A pilot comparative study of fissurectomy/diltiazem and fissurectomy/botulinum toxin in the treatment of chronic anal fissure

Background: Treatment of chronic anal fissure (CAF) by fissurectomy with botulinum toxin A (BTA) injection results in a healing rate of greater than 90%. BTA injection, however, can cause incontinence and perianal sepsis. The decrease in sphincter pressure following topical treatment with 2% diltiazem cream (DTC) is comparable to that following BTA injection but with potentially fewer complications and at less cost. We report the shortterm results of a pilot study comparing fissurectomy with BTA and fissurectomy followed by DTC for the treatment of CAF. Methods: The recorded outcomes of CAF following treatment with the two methods were analysed retrospectively. Patients underwent either fissurectomy followed by injection of 40 U BTA into the internal sphincter (group A) or fissurectomy followed by the perianal application of DTC twice daily for 8 weeks (group B). Symptom resolution and treatment side effects at the initial follow-up were compared. Results: Demographics, fissure characteristics and the number of multiparous women between the two groups were comparable. At a median follow-up of 12 weeks (range 8-20 weeks), the two groups had similar rates of complete symptom resolution (group A, 25/28, 89.3%; group B, 19/23, 82.6%; p=0.7739), with minor side effects. Conclusions: In this small pilot study fissurectomy combined with chemical sphincterotomy resulted in high short-term fissure healing rates. The study also suggested that fissurectomy followed by 8 weeks of topical DTC may be as good as fissurectomy with BTA injection in the treatment of CAF. A prospective study, adequately powered to determine the significance of differences is neede

Life-time independent approach to Lagrangian vortices detection

International audienc

How well mesoscale eddies are represented in oceanic models?

International audienceThe aim of this work is to assess the impact of data assimilation on the dynamics of mesoscale eddies. We do this based on the use of a recent mathematical method from nonlinear dynamics field that is capable of detecting Lagrangian eddies from birth to death. We apply this method on two composites time series of two configurations covering the whole globe, with and without assimilation, and carry on various statistical analysis to evaluate the impact of data assimilation on several properties of these Lagrangian mesoscale eddies

Associations between early childhood caries, malnutrition and anemia: a global perspective

Background Malnutrition is the main risk factor for most common communicable diseases. The aim of this study is to determine the relationship between country-level prevalence of early childhood caries (ECC), malnutrition and anemia in infants and preschool children. Methods Matched country-level ECC, malnutrition and anemia prevalence were generated from databases covering the period 2000 to 2017. Multivariate general linear models were developed to assess the relationship between outcome variables (prevalence of stunting, wasting, overweight, and anemia) and the explanatory variable (ECC prevalence) adjusted for gross national income per capita. Adjusted regression coefficients (B) and partial eta squared were computed. Results The mean (standard deviation (SD)) ECC prevalence was 23.8 (14.8)% for 0-2 year-olds and 57.3 (22.4)% for 3-5-year-olds. The mean (SD) prevalence of wasting was 6.3 (4.8)%, overweight 7.2 (4.9)%, stunting 24.3 (13.5)%, and anemia 37.8 (18.1)%. For 0-2-year-olds, the strongest and only significant association was between the prevalence of ECC and overweight (eta 2 = 0.21): 1 % higher ECC prevalence was associated with 0.12% higher prevalence of overweight (B = 0.12, P = 0.03). In 3-5-year-olds, the strongest and only significant association was between the prevalence of ECC and anemia (eta 2 = 0.08): 1 % higher prevalence of ECC was associated with 0.14% lower prevalence of anemia (B = - 0.14, P = 0.048). Conclusion Country-level prevalence of ECC was associated with malnutrition in 0-2-year-olds and with anemia in 3-5-year-olds. The pathway for the direct relationship between ECC and overweight may be diet related. The pathway for the inverse relationship between ECC and anemia is less clear and needs further investigations

The p38 MAPK pathway is essential for skeletogenesis and bone homeostasis in mice

