Are there mortality differences between men and women in all types of intracranial hemorrhages: subarachnoid, intraparenchymal and subdural? An analysis of the Spanish population

Objectives

There are 3 types of intracranial hemorrhage (ICH): 1) subarachnoid hemorrhage (SAH), CIE10:I60; 2) intraparenchymal hemorrhage (IPH), I61 and 3) subdural hemorrhage (SDH) I62. Epidemiological data on this field are scarce in Mediterranean countries. Our goal was to determine whether the relationship of ICH mortality with gender and age was different for the 3 types of HIC.

Methods

Data were retrospectively obtained from the Spanish National Institute of Statistics. Deaths/100.000 population of SAH, IPH and SDH were assessed for the entire Spanish population since 2008 to 2017 (n=46,527,039). Year 2017 was the last available for analysis. Incidence was analyzed for men and women and for age strata (<1 years of age, 2–10, 11–20, 21–30, 31–40, 41–50, 51–60, 61–70, 71–80; >80).

Results

In order to fit in the abstract space, only data of 2017 are presented, although years 2008 to 2017 were also analyzed and results were similar. Mortality/100,000 of IPH stayed very low under 40 years of age and then grew exponentially in both, men and women, and was significantly higher for men for all age strata. Mortality of SDH was much lower but behaved in a similar way: exponential growth since 40s and lower incidence in women. SAH behaved differently: it started to be significant since 20 years of age and there were no gender differences.

Conclusion

Mortality of intraparenchymal and subdural hemorrhage increases exponentially since 40 years of age and is lower in women. On the contrary, mortality of subarachnoid hemorrhage increases earlier and there are no gender differences.

Death/100.000 intracranial hemorrhage

Funding Acknowledgement

Type of funding source: None

Preventing Attachment Disorder (Ad): Attachment-Focused Dyadic Group Therapy With Borderline Personality Disorder – and Former Ad – Mothers

Children with mothers with Borderline Personality Disorder (BPD) have a high risk of developing attachment difficulties, and this risk is like to grow when their mothers experienced severe neglect and/or abuse in their childhood and early adolescence. Our objective was to clinically assess and lend support to a small group of young mothers at risk. We recruited mothers aged 18-25, with 1-12 month-old children. None was married, had a stable residence and sexual partner, and most were unemployed. All had early diagnosis of AD, had at present BPD, and had received extended global and residential psychiatric treatment in our Therapeutic Community (SIRIO Project) along their adolescence. We conducted six consecutive 4 h weekly sessions, which were attended by mothers with their babies in the familiar setting of the Community. The explicit aim proposed to them was: “to come to be listened and accompanied and to share their motherhood experiences” with members of our multidisciplinary team (nurse, social worker, therapeutic educator, psychologist and psychiatrist), who were known to them.

Fears, somatizations, more-or-less concealed rejection of her baby, apathy, sadness, suspiciousness, jealousy, relational difficulties with their couples and family figures… were common findings that were addressed in the sessions.

Main conclusion

Minor but positive changes occurred in the dyadic mother-baby relationship. This was more patent concerning breastfeeding, relationships with their couple and extended family and pediatricians, and attitudes toward job seeking. In addition, the frequent contact with these mothers elicited markedly positive reactions in the 8-9 children/adolescents currently residing in our community.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Outcomes of ulnar shortening osteotomy using a new compression plate

Ulnar impaction syndrome (UIS) is a frequent cause of ulnar-sided wrist pain. Several open and arthroscopic surgery techniques have been described. Ulnar shortening osteotomy (USO) is often the method of choice. It has the advantage of leveling the distal radioulnar joint extra-articularly while maintaining the integrity of the soft tissues that stabilize the joint. This retrospective study reports the short-term outcomes of 20 patients who underwent surgery between 2013 and 2015. USO was performed with a locked plate and a new compression device (Alians®, Newclip™, Haute Goulaine, France). Preoperative and postoperative ulnar variance were measured on wrist X-rays in neutral pronation-supination. Functional outcomes were evaluated with the QuickDASH score and the pain on VAS (visual analog scale). Postoperative range of motion and grip strength were compared to those of the contralateral wrist. The average follow-up was 16 months (4 to 28 months). Preoperative ulnar variance was positive with an average of 4mm (1-11mm). The average length of the final ulna shortening was 3.5mm (1.5-6mm); the mean time to union was 4 months (3-12 months). The average QuickDASH was 12 and pain had decreased 2.4mm on the VAS. The results achieved with this new compression plate designed specifically for USO are similar to those described in the literature. This kind of device has an easily reproducible technique and can reduce the operative time. LEVEL OF EVIDENCE: IV.

