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Introduction/Background* Breast cancer is the first women cancer. For adequate treatment we should have a relevant diagnosis based on morphology and immunohistochemistry (IHC). In our national institute of oncology the deadlines of pathology report are very long because of the significant number of samples received from different department. We have established a specific protocol to manage breast biopsy to speed up the histological report. We would represent in this paper the evaluation of the implantation of this support protocol in our lab. Methodology In the new procedure of our lab the breast biopsy was separately treated from other routine samples. They was treated in cassette of different color. Two technicians was specially dedicate to manage all the technical steps.In our laboratory we received both chirurgical and radiological biopsy. Both go under the same technical protocol. They are fixed with formalin then they goes through the preanalytical procedures the same day. To evaluate the impact of the implement of this procedure, we compare the report output deadline of biopsy received between January and February 2018 with those received the same period in 2020 after the implementation of the protocol. Result(s)* In 2018, the deadlines of issuing the final report were on average 21.5 day while in 2020 after implementation of the protocol, the deadlines issuing passed to 11.75 day. The deadlines stay long because of many others issues like long absence of patients especially for socio-economic reasons. For us in the laboratory we can guarantee a primary report based on morphological features within 2 days after receiving the biopsy. The final report with IHC report can be ready in maximum 6 days after receiving the sample. In fact it depends on the rhythm of the IHC technique which is programmed minimum twice per week. Conclusion* Pathology report is the key of all therapeutic issues in breast cancer. For a best supported therapy for our patients we accelerate the procedure of biopsy management while keeping a good quality of study. Our ultimate goal is to provide the most specific diagnosis as soon as possible to procure the best therapy for patients.

Introduction/Background* The presentstudywascarried out over a 1-year period (January 2017-December 2017) and conductedat the cytology unit of PathologyDepartment (Salah Azaiez Institute, Tunisia). It included all patients withbreastlesionreferred to our unit. Smearswerefixed and stained by May GrunwaldGiemsa .Cytologyresultswerecategorizedaccording to the NCI by twocytopathologistsindependently. Methodology The presentstudywascarried out over a 1-year period (January 2017-December 2017) and conductedat the cytology unit of PathologyDepartment (Salah Azaiez Institute, Tunisia). It included all patients withbreastlesionreferred to our unit. Smearswerefixed and stained by May GrunwaldGiemsa .Cytologyresultswerecategorizedaccording to the NCI by twocytopathologistsindependently. Result(s)* FNAC interpretivecategorizationwas as follows : 188 (31,3%)inadequate (C1), 378 (63%) benign (C2), 1 (0,16%) atypical, probablybenign (C3), 31 (5,14%) suspicious of malignancy (C4) and 2 (0,4%) malignant (C5).The histopathologicalexamination of category C3 showed a benignlesion.Histopathologicalexamination of category C4 wasassessedonly for 20 patients. 14/20 cases showedbenignlesions, in one case an in-situ carcinomawasdiagnosed and 5/20 cases showedmalignancy.The positive predictive value of C4 category in the diagnosis of malignancywas 30%. Conclusion* FNA is a safe and cost-effective technique for the diagnosis of breastlesions, especiallywhencorrelatedwithclinical and imagingstudies. It has achievedgreat importance in diagnosis and management of palpable breastlesions. However, we must beaware of possibility of “false positive” and “false negative” resultsespecially for categories C3 and C4.

Auditory sentence comprehension involves processing content (semantics), grammar (syntax), and intonation (prosody). The left inferior frontal gyrus (IFG) is involved in sentence comprehension guided by these different cues, with neuroimaging studies preferentially locating syntactic and semantic processing in separate IFG subregions. However, this regional specialisation has not been confirmed with a neurostimulation method. Consequently, the causal role of such a specialisation remains unclear. This study probed the role of the posterior IFG (pIFG) for syntactic processing and the anterior IFG (aIFG) for semantic processing with repetitive transcranial magnetic stimulation (rTMS) in a task that required the interpretation of the sentence’s prosodic realisation. Healthy participants performed a sentence completion task with syntactic and semantic decisions, while receiving 10 Hz rTMS over either left aIFG, pIFG, or vertex (control). Initial behavioural analyses showed an inhibitory effect on accuracy without task-specificity. However, electrical field simulations revealed differential effects for both subregions. In the aIFG, stronger stimulation led to slower semantic processing, with no effect of pIFG stimulation. In contrast, we found a facilitatory effect on syntactic processing in both aIFG and pIFG, where higher stimulation strength was related to faster responses. Our results provide first evidence for the functional relevance of left aIFG in semantic processing guided by intonation. The stimulation effect on syntactic responses emphasises the importance of the IFG for syntax processing, without supporting the hypothesis of a pIFG-specific involvement. Together, the results support the notion of functionally specialised IFG subregions for diverse but fundamental cues for language processing.

