The impact of nicotine smoking on spondyloarthritis and rheumatoid arthritis.

OBJECTIVE: Nicotine has major side effects on human health through numerous mechanisms, one of which is the alteration of the immune system and its genetic components. Such alteration can be a predisposing factor for autoimmune diseases such as spondyloarthritis (SpA) and rheumatoid arthritis (RA). This review aims to shed light on the effects of nicotine smoking on the pathophysiology, clinical presentation, and management of SpA and RA. METHODS: This review looked into the studies, excluding case reports and series, which were cited by PubMed/MEDLINE. RESULTS: Patients with established autoimmune conditions may have a different underlying pathophysiology and disease course when exposed to nicotine through cigarette smoking. Through the involvement of several cytokines, endothelial dysfunction, and epigenetic mechanisms, the severity of SpA is more prominent in smokers. The global health status, pain, and fatigue are worse in SpA patients. The evidence on the effect of nicotine smoking on the treatment of SpA is still limited. Nicotine can contribute to RA via the disruption of cellular regulatory activity, inflammatory responses, morphological, physiological, biochemical, and enzymatic responses. As such, smokers with RA have higher disease activity and are more likely to be seropositive through the citrullination of peptides. In addition, these patients are at risk of achieving a suboptimal response to tumor necrosis factor inhibitors. CONCLUSIONS: Cigarette smoking can substantially affect the pathophysiology and clinical presentation of patients with SpA and RA. The impact of nicotine on the management of these diseases still needs to be further studied.

Ancient mitogenomes of Phoenicians from Sardinia and Lebanon: A story of settlement, integration, and female mobility.

The Phoenicians emerged in the Northern Levant around 1800 BCE and by the 9th century BCE had spread their culture across the Mediterranean Basin, establishing trading posts, and settlements in various European Mediterranean and North African locations. Despite their widespread influence, what is known of the Phoenicians comes from what was written about them by the Greeks and Egyptians. In this study, we investigate the extent of Phoenician integration with the Sardinian communities they settled. We present 14 new ancient mitogenome sequences from pre-Phoenician (~1800 BCE) and Phoenician (~700-400 BCE) samples from Lebanon (n = 4) and Sardinia (n = 10) and compare these with 87 new complete mitogenomes from modern Lebanese and 21 recently published pre-Phoenician ancient mitogenomes from Sardinia to investigate the population dynamics of the Phoenician (Punic) site of Monte Sirai, in southern Sardinia. Our results indicate evidence of continuity of some lineages from pre-Phoenician populations suggesting integration of indigenous Sardinians in the Monte Sirai Phoenician community. We also find evidence of the arrival of new, unique mitochondrial lineages, indicating the movement of women from sites in the Near East or North Africa to Sardinia, but also possibly from non-Mediterranean populations and the likely movement of women from Europe to Phoenician sites in Lebanon. Combined, this evidence suggests female mobility and genetic diversity in Phoenician communities, reflecting the inclusive and multicultural nature of Phoenician society.

Aplicabilidade das variações respiratórias do volume sistólico e seus substitutos para predição da responsividade dinâmica a fluidos em pacientes críticos: uma revisão sistemática sobre a prevalência das condições requeridas / Applicability of respiratory variations in stroke volume and its surrogates for dynamic fluid responsiveness prediction in critically ill patients: a systematic review of the prevalence of required conditions

RESUMO Objetivo: Avaliar os dados publicados em relação à prevalência das condições requeridas para avaliação apropriada em pacientes críticos. Métodos: Foram realizadas buscas nas bases de dados MEDLINE, Scopus e Web of Science para identificar estudos que discutiam a prevalência de condições validadas para avaliação da responsividade a fluidos com uso de variações respiratórias do volume sistólico ou algum outro substituto em pacientes críticos adultos. O desfecho primário foi a prevalência de adequação para avaliação da responsividade. O objetivo secundário foi o tipo e a prevalência de pré-requisitos avaliados para definir a adequação. Resultados: Incluíram-se cinco estudos (14.804 pacientes). Observaram-se elevadas heterogeneidades do ponto de vista clínico e estatístico (I2 = 98,6%), o que impediu o agrupamento dos resultados em uma conclusão sumarizada significativa. A limitação mais frequentemente identificada foi a ausência de ventilação mecânica invasiva com volume corrente ≥ 8mL/kg. A adequação final para avaliação da responsividade a fluidos foi baixa (em quatro estudos, variou entre 1,9 e 8,3% e, em um estudo, foi de 42,4%). Conclusão: A aplicabilidade na prática diária de índices dinâmicos de responsividade da pré-carga que demandam interações cardiopulmonares pode ser limitada.

