Repair of parastomal hernia after Bricker procedure: retrospective consecutive experience of a tertiary center.

BACKGROUND: Ileal conduit parastomal hernias (ICPHs) are frequent after radical cystectomy with ileal conduit urinary diversion, but their management is debated. This study aimed to review the results of ICPH repair according to Sugarbaker or Sandwich techniques, with special interest in ICPH recurrence and urological complications. METHODS: The authors reviewed a consecutive series of patients undergoing ICPH repair between January 2014 and December 2020. Primary endpoints were ICPH recurrences at clinical exam and cross-sectional abdominal computed tomography (CT) scans. Secondary endpoints were any other complications possibly related to the ICPH repair. RESULTS: Twenty-three patients underwent ICPH repair surgery (16 Sugarbaker and 7 Sandwich techniques) during the study period. Sixteen patients underwent a primary laparoscopic approach. All but one patient underwent at least one abdominal CT during the follow-up. Median clinical and CT scan follow-up times were 57 and 50.5 months, respectively. Clinical and CT ICPH recurrence rates were 4.5% and 13% at 5 years, respectively. Eighteen patients (78%) suffered no urological complications during the follow-up period, but three patients (13%) needed redo surgery on the urinary ileal conduit. CONCLUSION: The modified Sugarbaker or Sandwich techniques might be considered as promising techniques for ICPH repair with a low rate of recurrence. The urological complications, and particularly the ileal conduit-related issues, need to be evaluated in further studies. Controlled and prospective data are required to compare the Sugarbaker and Sandwich techniques to the Keyhole approach for ICPH repairs.

Population structure and evolutionary history of the greater cane rat (Thryonomys swinderianus) from the Guinean Forests of West Africa.

Grasscutter (Thryonomys swinderianus) is a large-body old world rodent found in sub-Saharan Africa. The body size and the unique taste of the meat of this major crop pest have made it a target of intense hunting and a potential consideration as a micro-livestock. However, there is insufficient knowledge on the genetic diversity of its populations across African Guinean forests. Herein, we investigated the genetic diversity, population structures and evolutionary history of seven Nigerian wild grasscutter populations together with individuals from Cameroon, Republic of Benin, and Ghana, using five mitochondrial fragments, including D-loop and cytochrome b (CYTB). D-loop haplotype diversity ranged from 0.571 (± 0.149) in Republic of Benin to 0.921 (± 0.013) in Ghana. Within Nigeria, the haplotype diversity ranged from 0.659 (± 0.059) in Cross River to 0.837 (± 0.075) in Ondo subpopulation. The fixation index (FST), haplotype frequency distribution and analysis of molecular variance revealed varying levels of population structures across populations. No significant signature of population contraction was detected in the grasscutter populations. Evolutionary analyses of CYTB suggests that South African population might have diverged from other populations about 6.1 (2.6-10.18, 95% CI) MYA. Taken together, this study reveals the population status and evolutionary history of grasscutter populations in the region.

[CT scan in syncope : diagnostic yield and prescription habits]. / Imagerie CT des syncopes : apport diagnostique et habitudes de prescription.

Syncope is a frequent reason for emergency department admission. Brain imaging is theoretically not recommended. After exclusion of features orienting towards non-syncopal events, we retrospectively included 206 patients who underwent head CT scans in the University Hospital of Liège for transient loss of consciousness between December 2020 and July 2021. We surveyed physicians involved in the emergency department concerning their imaging prescription habits and motivations. CT diagnostic yield is 1 %. The oncologic background is associated with pathological findings (odds ratio 84,1, p = 0,005). Cervical angio-CT scans only lead to incidental findings and increased dose exposure. Only a minority (6.6 %) of physicians systematically prescribe brain imaging. Radioprotection is an important notion for only 10 % of the less experimented physicians. Obligation of means is an occasional justification for resort to imaging. A prospective decisional rule based on the exclusion of features orienting towards non-syncopal loss of cousciousness, old age and oncologic history might reduce the number of useless scans. Radioprotection is too often neglected by less experimented physicians. Obligation of means should not be mingled with reassurance behaviors as part of defensive medicine.

