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Our purpose was to compare the effects of Ramadan fasting on postural control in elderly fallers and non-fallers. The protocol involved twenty-four healthy old volunteer males divided into two groups: fallers (mean age = 75.43 ± 5.26 years, weight = 67.25 ± 5.30 kg and height = 1.65 ± 0.02 m) and non-fallers (mean age = 72.3 ± 6.42 years, weight = 65.5 ± 6.15 kg and height = 1.64 ± 0.03 m). Participants performed a simple reaction time test (SRT) and a postural control protocol on four different occasions: one week before Ramadan (BR), during the second (SWR) and the fourth week (FWR) of Ramadan and three weeks after Ramadan (AR). Center of pressure (CoP) parameters [the CoP medial-lateral length (CoP X ), and the CoP antero-posterior length (CoP Y )] were assessed using a force platform under two surface conditions: Firm surface and Foam surface. The results showed that Ramadan fasting influences similarly fallers and non-fallers. In fact, for both groups, the CoP X and the CoP Y values increased significantly during the SWR and the FWR compared to BR. These CoP parameters decreased significantly in the Firm surface conditions in the FWR. Moreover, the CoP parameters were significantly higher during the FWR and AR in comparison with BR in the Foam surface conditions. However, the amplitude of increase of the CoP [X] % and the CoP [Y] % (ΔCoP [X] % and ΔCoP [Y] %) between BR and the SWR was significantly higher in the fallers than non-fallers. The SRT of elderly fallers and non-fallers was significantly higher in the SWR and in the FWR compared to BR. In conclusion, Ramadan fasting alters similarly postural control of elderly fallers and non-fallers, but the amplitude (ΔCoP [X] % and ΔCoP [Y] %) of this alteration seems to be more pronounced in fallers than non-fallers. A probable beginning of adaptation occurs at the FWR. However, three weeks seems to be insufficient to recover postural control alterations due to Ramadan fasting in difficult sensory conditions in elderly fallers and non-fallers.

Objective:: To investigate the effectiveness of neuromuscular electrical stimulation added to pulmonary rehabilitation on walking tolerance and balance in patients with chronic obstructive pulmonary disease (COPD)., Design:: Randomized clinical trial., Setting:: Outpatient, Faculty of Medicine of Sousse, Tunisia., Subjects:: A total of 45 patients with COPD were assigned to an intervention group ( n = 25) or a control group ( n = 20)., Interventions:: The intervention group underwent a neuromuscular electrical stimulation added to pulmonary rehabilitation, and the control group underwent only a pulmonary rehabilitation, three times per week during six months., Main Measures:: Measures were taken at baseline and after six months of training. A stabilometric platform, time up and go, Berg balance scale tests, 6 minute walking test, and the maximal voluntary contraction were measured., Results:: In the intervention group, an increase in an exercise tolerance manifested by a longer distance walked in 6 minute walking test 619.5 (39.6) m was observed in comparison to the control group 576.3 (31.5) m. The values of the time up and go, Berg balance scale, and maximal voluntary contraction in the intervention group at follow-up were significantly higher than those in the control group ( P  = 0.02, P  = 0.01, P  = 0.0002, respectively). The center of pressure in the mediolateral and in the anteroposterior directions, as well as the center of pressure area was significantly more improved in open eyes and closed eyes in the intervention group compared to the control group ( P < 0.001)., Conclusion:: The neuromuscular electrical stimulation added to pulmonary rehabilitation group benefited from better walking tolerance and greater balance improvement than the only pulmonary rehabilitation.

Triple-negative breast cancer (TNBC) is the most refractory subtype of breast cancer. It causes the majority of breast cancer-related deaths, which has been largely associated with the plasticity of tumor cells and persistence of cancer stem cells (CSCs). Conventional chemotherapeutics enrich CSCs and lead to drug resistance and disease relapse. Development of a strategy capable of inhibiting both bulk and CSC populations is an unmet medical need. Inhibitors against estrogen receptor 1, HDACs, or mTOR have been studied in the treatment of TNBC; however, the results are inconsistent. In this work, we found that patient TNBC samples expressed high levels of mTORC1 and HDAC genes in comparison to luminal breast cancer samples. Furthermore, co-inhibition of mTORC1 and HDAC with rapamycin and valproic acid, but neither alone, reproducibly promoted ESR1 expression in TNBC cells. In combination with tamoxifen (inhibiting ESR1), both S6RP phosphorylation and rapamycin-induced 4E-BP1 upregulation in TNBC bulk cells was inhibited. We further showed that fractionated CSCs expressed higher levels of mTORC1 and HDAC than non-CSCs. As a result, co-inhibition of mTORC1, HDAC, and ESR1 was capable of reducing both bulk and CSC subpopulations as well as the conversion of fractionated non-CSC to CSCs in TNBC cells. These observations were partially recapitulated with the cultured tumor fragments from TNBC patients. Furthermore, co-administration of rapamycin, valproic acid, and tamoxifen retarded tumor growth and reduced CD44 high/+ /CD24 low/ - CSCs in a human TNBC xenograft model and hampered tumorigenesis after secondary transplantation. Since the drugs tested are commonly used in clinic, this study provides a new therapeutic strategy and a strong rationale for clinical evaluation of these combinations for the treatment of patients with TNBC.

Physical-cognitive interventions seem promising to improve balance and gait performances and prevent falls in the elderly. Although these beneficial effects, it is still not clear whether these physical-cognitive training modalities leads to more general non-specific adaptations that can be transferred to some measures reflecting every day abilities. This randomized controlled trial examined postural (center of pressure oscillations), physical (lower body strength, gait speed, functional mobility, dynamic balance) and cognitive performances (reaction time) and postural performance during daily life tasks (walking while conversing on a phone and maintaining an upright standing posture while buttoning a shirt) in older adults (66.29±3.61years) pre- and post- 6-months physical and physical-cognitive interventions. Results showed that both training modalities improve balance (p<0.001), physical functions (p<0.01) and attention (p<0.001) in older adults. Only simultaneous physical-cognitive training enhances performance in daily life tasks. Three months after the intervention, these improvements were generally maintained for physical functions and attention and were not maintained for the postural performances in daily life task. In conclusion, physical training improves postural balance, mobility, attention and physical functions in older adults. Only simultaneous physical-cognitive training modality enhances performance in some tasks relative to every day abilities. Nonetheless, these gains were lost after 3 months of detraining period suggesting a need for older people to participate regularly in such training for their daily life independence., (Copyright © 2017 Elsevier Inc. All rights reserved.)

