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Introduction: Virtual reality is being used more and more in the healthcare field, particularly during treatment. In the context of pain management, the question arises as to the effectiveness of using virtual reality during care in reducing the perception of procedural pain., Aim: To study the impact of using virtual reality on the perception of procedural pain and on the course of care in pediatric oncology., Methods: A quasi-experimental, matched-case-control study conducted at the pediatric oncology unit of the Tunis Children's Hospital over a three-month period. Each child had two nursing care : with and without the use of virtual reality., Results: Thirty-two children were enrolled. The sex ratio was 0.88. The edia nage was 96 ± 49 months. The care provided was peripheral venous line insertion (53%), blood sampling (32%) and port-a-catheter puncture (15%). The use of virtual reality significantly reduced heart rate (p<0.0001), respiratory rate (p<0.0001) and pain perception (p<0.0001). Workload was reduced, as evidenced by a drop in the duration of nursing care (p<0.0001) and in the number of people needed to carry out care (p<0.0001)., Conclusions: Virtual reality is a good non-pharmacological alternative for procedural pain control in a pediatric oncology unit.

The axial functionalization of Subporphyrazines (SubPzs) with unreported alkoxy groups, carboxy and carboperoxy rests, as well as sulfanyl, aryl and amino groups, forming B-O, B-S, B-C, and B-N bonds, respectively, has been investigated. The studied oxygen nucleophiles include aromatic and sterically demanding aliphatic alcohols, along with carboxylic acids and peracids. In general, direct substitution of the chloro-SubPz by oxygen nucleophiles of diverse nature proceeds smoothly, with yields of the isolated alkoxy and carboxy-substituted SubPzs ranging from 49 to 100 %. Conversely, direct substitution with sulphur, carbon and nitrogen nucleophiles do not afford the corresponding substituted SubPzs. In these cases, a stepwise procedure involving an axial triflate-SubPz intermediate was employed, affording only the phenyl-SubPz in 8 % yield. The major compound under these conditions was the unreported SubPz μ-oxo dimer, presumably arising from substitution of the triflate-SubPz by the in situ generated hydroxy-SubPz. This result indicates a quite low reactivity of the TfO-SubPz intermediate with carbon, sulphur and nitrogen nucleophiles. All SubPzs prepared in this work exhibited fluorescence at 510-515 nm with quantum yields ranging from 0.1 to 0.24. Additionally, all SubPzs generated singlet oxygen, with Φ Δ values ranging from 0.15 to 0.57, which show no apparent correlation with the axial substituents., (© 2024 The Authors. ChemPlusChem published by Wiley-VCH GmbH.)

Introduction: Cancer management in Africa faces diverse challenges due to limited resources, health system challenges, and other matters. Identifying hereditary cancer syndromic cases is crucial to improve clinical management and preventive care in these settings. This study aims to explore the clinicopathological features and genetic factors associated with hereditary cancer in Tunisia, a North African country with a rising cancer burden MATERIALS AND METHODS: Clinicopathological features and personal/family history of cancer were explored in 521 patients. Genetic analysis using Sanger and next-generation sequencing was performed for a set of patients RESULTS: Hereditary breast and ovarian cancer syndrome was the most frequent cluster in which 36 BRCA mutations were identified. We described a subgroup of patients with likely ''breast cancer-only syndrome'' among this cluster. Two cases of Li-Fraumeni syndrome with distinct TP53 mutations namely c.638G>A and c.733G>A have been identified. Genetic investigation also allowed the identification of a new BLM homozygous mutation (c.3254dupT) in one patient with multiple primary cancers. Phenotype-genotype correlation suggests the diagnosis of Bloom syndrome. A recurrent MUTYH mutation (c.1143&#95;1144dup) was identified in three patients with different phenotypes CONCLUSION: Our study calls for comprehensive genetic education and the implementation of genetic screening in Tunisia and other African countries health systems, to reduce the burden of hereditary diseases and improve cancer outcomes in resource-stratified settings., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Inc.)

Introduction and Aim: To assess physical activity (PA) and its determinants in breast cancer survivors (BCS), attending a Tunisian hospital, as well as to assess their quality of life (QOL) and examine the relationship between PA and BCS'QOL., Methods: We conducted a cross-sectional study among BCS attending the outpatient oncology, gynecology and radiotherapy clinics at a Tunisian hospital in April 2022 using a self-administered questionnaire. The valid Arabic version of the International Physical Activity. Questionnaire short version was used to assess PA and sitting time. QOL was assessed using the valid Arabic version of the 12-item Short-Form health survey., Results: A total of 95 BCS were recruited. BCS reported overall moderate PA levels with a median MET of 1440 (IQR 680- 2400) minutes/week and a mean total sitting time of 281.79±134.36 minutes/day. Overall, patients aged 50 years and above had significantly lower levels of sitting time (231.43±129.32vs 332.14±121.63, p= 0.04). Similarly, subjects aged 50 years and above, and of rural origin had higher levels of PA (1908.5 (IQR 939.7-3268.5) vs. 1266 (IQR 471-2946), p= 0.114 and 1788.5 (IQR 1072.5-3252) vs. 1440 (IQR 537-3057), p= 0.259 respectively). Regarding BCS'QOL, they showed moderate disability in the physical component (39.3 ±7.08) , and mild disability in the mental component (43.94 ±9.23). BCS' QOL was significantly correlated to PA (r=0,258, p=0,012)., Conclusion: Adherence to regular PA is effective in improving BC patients' survival rate. Therefore, to enhance survivors' QOL, a healthy lifestyle including regular PA is well recommended.

Background: Breast cancer in Tunisia is often diagnosed at a late stage with long delay in time to consultation and to diagnosis.The aim of this study is to estimate the sensitivity and specificity of the transcutaneous breast cancer detection by canine olfactionin Tunisian women and to identify the potential confounding factors., Methods: This is a diagnostic case control study that took place from October 2021 to November 2022 in the Department of Medical Oncology at the University Hospital Farhat Hached of Sousse and in the security and training dog center located in Sousse (K9 Dog Center Security & Training). A two-year-old male Belgian Malinois was trained to detect breast cancer on skin secretion samples in compresses that had been worn overnight by women on their breast and then a double-blind testing was performed. There was no contact between women and the dog. From the mentioned responses of the dog, four parameters were calculated: sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV)., Results: Two hundred women were included in this trial: 100 breast cancer (BC) patients recruited from Farhat Hached University Hospital of Sousse and 100 healthy volunteers (HV).The calculated sensitivity was 84% (95% CI 78-89%) and the calculated specificity was 81% (95% CI 75-86%). The calculated predictive values were: PPV = 83,51% (95% CI 78,37-88,65%) and NPV = 81,55% (95% CI 76.17-86.93%). In the multivariate study, only four confounding factors of test's sensitivity were retained: age (OR = 1.210 [95% CI = 1.085-1.349]; p = 0.001), history of diabetes(OR = 0.017 [95% CI = 0.001-0.228]; p = 0.002), sampling at hospital (OR = 0.010 [95% CI = 0.003-0.464]; p = 0.010) and testing during chemotherapy courses (OR = 0.034 [95% CI = 0.003-0.404]; p = 0.007).For test's specificity, we retained the three following confounding factors: age (OR = 1,104 [95% CI = 1.021-1.195]; p = 0.014), history of benign mastopathy (OR = 0.243 [95% CI = 0.074-0.805]; p = 0.021)and history of arterial hypertension (OR = 0.194 [95% CI = 0.053-0.707]; p = 0.013)., Conclusion: This is a pilot study that opens new avenues in developing a reliable cancer diagnostic tool that integrates the dog's olfactory ability to detect breast cancer using a transcutaneous sampling method. It could be a pre-test to select patients who are eligible to a screening mammogram, especially in low-income countries where there is no national mammography screening program. PACTR., Org Identifier: PACTR202201864472288, registration date 11/01/2022., (© 2024. The Author(s).)

