Meta-analysis of negative pressure wound therapy of closed groin incisions in arterial surgery.

BACKGROUND: Surgical-site infection (SSI) after groin incisions for arterial surgery is common and may lead to amputation or death. Incisional negative pressure wound therapy (NPWT) dressings have been suggested to reduce SSIs. The aim of this systematic review with meta-analysis was to assess the effects of incisional NPWT on the incidence of SSI in closed groin incisions after arterial surgery. METHODS: A study protocol for this systematic review of RCTs was published in Prospero (CRD42018090298) a priori, with predefined search, inclusion and exclusion criteria. The records generated by the systematic research were screened for relevance by title and abstract and in full text by two of the authors independently. The selected articles were rated for bias according to the Cochrane risk-of-bias tool. RESULTS: Among 1567 records generated by the search, seven RCTs were identified, including 1049 incisions. Meta-analysis showed a reduction in SSI with incisional NPWT (odds ratio (OR) 0·35, 95 per cent c.i. 0·24 to 0·50; P < 0·001). The heterogeneity between the included studies was low (I2 = 0 per cent). The quality of evidence was graded as moderate. Two studies had multiple domains in the Cochrane risk-of-bias tool rated as high risk of bias. A subgroup meta-analysis of three studies of lower limb revascularization procedures only (363 incisions) demonstrated a similar reduction in SSI (OR 0·37, 0·22 to 0·63; P < 0·001; I2 = 0 per cent). CONCLUSION: Incisional NPWT after groin incisions for arterial surgery reduced the incidence of SSI compared with standard wound dressings. The risk of bias highlighted the need for a high-quality RCT with cost-effectiveness analysis.

Improved Prognosis and Low Failure Rate with Anticoagulation as First-Line Therapy in Mesenteric Venous Thrombosis.

BACKGROUND: Monotherapy with anticoagulation has been considered as first-line therapy in patients with mesenteric venous thrombosis (MVT). The aim of this study was to evaluate outcome, prognostic factors, and failure rate of anticoagulation as monotherapy, and to identify when bowel resection was needed. METHODS: Retrospective study of consecutive patients with MVT diagnosed between 2000 and 2015. RESULTS: The overall incidence rate of MVT was 1.3/100,000 person-years. Among 120 patients, seven died due to autopsy-verified MVT without bowel resection and 15 underwent immediate bowel resection without prior anticoagulation therapy. The remaining 98 patients received anticoagulation monotherapy, whereof 83 (85%) were treated successfully. Fifteen patients failed on anticoagulation monotherapy, of whom seven underwent bowel resection and eight endovascular therapy. Endovascular therapy was followed by bowel resection in three patients. Two late bowel resections were performed due to intestinal stricture. The 30-day mortality rate was 19.0% in the former (2000-2007) and 3.2% in the latter (2008-2015) part of the study period (p = 0.006). Age ≥75 years (OR 12.4, 95% CI [2.5-60.3]), management during the former as opposed to the latter time period (OR 8.4, 95% CI [1.3-54.7]), and renal insufficiency at admission (OR 8.0, 95% CI [1.2-51.6]) were independently associated with increased mortality in multivariable analysis. CONCLUSIONS: Short-term prognosis in patients with MVT has improved. Contemporary data show that monotherapy with anticoagulation is an effective first choice in MVT patients.

Clinical implications of CT findings in mesenteric venous thrombosis at admission.