Resume Introduction Les facteurs genetiques sont a prendre en consideration dans le diagnostic etiologique de la lithiase urinaire. Le but de cette etude retrospective est de determiner les caracteristiques cliniques, metaboliques et evolutives de la lithiase urinaire hereditaire chez nos patients. Materiels et methodes Sur une periode de 10 ans allant de 2008 a 2018, nous avons collige 60 cas de lithiase urinaire hereditaire. Les malades ont ete adresses pour, un suivi a un âge adulte d’un service de pediatrie dans neuf cas, un bilan etiologique dans 42 cas et pour une insuffisance renale chronique dans neuf cas. Resultats Il s’agit de 35 hommes et de 25 femmes avec un genre ratio H/F : 1,4. L’âge moyen au moment du diagnostic de la cause hereditaire de la lithiase urinaire etait de 28,6 ans (3 mois–63 ans). Le delai moyen entre le debut de la lithiase urinaire et le diagnostic etiologique etait de 8 ans (0–42 ans). Nous avons note 31 cas de cystinurie, 18 cas d’hyperoxalurie primaire de type 1 avec deux mutations du gene AGXT (I244T dans 14 cas et 33-34 Insc dans 3 cas) et 11 cas de tubulopathie renale. Quatorze patients avaient une insuffisance renale chronique dont cinq au stade terminal. La cristallurie etait positive dans 62 % des cas. L’analyse morpho-constitutionnelle des calculs a ete faite dans 37 cas et a contribue au diagnostic dans 29 cas. Apres un suivi moyen de 16 ans, nous avons note une fonction renale normale dans 42 cas, une insuffisance renale chronique dans sept cas, une prise en charge en dialyse dans 10 cas tous atteints d’une HOP type 1 et une transplantation renale dans un cas. Conclusion Le diagnostic etiologique de la lithiase urinaire hereditaire dans notre etude a ete fait avec un retard important. La cystinurie a constitue l’etiologie la plus frequente et l’hyperoxalurie primaire etait l’affection la plus grave. Niveau de preuve 4.

Context and objective. Renal thrombotic microangiopathy (TMA) is a histological lesion that can be observed in several pathological settings. The present study aimed to describe the different etiological contexts in which TMA has been observed and provide particularities.Methods. A retrospective and descriptive study over a 16-year period, from January 2000 to January 2016 was conducted at the Tunis University Hospital. All patients aged over 16 years and presenting with TMA at renal biopsy were analyzed.Results. 100 cases of renal TMA were collected. The mean age of patients at the time of renal biopsy was 38.5 ± 12.9 years. The clinical picture was dominated by hypertension observed in 70 patients. Results of the laboratory investigations were as follows: kidney injury was noted in 92 patients and biological TMA was observed in 10 patients. At the renal biopsy, arteriolar TMA was seen in all patients and glomerular TMA was seen in 15 patients. Seventy-three patients reached end stage renal disease. TMA was observed mainly in association with glomerular nephropathy outside lupus nephropathy in 47 cases, lupus nephropathy in 19 cases, malignant hypertension in 18 cases and post-renal transplantation in 9 cases. TMA was related to atypical hemolytic uremic syndrome in one case and 6 sporadic cases were observed.Conclusion. Renal TMA has been observed in several pathological situations. Comparative studies with matched control cases in each group but without TMA lesions should be performed to identify risk factors for developing TMA and the influence of TMA on renal prognosis in each etiological setting. Contexte et objectif. La microangiopathie thrombotique (MAT) rénale est une lésion histologique caractérisée par la présence de microthrombi obstruant les vaisseaux de la microcirculation rénale. Actuellement, les patients atteints de MAT rénale sont répartis en fonction du contexte étiologique. L’objectif de la présente étude était de décrire les différents contextes pathologiques au cours desquels une MAT rénale a été observée.Méthodes. Il s’agissait d’une étude documentaire (16 ans). L’étude a inclus tous les patients adultes ayant des lésions de MAT à la ponction biopsie rénale (PBR).Résultats. Parmi 3240 PBR réalisées, la MAT a été observée chez 100 patients soit une incidence moyenne de 6,7 cas/an. L’âge moyen était de 38,5+/-12,9 ans avec une prédominance masculine. Les lésions de MAT rénale ont été associées à plusieurs contextes pathologiques: les néphropathies glomérulaires (47%), les néphropathies lupiques (19%), l’HTA maligne (18%), post transplantation rénale (9%), postgreffe de cellules souches hématopoïétiques (1%), post partum (2%), un contexte néoplasique (1%), une origine médicamenteuse (1%), un syndrome des antiphospholipides primaire (1%), et un syndrome hémolytique et urémique (1%).Conclusion. La MAT rénale est fréquemment secondaire et s’associe à plusieurs contextes pathologiques. Cependant un SHUa/PTT sous-jacents devrait toujours être recherchés.

