Epidemiology and impact of frailty in patients with atrial fibrillation in Europe

BACKGROUND

Frailty is a medical syndrome characterised by reduced physiological reserve and increased vulnerability to stressors. Data regarding the relationship between frailty and atrial fibrillation (AF) are still inconsistent.

OBJECTIVES

We aim to perform a comprehensive evaluation of frailty in a large European cohort of AF patients.

METHODS

A 40-item frailty index (FI) was built according to the accumulation of deficits model in the AF patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. Association of baseline characteristics, clinical management, quality of life, healthcare resources use and risk of outcomes with frailty was examined.

RESULTS

Among 10,177 patients [mean age (standard deviation) 69.0 (11.4) years, 4,103 (40.3%) females], 6,066 (59.6%) were pre-frail and 2,172 (21.3%) were frail, whereas only 1,939 (19.1%) were considered robust. Baseline thromboembolic and bleeding risks were independently associated with increasing FI. Frail patients with AF were less likely to be treated with oral anticoagulants (OACs) (odds ratio 0.70, 95% confidence interval 0.55-0.89), especially with non-vitamin K antagonist OACs and managed with a rhythm control strategy, compared with robust patients. Increasing frailty was associated with a higher risk for all outcomes examined, with a non-linear exponential relationship. The use of OAC was associated with a lower risk of outcomes, except in patients with very/extremely high frailty.

CONCLUSIONS

In this large cohort of AF patients, there was a high burden of frailty, influencing clinical management and risk of adverse outcomes. The clinical benefit of OAC is maintained in patients with high frailty, but not in very high/extremely frail ones.

A role for ceruloplasmin in the control of human glioblastoma cell responses to radiation

Background

Glioblastoma (GB) is the most common and most aggressive malignant brain tumor. In understanding its resistance to conventional treatments, iron metabolism and related pathways may represent a novel avenue. As for many cancer cells, GB cell growth is dependent on iron, which is tightly involved in red-ox reactions related to radiotherapy effectiveness. From new observations indicating an impact of RX radiations on the expression of ceruloplasmin (CP), an important regulator of iron metabolism, the aim of the present work was to study the functional effects of constitutive expression of CP within GB lines in response to beam radiation depending on the oxygen status (21% O₂ versus 3% O₂).

Methods and results

After analysis of radiation responses (Hoechst staining, LDH release, Caspase 3 activation) in U251-MG and U87-MG human GB cell lines, described as radiosensitive and radioresistant respectively, the expression of 9 iron partners (TFR1, DMT1, FTH1, FTL, MFRN1, MFRN2, FXN, FPN1, CP) were tested by RTqPCR and western blots at 3 and 8 days following 4 Gy irradiation. Among those, only CP was significantly downregulated, both at transcript and protein levels in the two lines, with however, a weaker effect in the U87-MG, observable at 3% O₂. To investigate specific role of CP in GB radioresistance, U251-MG and U87-MG cells were modified genetically to obtain CP depleted and overexpressing cells, respectively. Manipulation of CP expression in GB lines demonstrated impact both on cell survival and on activation of DNA repair/damage machinery (γH2AX); specifically high levels of CP led to increased production of reactive oxygen species, as shown by elevated levels of superoxide anion, SOD1 synthesis and cellular Fe2 + .

Conclusions

Taken together, these in vitro results indicate for the first time that CP plays a positive role in the efficiency of radiotherapy on GB cells.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12885-022-09808-6.

[Contribution of break up time in the diagnosis and the treatment of dry eye syndrome in tropic area: about 234 patients in Abidjan]

INTRODUCTION

Dry eye disease (DED) can be evaluated clinically by the tear film break up time (BUT). There is a discrepancy between symptoms in relationship with dry eye disease and objectives measures of BUT. So we tried to evaluate the reliability of BUT in the diagnosis and treatment of this disease in black African people.

METHODS

We carried out a prospective study of 6 months where melanoderms adults presenting subjective symptoms of dry eye disease according a questionnaire of 7 items were included. Then the measure of BUT is performed after ocular instillation of fluorescein eyedrop. This measured is done by recording the time elapsed from the last complete palpebral blink to the appearance of the first dry spot. Patients with subjective symptoms and time of BUT lower than 10seconds were called concordants (suffering really of DED). The discrepant group was represented by a BUT upper than 10seconds despite the fact that these patients answered positively to the questionnaire.

RESULTS

This survey included 234 patients and the average age was 49.1 years. Sex-ratio was 0.68 and we noticed predominance of BUT between 5 and 10seconds in 42.3% of cases. Subjective symptoms were strengthened clinically by a BUT lower to 10seconds in 149 patients. Therefore, the reliability of BUT as clinic tool for the diagnosis after symptoms in relationship with DED was 63.7%. In the group of concordants, women were more likely than men to experience symptoms of DED (P=0.0005). Age upper than 50 years and computer usage were risk factors of DED (P<0.01).

