Intervertebral disc prosthesis. Results and prospects for the year 2000

Presently, the kinematic disc prosthesis model (SB Charité) is the best disc replacement compromise, and is the basis of the evolution of the prosthetic concept at the dawning of the year 2000. Clinical results of a homogeneous series of 105 cases with a mean followup of 51 months show 79% of the patients had an excellent result and 87% returned to work, radiologically, these results correlated with restoration of a well balanced lordosis and with segmental mobility. Factors leading to failure are posterior facet arthritis, osteoporosis, structural deformities, and secondary facet pain. Two- and 3-dimensional numeric modeling enables one to study the total facet joint loading and the maximal local loading on the facet. Dissociation of the stiffness in pure rotation and stiffness in translation of the disc are the bases of the technologic improvement.

Biomechanical study of screws in the lateral masses: variables affecting pull-out resistance

The purpose of this study was to investigate the effects of the design of the screw, the depth of insertion, the vertebral level, and the quality of the host bone on the pull-out resistance of screws used in the lateral masses. The study included twelve fresh cervical spines from human cadavera. Radiographs were made of each specimen to ensure the absence of defects, and then the cancellous-bone density of the vertebral bodies was measured at each level with quantitative computed tomography scanning. Six commercially available screws of various diameters and thread configurations (2.7, 3.2, 3.5, and 4.5-millimeter cortical-bone screws; a 3.5-millimeter cancellous-bone screw; and a 3.5-millimeter self-tapping screw) that are currently used for fixation of the cervical lateral masses were tested for axial load to failure. A twelve-by-twelve Latin square design was used to randomize the screws with regard to level (second through seventh cervical vertebrae), side (right and left), and depth of insertion (unicortical or bicortical purchase). Each screw was then subjected to uniaxial load to failure. The data were analyzed to determine if the diameter of the screw, the thread configuration, the number of cortices engaged, the cervical level, or the bone density was associated with the load to failure. Three major subgroups (greatest, intermediate, and lowest pull-out resistance) were identified. The subgroup with the greatest pull-out resistance included only screws with bicortical purchase; the 3.2, 3.5, and 4.5-millimeter cortical-bone screws and the 3.5-millimeter cancellous-bone screw were in this subgroup. Regardless of the thread configuration, no screw with unicortical purchase was in the group with the greatest pull-out resistance. Two of the three values in the subgroup with the lowest pull-out resistance were for the 3.5-millimeter self-tapping screw (with unicortical or bicortical purchase). The cancellous-bone density of the vertebral body was not associated with pull-out resistance and it did not vary significantly according to the cervical level, with the numbers available. However, the pull-out resistance of the screws varied significantly (p = 0.004) by level: it was the greatest at the fourth cervical level, decreasing cephalad and caudad to that level.

Etiology of Severe Acute Watery Diarrhea in Children in the Global Rotavirus Surveillance Network Using Quantitative Polymerase Chain Reaction

Background

The etiology of acute watery diarrhea remains poorly characterized, particularly after rotavirus vaccine introduction.

Methods

We performed quantitative polymerase chain reaction for multiple enteropathogens on 878 acute watery diarrheal stools sampled from 14643 episodes captured by surveillance of children <5 years of age during 2013-2014 from 16 countries. We used previously developed models of the association between pathogen quantity and diarrhea to calculate pathogen-specific weighted attributable fractions (AFs).

Results

Rotavirus remained the leading etiology (overall weighted AF, 40.3% [95% confidence interval {CI}, 37.6%-44.3%]), though the AF was substantially lower in the Americas (AF, 12.2 [95% CI, 8.9-15.6]), based on samples from a country with universal rotavirus vaccination. Norovirus GII (AF, 6.2 [95% CI, 2.8-9.2]), Cryptosporidium (AF, 5.8 [95% CI, 4.0-7.6]), Shigella (AF, 4.7 [95% CI, 2.8-6.9]), heat-stable enterotoxin-producing Escherichia coli (ST-ETEC) (AF, 4.2 [95% CI, 2.0-6.1]), and adenovirus 40/41 (AF, 4.2 [95% CI, 2.9-5.5]) were also important. In the Africa Region, the rotavirus AF declined from 54.8% (95% CI, 48.3%-61.5%) in rotavirus vaccine age-ineligible children to 20.0% (95% CI, 12.4%-30.4%) in age-eligible children.

Conclusions

Rotavirus remained the leading etiology of acute watery diarrhea despite a clear impact of rotavirus vaccine introduction. Norovirus GII, Cryptosporidium, Shigella, ST-ETEC, and adenovirus 40/41 were also important. Prospective surveillance can help identify priorities for further reducing the burden of diarrhea.

