The association of intraprostatic calcifications and dosimetry parameters with biochemical control after permanent prostate implant

PurposeThe objective of this study was to evaluate the impact of intraprostatic calcifications (IC) on long-term tumor control in patients treated with permanent implant prostate brachytherapy (PIPB).Materials and MethodsData from 609 I-125 patients treated with PIPB were retrospectively reviewed. The presence of IC was determined by reviewing postimplant CT images. Doses delivered were determined using the Monte Carlo (model-based) calculations and the TG43 approach. Biochemical relapses at 7 and 10 years were determined according to Phoenix definition. Long-term biochemical relapse-free survival (bRFS) was determined using Kaplan–Meier estimates with log rank test. Cox proportional hazard models were used for analysis of predictor factors of biochemical recurrence.ResultsIC were observed for 11.1% of patients. Clinical stage, PSA, Gleason score, D'Amico risk group, and ADT use were comparable between IC and no IC groups. The 7- and 10-year bRFS for the entire cohort were 94.1% and 90.6%, respectively. The bRFS at 7 years was 90.5% (with IC) vs. 94.5% (without IC) (p = 0.198); the corresponding values at 10 years were 78.8% vs. 91.8% (p = 0.046). On Cox model, only prostatic calcifications were a significant risk factor for biochemical relapse (HR: 2.30, IC 95%: 1.05–5.00, p = 0.037; and HR: 3.94; IC 95%: 1.00–15.38; p = 0.049 for univariate and multivariate analysis, respectively).ConclusionThe presence of IC in patients treated with PIPB decreases V₁₀₀ and D₉₀ for postimplant Monte Carlo dosimetry (compared with TG43); correspondingly, IC are associated with a lower 10-y bRFS. Model-based dose calculations are critical to evaluate potential cold spots due to calcifications.     

Dietary α-linolenic acid-rich formula reduces adhesion molecules in rats with experimental colitis

ObjectiveThe ω-3 polyunsaturated fatty acid therapy in inflammatory bowel disease is focused on the effects on fish oil–derived polyunsaturated fatty acids. We speculated that a vegetal oil rich in α-linolenic acid (ALA) might also inhibit colitis. Therefore, we evaluated whether dietary ALA would decrease the expression of adhesion molecules by inducing the protective enzyme heme oxygenase-1 (HO-1) in a rat colitis model.MethodsColitis was induced at day 0 by an intrarectal injection of 2-4-6-trinitrobenzen sulfonic acid (TNBS), whereas control rats received the vehicle. Rats were fed an ALA-rich formula 450 mg · kg^?1 · d^?1, whereas the other colitic group (TNBS) and the control group were fed an isocaloric corn oil formula for 14 d (from day ?7 to day 7). The colonic expressions of intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), vascular endothelial growth factor A receptor-2 (VEGFR2), and HO-1 were studied by immunohistochemistry.ResultsThe ALA-rich diet significantly decreased the expression of ICAM-1, VCAM-1, and VEGFR-2 compared the TNBS group, but it did not affect the expression of HO-1.ConclusionA vegetal ALA-rich formula decreases the expression of ICAM-1, VCAM-1, and VEGFR-2 and independently of HO-1 in rats with TNBS-induced colitis. Further studies are required to evaluate its therapeutic potential in inflammatory bowel disease as an alternative to fish oil.     

Anti-inflammatory and anti-angiogenic effect of long chain n-3 polyunsaturated fatty acids in intestinal microvascular endothelium

Background & aims

The role of endothelial cells in inflammatory bowel disease has been recently emphasized. Endothelial activation and expression of adhesion molecules are critical for leukocytes recruitment into the inflammatory wall. Compelling evidence demonstrated anti-inflammatory effects of long chain n-3 PUFA in inflammatory models. We previously showed that long chain n-3 PUFA (EPA and DHA) inhibited inflammatory response in epithelial and dendritic cells. As long chain n-3 PUFA treatment led to a decreased expression of adhesion molecules in endothelial cells from other organs, we have now investigated their effect on intestinal endothelial cells in vitro and in colitic rats.

Methods

In vitro study: Primary culture of human intestinal microvascular endothelial cells (HIMEC) were pre-treated with DHA and then incubated with IL-1β. In vivo study: Colitis was induced in 2 groups at day0 by intrarectal injection of 2-4-6-trinitrobenzen sulfonic acid (TNBS). Rats received by gavage either fish oil, rich in EPA and DHA (TNBS+n-3) or an isocaloric isolipidic oil formula for 14 days.

Results

DHA led to a decreased VCAM-1, TLR4, cyclooxygenase-2 and VEGFR2 expression and a decreased production of IL-6, IL-8 and GM-CSF and a reduced production of PGE₂ and LTB₄ (p < 0.001) in IL-1β-induced HIMEC. Similarly, dietary intervention with fish oil rich in EPA and DHA significantly decreased colon production of PGE₂ and LTB_4, endothelial VCAM-1 and VEGFR2 in rats with colitis.

Conclusions

Data obtained from in vitro and in vivo studies reveal a potential anti-angiogenic role of long chain n-3 PUFA in intestinal endothelial cells. This protective effect of long chain n-3 PUFA may partly explain the observed benefit of dietary intake of long chain n-3 PUFA in IBD development.     

