[Evaluation of management of patients under clean intermittent catheterization by general practitioners]. / Évaluation de la prise en charge des patients sous sondage intermittent propre par les médecins généralistes.

INTRODUCTION: Clean Intermittent Catheterization (CIC) is the method of choice for bladder emptying in patients having bladder emptying disorders, acquired or pharmacologically induced, whether it is neurologically related or not. The aim of this study is to assess the theoretical and practical knowledge of general practitioners (GP) on CIC. MATERIALS: Observational prospective study (anonymous online questionnaire) was conducted with 224 GP between March and April 2020. Each physician had to complete a questionnaire about the definition of CIC, its indications and usage, the indications of urine culture, antibiotic therapy, and the complications of this method of drainage. RESULTS: Only 18.3% of GP that took part in the study gave an exact definition of CIC. As to the importance of it, 67.9% responded that it protects the upper urinary tract and 37.1% that it prevents urinary tract infections (UTI). Fifty-two per cent of physicians were unaware of the regular frequency at which it should carry out a day. Fifty eight percent prescribed sterile gloves and 57.1% an antiseptic. UTI was considered as the main complication of CIC by 87.1% of physicians and 35.7% requested a systematic urine culture for patients under CIC. For patients with an asymptomatic bacteriuria, 65.6% of GP prescribed antibiotic therapy. CONCLUSION: GP need to improve their knowledge of SIP, its framework, indications, modalities, and the way to deal with colonization or urinary tract infection. This will improve the management of impacted patients.

A cadaveric anatomical study of the adrenals: Relationship with the posterior abdominal wall muscles revisited.

AIM OF THE STUDY: The main difficulties during retroperitoneal laparoscopic adrenalectomies are due to its location. Our objective was to define the relationship of the adrenals with the diaphragm and the psoas muscle. METHODS: Our work is an anatomical dissection of 80 fresh cadavers' adrenals. To study the right adrenal, we performed a right nephrectomy and adrenal remained attached to the Inferior vena cava by its main vein. On the left, the edges of the adrenal have been identified by needles and the adrenal was reclined to study its projection on the posterior muscular wall. RESULTS: The right adrenal is located higher, 13mm [4-20mm] above the medial arcuate ligament (MAL) in 16 cases (40%). Its lower border was at the same level as the MAL in 18 cases (45%) and 11mm [10-17mm] below the MAL in 6 cases (15%). The posterior support of the right adrenal was the right crus of the diaphragm (Right-CD) in 34 cases (85%) and straddling the Right-CD and the psoas in 6 cases (15%). The study of the relationships of the left adrenal with the MAL showed that the lower edge of the gland was at its same level in 16 cases (40%) and below in 24 cases (60%) by 14mm [8-24mm]. The posterior support of the left adrenal was the left crus of the diaphragm (Left-CD) in 16 cases (40%) and straddling the Left-CD and the psoas in 24 cases (60%). CONCLUSIONS: Our results showed that the right adrenal is higher. The MAL is an important posterior element to the adrenal gland that could serve as an anatomical landmark to identify the adrenal during laparoscopic adrenalectomy.

Vesico-vaginal fistula in Tunisia: Epidemiology and risk factors of treatment failure.

INTRODUCTION: Vesico-vaginal fistula (VVF) is a global healthcare problem that has a high prevalence in developing countries. The aim of this work is to study the epidemiological, clinical and therapeutic characteristics of VVF post-obstetric and gynecologic procedures in order to identify the predictive factors of surgical treatment failure. METHODS: Data were collected from 132 VVF patients in our institution between 1985 and 2017. VVF was classified according to Zmerli's classification. Patients underwent surgical treatment and were evaluated after a follow-up period of 6 months. Successful treatment was defined as the absence of urine leakage whereas recurrence was defined as the presence of urine leakage immediately after the surgery or after a period of dryness with a confirmed VVF. Risk factors of surgical treatment failure were identified. RESULTS: The average age of patients was 44 years. The patients were multiparous in 62% of cases. VVF was consecutive to hysterectomy in 62.1% of cases, and after childbirth in 34%. VVF was retro-trigonal in 99 cases (75%) and trigonal in 33 cases (25%). The average size of the fistula was 1cm (0.3-2cm). VVF repair was performed by vaginal approach in 68% of cases and abdominal approach in 32% of cases. Treatment failure was noted in 36 patients (27%). Predictive factors of treatment failure were: vaginal fibrosis (P<0.001); trigonal location of the fistula (P<0.001); large diameter of the VVF>1cm (P<0.001); and complex and complicated fistulas (P=0.02). CONCLUSION: Although Tunisia is a developing country, the main cause of VVF was not obstetrical. Treatment failure, noted in almost one third of cases, was, in our series, correlated with the quality of the vaginal tissue, the size and the location of the fistula, and its complexity. LEVEL OF PROOF: 4.