Mesenchymal stem cell therapy regenerates the native bone-tendon junction after surgical repair in a degenerative rat model

Background

The enthesis, which attaches the tendon to the bone, naturally disappears with aging, thus limiting joint mobility. Surgery is frequently needed but the clinical outcome is often poor due to the decreased natural healing capacity of the elderly. This study explored the benefits of a treatment based on injecting chondrocyte and mesenchymal stem cells (MSC) in a new rat model of degenerative enthesis repair.

Methodology

The Achilles' tendon was cut and the enthesis destroyed. The damage was repaired by classical surgery without cell injection (group G1, n = 52) and with chondrocyte (group G2, n = 51) or MSC injection (group G3, n = 39). The healing rate was determined macroscopically 15, 30 and 45 days later. The production and organization of a new enthesis was assessed by histological scoring of collagen II immunostaining, glycoaminoglycan production and the presence of columnar chondrocytes. The biomechanical load required to rupture the bone-tendon junction was determined.

Principal Findings

The spontaneous healing rate in the G1 control group was 40%, close to those observed in humans. Cell injection significantly improved healing (69%, p = 0.0028 for G2 and p = 0.006 for G3) and the load-to-failure after 45 days (p<0.05) over controls. A new enthesis was clearly produced in cell-injected G2 and G3 rats, but not in the controls. Only the MSC-injected G3 rats had an organized enthesis with columnar chondrocytes as in a native enthesis 45 days after surgery.

Conclusions

Cell therapy is an efficient procedure for reconstructing degenerative entheses. MSC treatment produced better organ regeneration than chondrocyte treatment. The morphological and biomechanical properties were similar to those of a native enthesis.

Prevalence of epilepsy its treatment gap and knowledge, attitude and practice of its population in sub-urban Senegal an ILAE/IBE/WHO study

A door-to-door survey was used to determine the prevalence of epilepsy among 4500 people within the Pikine Health District (population 480,000) Senegal. Prevalence was 14.2/1000, and 23.4% of all people with epilepsy had never received appropriate treatment. Figures for the prevalence had increased since a previous survey in 1989. In parallel a study of knowledge attitude and practice was performed in the same district. Salient findings were that: two-thirds of interviewees had at some time witnessed a seizure, 51% agreed when asked if epilepsy is caused by evil spirits, 35% said epilepsy is contagious, only about 18% said that traditional therapy is best, 60% would not mind their child to play with a child with epilepsy but only 32% would agree if their child would want to marry a person with epilepsy.

Comparison of behavior and vector efficiency of Anopheles gambiae and An. arabiensis (Diptera:Culicidae) in Barkedji, a Sahelian area of Senegal

The ecology, population dynamics, and malaria vector efficiency of Anopheles gambiae and An. arabiensis were studied for 2 yr in a Sahelian village of Senegal. Anophelines were captured at human bait and resting indoors by pyrethrum spray. Mosquitoes belonging to the An. gambiae complex were identified by polymerase chain reaction. Of 26,973 females, An. arabiensis represented 79% of the mosquitoes captured and remained in the study area longer than An. gambiae after the rains terminated. There were no differences in nocturnal biting cycles or endophagous rates between An. gambiae and An. arabiensis. Based on an enzyme-linked immunosorbent assay test of bloodmeals, the anthropophilic rate of these 2 vectors were both approximately 60%, when comparisons were made during the same period. Overall, 18% of the resting females had patent mixed bloodmeals, mainly human-bovine. The parity rates of An. gambiae and An. arabiensis varied temporally. Despite similar behavior, the Plasmodium falciparum circumsporozoite protein (CSP) rates were different between An. gambiae (4.1%) and An. arabiensis (1.3%). P. malariae and P. ovale only represented 4% of the total Plasmodium identified in mosquitoes. Transmission was seasonal, occurring mainly during 4 mo. The CSP entomological inoculation rates were 128 bites per human per year for the 1st yr and 100 for the 2nd yr. Because of the combination of a high human biting rate and a low CSP rate, An. arabiensis accounted for 63% of transmission. Possible origin of differences in CSP rate between An. gambiae and An. arabiensis is discussed in relation to the parity rate, blood feeding frequency, and the hypothesis of genetic factors.

