[Endoscopic management of postoperative ureteral wound. Retrospective unicentric study from October 2003 to June 2014]

BACKGROUND

Ureteral wounds are rare with an incidence of 0.5 to 1% of pelvic surgeries. Their supports and their prognosis remain dependant of the period of support and the level of ureteral lesion. The importance of early treatment reduces morbidity and improves patient prognosis.

METHODS

A retrospective study from October 2003 to June 2014 was performed in a university hospital using a systematic chart review of patients' urology, digestive surgery, vascular surgery and gynecology.

RESULTS

Forty-six wounds were found in 43 patients. The majority of the ureteral wound was found at the pelvic ureter, i.e. 69.6% of the study population (n=32). The main cause was gynecological surgery (n=25). In the simple wound group, endoscopic treatment was effective in nearly 90% of cases (n=6). In the other two groups, the efficacy was only 30% and imposed a surgical treatment as second-line.

CONCLUSION

The management is based primarily on early detection or intraoperative, and on a correct initial knowledge of the location and size of the lesion. Endoscopic treatment can in most cases treated with a simple and minimally invasive operation an ureteral wound with nearly 90% success rate. In more complex wounds, endoscopy remains a step in the management with about 30% success rate in our study.

LEVEL OF EVIDENCE

5.

Faecal chitinase 3-like 1 is a reliable marker as accurate as faecal calprotectin in detecting endoscopic activity in adult patients with inflammatory bowel diseases

BACKGROUND

Faecal biomarkers are emerging tools in the assessment of mucosal healing in inflammatory bowel diseases (IBDs).

AIM

To evaluate the accuracy of faecal chitinase 3-like 1(CHI3L1) compared to calprotectin in detecting endoscopic activity in IBD.

METHODS

Overall, 86 IBD adults underwent colonoscopy consecutively and prospectively, with Crohn's disease Endoscopic Index of Severity (CDEIS) or Mayo endoscopic subscore calculation for ulcerative colitis, and stool collection. Faecal calprotectin was measured using quantitative immunochromatographic testing. Faecal CHI3L1 was quantified by ELISA. CHI3L1 cut-off value was determined using a receiver-operating curve.

RESULTS

In 54 Crohn's disease patients, faecal CHI3L1 (ρ = 0.70, P < 0.001) and calprotectin (ρ = 0.74, P < 0.001) levels correlated with CDEIS and were significantly increased in patients with endoscopic ulceration. In patients with ileal Crohn's disease, faecal CHI3L1 seemed to be better correlated with CDEIS than faecal calprotectin (ρ = 0.78 vs. ρ = 0.62, P < 0.001 for both). CHI3L1 > 15 ng/g detected endoscopic ulceration in Crohn's disease with a sensitivity of 100% and a specificity of 63.6%, compared to faecal calprotectin > 250 μg/g showing a sensitivity of 90.5% and a specificity of 59.1%. In 32 ulcerative colitis patients, faecal CHI3L1 and calprotectin levels correlated with Mayo endoscopic subscore (ρ = 0.44 and 0.61, respectively, P < 0.001 for both) and were significantly increased in ulcerative colitis patients with endoscopic activity. In ulcerative colitis patients, faecal CHI3L1 > 15 ng/g predicted endoscopic activity with a sensitivity of 81.8% and a specificity of 80.0%, compared to faecal calprotectin>250 μg/g showing a sensitivity of 86.4% and a specificity of 80.0%.

CONCLUSION

Faecal CHI3L1 is a reliable biomarker in detecting endoscopic activity in IBD.

Impact of a school-based intervention to promote fruit intake: a cluster randomized controlled trial

OBJECTIVE

There is evidence that fruit consumption among school children is below the recommended levels. This study aims to examine the effects of a dietary education intervention program me, held by teachers previously trained in nutrition, on the consumption of fruit as a dessert at lunch and dinner, among children 6-12 years old.

STUDY DESIGN

This is a randomized trial with the schools as the unit of randomisation.