La syncope est un motif fréquent d'admission aux Urgences. La réalisation d'une imagerie encéphalique n'est, théoriquement, pas recommandée. Après exclusion de critères évocateurs d'une étiologie non syncopale, nous avons rétrospectivement inclus 206 patients ayant passé un CT cérébral entre décembre 2020 et juillet 2021 au CHU de Liège pour perte de connaissance brève. Nous avons sondé les médecins impliqués dans le service des Urgences concernant leur habitudes de prescription. L'apport diagnostique du CT est de 1 %. Un contexte oncologique est associé aux résultats iconographiques pathologiques (odds ratio 84,1; p = 0,005). L'angio-CT cervical ne permet que la mise en évidence d'incidentalomes au prix d'une majoration de l'irradiation. Une minorité (6,6 %) de prescripteurs a systématiquement recours à l'imagerie. La radioprotection est jugée importante par seulement 10 % des intervenants les moins expérimentés et l'obligation de moyens est parfois avancée comme justification de prescription. Des critères décisionnels prospectifs (exclusion d'éléments évocateurs de pertes de connaissance non syncopales, âge et contexte oncologique) permettraient de réduire le nombre d'examens inutiles. La radioprotection est trop souvent négligée par les prescripteurs les moins expérimentés. L'obligation de moyens ne doit pas être confondue avec des comportements de réassurance dans le cadre de la médecine défensive.

[Bilateral subdural hematomas due to idiopathic cerebral spinal fluid leak treated by radiologically guided blood patch]. / Hygromes sous-duraux bilatéraux sur fuite de liquide céphalo-rachidien idiopathique traitée par «blood patch¼ radio-guidé.

We report a case of cerebral hypotension due to an idiopathic cerebral spinal fluid leak associated with bilateral sub-dural hygromas. The symptoms were not relieved despite of multiple lumbar, thoracic and cervical «blind¼ blood patches. The check-up led to a scopic controlled cervical blood patch directly on the leak by a paramedian approach with a complete clinical and radiological response to treatment.

Nous rapportons un cas d'hypotension cérébrale sur une fuite de liquide céphalo-rachidien d'origine idiopathique associée à la présence d'hygromes sous-duraux bilatéraux. La symptomatologie n'est pas soulagée malgré plusieurs «blood patchs¼ lombaires, thoraciques et cervicaux dits à l'aveugle. Le bilan a conduit à la réalisation d'un «blood patch¼ sous contrôle radiologique, ciblée sur le niveau de fuite par un abord paramédian avec réponse complète clinique et radiologique après cette procédure.

EFFICACY AND SAFETY OF BASAL INSULIN THERAPY IN ROMANIAN PATIENTS WITH TYPE 2 DIABETES IN REAL-LIFE SETTINGS: A SUB-GROUP ANALYSIS OF DUNE STUDY.

CONTEXT: Despite the available evidence showing the vital role of glycemic control in the management of type 2 diabetes, a significant proportion of patients are not achieving a good glycemic control. OBJECTIVE: Here we present the results of the Diabetes Unmet Need with basal insulin Evaluation (DUNE) study for patients enrolled in Romanian centers with the aim to describe the proportion of participants who achieved individualized HbA1c targets at 12 weeks following basal insulin therapy initiation. DESIGN: Prospective, observational study. SUBJECTS AND METHODS: 355 consecutive adults with type 2 diabetes, who were newly initiated with basal insulin therapy (Newly initiated group) or had been treated for less than 12 months with basal insulin prior to study enrollment (Previously initiated group) were enrolled and followed for 12 weeks. RESULTS: The individualized HbA1c target was achieved by 22.7% of the patients in the Newly initiated group and by 25.0% of the patients in the Previously initiated group. During the study period, in the Newly initiated group mean basal insulin dose increased from 16.2 U at baseline to 27.6 U at 12 weeks. In the Previously initiated group, the insulin dose increased from 27.4 U at baseline to 33.1 U at 12 weeks. In both groups, 9.7% and 12.8% of the patients reported at least 1 episode of symptomatic hypoglycemia. CONCLUSIONS: In real-world settings, despite insulin initiation a large number of patients fail to achieve their individualized glycemic targets. One of the reasons appeared to be linked to the insufficient basal insulin titration.