Carboxypeptidases B of Anopheles gambiae as targets for a Plasmodium falciparum transmission-blocking vaccine

Anopheles gambiae is the major African vector of Plasmodium falciparum, the most deadly species of human malaria parasite and the most prevalent in Africa. Several strategies are being developed to limit the global impact of malaria via reducing transmission rates, among which are transmission-blocking vaccines (TBVs), which induce in the vertebrate host the production of antibodies that inhibit parasite development in the mosquito midgut. So far, the most promising components of a TBV are parasite-derived antigens, although targeting critical mosquito components might also successfully block development of the parasite in its vector. We previously identified A. gambiae genes whose expression was modified in P. falciparum-infected mosquitoes, including one midgut carboxypeptidase gene, cpbAg1. Here we show that P. falciparum up-regulates the expression of cpbAg1 and of a second midgut carboxypeptidase gene, cpbAg2, and that this up-regulation correlates with an increased carboxypeptidase B (CPB) activity at a time when parasites establish infection in the mosquito midgut. The addition of antibodies directed against CPBAg1 to a P. falciparum-containing blood meal inhibited CPB activity and blocked parasite development in the mosquito midgut. Furthermore, the development of the rodent parasite Plasmodium berghei was significantly reduced in mosquitoes fed on infected mice that had been immunized with recombinant CPBAg1. Lastly, mosquitoes fed on anti-CPBAg1 antibodies exhibited reduced reproductive capacity, a secondary effect of a CPB-based TBV that could likely contribute to reducing Plasmodium transmission. These results indicate that A. gambiae CPBs could constitute targets for a TBV that is based upon mosquito molecules.

Whole genome detection of rotavirus mixed infections in human, porcine and bovine samples co-infected with various rotavirus strains collected from sub-Saharan Africa

Group A rotaviruses (RVA) are among the main global causes of severe diarrhea in children under the age of 5years. Strain diversity, mixed infections and untypeable RVA strains are frequently reported in Africa. We analysed rotavirus-positive human stool samples (n=13) obtained from hospitalised children under the age of 5years who presented with acute gastroenteritis at sentinel hospital sites in six African countries, as well as bovine and porcine stool samples (n=1 each), to gain insights into rotavirus diversity and evolution. Polyacrylamide gel electrophoresis (PAGE) analysis and genotyping with G-(VP7) and P-specific (VP4) typing primers suggested that 13 of the 15 samples contained more than 11 segments and/or mixed G/P genotypes. Full-length amplicons for each segment were generated using RVA-specific primers and sequenced using the Ion Torrent and/or Illumina MiSeq next-generation sequencing platforms. Sequencing detected at least one segment in each sample for which duplicate sequences, often having distinct genotypes, existed. This supported and extended the PAGE and RT-PCR genotyping findings that suggested these samples were collected from individuals that had mixed rotavirus infections. The study reports the first porcine (MRC-DPRU1567) and bovine (MRC-DPRU3010) mixed infections. We also report a unique genome segment 9 (VP7), whose G9 genotype belongs to lineage VI and clusters with porcine reference strains. Previously, African G9 strains have all been in lineage III. Furthermore, additional RVA segments isolated from humans have a clear evolutionary relationship with porcine, bovine and ovine rotavirus sequences, indicating relatively recent interspecies transmission and reassortment. Thus, multiple RVA strains from sub-Saharan Africa are infecting mammalian hosts with unpredictable variations in their gene segment combinations. Whole-genome sequence analyses of mixed RVA strains underscore the considerable diversity of rotavirus sequences and genome segment combinations that result from a complex evolutionary history involving multiple host species.

Monitoring survey of the use patterns and pesticide residues on vegetables in the Niayes zone, Senegal

The main objective of this work was to determine the impact of pesticide use practices on vegetables contamination in the Niayes zone of Dakar. A preliminary survey involving 200 farmers, showed the application of pesticides belonging to different groups on vegetable crops. Use practices in terms of application intervals and methods, measuring tools and dosage were not in compliance with good agricultural practices. In view of survey results, investigations on vegetable contamination were conducted. Therefore, 175 vegetable samples including cabbage (31 samples), lettuce (88 samples), tomato (57 samples) collected from four sites of the Niayes zone during four campaigns, were analyzed for residues of 21 pesticides, eighteen of which (18) were cited to be used by farmers. The results indicated that 65% of tomato samples, 71% of lettuce and 93% of cabbage contained one or more detectable residues. Among the monitored pesticides dicofol, chlorpyrifos, DDTs, dimethoate, and λ-cyhalothrin were the most predominant, found in at least 35% of samples for each vegetable. The frequencies of pesticide detection were, generally in agreement with the citation frequencies. The results provided important information on vegetable contamination status and pointed an urgent need to control pesticide use.

