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Background: Routine magnetic resonance imaging MRI is highly sensitive in detecting bone marrow alterations; however, it is of limited specificity in the evaluation of the causes of these alterations. Diffusion Weighted Imaging (DWI) is an imaging technique which probes the structure of a biologic tissue. The contrast achieved with this technique together with measurement of the apparent diffusion coefficient ADC values are useful complementary MRI tools and can be used for non-invasive tissue characterization and therefore reaching a more specific diagnosis.Aim of Work: The aim of this study is to determine the value of both qualitative and quantitative assessment of DWI in differentiation between different vertebral lesions and to determine cut off ADC value between benign and malignant lesions.Patients and Methods: This is a prospective study carried out in Radio-Diagnosis Department, Faculty of Medicine, Cairo University between August 2014 and February 2016 for patients diagnosed with or suspected to have vertebral lesion of any etiology. A total number of 40 patients (22 males and 18 females) with age range 2-88 (average 49).The MRI sequences obtained were sagittal T1WI, T2WI, STIR and axial T1WI, T2WI & DWI (± post contrast images in some patients). Bone marrow signal intensity was qualita-tively analyzed by visually comparing its signal intensity with the signal intensity of the intervertebral disc, fat and muscle tissue on T1-weighted images. Hyperintense lesions on the DWI were identified and ADC values were automatically calculated using the software provided by the MR scanner manufacturer (Diffusion Calculation: Philips Medical Systems) and the ADC quantitative parameter was expressed in: 1 0–3mm2/s.Results: Our study included 40 patients who were diag-nosed with or suspected to have vertebral lesion of any etiology. Qualitative evaluation of the lesion contrast in diffusion-weighted MRI of the vertebral column has been shown to be valuable for the differentiation of lesion etiology; however, visual assessment of high signal intensity was not specific for malignancy.On the other hand the quantitative assessment by meas-uring the ADC value was able to distinguish benign from malignant high signal intensity on DWI.In our study, infiltrated neoplastic marrow as well as hypercellular red marrow had higher ADC values than normal marrow while inflammatory lesions and hemangiomas had the highest ADC values.Conclusion: Diffusion weighted MRI is a reliable tool in characterization of different vertebral bone marrow abnormal-ities. The routine MRI protocol of spine examinations could be modified to include DWI as a cost effective substitute for the gadolinium enhanced scan especially in patients with contraindication for contrast administration.

Background: In recent years, MRI has increasingly become the modality of choice for imaging of musculoskeletal disor-ders. Diffusion weighted MR sequences provide microscopic information to supplement the macroscopic information pro-vided by conventional sequences. It is a non invasive imaging technique which is suitable for probing the physical structure of a biologic tissue at a microscopic level and it exploits the random, translational motion of water protons in a biologic tissue, which reflects the tissue specific diffusion capacity and can be used for tissue characterization.Aim of Work: The aim of this study is to determine the value of Diffusion Weighted Imaging (DWI) in differentiation between different causes of vertebral collapse.Patients and Methods: This is a prospective study carried out in Radio-Diagnosis Department, Faculty of Medicine, Cairo University between August 2014 and February 2016 for patients diagnosed with vertebral body collapse. A total number of 35 patients (20 males and 15 females) with age range 18-74 (average 52).The MRI sequences obtained were sagittal T1WI, T2WI, STIR and axial T1WI, T2WI & DWI (± post contrast images in some patients). Bone marrow signal intensity of the collapsed vertebra was analyzed by comparing its signal intensity with the signal intensity of the intervertebral disc, fat and muscle tissue on T1-weighted images, the signal intensity of the affected veteba was also inspected on DWI then ADC values were automatically calculated using the software provided by the MR scanner manufacturer (Diffusion Calculation: Philips Medical Systems) and the ADC quantitative parameter was expressed in: 10–3mm2/s.Results: Our study included 35 patients who were diag-nosed with vertebral body collapse. Qualitative evaluation of the lesion contrast in diffusion-weighted MRI of the vertebral column has been shown to be valuable for the differentiation of lesion etiology; however, visual assessment of high signal intensity was not specific for malignancy.On the other hand the quantitative assessment by meas-uring the ADC value was able to distinguish different types of vertebral collapse.In our study, there was statistically Highly Significant (HS) difference between malignant and the following benign causes of vertebral collapse; acute fracture, chronic osteoporot-ic collapse and pyogenic spondylodiscitis. There is also statistically significant difference (S) between malignant and TB spondylodiscitis lesions according to ADC values.Conclusion: Diffusion weighted MRI can be used as a reliable tool in differentiation between different causes of vertebral body collapse. DWI could be applied as a cost effective substitute for the gadolinium enhanced scan especially in patients with contraindication for contrast administration.

Benign prostatic hyperplasia (BPH) is considered a normal part of the aging process in men, and is characterized by an imbalance between cell proliferation and apoptosis. Our study aimed to investigate the potential protective role of silymarin (SIL) against testosterone-induced BPH in rats and to elucidate the molecular mechanisms underlying SIL pro-apoptotic and anti-proliferative effects. Forty adult male Wistar rats were divided equally into four groups: control group, BPH group (3 mg/kg testosterone propionate, s.c. for 14 days, SIL group (50 mg/kg SIL, orally, once daily concomitantly with 3 mg/kg testosterone propionate s.c.) and inhibitor group (50 mg/kg SIL orally concomitantly with 3 mg/kg testosterone, s.c. and 0.5 mg/rat Z-VAD-FMK, i.p.). Silymarin induced caspase-dependent apoptosis in BPH as SIL significantly reduced prostatic Bcl-2 protein and increased Bax protein concentration. Also, SIL down-regulated survivin (Inhibitor of apoptosis protein (IAPs) gene expression in rat prostate assisting mainly caspase-dependent pathway. Silymarin significantly decreased cytochrome-c cytosolic concentration and increased caspase 3 activity compared to BPH group. Silymarin significantly increased the content of p27/kip1 (Cyclin dependent kinase inhibitor (CDKIs) promoting cell cycle arrest. The histological features of BPH such as hypertrophy, papillary projections formation, improved in SIL group. Silymarin showed a significant anti-proliferative and pro-apoptotic role in BPH and accordingly it could be effectively and safely used as a treatment tool in cases of BPH or prostatic disorders.