PURPOSE: The main aim of this study was to evaluate the association of computed tomography (CT) findings at admission and bowel resection rate in patients with mesenteric venous thrombosis (MVT). It was hypothesized that abnormal intestinal findings on CT were associated with a higher bowel resection rate. METHODS: Retrospective study of MVT patients treated between 2004 and 2017. CT images at admission and at follow-up were scrutinized according to a predefined protocol. Successful recanalization was defined as partial or complete recanalization of the portomesenteric venous thrombosis at the latest CT follow-up (n = 70). RESULTS: We studied 102 patients (median age 58 years, 61 men). Lifelong anticoagulation was initiated in 64 patients, and bowel resection rate was 17%. No referral letter indicated suspicion of MVT, whereas three indicated suspected intestinal ischemia. Previous venous thromboembolism was associated with increased bowel resection rate (p = 0.049). No patient with acute pancreatitis (n = 17) underwent bowel resection (p = 0.068). The presence of mesenteric oedema (p = 0.014), small bowel wall oedema (p < 0.001), small bowel dilatation (p = 0.005), and ascites (p = 0.021) were associated with increased bowel resection rate. Small bowel wall oedema remained as an independent risk factor associated with bowel resection (OR 15.8 [95% CI 3.2-77.2]). Successful thrombus recanalization was achieved in 66% of patients. CONCLUSION: The presence of abnormal intestinal findings secondary to MVT confers an excess risk of need of bowel resection due to infarction. Responsible physicians should therefore scrutinize the CT images at diagnosis together with the radiologist to better tailor clinical surveillance.

Cost-effectiveness of Screening for Abdominal Aortic Aneurysm in Combination with Medical Intervention in Patients with Small Aneurysms.

OBJECTIVES: Screening for abdominal aortic aneurysm (AAA) among 65 year old men has been proven cost-effective, but nowadays is conducted partly under new conditions. The prevalence of AAA has decreased, and endovascular aneurysm repair (EVAR) has become the predominant surgical method for AAA repair in many centers. At the Malmö Vascular Center pharmacological secondary prevention with statins, antiplatelet therapy, and blood pressure reduction is initiated and given to all patients with AAA. This study evaluates the cost-effectiveness of AAA screening under the above mentioned conditions. METHODS: This was a Markov cohort simulation. A total of 4,300 65 year old men were invited to annual AAA screening; the attendance rate was 78.3% and AAA prevalence was 1.8%. A Markov model with 11 health states was used to evaluate cost-effectiveness of AAA screening. Background data on rupture risks, costs, and effectiveness of surgical interventions were obtained from the participating unit, the national Swedvasc Registry, and from the scientific literature. RESULTS: The additional costs of the screening strategy compared with no screening were €169 per person and year. The incremental health gain per subject in the screened cohort was 0.011 additional quality adjusted life years (QALYs), corresponding to an incremental cost-effectiveness ratio (ICER) of €15710 per QALY. Assuming a 10% reduction of all cause mortality, the incremental cost of screening was €175 per person and year. The gain per subject in the screened cohort was 0.013 additional QALYs, corresponding to an ICER of €13922 per QALY CONCLUSIONS: AAA screening remains cost-effective according to both the Swedish recommendations and the UK National Institute for Health and Care Excellence recommendations in the new era of lower AAA prevalence, EVAR as the predominant surgical method, and secondary prevention for all AAA patients.

Assessment of genetic diversity and relatedness among Tunisian almond germplasm using SSR markers.

Genetic diversity of 50 Tunisian almond (Prunus dulcis Mill.) genotypes and their relationships to European and American cultivars were studied. In total 82 genotypes were analyzed using ten genomic SSRs. A total of 159 alleles were scored and their sizes ranged from 116 to 227 bp. The number of alleles per locus varied from 12 to 23 with an average of 15.9 alleles per locus. Mean expected and observed heterozygosities were 0.86 and 0.68, respectively. The total value for the probability of identity was 4 × 10(-13) . All SSRs were polymorphic and they were able all together to distinguish unambiguously the 82 genotypes. The Dice similarity coefficient was calculated for all pair wise and was used to construct an UPGMA dendrogram. The results demonstrated that the genetic diversity within local almond cultivars was important, with clear geographic divergence between the northern and the southern Tunisian cultivars. The usefulness of SSR markers for almond fingerprinting, detection of synonyms and homonyms and evaluation of the genetic diversity in the Tunisian almond germplasm was also discussed. The results confirm the potential value of genetic diversity preservation for future breeding programs.

Effects of exogenous salicylic acid pre-treatment on cadmium toxicity and leaf lipid content in Linum usitatissimum L.

