249 research outputs found
A minimally invasive approach for peritonectomy procedures and hyperthermic intraperitoneal chemotherapy (HIPEC) in limited peritoneal carcinomatosis: The American Society of Peritoneal Surface Malignancies (ASPSM) multi-institution analysis
No full textBackground Minimally invasive surgery is playing an increasing role in the treatment of patients with gastrointestinal and gynaecological malignancies as the data show reduced morbidity, faster recovery and similar oncological outcome when compared to open procedures.Materials and methodsThe American Society of Peritoneal Surface Malignancies (ASPSM) conducted a retrospective study to analyse peritonectomy procedures and HIPEC done via the laparoscopic route. A database with standard clinical and pathological parameters was set up and distributed amongst ASPSM members. Rate of relapse, morbidity and mortality were the primary endpoints of the study.ResultsA total of 90 patients from 7 centres around the world were identified. Sixty percent were female. Mean age was 50years. Peritoneal carcinomatosis from appendiceal origin was the most common diagnosis in a 64.9% of patients and colon origin was diagnosed in 16.5% of patients. Mean peritoneal cancer index (PCI) was 4.1 (0-10). Forty-one percent of patients had a bowel resection. Mean operative time was 4.7h (2.5-8). All patients had a complete cytoreduction and HIPEC. Grade 3 and 4 morbidity was 3.0 and 6.5%, respectively. The most common reason for re-operation was an internal hernia in 2 out of 5 cases. Operative mortality and re-admission rates were 0 and 5%, respectively. Mean hospital stay was 7.4days (1-18). At a mean follow-up of 31.6months, 15/90 patients have a disease relapse but loco-regional relapse was identified in only five patients.ConclusionsAnalysis of these data suggests that minimally invasive approach for peritonectomy procedures and HIPEC is feasible, safe and should be considered as part of the armamentarium for highly selected patients with peritoneal surface malignancies with limited tumour burden, defined as PCI of 10 or less and borderline tumours as low-grade pseudomyxoma and benign multicystic mesothelioma
RAS/TP53 co-Mutation is Associated with Worse Survival after Concurrent Resection of Colorectal Liver Metastases and Extrahepatic Disease
No full textObjectiveTo determine if tumor genetics are associated with overall survival (OS) after concurrent resection of colorectal liver metastases (CLM) and extrahepatic disease (EHD).Summary background dataThe prognosis for patients who undergo concurrent resection of CLM/EHD is unclear and the impact of somatic mutations has not been reported.MethodsPatients undergoing concurrent resection of CLM and EHD from 2007-2017 were identified from two academic centers. From 1 center, patients were selected from a pre-existing database of patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC). The Kaplan-Meier method was used to construct survival curves, compared using the log-rank test. Multivariable Cox analysis for OS was performed.ResultsOne hundred nine patients were included. Most common EHD sites included lung (33 patients), peritoneum (32), and portal lymph nodes (14). TP53 mutation was the most common mutation, identified in 75 patients (69%), and RAS/TP53 co-mutation was identified in 31 patients (28%). The median OS was 49 months (IQR, 24-125), and 3- and 5-year OS rates were 66% and 44%, respectively. Compared to patients without RAS/TP53 co-mutation, patients with RAS/TP53 co-mutation had lower median OS: 39 vs. 51 months (P = .02). On multivariable analysis, lung EHD (hazard ratio [HR], 0.7; 95% CI, 0.3-1.4), peritoneal EHD (HR, 2.2; 95% CI, 1.1-4.2) and RAS/TP53 co-mutation (HR, 2.8; 95% CI, 1.1-7.2) were independently associated with OS.ConclusionsRAS/TP53 co-mutation is associated with worse OS after concurrent CLM/EHD resection. Mutational status and site of EHD should be included in the evaluation of patients considered for concurrent resection
Targeting the invisible: precision fiducial marker placement in poorly visible liver tumors prior to percutaneous ablation using real-time image fusion guidance
No full textThis study aimed to assess the feasibility and accuracy of fiducial marker placement using US-CT/MRI fusion imaging guidance in poorly conspicuous liver tumors prior to percutaneous thermal ablation (PTA).
From January 2016 to February 2018, 30 consecutive patients with 38 liver lesions that were poorly or not visible on conventional ultrasound underwent fiducial marker placement under real-time US-CT/MRI fusion imaging before the PTA procedure. Marker position was confirmed via CT or MRI immediately after placement. The shortest distance between the marker and the edge of the target lesion, the lesion size, and the depth were measured. The fiducial marker placement was considered successful if the marker was within, in contact or ≤5 mm distance from the lesion; a distance >5 mm was considered a failure.