ABSTRACT Objective: The present systematic review searched for published data on the prevalence of required conditions for proper assessment in critically ill patients. Methods: The Medline, Scopus and Web of Science databases were searched to identify studies that evaluated the prevalence of validated conditions for the fluid responsiveness assessment using respiratory variations in the stroke volume or another surrogate in adult critically ill patients. The primary outcome was the suitability of the fluid responsiveness evaluation. The secondary objectives were the type and prevalence of pre-requisites evaluated to define the suitability. Results: Five studies were included (14,804 patients). High clinical and statistical heterogeneity was observed (I2 = 98.6%), which prevented us from pooling the results into a meaningful summary conclusion. The most frequent limitation identified is the absence of invasive mechanical ventilation with a tidal volume ≥ 8mL/kg. The final suitability for the fluid responsiveness assessment was low (in four studies, it varied between 1.9 to 8.3%, in one study, it was 42.4%). Conclusion: Applicability of the dynamic indices of preload responsiveness requiring heart-lung interactions might be limited in daily practice.

Is the effect of topical intranasal steroids on obstructive adenoids transient or long-lasting? Case series and systematic review of literature.

OBJECTIVES: To study and review the short- and long-term effects of intranasal steroids on obstructive adenoids. METHODS: In this prospective cohort study, 19 children previously treated with mometasone furoate for 3 months were contacted at 3, 6 and 12 months after cessation of treatment. Main outcome measures included: change in severity of nasal obstruction, allergic rhinitis and obstructive symptoms. A systematic review of literature was also performed. RESULTS: By one year, 25 per cent of patients required adenoidectomy; the remaining children had no significant change in clinical score (p = 0.464), obstruction severity (p = 0.191) or allergic symptoms (p = 0.284). Fourteen pertinent studies were identified; all but one study showed improvement in the patients' symptoms and/or degree of obstruction. Two studies with follow up reaching 25 months showed positive effects. CONCLUSION: The short-term positive effect of some intranasal steroids on obstructive adenoids seems to persist in a significant number of patients after the cessation of treatment.

Intratympanic therapy in Meniere's syndrome or disease: up to date evidence for clinical practice.

BACKGROUND: Meniere's syndrome or disease (MS/D) is typically characterised by episodic vertigo, aural fullness, tinnitus and fluctuating hearing loss. There are multiple options available for treatment with variation in consensus on the best intervention. OBJECTIVE: To evaluate the evidence on the efficacy of intratympanic therapies [steroids, gentamicin, antivirals and other therapies] on the frequency and severity of vertigo and other symptoms of MS/D. SEARCH STRATEGY: A literature search was performed on AMED, EMBASE, HMIC, MEDLINE, PsycINFO, BNI, CINAHL, HEALTH BUSINESS ELITE, CENTRAL and Cochrane Ear, Nose and Throat disorders group trials register using various MeSH. The search was restricted to English and human subjects, and the last date of search was December 2014. SELECTION CRITERIA: Randomised controlled trials of intratympanic therapies [steroids, gentamicin antivirals and latanoprost] versus a placebo or another treatment. RESULTS: We analysed 8 RCT's comparing intratympanic steroids, gentamicin, ganciclovir (antiviral) and latanoprost versus another form of intratympanic treatment or placebo. CONCLUSIONS: On the basis of 6 RCT's (n = 242), there is evidence to support the effectiveness of intratympanic steroids and gentamicin to control symptoms of vertigo in MS/D albeit with a risk of hearing loss with gentamicin. However, there was no consensus found on doses or treatment protocols. There was no evidence to support the use of other forms of intratympanic therapy (antivirals and latanoprost) in MS/D.

Prevalence of arytenoid asymmetry in relation to vocal symptoms.

OBJECTIVES: (1) To assess the prevalence of arytenoid asymmetry during adduction, and (2) to correlate arytenoid asymmetry with vocal symptoms. MATERIALS AND METHOD: The medical records and video recordings of 116 patients who presented to the voice clinic were reviewed for the presence of arytenoid asymmetry, as regards sharpening of the aryepiglottic fold angle and altered positioning of the cuneiform and corniculate cartilages. RESULTS: There were 61 males and 55 females, with a mean age of 39 years and a standard deviation of 15 years. Almost one-third had a history of reflux, 25 per cent had a history of smoking and 9.6 per cent had a history of allergy. Hoarseness was the most common symptom, occurring in 42.2 per cent of patients, followed by vocal fatigue (25 per cent) and inability to project the voice. The most common type of asymmetry was corniculate asymmetry, present in 27.6 per cent of the cases and accounting for 74.39 per cent of cases. This was followed by cuneiform cartilage asymmetry, present in 15.5 per cent of cases. There was no correlation between arytenoid asymmetry and vocal symptoms, except for vocal fatigue (p = 0.038). CONCLUSION: The prevalence of arytenoid asymmetry during adduction is common. The presence of vocal symptoms such as hoarseness, breathiness, inability to project the voice and straining does not generally seem to correlate with the prevalence of arytenoid asymmetry. However, subjects with vocal fatigue are more likely to have cuneiform asymmetry.

