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The exact overall incidence of sarcoma and sarcoma subtypes is not known. The objective of the present population-based study was to determine this incidence in a European region (Rhone-Alpes) of six million inhabitants, based on a central pathological review of the cases. From March 2005 to February 2007, pathology reports and tumor blocks were prospectively collected from the 158 pathologists of the Rhone-Alpes region. All diagnosed or suspected cases of sarcoma were collected, reviewed centrally, examined for molecular alterations and classified according to the 2002 World Health Organization classification. Of the 1287 patients screened during the study period, 748 met the criteria for inclusion in the study. The overall crude and world age-standardized incidence rates were respectively 6.2 and 4.8 per 100,000/year. Incidence rates for soft tissue, visceral and bone sarcomas were respectively 3.6, 2.0 and 0.6 per 100,000. The most frequent histological subtypes were gastrointestinal stromal tumor (18%; 1.1/100,000), unclassified sarcoma (16%; 1/100,000), liposarcoma (15%; 0.9/100,000) and leiomyosarcoma (11%; 0.7/100,000). The observed incidence of sarcomas was higher than expected. This study is the first detailed investigation of the crude incidence of histological and molecular subtypes of sarcomas.

Usual laparoscopic surgery of localized prostate cancer uses antegrade dissection. We describe and evaluate the original RELP (Retrograde Extraperitoneal Laparoscopic Prostatectomy). A prospective cohort of 1005 patients with clinical localized cancer prostate were operated from December 1999 to September 2013, in Lyon (France), and followed up to 172 months (median: 60 months). Patients encountered a RELP procedure, a totally extra-peritoneal approach with a retrograde dissection from the apex to the bladder neck, and ascending dissection of the erectile neurovascular bundles, facilitated by the 30° optic telescope. Adjunctive treatments were: immediate radiotherapy (9.2%), salvage radiotherapy (13.4%), androgen deprivation therapy (10.8%), chemotherapy (1.4%), no treatment (75.8%). Results The mean age was 63.4, the Gleason score was 4+3 or worse in 24.9%, there were 2.3% unifocal tumors. The pathology stages were pT2A (8.71%), pT2B (2.80%), pT2C (69.0%), pT3A (13.1%), and pT3B (6.41%). There were 60.8% negative margins (R0) in total (90.1% for basal locations, and 75.8% for apical locations). The mean operating time was 115 minutes for the last 100 patients. The BPFSR (biological progression free survival rate, PSA≤0.10 ng/ml) was 71.9% at 5 years, and 61.4% at 10 years. The cancer specific survival rate was 99.4% at 5 years, and 98.3% at 10 years. After 12 months, 88.6% of patients did not require an incontinence pad, and 67.0% retained the pre-operative quality of their erection. RELP yields good oncologic results and quality of life, as good as robot-assisted surgery.

The exact overall incidence of sarcoma and sarcoma subtypes is not known. The objective of the present population-based study was to determine this incidence in a European region (Rhone-Alpes) of six million inhabitants, based on a central pathological review of the cases. From March 2005 to February 2007, pathology reports and tumor blocks were prospectively collected from the 158 pathologists of the Rhone-Alpes region. All diagnosed or suspected cases of sarcoma were collected, reviewed centrally, examined for molecular alterations and classified according to the 2002 World Health Organization classification. Of the 1287 patients screened during the study period, 748 met the criteria for inclusion in the study. The overall crude and world age-standardized incidence rates were respectively 6.2 and 4.8 per 100,000/year. Incidence rates for soft tissue, visceral and bone sarcomas were respectively 3.6, 2.0 and 0.6 per 100,000. The most frequent histological subtypes were gastrointestinal stromal tumor (18%; 1.1/100,000), unclassified sarcoma (16%; 1/100,000), liposarcoma (15%; 0.9/100,000) and leiomyosarcoma (11%; 0.7/100,000). The observed incidence of sarcomas was higher than expected. This study is the first detailed investigation of the crude incidence of histological and molecular subtypes of sarcomas.

The exact overall incidence of sarcoma and sarcoma subtypes is not known. The objective of the present population-based study was to determine this incidence in a European region (Rhone-Alpes) of six million inhabitants, based on a central pathological review of the cases. From March 2005 to February 2007, pathology reports and tumor blocks were prospectively collected from the 158 pathologists of the Rhone-Alpes region. All diagnosed or suspected cases of sarcoma were collected, reviewed centrally, examined for molecular alterations and classified according to the 2002 World Health Organization classification. Of the 1287 patients screened during the study period, 748 met the criteria for inclusion in the study. The overall crude and world age-standardized incidence rates were respectively 6.2 and 4.8 per 100,000/year. Incidence rates for soft tissue, visceral and bone sarcomas were respectively 3.6, 2.0 and 0.6 per 100,000. The most frequent histological subtypes were gastrointestinal stromal tumor (18%; 1.1/100,000), unclassified sarcoma (16%; 1/100,000), liposarcoma (15%; 0.9/100,000) and leiomyosarcoma (11%; 0.7/100,000). The observed incidence of sarcomas was higher than expected. This study is the first detailed investigation of the crude incidence of histological and molecular subtypes of sarcomas.

