Masses kystiques latérales du cou : une analyse comparative des approches diagnostiques

Les masses kystiques latérales du cou (MKLC) bénignes et malignes sont difficiles à différencier cliniquement. L’utilité des modalités d’imagerie et de prélèvement doit être clarifiée. Une revue rétrospective de cas entre 2010 et 2016. Les données d’imagerie ont été récoltées et plusieurs variables propres à la masse furent analysées. Les rapports de cytoponction à l’aiguille fine (CAAF), de la biopsie au trocart (BT) et des examens extemporanés (EE) ont été analysés. La sensibilité, la spécificité, la valeur prédictive positive (VPP) et la valeur prédictive négative (VPN) pour prédire la malignité ont été calculées pour toutes les variables comparées entre les masses kystiques bénignes et malignes. Aucune variable d’imagerie n’a pu différencier les masses kystiques bénignes de malignes. La sensibilité de la CAAF est plus basse que celle de la BT (59% vs 83%; p=0.036) et de l’EE (59% vs 93%; p=0.01). L’EE a une meilleure VPN que la CAAF (92% vs 40%; p<0.001) et que la BT (92% vs 50%; p=0.062). La VPP et la spécificité étaient similaires dans tous les groupes. Les cliniciens ne peuvent pas se fier uniquement à l’imagerie pour différencier les masses bénignes des masses malignes. Vu sa VPP adéquate (92%), la CAAF devrait être utilisée initialement pour tous les patients avec une MKLC. Si la CAAF s’avère négative, la BT devrait être utilisée vu sa meilleure sensibilité. Un examen extemporané devrait toujours suivre une BT négative vu la faible VPN de la BT. Un résultat positif à l’une des trois modalités de prélèvement indique la présence de malignité.Benign and malignant lateral cystic neck masses (LCNM) are difficult to distinguish clinically. The usefulness of imaging and sampling modalities in clarifying the diagnosis remains unclear. Retrospective review of cases between 2010 and 2016. Imaging data was reviewed and the variables pertaining to the mass were assessed including the following: size, nodal level, fat stranding, extracapsular spread, calcifications, vascularity, necrosis and standardized uptake value. Sampling reports of fine-needle aspiration (FNA), core-needle biopsy (CNB) and frozen section (FS) were also assessed. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for predicting malignancy were calculated for all variables and compared between benign and malignant cystic neck masses. Ultrasound was used in 47.2% and CT-Scan in 90.5% of patients. No variables on imaging could definitely differentiate benign from malignant LCNM. FNA had a lower sensitivity then CNB (59% vs 83%; p=0.036) and FS (59% vs 93%; p=0.01). FS had a better NPV when compared to FNA (92% vs 40%; p<0.001) and CNB (92% vs 50%; p=0.062). Specificities and PPV were similar among all groups. Clinicians cannot rely on imaging to differentiate benign from malignant LCNM. Given its adequate PPV (92%), FNA should be used initially on lateral cystic neck masses. Because of its high sensitivity, CNB should be considered if FNA is not diagnostic of malignancy. FS should always follow a CNB not indicative of malignancy, because of the low NPV. Any result diagnostic of malignancy on either FNA, CNB or FS strongly indicates presence of malignancy

Diabetic Peripheral Microvascular Complications: Relationship to Cognitive Function

Peripheral microvascular complications in diabetes are associated with concurrent cerebrovascular disease. As detailed cognitive assessment is not routinely carried out among diabetic patients, the aim was to establish whether the presence of clinical “peripheral” microvascular disease can identify a subgroup of patients with early evidence of cognitive impairment. Detailed psychometric assessment was performed in 23 diabetic patients with no microvascular complications (Group D), 27 diabetic patients with at least one microvascular complication: retinopathy, neuropathy, and/or nephropathy (Group DC), and 25 healthy controls (Group H). Groups D and DC participants had significantly lower scores on reaction time (P = 0.003 and 0.0001, resp.) compared to controls. Similarly, groups D and DC participants had significantly lower scores on rapid processing of visual information (P = 0.034 and 0.001, resp.) compared to controls. In contrast, there was no significant difference between Groups D and DC on any of the cognitive areas examined. The results show that diabetes, in general, is associated with cognitive dysfunction, but the additional presence of peripheral microvascular disease does not add to cognitive decline. The study, however, indirectly supports the notion that the aetiology of cognitive impairment in diabetes may not be restricted to vascular pathology

