When and where do patients with bone metastases actually break their femurs?

AIMS: Accurate estimations of the risk of fracture due to metastatic bone disease in the femur is essential in order to avoid both under-treatment and over-treatment of patients with an impending pathological fracture. The purpose of the current retrospective in vivo study was to use CT-based finite element analyses (CTFEA) to identify a clear quantitative differentiating factor between patients who are at imminent risk of fracturing their femur and those who are not, and to identify the exact location of maximal weakness where the fracture is most likely to occur. METHODS: Data were collected on 82 patients with femoral metastatic bone disease, 41 of whom did not undergo prophylactic fixation. A total of 15 had a pathological fracture within six months following the CT scan, and 26 were fracture-free during the five months following the scan. The Mirels score and strain fold ratio (SFR) based on CTFEA was computed for all patients. A SFR value of 1.48 was used as the threshold for a pathological fracture. The sensitivity, specificity, positive, and negative predicted values for Mirels score and SFR predictions were computed for nine patients who fractured and 24 who did not, as well as a comparison of areas under the receiver operating characteristic curves (AUC of the ROC curves). RESULTS: The sensitivity of SFR was 100% compared with 88% for the Mirels score, and the specificity of SFR was 67% compared with 38% for the Mirels score. The AUC was 0.905 for SFR compared with 0.578 for the Mirels score (p = 0.008). CONCLUSION: All the patients who sustained a pathological fracture of the femur had an SFR of > 1.48. CTFEA was far better at predicting the risk of fracture and its location accurately compared with the Mirels score. CTFEA is quick and automated and can be incorporated into the protocol of CT scanners. Cite this article: Bone Joint J 2020;102-B(5):638-645.

[Analysis of obstetric-pediatric care in the perinatal period. Are births before 31 weeks' gestation in level 2B maternity units avoidable?] / Analyse des parcours de soins en périnatalité. Les naissances avant 31 SA en maternité de type 2B sont-elles évitables ?

INTRODUCTION: Regionalization of perinatal care has been developed to improve the survival of preterm babies. The mortality rate is higher among very premature infants born outside level-3 maternity units. The objective of this study was to evaluate the preventability of these very premature births occurring outside recommendations within level-2B maternity units. The secondary objective was to describe the care of premature infants between 23 and 24 weeks. METHODS: This is a single-center retrospective qualitative study of the care delivery pathways. Thirty-one deliveries in which the fetus was alive between 23 and 30 weeks+6 days occurred in a level-2B maternity unit in Thionville, France, between 1 January 2013 and 31 December 2015. After oral presentation of the cases, a level 2-3 multidisciplinary committee of experts in Lorraine evaluated the preventability criteria and reasons, and divided the deliveries into three groups: (i) birth in level-2B institutions avoidable, (ii) inevitable with factors related to the mother or the organization of care, (iii) with no inevitable factors. RESULTS: Out of the 31 deliveries included, the committee classified six deliveries as preventable, 14 as inevitable with factors, and 11 as inevitable with no factors. The criteria for preventability of birth in a level-2B unit were underestimation of maternal and fetal risk, an erroneous initial estimate of term or preterm labor, and two births in the upper limits of the French recommendations for in utero transfer. Nineteen of the 35 premature infants before 31 weeks' gestation died, 16 children were transferred to a level-3 maternity ward, and 16 children were allowed to go home. CONCLUSION: Analysis of the obstetrical-pediatric care course by an expert committee determined the preventability of the average birth and prematurity in level-2B maternity units in Lorraine for a small but significant number of cases. The local regionalization of neonatal care could be improved by the application of this method of analysis to other maternity wards in the Lorraine network.

Latent autoimmune diabetes in Tunisian adults (LADA): identification of autoimmune markers.

