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In North Africa, the parasite Echinococcus granulosus is transmitted in a synanthropic cycle evolving mainly between dogs (DH) and sheep (IH), but other animals like cattle are most often found to be more infested with hydatid cysts but their potential role in human contamination via dogs is unknown. The purpose of this study is to assess the prevalence and fertility rates of hydatid cysts in ruminants (cattle and sheep) in two slaughterhouses in central and eastern Algeria. Determining the frequency and fertility of cysts in cattle will assess the degree of involvement of this species, alongside sheep, in the epidemiological cycle of E. granulosus in Algeria. In the present study, prevalence rates were estimated at 4.9% and 10% in slaughtered ruminants, all species combined at the slaughterhouses of El Harrach and Souk Ahras, respectively. The distribution of the prevalence by species indicates higher infestation rates in cattle compared to sheep: 6% vs 3.9% and 37% vs 4.7% in the slaughterhouses of El Harrach and Souk Ahras, respectively. The survey results showed relatively low cyst fertility rates in cattle compared to sheep: 13.8% vs 43.7% and 33.3% vs 71.4% in the two slaughterhouses, El Harrach and Souk Ahras, respectively. The low fertility rate of cysts in cattle can be explained by a poor adaptation of the species, E. granulosus sensu stricto, previously identified by molecular analysis in all samples of hydatid cysts collected from cattle in Algeria. In conclusion, cattle infested with E. granulosus sensu stricto, with low fertility rates, play a minor role in the epidemiology of cystic echinococcosis in Algeria. It is rather an indicator of the persistence of cystic echinococcosis infection in endemic regions.En Afrique du Nord, le parasite Echinococcus granulosus est transmis dans un cycle synanthropique évoluant principalement entre les chiens (HD) et les moutons (HI). Mais d’autres animaux comme les bovins se révèlent le plus souvent très infestés par les kystes hydatiques : leur rôle potentiel dans la contamination humaine via des chiens est inconnu. Le but de cette étude est d’évaluer la prévalence et les taux de fertilité des kystes hydatiques chez les ruminants (bovins et ovins) dans deux abattoirs du centre et de l’est de l’Algérie. La détermination de la fréquence et de la fertilité des kystes chez les bovins permettra d’évaluer le degré d’implication de cette espèce, aux côtés des ovins, dans le cycle épidémiologique d’E. granulosus en Algérie. Dans la présente étude, les taux de prévalence ont été estimés à 4,9 et 10 % chez les ruminants abattus, toutes espèces confondues dans les abattoirs d’El Harrach et de Souk Ahras respectivement. La répartition de la prévalence par espèce indique des taux d’infestation plus élevés chez les bovins que chez les ovins : 6 vs 3,9 % et 37 vs 4,7 % dans les abattoirs d’El Harrach et de Souk Ahras respectivement. Les résultats de l’enquête ont montré des taux de fertilité des kystes relativement bas chez les bovins par rapport aux ovins : 13,8 vs 43,7 % et 33,3 vs 71,4 % dans les deux abattoirs, El Harrach et Souk Ahras respectivement. Le faible taux de fertilité des kystes chez les bovins peut s’expliquer par une mauvaise adaptation de l’espèce E. granulosus sensu stricto, précédemment identifiée par analyse moléculaire dans tous les échantillons de kystes hydatiques prélevés sur des bovins en Algérie. En conclusion, les bovins infestés par E. granulosus sensu stricto, avec des kystes à faible taux de fertilité, jouent un rôle mineur dans l’épidémiologie de l’échinococcose kystique en Algérie. Il s’agit plutôt d’un indicateur de la persistance de l’infection à échinococcose kystique dans les régions endémiques.

Background Recombinant activated factor VII (rFVIIa; eptacog alfa activated, NovoSeven® , Novo Nordisk A/S) is a bypassing agent used in congenital hemophilia A patients with inhibitors. Emicizumab (Hemlibra® ; F Hoffmann-La Roche Ltd) is a recombinant, humanized, bispecific monoclonal antibody used for routine prophylaxis in patients with congenital hemophilia A with inhibitors. Concomitant use of the hemostatic agents rFVIIa and emicizumab carries a theoretical increased risk of thrombotic complications. Roche and Novo Nordisk collaboratively analyzed all available data on the use of rFVIIa in patients receiving emicizumab prophylaxis in the Study to Evaluate the Efficacy, Safety, and Pharmacokinetics of Prophylactic Emicizumab Versus no Prophylaxis in Hemophilia A Participants With Inhibitors (HAVEN) clinical development program. Objective Obtain further insights into the concomitant clinical use and safety of rFVIIa and emicizumab. Methods The initial individual rFVIIa dose, dosing intervals and cumulative dosing were evaluated in the HAVEN 1, HAVEN 2, and HAVEN 4 trials. All adverse events reported in each of the three trials in patients treated with rFVIIa, including available narratives, were assessed. Results The vast majority of bleeds occurred in HAVEN 1. When rFVIIa was used to treat a bleeding episode, a 100 ± 20 μg/kg dose was used to initiate treatment in the majority of cases. The dosing interval, as well as cumulative dosing were consistent with prescribing information and current practice. No serious adverse events, no thrombotic microangiopathy cases, or thromboembolic events were assessed to be associated with rFVIIa when used in conjunction with emicizumab prophylaxis in the HAVEN trials. Conclusion rFVIIa use in the context of emicizumab prophylaxis does not change the rFVIIa safety profile as described in the product information.

