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Pelvic organ prolapse (POP) occurs only in women and becomes more common as women age. However, the surgical practices remain poorly evaluated. The realization of a simulator of the dynamic behavior of the pelvic organs is then identified as a need. It allows the surgeon to estimate the functional impact of his actions before his implementation. In this work, the simulation will be based on a patient-specific approach in which each geometrical model will be carried out starting from magnetic resonance image (MRI) acquisition of pelvic organs of one patient. To determine the strain and stress in the soft biological tissues, hyperelastic constitutive laws are used in the context of finite element analysis. The Yeoh model has been implemented into an in-house finite element code FER to model these organ tissues taking into account large deformations with multiple contacts. The 2D and 3D models are considered in this preliminary study and the results show that our method can help to improve the understanding of different forms of POP.

Introduction and Hypothesis Female pelvic organ prolapses are common, but their treatment is challenging. Notably, diagnosis and understanding of these troubles remain incomplete. Tridimensional observations of displacement and deformation of the pelvic organs during a strain could support a better understanding and help to develop comprehensive tools for preoperative planning. Methods The present feasibility study evaluates tridimensional dynamic MRI in 12 healthy volunteers. Tridimensional acquisitions were approximated using five intersecting slices, each recorded twice per second. MRI was performed during rest and strain, with intrarectal and intravaginal contrast gel. Subject-specific dynamic 3D models were built for each volunteer through segmentation. Results For each volunteer, pelvic organs could be segmented in three dimensions with a rate of acquisition of two cycles per second on five slices, allowing for a fluid observation of displacements and deformations during strain. Manual segmentation of a full strain required 2 h and 33 min on average. The upper limit of the rectum and the pelvic floor were the most difficult structures to identify. This technique is limited by its time-consuming manual segmentation, which impedes its implantation for routine clinical use. This method must be tried in patients with pelvic organ prolapse. Conclusions This multi-planar acquisition technique applied during a dynamic MRI allows for observation of displacement and deformations of pelvic organs during a strain.

Sportsman’s hernia is very frequent in some sports, particularly in football. This painful syndrome is reported by high-level athletes as well as amateurs. There is no consensus about the management of sportsman’s hernia, because of the heterogeneity in anatomoclinic forms. In case of surgical indication, the Nesovic procedure, also named “fasciomyoplasty”, is one of the recommended procedures for the abdomino-parietal forms. Our objective was to report our experience with this procedure in terms of short- and mid-term results. All the patients who underwent Nesovic procedure between January 2009 and December 2022 in our center were retrospectively reviewed. 43 patients (98% men; mean age: 29.5 ± 9.2 years) were included. 37% of patients were professional athletes. The median time from symptoms' onset to diagnosis was 3 months (range = 1–72 months). The median time from diagnosis to surgery was 7 months (range = 1–58 months). Postoperative overall morbidity occurred in six patients (14%), including scrotum swelling (n = 2), hematoma (n = 1), serous collection (n = 1) and acute urinary retention (n = 2). No major complication occurred. At the end of follow-up (median: 1 year; range = 1 month—11 years), 84% of patients recovered their previous sports activity, after a mean delay of 2 months. Nesovic procedure is efficient in more than 80% of sports patients without any major morbidity.

Purpose To compare perioperative results of laparoscopic and robotic ventral mesh rectopexy for pelvic floor disorders at the beginning of the surgical experience. Methods Between 2017 and 2022, the first 30 laparoscopic ventral mesh rectopexies and the first 30 robotic ventral mesh rectopexies at the beginning of the experience of 2 surgeons were retrospectively analyzed. Perioperative (demographic characteristics, surgical indication, conversion rate, operative time), and postoperative (complications, length of stay, unplanned reintervention) data were compared between groups. Results Demographic characteristics were similar between groups. Conversion rate was lower (0 vs 17%, p = 0.05), but the operative time was significantly longer (182 [146–290] vs 150 [75–240] minutes, p < 0.0001) during robotic procedure when compared with laparoscopic approach. In terms of learning curve, the number of procedures to obtain the same operative time between the 2 approaches was 15. Postoperative results were similar between groups, in terms of pain (visual analogic scale = 2 [0–8] vs 4 [0–9], p = 0.07), morbidity (17 vs 3%, p = 0.2), and unplanned reintervention (1 vs 0%, p = 0.99). Mean length of stay was significantly reduced after robotic approach when compared with laparoscopic approach (3 [2–10] vs 5 [2–11] days, p < 0.01). Functional results were better after robotic than laparoscopic ventral mesh rectopexy, with higher satisfaction rate (93 vs 75%, p = 0.05), and reduced recurrence rate (0 vs 14%, p = 0.048). Conclusion Despite longer operative time at the beginning of the learning curve, robotic ventral mesh rectopexy was associated with similar or better perioperative results than laparoscopic ventral mesh rectopexy.

Background Alterations in HDAC s gene expression have been reported in a number of human cancers. No information is available concerning the status of HDAC s in pancreatic cancer tumors. The aim of the present study was to evaluate the expression levels of members of class I (HDAC1, 2,, 3), class II (HDAC4, 5, 6, and 7), and class III (SIRT1, 2, 3, 4, 5, and 6) in a set of surgically resected pancreatic tissues. Methods Total RNA was isolated from 11 pancreatic adenocarcinomas (PA): stage 0 ( n  = 1), IB ( n  = 1), IIB ( n  = 6), III ( n  = 1), IV ( n  = 2), one serous cystadenoma (SC), one intraductal papillary mucinous tumor of the pancreas (IMPN), one complicating chronic pancreatitis (CP), and normal pancreas (NP) obtained during donor liver transplantation. Moreover, six other control pancreatic were included. HDAC s gene expression was conducted using quantitative real-time polymerase chain reaction (qPCR). Protein expression levels were analyzed by Western blot and their localization by immunohistochemistry analyses of cancer tissues sections. Results Remarkably, 9 of the 11 PA (approximately 81%) showed significant increase of HDAC7  mRNA levels. In contrast to PA samples, message for HDAC7 was reduced in CP, SC, and IMPN specimens. The Western blot analysis showed increased expression of HDAC7 protein in 9 out of 11 PA samples, in agreement with the qPCR data. Most of the PA tissue sections examined showed intense labeling in the cytoplasm when reacted against antibodies to HDAC7. Conclusion The data showed alteration of HDAC s gene expression in pancreatic cancer. Increased expression of HDAC7 discriminates PA from other pancreatic tumors.