Infections after osteosynthesis are a feared complication of the surgical treatment of fractures and should be dealt with by a multidisciplinary team. In addition to the surgeon, also included in this multidisciplinary team are a specialist for infectious diseases, a microbiologist, a radiologist and often a plastic surgeon. This review article describes the current knowledge on the pathogenesis, diagnostics, classification and treatment. The aim is to demonstrate some basic rules in the treatment of infections associated with implants and to show potential therpeutic approaches. The principles of diagnostics and combined surgical and antibiotic treatment are presented based on the current specialist literature. With the help of a team approach the goals of treatment of an infected osteosynthesis, i.e. fracture healing, return to function and eradication of infection can be achieved. While the osteosynthesis material can usually be retained in acute infections, it is better to remove the infected hardware in chronic infections as eradication of the mature biofilm is no longer possible. With adequate local wound debridement, the use of local and systemic antibiotics, as indicated by the specialist for infectious diseases and appropriate soft tissue coverage and wound closure, acute as well as chronic infections can be successfully treated. Nowadays, the surgeon has many different options for the management of bone defects. Depending on the anatomical location and the size of the defect a variety of techniques ranging from acute shortening to the Masquelet technique up to the Ilizarov distraction technique are available. These techniques should be combined with local bactericidal treatment.

Massive Multiple-Input Multiple-Output (massive MIMO) system relies on channel state information (CSI) feedback to perform precoding and achieve performance gain in frequency division duplex (FDD) networks. However, transmission of massive MIMO system is subject to excessive feedback overhead. In this paper, we propose a Deep Learning (DL) approach-based channel estimation technique to enhance the performance of massive MIMO system. This technique is used to enhance recovery quality and improve trade-off between compression ratio (CR) and complexity of massive MIMO system. The proposed technique is based upon using the Channel State Information Network combined with gated recurrent unit (CsiNet-GRU). Moreover, the dropout method is used in the proposed technique to reduce overfitting during the learning process. The simulation results demonstrate that the proposed CsiNet-GRU technique results in a significant improvement in performance when compared with existing techniques used in conjunction with massive MIMO systems.

The Roberts syndrome (RBS) is a rare autosomal recessive disorder caused by mutation in ESCO2 gene. Among over 150 reported international cases, 16 cases are Egyptian including the presently reported patients. The current study reports 8 new Egyptian patients from 7 unrelated consanguineous families investigating clinical phenotype as well as cytogenetic changes in all cases and mutational spectrum in 4 cases. Clinical, orodental, cytogenetic and molecular studies were done to investigate genotype/phenotype correlation. Evaluation of the studied 8 patients showed that they all exhibited the main limb and craniofacial features of Roberts syndrome. Cytogenetic studies including centromeric separation and puffing by Giemsa and DAPI stains and for the first time in Egypt analysis for premature centromeric division by FISH showed consistent centromeric separation in all studied cases. Molecular studies of 4 available patients showed that they all have ESCO2 gene mutation. We conclude that RBS has a well-defined clinical spectrum. The cytogenetic changes are due to sister chromatid cohesion defects which lead to mitotic dysfunction. We confirmed previous results of lack of genotype/phenotype correlation. We also confirmed that the severity of limb malformation correlates with craniofacial manifestations. We recommend detailed evaluation of orodental changes for further definition of the phenotype and for proper patient management. We emphasize the need for further studies for the frequency of premature centromeric separation by FISH as a possible indicator of phenotypic severity.

Graphical abstract: TEM micrographs of La{sub 1−x}Ce{sub x}Fe{sub 1−x}Cr{sub x}O{sub 3} for x = 0.0. - Highlights: • The composition of La{sub 1−x}Ce{sub x}Fe{sub 1−x} Cr{sub x}O{sub 3} was prepared by co-precipitation method. • X-ray diffraction showed orthorhombic structure with space group Pnma. • With increasing Ce and Cr content, a decrease of the unit cell volume. • Enhancement in the coercivity (H{sub c}) with increasing Ce and Cr content. • Reduction of M{sub s} and M{sub r} up to x = 0.15 and increases with further increases of x. - Abstract: Nanocrystalline orthoferrites with the composition of La{sub 1−x}Ce{sub x}Fe{sub 1−x} Cr{sub x}O{sub 3} where (x = 0, 0.1, 0.15 and 0.2) were prepared by co-precipitation method. The structural and magnetic properties of the La{sub 1−x}Ce{sub x}Fe{sub 1−x}Cr{sub x}O{sub 3} system have been investigated. X-ray diffraction showed the formation of orthorhombic structure with space group Pnma for different compositions. With increasing Ce and Cr content, lattice parameters a and c were found to decrease while b increases, resulting in a decrease of the unit cell volume. The crystallite size was calculated from XRD data and compared with that obtained from TEM micrographs. Vibrating sample magnetometer measurements reveal an enhancementmore » in the coercivity (H{sub c}) with increasing Ce and Cr content and reduction of saturation magnetization (M{sub s}) and remnant magnetization (M{sub r}) up to x = 0.15 and increases with further increases of x. The magnetic susceptibility measurements vs. temperature showed canted-antiferromagnetic (AFM) in which the Neel temperature is increasing with Ce and Cr content.« less

