Results of retrograde open mesenteric stenting for acute thrombotic mesenteric ischemia

Objective

Acute mesenteric ischemia (AMI) is an emergent event with a high mortality rate; survivors have high rates of intestinal failure. Restoration of blood flow using endovascular or surgical revascularization is associated with better outcome in terms of survival rate and intestinal resection. Retrograde open mesenteric stenting (ROMS), which is a hybrid technique, combines two benefits: prompt blood flow restoration with an endovascular approach and inspection and resection of the small bowel. The aim of the study was to assess the results of ROMS in thrombotic AMI in a retrospective multicenter study.

Vers un rapprochement du syndrome de Klinefelter et de la psychopathie en psychiatrie légale

Klinefelter syndrome (KS) (47,XXY) is the most common aneuploidy (1/650) of sexual chromosome among male (0,1 à 0,2 % of male population) (Hong and Reiss, 2014). Because its large physical phenotypic variability (high tall, sparse hairiness, gynecomastia), this syndrome is largely underdiagnosed (less than 25 % of affected persons) (Samango-Sprouse et al., 2018). Nevertheless, cognitive variability is smaller. Normal to low average total IQ, low verbal IQ, social problems and high levels of psychiatric comorbidities including early aggressiveness are commonly described (Hong and Reiss, 2014). In Denmark, higher risks of committing sexual crime and arson (compared to criminal controls) was recently reported (Stochholm et al., 2012). Quite a few clinically relevant cases reports scattered in the literature, suggests the presence of a pattern of a specific subtype of KS inpatients among forensic population (Bénézech, 1975). However, very few studies provide quantitative or qualitative pertaining to robust results. KS well-documented neurobiological (van Rijn, 2018) (e.g. low levels of testosterone), neuropsychological (Bénézech, 1975; Hong and Reiss, 2014; Samango-Sprouse et al., 2018; Savic, 2012; Seara-Cardoso et al., 2016; Senon, 2005; Stochholm et al., 2012; van Rijn, 2018; van Rijn et al., 2008; van Rijn et al., 2018; van Rijn et al., 2014; van Rijn et al., 2012) [29] (e.g. alterations of both complex cerebral — attention, empathy — and behavioral regulation functions - inhibition, mental flexibility, emotional response modulation, control of own actions) and neuroanatomical (Hong and Reiss, 2014; Itti et al., 2003; Savic, 2012; van Rijn et al., 2008; van Rijn et al., 2012) [29] (e.g. limbic system and temporal lobe abnormal volume, hemispheric specialization shortcoming) features may be helpful to understand comorbid symptoms psychopathology. Numbers of recent studies conduct on KS pediatric or adult population provide interesting results on conduct, anxiety, psychotic and autism spectrum disorders. In addition, some authors use genetic and epigenetic specific features of sex chromosome aneuploidies (e.g. X genes neurodevelopmental role; imprinting) in order to clarify genotype-phenotype links of comorbid symptoms (Bruining et al., 2011; Zitzmann et al., 2004;). With Belgian colleagues from the Social Defense Research Center (CRDS, Tournai, Belgium), we are currently recruiting KS inpatients from security hospitals or psychiatric units in Belgium and France. We aim to assess psychopathic traits with the Psychopathy Checklist Revised (PCL-R, Hare) (Hare, 2003). Our first results concerning 3 KS males outline that PCL-R is useful for the characterization of clinical phenotype among KS forensic sample. While three of them present psychopathic traits, two of them present categorical double diagnose “psychopathy-KS” (total PCL-R score > = 30/40 (Delannoy et al., 2017)). Moreover, dimensional analysis support our hypothesis of a higher prevalence of “explosive profile” in comparison to other psychopathic profiles in our sample (Delannoy et al., 2017). The present article summarizes historic background (e.g. “psychopathy” disappearance of mental disorder reference classification schemes, “crime chromosome” (Bénézech, 1975)) and current context argues (e.g. French psychiatrists court experts widely refer to psychopathy concept despite a lack of consensual definition (Senon, 2005), weak knowledge and training of PCL-R and its related biopsychological recent findings (Blair, 2013; de Oliveira-Souza et al., 2008; Dotterer et al., 2017; Glenn and Raine, 2014; Hosking et al., 2017; Korponay et al., 2017; Pham, 1995; Pham, 2005; Raine, 2008; Raine et al., 2003); stigma and discrimination apprehensions of KS and psychopath) that motivate our research project. Finally, we discuss the advantages of our research protocol on KS participants assessed with PCL-R, such as tackling stigma and discrimination, better understanding psychopathology, and clarifying murky interactions of biological, psychological and social factors entangled in the development of these two fascinating troubles.     

