Halle E., Azahaf M., Duveau N., Nachury M., Branche J., Gerard R., Wils P., Desreumaux P., Ernst O., Pariente B.   Radiologic response reduces the risk of small-bowel surgery in Crohn''''s disease.  J. Crohns Colitis.  2018 ;12 :S465-S465
Golfier F., Chanavaz-Lacheray I., Descamps P., Agostini A., Poilblanc M., Rousset P., Bolze P. A., Panel P., Collinet P., Hebert T., Graesslin O., Martigny H., Brun J. L., Déchaud H., Malartic C. M., Piechon L., Wattiez A., Chapron C., Daraï E.   The definition of Endometriosis Expert Centres.  J Gynecol Obstet Hum Reprod.  2018 ;47 :179-181

Endometriosis is a common condition that causes pain and infertility. It can lead to absenteeism and also to multiple surgeries with a consequent risk of impaired fertility, and constitutes a major public health cost. Despite the existence of numerous national and international guidelines, the management of endometriosis remains suboptimal. To address this issue, the French College of Gynaecologists and Obstetricians (CNGOF) and the Society of Gynaecological and Pelvic Surgery (SCGP) convened a committee of experts tasked with defining the criteria for establishing a system of care networks, headed by Expert Centres, covering all of mainland France and its overseas territories. This document sets out the criteria for the designation of Expert Centres. It will serve as a guide for the authorities concerned, to ensure that the means are provided to adequately manage patients with endometriosis.

Wolpert F., Weller M., Berghoff A. S., Rushing E., Füreder L. M., Petyt G., Leske H., Andratschke N., Regli L., Neidert M. C., Stupp R., Stahel R., Dummer R., Frauenfelder T., Roth P., Reyns N., Kaufmann P. A., Preusser M., Le Rhun E.   F-fluordesoxyglucose positron emission tomography for patients with brain metastasis from unknown primary site.  Eur. J. Cancer.  2018 ;96 :64-72

BACKGROUND: In 30% of patients with brain metastasis (BM), neurological symptoms are the first clinical manifestation of systemic malignancy, referred to as BM from cancer of unknown primary site (BM-CUPS). Here, we define the diagnostic value of (18)F-fluordesoxyglucose positron emission tomography (FDG-PET/CT) in the workup of BM-CUPS. METHODS: We screened 565 patients operated for BM at the University Hospital Zurich and identified 64 patients with BM-CUPS with data on both FDG-PET/CT and contrast-enhanced chest/abdomen computed tomography (CT) available at BM diagnosis. A cohort of 125 patients with BM-CUPS from Lille and Vienna was used for validation. RESULTS: FDG-PET/CT was not superior to chest/abdomen CT in localising the primary lesion in the discovery cohort, presumably because most primary tumours were lung cancers. However, FDG-PET/CT identified additional lesions suspicious of extracranial metastases in 27 of 64 patients (42%). The inclusion of FDG-PET/CT findings shifted the graded prognostic assessment (GPA) score from 3 with CT alone to 2.5 for PET/CT (p = 3.8 x 10(-5), Wilcoxon's test), resulting in a predicted survival of 5.3 versus 3.8 months (p = 6.1 x 10(-5); Wilcoxon's test). All observations were confirmed in the validation cohort. CONCLUSIONS: Lung cancers are the most common primary tumour in BM-CUPS; accordingly, CT alone shows similar overall sensitivity for detecting the primary tumour as FDG-PET/CT. Yet, FDG-PET/CT improves the accuracy of staging by detecting more metastases, reflected by decreased GPA scores and decreased predicted survival. Therefore, randomised trials on patients with BM should standardise methods of staging, notably when stratifying for GPA.

Villers A., Puech P.   Editorial Comment.  J. Urol..  2018 ;200 :1121
Vignion-Dewalle A. S., Baert G., Thecua E., Lecomte F., Vicentini C., Abi-Rached H., Mortier L., Mordon S.   Comparison of 10 efficient protocols for photodynamic therapy of actinic keratosis: How relevant are effective light dose and local damage in predicting the complete response rate at 3 months?.  Lasers Surg Med.  2018 ;50 :576-589

BACKGROUND: Topical photodynamic therapy is an established treatment modality for various dermatological conditions, including actinic keratosis. In Europe, the approved protocols for photodynamic therapy of actinic keratosis involve irradiation with either an Aktilite CL 128 lamp or daylight, whereas irradiation with the Blu-U illuminator is approved in the United States. Many other protocols using irradiation by a variety of light sources are also clinically efficient. OBJECTIVES: This paper aims to compare 10 different protocols with clinically proven efficacy for photodynamic therapy of actinic keratosis and the available spectral irradiance of the light source. Effective irradiance, effective light dose, and local damage are compared. We also investigate whether there is an association between the complete response rate at 3 months and the effective light dose or local damage. METHODS: The effective irradiance, also referred to as protoporphyrin IX-weighted irradiance, is obtained by integrating the spectral irradiance weighted by the normalized absorption spectrum of protoporphyrin IX over the wavelength. Integrating the effective irradiance over the irradiation time yields the effective light dose, which is also known as the protoporphyrin IX-weighted light dose. Local damage, defined as the total cumulative singlet oxygen molecules produced during treatment, is estimated using mathematical modeling of the photodynamic therapy process. This modeling is based on an iterative procedure taking into account the spatial and temporal variations in the protoporphyrin IX absorption spectrum during treatment. RESULTS: The protocol for daylight photodynamic therapy on a clear sunny day, the protocol for daylight photodynamic therapy on an overcast day, the photodynamic therapy protocol for a white LED lamp for operating rooms and the photodynamic therapy protocol for the Blu-U illuminator perform better than the six other protocols-all involving red light illumination-in terms of both effective light dose and local damage. However, no association between the complete response rate at 3 months and the effective light dose or local damage was found. CONCLUSIONS: Protocols that achieve high complete response rates at 3 months and low pain scores should be preferred regardless of the effective light dose and local damage. Lasers Surg. Med. 50:576-589, 2018. (c) 2018 Wiley Periodicals, Inc.

