230 research outputs found

    Should We Assess Pituitary Function in Children After a Mild Traumatic Brain Injury? A Prospective Study

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    Objective: The aim of this study was to evaluate the frequency of hypopituitarism following TBI in a cohort of children who had been hospitalized for mild TBI and to identify the predictive factors for this deficiency.Design: A prospective study was conducted on children between 2 and 16 years of age who had been hospitalized for mild TBI according to the Glasgow Coma Scale between September 2009 and June 2013. Clinical parameters, basal pituitary hormone assessment at 0, 6, and 12 months, as well as a dynamic testing (insulin tolerance test) 12 months after TBI were performed.Results: The study included 109 children, the median age was 8.5 years. Patients were examined 6 months (n = 99) and 12 months (n = 96) after TBI. Somatotropic deficiency (defined by a GH peak <20 mUI/l in two tests, an IGF-1 <-1SDS and a delta height <0SDS) were confirmed in 2 cases. One case of gonadotrophic deficiency occurred 1 year after TBI among 13 pubertal children. No cases of precocious puberty, 5 cases of low prolactin level, no cases of corticotropic insufficiency (cortisol peak <500 nmol/l) and no cases diabetes insipidus were recorded.Conclusion: Pituitary insufficiency was present 1year after mild TBI in about 7% of children. Based on our results, we suggest testing children after mild TBI in case of clinical abnormalities. i.e., for GH axis, IGF-1, which should be assessed in children with a delta height <0 SDS, 6 to 12 months after TBI, and a dynamic GH testing (preferentially by an ITT) should be performed in case of IGF-1 <-1SDS, with a GH threshold at 20 mUI/L. However, if a systematic pituitary assessment is not required for mild TBI, physicians should monitor children 1 year after mild TBI with particular attention to growth and weight gain

    European Bat Lyssavirus Transmission among Cats, Europe

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    We identified 2 cases of European bat lyssavirus subtype 1 transmission to domestic carnivores (cats) in France. Bat-to-cat transmission is suspected. Low amounts of virus antigen in cat brain made diagnosis difficult

    The Beaker phenomenon and the genomic transformation of northwest Europe

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    From around 2750 to 2500 bc, Bell Beaker pottery became widespread across western and central Europe, before it disappeared between 2200 and 1800 bc. The forces that propelled its expansion are a matter of long-standing debate, and there is support for both cultural diffusion and migration having a role in this process. Here we present genome-wide data from 400 Neolithic, Copper Age and Bronze Age Europeans, including 226 individuals associated with Beaker-complex artefacts. We detected limited genetic affinity between Beaker-complex-associated individuals from Iberia and central Europe, and thus exclude migration as an important mechanism of spread between these two regions. However, migration had a key role in the further dissemination of the Beaker complex. We document this phenomenon most clearly in Britain, where the spread of the Beaker complex introduced high levels of steppe-related ancestry and was associated with the replacement of approximately 90% of Britain’s gene pool within a few hundred years, continuing the east-to-west expansion that had brought steppe-related ancestry into central and northern Europe over the previous centuries

    Ten millennia of hepatitis B virus evolution

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    Hepatitis B virus (HBV) has been infecting humans for millennia and remains a global health problem, but its past diversity and dispersal routes are largely unknown. We generated HBV genomic data from 137 Eurasians and Native Americans dated between similar to 10,500 and similar to 400 years ago. We date the most recent common ancestor of all HBV lineages to between similar to 20,000 and 12,000 years ago, with the virus present in European and South American hunter-gatherers during the early Holocene. After the European Neolithic transition, Mesolithic HBV strains were replaced by a lineage likely disseminated by early farmers that prevailed throughout western Eurasia for similar to 4000 years, declining around the end of the 2nd millennium BCE. The only remnant of this prehistoric HBV diversity is the rare genotype G, which appears to have reemerged during the HIV pandemic.Molecular Technology and Informatics for Personalised Medicine and Healt

    Ten millennia of hepatitis B virus evolution

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    Hepatitis B virus (HBV) has been infecting humans for millennia and remains a global health problem, but its past diversity and dispersal routes are largely unknown. We generated HBV genomic data from 137 Eurasians and Native Americans dated between ~10,500 and ~400 years ago. We date the most recent common ancestor of all HBV lineages to between ~20,000 and 12,000 years ago, with the virus present in European and South American hunter-gatherers during the early Holocene. After the European Neolithic transition, Mesolithic HBV strains were replaced by a lineage likely disseminated by early farmers that prevailed throughout western Eurasia for ~4000 years, declining around the end of the 2nd millennium BCE. The only remnant of this prehistoric HBV diversity is the rare genotype G, which appears to have reemerged during the HIV pandemic

    Apports et limites de l'IRM de perfusion et de la neuronavigation dans l'approche stéréotaxique des tumeurs cérébrales