METHODS

A total of 464 children (239 female, 6-12years) from seven elementary schools participated in this cluster randomized controlled trial. Three schools were allocated to the intervention and four to the control group. For the intervention schools, we delivered professional development training to school teachers (12 sessions of 3 h each). The training provided information about nutrition, healthy eating, the importance of drinking water and healthy cooking activities. After each session, teachers were encouraged to develop classroom activities focused on the learned topics. Sociodemographic was assessed at baseline and anthropometric, dietary intake and physical activity assessments were performed at baseline and at the end of the intervention. Dietary intake was evaluated by a 24-h dietary recall and fruit consumption as a dessert was gathered at lunch and dinner.

RESULTS

Intervened children reported a significant higher intake in the consumption of fruit compared to the controlled children at lunch (P = 0.001) and at dinner (P = 0.012), after adjusting for confounders.

CONCLUSIONS

Our study provides further support for the success of intervention programmes aimed at improving the consumption of fruit as a dessert in children.

Lean adolescents achieve higher intensities but not higher energy expenditure while playing active video games compared with obese ones

BACKGROUND

While decreased physical activity and increased sedentary behaviours are incriminated for their role in the progression of obesity, active video games (AVG) may offer a new alternative to increase energy expenditure in youth. This study is the first to examine the effect of a 1-h AVG play on lean and obese adolescents' energy expenditure.

METHODS

Body composition and aerobic fitness were assessed in 19 obese and 12 lean adolescent boys (12-15 years old). Participants performed a 1-h AVG session (Kinect Sports technology) while wearing a portable indirect calorimeter (K4b2) to assess their energy expenditure and heart rate.

RESULTS

Body weight (91.0 ± 9.5 vs. 58.5 ± 12.4 kg), body mass index (32.2 ± 3.1 vs. 20.3 ± 1.6 kg m(-2) ) and body fat (38.1 ± 2.7 vs. 13.4 ± 3.9%) were significantly higher in obese adolescents (P < 0.001). Absolute energy expenditure was significantly higher in obese (P < 0.05) but not when corrected for body composition. Maximal heart rate reached during AVG was significantly higher in lean adolescents (190 ± 25 vs. 183 ± 28 bpm, P < 0.05). Time spent between 3 and 6 METs (Metabolic Equivalent Task) was not different between groups but time spent above 6 METs was higher in lean adolescents (P < 0.05).

CONCLUSION

Although lean and obese adolescent boys experienced similar energy expenditure relative to their body size during a 1-h Kinect AVG session, lean adolescents spent more time in moderate-to-vigorous physical activity.

Opening-wedge high tibial osteotomy with a secure bone allograft (Osteopure™) and locked plate fixation: Retrospective clinical and radiological evaluation of 69 knees after 7.5years follow-up

BACKGROUND

Medial opening-wedge high tibial osteotomy (OWHTO) provides reliable and long-lasting benefits, despite the wide range of wedge-filling and internal-fixation techniques used. The purpose of this work was to assess the clinical and radiological outcomes in a case-series of OWHTO performed using a secure bone allograft and locked plate fixation.

HYPOTHESIS

The clinical and radiological outcomes of OWHTO with a high-safety bone allograft and locked plate fixation are similar to those reported in previous case-series studies.

MATERIALS AND METHODS

A single-centre retrospective design was used to study 69 knees in 64 patients with a mean age of 51.8years (31-53years) and a preoperative hip-knee-ankle (HKA) angle of 173° (165°-180°). The wedge was filled with secure Osteopure™ bone allograft and fixation was achieved using an Integra Surfix(®) locked plate. Mean follow-up was 7.5years (5-9.3years). Clinical and functional outcomes were assessed by determining the IKS and KOOS-PS scores and recording complications related or unrelated to the allograft. The main criterion for assessing OWHTO survival was the time to revision surgery for symptom recurrence. Radiological assessment criteria were the HKA angle, tibial slope, patellar height, and osteoarthritis grade. GESTO criteria were used to evaluate the behaviour of the allograft.

RESULTS

Of the 69 knees, 64 (92.8%) were re-evaluated. The survival rate after 9.3years was 95%±2.7% (3 failures managed with arthroplasty). The functional IKS score improved significantly, by 20 points (P<0.001). Mean increases of 7.8° for the HKA angle and 3.5° for tibial slope were recorded. Bone healing without radiological abnormalities was consistently achieved within 6months. There were no complications related to the allograft (infections, allergies; local or systemic toxicity).