Successful heart transplantation after prolonged cardiac arrest and extracorporeal life support in organ donor–a case report

Previously designed intra-thoracic paraaortic counterpulsation device has limited stroke volume and may depress the lung to cause complications. The purpose of this study was to evaluate the hemodynamic effects of an extra-thoracic paraaortic counterpulsation device (ETPACD) in comparison to intraaortic balloon pump (IABP) in an animal model with acute heart failure. The acute heart failure model was successfully induced by snaring branch of anterior descending coronary artery in sheep (weighting, 38-50 kg, n = 8). The ETPACD is a single port, 65-ml stroke volume blood chamber designed to be connected to descending aorta through a valveless graft and placed extra-thorax. In comparison, a standard clinical 40-ml IABP was placed in the descending aorta. The hemodynamic indices of both devices were recorded during counterpulsation assistance. Two of the sheep were allowed to survive for 1 week to examine the prolonged effect. Both ETPACD and IABP increased cardiac output with higher effect of ETPACD (13.52 % vs. 8.19 % in IABP, P < 0.05) and on mean diastolic aortic pressure (26.73 % vs. 12.58 % in IABP, P < 0.01). Both ETPACD and IABP also produced a greater reduction in left ventricular end-diastolic pressure (26.77 % vs. 23.08 %, P > 0.05). The ETPACD increased left carotid artery flow more significantly the IABP (18.00 % vs. 9.19 % , P < 0.05). In two of the sheep allowed to survive for 1 week, the device worked well with no complications and there was no thrombus formation in the chamber of ETPACD. This study demonstrated that both ETPACD and IABP provided benefit of circulatory support in acute heart failure with better effect on hemodynamic parameters provided by ETPACD. Therefore, ETPACD with theoretical larger stroke volume may become a promising counterpulsation device for treatment of heart failure.     

Direct laser manipulation reveals the mechanics of cell contacts in vivo

Cell-generated forces produce a variety of tissue movements and tissue shape changes. The cytoskeletal elements that underlie these dynamics act at cell–cell and cell–ECM contacts to apply local forces on adhesive structures. In epithelia, force imbalance at cell contacts induces cell shape changes, such as apical constriction or polarized junction remodeling, driving tissue morphogenesis. The dynamics of these processes are well-characterized; however, the mechanical basis of cell shape changes is largely unknown because of a lack of mechanical measurements in vivo. We have developed an approach combining optical tweezers with light-sheet microscopy to probe the mechanical properties of epithelial cell junctions in the early Drosophila embryo. We show that optical trapping can efficiently deform cell–cell interfaces and measure tension at cell junctions, which is on the order of 100 pN. We show that tension at cell junctions equilibrates over a few seconds, a short timescale compared with the contractile events that drive morphogenetic movements. We also show that tension increases along cell interfaces during early tissue morphogenesis and becomes anisotropic as cells intercalate during germ-band extension. By performing pull-and-release experiments, we identify time-dependent properties of junctional mechanics consistent with a simple viscoelastic model. Integrating this constitutive law into a tissue-scale model, we predict quantitatively how local deformations propagate throughout the tissue.During the development of an organism, cells change their shape and remodel their contacts to give rise to a variety of tissue shapes. Analysis of tissue kinematics has revealed that epithelial tissue morphogenesis is partly controlled by actomyosin contractility. The spatiotemporal deployment and coordination of actomyosin contractility produce shrinkage and extension of cell surfaces and interfaces, which can drive tissue invagination, tissue folding, or tissue extension (1). Understanding the mechanical nature of these processes requires force measurements in vivo; however, measurements in developing epithelia are limited, and most methods have been indirect. They rely on either force inference from image analysis (2–4) or laser dissection experiments at cell (5, 6) or tissue scales (7, 8), which provide the relative magnitude and direction of stresses from cell or tissue shape changes. In contrast, mechanical approaches have been developed in recent years to impose or measure stresses of cells in contact, including cell monolayer micromanipulation (9), pipette microaspiration on cell doublets (10), and traction force microscopy on migrating epithelia (11) and single-cell doublets (12). Recently, an elegant method using deformable cell-sized oil microdroplets has provided absolute values of stresses at the cell level in cell cultures and embryonic mesenchymes (13) but not yet in live epithelia. In this context, we sought a direct in vivo method for tension measurements and mechanical characterization at cell contacts and developed an experimental approach combining optical tweezers with light-sheet microscopy.To probe epithelial mechanics in a live organism, we chose the early epithelium of the Drosophila embryo as a model system. It consists of a simple sheet of cells that spread over the yolk and are in contact with each other through E-cadherin–based adhesion. During early embryogenesis at the blastula stage just after the end of cellularization, epithelial cells have very similar hexagonal shapes, suggesting that cell junctions have similar mechanical properties and that the internal pressure of these cells is homogeneous. At the later gastrula stage, cells undergo shape changes at distinct regions in the embryo. On the ventral side of the embryo, apical cell constriction of a few rows of cells drives tissue invagination (14), whereas on the ventrolateral side of the embryo, cell intercalation, a process whereby cells exchange neighbors by polarized remodeling of their junctions, drives tissue extension. The latter morphogenetic movement is driven by an anisotropic distribution of Myosin-II (Myo-II), which is more concentrated along junctions aligned with the dorsal/ventral (D/V) axis (15). Laser dissection of cortical actomyosin networks at cell junctions in the ventrolateral tissue has shown that such an anisotropic distribution of Myo-II causes an anisotropic cortical tension (6). However, the absolute values of tensile forces have not yet been measured, and more generally, the mechanics of cell–cell interfaces in vivo are largely unknown. Here, we addressed this issue by analyzing local mechanical measurements at cell junctions during tissue morphogenesis and determining the contribution of Myo-II to tension in this context. We determined the time-dependent response of cell–cell interfaces to forced deflection and delineated a viscoelastic model of junctions. Finally, we explored the propagation of local forces within the epithelial tissue.     