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    Objectifs : Les biopsies stéréotaxiques sont soumises à un risque important d erreurs. Le choix de la cible apparaît cruciale. La présence d une prise de contraste comme marqueur indirect de malignité peut être pris en défaut. Les auteurs sont partis de l hypothèse que l IRM de perfusion pouvait améliorer le choix de la cible lors des biopsies stéréotaxiques. L objectif secondaire était de déterminer la précision des biopsies guidées par neuronavigation. Matériels et méthodes : Il s agit d une étude portant sur 21 biopsies consécutives réalisées dans le service de neurochirurgie d Amiens entre juin 2009 et mars 2010. Résultats : L imagerie de perfusion a été utile à la définition de la cible dans 11 cas (52,4% des cas). A chaque fois il s agissait de tumeurs gliales (soit 84,6% des tumeurs gliales). La cartographie de perfusion apportait soit une cible mieux délimitée (9 cas) soit une cible différente (1 cas) soit une cible identique à la prise de contraste (1 cas). Les prélèvements réalisés à partir des cibles déterminées à l aide de l imagerie de perfusion apportaient à chaque fois le typage cellulaire et le grade. On retrouve une corrélation significative (p<0,01) entre le rCBV et le grade tumoral. La précision moyenne à la cible des procédures de biopsies sous neuronavigation par guidage IRM 3T était de 3,39 mm. Au point d entrée, la précision moyenne était de 9,2 mm. Lors de biopsies guidées par TDM en imagerie de référence avec co-régistration TDM/IRM, la précision moyenne à la cible était de 3,4 mm. La précision moyenne au point d entrée était de 4,3 mm. Conclusions : L utilisation de l IRM de perfusion pour guider les biopsies stéréotaxiques améliore le choix de la cible dès qu il existe une augmentation du rCBV (hyper perfusion). Le choix de la cible sur les données de l imagerie de perfusion permet de biopsier les contingents de plus fortes néoangiogénèses donnant par la même les contingents les plus malins de la lésion. Les biopsies sous neuronavigation par guidage IRM 3T seul sont soumises à un risque d imprécision important en raison de la distorsion majeure de l image. Une co-régistration avec imagerie TDM servant de référence est une solution. Les biopsies de lésions profondes et/ou a environnement vasculaire important nécessitent des procédures avec cadre et/ou fiduciaire invasif.Object: Stereotactic biopsies are subjects to sampling errors essentially due to target selection. Presence of contrast enhancement as indirect marker of malignity is not reliable. The author hypothesized that perfusion weighted imaging can improve target selection in stereotactic biopsies. The second objective was to establish the accuracy of 3T Mri guided frameless biopsies. Methods: We perform a prospective study among 21 consecutives patients between june 2009 and march 2010. Perfusion-weighted imaging and conventional weighted Mri guided all biopsies. Results: Perfusion weighted imaging helped for the determination of the target in 52,4% (11) cases. In all this cases, the histopathological diagnosis was a glial tumor. Perfusion weighted imaging afford a more precise target than contrast enhancement in 9 cases, a different target in 1 case and strictly the same target in 1 case. Perfusion selected sampling afford in all this cases cellular identity and grading. rCBV was significantly associated with grading (p<0,01). For lesions with no high rCBV value, perfusion weighted Mri did not help to determine the target but was useful for the surgical management. Mean accuracy was 9,2 mm at the entry point and 3,39 mm at the target point for 3T Mri alone frameless guided biopsies. Mean accuracy was 4,3 mm at the entry point and 3,4 mm at the target point for frameless biopsies with CT scan as reference imaging co registered with Mri. Conclusions:The use of the IRM of perfusion to guide the stereotaxic biopsies improves the choice of the target as soon as there is an increase in the rCBV (hyper perfusion). The choice of the target on the data of the imagery of perfusion allows of biopsier the quotas of stronger néoangiogénèses consequently giving the most malignant quotas of the lesion. The biopsies under neuronavigation by guidance IRM 3T only are subjected at the important risk of inaccuracy because of the major distortion of the image. A Co-registration with imagery TDM being used as reference is a solution. The biopsies of major lesions and/or has important vascular environment require procedures with framework and/or fiduciary invasive.AMIENS-BU Santé (800212102) / SudocSudocFranceF

    Prise en charge thérapeutique du glioblastome en 2012

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    Le glioblastome, appartenant aux tumeurs cérébrales est une pathologie qui est en augmentation. Si elle reste relativement rare lorsqu on compare son incidence aux autres cancers, la mortalité qui lui est associée est quant à elle très importante. Il s agit donc ici de décrire cette pathologie, et de faire le point sur les différentes approches thérapeutiques existantes, les protocoles en cours et ceux à l étude dont le but est d augmenter la survie et d améliorer la qualité de vie de ces patients.Glioblastoma, related to brain tumors, is an illness increasing in number. If it remains relatively scarce compared to other cancers incidence, the mortality that is associated to it is very important. Therefore, this thesis is about describing this disease, reviewing the different existing therapeutic approaches, the current protocols, and those under review, whose aim is to increase the patients life expectancy, as well as improving their quality of life and well being.AMIENS-BU Santé (800212102) / SudocSudocFranceF
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