Vickers A., Vertosick E. A., Sjoberg D. D., Hamdy F., Neal D., Bjartell A., Hugosson J., Donovan J. L., Villers A., Zappala S., Lilja H.   Value of intact prostate specific antigen and human kallikrein 2 in the four kallikrein predictive model: an individual patient data meta-analysis.  J. Urol..  2018 ;199 :1470-1474

PURPOSE: The 4 kallikrein panel, commercially available as the 4Kscore(R), is a statistical model that has been shown to accurately predict Gleason Grade Group 2 or greater (high grade) cancer on biopsy and the long-term risk of distant prostate cancer metastases. The panel includes 2 novel markers, namely intact prostate specific antigen and hK2. It has been questioned whether these 2 additional markers add discrimination to the clinical predictors of patient age, digital rectal examination and prior biopsy, and the established molecular markers total and free prostate specific antigen. MATERIALS AND METHODS: We performed an individual patient data meta-analysis of published studies in which the 4 kallikrein panel was measured in men undergoing prostate biopsy. We assess the improvement in discrimination associated with including intact prostate specific antigen and hK2 along with total and free prostate specific antigen in the statistical model. RESULTS: Included in analysis were 14,510 men from a total of 10 studies. The fixed effects meta-analytical estimate of the discrimination of the model without intact prostate specific antigen and hK2 was 0.742 (95% CI 0.727-0.756) compared to 0.813 (95% CI 0.801-0.825) for the full kallikrein model. The 95% CIs did not overlap and the difference in discrimination was highly statistically significant (0.069, 95% CI 0.057-0.080, p <0.0001). Intact prostate specific antigen (increase in discrimination 0.059, 95% CI 0.050-0.069) and hK2 (increase in discrimination 0.024, 95% CI 0.020-0.029, each p <0.0001) added independently to the model. CONCLUSIONS: The clinical value of the panel could not be replicated using data readily available to urologists without measuring intact prostate specific antigen and hK2.

Vicentini C., Vignion-Dewalle A. S., Thecua E., Lecomte F., Maire C., Deleporte P., Béhal H., Kerob D., Duhamel A., Mordon S., Mortier L.   Photodynamic therapy for actinic keratosis of the forehead and scalp: a randomized, controlled, phase II clinical study evaluating the non-inferiority of a new protocol involving irradiation with a light-emitting, fabric-based device (the Flexitheralight .  Br. J. Dermatol..  2018

BACKGROUND: Photodynamic therapy (PDT) is an effective treatment for actinic keratosis (AK), particularly for patients with large areas of field cancerization. Among the approved protocols in Europe, the most widely used requires irradiation with the Aktilite CL 128 lamp. However, pain during irradiation and the suboptimal adaptability of the lamp relative to the treatment area are two limiting factors of this protocol. To overcome these limits, a new protocol (referred to as the Flexitheralight protocol) involving irradiation with a light-emitting, fabric-based device was developed. OBJECTIVES: This paper aims to assess the noninferiority, in terms of PDT efficacy for treating AK, of the Flexitheralight protocol compared with the conventional protocol, which requires irradiation with the Aktilite CL 128 lamp. METHODS: A monocentric, randomized, controlled, phase II clinical study was performed. Twenty-five patients with grade I-II AKs of the forehead and scalp were treated with methyl aminolaevulinate PDT in two symmetrical areas. One area was treated with the conventional protocol (n = 154 AKs), whereas the other area was treated with the Flexitheralight protocol (n = 156 AKs). The primary end-point was the lesion complete response (CR) rate at 3 months (an absolute noninferiority margin of -10% was used). The secondary end-points included patient-reported pain at the end of the irradiation. RESULTS: At 3 months, the lesion CR rate with the Flexitheralight protocol was noninferior to that obtained with the conventional protocol (66.0% vs. 59.1%, respectively; absolute difference, 6.9%; 95% confidence interval -0.6% to 14.5%). Patient-reported pain was significantly lower with the Flexitheralight protocol than with the conventional protocol (mean +/- SD: 0.4 +/- 0.6 vs. 5.0 +/- 2.6; P < 0.0001). CONCLUSIONS: The Flexitheralight protocol is noninferior in terms of efficacy and superior in terms of tolerability to the conventional protocol for treating AKs of the forehead and scalp.

Vicentini C., Abi-Rached H., Thecua E., Lecomte F., Deleporte P., Vignion A. S., Szeimies R. M., Mortier L., Mordon S. R.   PHOS-ISTOS CLINICAL TRIAL: A NEW SOLUTION FOR PHOTODYNAMIC TREATMENT OF ACTINIC KERATOSIS WITHOUT PAIN.  Lasers Surg. Med..  2018 ;50 :377-377
Vésale E., Azaïs H., Belghiti J., Nikpayam M., Uzan C., Canlorbe G.   [How I do… a colpocleisis with hysterectomy for vaginal prolapse (Pitié-Salpêtrière Hospital, Paris, France)].  Gynecol Obstet Fertil Senol.  2018 ;46 :440-443