Hydrogen sulfide (H2S) is the third gasotransmitter discovered. Sulfide shares with the two others (NO and CO) the same inhibiting properties towards mitochondrial respiration. However, in contrast with NO or CO, sulfide at concentrations lower than the toxic (μM) level is an hydrogen donor and a substrate for mitochondrial respiration. This is due to the activity of a sulfide quinone reductase found in a large majority of mitochondria. An ongoing study of the metabolic state of liver in obese patients allowed us to evaluate the sulfide oxidation capacity with twelve preparations of human liver mitochondria. The results indicate relatively high rates of sulfide oxidation with a large variability between individuals. These observations made with isolated mitochondria appear in agreement with the main characteristics of sulfide oxidation as established before with the help of cellular models.

Defect reconstruction over the olecranon should be reliable, quick, relatively simple and with minimal complications. More recently, perforator flaps have been described with the benefit of minimal donor site morbidity when compared with muscle flaps or flaps relying on the major arteries of the upper extremity. So far, most of these flaps were harvested on the upper arm and rotated 180° into the defect. The aim of the present study was to analyse the results with the proximally based, distally extended lateral arm flap for soft-tissue reconstruction over the olecranon. The subcutaneous tissue layer in this area is thinner than in the upper arm, and less rotation of the pedicle is necessary. The location of the perforator just proximal to the lateral epicondyle and the precise territory of the flap are well known. Nine consecutive male patients with a mean age of 57±27 years presenting with soft-tissue defects after surgical treatment of bursitis (eight cases) or a pressure sore (one case) were operated on. The mean operation time was 60±15 min. In eight of the nine cases, the flap healed uneventfully or with a minor complication (fistula). One patient underwent revision surgery due to marginal flap necrosis. The defect was closed with a local advancement flap. In conclusion, the flap was reliable, relatively simple and quick to harvest, and yielded acceptable aesthetic results with minimal bulging over the olecranon. Postoperative recovery was relatively painless and short.

In this piece of work, high quality and homogeneity, barium hexaferrite (BaM) BaFe12O19 nanoparticles were prepared from organometallic precursors for the 1st time. This method is based on the formation of supramolecular crystal structure of Ba[Fe(H3NCH2CH2NH3)]Cl7·8H2O. The crystal structure, morphology and magnetic properties of BaFe12O19 at two different annealing temperatures namely 1000 °C and 1200 °C were investigated using X-ray diffraction, transmission electron microscope TEM and vibrating sample magnetometry (VSM). The results show that monophasic nanoparticles of hexaferrites were obtained. Nanoparticles of crystallite size 40–50 nm distinguished by narrow distribution and excellent homogeneity were obtained with superior magnetic properties which suggested single-domain particles of Ba-M hexaferrite.

Infections after osteosynthesis are a feared complication of the surgical treatment of fractures and should be dealt with by a multidisciplinary team. In addition to the surgeon, also included in this multidisciplinary team are a specialist for infectious diseases, a microbiologist, a radiologist and often a plastic surgeon. This review article describes the current knowledge on the pathogenesis, diagnostics, classification and treatment. The aim is to demonstrate some basic rules in the treatment of infections associated with implants and to show potential therpeutic approaches.The principles of diagnostics and combined surgical and antibiotic treatment are presented based on the current specialist literature.With the help of a team approach the goals of treatment of an infected osteosynthesis, i.e. fracture healing, return to function and eradication of infection can be achieved. While the osteosynthesis material can usually be retained in acute infections, it is better to remove the infected hardware in chronic infections as eradication of the mature biofilm is no longer possible.With adequate local wound débridement, the use of local and systemic antibiotics, as indicated by the specialist for infectious diseases and appropriate soft tissue coverage and wound closure, acute as well as chronic infections can be successfully treated. Nowadays, the surgeon has many different options for the management of bone defects. Depending on the anatomical location and the size of the defect a variety of techniques ranging from acute shortening to the Masquelet technique up to the Ilizarov distraction technique are available. These techniques should be combined with local bactericidal treatment.

Resume Objectif L’objectif de cette revue a ete d’evaluer les resultats du traitement laparoscopique des eventrations a l’aide d’une prothese intraperitoneale a partir des series publiees. Methodes Toutes les series importantes de cures d’eventration par laparoscopie et publiees entre 2002 et 2011 ont ete colligees. Les resultats des etudes randomisees controlees comparant cette technique a la voie abdominale anterieure ont ete inclus. Resultats Vingt-deux series ont ete analysees, total de 7057 patients (51 a 1242), IMC moyen 32,4 (de 28,5 a 46), orifice d’eventration moyen 10,6 cm (6 a 14,9 cm). Le taux moyen de conversion a ete de 2,7 %. En moyenne la duree operatoire a ete de 90 ± 33 minutes, la mortalite de 0,08 %, due a des plaies digestives passees inapercues (1,6 %) et plus frequentes en cas de seconde cure d’eventration, et la duree d’hospitalisation de 2,5 jours. Le taux d’infection a ete de 0,3 %. Le taux de recidive a ete en moyenne de 4,6 % (suivi moyen : 36 mois). Les etudes randomisees comparant la laparoscopie a la voie abdominale anterieure n’ont pas montre de difference en termes de complications postoperatoires ou de recidives. Seule la duree d’hospitalisation etait, dans certaines etudes, plus courte apres laparoscopie. Conclusion La voie laparoscopique est une technique fiable realisable pour des eventrations larges chez l’obese. Elle doit etre reservee aux eventrations non recidivees pour eviter le risque de plaies digestives. Elle semble permettre un temps d’hospitalisation postoperatoire plus court.

