Randomized clinical trial of mesh fixation with glue or sutures for Lichtenstein hernia repair.

BACKGROUND: Pain is the most likely reason for delay in resuming normal activities after groin hernia repair. The primary aim of this study was to determine whether the use of glue to fix the mesh instead of sutures reduced acute postoperative pain after inguinal hernia repair. Secondary objectives were to compare postoperative complications, chronic pain and early recurrence rates during 1-year follow-up. METHODS: Some 370 patients who underwent Lichtenstein hernia repair were randomized to receive either glue (Histoacryl®) or non-absorbable polypropylene sutures for fixation of lightweight polypropylene mesh. Postoperative complications, pain and recurrence were evaluated by an independent blinded observer. RESULTS: Postoperative pain at 8 h, 24 h, 7 days and 30 days was less when glue was used instead of sutures for all measures (P < 0·001). The operation was significantly quicker using glue (mean(s.d.) 35·3(8·7) min versus 39·9(11·1) min for sutures; P < 0·001). There were no significant differences between the groups in terms of postoperative complications, chronic pain and early recurrence at 1-year follow-up. CONCLUSION: Atraumatic mesh fixation with glue was quicker and resulted in less acute postoperative pain than sutures for Lichtenstein hernia repair. Registration number: NCT02632097 (http://www.clinicaltrials.gov).

Severe XLP Phenotype Caused by a Novel Intronic Mutation in the SH2D1A Gene.

We describe here a novel c.137 + 5G > A intronic mutation in the SH2D1A gene of the signaling lymphocyte activation molecule (SLAM)-associated protein (SAP) in association with Epstein-Barr virus (EBV)-induced fatal infectious mononucleosis (FIM) in an 8-year-old male patient and his 3-year-old step brother. The mother and the maternal grandmother of the boys are healthy and heterozygous for this sequence variant. Genetic sequencing of blood-cell-derived cDNA in the younger patient revealed a 22 bp deletion in the SH2D1A cDNA. Immunoblot and flow cytometry analysis performed in this younger patient showed the lack of SAP protein expression in peripheral blood lymphocytes. These data suggest that the novel c.137 + 5G > A mutation results in loss of function of SAP protein and leads to typical X-linked lymphoproliferative disease phenotype. We propose that intron 1 and the c.137 + 5G may be the most frequent intronic hot spot for SH2D1A splicing mutation.

Assessment of morphological and molecular similarity of Hungarian white grape varieties.

The aim of this paper was to find possible link between molecular and morphological similarities of 38 Hungarian white grape varieties. Three aspects of morphological and molecular similarity were assessed in the study: comparison of the ordered variety pairs, assessment of molecular and morphological mean similarity differences and separation of varieties into similar groups by divisive cluster analysis to define (DIANA). Molecular similarity was calculated from binary data based on allele sizes obtained in DNA analysis. DNA fingerprints were determined at 9 SSR loci recommended by the European GrapeGen06 project. Morphological similarity was calculated on the basis of quantitative morphological descriptors. Morphological and molecular similarity values were ordered and categorized after pairwise comparison. Overall correlation was found to be weak but case by case assessment of the variety pairs confirmed some coincidence of molecular and morphological similarity. General similarity position of each variety was characterized by Mean Similarity Index (MSI). It was calculated as the mean of n-1 pair similarity values of the variety concerned. Varieties were ordered and compared by the difference of the index. Five varieties had low morphological and high molecular MSI meaning that they share several SSR marker alleles with the others but seems relatively distinct according to the expression of their morphological traits. Divisive cluster analysis was carried out to find similar groups. Eight and twelve cluster solutions proved to be sufficient to distinct varieties. Morphological and molecular similarity groups partly coincided according to the results. Several clusters reflected parent offspring relations but molecular clustering gave more realistic results concerning pedigree.

Beneficial Effect of a Fermented Wheat Germ Extract in Intestinal Epithelial Cells in case of Lipopolysaccharide-Evoked Inflammation.