The effects of salicylic acid (SA) on cadmium (Cd) toxicity in flax plants were studied by investigating plant growth, lipid peroxidation and fatty acid composition. Cadmium inhibited biomass production as well as the absorption of K, Ca, Mg and Fe. Furthermore, it dramatically increased Cd accumulation in both roots and shoots. The pre-soaking of dry flax grains in SA-containing solutions partially protected seedlings from Cd toxicity during the following growth period. SA treatment decreased the uptake and the transport of Cd, alleviated the Cd-induced inhibition of Ca, Mg and Fe absorption and promoted plant growth. At leaf level, Cd significantly decreased both total lipid (TL) and chlorophyll (Chl) content and enhanced electrolyte leakage and lipid peroxidation as indicated by malondialdehyde (MDA) accumulation. Concomitantly, Cd caused a shift in fatty acid composition, resulting in a lower degree of their unsaturation. SA pre-soaking ameliorated the increased electrolyte leakage as well as Chl, MDA and TL content. SA particularly increased the percentage of linolenic acid and lowered that of palmitic acid by the same proportion. These results suggest that SA could be used as a potential growth regulator and a stabilizer of membrane integrity to improve plant resistance to Cd stress.

[Complicated hydatid cysts of the lung]. / Kystes hydatiques compliqués du poumon.

BACKGROUND: Hydatid disease which is caused by the parasite Echinococcus granulosis is one of the most important helminthic diseases. The parasitic infection is endemic in many areas worldwide, including the Mediterranean region. The lung is the second most common involved organ. In the present study, we review cases of complicated pulmonary hydatidosis, discussing pathophysiological mechanisms and the clinical, radiological features, as well as natural history and therapeutic options. METHODS: A retrospective study was conducted in the adult pulmonary department of The Tunis Chest Diseases and Surgery Training Hospital, a tertiary referral hospital for pulmonary diseases in Tunisia. RESULTS: 52 cases (mean age=34.6 years) were evaluated between 1998 and 2008. Rupture of the hydatid cyst occurred into the bronchi in the majority of cases (86.5%) and into the pleura in 9.6%. Extrathoracic involvement was found in 17.3% of the cases. Diagnosis of pulmonary hydatidosis was based on a consistent clinical and radiological presentation. Recourse to CT scan of the chest was helpful for diagnosis in 28% of the patients. Fibre-optic bronchoscopy (performed in 64.5% of cases) confirmed the diagnosis in 4 patients with total endoscopic extraction of hydatid cyst membrane in 2 cases. Surgical treatment was performed in 44 cases; resection of lung parenchyma was necessary in 8 patients (18.2%). Medical treatment was associated in 2 cases. Outcome revealed recurrence of pulmonary hydatidosis in 3 patients, and the death of 1 patient with chronic pulmonary hypertension due to chronic hydatid pulmonary embolism. CONCLUSION: Complicated pulmonary hydatidosis may present some diagnostic difficulties, even in endemic regions. Management may be difficult, costly, and may require pulmonary resections.

[The value of tumor markers in pulmonary tuberculosis]. / Apport des marqueurs tumoraux dans la tuberculose pulmonaire.

BACKGROUND: In thoracic oncology, no tumor marker has yet shown sufficient sensitivity nor specificity to be usefull for lung cancer diagnosis. However, in some cases, monitoring of tumor marker blood levels provides useful evaluation of response to specific treatment and assessment of infracfinical tumor progression. AIM: To determine the value of umor markers in pulmonary tuberculosis. METHODS: A prospective study was conducted in our department during 2 years 2005 through 2007. We included 40 men who presented confirmed pulmonary tuberculosis. Before starting antituberculous chemotherapy, serum assays were practiced for the following tumor markers: NSE, CA125, ACE and Cyfra 21.1. RESULTS: Mean age was 37.12 years (17-81). The levels of NSE were high in 91.66% of cases with an average value of 29.22 microg/l (2.24 X normal). This highest sensitivity was superior to those of other tumor markers: 55.55% for CA125, 28.94% for ACE and 7.6% for Cyfra 21.1. Analysis of the levels of NSE according to age, tobacco consumption, delay of consultation, type of the pulmonary lesions and negativation delay in smear did not show any significant difference, whereas levels of CA125 were higher in bilateral lesions (P = 0.05). CONCLUSION: The highest sensitivity of the NSE in pulmonary tuberculosis, with no neoplastic pathology could be interesting for diagnosis of smear negative tuberculosis, with small amounts of bacilli.

