[Adult Parietal Hernias At The Chad-China Friendship Hospital In N'djamena. Epidemiological, Clinical, Diagnostic And Therapeutic Aspects]. / Les Hernies Parietales De L'Adulte A L'hopital De L'AMitie Tchad-Chine De N'djamena. Aspects Epidemiologiques, Cliniques, Diagnostiques Et Therapeutiques.

INTRODUCTION: Parietal hernias were the first pathology after appendicitis at the Chad-China Friendship Hospital. OBJECTIVE: The aim of this study was to specify the epidemiological, clinical, diagnostic and therapeutic aspects of parietal hernias. PATIENTS AND METHOD: This was a retrospective descriptive cross-sectional and analytical study of adult patients operated for parietal hernias between June 2015 and July 2020. RESULTS: Of the 386 cases, there were 281 men (72.8%) and 105 women (27.2%). The sex ratio was 2.68. The mean age of the patients was 43.14 years with extremes of 20 and 79 years. In 7.5% of the cases, it was the strangulated hernias received in emergency (n=29). Inguinal hernia (n=268) was the most frequent variety with 69.4% of cases, followed bylinea alba hernia (78=20.2%) and umbilical hernia (40=10.4%). The main surgical technique used was the Bassini technique. Postoperative complications were 2 cases of hemorrhage (0.5%), 4 cases of hematoma (1%), 7 cases of urinary retention (1.8%) and 10 cases of parietal suppuration (2.6%). CONCLUSION: Parietal hernias are dominated by inguinal hernias. Raphy was the only technique performed. Early consultations could prevent complications.

INTRODUCTION: les hernies pariétales représentaient la première pathologie après l'appendicite à l'hôpital de l'amitié Tchad-chine. OBJECTIF: le but de cette étude était de préciser les aspects épidémiologiques, cliniques, diagnostiques et thérapeutiques des hernies pariétales. PATIENTS ET MÉTHODE: Il s'agissait d'une étude rétrospective descriptive transversale et analytique menée sur des malades adultes opérés pour hernies pariétales entre juin 2015 et juillet 2020. RÉSULTATS: sur les 386 cas, il y avait 281 hommes (72,8%) et 105 femmes (27,2%). Le sex-ratio était de 2,68. L'âge moyen des patients était 43,14 ans avec des extrêmes de 20 et 79 ans. Dans 7,5% des cas, il s'agissait des hernies étranglées reçues en urgence (n=29). La hernie inguinale (n=268) était la variété la plus fréquente avec 69,4% des cas, suivie de la hernie de la ligne blanche (78=20,2%) et de la hernie ombilicale (40=10,4%). La principale technique chirurgicale utilisée était celle de Bassini. Les complications postopératoires étaient 2 cas d'hémorragie (0,5%), 4 cas d'hématome (1%), 7 cas de rétention urinaire (1,8%) et 10 cas de suppuration pariétale (2,6 %). CONCLUSION: Les hernies pariétales sont dominées par les hernies inguinales. La raphie était la seule technique réalisée. Des consultations précoces pourraient prévenir les complications.

Oxygen deficit during supramaximal cycling exercise in humans: a new estimation method.

AIM: We propose a method to estimate O2 deficit (DefO2) during supramaximal exercise based on the analysis of gas exchanges. METHODS: We determined in 14 male subjects breath-by-breath ∙VO2 at the onset of step exercise of moderate and supramaximal intensities. ∙VO2 response during moderate-intensity exercise was fitted as a bi-exponential model. Third, we modelled a theoretical ∙VO2 kinetics during supramaximal exercise assuming that it conformed to the ∙VO2 kinetics measured during moderate-intensity exercise and tended towards a ∙VO2 equal to that hypothetically elicited by the workload. The difference between the O2 volume that would have been consumed in the hypothetical condition and that actually taken up during exercise yielded the lactacid fraction of DefO2. Finally, the difference between the estimated total energy requirement and the theoretical O2 volume consumed by the subject yielded in the alactacid fraction of total DefO2. RESULTS: Total DefO2 was 77.6 mL O2 kg-1; its anaerobic alactic and lactic fractions amounted to 38.5 and 39.1 mL O2 kg-1, respectively. The latter did not differ significantly from the value calculated independently from the peak increase in lactate concentration during supramaximal exercise times the energy equivalent of lactate. CONCLUSIONS: These results suggest that supramaximal DefO2 and its components may be estimated from an analysis of gas exchange kinetics. In addition, they are consistent with the view that the mechanism regulating muscular O2 uptake is regulated by the muscular concentration of putative metabolites.

