Search

Abstract Introduction - L’objectif de cette étude est d’évaluer l’apport d’un accompagnementinfirmier codifié dans l’amélioration du contrôle du diabète chez des adolescentsen déséquilibre métabolique persistant.Patients et méthodes - Cette étude randomisée contrôlée a comparé 2 groupesd’adolescents âgés de 12 à 17 ans, atteints de DT1, ayant un taux d’HbA1c ? 9% et< 15%. Le groupe « A » a bénéficié des appels téléphoniques, toutes les 4 semainespar une infirmière, en alternance avec des visites mensuelles supervisées médicalement.Le groupe « B » a bénéficié des consultations toutes les 4 semaines.Résultats - Nous avons étudié 58 adolescents. A la fin de l’intervention de 5 mois,il y a eu une baisse de 3,41 points d’HbA1c pour le groupe A, de 2,96 points pour legroupe B (p=0,32) ; le pourcentage de patient avec un taux d’HbA1c au-dessous de7,5% était de 62,07% dans le groupe A et de 37,93% dans le groupe B (p=0,06). Aprèsl’intervention, il y a ré-ascension de l’HbA1c pour les 2 groupes.Conclusion - La prise en charge intensive à forte implication paramédicale faited’entretiens éducatifs et téléphoniques en complément des visites médicales habituelleschez des adolescents en déséquilibre persistant a entraîné l’amélioration del’équilibre glycémique à moyen terme. AbstractIntroduction - The objective of this study is to evaluate the contribution of codified nursing support in improving the diabetes control of adolescents with persistent me-tabolic imbalance.Patients and methods - This randomized controlled trial compared 2 groups of 12-17 year old adolescents with T1D, with HbA1c ≥ 9% and

Abstract Introduction / objectifs - Dans le diabète de type 1, la rémission partielle a uneffet bénéfique sur les complications aigues et chroniques. Notre objectif était dedécrire la rémission partielle et d’identifier ses facteurs prédictifs dans une cohorted’enfants et d’adolescents atteints de cette maladie.Patients et méthodes - Les enfants et adolescents âgés de moins de 15 ans, admisentre juin 2013 et juillet 2014, ayant débuté l’insulinothérapie moins d’un moisavant leur admission ont été inclus dans l’étude.Résultats - Cent-dix-sept (117) nouveaux cas ont été étudiés avec un sex-ratio de0,86, ont été analysés. A l’admission, l’âge moyen était de 8,2± 4,3 ans. L’acidocétoseinaugurale était présente dans 26 % des cas. La rémission (moins de 0,5 U/Kg/j d’insuline et HbA1c? 7,5%) a été obtenue chez 21 enfants, soit dans 17,95 %des cas avec une durée moyenne de 5,2 ± 4,2 mois (min. 3-max. 15). La rémissionétait significativement plus fréquente chez les enfants qui n’avaient pas présentéd’acidocétose inaugurale (p< 0,01), chez ceux qui n’avaient pas de germains atteintsde DT1 (p< 0,05) et chez les filles (p< 0,02). Il n’y avait pas de relation significativeavec le taux d’HbA1c à l’admission, le niveau d’instruction ou d’occupationmaternelle, l’origine géographique et l’âge.Conclusions - L’acidocétose au diagnostic est un facteur prédictif négatif de rémissionpartielle. L’absence de DT1 chez les germains et le sexe féminin sont desfacteurs prédictifs de rémission propres à notre contexte de travail. AbstractIntroduction /objectives - Partial remission, in type 1 diabetes, has beneficial ef-fects on acute and chronic complications. The aim of the study was to describe par-tial remission and identify its predictive factors in a cohort of children and adoles-cents with type 1 diabetes.Methods - Children and adolescents under 15 years, admitted between June 2013 and July 2014, having started insulin treatment within a month before admission were studied.Results - One hundred and seventeen new consecutive cases were analyzed. At ad-mission, sex ratio was 0.86, age was 8.2 ± 4.3 years (27%