The study aimed to investigate the effects of repeated sprint (RS) training on somatic anxiety (SA), cognitive anxiety (CA), self-confidence (SC), rating of perceived exertion (RPE) and repeated sprint ability (RSA) indicators in elite young soccer players. Thirty elite soccer players in the first football league (age: 17.8±0.9years) volunteered to participate in this study. They were randomly assigned to one of two groups: a repeated sprint training group (RST-G; n=15) and a control group (CON-G; n=15). RST-G participated in 6weeks of intensive training based on RS (6×(20+20m) runs, with 20s passive recovery interval between sprints, 3 times/week). Before and after the 6-week intervention, all participants performed a RSA test and completed a Competitive Scale Anxiety Inventory (CSAI-2) and the RPE. After training RST-G showed a very significant (p<0.000) increase in RSA total time performance relative to controls. Despite the faster sprint pace, the RPE also decreased significantly (p<0.005) in RST-G, and their self confidence was significantly greater (p<0.01), while the cognitive (p<0.01) and somatic (p<0.000) components of their anxiety state decreased. When practiced regularly, short bouts of sprint exercises improve anaerobic performance associated with a reduction in anxiety state and an increase in SC which may probably boost competitive performance., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background & Aims: Undernutrition is associated with increased hospital costs. Whether these increased costs are totally compensated by third payer systems has not been assessed. We aimed to assess the differences between actual and reimbursed hospital costs according to presence/absence of nutritional risk, defined by a Nutritional risk screening-2002 (NRS-2002) score ≥3., Methods: Retrospective study. Administrative data for years 2013 and 2014 of the department of internal medicine of the Lausanne university hospital. The data included total and specific costs (i.e. clinical biology, treatments, pathology). Reimbursed costs were based on the Swiss Diagnosis Related Group (DRG) system., Results: 2200 admissions with NRS-2002 data were included (mean age 76 years, 53.9% women), 1398 (63.6%) of which were considered nutritionally 'at-risk'. After multivariate adjustment, patients nutritionally 'at-risk' had higher costs (multivariate-adjusted difference ± standard error: 34,206 ± 1246 vs. 22,214 ± 1666 CHF, p < 0.001) and higher reimbursements (26,376 ± 1105 vs. 17,783 ± 1477 CHF, p < 0.001). Still, the latter failed to cover the costs, leading to a deficit between costs and reimbursements of 7831 ± 660 CHF in patients 'at-risk' vs. 4431 ± 881 in patients 'not at-risk' (p < 0.003). Being nutritionally 'at-risk' also led to a lower likelihood of complete coverage of costs: multivariate-adjusted odds ratio and 95% confidence interval 0.77 (0.62-0.97). Patients 'at-risk' had lower percentage of total costs in medical interventions, food, imaging and "other", but the absolute differences were less than 2%., Conclusion: Hospital costs of patients nutritionally 'at-risk' are less well reimbursed than of patients 'not at-risk'. Better reporting of undernutrition in medical records and better reimbursement of undernourished patients is needed., (Copyright © 2017 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Background: This study aimed to compare the effectiveness of a hopping and jumping training programme (HJP) versus a sensorimotor rehabilitation programme (SRP) on postural performances in children with intellectual disability., Methods: Three groups of children with intellectual disability participated in the study: the HJP group, the SRP group and a control group. Postural capacities were tested with the Berg Balance Scale (BBS) and the Tinetti tests. The HJP and the SRP groups participated in the training programmes for eight weeks. Then, all participants were retested., Results: Results showed that before the training period, there are no significant differences between the three groups. After the training period, the BBS and the Tinetti scores increased significantly in the HJP group and the SRP group with greater extent in the HJP group than in the STP group., Conclusion: We suggest that HJP training is more recommended to improve postural capacities in children with intellectual disability., (© 2017 John Wiley & Sons Ltd.)

Background: Knee osteoarthritis is a common pathology, characterized by a prevalence that increases with age. Absence of anatomo-clinical correlation is a complex management, particularly in a geriatric setting where it is not well studied., Objective: The aim of the present study is to investigate the epidemio-clinical profile, functional impairment and radiographic features of knee osteoarthritis in the old patients versus younger patients (<65 years)., Methods: Cross-sectional study includes patients who were monitored for 6 months at a rheumatology department for knee osteoarthritis. Epidemio-clinical, anthropometric and radiographic data were gathered. A comparison was made of these various characteristics between patients of over 65 years of age (group1; n=56) and those under 65 (group2; n=56)., Results: The mean age of the group 1 patients was 71±5 with a clear feminine predominance. Comorbidity was observed in two thirds of cases. More than half of them were overweight. Gonalgia had been evolving for approximately 8.4±9.2 years and was bilateral in 82.6% of the cases and of mechanical type in 94.6% of the cases. The patients experienced an average pain scale of 65.2mm. Pain had an anterior site in major of cases. An axial deviation of the lower limbs were observed in 60.7% of the cases and a limited mobility of the knees in 48.2% of the cases. The mean value of Lequesne index was 11.02±4.8. The walking distance was not limited in 37.5% of the cases. Radiographically, knee osteoarthritis was bilateral in all cases and stage 4 was observed in 50% of the cases. Comparative study showed that elderly patients had a smaller waist size (p=0.003), a longer course of gonalgia (p<0.0001), a widespread site of pain (p=0.004), and a more frequent limitation of walking distance (p<0.0001) as well as more axial deviation (p<0.0001) and joint mobility limitation (p=0.005). Gonalgia manifesting during rest was more frequent in elderly patients (p=0.001). In addition, impaired functioning (p=0.001) and the stage of radiographic damage (p=0.02) were more advanced in elderly patients., Conclusion: The present study shows that knee osteoarthritis is more severe in the elderly patients in terms of clinical presentation and functional impairment., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.)

