Is conservative treatment of HELLP syndrome safe?

HELLP syndrome is associated with a high rate of maternal and perinatal morbidity and mortality, and often leads to immediate fetal extraction. However, this condition may occur very early in pregnancy and conservative approaches have been recently proposed. The limits of this approach are discussed with two cases of conservative management of HELLP syndrome complicated by abruptio placentae.     

Radiation damage to triplex DNA induced by gamma-rays: a footprinting study and Monte Carlo simulation

PURPOSE: This study is aimed at comparing the radiosensitivity of a 21-mer DNA fragment in duplex and triplex form (Py x Pu duplex and Py x Pu:Py triplex) and to give insights into the fine structural features due to the different strandedness. MATERIALS AND METHODS: The triplex sample was characterized by means of electrophoretic mobility, circular dichroism spectra and UV melting experiments. Triplex and duplex, labelled on the homopyrimidine or homopurine strand, were irradiated with 60Co gamma-rays. The samples were analysed by sequencing gel electrophoresis and the patterns of relative probabilities of frank strand breakage (FSB) and alkali-revealed breakage (ARB) at each nucleotide site were determined. Relative probabilities of OH* radical attack to duplex and triplex DNA built up with a molecular modelling software were calculated using a previously reported simulation procedure (Sy et al. 1997). The experimental data were compared with the results of the theoretical simulations of OH* radical attack to DNA. RESULTS: Globally, the duplex is more attacked than the triplex, mainly in the Pu strand. Sequence-dependent variations of FSB and FSB+ARB probabilities in both duplex and triplex were revealed. No significant differences between the patterns of damage in the triplex and in the duplex were observed. CONCLUSIONS: The presence of the third Py strand located in the major groove of the DNA duplex modifies the total yields of radiation-induced DNA damage, but not the sequence-dependent patterns of relative probability of damage at each nucleotide site.     

Monoclonal antibody SPan-1 in the diagnosis of exocrine pancreatic adenocarcinoma

The great progress made in imaging techniques over the past few years has not resulted in an improvement in terms of earlier diagnosis of exocrine pancreatic cancer. The search for a non-invasive diagnostic tool, capable of yielding an early diagnosis, has led to the development of a series of serum tumour markers. This article discusses the clinical evaluation of SPan-1 and its comparison with established markers such as CA 19.9, CEA, TPA and CA 242. The markers were tested in preoperative serum samples collected from 46 patients operated on for ductal carcinoma of the pancreas, 20 patients with chronic pancreatitis and 23 patients with other digestive neoplasms. Sensitivity, specificity and diagnostic accuracy for pancreatic cancer were as follows: [table: see text] The antigenic determinant recognised by monoclonal antibody SPan-1 is high in sera of patients with exocrine pancreatic cancer. SPan-1 may be another useful, reliable serum marker in detecting this neoplasm, but this study indicates that SPan-1 does not greatly improve the diagnostic accuracy achieved with CA19.9.     

Impact de la protéine C-réactive (CRP) en microméthode sur la prise en charge des enfants fébriles aux urgences pédiatriques en Ile-de-France

OBJECTIVE: Fever is a common cause of children visits to emergency units. Clinical evaluation does not always eliminate a bacterial infection. Among blood markers, several publications showed the interest of CRP. This study was undertaken to evaluate correlation between two techniques of CRP, one by usual technique at the laboratory and the other by a rapid test, and to evaluate the impact of this rapid test for febrile children at the emergency room, when a hospitalization was not immediately decided. MATERIAL AND METHODS: The study was undertaken in 2004-2005 in eight emergency paediatric units in Ile-de-France concerning febrile children during two periods. In period A, children had at the same time a CRP dosage through two methods, whereas in period B, only a rapid CRP test was first managed. The test used was NycoCard CRP Single test (Progen Biotechnique). RESULTS: Between September 2004 and June 2005, 572 children were included, 268 in period A and 304 in period B. Comparison of CRP results by the two methods showed for 247 children (93%) a fairly good linear correlation (r: 0.929). Blood cell count was the most often prescribed test (99.4 vs 10.5%). Conversely to chest radiography, blood culture, fibrinogen and urinary test were significantly most frequent in period A. The average cost of the additional examinations was 2.6 times more important during the first period. Duration of children management in the units was approximately two times shorter when rapid CRP test was used (199.7+/-92.8 vs 103.5+/-98.6 min). CONCLUSION: This study shows the interest of rapid CRP test for febrile children in the emergency units, and has to be confirmed in ambulatory paediatric practice.     