Evolutionary algorithms are a large class of optimization techniques inspired by the ideas of natural selection, and can be employed to address challenging problems. These algorithms iteratively evolve populations using crossover, which combines genetic information from two parent solutions, and mutation, which adds random changes. This iterative process tends to produce effective solutions. Inspired by this, the current study presents the results of thermal variation on the surface of a wetted wavy fin using a genetic algorithm in the context of parameter estimation for artificial neural network models. The physical features of convective and radiative heat transfer during wet surface conditions are also considered to develop the model. The highly nonlinear governing ordinary differential equation of the proposed fin problem is transmuted into a dimensionless equation. The graphical outcomes of the aspects of the thermal profile are demonstrated for specific non-dimensional variables. The primary observation of the current study is a decrease in temperature profile with a rise in wet parameters and convective-conductive parameters. The implemented genetic algorithm offers a powerful optimization technique that can effectively tune the parameters of the artificial neural network, leading to an enhanced predictive accuracy and convergence with the numerically obtained solution.

The present research focuses on the significance of thermophoretic particle deposition on a ZnO-SAE50 nanolubricant flow in a stretchable/shrinkable convergent/divergent channel in the presence of an applied magnetic field and nonlinear heat radiation. A parameter in the governing differential equations and wall boundary conditions defines the physical mechanism of the model. The Galerkin finite element method, combined with similarity transformation, is adopted to solve the governing equations. The Levenberg-Marquardt backpropagating algorithm of an artificial neural network model forecasts heat and mass transfer properties. The results reveal that by stretching/shrinking the walls enough, the classical flow and heat properties are significantly affected. The stretching of the convergent or divergent channel is observed to increase the velocity profiles, whilst shrinking results in backflow regions. In terms of the temperature field, stretching causes more heat to be produced in the flow; nevertheless, the thermal layer is decreased and cooling is attained by channel shrinkage, which may have important technical implications., Competing Interests: There are no conflicts to declare., (This journal is © The Royal Society of Chemistry.)

Non-Newtonian fluids have unique heat transfer properties compared to Newtonian fluids. The present study examines the flow of a Maxwell nanofluid across a rotating rough disk under the effect of a magnetic field. Furthermore, the Cattaneo-Christov heat flux model is adopted to explore heat transport features. In addition, a comparison of fluid flow without and with aggregation is performed. Using similarity variables, the governing partial differential equations are transformed into a system of ordinary differential equations, and this system is then solved by employing the Runge-Kutta Fehlberg fourth-fifth order method to obtain the numerical solution. Graphical depictions are used to examine the notable effects of various parameters on velocity and thermal profiles. The results reveal that an increase in the value of Deborah number decreases the velocity profile. An increase in the thermal relaxation time parameter decreases the thermal profile. An artificial neural network is employed to calculate the rate of heat transfer and surface drag force. The R values for skin friction and Nusselt number were computed. The results demonstrate that artificial neural networks accurately predicted skin friction and Nusselt number values., Competing Interests: There are no conflicts to declare., (This journal is © The Royal Society of Chemistry.)

Purpose: Over the past years, there has been a considerable increase in complementary and alternative medicine (CAM) use among cancer patients. However, guidance from health care workers (HCWs) is not always provided. We aimed to determine the knowledge, attitude and practice of Tunisian HCWs regarding the use of CAM in cancer patients., Methods: We conducted a multicenter cross-sectional study over 5 months from February to June 2022 among HCWs caring for cancer patients in the Tunisian center region. Data were collected using a self-administered questionnaire developed by our investigators., Results: The level of knowledge about CAM was declared limited by 78.4% of our population. The best known CAM therapies were herbal medicine and homeopathy while chiropractic and hypnosis where the least. HCWs who had sought information on CAM represented 54.3% of our sample and the main source of information was the Internet (37.1%). A positive attitude towards the use of CAM was found in 56% of HCWs. The integration of CAM into supportive care in oncology was approved by 78% of HCWs. Concerning training on CAM, 78% declared its necessity for HCWs and 73.3% expressed a desire to have it. A personal use of CAM was found in 53% of HCWs while 38.8% had previously used CAM in the treatment of their cancer patients., Conclusion: The majority of HCWs had a positive attitude towards the use of CAM in oncology despite their poor knowledge about it. Our study emphasizes the need to train HCWs dealing with cancer patients on CAM., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Colorectal cancer (CRC) is the third most common cancer and the fourth leading cause of cancer death. 5-Fluorouracil (5-FU) is an essential component of systemic chemotherapy for CRC. Our objective was to determine the genotypic frequency of polymorphisms affecting dihydropyrimidine dehydrogenase ( DPYD ) and thymidylate synthetase ( TYMS ) genes and to correlate the genetic profile with the toxicity due to 5-FU, also considering nongenetic factors. This is a prospective study that involved 66 patients. We extracted DNA by salting out methods. We carried out the genotyping of the different polymorphisms by simple PCR for the TYMS 5'UTR and by PCR-RFLP for DPYD : 1905 + 1 G > A, 85 T > C, 496 A > G, 1679 T > G, c.483 + 18G > A and the TYMS : 5'UTR VNTR, 5'UTR G > C and 3'UTR. The study of the association of DPYD and TYMS polymorphisms with the various signs of toxicity under 5-FU revealed that the polymorphisms 496 A > G were significantly associated with hepatotoxicity: OR =  3.85 (p = 0.04). In addition, 85 T > C was significantly associated with mucositis and neurotoxicity: OR =  4.35 (p = 0.03), OR =  3.79 (p = 0.02). For TYMS, the only significant association we observed for 5'UTR with vomiting: OR =  3.34 (p = 0.04). The incidence of adverse reactions related to 5-FU appears to be influenced in patients with CRC by the identified DPYD and TYMS gene polymorphisms in the Tunisian population.