Inhibitory effect of various Tunisian olive oils on chemical mediator release and cytokine production by basophilic cells.

Tunisian olive oils have been traditionally used as a medicinal food for chronic inflammation. To investigate the antiallergic effect of virgin olive oil samples from five principal olive varieties grown in various regions of Tunisia, we used the type I allergy reaction model using rat basophilic leukemia (RBL-2H3) cells and different dilutions of olive oil samples to determine beta-hexosaminidase release inhibition at two different response stages. Results showed that the Sayali olive oil significantly inhibited beta-hexosaminidase release by the IgE antibody-sensitized, BSA antigen-stimulated RBL-2H3 cells at the antibody-antigen binding stage. The result of our experiment shows that the anti-allergic effect of olive oil at this binding stage may be dependent on their flavone content. The Zarrazi olive oil significantly inhibited beta-hexosaminidase release at the antigen-receptor binding stage. Moreover, we investigated the effect of olive oil samples on histamine release and production of cytokines by activated human basophilic (KU812) cells. Different dilutions of Sayali olive oil dose-dependently inhibited the production of tumor necrosis factor-alpha (TNF-alpha) and interleukin-4 (IL-4), and different dilutions of Zarrazi olive oil dose-dependently inhibited histamine release and IL-4 production by calcium ionophore A23187 plus phorbol 12-myristate 13-acetate (PMA)-stimulated KU812 cells.

Testing for thrombophilia in mesenteric venous thrombosis - Retrospective original study and systematic review.

The aim was to perform a local study of risk factors and thrombophilia in mesenteric venous thrombosis (MVT), and to review the literature concerning thrombophilia testing in MVT. Patients hospitalized for surgical or medical treatment of MVT at our center 2000-2015. A systematic review of observational studies was performed. In the local study, the most frequently identified risk factor was Factor V Leiden mutation. The systematic review included 14 original studies. The highest pooled percentage of any inherited thrombophilic factor were: Factor V Leiden mutation 9% (CI 2.9-16.1), prothrombin gene mutation 7% (CI 2.7-11.8). The highest pooled percentage of acquired thrombophilic factors were JAK2 V617F mutation 14% (CI -1.9-28.1). The wide range of frequency of inherited and acquired thrombophilic factors in different populations indicates the necessity to relate these factors to background population based data in order to estimate their overrepresentation in MVT. There is a need to develop guidelines for when and how thrombophilia testing should be performed in MVT.

Leukemia in Patients with Klinefelter Syndrome: A Report of Two Cases.

Klinefelter syndrome (KS) is a chromosome abnormality characterized by a 47, XXY karyotype associated with hypogonadism and infertility. We present two cases of leukemia in patients with KS. The first patient presented with acute promyelocytic leukemia. He relapsed after the end of treatment. The second patient was diagnosed with chronic myeloid leukemia. Treatment with imatinib failed and the patient presented with myeloid blast crisis.

Ultrastructure and lipid alterations induced by cadmium in tomato (Lycopersicon esculentum) chloroplast membranes.

The effects of cadmium (Cd) uptake on ultrastructure and lipid composition of chloroplasts were investigated in 28-day-old tomato plants (Lycopersicon esculentum var. Ibiza F1) grown for 10 days in the presence of various concentrations of CdCl2. Different growth parameters, lipid and fatty acid composition, lipid peroxidation, and lipoxygenase activity were measured in the leaves in order to assess the involvement of this metal in the generation of oxidative stress. We first observed that the accumulation of Cd increased with external metal concentration, and was considerably higher in roots than in leaves. Cadmium induced a significant inhibition of growth in both plant organs, as well as a reduction in the chlorophyll and carotenoid contents in the leaves. Ultrastructural investigations revealed that cadmium induced disorganization in leaf structure, essentially marked by a lowered mesophyll cell size, reduced intercellular spaces, as well as severe alterations in chloroplast fine structure, which exhibits disturbed shape and dilation of thylakoid membranes. High cadmium concentrations also affect the main lipid classes, leading to strong changes in their composition and fatty acid content. Thus, the exposure of tomato plants to cadmium caused a concentration-related decrease in the fatty acid content and a shift in the composition of fatty acids, resulting in a lower degree of fatty acid unsaturation in chloroplast membranes. The level of lipid peroxides and the activity of lipoxygenase were also significantly enhanced at high Cd concentrations. These biochemical and ultrastructural changes suggest that cadmium, through its effects on membrane structure and composition, induces premature senescence of leaves.