Une étude a été menée de mai 2008 à avril 2009 pour déterminer une fois par mois dans deux élevages de la région de Constantine (étage subhumide de l’Algérie), situés respectivement à 500 et 1000 mètres d’altitude, l’évolution de l’infestation des bovins par les tiques. Sur quarante bovins suivis (20 par élevage), 2031 tiques ont été récoltées sur les différentes régions anatomiques (périnée, mamelle, scrotum, oreilles, entre autres). Sept espèces de tiques réparties en quatre genres ont été identifiées : Rhipicephalus bursa (48,5 %), tiques du groupe R. sanguineus (26,6 %), Hyalomma marginatum (11 %), Haemaphysalis punctata (5,7%), Hy. lusitanicum (3,9 %), Hy. scupense (2,7 %) et Ixodes ricinus (1,5 %). La prédominance de R. bursa, d’une part, et l’absence de H. scupense à 1000 m d’altitude, d’autre part, ont été notées. Par ailleurs, l’influence de l’altitude et de l’âge a été étudiée, et la localisation des tiques sur les animaux a été enregistrée. L’étude de la dynamique saisonnière d’infestation a montré que la lutte antivectorielle, en cas de fortes infestations, devrait être principalement appliquée durant la période chaude (de mai à août), correspondant au pic d’abondance de R. bursa et de H. scupense, principales espèces responsables de la transmission des piroplasmoses chez les bovins, dont les babésioses et la theilériose tropicale.

Introduction Challenges with personalised prophylaxis in haemophilia remain, including designing unique dosing schedules that require continual adjustments and monitoring using complex sampling procedures. Aim To assess long-term efficacy and pharmacokinetic outcomes with fixed-dose N8-GP prophylaxis. Methods Descriptive analyses were performed on data from the pathfinder 2 and pathfinder 5 trials of patients with severe haemophilia A. Bleed frequency and reoccurrence were assessed in relation to several clinical criteria of interest. Bleed risk relative to time since last dose was assessed using calculated annualised bleeding rate (ABR). Long-term ABR and mean factor VIII (FVIII) trough levels were assessed in patients who received consistent N8-GP prophylaxis every 4 days (Q4D). Results During pathfinder 2, 117/136 patients with study-drug exposure of ≥600 days experienced bleeding episodes; 8.6% of bleeds were reoccurring bleeds; bleed reoccurrence decreased over time. For patients who received consistent Q4D prophylaxis across the trial (n = 61), mean ABR decreased from 3.5 bleeds/year (Year 1) to 1.6 bleeds/year (Year 6); mean FVIII trough levels stabilised at approximately 5% (Year 6). Across patients who received prophylaxis at some point during pathfinder 2 (n = 177), 125/126 (99%) reoccurring bleeds were joint bleeds. For patients receiving Q4D prophylaxis, bleeding risk generally increased as the time since the last prophylaxis dose increased. A similar reduction in ABR and stabilisation of trough level was observed in pathfinder 5. Conclusion Long-term exposure (> 5 years) to fixed-dose N8-GP prophylaxis resulted in a protective haemostatic effect, with reduction in bleed frequency and reoccurrence, and stabilisation of FVIII trough level over time.

Au cours d’une enquête menée dans 88 fermes de deux provinces du nord-est de l’Algérie – Oum El Bouaghi et Skikda –, 89 cas cliniques de piroplasmoses, soit un taux d’infection de 11,6 % des bovins examinés, ont été enregistrés entre mai et septembre 2011 dans 86,4 % des fermes visitées. Trois espèces de piroplasmes ont été identifiées dans les étalements sanguins colorés au Giemsa : Theileria annulata (chez 94,0 % des bovins malades), Babesia bovis (33,7 %) et Babesia bigemina (3,4 %), avec 31 % de co-infections. Il n’y avait pas de différence significative de prévalence entre les deux provinces ni entre les races bovines. La theilériose tropicale a provoqué une baisse significative de la production laitière, estimée à 319 litres par vache infectée pendant les deux mois suivant la maladie. Sept espèces de tiques ont été collectées dans les fermes pendant l’étude. Le pic d’infestation a été observé en juillet pour Hyalomma scupense (syn. H. detritum), H. lusitanicum, H. anatolicum, Rhipicephalus bursa et R. turanicus, et en août pour H. marginatum et H. excavatum. Une corrélation positive a été observée entre les cas cliniques de theilériose tropicale bovine et la charge parasitaire en H. scupense, d’une part, et entre les cas cliniques de babésioses et la charge parasitaire en R. bursa, d’autre part.

In North Africa, the domestic dog is regarded as the main reservoir for infection by Echinococcus granulosus of domestic livestock and man. In Algeria, there is very little data on the rate of infestation of dogs, while the prevalence of E. granulosus in the definitive host is a very reliable marker of the potential risk of transmission of cystic tapeworm to humans and livestock. To find out this information, a survey was conducted to assess the prevalence of infection with E. granulosus in stray dogs in the region of Constantine (North-East Algeria). We autopsied and examined 120 stray dogs, 22 (18.3%) of which were infected with E. granulosus, with an average intensity of infestation of 249 worms. The prevalence in the area of survey was evaluated: 15.5% (14/90) and 26.6% (8/30) dogs were parasitized by E. granulosus in urban and rural areas respectively. The influence of age on the rate of infection was very marked. In addition, the appreciation of the prevalence of parasitism by cestodes as a whole showed that 56 (46.6%) animals out of 120 were infected. Facing such a situation of endemic tapeworm parasitism, with a potential risk of transmission to humans, there is an urgent need to take measures to control and break the epidemiological cycles of the parasite.