The aim of this study was to examine the relationship between bone mass and bone turnover markers with lean mass (LM) in pubescent soccer players. Two groups participated in this study, which included 65 elite young soccer players who trained for 6-8 hours per week and 60 controls. Bone mineral density; bone mineral content in the whole body, lower limbs, lumbar spine, and femoral neck; biochemical markers of osteocalcin; bone-specific alkaline phosphatase; C-telopeptide type I collagen; and total LM were assessed. Young soccer players showed higher bone mineral density and bone mineral content in the whole body and weight-bearing sites (P < .001). Indeed, the total LM correlated with whole-body bone mineral density and bone mineral content (P < .001). There were significant differences within the bone formation markers and osteocalcin (formation)/C-telopeptide type I collagen (resorption) ratio between young soccer players compared with the control group, but no significant difference in C-telopeptide type I collagen was observed between the 2 groups. This study showed a significant positive correlation among bone-specific alkaline phosphatase, osteocalcin, and total LM (r = .29; r = .31; P < .05) only for the young soccer players. Findings of this study highlight the importance of soccer practice for bone mineral parameters and bone turnover markers during the puberty stage.

Cell transplantation using ventral mesencephalic tissue is an experimental approach to treat Parkinson's disease. This approach is limited by poor survival of the transplants and the high number of dopaminergic neurons needed for grafting. Increasing the yield of dopaminergic neurons in donor tissue is of great importance. We have previously shown that antagonization of the Nogo-receptor 1 by NEP1-40 promoted survival of cultured dopaminergic neurons and exposure to neurotrophin-4/5 increased dopaminergic cell densities in organotypic midbrain cultures. We investigated whether a combination of both treatments offers a novel tool to further improve dopaminergic neuron survival. Rat embryonic ventral mesencephalic neurons grown as organotypic free-floating roller tube or primary dissociated cultures were exposed to neurotrophin-4/5 and NEP1-40. The combined and single factor treatment resulted in significantly higher numbers of tyrosine hydroxylase positive neurons compared to controls. Significantly stronger tyrosine hydroxylase signal intensity was detected by Western blotting in the combination-treated cultures compared to controls but not compared to single factor treatments. Neurotrophin-4/5 and the combined treatment showed significantly higher signals for the neuronal marker microtubule-associated protein 2 in Western blots compared to control while no effects were observed for the astroglial marker glial fibrillary acidic protein between groups, suggesting that neurotrophin-4/5 targets mainly neuronal cells. Finally, NEP1-40 and the combined treatment significantly augmented tyrosine hydroxylase positive neurite length. Summarizing, our findings substantiate that antagonization of the Nogo-receptor 1 promotes dopaminergic neurons but does not further increase the yield of dopaminergic neurons and their morphological complexity when combined with neurotrophin-4/5 hinting to the idea that these treatments might exert their effects by activating common downstream pathways., (Copyright © 2017 Elsevier B.V. All rights reserved.)

This study aimed to explore the effect of local muscle fatigue on the unipedal stance in men with intellectual disability (ID). The Centre of pressure (CoP) excursions and the isometric maximal voluntary contraction (MVC) were measured before and after a fatiguing exercise. Higher baseline values of CoP excursions and lower MVC values were recorded in the ID group. After the fatiguing exercise, this group showed higher MVC decrease and higher percentage of increase of the mean CoP velocity. In conclusion, men with ID are more vulnerable to the disturbing effects of fatigue during the unipedal stance compared to men without ID.

Background Illicit substance use among college students represents one of the most complicated social problems. Studying its predictors could help deal with this problem more efficiently. Aims To determine the prevalence of life time illicit substance use and its predictors among Tunisian college students. Methods A cross-sectional study was conducted in five colleges in the region of Sousse, Tunisia in the 2012-2013 school year. A sample of 556 college students responded to an anonymous self-administrated questionnaire. Collected data concerned socio-demographic characteristics and substances use. Results The mean age of students was 21.8 ± 2.2 years. Females represented 51.8% of participants. Among respondents: 31 (5.6%) had used illicit substance at least once. Cannabis was the main substance used by 26 (4.7%) students. The average age of the illicit substance use initiation was 19 (±2.5) years while it was almost 17 (±3) years for both tobacco and alcohol use initiations. Proportions of male students and academic failure were significantly more important among illicit substance users than among non users. While the most influential factors on illicit substance use were: alcohol use, tobacco use and low socioeconomic level. Conclusion This study highlights the strong association between the other risk behaviors and illicit drug use. Future interventions should focus on the whole risk behaviors simultaneously at late adolescence with regard to the environmental context.

Cell phone use is considered as an essential part of everyday life saturating all age groups and demographics. This study aimed to explore the effect of various cell phone functions on postural control and mobility in the elderly. Twenty healthy older (mean age 72.5±2.9) and twenty young (26.3±2.8) adults participated in this study. Postural balance was assessed by measuring the center of pressure (CoP) displacement with (talking on a cell phone (CONVERSE), dialing a number (DIAL) and listening to music (MUSIC)) and without cell phone use. Mobility was assessed by the Timed Up and Go Test (TUGT). Results showed that for both groups, the CoP parameters increased significantly during the CONVERSE (p<0.001) and the DIAL (CoP area , CoP X : p<0.05; CoP Y : p<0.01) conditions compared to the control condition. Moreover, the CoP area values were significantly higher during the CONVERSE condition in comparison to the DIAL (p<0.05) one. In older adults, the TUGT scores increased significantly in the DIAL (p<0.01) condition compared to the CONVERSE and the MUSIC conditions. In conclusion, cell phone use impairs similarly standing postural balance of elderly and young adults. Interestingly, in the elderly, all cell phone functions used altered mobility with the dialing function causing the largest mobility deterioration., (Copyright © 2017 Elsevier Inc. All rights reserved.)