Evolution of the technique and indications of mini-invasive surgery of cholelithiasis

BACKGROUND: A review of the experience with laparoscopic cholecystectomy to evaluate the impact of the efficacy, safety, and complications on the learning curve. Study design: Retrospective study. METHODS: Between 1993 and 1998, 415 patients, 123 males and 292 females, median age 52.1 years (range 23-96 years), with symptomatic cholelithiasis, underwent laparoscopic cholecystectomy. On the basis of different selection criteria and surgical techniques adopted, our experience was divided into two periods (93-95 and 96-98). RESULTS: The success rate was 89.4% (371 patients) with a conversion rate of 10.6% (44 patients). Overall complications rate was 2.9% (12 patients): 7 major complications (2 biliary tract injuries, 2 hemorrhages, 1 sub-phrenic abscess, 1 gastric perforation and 1 choleperitoneum) and 3 minor complications (1 biliary leakage and 2 wound infections) with 2 long-term sequela (umbilical site eventration). Median hospital stay was 3.3 days, 2.2 days for uncomplicated cases and 5.6 in those converted or complicated. Comparison between the two groups showed a conversion rate of 10.6 vs 10.4% (23 vs 21 patients), with a complication rate of 4.2% vs 2.2%. CONCLUSIONS: Laparoscopic cholecystectomy can be considered a safe and effective procedure for the treatment of simple or complicated cholelithiasis. French surgical technique seems to be easier in the management of acute cholecystitis or lithiasis occurring after acute pancreatitis. Specific training in laparoscopy surgery is mandatory to avoid major complications.     

Characterization of erenumab and rimegepant on calcitonin gene-related peptide induced responses in Xenopus Laevis oocytes expressing the calcitonin gene-related peptide receptor and the amylin-1 receptor

BackgroundThe clinical use of calcitonin gene-related peptide receptor (CGRP-R) antagonists and monoclonal antibodies against CGRP and CGRP-R has offered new treatment possibilities for migraine patients. CGRP activates both the CGRP-R and structurally related amylin 1 receptor (AMY₁-R). The relative effect of erenumab and the small-molecule CGRP-R antagonist, rimegepant, towards the CGRP-R and AMY-R needs to be further characterized.MethodsThe effect of CGRP and two CGRP-R antagonists were examined in Xenopus laevis oocytes expressing human CGRP-R, human AMY₁-R and their subunits.ResultsCGRP administered to receptor expressing oocytes induced a concentration-dependent increase in current with the order of potency CGRP-R> > AMY₁-R > calcitonin receptor (CTR). There was no effect on single components of the CGRP-R; calcitonin receptor-like receptor and receptor activity-modifying protein 1. Amylin was only effective on AMY₁-R and CTR. Inhibition potencies (pIC₅₀ values) for erenumab on CGRP induced currents were 10.86 and 9.35 for CGRP-R and AMY₁-R, respectively. Rimegepant inhibited CGRP induced currents with pIC₅₀ values of 11.30 and 9.91 for CGRP-R and AMY₁-R, respectively.ConclusionOur results demonstrate that erenumab and rimegepant are potent antagonists of CGRP-R and AMY₁-R with 32- and 25-times preference for the CGRP-R over the AMY₁-R, respectively. It is discussed if this difference in affinity between the two receptors is the likely reason why constipation is a common and serious adverse effect during CGRP-R antagonism but less so with CGRP binding antibodies.Supplementary InformationThe online version contains supplementary material available at 10.1186/s10194-022-01425-9.     

