[Profile of the victims of sexual violence in child psychiatry consultation]. / Enfants victimes de violences sexuelles en consultation de pédopsychiatrie.

INTRODUCTION: Child sexual abuse is a major health problem that remains under-declared and under-reported worldwide. In this paper we have taken an interest in establishing the profile of the victims in a clinical population of children consulting for sexual abuse. METHOD: We conducted a descriptive retrospective study in the child and teenager psychiatry department of the Mongi-Slim hospital (Tunis, Tunisia). We included all patients referred for treatment or medical expertise during the period from January 2013 to June 2019 and recorded sociodemographic data and clinical characteristics on pre-established charts from patient files. RESULTS: The total number of consultants was 150 patients with 61,33 % of female subjects (n=92). The average age was 9,9 years old with extremes ranging from 2 to 18 years old. The assault was unique in 62,7 % and happened in a place known by the victim in 47,33 %. Sexual abuse with non-penetrating contact was the most frequent (48 %). The average age at which the first sexual abuse happened was 9 years old. In the vast majority of cases, the abuser was a male. Concerning the identity of the abuser, he was someone of the family in 37,3 % of the cases and in half of these cases, he was the father. In the other cases where the abuser wasn't a family member, the identity was known by the child and/or his family in 48,66 %. A psychiatric diagnosis was made in 58 % of the cases with a percentage of 52,1 % among girls and 60,3 % among boys. Main diagnoses were acute stress disorder in 10,6 %, post trauma stress disorder in 19,3 %, adjustment disorder in14,6 % and a major depressive disorder in 8 %. CONCLUSION: Knowing the profile of victims of child sexual abuse and taking into consideration the social and psychiatric impact can help in adapting the means to intervene properly in order to take care of the victims and prevent such abuse.

[Correlates of psychopathic personality traits in a sample of college students in Tunisia]. / Les corrélats des traits de personnalité psychopathiques dans un échantillon d'étudiants universitaires en Tunisie.

BACKGROUND: Although psychopathy and its predictive factors are well documented in clinical samples, studies in non-clinical populations are relatively rare. We proposed to assess psychopathy traits in a population of Tunisian university students and to analyze their predictive factors. METHOD: This was a cross-sectional study of 516 university students enrolled at three major Tunisian universities (Faculty of Humanities and Social Sciences of Tunis, National Engineering School of Tunis, Faculty of Medicine of Tunis). Participants responded to a survey sheet containing sociodemographic data and the Levenson Self-Report Psychopathy Scale. RESULTS: The students were female in 63.2 % of the cases, with a mean age of 22.7years. The socio-economic level was middle class in 62.4% of the cases. More than one-quarter of students (26.7%) consumed tobacco. The majority of students (81.4%) spent their free time on the Internet, while 11.8% participated in associative work. Psychopathy scores were relatively high (mean LSRPS scores=64.8) with no noticeable gender differences. Psychopathic traits were significantly associated with university (P=0.017), maternal occupational status (P=0.038), and tobacco use (P=0.029). In addition, the total psychopathy score was significantly lower among students sharing activities with their families (P=0.044) and among students participating in associational work (P=0.025). The multivariate multiple regression has retained as predictive factors of psychopathic traits the fact of being the eldest of his siblings and the associative work. CONCLUSION: Prevention strategies should be put in place to prevent psychopathy and its individual and social impacts in young adults in general, and in university students in particular, especially promoting associative activity in the university environment which is currently lacking in our context.

MALT1 Controls Attenuated Rabies Virus by Inducing Early Inflammation and T Cell Activation in the Brain.