DISCUSSION

The clinical, radiological, and safety outcomes documented in our study were similar to those reported in earlier work.

LEVEL OF EVIDENCE

IV, retrospective case-series study.

Endoscopic Factors Influencing Fecal Calprotectin Value in Crohn's Disease

BACKGROUND AND AIMS

Fecal calprotectin [fcal] is a biomarker of Crohn's disease [CD] endoscopic activity. Identifying the endoscopic situations in which fcal is less reliable remains unexplored. We aimed to determine the endoscopic factors influencing fcal level in CD.

METHODS

Overall, 53 CD patients consecutively and prospectively underwent colonoscopy, with CD Endoscopic Index of Severity [CDEIS] calculation and stool collection. Fcal was measured using a quantitative immunochromatographic test. Correlation analysis was done with Pearson statistics.

RESULTS

Fcal was correlated with CDEIS [0.66, p < 0.001]. In univariate analysis, fcal was correlated with the affected surface [0.65, p < 0.001] and the ulcerated surface [0.47, p < 0.001]. Fcal was significantly associated with ulceration depth, with median fcal of 867.5 µg/g, 1251.0 µg/g, and 1800.0 µg/g, in patients presenting with non-ulcerated lesions, superficial ulcerations [SU], and deep ulcerations [DU], respectively. Lesion locations did not influence fcal. In multivariate analysis, fcal was associated with affected surface [p = 0.04] and the presence of CD lesions. Moreover, fcal increased with the ulceration depth [p = 0.03]. However, ulcerated surface and CD location did not affect fcal. Using a receiver operating characteristic [ROC] curve, we showed that fcal of 400 µg/g was the best compromise between sensitivity [0.76] and specificity [0.77], whereas fcal ≥ 200 µg/g was highly sensitive [0.86] to detect SU or DU.

CONCLUSIONS

Fcal is a very reliable biomarker to detect endoscopic ulcerations in CD. We suggest repeating measurement in case of intermediary results [200-400 µg/g] in daily practice. Fcal level is mostly influenced by the presence of CD lesions [even non-ulcerated], in a depth-related manner and by the affected surface.

[Assessment of postoperative pain after corneal collagen cross-linking by iontophoresis vs the rapid epithelium-off technique in progressive keratoconus patients]

INTRODUCTION

Cross-linking (CXL) increases corneal biomechanical strength in progressive keratoconus. Since riboflavin cannot penetrate intact corneal epithelium, removal of epithelium is necessary for the classic CXL procedure (epi-off), but can cause severe postoperative pain. To avoid this problem, a method preserving the epithelium (epi-on) is used. In this study, we aimed to evaluate and compare postoperative pain after epi-off CXL and epi-on CXL.

MATERIALS AND METHODS

We present a retrospective study assessing the level of pain postoperatively in 38 patients between the age of 12 and 53 years who underwent CXL procedures at the University Hospital of Clermont-Ferrand from July 2013 to May 2014. Epi-off consisted of manual corneal de-epithelialization and riboflavin instillation for 20minutes, followed by UVA exposure for 9minutes. The epi-on technique used an applicator on the eye, filled with riboflavin, and a generator delivered a continuous low-level current for 5minutes. The duration of light exposure was similar in both groups. Postoperative medications were the same for both techniques. Assessment of pain and analgesic intake were reported by the patient on paper questionnaires. Pain was evaluated from preoperatively up until the end of the month. Statistical analyses were performed in bilateral formulation to an alpha type I and error risk of 5%.

