Vascular coil erosion into hepaticojejunostomy following hepatic arterial embolisation

BACKGROUND: Right hepatic arterial injury (RHAI) is the most common vascular injury sustained during laparoscopic cholecystectomy, occurring in up to 7% of cholecystectomies. RHAI is also the most common vascular injury associated with a bile duct injury (BDI) and is reported to occur in up to 41 - 61% of cases when routine angiography is employed following a BDI. We present an unusual case of erosion of vascular coils from a previously embolised right hepatic artery into bilio-enteric anastomoses causing biliary obstruction. This is on a background of biliary reconstruction following a major BDI. CASE PRESENTATION: A 37-year old man underwent a bile duct reconstruction following a major BDI (Strasberg-Bismuth E4 injury) sustained at laparoscopic cholecystectomy. He had two separate bilio-enteric anastomoses of the right and left hepatic ducts and had a modified Terblanche Roux-en-Y access limb formed. Approximately three weeks later he was admitted for significant gastrointestinal bleeding and was hypotensive and anaemic. Selective computed tomography angiography revealed a 2 x 2 centimetre right hepatic artery pseudoaneurysm, which was urgently embolised with radiological coils. Two months later he developed intermittent fevers, rigors, jaundice, and right upper quadrant pain with evidence of intrahepatic biliary dilatation on magnetic resonance cholangiopancreatography. The degree of intrahepatic biliary dilatation progressively increased on subsequent imaging over several months, suggesting stricturing of the bilio-enteric anastomoses. Several attempts to traverse these strictures with a percutaneous transhepatic approach had failed. Then, approximately ten months after the initial BDI repair, choledochoscopy through the Terblanche access limb revealed multiple radiological coils within the bilio-enteric anastomoses, which had eroded from the previously embolised right hepatic artery. A laparotomy was performed to remove the coils, take down the existing obstructed bilio-enteric anastomoses and revise this. Following this the patient recovered uneventfully. CONCLUSION: Obstructive jaundice and cholangitis secondary to erosion of angiographically placed embolisation coils is a rarely described complication. In view of the relative frequency of arterial injury and complications following major bile duct injury, we suggest that these patients be formally assessed for associated arterial injury following a major BDI.Soondoos Raashed, Manju D Chandrasegaram, Khaled Alsaleh, Glen Schlaphoff, and Neil D Merret

The Reading Perception Of Medical Staff About The Use Of Prehospital Ultrasound

This study was a focus on the use of pre-hospital ultrasound in Saudi Arabia. Generally, ultrasound is used in a high frequency by health care providers in different countries within hospitals or pre-hospital. The main point of using the ultrasound was to reduce the time of diagnosis at the hospital and decrease the rate of mortality and morbidity. The study was a cross-sectional study and was used to assess the perception of medical staff about the use of pre-hospital ultrasound. This survey study had 130 participants, and 80 of them were agreed to involve in this study. It was conducted in King Abdulaziz Hospital of National Guards, Al Ahsa and College of Applied Medical Sciences, King Saud Bin Abdul Aziz University for Health Sciences, Al Ahsa Campus, Saudi Arabia. ATLAST ti 8 was used for systematic literature review and SPSS v23 obviously for data analysis. This was a new and novel study as the Pre-hospital ultrasound was not used before in the pre-hospital. On the other hand, the findings showed that the participants displayed a high level of interest in improving their knowledge and skills of using ultrasound during its application in the pre-hospital setting. It was also recommended to have more research in future on the subject