Purpose: Colon cancer survivors can experience several post-treatment consequences that include fatigue and often report severe psychological illnesses such as depression or anxiety. There is little published quantitative data on the quality of life and psychological well-being associated with the health of Tunisian colon cancer survivors., Methods: A total of 60 recovering colon cancer patients underwent a structured interview, which included the Hospital Anxiety and Depression (HADS) scale, the Piper fatigue scale and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30)., Results: Patients were 59.26 years old on average. The median length of remission was 33.3 months. Surgery was performed on all patients, followed by 96.7% adjuvant chemotherapy. 15.1% of study participants were in the severe category for the depression score and 10% were in this category for the anxiety score. Ninety-one percent reported pathological fatigue scores on the Piper scale. However, only 8.33% were experiencing severe fatigue. According to the QLQ-C30 assessment, the overall quality of life was slightly impaired with an overall average score of 79.54 ± 16.98. Anxiety, depression and fatigue negatively affect global health outcomes and all their dimensions., Conclusion: Even in the recovery phase, colon cancer patients can see their quality of life deteriorate. It comes out of their psychological experience and their physical life. It is, therefore, crucial to provide greater attention to these patients for holistic and multi-disciplinary care., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: Quality of life (QOL) of colorectal cancer (CRC) patients has been little studied in Tunisia. The aim of this work was to evaluate the QOL of CRC patients and to identify factors that may influence it., Methods: A cross-sectional, study spread was made over a period of 6 months on patients with CRC treated in the department of Medical Oncology of Farhat Hached University Hospital of Sousse. The EORTC questionnaires translated and validated in Arabic (QLQ-C30 and QLQ-CR29) were used., Results: 142 patients diagnosed with colon or rectal cancer were enrolled. The overall QOL score was 58.5 ± 29.1. The emotional and sexual functional dimensions were the most affected, especially in women and patients under 50 years of age. QOL scores were higher in patients who were in complete remission (71.4 ± 24.7) and in good general condition (63.7 ± 26.6) physical activity may have a significant influence on all functional dimensions of QOL (p < 0.001). Fatigue was significantly (p < 0.001) more present when there was a sedentary lifestyleradiotherapy, palliative chemotherapy (1st and 2nd line) and targeted therapy., Conclusion: Evaluating quality of life of patients with colorectal cancer in Tunisia is necessary especially those under 50 years old and in women. Laparoscopic surgery with restoration of intestinal continuity, less toxic palliative chemotherapy protocols, more accessibility to new radiotherapy technics will improve QOL of CRC patients. Physical activity and nutrition support are also essential in promoting QOL of these patients., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Lynch syndrome is a heritable condition caused by a heterozygous germline inactivating mutation of the DNA mismatch repair (MMR) genes, most commonly the MLH1 gene. However, one third of the identified alterations are missense variants, for which the clinical significance is unclear in many cases. We have identified three MLH1 missense alterations (p.(Glu736Lys), p.(Pro640Thr) and p.(Leu73Pro)) in six individuals from large Tunisian families. For none of these alterations, a classification of pathogenicity was available, consequently diagnosis, predictive testing and targeted surveillance in affected families was impossible. We therefore performed functional laboratory testing using a system testing stability as well as catalytic activity that includes clinically validated reference variants. Both p.(Leu73Pro) and p.(Pro640Thr) were found to be non-functional due to severe defects in protein stability and catalytic activity. In contrast, p.(Glu736Lys) was comparable to the wildtype protein and therefore considered a neutral substitution. Analysis of residue conservation and of the structural roles of the substituted residues corroborated these findings. In conjunction with the available clinical data, two variants fulfil classification criteria for class 4 "likely pathogenic". The findings of this work clarify the mechanism of pathogenicity of two unclear MLH1 variants and enables predictive testing and targeted surveillance in members of carrier families worldwide., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2022 Mahdouani et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Purpose: Carotid artery stenting (CAS) appears as a promising alternative treatment to carotid endarterectomy for radiation therapy (RT)-induced carotid stenosis. However, this is based on a poor level of evidence studies (small sample size, primarily single institution reports, few long-term data). The purpose of this study was to report the long-term outcomes of a multicentric series of CAS for RT-induced stenosis., Methods: All CAS for RT-induced stenosis performed in 11 French academic institutions from 2005 to 2017 were collected in this retrospective study. Patient demographics, clinical risk factors, elapsed time from RT, clinical presentation and imaging parameters of carotid stenosis were preoperatively gathered. Long-term outcomes were determined by clinical follow-up and duplex ultrasound. The primary endpoint was the occurrence of cerebrovascular events during follow-up. Secondary endpoints included perioperative morbidity and mortality rate, long-term mortality rate, primary patency, and target lesion revascularization., Results: One hundred and twenty-one CAS procedures were performed in 112 patients. The mean interval between irradiation and CAS was 15 ± 12 years. In 31.4% of cases, the lesion was symptomatic. Mean follow-up was 42.5 ± 32.6 months (range 1-141 months). The mortality rate at 5 years was 23%. The neurologic event-free survival and the in-stent restenosis rates at 5 years were 87.8% and 38.9%, respectively. Diabetes mellitus (p=0.02) and single postoperative antiplatelet therapy (p=0.001) were found to be significant predictors of in-stent restenosis. Freedom from target lesion revascularization was 91.9% at 5 years., Conclusion: This study showed that CAS is an effective option for RT-induced stenosis in patients not favorable to carotid endarterectomy. The CAS was associated with a low rate of neurological events and reinterventions at long-term follow-up.

Objectives: Aberrant subclavian artery (ASCA) occurs rarely but is one of the most frequent anatomical variations of the supra-aortic trunks. No consensus has been established on its best treatment. The goal of this study was to report the outcomes of ASCA treated by the hybrid approach., Methods: This non-interventional retrospective multicentre analysis included patients treated for ASCA by the hybrid approach in 12 French university hospitals between 2007 and 2019. The hybrid approach was defined as an endovascular procedure combined with open surgery or a hybrid stent graft. Patients were divided in 4 groups (from less to more complex treatment). The primary end point was 30-day mortality. The secondary end points were 30-day complications and late mortality., Results: This study included 43 patients. The mean age was 65 (SD, standard deviation: 16) years. Symptoms were found in 33 patients. Subclavian revascularization combined with aberrant subclavian artery occlusion was undertaken in 13 patients. Unilateral and bilateral subclavian revascularization combined with a thoracic aortic stent graft was undertaken in 11 and 6 patients, respectively. Total aortic arch repair combined with a thoracic aortic stent graft was undertaken in 13 patients. Thirty-day mortality was 2.3% with a technical success rate of 95.3%. The 30-day major postoperative complication rate was 16.3%: 4 strokes, 2 tamponades, 1 acute respiratory distress syndrome. Mean follow-up was 56.3 (SD: 44.7) months. The late mortality was 18.6%., Conclusions: The ASCA hybrid approach is feasible, safe and effective with low early mortality. Morbidity is rather high. However, it increases with the complexity of the hybrid approach, which should be kept as simple as possible if the anatomical morphology allows., (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.)

The formation of polysubstituted cyclopropane derivatives in the gold(I)-catalyzed reaction of olefins and propargylic esters is a potentially useful transformation to generate diversity, therefore any method in which its stereoselectivity could be controlled is of significant interest. We prepared and tested a series of chiral gold(I)-carbene complexes as a catalyst in this transformation. With a systematic optimization of the reaction conditions, we were able to achieve high enantioselectivity in the test reaction while the cis:trans selectivity of the transformation was independent of the catalyst. Using the optimized conditions, we reacted a series of various olefins and acetylene derivatives to find that, although the reactions proceeded smoothly and the products were usually isolated in good yield and with good to exclusive cis selectivity, the observed enantioselectivity varied greatly and was sometimes moderate at best. We were unable to establish any structure-property relationship, which suggests that for any given reagent combination, one has to identify individually the best catalyst.

Objective: A crucial step in designing fenestrated stent grafts for treatment of complex aortic abdominal aneurysms is the accurate positioning of the fenestrations. The deployment of a fenestrated stent graft prototype in a patient-specific rigid aortic model can be used for design verification in vitro, but is time and human resources consuming. Numerical simulation (NS) of fenestrated stent graft deployment using the finite element analysis has recently been developed; the aim of this study was to compare the accuracy of fenestration positioning by NS and in vitro., Methods: All consecutive cases of complex aortic abdominal aneurysm treated with the Fenestrated Anaconda (Terumo Aortic) in six European centers were included in a prospective, observational study. To compare fenestration positioning, the distance from the center of the fenestration to the proximal end of the stent graft (L) and the angular distance from the 0° position (C) were measured and compared between in vitro testing (L1, C1) and NS (L2, C2). The primary hypothesis was that ΔL (|L2 - L1|) and ΔC (|C2 - C1|) would be 2.5 or less mm in more than 80% of the cases. The duration of both processes was also compared., Results: Between May 2018 and January 2019, 50 patients with complex aortic abdominal aneurysms received a fenestrated stent graft with a total of 176 fenestrations. The ΔL and ΔC was 2.5 mm or less for 173 (98%) and 174 (99%) fenestrations, respectively. The NS process duration was significantly shorter than the in vitro (2.1 days [range, 1.0-5.2 days] vs 20.6 days [range, 9-82 days]; P < .001)., Conclusions: Positioning of fenestrations using NS is as accurate as in vitro and could significantly decrease delivery time of fenestrated stent grafts., (Copyright © 2021 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)