Kinematic analysis of the upper limb: a useful tool in children with cerebral palsy

Upper limb involvement in cerebral palsy is usually more complex than lower limb involvement. Each child has a specific brain lesion and the clinical pattern is highly variable. Current clinical methods of assessment do not fully evaluate the kinematic activity during simple activities of daily life. We defined an upper limb three-dimensional kinematic protocol in order to complete the clinical analysis of such patients and reproducibility tests are in progress. Data were presented for one of the patients studied and showed some important differences between the clinical analysis and the kinematic one. A three-dimensional upper limb motion analysis gives a more complete kinematic evaluation and should help better measure the results of treatments.

Crimean-Congo hemorrhagic fever in ticks (Acari: Ixodidae) and ruminants: field observations of an epizootic in Bandia, Senegal (1989-1992)

From 1989 to 1992, a longitudinal study of the relationships between different tick species and domestic ungulates in the transmission and amplification of Crimean-Congo hemorrhagic fever (CCHF) virus was undertaken in the Bandia area in Senegal where the presence of the virus had been reported previously. An epizootic occurred in 1991-1992 and 22 strains of CCHF virus were isolated from Hyalomma marginatum rufipes Koch, Amblyomma variegatum (F.), Rhipicephalus guilhoni Morel & Vassiliades, and R. evertsi evertsi Neumann ticks collected from cattle and goats. No human cases were reported. Transmission of CCHF virus in the area involves a complicated pattern including many tick species and hosts. Amplicons of the S fragment (536 bp) of the CCHF genome of 12 isolates from the study were obtained by polymerase chain reaction and analyzed by restriction-length fragment polymorphism. Three different genotypes of CCHF virus were identified and present during the epizootic. One genotype was recovered from A. variegatum, R. guilhoni, and R. e. evertsi and 2 genotypes were isolated from H. m. rufipes.

Tetrodotoxin blocks HIV coat protein (gp120) toxicity in primary neuronal cultures

HIV-1-associated cognitive/motor complex is a frequent neurological complication of the acquired immunodeficiency syndrome (AIDS). The pathogenesis of this syndrome implicates immunopathological and toxic events such as the production of cytokines. The HIV envelope glycoprotein gp120 seems also to play a major role in this process. Gp120 could produce a slow neuronal death probably via the release of neurotoxic factors by CNS macrophages/monocytes. NMDA antagonists and Ca2+ channel blockers in vitro have a powerful neuroprotective effect against gp120 neurotoxicity. The purpose of the present work is to determine whether gp120-induced neurotoxicity is associated with an abnormal neuronal depolarization induced by putative neurotoxins. We have compared in vitro the neuroprotective effects of Tetrodotoxin a Na+ channel blocker, the Ca2+ channel blocker nifedipine and the NMDA antagonist MK-801 in primary cortical neurons taken from embryonic rat and intoxicated with gp120. We observed comparable neuroprotective effects with the 3 precited compounds suggesting that gp120-induced neurotoxic factors act on Na+ channels, NMDA receptors and Ca2+ channels in a cascade of cellular events. We confirmed that the presence of macrophages is needed to trigger a marked gp120-induced neurotoxicity. These results underline the fact that depolarization is an important component of gp120 neurotoxicity in primary neuronal cultures.

Epidemiology and Burden of Bloodstream Infections Caused by Extended-Spectrum Beta-Lactamase Producing Enterobacteriaceae in a Pediatric Hospital in Senegal

Context

Severe bacterial infections are not considered as a leading cause of death in young children in sub-Saharan Africa. The worldwide emergence of extended-spectrum beta-lactamase producing Enterobacteriaceae (ESBL-E) could change the paradigm, especially in neonates who are at high risk of developing healthcare-associated infections.

Objective

To evaluate the epidemiology and the burden of ESBL-E bloodstream infections (BSI).

Methods

A case-case-control study was conducted in patients admitted in a pediatric hospital during two consecutive years. Cases were patients with Enterobacteriaceae BSI and included ESBL-positive (cases 1) and ESBL-negative BSI (cases 2). Controls were patients with no BSI. Multivariate analysis using a stepwise logistic regression was performed to identify risk factors for ESBL acquisition and for fatal outcomes. A multistate model was used to estimate the excess length of hospital stay (LOS) attributable to ESBL production while accounting for time of infection. Cox proportional hazards models were performed to assess the independent effect of ESBL-positive and negative BSI on LOS.