This study examined the effects of electrostimulation (ES) strength training at the same time-of-day on the diurnal fluctuations of maximal voluntary isometric contractions (MVIC) and surface electromyography (EMG). 20 male performed 3 MVICs of knee extension coupled with surface EMG before and after 5 weeks of 3 ES training sessions per week. Each ES training session consisted in 45 isometric contractions. The participants were randomly assigned to either a morning (MTG, 07:00-08:00 h) or an evening (ETG, 17:00-18:00 h) training group. Both groups performed the evaluation tests at 07:00 and 17:00 h. Before ES training, MVIC was significantly higher in the evening compared to the morning for all groups, but there was no significant difference between groups for all EMG parameters. After the ES training, the diurnal variations in MVIC were blunted in the MTG and persisted in the ETG. Significant time-of-day effect was noticed for all EMG parameters but there was no group effect. The elimination of the diurnal fluctuations of MVIC and the appearance of EMG variations by training in the morning hours suggest that neural adaptations are the main source of temporal specificity of neuromuscular performance after ES strength training., (© Georg Thieme Verlag KG Stuttgart · New York.)

Pressure ulcer (PU) remains a common worldwide problem in all health care settings, it is synonymous with suffering. PU is a complex disease that is dependent on a number of interrelated factors. It involves multiple mechanisms such as physiological risk factors, chronic inflammation, oxidant-antioxidant imbalance and proteolytic attack on extracellular matrix by matrix metalloproteinases (MMP). Therefore, we propose that these wounds lead to molecular variations that can be detected by assessing biomarkers. In this study, we aimed to evaluate the major clinical elements and biological scars in Tunisian patients suffering from PU. Consistently, non-healing wound remains a challenging clinical problem. The complex challenges of the wound environment, involving nutrient deficiencies, bacterial infection, as well as the critical role played by inflammatory cells, should be considered because of their negative impact on wound healing. In addition, an imbalance between pro-oxidants and antioxidant systems seems to be more aggravated in patients with PU compared to healthy subjects. Of interest, this study provides further evidence to support a core role of the biological activity of MMP-9 in the pathogenesis of PU and indicates that the MMP9-1562 C/T (rs 3918242) functional polymorphism is associated with protection against this disease.

The aim of our study was to investigate the effect of a combined strength and proprioception training (CSPT) program on muscle strength and postural balance in children with intellectual disability (ID). The maximum voluntary contraction (MVC) and postural parameters (CoPVm, CoPLX, CoPLY) of 20 children with ID were recorded before and after 8 weeks of a CSPT program. The participants were divided into two groups: an experimental group who attended a CSPT program and a control group who continued with daily activities. In the trained group, the MVC increased significantly (p<0.001) after the training period and the postural parameters decreased significantly in Double-Leg Stance (DLS) and One-Leg Stance (OLS) during the firm surface condition as well as in the DLS during the foam surface condition; in both eyes open (EO) and eyes closed (EC) conditions. A CSPT program improves postural balance in children with ID could be due to the enhancement in muscle strength and proprioceptive input integration., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Introduction: A better understanding of socio-demographic characteristics of subgroups, which have a high risk to develop chronic diseases, is essential to develop more efficient interventional programs especially for youth. This study aimed to determine the association between clusters of non communicable diseases (NCDs') risk factors and the socio-demographic characteristics among a sample of Tunisian school children., Materials and Methods: We conducted, in 2013/2014, a cross-sectional study among a proportional and stratified school children sample, selected in 17 elementary public schools in Sousse (Tunisia). A cluster analysis was used to identify different NCDs risk factors clusters, based on tobacco use, physical inactivity, unhealthy diet, and excess weight. Subsequent χ2-tests were used to identify differences between the NCDs risk factors clusters in regards to socio-demographic characteristics., Results: Four clusters of NCDs risk factors were found: 1) Cluster 1: physical inactivity behavior with normal weight, 2) Cluster 2: physical inactivity behavior associated to excess weight, 3) Cluster 3: unhealthy diet associated to excess weight and low practice of physical activity, and 4) Cluster 4: smoking behavior with physical activity behavior. The pattern of cluster membership differed across sex (<10-3), school level, and socioeconomic level (<10-3) but there was no significant difference between clusters for mother's education levels and household tenure., Conclusion: This study can have important implications for health policy and practice. Indeed, it found that many subjects have simultaneous multiple NCDs risk factors which leads to identify groups at risk and implement integrated intervention program.

Objective: Our purpose is to investigate the static balance control of young adolescents practicing kung-fu and swimming in order to find out which of these physical activities is the most effective in developing specific balance abilities in young adolescents., Design: Comparative experimental study., Setting: University laboratory research., Participants: Three groups of 11-13-year-old boys (12 practicing Kung-Fu, 12 practicing swimming and 12 controls)., Main Outcome Measures: Center of pressure (CoP) excursions were registered in upright bipedal and unipedal stances on a stabilometric force platform in eyes open (EO) and eyes closed (EC) conditions., Results: Kung-fu practitioners control their balance (P < .05) better than controls and swimmers in the unipedal posture when visual inputs are available. Kung-fu training improved (P < .05) the bipedal balance control in the EO condition. However, swimming training developed (P < .05) bipedal balance control in both EO and EC conditions. The swimmers showed a lower reliance on vision (P < .05) compared to kung-fu practitioners., Conclusions: Both of these physical activities could be recommended for young adolescents as recreational or rehabilitation programs as they develop specific balance abilities that could be important for improving and maintaining optimal health., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

