Hyphal network whole field imaging allows for accurate estimation of anastomosis rates and branching dynamics of the filamentous fungus Podospora anserina.

The success of filamentous fungi in colonizing most natural environments can be largely attributed to their ability to form an expanding interconnected network, the mycelium, or thallus, constituted by a collection of hyphal apexes in motion producing hyphae and subject to branching and fusion. In this work, we characterize the hyphal network expansion and the structure of the fungus Podospora anserina under controlled culture conditions. To this end, temporal series of pictures of the network dynamics are produced, starting from germinating ascospores and ending when the network reaches a few centimeters width, with a typical image resolution of several micrometers. The completely automated image reconstruction steps allow an easy post-processing and a quantitative analysis of the dynamics. The main features of the evolution of the hyphal network, such as the total length L of the mycelium, the number of "nodes" (or crossing points) N and the number of apexes A, can then be precisely quantified. Beyond these main features, the determination of the distribution of the intra-thallus surfaces (Si) and the statistical analysis of some local measures of N, A and L give new insights on the dynamics of expanding fungal networks. Based on these results, we now aim at developing robust and versatile discrete/continuous mathematical models to further understand the key mechanisms driving the development of the fungus thallus.

A Case Report of Myotonic Disease and Gastric Bypass and a Literature Review.

We report the case of a woman with myotonic dystrophy type 1, followed for 8 years after a Roux-en-Y gastric bypass. Weigh loss was substantial (53% of initial body weight) with functional improvement in spite of the natural course of the pathology. Five other cases have been published and have reported a relatively positive benefit/risk ratio. Precautions are to be taken at the time of anesthesia and follow-up in order to detect possible degradation of muscle function.

An Application May Help Improve Protein Consumption after Bariatric Surgery.

This brief communication suggests that in patients who had bariatric surgery and in whom protein intake is lower than 60 g/d, the use of an application is likely to improve protein intake.

Mid-term outcomes after biologic mesh use: Does their performance meet our expectations?

INTRODUCTION: The indications for use of biological mesh prostheses are very limited because of their high cost, but include parietal repair in a contaminated setting. Their efficacy has been questioned by several recent studies. We therefore studied the results of all of our patients who received a biological prosthesis, including hernia recurrence and infectious complications. PATIENTS AND METHODS: We retrospectively reviewed the outcomes of 68 patients who underwent biological prosthesis placement from 2009 to 2015 in a single center. RESULTS: The site of implantation was on the anterior abdominal wall in 49 (72%) of cases, in the pelvis in 19 (28%). The median follow-up was 19 months. In the early post-operative period, 22 (32.3%) of patients presented with wall abscess; eight (11.7%) underwent surgical revision and seven (10.2%) underwent interventional radiological drainage. In the medium term, 41/56 (73%) had a late complication; 32 (57%) of the patients developed recurrent herniation and 15 (26.7%) of them were re-operated. In addition, nine (16%) of patients developed a late surgical site infection and eight (14.2%) a chronic residual infection. In multivariate analysis, the risk factors for recurrence were parastomal hernia (P=0.007) and a history of recurrent hernia (P=0.002). CONCLUSION: A majority of patients developed recurrent incisional herniation in the medium term. This puts the use of biological prostheses into question. These results need to be compared to those of semi-absorbable prostheses.

Gastric bleeding risk following spleen preserving distal pancreatectomy with excision of the splenic vessels: a long-term follow-up.

BACKGROUND: Spleen-preserving distal pancreatectomy with resection of the splenic vessels (VR-SPDP) is an effective procedure. However, hemodynamic changes in splenogastric circulation may lead to the development of gastric varices (GV) with a risk of gastrointestinal (GI) bleeding. This retrospective study aimed to assess the long-term postoperative clinical follow-up of patients and review the late postoperative abdominal computed tomography (CT) or endoscopic examination. METHODS: From 1988 to 2015, 48 consecutive VR-SPDP for benign or low-grade malignant disease were included. Late postoperative follow-up was undertaken with the use of a prospective database and assessment undertaken by CT and/or endoscopy. RESULTS: The median follow-up was 76 months (range: 12-334 months). Two patients were lost to follow-up. Gastrointestinal hemorrhage occurred in one patient. Endoscopy and abdominal CT showed submucosal GV in five patients. Ten patients had perigastric varices (27%), but none developed clinical complications from their varices. All varices occurred within one year after distal pancreatectomy and remained stable during follow-up. DISCUSSION: Asymptomatic varices frequently occurred in patients who underwent VR-SPDP, but bleeding risk seemed low. Abdominal CT could identify GV and distinguish submucosal varices with a higher risk of gastric bleeding.