Alanyl-glutamine restores maternal deprivation-induced TLR4 levels in a rat neonatal model

Background & aims

Increased intestinal permeability of Irritable bowel syndrome (IBS) patients has been recently associated with a decreased level of glutamine synthetase. Neonatal maternal deprivation (NMD) is considered as an IBS-like model. The aim of our study was to investigate whether early nutritional intervention with glutamine may attenuate the deleterious impact of early life stress on gut barrier function in NMD.

Methods

124 rat pups were separated from their dam 3 h daily during postnatal days 2–14, or left undisturbed (NS). Separated rats received by gavage either with alanyl-glutamine (GLN), an isonitrogenous amino acid mix (AA, control) or an equal amount of drinking water (H₂O). Production of cytokines was measured by multiplex, expression of COX-2, PPARγ, tight junction proteins and TLR4 by western blot. Intestinal permeability was studied by Lactulose/Mannitol test.

Results

Treatment of pups with GLN or AA abolished the decrease in body weight observed in NMD. Treatment with GLN decreased in the colon (i) TLR4 expression at D20, (ii) IL-2 and -10 productions at D60 (iii) protein expression of occludin at D20 compared to AA. GLN also decreased colon expression of COX2 and PPARγ at D60 compared to NS. Colon production of IFNγ is significantly reduced by GLN compared to H₂O. No significant change in intestinal permeability was observed.

Conclusions

These results showed that an early nutritional intervention with alanyl-glutamine specifically abolished the up-regulation of TLR4 expression in NMD. Glutamine may be evaluated as a potential treatment for IBS patients.     

Surveillance of Viral Encephalitis in the Context of COVID-19: A One-Year Observational Study among Hospitalized Patients in Dakar,Senegal

The burden of encephalitis and its associated viral etiology is poorly described in Africa. Moreover, neurological manifestations of COVID-19 are increasingly reported in many countries, but less so in Africa. Our prospective study aimed to characterize the main viral etiologies of patients hospitalized for encephalitis in two hospitals in Dakar. From January to December 2021, all adult patients that met the inclusion criteria for clinical infectious encephalitis were enrolled. Cerebrospinal fluids, blood, and nasopharyngeal swabs were taken and tested for 27 viruses. During the study period, 122 patients were enrolled. Viral etiology was confirmed or probable in 27 patients (22.1%), with SARS-CoV-2 (n = 8), HSV-1 (n = 7), HHV-7 (n = 5), and EBV (n = 4) being the most detected viruses. Age groups 40–49 was more likely to be positive for at least one virus with an odds ratio of 7.7. The mortality was high among infected patients, with 11 (41%) deaths notified during hospitalization. Interestingly, SARS-CoV-2 was the most prevalent virus in hospitalized patients presenting with encephalitis. Our results reveal the crucial need to establish a country-wide surveillance of encephalitis in Senegal to estimate the burden of this disease in our population and implement strategies to improve care and reduce mortality.     

Cerebral venous thrombosis in a sub-saharan African country: A preliminary monocentric study of a 70 case series at the neurology department of Fann teaching hospital in Dakar – Senegal

IntroductionCerebral venous thrombosis (CVT) are underdiagnosed in sub-saharan Africa where publications are uncommon. Our study aim was to describe the CVT diagnostic and therapeutic features through a senegalese case series.Patients and methodA monocentric retrospective and prospective study was conducted at the adult Neurology department of Fann Teaching Hospital in Dakar (Senegal), between January 01, 2013 and April 30, 2020. It had included all CVT cases diagnosed by neurovascular imaging.ResultsSeventy CVT cases were collected including 48 women (68.6%). The average age of the patients was 35.2 ± 14 years. The main neurological signs were headache (92.8%) and motor deficit (41.4%), with subacute onset in 67.2% of cases. The superior sagittal sinus (54.3%) and the transverse sinus (38.6%) were the most affected with multiple involvements in 27 patients (38.6%). Thirty patients (42.8%) had indirect parenchymal signs such as venous infarction (15.7%), cerebral edema (11.4%) or intracerebral hemorrhage (12.8%). The etiological factors were mostly infectious (41.4%) with meningoencephalitis (12.8%) and otorhinolaryngological infection (10%). Gyneco-obstetric factors (27%) and Behçet's disease (7%) were the main aseptic factors. In the short-term clinical course, curative anticoagulation (98.6%) had enabled a favourable outcome (mRS 0-1) in half of the patients.ConclusionOur study, the largest series in sub-saharan Africa to this date, confirms that CVT is a young women disease. Infectious etiology is the most frequent at the Fann national teaching hospital (41.4% in Dakar against 6.5% in Germaine Bousser's series) even if the etiological assessment is limited by financial constraints (no coagulopathy/thrombophilia check-up).     

Hématome duodénal intramural suite à un surdosage aux AVK. Apport de la tomodensitomérie. A propos d’un cas

Spontaneous intramural duodenal hematoma is considered as a rare complication of anticoagulant therapy. We report the clinical case of a spontaneous duodenal hematoma at a patient 83 years old after VKA overdose diagnosed at CT scan.