The present study aimed to examine the effect of time-of-day on postural control, body temperature, and attentional capacities in 5-6 year old children. Twelve male children (5-6-year-old) were asked to maintain an upright bipedal stance on a force platform with eyes open (EO) and eyes closed (EC) at 07:00, 10:00, 14:00, and 18:00 h. Postural control was evaluated by center of pressure (CoP) surface area (CoPArea), CoP mean velocity (CoPVm), length of the CoP displacement as a function of the surface (LFS) ratio and Romberg's index (RI). Oral temperature and the simple reaction time were also recorded at the beginning of each test session. The one way ANOVA (4 time-of-day) showed significant time-of-day effects on CoPArea (p<0.001), CoPVm (p<0.01), LFS ratio (p<0.001) and RI (p<0.01). Children's postural control was lower at 07:00 h and at 14:00 h in comparison with 10:00 h and 18:00 h. Likewise, the reaction time was significantly (p<0.001) better at 10:00 h and 18:00 h in comparison with 07:00 h and 14:00 h. Oral temperature was higher at 14:00 h and 18:00 h than 08:00 h and 10:00 h (p<0.001). In conclusion, the children's postural control fluctuates during the daytime (i.e., better postural control at 10:00 h and at 18:00 h) with a diurnal rhythm close to that of body temperature and attentional capacities. Therefore, the evaluation of changes in postural control of 5-6-year-old children using force plate measures is recommended in the middle morning or the late afternoon to avoid the post-awakening and the post-prandial phases., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Early detection and treatment of high-grade dysplasia (HGD) in Barrett's esophagus may reduce the risk of developing esophageal adenocarcinoma. Confocal endomicroscopy (CLE) has shown advantages over routine white-light endoscopic surveillance with biopsy for histological examination; however, CLE is compromised by insufficient contrast and by intra- and interobserver variation. An FDA-approved PDT photosensitizer was used here to reveal morphological and textural features similar to those found in histological analysis. Support vector machines were trained using the aforementioned features to obtain an automatic and robust detection of HGD. Our results showed 95% sensitivity and 87% specificity using the optimal feature combination and demonstrated the potential for extension to a three-dimensional cell model.

The aim of this study was to explore the voluntary activation level during maximal voluntary contraction (MVC) in individuals with intellectual disability (ID) versus individuals without ID using the twitch interpolation technique. Ten individuals with mild ID (ID group) and 10 sedentary men without ID (control group) participated in this study. The evaluation of neuromuscular function consisted in three brief MVCs (3s) of the knee extension superimposed with electrical nerve stimulation (NES) to measure voluntary activation. Muscle activity levels were also measured with surface EMG. The root mean square (RMS) was extracted from the EMG signal. The RMS/Mmax ratio and the neuromuscular efficiency (NME) were calculated. Our results reported that individuals with ID present lower muscle strength (p < 0.001), lower voluntary activation level (p < 0.001), lower RMS values of vastus lateralis (p < 0.05), vastus medialis (p < 0.05), and rectus femoris (p < 0.001) muscles. In addition, our results showed lower RMS/Mmax values in the ID group than in the control group for the VM (0.05 ± 0.01 mV vs. 0.04 ± 0.01 mV; p < 0.05) and the RF (0.06 ± 0.02 mV vs. 0.05 ± 0.02 mV; p < 0.05) muscles. However, no significant difference was reported for the VL muscle (0.05 ± 0.02 mV vs. 0.05 ± 0.02 mV; p=0.463). Moreover, Individuals with ID present smaller potentiated twitch (p < 0.001). However, no significant difference was reported in the NME ratio. These results suggest that the lower muscle strength known in individuals with ID is related to a central nervous system failure to activate motor units and to some abnormal intrinsic muscle properties. It seems that the inactive lifestyle adopted by individuals with ID is one of the most important factors of their lower voluntary activation levels. Therefore, physical activities should be introduced in life style of individuals with ID to improve their neuromuscular function., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

A non-thermal atmospheric pressure argon plasma jet for medical applications has been generated using a high-voltage pulse generator and a homemade dielectric barrier discharge (DBD) reactor with a cylindrical configuration. A plasma jet of about 6 cm of length has been created in argon gas at atmospheric pressure with an applied peak to peak voltage and a frequency of 10 kV and 50 kHz, respectively. The length and the shape of the created plasma jet were found to be strongly dependent on the electrode setup and the applied voltage and the signal frequency values. The length of the plasma jet increases when the applied voltage and/or its frequency increase, while the diameter at its end is significantly reduced when the applied signal frequency increases. For an applied voltage of 10 kV, the plasma jet diameter decreases from near 5 mm for a frequency of 10 kHz to less than 1 mm at a frequency of 50 kHz. This obtained size of the plasma jet diameter is very useful when the medical treatment must be processed in a reduced space. PACS 2008: 52.50.Dg; 52.70.-m; 52.80.-s.

