Goitre plongeant: Particularités cliniques et thérapeutiques / Sub-sternal goitre: Clinical and therapeutic features

Etudier les caractéristiques cliniques, radiologiques et thérapeutiques des goitres plongeants et établir un arbre décisionnel de prise en charge Méthodes: Nous rapportons une étude rétrospective portant sur 67 cas de goitre plongeant colligés sur une période de 27 ans entre 1990 et 2016. Résultats: L'âge moyen des patients était de 53 ± 15,1 ans et le sex-ratio de 0,24. La tuméfaction basicervicale antérieure était le motif de consultation le plus fréquent, rapportée dans 82% des cas associée à des signes de compression dans 31% des cas. Une paralysie récurrentielle unilatérale a été objectivée dans quatre cas. Une radiographie de thorax a montré une opacité médiastinale dans 75% des cas et une déviation trachéale dans 85% des cas. Un scanner cervico-thoracique pratiquée dans 73% des cas a confirmé le diagnostic en objectivant cinq prolongements dépassant la crosse de l'aorte. Le traitement chirurgical était mené par voie cervicale dans 99% des patients et une sternotomie a été réalisée devant l'échec d'extraction par cervicotomie. Une paralysie récurrentielle postopératoire a été observée dans un cas et l'hypoparathyroïdie définitive a été rapportée chez six malades avec un recul moyen de trois ans. Conclusion: Les goitres plongeants sont devenus rares en Tunisie du fait de la prise en charge plus précoce des nodules thyroïdiens. Le scanner cervico-thoracique représente le gold standard pour l'étude et la confirmation du diagnostic du goitre plongeant ainsi que pour l'attitude thérapeutique. L'indication chirurgicale est toujours impérative devant le risque vital qu'il pose.

Goitre plongeant Particularités cliniques et thérapeutiques / Sub-sternal goitre: Clinical and therapeutic features

Etudier les caractéristiques cliniques, radiologiques et thérapeutiques des goitres plongeants et établir un arbre décisionnel de prise en charge Méthodes: Nous rapportons une étude rétrospective portant sur 67 cas de goitre plongeant colligés sur une période de 27 ans entre 1990 et 2016. Résultats: L'âge moyen des patients était de 53 ± 15,1 ans et le sex-ratio de 0,24. La tuméfaction basicervicale antérieure était le motif de consultation le plus fréquent, rapportée dans 82% des cas associée à des signes de compression dans 31% des cas. Une paralysie récurrentielle unilatérale a été objectivée dans quatre cas. Une radiographie de thorax a montré une opacité médiastinale dans 75% des cas et une déviation trachéale dans 85% des cas. Un scanner cervico-thoracique pratiquée dans 73% des cas a confirmé le diagnostic en objectivant cinq prolongements dépassant la crosse de l'aorte. Le traitement chirurgical était mené par voie cervicale dans 99% des patients et une sternotomie a été réalisée devant l'échec d'extraction par cervicotomie. Une paralysie récurrentielle postopératoire a été observée dans un cas et l'hypoparathyroïdie définitive a été rapportée chez six malades avec un recul moyen de trois ans. Conclusion: Les goitres plongeants sont devenus rares en Tunisie du fait de la prise en charge plus précoce des nodules thyroïdiens. Le scanner cervico-thoracique représente le gold standard pour l'étude et la confirmation du diagnostic du goitre plongeant ainsi que pour l'attitude thérapeutique. L'indication chirurgicale est toujours impérative devant le risque vital qu'il pose.

The utility HBA1c test as a screening biomarker for detecting gestational diabetes mellitus.