DISCUSSION

Dry eye disease is a multifactorial affection of tear and ocular surface frequently seen in female and people using computer and older than 50. The reliability of BUT near to 65% is a reason to perform this test in our daily practice.

CONCLUSION

Tear BUT is a reliable clinical test which must be performed systematically to assess the diagnosis of DED in black African people.

Results of urogenital fistulas repair using caravan approach in Côte d’Ivoire

Aims: To report the experience of surgical caravans for urogenital fistulas care. Methods: It was a retrospective study covering the period from January 1st 2014 to December 31st 2014 and which took place on 7 sites of fistula care. The epidemiological, anatomic, clinical, therapeutic and evolutionary aspects were studied. Recruitment was made by radio announcements and word of mouth approaches. Treatment was free of charge for patients. Results: During 14 caravans 346 patients were operated. Their mean age was 33.11 years (12 - 70 years). Most of these patients were without remunerative activities (80%) and without education (63.3%). They had been living with fistula for 6.08 years on average (0 to 42). Obstetrical etiology was predominant (87.9%), the otherswere iatrogenic and traumatic. According to the Kees Waaldijk classification, fistulas were distributed as follows: type I (67.4%), type II Aa (12.7%), type II Ab (8.4%) and type III (11.5%). The most common surgical approach was the transvaginal route (82.1%). The vesicovaginal splitting with separated suture of the bladder and the vagina was the basic technique (94.7%). The therapeutic results were judged after a follow-up of 1 month and 3 months. Lost to follow-up within that period was 23% i.e. 80 patients in month one and 70% (245 patients) at month three. The success rates evaluated in patients reviewed at month one and at  month  3 were respectively 70% and 64%. Conclusions: Caravan approach to recruit patients with fistula was feasible using local advertisements mans. Patients have been living with fistula for long time. Follow-up was difficult at Month 3. 

Regional point prevalence study of healthcare-associated infections and antimicrobial use in acute care hospitals in Liguria, Italy

BACKGROUND

Given the importance of monitoring healthcare-associated infections (HCAIs) and the consumption of antibiotics, a regional point prevalence survey was conducted in Liguria between March and April 2016.

AIM

To measure the overall prevalence of HCAI and describe the use of antibiotics in all public hospitals.

METHODS

Data on risk factors and use of antibiotics were collected for each hospitalized patient. To define the variables significantly associated with HCAI, univariate and multivariate analyses were conducted. Standardized infection ratio and standardized antimicrobial use ratio were measured for each participating hospital.

FINDINGS

A total of 3647 patients were enrolled. In all, 429 HCAIs were diagnosed in 376 patients, giving a prevalence of HCAI of 10.3%. Respiratory tract (21.7%) and urinary tract (20%) were the most frequent sites of infection. High rates of meticillin-resistant Staphylococcus aureus (47.4%) and Enterobacteriaceae resistant to carbapenems (26.3%) were isolated. Forty-six percent of patients received at least one antibiotic. Combinations of penicillins including β-lactamase inhibitors (24.1%) were the most widely used; the main indication (46.7%) was the treatment of a community-acquired infection.

CONCLUSION

There was an increase in HCAI prevalence compared to a similar survey conducted in 2007; however, the performance of overlapping investigations will enable more reliable considerations. Nevertheless, data on antimicrobial resistance and use of antibiotics are consistent with the national trend. Despite methodological limitations, prevalence studies are useful to monitor HCAI over time and encourage greater awareness of the problem by all stakeholders.

[Pseudo-tumoral invasive fungus infection of the maxillary sinus in Abidjan]

INTRODUCTION

The invasive fungal infection of the maxillary sinus is a rare and serious disease generally favored by immunosuppression. We report an exceptional case of pseudotumoral invasive fungal infection of the maxillary sinus in an immunocompetent patient.

OBSERVATION

A 32-year-old patient consulted for labial and left temporal swelling associated with proptosis and chemosis that has been developing for 18 months. The scanner objectified a filling of the left maxillary sinus, and the ipsilateral orbital cavity, and the surrounding muscles. Histological examination of the surgical specimen revealed invasive fungal infection of the left maxillary sinus. The relevant antifungal therapy, namely voriconazole, could not be administered due to the unavailability of the medicine. However, the patient has received 200mg of itraconazole every 12hours for three weeks. The change proved disappointing with recurrence and significant sequelae, sort of sagging of the right hemifacial, severe limitation of mouth opening and functional loss of the right eye.

CONCLUSION

The invasive fungus infections of the maxillary sinus and the orbit are exceptional in immunocompetent patient. Healing is based on early diagnosis and administration of the reference antifungal to face the risk of recurrence.

