Caprine nodular thelitis due to Mycobacterium uberis: A series of 26 cases in 11 dairy goat farms in Western France.

Bovine Nodular Thelitis (BNT) is a granulomatous dermatitis of teat skin associated with acid-fast bacilli. A similar condition has been recorded in a dairy goat flock in France recently. The causative agent was shown to be related to the leprosy-causing bacilli Mycobacterium leprae and M. lepromatosis, then sequenced and named M. uberis. Following the initial report in goats, the aim of this study was to investigate new cases of Caprine Nodular Thelitis (CNT) in the same area to confirm the presence of M. uberis by molecular techniques and to get a better description of the clinical signs and of the affected flocks. Twenty-six animals (25 females and 1 male) from 11 flocks were included in the study. Lesions were located on the udder/teat skin (24/25), on the body skin (6/25) or on the scrotum skin (1/1). Udder skin lesions were circular, nodular and/or ulcerate covered with a crust and associated with supramammary lymph node enlargement. Body skin lesions were located at different parts of the body, showed large necrotizing ulcers with undetermined edges and were associated with regional lymph node enlargement. Histopathological results indicated granulomatous dermatitis and lymphadenitis of varying intensity with no acid-fast bacilli seen after Fite-Faraco staining. M. uberis DNA was amplified from 26 samples out of 47 (udder: 11/22; lymph node: 11/20; body: 4/5). The female goats were mostly older than 4 year of age and originated from breeding units characterized by large flock size and high proportion of goat in continuous lactation.

Construction and validation of the Lebanese Osteoporosis Knowledge Scale among a representative sample of Lebanese women.

Our study aimed at constructing and validating the Lebanese Osteoporosis Knowledge Scale adapted for use among Lebanese women and to assess factors associated with the poorest knowledge of osteoporosis definition, risk factors, and preventive measures. This scale showed adequate psychometric properties; higher knowledge scores were reached in women who already heard about the disease and had a formal education. As a result, the LOKS-19 can be used to measure knowledge of osteoporosis and help assess osteoporosis-related interventions. INTRODUCTION: The primary objective of this study was to describe the construction of the Lebanese Osteoporosis Knowledge Scale (LOKS) and assess its psychometric properties in a representative sample of Lebanese women aged 40 years and above. Secondary objectives were to explore factors associated with this knowledge score. METHODS: A cross-sectional study carried out between March and June 2018, enrolled 560 women over the age of 40 years living in the community. This proportionate sample was randomly selected from all Lebanese governorates to cover the entire Lebanese area. A survey was developed and adapted to the Lebanese population based on preexisting scales. Personal interviews were conducted to collect data. RESULTS: The items of the LOKS were distributed across seven factors with an Eigenvalue over 1 solution, outlining an overall value of 55.89% of the variance. A high Cronbach's alpha was found for the full scale (0.725). Individuals having a university level of education (beta = 1.62; compared to illiteracy), having heard of osteoporosis (beta = 2.62), taking supplements of calcium and vitamin D compared to none (beta = 0.77), and having had Crohn's disease (beta = 1.71) had significantly higher knowledge scores of osteoporosis; oppositely, having diabetes (beta = - 1.17), currently taking chemotherapy (beta = - 2.25), and ever having had a fracture (beta = - 0.74) were significantly correlated with lower awareness of osteoporosis. CONCLUSIONS: Our findings suggest that the LOKS-19 can be used to measure knowledge of osteoporosis and help assess osteoporosis-related interventions. A better knowledge seems to be associated with more preventive measures and less risk of fracture.

Osteoporosis awareness and health beliefs among Lebanese women aged 40 years and above.

