[Associated factors and sub-clinical myocardial dysfunction in obese patients with masked hypertension]. / L'hypertension artérielle masquée chez les obèses : facteurs associés et atteinte myocardique infraclinique.

INTRODUCTION: Obesity is a worldwide health problem. Masked hypertension is a relatively recent reported entity with a diagnostic problem. The aim of this study was to determine the clinical and paraclinical characteristics and to identify the predictive factors of masked hypertension in obese patients. METHODS: It is a prospective study including obese patients with normal arterial pressure at office. All of these patients were given ambulatory blood pressure measurement (ABPM) to screen for masked hypertension, laboratory tests and a complete echocardiography study. RESULTS: A total of 50 patients were included. The mean age was 46.52±10.4 years. The mean systolic blood pressure (BP) at office was 120.8±8.8mmHg and the mean diastolic BP was 75±7.3mmHg. The prevalence of masked hypertension in obese adults was 36% with a predominantly non-dipper profile (38%). The study of echocardiographic parameters found dilated left atrium (LA) in 16 patients (32%). The left ventricle (LV) was hypertrophied in 32 patients (64%). The overall LV global longitudinal strain (GLS) was on average -18.85±0.9% and the LA GLS was on average 37.35±4.5%. In our study, metabolic syndrome, low HDL cholesterol, elevated fasting blood glucose, hyperuricemia, LA dilatation, LV hypertrophy, diastolic LV dysfunction and altered myocardial deformities were factors associated with masked hypertension in obese adults. CONCLUSION: It is important to screen for hypertension by ambulatory measurement in at-risk obese patients who present associated cardiovascular risk factors to reduce morbidity and mortality. Echocardiography and speckle tracking analysis could be helpful in detection sub-clinical myocardial deterioration in obese patients with masked hypertension.

[Impact of socioeconomic factors on blood pressure control: Observational study about 2887 hypertensive patients]. / Impact des facteurs socioéconomiques sur l'équilibre de la pression artérielle : étude observationnelle à propos de 2887 hypertendus.

INTRODUCTION: Despite therapeutic progress, less than half of hypertensive patients are controlled. The objective of this study was to examine the links between blood pressure control and socioeconomic factors. METHODS: We used data collected in the cardiology department of Sfax University Hospital as part of the Tunisian national hypertension registry. We studied the associations between the socio-economic variables (educational level, profession, medical insurance) and optimal blood pressure control (SBP<140mmHg and DBP<90mmHg) using logistic regression models. RESULTS: The average age of our population was 65 and the sex ratio was 0.95. We found, as expected, the clinical and behavioral factors associated with a good blood pressure control, namely: female sex, low-sodium diet, therapeutic compliance, and regular physical activity. However, obesity and an increased number of antihypertensive drugs have been associated with poor blood pressure control. The study of the effect of socio-economic variables on BP control finds a significant gradient against the most disadvantaged social categories for our three social variables in the univariate analysis. The inclusion of clinical and behavioral factors in the multivariate analysis attenuated these associations but did not fully explain them. CONCLUSION: Our study shows that there are social inequalities in the control of blood pressure. Social justice and improving living conditions are probably the real solutions to the problem of these social inequalities in health.

Endovascular treatment of an immediate postoperative transplant renal artery stenosis with a polymer free drug eluting stent.

The transplant renal artery stenosis occurred up to 23% after kidney transplantation. Endovascular treatment has become the treatment of choice of this complication, but could be challenging in immediate postoperative anastomotic narrowing. We report the case of a adolescent with early renal graft artery stenosis located in the anastomosis and diagnosed 3 days after renal transplantation, with necessity of haemodialysis. This complication was treated by angioplasty on the 25th day, using a polymer free drug eluting stent with a good result. We discussed the precautions and technical features of this procedure.

Greater volumes of static and dynamic stretching within a warm-up do not impair star excursion balance performance.