European Position Paper on Rhinosinusitis and Nasal Polyps 2020

The European Position Paper on Rhinosinusitis and Nasal Polyps 2020 is the update of similar evidence based position papers published in 2005 and 2007 and 2012. The core objective of the EPOS2020 guideline is to provide revised, up-to-date and clear evidence-based recommendations and integrated care pathways in ARS and CRS. EPOS2020 provides an update on the literature published and studies undertaken in the eight years since the EPOS2012 position paper was published and addresses areas not extensively covered in EPOS2012 such as paediatric CRS and sinus surgery. EPOS2020 also involves new stakeholders, including pharmacists and patients, and addresses new target users who have become more involved in the management and treatment of rhinosinusitis since the publication of the last EPOS document, including pharmacists, nurses, specialised care givers and indeed patients themselves, who employ increasing self-management of their condition using over the counter treatments. The document provides suggestions for future research in this area and offers updated guidance for definitions and outcome measurements in research in different settings. EPOS2020 contains chapters on definitions and classification where we have defined a large number of terms and indicated preferred terms. A new classification of CRS into primary and secondary CRS and further division into localized and diffuse disease, based on anatomic distribution is proposed. There are extensive chapters on epidemiology and predisposing factors, inflammatory mechanisms, (differential) diagnosis of facial pain, allergic rhinitis, genetics, cystic fibrosis, aspirin exacerbated respiratory disease, immunodeficiencies, allergic fungal rhinosinusitis and the relationship between upper and lower airways. The chapters on paediatric acute and chronic rhinosinusitis are totally rewritten. All available evidence for the management of acute rhinosinusitis and chronic rhinosinusitis with or without nasal polyps in adults and children is systematically reviewed and integrated care pathways based on the evidence are proposed. Despite considerable increases in the amount of quality publications in recent years, a large number of practical clinical questions remain. It was agreed that the best way to address these was to conduct a Delphi exercise. The results have been integrated into the respective sections. Last but not least, advice for patients and pharmacists and a new list of research needs are included.Peer reviewe

Role of basic amino acids in the N-terminal region of the core protein in the assembly of hepatitis C virus

La fonction majeure de la protéine de capside (C) du virus de l’hépatite C (HCV) est d’interagir avec l’ARN génomique pour former la nucléocapside, un élément essentiel de la particule virale. Les études menées pour identifier les résidus basiques de la protéine C du HCV ont été principalement réalisées à l’aide d’un système acellulaire mais celui-ci ne permettait pas d’évaluer leur effet sur l’infectiosité du HCV. Le développement du système infectieux en culture cellulaire du HCV (HCVcc) permet de préciser le rôle de ces résidus pendant le cycle viral. Dans notre travail, le rôle de ces résidus basiques a été étudié par mutagenèse dirigée en utilisant le système HCVcc. Nous avons modifié les résidus basiques contenus dans deux régions (région 1, aa 6 à 23 et région 2, aa 39 à 62), situés au sein des 62 aa N-terminaux de la protéine C du HCV. Nos résultats ont montré que les résidus de la première région ont un effet mineur sur la réplication virale et qu’ils ne sont pas nécessaires à l’infectiosité du HCV. Par contre, quatre résidus basiques de la deuxième région se sont révélés être essentiels pour la production de particules virales infectieuses. La modification de ces résidus n’a pas d’effet sur la localisation subcellulaire de la protéine C, l’interaction protéine capside-ARN, l’oligomerisation de la protéine de capside et son enveloppement par les membranes intracellulaires. Dans l’ensemble, nos données suggèrent que les résidus basiques R50, K51, R59 et R62 jouent un rôle majeur dans la formation des particules virales infectieuses à une étape précoce, ultérieure à l’assemblage de la nucléocapside virale.A major function of the hepatitis C virus (HCV) core protein is the interaction with genomic RNA to form the nucleocapsid, an essential component of the virus particle. Analyses to identify basic amino acid residues of HCV core protein, important for capsid assembly, were initially performed with a cell-free system, which did not indicate the importance of these residues for HCV infectivity. The development of a cell culture system for HCV (HCVcc) allows a more precise analysis of these core protein amino acids during the HCV life cycle. In the present study, we used a mutational analysis in the context of the HCVcc system to determine the role of the basic amino acid residues of the core protein in HCV infectivity. We focused our analysis on basic residues located in two clusters (cluster 1, amino acids [aa]6 to 23; cluster 2, aa 39 to 62) within the N-terminal 62 amino acids of the HCV core protein. Our data indicate that basic residues of the first cluster have little impact on replication and are dispensable for infectivity. Furthermore, only four basic amino acids residues of the second cluster (R50, K51, R59, and R62) were essential for the production of infectious viral particles. Mutation of these residues did not interfere with core protein subcellular localization, core protein-RNA interaction, or core protein oligomerization. Moreover, these mutations had no effect on core protein envelopment by intracellular membranes. Together, these data indicate that R50, K51, R59, and R62 residues play a major role in the formation of infectious viral particles at a post-nucleocapsid assembly step