BACKGROUND: Glycated Hb (HbA1c) has not been used for the diagnosis of gestational diabetes mellitus (GDM). Measurement of HbA1c levels is less complicated and more comfortable than glucose challenge test (GCT) for pregnant women. We studied HbA1c as a biomarker of GDM and as a screening test to avoid the use of GCT. METHODS: A prospective case-control study involves 745 pregnant women between 24th and 28th gestation week. HbA1c levels were measured and GDM was diagnosed according to Carpenter-Coustan criteria. Mean and SD were calculated for GCT value, HbA1c, age, and body mass index (BMI). A receiver operating characteristic (ROC) curve was plotted to evaluate the diagnostic performance of HbA1c test in diagnosing GDM. Cut-off points were calculated to rule out GDM and sensitivity (Se) and specificity (Sp) were also determined. A study of the implementation of HbA1c cut-offs was performed to avoid the GCT or to perform the confirmatory oral glucose tolerance test (OGTT). RESULTS: The area under the curve (AUC) was 0.67 (0.58-0.76). Using 4.6% HbA1c as a cut-off prevented false negatives but only decreased the number of GCTs performed by 7.2%. However, using 4.7% HbA1c resulted in one false negative (reduction of 15.0%). Finally, by selecting 4.8% HbA1c, we found two false negatives, but there were 25.9% who do not require a GCT. CONCLUSIONS: Adoption of HbA1c as a screening test for GDM may eliminate the need of GCT. Although the HbA1c test does not have sufficient Se and Sp to be used as the only diagnostic test, the use of a rule-out strategy in combination with the OGTT could be useful.

Plasmonic enhancement of Eu:Y2O3 luminescence by Al percolated layer.

The coupling between Eu(3+) rare earth emitters and Al has been investigated in multilayer structures, which consist of an Eu:Y2O3 phosphor film deposited between percolated and continuous Al films. Passive buffer Y2O3 layers were deposited between phosphor and Al films with different thicknesses to analyze the role of the Eu-Al distance on the nanostructuration and emission of the Eu:Y2O3 film. By using Eu(3+) emitters as local structural probes completed by transmission electron microscopy analyses, we show that the deposition on Al promotes the growth of the cubic crystallites. A fluorescence analysis allows us to evaluate the presence of a perturbed structural shell around the cubic core of the crystallites. Moreover, the enhancement observed at short distances is attributed to the localized plasmon resonance of the percolated upper Al film.

Growth process of nanosized aluminum thin films by pulsed laser deposition for fluorescence enhancement.

Pulsed laser deposition was used to deposit aluminum thin films of various thicknesses (tAl) ranging from 5 to 40 nm and to investigate their growth process when they are deposited onto SiO2 and Y2O3. Atomic force microscopy and x-ray reflectivity measurements show that the structure of the Al films are related to the wettability properties of the underlaying layer. Onto SiO2, ultra-smooth layers of aluminum are obtained, due to a perfect wetting of SiO2 by Al. In contrast when deposited onto Y2O3, percolated Al layers are observed with apparent pore size decreasing from 200 to 82 nm as t(Al) is increased from 5 to 40 nm, respectively. This particular morphology is related to partial dewetting of Al on Y2O3. These two different growth mechanisms of aluminum depend therefore on the surface properties of SiO2 and Y2O3. The plasmon resonance of such Al nanostructures in the UV region was then analyzed by studying the coupling between Eu(3+) rare earth emitters and Al.

Comparability of behavioural assays using zebrafish larvae to assess neurotoxicity.

Testing of compounds for neurotoxicity has become increasingly important in recent years. It has been shown that neurological disorders like autism may be related to chemical exposures, which may play a crucial role in the progression of these diseases. Special attention has been be given to the substances causing developmental neurotoxicity as the developing nervous system is more vulnerable to impacts by chemicals than the adult nervous system. The zebrafish (Danio rerio) is a well-established model species in developmental biology and an emerging model in behavioural and neurological studies. Zebrafish larvae display numerous behavioural patterns highly similar to rodents and humans. Their physical characteristics make them well suited for automated high-throughput screening. In the last years, the number of behavioural studies conducted with zebrafish larvae has increased notably. The goal of this review is to provide an overview of behavioural assays commonly used to test substances for developmental neurotoxicity. Literature from 1995 to 2014 was reviewed and focussed on assays performed with zebrafish larvae younger than 7 days post fertilization (dpf). The behavioural tests were scrutinized, and parameters describing the different experimental setups were defined. In the next step, we investigated if differences in the experimental parameters alter the outcome of the test. In order to test the comparability of behavioural assays, we analysed several studies using ethanol, valproate and pentylenetetrazole as model substances. Based on our findings, we provide recommendations which could help improve future behavioural studies performed with zebrafish larvae.