MALT1 is involved in the activation of immune responses, as well as in the proliferation and survival of certain cancer cells. MALT1 acts as a scaffold protein for NF-κB signaling and a cysteine protease that cleaves substrates, further promoting the expression of immunoregulatory genes. Deregulated MALT1 activity has been associated with autoimmunity and cancer, implicating MALT1 as a new therapeutic target. Although MALT1 deficiency has been shown to protect against experimental autoimmune encephalomyelitis, nothing is known about the impact of MALT1 on virus infection in the central nervous system. Here, we studied infection with an attenuated rabies virus, Evelyn-Rotnycki-Abelseth (ERA) virus, and observed increased susceptibility with ERA virus in MALT1-/- mice. Indeed, after intranasal infection with ERA virus, wild-type mice developed mild transient clinical signs with recovery at 35 days postinoculation (dpi). Interestingly, MALT1-/- mice developed severe disease requiring euthanasia at around 17 dpi. A decreased induction of inflammatory gene expression and cell infiltration and activation was observed in MALT1-/- mice at 10 dpi compared to MALT1+/+ infected mice. At 17 dpi, however, the level of inflammatory cell activation was comparable to that observed in MALT1+/+ mice. Moreover, MALT1-/- mice failed to produce virus-neutralizing antibodies. Similar results were obtained with specific inactivation of MALT1 in T cells. Finally, treatment of wild-type mice with mepazine, a MALT1 protease inhibitor, also led to mortality upon ERA virus infection. These data emphasize the importance of early inflammation and activation of T cells through MALT1 for controlling the virulence of an attenuated rabies virus in the brain.IMPORTANCE Rabies virus is a neurotropic virus which can infect any mammal. Annually, 59,000 people die from rabies. Effective therapy is lacking and hampered by gaps in the understanding of virus pathogenicity. MALT1 is an intracellular protein involved in innate and adaptive immunity and is an interesting therapeutic target because MALT1-deregulated activity has been associated with autoimmunity and cancers. The role of MALT1 in viral infection is, however, largely unknown. Here, we study the impact of MALT1 on virus infection in the brain, using the attenuated ERA rabies virus in different models of MALT1-deficient mice. We reveal the importance of MALT1-mediated inflammation and T cell activation to control ERA virus, providing new insights in the biology of MALT1 and rabies virus infection.

Inhibition of MALT1 Decreases Neuroinflammation and Pathogenicity of Virulent Rabies Virus in Mice.

Rabies virus is a neurovirulent RNA virus, which causes about 59,000 human deaths each year. Treatment for rabies does not exist due to incomplete understanding of the pathogenesis. MALT1 mediates activation of several immune cell types and is involved in the proliferation and survival of cancer cells. MALT1 acts as a scaffold protein for NF-κB signaling and a cysteine protease that cleaves substrates, leading to the expression of immunoregulatory genes. Here, we examined the impact of genetic or pharmacological MALT1 inhibition in mice on disease development after infection with the virulent rabies virus strain CVS-11. Morbidity and mortality were significantly delayed in Malt1-/- compared to Malt1+/+ mice, and this effect was associated with lower viral load, proinflammatory gene expression, and infiltration and activation of immune cells in the brain. Specific deletion of Malt1 in T cells also delayed disease development, while deletion in myeloid cells, neuronal cells, or NK cells had no effect. Disease development was also delayed in mice treated with the MALT1 protease inhibitor mepazine and in knock-in mice expressing a catalytically inactive MALT1 mutant protein, showing an important role of MALT1 proteolytic activity. The described protective effect of MALT1 inhibition against infection with a virulent rabies virus is the precise opposite of the sensitizing effect of MALT1 inhibition that we previously observed in the case of infection with an attenuated rabies virus strain. Together, these data demonstrate that the role of immunoregulatory responses in rabies pathogenicity is dependent on virus virulence and reveal the potential of MALT1 inhibition for therapeutic intervention.IMPORTANCE Rabies virus is a neurotropic RNA virus that causes encephalitis and still poses an enormous challenge to animal and public health. Efforts to establish reliable therapeutic strategies have been unsuccessful and are hampered by gaps in the understanding of virus pathogenicity. MALT1 is an intracellular protease that mediates the activation of several innate and adaptive immune cells in response to multiple receptors, and therapeutic MALT1 targeting is believed to be a valid approach for autoimmunity and MALT1-addicted cancers. Here, we study the impact of MALT1 deficiency on brain inflammation and disease development in response to infection of mice with the highly virulent CVS-11 rabies virus. We demonstrate that pharmacological or genetic MALT1 inhibition decreases neuroinflammation and extends the survival of CVS-11-infected mice, providing new insights in the biology of MALT1 and rabies virus infection.

EVALUATION OF THERMOTOLERANT ACETOBACTER PASTEURIANUS STRAINS ISOLATED FROM MOROCCAN FRUITS CATALYZING OXIDATIVE FERMENTATION AT HIGH TEMPERATURE.