Quantification of physical activity using the QAPACE questionnaire: A two stage cluster sample design survey of children and adolescents attending urban school.

BACKGROUND: Quantification of physical activity as energy expenditure is important since youth for the prevention of chronic non communicable diseases in adulthood. It is necessary to quantify physical activity expressed in daily energy expenditure (DEE) in school children and adolescents between 8-16 years, by age, gender and socioeconomic level (SEL) in Bogotá. METHODS: This is a Two Stage Cluster Survey Sample. From a universe of 4700 schools and 760000 students from three existing socioeconomic levels in Bogotá (low, medium and high). The random sample was 20 schools and 1840 students (904 boys and 936 girls). Foreshadowing desertion of participants and inconsistency in the questionnaire responses, the sample size was increased. Thus, six individuals of each gender for each of the nine age groups were selected, resulting in a total sample of 2160 individuals. Selected students filled the QAPACE questionnaire under supervision. The data was analyzed comparing means with multivariate general linear model. Fixed factors used were: gender (boys and girls), age (8 to 16 years old) and tri-strata SEL (low, medium and high); as independent variables were assessed: height, weight, leisure time, expressed in hours/day and dependent variable: daily energy expenditure DEE (kJ.kg-1.day-1): during leisure time (DEE-LT), during school time (DEE-ST), during vacation time (DEE-VT), and total mean DEE per year (DEEm-TY) RESULTS: Differences in DEE by gender, in boys, LT and all DEE, with the SEL all variables were significant; but age-SEL was only significant in DEE-VT. In girls, with the SEL all variables were significant. The Post-hoc multiple comparisons tests were significant with age using Fisher's Least Significant Difference (LSD) test in all variables. For both genders and for all SELs the values in girls had the higher value except SEL high (5-6) The boys have higher values in DEE-LT, DEE-ST, DEE-VT; except in DEEm-TY in SEL (5-6) In SEL (5-6) all DEEs for both genders are highest. For SEL (3-4) all DEEs are lowest. CONCLUSIONS: Children and adolescents in Bogotá have less DEE than at other latitudes. Girls have more free time but lower energy expenditure in their different activities. The socioeconomic level has influence in DEE.

Determinants of changes in muscle mass after bariatric surgery.

AIM: The constituents of weight loss following bariatric surgery are poorly known. There is an expectation of a limited loss of lean body mass (LBM), and a significant loss of fat mass (FM) as well as muscle mass (MM), which could lead to functional loss and metabolic impairment. This prospective study analysed the determinants of MM changes after Roux-en-Y gastric bypass and sleeve gastrectomy. METHODS: The study cohort comprised 114 consecutive candidates for bariatric surgery referred to a bariatric surgery centre. Using DEXA, the subjects' body composition was assessed before, and three and 12 months (n=92) after, the surgery, along with their biological status. The main study outcome was changes in MM. RESULTS: At three months, patients had lost 20.3 kg, made up of 41% LBM and 59% FM. The contribution of MM to weight loss was 16.4%. Cluster analysis showed that 52 patients lost<15% of their weight as MM, while 62 patients lost>15% as MM. At 12 months, patients had lost 37 kg, made up of 70% FM and 30% LBM. At this time, only 27 patients lost>15% of their weight as MM. The determinants that were negatively and independently associated with MM changes at three months were FM loss and changes in glycaemia and thyroid-stimulating hormone ([TSH]; thyrotropin) before surgery, whereas change in glycaemia was the only 12-month determinant associated with MM changes. CONCLUSION: Two phenotypes - one with muscle wasting and the other with acceptable muscle loss - with a threshold of 15% and very few predictive factors were identified by this study.