Anti-Gal titers in healthy adults and inflammatory bowel disease patients.

INTRODUCTION: ALPHA-GAL is a glycoconjugate present on cell membranes of mammals and bacteria but not humans who display anti-Gal antibodies (AB) in high titers provoked by the commensal gut flora. In the present study, we sought to determine the longitudinal course of alpha-Gal specific AB titers of all isotypes over 8 weeks among healthy adult subjects. Furthermore, we hypothesized that inflammatory bowel disease (IBD) patients display increased anti-Gal titers. MATERIALS AND METHODS: We drew serum from healthy probands (n=20) weekly for 8 weeks and obtained plasma samples of from patients suffering from Crohn's disease (n=20) and ulcerative colitis (n=20). We measured anti-Gal ABs of all isotypes and total immunoglobulin (Ig) content using an enzyme-linked immunosorbent assay technique. For statistical evaluation of the longitudinal titers, we calculated confidence intervals for the slopes of a random intercept model, comparing variances between and within the probands. For group comparisons, we performed paired student t-tests and Pearson correlations. RESULTS: Alpha-Gal specific IgG, IgM, IgD, and IgA titers remained unvaried within a narrow range upon longitudinal observation. Most probands did not display alpha-Gal specific IgE ABs. Crohn's disease patients showed highly increased alpha-Gal-specific IgA titers compared with control subjects (P<.01). CONCLUSION: Apart from IgE, alpha-Gal-specific ABs of all isotypes remained constant over longer time periods in healthy subjects. Thus, significant titer changes actually represent increased antigen exposure and a specific anti-alpha-Gal response. Crohn's disease patients display increased anti-Gal IgA titers compared with healthy controls, which reflects a chronically impaired mucosal gut barrier in this patient cohort.

Oxygen uptake, cardiac output and muscle deoxygenation at the onset of moderate and supramaximal exercise in humans.

VO2, Q and muscular deoxyhaemoglobin (HHb) kinetics were determined in 14 healthy male subjects at the onset of constant-load cycling exercise performed at 80% of the ventilatory threshold (80%(VT)) and at 120% of VO2max (120%(Wmax)). An innovative approach was applied to calculate the time constant (τ2) of the primary phase of VO2 and Q kinetics at 120%(Wmax). Data were linearly interpolated after a semilogarithmic transformation of the difference between required/steady state and measured values. Furthermore, VO2, Q and HHb data were fitted with traditional exponential models. τ2 of VO2 kinetics was longer (62.5 ± 20.9 s) at 120%(Wmax) than at 80%(VT) (27.8 ± 10.4 s). The τ2 of Q kinetics was unaffected by exercise intensity and, at 120% of VO2max, it was significantly faster (τ2 = 35.7 ± 28.4 s) than that of VO2 response. The time delay of HHb kinetics was shorter (4.3 ± 1.7 s) at 120%(Wmax) than at 80%(VT) (8.5 ± 2.6 s) suggesting a larger mismatch between O2 uptake and delivery at 120%(Wmax). These results suggest that VO2 at the onset of exercise is not regulated/limited by muscle's O2 utilisation and that a slower adaptation of capillary perfusion may cause the deceleration of VO2 kinetics observed during supramaximal exercise.

Cerebral distribution of white matter lesions in migraine with aura patients.