Optimisation of Off-Soil Tomato Fertilization and Substrate Recipes

Substrate and fertilizers recipes and their balances are two factors affecting the growth of hydroponic crops. However, the responses of crop cultivars to different substrate and fertilizer are less clear. This study was aimed at assessing the different responses of tomato (Solanum Lycopersicum&nbsp;L.) cultivars to the different substrate and fertilizer supply. The study was carried out at the Centre de Recherche et de Formation Agricole (CRFA) of the Lebanese University to test three types of substrates; S1 (100% coconut fiber), S2 (50% coconut fiber and 50% grape marc) and S3 (25% coconut fiber and 75% grape marc). As well as three fertilization recipes; F1 (ARTC), F2 (University of Arizona) and F3 (Farmer) were applied in order to be able to recommend the best substrates and fertilizers adapted to the conditions of cultivation off-soil. The production cycle was divided into three phases; phase1 (0-6 weeks), phase2 (6-12 weeks) and phase3 (&gt; 12 weeks). Various parameters were measured throughout the cycle; stem length, number and distance between nodes, number and distance between flower buds, and fruit yield. Results for stem length and number of nodes showed good interaction in favor of F2-S1 throughout the cycle. As far as the distance between nodes is concerned, F1 is the best despite the fact that F2 is more economical and S1 showed a superiority. The number of flower buds is positively affected by F1 and F2 and S1 and S3. As far as the distance between floral buds is concerned, F1 and F2 are the best, F2 is the most profitable and S2 played a favorable role in the distance between floral buds. The number of fruits is in favor of F1 and F2, S1 is the best. In terms of plant yield, F2 is the most favorable and S2 is the best. After that, F2 is the best recipe and F1 is the most economical. S1 and S2 did well in the development of the tomato plant by their proper physico-chemical properties. S1 is slightly better

Ablation of the locally advanced pancreatic cancer: An introduction and brief summary of techniques

Pancreatic ductal adenocarcinoma is a lethal and late presenting malignancy with dismal survival rates. An estimated total of 330,000 people died from this malignancy in 2012. Although there have been improvements in diagnostic and treatment methods, the survival of late stage pancreatic cancer has not shown significant improvement in the past 4 decades. Multiple treatment approaches are available including chemotherapy, radiotherapy, and immunotherapy, but to this day surgical resection remains the only curative treatment option. Ablative techniques use various forms of energy to cause local tissue destruction through necrosis or apoptosis. They are relevant in pancreatic ductal adenocarcinoma as they are a treatment option in non-resectable tumors where their use ranges from symptom control to reducing tumor size for resection. In this narrative review we have grouped and outlined the various ablative methods, classifying them into thermal (Radiofrequency ablation, Microwave ablation, High Intensity Focused Ultrasound ablation, Cryoablation), and non-thermal ablative methods (Irreversible Electroporation (NanoKnife®), Photodynamic Therapy). This is followed by a description and review of the available evidence on survival and complications for each of these ablative methods. According to the literature, thermal ablative methods appear to be more accessible but are implicated with more complications than non thermal ablative methods which show the most promise

Changes of renin-angiotensin system-related aminopeptidases in early stage Alzheimer's disease

Activities of aminopeptidases A, B, and N (ApA, ApB & ApN) and insulin-regulated aminopeptidase (IRAP) have been seen to be decreased amongst patients with Alzheimer's disease (AD). All of these enzymes are involved with the brain renin-angiotensin system which is believed to be involved with learning and memory. This study aimed to explore the time course and the mechanisms underlying these changes. Serum samples were collected from 45 AD patients at the start of the study, and again 13 months later (n = 37). The control group was 22 healthy, older, adults. Enzyme activity was determined at two substrate concentrations to allow Michaelis-Menten analysis of the enzyme activity. The results indicated that there was decreased activity of ApA, ApB and ApN amongst AD patients but no difference in serum IRAP activity. There were no associations between enzyme activity and age, gender nor scores on psychomotor tests. Consideration of the data for the two time points for AD patients showed that the changes in ApB occurred at an early stage of the disease and persisted, whilst those of ApA and ApN only became apparent at later stages of the disease. Although differences in Michaelis-Menten parameters were not statistically significant, consideration of the values suggested that the decrease in ApB activity may be a result of changes in enzyme protein conformation, whilst that of ApN may be a consequence of decreased enzyme expression. Importantly, the different time courses of the effects and the differential changes in enzyme affinity and expression indicated that the observed changes with progression of AD were not a ‘class effect’ for serum aminopeptidases but were idiosyncratic for the individual enzymes