Of the 38 lesions, 28 (74%) were undetectable using ultrasound alone, while 10 (26%) were not confidently identified. After fusion, 26 lesions (68%) showed enhanced visibility, while 12 (32%) remained undetectable. Overall, the mean distance between the fiducial marker and the lesion's edge was 4 mm (range: 0-45 mm). Successful placement was achieved in 30 lesions (79%): 27, inside or in contact, and 3, at a <5 mm distance from the target lesion. Placement was unsuccessful in eight lesions (21%). No procedure-related complications occurred.
The present work suggests that pre-PTA placement of a fiducial marker in poorly visible tumors using real-time US-CT/MRI fusion imaging is accurate, potentially enhancing the effectiveness of subsequent PTA.
© 2025 Villard, Tsoumakidou, Gay, Rousset, Passot, Muller, Dumortier, Valette and Milot
Miedo a la muerte y ansiedad en el contexto Covid-19
No full textThis bibliographical review article authorized by the chair will present, develop and analyze two important variables within the field of mental health: fear of death and anxiety, both responding to the same psychobiological notion, where fear of death is a subset within the anxiety set. Faced with this, an analysis of them will be carried out in relation to the context of what was the global health emergency due to the Covid-19 pandemic. It has been carried out as a professional interest, since it summons us as future psychologists to learn about and make a contribution to the problem of the phenomenon. It was concluded that the Covid-19 pandemic has left consequences in the history of mental health worldwide, which will be the responsibility of public policies and of each individual in particular to improve the quality of life.Este artículo de revisión bibliográfica autorizado busca desarrollar y analizar dos variables importantes dentro del campo de la salud mental: miedo a la muerte y ansiedad, siendo que ambas responden a la misma noción psicobiológica, donde el miedo a la muerte es un subconjunto dentro del conjunto ansiedad. Frente a esto, se va a realizar un análisis de las mismas en relacion al contexto de lo que fue la emergencia sanitaria mundial por la pandemia Covid-19. El mismo se ha realizado a modo de interés profesional, ya que nos convoca como futuros psicólogos y psicólogas para conocer y realizar un aporte a la problemática del fenómeno. Se concluyó que la pandemia por Covid-19 ha dejado secuelas en la historia de la salud mental a nivel mundial, las cuales serán responsabilidad de las políticas públicas y de cada sujeto en particular para mejorar la calidad de vida
Rôle et spécificité d'interaction des systèmes par ABS de Burkholderia cenocepacia, bactérie multi-chromosomique
No full textNotre modèle d'étude est B.cenocepacia J2315 (Bcen) dont le génome comporte 3 chromosomes (c1, c2 et c3) et 1 plasmide (pBC), chacun porteur d'un système parABS, homologue de systèmes de ségrégation plasmidiques connus. L'étude de délétions des opérons parAB et d'excès des sites parS a montré l'importance des parABS pour la croissance et la viabilité de Bcen. L'analyse de la localisation des origines des réplicons dans les mutants montre que les parABS sont impliqués dans la ségrégation leur réplicon.
La cohabitation des 4 parABS nécessite l'absence d'interaction croisée. Ceci est possible grâce à l'étroitesse d'interaction entre ParB et parS, visible par la faible tolérance aux mutations de parSc1 et parSc3 dans des tests de toxicité chez Bcen. L'identification et l'analyse d'un groupe de systèmes parABS apparentés nous a permis d'identifier un domaine pHTH impliqué dans la fixation de ParB sur parS, et de révéler un rôle de la compatibilité dans la diversification des systèmes parABS.We are working on B.cenocepacia J2315 (Bcen), which genome is divided into 3 chromosomes (c1, c2, c3) and 1 plasmid (pBC), each carrying a parABS system, homologs of known plasmid segregation systems. By studying deletions of the parAB operons and excess of parS sites, I proved that parABS systems are important for fitness. More specifically, the analysis of the replicon origin localizations indicates that these systems are implied in the segregation of their own replicons. To avoid incompatibility, the 4 parABS systems must avoid cross-interactions. This is achieved by a stringent ParB-parS interaction, as shown by lack of recognition of mutant parSc1 or parSc3 in toxicity tests in Bcen. Identification and analysis of a group of related parABS, exclusive of the secondary replicons of the Burkholderiales, allowed us to identify a pHTH domain implied in ParB binding on parS, and to reveal that compatibility drives a diversifying evolution of the parABS systems
What Makes a Novel's First Sentence Special? How the reader feels its specificity, how linguistics can account for it. A study upon English-written material
