Open preperitoneal vs. open anterior repair for the treatment of emergency femoral hernia: a bicentric retrospective study.

PURPOSE: The aim of this study is to compare the postoperative results, in terms of complications and recurrence, between the anterior and open preperitoneal approaches in emergency femoral hernia. METHODS: This bi-centric retrospective cohort study included patients who underwent emergency femoral hernia repair between January 2010 and December 2018. Postoperative complications and recurrence were analyzed comparing anterior and open preperitoneal approaches. The predictors of complications, mortality and recurrence were investigated using multivariate logistic regression. RESULTS: A total of 204 patients met the inclusion criteria. Open anterior approach was performed in 128 (62.7%) patients and open preperitoneal was performed in 76 (37.3%). Open preperitoneal approach was associated with lower rates of recurrence (P = 0.033) and associated midline laparotomies (P = 0.006). Multivariable analysis identified patients with chronic nephropathy (OR, 3.801; 95%CI, 1.034-13.974; P = 0.044), preoperative bowel obstruction (OR, 2.376; 95%CI, 1.118-5.047; P = 0.024) and required midline laparotomy (OR, 12.467; 95%CI, 11.392-102.372; P = 0.030) as risk factors for complications and ASA ≥ III (OR, 7.820; 95%CI, 1.279-47.804; P = 0.026), COPD (OR, 5.064; 95%CI, 1.188-21.585; P = 0.028), necrotic contents (OR, 36.968; 95%CI, 4.640-294.543; P = 0.001), and required midline laparotomy (OR, 11.047; 95%CI, 1.943-62.809; P = 0.007). as risk factors for 90-day mortality. Male gender (OR, 4.718; 95%CI, 1.668-13.347; P = 0.003) and anterior approach (OR, 5.292; 95%CI, 1.114-25.149; P = 0.036) were risk factors for recurrence. CONCLUSION: Open preperitoneal approach may be superior to anterior approach in the emergency setting because it can avoid the morbidity of associated midline laparotomies, with a lower long-term recurrence rate.

Males and females with first episode psychosis present distinct profiles of social cognition and metacognition.

Deficits in social cognition and metacognition impact the course of psychosis. Sex differences in social cognition and metacognition could explain heterogeneity in psychosis. 174 (58 females) patients with first-episode psychosis completed a clinical, neuropsychological, social cognitive, and metacognitive assessment. Subsequent latent profile analysis split by sex yielded two clusters common to both sexes (a Homogeneous group, 53% and 79.3%, and an Indecisive group, 18.3% and 8.6% of males and females, respectively), a specific male profile characterized by presenting jumping to conclusions (28.7%) and a specific female profile characterized by cognitive biases (12.1%). Males and females in the homogeneous profile seem to have a more benign course of illness. Males with jumping to conclusions had more clinical symptoms and more neuropsychological deficits. Females with cognitive biases were younger and had lower self-esteem. These results suggest that males and females may benefit from specific targeted treatment and highlights the need to consider sex when planning interventions.

Open Emergent Groin Hernia Repair: Anterior or Posterior Approach?

Introduction: The current literature has not yet provided a definitive conclusion on the best emergency groin hernia repair. The aim of this study was first to compare the short and long-term outcomes between open preperitoneal and anterior approach in emergency groin hernia repair and second to identify risk factors for postoperative complications, mortality, and recurrence. Materials and Methods: This retrospective cohort study included patients who underwent emergency groin hernia repair between January 2010 and December 2018. Short and long-term outcomes were analyzed comparing approach and repair techniques. The predictors of complications and mortality were investigated using multivariate logistic regression. Cox regression multivariate analysis were used to explore risk factors of recurrence. Results: A total of 316 patients met the inclusion criteria. The most widely used surgical techniques were open preperitoneal mesh repair (34%) and mesh plug (34%), followed by Lichtenstein (19%), plug and patch (7%) and tissue repair (6%). Open preperitoneal mesh repair was associated with lower rates of recurrence (p = 0.02) and associated laparotomies (p < 0.001). Complication and 90-day mortality rate was similar between the techniques. Multivariable analysis identified patients aged 75 years or older (OR, 2.08; 95% CI, 1.14-3.80; p = 0.016) and preoperative bowel obstruction (OR, 2.11; 95% CI, 1.20-3.70; p = 0.010) as risk factors for complications and Comprehensive Complication Index ≥26.2 as risk factor for 90-day mortality (OR, 44.76; 95% CI, 4.51-444.59; p = 0.01). Female gender was the only risk factor for recurrence. Conclusion: Open preperitoneal mesh repair may be superior to other techniques in the emergency setting, because it can avoid the morbidity of associated laparotomies, with a lower long-term recurrence rate.

