Artificial neural networks assessing adolescent idiopathic scoliosis: comparison with Lenke classification

Background contextVariability in classifying and selecting levels of fusion in adolescent idiopathic scoliosis (AIS) has been repeatedly documented. Several computer algorithms have been used to classify AIS based on the geometrical features, but none have attempted to analyze its treatment patterns.PurposeTo use self-organizing maps (SOM), a kind of artificial neural networks, to reliably classify AIS cases from a large database. To analyze surgeon's treatment pattern in selecting curve regions to fuse in AIS using Lenke classification and SOM.Study designThis is a technical concept article on the possibility and benefits of using neural networks to classify AIS and a retrospective analysis of AIS curve regions selected for fusion.Patient sampleA total of 1,776 patients surgically treated for AIS were prospectively enrolled in a multicentric database. Cobb angles were measured on AIS patient spine radiographies, and patients were classified according to Lenke classification.Outcome measuresFor each patient in the database, surgical approach and levels of fusion selected by the treating surgeon were recorded.MethodsA Kohonen SOM was generated using 1,776 surgically treated AIS cases. The quality of the SOM was tested using topological error. Percentages of prediction of fusion based on Lenke classification for each patient in the database and for each node in the SOM were calculated. Lenke curve types, treatment pattern, and kappa statistics for agreement between fusion realized and fusion recommended by Lenke classification were plotted on each node of the map.ResultsThe topographic error for the SOM generated was 0.02, which demonstrates high accuracy. The SOM differentiates clear clusters of curve type nodes on the map. The SOM also shows epicenters for main thoracic, double thoracic, and thoracolumbar/lumbar curve types and transition zones between clusters. When cases are taken individually, Lenke classification predicted curve regions fused by the surgeon in 46% of cases. When those cases are reorganized by the SOM into nodes, Lenke classification predicted the curve regions to fuse in 82% of the nodes. Agreement with Lenke classification principles was high in epicenters for curve types 1, 2, and 5, moderate in cluster for curve types 3, 4, and 6, and low in transition zones between curve types.ConclusionsAn AIS SOM with high accuracy was successfully generated. Lenke classification principles are followed in 46% of the cases but in 82% of the nodes on the SOM. The SOM highlights the tendency of surgeons to follow Lenke classification principles for similar curves on the SOM. Self-organizing map classification of AIS could be valuable to surgeons because it bypasses the limitations imposed by rigid classification such as cutoff values on Cobb angle to define curve types. It can extract similar cases from large databases to analyze and guide treatment.     

Pustular drug hypersensitivity syndrome due to allopurinol

Allopurinol hypersensitivity syndrome (AHS) is a severe drug reaction. It is characterized by rash, fever, and internal organ involvement. It may present in different clinical forms. We present a case of acute generalized exanthematous pustulosis occurring as a manifestation of AHS.KEY WORDS: Allopurinol, hypersensitivity syndrome, pustulosis     

Screening of SLC26A4 gene in autoimmune thyroid diseases

The Pendred syndrome (PS) gene, SLC26A4, was involved in the genetic susceptibility of autoimmune thyroid disease (AITD) in Tunisian population. Recently, functional assays have shown a differential expression of SLC26A4 gene between Graves’ disease (GD) and Hashimoto's thyroiditis (HT). Here, by the mean of DHPLC and HRM, we explored the 21 exons and their flanking intronic sequences of 128 patients affected with GD (n = 64) or HT (n = 64). The pathogenic effect of identified variations on splice was investigated using the web server HSF. Eighteen allelic variations were identified and ranged on missense, sens and splice variations. Nine identified variations (c.‐66C>G, c.898A>C, c.1002‐9A>C, c.1061T>C, c.1544 + 9G>T, c.1545‐5T>G, c.1790T>C, c.1826T>G, c.2139T>G) were previously reported in hearing impairment studies. Forty‐seven per cent (30/64) of GD patients and 37,5% (24/64) of HT patients present at least one variant in the explored sequences. Moreover, the analysis of the variant distribution between HT (9 (5′UTR), 12 exonic and 13 intronic) and GD (18 (5′UTR), 13 exonic and 5 intronic) patients showed a significant difference (χ² = 6.54, 2df, P = 0.03). Interestingly, missense changes (I300L, p.M283I, F354S and p.L597S) affected conserved residues of pendrin. On the other hand, the HSF analyses ascertain that some variants identified in HT disease are predicted to have a pathogenic effect on splice. In conclusion, our analysis of SLC26A4 sequence variations suggested a distinct genetics basis between HT and GD patients, which should be confirmed on a large cohort.     