[Urinary complications of pelvic exenterations for rectal cancer with urinary invasion]. / Complications urinaires des exentérations pelviennes pour cancer du rectum avec envahissement urinaire.

OBJECTIVE: Pelvic exenteration for rectal cancer is indicated in locally advanced rectal tumors or pelvic recurrence invading adjacent organs. The oncologic goal being a complete R0 resection. Our aim was to study the urinary complications resulting from pelvic exenterations with urinary reconstruction in order to obtain a complete local control of the disease. METHODS: Between April 2004 and June 2013, 42 patients who underwent pelvic exenteration for primary or recurrent rectal adenocarcinoma with urinary tract reconstruction were included. The urinary reconstruction was performed based on preoperative imaging and intraoperative findings. We studied early (within 30 postoperative days) and late urinary morbidity, as well as postoperative carcinologic control. RESULTS: Forty-two exenterations were performed for primary rectal cancer (n=15) or pelvic recurrence (n=27). R0 complete resection was achieved in 64% of patients. The resection was incomplete (R1) on the urinary tract in 9.5% of patients. The urinary reconstruction methods used were: 31 transileal ureterostomies after total exenteration (bricker procedure), 6 ureteral reimplantations on psoic bladder, 2 ureteroileoplasties, 2 partial cystectomies and one ureteral resection with simple ligation. The median follow-up was 20 months. The perioperative mortality was 2.3% (n=1) and postoperative overall morbidity was 64%. Early and late urinary morbidity was 23.8% and 21.4% respectively. Six patients developed major urinary complications (≥ Clavien IIIb). CONCLUSION: Pelvic exenteration with urinary resection resulted in our experience, in a local disease control of 64% (including a 90.5% for the urinary tract) at the price of an acceptable early specific morbidity and a low mortality that seems to justify an aggressive surgical approach.

[Previa uterine leiomyoma: a rare case of bowel obstruction during pregnancy]. / Fibrome prævia : une cause rare d'occlusion intestinale aiguë en cours de grossesse.

We report the case of a massive posterior leiomyoma leading to a bowel acute obstruction and an obstructive renal failure in a 33 years old primigest woman during pregnancy. The patient underwent a urinal and an intestinal derivation during de second trimester of pregnancy as a conservative management. End of pregnancy was uneventful and she gave birth to an healthy boy (2345g) at term, by cesarean section for praevia leiomyoma. The myoma was removed 6 weeks after delivery with restoration of digestive continuity in the same time. This case report shows the morbidity of 10cm and larger leiomyoma during pregnancy.

[Preeclampsia and benefit form magnesium sulfate. About 105 cases]. / Sulfate de magnésium en prévention de l'éclampsie. À propos de 105 cas.

OBJECTIVES: The aim of this study was to determine the amount of magnesium sulfate involved when we diagnose a severe preeclampsia in pregnant women. Other goals were to know what the MgSO4 side-effects and complications are, and what benefits this treatment brings to prevent an eclampsia. PATIENTS AND METHODS: This retrospective and descriptive study was conducted for 7 years. We identified 105 women treated by MgSO4 out of 560 preeclampsia cases. To prevent eclampsia, those women were administrated MgSO4 before, during or after labor. All data about hospitalization term and MgSO4 term administration were collected in order to understand if MgSO4 side-effects for the women and the fetus occurred before, during or after labor. Those tables are compared with the MgSO4 administered dosages. RESULTS: MgSO4 isn't systematically used in all the preeclampsia cases. Forty percent of women under treatment presented low side effects. Overdoses, encountered in 31.4% of cases, regressed as soon as the MgSO4's perfusion was stopped. No major complications were noted. Only 0.95% of women treated by MgSO4 presented an eclampsia. DISCUSSION AND CONCLUSION: MgSO4 administered only to women having a neurological preeclampsia, within therapeutic doses and with rigorous monitoring, does not bring deleterious effects to the mother or newborn baby. Consequently, MgSO4's benefits were above the risks.

Prophylactic cholecystectomy during abdominal surgery.

