Primary Closure Versus Biliary Drainage After Laparoscopic Choledocotomy: Results of a Comparative Study.

International audienceTo evaluate the feasibility, safety, and short-term outcomes of primary closure (PC) and biliary drainage (BD), after the laparoscopic treatment of common bile duct (CBD) stones by choledocotomy.Between January 2009 and December 2014, 102 patients underwent laparoscopy for lithiasis of the CBD. Intraoperative cholangiography was systematically performed, followed by choledocoscopy, depending on the size of the CBD.Eighty (78.4%) of the 102 patients underwent laparoscopic stone extraction by choledocotomy, and were assigned to 2 groups: PC (group A, n=25), and BD (group B, n=55). Groups A and B were comparable in terms of age (62.3±26.1 vs. 66.0±19.3 y; P=0.53), the percentage of women (72.0% vs. 76.4%; P=0.68), body mass index (25.9±6.1 vs. 26.9±4.4 kg/m; P=0.52), and CBD diameter (11.6±3.1 vs. 12.1±3.8 mm; P=0.59). The mean durations of surgery and of hospital stay were significantly shorter in group A: 179±38 versus 211±57 minutes (P=0.02) and 5.4±2.0 versus 8.4±3.2 days (P<0.001). Groups A and B were comparable in terms of serious postoperative morbidity (Clavien-Dindo scores of 3, 4, and 5): 2 versus 4 (P=1). In group B, bile drain removal was complicated by choleperitoneum in 3 cases.With shorter durations of surgery and hospital stay, equivalent postoperative morbi-mortality, and an absence of the specific morbidity due to bile drainage, PC may be considered a safe and feasible option for the laparoscopic management of CBD stones by choledocotomy

Colovesical Fistula Complicating Diverticular Disease

International audienc

EVALUATION OF THE CARDIOMYOTOXIC EFFECTS OF DOXYCYCLINE OVERDOSE IN CALVES USING 2-DIMENSIONAL SPECKLE TRACKING.

Doxycycline (DOXY) is associated with left ventricular (LV) dysfunction in calves in accidental overdose but not in experimental models when evaluated with classical and Doppler echocardiography. Two-dimensional-speckle tracking (2DST) is used to evaluate LV dysfunction in numerous species but not in cattle. The aim of this study was to evaluate the cardiotoxic effects of an experimental overdose of DOXY using 2DST in calves. Ten healthy male Holstein calves. Group 1: 5 calves (mean age 58.0 +/- 16.3 days; mean body weight 72.2 +/- 13.0 kg) received 25 mg/kg of DOXY orally for 5 days. Group 2: 5 calves (mean age 56.4 +/- 15.7 days; mean body weight 73.4 +/- 7.0 kg) received a placebo. Electrocardiography (ECG) and 2DST echocardiography were performed at day 0 and day 8. ECG tracings were analysed for occurrence of arrhythmias. 2DST measurements included global and segmental, peak values for radial and circumferential strains (SR, SC), strain rates (SrR, SrC), rotation (Rot), rotation rates (RotR) and radial displacement (DR). All calves completed the study. ECG recordings were unremarkable in both groups. Heart rate was neither significantly different between groups nor before and after treatment. LV systolic function was affected in calves receiving an overdose of DOXY as shown by a significant decrease of segmental SR (P < 0.05), SC (P < 0.05) and DR (P < 0.05) in treated calves compared to the placebo group in several segments. The SrC in early diastole was also significantly decreased in 1 segment (<0.05). In calves, DOXY overdose induces a LV dysfunction in systole, and to a lesser extent, in diastole. A better comprehension of the pathophysiology involved in the DOXY overdose will help in the treatment of accidental cases

A case-control study of risk factors for intussusception among infants in eastern France after the introduction of the rotavirus vaccine