This paper deals with the reliability characteristics of two different series system configurations with mixed standby (include cold and warm standby) components. The failure rates of the primary and warm standby components are assumed to follow the Weibull distribution. The repair time distribution of each server is exponentially distributed. Moreover, we will derive the mean time-to-failure, and the steady-state availability for a special case of a serial system of two primary components, two warm standby components, and one cold standby component, when the failure and repair rate are constant.

Objectif Evaluation des resultats de la sleeve gastrectomie (SG) laparoscopique chez 30 patients supersuperobeses (IMC > 60 kg/m2).

Ni ferrite nanoparticles were prepared using citrate method. XRD pattern revealed the formation of the samples as synthesized in the spinel cubic structure. Silver doping effect on the magnetic properties of Ni ferrite was investigated. The lattice parameter was slightly increased while the values of the Curie temperature decreased with increasing Ag content. The magnetic susceptibility was measured using Faraday’s method and the calculated magnetic constants were reported. The data showed that χM and effective magnetic moment decrease with increasing Ag content.

The electrical properties measurements were carried out for the complex (CH 2 ) 2 (NH 3 ) 2 Mn 1− x Cd x Cl 4 , 0.0 ≤ x ≤ 1.0 at different temperatures as a function of frequency (100–1000 kHz). Four transition points were obtained for x = 0.5, which are assigned as thermochromism, interlayer exchange interaction, order–disorder and chain melting. The presence of more than one straight line in the conductivity data clarifies the presence of more than one conduction mechanism, and the calculated values of the activation energy indicate the semiconducting characteristics of the investigated complexes. The values of the calculated relaxation time indicate its dependence on Cd content as well as the heating temperature. The expected critical concentration at x = 0.5 agree well with the percolation theory of Mont-Carlo group. The IR spectra indicate that the force constant of the bonds and the atomic mass vibration are affected by Cd content.

Situation La gastrectomie longitudinale ou sleeve gastrectomie (SG) est de plus en plus choisie comme traitement chirurgical de l’obesite morbide. Cela en raison de son efficacite et de son taux acceptable de complications. A long terme, la dilatation de la poche gastrique peut entrainer une stagnation de la perte de poids et une reprise ponderale.

Objectif L'obesite est associee a une hyperactivite sympathique plus marquee en cas de syndrome metabolique. Le role de l'inflammation dans le developpement de la maladie hepatique a ete suggere. L'objectif de cette etude etait de determiner si chez les obeses metaboliquement sains (MHO) les marqueurs de l'inflammation, le cortisol, l'activite sympathique et l'oxydation des substrats etaient associes a la steatose hepatique non alcoolique (NAFLD). Patients et Methodes Une biopsie hepatique laparoscopique a ete realisee au cours d'une chirurgie bariatrique chez 65 patients obeses morbides (53 femmes), âges de 36,4±9,6 ans, IMC 44,7±0,9kg/m 2 , tous indemnes d'atteinte virale ou toxique. Des parametres biologiques hepatiques, lipidiques, glycemiques, le cortisol plasmatique (8h, 16h) et des marqueurs de l'inflammation (CRP, fibrinogene) ont ete mesures, et l'activite sympathique a ete evaluee par les taux d'adrenaline et noradrenaline plasmatiques a jeun et 2 heures apres charge orale en glucose. La depense energetique de repos (DER) et l'oxydation des lipides et des glucides ont ete mesurees a jeun par calorimetrie indirecte. Le phenotype MHO a ete defini par l'absence de critere IDF du syndrome metabolique en dehors du tour de taille eleve. Resultats L'histologie a identifie une NAFLD chez 52 patients (36 steatoses, 16 NASH). Parmi les 21 MHO, 7 avaient un foie normal, 11 une steatose et 3 une NASH. Les MHO avec NAFLD avaient des valeurs comparables pour les parametres hepatiques, lipidiques, glycemiques, HOMA-IR et pour la proportion de patients hypertendus ou avec syndrome d'apnees du sommeil aux MHO avec foie normal, mais des taux plus eleves de CRP, cortisol 16 h et noradrenaline apres glucose ( p Conclusions La prevalence de NAFLD est elevee (66 %) chez les MHO. La NAFLD avec ou sans desordres metaboliques s'accompagne d'un profil inflammatoire plus marque, d'un taux de cortisol plus eleve et d'une hyperacti-vite sympathique. Ces donnees suggerent le role de l'hyperactivite sympathique dans le developpement de NAFLD.

Summary Objective The objective of this review is to evaluate the results of laparoscopic treatment of ventral hernias using intra-peritoneal prosthetic mesh through a review of published surgical series. Methods All large series of patients treated for an incisional hernia by laproscopy and published between 2002 and 2011 were identified. The results of controlled randomized series comparing this technique with open surgical repair were analyzed. Results Twenty-two series with a total of 7057 patients were analyzed (range 51–1242); the mean Body Mass Index (BMI) was 32 (range: 28.5–46), and the mean size of the hernia defect was 10.6 cm (range: 6–14.9 cm). The mean rate of conversion to open surgical repair was 2.7%. Mean operative duration was 90 ± 33 minutes. Mortality was 0.8%, usually due to an unrecognized intestinal injury (1.6%), which occurred more frequently with second or iterative hernia repairs. Hospital stay averaged 2.5 days. The infection rate was 0.3% and the rate of hernia recurrence was 4.6% (with a mean follow-up of 36 months). No statistically significant differences were found in terms of post-operative complications or hernia recurrence in the randomized studies comparing laparoscopic to open anterior abdominal surgical repair. However, duration of hospital stay was shorter after laparoscopy in some studies. Conclusion Laparoscopic repair of ventral incisional hernia is technically feasible and reliable for large hernia defects, even in obese patients. This approach should be reserved for patients with no history of previous hernia repair in order to avoid the risk of intestinal injury. It appears to allow for a shortened duration of hospitalization.