OBJECTIVE: The objective of the study was to compare the cerebral distribution of white matter lesions (WMLs) between migraine patients with different aura symptoms. METHODS: Migraine with aura (MA) patients were consecutively enrolled as part of the Shunt-Associated Migraine (SAM) study. According to clinical symptoms, aura was classified as motor, aphasic, sensory, visual or vertebrobasilar. Standard and FLAIR (fluid attenuated inversion recovery) T(2)-weighted MRI sequences were inspected for WMLs by three independent raters blinded to clinical data. WMLs were assessed in the periventricular areas (PV-WMLs) with the Fazekas scale and in the deep white matter (D-WMLs) with the Schelten's scale. Interobserver agreement was good to excellent (k = 0.64 to 0.96, p < .0001). RESULTS: One hundred and eighty-five patients (77% women) were included. Aura symptoms were classified as visual in 172 (99%) patients, sensory in 76 (42%), aphasic in 54 (30%), motor in 39 (21%) and vertebrobasilar in 17 (9%) patients. One hundred and four patients (57%) exhibited more than one type of aura. D-WMLs were mainly detected in the frontal lobes (86%). There was no association between type of aura and the presence of WMLs in any cerebral location. CONCLUSION: Aura symptoms do not influence the cerebral distribution of WMLs associated with migraine disease.

Mechanical characterization of thin TiO2 films by means of microelectromechanical systems-based cantilevers.

The measurement of mechanical parameters by means of microcantilever structures offers a reliable and accurate alternative to traditional methods, especially when dealing with thin films, which are extensively used in microfabrication technology and nanotechnology. In this work, microelectromechanical systems (MEMS)-based piezoresistive cantilevers were realized and used for the determination of Young's modulus and residual stress of thin titanium dioxide (TiO(2)) deposited by sputtering from a TiO(2) target using a rf plasma discharge. Films were deposited at different thicknesses, ranging from a few to a hundred nanometers. Dedicated silicon microcantilevers were designed through an optimization of geometrical parameters with the development of analytical as well as numerical models. Young's modulus and residual stress of sputtered TiO(2) films were assessed by using both mechanical characterization based on scanning profilometers and piezoresistive sensing elements integrated in the silicon cantilevers. Results of MEMS-based characterization were combined with the tribological and morphological properties measured by microscratch test and x-ray diffraction analysis.

Radiation exposure prior to ischemia decreases lesion volume, brain edema and cell death.

PURPOSE: To investigate the neuronal response to ischemic injury following exposure to whole brain proton irradiation. METHODS: Brain only proton irradiation (8 Gy, 250 MeV) was performed ten days prior to middle cerebral artery occlusion (MCAO) in 1 year old male Sprague Dawley rats. MCAO was induced in two animal groups: proton irradiated (MCAO + Rad) and MCAO only. Magnetic resonance imaging (MRI) and quantitative analysis were performed prior to and 2 days after irradiation, and then 2, 14 and 28 days after MCAO. After the last imaging time point animals were sacrificed and TUNEL staining was performed on 4% paraformaldehyde - fixed brain sections. RESULTS: Neuroimaging demonstrated a reduction in ischemic lesion volume in the MCAO + Rad group compared with MCAO alone. Neurological deficits did not differ between ischemia groups. Interestingly, there was a 34% decrease in the number of TUNEL-positive cells in MCAO + Rad brains compared to MCAO alone. CONCLUSION: Our results suggest that radiation treatment reduces brain edema, ischemic lesion volume and peri-ischemic apoptosis. The underlying mechanisms are currently unknown and additional studies will elucidate the significance of these results.

Oxygen deficits and oxygen delivery kinetics during submaximal intensity exercise in humans after 14 days of head-down tilt-bed rest.

Beat-by-beat Q(a)O2 and breath-by-breath VO2 were assessed in ten male subjects (24 +/- 3.5 years; 78 +/- 7.7 kg; 182 +/- 5.6 cm) during cycling exercise at 50 W before and after a 14-day period of head-down tilt-bed rest (HDTBR). O2 deficit (DefO2) was calculated as the difference between the volume of O2 that would have been consumed if a steady state had been immediately attained minus that actually taken up during exercise. Q(a)O2 kinetics was described fitting the data with a non-linear mono-exponential model with time delay. Mean response times (MRT) of VO2 and Q(a)O2 kinetics were then calculated. DefO2 and MRT of VO2 response did not change after HDTBR, whereas MRT of Q(a)O2 kinetics increased. The invariance of VO2 kinetics after HDTBR suggests that, although Q(a)O2 response became slower after HDTBR, it did not affect the kinetics of peripheral gas exchange, which probably remained under the control of local muscular mechanisms.