Six strains of acetic acid bacteria were isolated from Moroccan local products and their potential as industrial strains was evaluated in lab-bioreactor. Three of them, namely TAV01, AF01 and CV01, isolated from traditional apple vinegar, apple and cactus fruit, respectively were selected and their responses to high temperature were assessed. Morphological and biochemical identification confirmed that these strains belong to Acetobacter species. Their growth and acetic acid production were compared with the thermoresistant reference strain, Acetobacter senegalensis and mesophilic strains of Acetobacter pasteurianus. The two strains AF01 and CV01 showed abundant growth and noticeable acetic acid production ability at high temperatures (38 to 41°C). A thermophilic character was observed for AF01 strain. Indeed, this bacterium grew better at 38 than 30°C.

Pentoxifylline and its association with kaempferol improve NASH-associated manifestation in mice through anti-apoptotic, anti-necroptotic, antioxidant, and anti-inflammatory mechanisms.

OBJECTIVE: Non-alcoholic fatty liver disorders (NAFLD), particularly non-alcoholic steatohepatitis (NASH), have emerged as a leading cause of liver transplantation and mortality. However, the pathophysiology of NASH remains unknown. Oxidative stress, apoptosis, and necroptosis pathways are heavily linked to NASH. Therefore, the current study aimed to investigate the underlying mechanism for Pentoxifylline's (PTX) activity in NASH management, either alone or in combination with Kaempferol (KP). MATERIALS AND METHODS: A total of 32 male C57BL/6J mice were divided into four groups: the mice in the control group were fed a standard chow diet and given a vehicle; the mice in NASH group were maintained on NASH protocol for 25 days; the mice in the PTX group were kept on NASH protocol for 25 days and given PTX (100 mg/kg), and PTX+KP mice group were given NASH protocol along with KP (50 mg/kg) and PTX (100 mg/kg) simultaneously. RESULTS: The LDL-C, total cholesterol, triglycerides, glutathione peroxidase (GPx), superoxide dismutase (SOD), malondialdehyde (MDA), glucose, insulin, and HOMA-IR levels were considerably decreased in the PTX and PTX+KP treated groups. AMP-activated protein kinase (AMPK) Gene expression of the liver was significantly increased in the other treated groups, but peroxisome proliferator-activated receptor (PPAR), phosphorylated mixed lineage kinase-like protein (pMLKL), and sterol regulatory element binding protein 1 (SREBP1) were reduced significantly. Caspase-8 and receptor-interacting serine/threonine protein kinase (RIPK3) protein expression were significantly decreased in the PTX and PTX+KP groups compared to NASH group and nuclear factor kappa B (NF-κB), interleukin-6 (IL-6), and tumor necrosis factor alpha (TNF-α) immunohistochemistry expression. CONCLUSIONS: Our current study suggests that PTX and its combination with KP have a significant ameliorative effect against NASH via novel mechanisms involving the regulation of apoptosis and necroptosis, as well as decreased oxidative stress, lipogenesis, proinflammatory cytokines, and modulation of histopathological manifestation.

Prevalence of transferable blaCTX-M-15 from hospital- and community-acquired Klebsiella pneumoniae isolates in Scotland.

OBJECTIVES: This study was performed to investigate the prevalence and genetic characteristics of transferable bla(CTX-M-15) from hospital- and community-acquired Klebsiella pneumoniae isolates in Scotland. METHODS: A total of 219 clinical isolates of K. pneumoniae collected in 2006 and 2007 at the Royal Infirmary of Edinburgh, Scotland, were tested for antimicrobial susceptibility by the agar double dilution method. PCR and sequencing were used to detect bla(CTX-M), bla(TEM), bla(SHV) and qnr genes. Clonality of the isolates was assessed by PFGE. RESULTS: Sixteen (7.3%) isolates were found to be producers of CTX-M-15 extended-spectrum ß-lactamases (ESBLs), of which two isolates (12.5%) were reported to be from patients with community-acquired infections. The ISEcp1 was detected by sequencing 48 nucleotides upstream of bla(CTX-M-15) in all isolates but one. A total of one to two plasmids, ranging in size from ~40 to 210 kb, were observed per strain. By a PCR-based replicon typing method, plasmids carrying bla(CTX-M-15) were assigned to IncFII or IncN types. Sequencing and PCR analysis revealed the presence of complex class 1 integrons in all isolates but one. Two isolates positive for class 1 integrons were positive for class 2 integrons as well. Five different clones of CTX-M-15-producing isolates were identified by PFGE. CONCLUSIONS: This work reports the emergence of hospital- and community-acquired CTX-M-type enzymes in the Edinburgh area of Scotland.