DNA Barcoding Silver Butter Catfish (Schilbe intermedius) Reveals Patterns of Mitochondrial Genetic Diversity Across African River Systems.

The silver butter catfish (Schilbe intermedius) is widely distributed across African river systems. To date, information on its mitochondrial genetic diversity, population structure, and historical demography are not well-established. Herein, we combined newly generated mitochondrial cytochrome c oxidase (COI) subunit I gene sequences with previously published COI sequences in the global databases to reconstruct its phylogeography, population genetic structure, and historical demography. Results from the mtDNA phylogeography and species delimitation tests (Cluster algorithm - Species Identifier, Automatic Barcode Gap Discovery and Poison Tree Process model) revealed that S. intermedius comprises at least seven geographically defined matrilines. Although the overall haplotype diversity of S. intermedius was high (h = 0.90), results showed that East (Kenya) and West (Nigeria) African populations had low levels of haplotype diversity (h = ~0.40). In addition, population genetic polymorphism and historical demographics showed that S. intermedius populations in both East and West Africa underwent severe contractions as a result of biogeographic influences. The patterns of genetic diversity and population structure were consistent with adaptive responses to historical biogeographic factors and contemporary environmental variations across African river systems. This is suggestive of the influence of historical biogeographic factors and climatic conditions on population divergence of S. intermedius across African river systems. Given our discovery of previously underappreciated diversity within S. intermedius, we recommend that this species be considered for increased conservation and management.

Bioaccumulation and physiological effects of copepods sp. (Eucyclop sp.) fed Chlorella ellipsoides exposed to titanium dioxide (TiO2) nanoparticles and lead (Pb2+).

The demand for manufactured products and the derivatives of nanomaterials and non essential metals continue to increase, and as a consequence their presence in fisheries and aquaculture has therefore become a major concern for the risks to which our environment is exposed. The bioaccumulation profile of binary compounds (Titanium dioxide nanoparticles and lead) and their effects on the feeding behaviour of copepods were assessed in a simplified food chain including, the freshwater alga Chlorella ellipsoides and the cyclopoids copepods sp. Our results indicated that Pb and TiO2 NPs individually and mixed can be transferred from alga to copepods via dietary pathway. The highest bioconcentration factor (748.5) was recorded for Pb in the combined compounds (Pb15 + Ti16.5) µg L-1 and the highest BCF (5.57) recorded for TiO2 NPs was found in TiO2 NPs (16.5) alone. Ingestion and filtration rate decreased significantly (p < 0.05) in all treatments. Analysis of variance (ANOVA) showed that the combination of these metals significantly (p < 0.05) decreased ingestion and filtration rate. In addition, the individual compounds and their combinations significantly (p < 0.05) increased carbohydrate and total lipid content. The antioxidant activities showed significant (p < 0.05) effect of Glutathione peroxidase (GPx), Glutathione reductase (GR), catalase (CAT) however, SOD and MDA were not significant (p > 0.05) in both single and binary treatments. The results demonstrate that the co-exposure of TiO2 NPs and Pb inhibit the ingestion and filtration of microalgae by cyclopoid copepods sp. and also induce increase of carbohydrate, lipid; GPx, GR and CAT due to stress.