Background: Breast cancer is the world's most common cancer among women. It is becoming an increasingly urgent problem in low- and middle-income countries (LMICs) where a large fraction of women is diagnosed with advanced-stage disease and have no access to treatment or basic palliative care. About 5-10% of all breast cancers can be attributed to hereditary genetic components and up to 25% of familial cases are due to mutations in BRCA1 /2 genes. Since their discovery in 1994 and 1995, as few as 18 mutations have been identified in BRCA genes in the Tunisian population. The aim of this study is to identify additional BRCA mutations, to estimate their contribution to the hereditary breast and ovarian cancers in Tunisia and to investigate the clinicopathological signatures associated with BRCA mutations., Methods: A total of 354 patients diagnosed with breast and ovarian cancers, including 5 male breast cancer cases, have been investigated for BRCA1/2 mutations using traditional and/or next generation sequencing technologies. Clinicopathological signatures associated with BRCA mutations have also been investigated., Results: In the current study, 16 distinct mutations were detected: 10 in BRCA1 and 6 in BRCA2 , of which 11 are described for the first time in Tunisia including 3 variations that have not been reported previously in public databases namely BRCA1 &#95;c.915T>A; BRCA2 &#95;c.-227-?&#95;7805+? and BRCA2 &#95;c.249delG. Early age at onset, family history of ovarian cancer and high tumor grade were significantly associated with BRCA status. BRCA1 carriers were more likely to be triple negative breast cancer compared to BRCA2 carriers. A relatively high frequency of contralateral breast cancer and ovarian cancer occurrence was observed among BRCA carriers and was more frequent in patients carrying BRCA1 mutations., Conclusion: Our study provides new insights into breast and ovarian cancer genetic landscape in the under-represented North African populations. The prevalence assessment of novel and recurrent BRCA1/2 pathogenic mutations will enhance the use of personalized treatment and precise screening strategies by both affected and unaffected North African cancer cases., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Hamdi, Mighri, Boujemaa, Mejri, Ben Nasr, Ben Rekaya, Messaoud, Bouaziz, Berrazega, Rachdi, Jaidane, Daoud, Zribi, Ayari, El Benna, Labidi, Ben Hassouna, Haddaoui, Rahal, Benna, Mrad, Ben Ahmed, Boussen, Boubaker and Abdelhak.)

In this work, we describe the CRIMSON (CardiovasculaR Integrated Modelling and SimulatiON) software environment. CRIMSON provides a powerful, customizable and user-friendly system for performing three-dimensional and reduced-order computational haemodynamics studies via a pipeline which involves: 1) segmenting vascular structures from medical images; 2) constructing analytic arterial and venous geometric models; 3) performing finite element mesh generation; 4) designing, and 5) applying boundary conditions; 6) running incompressible Navier-Stokes simulations of blood flow with fluid-structure interaction capabilities; and 7) post-processing and visualizing the results, including velocity, pressure and wall shear stress fields. A key aim of CRIMSON is to create a software environment that makes powerful computational haemodynamics tools accessible to a wide audience, including clinicians and students, both within our research laboratories and throughout the community. The overall philosophy is to leverage best-in-class open source standards for medical image processing, parallel flow computation, geometric solid modelling, data assimilation, and mesh generation. It is actively used by researchers in Europe, North and South America, Asia, and Australia. It has been applied to numerous clinical problems; we illustrate applications of CRIMSON to real-world problems using examples ranging from pre-operative surgical planning to medical device design optimization., Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: CAF and CA are Members of CRIMSON Technologies LLC, a company established to support the future development of CRIMSON.

Scurvy is one of the oldest diseases known to mankind. Although rare lately, the clinical suspicion arises in front of a precarious situation or deficient nutrition and food restriction secondary to a psychiatric condition, even in patients with non-specific complaints. We report the observation of a 6 -year- old boy, followed for autism since the age of 3 years and who was admitted for limping, hemorrhagic syndrome, arthritis and weakness. The diagnosis of child abuse was initially suspected but clinical and radiological abnormalities seen were characteristic of scurvy. Vitamin C level was undetectable. The child had an unbalanced diet.A favorable outcome was rapidly obtained following supplementation. Scurvy is rare, but it should be mentioned among children with psychiatric disorders, presenting with musculoskeletal manifestations or hemorrhagic syndrome. It is essential to prevent it by systematic dietary supplementation of vitamin C in children with eating difficulties.

Objective: The chimney technique (ChEVAR) allows for proximal landing zone extension for endovascular repair of complex aortic aneurysms. The aim of the present study was to assess ChEVAR national outcomes in French university hospital centres., Methods: All centres were contacted and entered data into a computerised online database on a voluntary basis. Clinical and radiological data were collected on all consecutive ChEVAR patients operated on in 14 centres between 2008 and 2016. Patients were deemed unfit for open repair. Factors associated with early (30 day or in hospital) mortality and type 1 endoleak (Type I EL) were calculated using multivariable analysis., Results: In total, 201 patients with 343 target vessels were treated. There were 94 juxtarenal (46.8%), 67 pararenal (33.3%), 10 Crawford type IV thoraco-abdominal (5%) aneurysms, and 30 (15.1%) proximal failures of prior repairs. The pre-operative diameter was 66.8 ± 16.7 mm and 28 (13.9%) ChEVAR were performed as an emergency, including six (2.9%) ruptures. There were 23 (11.7%) unplanned intra-operative procedures, mainly related to access issues. The rate of early deaths was 11.4% (n = 23). The elective mortality rate was 9.8% (n = 17). Nine patients (4.5%) presented with a stroke. The rate of early proximal Type I EL was 11.9%. Survival was 84.6%, 79.4%, 73.9%, 71.1% at 6, 12, 18, and 24 months, respectively. The primary patency of chimney stents was 97.4%, 96.7%, 95.2%, and 93.3% at 6, 12, 18, and 24 months, respectively. Performing unplanned intra-operative procedures (OR 3.7, 95% CI 1.3-10.9) was identified as the only independent predictor of post-operative death. A ChEVAR for juxtarenal aneurysm was independently associated with fewer post-operative Type I ELs (OR 0.17, 95% CI 0.05-0.58)., Conclusion: In this large national ChEVAR series, early results were concerning. The reasons may lie in heterogeneous practices between centres and ChEVAR use outside of current recommendations regarding oversizing rates, endograft types, and sealing zones. Future research should focus on improvements in pre-operative planning and intra-operative technical aspects., (Copyright © 2020 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.)

A high colorectal cancer (CRC) incidence is observed in Tunisia, with a relatively high proportion of patients developing CRC before the age of 40. While this suggests a genetic susceptibility, only a few Tunisian Lynch Syndrome families have been described. In this study we aimed to identify the underlying genetic cause in 32 patients with early onset CRC and/or a positive family history. Of twenty-four patients' tumor or biopsies could be analyzed with immunohistochemical staining to detect loss of expression of one of the MMR proteins. Ten tumors showed loss of expression, of which one tumor was from a patient where a germline pathogenic MSH2 variant was detected previously with Sanger sequencing. Next generation sequencing of the MMR, POLE and POLD1 genes was performed in leukocyte and tumor DNA of the remaining nine patients, as well as in two patients with MMR-proficient tumors, but with severe family history. In six of 11 patients a germline variant was detected in MLH1 (n = 5) or MSH2 (n = 1). Two of six patients were from the same family and both were found to carry a novel in-frame MLH1 deletion, predicted to affect MLH1 function. All MLH1 variant carriers had loss of heterozygosity with retention of the variant in the tumors, while a somatic pathogenic variant was detected in the patient with the germline MSH2 variant.