This study examined neuromuscular fatigue after high-intensity intermittent exercise in 10 men with mild intellectual disability (ID) in comparison with 10 controls. Both groups performed three maximal voluntary contractions (MVC) of knee extension with 5 min in-between. The highest level achieved was selected as reference MVC. The fatiguing exercise consists of five sets with a maximal number of flexion-extension cycles at 80% of the one maximal repetition (1RM) for the right leg at 90° with 90 s rest interval between sets. The MVC was tested again after the last set. Peak force and electromyography (EMG) signals were measured during the MVC tests. Root Mean Square (RMS) and Median Frequency (MF) were calculated. Neuromuscular efficiency (NME) was calculated as the ratio of peak force to the RMS. Before exercise, individuals with ID had a lower MVC (p<0.05) and a lower RMS (p<0.05). No significant difference between groups in MF and NME. After exercise, MVC decreases significantly in both groups (p<0.001). Individuals with ID have greater force decline (p<0.001 vs. p<0.01). RMS decreased significantly (p<0.001) whereas the NME increased significantly (p<0.05) in individuals with ID, but both remained unchanged in controls. The MF decreased significantly in both groups (p<0.001). In conclusion, individuals with ID presented a lower peak force than individuals without ID. After a high-intensity intermittent exercise, individuals with ID demonstrated a greater force decline caused by neural activation failure. When rehabilitation and sport train ID individuals, they should consider this nervous system weakness., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Background Context: Concerns have been raised about the effect of backpack carrying on adolescent balance. For adolescent idiopathic scoliosis (AIS) subjects, the effect of backpack carrying method on their balance has not been determined. Our aim is to examine the effects of backpack load and carrying method on AIS subjects' balance., Study Design/setting: Paired sample matched for age and sex., Patient Sample: Twelve healthy adolescents matched for age and sex with 14 adolescents with mild AIS participated in this study., Outcome Measures: A test battery including clinical examination, radiological assessment, and stabilometric measurements of the postural sways in the upright standing posture were conducted., Methods: Center of pressure excursions of our subjects were recorded with a stabilometric platform during the upright standing posture without a backpack and while carrying a backpack symmetrically and asymmetrically on each shoulder. For each carrying method, the backpack is loaded at 10% and 15% of body weight (BW)., Results: Our results indicated that postural sways increased with increasing backpack load. These postural sways were observed when normal adolescents carried a backpack loaded with 15% BW load, whereas, for age- and sex-matched AIS subjects, these postural responses were observed for the 10% BW load. The symmetrical backpack carrying induced better balance compared with the asymmetrical one. Asymmetrical carrying on the convex side of the scoliotic curve affects AIS subjects' balance more than carrying it on the concave side., Conclusions: Load carriage of 10% BW seems to alter AIS subjects' balance. Asymmetrical carrying should be avoided especially on the convex side of the scoliotic curve because it causes balance impairments that may increase spinal pain., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Background: Esophageal perforation is uncommon and often iatrogenic., Aim: To report a neonatal case of esophageal perforation., Case: A premature newborn boy was admitted with a diagnosis of oesophageal atresia after several unsuccessful attempts to insert an orogastric tube. A chest x-ray showed a "high pouch" with a gasless intestine. At operation, no atresia was found and a large traumatic perforation of the lower cervical segment was identified, requiring cervicotomy and primary closure. Oral feeding was started after 3 weeks. As a result, nosocomial sepsis occurred, causing death in the third month after surgical treatment., Conclusion: Oesophageal perforation in the neonate is often iatrogenic and may mimic oesophageal atresia. The authors highlight the importance of early diagnosis and management.

Aim: The aim of the study is to determinate the using dominant multiple intelligence types and compare the learning preferences of Turkish cochlear implanted children aged four to ten in Turkey and Germany according to Theory of multiple intelligence., Material and Method: The study has been conducted on a total of 80 children and four groups in Freiburg/Germany and Ankara/Turkey. The applications have been done in University of Freiburg, Cochlear Implant Center in Germany, and University of Hacettepe, ENT Department, Audiology and Speech Pathology Section in Turkey. In this study, the data have been collected by means of General Information Form and Cochlear Implant Information Form applied to parents. To determine the dominant multiple intelligence types of children, the TIMI (Teele Inventory of Multiple Intelligences) which was developed by Sue Teele have been used., Results: The study results exposed that there was not a statistically significant difference on dominant intelligence areas and averages of scores of multiple intelligence types in control groups (p>0.05). Although, the dominant intelligence areas were different (except for first dominant intelligence) in cochlear implanted children in Turkey and Germany, there was not a statistically significant difference on averages of scores of dominant multiple intelligence types., Conclusion: Every hearing impaired child who started training, should be evaluated in terms of multiple intelligence areas and identified strengths and weaknesses. Multiple intelligence activities should be used in their educational programs., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Aim: The main goal of this study is investigating child raising attitudes of fathers having or not having a child with hearing loss., Material and Method: The fathers of 20 children with hearing loss who attend the Training Unit of Hearing and Speaking Abilities in Hacettepe University Department of Audiology and Speech Defects and 20 fathers having children who have a normal hearing have participated in this study. Demographic Information Form and P.A.R.I (Parental Attitude Research Instrument) have been used as devices for data collecting., Results: Sub dimension of overprotection scores (42.76 ± 5.59) of the fathers having a child with hearing loss are found higher on a statistically meaningful level than the scores (40.16 ± 6.55) of fathers who do not have a handicapped child (p<0.01). Together with this, the fathers having a child with hearing loss get lower scores from the democratic/equality and strict discipline sub dimensions as compared to the fathers who do not have a handicapped child, and this situation is found meaningful statistically (p<0.01)., Conclusion: It is very important that the father's having enough information and support help the father to be encouraged and feel himself enough for this issue. Moreover, the wrong attitudes and behaviors towards the child can be corrected upon noticing them., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Hydatid cyst disease is still a significant clinical problem in endemic regions. The lungs and the liver are most often involved in the child. A mediastinal localisation is rare and represents 0.1 to 4% of all cases of hydatidosis. The authors reports on two cases and provides a review of the literature. In a retrospective review of the last 12 years, the authors treated two cases with a mediastinal localisation out of total of 235 intrathoracic hydatid cysts arising in 222 patients (0.85%). Two girls, one 12 and the other 13 years old, were admitted with a previous history of chest pain. The chest x-ray revealed an homogenous opacity of 150 mm in the first case and 50 mm in the second. Computed tomography in the second case revealed a cyst in the posterior mediastinum. The abdominal ultrasound was normal in both cases. The patients were approached through a posterolateral thoracotomy and the diagnosis was confirmed macroscopically. The cysts were intact and located on the left side of the posterior mediastinum. The operative field was isolated and protected with hypertonic saline solution. Hydatid fluid was aspirated, followed by the extraction of the hydatid membrane and subtotal excision of the residual cavity in both cases. The postoperative course was uneventful without any relapse or other organ involvement during four and three years, respectively. The authors notes that hydatidosis should be considered in the differential diagnosis of a mediastinal cyst mass. Because of the benign nature of the disease, they emphasize that surgical treatment must be conservative., (Copyright © 2009 Elsevier Masson SAS. All rights reserved.)