Usefulness of ligation-mediated PCR genotyping in tracking outbreak-associated Mycobacterium tuberculosis strains.

With the emergence of a multidrug resistant tuberculosis (MDR-TB) outbreak, the availability of a rapid typing method to carry out a nationwide prospective survey for the tracking of newly emerging MDR-TB foci became a priority. For this purpose, we have applied the IS6110 PCR-based genotyping assay, namely, LM-PCR (ligation-mediated PCR). The latter relies on ligation of a synthetic oligonucleotide priming site to a restriction site flanking IS6110. Sequences between the IS element and the restriction site are then amplified using an IS6110 specific outward primer and an oligonucleotide specific to the ligated priming site. Although it was found slightly less discriminative than the standard IS6110 restriction fragment length polymorphism analysis (IS6110 RFLP), LM-PCR allowed for the rapid and prospective identification of new outbreak-related cases within a large pool of circulating M. tuberculosis isolates. In comparison to IS6110 RFLP LM-PCR was found simple enough to justify its implementation in laboratories involved in MDR-TB surveillance at a nationwide scale.

Solid tumors after chronic lymphocytic leukemia patients: Report of six cases and review of the literature.

INTRODUCTION: Malignancies have been reported to occur with increased frequency in chronic lymphocytic Leukemia (CLL) patients. The aim of this study was to describe which second malignancies occur in patients with CLL, whether these malignancies are related to CLL, its treatment, or both. We also attempt to study factors predicting the development of other malignancies. PATIENTS AND METHODS: Between 1995 and 2009, six cases of CLL associated with solid tumor were diagnosed in Hematology Department of Military Hospital of Tunis. The diagnosis of CLL was made by immunophenotyping of peripheral blood circulating B cells, and the diagnosis of solid tumors was made by biopsy with anatomopathological exam and immunohistochemical study. RESULTS: The mean age of patients was 71 years. Five patients were male. The CLL was classified Stage A in one case, Stage B in three cases and Stage C in two cases. Two patients had abnormal karyotype. Three patients have not received specific treatment for their CLL. Solid tumors were represented by skin cancer in three cases, lung cancer in two cases and breast cancer in one case. The median time between diagnosis of CLL and that of solid tumor was 53 months. CONCLUSION: Patients with CLL have an increased risk of developing a second cancer. Awareness of risk factors could permit early detection.

Social and leisure activities and risk of dementia: a prospective longitudinal study.

OBJECTIVE: To study the relationship between social and leisure activities and risk of subsequent dementia in older community residents. SETTING: A cohort study of people aged 65 and older were followed-up 1 and 3 years after a baseline screening (the Paquid study). PARTICIPANTS: 2040 older subjects living at home in Gironde (France) were randomly selected and followed for at least 3 years. DATA COLLECTION: Information about social and leisure activities was collected during the baseline screening with an interview by a psychologist. Incident cases of dementia were detected during the first and third year follow-up screenings according to the DSM-III-R criteria. MAIN RESULTS: All but one of the social and leisure activities noted were significantly associated with a lower risk of dementia. Only golden club participation was not significantly associated with this risk. After adjustment for age and cognitive performance measured by the Mini-Mental State Exam, visual memory test, and verbal fluency test, only traveling (Relative risk (RR) = .48,95% Confidence Interval (95% CI) = .24-.94), odd jobs or knitting (RR = .46,95% CI = .26-.85), and gardening (RR = .53, 95% CI = .28-.99) remained significant. CONCLUSIONS: Regular participation in social or leisure activities such as traveling, odd jobs, knitting, or gardening were associated with a lower risk of subsequent dementia.