Pour déterminer la prévalence de l’infection par Theileria annulata et l’influence de certains facteurs de risque, une étude moléculaire a été menée dans la région de Sétif (Algérie). Au total, 134 échantillons sanguins de bovins provenant de 21 fermes ont été collectés deux fois, en avril et novembre 2015, avant et après la saison des vecteurs de tiques. La prévalence moléculaire de T. annulata a été de 25,4 % en avril et de 50 % en novembre, indiquant une augmentation significative (p < 0,001) du nombre d’animaux porteurs asymptomatiques. La prévalence moléculaire a été significativement plus élevée que la prévalence sur frottis sanguins colorés au Giemsa pour les deux périodes. En avril, la race Fleckvieh a eu la prévalence moléculaire la plus faible mais cette prévalence a considérablement augmenté en novembre (p < 0,001). Le type d’élevage et le sexe n’ont eu aucune influence sur la prévalence de T. annulata. Toutefois, le taux d’infection a augmenté de manière significative pendant la période d’infestation par les tiques, car les murs n’étaient pas crépis et présentaient des fissures (p < 0,001). La séquence algérienne du gène Tams1 a été très similaire aux séquences mauritaniennes, tunisiennes et égyptiennes déjà connues.Temporaire Ouarda Ayadi

International audience; PURPOSE:To evaluate perioperative cost related to surgical treatments of benign prostatic obstruction (BPO): photoselective vaporization of the prostate (pvp), holmium/thullium laser enucleation (HoLEP/ThuLEP), transurethral resection of the prostate (TURP) and open prostatectomy (OP).MATERIAL AND METHODS:We retrospectively collected data from 237 patients who consecutively underwent a surgical treatment for BPH between January 2012 and June 2013 at nine institutions in France. An economic simulation model was constructed to estimate the cost of hospitalization related to surgical procedure from the hospital perspective and a cost minimization analysis was performed.RESULTS:TURP, OP, HoLEP/ThuLEP and PVP were performed in 99 (42%), 23 (10%), 64 (27%) and 51 (21%) patients, respectively. For men with prostate size

Supplemental Digital Content is available in the text, Home therapy for uncomplicated mild/moderate bleeding can decrease healthcare burden, promote self-esteem, reduce complications, and provide near-normal quality of life. To evaluate recombinant activated factor VII (rFVIIa) as home therapy for joint bleeds in Algeria, Morocco, Oman, Saudi Arabia, and United Arab Emirates. Twenty-seven patients aged more than 2 years with congenital haemophilia and inhibitors were monitored for up to 8 months after a first haemarthrosis episode treated with rFVIIa. Assessments were made by patients/caregivers with a standardized diary. The main measures included home-managed bleeds, haemostasis, and pain relief within 9 h after first injection. Additional analyses included convenience, time to pain resolution, and doses given within 48 h. Of 132 bleeds, 84 (63.6%) were managed at home. Of these, successful haemostasis (partial or complete) was achieved at 9 h in 87.8%, with pain relief for 84.0%. For all treatment settings, successful haemostasis at 9 h was achieved for 86.3% of bleeds, with pain relief achieved for 74.8% of bleeds. Higher initial dosing was associated with fewer injections. Median time to complete haemostasis was 48 h (spontaneous bleeds) and 24 h (traumatic bleeds). Median time to complete pain relief was 24 h for both bleed types. Satisfaction with treatment was high. No safety concerns were reported. Results from this observational study agree with previous data on the safety and efficacy of home treatment with rFVIIa and will help to increase awareness and aggregate experience, fostering confidence in home management of haemophilia patients with inhibitors in developing countries.

Hip dysplasia is an important cause of osteoarthritis in young adults. For these patients, conservative treatment is an interesting alternative to arthroplasty. The current literature suggests better clinical and functional outcomes when shelf acetabuloplasty is performed for a moderate joint pinch (

Introduction Early treatment for acute bleeds in patients with haemophilia and inhibitors is feasible when patients are managed in haemophilia treatment centres (HTCs). Patients may need to attend non-HTCs for out-of-hours emergency care, especially if HTCs are not local and/or transport is difficult. Aim We evaluated the barriers to the fast treatment of bleeds in patients with haemophilia and inhibitors presenting at non-HTCs. Methods Healthcare professionals (HCPs) from non-HTCs in the United States (n = 218) and Germany (n = 98) were selected from validated online panels and invited to participate in a survey (October-November 2017). Results A mean of 6 (US) and 5 (German) patients with haemophilia and inhibitors were managed for bleeds by these HCPs over 12 months; patient characteristics were similar in both countries. The main HCPs involved in treating bleeds were emergency room specialists (94%) and haematologists (91%) (US); haematologists (79%) and anaesthesiologists (59%) (Germany). Only 26% (US) and 28% (Germany) of HCPs had access to treatment guidelines for these patients; access to bypassing agents was similarly limited: 44% (US) and 38% (Germany) of HCPs reported their institution did not stock these agents. In both countries, key reasons for delaying treatment were lack of bypassing agent availability, HCP experience/education of bleed disorders and internal process time. Conclusion Barriers to fast treatment of bleeds in patients with haemophilia and inhibitors were identified in non-HTCs in the United States and Germany. These could be reduced by improving the availability of treatment guidelines, bypassing agents and HCP education/training.

Purpose: We determined the characteristics of Chinese men undergoing initial prostate biopsy and evaluated the relationship between prostate specific antigen levels and prostate cancer/high grade prostate cancer detection in a large Chinese multicenter cohort.Materials and Methods: This retrospective study included 13,904 urology outpatients who had undergone biopsy for the indications of prostate specific antigen greater than 4.0 ng/ml or prostate specific antigen less than 4.0 ng/ml but with abnormal digital rectal examination results. The prostate specific antigen measurements were performed in accordance with the standard procedures at the respective institutions. The type of assay used was documented and recalibrated to the WHO standard.Results: The incidence of prostate cancer and high grade prostate cancer was lower in the Chinese cohort than the Western cohorts at any given prostate specific antigen level. Around 25% of patients with a prostate specific antigen of 4.0 to 10.0 ng/ml were found to h...