No full textDélaissée par les théoriciens pour la notion plus large d'incipit, il semble pourtant acquis que la première phrase d'un roman est spécifique. À l'aide des outils de la linguistique et dans une approche centrée sur le lecteur, on a voulu caractériser cette spécificité ressentie, identifier ses causes et ses effets. Le matériel est un corpus de 402 premières phrases tirées de romans publiés de 1980 à 2011, rédigés en langue anglaise. Penser le commencement est un défi pour la cognition. Le début de roman rejoue ses problématiques et met face à l'arbitraire indépassable de toute création. Le passage du discours ordinaire au discours fictionnel pose la question du statut logique de la fiction et fait apparaître la première phrase comme le seuil critique où s'articule un dialogue entre réalité et fiction. La théorie littéraire et le structuralisme attribuent des fonctions (programmation, codification) au commencement. La première phrase inaugure un espace énonciatif ludique et est le lieu d'un transfert d'autorité énonciative de l'auteur au narrateur. Elle construit le cadre énonciatif et narratif du récit, mais aussi ses premiers contenus, dont le lecteur élabore des représentations mentales. L'étude de l'anatomie du corpus révèle un manque de spécificité grammaticale, le jeu consistant à faire comme si la phrase n'était pas la première. En résulte une énigme, dont la résolution détourne à des fins ludiques les fonctions cognitives habituellement dévolues aux problèmes sérieux. Ce piège séductif explique le phénomène d'immersion fictionnelle, dont on explore également le versant esthétique. La spécificité de la première phrase de roman est avant tout cognitive et affective.Despite being neglected by theorists for the larger notion of incipit, it is generally accepted that the first sentence of a novel is special. Taking the point of view of the reader, this dissertation aims at characterizing this specificity and identifying its causes and effects, using the tools and concepts of linguistics. 402 first sentences were studied, taken from novels published from 1980 to 2011 and written in English. Beginnings are cognitive non-sense. The opening sentence inherits this specificity and places the reader in front of the arbitrariness inherent to creation. The emerging fictional discourse also raises the question of its logical status and makes the opening sentence appear as a hinge between reality and fiction. For literature theorists and structuralists, beginnings have functions (programmatic, codifying). Also, the first sentence is often seen as a crucial brick in the fictional apparatus. It is the opening fringe of a new speech territory, ie a game one, and the edge where enunciative authority is being transferred from the author onto the narrator. It sets the enunciative and narrative frame-work of the story, as well as its first contents, of which readers elaborate mental representations. A study of the anatomy of the corpus reveals its lack of grammatical specificity, part of the game being for the opening sentence not to appear as such. The result is an enigmatic sentence which, for the purpose of the game, hijacks cognitive functions meant for serious matters. This cognitive hijacking is a seduction, it facilitates fictional immersion, which also is an aesthetic experience. The specificity of the first sentence is cognitive and affective
Turbulence in collisionless plasmas : statistical analysis from numerical simulations with pressure anisotropy
No full textIn recent years, we have experienced increasing interest in the understanding of the physical properties of collisionless plasmas, mostly because of the large number of astrophysical environments (e. g. the intracluster medium (ICM)) containing magnetic fields that are strong enough to be coupled with the ionized gas and characterized by densities sufficiently low to prevent the pressure isotropization with respect to the magnetic line direction. Under these conditions, a new class of kinetic instabilities arises, such as firehose and mirror instabilities, which have been studied extensively in the literature. Their role in the turbulence evolution and cascade process in the presence of pressure anisotropy, however, is still unclear. In this work, we present the first statistical analysis of turbulence in collisionless plasmas using three-dimensional numerical simulations and solving double-isothermal magnetohydrodynamic equations with the Chew-Goldberger-Low laws closure (CGL-MHD). We study models with different initial conditions to account for the firehose and mirror instabilities and to obtain different turbulent regimes. We found that the CGL-MHD subsonic and supersonic turbulences show small differences compared to the MHD models in most cases. However, in the regimes of strong kinetic instabilities, the statistics, i.e. the probability distribution functions (PDFs) of density and velocity, are very different. In subsonic models, the instabilities cause an increase in the dispersion of density, while the dispersion of velocity is increased by a large factor in some cases. Moreover, the spectra of density and velocity show increased power at small scales explained by the high growth rate of the instabilities. Finally, we calculated the structure functions of velocity and density fluctuations in the local reference frame defined by the direction of magnetic lines. The results indicate that in some cases the instabilities significantly increase the anisotropy of fluctuations. These results, even though preliminary and restricted to very specific conditions, show that the physical properties of turbulence in collisionless plasmas, as those found in the ICM, may be very different from what has been largely believed. Implications can range from interchange of energies to cosmic ray acceleration.Peer reviewe
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