In this study, the protective effect of a fermented wheat germ extract (FWGE) against LPS-induced inflammation and oxidative stress in IPEC-J2 porcine intestinal epithelial cells was studied. Enterocytes were treated with LPS derived from Salmonella enterica ser. Typhimurium and Escherichia coli O55:B5, O111:B4, and O127:B8 strains. Intracellular ROS level and extracellular H2O2 level were followed up by two fluorescent assays (DCFH-DA and Amplex Red). The effect of FWGE on the intestinal barrier integrity was determined by transepithelial electric resistance measurements and using a FD4 fluorescent tracer dye. IL-6 concentration of supernatants was also measured by the ELISA method. Our data revealed that FWGE had a significant lowering effect on the inflammatory response especially related to oxidative stress. Treatment with FWGE (1-2%) significantly decreased the level of intracellular ROS compared to LPS-treated cells. Furthermore, LPS-triggered partial disruption of epithelial integrity was reduced after FWGE application.

High level of anticholesterol antibodies (ACHA) in HIV patients. Normalization of serum ACHA concentration after introduction of HAART.

Anticholesterol antibodies (ACHA) are natural antibodies against the 3beta-OH group of cholesterol. Since lipid disorders are common in HIV infection and HAART may further enhance dislipidaemia, we determined by using an ELISA method serum ACHA concentrations in HIV patients and healthy HIV-seronegative controls. ACHA levels were almost 4 times higher in the sera of 46 patients than in 110 controls. No difference in the specificity of ACHA was found between HIV-seropositive and HIV-seronegative sera. Binding of ACHA to cholesterol-coated plates from a HIV-seropositive serum was dose-dependently inhibited by preincubation with HIV-1(BA-L) preparation. Serum concentration of ACHA was significantly higher in the patients with low serum cholesterol levels than in those with normal cholesterol levels. HAART induced a marked drop of ACHA concentration. We found a significant negative correlation between the length of HAART and the ACHA levels. By contrast, HAART did not significantly influence total IgG concentration and titers of antibodies against 60 kD heat shock protein. Our findings indicate that high levels of ACHA in HIV-infection may contribute to the development of hypocholesterolaemia frequently observed in this disease.

Changes in tear protein pattern after photorefractive keratectomy.

PURPOSE: Changes in tear protein composition of patients who underwent photorefractive keratectomy (PRK) were analyzed. METHODS: Tear samples were obtained from 23 eyes of 23 patients immediately before PRK and on the fourth postoperative day with glass capillaries. Tear proteins were separated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. Digital image analysis and evaluation of the densitometric data of the electrophoretic separations were done with BioDoc-Analyze. RESULTS: Analysis of discriminance found a significant difference in the protein patterns (p < 0.001). This type of analysis of the electrophoretic densitographs uses all peak information simultaneously. A significant decrease (p < 0.005) in three of the main protein peaks--lactoferrin, immunoglobulin A heavy chain, and lysozyme--was also found after PRK. CONCLUSIONS: Excimer laser ablation of the cornea has an acute effect on lacrimal gland protein secretion. Changes in tear composition may lead to feelings of dryness and to a decrease in tear film stability postoperatively.

[Positron emission tomography using 18-FDG-PET in radiologically indeterminate pulmonary lesions]. / Tomografía por emisión de positrones mediante PET-18FDG en lesiones pulmonares radiológicamente indeterminadas.

OBJECTIVE: Fluorine-18 deoxyglucose Positron Emission Tomography (FDG-PET) is a non-invasive technique that offers the possibility to define if the radiologically indetermined pulmonary lesions are benign or malignant with high positive and negative predictive values. Considering the indexed literature we can observe that there are few original studies performed with the diagnostic possibilities of our means. For this reason, our main objective is to evaluate the diagnostic accuracy of positron emission tomography in sixty-seven radiologically indetermined pulmonary nodular lesions. MATERIAL AND METHOD: Retrospectively, we evaluated the diagnostic ability of FDG-PET globally (by means of visual and semiquantitative analysis) and partially (only considering the Standardized Uptake Value (SUV)), in sixty-seven patients confirmed by pathology or clinical and radiological monitoring, in a time interval superior to one year. RESULTS: Globally, FDG-PET had a sensitivity (S) of 92%, specificity (SP) of 86.6%, positive predictive value (PPV) of 89.4%, negative predictive value (NPV) of 89.6% and diagnostic accuracy (DA) of 89%. The best results were obtained for an SUV equal or superior to 2.5. With this value, the clinical efficacy parameters were: S 0.92, SP 0.90, PPV 0.92, NPV 0.90 and DA 0.91. CONCLUSIONS: We can characterize most of the radiologically indetermined pulmonary lesions by FDG-PET. The additional use of SUV facilitates an increase in the positive predictive value and specificity of FDG-PET.

