Pediatric intracranial aneurysms in Senegal: a series of 10 cases treated in unfavorable socio-economic conditions.

OBJECTIVE: The aim of this study is to show the characteristics of pediatric intracranial aneurysms in a sub-Saharan country and to analyze the results of treatment in this challenging medical environment. METHOD: The authors reviewed retrospectively ten patients ≤ 18 years old between May 2013 and December 2016 in Neurosurgery department of Fann Hospital in Dakar. For each child, clinical features, radiological findings, and outcome were determined with mean follow-up of 22 months. RESULTS: Ten children were treated for intracranial aneurysm including four boys and six girls. Two patients had evolutive infectious endocarditis with rheumatic heart disease at the time of diagnosis. Neurological signs of deficiency were present in six patients (WFNS ≥ 3). The diagnosis of aneurysm was made by CT angiography in all patients, and in two of them respectively arteriography and angioMRI were performed in complement. The aneurysm was on the middle cerebral artery in six patients, on the internal carotid artery in two others, anterior communicating artery in another, and the last one was located on the anterior cerebral artery on its 3rd segment. The treatment of the aneurysm was surgical in seven patients and endovascular in one of them. The postoperative course was excellent in two patients and good in the five patients. No postoperative worsening was noted. One child died 4 months in the postoperative course from acute cardiac deterioration. CONCLUSIONS: In Senegal, pediatric aneurysms represent about 8.3% of all intracranial aneurysms. They are most often located on the MCA and have commonly fusiform shape. Despite difficult treatment conditions, overall outcome was good.

Microsurgical Treatment of Ruptured Intracranial Aneurysms in Sub-Saharan Africa: A Series of 102 Consecutive Cases Treated in Senegal.

INTRODUCTION: In sub-Saharan Africa, the management of ruptured intracranial aneurysms (RIAs) is difficult for many reasons. In this retrospective, 3-year study, the authors will demonstrate the particularities of the management of RIAs in Senegal. METHODS: We analyzed retrospectively 102 consecutive cases of RIAs operated on between May 2013 and December 2016 in Neurosurgical Department of Fann Hospital in Dakar, Senegal. Patients characteristics, imaging results, aneurysms, treatment, and outcome were analyzed. RESULTS: One hundred two cases were operated in this 3-year period of a total of 129 cases of RIAs received in our department in the same period. A total of 65% of the patients were female. According to the World Federation of Neurosurgical Societies (WFNS) scale, 49% were WFNS I, and 33% WFNS III. Fisher scale showed 29% of Fisher 2 and 45% of Fisher 4. The aneurysms were located on anterior communicating complex in 38%, on the internal carotid artery in 28%, on the middle cerebral artery in 27% of cases and on posterior circulation in 9 cases. The pterional approach was used in 93 cases. According to the modified Rankin Scale, 67 patients (65.6%) had good outcome, 22 (21.5%) had poor outcome, and the mortality rate was 12.7% (13 patients) at last follow-up. CONCLUSIONS: This study demonstrates encouraging results if one refers to the global patient postoperative outcomes. However, the large number of patients not undergoing treatment also requires us to improve preoperative management conditions.

Selection of AU-rich transiently expressed sequences: reversal of cDNA abundance.

Study of early and transient response gene expression is important for understanding the mechanisms of response to growth stimuli and exogenous agents such as microbes, stress, and radiation. Many of the cytokines, proto-oncogenes, and other transiently expressed gene products are encoded by mRNAs that contain AU-rich elements (AREs) in their 3' untranslated regions (UTRs). In this article, we describe an approach to selectively synthesize ARE-containing cDNA (ARE-cDNA) using an innovative combination of culture treatment, thermostabilization of reverse transcriptase (RT) by the disaccharide trehalose, and use of optimized ARE-specific oligomers. The monocytic cell line, THP-1, was treated with cycloheximide and endotoxin to enrich for ARE-mediated gene expression followed by the RT procedure. Selection of ARE-cDNA with simultaneous suppression of abundant cDNA was made possible using the procedure as monitored by the preferential expression of IL-8, an ARE-cDNA molecule, over the abundant housekeeping cDNA, beta-actin. The use of trehalose dramatically reversed cDNA abundance, resulting in almost complete suppression of housekeeping cDNA. Finally, construction of specialized ARE-cDNA libraries confirmed the selectivity of ARE-cDNAs and the presence of rare genes. The ability to reverse the abundance of housekeeping and other highly expressed genes toward ARE genes facilitates the discovery and study of rare early response and transiently expressed genes.

An integrated computational and laboratory approach for selective amplification of mRNAs containing the adenylate uridylate-rich element consensus sequence.

Messenger RNAs that have the stability determinants, adenylate uridylate-rich elements (AREs), in their 3' untranslated region (UTR) code for key products that regulate early and transient biological responses. We used a computational laboratory approach for amplification of large, including full-length, protein-coding regions for ARE genes. Statistical analysis of the initiation regions in the 5' UTR of ARE-mRNAs was performed. Accordingly, several 5' primers and a single universal 3' primer that targeted the initiation consensuses and ARE regions, respectively, were designed. Using optimized conditions, the primers were able to enrich and amplify large protein-coding regions for the ARE gene family. The selective amplification of ARE cDNAs was verified using specific polymerase chain reactions (PCRs) to known ARE mRNA molecules and monitoring the abundance of the non-ARE beta-actin signal. A mini-library from the amplified ARE products was constructed for further confirmation of ARE selection. Distinct ARE amplified cDNA pools were selectively generated by distinct 5' primers. The biological utility of the method was shown with differential display. The up-regulation of several ARE-mRNAs, including the full-length coding region of the small inducible cytokine A4 (SCYA4) gene, was shown in endotoxin-stimulated monocytic cells. The integrated computational and laboratory approach should lead to enhanced capability for discovery and expression analysis of early and transient response genes.