BACKGROUND: LADA or type 1.5 diabetes is a slowly progressive form of autoimmune diabetes of adults. The aim of this study is to evaluate the frequency of autoimmmune markers and to identify patients with LADA among diabetics diagnosed initially as having type 2 diabetes. METHODS: Our study concerned 100 diabetics, aged between 31 and 77 years (age at onset > 30 years), with short term diabetes (duration < 6 years) and who required insulin therapy after 6 months from diagnosis of diabetes. All patients were screened for antibodies to Glutamic Acid Decarboxylase (GAD65), the Tyrosine Phosphatase (IA2) and Islet Cell antibodies (ICA). RESULTS: Mean age of patients is 53 +/- 10.5 years. Mean age at onset of diabetes was 43.3 +/- 10 years. Insulin treatment required after 3.1 +/- 1.8 years. Positivity of at least one of the auto-antibodies was found in 78% of patients. ICA were detected in 48.5% of cases. IA2 and GAD antibodies were positive respectively in 42% and 18% of tested patients. There was no significant difference of gender. Anti-GAD positive patients had statistically significant higher initial fasting blood glucose and HDL-cholesterol serum (p = 0.01 and 0.007) than those with anti-GAD negative. Patients with anti-IA2 were characterized by more important frequency of autoimmune diseases and low rate of triglycerides. The frequency of macrovascular complications was lower in ICA positive diabetics than those with ICA negative. Patients initially diagnosed as type 2 diabetes may in many cases suffer from LADA. Auto-antibodies screening may be of interest to identify LADA at the earliest stage. CONCLUSION: Frequency of type 1 diabetes in adults is underestimated. The identification of LADA may help to classify dabete and to indicate the moment of insulinotherapy.

Shedding of CD44 from PMA-differentiated U-937 cells is enhanced by treatment with mineral particles.

In this report, we show that enhanced shedding of CD44 might contribute to the down-regulation of this receptor observed after phagocytosis of MnO2 particles by PMA-differentiated U-937. The apparent Mr of the soluble CD44 detected in culture supernatants was slightly lower than that of the membrane form suggesting that shedding resulted from proteolytic cleavage. Increased shedding of CD44 was also noted with other mineral particles (chrysotile and DQ12) but to a lower extent whereas some (TiO2 and amosite) had no effect on this process. These results indicate that shedding enhancement was particle-specific rather than a general consequence of phagocytosis. The ability of the particles to enhance CD44 shedding was not directly dependent on their cytotoxic potency. Different patterns of reactivity were noted with CD11b, suggesting that the underlying mechanisms are specific.

Alterations in protein glycosylation in PMA-differentiated U-937 cells exposed to mineral particles.

Carbohydrate moieties of cell glycoconjugates play a pivotal role in molecular recognition phenomena involved in the regulation of most biological systems and the changes observed in cell surface carbohydrates during cell activation or differentiation frequently modulate certain cell functions. Consequently, some aspects of macrophage response to particle exposure might conceivably result from alterations in glycosylation. Therefore, the effect of mineral particles on protein glycosylation was investigated in phorbol myristate acetate (PMA)-differentiated U-937. Jacalin, a lectin specific for O-glycosylated structures, showed a global increase in O-glycosylation in particle-treated cells. In contrast, no significant modifications were observed with concanavalin A, a lectin that recognizes certain N-glycosylated structures. The sialic acid-specific lectins Sambucus nigra agglutinin and Maackia amurensis agglutinin and the galactose-specific lectin Ricinus communis agglutinin revealed a complex pattern of alterations in glycoprotein glycosylation after crystalline silica or manganese dioxide treatments. Expression of sialyl Lewis(x), a glycosylated structure implicated in leukocyte trafficking, could not be detected in control or treated cells. This finding was consistent with the decrease in sialyl Lewis(x) expression observed during PMA-induced differentiation. In conclusion, various treatments used in this study induced quantitative as well as qualitative changes in protein glycosylation. Whether these changes are due to glycosidase release or to an alteration in glycosyltransferase expression remains to be determined. The potential functional implications of these changes are currently under investigation.

Inhibition of acid sialidase by inorganic sulfate.

Sulfated glycosaminoglycans are known to inhibit mammalian acid-active sialidase. Although the inhibition depends clearly on the presence of sulfate groups on these macromolecules, there was no information on the intrinsic inhibitory potency of inorganic sulfate. In this study, we demonstrate that inorganic sulfates inhibit acid-active Mu-Neu5Ac sialidase of U937 cells. This inhibition was found to be reversible and it appeared to be of the mixed competitive type. Sulfate-induced inhibition was also observed in other cells as well as with other substrates such as sialyl lactose and bovine mixed brain gangliosides. We conclude that the intrinsic inhibitory potency of sulfate groups may be significantly involved in the inhibition of acid-active sialidase by sulfated glycosaminoglycans. In addition, inorganic sulfate by its apparent potency to selectively inhibit acid sialidases might constitute an interesting tool for the characterisation of the minor forms of sialidases occurring in mammalian cells.

Cell localization and regulation of expression of cytochrome P450 1A1 and 2B1 in rat lung after induction with 3-methylcholanthrene using mRNA hybridization and immunohistochemistry.

