Enquête ethnobotanique sur la <Emphasis Type="Italic">Ballota hirsuta</Emphasis> Benth à Sidi Bel Abbes (Algérie)

Our investigation, carried out into 2012, in Sidi Bel Abbes city and Tessala town (western Algeria), allowed to identify 11 pathologies to treat by the various parts of Ballota hirsuta Benth. The species studied is frequently used by the urban population of the city of Sidi Bel Abbes. The population of the two communities has classified as medicinal plant. The results of the survey showed that the leaves are the most used part then the other organs of the plant. Thespecies is used in most casesas cataplasm and powder, the powder is used more by men (6.4 to 9%) than women (6 to 8.4%). Use as cataplasm is higher or lower in men (11 to 20%) than women (10 to 18%). The most commonly treated by the plant diseases are studied contusion, injuries and rheumatic pain.     

Comparison between two computer-assisted total knee arthroplasty: gap-balancing versus measured resection technique

Two surgical strategies are possible in total knee arthroplasty (TKA): a measured resection technique, in which bone landmarks are used to guide resections equal to the distal and posterior thickness of the femoral component, or a gap-balancing approach, in which equal collateral ligament tension in flexion and extension is sought before and as a guide to final bone cuts. In this study performed with computer assisted system, we compared the 2 different methods in 126 patients followed prospectively in order to analyze the effect of both the techniques on joint-line (JL) maintenance, axial limb restoration and components position. The gap technique showed a statistical increase in the post-operative value when compared with the measured resection technique, (P = 0.008). When comparing the two groups regarding to the pre-operative deformity, we have found a statistical difference (P = 0.001) in case of moderate pre-operative deformity (less than 10°), and the measured resection technique showed a slight superiority in preserving a joint line more faithful to the pre-operative. We found an ideal alignment for the mechanical axis (180° ± 3°) (95% of cases). In six cases (5%), the mean post-operative value exceeded (varus or valgus) the ideal value by more than 3°. In the frontal plane, a good alignment was observed for both femoral and tibial components without a significant difference between the two techniques. In the sagittal plane was found more alignment variability due to the different implants used and their ideal starting slope, from 7° to 3°. Finally, the surgeon can use the approach with which he has more confidence; however, as the measured resection technique causes less reduction in the post-operative joint-line position, in case of shortening of patellar tendon or patella infera, this technique is preferable.     

High-dose chemotherapy in soft tissue sarcoma in children

Soft tissue sarcomas (STS) are highly malignant tumours that constitute 5-6% of all malignant childhood neoplasms. Of these, rhabdomyosarcoma (RMS) is the most common in children, and has a characteristic two-peak age incidence, 2-5 and 15-19 years. Most children with RMS are cured with conventional chemotherapy and local therapy (surgery with or without radiotherapy). Children with metastatic disease at presentation, particularly those older than 10 years or with bone marrow or bone involvement have a much poorer outcome. In this subgroup, high-dose therapy with stem cell rescue has been studied over the last two decades. Various single or multiagent chemotherapy regimens with or without radiotherapy and autologous stem cell rescue have been used as consolidation treatment with little success. Recent trials using sequential high-dose chemotherapy in the early phase of treatment have proved to be feasible, but the beneficial effect has to be confirmed. The role of purging remains unclear. Collaboration between different international groups is urgently required, in an attempt to improve the poor outcome of children with high risk STS.     

Incidence of antibodies to native and denatured cartilage collagens (types II, IX, and XI) and to type I collagen in rheumatoid arthritis.

The frequencies of antibodies to the cartilage type IX and XI collagens and to type I collagen were determined in 188 patients with rheumatoid arthritis, of whom 76 were positive for antibodies to native type II collagen. A higher proportion of patients with antibodies to native type II collagen had antibodies to these other collagens, but about one third of patients without antibodies to native type II collagen had antibodies to one or more denatured collagens. The patterns of antibodies present in individual sera suggested that there was a selective response to the collagens in an individual patient. The incidence of patients having antibodies to these native and denatured collagens in a random group of patients with rheumatoid arthritis was calculated.     

Costs and outcomes of patients admitted with chest pain and essentially normal electrocardiograms

Background: Although inroads have been made in the outpatient evaluation of chest pain, the majority of hospitals in the United States do not have chest pain centers and the direct costs associated with hospital admissions in low-risk patients is unknown. Hypothesis: The study was undertaken to evaluate the cost and outcomes of admission to the hospital for patients with acute chest pain and essentially normal electrocardiograms (ECGs). Methods: For that purpose, we reviewed 1,670 patients presenting to our emergency department with chest pain over a 5-month period in 1994. Of these, 567 [34.0%, confidence interval (CI) 95%, 31.7–36.3%] patients were considered to be low risk by ECG criteria alone. Results: Complete clinical and financial data were available in 445 cases of which 152 had a previous history of coronary artery disease (CAD) and 31 (7.0%, CI95%, 4.9-9.6%) were ultimately proven to have acute myocardial infarction (AMI). There were no deaths. All patients initially underwent noninvasive evaluation, and an additional 177 (39.8%) underwent subsequent cardiac catheterization. Of those, 107 (60.5%) had significant CAD (at least one vessel>70% stenosis). We assumed an expected mortality rate of 1% in the AMI group based on previously reported series with all the mortalities preventable by hospitalization. This yielded a valuation of $1.7 million dollars per life saved. Sensitivity analysis revealed the practice of admission and in-patient evaluation for this group of patients was cost ineffective at all assumption levels. Conclusion: The practice of hospital admission for patients with chest pain and essentially normal ECGs is not cost favorable, and all hospital facilities should consider outpatient chest pain evaluation strategies.     

Impact of severe ADAMTS13 deficiency on clinical presentation and outcomes in patients with thrombotic microangiopathies: the experience of the Harvard TMA Research Collaborative

The Harvard TMA Research Collaborative is a multi‐institutional registry‐based effort to study thrombotic microangiopathies (TMA). Laboratory and clinical parameters were recorded for 254 cases of suspected autoimmune thrombotic thrombocytopenic purpura (TTP). Patients with severe ADAMTS13 deficiency (activity ≤10%, N = 68) were more likely to be young, female and without a history of cancer treatment or transplantation. While all patients with severe deficiency were diagnosed with autoimmune TTP, those without severe deficiency frequently had disseminated intravascular coagulation, drug‐associated TMA and transplant‐related TMA. Patients with severe ADAMTS13 deficiency had superior overall survival at 360 d compared to those without severe deficiency (93·0% vs. 47·5%, P < 0·0001). Almost all patients with severe deficiency received therapeutic plasma exchange (TPE), but the use of TPE in patients with ADAMTS13 activity >10% varied significantly across the institutions in our consortium (13·2–63·8%, P < 0·0001). Nevertheless, 90‐d mortality was not different in patients with ADAMTS13 activity >10% between the three hospitals (P = 0·98). Our data show that patients with severe ADAMTS13 deficiency represent a clinically distinct cohort that responds well to TPE. In contrast, TMA without severe ADAMTS13 deficiency is associated with increased mortality that may not be influenced by TPE.