Binary effect of titanium dioxide nanoparticles (nTio2) and phosphorus on microalgae (Chlorella 'Ellipsoides Gerneck, 1907).

The wide application of titanium dioxide nanoparticles and phosphorus in the manufacturing of many industrial products mainly used in agricultural sector has resulted in the release of considerable amounts of these compounds into freshwater aquatic ecosystem. These compounds may cause some unexpected effects to aquatic organisms. This study assessed the binary effects of Titanium nanoparticles (nTiO2) and Phosphorus on Chlorella ellipsoides. Toxicological assay test of the compounds nTiO2 (1.25 µM) alone and the combination of Titanium dioxide (1.25 µM) and Phosphorus (16, 32, 80, 160, 240 µM) was assessed, after 96 h exposures, for optical density (OD680), specific growth rate, chlorophyll levels and lipid peroxidation via Malondialdehyde (MDA) activity. Superoxide dismutase (SOD), peroxidase (POD) and glutathione-s-transferase (GST) activities were also measured. Two-way ANOVA showed a significant interaction (P < 0.05) between binary mixture. Co-exposure showed a decreased phosphorus bioconcentration in the microalgae with significant increase (P < 0.05) in chlorophyll a/b and total chlorophyll contents. A significant decrease (P < 0.05) in specific growth rate and optical density were recorded whereas, antioxidant enzymes (MDA, SOD, POD, GST) activities were significantly (P < 0.05) increased. These results showed that the addition of nTiO2 to Phosphorus affected the physiology of microalgae and should be of great concern for freshwater biodiversity.

Estrogen and progesterone receptor expression in the mammary gland tumors.

In the primary mammary malignant tumors, including in situ carcinoma, it is recommended the carrying out of immunohistochemical diagnosis for the estrogen (ER) and the progesterone receptors (PR). We have studied the ER and the PR expression in malignant tumors, trying to identify the corresponding phenotypes according to the presence of these tumors. We have carried out a study on a total number of 80 carcinomas, divided into two groups: the first one constituted of 54 cases of carcinomas on which we had clinical data, and another group, constituted of 26 cases of mammary carcinoma, where no clinical data was available. We have observed that the values and the distribution of the ER and PR taken from the biopsies made in the patients with mammary carcinoma are influenced by the age and menopausal status. The combination of the ER/PR results lead to the definition of many tumoral phenotypes.

Immunohistochemical profile of the estrogen and progesterone receptors in mammary benign lesions.

UNLABELLED: The immunohistochemical diagnosis for estrogen and progesterone receptors must be carried out in the tracking of every primary tumor, benign or malign, especially in the case of in situ carcinoma. MATERIAL AND METHOD: We have studied the expression of estrogen and progesterone receptors in benign lesions, identifying phenotypes depending on the presence of estrogen and progesterone receptors. RESULTS: The result "positive" or "negative" in the report sent to the doctor is not sufficient, the inclusion of the total score in the case of a positive result, the clone used, the usage / non-usage of antigenic exposure and also the quality control being necessary. The benign mammary lesions occur in the context of a hormonal imbalance, which, in the long run runs the risk of developing a mammary carcinoma. CONCLUSION: The further study of the hormonal spectrum of those lesions, considered as pre-malignant, may lead to the identification of some groups of hyperplastic lesions, presenting a high risk for developing a mammary cancer.

Human epidermal growth factor receptor 2 (HER2/neu) supraexpression in the mammary tumors.