Background: The purpose of this study was to report our experience of treatment of aortic aneurysms using combination of renal and visceral arteries bypasses and fenestrated/branched stent graft in various complex anatomical situations., Methods: Between November 2005 and March 2017, 10 patients underwent a hybrid strategy combining bypasses for renal and/or visceral arteries and custom-made fenestrated/branched stent grafts. Two patients had abdominal aortic aneurysm (1 juxtarenal and 1 suprarenal), and 8 patients had thoracoabdominal aortic aneurysm (1 type I, 2 type II including one dissection, 2 type III, 1 type IV, and 2 type V). In total, 37 renal and visceral arteries were targeted, of which 23 were treated using fenestrated or branched stent graft and 14 were treated by bypass (11 to renal artery and 3 to celiac trunk)., Results: Technical success was 100%, and no patient died during a mean follow-up of 24.3 ± 21 months. Six patients had 7 postoperative complications after bypass surgery, and 3 patients had 3 complications after fenestrated or branched endovascular aneurysm repair (FEVAR/BEVAR) procedure. Seven reinterventions were performed in 3 patients. No occlusion of target vessels occurred. Renal function was stable during follow-up in all patients except one who developed end-stage renal failure requiring permanent dialysis. On the last follow-up computed tomography scan, aneurysm diameter decreased for 6 patients, was stable for 3 patients, and increased for one patient, in which persistent type II endoleak was observed. Aneurysm exclusion was complete in the remaining 9 patients., Conclusions: Combination of FEVAR/BEVAR procedures with renal and/or visceral artery bypass in patients with complex aortic aneurysms is feasible with acceptable results. Morbidity associated with bypass surgery has to be carefully balanced with the risk of catheterization difficulties in the setting of adverse anatomical features of the visceral/renal arteries or the aorta., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Introduction: Breast cancer is often diagnosed at a late stage in Tunisia with long delay in time to consultation and to diagnosis. The aim of the study was to identify explanatory factors to delayed diagnosis., Methods: A case control analytical was performed from January 2013 to December 2014 in the department of Medical Oncology in FarhatHachedUniveristy Hospital.Patients with the diagnosis of ductal breast carcinoma were included in the study.Characteristics of a first group of 200 women with locally advanced or metastatic breast cancer (G1)were compared to a second group of 200 patients with early stage (G2)., Results: Median delay in consultation and mean tumor size were significantly more important in group G1 (p<0,001).A low level of schooling, a rural origin, poor socio-economic conditions and no encouragement by the patient relatives do not allow an early diagnosis.Misinterpretation of clinical breast signs was the only explanatory factor related to the system. In multivariate study, a low level of schooling(adjusted OR=2.72; CI 95% [1,65-4,49]), no encouragement by the patient's relatives(adjusted OR=7.86; CI 95% [4,24-14,57])and more than three dependants(adjusted OR=2.49; CI 95% [1,58-3,93]) were the independent factors that could explain the delay in diagnosis., Conclusion: Our study confirm the inverse relationship between socio-economic and scholar level and disease stage. Health education campaigns particularly among women with a low schooling level and of rural origin could reduce time for consultation. Promoting continuing medical education could avoid diagnostic errors.

Aim: To report the epidemiologic, clinical features, treatment modalities and prognosis of primary bone lymphomas (PBL) within a retrospective Tunisian series., Methods: We collected cases of histologically confirmed PBL in 3 medical oncology departments from northern and central Tunisia andwe analyzed their characteristics., Results: From January 1990 to July 2014, we collected 32 patients with histologically proven PBL, having a median age of 53 years. They affected mainly the long bones and diagnosed at early stages. 91% of the PBL were large cell B lymphoma. All patients received CHOP or CHOP-likeChemotherapy (CT), associated to Rituximab in the last 9 cases, with 14/32 patients received loco-regional radiotherapy and one patient had a resection-reconstruction surgery. We observed 90% of objective responses after primary CT.With a median follow-up of 38.5 months (1 to 192), the 5-year overall survival OS rate was 63%.18 patients relapsed and 14 remain alive in complete remission., Conclusion: PBL remains a rare disease lately diagnosed in Tunisia. However, most of the patients had early stages tumors. Furthermore, the efficacy of CT and introduction of Rituximab leads to a high rate of complete/objective responses, improving the survival rate.

Objective: The objective of this study was to evaluate the early and long-term outcome of cryopreserved arterial allografts (CAAs) used for in situ reconstruction of abdominal aortic native or secondary graft infection and to identify predictors of mortality., Methods: We retrospectively included 71 patients (mean age, 65.2 years [range, 41-84 years]; men, 91.5%) treated for abdominal aortic native or secondary graft infection (65 prosthetic graft infections; 16 of them had secondary aortoenteric fistula, 2 venous graft infections, and 4 mycotic aneurysms) by in situ reconstruction with CAA in the university hospitals of Clermont-Ferrand and Saint-Etienne from 2000 to 2016. The cryopreservation protocol was identical in both centers (-140°C). Early (<30 days) and late (>30 days) mortality and morbidity, reinfection, and CAA patency were assessed. Computed tomography was performed in all survivors. Survival was analyzed with the Kaplan-Meier method. Univariate analyses were performed with the log-rank test and multivariate analysis with the Cox regression model., Results: Mean follow-up was 45 months (0-196 months). Early postoperative mortality rate was 16.9% (11/71). Early postoperative CAA-related mortality rate was 2.8% (2/71); both patients died of proximal anastomotic rupture on postoperative days 4 and 15. Early CAA-related reintervention rate was 5.6% (4/71); all had an anastomotic rupture, and two were lethal. Early postoperative reintervention rate was 15.5% (11/71). Intraoperative bacteriologic samples were positive in 56.3%, and 31% had a sole microorganism. Escherichia coli was more frequently identified in the secondary aortoenteric fistula and Staphylococcus epidermidis in the infected prosthesis. Late CAA-related mortality rate was 2.8%: septic shock at 2 months in one patient and proximal anastomosis rupture at 1 year in one patient. Survival at 1 year, 3 years, and 5 years was 75%, 64%, and 54%, respectively. Multivariate analysis identified type 1 diabetes (hazard ratio, 2.49; 95% confidence interval, 1.05-5.88; P = .04) and American Society of Anesthesiologists class 4 (hazard ratio, 2.65; 95% confidence interval, 1.07-6.53; P = .035) as predictors of mortality after in situ CAA reconstruction. Reinfection rate was 4% (3/71). Late CAA-related reintervention rate was 12.7% (9/71): proximal anastomotic rupture in one, CAA branch stenosis/thrombosis in five, ureteral-CAA branch fistula in one, and distal anastomosis false aneurysm in two. Primary patency at 1 year, 3 years, and 5 years was 100%, 93%, and 93%, respectively. Assisted primary patency at 1 year, 3 years, and 5 years was 100%, 96%, and 96%, respectively. No aneurysm or dilation was observed., Conclusions: The prognosis of native or secondary aortic graft infections is poor. Aortic in situ reconstruction with CAA offers acceptable early and late results. Patients with type 1 diabetes and American Society of Anesthesiologists class 4 are at higher risk of mortality., (Copyright © 2017 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)

An 81-year-old woman was referred for the treatment of a 79-mm-diameter short neck abdominal aortic aneurysm with highly tortuous iliac arteries. She was considered at high risk for open repair and not suitable for standard endovascular repair given the short length of the proximal neck. Delay for a manufactured custom-made fenestrated stent graft was too long given the diameter of the aneurysm. A flexible stent graft was preferred because of severe iliac tortuosity. Endovascular repair was performed using a physician-modified Anaconda stent graft with 1 fenestration for the left renal artery. The technique for device modification and implantation is described. Postoperative course was uneventful and 1-year computed tomography scan showed complete exclusion of the aneurysm sac and patent left renal artery., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: The aim of this study was to evaluate the perioperative results of eversion carotid endarterectomy (e-CEA) without shunt at 30 days., Methods: From January 2004 to December 2013, 1385 e-CEAs were performed in 981 men and 404 women, for 268 hemispheric, 55 ocular and 12 oculopyramidal symptoms of carotid stenosis. The average age was 71.1 years. The contralateral internal carotid artery (ICA) was occluded in 77 cases. All e-CEAs were performed using Vanmaele technique, with blood pressure monitoring and under general anesthesia except in two cases (locoregional anesthesia alone). The need for application of an intra-arterial shunt was evaluated using visual quantification of adequate retrograde ICA pressure based on the quality of back-bleeding from the ICA. If well pulsatile, a shunt was not required. Otherwise, the systolic blood pressure was increased until a good quality ICA back-flow was obtained., Results: Freedom from intra-arterial shunt placement was 100% as a result of estimation and augmentation of arterial perfusion to demonstrate pulsatile perfusion by retrograde ICA filling. A peroperative angiography was performed in 910 cases. All surgical sites were evaluated postoperatively by Duplex imaging. The overall stroke and death rate was 1.3%. Nine (0.7%) patients died perioperatively. The 24 (1.7%) non-fatal neurologic events were ipsilateral: 6 (0.4%) disabling and 9 (0.6%) regressive stroke, 3 (0.2%) permanent and 1 (0.1%) transient ocular ischemia, and 5 (0.4%) transient ischemic attacks. Three (0.2%) patients had a perioperative myocardial infarction. Eleven compressive neck hematomas (0.8%) were reoperated in emergency., Conclusions: E-CEA can be performed safely, as a routine technique, based on the surgeon's evaluation of arterial back-bleeding and an increase in ipsilateral arterial perfusion with standard anesthetic procedures. Also e-CEA may be considered a cost effective method of reducing the frequency of intra-arterial shunt placement and adjuncts used to assess adequate cerebral perfusion of the ipsilateral carotid artery during e-CEA.