Persons with first episode psychosis have distinct profiles of social cognition and metacognition.

Subjects with first-episode psychosis experience substantial deficits in social cognition and metacognition. Although previous studies have investigated the role of profiles of individuals in social cognition and metacognition in chronic schizophrenia, profiling subjects with first-episode psychosis in both domains remains to be investigated. We used latent profile analysis to derive profiles of the abilities in 174 persons with first-episode psychosis using the Beck's Cognitive Insight Scale, the Faces Test, the Hinting Task, the Internal, Personal and Situational Attributions Questionnaire, and the Beads Task. Participants received a clinical assessment and a neuropsychological assessment. The best-fitting model was selected according to the Bayesian information criterion (BIC). We assessed the importance of the variables via a classification tree (CART). We derived three clusters with distinct profiles. The first profile (33.3%) comprised individuals with low social cognition. The second profile (60.9%) comprised individuals that had more proneness to present jumping to conclusions. The third profile (5.7%) presented a heterogeneous profile of metacognitive deficits. Persons with lower social cognition presented worse clinical and neuropsychological features than cluster 2 and cluster 3. Cluster 3 presented significantly worst functioning. Our results suggest that individuals with FEP present distinct profiles that concur with specific clinical, neuropsychological, and functional challenges. Each subgroup may benefit from different interventions.

Assessing the effect of catchment characteristics to enhanced coagulation in drinking water treatment: RSM models and sensitivity analysis.

Coagulation is the main process for removing natural organic matter (NOM), considered to be the major disinfection by-products (DBPs) precursor in drinking water production. In this work, k-means clusters analysis were used to classify influent waters from two different surface drinking water treatment plants (DWTPs) located in the Mediterranean region. From this, enhanced coagulation models based on response surface methodology (RSM) were then developed to optimise coagulation at two water catchments (river and reservoir). The cluster analysis classified the water quality of the raw waters into two groups related to baseline and peak organic loads. The developed enhanced coagulation models were based on the turbidity, total organic carbon (TOC) and UV254 removals. Sensitivity analysis applied to the models (after predictors selection) determined the factors relative individual contributions for each DWTP scenario. Then, profile plots for enhanced coagulation were studied to identify the optimal levels for each case. Models mean R2 were 0.85 and 0.86 in baseline and 0.85 and 0.84 in peak scenario for river and reservoir catchments, respectively. Results of this study indicate that the surface water quality variation in river DWTP is seasonal and is expressed by an increase of turbidity, while in the reservoir DWTP is related to extreme weather events showing high levels of dissolved organic load (TOC and UV254). During baseline cases, where raw waters present low levels of organics, the three factors optimal adjustment should be ensured to optimise coagulation. Then, during peak scenarios, where influent waters present high organics, the optimal for enhanced coagulation relies on the correct adjustment of Cd. The presented work provides models for drinking water production aimed to propose the optimum conditions for enhanced coagulation, considering the influent water characteristics under different weather conditions.

[Case report of severe acute eosinophilic pneumonia induced by amoxicillin]. / Une forme sévère de pneumopathie aiguë à éosinophiles liée à l'amoxicilline.