Background: Xanthogranulomatous pyelonephritis is an uncommon form of chronic pyelonephritis rarely seen in children. Preoperative diagnosis is difficult and management is still obscure., Aim: The authors report on a focal pseudotumoral case and discuss therapeutic modalities., Case: A 2-year-old boy was admitted for a 2-weeks history of fever and right flank pain. Physical examination revealed a right lumbar mass. White blood cell count was 12.800/mm3 and C reactive protein elevated (50 mg/l). The urine culture was negative. Ultrasonography and computerized tomography demonstrated a focal multilocular cystic mass of the lower polar of right kidney, measuring 80 millimeters, with peripheral enhancement and perirenal involvement. At surgical exploration, a huge abscess of the lower polar of the kidney with dense adhesions to adjacent structures were noted. Excision of the collection and local drainage were performed. Pathologic examination of biopsy specimen confirmed the diagnosis of xanthogranulomatous pyelonephritis. Intraoperative culture was positive for Escherichia coli. Successful treatment of the lesion was achieved with adjunctive antibiotic therapy. The postoperative course was uneventful over a follow-up period of 2 years., Conclusion: Xanthogranulomatous pyelonephritis should be considered in the differential diagnosis of a renal mass. A first-line conservative treatment must be strongly recommended in pediatric focal cases.

Background: Epidermal cysts are a common benign lesion, occurring often above the shoulder and within the face and the scalp. Presternal site and huge volume are quite rare, especially in children., Aim: The authors report on two paediatric cases, discuss etiopathogenesis and diagnostic difficulties., Cases: A 2, 5 and 3-year-old boys were admitted for voluminous subcutaneous tumour of the chest. The lesions had appeared since neonatal period with rapid growth after a minimal trauma for the last year. The physical examination found a great presternal cystic mass of 70 mm in diameter which is painless round and mobile. Ultrasonography and magnetic resonance imaging, showed a subcutaneous cystic mass with no mediastinal involvement or other localization in both. Complete surgical excision including the overlying skin with direct cutaneous closure was performed in both cases. The histological examinations confirmed the diagnosis of epidermal cyst. Postoperative courses were uneventful with no recurrence during respectively 18 months and 5 years follow-up periods., Conclusions: Giant presternal epidermal cyst is uncommon and can raise diagnostic problems. Imaging investigations facilitate accurate diagnosis. Because of malignant degeneration, surgical excision should be mandatory.

Objective: The purpose of this study is to compare the levels of depressive emotioning of adolescents with cochlear implants and the ones who have normal hearing., Methods: For this purpose, Rosenberg Self-Esteem Scale is applied upon the study group which consists of 30 adolescents with cochlear implant between the ages of 12-19 and upon the control group which consists of 60 adolescents having the similar characteristics. The scale is used to evaluate the level of depressive emotioning of adolescents with cochlear implant and with normal hearing., Results: At the end of the application, the scores of these two groups which they got according to their answers were compared statistically. When the results were examined, there seemed to be no significant difference statistically between the depressive emotioning values of the cochlear implant group and the control group. Apart from this, in this study, we examined changes in the level of depressive emotioning according to different variables. As a result, it was found out that in both groups level of depressive emotioning was lower for adolescents who had had preschool education, had brothers/sisters, high level of income, whose father and mother had higher levels of education. On the other hand, the birth sequence and the child's father's profession did not seem to have any effect on the child's level of depressive emotioning., Conclusions: As a result of these findings, it was thought that cochlear implantation had a positive effect on life quality and it was suggested that the adolescents and their families should get assistance from experts about the characteristics and principles of approaching the child in this period. The adolescent should be directed towards social activities and courses, their positive sides should be supported and further studies should be carried out with different case groups on this matter. In addition to, examining the interactions of hearing loss effects can help professionals determine the individuals who are at a higher risk for developing mental distress.

Background: Stump appendicitis is a delayed complication of appendectomy. It is rare and few cases reported in the paediatric literature. The authors report on another case in a child and focus on the diagnostic peculiarities of this entity., Case: A 9-year-old boy with previous history of open appendectomy was admitted for a right lower quadrant pain with bilious vomiting and fever. Physical examination demonstrated tenderness in the right lower quadrant and guarding over the appendectomy scar. The white blood cell count was 23.500 cells/mm3. Plain abdominal radiograph and ultrasonography revealed fecalith localized in the right iliac fossa. The diagnosis of stump appendicitis was advocated and confirmed at laparotomy. A gangrenous and perforated appendiceal stump was found and completely removed. The post-operative course was uneventful after 18 months follow-up period., Conclusion: Stump appendicitis is rare and should be considered in any patient with right lower quadrant pain even if there is a history of appendectomy. Complete removal of the appendix is the only mean to prevent the occurrence of this complication.

Background: Xanthogranulomatous pyelonephritis (XGP) is a specific form of chronic inflammatory kidney disease rarely seen in children. The Symptoms are often vague and non-specific, Aim: the aim of this paper is to return the particularities of imaging features in xanthogranulomatous pyelonephritis, insisting on differential diagnosis with renal tumors, especially in case of no renal stone or tract obstruction evidence., Case: We report a case of xanthogranulomatous pyelonephritis in a 2-year-old boy involving the lower renal pole which demonstrates the diagnostic difficulties encountered in this disease, Conclusion: Xanthogranulomatous pyelonephritis is a rare condition in children and should be included in the differential diagnosis of a child presenting a renal mass.

Context: There is limited information about the effects of increasing load while squatting., Objective: To quantify tibiofemoral joint kinetics during squatting with variable loads., Setting: Research laboratory., Participants: 20 male students., Intervention: Tibiofemoral joint kinetics and electromyographic (EMG) activity of four involved muscles were determined by recording the half squat with variable external loads., Main Outcome Measures: Tibiofemoral joint force and external moment components and EMG activity of four involved muscles., Results: Throughout the exercise, a posterior direction for the antero-posterior shear force and a net extension for the external moment were observed. They increased with knee flexion reaching peak force of 29% of the subject body weight (BW) and moment of 88Nm (without external load). All force and moment components and muscle activities increased as the external load increased., Conclusion: These findings suggest that half squat may be safe to use for quadriceps strengthening with very low potential loading on the anterior cruciate ligament (ACL). Our data can help clinicians choose the appropriate external load.