Novel genetic context of multiple bla OXA-58 genes in Acinetobacter genospecies 3.

OBJECTIVES: The detection in Acinetobacter genospecies 3 isolates of OXA-type carbapenemases, resulting in reduced susceptibility to carbapenem antibiotics, is increasingly reported. We identified an Acinetobacter genospecies 3 isolate carrying the gene for OXA-58 and aimed to resolve the genetic environment surrounding the bla(OXA-58) gene. METHODS: Species identification was confirmed by 16S-23S rRNA restriction analysis. MICs of imipenem, meropenem and ertapenem were determined, and the isolate was screened by PCR for bla(OXA-23-like), bla(OXA-40-like), bla(OXA-51-like) and bla(OXA-58-like) genes. The sequence surrounding bla(OXA-58) was determined through amplification by inverse PCR and genome walking followed by sequencing. Genetic localization was investigated by Southern blotting. RESULTS: Isolate A164 was confirmed as belonging to Acinetobacter genospecies 3 and had reduced susceptibility to the carbapenems. The isolate was found to encode two bla(OXA-58) genes that may have been duplicated by the insertion sequence ISAba125, two copies of which were inserted into ISAba3 elements. The bla(OXA-58) genes appear to be plasmid borne. CONCLUSIONS: This is the first report of beta-lactamase duplication in Acinetobacter genospecies 3 and of gene duplication mediated by ISAba125.

Presentation and survival of operable esophageal cancer in patients 55 years of age and below.

BACKGROUND: The increased incidence of esophageal cancer, especially in the younger age group, should encourage early diagnosis. The perceived rarity and poor prognostic outcome of esophageal cancer in this group is based on retrospective studies. The goal of this study was to review the presentation and survival of young patients with esophageal cancer. METHODS: This study was conducted from 2000 to 2007 in a specialized esophagogastric center. All patients who had esophageal cancer operations were included. Variables collected included ages, duration of symptoms, presenting symptoms, tumor characteristics, and follow-up data. RESULTS: In total, 365 esophagectomies were performed for cancer, of which 76 patients were younger than aged 55 years (20.8%) and 289 were older than aged 55 years. In patients younger than aged 55 years, 15 patients had symptoms for 6 months or more, 54 had dysphagia, 35 had weight loss compared with 220 and 175 respectively of patients older than aged 55 years. On histopathology, 48 had T3 tumors (63.2%), 17 had T2 (22.4%), and 10 had T1 (13.2%) for patients younger than aged 55 years compared with 141 had T3 (48.7%), 85 had T2 (29.4%), and 55 had T1 (19%) for patients older than aged 55 years. These differences in tumor stage at presentation between groups were significant (p < 0.05 with 3DF). In-hospital mortality was 0 for the group younger than aged 55 years and 5 for those older than aged 55 years. Average follow-up was 35 (minimum, 15) months. Thirty patients had locoregional recurrence in the first group and 110 in the latter group. Survival at 1 year after surgery was 79.6%, at 2 years 65.1%, and at 5 years 42.3% compared with 78.4, 60.6, and 45.9%, respectively, for the group older than aged 55 years, but this was not significant using log-rank (p = 0.99). CONCLUSIONS: A significant proportion (20.8%) of patients presenting with operable esophageal cancer was younger than aged 55 years. Almost two-thirds of those presenting younger than aged 55 years had T3 stage tumors, which was significantly different than those older than aged 55 years. Despite more advanced tumor stage at presentation, the prognosis of esophageal cancer for patients younger than aged 55 years is similar to those older than aged 55 years (log-rank = 0.99).

Living with type 1 diabetes mellitus: How does the condition affect children's and adolescents' quality of life?

OBJECTIVE: Our study aimed to measure the health-related quality of life (QoL) of Tunisian children and adolescents with type 1 diabetes mellitus (T1MD). METHODS: This cross-sectional study included 48 patients aged 3-18 years with T1MD, diagnosed for at least 6 months, and their parents, who underwent outpatient examinations from September to December 2018. The children's QoL was assessed using the PedQL 3.0 Diabetes Module exploring five dimensions: diabetes symptoms, treatment barriers, treatment adherence, worry, and communication problems. Parents shared their perception of their children's QoL through the PedQL 4.0 parents' report (general health and emotional, social, and scholar functioning). Glycemic control was assessed using the last glycated haemoglobin (HbA1c) values. RESULTS: The patients' average QoL score was 80.52 (±13.61) without significant differences between gender and age. The longer the duration of the disease, the worse the glycemic control. Girls and adolescents seemed to have poorer glycemic control. Boys and adolescents had more difficulties in all aspects of QoL. Parents perceived a worse QoL than that reported by their sons/daughters (72.34±16.42; P=0.006). CONCLUSION: These findings emphasize the importance of an interdisciplinary, biopsychosocial, and family-centered care approach to patients with T1MD.

