Quelle est l’évolution sémiologique du trouble déficit d’attention avec hyperactivité après 60 ans ?

Le trouble déficit de l’attention/hyperactivité est un trouble neurodéveloppemental qui associe à des degrés divers des symptômes d’inattention, d’hyperactivité et d’impulsivité. Ce trouble, bien repéré dans l’enfance, reste insuffisamment diagnostiqué chez l’adulte. Les données épidémiologiques s’accordent sur un taux de 50 % de persistance des symptômes à l’âge adulte, avec une prévalence de 3–4 %. Il existe encore trop peu de données concernant le TDA/H chez les sujets de plus de 60 ans. Pourtant, nous observons depuis ces dernières années une littérature émergente sur le vieillissement du TDA/H.

Premièrement, une prévalence comparable à celle des adultes plus jeunes est observée. Contrairement à l’idée reçue, les manifestations d’hyperactivité sont présentes et aisément repérables chez les sujets âgés souffrant de TDA/H. Chez ces sujets, le TDA/H est responsable d’un impact significatif sur la qualité de vie et l’état de santé. Tout comme chez l’adulte jeune, le trouble est fréquemment associé à des manifestations anxieuses et une fréquence élevée de troubles de l’humeur. De possibles interactions existent entre TDA/H et les troubles cognitifs neurodégénératifs.

LKB1 reduces ROS-mediated cell damage via activation of p38

Liver kinase B1 (LKB1, also known as serine/threonine kinase 11, STK11) is a tumor suppressor mutated in Peutz-Jeghers syndrome and in a variety of sporadic cancers. Herein, we demonstrate that LKB1 controls the levels of intracellular reactive oxygen species (ROS) and protects the genome from oxidative damage. Cells lacking LKB1 exhibit markedly increased intracellular ROS levels, excessive oxidation of DNA, increased mutation rates, and accumulation of DNA damage, which are effectively prevented by ectopic expression of LKB1 and by incubation with antioxidant N-acetylcysteine (NAC). The role of LKB1 in suppressing ROS is independent of AMPK, a canonical substrate of LKB1. Instead, under the elevated ROS, LKB1 binds to and maintains the activity of cdc42-PAK1 (p21 activated kinase 1) complex, which triggers the activation of p38 and its downstream signaling targets, such as ATF-2, thereby enhancing the activity of SOD-2 and catalase, two antioxidant enzymes that protect the cells from ROS accumulation, DNA damage, and loss of viability. Our results provide a new paradigm for a non-canonical tumor suppressor function of LKB1 and highlight the importance of targeting ROS signaling as a potential therapeutic strategy for cancer cells lacking LKB1.

[Study of renal veins by multidetector-row computed tomography scans]

PURPOSE

To determine the prevalence of renal vein variants. To investigate the distribution of renal veins.

METHODS

We retrospectively reviewed spiral computed tomography (CT) scans of the abdomen performed during a two-month period. The same protocol was used for all CT scans: same multidetector-row CT scanner (Siemens(®)), 1 to 2-mm section thickness, injection of intravenous iomeprol. The study group included 121 patients, aged 21.7 to 93.4 years (mean age 60.9 ± 15.4 years). The sex ratio was 2/1, with 80 men and 41 women.

RESULTS

Seventy-three percent of the study group (88 patients) had no variants of the renal veins. Indeed almost 40% (48 patients) had one artery and one vein on each side, with typical course, and 33% (40 patients) had course and/or number variants of the renal arteries. Variants of the right renal vein consisted in multiple veins in 20.6% (25 cases). We detected no case of multiple left renal veins, but we described variations of its course in 9.1% (11 cases): 5 cases of retroaortic left renal vein (4.1%) and 6 cases of circumaortic left renal vein (5%). Three of these 11 patients had an associated double right renal vein. The probability to have a right renal vein variant was significantly higher than a left one (OR = 2.6, P = 0.01). And we found a significantly higher risk of having a venous variant in women (OR = 2.4, P = 0.04). We detected no case of inferior vena cava variant.

CONCLUSION

In our study, prevalence of a circum- or retroaortic left renal vein appeared higher than previously reported in the literature (9.1%). Knowledge of anatomical variants of renal vasculature is crucial and this study puts the emphasis on variations of course and number of renal vessels. Those variations are not so uncommon and should be known by radiologists and also by surgeons. Their knowledge has major clinical implications in practice and it contributes to the safety of renal and retroperitoneal surgery.

Impact of untreated portal vein thrombosis on pre and post liver transplant outcomes in cirrhosis

BACKGROUND AND AIMS

Most portal vein thromboses (PVT) in cirrhotics are discovered incidentally. While case series demonstrate improved portal vein patency with anti-coagulation, there is little information on impact of PVT on morbidity and mortality. This study aimed to compare morbidity and mortality in cirrhotics with untreated PVT with those without PVT.