Word onset phonetic properties and motor artifacts in speech production EEG recordings

Electrophysiological research using verbal response paradigms faces the problem of muscle artifacts that occur during speech production or in the period preceding articulation. In this context, this paper has two related aims. The first is to show how the nature of the first phoneme influences the alignment of the ERPs. The second is to further characterize the EEG signal around the onset of articulation, both in temporal and frequency domains. Participants were asked to name aloud pictures of common objects. We applied microstate analyses and time‐frequency transformations of ERPs locked to vocal onset to compare the EEG signal between voiced and unvoiced labial plosive word onset consonants. We found a delay of about 40 ms in the set of stable topographic patterns for /b/ relative to /p/ onset words. A similar shift was observed in the power increase of gamma oscillations (30–50 Hz), which had an earlier onset for /p/ trials (～150 ms before vocal onset). This 40‐ms shift is consistent with the length of the voiced proportion of the acoustic signal prior to the release of the closure in the vocal responses. These results demonstrate that phonetic features are an important parameter affecting response‐locked ERPs, and hence that the onset of the acoustic energy may not be an optimal trigger for synchronizing the EEG activity to the response in vocal paradigms. The indexes explored in this study provide a step forward in the characterization of muscle‐related artifacts in electrophysiological studies of speech and language production.     

Comparison between single-incision and conventional laparoscopic cholecystectomy: a prospective trial of the Club Coelio

Background

The aim of this study was to compare the outcomes of single-incision laparoscopic cholecystectomy (SILC) and conventional laparoscopic cholecystectomy (CLC).

Method

Patients’ inclusion criteria were uncomplicated gallstones, BMI ≤30, ASA score ≤2, and no past surgery in the upper abdomen. Five surgeons performed only SILC and seven only CLC. Data analyzed included operative time, morbidity, quality of life (QOL), cosmetic result, and global patient satisfaction. The last three parameters were evaluated 3 months after surgery. QOL was assessed with the Gastrointestinal Quality of Life Index (GIQLI) questionnaire. Cosmetic result and patient satisfaction were rated using a 5-grade Likert scale.

Results

This study included 104 patients operated on between April and June 2010. A SILC was performed in 35 patients and a CLC in 69. The preoperative characteristics of the two groups were similar. Median operative time for SILC was higher than that for CLC: 55 versus 40 min (p < 0.001). Postoperative complications (0 vs. 2) and postoperative GIQLI scores (123 ± 13 vs. 121 ± 18) were not significantly different between groups. Cosmetic result and patient satisfaction were better for SILC than for CLC. The percentages of results rated as excellent were 68 versus 37 % (p < 0.006) and 80 versus 57 % (p < 0.039), respectively. For the whole group, multivariate statistical analysis revealed that postoperative GIQLI score and cosmetic result were independent predictive factors of patient satisfaction. The percentages of satisfaction rated as excellent were greater in patients who had a postoperative GIQLI score ≥130 (92 vs. 49 %, odds ratio [OR] = 4, p < 0.001) and in patients who had an excellent cosmetic result (82 vs. 47 %, OR = 7, p < 0.001).

Conclusions

Compared to CLC, SILC is associated with a longer operative time, an equivalent morbidity and QOL, and a better cosmetic result. The improved aesthetic result also leads to a better global patient satisfaction.