Laparoscopic gastrectomy (LG) is still not a widely accepted option for the treatment of invasive gastric cancer. This study was conducted to evaluate the results of LG for gastric adenocarcinoma in two French surgical departments.Between 2001 and 2007, 51 patients underwent LG for gastric cancer. The results were compared to those of 79 patients who had open gastrectomy (OG) during the same study period.Mean age was 61 years (31-81) and 66 years (27-88) in the LG group and in the OG group, respectively. The sex ratio was 21 women to 30 men and 25 women for 54 men in the LG group and the OG group, respectively. The mean operative duration was 260 minutes (90-420) and 200 (120-360) the LG group and the OG group, respectively (P=0.11). Estimated operative blood loss was 150 ml (50-870) and 240 (120-955) in the LG group and the OG group, respectively (P=0.07). The mean number of harvested lymph nodes was 19 (8-51) in the LG group and 22 (3-101) in the OG group, respectively (P=0.76). The overall mortality rate was 0% and 2.5% in the LG group and the OG group, respectively (P=0.49). The overall abdominal morbidity rate was 12% and 16.4% in the LG group and the OG group, respectively (P=0.42). The mean duration of hospital stay was 8.0 days (5-23) and 11.5 days (5-31) in the LG group and the OG group, respectively (P=0.023). Survival analysis at 1, 2, and 3 years showed no significant difference between the two groups.LG for cancer is feasible and safe in patients with invasive gastric cancer. However, randomized controlled trials are necessary to accurately define the role of laparoscopy in the treatment of gastric cancer.

Die Luxation der Tibialis posterior Sehne am oberen Sprunggelenk ist im Vergleich zu Verletzungen der Peronealsehnen oder der Ruptur des M. tibialis posterior selten. Bei entsprechendem Unfallmechanismus und starken Schmerzen im Bereich des Malleolus medialis mus an diese Verletzung gedacht werden. Die Diagnose kann durch eine sorgfaltige klinische Untersuchung gestellt werden. Das Magnetresonanzuntersuchung (MRT) kann zur Diagnosefindung und bei Verdacht auf Zusatzverletzungen hilfreich sein. Die operative Versorgung ist einfach und zeigt gute Langzeitresultate.

Urgent appendectomy in patients with acute appendicitis (AA) complicated by abscess or phlegmon is associated with a high rate of complications. Recent developments in CT scanning have allowed patients with complicated appendicitis to be better identified. We choose to treat these patients with initial antibiotic therapy followed by elective appendectomy. We reported the results of this strategy and compared it with urgent appendectomy.A retrospective analysis of patients diagnosed with complicated acute appendicitis (CAA) between 1998 and 2007 treated either by urgent appendectomy or with antibiotic therapy and elective appendectomy was performed. We assessed the efficacy of antibiotic therapy for CAA. We compared the postoperative course between urgent and elective appendectomy.We treated 56 patients with CAA: 40 by urgent appendectomy and 16 by antibiotics. All 16 patients improved with no need for urgent surgery, with 15 undergoing elective appendectomy. Postoperative complications were significantly lower in the elective group. Conversion rate and mean operative time were also lower but not significantly different. However, the duration of total hospital stay, antibiotic therapy and sick leave were higher.Initial antibiotic therapy followed by elective appendectomy may be proposed in patients diagnosed with CAA.

Objectif La NAFLD affecte souvent les patients obeses et/ou diabetiques de type 2. Elle peut etre consideree comme un composant supplementaire du syndrome metabolique (SM). L'insulinoresistance (IR) serait le substratum physiopathologique commun au SM et a la NAFLD. L'hyperactivite sympathique affecte souvent les sujets obeses ou dysmetaboliques. L'inflammation ainsi que l'hyperactivite sympathique pourraient rendre compte de l'evolution de NAFLD vers la steatohepatite (NASH). Notre but etait de determiner dans une population de patients obeses morbides operes d'une chirurgie bariatrique la part des marqueurs de l'inflammation de bas grade, de l'IR, du cortisol plasmatique et de l'activite sympathique dans la maladie hepatique steatosique confirmee par biopsie chirurgicale. Patients et methodes Dans cette etude prospective approuvee par le comite regional d'ethique, des biopsies peroperatoires du lobe gauche du foie ont ete realisees. Chez 36 patients (6 hommes/30 femmes ; âge: 36,4±9,6 ans, IMC 44,8±5,3 kg/m²), les lipides circulants, la glycemie a jeun et apres charge orale en glucose, le cortisol plas-matique (8 h, 16 h), CRP, fibrinogene ont ete doses. HOMA-IR calcule ; l'activite sympathique a ete exploree par dosage de l'adrenaline et la noradrenaline plasmatiques a jeun et 2 heures apres glucose. Le SM etait defini selon les criteres IDF. Resultats Les patients ont ete classes par la biopsie en: 8 foie normal, 17 NAFLD et 11 NASH. Les patients avec NAFLD ou NASH avaient HOMAIR, noradrenaline post-charge et cortisol a 16 heures plus eleves ( p =0,03 pour tous ces parametres). Plus d'entre eux avaient un SM compares aux patients a foie sain ( p =0,04) avec une CRP un peu plus forte ( p =0,08). Conclusion Les patients obeses morbides avec preuve histologique de NAFLD/NASH ont une inflammation et une insulinoresistance plus marquees et une hyperactivite sympathique, des desordres dont le role dans la progression de la maladie hepatique reste a determiner. Declaration d’interet Les auteurs declarent ne pas avoir d'interet direct ou indirect (financier ou en nature) avec un organisme prive, industriel ou commercial en relation avec le sujet presente.