Results

The incidence rate of ESBL-E BSI was of 1.52 cases/1000 patient-days (95% CI: 1.2–5.6 cases per 1000 patient-days). Multivariate analysis showed that independent risk factors for ESBL-BSI acquisition were related to underlying comorbidities (sickle cell disease OR = 3.1 (95%CI: 2.3–4.9), malnutrition OR = 2.0 (95%CI: 1.7–2.6)) and invasive procedures (mechanical ventilation OR = 3.5 (95%CI: 2.7–5.3)). Neonates were also identified to be at risk for ESBL-E BSI. Inadequate initial antibiotic therapy was more frequent in ESBL-positive BSI than ESBL-negative BSI (94.2% versus 5.7%, p<0.0001). ESBL-positive BSI was associated with higher case-fatality rate than ESBL-negative BSI (54.8% versus 15.4%, p<0.001). Multistate modelling indicated an excess LOS attributable to ESBL production of 4.3 days. The adjusted end-of-LOS hazard ratio for ESBL-positive BSI was 0.07 (95%CI, 0.04–0.12).

Conclusion

Control of ESBL-E spread is an emergency in pediatric populations and could be achieved with simple cost-effective measures such as hand hygiene, proper management of excreta and better stewardship of antibiotic use, especially for empirical therapy.

Infections caused by extended-spectrum beta-lactamases producing Enterobacteriaceae: clinical and economic impact in patients hospitalized in 2 teaching hospitals in Dakar, Senegal

BACKGROUND

Infections caused by extended-spectrum beta-lactamases producing Enterobacteriaceae (ESBL-E) are of major concern in clinical practice because of limited therapeutic options effective to treat them. Published studies showed that ESBL-E, widely spread in Europe, United States or Asia; are also frequent in Africa. However, the impact of ESBL-E infections is yet to be adequately determined in Sub-Saharan African countries, particularly in Senegal. The aim of our study was to estimate the incidence rate of ESBL-E infections and to assess their clinical and economic impact in Senegal.

METHODS

Two retrospective cohort studies were conducted in patients hospitalized from April to October 2012. A classic retrospective cohort study comparing patients infected by an Enterobacteriaceae producer of ESBL (ESBL+) and patients infected by an Enterobacteriaceae non-producer of ESBL (ESBL-) was carried out for fatal outcomes. Besides, a retrospective parallel cohort study comparing infected patients by an ESBL+ and ESBL- versus uninfected patients was carried out for the excess LOS analyses. Multivariable regression analysis was performed to identify risk factors for fatal outcomes. A multistate model and a cost-of-illness analysis were used to estimate respectively the excess length of stay (LOS) attributable to ESBL production and costs associated. Cox proportional hazards models were used to assess the independent effect of ESBL+ and ESBL- infections on LOS.

RESULTS

The incidence rate of ESBL-E infections was 3 cases/1000 patient-days (95 % CI: 2.4-3.5 cases/1000 patient-days). Case fatality rate was higher in ESBL+ than in ESBL- infections (47.3 % versus 22.4 %, p = 0.0006). Multivariable analysis indicated that risk factors for fatal outcomes were the production of ESBL (OR = 5.7, 95 % CI: 3.2-29.6, p = 0.015) or being under mechanical ventilation (OR = 5.6, 95 % CI: 2.9-57.5, p = 0.030). Newborns and patients suffering from meningitidis or cancer were patients at-risk for fatal outcomes. ESBL production increased hospital LOS (+4 days) and reduced significantly the hazard of discharge after controlling for confounders (HR = 0.3, 95 % CI:0.2-0.4). The additional cost associated with ESBL-production of €100 is substantial given the lower-middle-income status of Senegal.

CONCLUSION

Our findings show an important clinical and economic impact of ESBL-E infections in Senegal and emphasize the need to implement adequate infection control measures to reduce their incidence rate. An antibiotic stewardship program is also crucial to preserve the effectiveness of our last-resort antibiotic drugs.

The presence of calbindin in rat cortical neurons protects in vitro from oxydative stress

Free radicals are highly reactive chemicals containing an unpaired electron and are normally produced by the cellular metabolism. The oxydative stress is defined as a lack of balance between the production of free radicals and the activity of antioxydant metabolites. It induces cellular damages to lipids, proteins and membranes. Abnormal calcium metabolism can be a consequence of oxydative stress leading to increased intracellular concentrations. Calbindin D28K is a calcium binding protein which could have a neuroprotective action against various cellular insults. In this study rat cortical cell cultures were exposed during various times and at different concentrations to the couple Xanthine/Xanthine oxydase (XA/XO), which produces the superoxyde radical O2-.. Neuronal survival revealed that XA/XO is toxic for cortical cell cultures. The Calbindin D28K immunocytochemical study shows that the percentages of Calbindin positive cells are greater in surviving neurons following the XA/XO exposure compared to controls. There is a time-dependent and a dose-dependent relation between the number of surviving neurons and the percentage of Calbindin positive neurons. These results suggest that the presence of cytosolic neuronal Calbindin D28k is associated with a greater resistance to oxydative stress.