Functional implications of short‐term retinal detachment in porcine eyes: study by multifocal electroretinography

Purpose: The aim of the study was to determine the type and magnitude of detectable changes in pig multifocal electroretinography (mfERG) induced by the vitreoretinal surgical procedures necessary to gain access to the subretinal space. Methods: Twenty pigs underwent posterior segment surgery. Six animals had a vitrectomy (V), six had in addition a retinal bleb detachment (V + B); five had in addition a retinal diathermia on the bleb (V + B + D) and three received a retinotomy in the diathermized retinal area (V + B + D + R). mfERG evaluation was performed at baseline and 1 and 6 weeks postoperatively. Selected eyes were enucleated for histological evaluation. Results: The retinal detachments blebs all reattached spontaneously. All four surgical sequences resulted in slight, non‐significant changes in the mfERG peaks. A trend towards an amplitude reduction of the mfERG peaks N1, P1 and N2 were observed within the first postoperative week. After 6 weeks, all amplitudes had normalized. Of the implicit times only that of peak N1 (after retinal diathermia) was prolonged significantly at 1 week (P = 0.037). However, it returned to the preoperative level after 6 weeks. Histologically, the retinal detachment bleb was characterized by transient double layering of the retinal pigment epithelium (RPE) and loss photoreceptor outer segments. Conclusion: Access to the subretinal space in pigs can be gained without permanent detectable changes in the mfERG. A short‐term retinal detachment was found to cause only reversible electrophysiological and histological changes in the outer retina, which suggests that this procedure is tolerated well in the porcine retina. The size of the known destructive lesion (retinotomy) was too small to be detected, given the spatial resolution of the mfERG method applied. In the future, the presented protocol can be used to assess the functional outcome of surgery and transplantation in the subretinal space in pigs.     

Checklists for Assessing Skills of Children With Type 1 Diabetes on Insulin Injection Technique

Background:School-aged children often participate in type 1 diabetes (T1D) self-care tasks. Despite widespread discussion about the importance of developing self-care skills in childhood, few explain how the health care team should assess the skills of children with T1D when performing insulin injections.Objective:We sought to assess content validity evidence in two checklists regarding injection technique performed by children.Methods:Two checklists were designed based on a systematic review of the insulin injection technique. Experts in pediatric diabetes, health literacy, and diabetes education assessed the checklists regarding their clarity, objectivity, and relevance. Content validity was assessed using the content validity ratio (CVR).Results:Eleven providers (72% nurses or physicians, professional experience 19.4 ± 10.1 years, 45% of specialists in endocrinology, and 18% in pediatrics) participated in the assessment. Experts considered items containing the word homogeneity inappropriate. Items related to the needle insertion angle and the skin fold did not reach the CVR critical value. The final version of the checklist for syringe injection comprised 22 items with CVR = 0.91, and the checklist for pen injection comprised 18 items with CVR = 0.87.Conclusions:The checklists presented clear, objective, and relevant content that assesses the skills of children with T1D for insulin injection. The checklists formally present the order of the technique and all the steps for insulin injection and allow a quantitative assessment of the operational skills of children. The developed instruments offer providers the possibility of continuous assessment of the progress of the pediatric clientele until they reach independence in diabetes self-care.     

Oral hygiene, dentition, sexual habits and risk of oral cancer

In an Italian case-control study of oral cancer, number of missing teeth and other aspects of dental care were similar, but the general condition of the mouth, as indicated by gum bleeding, tartar deposits and mucosal irritation, was worse among oral cancer cases than controls. No differences were detected in sexual practices (including oral sex) and (previous) sexually transmitted infections.