Objectif Les sujets obeses metaboliquement sains (MHO) constituent un pheno-type d’obeses caracterise par un profil insulinosensible, une pression arterielle et des parametres metaboliques normaux. Un risque cardio-vasculaire lui est neanmoins associe. Le statut hepatique n’est pas precisement connu. L’objectif de notre etude etait d’examiner la prevalence de NAFLD chez les MHO dans notre cohorte de patients operes d’une chirurgie bariatrique. Patients et methodes Dans cette etude prospective approuvee par le comite regio-nal d’ethique 66 patients ont eu pendant la chirurgie bariatrique des biopsies du lobe gauche hepatique (54 femmes, âge 36,4 ± 9,6 ans, IMC 44,8 ± 5,3 kg/m²), tous indemnes d’atteinte hepatique virale ou toxique. Les patients ont ete clas-ses selon les donnees histologiques (classification de Bedossa 2012): foie normal, NAFLD (simple steatose) et steatohepatite (NASH). Les parametres biolo-giques hepatiques, lipidiques et glycemiques, le HOMA-IR et le FLI (fatty liver index) ont ete evalues. Les obeses metaboliquement sains sont definis selon les criteres IDF. Resultats Parmi les 66 patients, 22 etaient MHO, 10 avaient un foie normal et 12 une NAFLD (9 steatoses et 3 NASH). Chez les 44 patients metaboliquement non sains, 6 avaient un foie histologiquement normal et 38 avaient une NAFLD (25 steatose, 13 NASH). Les MHO avec NAFLD avaient un IMC plus eleve que ceux a foie normal (47,4 ± 6,4 vs 41,6 ± 3,8 kg/m², p = 0,03) ; ALAT, ASAT, GGT, glycemie et insulinemie a jeun, HOMA-IR et FLI etaient similaires. Conclusion La prevalence de la NAFLD notamment de la NASH est elevee parmi les patients MHO, sans marqueur simple en dehors de l’IMC. Declaration d’interet Les auteurs declarent ne pas avoir d’interet direct ou indirect (financier ou en nature) avec un organisme prive, industriel ou commercial en relation avec le sujet presente.

Einleitung Die Rolle der transarteriellen Embolisation als Teil des Behandlungskonzepts bei Patienten mit Abdominaltrauma ist noch ungenugend definiert. Wahrend in einigen Traumazentren die routinemasige Angiographie propagiert wird, sind wir der Ansicht, dass sie einer strengen Indikationsstellung unterliegen muss.

The role of transarterial embolisation in patients with abdominal injuries is controversial. Some trauma centres advocate routine angiography, whereas others believe in restricted indications such as increasing haematomas or persistent/recurrent haematuria.We prospectively studied 167 patients with blunt and penetrating abdominal trauma. We used restricted indications for angiography and embolisation.Eleven of 167 patients with abdominal trauma (7%) were treated with angiography and embolisation., Overall, three of 11 patients (27%) with angiography and embolisation were treated emergently and eight of them (73%) at an average of 7.3 days. There were no complications due to the embolisation procedure, and all bleeding could be stopped.Transarterial angiography and embolisation is an important and safe tool in the treatment of acute abdominal injury when used for restricted indications. We believe this should not be performed as a routine procedure, especially in unstable patients.

Hydrogen sulfide is considered as the third gasotransmitter, comparison with the two others (NO and CO) revealing similarities and differences. All three are in fact poisons as potent as cyanide because of the shared property to inhibit cellular respiration. However, in sharp contrast with the others H2S is also a mitochondrial substrate oxidized by mammalian cells if present below its toxic level (#10–50 μM) in the extracellular medium. The enzymatic machinery involves several enzymes and notably a sulfide quinone reductase as well as a dioxygenase. This mitochondrial sulfide oxidation constitutes a sink able to neutralize continuous release of sulfide as long as its concentration remains lower than the low micromolar range. Thus mitochondria are likely to contribute to the control of sulfide signaling. The disturbance of cellular bioenergetics by the combined action of gasotransmitters might underline some of their pharmacological (if not physiological) effects. In this respect the microbiota hosted in the large intestine of mammals constitutes a sulfide source leading to toxic concentrations challenging the epithelium and surrounding tissues. Accordingly, a large capacity for sulfide oxidation is found in the colonic epithelium. Our studies aim to describe sulfide oxidation in mammals and to provide information with regards to its relevance to signaling, and reveal notably that human liver mitochondria have the capacity to neutralize a significant flux of incoming sulfide.