La TC con carico assiale nella instabilità del rachide lombo-sacrale

La diagnosi di instabilità del rachide lombo-sacrale è, a tutt'oggi, fondamentalmente clinica.

Anche le più sofisticate tecniche di diagnostica radiologica consentono infatti solo una valutazione statica di questa entità nosologica (che, per definizione si manifesta durante la deambulazione e con la stazione eretta) la cui definizione dinamica è campo pressochè esclusivo della radiologia convenzionale. Presentiamo i risultati di uno studio condotto attraverso l'uso di uno strumento originale progettato per sviluppare un carico assiale variabile e riproducibile in un paziente supino: il Compressore assiale. Con questo strumento, compatibile con l'esecuzione di esami TC, sono stati valutati 24 pazienti con forte sospetto clinico-radiologico di instabilità lombare.

La metodica di studio, denominata Axial Loaded - Computed Tomography (AL-CT) si basa sull'acquisizione successiva di esami TC basali e con carico assiale (AL), che vengono poi comparati. Il confronto avviene sia sulle scansioni assiali che su immagini ricostruite su piani sagittali e con «rendering» tridimensionale (3D-TC). La valutazione comparativa prevede sia l'uso di immagini statiche che l'organizzazione in sequenze cine (cine AL-CT) delle immagini 2D e 3D ottenute. Tutti i procedimenti di rielaborazione sono indispensabili nella valutazione dei risultati.

I risultati mostrano con chiarezza reperti (numerosi e spesso simultanei) a carico di tutte le component le unità funzionali spinali; fra questi meritano una segnalazione: l'incremento o la accentuazione di protrusioni discali sotto carico; la scomparsa del vacuum discale e/o intraarticolare durante la compressione («segno del vacuum»); l'accentuazione della listesi sotto carico; la ottimale ed originale visualizzazione dell' ipermobilità delle faccette articolari.

Proponiamo AL-CT e cine AL-CT come metodiche di scelta nello studio dell'instabilità lombare.

Glucose-dependent insulinotropic polypeptide (GIP) dose-dependently reduces osteoclast differentiation and resorption

A role for glucose-dependent insulinotropic polypeptide (GIP) in controlling bone resorption has been suspected. However uncertainty remains to identify whether GIP act directly on osteoclasts. The aim of the present study were (i) to identify in different osteoclast differentiation models (human peripheral blood mononuclear cells-PBMC, murine bone marrow macrophage-BMM and murine Raw 264.7 cells) whether GIP was capable of reducing osteoclast formation and resorption; (ii) ascertain whether the highly potent GIP analogue N-AcGIP was capable of inducing a response at lower concentrations and (iii) to decipher the molecular mechanisms responsible for such effects. [d-Ala(2)]-GIP dose-dependently reduced osteoclast formation at concentration as low as 1nM in human PBMC and 10nM in murine BMM cultures. Furthermore, [d-Ala(2)]-GIP also reduced the extent of osteoclast resorption at concentration as low as 1nM in human PBMC and murine BMM cultures. The mechanism of action of [d-Ala(2)]-GIP appeared to be mediated by reduction in intracellular calcium concentration and oscillation that subsequently inhibited calcineurin activity and NFATc1 nuclear translocation. The potency of the highly potent N-AcGIP was determined and highlighted an effect on osteoclast formation and resorption at concentration ten times lower than observed with [d-Ala(2)]-GIP in vitro. Furthermore, N-AcGIP was also capable of reducing the number of osteoclast in ovariectomized mice as well as the circulating level of type I collagen C-telopeptide. Pharmacological concentrations required for reducing osteoclast formation and resorption provide the impetus to design and exploit enzymatically stable GIP analogues for the treatment of bone resorption disorders in humans.

La Tomografia Computerizzata Tridimensionale (3D-TC) nella patologia vascolare intracranica

È stata valutata l'utilità diagnostica del rendering tridimensionale di esami TC (3D-TC) nelle malformazioni artero-venose e negli aneurismi del poligono di Willis.

Particolare attenzione è stata posta sulla scelta dei valori di soglia di campionamento delle tessere, da cui dipendono sia la qualità che il significato diagnostico dell'imagine 3D ottenuta. Il rendering 3D concentra in poche immagini significative una considerevole quantità di informazioni con passaggio di un elevato flusso informativo dal radiologo al clinico.

In particolari situazioni di diagnostica differenziale la scelta di corretti valori di soglia («segno dell a soglia») può fornire informazioni diagnostiche originali.