RESULTS

Twenty-three epi-off patients and 15 epi-on patients. Twenty-nine men and 9 women (76.3%/23.7%). Mean age: 28 years. Reference base time was the return from the operating room. In the epi-off group, pain increased significantly until the morning of D2 and did not return to its intraoperative level until noon D2, 1.8±2.0 vs 2.5±2.5 (P=0.12). Pain remained stable until the morning of D4. From noon D4 until D30, it was significantly less than intraoperatively 1.8±2.0 vs 0.7±1.4 (P=0.01). In the epi-on group, pain was significantly higher than intraoperatively until noon of D1 2.5±2.2 vs 3.8±2.5 (P=0.01). From the evening of D1, it returned to its intraoperative level until the evening of D2 2.5±2.2 vs 2±1.7 (P=0.34). From the morning of D3 it was significantly less than intraoperatively 2.5±2.2 vs 0.8±0.9 (P=0.001). Considering all measurement times, there was no significant difference between the two groups (P=0.75), except from evening of D2 until evening of D3 in favor of iontophoresis: 1.9±2.3 vs 1.0±1.3 (P=0.038).

DISCUSSION

Epi-on seems less painful in the short term (up to noon of D1 for epi-on vs morning of D2 for epi-off) and with a shorter duration than epi-off. This can be explained by the absence of corneal de-epithelialization. However, the reduction in pain is not significant at all postoperative times, and a risk of epithelial abrasion during placement and removal of the corneal applicator may exist.

CONCLUSION

Iontophoresis maintains the corneal epithelium, decreases pain and improves patient comfort. A new study involving more patients and strict monitoring of medication intake would strengthen the validity of these results.

Reduced neural response to food cues following exercise is accompanied by decreased energy intake in obese adolescents

BACKGROUND

Acute exercise has been found to favor a transient anorexigenic effect in obese adolescents. Although the role of some gastro-peptides has been suggested as an explanation for this observed reduced energy intake after exercise, it is unknown whether neural pathways involved in the regulation of food intake are modulated in youth.

METHODS

Body composition (dual-energy X-ray absorptiometry) and aerobic capacities were assessed in 19 obese adolescent boys. Participants were randomized to remain at rest in a sitting position (CON condition) or to exercise 45 min at 65% of their maximal capacities (EX condition) by the end of the morning. An attentional computer task with electroencephalography recording was completed immediately after the exercise or sitting period to measure an event-related component (P3b) reflecting the level of cognitive engagement in the processing of food cues. A lunch test-meal was offered ad libitum and appetite feelings assessed at regular intervals using visual analog scales.

RESULTS

The 45-min cycling exercise set at 65% VO2max induced a mean energy expenditure of 399±75 kcal. Both absolute (P<0.05) and relative (P<0.001) subsequent energy intake were significantly reduced after EX (1037±260 and 639±256 kcal, respectively) compared with CON (1116±243 and 1011±239 kcal, respectively). The energy ingested derived from each macronutrient and self-reported appetite remained unchanged. Although the amplitudes of the P3b component evoked by food and non-food visual stimuli were not significantly different during CON, the response to food cues was significantly reduced compared with non-food stimuli after exercise (P<0.01).

DISCUSSION

An acute exercise favors decreased neural response to food cues compared with non-food ones in obese adolescents that may contribute to their subsequently reduced energy intake.

French validation of the Foot Function Index (FFI)

OBJECTIVE

French validation of the Foot Function Index (FFI), self-questionnaire designed to evaluate rheumatoid foot according to 3 domains: pain, disability and activity restriction.

METHODS

The first step consisted of translation/back translation and cultural adaptation according to the validated methodology. The second stage was a prospective validation on 53 patients with rheumatoid arthritis who filled out the FFI. The following data were collected: pain (Visual Analog Scale), disability (Health Assessment Questionnaire) and activity restrictions (McMaster Toronto Arthritis questionnaire). A test/retest procedure was performed 15 days later. The statistical analyses focused on acceptability, internal consistency (Cronbach's alpha and Principal Component Analysis), test-retest reproducibility (concordance coefficients), external validity (correlation coefficients) and responsiveness to change.

RESULTS

The FFI-F is a culturally acceptable version for French patients with rheumatoid arthritis. The Cronbach's alpha ranged from 0.85 to 0.97. Reproducibility was correct (correlation coefficients>0.56). External validity and responsiveness to change were good.

CONCLUSION

The use of a rigorous methodology allowed the validation of the FFI in the French language (FFI-F). This tool can be used in routine practice and clinical research for evaluating the rheumatoid foot. The FFI-F could be used in other pathologies with foot-related functional impairments.