International audience; PURPOSE:Ejaculatory dysfunction is the most common side effect related to surgical treatment of benign prostatic obstruction (BPO). Nowadays, modified surgical techniques and non-ablative techniques have emerged with the aim of preserving antegrade ejaculation. Our objective was to conduce a systematic review of the literature regarding efficacy on ejaculatory preservation of modified endoscopic surgical techniques, and mini-invasive non-ablatives techniques for BPO management.METHODS:A systematic review of the literature was carried out on the PubMed database using the following MESH terms: "Prostatic Hyperplasia/surgery" and "Ejaculation", in combination with the following keywords: "ejaculation preservation", "photoselective vaporization of the prostate", "photoselective vapo-enucleation of the prostate", "holmium laser enucleation of the prostate", "thulium laser", "prostatic artery embolization", "urolift", "rezum", and "aquablation".RESULTS:The ejaculation preservation rate of modified-TURP ranged from 66 to 91%. The ejaculation preservation rate of modified-prostate photo-vaporization ranged from 87 to 96%. The only high level of evidence studies available compared prostatic urethral lift (PUL) and aquablation versus regular TURP in prospective randomized-controlled trials. The ejaculation preservation rate of either PUL or aquablation compared to regular TURP was 100 and 90 versus 34%, respectively.CONCLUSIONS:Non-ablative therapies and modified endoscopic surgical techniques seemed to be reasonable options for patients eager to preserve their ejaculatory functions.

This case report introduces a new approach of corticotomy-assisted rapid maxillary expansion for treating a severe maxillary transverse discrepancy in a skeletally mature patient. This approach uses piezo-bone perforation in conjunction with a fixed appliance and an expander. This report describes the treatment of a 14-year-old girl with a severe maxillary transverse discrepancy. She had a straight profile, severe maxillary crowding, a maxillomandibular transverse differential index of 9 mm, and a Class I skeletal relationship. The treatment protocol consisted of surgical intervention with piezo-bone perforation and active orthodontic therapy. Immediately after the piezo-bone perforation on the lateral buccal side of the maxilla, active orthodontic therapy was started with activation of an expander. The expander was reactivated weekly. Treatment duration was 5 months 2 weeks. Proper overbite and overjet, facial balance, and occlusion were achieved. The treatment outcome was stable at the 3-year follow up. This treatment approach considerably reduced the treatment time and gained bony volume. Additionally, it transformed the periodontal biotype in contrast to conventional therapy. This approach is a good alternative for treating a severe maxillary transverse discrepancy in a skeletally mature patient, especially for a patient who does not want surgical rapid palatal expansion.

This updated safety review summarises the large body of safety data available on the use of recombinant activated factor VII (rFVIIa) in approved indications: haemophilia with inhibitors, congenital factor VII (FVII) deficiency, acquired haemophilia and Glanzmann's thrombasthenia. Accumulated data up to 31 December 2013 from clinical trials as well as post-marketing data (registries, literature reports and spontaneous reports) were included. Overall, rFVIIa has shown a consistently favourable safety profile, with no unexpected safety concerns, in all approved indications. No confirmed cases of neutralising antibodies against rFVIIa have been reported in patients with congenital haemophilia, acquired haemophilia or Glanzmann's thrombasthenia. The favourable safety profile of rFVIIa can be attributed to the recombinant nature of rFVIIa and its localised mechanism of action at the site of vascular injury. Recombinant FVIIa activates factor X directly on the surface of activated platelets, which are present only at the site of injury, meaning that systemic activation of coagulation is avoided and the risk of thrombotic events (TEs) thus reduced. Nonetheless, close monitoring for signs and symptoms of TE is warranted in all patients treated with any pro-haemostatic agent, including rFVIIa, especially the elderly and any other patients with concomitant conditions and/or predisposing risk factors to thrombosis.

AIMS To systematically review the effectiveness of on-demand treatment with recombinant coagulation factor VIIa (rFVIIa) in congenital haemophilia with inhibitors and, if feasible, perform a meta-analysis of the data. MATERIALS AND METHODS Publications from Embase® , MEDLINE® , MEDLINE® In-Process and the Cochrane Central Register of Controlled Trials were searched. Selected publications were reviewed for inclusion by two independent expert reviewers. Discrepancies were reconciled by a third independent reviewer. Data from selected studies were extracted using a predefined grid to ensure uniform and comparable results were captured. RESULTS A systematic search (cut-off date of 2 May 2016) identified 20 studies (13 observational; seven randomized controlled trials). All studies were of sufficient quality to include in this analysis and comprised 1221 participants, with 5981 bleeds in 746 individuals treated with rFVIIa. Haemostatic overall effectiveness of the individual studies identified ranged from 68% to 100% at ≤12 hours, 86% to 96% at 13-24 hours and 76% to 99% at 24-48 hours with rFVIIa

Nous rapportons un cas rare de kyste hydatique du psoas chez une patiente âgée de 79 ans, qui a présenté une tuméfaction de la face antéro-interne de la cuisse droite. L’échographie abdomino-pelvienne, la tomodensitométrie et la sérologie hydatique ont contribué au diagnostic préopératoire. Le traitement était chirurgical et a consisté en une périkystectomie totale par un abord rétropéritonéal. La masse a été enlevée en totalité par une approche rétropéritonéale.

JAK2 V617F point mutation is now well recognized in patients with chronic myeloproliferative neoplasms (MPNs). However, its frequency in Algerian patients is still unknown. We determined the JAK2 V617F mutation in blood samples from 344 patients from five hematology departments across West Algeria, using amplification refractory mutation system-polymerase chain reaction (ARMSPCR). The JAK2 V617F mutation was identified in 157/344 patients (45.63%), 80/98 polycythemia vera patients (81.6%), 44/75 essential thrombocythemia patients (58.6%), 6/13 primary myelofibrosis patients (46.2%), 21/87 with suspected MPN (12.9%), and 2/32 secondary thrombocytosis patients (6.2%), but was not detected in 28 patients with secondary erythrocytosis. Detection of JAK2 V617F mutation is an essential molecular tool to establish myeloproliferative neoplasm diagnosis, which allowed us to adjust the diagnosis for 6 patients and should be systematically included into the initial evaluation of patients suspected of MPNs in Algeria.