In order to characterize the response of various pulmonary cell types to polycyclic aromatic hydrocarbons, the expression of cytochrome P450 (CYP) 1A1 and 2B1 mRNA in the lung of rats, with or without induction by 3-methylcholanthrene (3MC), was analyzed by in situ hybridization using appropriate 35S-labeled riboprobes. The expression of the corresponding proteins was investigated immunohistochemically. Following induction with 3MC, the kinetics of mRNA expression differed considerably between Clara cells and type II pneumocytes and venous endothelial cells. In Clara cells, mRNA expression was detected as early as 1 h after induction, peaked between 2 and 4 h, and was completely undetectable at 14 h. In contrast, venous endothelial cells and type II pneumocytes exhibited permanent mRNA expression of CYP 1A1 in 3MC-pretreated rats. These kinetic results explain the striking absence of correlation between mRNA and protein expression observed in Clara cells 24 h after the end of the induction protocol, as these cells exhibited intense protein expression with no mRNA. In contrast, a good correlation was observed for mRNA and protein expression of CYP 2B1, with similar expressions for Clara cells and type II pneumocytes, but no expression in endothelial cells. This study clearly distinguished the regulation of CYP 1A1 expression in the rat lung from that described in the liver. The differences observed in the various lung cell types, whatever the post-transcriptional mechanisms involved, emphasize that studies must be performed at the cellular level in order to understand the specific response to xenobiotics, not only of this organ as a whole but also of its various anatomic structures.

[Iatrogenic urethral stenosis. Apropos of 100 cases]. / Le rétrécissement urétral iatrogène. A propos de 100 cas.

Iatrogenic causes of stenosis of urethra appear to be increasing in frequency. 100 cases out of a total of 582 patients being of iatrogenic origin. The principal cause is the use of a urethral catheter. Various therapeutic methods are used, preference being given quite clearly to internal urethrotomy. Prevention is of fundamental importance and is based on the less untimely routine use of urethral catheters, particularly after general surgical operations and in intensive care.

[Vesico-uterine fistula. Apropos of 5 cases]. / Les fistules vésico-utérines. A propos de cinq cas.

Five cases of VUF have been observed by the authors over a period of 15 years, reflecting the rarity of this condition. Based on a review of the literature, the authors present an exhaustive study of the various aspects of VUF: 1) aetiopathogenic features: they emphasise the rarity of the disease and its aetiology which is currently dominated by caesarean section; 2) clinical features with little variability in the symptoms (urine leak from the vagina with or without associated menouria) and the usually simple diagnosis based on a thorough clinical examination and routine complementary investigations (IVP, cystography...); 3) lastly the therapeutic aspects, based on surgical cure, which is almost always satisfactory. On the basis of their experience and their results, VUF constitutes a benign lesion, but a source of discomfort, which should be prevented.

[Clear cell epithelioma of the kidney in a child. Apropos of a case]. / L'épithélioma à cellules claires du rein chez l'enfant. A propos d'un cas.

The authors report a case of renal hypernephroma in a child. This is an uncommon tumour which is very rarely diagnosed preoperatively. Its treatment is exclusively surgical. As in adults, the prognosis depends on the stage of the tumour at the time of discovery.

[Abscess of the kidney. Apropos of 21 cases]. / L'abcès du rein. A propos de 21 cas.

Renal abscess is rather an uncommon lesion caused predominantly by an urogenic infection. The authors report 21 cases in a period of 10 years. They describe and evaluate the actual investigation possibilities which are accurate enough to lead to the right diagnosis of renal abscess in a good rate. The evolution of the therapeutic modes is studied, with a special reference to the percutaneous drainage which is to substitute the classical surgery of this abscess. For the authors, treated in the right time and in the right way, renal abscess is nowadays a benign lesion, preserving a good prognosis for the kidney and the patient.

[Total hematuria with normal intravenous urography. Apropos of 36 cases]. / Les hématuries totales à UIV normales. A propos de 36 cas.

The authors present a critical study and retrospective of 36 cases of hematuria without urographic anomalies. Renal angiography was performed in 69% of the patients. 84% of these angiograms were negative. Only 2 identified the cause of the bleeding. 28% of the patients underwent disappointing surgery. In 40% of the cases the appearance of the kidney was normal. Only one of the 6 nephrectomies was justified. The authors recommend the use of modern and non invasive methods of investigation.