INTRODUCTION: Acute eosinophilic pneumonia (AEP) is a rare and potentially severe disorder, characterized by an acute febrile respiratory illness with diffuse pulmonary infiltrates, pleural effusions and an eosinophilic alveolitis identified on broncho-alveolar lavage or lung biopsy. The condition can be idiopathic, or induced by the inhalation of toxic substances, by infections or by medications. The condition tends to respond rapidly to treatment with systemic steroids. CASE REPORT: We report the case of a 16-year old patient who presented severe acute interstitial pneumonia with eosinophilia (1.17g/L). They had taken a seven-day course of amoxicillin treatment two weeks previously for a dental abscess. The patient initially required respiratory support by mechanical ventilation followed by extracorporeal membrane oxygenation due to severe refractory hypoxemia. After exhaustive investigation a diagnosis of amoxicillin-induced acute eosinophilic pneumonia was made. After steroid treatment was initiated the clinical response was rapidly favorable and remission was achieved. The patient has been advised to avoid beta lactam antibiotics for life. CONCLUSION: This case illustrates a rare case of severe acute eosinophilic pneumonia induced by amoxicillin.

Application of Ant-Colony-Optimization algorithm for improved management of first flush effects in urban wastewater systems.

The first flush effect in combined sewer systems during storm events often causes overflows and overloads of the sewage treatment, which reduces the efficiency of the sewage treatment and decreases the quality of the receiving waters due to the pollutants that are contributed. The use of retention tanks constitutes a widely used way to mitigate this effect. However, the management of the pollutant loads encounters difficulties when the retention tanks are emptied. A new approach is proposed to solve this problem by fulfilling the treatment requirements in real time, focussing on the characteristics of the wastewater. The method is based on the execution of an Ant Colony Optimisation algorithm to obtain a satisfactory sequence for the discharge of the retention tanks. The discharge sequence considers the volume of stormwater and its concentration of pollutants including Suspended Solids, Biological Oxygen Demand and Chemical Oxygen Demand, Total Nitrogen and Total Phosphorus. The Ant Colony Optimisation algorithm was applied successfully to a case study with overall reduction of pollutant loads stored in retention tanks. The algorithm can be adapted in a simple way to the different scenarios, infrastructures and controllers of sewer systems.

Spin-crossover and liquid crystal properties in 2D cyanide-bridged Fe(II)-M(I/II) metalorganic frameworks.

Novel two-dimensional heterometallic Fe(II)-M(Ni(II), Pd(II), Pt(II), Ag(I), and Au(I)) cyanide-bridged metalorganic frameworks exhibiting spin-crossover and liquid crystal properties, formulated as {FeL(2)[M(I/II)(CN)(x)](y)}·sH(2)O, where L are the ligands 4-(4-alkoxyphenyl)pyridine, 4-(3,4-dialkoxyphenyl)pyridine, and 4-(3,4,5-trisalkoxyphenyl)pyridine, have been synthesized and characterized. The physical characterization has been carried out by means of EXAFS, X-ray powder diffraction, magnetic susceptibility, differential scanning measurements, and Mössbauer spectroscopy. The 2D Fe(II) metallomesogens undergo incomplete and continuous thermally induced spin transition at T(1/2) ≈ 170 K and crystal-to-smectic transition above 370 K.

Voltage-dependent potassium channels Kv1.3 and Kv1.5 in human cancer.