Late diagnosis of positive HIV serology in pregnancy incidentally discovered by the widespread appearance of Kaposi's sarcoma

The authors report a case of Kaposi's sarcoma (KS) found in a pregnant woman. On discovery, the condition had spread throughout her body as is characteristic in some cases of individuals with HIV-positive serology. She was unaware of her HIV positive status. Her HIV infection had been diagnosed at the same time as KS at her last prenatal consultation. The newborn was delivered by an uncomplicated cesarean section. Appropriate treatment and multidisciplinary management after childbirth resulted in complete remission.

Quantitation of multiple mycotoxins and cyanogenic glucosides in cassava samples from Tanzania and Rwanda by an LC-MS/MS-based multi-toxin method

A multi-mycotoxin method based on liquid chromatography/tandem mass spectrometry (LC-MS/MS) was used for a mycotoxin survey in 627 samples of processed cassava collected from different districts across Tanzania and Rwanda after the method performance for this matrix had been determined. Matrix effects as well as extraction efficiencies were found to be similar to most other previously investigated matrices with the exception of distinct matrix effects in the negative ionisation mode for early eluting compounds. Limits of detection were far below the regulatory limits set in the European Union for other types of commodities. Relative standard deviations were generally lower than 10% as determined by replicates spiked on two concentration levels. The sample-to-sample variation of the apparent recoveries was determined for 15 individually spiked samples during three different analytical sequences. The related standard deviation was found to be lower than 15% for most of the investigated compounds, thus confirming the applicability of the method for quantitative analysis. The occurrence of regulated mycotoxins was lower than 10% (with the exception of zearalenone) and the related limits were exceeded only in few samples, which suggests that cassava is a comparatively safe commodity as regards mycotoxins. The most prevalent fungal metabolites were emodin, kojic acid, beauvericin, tryptophol, 3-nitropropionic acid, equisetin, alternariol methylether, monocerin, brevianamide F, tenuazonic acid, zearalenone, chrysophanol, monilifomin, enniatins, apicidin and macrosporin. The related concentrations exceeded 1 mg kg(-1) only in few cases. However, extremely high levels of cyanogenic plant toxins, which had been previously added to the method, were observed in few samples, pointing out the need for improved post-harvest management to decrease the levels of these compounds.

[Cataracts related to the extended application of dermocorticosteroids. A study of 8 cases in Abidjan]

INTRODUCTION

Cataract induced by corticosteroids is an entity, which has been well described for a relatively long time, but this eventuality caused by the cutaneous application of corticosteroids remains inadequately reported. The purpose of this study was to describe cataract as one of the complications of the misuse of cutaneous application of corticosteroids.

MATERIALS AND METHODS

In eight patients seen for visual loss, bilateral cataract was discovered. The only probable etiology in these cases appeared to be the cutaneous application of corticosteroids. Indeed, the work-up and careful history performed did not uncover any other etiology.

RESULTS

Eight patients, six women and two men, exhibited cataracts related to the application of topical corticosteroids. The age of the patients ranged between 39 and 45 years. The cataracts were bilateral and posterior subcapsular alone or combined. The period of use of corticosteroids ranged from 5 to 10 years. The products used consisted of a variety of chemicals including corticosteroids mainly in the form of traditionally manufactured soap, but also as ointment or other types of mixtures.

CONCLUSION

Topical corticosteroids induce posterior subcapsular cataract. The mechanism of action is direct access to the eye without any hepatic-first pass effect on the corticosteroid in question. The increasingly frequent use of corticosteroids in African blacks for skin lightening raises concern regarding the risk of epidemic cataracts in young women attempting to lighten their skin to be beautiful. Increased public awareness should be undertaken to prevent this growing and harmful phenomenon.

Amniotic band syndrome (ABS): can something be done during pregnancy in African poor countries? Three cases and review of the literature

Amniotic band syndrome (ABS) is a fetal congenital malformation, affecting mainly the limbs, but also the craniofacial area and internal organs. Two mains pathogenic mechanisms are proposed in its genesis. Firstly the early amnion rupture (exogenous theory) leading to fibrous bands, which wrap up the fetal body; secondly, the endogenous theory privileges vascular origin, mesoblastic strings not being a causal agent. The authors believe that the second theory explain the occurrence of ABS. The outcome of the disease during pregnancy depends on the gravity of the malformations. Interruption of the pregnancy is usually proposed when diagnosis of severe craniofacial and visceral abnormalities is confirmed. Whereas minor limb defects can be repaired with postnatal surgery. In case of an isolated amniotic band with a constricted limb, in utero lysis of the band can be considered to avoid a natural amputation. In an African country, such treatment is not possible as far as the antenatal diagnosis.

Spontaneous cutaneous umbilical endometriosis: a rare variant of extragenital endometriosis

Umbilical endometriosis is a very uncommon condition which presents as a pigmented umbilical nodule, papular or cystic, with symptoms punctuated rhythmed by menses. The authors report the case of a 32-year-old with spontaneous umbilical endometriosis. Surgical resection was performed with a good cosmetic result and no recurrence at six months. A review of the literature allowed the authors to discuss the diagnosis difficulties and treatment in a underdeveloped country.