Nearly every extracellular ligand that has been found to play a role in regulating bone biology acts, at least in part, through MAPK pathways. Nevertheless, much remains to be learned about the contribution of MAPKs to osteoblast biology in vivo. Here we report that the p38 MAPK pathway is required for normal skeletogenesis in mice, as mice with deletion of any of the MAPK pathway member–encoding genes MAPK kinase 3 (Mkk3), Mkk6, p38a, or p38b displayed profoundly reduced bone mass secondary to defective osteoblast differentiation. Among the MAPK kinase kinase (MAP3K) family, we identified TGF-β–activated kinase 1 (TAK1; also known as MAP3K7) as the critical activator upstream of p38 in osteoblasts. Osteoblast-specific deletion of Tak1 resulted in clavicular hypoplasia and delayed fontanelle fusion, a phenotype similar to the cleidocranial dysplasia observed in humans haploinsufficient for the transcription factor runt-related transcription factor 2 (Runx2). Mechanistic analysis revealed that the TAK1–MKK3/6–p38 MAPK axis phosphorylated Runx2, promoting its association with the coactivator CREB-binding protein (CBP), which was required to regulate osteoblast genetic programs. These findings reveal an in vivo function for p38β and establish that MAPK signaling is essential for bone formation in vivo. These results also suggest that selective p38β agonists may represent attractive therapeutic agents to prevent bone loss associated with osteoporosis and aging

Epidemiology of hepatitis viruses among hepatocellular carcinoma cases and healthy people in Egypt: A systematic review and meta-analysis

Liver cancers are strongly linked to hepatitis B virus (HBV) and hepatitis C virus (HCV). Egypt has the highest prevalence of HCV worldwide and has rising rates of hepatocellular carcinoma (HCC). Egypt's unique nature of liver disease presents questions regarding the distribution of HBV and HCV in the etiology of HCC. Accordingly, a systematic search of MEDLINE, ISI Web of Science, ScienceDirect and World Health Organisation databases was undertaken for relevant articles regarding HBV and HCV prevalence in Egypt among healthy populations and HCC cases. We calculated weighted mean prevalences for HBV and HCV among the populations of interest and examined differences in prevalence by descriptive features, including age, year and geographic region. Prevalences for HBV and HCV were 6.7% and 13.9% among healthy populations, and 25.9% and 78.5% among HCC cases. Adults had higher prevalences of both infections (Adult HBV = 8.0%, Child HBV = 1.6%; Adult HCV = 15.7%, Child HCV = 4.0%). Geographically, HBV was higher in the south, whereas HCV was greater in the north (North HBV = 4.6%, South HBV = 11.7%; North HCV = 15.8%, South HCV = 6.7%). Among HCC cases, HBV significantly decreased over time ( p = 0.001) while HCV did not, suggesting a shift in the relative influences of these viruses in HCC etiology in Egypt. Our results highlight large amounts of heterogeneity among the epidemiological factors associated with liver disease in Egypt and underscore the necessity of an integrated strategy for the successful prevention of viral hepatitis infections and chronic liver disease. © 2008 Wiley-Liss, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/61320/1/23937_ftp.pd

Quasi-static and fatigue properties of a balsa cored sandwich structure with thermoplastic skins reinforced by flax fibres

This paper presents the results of several experimental analyses performed on a biobased sandwich structure. The material studied is made up of thermoplastic skins reinforced by flax fibres and applied to a balsa core. It is produced by a single-step liquid resin infusion process. First, the skin–core interfacial properties were measured and compared with those of the existing materials. Then, several quasi-static and dynamic analyses were performed to study the flexural behaviour of sandwich beams. The elastic and ultimate properties of the skins and core were deduced from these flexural tests. In addition, a failure mode map was developed based on the existing theories to explain the failure modes observed under different boundary conditions. The influence of the statistical spread of the core’s mechanical properties on the failure of sandwich beams was considered. Moreover, fatigue analyses were conducted to determine the fatigue resistance of this bio-based structure. Its behaviour was compared with that of the previously tested non-bio-based sandwich beams

Analyse de l'endommagement d'un composite à matrice thermoplastique renforcée de fibres de lin par émission acoustique

L’étude expérimentale proposée à pour objectifs de décrire les mécanismes d’endommagement survenant dans un composite à matrice polymère renforcée par des fibres végétales. Les résultats obtenus au cours d’essais de traction uni-axiale ont été analysés, afin de cerner, qualifier et quantifier les mécanismes en jeu. Des fibres de lin unidirectionnelles continues ont été associées à une résine thermoplastiqueliquide par infusion. Des éprouvettes du composite stratifié ont été testées selon différentes orientations et différentes séquences d’empilement. Les essais ont été suivis par émission acoustique et les évènements enregistrés ont été classifiés de manière non supervisée selon des descripteurs temporels. D’autre part, des analyses microscopiques des fronts de rupture ainsi que des sections d’éprouvettes partiellement sollicitées ont été réalisées afin de tenter de corréler à différentes échelles la classification obtenue des évènements acoustiques et les mécanismes d’endommagement