Our study investigated the characteristics of Lebanese women population groups with the poorest knowledge of osteoporosis definition, risk factors, and preventive measures in order to identify categories that should be targeted in future campaigns and educational programs. Higher knowledge scores were reached in women who already heard about the disease and had a formal education. As a result, osteoporosis awareness campaigns and educational programs are mostly needed in populations with lower educational levels. INTRODUCTION: Our study investigated the characteristics of Lebanese women population groups with the poorest knowledge of osteoporosis definition, risk factors, and preventive measures. METHODS: A cross-sectional study, conducted between March and June 2018, enrolled 560 community dwelling women aged 40 years and above. A questionnaire was used to collect data. A proportionate random sample from all Lebanese Mohafazat was used. Data collection was performed through personal interviews. The median was used as a cutoff point for both the Knowledge and Health Belief scales. RESULTS: The study results showed that 47.3% of participants had a poor knowledge score. Women who received no education, compared to a higher education and have not previously heard about the disease, had lower knowledge scores. In addition, women not taking calcium and vitamin D supplements and not exercising or exercising less than 20 min per day compared to those having these characteristics had lower osteoporosis knowledge levels. A lower knowledge score was associated with less recognized benefits of adequate calcium intake and regular physical activity, more perceived barriers towards their practice, and a less important health motivation. A lower level of education correlated to the same results. CONCLUSION: Lower knowledge scores were reached in women who have never heard of osteoporosis and had a lower level of education. As a result, osteoporosis awareness campaigns and educational programs need to target population categories with lower educational levels.

Proposal of a therapeutic protocol for selected patients with patellofemoral knee osteoarthritis: arthroscopic lateral retinacular release followed by viscosupplementation.

BACKGROUND: Lateral retinacular release has been demonstrated to reduce articular patellofemoral pressures, while intra-articular injection of hyaluronic acid can improve the biological and rheological knee pathway. We evaluated whether treatment protocol consisting on combination of these two therapies can provide significant symptomatic improvement in patients with patellofemoral osteoarthritis (PFO) and patellar tilt. MATERIALS AND METHODS: We retrospectively analyzed the clinical and radiological data of 28 knees (25 patients with anterior knee pain) who underwent arthroscopic lateral retinacular release followed by viscosupplementation for isolated patellofemoral osteoarthritis without clinical or radiological signs of patellar instability. Clinical evaluation was performed at a mean follow-up of 32.4 months (range 24-47 months) by an independent surgeon using the Kujala score, visual analog scale (VAS), and patient satisfaction scale. Univariate and multivariate analysis was used to identify best determinants to have a good clinical outcome. RESULTS: Mean Kujala score improved from 45.8 points before surgery (range 33-65 points) to 82.7 points after treatment protocol (range 52-100 points). VAS improved of 68.5 % from preoperative and all patients except one were satisfied. Linear multiple regression modeling showed that younger age (OR 1.134, 95 % CI 1.018-1.263, p = 0.022) and short time delay between the onset of symptoms and treatment (OR 1.207, 95 % CI 0.982-1.484, p = 0.007) were the best determinants for a good final outcome. CONCLUSIONS: Arthroscopic lateral retinacular release followed by viscosupplementation is an effective treatment protocol for PFO, simple and minimally invasive with respect to other therapeutic options.

Establishing a database of radionuclide transfer parameters for freshwater wildlife.

Environmental assessments to evaluate potentials risks to humans and wildlife often involve modelling to predict contaminant exposure through key pathways. Such models require input of parameter values, including concentration ratios, to estimate contaminant concentrations in biota based on measurements or estimates of concentrations in environmental media, such as water. Due to the diversity of species and the range in physicochemical conditions in natural ecosystems, concentration ratios can vary by orders of magnitude, even within similar species. Therefore, to improve model input parameter values for application in aquatic systems, freshwater concentration ratios were collated or calculated from national grey literature, Russian language publications, and refereed papers. Collated data were then input into an international database that is being established by the International Atomic Energy Agency. The freshwater database enables entry of information for all radionuclides listed in ICRP (1983), in addition to the corresponding stable elements, and comprises a total of more than 16,500 concentration ratio (CRwo-water) values. Although data were available for all broad wildlife groups (with the exception of birds), data were sparse for many organism types. For example, zooplankton, crustaceans, insects and insect larvae, amphibians, and mammals, for which there were CRwo-water values for less than eight elements. Coverage was most comprehensive for fish, vascular plants, and molluscs. To our knowledge, the freshwater database that has now been established represents the most comprehensive set of CRwo-water values for freshwater species currently available for use in radiological environmental assessments.

[Arthroscopic surgery of the acromioclavicular joint.] / Arthroscopie de l'articulation acromioclaviculaire.