Membrane ion channels participate in cancerous processes such as proliferation, migration and invasion, which contribute to metastasis. Increasing evidence indicates that voltage-dependent K(+) (Kv) channels are involved in the proliferation of many types of cells, including tumor cells. Kv channels have generated immense interest as a promising tool for developing new anti-tumor therapies. Therefore, the identification of potential biomarkers and therapeutic targets in specific cancers is an important prerequisite for the treatment. Since Kv1.3 and Kv1.5 are involved in the proliferation of many mammalian cells, we aimed to study the expression of Kv1.3 and Kv1.5 in a plethora of human cancers. Thus, tissues from breast, stomach, kidney, bladder, lung, skin, colon, ovary, pancreas, brain, lymph node, skeletal muscle and some of their malignant counterparts have been analyzed. Whereas Kv1.3 expression was either decreased or did not change in most tumors, Kv1.5 was overexpressed. However, the presence of Kv1.3 was mostly associated with inflammatory lymphoplasmocytic cells. Independent of the suitability of individual channels as therapeutic targets, the identification of a Kv phenotype from tumor specimens could have a diagnostic value of its own. Our results demonstrate that Kv1.5, and to some extent Kv1.3, are aberrantly expressed in a number of human cancers. These channels could serve both as novel markers of the metastatic phenotype and as potential new therapeutic targets. The concept of Kv channels as therapeutic targets or prognostic biomarkers attracts increasing interest and warrants further investigation.

Thermal- and light-induced spin crossover in novel 2D Fe(II) metalorganic frameworks {Fe(4-PhPy)(2)[M(II)(CN)(x)](y)}.sH(2)O: spectroscopic, structural, and magnetic studies.

Five novel two-dimensional coordination polymers {Fe(4PhPy)(2)[M(II)(CN)(4)]}.sH(2)O (4PhyPy = 4-phenylpyridine; 1: M(II) = Pd, s = 0; 2: M(II) = Ni, s = 0; 3: M(II) = Pt, s = 1) and {Fe(4PhPy)(2)[M(I)(CN)(2)](2)}.sH(2)O (4: M(I) = Ag, s = 1; 5: M(I) = Au, s = 0.5) exhibiting spin-crossover properties have been synthesized. They were characterized at various temperatures using X-ray absorption spectroscopy (XAS), powder X-ray diffraction (PXRD), differential scanning calorimetry (DSC), and magnetic susceptibility measurements. The occurrence of a cooperative thermal spin transition detected by the magnetic method is located at critical temperatures T(c)( downward arrow)/T(c)( upward arrow) = 163 K/203 K (1), 135 K/158 K (2), and 172 K/221 K (3), and a less cooperative one is located at T(c) = 188 K (4) and 225 K (5). Compounds 1-5 show an abrupt color change from yellow (high-spin (HS) state) to red (low-spin (LS) state) upon spin-state conversion. The dehydration of the compounds changes the type of the spin transition, making it more abrupt and shifting the critical temperature to higher temperatures. For 1 and 2, XAS provides local structural information on the contraction of the FeN(6) coordination sphere upon the HS-to-LS transition, in line with the magnetic results. Variable-temperature characterization of 1 by X-ray diffraction evidences the very abrupt phase transition with a large hysteresis. A light-induced spin conversion (LIESST effect) is detected by magnetic measurements in 1-5 below 70 K.

[Obstructive sleep apnoea syndrome (OSAS) in women: a specific entity?]. / Pathologie pulmonaire au féminin: le SAOS de la femme, une entité particulière?

Despite a variable prevalence in the literature, OSAS is characterized by a higher frequency in men. This study involved a review of published data describing the impact of gender on features of OSAS. In women, OSAS seems to be associated with certain anatomical factors such as more significant obesity, a thinner oropharyngeal junction, a shorter uvula and reduced upper airway (UA) collapsibility, in comparison with men. Sleep related breathing disorders observed during pregnancy are more likely UA resistance syndrome than true OSAS, and are associated with severe fetal and maternal complications that could be improved by the use of nasal CPAP. Though OSAS symptoms are underestimated by women, the Epworth score as well as snoring are not influenced by gender. Gender does not seem to be a risk factor for increased mortality. Compliance with nasal CPAP is identical in both sexes, but oral appliance seem to be more effective in women. Further studies are needed to produce the required complementary data to confirm specific sex-related features in the diagnosis and treatment of OSAS.

One-dimensional iron(II) compounds exhibiting spin crossover and liquid crystalline properties in the room temperature region.

