bleeding during surgical dissection, involves the theoretical risk for increasing intraperitoneal adhesions because of burn damages to the peritoneum secondary to bipolar electrocautery. MATERIAL AND METHOD: Thirty-six white new-Zealand rabbits have been included in a double-blind randomised trial to undergo a laparotomy using either a sharp scissors with on-demand monopolar coagulation or a bipolar scissors. Operatives procedures were standardised: midline laparotomy (5 cm), mobilisation of the right colon, incision of the colonic serosa without suture, incision of the colonic serosa with running sutures, incision of the mesentery. All these steps were performed by the same device according to the randomisation. Ten days later, the rabbits were killed. Adhesions were measured and scored according to the Zühlke classification by a surgeon who was not aware of the type of scissors used. Finally a pathological examination of adhesion was randomly performed. RESULTS: The two groups were similar for weight and sex-ratio. Two rabbits died before the tenth postoperative day (1 unknown aetiology and 1 evisceration). 34 rabbits were available for the study (18 in the "PowerStar" group and 16 in the control group). The results showed no significant difference between the groups for all measured endpoints (length and score of intraperitoneal and parietal adhesions). Nevertheless, pathological examination showed the burn damages to be less pronounced after using PowerStar. CONCLUSION: Bipolar scissors do not increase postoperative adhesions in the rabbit and probably induce less burn damages than monopolar cautery. The additional advantage i.e. the decrease adhesions formation, because of a less intraperitoneal bleeding, has not been observed in this randomised trial.

[French randomized trials in general and digestive surgery in the last decade]. / Essais randomisés français en chirurgie générale et digestive au cours de la dernière décennie.

STUDY AIM: To study the characteristics of randomized trials published by general and digestive French surgeons over the last decade. MATERIAL AND METHODS: An extensive electronic and manual literature search was performed. Trials published as original articles compared two surgical techniques or a surgical procedure with a nonsurgical treatment. The characteristics of the trials and their methodology were assessed. At the same time, a survey was conducted among authors to assess the impact of application of the Huriet-Sérusclat law (ethics related to the protection of individuals subjected to bioclinical research) on the conduct of the trial. RESULTS: Forty trials (including 22 multicentre trials) were found. Twelve trials (30%) addressed a key-question and twenty (50%) addressed a particular step of the procedure (anastomosis, drainage, etc). Most trials (83%) were published in English language journals. The 18 trials with a good methodological quality mainly had a multicentre design (n = 16). The survey showed that 10 trials were conducted prior to the publication of Huriet-Sérusclat law and that 14 trials were conducted in compliance with this law. CONCLUSION: This study revealed the large number of well designed multicentre trials in France. But most trials assessed technical steps of the surgical procedures. Application (without prerequisite) of the Huriet-Sérusclat law could probably explain the rarity and the difficulties of conducting trials comparing two different procedures or a surgical with a medical treatment.