Lesion of the acromioclavicular joint is a usual clinical condition because of it superficial situation. It is often involved in trauma of the shoulder girdle. Moreover, degenerative changes are quite always observed for patients over 40. Distal clavicle resection as a treatment of acromioclavicular joint disease had been first described in 1941. Clinical results in term of mobility and shoulder pain are good and durable in time. Referring to the expansion arthroscopic techniques, distal clavicle resection lead to same middle and long term results as open surgery. Arthroscopic procedures have the theoretical advantages of no deltoid disruption and may help the surgeon to diagnose and treat associated lesions such as rotator cuff ruptures. More recently, arthroscopic surgeries for fresh and/or chronic acromioclavicular disjunctions were proposed. These procedures remain in development and need further evaluations.

[Arthroscopic surgery of the acromioclavicular joint]. / Arthroscopie de l'articulation acromioclaviculaire.

Lesion of the acromioclavicular joint is a usual clinical condition because of it superficial situation. It is often involved in trauma of the shoulder girdle. Moreover, degenerative changes are quite always observed for patients over 40. Distal clavicle resection as a treatment of acromioclavicular joint disease had been first described in 1941. Clinical results in term of mobility and shoulder pain are good and durable in time. Referring to the expansion arthroscopic techniques, distal clavicle resection lead to same middle and long term results as open surgery. Arthroscopic procedures have the theoretical advantages of no deltoid disruption and may help the surgeon to diagnose and treat associated lesions such as rotator cuff ruptures. More recently, arthroscopic surgeries for fresh and/or chronic acromioclavicular disjunctions were proposed. These procedures remain in development and need further evaluations.

[Arthroscopic repair of full-thickness cuff tears: a multicentric retrospective study of 576 cases with anatomical assessment]. / Réparation arthroscopique des ruptures transfixiantes de la coiffe des rotateurs: étude rétrospective multicentrique de 576 cas avec contrôle de la cicatrisation.

PURPOSE OF THE STUDY: Totally arthroscopic repair of rotator cuff tears is now common practice. The techniques used were evaluated by a retrospective multicentric analysis conducted by the French Society of Arthroscopy. MATERIAL AND METHODS: The series was limited to arthroscopic repair of full thickness tears of the supraspinatus or infraspinatus evaluated using the Constant score and arthro-MRI or arthroscan performed with at least one year follow-up. Data were processed with SPSS 10. The series included 576 patients who underwent surgery between January 2001 and June 2003. Mean patient age was 57.7 years; 52% were men and 60% were manual laborers. The mean preoperative Constant score was 46.4 +/- 13.4/100. The tear was limited to the supraspinatus in 69% of shoulders, with extension to the upper third of the infraspinatus in 23.5% and the entire infraspinatus in 7.5%. The supraspinatus tear was distal in 41.7% of shoulders, intermediary in 44% and retracted in 14.3%. Fatty degeneration of the supraspinatus was noted grade 0 in 60%, 1 in 27%, 2 in 11% and 3 in 2%. Arthroscopic repair was performed in all cases, with locoregional anesthesia in 60.9%. Bioresorbable implants were used in 33% and metallic implants in 62.1%. Acromioplasty was performed in 92.7% and capsulotomy in 14.9%. RESULTS: On average, the subjective outcome was scored 8.89/10. The Constant score improved from 46.3 +/- 13.4 to 82.7 +/- 10.3 with 62% having a strictly pain free shoulder. Muscle force improved from 5.8 +/- 3.7 to 13.6 +/- 5.4. Outcome was excellent in 94% of shoulders at 18.5 months mean follow-up. The complication rate in this series was 6.2% with 3.1% prolonged stiffness, 2.7% reflex dystrophy, 0.2% infection, and 0.2% anchor migration. The cuff was considered normal in 55.7% of shoulders with an intratendon addition image in 19%, i.e. 74.7% of non-ruptured cuffs. Minimal loss of integrity was noted in 9.5% and was marked in 15.7%, i.e. 25.2% iterative tears.ANATOMOCLINICAL CORRELATIONS: The Constant score was strongly correlated with rotator cuff integrity (p<0001). This correlation was also found for force (p<0001), motion (0.01) and activity (0.04), but not for pain. The clinical outcome was correlated with extension, retraction, intrasubstance tear, and fatty degeneration of the lesion preoperatively. Anatomic results were statistically less favorable for tears which were older, extensive, retracted or associated with fatty degeneration. Age was correlated with extent of the initial tear and also with less favorable anatomic and clinical outcome. Occupational accidents were correlated with less favorable clinical outcome. CONCLUSION: Functional improvement after healing is a strong argument for repair. Arthroscopy has the advantage of combining a low complication rate with good clinical and anatomic results. Age is correlated with functional outcome and healing, but is not a contraindication.