Background Pleuroparenchymal fibroelastosis (PPFE) has a variable disease course with dismal prognosis in the majority of patients with no validated drug therapy. This study is to evaluate the effect of nintedanib in patients with idiopathic and secondary PPFE. Patients admitted to a tertiary care center (2010–2019) were included into this retrospective analysis if they had a multidisciplinary diagnosis of PPFE, had been followed-up for 3 months or more, and had lung function tests and chest CTs available for review. Changes in pulmonary function tests were assessed using non-parametric tests and linear mixed effect model. Lung volumes were measured with lobar segmentation using chest CT. Results Out of 21 patients with PPFE, nine had received nintedanib, six had received another treatment and another six patients were monitored without drug therapy. Annual FVC (% of predicted) relative decline was − 13.6 ± 13.4%/year before nintedanib and − 1.6 ± 6.02%/year during nintedanib treatment (p = 0.014), whereas no significant change in FVC% relative decline was found in patients receiving another treatment (− 13.25 ± 34 before vs − 16.61 ± 36.2%/year during treatment; p = 0.343). Using linear mixed effect model, the slope in FVC was − 0.97%/month (95% CI: − 1.42; − 0.52) before treatment and − 0.50%/month (95% CI: − 0.88; 0.13) on nintedanib, with a difference between groups of + 0.47%/month (95% CI: 0.16; 0.78), p = 0.004. The decline in the upper lung volumes measured by CT was − 233 mL/year ± 387 mL/year before nintedanib and − 149 mL/year ± 173 mL/year on nintedanib (p = 0.327). Nintedanib tolerability was unremarkable. Conclusion In patients with PPFE, nintedanib treatment might be associated with slower decline in lung function, paving the way for prospective, controlled studies.

Introduction: De novo anti-HLA donor specific antibodies (DSA) have been inconsistently associated with cardiac allograft vasculopathy (CAV) and long-term mortality. We tested whether C3d-binding de novo DSA were associated with CAV or long-term-survival. Methods: We included 282 consecutive patients without preformed DSA on coronary angiography between 2010 and 2012. Angiographies were classified according to CAV ISHLT grading. The primary outcome was a composite criterion of severe CAV or mortality. As the impact of de novo antibodies should be assessed only after appearance, we used a Cox regression with time-dependent covariables. Results: Of the 282 patients, 51(18%) developed de novo DSA during follow-up, 29 patients had DSA with C3d-binding ability (DSA+C3d+), and 22 were without C3d-binding ability (DSA+C3d-). Compared with patients without DSA, DSA+C3d+ patients had an increased risk for the primary outcome of severe CAV or mortality (adjusted HR = 4.31 (2.40–7.74) p < 0.001) and long-term mortality (adjusted HR = 3.48 (1.97–6.15) p < 0.001) whereas DSA+C3d- did not (adjusted HR = 1.04 (0.43–2.47) p = 0.937 for primary outcome and HR = 1.08 (0.45–2.61) p = 0.866 for mortality). Conclusion: According to this large monocentric study in heart transplant patients, donor specific antibodies were associated with worse clinical outcome when binding complement. DSA and their complement-binding ability should thus be screened for to optimize heart transplant patient follow-up.

Sleep apnea syndrome occurs when, during sleep, breathing stops for 10 seconds or longer, with an index of 5 times or more an hour. It is clinically characterized by loud snoring at night, continuous or interrupted by pauses followed by loud breathing. Sleep is fitful, broken by arousals, and yields little rest. There is daytime excessive sleepiness with repeated involuntary falling asleep, often unknown by the subject. In this article, we describe an observation of central sleep apnea syndrome in a female patient receiving an opiate replacement therapy. An analysis of the before and after methadone withdrawal polysomnograhic tracing was done for this patient. This diagnosis etiology and physiopathology are critically approached. Clinicians should be careful in treating induced sleep disorders in such patients. Prescribing benzodiazepines during an opiate withdrawal of the methadone type is not recommended when central apnea occurs.

Position du problème: Le syndrome d'apnées du sommeil se définit par la survenue, pendant le sommeil, d'arrěts respiratoires de durée supérieure ou égale à 10 secondes, selon un index supérieur ou égal à 5 par heure. Cliniquement, il se caractérise par la présence de ronflements nocturnes sonores continus ou entrecoupés de pauses avec reprise respiratoire bruyante. Le sommeil est agité, entrecoupé d'éveils, peu reposant. Il existe une hypersomnolence diurne avec présence d'endormissements involontaires répétés et souvent méconnus par le sujet. Description clinique: Dans cet article, une observation de syndrome d'apnées du sommeil d'origine centrale chez une patiente en thérapeutique de substitution par opiacés est décrite. Méthodologie: Une analyse du tracé polysomnographique avant et après sevrage de méthadone est réalisée chez cette patiente. Discussion: L'étiologie et la physiopathologie de ce diagnostic font l'objet d'une approche critique. Le rappel d'une attention nécessaire de la part du clinicien face à de tels patients dans le cadre du traitement de troubles du sommeil induits est posé. Conclusion: La présence d'apnées centrales est une contre-indication à la prescription de benzodiazépines durant le sevrage d'opiacés de type méthadone.