A novel series of 1D Fe(II) metallomesogens have been synthesized using the ligand 5-bis(alkoxy)- N-(4 H-1,2,4-triazol-4-yl)benzamide (C n -tba) and the Fe(X) 2. sH 2O salts. The polymers obey the general formula [Fe(C n -tba) 3](X) 2. sH 2O [X = CF 3SO 3 (-), BF 4 (-); n = 4, 6, 8, 10, 12]. The derivatives with n = 4, 6 exhibit spin transition behavior like in crystalline compounds, whereas those with n = 8, 10, 12 present a spin transition coexisting with the mesomorphic behavior in the room-temperature region. A columnar mesophase has been found for the majority of the metallomesogens, but also a columnar lamellar mesophase was observed for other derivatives. [Fe(C 12-tba) 3](CF 3SO 3) 2 represents a new example of a system where the phase transition directly influences the spin transition of the Fe(II) ions but is not the driving energy of the spin crossover phenomenon. The compounds display drastic changes of color from violet (low-spin state, LS) to white (high-spin state, HS). The compounds are fluid, and it is possible to prepare thin films from them.

[Serotonin syndrome: four report cases and review of the literature]. / Síndrome serotoninérgico: Presentación de cuatro casos y revisión de la literatura.

The serotonin syndrome is a clinical condition associated with serotonin agonists. Is due to an overstimulation of central and peripheral serotonin receptors that leads to mental, autonomic and neuromuscular changes. Usually the disorder resolves within the first 24 hours after the medications are discontinued, however some patients progress to a multiple organ failure and die. We describe four elderly patients that presented with the classic triad. They presented the symptoms in average at the third day after the initiation or variation of the treatment with serotonin reuptake inhibitors. All had a favorable response with the suspension of medications and, in three cases, with the treatment with chlorpromazine. We believe it is a potentially fatal but reversible condition, probably underdiagnosed that requires a high index of suspicion.

Mixed valency and magnetism in cyanometallates and Prussian blue analogues.

Prussian blue (PB) is a well-known archetype of mixed valency systems. In magnetic PB analogues {CxAy[B(CN)6]z}.nH2O (C alkali cation, A and B transition metal ions) and other metallic cyanometallates {Cx(AL)y[B(CN)8]z}.nH2O (L ligand), the presence of two valency states in the solid (either A-B, or A-A' or B-B') is crucial to get original magnetic properties: tunable high Curie temperature magnets; photomagnetic magnets; or photomagnetic high-spin molecules. We focus on a few mixed valency pairs: V(II)/V(III)/V(IV); Cr(II)/Cr(III); Fe(II)-Fe(III); Co(II)-Co(III); Cu(I)-Cu(II); and Mo(IV)/Mo(V), and discuss: (i) the control of the degree of mixed valency during the synthesis, (ii) the importance of mixed valency on the local and long-range structure and on the local and macroscopic magnetization, and (iii) the crucial role of the cyanide ligand to get these original systems and properties.

Time- and dose-related effects of three 5-HT receptor ligands on the genioglossus activity in anesthetized and conscious rats.

Clinical trials in obstructive sleep apnea syndrome patients reported moderate effects of serotoninergic drugs on oropharyngeal apneas, although numerous specific 5-HT ligands highly modulate the genioglossus muscle (GG) activity in experiments performed in anesthetized animals. The purpose of this study was to investigate time- and dose-related effects of central and systemic injections of 8-OHDPAT (5-HT1A agonist), SB224289 (5-HT1B antagonist), and DOI (5-HT2A/2C agonist) on the GG activity in anesthetized and conscious rats. Electromyographic recordings of the GG activity (GGemg) were analyzed after central and systemic injections of each drug in ketamine-xylazine anesthetized rats. Electroencephalograms (EEG), as well as neck and GG muscle activities (Nemg and GGemg), were recorded in 15 additional rats to analyze changes in sleep-wake states before and after systemic injection of the drugs. Central injections of 8-OHDPAT and DOI in anesthetized rats induced clear dose-related increases in phasic and tonic GGemg activities, respectively. The time-responses were inferior to 30 min with 8-OHDPAT and over 50 min with DOI. Moderate increases in phasic GGemg activity were also observed after central, but not peripheral injection of SB and DOI. The total sleep time measured in conscious rats significantly decreased after systemic injections of DOI and 8-OHDPAT, although no change was observed in phasic or tonic GGemg activity. The dose- and time-responses of the DOI in anesthetized rat partly explain the lack of GGemg tonic change in conscious rat. The moderate effect on the GGemg phasic activity of peripheral 5-HT1A ligand injection easily explains the lack of change in conscious rat. The serotonergic modulation of the respiratory component of the GGemg remains complex, but is highly sensitive to 5-HT1A receptors after central injection in rats under anesthesia. Forthcoming therapy in OSAS should be made of mixed profiled neurotransmitters and different routes of administration.