[Complex anomaly of the origin of supraaortic vessels]. / Anomalie complexe de naissance des vaisseaux supra-aortiques.

We present a congenital variation of the origin of the supraaortic trunks discovered on an angioscan and described here for the first time in the literature. This variation combines a common carotid trunk, an arteria lusoria and an aberrant origin of the vertebral arteries, from the common carotid artery on the right side and from the aortic arch on the left. This complex anomaly is asymptomatic like most of the arterial variations but its detection is useful, even essential preoperatively, in order to adapt the intervention and limit potential complications.

[Transhepatic embolization of a hepatic artery aneurysm following laparoscopic cholecystectomy]. / Embolisation trans-hépatique d'un anévrisme de l'artère hépatique post-cholécystectomie laparoscopique.

Vascular complications following laparoscopic cholecystectomy are less frequent but carry higher morbidity than bile ducts lesions. We report on a 19-year-old patient, who presented a ruptured pseudoaneurysm of the hepatic artery 2 months after laparoscopic cholecystectomy. This case illustrates the alternative of direct transhepatic puncture with exclusive glue embolization in case of endovascular access failure.

[Glue embolization of an unruptured ovarian aneurysm]. / Embolisation à la glu d'un anévrisme non rompu de l'artère ovarienne.

Ovarian artery aneurysms are extremely rare, only 17 cases having been published till now. They usually present with rupture during delivery or in the immediate post-partum. We report a case of asymptomatic, unruptured ovarian artery aneurysm in a 40-year-old woman. Diagnosis was achieved by computed tomography performed for an unrelated reason and confirmed by angiography. Transcatheter arterial embolization using coils and glue excluded the lesion. To the best of our knowledge, this is the first report of an asymptomatic ovarian artery aneurysm, diagnosed outside a context of rupture.

[Giant venous malformation of the tongue: the value of Surgiflo]. / Malformation veineuse géante de la langue: intérêt du surgiflo.

Cavernous hemangiomas are rare congenital venous malformations having propensity for the head and neck. These venous malformations, especially the large and intraoral ones, may cause severe symptoms requiring aggressive treatment. Today, the main treatment is based on sclerotherapy, associated or no with surgery. We report on a patient presenting an enormous venous malformation of the face and tongue, which was treated successfully in our department by embolization, sclerotherapy and maxillo-facial surgery, with a special focus on Surgiflo in our technique.

[Intermittent claudication: sign of epidemiological transition in Gabon]. / L'asymétrie tensionnelle humérale, reflet de la transition épidémiologique au Gabon.

Africa is in the midst of an epidemiological transition characterized by an increase in degenerative illnesses, in particular cardiovascular disease, and a decrease in infectious illnesses. In this context it is of critical importance to develop simple and effective low-cost tools to identify subjects at high risk for cardiovascular events. Screening for subclavian artery stenosis (SAS) could provide a useful risk indicator. The prevalence of SAS in the general population over the age of 40 years in Gabon is 5.1 %, which is close to prevalence values observed in industrialized countries. Presence of SAS has been associated with hypertension (OR: 5.79, 95% CI: 2.21-15.2; p < 0.05) and male gender (OR 2.34, 95% CI: 1.13-4.83; p < 0.05). These data confirm the epidemiological shift towards cardiovascular diseases and suggest that screening for SAS could be useful to identify subjects at high risk for cardiovascular events who could benefit from preventive strategies.

Hybrid approach for arch and thoracoabdominal pathologies.

The endovascular era began about 20 years ago and subsequently revolutionized vascular surgery as a less invasive treatment option, especially for high risk patients. In the late 1990s, a new hybrid approach for arch and thoracoabdominal pathologies was developed. Debranching and rerouting supra-aortic and visceral aortic branches with extra-anatomic bypass grafting was performed in order to achieve sufficient landing zones demanding for subsequent stent grafting. The initial single-center results of small series up to 20 patients were encouraging with acceptable complication rates. Hybrid arch procedures are feasible but seem to carry risks. However, the latest reports for thoracoabdominal hybrid procedures demand a word of caution due to high morbidity rates. The hybrid approach may be reserved for a selected comorbid patient cohort, which is regarded unfit for open reconstruction.

[Intradural vertebral dissection: case report and literature review]. / Dissection vertébrale intradurale: cas clinique et revue de la littérature.

