Anatomy of bluetongue virus serotype 8 epizootic wave, France, 2007-2008

The introduction of bluetongue virus serotype 8 into northern Europe at the end of summer 2006 initiated one of the most widespread epizootics of bluetongue infection ever to occur. In winter 2007-2008, a cross-sectional serologic study was conducted in France along a transect perpendicular to the epizootic wave. Cattle herd-level seroprevalence varied from 4% to 100%, and animal-level seroprevalence from <1% to 40%. Only a low proportion of seropositive herds reported clinical cases in 2007. Sheep flocks were less frequently affected than cattle herds. The local occurrence of clinical cases and environmental indicators linked to forests were seropositivity risk factors, whereas the local density of cows had a protective effect. Overall results suggest that amplification of virus circulation in affected herds played a limited role in the epizootic wave diffusion and that bluetongue virus serotype 8 circulation in natural ecosystems could have played a substantial role in this progression.     

Worldwide practice in gastric cancer surgery

AIM: To evaluate the current status of gastric cancer surgery worldwide.METHODS: An international cross-sectional survey on gastric cancer surgery was performed amongst international upper gastro-intestinal surgeons. All surgical members of the International Gastric Cancer Association were invited by e-mail to participate. An English web-based survey had to be filled in with regard to their surgical preferences. Questions asked included hospital volume, the use of neoadjuvant treatment, preferred surgical approach, extent of the lymphadenectomy and preferred anastomotic technique. The invitations were sent in September 2013 and the survey was closed in January 2014.RESULTS: The corresponding specific response rate was 227/615 (37%). The majority of respondents: originated from Asia (54%), performed > 21 gastrectomies per year (79%) and used neoadjuvant chemotherapy (73%). An open surgical procedure was performed by the majority of surgeons for distal gastrectomy for advanced cancer (91%) and total gastrectomy for both early and advanced cancer (52% and 94%). A minimally invasive procedure was preferred for distal gastrectomy for early cancer (65%). In Asia surgeons preferred a minimally invasive procedure for total gastrectomy for early cancer also (63%). A D1+ lymphadenectomy was preferred in early gastric cancer (52% for distal, 54% for total gastrectomy) and a D2 lymphadenectomy was preferred in advanced gastric cancer (93% for distal, 92% for total gastrectomy)CONCLUSION: Surgical preferences for gastric cancer surgery vary between surgeons worldwide. Although the majority of surgeons use neoadjuvant chemotherapy, minimally invasive techniques are still not widely adapted.     

A Multidisciplinary Approach on the Perioperative Antithrombotic Management of Patients With Coronary Stents Undergoing Surgery: Surgery After Stenting 2

Perioperative management of antithrombotic therapy in patients treated with coronary stents undergoing surgery remains poorly defined. Importantly, surgery represents a common reason for premature treatment discontinuation, which is associated with an increased risk in mortality and major adverse cardiac events. However, maintaining antithrombotic therapy to minimize the incidence of perioperative ischemic complications may increase the risk of bleeding complications. Although guidelines provide some recommendations with respect to the perioperative management of antithrombotic therapy, these have been largely developed according to the thrombotic risk of the patient and a definition of the hemorrhagic risk specific to each surgical procedure, key to defining the trade-off between ischemia and bleeding, is not provided. These observations underscore the need for a multidisciplinary collaboration among cardiologists, anesthesiologists, hematologists and surgeons to reach this goal. The present document is an update on practical recommendations for standardizing management of antithrombotic therapy management in patients treated with coronary stents (Surgery After Stenting 2) in various types of surgery according to the predicted individual risk of thrombotic complications against the anticipated risk of surgical bleeding complications. Cardiologists defined the thrombotic risk using a “combined ischemic risk” approach, while surgeons classified surgeries according to their inherent hemorrhagic risk. Finally, a multidisciplinary agreement on the most appropriate antithrombotic treatment regimen in the perioperative phase was reached for each surgical procedure.     

La demande de chirurgie esthétique : questions ouvertes et nouvelles perspectives pour la recherche

Objectives

This study aims to offer an overview of the most important results of current research on the request for cosmetic surgery, to provide some indications for practitioners working in the field, and to open new avenues for research.

A new model of pharmacovigilance? A pilot study

This multicenter study tested the actuation of a new model of pharmacovigilance, focused on three pharmacological wide-used categories (non-steroidal anti-inflammatory drugs, NSAID, oral anticoagulants, and antihypertensive drugs). Besides the traditional way of pharmacovigilance, an active investigation was performed, using a phone-structured interview. Patients discharged from the participating hospitals were included into the study, if their prescribed therapy included some of the above drugs and after informed consent. Three hundred subjects were interviewed, 100 for each pharmacological category. For a period of six months after patient's discharge from the hospital, a traditional pharmacovigilance survey was carried out. About 30 days after discharge from the hospital, patients were interviewed by the medical staff and data recorded. NSAID group stratification evidenced a significant percentage of severe haemorrhage among the patients who were using acetylsalicylic acid (ASA) as antiaggregant (6.8%) compared to the patients who were using non-ASA NSAID, at therapeutic dosage (1.8%). From this data, it seems that the active pharmacovigilance model was able to better highlight a real problem for the NSAID category, in particular it evidenced a pharmacological subclass (ASA) more prone to cause ADR than expected from literature data related to whole pharmacological class. Given the required economical effort, this pharmacovigilance method could take place as a selected tool when pharmacovigilance signals from the international databases become consistent or for new wide-used drugs, to screen potentially dangerous pharmacological subclasses, normally “hidden” because of a “camouflage” among ADRs of the entire pharmacological class.