Characterization of resistance in transgenic Nicotiana benthamiana encoding N-terminal deletion and assembly mutants of the tobacco etch potyvirus coat protein.

The resistance of transgenic Nicotiana benthamiana plants encoding wild type, truncated and point mutants of the tobacco etch virus (TEV) coat protein (CP) was analyzed. After R1 plants from 45 transgenic lines were challenged with TEV, six percent of the lines exhibited high resistance, 38% exhibited low resistance, and the remainder were susceptible. The phenomenon of recovery and delay in symptom development was observed in 65% and 56% of the resistant and susceptible lines, respectively. Plants containing genes that encode sequences of two assembly-deficient mutants of TEV-CPDelta1-63 exhibited resistance to infection, suggesting that self-assembly of the CP is not responsible for resistance. Highly resistant lines accumulated low levels of transgene mRNA and non-detectable amounts of protein, and tissues accumulated lower amounts of transgene mRNA following recovery than before infection. In addition, co-suppression of replication of a recombinant tobamovirus containing the TEV-CPDelta1-63 sequence was observed in several lines, suggesting homology-dependent degradation of RNA, most likely through induction of post-transcriptional gene silencing. Plants not exhibiting high resistance via gene silencing exhibited moderate levels of resistance that is attributed to and/or affected by the CP molecule.

[Pneumoperitoneum and pneumomediastinum complicating non-invasive ventilation]. / Un pneumoperitoine compliquant un pneumomediastin au cours de la ventilation non invasive.

INTRODUCTION: Pneumoperitoneum is known to be a rare complication of invasive mechanical ventilation. However it has not previously been described as a consequence of non-invasive ventilation. CASE REPORT: The authors report a case of pneumoperitoneum associated with pneumomediastinum occurring in a 64-year-old patient treated for 3 years with bilevel ventilation via a nasal mask (expiratory pressure = 9 cm H2O, inspiratory pressure = 15 cm H2O) for obesity hypoventilation syndrome. Respiratory and gastroenterological investigations did not demonstrate a cause for this complication which resolved spontaneously following the cessation of ventilation. Nine months later, clinical deterioration and a worsening of blood gas parameters led to a recommencement of non-invasive mechanical ventilation at the same levels as previously. Over two years of follow up there have been no clinical or radiological signs of a recurrence of pneumomediastinum or pneumoperitoneum. CONCLUSION: In the absence of any other explanation, barotrauma due to nasal ventilation appears to be the most likely explanation for this complication.

[Angioplasty of intra-stent restenosis of a saphenous graft complicated by massive embolism]. / Angioplastie d'une resténose intra-stent de greffon saphène compliquée d'embolie massive.

The main risk of angioplasty of saphenous vein aortocoronary bypass grafts is myocardial infarction by distal embolism, explaining the introduction of systems of distal protection with encouraging results. Although embolism of an atheromatous stenosis is classical, that of intra-stent restenosis is exceptional. The authors report a very unusual case of atheromatous and/or thrombotic embolism occurring during angioplasty of an intra-stent restenosis which was recovered by a micropore filter system.