MATERIAL AND METHODS

Cirrhotics evaluated for orthotopic liver transplant in a single large transplant center were prospectively followed. Subjects had contrast CT or MRI at initial evaluation and serial imaging every 6 months until transplantation, removal from the list or death. Univariate and multivariate Cox regression analysis were used to assess associations between new PVT and factors of interest.

RESULTS

Of the 290 prospectively followed cirrhotics who met inclusion criteria, PVT was detected in 70 (24.1%)-47 had PVT at the time of initial evaluation and 23 developed one during the pre-transplant study period. A third of the patients with PVT had re-canalization or spontaneous resolution of thrombus while awaiting transplantation. There was no difference in the pre or posttransplant mortality between cirrhotics with and without PVT.

CONCLUSION

Cirrhotics with untreated PVT fared equally well as those without PVT before and after transplantation. Further studies with larger numbers of patients are needed to determine if anticoagulation therapy truly improves outcomes in cirrhotics with portal vein thrombosis.

Novel small molecules disrupting Hec1/Nek2 interaction ablate tumor progression by triggering Nek2 degradation through a death-trap mechanism

Hec1 (highly expressed in cancer 1) or Nek2 (NIMA-related kinase 2) is often overexpressed in cancers with poor prognosis. Both are critical mitotic regulators, and phosphorylation of Hec1 S165 by Nek2 is required for proper chromosome segregation. Therefore, inactivation of Hec1 and Nek2 by targeting their interaction with small molecules represents an ideal strategy for tackling these types of cancers. Here we showed that new derivatives of INH (inhibitor for Nek2 and Hec1 binding) bind to Hec1 at amino acids 394-408 on W395, L399 and K400 residues, effectively blocking Hec1 phosphorylation on S165 by Nek2, and killing cancer cells at the nanomolar range. Mechanistically, the D-box (destruction-box) region of Nek2 specifically binds to Hec1 at amino acids 408-422, immediately adjacent to the INH binding motif. Subsequent binding of Nek2 to INH-bound Hec1 triggered proteasome-mediated Nek2 degradation, whereas the Hec1 binding defective Nek2 mutant, Nek2 R361L, resisted INH-induced Nek2 degradation. This finding unveils a novel drug-action mechanism where the binding of INHs to Hec1 forms a virtual death-trap to trigger Nek2 degradation and eventually cell death. Furthermore, analysis of the gene expression profiles of breast cancer patient samples revealed that co-elevated expressions of Hec1 and Nek2 correlated with the shortest survival. Treatment of mice with this kind of tumor with INHs significantly suppressed tumor growth without obvious toxicity. Taken together, the new INH derivatives are suitable for translation into clinical application.

Timed barium esophagram in achalasia types

Relationships of timed barium esophagram (TBE) findings to achalasia types defined by high-resolution manometry (HRM) have not been elucidated. Therefore, we correlated preoperative TBE and HRM measurements in achalasia types and related these to patient symptoms and prior treatments. From 2006 to 2013, 248 achalasia patients underwent TBE and HRM before Heller myotomy. TBE height and width were recorded at 1 and 5 minutes; HRM measured lower esophageal sphincter mean basal pressure, integrated relaxation pressure (IRP), and mean esophageal body contraction amplitude. Achalasia was classified into types I (25%), II (65%), and III (9.7%). TBE height at 5 minutes was higher for I (median 8 cm; interquartile range 6-12) and II (8 cm; 8-11) than for III (1 cm; 0-7). TBE width at 5 minutes was widest (3 cm; 2-4), narrower in II (2 cm; 2-3), and narrowest in I (1 cm; 0-2), P < 0.001. Volume remaining at 1 and 5 minutes was lower in III (1 m(2) ; 0-16) than I (42 m(2) ; 17-106) and II (39 m(2) ; 15-60), highlighting poorer emptying of I and II. Increasing TBE width correlated with deteriorating morphology and function from III to II to I. Symptoms poorly correlated with TBE and HRM. Prior treatment was associated with less regurgitation, faster emptying, and lower IRP. Although TBE and HRM are correlated in many respects, the wide range of their measurements observed in this study reveals a spectrum of morphology and dysfunction in achalasia that is best characterized by the combination of these studies.