Objective To assess the quality of specimens obtained from prostate biopsies performed by urology residents and evaluate the number of procedures required to perform high-quality transrectal ultrasound (TRUS)-guided prostate biopsies. Materials and Methods Between 2006 and 2009, 770 patients underwent TRUS-guided prostate biopsies in our academic center. During the 6 semesters of this period, 24 residents (4 per semester) performed 1 session of 5.6 ± 1.5 procedures each month for a total of 33.6 ± 9 procedures during the study. The first session was performed with a senior urologist. Prostate cancer detection rate and standards of quality (average length of prostatic core biopsy specimens and absence of prostatic tissue) were retrospectively studied between the beginning and the end of each semester. Results A total of 12,760 biopsy cores were performed for 770 procedures. Mean patient age (64.5 ± 6.1 years), and median prostate-specific antigen (8.7 ± 3.7 ng/mL) were comparable between the study periods. The average length of biopsy cores significantly improved (+10%) from the first (12 ± 2.7 mm) to the last month (13.2 ± 2.1 mm) with a plateau after 12 procedures. Overall, cancer detection rate was 47% and was stable during the semester (41.3% the first month vs 44.1% the last month; P = .39). On univariate and multivariate analysis the mean length of biopsy specimens was associated with the number of procedures ( P P Conclusion Twelve procedures are necessary to perform high-quality TRUS-guided prostate biopsies without compromising prostate cancer detection. In current training programs, we strongly recommend that residents have direct supervision for a minimum of 12 cases before they are allowed to perform TRUS-guided biopsies with indirect supervision.

Background We have previously shown that a panel of kallikrein markers - total prostate-specific antigen (PSA), free PSA, intact PSA and human kallikrein-related peptidase 2 (hK2) - can predict the outcome of prostate biopsy in men with elevated PSA. Here we investigate the properties of our panel in men subject to clinical work-up before biopsy. Methods We applied a previously published predictive model based on the kallikrein panel to 262 men undergoing prostate biopsy following an elevated PSA (≥ 3 ng/ml) and further clinical work-up during the European Randomized Study of Prostate Cancer screening, France. The predictive accuracy of the model was compared to a "base" model of PSA, age and digital rectal exam (DRE). Results 83 (32%) men had prostate cancer on biopsy of whom 45 (54%) had high grade disease (Gleason score 7 or higher). Our model had significantly higher accuracy than the base model in predicting cancer (area-under-the-curve [AUC] improved from 0.63 to 0.78) or high-grade cancer (AUC increased from 0.77 to 0.87). Using a decision rule to biopsy those with a 20% or higher risk of cancer from the model would reduce the number of biopsies by nearly half. For every 1000 men with elevated PSA and clinical indication for biopsy, the model would recommend against biopsy in 61 men with cancer, the majority (≈80%) of whom would have low stage and low grade disease at diagnosis. Conclusions In this independent validation study, the model was highly predictive of prostate cancer in men for whom the decision to biopsy is based on both elevated PSA and clinical work-up. Use of this model would reduce a large number of biopsies while missing few cancers.

OBJECTIVES: To compare the predictive performance and potential clinical usefulness of risk calculators of the European Randomized Study of Screening for Prostate Cancer (ERSPC RC) with and without information on prostate volume. METHODS: We studied 6 cohorts (5 European and 1 US) with a total of 15,300 men, all biopsied and with pre-biopsy TRUS measurements of prostate volume. Volume was categorized into 3 categories (25, 40, and 60 cc), to reflect use of digital rectal examination (DRE) for volume assessment. Risks of prostate cancer were calculated according to a ERSPC DRE-based RC (including PSA, DRE, prior biopsy, and prostate volume) and a PSA + DRE model (including PSA, DRE, and prior biopsy). Missing data on prostate volume were completed by single imputation. Risk predictions were evaluated with respect to calibration (graphically), discrimination (AUC curve), and clinical usefulness (net benefit, graphically assessed in decision curves). RESULTS: The AUCs of the ERSPC DRE-based RC ranged from 0.61 to 0.77 and were substantially larger than the AUCs of a model based on only PSA + DRE (ranging from 0.56 to 0.72) in each of the 6 cohorts. The ERSPC DRE-based RC provided net benefit over performing a prostate biopsy on the basis of PSA and DRE outcome in five of the six cohorts. CONCLUSIONS: Identifying men at increased risk for having a biopsy detectable prostate cancer should consider multiple factors, including an estimate of prostate volume.

OBJECTIVES: To evaluate the discrimination, calibration, and net benefit performance of the Prostate Cancer Prevention Trial Risk Calculator (PCPTRC) across five European randomized study of screening for prostate cancer (ERSPC), 1 United Kingdom, 1 Austrian, and 3 US biopsy cohorts. METHODS: PCPTRC risks were calculated for 25,733 biopsies using prostate-specific antigen (PSA), digital rectal examination, family history, history of prior biopsy, and imputation for missing covariates. Predictions were evaluated using the areas underneath the receiver operating characteristic curves (AUC), discrimination slopes, chi-square tests of goodness of fit, and net benefit decision curves. RESULTS: AUCs of the PCPTRC ranged from a low of 56% in the ERSPC Goeteborg Rounds 2-6 cohort to a high of 72% in the ERSPC Goeteborg Round 1 cohort and were statistically significantly higher than that of PSA in 6 out of the 10 cohorts. The PCPTRC was well calibrated in the SABOR, Tyrol, and Durham cohorts. There was limited to no net benefit to using the PCPTRC for biopsy referral compared to biopsying all or no men in all five ERSPC cohorts and benefit within a limited range of risk thresholds in all other cohorts. CONCLUSIONS: External validation of the PCPTRC across ten cohorts revealed varying degree of success highly dependent on the cohort, most likely due to different criteria for and work-up before biopsy. Future validation studies of new calculators for prostate cancer should acknowledge the potential impact of the specific cohort studied when reporting successful versus failed validation.