Right-to-left shunt does not increase white matter lesion load in migraine with aura patients.

BACKGROUND: White matter lesions (WMLs) are commonly found on brain MRI of migraine patients. Migraine with aura (MA+) is associated with an increased frequency of right-to-left shunt (RLS) mostly due to patent foramen ovale. The relationship between WML load and RLS in MA+ is currently unknown. METHODS: MA+ patients were consecutively enrolled as part of the Shunt Associated Migraine (SAM) study. Patients underwent a standardized headache and vascular risk factors questionnaire, contrast-enhanced transcranial Doppler, blood coagulation tests, and brain MRI. RLS was categorized into four grades: no shunt, <10 microbubbles (mb), >10 mb single spikes pattern, and >10 mb shower/curtain pattern. Standard and fluid-attenuated inversion recovery T2-weighted MRI sequences were inspected for WMLs by three independent raters blinded to RLS grade. WML load was scored in the periventricular areas (PV-WMLs) with the Fazekas scale and in the deep white matter (D-WMLs) with the Scheltens scale. Interobserver agreement was good to excellent (kappa = 0.64 to 0.96, p < 0.0001). WML load was then correlated between patients with and without RLS. RESULTS: One hundred eighty-five patients (77% women) were included. PV-WML load was similar between patients with and without RLS. D-WML load decreased in patients with RLS (p = 0.045). On logistic regression analysis, only age was associated with WMLs (p < 0.001). CONCLUSIONS: The presence of right-to-left shunt does not increase white matter lesion load in patients who have migraine with aura.

Is migraine associated with right-to-left shunt a separate disease? Results of the SAM study.

Migraine with aura (MA) is associated with the persistence of patent foramen ovale (PFO) in about 50% of cases, and migraineurs tend to have larger shunts than controls, suggesting that right-to-left shunt (RILES) determined by PFO could play a role in triggering migraine attacks. Moreover, some preliminary reports have suggested that PFO closure may give relief to both migraine and aura attacks. The aim of this study was to clarify if shunt-associated migraine (SAM) has clinical features that allow a distinction from shunt-unrelated migraine (SUM), in a prospective, multicentre, observational study (SAM study). We enrolled consecutive MA patients, who underwent a structured, standardized questionnaire for family and personal history and for detailed migraine features. All were systematically screened for RILES with transcranial Doppler, and for coagulation disorders. Overall, 460 patients were included; the SUM and SAM classes comprised 58% and 42% of patients, respectively. SAM patients were significantly younger (34.1 +/- 10 vs. 37.1 +/- 11 years), had a more frequent family history of migraine (76% vs. 66%) and a higher frequency of sensory symptoms of aura (51% vs. 41%); by contrast, there was a lesser association of SAM with other cardiac abnormalities and with coagulation disorders. The SAM study suggests that the effect of RILES on migraine features is not relevant. The higher family history of migraine in SAM suggests a possible genetic linkage between migraine and RILES.

GAMT deficiency: features, treatment, and outcome in an inborn error of creatine synthesis.

BACKGROUND: Guanidinoactetate methyltransferase (GAMT) deficiency is an autosomal recessive disorder of creatine synthesis. The authors analyzed clinical, biochemical, and molecular findings in 27 patients. METHODS: The authors collected data from questionnaires and literature reports. A score including degree of intellectual disability, epileptic seizures, and movement disorder was developed and used to classify clinical phenotype as severe, moderate, or mild. Score and biochemical data were assessed before and during treatment with oral creatine substitution alone or with additional dietary arginine restriction and ornithine supplementation. RESULTS: Intellectual disability, epileptic seizures, guanidinoacetate accumulation in body fluids, and deficiency of brain creatine were common in all 27 patients. Twelve patients had severe, 12 patients had moderate, and three patients had mild clinical phenotype. Twenty-one of 27 (78%) patients had severe intellectual disability (estimated IQ 20 to 34). There was no obvious correlation between severity of the clinical phenotype, guanidinoacetate accumulation in body fluids, and GAMT mutations. Treatment resulted in almost normalized cerebral creatine levels, reduced guanidinoacetate accumulation, and in improvement of epilepsy and movement disorder, whereas the degree of intellectual disability remained unchanged. CONCLUSION: Guanidinoactetate methyltransferase deficiency should be considered in patients with unexplained intellectual disability, and urinary guanidinoacetate should be determined as an initial diagnostic approach.