Cadmium- and copper-induced changes in tomato membrane lipids.

Cadmium and copper uptake and distribution, as well as their effects on growth and lipid composition were investigated in 17-day-old tomato seedlings (Lycopersicon esculentum Mill. cv. 63/5 F1) grown in culture solution supplied with two concentrations of Cd or Cu (0, 5 and 50 microM). The accumulation of Cd and Cu increased with external metal concentrations, and was considerably higher in roots than in primary leaves. Biomass production of the growing roots and primary leaves was strongly depressed at high metal levels. Also, significant decreases in the content of lipid classes and changes of fatty acid composition were recorded in heavy metal-stressed plants in comparison with controls. Glycolipid contents were decreased more in leaves than in roots by Cd-treatment, but copper decreased both to similar extents in both organs. Likewise, both metals reduced the phospholipid and neutral lipid contents more in roots than in leaves. In almost all lipid classes the proportion of palmitic acid (16:0) increased, and that of linoleic (18:2) or linolenic (18:3) acid decreased, suggesting that heavy metal treatment induced an alteration in the fatty acid desaturation processes. Furthermore, the accumulation of palmitate (16:0) rather than stearate (18:0) indicated an alteration in the ratio of products from the fatty acid synthase. Copper was found to be the most unfavourable for plant growth and lipid metabolism. The possible mechanisms by which heavy metals, especially Cu, induce a strong lipid shift are discussed.

[Treatment of recurrent pulmonary tuberculosis]. / Traitement des récidives de tuberculose pulmonaire.

INTRODUCTION: Tuberculosis (TB) is a greatest public health problem of the world. This work aims to study the antituberculous treatment and the evolution of the patients with recurrent tuberculosis. PATIENTS AND METHOD: The study is a retrospective study on 64 patients with recidivant pulmonary TB: A1 group: at the first TB attack; A2 group: at the time of recidivant TB, and 105 controls patients with confirmed TB without recidive. RESULTS: Multidrug-resistant TB is more frequent with recidivant TB (21.1% vs 3%, P<0.05) and also extensively drug-resistant. Antituberculous treatment duration in group A1, A2 and T was respectively 8.63 months, 9.79 months, and 7.08 months. Antituberculous drug complications were more frequent in group A2 compared to group T (76.1% vs 41.2%; P<0.001). CONCLUSION: All tuberculous patients, specially recidivant TB, should benefit of particular care and drug protocol adaptation.

[Anaphylaxis due to chicken meat]. / Choc anaphylactique à la viande de poulet.

Acute anaphylaxis due to chicken meat is very rare; only a few cases have been reported in the literature. We report the case of a 13-year-old girl, with a past history of allergic urticaria due to eggs, who presented immediately after ingestion of lightly grilled chicken meat with facial edema, dysphonia, acute dyspnoea and a feeling of suffocation. A few months later, the patient developed asthma in the vicinity of poultry and after contact with chicken feathers.

[Pain and primary lung cancer in the elderly]. / Douleur et cancer bronchopulmonaire primitif du sujet âgé

The study of pain in elderly patients with a primary lung cancer (PLC) deserves special attention particularly because this symptom is frequently associated with the condition and influences the management and prognosis. To study the characteristics of pain due to PLC in the elderly, we prospectively evaluated pain in all patients aged over 65 years admitted for PLC. Thirty-nine elderly patients were enrolled in 15 months (62% of all PLC). The average age was 72 years. The cancer was advanced NSCLC in most cases. Pain was present in 74.3%. It was significantly less common among those over 75 years (50% versus 85.1%; P<0.05). The pain, mild in most cases, worsened during follow-up in 55.5%. The last mean visual analogue scale score was significantly lower than the first (1.3 versus 3.6; P=0.001). The pain treatment required was based on level I in 20.6%, level II in 48.2% and level III in 31% of cases. Pain management in the elderly should be early, adequate and continued in order to preserve to a maximum the quality of life of these patients with PLC.