Cognitive and neural signatures of the APOE E4 allele in mid-aged adults

The apolipoprotein E (APOE) e4 allele is strongly associated with increased risk of cognitive impairments in older adulthood. There is also a possible link to enhanced cognitive performance in younger adults, and the APOE e4 allele may constitute an example of antagonistic pleiotropy. The aim of this work was to investigate the cognitive and neural (functional) effects of the APOE e4 allele during mid-age (45-55 years), where a transition toward cognitive deficit might be expected. APOE e4 carriers (e4+) were compared with non-e4 carriers (e4-) on tasks of sustained and covert attention and prospective memory, and functional magnetic resonance imaging data acquired. Performance by e4+ was equivalent or better than e4- on all 3 tasks, although performance benefits were less pronounced than in youth. Neurally, e4+ showed less task-related recruitment of extrastriate and parietal areas. This became more evident when neural activation data were compared with that of young adults acquired in a parallel study. As expected, mid-age participants showed more diffuse neural activation. Notable was the fact that e4+ showed a relative inability to recruit parietal regions as they aged. This was coupled with a tendency to show greater recruitment of frontal regions, and underactivation of extrastriate visual regions. Thus, mid-age e4+ show a pattern of neural recruitment usually seen later in life, possibly reflecting the source of an accelerated aging profile that describes the e4 genotype

A case of pneumococcal peritonitis after caesarean section in a healthy woman

Pneumococcal peritonitis is prevalent in children and adults with comorbidities but extremely rare in healthy adults. Here we describe a case of pneumococcal peritonitis in a previously healthy woman with no known risk factors who presented with constipation, abdominal pain, and distention. Her only past medical history was an uncomplicated C-section two months prior to presentation. A laparotomy revealed a pneumococcal peritonitis without visible source of infection. The patient remained hospitalized until completion of antibiotic regimen with Ceftriaxone and resolution of symptoms. This report adds to the small body of evidence showing possible pneumococcal peritonitis in healthy young adults

Irreversible electroporation (Nanoknife® treatment) in the field of hepatobiliary surgery: current status and future perspectives

Purpose: We aimed to provide an overview of current understanding on the potential use of irreversible electroporation (IRE) in the field of hepatobiliary surgery with a focus on current results in hepatic and pancreatic cancers, its limitations, and its current directions. Methods: Through a review of the literature we have gathered the key articles and trials that are shaping our understanding of the current status of IRE and its prospective uses, and organized them in an easily understandable format showcasing the most up to date results. Results: IRE appears to be comparable in effectiveness and postoperative pain to the more established thermal ablation methods, while having the benefit of avoiding their detrimental thermal effects. In liver cancer, IRE was shown to be efficacious with low levels of local recurrences and only minimal complications. In pancreatic cancer it proved to have significant survival benefits but more significant (although rare) complications compared to the ones seen when IRE is used in liver cancer. Current evidence suggests a promising future for IRE, but clinical randomized control trials, and further developments of treatment protocols are required to come to more stable conclusions on the effectiveness and safety of IRE. Conclusions: IRE is proving to be an adequate method for the treatment of tumors of the pancreas and liver in cases where traditional methods are unavailable. It has been proven particularly efficacious in patients with masses in close proximity to vital structures such as vessels, as well as major biliary and hepatic structures where thermal methods of ablation would cause significant complications

A Case of Pneumococcal Peritonitis after Caesarean Section in a Healthy Woman

Pneumococcal peritonitis is prevalent in children and adults with comorbidities but extremely rare in healthy adults. Here we describe a case of pneumococcal peritonitis in a previously healthy woman with no known risk factors who presented with constipation, abdominal pain, and distention. Her only past medical history was an uncomplicated C-section two months prior to presentation. A laparotomy revealed a pneumococcal peritonitis without visible source of infection. The patient remained hospitalized until completion of antibiotic regimen with Ceftriaxone and resolution of symptoms. This report adds to the small body of evidence showing possible pneumococcal peritonitis in healthy young adults

Cytogenetical anchoring of sheep linkage map and syntenic groups using a sheep BAC library

In order to simultaneously integrate linkage and syntenic groups to the ovine chromosomal map, a sheep bacterial artificial chromosome (BAC) library was screened with previously assigned microsatellites using a sheep-hamster hybrid panel and genetic linkage. Thirty-three BACs were obtained, fluorescently labelled and hybridised on sheep-goat hybrid metaphases (2n = 57). This study allowed us, (i), to anchor all linkage groups on sheep chromosomes, (ii), to give information on the probable position of the centromere on the linkage map for the centromeric chromosomes, (iii), to contradict the previous orientation of the ovine × linkage group by the mapping of BMS1008 on OARXq38. Concerning our somatic cell hybrid panel, this study resulted in the assignment of all the previously unassigned groups to ovine chromosomes and a complete characterisation of the hybrid panel. In addition, since hybridisations were performed on a sheep-goat hybrid, new marker/anchoring points were added to the caprine cytogenetic map