An in vitro biomechanical study of bone plate and interlocking nail in a canine diaphyseal femoral fracture model

OBJECTIVE

To compare the structural properties and the interfragmentary motion in ostectomized canine femurs stabilized with either an 8-mm interlocking nail system (IN) or a 10-hole dynamic compression broad plate (DCP).

ANIMAL OR SAMPLE POPULATION

Ten pairs of adult canine femurs with a 25-mm mid-diaphyseal gap.

METHODS

Bone specimens were divided into 2 groups (10 femurs each). Left femurs were stabilized with a DCP and 8 bicortical screws; right femurs were stabilized with an IN and 3 screws. Mechanical tests were performed in eccentric axial loading and in craniocaudal bending. The testing was first conducted nondestructively and then until breakage. Structural properties, ie, stiffness, yield limits, and failure limits, were determined. Interfragmentary motion was measured during nondestructive tests with the use of an optoelectronic device. Axial, transverse, and rotational motions were calculated. Mean values of stiffness, yield and failure limits, and axial and shear motions for each fixation method were compared using a paired t test within each group (P <.05).

RESULTS

Mean (+/-SD) values of stiffness and failure limit were significantly higher for IN constructs than for DCP constructs in compression, while there was little difference in the results between each tested group in bending. Mean yield load values were significantly higher for IN than for DCP specimens in compression as well as in bending. The axial-motion analysis revealed significant differences between IN and DCP groups during bending tests only. The highest score of transverse motion at the gap was recorded during bending tests, and was higher for DCP than for IN specimens. There were insignificant differences between the two groups with regard to rotation around the diaphyseal axis.

CONCLUSIONS AND CLINICAL RELEVANCE

Structural properties and interfragmentary shear motion analysis demonstrated a much higher rigidity in the IN-bone than in the DCP-bone constructs.

Epilepsy and mortality in Africa: a review of the literature

PROBLEM

The prevalence of epilepsy is high in many areas of Africa. This condition is stigmatized, and there are limited health personnel and facilities for diagnosis and treatment. A huge treatment gap is suspected for epilepsy, and data suggest that nearly 80-85% of people with epilepsy have never been diagnosed or treated. It is reported worldwide that the mortality among people with epilepsy is two- to threefold higher than in general population. An increase of at least this magnitude is suspected in Africa, but there are very few data. Verbal autopsy studies may be one way of carrying out studies of mortality for epilepsy in Africa because these methods do not rely on autopsies, which are rare, or upon death certificates, which are a poor source of information on death in Africa.

METHODS

This paper presents the literature on mortality after seizures in Africa, although there are few studies of mortality among people with epilepsy in Africa.

RESULTS

The existing studies suggest an increased risk of dying and a greater proportion of deaths that are epilepsy-related. One study reports a sixfold increase in mortality in people with epilepsy. This is higher than the two- to threefold increase reported in developed countries.

CONCLUSIONS

Considering the high prevalence of this condition, the public health impact of epilepsy mortality is likely to be enormous.

In vitro biomechanical comparison of three different types of single- and double-row arthroscopic rotator cuff repairs: analysis of continuous bone-tendon contact pressure and surface during different simulated joint positions

HYPOTHESIS

We assessed bone-tendon contact surface and pressure with a continuous and reversible measurement system comparing 3 different double- and single-row techniques of cuff repair with simulation of different joint positions.

MATERIALS AND METHODS

We reproduced a medium supraspinatus tear in 24 human cadaveric shoulders. For the 12 right shoulders, single-row suture (SRS) and then double-row bridge suture (DRBS) were used. For the 12 left shoulders, DRBS and then double-row cross suture (DRCS) were used. Measurements were performed before, during, and after knot tying and then with different joint positions.

RESULTS

There was a significant increase in contact surface with the DRBS technique compared with the SRS technique and with the DRCS technique compared with the SRS or DRBS technique. There was a significant increase in contact pressure with the DRBS technique and DRCS technique compared with the SRS technique but no difference between the DRBS technique and DRCS technique.