Abstract Introduction - Le diabète chez l’enfant subit une mutation profonde en termes de fréquence et de recul de l’âge de début depuis une vingtaine d’années au niveau mondial. L’Algérie est particulièrement impactée par l’épidémie au point de figurer depuis 2016 dans le ‘top 10’ des pays à très forte incidence de diabète de type 1 (DT1). Notre étude a pour but de présenter l’évolution épidémiologique du DT1 de l’enfant à travers le registre de la wilaya d’Oran. Matériels et méthodes - La population de référence est celle de la wilaya d’Oran. Les nouveaux cas de DT1 proviennent des unités de première ligne et des services de pédiatrie. L’enregistrement était centralisé au niveau du service de pédiatrie «C» du CHU d’Oran depuis 1973 avec une exhaustivité proche de 100%. Résultats - Du 1er janvier 1973 au 31 décembre 2017, 2358 nouveaux cas de DT1 de moins de 15 ans au diagnostic du DT1 ont été enregistrés. L’incidence annuelle moyenne des moins de 15 ans des cinq dernières années 2013-2017 s’établit à 31,12± 3,60 cas pour 100 000 avec une évolution annuelle moyenne de 12,78% sur les 25 dernières années. Les évolutions annuelles moyennes des classes d’âge pédiatriques de [0-4], [5-9] ans et [10-14] ans sont de 15,03, 15,50 et de 9,10%, respectivement. L’incidence pour 1000 naissances vivantes des années 1998-2002 montre un risque de contracter un DT1 dans les 15 premières années de vie de 3,5 p. 1000. La prévalence était de 207 pour 100.000, soit 1 DT1 pour 482 enfants de moins de 15 ans, au 31 décembre 2017. Le sex-ratio s’établit à 0,99 pour l’ensemble des cas, mais subit des variations cycliques significatives avec des extrêmes de 0,80 et 1,14 (p=0,02). La saisonnalité hiver/été, significative de 1973 à 2014 en faveur des mois d’hiver, ne l’est plus à partir de 2015. Conclusion - L’augmentation persistante de l’incidence et le rajeunissement marqué de l’âge d’apparition du DT1 de l’enfant de la wilaya d’Oran sont une réalité depuis une vingtaine d’années. Cette évolution, liée essentiellement à l’environnement, ne va pas sans poser de nouvelles difficultés aux familles et aux équipes en charge. Abstract Introduction - Diabetes in children is undergoing a profound change in terms of fre-quency and decrease in age in the last twenty years worldwide. Algeria is particularly impacted by the epidemic to the point of appearing in the ‘top 10’ 2016 of countries with very high incidence of type 1 diabetes (T1D). Our study aims to present the epidemiological evolution of T1D in children through a recruitment of 45 years in the register of the department of Oran. Materials and Methods - The reference population is that of the department of Oran. New cases of T1D are children under 15 years old coming from front-line units and pediatric departments. Registration was centralized at the level of the «C» pediatric unit of Oran University Hospital since 1973 with an assessment close to 100%. Results - From January 1st, 1973 to December 31st, 2017, 2358 T1D new cases aged less than 15 years at T1D diagnosis have been registered. The average annual inci-dence under 15 years old for the last 5 years 2013-2017 is 31.12± 3.60 cases per 100 000 with an annual evolution average of 12.78% in the last 25 years. The annual evo-lution average of pediatric age groups are 15.03, 15.50 and 9.10%, respectively for children of [0-4], [5-9] and [10-14] years old. The incidence per 1 000 live births shows a risk of contracting T1D in the first 15 years of life of around 3.5. At December 31, 2017, the prevalence was 207 for 100 000 equivalent to 1 T1D for 482 children under 15,. The sex-ratio for all cases is 0.99 (1175 boys / 1183 girls), but undergoes cyclical variations with extremes of 0.80 and 1.14 between the periods 1978-1997 and 1998-2007 (p= 0.02). The winter/summer seasonality, significant from 1973 to 2014 in favor of winter months is no longer available starting from 2015. Conclusion - In agreement with other teams, we confirm the outsized increase in the incidence of T1D and the rejuvenation of the age at onset in children under 15 in our country. This evolution, mainly related to environmental problems poses new difficul-ties to families and teams in charge of the disease.

