Magnetic resonance imaging characteristics of ischemic stroke in an Afro-Caribbean population: A 1-year prospective MRI study on 534 consecutive patients.

PURPOSES: Few population-based MRI studies on stroke, particularly in African-descent populations, are available. Based on a 1-year Afro-Caribbean population-based study MRI, ischemic stroke characteristics were extensively analyzed. METHODS: All strokes occurring in Martinique (390,371 inhabitants) were prospectively included. Ascertainment was based, whenever possible, on MRI. All patients were categorized as single- (subclassified as cortical, cortical-subcortical, subcortical, lacunar) or multiple-lesion pattern, and vascular (single, multiple or junctional) territory. Brain parenchyma was evaluated, based on visualization of macrobleeds, microbleeds, white-matter hyperintensities or stroke sequelae. Etiology was classified according to TOAST criteria. RESULTS: Among 596 ischemic stroke patients included, 534 (295 men, 239 women; mean age, 71 [range 23-110] years) underwent MRI (median delay 1 day). Four hundred and eighty-eight had single-type lesion (14.8% cortical, 42.4% cortical-subcortical, 14.5% subcortical, 16.6% lacunar), involving anterior cerebral (4%), middle cerebral (63.7%), posterior cerebral artery (10.4%) or basilar trunk (11.7%) territories, with 10.3% simultaneously involving multiple territories and 4.9% junctional infarction. Etiologies were LAA (11.2%), SVD (10.7%), CE (29.6%), rare (4.5%) or undetermined (44.1%). CONCLUSION: Our prospective, consecutive, ischemic stroke series gives a comprehensive description of ischemic stroke imaging patterns and etiologic distributions in an Afro-Caribbean population with high socio-economic status. Our patients' stroke characteristics are close to those of European-descent populations.

The introduction of early patient rehabilitation in surgery of soft tissue sarcoma and its impact on post-operative outcome.

BACKGROUND: Enhanced recovery after surgery (ERAS) programs are implemented in multiple fields of surgery, but not yet in soft-tissue sarcoma (STS) surgery. We wondered whether its introduction into STS surgery might have impacted postoperative outcome. METHODS: Two hundred and fifty seven adult patients with primary limb or trunk wall STS received ERAS from 2008 to 2012 as a part of the intra-operative management. We evaluated, in retrospect, the intra-operative management, post-operative outcomes, functional and oncological results of these patients and compared them with 459 prior patients treated under a standard recovery after surgery (SRAS) program from 1989 to 2007. RESULTS: The most visible change from SRAS to ERAS in the perioperative management was decrease of wound drainage (72% vs. 15%, p < 0.001) and increase of wound bandaging (16% vs. 66%; p < 0.001), underlining the appliance of the ERAS protocol. Post-operatively, hospital stay dropped from nine (0-74) to three (0-22) days (p < 0.001) without affecting major morbidity (8% vs. 5%, NS) or readmission to the hospital (5% vs. 4%, NS). Functional outcome improved (p = 0.009) but whether this change was due to ERAS remains to be proved because complementary treatments changed over time. Tumour control remained unaffected, with an estimated risk of local recurrence at 5 years of 12% in both groups. CONCLUSION: Introducing a rapid recovery program was associated with a shorter hospitalization stay without compromising surgical or oncological outcomes. The program appears to be safe and reliable to use in patients undergoing STS surgery.

Dental caries in children with asthma undergoing treatment with short-acting beta2-agonists.