Queens of the desert: the digital practices of Arab MSM

Potential, repression and power have emerged as themes foundational to the academic oeuvre seeking to explore the identities of Arab men who have sex with men (Arab MSM); resulting in cultural and academic conceptions of Arab desiring identities that are orientated in relation to Western formations and critiques. This thesis intervenes on the field by proposing a ‘third way’ necessary to academic critique that is informed by the lived experiences of Arab MSM living in the Gulf region of the Arabian Peninsula. In our analyses of both qualitative and empirical data, the Arab MSM is centred in the text as we are afforded valuable insight on the rich interiority of our subjects’ lives, and their resultant conceptions of self. By exploring these mediations of self with their identities, practices, gender, politics, and other such articulations within both global and local contexts we move past reductive discursive narratives surrounding conceptions of Arab MSM in the field of post-colonial studies. Thereby capturing a snapshot of how Arab MSM are conceiving of, expressing and inhabiting their personhood today

Rôle des acides aminés basiques de la partie N-terminale de la protéine de capside dans l'assemblage du virus de l'hépatite C

La fonction majeure de la protéine de capside (C) du virus de l hépatite C (HCV) est d interagir avec l ARN génomique pour former la nucléocapside, un élément essentiel de la particule virale. Les études menées pour identifier les résidus basiques de la protéine C du HCV ont été principalement réalisées à l aide d un système acellulaire mais celui-ci ne permettait pas d évaluer leur effet sur l infectiosité du HCV. Le développement du système infectieux en culture cellulaire du HCV (HCVcc) permet de préciser le rôle de ces résidus pendant le cycle viral. Dans notre travail, le rôle de ces résidus basiques a été étudié par mutagenèse dirigée en utilisant le système HCVcc. Nous avons modifié les résidus basiques contenus dans deux régions (région 1, aa 6 à 23 et région 2, aa 39 à 62), situés au sein des 62 aa N-terminaux de la protéine C du HCV. Nos résultats ont montré que les résidus de la première région ont un effet mineur sur la réplication virale et qu ils ne sont pas nécessaires à l infectiosité du HCV. Par contre, quatre résidus basiques de la deuxième région se sont révélés être essentiels pour la production de particules virales infectieuses. La modification de ces résidus n a pas d effet sur la localisation subcellulaire de la protéine C, l interaction protéine capside-ARN, l oligomerisation de la protéine de capside et son enveloppement par les membranes intracellulaires. Dans l ensemble, nos données suggèrent que les résidus basiques R50, K51, R59 et R62 jouent un rôle majeur dans la formation des particules virales infectieuses à une étape précoce, ultérieure à l assemblage de la nucléocapside virale.A major function of the hepatitis C virus (HCV) core protein is the interaction with genomic RNA to form the nucleocapsid, an essential component of the virus particle. Analyses to identify basic amino acid residues of HCV core protein, important for capsid assembly, were initially performed with a cell-free system, which did not indicate the importance of these residues for HCV infectivity. The development of a cell culture system for HCV (HCVcc) allows a more precise analysis of these core protein amino acids during the HCV life cycle. In the present study, we used a mutational analysis in the context of the HCVcc system to determine the role of the basic amino acid residues of the core protein in HCV infectivity. We focused our analysis on basic residues located in two clusters (cluster 1, amino acids [aa]6 to 23; cluster 2, aa 39 to 62) within the N-terminal 62 amino acids of the HCV core protein. Our data indicate that basic residues of the first cluster have little impact on replication and are dispensable for infectivity. Furthermore, only four basic amino acids residues of the second cluster (R50, K51, R59, and R62) were essential for the production of infectious viral particles. Mutation of these residues did not interfere with core protein subcellular localization, core protein-RNA interaction, or core protein oligomerization. Moreover, these mutations had no effect on core protein envelopment by intracellular membranes. Together, these data indicate that R50, K51, R59, and R62 residues play a major role in the formation of infectious viral particles at a post-nucleocapsid assembly step.LILLE1-Bib. Electronique (590099901) / SudocSudocFranceF