Revues systématiques et méta-analyses en chirurgie cardiaque : défis et solutions

Objectif: Explorer, adapter et développer de nouvelles méthodologies permettant de réaliser des revues systématiques et méta-analyses en chirurgie cardiaque. Méthodes: Le text mining et la citation chasing ont été utilisés pour l’optimisation de l’efficience et de la sensibilité de la recherche. Nous avons participé à l’évaluation des nouveaux outils (Risk of Bias 2.0 et Risk of bias in non-randomized studies of interventions) pour l’évaluation de la qualité des études randomisées et non randomisées et qui ont été adoptés pour nos projets futurs. Une nouvelle méthodologie graphique a été développée pour la réalisation des méta-analyses de données de survie. Résultats: Ces approches ont été utilisées pour répondre à diverses questions de recherche touchants différents aspects de la chirurgie cardiaque : 1) la rédaction des premières lignes directrices de l’Enhanced Recovery After Cardiac Surgery, 2) une revue systématique des résultats de la chirurgie valvulaire et aortique chez le transplanté cardiaque, démontrant les bons résultats de ces procédures dans une population à haut risque et l’émergence des techniques trans-cathéters dans la prise en charge de ces pathologies, 3) une méta-analyse portant sur les arythmies supra-ventriculaires chez les patients ayant eu une intervention de Fontan, concluant à un effet bénéfique de la technique du conduit extra-cardiaque et 4) une méta-analyse portant sur l’insuffisance aortique chez les patients porteurs d’assistance ventriculaire gauche, objectivant une incidence sous-estimée de cette situation clinique avec un impact significatif sur la survie de cette population de patients. Conclusion: Cette thèse aborde certaines contraintes de la littérature en chirurgie cardiaque comme la sensibilité sous optimale de la recherche systématique et les méta-analyses de données de survie, et a proposé des solutions. D’autres contraintes telles que les comparaisons multiples subsistent. Des recherches futures axées sur de nouvelles approches comme le network meta-analysis ou l’approche bayésienne pourraient offrir des solutions.Objective: To explore, adapt and develop new methodologies for performing systematic reviews and meta-analyses in cardiac surgery. Methods: Text mining and citation chasing were used to optimize the efficiency and sensitivity of search process. We participated in the evaluation of new tools (Risk of Bias 2.0 and Risk of bias in non-randomized studies of interventions) for quality assessment of randomized and nonrandomized studies and we have adopted them for our future projects. A new graphic methodology has been developped for the performance of meta-analyses of time-to-event data. Results: These approaches have been used to answer various research questions touching different aspects of cardiac surgery: 1) writing the first guidelines of enhanced recovery after cardiac surgery, 2) a systematic review of the results of valvular surgery and aortic in cardiac transplantation, demonstrating good results of these procedures in a high-risk population and the emergence of trans-catheter techniques in the management of these pathologies, 3) a meta-analysis of supra-ventricular arrhythmias in patients who had a Fontan intervention, finding a beneficial effects of the extracardiac conduct technique and 4) a meta-analysis of aortic insufficiency in patients with left ventricular assist device, showing an under-estimated incidence of this clinical entity with a significant impact on the survival of this population of patients. Conclusion: This thesis addresses some of the short comings of the heart surgery literature such as the sensitivity of the systematic search and time-to-event data meta-anlysis and proposed novel solutions. Other issues such as the need to summarize a comprehensive and coherent set of comparisons remain. Future researchs focused on new approaches such as the network meta-analysis or the Bayesian approach can solve these issues

THE RELATIONSHIP BETWEEN BANK PROFITABILITY AND ECONOMIC GROWTH FOR CONVENTIONAL BANKS IN GCC COUNTRIES

Does bank profitability encourage economic growth? Even while it seems like political leaders are quite concerned about the low level of bank profitability, it is still unclear how bank profitability affects economic growth. It might help economic growth and financial stability, but it could also reduce competition and, as a result, slow down economic progress.  We present the first empirical study to evaluate how bank profitability affects economic growth. Using the Generalized Method of Moments (GMM), we build an econometric model for 72 conventional banks across six countries from GCC region from 2000 to 2019. We find that the profitability of the banks has a positive short- and long-term impact on economic growth. For regulating the dynamics of bank profitability, these findings are trustworthy. Additionally, they are sensitive to deadlines, restrictions, and exchange measures

Polysaccharides from Tossa jute (Corchorus olitorius L.) leaves: Extraction, antioxidant and antibacterial activities

The biological proprieties of mucilaginous polysaccharides (PSc) extracted from Tossa jute leaves (Corchorus olitorius  L.) using an ethanol precipitation method were studied. The results showed that PSc had higher total polyphenols and flavonoids and greater antioxidant activities. At 1.5 mg/ml PSc, the antioxidant activities were about 90% against 1,1-diphenyl-2-picryl hydrazyl radical (DPPH•) and 78% against lipid peroxidation. The PSc with a FRAP assay at the same concentration showed an effective protection against hydroxyl radicals and DNA breakage. Furthermore, the extracted PSc had a wide spectrum of antibacterial activities against all bacteria tested (Gram+ and Gram-). The overall data suggested that this natural PSc may be used as a competitive antioxidant and antimicrobial additive in food and in medicinal preparations