The presence of asymptomatic gallstones is no longer an indication for elective prophylactic cholecystectomy (PC) according to the recommendations of the 1991 French Consensus Conference on cholelithiasis. However, there may be potential benefits of performing prophylactic cholecystectomy during certain abdominal procedures for non-biliary disease; this remains a subject of debate. This debate has become livelier with the recent increase in bariatric surgery. Gastrectomy for cancer, small bowel resection, colonic resection, and splenectomy for hereditary spherocytosis as well as all bariatric surgical interventions can all alter the physiology of gallstone disease raising the question of the value of PC, but the specific morbidity of cholecystectomy must be kept in mind. The purpose of this study was to report epidemiological and pathophysiological data and the results from literature reports in order to assess the value of concomitant prophylactic cholecystectomy during various common surgical situations.

[Magnesium sulfate in the prophylaxis of eclampsia: a retrospective study]. / Évaluation de l'utilisation du sulfate de magnésium dans la prévention secondaire de l'éclampsie: étude rétrospective sur 39 cas.

INTRODUCTION: The use of magnesium sulfate (MgSO(4)) has been advocated since 2000 in France in the management of eclampsia. The aim of this study was to determine the frequency of use of this treatment for eclampsia in a French department. PATIENTS AND METHODS: All patients obstetrical patients admitted to Critical Care Units of Seine-Maritime for eclampsia over a period of 7 years (2002-2008) were included. Obstetric data, the treatment used for eclampsia and pre-eclampsia and maternofetal complications were collected. The primary outcome parameter was the use of MgSO(4) in the secondary prevention of eclampsia. RESULTS: Thirty-nine patients were included. Nineteen patients (48%) had eclampsia in prepartum, three (8%) in per-partum and 17 (44%) in post-partum periods. The use of MgSO(4) in the secondary prevention of eclampsia was observed in 92% of cases (36/39). Primary prevention was seen in 8% of cases. The duration of treatment was 2 days (1-7 days). The maternal and perinatal mortality was respectively 2.5 and 11%. CONCLUSION: In this study, the use of MgSO(4) in the secondary prevention is frequent. This result emphasizes the importance of the recommendations of learned societies in the homogenization of the management of rare but serious conditions such as eclampsia.

Gallbladder volvulus.

Gallbladder volvulus is a rare condition caused by torsion of the cholecystic pedicle and is favored by a long or nonexistent cholecystic mesentery. Gallbladder torsion presents clinically as gangrenous cholecystitis. Emergency cholecystectomy is the standard treatment. Lack of awareness of this condition can result in delayed diagnosis and worsen the prognosis of elderly patients.

Management of postoperative chylothorax.

Chylothorax is a rare but severe complication of thoracic and esophageal surgery. The anatomical relations of the thoracic duct and its highly variable anatomy may explain the occurrence of thoracic duct injury during dissection of the posterior mediastinum. At an early stage, chylothorax can lead to severe cardiorespiratory and volemic complications. In case of chronicization, malnutrition and immunologic complications can occur, responsible for a mortality rate of up to 50%. Optimal management of chylothorax can decrease mortality. It is based on three options: conservative treatment, surgery and radiological treatment. Conservative treatment must be initiated at diagnosis and results in resolution of the chylothorax is achieved in 50 to 70% of cases. In case of either high flow rate chylothorax or failure of conservative treatment, reoperation is indicated. Percutaneous embolization is an interesting and minimally invasive alternative to surgery.

[Amniotic fluid embolism during curettage for a pregnancy arrest. Case report]. / Embolie amniotique lors d'un curetage pour une grossesse arrêtée. A propos d'un cas.

Amniotic fluid embolism is always a serious complication during the peripartum period. We report the case of an amniotic fluid embolism during curettage for a pregnancy arrest at 13 weeks. The diagnosis was confirmed by the presence of epithelial cells into the maternal blood.

[Transjugular intrahepatic portosystemic shunt before hepatic surgery in a patient with cirrhosis and portal hypertension: case report]. / Dérivation portocave intrahépatique transjugulaire avant chirurgie hépatique en cas de cirrhose compliquée d'hypertension portale.