[Role of glycosaminoglycans in the pathogenesis of vertebral osteochondrosis (clinico-experimental study)]. / O roli glikozaminoglikanov v patogeneze osteokhondroza pozvonochnika (kliniko-éksperimental'nye issledovaniia).

Glycosaminoglycans (GAGs) and their fractions were measured in relation to age. The material for examination consisted of labile intervertebral disks (27 cases) obtained during operations for discogenic lumbosacral radiculites and disks obtained from people (n = 35) who had died in accidents. The findings showed marked deviations in the total GAGs and their fractions in labile disks, which differed from age-specific changes. The changes revealed in animals with cholesterol atherosclerosis (50 rabbits) and chronic papain degeneration (56 rabbits) resembled those characteristic of vertebral osteochondrosis. It is concluded that degenerative dystrophic changes in osteochondrosis may be induced by both atherosclerotic process and an elevated activity of lysosome enzymes.

[Exercise training of patients in a health resort after surgery for rheumatic heart disease]. / Fizicheskie trenirovki na terrenkure bol'nykh, operirovannykh po povodu revmaticheskikh porokov serdtsa.

We studied the effect of cardiovascular system function on the response to terrain cure in the course of rehabilitation of 88 patients after surgical correction of valvular defects in conditions of low-mountain health resort. We have found that the response to the above exercise depends on functional condition of the cardiovascular system (the degree of correction of hemodynamic disorders related to valvular disease, the degree of myocardial hypertrophy and dilation of the chambers, left ventricular contractility). Terrain cure exercise promotes improvement in regulation of cardiovascular system and mobilization of its reserves.

[Changes in cardiovascular function of ischemic heart disease patients on the course of rehabilitation at low-mountain health resort after surgical revascularization of myocardium]. / Dinamika funktsional'nogo sostoianiia serdechno-sosudistoi sistemy v protsesse reabilitatsii na nizkogornom kyrorte bol'nykh ishemicheskoi bolezn'iu serdtsa posle khirurgicheskoi revaskuliarizatsii miokarda.

Sanatorium treatment at low-mountain resort of IHD-patients subjected to surgical revascularization brought an increase in exercise tolerance, a positive trend in ECG parameters, improvement in left ventricular myocardial contractility. The benefit is especially pronounced in patients with IHD of functional class I, II and normal contractility of the left ventricular myocardium.

[The role of carbonate mineral baths in the total health-resort treatment complex and the mechanisms of their effect on patients with ischemic heart disease who have had an aortocoronary bypass]. / Rol' mineral'nykh uglekislykh vann v obshchem komplekse kurortnogo lecheniia i mekhanizmy ikh vliianiia na bol'nykh ishemicheskoi bolezn'iu serdtsa, perenesshikh aortokoronarnoe shuntirovanie.

The data obtained by the authors demonstrate a favourable effect of effervescent baths on coronary heart disease patients who have undergone aortocoronary shunt. The baths have a training effect on the cardiac muscle, improve coronary circulation autoregulation and stimulate basic metabolism.

[Carbonate mineral baths in the combined treatment at a piedmont health resort of patients operated on for rheumatic heart defects]. / Mineral'nye uglekislye vanny v kompleksnom lechenii na nizkogornom kurorte bol'nykh, operirovannykh po povodu revmaticheskikh porokov serdtsa.

The response of the cardiovascular system of 64 patients operated for rheumatic heart disease to mineral carbon dioxide baths was studied in the course of rehabilitation in low-mountain health resort. It was found that the above baths have a training effect on the cardiac muscle, improve myocardial metabolism. They are an essential factor in combined sanatorium treatment of patients after surgical correction of valvular defects. Baths-induced changes in the central and peripheral hemodynamics depend on cardiovascular function. Therefore, they require an individual approach. If the exposition increases to 15 minutes, mineral carbon dioxide baths have more potent training effect on the myocardium and raise effectiveness of the sanatorium treatment.