Retro-peritoneal paraganglioma, diagnosis and management.

INTRODUCTION: Paragangliomas, defined as extra-adrenal chromaffin-cells tumors, are rarely located in the retro-peritoneum. Clinical presentation is similar to pheochromocytoma, and mainly depends on the producing character of the tumor. Positive diagnosis requires plasmatic and urinary hormonal assays. Radiological and isotopic explorations are essential before surgery. The only curative therapeutic strategy is surgical, associated to peri-operative prevention and monitoring of the frequently reported hemodynamic and cardiovascular disorders. Outcome depends of the metastatic character of the tumor, the presence of tumor remnant after surgical resection. Genetic study is recommended; the risk of recurrence and association to other neoplasm is more described in genetic forms. MATERIAL AND METHODS: Authors report 5cases of retro-peritoneal paraganglioma, operated in the department of urology of Hospital, between 2013 and 2017. Observations are about 2men and 3women. Clinical presentation is not always specific and paraganglioma may be discovered fortuitously. Two patients have been operated by coelioscopic approach, midline incision was performed in two other cases, and dorsal lumbotomy associated to a Rutherford-Morrison incision in a patient. RESULTS: Two patients presented resistant hypertension and palpitation associated to suspect retro-peritoneal masses in imagery and elevated urinary methoxylated derivates before surgery. One patient was asymptomatic and the tumor was discovered in imagery. Per-operative hypertensive crisis and sinus tachycardia occurred in a case. The average follow-up period is 22.8months. Hypertension and palpitation disappeared after surgery. There was no recurrence for all the operated patients. CONCLUSION: Retro-peritoneal paraganglioma is a rare condition. Symptoms are not specific and clinical presentation may be similar to pheochromocytoma. Abdominal CT-scan and MRI, in association with MIBG scintigraphy are strongly evocative. Histological examination ensures diagnosis. Per-operative cardio-vascular disorders are to consider and must prevented and managed by anesthesiologists. Complete surgical resection is the only curative treatment and avoids recurrences.

Antimicrobial prophylaxis protocol based on rectal swab culture before prostate biopsy to prevent infectious complications: a prospective randomized comparative study.

PURPOSE: To evaluate the benefit of targeted antibiotic prophylaxis (TAP) based on rectal swab culture in comparison with standard empiric antimicrobial prophylaxis in patients undergoing transrectal ultrasound-guided needle biopsy of the prostate (TRUS-BP), as well as to assess rate of fecal carriage of Fluoroquinolone-resistant Enterobacterales FQRE. PATIENTS AND METHODS: We prospectively analyzed data that randomized 157 patients within two groups: (G1) TAP according to rectal swab performed 10 days before PB; (G2): empirical antibiotic prophylaxis with ciprofloxacin. Prevalence of FQRE digestive carriage and risk factors were investigated. Incidence of infectious complications after (TRUS-BP) in each group was compared. RESULTS: G2 included 80 patients versus 77 in G1. There was no difference between the two groups regarding age, diabetes, prostate volume, PSA, number of biopsy cores, and risk factors for FQRE. In G2, the prevalence of FQRE digestive carriage was 56.3% all related to E. coli species. In the case of digestive carriage of FQRE, TAP according to the rectal swab culture with third-generation cephalosporins was performed in 73.3%. Patients with FQRE had history of FQ use within the last 6 months in 17.8% (p = 0.03). Rate of febrile urinary tract infection after PB was 13% in G1 and 3.8% in G2 (p = 0.02). CONCLUSIONS: Incidence of FQ resistance in the intestinal flora of our local population was prevalent. Risk factor for resistance was the use of FQ within the last 6 months. TAP adapted to rectal swab, mainly with third-generation cephalosporins, significantly reduced the rate of infectious complications after (TRUS-BP).