[Infections in cancer patients with granulocytopenia. Retrospective studies of 59 febrile episodes with hospitalization]. / Infections chez les cancéreux granulocytopéniques. Etudes rétrospectives de 59 épisodes fébriles hospitalisés.

A total of 59 febrile neutropenic episodes were retrospectively recorded at Hôtel-Dieu de France Hospital between August 1st 1991 and December 31st 1992. These episodes were recorded in 51 cancer patients. Median neutropenia was less than one week in 50% of the cases. The etiology of these fever was documented in 27 episodes (46%) and in 70% of the cases gram (-) rods were documented. B-Lactam and Aminoglycoside antibiotics were used in 34 episodes at the initial treatment of these patients. Success rate at this initial treatment or with a modification of the antibiotic therapy was recorded in 85% of the patients. Only 15% of the patients failed to this antibiotherapy, 2/3 of them had their disease in progression. The systemic use of Amphotericine E in those patients with prolonged febrile neutropenia and the concommitent use of growth factors in a sub-group of patients at high risk could lead to a higher success rate in these patients.

Effects of amrinone and dobutamine on PGF2 alpha-induced pulmonary hypertension in dogs.

The hemodynamic benefits and pulmonary vascular selectivity of amrinone, dobutamine and amrinone + dobutamine were assessed in a canine model of vasoconstrictive pulmonary hypertension. Dogs were equipped with central and peripheral catheters and with an electromagnetic flow probe placed around the ascending aorta for the measurement of cardiac function. Through a laparotomy, an arteriovenous fistula was created between the abdominal aorta and the inferior vena cava. Gradual opening of this fistula, which permitted construction of pressure-flow curves (mean pulmonary artery pressure over the cardiac index, PAP/CI), was utilized to identify the pulmonary vascular effects of amrinone and dobutamine. PGF2 alpha, prostaglandin derivative, induced stable pulmonary hypertension along with significant reduction in CI. The resultant pulmonary hypertension translated into a significant increase in both the slope and pressure intercept of the PAP/CI curve. The bipyridine derivative, amrinone, did not reverse the CI reduction observed with PGF2 alpha: both mean arterial pressure and PAP were decreased as was the intercept of the PAP/CI curve. Dobutamine, a beta-agonist, reversed the CI decline elicited by PGF2 alpha but the elevated pulmonary pressure remained unaffected; dobutamine reduced the slope of the PAP/CI curve. When combined, amrinone and dobutamine demonstrated additive beneficial hemodynamic effects and improved lung perfusion. Their additive effects were also indicated by data on the PAP/CI curve: both the slope and the pressure intercept were significantly reduced. These results suggest that amrinone and dobutamine interact at different sites of the pulmonary vasculature and that their association might be beneficial in vasoconstrictive pulmonary hypertension although no significant pulmonary vascular selectivity could be observed.

Calcium effects on human esophageal smooth and striated muscle.

Because of conflicting results in earlier investigations, our study was carried out to determine the effects of acute hypercalcemia on esophageal muscle function at the lower esophageal sphincter and on the smooth and striated muscle of the esophageal body. Variables measured included lower esophageal sphincter pressure and length and esophageal body contraction pressure, duration, and velocity in the middle, distal, and proximal esophagus. Despite 3 hr of induced acute hypercalcemia, there were no statistically significant changes in any of the variables. Although esophageal muscle contraction requires calcium, our results, in contrast to some earlier studies, suggest that the availability of excess calcium does not effect esophageal function.

A developmentally regulated program restricting insolubilization of elastin and formation of laminae in the fetal lamb ductus arteriosus.