CONCLUSIONS

The DRCS technique seems to be superior to the DRBS and SRS techniques in terms of bone-tendon contact surface and pressure.

Upper limb motion analysis in children with hemiplegic cerebral palsy: proximal kinematic changes after distal botulinum toxin or surgical treatments

PURPOSE

The purpose of this study is to describe the kinematic changes in children with cerebral palsy (CP) after treatments performed on the forearm, wrist or thumb, with specific attention to the changes around the trunk, shoulder and elbow kinematics.

METHODS

With the use of a specific kinematic protocol, we first described the upper limb kinematics in a group of 27 hemiplegic patients during two simple daily tasks. Eight of these children were treated with botulinum toxin (Botox(®), Allergan) injection or surgery and were, thereafter, evaluated with another kinematic analysis in order to compare the pre- and post-therapeutic condition. The target muscles were the pronator teres, flexor carpi radialis, flexor carpi ulnaris, flexor digitorum superficialis, flexor pollicis longus and the adductor pollicis.

RESULTS

Significant kinematic changes were found after treatment. Patients increased forearm supination (P < 0.05) and wrist extension (P < 0.05) during both tasks. Patients also decreased trunk flexion/extension range of motion (ROM) (P < 0.05), improved elbow ROM (P < 0.05) and improved internal shoulder rotation (P < 0.05).

CONCLUSIONS

Dynamic shoulder or elbow limitations in children with mild hemiplegia involvement could be related to a compensatory movement strategy and/or co-contractions. As these proximal kinematics anomalies are improved after treatments performed at the forearm, wrist and thumb, they should not be treated first but should be reconsidered after the treatment of more distal problems.

Tendon fixation in arthroscopic latissimus dorsi transfer for irreparable posterosuperior cuff tears: an in vitro biomechanical comparison of interference screw and suture anchors

BACKGROUND

The fixation of the tendon to the bone remains a challenging problem in the latissimus dorsi tendon transfer for irreparable cuff tears and can lead to unsatisfactory results. A new arthroscopic method of tendon to bone fixation using an interference screw has been developed and the purpose of this study was to compare its biomechanical properties to the ones of a standard fixation technique with anchors.

METHODS

Six paired fresh frozen cadaveric human humeri were used. The freed latissimus dorsi tendon was randomly fixed to the humeral head with anchors or with interference screw after a tubularization procedure. Testing consisted to apply 200 cycles of tensile load on the latissimus dorsi tendon with maximal loads of 30 N and 60 N, followed by a load to failure test. The stiffness, displacements after cyclic loadings, ultimate load to failure, and site of failure were analysed.

FINDINGS

The stiffness was statistically higher for the tendons fixed with interference screws than for the ones fixed with anchors for both 30 N and 60 N loadings. Likewise, the relative bone/tendon displacements after cyclic loadings were lower with interference screws compared to anchors. Load to failure revealed no statistical difference between the two techniques.

INTERPRETATION

Compared to the standard anchor fixation, the interference screw fixation technique presents higher or similar biomechanical performance. These results should be completed by further biomechanical and clinical trials to confirm the interest of this new technique as an alternative in clinical use.

The effectiveness and safety of introducing condom-catheter uterine balloon tamponade for postpartum haemorrhage at secondary level hospitals in Uganda, Egypt and Senegal: a stepped wedge, cluster-randomised trial

OBJECTIVE

To assess the effectiveness of introducing condom-catheter uterine balloon tamponade (UBT) for postpartum haemorrhage (PPH) management in low- and middle-income settings.

DESIGN

Stepped wedge, cluster-randomised trial.

SETTING

Eighteen secondary-level hospitals in Uganda, Egypt and Senegal.

POPULATION

Women with vaginal delivery from October 2016 to March 2018.

METHODS

Use of condom-catheter UBT for PPH management was introduced using a half-day training and provision of pre-packaged UBT kits. Hospitals were randomised to when UBT was introduced. The incident rate (IR) of study outcomes was compared in the control (i.e. before UBT) and intervention (i.e. after UBT) periods. Mixed effects regression models accounted for clustering (random effect) and time period (fixed effect).

MAIN OUTCOME MEASURES

Combined IR of PPH-related invasive surgery and/or maternal death.

RESULTS

There were 28 183 and 31 928 deliveries in the control and intervention periods, respectively. UBT was used for 9/1357 and 55/1037 women diagnosed with PPH in control and intervention periods, respectively. PPH-related surgery or maternal death occurred in 19 women in the control period (IR = 6.7/10 000 deliveries) and 37 in the intervention period (IR = 11.6/10 000 deliveries). The adjusted IR ratio was 4.08 (95% confidence interval 1.07-15.58). Secondary outcomes, including rates of transfer and blood transfusion, were similar in the trial periods.