Detection and Classification of Movements in Bed using Load Cells.

The quality of our life is tied to the quality of our sleep. People with sleep deficits may experience impaired performance, irritability, lack of concentration, and daytime drowsiness. Increased mobility in bed can be a sign of disrupted sleep. Therefore, body movements in bed represent an important behavioral aspect of sleep. In this paper, we propose a method for detection and classification of movement that uses load cells placed at each corner of a bed. The detection of movements is based on short-term analysis of the mean-square differences of the load cell signals. Movement classification is based on features extracted from a wavelet-based tiresolution analysis (MRA) to classify the type of movement into two classes: small and large. A linear classifier is trained on each level of the MRA, and the decisions of the 4 classifiers are combined using a Bayesian combination rule. The method is evaluated on load cell data collected from 6 subjects. Each subject performed 5 trials composed of 20 pre-defined movements including small shifts of position to large movements of torso and limbs. The performance measure for the detection problem is the equal error rate (EER). We show that the detection method achieves a 2.9% EER and that the classification method has a classification error of 4%.

Relationship between severity of MR perfusion deficit and DWI lesion evolution.

OBJECTIVE: To assess whether a quantitative analysis of the severity of the early perfusion deficit on MRI in acute ischemic stroke predicts the evolution of the perfusion/diffusion mismatch and to determine thresholds of hypoperfusion that can distinguish between critical and noncritical hypoperfusion. METHODS: Patients with acute ischemic stroke were studied in whom perfusion-weighted imaging (PWI) and diffusion-weighted imaging (DWI MRI) were performed within 7 hours of symptom onset and again after 4 to 7 days. Patients with early important decreases in points on the NIH Stroke Scale were excluded. Maps of cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time (MTT) were created. These hemodynamic parameters were correlated with the degree of recruitment of the baseline PWI lesion by the DWI lesion. RESULTS: Twelve patients had an initial PWI > DWI mismatch of >20%. A linear relationship was observed between the initial MTT and the degree of recruitment of the baseline PWI lesion by the DWI lesion at follow-up (R(2) = 0.9, p < 0.001). Higher CBV values were associated with higher degrees of recruitment (rho = 0.732, p < 0.007). The volume of MTT of >4 (R(2) = 0.86, p < 0.001) or >6 seconds (R(2) = 0.85, p < 0.001) predicted final infarct size. CONCLUSION: Among patients who have had an acute stroke with PWI > DWI, who do not have dramatic early clinical improvement, the degree of expansion of the initial DWI lesion correlates with the severity of the initial perfusion deficit as measured by the mean transit time and the cerebral blood volume.

Pharmacokinetics of intrathecal transferrin-ricin a chain immunotoxin.

We have studied the pharmacokinetics of an anti-transferrin receptor immunotoxin following intrathecal (i.t.) and intravenous (i.v.) bolus inoculation in healthy rats. After i.t. inoculation of 4.9 microg transferrin-ricin A-chain (Tfn-RTA) we have measured the immunotoxin concentration in the cerebrospinal fluid (CSF), in the brain tissue and in the peripheral blood. After i.v. administration of 4.9 microg Tfn-RTA the concentration of Tfn-RTA immunotoxin was evaluated in the peripheral blood. We found that the clearance of Tfn-RTA from the CSF is rapid (9.1 microLmin(-1)), the immunotoxin then diffuses into the brain tissue and in the peripheral blood where it reaches concentrations below the MTC50 (Minimum Toxin Concentration 50%). The rate of immunotoxin elimination from the peripheral blood following either i.v. or i.t. administration are similar (kel = 0.0021 min(-1) vs. 0.0025 min(-1)). Thus, in the healthy rat the immunotoxin does not accumulate following i.t. inoculation, reaching non toxic concentrations in the brain tissue and in the peripheral blood, whereas in the CSF as well as at the interface CSF/brain tissue the immunotoxin may reach potentially therapeutic concentrations. In conclusion we believe that the i.t. inoculation of an immunotoxin could be considered a potentially useful route of administration in the treatment of leptomeningeal carcinomatosis.