Objectif Une steatopathie non-alcoolique (NAFLD : non alcoholic fatty liver disease), allant de la steatose simple a la steatohepatite non alcoolique (NASH), est frequemment observee chez les patients obeses et est consideree comme la manifestation hepatique du syndrome metabolique. Les anomalies metaboliques en cause restent mal identifiees. Notre objectif a ete de determiner s'il existait une correlation entre la severite de la NAFLD et des alterations du metabolisme hepatique des lipides. Patients et methodes Une biopsie hepatique peroperatoire a ete realisee chez des patients operes d'une obesite morbide et des patients temoins non obeses. Un examen histologique a evalue la severite de la NAFLD, classee en 3 groupes : G1, foie normal i.e. pas de steatose ; G2, steatose simple ; G3, NASH. Les flux d'oxydation et d'esterification d'un acide gras a chaine longue (AGCL), l'oleate [1–14C], ont ete mesures. Resultats 50 biopsies ont ete realisees chez 50 patients dont 45 obeses (âge=38,2±2,5 ans ; IMC=44,06±1,06 kg/m 2 ) et 5 controles (âge=37,6±6,9 ans ; IMC=21,9±1,7 kg/m 2 ). Parmi les obeses, 11 etaient du G1 (24 %), 23 du G2 (51 %) et 11 du G3 (24 %). Le contenu hepatique en triglycerides etait augmente chez les patients G2 et G3 tandis que celui en diacylglycerols n'etait significativement augmente que chez les patients G3. L'orientation metabolique de l'oleate [1–14C] (oxydation versus esterification) etait identique dans les 3 groupes de patients obeses et le groupe controle. En revanche, la production de CO2 et le ratio oxydation complete/incomplete (CO2/corps acido-solubles) etaient significativement diminues dans le groupe G3, compare aux autres groupes (p Conclusion Ces resultats suggerent que la NASH est associee a une moindre capacite du foie a oxyder completement les AGCL en comparaison des patients ayant un foie histologiquement normal ou avec une steatose simple.

In Europe, there is little experience in the application of temporary cava filters in patients with multiple injuries. Especially patients with pelvic injuries, fractures of the spine, and the lower extremities are at high risk for thromboembolic events like thrombosis or pulmonary emboli. Moreover, in patients with severe head injuries, anticoagulation is contraindicated.We present in this paper our experience with 24 consecutive patients with multiple injuries who were treated with a temporary cava filter. The insertion site was either the femoral (n = 20) or the jugular (n = 4) vein. The 24 patients revealed a mean ISS of 35.1 +/- 2.01 points. Nineteen patients had pelvic injuries and 17 patients suffered from severe head injury. In 17 patients the insertion of the filter was prophylactic, in 4 patients a thrombosis was present and in 3 patients a non-fatal pulmonary emboli was diagnosed before the application of a cava filter.No complication occurred due to insertion of the filter. In one patient a thrombosis of the cava was observed as the only overall complication (1 of 24 = 4.2%).The insertion of a cava filter in patients with multiple injuries with contraindication for anticoagulation is a safe and effective procedure to prevent fatal pulmonary emboli.

Field and laboratory data provided convincing evidence implicating O. savignyi at Shelateen, Halayeb province as a reservoir and a vector of a specific Borrelia. Using direct immunofluorescence Borrelia infection was detected for the first time in a natural population of O. savignyi in Egypt. The overall infection rate (IR) was relatively high (50.63%) and the infected ticks were capable of transmitting the infection to hamsters during feeding. Infected nymphs maintained borrelial infection transstadially to adults and the transstadially infected stages transmitted the spirochetes to hamsters. However, directly infected females were more efficient than males in transmitting the spirochetes to hamster and the IR of hamsters increased gradually by increasing the number of feeding infected ticks upon each hamster. Transovarial transmission of Borrelia intrinsic to O. savignyi occurred during the first and second gonadotrophic cycle of the infected females. The Borrelia sp. detected in the field collected O. savignyi showed specificity for its own natural tick host species when compared with B. crocidurae isolated from O. erraticus. Although the two tick species acquired, transstadially transferred and transmitted the two spirochetal infections, each tick species failed to transovarially transmit Borrelia isolated from the natural population of the other tick species.

Einleitung: In Europa existieren nur wenig Erfahrungen mit der Einlage von Cava-Filtern bei schwerverletzten Patienten. Besonders nach Verletzungen des Beckens, der Wirbelsaule und nach Frakturen der unteren Extremitat weisen mehrfachverletzte Patienten ein erhohtes Thromboserisiko mit Gefahr einer Lungenembolie (LE) auf. Eine zusatzliche Problematik findet sich bei Patienten mit schwerem Schadel-Hirn-Trauma (SHT), bei denen eine Kontraindikation zur Anticoagulation besteht. Die vorliegende Arbeit zeigt unsere Erfahrungen mit einem temporaren Cava-Filter (Gunter-Tulip) bei polytraumatisierten Patienten mit hohem Thrombose- bzw. Embolierisiko und gleichzeitiger Kontraindikation zur Anticoagulation. Methode: 24 konsekutive Patienten mit Mehrfachverletztung die zwischen September 1996 und Marz 2000 einen Cava-Filter erhalten haben wurden im Sinne einer konsekutiven Beobachtungsstudie analysiert. Die Einlage des Filters erfolgte percutan uber die V. femoralis (n = 20) und V. jugularis (n = 4). Die 24 Patienten wiesen einen durchschnittlichen Injury Severity Score (ISS) von 35,1 ± 2,01 auf und waren im Schnitt 41,4 ± 2,89 Jahre alt. Die haufigsten Begleitverletzungen waren ein schweres SHT (n = 17) bzw. eine Beckenringverletzung (n = 19). Die Einlage erfolgte bei 17 Patienten prophylaktisch, bei 3 Patienten nach der Diagnose von Lungenembolien und bei 4 Patienten nach der Diagnose einer tiefen Beinvenenthrombose. Ergebnisse: Die Einlage des Filters war bei allen Patienten komplikationslos. Nach der Schirmeinlage wurde klinisch bei keinem Patienten eine Lungenembolie diagnostiziert. Als Komplikation trat bei einem Patienten (1/24 = 4,2 %) eine Cavathrombose auf. Schlussfolgerung: Die Einlage eines Cava-Schirms zur Prophylaxe von Lungenembolien ist bei polytraumatisierten Patienten, die u. a. wegen eines SHT nicht anticoaguliert werden konnen, ein sicheres und effizientes Verfahren mit geringer Komplikationsrate.