CONCLUSIONS

Introduction of condom-catheter UBT in these settings did not improve maternal outcomes and was associated with an increase in the combined incidence of PPH-related surgery and maternal death. The lack of demonstrated benefit of UBT introduction with respect to severe outcomes warrants reflection on its role.

TWEETABLE ABSTRACT

Stepped wedge trial shows UBT introduction does not reduce the combined incidence of PPH-related surgery or death.

Automatic in vivo NMR data processing based on an enhancement procedure and linear prediction method

A new data processing method for in vivo NMR data quantitation is presented. This method (EPLPSVD) is based on the enhancement procedure (EP) proposed by J. A. Cadzow (IEEE Trans. Acoust. Speech Signal Process. 36, 49, 1988) followed by the usual linear prediction method using the singular value decomposition (LPSVD). The evaluation of this protocol is performed using synthesized 31P signals with different signal-to-noise ratios. A Monte-Carlo simulation as a function of signal-to-noise ratio (SNR) has proved that EPLPSVD leads to unbiased estimated values of parameters. Then the Cramer-Rao method yields reliable confidence intervals for the estimated parameters. The estimates of NMR parameters using EPLPSVD are reliable and accurate for SNR > or = 1.2 while the LPSVD method failed for SNR < or = 4. This protocol is applied to analyze automatically a series of 31P free induction decays obtained from the human gastrocnemius muscle during exercise. Spectral parameters with their confidence intervals, curves of relative intensity variations in phosphocreatine and inorganic phosphate, and pH curves are automatically provided.

Homogeneity among Senegalese strains of yellow fever virus

A series of 16 yellow fever (YF) viruses isolated from mosquitoes, monkeys and humans in different epidemiological contexts in Senegal and The Gambia between 1976 and 1983, was analyzed by T1 RNase oligonucleotide fingerprints of the genomic 32P-labeled RNA, by SDS-polyacrylamide gel electrophoresis of the intracellular virus-specified polypeptides, by peptide mapping of the envelope E glycoprotein and by immunological reactivities with monoclonal antibody fluids (MAF's) against the E glycoprotein. These strains had not been passed in suckling mice and were isolated in Aedes pseudoscutellaris Mos 61 cultured cells. These strains showed no virulence in three-week-old Swiss mice when injected intraperitoneally. Direct comparison of the large T1 RNase-resistant oligonucleotide maps indicated a relative genetic stability (92%-100%). A greater change was observed when these strains were compared with an epidemic YF strain isolated in 1965 with an oligonucleotide fingerprint map sharing 82%-88% similarity. The YF-specified proteins were identical in their molecular weight, and the fragments obtained after limited proteolysis of the envelope protein using protease V8 or alphachymotrypsine indicated that the strains were chemically similar. Only a few differences were observed when the strains were seroneutralized with MAF's, but no relation could be made with genetic or biological data. This suggested that the YF virus strains isolated from the same geographic area and during a short period of time had evolved slowly. Moreover, all the viruses were closely related and no correlation could be established with the apparent variations in virulence in nature.

Calbindin D28K-containing neurons, and not HSP70-expressing neurons, are more resistant to HIV-1 envelope (gp120) toxicity in cortical cell cultures

HIV-1-associated cognitive/motor complex is one of the major neurological complications of AIDS and is associated with neuronal loss. Gp120, the HIV envelope protein, is toxic for neurons in cultures and produces a rise in intracytosolic calcium. This neurotoxicity is dose-dependent and time-dependent. We evaluated the selective gp120 toxicity in primary neuronal cultures for calbindin-free and calbindin-containing neurons with semi-quantitative immunocytochemistry using an anti-calbindin D28K monoclonal antibody. The number of immunolabelled neurons was inversely correlated to neuronal survival. In cultures exposed to gp120 (100 pM) for 24 hr the neuronal survival of initial platings was 19.7 +/- 2.1% and the percentage of neuronal survival was 84.6 +/- 4.9% in control cultures exposed to the vehicle. The corresponding percentages of immunolabelled neurons were 85.0 +/- 2.1% in treated cultures and 23.6 +/- 3.1% in control cultures (P < 0.001). The expression of heat shock proteins by heating cell cultures did not protect neurons from gp120 toxicity. These results suggest that calbindin D2K28-containing neurons are more resistant to gp120-toxicity in this cell culture system.