Major abdominal surgery may be contraindicated in patients with cirrhosis because of the high risk of intraoperative bleeding and postoperative decompensation. Careful preparation of these patients is essential, aimed especially at reducing portal hypertension. We report the case of a patient with cirrhosis complicated by hepatocellular carcinoma, whose portal hypertension manifested almost exclusively by reanastomosis from the umbilical vein. A transjugular intrahepatic portosystemic shunt (TIPS) was placed before surgery to prepare the patient for hepatic resection. In addition to the singularity of the presentation of portal hypertension, this case prompts us to consider neoadjuvant TIPS as a means of preparing these at-risk patients for major abdominal surgery.

Liver transplantation with reconstruction of the inferior vena cava for hepatocarcinoma on chronic Budd-Chiari: a case report.

Management of Budd-Chiari syndrome, from simple medical treatment to liver transplantation, depends on the acute and chronic evolution of the disease and on the degree of hepatic insufficiency. Herein we have reported the case of a man who underwent transplantation after evolution of a Budd-Chiari syndrome with membranous obstruction of the vena cava and developed 2 lesions of hepatocellular carcinoma. Surgery was difficult due to previous procedures requiring reconstruction of the supra-hepatic vena cava. This case emphasized the timing of liver transplantation versus other treatments to decrease the operative risk.

Altered myosin isoform expression in rat skeletal muscles induced by a changed thyroid state.

The aim of our study was to find out, which are the thyroid linked mechanisms responsible for the changes in myosin isoform composition which accompany endurance training (ET) in rodents. We studied the interaction between ET and altered sedentary group with no thyroid treatment or Se group. Six groups of rats were compared: (1) a trained group with no thyroid treatment or T group; (2) a thyroid state in rats; (3) a sedentary group rendered hypothyroid with 6-n-propyl thio uracil (H); (4) a sedentary group rendered hyperthyroid with T3 (150 microg kg(-1) every other day for 4 weeks) (St); (5) trained rats rendered hyperthyroid with T3 (150 microg kg(-1) every other day for 4 weeks) (Tt) and (6) a trained group kept euthyroid with T3 (150 ng kg(-1) every other day for 4 weeks) (Te). In each group myosin isoform composition was determined in five muscles, three locomotor muscles: (1) extensor digitorum longus, (2) superficial lateral gastrocnemius, (3) deep medial gastrocnemius, (4) an antigravity muscle, the soleus and (5) a rhytmic respiratory muscle, the crural diaphragm. Different muscles responded in a specific way to variations of the thyroid state and training.

Oxidative stress in hemodialyzed patients during exhausting exercise.

BACKGROUND: This study was designed to study the effect of an exhausting exercise test on plasma lipid peroxidation marker (malondialdehyde, MDA) and on vitamin E levels in hemodialyzed patients (HD) compared to healthy control subjects (HC). METHODS: Eight sedentary chronically HD, (39.0+/-10.8 years) and eight sedentary HC (38.4+/-12.4 years) were studied. Before exercise, the activity of scavenger enzymes [plasma and erythrocyte glutathione peroxidase (GPX), and erythrocyte superoxide dismutase (SOD)] was determined. All subjects performed a symptom-limited exercise test; respiratory gas exchanges were collected on-line and blood was sampled five min before exercise, at exhaustion and after 30 min of recovery. RESULTS: At rest, the activity of plasma and erythrocyte GPX and erythrocyte SOD was significantly lower in HD than in HC. Exercise provoked an increase of plasma MDA concentration after recovery in HD patients, whereas our HC group show a decrease in MDA plasma level immediately after exercise, returning to the rest values during recovery. Exercise induced no change of vitamin E concentration in HD whereas in HC it increased during recovery. CONCLUSIONS: Our results indicate that: 1) at rest: although hemodialyzed patients showed lower scavenger enzymes activity than HC subjects, there was no difference in MDA plasma level between groups; 2) there is some evidence that physical exercise contribute to oxidative stress during recovery in HD patients, and 3) exercise induced an increase in plasma vitamin E concentration in healthy subjects.