A series of morphological and molecular factors can be used in order to appreciate the prognostic of mammary cancer. A multitude of molecular factors has been investigated in order to identify a prognostic factor, one of the most studied factors being HER2 (human epidermal receptor growth factor). For this purpose, we have carried out an immunohistochemical research, in order to determine the correlation between the presence of morphological factors in tumor formation, different stages of evolution, and the response to therapy. We have correlated HER2 expression with the histological type of carcinomas, the histological differential degree, ER, PR immunohistochemical expression, as well as the available clinical data. Within the studied carcinomas, we have identified a number of 98/156 (62.8%) carcinomas HER2/neu negative, out of which 74/156 (47.4%) did not reveal the presence of HER2/neu and 24/156 (15.4%) have been quantified as being 1+. The HER2/neu supraexpression was encountered in 58/156 (37.17%) cases: in 34/156 (21.8%) cases the immunostaining was interpreted as being 2+ and in 24/156 (15.4%) cases it was interpreted as being 3+. HER2/neu supraexpression should be routinely determined through immunohistochemical methods in all primary mammary tumors, especially in those poorly differentiated.

Placental growth factor provides a novel local angiogenic therapy for ischemic cardiomyopathy.

BACKGROUND: Heart failure occurs predominantly due to coronary artery disease and may be amenable to novel revascularization therapies. This study evaluated the effects of placental growth factor (PlGF), a potent angiogenic agent, in a rat model of ischemic cardiomyopathy. METHODS: Wistar rats underwent high proximal ligation of the left anterior descending coronary artery and direct injection of PlGF (n = 10) or saline as a control (n = 10) into the myocardium bordering the ischemic area. After 2 weeks, the following parameters were evaluated: ventricular function with an aortic flow probe and a pressure/volume conductance catheter, left ventricular (LV) geometry by histology, and angiogenesis by immunofluorescence. RESULTS: PlGF animals had increased angiogenesis compared to controls (22.8 +/- 3.5 vs. 12.4 +/- 3.2 endothelial cells/high-powered field, p < 0.03). PlGF animals had less ventricular cavity dilation (LV diameter 8.4 +/- 0.2 vs. 9.2 +/- 0.2 mm, p < 0.03) and increased border zone wall thickness (1.85 +/- 0.1 vs. 1.38 +/- 0.2 mm, p < 0.03). PlGF animals had improved cardiac function as measured by maximum LV pressure (95.7 +/- 4 vs. 73.7 +/- 2 mmHg, p = 0.001), maximum dP/dt (4206 +/- 362 vs. 2978 +/- 236 mmHg/sec, p = 0.007), and ejection fraction (25.7 +/- 2 vs. 18.6 +/- 1%, p = 0.02). CONCLUSIONS: Intramyocardial delivery of PlGF following a large myocardial infarction enhanced border zone angiogenesis, attenuated adverse ventricular remodeling, and preserved cardiac function. This therapy may be useful as an adjunct or alternative to standard revascularization techniques in patients with ischemic heart failure.

Creatine phosphate administration preserves myocardial function in a model of off-pump coronary revascularization.

AIM: Off pump coronary artery bypass grafting (OPCAB) involves, and is occasionally impaired by obligatory regional myocardial ischemia, particularly with the use of proximal coronary in-flow occlusion techniques. Intracoronary shunts do not guarantee absence of distal ischemia given their small inner diameter and the presence of proximal coronary stenosis. Additional adjunctive measures to provide short-term myocardial protection may facilitate OPCAB. High-energy phosphate supplementation with creatine phosphate prior to ischemia may attenuate ischemic dysfunction. METHODS: In a rodent model of a transient coronary occlusion and myocardial ischemia, 36 animals underwent preischemic intravenous infusion of either creatine phosphate or saline, 10 minutes of proximal left anterior descending (LAD) occlusion, and 10 minutes of reperfusion. Rats underwent continuous intracavitary pressure monitoring and cellular ATP levels were quantified using a luciferin/luciferase bioluminescence assay. RESULTS: Within 2 minutes of ischemia onset, creatine phosphate animals exhibited statistically significant greater preservation of myocardial function compared to controls, an augmentation which persisted throughout the duration of ischemia and subsequent reperfusion. Furthermore, significantly greater cellular ATP levels were observed among creatine phosphate treated animals (344+/-55 nMol/g tissue, n=5) compared to control animals (160+/-9 nMol/g tissue, n=5)(p=0.014). CONCLUSIONS: A strategy of intravenous high-energy phosphate administration successfully prevented ischemic ventricular dysfunction in a rodent model of OPCAB.