How do parents of children with type 1 diabetes mellitus cope and how does this condition affect caregivers' mental health?

OBJECTIVE: To evaluate the impact that type 1 diabetes mellitus (T1DM) in children has on parents' mental health and parents' coping with this condition. METHODS: A cross-sectional study involving, at the outpatient examination, 41 caregivers of T1DM patients who had been diagnosed for at least 6 months. We evaluated the parents' coping strategies with the Brief COPE and their depressive and anxiety symptoms with the Hospital Anxiety and Depression Scale (HADS). Glycemic control of patients was assessed using the last glycated hemoglobin (HbA1c) values. RESULTS: The average total score at HADS was 17.62 (SD=6.98). Half of the parents had an anxious score over the cut-off. The more parents were depressed or anxious, the more they used emotion-focused coping (P=0.002 and P=0.00, respectively). The more parents were anxious or depressed, the more they used maladaptive coping strategies such as avoidance and distraction. CONCLUSION: These findings emphasise the key role of healthcare providers in assessing parents' difficulties and taking special care of those who have the most problems.

Simulation of motorcycle crashes with w-beam guardrail: injury patterns and analysis.

This study uses computer simulations to study the impact of a motorcycle with the conventional w-beam guardrail. A three-dimensional computer simulation of a scaled hybrid III 50th-percentile male dummy mounted on a motorcycle and colliding with a w-beam guardrail is carried out. A multi-body model of the motorcycle and finite element model of the guardrail are developed using commercially available software. The simulation model is validated with a physical crash test conducted with same initial impact configurations. Impacts at speeds of 32, 48, and 60 km/h at an impact angle at 45 degrees are considered. The predicted forces and accelerations are compared with the biomechanical limits for each body part and the risk of injury to the rider are evaluated. Speed was found to have a significant influence on the level of injury to the head, neck, chest, and femur. A significant reduction of the severity of injuries was found when the impact speed was reduced from 60 to 32km/h. The accelerations experienced by the head and chest are found to be higher than safe levels for impact speeds of 48 and 60 km/h. The biomechanical limit for the right femur is exceeded at all three considered impact speeds. Neck injuries are also a concern, with the predicted tension values and neck bending extent being higher than the biomechanical limit for the 60 km/h impact speed. In light of these results, it is suggested that the design of guardrails should be reviewed with a focus on the safety of motorcyclists.

Sera from different age cohorts in Belgium show limited cross-neutralization between the mumps vaccine and outbreak strains.

OBJECTIVES: Mumps used to affect children between 2 and 15 years old. The mumps-measles-rubella (MMR) vaccine is available, with vaccine coverage rate of about 85% after two vaccine doses. Recently new mumps outbreaks have emerged in highly vaccinated populations; the causes for these new outbreaks are yet unknown. We tested if a difference in seroneutralizing capacity against the vaccine and wild-type viruses existed and if waning immunity could be detected. METHODS: In this study, 570 serum samples (age group 2-3 years (n = 96), 8-9 years (n = 95), 13-14 years (n = 94), 18-20 years (n = 96), 24-26 years (n = 92) and 50 + years (n = 97)) in Belgium were tested in the rapid fluorescent foci inhibition test for their neutralizing capacity against the vaccine and wild-type viruses. RESULTS: Neutralizing antibodies against the vaccine strain were present in 84% (81/97) of the 2-3-year, 74% (70/95) of the 8-9-year, 81% (76/94) of the 13-14-year, 76% (73/96) of the 18-20-year, 67% (62/92) of the 24-26-year and 77% (75/97) of the 50+-year age group serum samples. For all age groups, only about half of these serum samples were also positive for the wild-type virus. The geometric mean titres for the vaccine and wild-type virus for all younger age groups, except for 24-26 years, were significantly different, demonstrating poor in vitro cross-neutralization. CONCLUSIONS: A possible contribution of antigenic differences between the genotype A and G mumps virus as well as other immune factors, in addition to lower-than-optimal vaccination coverage and waning immunity, could explain the poor in vitro cross-neutralization and should be further studied.