Critical microphase properties of crosslinked polymer blends with quenched random impurities.

We extend published works dealing with microphase separation in crosslinked polymer blends to the case where these are surrounded by random impurities. To study their influence on critical microphase properties, from a static and kinetics point of view, we first assume that the (real) disorder caused by impurities is quenched. Second, the replica theory is used to study such critical properties, upon the impurities concentration and their interaction strength. More precisely, we compute the spinodal temperature and structure factor. We find that the spinodal temperature is shifted towards its lower and higher values, for attractive and repulsive impurities, respectively. The obtained expression for the static structure factor suggests that, contrarily to repulsive impurities, the crosslinked mixture scatters better in the presence of attractive ones. Thereafter, the study is extended to kinetics of microphase separation, when the mixture is impregnated by small random impurities. Kinetics is investigated through the growth rate, and in particular, we demonstrate that the latter is increased by the presence of repulsive impurities. This is natural, since these play a stabilizer role. Finally, the discussion is extended to crosslinked polymer blends immersed in a good solvent, which induces drastic changes of the critical microphase properties.

[Cardiac metastasis of renal cell carcinoma, a rare location]. / Métastase cardiaque du cancer du rein : site inhabituel.

The renal carcinoma is situated in the third rank of the urologic cancers. It is metastatic in a third of the cases, when we made the diagnosis of the cancer. Lungs, bone, the liver, the suprarenal gland and the brain stay metastatic sites of preference. Some metastatic locations are anecdotal and made the object of some publications. We report the case of a cardiac metastasis of renal carcinoma at an old patient 81 years old operated for cardiac tumor.

An efficient approach to study membrane nano-inclusions: from the complex biological world to a simple representation.

Membrane nano-inclusions (NIs) are of great interest in biophysics, materials science, nanotechnology, and medicine. We hypothesized that the NIs within a biological membrane bilayer interact via a simple and efficient interaction potential, inspired by previous experimental and theoretical work. This interaction implicitly treats the membrane lipids but takes into account its effect on the NIs micro-arrangement. Thus, the study of the NIs is simplified to a two-dimensional colloidal system with implicit solvent. We calculated the structural properties from Molecular Dynamics simulations (MD), and we developed a Scaling Theory to discuss their behavior. We determined the thermal properties through potential energy per NI and pressure, and we discussed their variation as a function of the NIs number density. We performed a detailed study of the NIs dynamics using two approaches, MD simulations, and Dynamics Theory. We identified two characteristic values of number density, namely a critical number density n c = 3.67 × 10-3 Å-2 corresponded to the apparition of chain-like structures along with the liquid dispersed structure and the gelation number density n g = 8.40 × 10-3 Å-2 corresponded to the jamming state. We showed that the aggregation structure of NIs is of fractal dimension d F < 2. Also, we identified three diffusion regimes of membrane NIs, namely, normal for n < n c, subdiffusive for n c ≤ n < n g, and blocked for n ≥ n g. Thus, this paper proposes a simple and effective approach for studying the physical properties of membrane NIs. In particular, our results identify scaling exponents related to the microstructure and dynamics of membrane NIs.

Effect of hydrophobically modified PEO polymers (PEO-dodecyl) on oil/water microemulsion properties: in vitro and in silico investigations.

Microemulsions are excellent systems for transdermal delivery of multifunctional drugs because they have the potential to improve drug absorption/permeation and handling limitations. Biocompatible polymers are used as a coating of microemulsions to avoid the interactions that can occur between the microemulsions and the skin. Thus, they protect and lubricate these transporter nanovesicles. In this paper, we studied decane/water microemulsions covered with hydrophobically modified PEO polymer (PEO-m). To reveal the effect of hydrophobically modified PEO (PEO-m) polymer on the shape, the micro-arrangement and the dynamics of the microemulsions, we used an integrated strategy combining Molecular Dynamics simulation (MD), Small-Angle Neutron Scattering experiments (SANS), and the Ornstein-Zernike integral equations with the Hypernetted Chain (HNC) closure relation. We determined the microemulsion shape in vitro using the renormalized intensities spectra from SANS experiments. We discussed the micro arrangements of microemulsions, in vitro and in silico, employing the pair correlation function g(r) and the structure factor S(q), obtained from the three approaches with good agreement. Thus, we used the validated MD simulations to calculate the microemulsion's dynamics properties that we discussed using the mean-squared displacement (MSD) and the diffusion coefficients. We found that the presence of moderate quantities of PEO-m, from 4 to 12 PEO-m per microemulsion, does not influence the microemulsion shape, increases the stability of the microemulsion, and slightly decrease the dynamics. Our in vitro and in silico results suggest that polymer incorporation, which has interesting in vivo implications, has no disadvantageous effects on the microemulsion properties.