Calcium signaling inhibits interleukin-12 production and activates CD83(+) dendritic cells that induce Th2 cell development.

Mature dendritic cells (DCs), in addition to providing costimulation, can define the Th1, in contrast to the Th2, nature of a T-cell response through the production of cytokines and chemokines. Because calcium signaling alone causes rapid DC maturation of both normal and transformed myeloid cells, it was evaluated whether calcium-mobilized DCs polarize T cells toward a Th1 or a Th2 phenotype. After human monocytes were cultured for 24 hours in serum-free medium and granulocyte-macrophage colony-stimulating factor to produce immature DCs, additional overnight culture with either calcium ionophore (CI) or interferon gamma (IFN-gamma), tumor necrosis factor-alpha (TNF-alpha), and soluble CD40L resulted in phenotypically mature DCs that produced interleukin-8 (IL-8) and displayed marked expression of CD80, CD86, CD40, CD54, CD83, DC-LAMP, and RelB. DCs matured by IFN-gamma, TNF-alpha, and soluble CD40L were additionally distinguished by undetectable CD4 expression, marked secretion of IL-12, IL-6, and MIP-1beta, and preferential ability to promote Th1/Tc1 characteristics during T-cell sensitization. In contrast, DCs matured by CI treatment were distinguished by CD4 expression, modest or absent levels of IL-12, IL-6, and MIP-1beta, and preferential ability to promote Th2/Tc2 characteristics. Calcium signaling selectively antagonized IL-12 production by mature DCs activated with IFN-gamma, TNF-alpha, and soluble CD40L. Although the activation of DCs by calcium signals is largely mediated through calcineurin phosphatase, the inhibition of IL-12 production by calcium signaling was independent of this enzyme. Naturally occurring calcium fluxes in immature DCs, therefore, negatively regulate Dc1 differentiation while promoting Dc2 characteristics and Th2/Tc2 polarization. Calcium-mobilized DCs may have clinical usefulness in treating disease states with excessive Th1/Tc1 activity, such as graft-versus-host disease or autoimmunity.

[Prevalence and determinants of HIV infection in 581 drug addicts in the Northeastern Italy, from 1984 to 1988]. / Prevalenza e determinanti dell'infezione da HIV in 581 tossico-dipendenti nel Nord Est Italia, dal 1984 al 1988.

Prevalence and determinants for human immunodeficiency (HIV) virus infection was assessed in 581 heterosexual intravenous drug users, recruited from public drug assistance centers in the northeast of Italy between 1984 and 1988. The overall seroprevalence rate for HIV antibody was 39% (95% confidence interval-CI-35-43%). HIV prevalence had risen from 32% in 1984-85 to 47% in 1986-88. Age was not associated with HIV infection risk, whereas gender was, women being at lower risk of infection than men (odds ratio-OR- = 0.7, 95% CI: 0,5-1.0). Seropositivity rates showed a strong east-west geographical gradient: intravenous drug users living in the western part of the study area had a nearly sevenfold higher risk of infection (95% CI = 4.4-13.9) than those living in the eastern part. Sharing of drug injection equipment was by far the most important risk factor. IVDUs who reported to always share injection equipment had a fourfold higher risk of HIV infection, as compared with those who never did (95% CI = 1.6-12.7). The duration of drug addiction (odds ratio = 2.6), the use of heroin in high-incidence cities (odds ratio = 2.3) and of cocaine in addition to heroin (odds ratio = 1.5) and the practice of prostitution (odds ratio = 2.3) were also important determinants of HIV infection. Over the study period, the odds ratios associated with area of residence decreased, whereas those associated with the use of heroin in high-incidence cities and with prostitution increased.