Based on the conflicting static stretching (SS) literature and lack of dynamic stretching (DS) literature regarding the effects of differing volumes of stretching on balance, the present study investigated the effects of 4, 8, and 12 sets of SS and DS following a 5 min aerobic running warm-up on the star excursion balance test (SEBT). The objective was to examine an optimal stretch modality and volume to enhance dynamic balance. A randomized, within-subjects experimental design with repeated measures for stretching (SS and DS) versus no-stretching treatment was used to examine the acute effects of 10 (4 sets), 20 (8 sets), and 30 (12 sets) min, of 15s repetitions per muscle of SS and/or DS following a 5 min aerobic warm-up on the performance of the SEBT. Results indicated that a warm-up employing either SS or DS of any volume generally improves SEBT by a "small" amount with effect sizes ranging from 0.06 to 0.50 (11 of 18 conditions>75% likely to exceed the 1.3-1.9% smallest worthwhile change). Secondly, the difference between static and dynamic warm-up on this observed improvement with warm-up improvement was "trivial" to "moderate" (d=0.04 to 0.57) and generally "unclear" (only two of nine conditions>75% likely to exceed the smallest worthwhile change). Finally, the effect of increasing the volume of warm-up on the observed improvement with a warm-up is "trivial" to "small" (d<0.40) and generally "unclear" (only three of 12 conditions>75% likely to exceed the smallest worthwhile change). In summary, an aerobic running warm-up with stretching that increases core and muscle temperature whether it involves SS or DS may be expected to provide small improvements in the SEBT.

Pediococcus acidilactici UL5 and Lactococcus lactis ATCC 11454 are able to survive and express their bacteriocin genes under simulated gastrointestinal conditions.

AIMS: The aim of this work is to study the expression of stress genes and those involved in pediocin and nisin production in Pediococcus acidilactici UL5 and Lactococcus lactis ATCC11454 under simulated gastrointestinal (GI) physiological conditions. METHODS AND RESULTS: The two strains were fed to a dynamic GI model (TIM-1). Samples were taken from different compartments and analysed for strain survival as well as for the expression of pediocin PA-1 operon, nisin A production gene and stress genes using RT-qPCR. Ileal-delivered efflux showed a survival rate of 17 and 0·0007% for Ped. acidilactici and La. lactis, respectively. Pediocin operon genes from stressed cells were generally expressed at least at the same level as for unstressed cells. However, pedA is up-regulated in the effluent at 120 and 180 min. Nisin A genes were always up-regulated with particularly in the stomach after 70 min compared with control. CONCLUSIONS: Bacteriocin production of Ped. acidilactici UL5 and Lc. lactis ATCC 11454 are not affected by upper GI simulated conditions and thus could be considered as relevant probiotic candidates. SIGNIFICANCE AND IMPACT OF THE STUDY: This study demonstrates the capacity of lactic acid bacteria to survive and express their bacteriocins genes under simulated GI conditions.

[Acquired coronary-cameral fistula complicated by a ventricular pseudoaneurysm]. / Fistule coronaro-camérale acquise compliquée d'un pseudo-anévrysme ventriculaire.

Coronary-cameral fistulas are usually congenital, rarely acquired; the complication of this anomaly with ventricular pseudoaneurysm is exceptional. We report a new case of acquired coronary-cameral fistula, occurred in a patient who had received a bypass graft and who had suffered from angina 1 year after the surgery. On computed tomography coronary angiography, the fistula seems to communicate the first diagonal to a left ventricle pseudoaneurysm. Embolization of the fistula and filling of the pseudoaneurysm by neurocoil were successfully performed. The clinical and angiographic control after 3 months showed symptoms improvement and absence of recanalization of the fistula.

[Supraventricular tachycardia in infants]. / Les troubles du rythme supraventriculaires chez le nourrisson et l'enfant. À propos de six cas.

Supraventricular tachycardia in infants are variable. We try to summarize clinical, electrical and treatment particularities of supraventricular arrhythmia in infants. The majority of infants with supraventricular arrhythmia have a good clinical outcome and an excellent prognosis and may not require chronic antiarrhythmic therapy if they had precocious treatment.

Left ventricular thrombus complicating tachycardia-induced cardiomyopathy.

A 45 day old new-born with arrhythmia-induced cardiomyopathy complicated by thrombus formation is presented. Drug treatment produced immediate symptomatic relief and subsequent reversion to normal cardiac function. The thrombus disappeared a few days later.