Properties Investigation of GO/HA/Pt Composite Thin Film.

Hydroxyapatite/graphene oxide/platinum (HA/GO/Pt) nanocomposite was synthesized and electrodeposited on a pure zirconium substrate. The coated zirconium was annealed at 200, 300, 400, and 600°C in vacuum furnace in presence of argon gas. The structure and morphology of the coated samples were characterized. Biocompatibility and wear and corrosion resistances of specimens were examined. The result of corrosion tests shows that the graphene into HA/Pt composites significantly improves their corrosion resistance. The wear tests results of uncoated and coated samples before and after annealing show that coated samples annealed at 300°C had better wear resistance compared with uncoated and coated samples at other temperatures. Furthermore, the biocompatibility test shows that the coatings improved the cell attachment and proliferation compared to the pure zirconium substrate.

OXA-51-like beta-lactamases and their association with particular epidemic lineages of Acinetobacter baumannii.

Sixty diverse clinical Acinetobacter baumannii isolates of worldwide origin were assigned to sequence groups, based on a multiplex PCR for the ompA, csuE and bla(OXA-51-like) genes. The majority (77%) of isolates belonged to sequence groups 1 and 2 (SG1 and SG2), with sequence group 3 (SG3) and non-grouped isolates accounting for the remainder. The isolates were not closely related according to pulsed-field gel electrophoresis (PFGE), and the majority were sensitive to imipenem and meropenem. The construction of a linkage map of OXA-51-like beta-lactamase sequence relationships revealed two closely related clusters of enzymes, one focused around OXA-66 and the other around OXA-69. Isolates belonging to SG1 encoded an enzyme from the OXA-66 cluster, while those belonging to SG2 encoded an enzyme from the OXA-69 cluster. All SG3 isolates encoded OXA-71, which does not form part of a close enzyme grouping. Major multinational lineages accounted for a significant proportion of A. baumannii clinical isolates, and the evolution of the OXA-51-like enzymes appears to be an ongoing process.

Macroscopic and nanoscale study of wettability alteration of oil-wet calcite surface in presence of magnesium and sulfate ions.

Effect of Mg2+ and SO2*4 on wettability alteration of modified calcite surface to oil-wet by stearic acid (SA) is addressed both in macroscopic and nanoscale using contact angle and atomic force microscopy technique (AFM), respectively. No apparent difference is shown by AFM images, compared to a clear trend that is obtained form contact angle measurements, where Mg2+ ions have shown to alter the modified calcite surface to more water-wet than that in presence of SO2*4 ions. The adhesion forces, due to the presence of SA, are shown to be less pronounced in presence of Mg2+ ion than that in case of SO2*4. This confirms the macroscale measurements of contact angle by nanoscale level. The phenomenon of the alteration to more water-wet calcite surface is related to the distribution coefficient of SA in n-decane/water system, which decreased in presence of Mg2+ and SO2*4 ions, indicating less adsorption of SA on calcite surface.

A new endoscopic technique for the buried bumper syndrome.

BACKGROUND: The Buried Bumper Syndrome is a well-recognized long-term complication of percutaneous endoscopic gastrostomy (PEG). Overgrowth of gastric mucosa over the inner bumper of the tube will cause mechanical failure of feed delivery, rendering the tube useless. Endoscopic removal is usually attempted but fails in most cases. Therefore, most of the buried inner bumpers are removed by making an external incision over the PEG site under local anaesthesia or at laparotomy. These approaches can be associated with pain, wound infection, or a gastrocutaneous fistula. TECHNIQUE: A new method to facilitate the removal of a PEG tube, where the inner bumper is buried in the gastric mucosa, is described. A length of ureteric catheter, or similar tube, is passed through the shortened external PEG tube into the gastric cavity and is then tied to the tube above the skin. The intragastric part of that tube helps to identify the site of the buried bumper and is then trapped within an endoscopic snare. Traction is then applied to the snare, inverting the tube and dislodging the bumper with minimum disruption to the stomach wall. This avoids the need for repair and allows for immediate reinsertion of a fresh PEG tube. CONCLUSIONS: A PEG tube in a patient with buried bumper syndrome can be safely removed endoscopically, without a skin incision or gastric wall disruption. A novel, simple, and safe endoscopic removal technique is described.