International audienceObjectiveThe objective of the present study was to investigate the risk factors for intussusception (IS) among infants, including vaccination against rotavirus.MethodsCase-control study with systematic inclusion of all infants aged <1 year with suspected IS admitted to emergency departments in the eastern region of France between 1 April 2008 and 31 March 2012. All cases classed level 1 according to the Brighton classification were matched to 4 hospital controls. Two exposure windows were examined; exposure to the first dose of rotavirus vaccine in the 7 and in the 14 days prior to the occurrence of IS.ResultsA total of 115 cases were matched with 457 controls. The average vaccination coverage rate over the 4 years of study was 8.6%. Rotavirus vaccine was not found to be significantly associated with the occurrence of IS in the 7 days (odds ratio (OR) not calculated; p = 0.99) and in the 14 days after administration of one dose vaccine (OR 1.33, 95% confidence interval (CI) 0.14–12.82). Infant formula alone or combined with breastfeeding was associated with an excess risk of IS (OR 2.74, 95% CI 1.10–6.79). A history of gastroenteritis within 2 weeks prior to hospitalisation was also associated with an increased risk (OR 2.24, 95% CI 1.07–4.67).ConclusionOur study indicates that infant formula alone or combined with breastfeeding is a risk factor for IS. A small, non-significant increase in the risk of IS was observed after rotavirus vaccination, although the low vaccine coverage rate likely precluded detection of a significant increase in risk

L’analyse ergonomique du travail et de la formation : quelques contributions récentes

Ce numéro spécial est dédié aux travaux récents des membres du groupe Ergonomics analysis of work and training (EAWT) qui se réunit périodiquement, depuis 1991, dans le cadre du Congrès de l’Association internationale d’ergonomie (IEA). Les six contributions présentées ici découlent du dernier congrès tenu à Recife en 2012 et des collaborations subséquentes entre des chercheurs de plusieurs pays. Vous pourrez découvrir les particularités de l’approche ergonomique des questions de formation ainsi que la diversité de ses apports. Ces travaux offrent l’occasion de réfléchir aux conceptions de la formation et à leurs liens avec l’activité de travail et avec les conditions de travail et d’apprentissage. Ils permettent aussi de prendre connaissance des cadres conceptuels et méthodologiques variés qui alimentent aujourd’hui ce domaine de recherche

Beyond the Rule of 5: Impact of PEGylation with Various Polymer Sizes on Pharmacokinetic Properties, Structure–Properties Relationships of mPEGylated Small Agonists of TGR5 Receptor

International audiencePEGylation of therapeutic agents is known to improve the pharmacokinetic behavior of macromolecular drugs and nanoparticles. In this work, we performed the conjugation of polyethylene glycols (220-5000 Da) to a series of non-steroidal small agonists of the bile acids receptor TGR5. A suitable anchoring position on the agonist was identified to retain full agonistic potency with the conjugates. We describe herein an extensive structure-properties relationships study allowing us to finely describe the non-linear effects of the PEG length on the physicochemical as well as the in vitro and in vivo pharmacokinetic properties of these compounds. When appending a PEG of suitable length to the TGR5 pharmacophore, we were able to identify either systemic or gut lumen-restricted TGR5 agonists

ADAM30 Downregulates APP-Linked Defects Through Cathepsin D Activation in Alzheimer's Disease

Although several ADAMs (A disintegrin-like and metalloproteases) have been shown to contribute to the amyloid precursor protein (APP) metabolism, the full spectrum of metalloproteases involved in this metabolism remains to be established. Transcriptomic analyses centred on metalloprotease genes unraveled a 50% decrease in ADAM30 expression that inversely correlates with amyloid load in Alzheimer's disease brains. Accordingly, in vitro down- or up-regulation of ADAM30 expression triggered an increase/decrease in Aβ peptides levels whereas expression of a biologically inactive ADAM30 (ADAM30mut) did not affect Aβ secretion. Proteomics/cell-based experiments showed that ADAM30-dependent regulation of APP metabolism required both cathepsin D (CTSD) activation and APP sorting to lysosomes. Accordingly, in Alzheimer-like transgenic mice, neuronal ADAM30 over-expression lowered Aβ42 secretion in neuron primary cultures, soluble Aβ42 and amyloid plaque load levels in the brain and concomitantly enhanced CTSD activity and finally rescued long term potentiation alterations. Our data thus indicate that lowering ADAM30 expression may favor Aβ production, thereby contributing to Alzheimer's disease development