les plaies cranio-encephaliques: Aspects epidemic-Cliniques et Therapeutiques a Dakar(Senegal)

Objectif Le but de cette étude était de montrer les aspects épidémio-cliniques des plaies crânio-encéphaliques et d’évaluer leur prise en charge dans un pays Africain tel le Sénégal.Introduction La plaie crânio-encéphalique est une solution de continuité de tous les plans de couverture séparant le parenchyme cérébral du milieu extérieur. L’infection devient alors la hantise et motive la rapidité de la prise en charge.Malades et méthodes Nous avons fait une étude rétrospective de 14 dossiers colligés de janvier 2006 à janvier 2008. Tous les patients ont été admis au service d’urgence ont été évalué cliniquement par le score de Glasgow et un examen neurologique complet. Ils ont bénéficié d’un scanner cérébral avant une prise en charge médicale et chirurgicale. Ils ont été suivis sur une durée moyenne de 17 mois.Résultats L’âge moyen de nos patients était de 30 ans, avec une prédominance masculine 11cas. La principale cause était les accidents de la voie publique (8cas) suivi par les agressions (4cas). Le délai moyen avant l’hospitalisation était de 24 heures et le délai moyen de prise en charge chirurgicale était de 57 heures ; la majorité des patients avaient un bon état de conscience selon l’échelle de GLASGOW 6 cas (15 - 13) et 4 cas (12 - 9). Le scanner cérébral a permis de montrer les lésions osseuses et intra parenchymateuses : 12 cas de contusions, sept cas de pneumencéphalie, cinq cas d’hématome sous dural et 1un cas de présence de corps étranger. La prise en charge thérapeutique comportait un volet médical et un autre chirurgical (craniectomie, reconstruction de la dure mère et de la peau). La durée moyenne d’hospitalisation était de 12 jours L’évolution post opératoire immédiate était excellente était dans 12 cas. Un patient était décédé et un autre avait gardé une hémiparésie. Conclusion Les plaies crânio-encéphaliques constituent une entité neuro-traumatique assez fréquente dont la principale complication est l’infection méningée. Une prise en charge précoce avec parage et antibioprophylaxie permettraient d’obtenir des résultats satisfaisants surtout en Afrique

Effect of wearing a helmet on the occurrence of head injuries in motorcycle riders in Benin: a case-control study

BACKGROUND: In Benin, motorcycles are the main means of transport for road users and are involved in more than half of crashes. This study aims to determine the effect of wearing a helmet on reducing head injuries in road crashes in Benin. METHODS: This case-control study took place in 2020 and focused on road trauma victims. The sample, consisting of 242 cases (trauma victims with head injuries) for 484 controls (without head injuries), was drawn from a database of traffic crash victims recruited from five hospitals across the country from July 2019 to January 2020. Four groups of independent variables were studied: socio-demographic and economic variables, history, behavioural variables including helmet use and road-related and environmental variables. To assess the shape of the association between the independent variables and the dependent variable, a descending step-by-step binary logistic regression model was performed using an explanatory approach. RESULTS: Fewer of the subjects with a head injury were wearing a helmet at the time of the crash 69.8% (95% CI = 63.6-75.6) compared to those without a head injury 90.3% (95% CI = 87.3-92.8). Adjusting for the other variables, subjects not wearing helmets were at greater risk of head injuries (OR = 3.8, 95% CI (2.5-5.7)); the head injury rating was 1.9 (95% CI = 1.2-3.3) times higher in subjects who were fatigued during the crash than among those who were not and 2.0 (95% CI = 1.2-3.3) times higher in subjects with no medical history. CONCLUSION: Failure to wear a helmet exposes motorcyclists to the risk of head injuries during crashes. It is important to increase awareness and better target such initiatives at the subjects most at risk

Single-cell RNA sequencing reveals localized tumourablation and intratumoural immunostimulant deliverypotentiate T cell mediated tumour killing

Background: Metastatic breast cancer poses great challenge in cancer treatment. N-dihydrogalactochitosan (GC) is a novel immunoadjuvant that stimulates systemic immune responses when administered intratumourally following local tumour ablation. A combination of photothermal therapy (PTT) and GC, referred to as localized ablative immunotherapy (LAIT), extended animal survival and generates an activated B cell phenotype in MMTV-PyMT mouse mammary tumour microenvironment (TME). However, how T cell populations respond to LAIT remains to be elucidated.Methods: Using depletion antibodies, we studied the contributions of CD8+ and CD4+ T cells to the therapeutic effect of LAIT. Using single-cell RNA-sequencing (scRNAseq), we analysed tumour-infiltrating T cell heterogeneity and dissected their transcriptomes upon treatments of PTT, GC, and LAIT (PTT+GC).Results: Loss of CD8+ T cells after LAIT abrogated the therapeutic benefits of LAIT. Ten days after treatment, proportions of CD8+ and CD4+ T cells in untreated TME were 19.2% and 23.0%, respectively. Upon LAIT, both proportions were increased to 25.5% and 36.2%, respectively. In particular, LAIT increased the proportions of naïve and memory cells from a resting state to an activated state. LAIT consistently induced the expression of co-stimulatory molecules, type I IFN responsive genes, and a series of antitumor cytokines, Ifng, Tnf, Il1, and Il17 in CD8+ and CD4+ T cells. LAIT also induced immune checkpoints Pdcd1, Ctla4, and Lag3 expression, consistent with T cell activation. Relevant to clinical translation, LAIT also upregulated genes in CD8+and CD4+T cells that positively correlated with extended survival of breast cancer patients.Conclusions: Overall, our results reveal that LAIT prompts immunological remodelling of T cells by inducing broad proinflammatory responses and inhibiting suppressive signalling to drive antitumour immunity.Financial support was provided by the University of Oklahoma Libraries’ Open Access Fund. National Cancer Institute, Grant/AwardNumbers: R01CA205348, R01CA269897;Oklahoma Center for the Advancement ofScience and Technology, Grant/AwardNumbers: HR16-085, HF20-019.Ye