Background: The fate of autogenous arteriovenous fistula (aAVF) after renal transplantation (RT) remains variable. The aim of this study was to determine the predictors for their thrombosis after RT., Methods: We conducted a monocentric retrospective review of prospective clinical records of 145 patients with a functional aAVF who had an RT between January 2004 and December 2009 in the University Hospital of Clermont-Ferrand. Our primary end point was the thrombosis of the aAVF. Univariate and multiple logistic regression analyses were used to identify risk factors associated to aAVF thrombosis after RT., Results: There were 105 men (72%) and 40 women (28%), mean age 52 years (range: 18.4-74.7 years). The aAVF was created on average 40 months (range: 2-169) before the RT. The aAVF was distal in 96 cases (66%) and proximal in 49 cases (34%). Nineteen aAVF (13.1%) were complicated and required an endovascular or surgical repair before RT. Forty-nine patients (34%) required multiple aAVF (>2). Mean follow-up from RT was 58 months (range: 1 day-123 months) and from aAVF creation 97 months (range: 5-262 months). At the end of the follow-up, 81 aAVFs (59%) were patent, 42 (29%) were thrombosed, and 22 (15%) were surgically closed. Patients that had multiple fistulas before RT and active smokers were significantly at risk to thrombose their aAVF after the RT in univariate (P = 0.03 and P = 0.02, respectively) and multiple logistic regression analyses (P = 0.03 and P = 0.047, respectively)., Conclusions: Thrombosis is a part of the natural history of the aAVF after RT. A history of multiple aAVF creations before RT and active smoking were associated to significant increased risk for fistula thrombosis. Because hemodialysis may be needed after RT, the aAVF patency should be preserved, excepted when the aAVF resulted in complications. Follow-up of the aAVF after RT is important to detect and treat complications before thrombosis occurs., (Copyright © 2017 Elsevier Inc. All rights reserved.)

It has become increasingly evident that morphologically similar gliomas may have distinct clinical phenotypes arising from diverse genetic signatures. To date, glial tumours from the Tunisian population have not been investigated. To address this, we correlated the clinico-pathology with molecular data of 110 gliomas by a combination of HM450K array, MLPA and TMA-IHC. PTEN loss and EGFR amplification were distributed in different glioma histological groups. However, 1p19q co-deletion and KIAA1549:BRAF fusion were, respectively, restricted to Oligodendroglioma and Pilocytic Astrocytoma. CDKN2A loss and EGFR overexpression were more common within high-grade gliomas. Furthermore, survival statistical correlations led us to identify Glioblastoma (GB) prognosis subtypes. In fact, significant lower overall survival (OS) was detected within GB that overexpressed EGFR and Cox2. In addition, IDH1R132H mutation seemed to provide a markedly survival advantage. Interestingly, the association of IDHR132H mutation and EGFR normal status, as well as the association of differentiation markers, defined GB subtypes with good prognosis. By contrast, poor survival GB subtypes were defined by the combination of PTEN loss with PDGFRa expression and/or EGFR amplification. Additionally, GB presenting p53-negative staining associated with CDKN2A loss or p21 positivity represented a subtype with short survival. Thus, distinct molecular subtypes with individualised prognosis were identified. Interestingly, we found a unique histone mutation in a poor survival young adult GB case. This tumour exceptionally associated the H3F3A G34R mutation and MYCN amplification as well as 1p36 loss and 10q loss. Furthermore, by exhibiting a remarkable methylation profile, it emphasised the oncogenic power of G34R mutation connecting gliomagenesis and chromatin regulation.

Objective/background: Several risk factors have been identified in type B aortic dissection (TBAD), namely tear size, location, patency and number, and false lumen (FL) location. However, the individual impact of each of these factors is poorly understood. The impact of these factors was investigated using computational fluid dynamics (CFD)., Methods: Fourteen idealized models of chronic TBAD were created of different shapes (straight vs. curved vessels), different number of proximal and distal tears, tear size (4, 10, and 20 mm diameter) and shape (circular or elliptical), FL location (inner or outer arch), treated (stented), and untreated. All models had identical length, relative size of true lumen (TL) and FL, and inlet (flow) and outlet (pressure) boundary conditions. Using validated CFD tools, inlet mean pressure (MP), pulse pressure (PP), TL and FL pressures, velocities, and flows were computed for each model., Results: AD increased PP and MP relative to undissected aorta. Curvature did not change pressure and flow ratio between TL and FL. Inner curvature FL showed slightly larger pressures and tear velocities. Larger tears decreased hemodynamic differences between TL and FL. The combination of proximal and distal tear size determines the overall hemodynamics: larger proximal tears increased FL PP by up to 76%. Conversely, larger distal tears decreased FL PP and MP. Large proximal and distal tears decreased tear velocity (by up to 65%) and increased FL flow (up to 12 times). Proximal tear stenting resulted in a 54% reduction of PP. Conversely, distal occlusion tear increased FL PP and MP by 144% and 7%, respectively., Conclusion: Unfavorable hemodynamic conditions such as larger FL pressure occur when distal tear is small or absent, proximal tears are large, and FL is at the inner curvature, in agreement with previous clinical studies. CFD analysis is a powerful tool to understand the interplay between anatomy and hemodynamics in TBAD., (Copyright © 2016 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.)

The Tunisian adult's Hodgkin lymphoma (HL) Study Group was created in 1999. It aimed to improve the management of this curable hematologic malignancy by standardizing the diagnosis, assessment of disease, treatment management and therapeutic evaluation in different Tunisian centers (Hematology, oncology and radiotherapy).Since 1998, four versions of the prospective national protocol for treating adult Hodgkin lymphoma have succeeded (MDH99, MDH2002, MDH2008, MDH2015). Each version was based on the results of the previous version and analyzed according to new data from the literature. Due to this national study group, the number of patients lost to follow decreased significantly (30% before the creation of the group and only 3% for patients treated with MDH2008), the complete and uncertain response rates have improved (75% before the creation of the group and 92% in patients treated with MDH2008) with dramatically improved rates of overall survival from 57% to 90%. On the other hand there was an improvement of toxic death rate (13% of toxic deaths in MDH2002 to 4.37% in the MDH2008) with a decrease of the respective rate of primary failure and relapse by 17% and 12.5% in MDH2002 against the 11.4% and 7.8% in the MDH2008. This resulted in an improvement in overall survival (90%) and event-free survival at 5 years (75%). Now with the introduction of positron emission tomography in Tunisia, we hope yet to finalize the assessment of response and thus better adapt the treatment of this disease. Our objective remains the improvement of event-free survival rate to reach 80%.