7 OESTRAL RESPONSE AND FERTILITY IN DAIRY COWS TREATED WITH PROGESTERONE FOR 6 DAYS PRIOR TO OESTRUS SYNCHRONIZATION WITH PROSTAGLANDIN F2α

The present study tested whether the increase in serum progesterone concentrations for 6 days before oestrus synchronization with prostaglandin F2α (PGF2) increases oestral response, pregnancy rate, and reduces the incidence of twin births in dairy cattle. Seven hundred and eighty-three first-service dairy cows were synchronized with 2 injections of PGF2 14 days apart, starting on Day 35 postpartum. Six days before the second PGF2 injection, cows were assigned to 2 groups: P4 and control. The P4 group (n = 387) received a progesterone-releasing intravaginal device and an intramuscular injection of 500 mg of progesterone. The control group (n = 396) did not receive the progesterone-releasing intravaginal device or progesterone injection. Cows were inseminated 12 h after exhibiting oestrus. Pregnancy diagnosis was performed 40 and 45 days after insemination by rectal palpation and the cumulative pregnancy rate on Day 90 postpartum was determined retrospectively through the individual records. The response to the progesterone treatment varied according to the parity of the cows (P < 0.05). Thus, progesterone administration improved the percentage of cows detected in oestrus in multiparous [192/255 (75.2%) v. 161/267 (60.2%)] but not in primiparous [93/132 (70.4%) v. 90/129 (69.7%)] cows. Progesterone treatment increased pregnancy rate in multiparous [53/192 (27.6%) v. 27/161 (16.7%)] but not in primiparous cows [25/93 (26.8%) v. 29/90 (32.2%)]. Likewise, progesterone administration increased the cumulative percentage of pregnant cows on day 90 postpartum in multiparous [149/255 (58.4%) v. 129/267 (48.3%)] but not in primiparous cows [77/132 (58.3%) v. 82/129 (63.5%)]. The incidence of twin births was lower (P = 0.07) in cows treated with progesterone [1/74 (1%)] than in the control group [4/53 (7%)]. It is concluded that progesterone administration before oestrus synchronization with PGF2 in first service dairy cows improves oestral response, increases pregnancy rate, and percentage of pregnant animals on Day 90 postpartum in multiparous cows, but not in primiparous cows, and decreases the incidence of twin births. This research was supported by PAPIIT-UNAM research grant (IN219811-3).

Portal vein thrombosis as a complication of laparoscopic sleeve gastrectomy

Laparoscopic sleeve gastrectomy (LSG) is a popular form of weight loss surgery in New Zealand. The current case report describes an incident of portal vein thrombosis (PVT) following this surgery and serves to increase the understanding of the unique risks of this operation.

Links between obesity, diabetes and ethnic disparities in breast cancer among Hispanic populations

Breast cancer is the most prevalent malignancy in women worldwide and is a growing concern due to rising incidence and ongoing ethnic disparities in both incidence and mortality. A number of factors likely contribute to these trends including rising rates of obesity and diabetes across the globe and differences in genetic predisposition. Here, we emphasize Hispanic populations and summarize what is currently known about obesity, diabetes and individual genetic predisposition as they relate to ethnic disparities in breast cancer incidence and mortality. In addition, we discuss potential contributions to breast cancer aetiology from molecular mechanisms associated with obesity and diabetes including dyslipidemia, hyperglycaemia, hyperinsulinaemia, endocrine dysfunction and inflammation. We propose that unique differences in diet and lifestyle coupled with individual genetic predisposition and endocrine/immune dysfunction explain most of the ethnic disparities seen in breast cancer incidence and mortality.

Ca2+-activated Cl- channels of the ClCa family express in the cilia of a subset of rat olfactory sensory neurons

The Ca²⁺-activated Cl⁻ channel is considered a key constituent of odor transduction. Odorant binding to a specific receptor in the cilia of olfactory sensory neurons (OSNs) triggers a cAMP cascade that mediates the opening of a cationic cyclic nucleotide-gated channel (CNG), allowing Ca²⁺ influx. Ca²⁺ ions activate Cl⁻ channels, generating a significant Cl⁻ efflux, with a large contribution to the receptor potential. The Anoctamin 2 channel (ANO2) is a major constituent of the Cl⁻ conductance, but its knock-out has no impairment of behavior and only slightly reduces field potential odorant responses of the olfactory epithelium. Likely, an additional Ca²⁺-activated Cl⁻ channel of unknown molecular identity is also involved. In addition to ANO2, we detected two members of the ClCa family of Ca²⁺-activated Cl⁻ channels in the rat olfactory epithelium, ClCa4l and ClCa2. These channels, also expressed in the central nervous system, may correspond to odorant transduction channels. Whole Sprague Dawley olfactory epithelium nested RT-PCR and single OSNs established that the mRNAs of both channels are expressed in OSNs. Real time RT-PCR and full length sequencing of amplified ClCa expressed in rat olfactory epithelium indicated that ClCa4l is the most abundant. Immunoblotting with an antibody recognizing both channels revealed immunoreactivity in the ciliary membrane. Immunochemistry of olfactory epithelium and OSNs confirmed their ciliary presence in a subset of olfactory sensory neurons. The evidence suggests that ClCa4l and ClCa2 might play a role in odorant transduction in rat olfactory cilia.