[Changes in lipoprotein metabolism during the rehabilitation of ischemic heart disease patients after aortocoronary bypass at a health resort in the foothills]. / Izmenenie obmena lipoproteidov pri reabilitatsii bol'nykh ishemicheskoi bolezn'iu serdtsa posle aortokoronarnogo shuntirovaniia v usloviiakh nizkogornogo kurorta.

284 patients with IHD after coronary artery bypass operation have undergone rehabilitation at low-mountain health resort Kislovodsk. The study of lipoprotein metabolism has detected a positive trend in this metabolism as shown by lowering of blood cholesterol, low density lipoproteins, phospholipids and triglycerides, elevated levels of high density lipoproteins.

[The terrain cure under moderate altitude hypoxia in the combined sanatorium-health resort treatment of patients with ischemic heart disease after aortocoronary bypass]. / Terrenkur v usloviiakh umerennoi vysotnoi gipoksii v kompleksnom sanatorno-kurortnom lechenii bol'nykh ishemicheskoi bolezn'iu serdtsa posle aortokoronarnogo shuntirovaniia.

Muscular exercise in the form of terrain walking proved to be a useful component of combined conditioning of coronary heart disease patients after aortocoronary shunt functional class 1 and 2. In conditions of moderate altitude resort such training mobilizes cardiovascular reserves of CHD patients. The outcome of the above sanatorium rehabilitation depends largely on contractility of left ventricular myocardium.

[The reaction of the cardiovascular system to terrain cure in patients with ischemic heart disease who have undergone surgical myocardial revascularization]. / Reaktsiia serdechno-sosudistoi sistemy na terrenkur u bol'nykh ishemicheskoi bolezn'iu serdtsa, perenesshikh khirurgicheskuiu revaskuliarizatsiiu miokarda.

Muscular training in IHD patients who have undergone surgical revascularization of the myocardium should be planned on the individual basis regarding functional condition of the cardiovascular system. Patients with reduced left ventricular contractility should exercise under Holter ECG monitoring to control episodes of ventricular arrhythmia.

[The dynamic clinical manifestations of ischemic heart disease during the rehabilitation at a low-altitude health resort of patients who have undergone surgical myocardial revascularization]. / Dinamika klinicheskikh proiavlenii ishemicheskoi bolezni serdtsa v protsesse reabilitatsii na nizkogornom kurorte bol'nykh, perenesshikh khirurgicheskuiu revaskuliarizatsiiu miokarda.

Left ventricular myocardial contractility was found essential in dynamics of clinical IHD picture in patients on rehabilitation treatment at low mountain resorts. All the patients have previously undergone surgical myocardial revascularization. Patients with normal left ventricular myocardial contractility benefited most of all.

[Development of external quality control protocol for CyberKnife beams dosimetry: preliminary tests multicentre]. / Développement d'une procédure de contrôle de qualité externe des faisceaux du CyberKnife: étude préliminaire multicentrique.

PURPOSE: To develop an external quality control procedure for CyberKnife(®) beams. This work conducted in Nancy, has included a test protocol initially drawn by the medical physicist of Nancy and Lille in collaboration with Equal-Estro Laboratory. MATERIALS AND METHODS: A head and neck anthropomorphic phantom and a water-equivalent homogeneous cubic plastic test-object, so-called "MiniCube", have been used. Powder and solid thermoluminescent dosimeters as well as radiochromic films have been used to perform absolute and relative dose studies, respectively. The comparison between doses calculated by Multiplan treatment planning system and measured doses have been studied in absolute dose. The dose distributions measured with films and treatment planning system calculations have been compared via the gamma function, configured with different tolerance criteria. RESULTS: This work allowed, via solid thermoluminescent dosimeter measurements, verifying the beam reliability with a reproducibility of 1.7 %. The absolute dose measured in the phantom irradiated by the seven participating centres has shown an error inferior to the standard tolerance limits (± 5 %), for most of participating centres. The relative dose measurements performed at Nancy and by the Equal-Estro laboratory allowed defining the most adequate parameters for gamma index (5 %/2mm--with at least 95 % of pixels satisfying acceptability criteria: γ<1). These parameters should be independent of the film analysis software. CONCLUSION: This work allowed defining a dosimetric external quality control for CyberKnife(®) systems, based on a reproducible irradiation plan through measurements performed with thermoluminescent dosimeters and radiochromic films. This protocol should be validated by a new series of measurement and taking into account the lessons of this work.