Priming of hepatocytes enhances in vivo liver transduction with lentiviral vectors in adult mice

Lentiviral vectors are promising tools for liver disease gene therapy, because they can achieve protracted expression of transgenes in hepatocytes. However, the question as to whether cell division is required for optimal hepatocyte transduction has still not been completely answered. Liver gene-transfer efficiency after in vivo administration of recombinant lentiviral vectors carrying a green fluorescent protein reporter gene under the control of a liver-specific promoter in mice that were either hepatectomized or treated with cholic acid or phenobarbital was compared. Phenobarbital is known as a weak inducer of hepatocyte proliferation, whereas cholic acid has no direct effect on the cell cycle. This study shows that cholic acid is able to prime hepatocytes without mitosis induction. Both phenobarbital and cholic acid significantly increased hepatocyte transduction six- to ninefold, although cholic acid did not modify the mitotic index or cell-cycle entry. However, the effect of either compound was weaker than that observed after partial hepatectomy. In no cases was there a correlation between the expression of cell-cycle marker and transduction efficiency. We conclude that priming of hepatocytes should be considered a clinically applicable strategy to enhance in vivo liver gene therapy with lentiviral vectors.

Vulvar squamous cell carcinoma developing in a young black African HIV woman

Vulvar cancers are uncommon, represented in 90% of cases by squamous cell carcinoma (SCC). The reduction of the frequency and the severity proceed by recognition of precancerous or beginning lesions. They occur most often in the third age in postmenopausal women. The diagnosis is almost difficult and often late and therefore prognosis is severe. Conditions for diagnosis and treatment are difficult in underdeveloped countries due to the inaccessibility of proper equipment in the healthcare system. The authors report a case of SCC diagnosed late in a young human immunodeficiency virus (HIV) women who have been treated with neoadjuvant chemotherapy and radical surgery of the vulva.

Spontaneous rupture of uterine varices in third trimester pregnancy: an unexpected cause of hemoperitoneum. A case report and literature review

The authors report a case of spontaneous rupture of uterine varices occurring in the third trimester of pregnancy. It was responsible for a collapse in breast hemoperitoneum. The patient, whose pregnancy was a simple, suddenly felt symptoms of preterm labor. There was a rapid onset of maternal collapse with acute fetal distress. Only emergency exploratory laparotomy allowed for etiological diagnosis and treatment.

[Surgery of the idiopathic epimacular membrane on transconjunctival 25-gauge vitrectomy (TSV): a series of 50 cases]

BACKGROUND

The surgery of the idiopathic epimacular membrane has gained from the advent of 25-gauge transconjunctival vitrectomy (TSV) initiated by Fujii in 2002.

PATIENTS AND METHODS

In this retrospective study, we tested 50 patients operated on for epimacular membrane with 25-gauge TSV at the Quinze-Vingts National Ophthalmology Hospital in Paris from December 2004 to June 2006.

RESULTS

No postoperative endophthalmitis, major hypotonia, or sclerotomy leakage were observed. However, two cases (4%) of retinal detachment and 47% postoperative cataract were noted at 3 months. After evolving 3 months later, distant and close visual acuity were significantly improved.

CONCLUSION

TSV appears to be a useful method for epimacular membrane ablation.

Lentiviral vectors that express UGT1A1 in liver and contain miR-142 target sequences normalize hyperbilirubinemia in Gunn rats

BACKGROUND & AIMS

Crigler-Najjar type 1 (CN-I) is an inherited liver disease caused by an absence of bilirubin-uridine 5'-diphosphate-glucuronosyltransferase (UGT1A1) activity. It results in life-threatening levels of unconjugated bilirubin, and therapeutic options are limited. We used adult Gunn rats (an animal model of the disease) to evaluate the efficiency of lentiviral-based gene therapy to express UGT1A1 in liver.

METHODS

Gunn rats were given intraportal injections of VSVG-pseudotyped lentiviral vectors that encode UGT1A1 under the control of a liver-specific transthyretin promoter (mTTR.hUGT1A1); this vector does not contain target sequences for miR-142, a microRNA that is expressed specifically in hematopoietic cells. Rats were also injected with the vector mTTR.hUGT1A1.142T, which contains 4 copies of the miR-142 target sequences; its messenger RNA should be degraded in antigen-presenting cells. Bilirubinemia was monitored, and the presence of transduced hepatocytes was analyzed by quantitative polymerase chain reaction. Vector expression was tested in vitro in rat hematopoietic cells.