Correction: Effect of hydrophobically modified PEO polymers (PEO-dodecyl) on oil/water microemulsion properties: in vitro and in silico investigations.

[This corrects the article DOI: 10.1039/D0RA09804C.].

Sol/gel transition of oil/water microemulsions controlled by surface grafted triblock copolymer dodecyl-PEO227-dodecyl: molecular dynamics simulations with experimentally validated interaction potential.

We studied a large range of identical spherical oil/water microemulsion (O/W-MI) volume fractions. The O/W-MIs are stabilized by cetylpyridinium chloride ionic surfactant (CpCl) and octanol cosurfactant and dispersed in salt water. We grafted different numbers of dodecyl-(polyEthylene oxide)227-dodecyl triblock copolymer that we note (n(D-PEO227-D)), where n varies from 0 to 12. We accomplished the grafting process by replacing a small amount of CpCl and octanol with the appropriate n(D-PEO227-D). The aim is to determine the interaction/structure relationship of the covered microemulsions. Precisely, we are interested in a quantitative investigation of the influence of volume fraction Φ, temperature (T), and n(D-PEO227-D) on the microemulsion sol/gel transition. To this end, we first study the uncoated microemulsion structure depending only on Φ. Second, we determine the coated microemulsions structure as a function of n(D-PEO227-D) for different Φ. Third, we examine the effect of temperature on the uncoated and coated microemulsion. We show that the sol/gel transition is controlled by the three main parameters, Φ, T, and n(D-PEO227-D). Accordingly, the uncoated microemulsion sol/gel transition, at ambient temperature, occurred for Φ ≃ 33.65%. By increasing Φ, the O/W-MIs show a glass state, which occurs, along with the gel state, at Φ ≃ 37% and arises clearly at Φ ≃ 60%. The coated O/W-MI sol/gel transition is found to be linearly dependent on n(D-PEO227-D) and takes place for Φ ≃ 26.5% for n(D-PEO227-D) = 12. Ordinarily, the decrease in temperature leads to gel formation of microemulsions for low Φ. Additionally, in this work, we found that the gelation temperature increases linearly with n(D-PEO227-D). Thus, the parameter n(D-PEO227-D) can control the sol/gel transition of the O/W-MIs at ambient temperature and moderate Φ.

Theory of microphase separation in crosslinked polymer blends immersed in a θ-solvent.

The aim of this work is a theoretical study of the effects of the solvent quality on the microphase separation in crosslinked polymer blends, from a static and kinetics point of view. More precisely, we assume that the crosslinked mixture is trapped in a θ-solvent. The static microphase properties are studied through the static structure factor. The latter is computed using an extended blob model, where the crosslinked unlike chains can be viewed as sequences of blobs. We demonstrate that the presence of the θ-solvent simply leads to a multiplicative renormalization of these properties, and the renormalization factors are powers of the overall monomer volume fraction. Second, we investigate the early kinetics of the microphase separation, via the relaxation rate, τ(q), which is a function of the wave number q (at fixed temperature and monomer volume fraction). We first show that the kinetics is entirely controlled by local motions of Rouse type, since the slow motions are frozen out by the presence of crosslinks. Using the blob model, we find an explicit form for the growth rate Ω(q) = τ(q)⁻¹, which depends, in addition to the wave number q , on the overall monomer volume fraction, Φ. Also, we discuss the effect of initial entanglements that are trapped when the system is crosslinked. In fact, these play the role of true reticulation points, and then, they quantitatively contribute to the microseparation phenomenon. Finally, the results are compared to their homologous relatively to the molten state and to the good solvent case. The main conclusion is that the quality of the solvent induces drastic changes of the microphase properties.