AIM: This study sought to evaluate possible higher risk for dental caries among asthmatic children undergoing treatment with short-acting beta2-agonists. METHODS: Dental clinical assessments, saliva analysis and a questionnaire survey were carried out on 60 children aged 6-12, of whom 30 were asthmatic subjects undergoing treatment with short-acting beta2-agonists and 30 were used as controls. The obtained data for DMFT/dmft scores, Silness-Löe plaque index, buffer capacity and bacteria counts for Streptococcus mutans and Lactobacillus in the saliva, oral hygiene and dietary habits were compared using Student t-test and Pearson chi-square test. RESULTS: We registered a higher DMFT score among asthmatics of 1.2-/+1.8 (SD) and 0.3-/+0.8 among non-asthmatic patients (p<0.05), while comparison of dmft scores between the examined groups showed not significant (Student t-test). Saliva analysis revealed lower buffer capacity in 43.3% of the asthmatic children, followed by higher cariogenic bacteria counts in their saliva (p<0.05 Student t-test). These results show the lower plaque index in the asthmatic group (1.6+/-0.4) compared with the control (2.1+/-0.3). Asthmatic children expressed better oral-health habits with more frequent tooth- brushing and usage of fluorides. CONCLUSION: The results from our study suggest a higher caries-susceptibility among asthmatic children undergoing treatment with short-acting beta2-agonists, but a clear association between these drugs, salivary changes and dental caries among children, still remains to be demonstrated.

Standardized quantitative RT-PCR assays for quantitation of yellow fever and chimeric yellow fever-dengue vaccines.

Yellow fever-dengue chimeras (CYDs) are being developed currently as live tetravalent dengue vaccine candidates. Specific quantitative assays are needed to evaluate the viral load of each serotype in vaccine batches and biological samples. A quantitative real-time RT-PCR (qRT-PCR) system was developed comprising five one-step qRT-PCRs targeting the E/NS1 junction of each chimera, or the NS5 gene in the yellow fever backbone. Each assay was standardized using in vitro transcribed RNA qualified according to its size and purity, and precisely quantified. A non RNA-extracted virus sample was introduced as external quality control (EQC), as well as 2 extraction controls consisting of 2 doses, 40 and 4,000 GEQ (genomic equivalents), of this EQC extracted in parallel to the samples. Between 6 and 10 GEQ/reaction were reproducibly measured with all assays and similar titers were obtained with the two methods when chimeric virus samples were quantified with the E/NS1- or the NS5-specific assays. Reproducibility of RNA extraction was ensured by automation of the process (yield>or=50%), and infectious virus was isolated in >or=80% of PCR-positive sera from immune monkeys.

[Right colectomy with regional anaesthesia and hypnosedation in ASA 3 patient]. / Colectomie droite sous anesthésie péridurale et hypnosédation chez une patiente ASA 3.

In high-risk anaesthetic patients, the choice of a preoperative anaesthesia remains a difficult challenge before performing a heavy surgery such as colon excision. Nowadays, hypnosedation may be considered as an additional anaesthetic technique given to be associated with local or regional anaesthesia, in order to permit more surgery possibilities in high risk patients.

[Administration of ketamine during induction and maintenance of anaesthesia in postoperative pain prevention]. / Apport de l'administration de kétamine à l'induction et en entretien anesthésique dans la prévention de la douleur postopératoire Essai clinique en oncologie.

INTRODUCTION: Carcinologic breast surgery is responsible of intermediary postoperative pain and needs 30% additional morphine. Now, morphine administration generates adverse effects. Publications about morphine saving effect of ketalar as antagonist of R-NMDA, administrated in perioperative increase are discussed. OBJECTIVE: To evaluate the morphine saving effect of ketalar in carcinologic breast surgery. PATIENTS AND METHOD: This phase III randomized and double-blind study includes 208 patients during 14 months. Surgery consisted in mastectomy with or without axillary lymph node dissection or lumpectomy with axillary lymph node dissection. Group K received ketalar at induction until the end of surgery. Group P (placebo) received physiologic serum in the same condition. During the postoperative first 48h, morphine's consumption and EN are measured. RESULTS: No significant difference between two groups was observed. The EN evaluation and morphine consumption remained the same in the two groups. Our results did not find any benefit with use of ketamine between axillary lymph node dissection and no axillary lymph node dissection group. CONCLUSION: Ketalar adjunction in our analgesic protocol did not induce significant morphine saving in carcinologic breast surgery.