IntroductionPsychotraumatism can constitute for some people a real existential fracture, a real upheaval of the psychic organization.Immediate psychological reactions can vary from one-off and temporary reactions to far more severe and sometimes enduring reactions.Material and methodsWe collected the case of a patient who was hospitalised in April 2015 for manic symptoms in the immediate aftermath of a terrorist attack, with a review of the literature.Clinical caseThis is Mr. A. F., aged 38, with a personal history of AVP and a shooting wound following a terrorist attack. He had presented a psychomotor instability and an exaltation of the mood in the immediate aftermath of an ambush.Behavioural problems were identified by the psychiatric team during the group debriefing conducted at the HMPIT emergency room. During his hospitalisation, a chemotherapy based on thymoregulators, neuroleptics and anxiolytics was introduced.The evolution was marked by a significant regression of the manic syndrome after ten days, and the installation of a post-traumatic stress condition (PTSD). At the end of eight months, the patient was able to resume his work with long-term thymoregulatory treatment, a ban on weapons and safety posts.ConclusionManic episodes are rarely observed as an immediate post-traumatic reaction. Their occurrence does not prevent the subsequent installation of PTSD. Has psychic trauma revealed a latent psychosis? Is it a trauma-induced mood disorder?Disclosure of interestThe authors have not supplied their declaration of competing interest.

The classification within Echinococcus granulosus is currently under debate. To assess the reproductive potential between the G1 and G6 strains, an experimental double infection was carried out in a dog. First, two fertile hydatid cysts were collected in Algeria from a cow and a dromedary. They were identified as being G1 and G6 with the markers coxI and nadI. Subsequently, a dog was inoculated with protoscoleces from these two cysts. Sixty days after infection, 85 adult worms were recovered from the intestine of the dog. Then, the two cysts and each of these individual parasites were characterized with the multilocus microsatellite EmsB and compared. For all worms, the scolex and the gravid proglottids, separately analyzed, provided an identical profile: the G1 profile was observed in 70 adults, and the G6 profile in the 15 others. No single worm exhibited a hybrid G1/G6 profile. This result suggests the absence of cross-fertilizing between the two taxa under the given experimental conditions, and so, the presence of a strong cross-reproductive barrier. This observation corroborates with the recent reclassification of G1 and G6 within two distinct species.

In case of biochemical recurrence after radical prostatectomy, hormonal treatments are equally efficient. Early hormonal treatment after biochemical recurrence reduces specific mortality, local and metastatic progression. In locally advanced prostate cancer, adjuvant radiation therapy after biochemical recurrence reduces local and metastatic recurrence. Withdrawal of the steroid hormone should be the first maneuver after primary hormonal therapy failure. Second generation anti-androgens (abiraterone and MDV 3100) should be released soon. These new hormonal agents are in clinical trials and show promising activity in patients with CRPC.

Actinomycosis is an unusual and unrecognized cause of spinal cord compression of infectious origin. We report the case of a 57-year-old immunocompetent woman admitted for sub-acute lower limb ataxia. The diagnosis of spinal cord compression secondary to actinomyces infectious arthritis was established. Surgical decompression and long-term antibiotic treatment enabled complete recovery. Data from the literature indicate that actinomycosis is a potential cause of several neurological manifestations. Unusual but treatable, actinomycosis is a potential alternative when the main etiologies have been ruled out.

A first serum total PSA assay is recommended during the first three months after treatment. When PSA is detectable, PSA assay should be repeated three months later to confirm this elevation and to estimate the PSA doubling time (PSADT). In the absence of residual cancer, PSA becomes undetectable by the first month after total prostatectomy: less than 0.1 ng/ml (or less than 0.07 ng/ml) for the ultrasensitive assay method and less than 0.2 ng/ml for the other methods. In the presence of residual cancer, PSA either does not become undetectable or increases after an initial undetectable period. A consensus has been reached to define recurrence as PSA greater than 0.2 ng/ml confirmed on two successive assays. After external beam radiotherapy, PSA can decrease after a mean interval of one to two years to a value less than 1 ng/ml (predictive of recurrence-free survival). Biochemical recurrence after radiotherapy is defined by an increase of PSA by 2 ng or more above the PSA nadir, whether or not it is associated with endocrine therapy. After endocrine therapy, the PSA nadir is correlated with recurrence-free survival. PSA is decreased for a mean of 18 to 24 months followed by a rise in PSA, corresponding to hormone-independence. The time to recurrence or the time to reach the nadir and the PSA doubling time after local therapy with surgery or radiotherapy have a diagnostic value in terms of the site of recurrence, local or metastatic and a prognostic value for survival and response to complementary radiotherapy or endocrine therapy. A PSADT less than eight to 12 months is correlated with a high risk of metastatic recurrence and 10-year mortality. The histological and biochemical characteristics in favour of local recurrence are Gleason score less or equal to seven (3+4), elevation of PSA after a period greater than 12 months and PSADT greater than 10 months. In other cases, recurrence is predominantly metastatic. The risk of demonstrating metastasis in the case of biochemical recurrence after total prostatectomy and before endocrine therapy depends on the PSA level and the PSADT. No consensus has been reached concerning the indication for complementary investigations by bone scan and abdominopelvic CT in patients with biochemical recurrence after treatment of localized cancer without endocrine therapy. However, when PSADT greater than six months, the risk of metastasis is less than 3% even for PSA greater than 30 ng/ml. When PSADT less than six months and PSA greater than 10 ng/ml, the risk of metastasis is close to 50%.