[Lymphoceles after renal transplantation: Study of risk factors]. / Facteurs de risque de la lymphocèle post-greffe rénale.

AIM: To identify the risk factors of post renal transplant lymphocele. PATIENTS AND METHOD: Over a period of 20 years (1986-2006) we carried out 377 renal transplants on 372 patients. Thirty cases of lymphocele were recorded (8%). The medical history of patients was retrospectively examined in order to identify the risk factors of this complication among the data relating to recipents, donors, the operation itself and post operative incidents. The different parameters liable to correlate with the incidence of lymphocele were subjected to a univaried then multivaried statistical study. RESULTS: Unifactorial analysis identified four predictive factors related to the incidence of lymphocele. They were the age of the recipient greater or equal to 35 years old, the cadaverous origin of the transplanted organ, the duration of ischemy greater or equal to 24hours for the kidneys of deceased donors, and immunosuppressor treatment associated with Mycophenolate mofetil-Cyclosporine. The only independent risk factor significant in multifactorial analysis was the cadaverous origin of the transplanted organ. CONCLUSION: Our study showed that the cadaverous origin of the transplanted organ would appear to play an important role in the genesis of post renal transplant lymphocele. A better preparation of the organs of cadaverous origin before their implantation with meticulous ligature of the hilum of lymph nodes could reduce the incidence of this complication. This observation, as well as the benefit of such a procedure, remains to be confirmed by studies on a larger scale.

Static and dynamic properties of decane/water microemulsions stabilized by cetylpyridinium chloride cationic surfactant and octanol cosurfactant.

Molecular dynamics simulation (MD) is used to study the static and dynamic properties of positively charged decane/water microemulsions, for various volume fractions Φ (2.8%, 6.98%, 14%, and 26.5%). An effective hybrid potential combining three potentials, namely the hard-sphere repulsive potential, the van der Waals attractive potential, and the Yukawa repulsive potential, is used to describe the microemulsion interactions. The microemulsion shape is determined using the renormalized spectra in Porod representation. The appropriate potential parameters are tested using the Ornstein-Zernike integral equation approach with the Hypernetted Chain (HNC) closure relation by a comparison between the structure factor calculated from HNC and that obtained from Small Angle Neutron Scattering experiments (SANS). Thus, the micro arrangements of microemulsions have been analyzed using the pair correlation function g(r) and the structure factor S(q) obtained from HNC, SANS, and MD simulation using these parameters. The microemulsion dynamic properties were discussed using the mean-square displacement (MSD) and the diffusion coefficient D c calculated from MD simulations.

A practical calibration procedure for fluorescence colocalization at the single organelle level.

We have determined practical requirements for antigen colocalization on subcellular structures. The calibration standards used were 175-nm fluorescent microspheres and microtubules (approximately 255 nm) in cultured astrocytes. The colocalization problem became apparent with detection of anti-alpha-tubulin labelling in three colour channels, when images were not identical. Complete superimposition could only be achieved by shifting the single colour image stacks relative to one another in three dimension, and images in the xy plane. The errors could be traced in chromatic aberration (100 nm each between blue and green, and green and red), and to a lateral pixel shift (approximately 150 nm). For such colocalization, it was essential to apply image projection on the camera chip at high magnification (200 x), focus steps (100 nm) smaller than required by the Nyquist criterion and very narrow band filter sets, in addition to high-aperture achromat lenses. Several steps in the deconvolution settings and in 3D reconstruction had to be standardized. As a result, the 175-nm microspheres, which displayed roughly symmetric diffraction patterns above and below the object plane, were reconstructed as spherical objects. Several neighbouring microtubules could be resolved with a limit < 200 nm. Also, three-colour colocalization on a single tubule was validated. Applying this setup, it was possible to colocalize several antigens in astrocytes, at the level of organelles, presumptive exocytosis vesicles. We colocalized glutamate and 14-3-3 protein as well as synaptophysin and 14-3-3 protein, which may be involved in early steps of exocytosis. The practical parameters validate colocalization on subcellular structures at a resolution limit below conventional light microscopy.