Intraoperative cholangiography facilitates simple transcystic clearance of ductal stones in units without expertise for laparoscopic bile duct surgery.

BACKGROUND: In the absence of facilities and expertise for laparoscopic bile duct exploration (LBDE), most patients with suspected ductal calculi undergo preoperative endoscopic duct clearance. Intraoperative cholangiography (IOC) is not performed at the subsequent laparoscopic cholecystectomy. This study aimed to investigate the rate of successful duct clearance after simple transcystic manipulations. METHODS: This prospective study investigated 1,408 patients over 13 years in a unit practicing single-session management of biliary calculi. For the great majority, IOC was attempted. Abnormalities were dealt with by flushing of the duct, glucagon injection, Dormia basket trawling, choledochoscopic transcystic exploration, or choledochotomy. RESULTS: Of 1,056 cholangiograms performed (75%), 287 were abnormal (27.2%). Surgical trainees, operating under supervision, successfully performed 24% of all cholangiograms. Of 396 patients admitted with biliary emergencies, 94.1% had abnormal cholangiograms. Of the 287 patients with abnormal IOCs, 9.4% required no intervention, 18% were clear after glucagon and flushing, and 13% were cleared using Dormia basket trawling under fluoroscopy. A total of 95 patients required formal LBDE, and 2 required postoperative endoscopic retrograde cholangiopancreatography (ERCP). No postoperative ERCP for retained stones was required after simple transcystic manipulation. Eight conversions occurred, one during a transcystic exploration. Follow-up evaluation continued for as long as 6 years in some cases. Two patients had recurrent stones after LBDE and a clear postoperative tube cholangiogram. CONCLUSION: In this series, 10% of the abnormal cholangiograms occurred in patients without preoperative risk factors for bile duct stones. Altogether, 88 IOCs (31%) were cleared after either simple flushing or trawling with a Dormia basket. Formal LBDE was not required for 40% of abnormal cholangiograms. Simple transcystic manipulations to clear the bile ducts justify the use of routine IOC in units without laparoscopic biliary expertise.

Wettability of calcite and mica modified by different long-chain fatty acids (C18 acids).

The effect of long-chain fatty acid adsorption on the wetting states of calcite and mica powders is investigated. The selected long-chain fatty acids are saturated or unsaturated aliphatic acids (stearic acid and oleic acid, respectively) and naphthenic acids with saturated or unsaturated aromatic rings (18-cyclohexyloctadecanoic acid and 18-phenoloctadecanoic acid, respectively). The amount of irreversibly adsorbed acid is determined by thermogravimetric analysis. The affinity of water and n-decane for these samples before and after modification is deduced from their adsorption isotherm and microcalorimetry. Thermodynamic analysis of surface pressure and spreading tension are performed based on adsorption isotherms. The enthalpy versus coverage curve for water adsorption and its comparison to liquefaction enthalpy is shown to be a meaningful method for characterizing the wettability of a surface. The naphthenic acid with unsaturated aromatic ring deeply modifies the calcite to an oil-wet state. The mica powder was not as strongly modified as calcite by these acid molecules.

From Zirconium Nanograins to Zirconia Nanoneedles.

Combinations of three simple techniques were utilized to gradually form zirconia nanoneedles from zirconium nanograins. First, a physical vapor deposition magnetron sputtering technique was used to deposit pure zirconium nanograins on top of a substrate. Second, an anodic oxidation was applied to fabricate zirconia nanotubular arrays. Finally, heat treatment was used at different annealing temperatures in order to change the structure and morphology from nanotubes to nanowires and subsequently to nanoneedles in the presence of argon gas. The size of the pure zirconium nanograins was estimated to be approximately 200-300 nm. ZrO2 nanotubular arrays with diameters of 70-120 nm were obtained. Both tetragonal and monoclinic ZrO2 were observed after annealing at 450 °C and 650 °C. Only a few tetragonal peaks appeared at 850 °C, while monoclinic ZrO2 was obtained at 900 °C and 950 °C. In assessing the biocompatibility of the ZrO2 surface, the human cell line MDA-MB-231 was found to attach and proliferate well on surfaces annealed at 850 °C and 450 °C; however, the amorphous ZrO2 surface, which was not heat treated, did not permit extensive cell growth, presumably due to remaining fluoride.