Molecular forms of serum PSA (prostate specific antigen) have been developped to improve total PSA sensitivity and specificity in prostate cancer diagnosis and staging. Total PSA is measured in bound (complexed PSA) and unbound (free PSA) molecular forms. Their levels in absolute values and in relation to total PSA (f/t PSA and c/t PSA) have been evaluated. The percentage of free PSA is more specific but less sensitive than tPSA and it is not recommended as a first line diagnostic test. It may be useful as a second-line test, prescribed by the urologist after a first series of negative biopsies. There is general agreement that at high sensitivity, cPSA provides higher specificity compared with tPSA in the gray zone (2-10 ng/ml). Nevertheless the widespread use of tPSA an the small benefit in terms of specificity explains why cPSA is not generally recommanded. Molecular derivates of free PSA have been identified: proPSA (precursor inactive form of PSA), intact PSA (an additionnal form of proPSA that is found intact and inactive), human Kallikrein 2 and BPSA (for benign PSA wich is associated to BPH) have been evaluated. Preliminary studies did not have demonstrate their ability to discriminate between cancer and BPH, and did not define cutoff values.

Study design A reliability study was conducted in quantitative 3-dimensional (3D) measurements for mild scoliosis. Objective To evaluate the intrarater and interrater reliability of a computer tool used for 3D reconstruction of the spine. Summary of background data No reliability study of spinal in vivo 3D medical imaging measurements has been performed in the literature. Methods This study included 30 patients (mean age 13 years) with mild idiopathic scoliosis. Spinal 3D reconstruction was performed using a new technique called semiautomatic 3D reconstruction, which requires only the location of the corners of each vertebral body on 2 orthogonal views. Three raters performed the 3D reconstruction procedure on the 30 pairs of radiographs in random order. One of the raters repeated the procedure for the 30 patients 15 days later. Inter-reliability and intra-reliability were estimated for different parameters: thoracic kyphosis, lumbar lordosis, Cobb's angle, pelvic morphologic and positional parameters, and axial rotation. Results Intraclass correlation coefficient showed good or very good agreement for most of the measurements. The 95% prediction limits are approximately 4 degrees for the measurements of spinal curves, 2 degrees for pelvic parameters, and axial vertebral rotation. Conclusions The reliability of 3D reconstruction of the spine is acceptable, and this technique can be used for clinical studies.

The authors investigated biochemical and haematological parameters in 40 healthy and 40 tropical theileriosis (Theileria annulata) clinically infected cattle in El Eulma region (North East Algeria). The mean haematological and biochemical parameters including the number of erythrocytes, haemoglobin, haematocrit, mean corpuscular volume, mean corpuscular haemoglobin concentration and mean corpuscular haemoglobin were estimated. The mean hematological and biochemical parameters including the number of leukocytes, erythrocytes, hemoglobin, hematocrit, glucose, albumin, total proteins decreased significantly (p = 0.005; 0.008; 0.03 0.048; 0.002; 0.027 and 0.018; respectively) in Montbeliard breed clinically infected with T. annulata. In all diseased animals, the concentration of total and direct bilirubin increased significantly (p

STUDY DESIGN This is a prospective radiographic and force plate analysis involving adult volunteer and patients with scoliosis. OBJECTIVE To assess accurately the center of pressure in standing volunteers and patients with scoliosis, and correlate these finding with radiographic data. SUMMARY OF BACKGROUND DATA A simple and commonly applied parameter of global balance is the plumbline offset. This radiographic measurement refers to the center of C2 (or C7) drawn vertically downward. Although this measurement is simple, it may not accurately reflect the balance of the spine. METHODS This study included adult volunteers (n = 41) and patients with scoliosis (n = 45). Full-length, freestanding spine radiographs were obtained with subjects on a force plate. Simultaneous assessment of the radiologic spinal posture and the floor projection of the center of pressure (gravity line) was possible. The latter was projected on the full spine images and correlated to common radiographic parameters. RESULTS The position of the gravity line differed significantly from the plumbline in frontal and sagittal planes (P < 0.001). This difference was maintained in both study populations. The mean frontal plane alignment of the gravity line was consistently to the right of the plumbline. The mean sagittal plane alignment of the gravity in relation to the plumbline revealed an offset anteriorly. CONCLUSIONS The data analysis of offsets between the gravity line and radiographic parameters revealed a frontal plane mean displacement of the gravity line to the right. In the sagittal plane, a highly significant lack of correlation between the gravity line and plumbline was noted. The plumbline represents a common and convenient visual display of apparent sagittal plane imbalance, but its value as a marker of true postural balance must be questioned.

Study design A prospective self-assessment analysis and evaluation of nutritional and radiographic parameters in a consecutive series of healthy adult volunteers older than 60 years. Objectives To ascertain the prevalence of adult scoliosis, assess radiographic parameters, and determine if there is a correlation with functional self-assessment in an aged volunteer population. Summary of background data There exists little data studying the prevalence of scoliosis in a volunteer aged population, and correlation between deformity and self-assessment parameters. Methods There were 75 subjects in the study. Inclusion criteria were: age > or =60 years, no known history of scoliosis, and no prior spine surgery. Each subject answered a RAND 36-Item Health Survey questionnaire, a full-length anteroposterior standing radiographic assessment of the spine was obtained, and nutritional parameters were analyzed from blood samples. For each subject, radiographic, laboratory, and clinical data were evaluated. The study population was divided into 3 groups based on frontal plane Cobb angulation of the spine. Comparison of the RAND 36-Item Health Surveys data among groups of the volunteer population and with United States population benchmark data (age 65-74 years) was undertaken using an unpaired t test. Any correlation between radiographic, laboratory, and self-assessment data were also investigated. Results The mean age of the patients in this study was 70.5 years (range 60-90). Mean Cobb angle was 17 degrees in the frontal plane. In the study group, 68% of subjects met the definition of scoliosis (Cobb angle >10 degrees). No significant correlation was noted among radiographic parameters and visual analog scale scores, albumin, lymphocytes, or transferrin levels in the study group as a whole. Prevalence of scoliosis was not significantly different between males and females (P > 0.03). The scoliosis prevalence rate of 68% found in this study reveals a rate significantly higher than reported in other studies. These findings most likely reflect the targeted selection of an elderly group. Although many patients with adult scoliosis have pain and dysfunction, there appears to be a large group (such as the volunteers in this study) that has no marked physical or social impairment. Conclusions Previous reports note a prevalence of adult scoliosis up to 32%. In this study, results indicate a scoliosis rate of 68% in a healthy adult population, with an average age of 70.5 years. This study found no significant correlations between adult scoliosis and visual analog scale scores or nutritional status in healthy, elderly volunteers.