Traumatic dislocations of the tibialis posterior tendon are a rare entity compared to other injuries of the ankle joint. It should be considered if the patient presents with the mechanism of an ankle sprain in combination with severe pain in the region of the internal malleolus. We report of two cases of a traumatic dislocation of the tibialis posterior tendon and discuss the clinical image and the operative treatment.

Des analyses de sol ont ete faites a partir d'echantillons preleves dans des gites larvaires de Phlebotomus langeroni et P. papatasi et compares aux sols de sites ou l'on ne rencontre pas de larves de phlebotomes. Les sols caracterises par un taux d'humidite relativement eleve, qui sont riches en matiere organique et en composes tels que les phosphates de potassium et les nitrates, qui possedent un fort pourcentage de limon et un pH legerement alcalin constituent un biotope favorable au developpement de ces deux especes

The biocompatibility of bone implants and substitutes is usually tested on cell-lines only, despite a different and more relevant behaviour on primary osteoblasts as final targets can be expected. "Osteoblast-like" cell line (MC3T3-E1) and fresh human osteoblasts (HOB), cultured from cancellous bone grafts from the iliac crest were used for the study. Three different clinically used biomaterials were compared regarding biocompatibility: titanium, steel and hydroxyapatite (Bio-Oss). "Osteoblast-like" cell line and fresh human osteoblasts (5x104) were seeded on the three bone implants. Cell proliferation and osteocalcin synthesis were determined 1, 3, 7, and 10 days after the cells were plated on the biomaterials. All experiments were performed in five times (pro culture double measurements). HOB proliferation on hydroxyapatite was decreasing after 3 days, whereas cells from "Osteoblast-like" cell line showed comparable proliferation to the control group. The most interesting observation was the significant decrease of the osteocalcin levels (in conditioned medium) of "osteoblast like" cells and HOB on HA (Bio-Oss). We conclude that HA disturbs the proliferation and osteocalcin synthesis of HOB.

Background: The most common chromosomal abnormalities are aneuploidies of chromosome 21, 18, 13, X and Y. Prenatal diagnosis of fetal aneuploidies is routinely done by traditional cytogenetic culture, a major drawback of this technique is the long period required to reach a diagnosis. In this study we evaluated the QF-PCR as a rapid technique for prenatal diagnosis of common aneuploidies Method: This work was carried out on Sixty amniotic fluid samples taken from patients with one or more of the following indications: Advanced maternal age (3 case), abnormal biochemical markers (6 cases), abnormal ultrasound (12 cases) or previous history of abnormal child (39 cases). Each sample was tested by QF-PCR and traditional cytogenetic. Aneuploidy screenings were performed amplifying four STRs on chromosomes 21, 18, 13, two pseudoautosomal,one X linked, as well as the AMXY and SRY; markers were distributed in two multiplex QFPCR assays (S1 and S2) in order to reduce the risk of sample mishandling. Results: All the QF-PCR results were successful, while there was two culture failures, only one of them was repeated. No discrepancy was seen between the results of both techniques. Fifty six samples showed normal patterns, three sample showed trisomy 21, successfully detected by both techniques and one sample showed normal pattern by QF-PCR but could not be compared to the cytogenetics due to culture failure, the pregnancy outcome of this case was a normal baby. Conclusion: Our study concluded that QF-PCR is a reliable technique for prenatal diagnosis of the common chromosomal aneuploidies.

Introduction La transplantation d’hepatocytes presente un traitement potentiel pour les maladies metaboliques hepatiques hereditaires. L’obstacle principal reste la survie a long terme des cellules greffees. Tous les marqueurs cellulaires ont une demie vie courte et necessitent une biopsie hepatique pour leur detection. Les nanoparticules superparamagnetique d’oxyde de fer presentent un marqueur magnetique cellulaire perenne permettant un suivi non invasif utilisant l’imagerie par resonance magnetique (IRM). Cette technique du marquage a deja ete utilisee pour T lymphocytes et des cellules neurologiques in vitro ainsi que in vivo. Le but de ce travail a ete d’appliquer ce marqueur aux hepatocytes et d’evaluer sa detection histologique ainsi que radiologique. Materiels et Methodes Des hepatocytes humains et murins ont ete isoles et marques aux differentes concentrations des nanoparticules superparamagnetiques d’oxyde du fer. Ils etaient ensuite transplantes chez les souris syngeniques par ponction directe de la veine porte. Simultanement, des biopsies hepatiques et des coupes d’IRM ont ete realisees a differents jours. L’efficacite du marquage et la viabilite des hepatocytes ont ete evaluees in vitro ainsi que in vivo en comparant le resultat histologique aux images d’IRM. Resultats La concentration du fer a 5 mM a ete la plus visible, cependant, elle etait associee avec une mortalite cellulaire plus elevee (58 %). La concentration de 1 mM a permis la meilleure viabilite cellulaire in vitro (65 %). Un signal magnetique fort en IRM a ete observe avec le 5 mM, or les hepatocytes marques au 1 mM n’ont pas ete detectees radiologiquement. Le 3 mM semble etre la concentration la plus adaptee, associee a une viabilite cellulaire de 60 %, et un signal detectable en IRM. Les hepatocytes marques au fer representaient 1 - 4 % du foie de l’hote. Ils etait prouves fonctionnels in vivo. Conclusion Nous avons mis au point une nouvelle technique du marquage d’hepatocyte in vitro et evalue son efficacite in vivo. Il permet une detection non invasive et repetitive des hepatocytes greffes dans le foie du hote. La recherche est en cours afin d’identifier la concentration optimale du fer capable de donner un signal magnetique et radiologique fort ainsi que une viabilite cellulaire preservee.