Radial neck fracture in children: anatomic and functional results of Metaizeau technique

Fractures of the radial neck accounts for 1% of all childhood fractures and 5% to 10% of childhood traumatic lesions involving the elbow. Intramedullary percutaneous nail reduction (Metaizeau technique) is considered the most effective surgical technique. The purpose of this study was to identify the main clinical features of radial neck fracture in children and to evaluate the anatomical and functional results of the Metaizeau technique. In this retrospective study, we evaluated 22 patients under the age of 16 who were treated for radial neck fracture at the orthopedic and trauma surgery department of Sahloul University Hospital in Sousse over a period of 16 years from January 2001 to April 2017. Authors used Metaizeau classification. Functional results were evaluated by Mayo elbow performance score (MEPS) and the radiological evaluation was based on standard images with measurement of the residual rocker. The average age was 8.6 years (5-13 years). Seven fracture were grade III injuries and three grade IV. In the immediate postoperative period, radiological measurements showed a residual rocker less than 20° in 86.3% and more than 20° in 13.7% of cases. At an average follow-up of 13 months and a half, the MEPS score was excellent and good for 17 patients. Four types of complications were found: necrosis of the radial head in 1 case, pseudarthrosis in 1 case, periarticular calcification in 2 cases and stiff-ness of the elbow in 3 cases. Despite the small number of patients in our series, we believe that the elastic stable intramedullary pinning according to the Metaizeau technique is the treatment of choice for displaced radial neck fractures in children

Tricuspid Valve Infective Endocarditis

The tricuspid valve, which has been known as the “forgotten valve”, must not be ignored in infective endocarditis. Tricuspid valve infective endocarditis is a very complex condition and occurs in a complex patient population. The causative organisms are often highly virulent and patients usually have a history of intravenous drug abuse. Although the success rate of antibiotic therapy is high, certain features or complications may require surgery. Understanding the therapeutic options, the challenges of surgical intervention and the components of the patient-centered longitudinal care plan is crucial in order to minimize the risk of relapse, which is unfortunately not uncommon in these patients

Impact of Zinc Excess on Germination, Growth Parameters and Oxidative Stress of Sweet Basil (Ocimum basilicum L.)

In the present study, the effects of elevated zinc concentrations on germination, physiological and biochemical parameters were investigated in basil (Ocimum basilicum L.). Results indicate that zinc excess (1–5 mM ZnSO4) did not affect germination process, but it drastically reduced vigor index and radicle elongation, and induced oxidative stress. Exposure of basil plants to 400 and 800 µM Zn decreased aerial parts and roots dry biomass, root length and leaf number. Under these conditions, the reduction of plant growth was associated with the formation of branched and abnormally shaped brown roots. Translocation factor \u3c 1 and bioconcentration factor \u3e 1 was observed for 100 µM Zn suggested the possible use of basil as a phytostabiliser. Excess of Zn supply (\u3e 100 µM) decreased chlorophyll content, total phenol and total flavonoid contents. Additionally, an increased TBARS levels reflecting an oxidative burst was observed in Zn-treated plants. These findings suggest that excess Zn adversely affects plant growth, photosynthetic pigments, phenolic and flavonoid contents, and enhances oxidative stress in basil plants

TAVI-PREP: A Deep Learning-Based Tool for Automated Measurements Extraction in TAVI Planning

ABSTRACT: Background: Transcatheter aortic valve implantation (TAVI) is a less invasive alternative to open-heart surgery for treating severe aortic stenosis. Despite its benefits, the risk of procedural complications necessitates careful preoperative planning. Methods: This study proposes a fully automated deep learning-based method, TAVI-PREP, for pre-TAVI planning, focusing on measurements extracted from computed tomography (CT) scans. The algorithm was trained on the public MM-WHS dataset and a small subset of private data. It uses MeshDeformNet for 3D surface mesh generation and a 3D Residual U-Net for landmark detection. TAVI-PREP is designed to extract 22 different measurements from the aortic valvular complex. A total of 200 CT-scans were analyzed, and automatic measurements were compared to the ones made manually by an expert cardiologist. A second cardiologist analyzed 115 scans to evaluate inter-operator variability. Results: High Pearson correlation coefficients between the expert and the algorithm were obtained for most parameters (0.90–0.97), except for left and right coronary height (0.8 and 0.72, respectively). Similarly, the mean absolute relative error was within 5% for most measurements, except for left and right coronary height (11.6% and 16.5%, respectively). A greater consensus was observed among experts than when compared to the automatic approach, with TAVI-PREP showing no discernable bias towards either the lower or higher ends of the measurement spectrum. Conclusions: TAVI-PREP provides reliable and time-efficient measurements of the aortic valvular complex that could aid clinicians in the preprocedural planning of TAVI procedures