A disseminated Fusarium oxysporum infection with skin localization was diagnosed in a woman with a relapse of B-acute leukemia during induction chemotherapy. The infection was refractory to amphotericin B-lipid complex alone but responded successfully when voriconazole was added.

Purpose: The relationship between prostate-specific antigen (PSA) level and prostate cancer risk remains subject to fundamental disagreements. We hypothesized that the risk of prostate cancer on biopsy for a given PSA level is affected by identifiable characteristics of the cohort under study. Experimental Design: We used data from five European and three U.S. cohorts of men undergoing biopsy for prostate cancer; six were population-based studies and two were clinical cohorts. The association between PSA and prostate cancer was calculated separately for each cohort using locally weighted scatterplot smoothing. Results: The final data set included 25,772 biopsies and 8,503 cancers. There were gross disparities between cohorts with respect to both the prostate cancer risk at a given PSA level and the shape of the risk curve. These disparities were associated with identifiable differences between cohorts: for a given PSA level, a greater number of biopsy cores increased the risk of cancer (odds ratio for >6- versus 6-core biopsy, 1.35; 95% confidence interval, 1.18-1.54; P < 0.0005); recent screening led to a smaller increase in risk per unit change in PSA (P = 0.001 for interaction term) and U.S. cohorts had higher risk than the European cohorts (2.14; 95% confidence interval, 1.99-2.30; P < 0.0005). Conclusions: Our results suggest that the relationship between PSA and risk of a positive prostate biopsy varies, both in terms of the probability of prostate cancer at a given PSA value and the shape of the risk curve. This poses challenges to the use of PSA-driven algorithms to determine whether biopsy is indicated. Clin Cancer Res; 16(17); 4374–81. ©2010 AACR.

Study design Retrospective review of a series of patients who underwent spinal surgery at a single spine unit during a 1 year period. Objectives To assess the incidence, treatment, clinical consequence, complications of incidental durotomy during spine surgery and results of 37 months clinical follow-up. Summary of background data Incidental durotomy is an underestimated and relatively adverse event during spinal surgery. Several consequences of inadequately treated dural tears have been reported. Methods A retrospective review was conducted on 1326 consecutive patients who underwent spinal surgery performed in one French spine unit from January 2005 to December 2005. We excluded from this study patients treated for emergency spine cases. Results Fifty-one dural tears were identified (3.84%). Incidental durotomies were associated with anterior cervical approach in 1 case, with posterior cervical approach in 1 case, with anterior retroperitoneal approach in 1 case and with posterior thoracolumbar approach in 48 cases. In addition, any clinically significant durotomy unrecognised during surgical procedure were included. Thirteen patients presented postoperative complications including 7 cerebrospinal fluid leaks, 2 wound infections, 2 postoperative haematomas, and 2 pseudomeningoceles. Nine of these 13 patients required a revision procedure. A mean follow-up of 37 months showed good long-term clinical results. Conclusions Incidental durotomy is a common complication of spine surgery. All incidental durotomies must be repaired primarily. Dural tears that were immediately recognised and treated accordingly did not lead to any significant sequelae at a mean follow-up of 37 months. However, long-term follow-up studies will be needed to confirm this finding. The risks associated with dural tears and cerebrospinal fluid leaks are serious and should be discussed with any patients undergoing spine surgery.

Summary We report on a case of isolated lesser trochanter fracture, without associated trauma, secondary to pulmonary adenocarcinoma metastasis. Treatment consisted in resection–reconstruction by megaprosthesis. This form of isolated fracture is rare, and results from infiltration of the trochanteric area by a malignant tumoral process, which is usually metastatic.

Cystic echinococcosis (CE) is a widespread and severe zoonotic disease caused by infection with the larval stage of the eucestode Echinococcus granulosus sensu lato. The polymorphism exhibited by nuclear and mitochondrial markers conventionally used for the genotyping of different parasite species and strains does not reach the level necessary for the identification of genetic variants linked to restricted geographical areas. EmsB is a tandemly repeated multilocus microsatellite that proved its usefulness for the study of genetic polymorphisms within the species E. multilocularis , the causative agent of alveolar echinococcosis. In the present study, EmsB was used to characterize E. granulosus sensu lato samples collected from different host species (sheep, cattle, dromedaries, dogs, and human patients) originating from six different countries (Algeria, Mauritania, Romania, Serbia, Brazil, and the People's Republic of China). The conventional mitochondrial cox1 and nad1 markers identified genotypes G1, G3, G5, G6, and G7, which are clustered into three groups corresponding to the species E. granulosus sensu stricto, E. ortleppi , and E. canadensis . With the same samples, EmsB provided a higher degree of genetic discrimination and identified variations that correlated with the relatively small-scale geographic origins of the samples. In addition, one of the Brazilian single hydatid cysts presented a hybrid genotypic profile that suggested genetic exchanges between E. granulosus sensu stricto and E. ortleppi . In summary, the EmsB microsatellite exhibits an interesting potential for the elaboration of a detailed map of the distribution of genetic variants and therefore for the determination and tracking of the source of CE.