Context and objective. IgA vasculitis is a leukocytoclastic vasculitis with IgA deposits characterized by the association of cutaneous, articular and digestive involvements. Renal involvement worsens the pronostic of the disease. The main objective of this work was to identify the risk factors of end-stage renal failure in Tunisian adults with IgA vasculitis.Methods. From 1975 to 2017, patients with IgA vasculitis and nephritis were studied retrospectively. All the patients benefited from a renal biopsy classified histologically according to Pillebout.Results. Thirty-four adult patients (mean age at nephritis onset: 39 ± 17.6y) mainly men, were included. Risk factors for progression to end stage renal disease were: edema (p=0.002), oligoanuria (p=0.003), initial renal impairment (p=0.001), anemia (p=0.010), hyperuricemia (p=0.015), class IV (p=0.018), crescents (p=0.018) and interstitial fibrosis (p=0.017).Conclusion. The outcome of renal involvement during IgA vasculitis is relatively poor. Renal involvement conditions the long-term prognosis of the disease. The identification of clinical, biological and histological risk factors of end stage renal failure would improve its management. Contexte et objectif. Le purpura rhumatoïde est une vascularite leucocytoclasique à dépôts d’IgA caractérisée par l’association de signes cutanés, articulaires et digestifs. L’atteinte rénale fait la gravité de la maladie. Le principal objectif de ce travail était d’identifier les facteurs prédictifs de la maladie rénale chronique stade 5 chez des patients ayant un Purpura Rhumatoïde avec atteinte rénale.Méthodes. Nous avons étudié de façon rétrospective les observations de patients ayant présenté un purpura rhumatoïde avec atteinte rénale colligés de 1975 à 2017. Les lésions histologiques ont été classées selon la classification de Pillebout.Résultats. Nous avons colligé 34 patients adultes atteints de Purpura Rhumatoïde avec atteinte rénale. L’âge moyen des patients était de 39 ± 17,6 ans avec une prédominance masculine. Les facteurs prédictifs de la Maladie Rénale Chronique stade 5 étaient : les œdèmes (p=0,002), l’oligoanurie (p=0,003), l’insuffisance rénale initiale (p=0,001), l’anémie (p=0,010), l’hyperuricémie (p=0,015), la classe histologique IV (p=0,018), les croissants (p=0,009) et la fibrose interstitielle (p=0,017).Conclusion. L’atteinte rénale au cours du Purpura Rhumatoïde conditionne le pronostic à long terme. Sa recherche doit être systématique afin de prévenir ou de ralentir l’évolution vers la maladie rénale chronique stade 5.

The language system uses syntactic, semantic, as well as prosodic cues to efficiently guide auditory sentence comprehension. Prosodic cues, such as pitch accents, can build expectations about upcoming sentence elements. This study investigates to what extent syntactic and semantic expectations generated by pitch accents can be dissociated and if so, which cues take precedence when contradictory information is present. We used sentences in which one out of two nominal constituents was placed in contrastive focus with a third one. All noun phrases carried overt syntactic information (case-marking of the determiner) and semantic information (typicality of the thematic role of the noun). Two experiments (a sentence comprehension and a sentence completion task) show that focus, marked by pitch accents, established expectations in both syntactic and semantic domains. However, only the syntactic expectations, when violated, were strong enough to interfere with sentence comprehension. Furthermore, when contradictory cues occurred in the same sentence, the local syntactic cue (case-marking) took precedence over the semantic cue (thematic role), and overwrote previous information cued by prosody. The findings indicate that during auditory sentence comprehension the processing system integrates different sources of information for argument role assignment, yet primarily relies on syntactic information.