We report a patient who developed a type B aortic dissection and ruptured his aneurysmal sac 1 year after endovascular abdominal aortic aneurysm repair (EVAR), despite standard follow-up. This 79-year-old man was presented to emergency room with acute abdominal pain and an acute lower limb ischemia. Computed tomography scan showed an acute type B aortic dissection feeding the aneurysmal sac of the EVAR. The aneurysm rupture occurred during imaging. Type B aortic dissection is a rare cause of aneurysmal rupture after EVAR. The first postoperative computed tomography scan should maybe include the arch and the descending thoracic aorta to rule out an iatrogenic dissection after EVAR., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: Endovascular treatment of proximal supra-aortic trunks (SAT) has become a safe and reliable alternative to conventional open surgery, with a lower morbimortality rate and good short- and middle-term patency rates. The aim of our study was to assess the long-term results of endovascular treatment of proximal lesions of the SAT (brachiocephalic trunk, common carotid artery, and subclavian artery) and identify predictive risk factors of restenosis., Methods: From 1999 to 2013, 67 consecutive stenotic lesions of the proximal SAT were treated by angioplasty (13.4%) or stenting (86.6%) in 63 patients with a mean age of 65.5 years (40-87). Procedures were performed under general (69%), local (24%), or locoregional (7%) anesthesia, with percutaneous puncture (47.8%) or open access (52.2%). Patients were followed up for 3, 6, and 12 months, and then every year with clinical examination, Doppler ultrasound and if required an angio-CT scan., Results: The technical success rate was 98.5%. There was no postoperative death or strokes. One myocardial infarction occurred at day 2. There were 2 access complications: a nonsurgical hematoma after brachial access and a brachial thrombosis postpuncture. The mean follow-up was 4.5 years (2-163 months). The primary- and assisted-patency rates were 90.1%, 86.4%, 77.9% and 93.3%, 91.4%, 82.9% at 1, 2, and 5 years, respectively. Eleven restenosis (16.4%) occurred at 28.5 months (3, 0-112, 0) of follow-up. Four of them required an endovascular repair and 3 required a surgical one. The restenosis rate was 17.5% in the stented group on average at 30.2 months of follow-up (range, 3.0-112.0) and 10% in the group of patients with angioplasty alone at 8 months of follow-up, without significant statistically difference (P = 0.9). No predictive risk factor of restenosis was statistically identified., Conclusions: The endovascular treatment of proximal stenosis of SAT is a safe, reliable, and efficient technique with a low morbidity and mortality. The long-term results are good, but restenosis can occur. Long-term follow-up should be performed to detect and treat restenosis., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Objective: During endovascular repair of abdominal aortic aneurysms (EVAR), in the absence of a distal iliac landing zone, the Amplatzer plug is increasingly being used to replace other internal iliac artery (IIA) embolization techniques. This study aimed at assessing the technical success, complication occurrence, and durability of the Amplatzer plug for IIA embolization., Method: From January 1, 2007 to December 31, 2013, all consecutive patients who underwent internal iliac embolization with an Amplatzer plug during EVAR were included in the study. There were 169 patients, (160 men, 9 women, mean 75 ± 9 years), treated by unilateral (158 cases, 93%) or bilateral (11 cases, 7%) embolization of the IIA, performed either separately prior to (65 cases, 38.5%) or during EVAR (104 cases, 61.5%). Follow up CT scan and/or US scan were performed 1 month after treatment and yearly thereafter. The inclusions were done retrospectively but the series was continuous and consecutive. Data were collected and analyzed using acquisition REDCap software., Results: The technical success rate was 97.6%. Failures were device migration (n = 1), navigation failure (n = 2), and release outside the target zone (n = 1). On average, 1.43 plugs were required to achieve the embolization. The average amount of contrast agent for the embolization procedure was 111 ± 51 mL and the radiation dose was 127,777 ± 89,528 mGy/cm(2). The total fluoroscopy time was 854 ± 538 seconds. No re-canalization of the IIA trunk was observed during follow up. Complications were buttock claudication (n = 41, 24.3%), which resolved in 24 cases (58.5%, 24/41) at the first follow up, and intestinal ischemia requiring limited bowel resection in two cases., Conclusion: This multicenter study is the largest published to date. It demonstrates the efficacy and reliability of the Amplatzer plug to embolize the IIA during EVAR, with few side effects., (Copyright © 2015 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.)

Background: The aim of this study was to identify the predictive factors for the development of type II endoleaks (EL-II) after endovascular aneurysm repair (EVAR)., Methods: We assessed the preoperative and postoperative computed tomography data of 308 patients who underwent EVAR between 2000 and 2012 and in 84 of whom primary or secondary EL-II occurred. The data analyzed were: demographics, number and diameter of lumbar arteries (LAs), inferior mesenteric artery (IMA), median sacral artery (MSA), accessory renal arteries (ARas), maximum diameter of infrarenal abdominal aortic aneurysm, diameter and length of proximal aortic neck. Statistical analysis was performed using Stata software (version 12). Categorical parameters were compared between groups using chi-squared or Fisher's exact tests as appropriate. Continuous variables were analyzed using Student's t-test or Mann-Whitney test as appropriate (normality studied by the Shapiro-Wilk and homoscedasticity verified using the Fisher-Snedecor test)., Results: Of the 308 patients included (mean age, 73.8 ± 8.74 years), 284 (92%) were men, 61 (20%) were smokers, 113 (37%) had chronic obstructive pulmonary disease, 215 (70%) were taking antiplatelet. Respectively, 13, 51, 60, 103, 28, 40, 2, and 7 patients had 1, 2, 3, 4, 5, 6, 7, and 8 patent LAs. Before surgery, 221 IMAs and 136 MSA were patent. The sources of EL-II were: LA (n = 51), IMA (n = 22), MSA (n = 1), IMA and LA (n = 8), IMA and ARa (n = 1), and unknown (n = 1). Logistic regression models adjusting for clinically relevant covariables (age, American Society of Anesthesiologists, smoking status, dyslipidemia, and diuretics) were proposed to study morphologic EL-II predictive factors, first in the entire population, and then in the more specific population for whom IMA was patent. Risk factors of occurrence EL-II were: permeability of the IMA (70 patients [83%] vs. 155 [69%], P = 0.01), IMA diameter (3.49 mm vs. 2.71 mm, P < 0.001), number of LAs patent higher than or equal to 4 (P < 0.001), the mean LA diameter greater than 2.4 mm (P < 0.001), and MSA diameter (2.28 mm vs. 1.94 mm; P < 0.01)., Conclusions: Our results show the major role of the number and diameter of the patent aortic branches in the development of EL-II. As they can result in complications increasing the morbidity and mortality after EVAR, it is relevant to identify the risk factors of their occurrence., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Background: Hypertension (HT) after carotid endarterectomy (CEA) is a risk factor for postoperative myocardial infarction, stroke, and neck hematoma. We compared the incidence of postoperative HT within the week after eversion CEA (e-CEA) and patch closure CEA (p-CEA). Postoperative HT was defined as a systolic blood pressure (sBP) ≥ 160 mm Hg and/or the need for postoperative vasodilatators. The aim of our study was to determine if the technique of CEA had an effect on postoperative HT., Methods: Between January 2010 and June 2011, we prospectively reviewed 560 consecutive endarterectomies (340 p-CEAs and 220 e-CEAs) performed in 443 patients under general anesthesia. All had >70% stenoses, 119 were symptomatic, and 441 asymptomatic. We compared preoperative, peroperative, and postoperative sBP and diastolic blood pressure, carotid sinus nerve block, postoperative intravenous and oral antihypertensive medications, neurologic and cardiac complications, and mortality., Results: The e-CEA group had a higher incidence of women (36.4% vs. 21.8%, P = 0.0002) and HT (85.0% vs. 78.2%, P = 0.04). The e-CEAs had a significantly higher incidence of carotid sinus nerve block (93.6% vs. 15.6%, P < 0.0001). The incidence of postoperative HT was not significantly different between the 2 groups (75.9% in the e-CEA group versus 68.5% in the p-CEA group, P = 0.06). The average postoperative sBP between postoperative hour (H) 2 and H12 was significantly higher in the e-CEA group but <160 mm Hg. The sBP dropped between H2 and H6, and this decrease was greater in the p-CEA group (30% vs. 15% in the e-CEA group). The need for postoperative antihypertensive medication was not different between the 2 groups. One independent risk factor of postoperative HT was identified: history of HT. The rate of postoperative complications was not significantly different between the 2 groups., Conclusions: The e-CEA technique is not a risk factor and does not have an effect on postoperative HT. The postoperative sBP was more stable in this group. Eversion carotid endarterectomy has been considered, in the literature, as a risk factor of postoperative hypertension. We conducted a large prospective and comparative study of the endarterectomy technique by eversion and with conventional patch closure. The primary end point was the blood pressure value and the administration of antihypertensive treatment. Our study shows that postoperative hypertension after carotid endarterectomy is not related to the surgical technique. Changes in blood pressure after carotid endarterectomy by eversion are lower than those observed after conventional endarterectomy with patch closure. This technique prevents the occurrence of possible hypotension occurrence, which can be the cause of perioperative complications., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Background: Neuroblastoma (NB) shows a complex combination of genetic aberrations. Some of them represent poor genetic prognosis factors that require specific and intensive chemotherapy. MYCN amplification consists of the major bad outcome prognostic factor, it is indeed frequently observed in aggressive neuroblastomas. To date different methods are used for MYCN status detection., Objectives: The primary aim of our study was to provide a critical assessment of MYCN status using 2 molecular techniques CISH and MLPA. We also focused on the correlation between neuroblastoma genetic markers and patient's clinical course among 15 Tunisian patients., Methods: we developed a descriptive study that includes 15 pediatric Tunisian patients referred to our laboratory from 2004 to 2011. We reported the analysis of fresh and FFPE NB tumors tissues., Results: No significant correlation was found between COG grade and patients overall survival. Assessment of NMYC gene copy number by kappa statistic test revealed high concordance between CISH and MLPA tests (kappa coefficient = 0.02)., Conclusion: Despite misdiagnosing of MYCN status fewer than 5 copies, MLPA remains an effective molecular technique that enables a large panel of genomic aberrations screening. Thus combining CISH and MLPA is an effective molecular approach adopted in our laboratory. Our results allow pediatric oncologists to set up the first Neuroblastoma therapeutic strategy based on molecular markers in Tunisia.