Bipallidal haemorrhage after ethylene glycol intoxication.

Acute or subacute bipallidal lesion, an uncommon radiological feature produced by metabolic disorders or poisoning, has never been attributed to ethylene glycol (EG) intoxication. This 50-year-old Afro-Caribbean alcoholic man had unexplained loss of consciousness. Blood tests showed osmolar gap. Drug screening was positive for EG at 6.06 mmol/l. Brain CT revealed bilateral pallidal haemorrhage. Pallidal haematoma, which could be related to deposition of oxalate crystals issued from EG metabolism, should lead to toxicological screening.

Synthesis of biphenylyltetrazole derivatives of 1-aminopyrroles as angiotensin II antagonists.

Based on preliminary molecular modelling study, the synthesis of two different classes of biphenylyltetrazole derivatives of 1-aminopyrroles, as potentially active non-peptide angiotensin II (AII) antagonists, is reported. Some NH-Boc protected l-aminopyrroles were deprotected, N-acylated, N-alkylated with 5-[4'-bromomethyl-1,1'-biphenyl-2-yl]-1-triphenylmethyl-1H-tetrazo le, and then detritylated to give the first class of title compounds. Other 1-NH-Boc protected 1,2-diaminopyrroles were regioselectively subjected to the 1-alkylation with 5-[4'-bromomethyl-1,1'-biphenyl-2-yl]-1-triphenylmethyl-1H-tetrazo le, to the acylation of the amino group at 2-position of the pyrrole ring, and then to the detritylation process to yield the second class of title compounds.

4-Diazinyl- and 4-pyridinylimidazoles: potent angiotensin II antagonists. A study of their activity and computational characterization.

A series of N-[biphenylyl(tetrazolyl)methyl]-2-butylimidazoles containing variously substituted diazine or pyridine moieties either as their free bases or N-oxide derivatives attached to the 4-position of the imidazole ring was synthesized and tested for interaction with the AT1 receptors of rat adrenal cortex membranes (receptor binding assay). Some compounds were then chosen for further evaluation in vivo in the A II-induced pressor response in conscious normotensive rats. The most potent in the AT1 binding assay were found to be compounds in which the diazine or pyridine ring nitrogen is adjacent to the point of attachment between the two heteroaromatic rings such as 2-butyl-4-(3,6-dimethylpyrazin-2-yl)-1-[[2'-(1H-tetrazol-5-y l)-biphenyl-4- yl]methyl]-1H-imidazole (3b) or 2-butyl-4-[5-(methoxycarbonyl)pyrid-2-yl]-1-[[2'-(1H-tetrazol++ +-5- yl)biphenyl-4-yl]methyl]-1H-imidazole (6c). The binding affinities and oral activities of the pyridine N-oxide imidazoles in which a stabilizing group ortho to the pyridine ring nitrogen is present were markedly improved as in 2-butyl-4-[(3-methoxycarbonyl)-6-methyl-N-oxopyridin-2-yl]-1-[[2'- (1H- tetrazol-5-yl)biphenyl-4-yl]methyl]-1H-imidazole 31b. Molecular modeling studies were carried out to determine the molecular electrostatic potential values of related model systems and to correlate their receptor interaction energies with the observed activities of our compounds.

Transferrin-binding proteins isolated from Neisseria meningitidis elicit protective and bactericidal antibodies in laboratory animals.

Transferrin-binding proteins (Tbps) were affinity-isolated from group B Neisseria meningitidis strain B16B6 and used to raise specific antisera. Administration of the antisera to mice loaded with human transferrin before bacterial challenge significantly protected the animals from death. In active immunization studies, mice received three 25 micrograms injections of purified Tbps over a period of 28 days, 7 days after which they were challenged with N. meningitidis. The survival rate in immunized mice was much higher than in control groups. In both active and passive immunization experiments mice were protected against at least 100 LD50. A specific Tbp antiserum was highly bactericidal against the parent strain and against approximately half of the strains tested.