Tese no âmbito do Programa Interuniversitário de Doutoramento em Matemática, apresentada ao Departamento de Matemática da Faculdade de Ciências e Tecnologia da Universidade de Coimbra. In this work we study two matrix rank minimization problems, which lead to two new notions of matrix rank. In the first one, our goal is to minimize the rank of a complex matrix whose absolute values of the entries are given. We call this minimum the phaseless rank of the matrix of the entrywise absolute values. In the second, the rank minimization is performed over complex matrices whose entries have prescribed arguments. In this case, the minimum is named as the phase rank of the matrix of phases or arguments. Regarding phaseless rank, we extend a classic result of Camion and Hoffman and connect it to the study of amoebas of determinantal varieties and of semidefinite representations of convex sets. As a result, we prove that the set of maximal minors of a matrix of indeterminates forms an amoeba basis for the ideal they define, and we attain a new upper bound on the complex semidefinite extension complexity of polytopes, dependent only on their number of vertices and facets. We also highlight the connections between the notion of phaseless rank and the problem of finding large sets of complex equiangular lines or mutually unbiased bases. The main contributions on phase rank are a new and simpler characterization of the 3×3 case, more specifically that the coamoeba of the 3×3 determinant is completely characterized by the condition of colopsidedness, and a simple upper bound on the phase rank dependent only on the dimensions of the matrix. Nesta tese estudamos dois problemas de minimização de característica matricial, que dão origem eles próprios a dois novos conceitos de característica matricial. No primeiro deles, pretendemos determinar a característica mínima de todas as matrizes complexas cujos valores absolutos das entradas são dados. Este mínimo é chamado característica sem fase da matriz dos valores absolutos. No segundo, a minimização da característica restringe-se às matrizes complexas cujos argumentos estão fixos. Neste caso, o mínimo é designado por característica de fase da matriz dos argumentos. Relativamente à característica sem fase, generalizamos um resultado clássico de Camion e Hoffman que pode ser reinterpretado em termos de amibas de variedades determinantais e ligado às representações semidefinidas de conjuntos convexos. Em particular, provamos que o conjunto dos menores maximais de uma matriz de variáveis constitui uma base da amiba do ideal por eles definido, além de obtermos um novo majorante para a complexidade de extensão complexa semidefinida de polítopos, dependente apenas dos seus números de vértices e facetas. Enfatizamos também as relações entre o conceito de característica sem fase e os problemas das linhas equiangulares complexas e das "mutually unbiased bases". Quanto à característica de fase, os principais contributos desta tese são uma nova e mais simples caracterização do caso 3×3, nomeadamente que a coamiba do determinante 3×3 é totalmente determinada pela condição de "colopsidedness", e um majorante simples para a característica de fase que depende apenas das dimensões da matriz.

Background and Aims Peritoneal Dialysis (PD) is now often being initiated in older patients. The benefits of this modality of dialysis have been well demonstrated in the literature. The aim of our study was to analyse the epidemiological and clinical profile of the elderly patients and to determine predictive factors of mortality Method It was a retrospective study including 51 case defined as patients ≥65-year-old, treated by PD in the Internal Medicine Department of the Charles Nicolle hospital during the period between 1986 and 2020. Results Fifty one patients were enrolled in the study. Their mean age was 71,6 ± 5,4 years [65 - 86]. There were 32 men (62, 7%) and 19 women (37,2%) . The method of initiation was the PD in 53, 84%. Diabetic and vascular nephropathy was the first cause of End-Stage Renal Disease in 56% and 19,6%. The mean Charlson score was 5,5 ± 1,4 [3-9]. The mean age when using PD was 70.8 ± 6 years [54-86]. Autonomous and active patients were detected in 29.4%. Diabetes mellitus, hypertension and coronary artery disease was observed in 58,8%, 29,4% and 15.7% of patients. In our study, 82.35% started on automated PD (APD) and 17,6% on continuous ambulatory PD (CAPD). The rate of mortality was 53%. Switching modality from PD to hemodialysis occurred in 29,4% of cases. A univariate logistic regression identified a coronary artery disease as significantly associated with increased mortality (HR=2,1 [1-2,1, IC 95%](p=0.035)). Conclusion Elderly patients on dialysis face many issues but can have continued success with PD when they have adequate care and support. The control of the morbidities such as coronary artery disease is important to decrease the rate of mortality in patients using this modality of dialysis.