Vertebro-basilar dissections represent a rare but severe cause of posterior vascular accident and constitute 3 to 7% of non-traumatic subarachnoid hemorrhage. Digital angiography is classically the standard method for diagnosing of arterial dissections but CT and MR angiography are recently widely used as non-invasive and accurate ways of diagnosis. We report a case of atypical subarachnoid hemorrhage, with focus on contribution of the different techniques.

Aerodynamics of the pseudo-glottis.

OBJECTIVE: The aim of this work is to study the hitherto unclear aerodynamic parameters of the pseudo-glottis following total laryngectomy. These parameters include airflow rate, sub-pseudo-glottic pressure (SubPsG), efficiency and resistance, as well as sound pressure level (SPL). PATIENTS AND METHODS: Eighteen male patients who have undergone total laryngectomy, with an age range from 54 to 72 years, were investigated in this study. All tested patients were fluent esophageal 'voice' speakers utilizing tracheo-esophageal prosthesis. The airflow rate, SubPsG and SPL were measured. RESULTS: The results showed that the mean value of the airflow rate was 53 ml/s, the SubPsG pressure was 13 cm H(2)O, while the SPL was 66 dB. The normative data obtained from the true glottis in healthy age-matched subjects are 89 ml/s, 7.9 cm H(2)O and 70 dB, respectively. Other aerodynamic indices were calculated and compared to the data obtained from the true glottis. CONCLUSION: Such a comparison of the pseudo-glottic aerodynamic data to the data of the true glottis gives an insight into the mechanism of action of the pseudo-glottis. The data obtained suggests possible clinical applications in pseudo-voice training.

[Left innominate artery arising from the ascending aorta in the absence of right innominate artery]. / Tronc artériel brachiocéphalique gauche naissant de l'aorte ascendante en l'absence de tronc artériel brachiocéphalique droit.

It is important to detect anatomic variants of the supraaortic trunks prior to cardiovascular surgery in order to adjust the surgical technique. We report here, an anatomic variant that was not described previously, detected on a chest multidetector CT and confirmed during surgery. This variant consists of a left innominate artery, arising from the ascending aorta before the right subclavian and common carotid arteries that arise separately from the aortic arch. It is important to notice the absence of associated cardiovascular malformations. We formulate a possible explanation of the described variant through an embryologic study of the vasculogenesis.

[Unusual variation of the splenic artery]. / Variante originale de l'artère splénique.

The authors describe an exceptional variation of the splenic artery found on a preoperative angiogram and confirmed after surgery on splenopancreatectomy specimens. Total duplication of the splenic artery is herein reported for the first time and suggest the need for a new classification of digestive arteries anomalies.

[Value of sonography and MR imaging for the evaluation of deep pelvic endometriosis]. / Valeurs diagnostiques de l'echographie et de l'IRM pour l'evaluation de l'endométriose pelvienne profonde.

Deep pelvic endometriosis may involve the uterosacral ligaments, cul-de-sac of Douglas, vagina, rectum, and occasionally the bladder. Evaluation by physical examination is difficult, and imaging techniques are needed to evaluate the location and extent of endometriosis. In this review, we review the transvaginal and transrectal sonographic and MR imaging features suggestive of deep pelvic endometriosis and their diagnostic value.

[Imaging of an aberrant occipital artery arising from the extracranial segment of the internal carotid artery]. / Imagerie d'une artère occipitale aberrante naissant de l'artère carotide interne à l'étage cervical.

We report a case of asymptomatic occlusion of the right internal carotid artery owing to the presence of a rare anatomic variant (occipital artery originating from the extracranial segment of the internal carotid artery). During the preoperative workup for a coronary artery bypass grafting (CABG) in a 65-year-old patient, an occlusion of the right internal carotid artery was visualized on Duplex ultrasound. Distally to the occluded site, the artery was patent thanks to a vessel parallel to it but with a reverse blood flow. MRA and angiography of the brachiocephalic trunk confirmed the occlusion of the internal carotid artery and its opacification distally via an aberrant occipital artery arising at the supra-bulbar level and communicating with the right vertebral artery. Therapeutic abstention was decided and the patient was operated of CABG without any neurological complication. Occipital artery arising from the internal carotid artery is a rare anomaly. Its association with internal carotid artery occlusion may be beneficial because it makes surgery possible, even in a chronic stage, if the patient is symptomatic. If the patient is asymptomatic, therapeutic abstention could be considered.

[Angioplasty with stenting for buttock claudication]. / Angioplastie avec mise en place d'un stent pour occlusion fessière.

We report the case of a patient presenting severe buttock claudication with normal neurologic and osteoarticular exams. He underwent a guidewire recanalization of his occluded superior gluteal artery followed by a percutaneous angioplasty with stenting, resulting in total relief of symptoms. This observation represents the first publication describing the use of a stent with recanalization of the gluteal artery. The technique seems promising for buttock pathology.