RESULTS

In Gunn rats, bilirubin levels normalized 2 weeks after administration of mTTR.hUGT1A1. However, hyperbilirubinemia resumed 8 weeks after vector administration, concomitant with the induction of an immune response. In contrast, in rats injected with mTTR-UGT1A1.142T, bilirubin levels normalized for up to 6 months and transduced cells were not eliminated.

CONCLUSIONS

Lentiviral vectors that express UGT1A1 reduce hyperbilirubinemia in immunocompetent Gunn rats for at least 6 months. The immune response against virally expressed UGT1A1 can be circumvented by inclusion of miR-142 target sequences, which reduce vector expression in antigen-presenting cells. This lentiviral-based gene therapy approach might be developed to treat patients with CN-I.

Transient increase in intrahepatic pressure mediates successful treatment of the Gunn rat with reduced doses of lentiviral vector

Lentiviral vectors can stably transduce hepatocytes and are promising tools for gene therapy of hepatic diseases. Although hepatocytes are accessible to blood-borne viral vectors through fenestrations of the hepatic endothelium, improved liver transduction after delivery of vectors to the blood stream is needed. As the normal endothelial fenestration and lentiviral vectors are similar in size (150 nm), we hypothesized that a transient increase in hepatic blood pressure may enhance in vivo gene transfer to hepatocytes. We designed a simple surgical procedure, by which the liver is temporarily excluded from blood flow. Lentiviral vectors were injected in a large volume to increase intrahepatic pressure. We demonstrated that in the Gunn rat, a model of Crigler-Najjar disease, the administration of low vector doses (corresponding to a multiplicity of infection of 0.2) by this procedure resulted in therapeutic correction of hyperbilirubinemia, without toxicity. The correction was sustained for 10 months (end of study). The same vector amounts yielded only partial correction after intraportal delivery. We believe that this new and clinically applicable strategy may broaden the range of genetic liver diseases accessible to gene therapy.

Enteric glia modulate epithelial cell proliferation and differentiation through 15-deoxy-12,14-prostaglandin J2

The enteric nervous system (ENS) and its major component, enteric glial cells (EGCs), have recently been identified as a major regulator of intestinal epithelial barrier functions. Indeed, EGCs inhibit intestinal epithelial cell (IEC) proliferation and increase barrier resistance and IEC adhesion via the release of EGC-derived soluble factors. Interestingly, EGC regulation of intestinal epithelial barrier functions is reminiscent of previously reported peroxisome proliferator-activated receptor gamma (PPARgamma)-dependent functional effects. In this context, the present study aimed at identifying whether EGC could synthesize and release the main PPARgamma ligand, 15-deoxy-(12,14)-prostaglandin J2 (15dPGJ2), and regulate IEC functions such as proliferation and differentiation via a PPARgamma dependent pathway. First, we demonstrated that the lipocalin but not the haematopoetic form for prostaglandin D synthase (PGDS), the enzyme responsible of 15dPGJ2 synthesis, was expressed in EGCs of the human submucosal plexus and of the subepithelium, as well as in rat primary culture of ENS and EGC lines. Next, 15dPGJ2 was identified in EGC supernatants of various EGC lines. 15dPGJ2 reproduced EGC inhibitory effects upon IEC proliferation, and inhibition of lipocalin PGDS expression by shRNA abrogated these effects. Furthermore, EGCs induced nuclear translocation of PPARgamma in IEC, and both EGC and 15dPGJ2 effects upon IEC proliferation were prevented by the PPARgamma antagonist GW9662. Finally, EGC induced differentiation-related gene expression in IEC through a PPARgamma-dependent pathway. Our results identified 15dPGJ2 as a novel glial-derived mediator involved in the control of IEC proliferation/differentiation through activation of PPARgamma. They also suggest that alterations of glial PGDS expression may modify intestinal epithelial barrier functions and be involved in the development of pathologies such as cancer or inflammatory bowel diseases.

[Influence of ethnic and eye condition on ultrasound A in ophthalmology at UHNC-HKM of Cotonou]

PURPOSE

To study impact of sociocultural groups and ocular condition on biometric data at University and Hospital National Center of Cotonou

PATIENTS AND METHODS

We conducted a descriptive cross-sectional study from 1st January to March 31, 2009 in the eye clinic at CNHU-HKM of Cotonou. It involved 116 patients aged over 16 years and Beninese nationality.

RESULTS

The mean age was 48 years ± 15.7. The sex ratio was 0.78. The "fon" socio-cultural's group was the largest with 43.96%. The eye condition was normal in 79 cases (68.10%). Primary glaucoma with open angle (OAPG) and cataract were observed in respectively 18.10% and 13.79%. Biometrics eye was not influenced by the socio-cultural groups, or by the OAPG. In contrast, cataract induced increase in the lens's thickness and reducing the depth of anterior chamber.