In various imaging applications, shape variations are studied in order to define the transformations involved or to quantify a distance between each change performed. Regardless of the way the shapes may be extracted, with 2D imaging, shapes concern essentially curves or sets of points depending on the available data. Wether time is related to the shape variations or not, one can consider a set of shapes as the observation of the temporal evolution of an initial shape. In this context, we present a methodology aiming at quantifying the evolution of a set of contours without landmarks. Our characterization of temporal sequences is based on the large deformation diffeomorphic mapping paradigm and the shape representation based on currents, which allow both to propose a shape metric and a curve matching of the timed variations. Then, mechanics related features are extracted as they are physically meaningful and quite painless understandable. In this paper, the process is applied within the scope of a pelviperineology study. Available clinical diagnoses are combined with statistical analysis to show the soundness of the approach. Indeed, pelvic floor disorders are characterized by abnormal organ descents and deformations during abdominal strains. As they are soft-tissue organs, the pelvic organs have no fixed landmarks, in addition to wide shape differences. Routinely used, 2D sagittal mri sequences are segmented to provide the contour sets from which the characterization should highlight pelvic organ behaviors. We believe that a statistical analysis of these behaviors on several dynamic mri sequences could help to a better understanding of the pelvic floor pathophysiology. The methodology is applied on a dataset of 30 patients with different clinical diagnoses. Some promising results are presented, where the pathology detection capability of the deformation features is assessed, and the principal organ dynamics modes are computed, through an inter-patient analysis. Also, an organ parcellation is proposed thanks to the local deformation analysis, it identifies spatial references which are clinically relevant.

[...]a prospective study of approximately 1188 consecutive curative resections for sigmoid colon and rectal cancer demonstrated that only 1.0 per cent of patients had metastatic involvement of nodes along the inferior mesenteric artery proximal to the origin of the left colic artery in case of sigmoid cancer.1 Moreover, a recently published large study confirmed that SFM confers no advantage in terms of survival in high rectal cancer.2 In our study, there was no statistically sig- nificant difference found for survival or node harvest, irrespective if the splenic flexure was mobilized or not. [...]the present study demonstrates that in the hands of experienced colorectal surgeons, left colectomy for cancer might be performed without SFM not compromising patients' survival or anastomotic leakage rate independent of the surgical approach (laparoscopy or laparotomy).

There is ongoing interest to identify signaling pathways and genes that play a key role in carcinogenesis and the development of resistance to antitumoral drugs. Given that histone deacetylases (HDACs) interact with various partners through complex molecular mechanims leading to the control of gene expression, they have captured the attention of a large number of researchers. As a family of transcriptional corepressors, they have emerged as important regulators of cell differentiation, cell cycle progression, and apoptosis. Several HDAC inhibitors (HDACis) have been shown to efficiently protect against the growth of tumor cells in vitro as well as in vivo. The pancreatic cancer which represents one of the most aggressive cancer still suffers from inefficient therapy. Recent data, although using in vitro tumor cell cultures and in vivo chimeric mouse model, have shown that some of the HDACi do express antipancreatic tumor activity. This provides hope that some of the HDACi could be potential efficient anti-pancreatic cancer drugs. The purpose of this review is to analyze some of the current data of HDACi as possible targets of drug development and to provide some insight into the current problems with pancreatic cancer and points of interest for further study of HDACi as potential molecules for pancreatic cancer adjuvant therapy.

Purpose This work aimed to analyse short- and long-term results of enterocele surgical treatment by ventral rectopexy. Methods All females who underwent ventral rectopexy for enterocele in our department were included. All patients underwent standardized preoperative evaluation. Data was retrospectively collected, after examination of patients or by telephone survey. Postoperative evaluation was performed by an independent observer. Results One hundred thirty-eight females (median age = 63 years [21–86 years]) were included. They were postmenopausal and multiparous in 94 and 70% of cases, respectively. Pelvic pressure, vaginal prolapse, or the both were observed in 28, 16 or 56% of the patients, respectively. The most frequent associated symptoms were dyschezia (63%) and faecal incontinence (30%). On preoperative workup, enterocele was isolated in two cases. Rectocele, internal rectal prolapse and cervicocystoptosis were the most frequently associated pelvic floor disorders. Ventral rectopexy was performed through laparoscopy in 128 patients (93%). In the short term, all pelvic symptoms were significantly improved, except urinary incontinence. At the end of follow-up (56 months [7–125]), specific symptoms and dyschezia were still significantly improved. Secondary failure was reported in 31% of patients. By multivariate analysis, two predictive factors for long-term failure were found: diagnosis of rectocele on preoperative MRI (odd ratio = 15; 95% CI 1.4–163; p  = 0.03) and conversion into open surgery (odd ratio = 8; 95% CI 1.4–43; p  = 0.02). Conclusion This study suggests that ventral rectopexy is an effective treatment of enterocele, but secondary failure can be observed. Patients should be informed of the potential risk of long-term degradation.