Modeling of the full-length Escherichia coli SeqA protein, in complex with DNA.

The Escherichia coli SeqA protein, a negative regulator of chromosome DNA replication, prevents the overinitiation of replication within one cell cycle by binding to hemimethylated GATC sequences in the replication origin, oriC. In addition to the hemimethylated DNA-binding activity, the SeqA protein has a self-association activity, which is also considered to be essential for its regulatory function in replication initiation. To study the SeqA protein biological activity, we performed a SeqA protein model to examine its architecture. SeqA has a bipartite structure composed of a large and small lobe. The SeqA spatial conformation contributes to its ability to bind to a pair of hemimethylated GATC sequences and to its cooperative behavior.

[Intramedullary interlocking nailing for humeral fractures: report of 38 cases treated by Russel and Taylor nail]. / Enclouage verrouillé des fractures diaphysaires récentes de l'humérus.

PURPOSE OF THE STUDY: We assessed outcome after intramedullary interlocking nailing for humeral fractures to identify problems and indications in comparison with reports in the literature. MATERIAL AND METHODS: We implanted the Russel and Taylor nail to treat 38 fresh humeral shaft non-pathological fractures using 33 anterograde insertions and 5 retrograde insertions. RESULTS: All patients were examined at a mean follow-up of 16.3 months. Problems and complications involved 3 open procedure conversion, 3 peroperative re-fractures, 2 locking errors, 2 secondary dismantelings, 2 regressive iatrogenic palsies, and 4 cases of pain due to protruding material. First intention bone healing was achieved in 34 cases and following a revision procedure in 2. Two cases of nonunion were not reoperated. The Neer and Constant scores, used to assess functional outcome, identified 5 non-satisfactory results. DISCUSSION: The risk of infection with locking nails is low, as is the risk of nervous complications which are generally related to traction manoeuvres during reduction. Bone healing is easily achieved if the assembly is perfectly stable. The risk of disassembly or nonunion is related to technical errors: defective locking, insufficient hold in the bone fragments. The risk of stiffness or rotator cuff tears is low, generally related to protrusion of the material and not to insertion through the cuff muscles. Retrograde insertion can be recommended for fractures of the distal third of the humeral shaft. CONCLUSION: Insertion of the Russel and Taylor intramedullary locking nail requires a learning curve to minimize the risk of iatrogenic complications. It can be proposed for fractures of the mid-third of the humeral shaft and can be discussed for the proximal and distal thirds if perfect stability can be obtained on the short bony fragment.

[Radiographic analysis of the orientation of the distal articular surface of the first metatarsal in the horizontal plane]. / Analyse radiographique de l'orientation de la surface articulaire distale du premier métatarsien (AADM) dans le plan horizontal.

PURPOSE OF THE STUDY: The lateral obliquity of the distal metatarsal articular surface is a predominant anatomical factor in hallux valgus pathology. It is important to know its normal angular value. MATERIAL-METHODS: The study included 105 feet without any pathology (48 females and 57 males; 53 left and 52 right between 15 and 72 year old). Weight-bearing, anteroposterior X-rays of the foot was made. We measured the distal metatarsal articular angulation (DMAA), the intermetatarsal angle, the metatarsophalangeal angle, the obliquity of the metatarsocuneiform joint and the length of the first and second metatarsal, and the length of the hallux. RESULTS: The main value of the DMAA was 5.78 degrees in our study, 6.79 degrees for women and 4.92 degrees for men. There was no difference between left and right side, no correlation between intermetatarsal angle and DMAA, neither between biometrics parameters and DMAA. DISCUSSION: Our results confirm the Richardson study on cadaver with a main value of 6 degrees for the DMAA. The DMAA value increases in women and it does not increase proportionaly to the intermetatarsal angle; it increases with the value of the metatarsophalangeal angle. All these points have to be taken in consideration in hallux valgus evaluation. CONCLUSION: The distal metatarsal articular surface has a lateral obliquity of 5.78 degrees. It must be evaluated before surgical correction of hallux valgus, in order to decrease recurrence rate of this pathology and iatrogenic deformity.