CONCLUSION

The lens plays a key role in changing the biometrics of the anterior segment.

A cell-based bicistronic lentiviral reporter system for identification of inhibitors of the hepatitis C virus internal ribosome entry site

This report describes the development, optimization and implementation of a persistent cell-based system to test inhibitors of hepatitis C (HCV) translation. The assay is based on a heterologous human immunodeficiency virus-1/simian immunodeficiency virus (HIV-1/SIV) lentiviral vector expressing the bicistronic cassette containing the firefly and renilla luciferase genes, respectively, as reporters, and the HCV internal ribosome entry site (IRES) inserted in between, under the control of the cytomegalovirus (CMV) promoter. The drug target in this assay is the HCV IRES, the activity of which leads to modulation of the renilla luciferase gene expression under its control, which is monitored by luminometry. The system has been validated using interferon (IFN), which is still the only consensual antiviral agent against HCV infection, associated with ribavirin. This bicistronic vector, extended to other viral IRESs and assayed in different cell lines, exhibited weak cell tropism, allowing its broad use in gene therapy, which frequently needs a multicistronic transfer vector to follow the expression of a gene of interest inside the target cells with the aid of a reporter, a drug selection marker, or a suicide gene, expressed from the same transcript.

[Cervical cancer: epidemiology and medical assistance in African society]

OBJECTIVES

The aim of this study was to improve the medical assistance and the prognostic of cervical cancer in African society.

MATERIALS AND METHODS

It was a retrospective and descriptive study carried out in the gynecology and obstetrics department at the teaching hospital of Cocody. It spanned over five years, from January 1st, 2002 to December 31st, 2006. It was focused on 171 cases of cervical cancer histologically confirmed.

RESULTS

The frequency of cervical cancer in that study was 1.7%. Patients had an average age of 48.5 years. 38.7% of patients were aged between 41 and 50. Multiparous represented 73.1% of patient with a majority of 38.6% for seven births and more. Patient socio-economic background was low in 72% of cases, married and divorced patients represented 63.2%. Patients who had an early sex and those with numerous partners respectively represented 77.2% and 73.2%. In 70.2% of cases, they had suffered a sexually transmitted infection once. Extension rate was limited to the financial capacities of our patients. Operable stages represented 19.3% and belated stages 57.1%. Only 8.8% of our patients were operated. The average theoretical cost of the surgical treatment was 298.203 F CFA.

CONCLUSION

This study showed that to improve medical assistance to patients, it is (capital) urgent to face efficiently the out break of factors of risk and improve diagnosis and therapy.

[Placenta praevia: maternal and featal prognosis in University Hospital of Cocody (Abidjan-Cote d'Ivoire)]

INTRODUCTION

In Africa, in spite of systematical practice of echography, Placenta praevia (PP) remains a high risky gravid complication, very unpredictable, with a high lethality rate.

OBJECTIVES

The aim of our study was to reconsider the frequency of this pathology, to appreciate the maternal and fetal prognosis.

PATIENTS AND METHODS

This was a retrospective cohort study, about 340 cases of PP, at the University Hospital of Cocody in Abidjan, during 5 years, from January 1st 2002 to December 31st 2006. We included in this study all the parturients with a gestational age > or = 28 weeks of amenorrhea, and a PP diagnosed during either pregnancy, or labour, or after placenta stage. Maternal age, parity, gynecologic and obstetrical antecedents, mode of delivery and maternal and fetal prognosis was compared between patients with PP and a group of witness chosen among normal pregnancies. The comparison has been done by using X² and Fischer test with a threshold of signification of 5%.

RESULTS

The frequency of PP in our study was 1.6%. The maternal age was > or = 30 years old for 43.2% of patients with PP against 28% in witness group (p=0.000). Among cases of PP, multiparous and high multiparous represented 37.7% against 10% in the witness group. Healing uterus was an increasing factor of PP (32 cases against 8 in witness group; p=0.024). Caesarean operation has been the principal mode of delivery among the patients with PP (80%). 43.8% of newborn was premature against 8.5% in the witness group (p=0.0000). The perinatal mortality was 21.3% in cases of PP against 3.8% in witness group. Three maternal deaths (0.9%) have been noticed among patients with PP.

CONCLUSION

The management of PP is still badly definite in Africa. The early diagnostic by ultrasound examination permit an adapted supervision and the prevention of all obstetrical complications of this pathology.

[Central serous chorioretinopathy: a study of six cases observed in Abidjan between 2003 and 2005, suggesting a role played by the Ivorian political-military crisis]

OBJECTIVE

This study aimed to show that central serous chorioretinopathy is present in Ivory Coast and that the emotional and psychosocial context plays an important role in this disorder's pathogenesis.