Osteocutaneous free transfer of vascularized fibula in cervico-thoracic spinal reconstruction with filling of an esophageal fistula: A case report

The case under review is a 60-year-old patient with a vertebral plasmocytoma treated by cervico-thoracic fusion 2 years previously. He presented a thoracic spinal septic non-union complicated by esophagospinal fistula. We performed vascularized fibula transplant with cutaneous pad to fill the esophageal fistula. Control CT at day 5 confirmed vascular anastomosis permeability and bone transplant position. Osseointegration was achieved at 18 months postoperatively. The patient was alive 3 years after the last procedure (5 years after tumorectomy). A systematic review of the literature on spinal reconstruction by vascularized fibula transplant showed the diversity of surgical techniques available. In view of the multiplicity of possible organ and soft tissue defects involving the spine, reminders are provided of the different approaches and recipient vessels in this type of reconstruction depending on location.

[Mycetoma of the foot: a case report]

Mycetoma is a chronic inflammatory cutaneous and subcutaneous pathology caused by either a fongic (eumycetoma) or bacterial (actinomycetoma) infection, which lead to a granulomatous tumefaction with multiple sinuses. When localized in the foot this infection is named "Madura foot". This infection is endemic to tropical and subtropical regions and rarely occurs in western countries. A historical case in Europe of a foot mycetoma evolving since 20 years without any treatment is presented. A histopathologic diagnosis of actinomycetoma has been done in 1987. The patient presented a severe Staphylococcus aureus chronic osteitis leading to a trans-tibial amputation. This case allows to present this infection which, even if rarely presented in France, can be meet especially among a migrant's population.

Rotational Brownian dynamics of semiflexible broken rods

Using the Brownian dynamics simulation technique, we study the rotational dynamics of a semiflexible broken rod. We employ a suitable bead model with stiff springs between beads and strong forces opposing to bending, except at the joint where flexibility is variable. We consider mostly broken rods with equal arms. From the simulated Brownian trajectories we obtain the correlation function for the second order Legendre polynomial of the reorientational angle of the end-to-end vector and of the arm vector. These correlation functions are closely related to fluorescence anisotropy decay and electric birefringence decay, respectively. In the first case, the relaxation time for a completely flexible rod agrees with the Harvey-Wegener theory, and in the second, the longest relaxation time agrees well with that obtained from the rigid-body treatment over the whole range of flexibility. Furthermore, we discuss the relative importance of flexibility in both types of decay. Finally, we present results for a case with unequal arms, confirming the validity of the Harvey-Wegener theory and the rigid-body treatment.

[Nerve injuries in children]

Management of peripheral nerve lesions in children does not differ fundamentally from that in adults. Nevertheless, difficulty to perform an extensive clinical examination can explain initial misdiagnosis and postoperative follow up can be tricky. The poor compliance of the children in the postoperative care makes a postoperative immobilization mandatory. If the peripheral nerve injuries involving children have a better prognosis reputation than in adults, fundamental studies results do not comfort this conventional wisdom, but rather claim for a better adaptability of the child to the relapses left by the peripheral nerves lesions.

[Relation between isolation of bacteriophages from Clostridium difficile and cytotoxicity of the strains]

We studied the possible relationship between the presence of bacteriophages and cytotoxicity of Clostridium difficile strains from multiple origin. A total of 143 strains were studied, 38.46% showed lysogenic activity to at least one of control strains and 85.3% produces cytopathic effects on McCoy cells, that were neutralized by C. sordellii antitoxin. All bacteriophages seen on electron microscopy showed similar shape and size (hexagonal head shape and flexible tail ended in a basal plate). According to our results, a significant relationship between those two factors seems not to exist.

Hydrodynamic study of flexibility in immunoglobulin IgG1 using Brownian dynamics and the Monte Carlo simulations of a simple model

A simple bead model is proposed for the antibody molecule immunoglobulin IgG1. The partial flexibility of the hinge is represented by a quadratic potential associated to the angles between arms. Conformational and hydrodynamic properties are calculated using Monte Carlo (rigid-body) and Brownian dynamics simulations. Comparison of experimental and calculated values for some overall properties allows the assignment of dimensions and other model parameters. The Brownian dynamics technique is used next to simulate a rotational correlation function that is comparable with the decay of fluorescence emission anisotropy. This is done with varying flexibility at the hinge. The longest relaxation time shows a threefold decrease when going from the rigid Y-shaped conformation to the completely flexible case. The calculations are in good agreement with the decay times observed for IgG1. A flexibility analysis of the latter indicates that a variability of +/- 55 degrees (standard deviation) in the angle between the Fab arms.

Transport properties of rigid bent-rod macromolecules and of semiflexible broken rods in the rigid-body treatment. Analysis of the flexibility of myosin rod

The translational diffusion coefficients, rotational relaxation times and intrinsic viscosities of rigid bent rods, composed by two rodlike arms joined rigidly at an angle alpha, have been evaluated for varying conformation using the latest advances in hydrodynamic theory. We have considered semiflexible rods in which the joint is an elastic hinge or swivel, with a potential V(alpha) = 1/2Q alpha 2 with constant Q. Accepting the rigid-body treatment, we calculate properties of broken rods by averaging alpha-dependent values for rigid rods. The results are finally used to interpret literature values of the properties of myosin rod. Q is regarded as an adjustable parameter, and the value fitted is such that the average bending angle of myosin rod is approximately 60 degrees.