Background: Obesity becomes a major problem in our country during the last decades., Aim: Evaluation of the prevalence of obesity and overweight in Tunisia., Methods: Prospective epidemiological survey concerning a representative sample of Tunisian Population realised on 2001 by the Tunisian National Health Public Institut. Medical visit and anthropometric measurements were performed by medical investigators at subject's home. Statistical analysis using SAS program were performed. WHO body mass index criteria were used to define overweight and obesity. Population investigated included 8576 adults and adolescents 15 years or older, 4232 men and 4344 women., Results: Prevalence of obesity is 12.2% (6.1% in men, 18.3% in women, p<0.001). Prevalences of obesity grade I, II, and III are respectively 8.7%, 2.9% and 0.7%. Prevalence of overweight is 21.8% (8.9% in men, 12.8% in women, p<0.001). Prevalences of obesity and overweight are respectively in rural districts 8.6% and 10.2%, in urban districts 14.8% and 23.6% (p<0.001). Tunisian eastern areas are more affected by obesity and overweight than western areas but there isn't a north-south gradient., Conclusion: Our study shows that prevalences of overweight and obesity in Tunisia became quite similar to the prevalence in European countries, but concerned especially women and eastern areas, more industrialised and more urbanised than the western ones. Preventive strategies should be rapidly implemented in Tunisia to stop the growing of this health public problem.

Pancreatic hydatid cysts represent 0.1 to 1% of all hydatidoses. A 12 year-old-boy, with a previous history of abdominal pain, was admitted for acute cholangitis. Laboratory investigations showed cholestasis, cytolysis and eosinophilia. Serum amylase levels were normal. Abdominal ultrasound and CT scan revealed a 100 mm hydatid cyst, located in the head of the pancreas. The biliary and pancreatic ducts were markedly dilated. Exploratory laparotomy confirmed the diagnosis. A pancreatic fistula was discovered. Subtotal excision of the cyst and external drainage of the pancreatic fistula were performed. Laboratory tests were normal post-operatively. The pancreatic fistulae persisted for two months. Hypercaloric and hyperprotidic feeding resulted in occlusion in three weeks. The rest of the postoperative course was uneventful and the size of the biliary and pancreatic ducts was normal. The authors discuss the diagnostic features of pancreatic hydatid cyst and discuss therapeutic modalities.

This study examined the effects of Ramadan fasting on anaerobic performances and their diurnal fluctuations. In a balanced and randomized study design, 12 subjects were measured for maximal power (P(max); force-velocity test), peak power (P(peak)), and mean power (P(mean)) with the Wingate test at 07:00, 17:00, and 21:00 h on four different occasions: one week before Ramadan (BR), the second week of Ramadan (SWR), the fourth week of Ramadan (ER), and two weeks after Ramadan (AR). There was an interval of 28 h between any two successive tests. Oral temperature was measured before each test. Under each condition, the results showed a time-of-day effect on oral temperature. Analysis of variance revealed a significant (Ramadanxtime-of-day of test) interaction effect on P(max). This variable improved significantly from morning to evening before Ramadan (1.1+/-0.2 W x kg(-1)), during the second week of Ramadan (0.6+/-0.2 W x kg(-1)), and two weeks after the end of Ramadan (0.9+/-0.2 W x kg(-1)). However, daily fluctuations disappeared during the fourth week of Ramadan. For P(peak) and P(mean), there was no significant Ramadan x test-time interaction. These variables improved significantly from morning to evening before Ramadan ([1+/-0.3 W x kg(-1)] for P(peak) and [1.7+/-1.6 W x kg(-1)] for P(mean)) and in the second week of Ramadan ([0.9+/-0.6 W x kg(-1)] for P(peak) and [1.7+/-1.5 W x kg(-1)] for P(mean)). However, they were not affected by time-of-day in the fourth week of Ramadan. Considering the effect of Ramadan on anaerobic performances, in comparison with before Ramadan, no significant difference was observed during Ramadan at 07:00 h. The variables were significantly lower in the second week of Ramadan and in the fourth week of Ramadan at 17:00 h and 21:00 h. P(mean) was not affected during the second week of Ramadan. In conclusion, the time-of-day effect on anaerobic power variables tends to disappear during Ramadan. In comparison with the period before Ramadan, anaerobic performances were unaffected in the morning but impaired in the evening during Ramadan.

Objective: The purpose of this study is to compare the levels of self-esteem of adolescents with cochlear implants (before and after cochlear implantation) and the ones who have normal hearing., Methods: For this purpose, Rosenberg self-esteem scale is applied upon the study group which consists of 30 adolescents with cochlear implant between the ages of 12-19 and upon the control group which consists of 60 adolescents having the similar characteristics. The scale is used to evaluate the level of self-esteem of adolescents with cochlear implant and with normal hearing., Results: At the end of the application, the scores of these two groups which they got according to their answers were compared statistically. When the results were examined, there seemed to be no significant difference statistically between the self-esteem values of the cochlear implant group and the control group. Apart from this, there seemed to be significant difference statistically between the self-esteem values of the before cochlear implantation and control group. In this study, we examined changes in the level of self-esteem according to different variables. As a result, it was found out that in both groups levels of self-esteem was higher for adolescents who had had preschool education, had brothers/sisters, high level of income, whose mother was working and whose father and mother had higher levels of education. On the other hand, the birth sequence and the child's father's profession did not seem to have any effect on the child's level of self-esteem., Conclusions: As a result of these findings, it was thought that cochlear implantation had a positive effect on life quality and it was suggested that the adolescents and their families should get assistance from experts about the characteristics and principles of approaching the child in this period. The adolescent should be directed towards social activities and courses, their positive sides should be supported and further studies should be carried out with different case groups on this matter.