PATIENTS AND METHOD

The authors report six central serous chorioretinopathy cases based on angiographic diagnosis, five in Black African subjects and one in a European subject. These cases were observed over a period of 2 years during the Ivorian political-military crisis.

RESULTS

In a center where angiography has been a current practice since 1999, up to 2002 479 angiographies were done without a single central serous chorioretinopathy case being diagnosed. After the beginning of the political-military crisis, six cases of central serous chorioretinopathy were observed out of 417 angiographies over a period of 2 years. All the patients were males, between 20 and 50 years old, five were Black Africans and one was a white European. Their professions varied (a contractor, a soldier, a business executive, for example). The angiography showed break points in ink spots in the majority of the cases, with one case showing multiple break points. All the patients were emotionally distraught because of the uncertainty of the political situation.

CONCLUSION

This study confirms that central serous chorioretinopathy does indeed exist in the Black African subject, as it exists in the leucoderma subject without discrimination. This study emphasizes the anxiety and extreme emotional context as an initiating factor in the occurrence of central serous chorioretinopathy.

[Endothelial changes during penetrating keratoplasty]

The authors analyzed the post operative results of the penetrating keratoplasty after removal suture in Ophthalmology Service of University and Hospital's Center in Tours. The age of patients varied 20 to 90 years with an average of 56,83 years. 41,71% of patients had a pseudophakic or aphakic bullous keratopathy. Ocular hypertony was the most frequently post operative complication (63,67%). Final removal's suture improved the transparency of grafts and so the visual acuity in spite of greater endothelial cell loss (65,65%) and residual corneal oedema.

[Heavy silicone oil as internal tamponade for retinal detachment: efficacy and tolerance]

INTRODUCTION

To evaluate the tolerance and efficacy of heavy silicone oil as internal tamponade for retinal detachment surgery.

PATIENTS AND METHODS

Sixty-six eyes requiring heavy silicone oil for retinal detachment, with at least 1 month follow-up, were retrospectively studied. Preoperative status, surgical technique, tolerance, and anatomical and functional results were analyzed from the patient's file. Indications for heavy silicone injection were inferior retinotomy or inferior retraction in 65% of cases. PVR grade C was present in at least 63% of cases. Retinotomy was performed in 45% of cases. An exchange procedure was performed versus DKline in 65% of cases. Mean follow-up was 7 +/- 4 months.

RESULTS

At the end of follow-up, 59% of eyes had a completely reattached retina, 32% without internal tamponade. Another surgery was necessary in 54% of cases. During follow-up, mean intraocular pressure was normal, and there was a significant intraocular inflammation in three cases (4.5%). In seven cases of the 44 ablations of heavy silicone oil, an adherence of residual bubbles was present. Redetachment occurred after ablation for anatomical success in 41% of cases. BCVA was better than 0.05 (20/400) in 54% of cases at the end of follow-up.

CONCLUSION

Heavy silicone was well tolerated and seems not to be pro-inflammatory in our study. It is a good alternative to standard silicone for inferior retinotomy and inferior breaks without PVR. It is not a treatment of inferior retraction, and is not a long-term internal tamponade. During the ablation of heavy silicone oil, adherence of residual bubbles is possible, in which case a coaxial light or an endoillumination could be needed during ablation.

Valeurs biométriques de l’œil du sujet africain de race noire et hypothèse du rôle dans certaines pathologies

INTRODUCTION

The international literature seldom refers to eye measurements of the black African patient. Therefore, the various patterns where biometry elements are used as constituents deserve reconsideration as they may not correspond to the eye of the black patient of our region. This study provides true measurements for the black African patient in Ivory Coast. It also establishes hypotheses by extrapolating the role of measurements in pathologies such as glaucoma.

MATERIAL

and method: The study included 325 eyes of 217 male and female patients. All the patients underwent ocular keratometrics and echo biometrics to measure the depth of the anterior chamber, the width of the lens, and the total axial length with the ultrascan biometer using the contact method in A echometrics.

RESULTS

The mean keratometry in women was significantly higher than in men (43.99 +/- 1.62 diopters vs 43.46 +/- 1.45 diopters). The anterior chamber was deeper in men (2.69 mm +/- 0.54 vs 2.53 mm +/- 0.48). The men's eyes were significantly longer, with an axial length of 23.26 mm +/- 1.07 vs 22.56 mm +/- 0.90.

CONCLUSION

Significant biometric differences between men's and women's eyes, on the one hand, and between black African and white patients' eyes, on the other hand, can be observed. The reasons for these differences are several: they are natural, socioeconomic, and technical. If standard implant of a different power for black and white patients can be imagined, can we also infer that the biometrics of a black African patient predisposes him to a disorder such as glaucoma more than a white patient? Further in-depth studies could provide an answer to this question.