Background and Aims Acute kidney injury (AKI) is common in the elderly due to physiologic renal aging and underlying pathologies. Few studies focused on AKI in Tunisian elderly. The aim of our study was to highlight the epidemiological, clinical, etiological, therapeutic, and progressive characteristics of AKI in elderly. Method We conducted a descriptive retrospective study of AKI in patients admitted to our department over a period of 04 years from 01/01/2014 to 31/12/2017. Results We collected 40 patients including 25 women and 15 men with a sex ratio of 1.66. The mean age was 74 [65-87] years. We noted the presence of pre-existing chronic kidney disease in 58% of cases, diabetes in 50% of cases and hypertension in 73% of cases. Polypharmacy was found in 40% of cases. AKI was symptomatic in 80% of cases and found on a routine check-up in 20% of cases. Mean creatinine was 612+/-334 µmol/l. AKI was pre-renal in 37% and parenchymal in 63% of cases. Iatrogenic origin was found in 33% of cases. Renal biopsy was performed for diagnostic purposes in 6 cases. Haemodialysis was necessary in 50% of cases. Etiopathogenic treatment was initiated in 73% of cases. Intra-hospital mortality was 10%, recovery of renal function (RF) was partial in 40 % of cases and total in 20 % of cases. Follow-up time was 16 +/- 23.2 months. And at the last news, recovery of renal function (RF) was partial in 7 cases and total in 10 cases, 6 patients kept a chronic renal failure (CRF), among them 3 cases had and end-stage of CRF. Conclusion AKI is a frequent pathology in the elderly and its severity is linked to mortality and the transition to chronicity. Iatrogenic causes are frequent and preventable in this population, hence the major interest of prevention.

Background and Aims The B cells have a central role in the pathogenesis of several renal pathologies. Rituximab, a monoclonal antibody directed against the CD20 receptor expressed on the surface of B cells is an interesting alternative to conventional treatments of kidney pathologies. Method We conducted a descriptive retrospective study of the use of rituximab in nephrology patients. Results We collected 25 patients including 12 women and 13 men. The mean age was 33,5 [16-55] years. The rituximab was indicated for an extramembranous glomerulopathy in 6 patients, a focal segmental glomerulosclerosis in 4 patients, a minimal change disease in 4 patients, a lupus nephritis in 5 patients, and a granulomatosis with polyangiitis in 2 patients. Four kidney transplant patient received rituximab for the treatment of antibody mediated rejection in 3 cases and large cell lymphoma in 1 case. The average time between the diagnosis of the renal disease and starting treatment with rituximab was of 76 +/- 46,5 months. And it was of 16 [ 0,7 ; 59,8] months after transplantation in kidney transplant recipients. Side effects have been observed in 11 cases (44%). A favorable response has been obtained in 10 cases (40 %), within an average of 2,27 months, with at least one relapse in 4 cases. The follow-up time was 36,33 +/- 31,67 months. Conclusion Rituximab has been shown to be helpful in several cases of kidney disease. It may reduce the need for maintenance immunosuppression and help in some cases that are refractory to other therapies.

In this paper, we introduce and study the notion of phase rank. Given a matrix filled with phases, i.e., with complex entries of modulus $1$, its phase rank is the smallest possible rank for a complex matrix with the same phase, but possible different modulus. This notion generalizes the notion of sign rank, and is the complementary notion to that of phaseless rank. It also has intimate connections to the problem of ray nonsingularity and provides an important class of examples for the study of coamoebas. Among other results, we provide a new characterization of phase rank $2$ for $3 \times 3$ matrices, that implies the new result that for the $3\times 3$ determinantal variety, its coamoeba is determined solely by the colopsidedness criterion.