Background: General practitioners have a major contribution in cancer prevention and screening. However, their contribution in the treatment plan management and in the post treatment follow-up of cancer patients needs to be clarified., Objective: To evaluate the contribution of general practitioners of the public and private sectors in the management of cancer patients during and after the treatment protocol. To analyze the problems they encounter and find the possible solutions., Method: A retrospective declarative KAP (Knowledge, Attitudes and Practices) survey was conducted from first September 2010 to 28 February 2011 in the central region of Tunisia among 215 primary care physicians in the public and private sectors. The questionnaire focused on their effective involvement, the role during treatment, follow up and supportive care., Results: Nearly 80% of physicians who participated in the survey were involved in the management of their patients, primarily by ensuring adherence to their treatment (42.9%), in the follow up care after treatment (42.3%) and in palliative care (29%), however the majority has never prescribed opioid drugs (66.5%). Only 46.6% of the physicians announced the diagnosis of cancer to their patients. The questioned doctors deplored the lack of training in oncology (22.8%) and the feeling of being excluded from the management of their patients once they have addressed them to their specialist peers (48.8%). The interviewed physicians expressed their wish to have a further medical training in oncology (79.5%) and to join a structured cancer network (55.8%)., Conclusion: The majority of interviewed general practitioners of our region were engaged in cancer patients' care. However, gaps were identified especially in palliative care and in prescribing opioid drugs. Promoting continuing education in this field and the establishment of cancer networks will allow extend the scope of general practitioners' intervention in the cancer network.

Mild cognitive impairment (MCI) is a heterogeneous cognitive status that can be a prodromal stage of Alzheimer's disease (AD). It is particularly relevant to focus on prodromal stages of AD such as MCI, because patho-physiological abnormalities of AD start years before the dementia stage. Medial temporal lobe (MTL) atrophy resulting from AD lesions and cerebrovascular lesions [i.e., white matter lesions (WML), lacunar strokes, and strokes] are often revealed concurrently on magnetic resonance imaging (MRI) in MCI subjects. Personality changes have been reported to be associated with MCI status and early AD. More specifically, an increase in neuroticism and a decrease in conscientiousness have been reported, suggesting that higher and lower scores, respectively, in neuroticism and conscientiousness are associated with an increased risk of developing the disease. However, personality changes have not been studied concomitantly with pathological structural brain alterations detected on MRI in patients suffering from MCI. Therefore, the objective of the present study was to assess the relationship between MTL atrophy, WML, lacunar strokes, and personality traits in such patients. The severity of WML was strongly associated with lower levels of conscientiousness and higher levels of neuroticism. Conversely, no association was detected between personality traits and the presence of lacunar strokes or MTL atrophy. Altogether, these results strongly suggest that personality changes occurring in a MCI population, at high risk of AD, are associated with WML, which can induce executive dysfunctions, rather than with MTL atrophy.

Objectives: The aim of this study was to assess the results of hybrid techniques for the treatment of thoracic, thoracoabdominal, and abdominal aortic aneurysms based on multicenter results and the various series regarding hybrid procedures reported in the literature., Methods: The results of 76 hybrid procedures performed in 19 French university hospital centers between November 2001 and October 2011 were collected. There were 50 men and 26 women, mean age 68.2 (35-86) years. All patients were considered at high risk (ASA≥3) for conventional surgery. Aneurysms involved the thoracic, abdominal, and thoracoabdominal aorta in five, 14, and 57 cases respectively. There were 11 emergent repairs. The revascularization of four visceral arteries was performed in 38 cases. Between one and three visceral arteries were revascularized in the other cases. Visceral artery debranching and stent graft deployment were performed in a one-stage procedure in 53 cases and in a two-stage procedure in 23 cases., Results: There were 26 (34.2%) postoperative deaths. Nine of the survivors developed paraplegia, of which one resolved completely. Bowel ischemia occurred in 13 cases (17.1%), and one patient was treated by a superior mesenteric artery bypass. Four patients required long-term hemodialysis. Postoperative computed tomography scan showed a type II endoleak in two patients., Conclusions: Morbidity and mortality in this study were greater than previously reported. Candidates for hybrid aortic repair should be carefully selected., (Copyright © 2014 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.)

The prognosis of breast cancer has significantly improved during the last years due to progress of the treatment options. It is a public health problem because of its frequency, severity, physical and psychological consequences. Quality of life appears increasingly as fundamental criteria in the assessment of treatment outcomes. This underlines the specific impact on sexuality. Aim. To evaluate the frequency and type of sexual dysfunction in 100 patients treated for non-metastatic breast cancer in post-treatment monitoring in external consultation of the Department of Oncological Medicine, CHU Farhat Hached, Sousse. Then, to identify predictive factors of these disorders. Procedure. Sexuality and body image were evaluated respectively using two scales: Relationship and Sexuality (RSS) and Body-Esteem Scale for Adolescents and Adults (BESAA). Results. Sexual desire has been affected by the disease and its treatment for 47 women. The capacity to achieve orgasm was reduced in 61 patients. Twenty felt less sexually attractive. Fifty-three women had reported a decrease in the frequency of sexual intercourse. Sixteen patients had reported a fear of sex. Dyspareunia and vaginal dryness were present in 45 women. The analytic study had found that sexual problems are related to the rural origin, the profession of the husband, the premenopausal period, lack of breast reconstruction, the CMF chemotherapy protocol (cyclophosphamide, methotrexate, 5-fluorouracil) and number of cycles of chemotherapy. Body image was significantly altered in patients with sexual dysfunction. In addition, psychosocial factors that best predicted sexual difficulties are the perception by the wife of an emotional distance in the relationship with her partner and fear of sex. Conclusion. The support for these sexual difficulties requires a joint and collaborative approach between oncologists, gynecologists, psychiatrists and sexologists.