BACKGROUND: The ductus arteriosus (DA) is a fetal vessel in which the elastic laminae fail to assemble normally in late gestation. This feature is associated with the development of intimal cushions, structures that partially occlude the DA lumen and assure that the vessel will close completely when it constricts postnatally. EXPERIMENTAL DESIGN: We studied the fetal lamb DA at two different gestational time-points, 100 days before, and 138 days coincident with intimal cushion formation (term = 145 days) to establish the ultrastructural basis for the 'disassembly' of elastic laminae apparent on light microscopy and to determine further whether the mechanism was due to increased elastolytic activity, decreased synthesis of tropoelastin, or impaired insolubilization of tropoelastin. RESULTS: Morphometric ultrastructural analyses of tissue from the 138-day gestation fetal lambs revealed that the volume density of elastin in the DA vessel wall was only 40% of that in the aorta (Ao) and 50% of that in the pulmonary artery (PA). Moreover, only 16% of the elastin present contributed to the formation of laminae when compared to 80% in the Ao and 50% in the PA. Despite the morphologic appearance of 'fragmented' elastin, there was no evidence of increased elastolytic activity in the DA at either gestational time-point as judged by solubilization of a [3H] elastin substrate. The reduced elastin apparent was morphologically accompanied by an increase in soluble (tropo) elastin in DA compared with Ao and PA, as measured by enzyme linked immunosorbent assay, in tissue from both 100- and 138-day gestation lambs. Lack of differences in tropoelastin mRNA levels when comparing the 3 vessels suggested that the enzyme linked immunosorbent assay measurements reflected increased DA tropoelastin accumulation owing to lack of insolubilization rather than an increase in synthesis. Reduced insolubilization of newly synthesized elastin was evident in the DA compared with the Ao at 100 days gestation and in the DA compared with both Ao and PA at 138 days gestation in association with reduced desmosine levels. CONCLUSIONS: The mechanism of the decrease in tropoelastin insolubilization was unrelated to lysyl oxidase activity in the tissue and represents a unique developmental program.

Effects of PGE1 in experimental vasoconstrictive pulmonary hypertension.

The pulmonary vascular and systemic effects of PGE1 were studied in a canine model of pulmonary hypertension. Systemic arterial, central venous and pulmonary arterial pressures were monitored and an electromagnetic flow probe was placed around the ascending aorta for continuous cardiac index (CI) measurements. Through a laparotomy, an arteriovenous fistula was created between the abdominal aorta and inferior vena cava. Gradual opening of this fistula significantly affected CI and these values were used to generate pressure-flow curves (pulmonary arterial pressure (PAP)/CI). Following PGF2 alpha infusion (5-10 micrograms/kg/min) significant pulmonary hypertension was observed (2- to 3-fold increase in PAP). PGF2 alpha infusion also resulted in a significant rise in heart rate and systemic vascular resistance (SVR) while CI was reduced. PGF2 alpha significantly increased both the line slope (vascular resistance) and intercept (outflow pressure) of the pressure-flow curves. Intravenous PGE1 infusion in doses ranging from 40 to 320 ng/ml/min elicited a dose-dependent reduction of both pulmonary and systemic vascular resistances, the former being slightly more affected. With PGE1 infusions only the intercept of the pressure-flow curve was affected suggesting that specific components of the pulmonary vascular bed modulating the outflow pressure were involved. High doses of PGE1 significantly decreased arterial PO2, indicating that this prostaglandin derivative deteriorates pulmonary gas exchanges.

Positive hemodynamic interaction between amrinone and diltiazem in anesthetized dogs.

The direct negative inotropic actions of calcium channel blockers limit the use of these otherwise effective systemic and coronary vasodilators in patients with heart failure. We studied the effects of amrinone pretreatment on the dose--hemodynamic response curve of diltiazem in order to test the hypothesis that amrinone might potentiate diltiazem's positive effects in anesthetized dogs. The control group (no pretreatment, n = 6) had a typical dose-related response to diltiazem (50, 100, and 150 micrograms/kg): coronary and systemic vasodilation, increased stroke volume, and no change in myocardial work and power. Amrinone pretreatment of the study group (n = 7) altered the hemodynamic response, thus maximal systemic vasodilation and stroke volume increase at a lower diltiazem dose, a 15 to 35% increase in myocardial work and power, and more profound coronary vasodilation. We propose that amrinone, by inhibiting phosphodiesterase, potentiates diltiazem vasodilation and reflexly secreted catecholamines' actions on the heart. This positive interaction may permit effective use of lower doses of diltiazem, thus circumventing its dose-limiting direct negative effects while still profitting from beneficial peripheral, reflex, and coronary actions.