Cystic echinococcosis in children in Tunisia: fertility and case distribution of hydatid cysts

Cystic echinococcosis, which commonly starts during childhood or adolescence, is a serious problem of public health in Tunisia. For 121 children (161 cysts), the localization and fertility of cysts as well as viability of their protoscoleces were determined. Results indicated that the lung was the primary localization of cyst (59%) followed by the liver (35%). Children's infection is more frequent in male than in female (sex ratio 1.96) and the greatest number of cases is observed in the 4-9 year age groups (94 cases). The fertility of the cyst was independent of its site or its size and no incidence of age of children was detected. Nevertheless, the fertility rate is higher in females than in males for the liver localization.     

Effect of Paraffin and Silica Matrix Phase Change Materials on Properties of Portland Cement Mortars

In the search for methods to incorporate Phase Change Materials (PCM) into Portland cement mortar mixtures, PCM based on paraffins adhered to a silica-based matrix appear as a suitable option. However, paraffin particles have been observed to escape from the silica matrix when water is added. There are only limited data on how the use of such PCM affects the behaviour of mortars. To evaluate the effect of this PCM addition, Portland mortar mixtures were elaborated with 5%, 10% and 15% of PCM content, and using CEM 42.5 I R and CEM I 52.5 R cement types. Physical properties such as density, open porosity, air content and water absorption were analysed for fresh and dry samples. The results obtained show that the PCM-added mixtures require greater water and cement amounts than the standard mortar mixtures to achieve similar compressive strengths. Compared to non-PCM mixtures the PCM-added mortars present a density lowering of 37% for fresh mixtures and near 45% for dry state forms. A maximum compressive strength of 15.9 MPa was reached for 15% PCM mixtures, while values beyond 40 MPa were achieved for 5% PCM mixtures. Thus, the proposed study contributes to broad the available knowledge of PCM cement mortar mixtures behaviour and their mix design.     

Both aluminum and polyphenols in green tea decoction (<Emphasis Type="Italic">Camellia sinensis</Emphasis>) affect iron status and hematological parameters in rats

Background Green tea leaves naturally contain high levels of polyphenols and aluminum (Al). Polyphenols in green tea decoction are considered to be one of the major factors responsible of low iron status. However, the effects of Al from green tea decoction on iron status and hematological parameters remained unclear. Aim of the study The objective was to investigate the Al absorption from green tea decoction and studied its influence on iron status and hematological parameters in rats. Methods During the experiment period, rats were given the experimental diet + a simple dose of Al sulfate with or without graded doses of green tea decoction (25, 50 and 100 g/l). The Al absorption was evaluated in the serum; however, iron status was evaluated by the iron concentration in the liver, kidney, spleen and femur. In addition, the hemoglobin and hematocrit were evaluated. Results Our results showed that the serum Al significantly increased between 61.5 and 342%, as tea doses-dependant. The Al sulfate significantly decreased the reserve of iron in all studied organs between 21.7 and 17% (P < 0.05). In groups receiving green tea decoction alone or Al + graded doses of tea, the reserve of iron significantly decreased in all studied organs between 59.4 and 18.5% (P < 0.01). Al alone or associated with drinking doses of tea significantly decreased hemoglobin concentration between 23.6 and 9% (P < 0.05) and hematocrit between 12.7 and 7% (P < 0.01). Conclusion Our data showed that Al from green tea decoction was more absorbed in the serum than Al sulfate. Al absorption was associated with low iron status and reduction of hemoglobin and hematocrit. Considering that Al competes with iron in different stage of erythropoiesis including transferrin binding, so we could assume that the negative effect of tea on iron status arises not only from polyphenols iron complexes but also from Al released in tea decoction.