Prediction of hemorrhagic transformation following acute stroke: role of diffusion- and perfusion-weighted magnetic resonance imaging.

BACKGROUND: Acute diffusion-weighted (DWI) and perfusion-weighted (PWI) magnetic resonance imaging (MRI) findings may correlate with secondary hemorrhagic transformation (HT) risk in patients with stroke. This information could be of value, particularly in individuals being considered for thrombolytic therapy. OBJECTIVE: To determine the relationship between DWI and PWI findings and the risk of secondary HT in patients with acute stroke. DESIGN: Retrospective case series. SETTING: Academic medical center. PATIENTS: Twenty-seven patients with acute stroke capable of being evaluated with DWI/PWI 8 hours or less after symptom onset. MAIN OUTCOME MEASURES: Apparent diffusion coefficient values, perfusion delay measurements, and subsequent MRI or computed tomographic scans detected HT. RESULTS: The mean +/- SD apparent diffusion coefficient of ischemic regions that experienced HT was significantly lower than the overall mean +/- SD apparent diffusion coefficient of all ischemic areas analyzed (0.510 +/- 0.140 x 10(-3) mm(2)/s vs 623 +/- 0.113 x 10(-3) mm(2)/s; P =.004). This difference remained significant when comparing the HT-destined ischemic areas with the non-HT-destined areas within the same ischemic lesion (P =.02). Patients receiving recombinant tissue-type plasminogen activator (rt-PA) experienced HT significantly earlier than patients not receiving rt-PA (P =.002). Moreover, a persistent perfusion deficit in the area of subsequent hemorrhage at 3 to 6 hours after the initial MRI scan was identified in significantly more patients who experienced HT than in those who did not (83% vs 30%; P =.03). CONCLUSION: Both DWI and PWI scans detect abnormalities that are associated with HT. These findings support a role for MRI in identifying patients who are at increased risk for secondary HT following acute ischemic stroke.

CD23 and CD69 expression on human neutrophils of healthy subjects and patients with peripheral arterial occlusive disease.

In this work we studied, on human neutrophils from healthy donors and patients with peripheral arterial occlusive disease, the expression of CD23 and CD69 and the modulatory effects of IFN-gamma, GM-CSF and IL-4. Neutrophils were isolated from 9 patients and 9 healthy subjects and cultured for 24 h in absence or presence of IFN-gamma (1000 U/ml), GM-CSF (10 U/ml) and IL-4 (10 ng/ml). Expression of CD23 and CD69 was analyzed by FACScan cytofluorimeter. Neutrophils of both patients and healthy donors resulted negative for CD23 and CD69 expression immediately after isolation. After 24 h without stimuli, neutrophils from some patients and healthy donors expressed CD23 and CD69. IFN-gamma and GM-CSF had opposite effects on these two antigens, down-regulating CD23 and up-regulating CD69. IFN-gamma, GM-CSF and IL-4 were not able to induce CD23 expression, while CD69 expression was induced in some negative healthy donors and patients by IFN-gamma, GM-CSF and IL-4 respectively. From our data, we identified two subpopulations of neutrophils that, independently from the vascular pathology, showed a different behaviour towards temperature and some cytokines.

Relationship between apparent diffusion coefficient and subsequent hemorrhagic transformation following acute ischemic stroke.

BACKGROUND AND PURPOSE: A method for identifying patients at increased risk for developing secondary hemorrhagic transformation (HT) after acute ischemic stroke could be of significant value, particularly in patients being considered for thrombolytic therapy. We hypothesized that diffusion-weighted MRI might aid in the identification of such patients. METHODS: We retrospectively analyzed 17 patients with ischemic stroke who received diffusion-weighted MRI within 8 hours of symptom onset and who also received follow-up neuroimaging within 1 week of initial scan. The apparent diffusion coefficient (ADC) for each pixel in the whole ischemic area was calculated, generating a histogram of values. Areas subsequently experiencing HT were then compared with areas not experiencing HT to determine the relationship between ADC and subsequent HT. RESULTS: A significantly greater percentage of pixels possessed lower ADCs (40% of the pixels possessed values