Abstract Introduction /objectifs - Les regroupements éducatifs pour adolescents atteints dediabète type 1 ont pour but, d’une part, d’offrir une détente à ces jeunes, de leurpermettre de se rencontrer et de partager leurs expériences et, d’autre part, defaire de l’éducation thérapeutique (ETP) de groupe dans le cadre des programmescontinus d’éducation.L’objectif de ce travail était d’évaluer l’efficacité de cette forme d’éducation thérapeutiquecontinue.Patients et méthodes - Soixante-dix-sept adolescents ont été évalués, avant etaprès chaque regroupement éducatif de 5 jours, sur l’hémoglobine glyquée (HbA1c),la connaissance du DT1, la qualité de vie, le vécu de la maladie, l’adhésion et l’autonomiethérapeutiques, et la perception de l’état de santé.Résultats - Les adolescents étaient âgés de 13,57±1,46 ans et scolarisés à 97%.L’HbA1c passe de 8,64±2,44% à l’inclusion avec 36,36% de valeurs au seuil ciblede 7,5% à 8,09±2,28% (p

Objective: To determine the frequency and etiology of Early Return Visits within 3 days of discharge to the Emergency Department. Study Design: Prospective longitudinal study. Place and Duration of Study: Emergency Department of Combined Military Hospital, Rawalpindi Pakistan, from Jan to Jun 2022. Methodology: All patients visiting the Emergency Department within the defined 6-month period were included in this study, which came to 101’113. To determine overall incidence of Early Return Visits, total number of patients revisiting within 72 hours of Emergency Department discharge was used. To find out the possible factors responsible for ERVs, a sample size of 80 patients revisiting the Emergency Department was calculated through World Health Organization calculator and selected through random sampling technique. Factors responsible for unscheduled Early Return Visits were divided into three broad categories: Doctor-associated, Disease-associated, and Patient-associated. Results: The total number of patients revisiting Emergency Department within 72 hours was 2,880 (2.9%). Out of these 52.5% patients reported back to the Emergency Department due to disease-associated reasons, 27.5% due to doctor-related reasons, and 20% revisited for patient-related reasons. Conclusion: Two-point nine percent patients made ERVs to the Emergency Department within 72 hours. The most common causes of Early Return Visits in this study are disease-related issues followed by doctor-related issues.

Intussusceptions of the small intestine in adults is very rare and represents only 1% of all cases of intestinal obstruction; this condition is rarely described in the literature. Surgery is the procedure of choice in most cases. We report a case of ileo-ileal intussusceptions secondary to a melanoma metastatic tumor, occurring 4 years after surgery for malignant melanoma of the cheek. The diagnosis of intussusception was confirmed by abdominal CT-Scan. However, only palliative surgery was feasible for this patient. At seven months after his surgery, the patient is alive and in good general condition. Intussusception in adults is the main clinical presentation indicative of intestinal metastasis from malignant melanoma. After our review of the literature, it seems that this complication occurs mainly in male patients and the site of predilection for this metastasis is the jejunum.

Introduction. Obesity has become one of the most prevalent nutritional disor-ders, characterized by excess adipose tissue with physical and psychosocial conse-quences, affecting negatively quality of life. Objectives. To study the diet quality and identify eating disorders (TCA) in a pediatric population suffering from overweight. Population and methods. Thirty patients (16 girls/14 boys), aged 5 to 17 years, were recruited from the Pediatric Department of Oran University Hospital. Anthropometric parameters were measured. Physical activity level as well as diet quality by the KIDMED index were evaluated. The Binge Eating Scale (ADO-BED), and the Child-Three Factor Eating Questionnaire (CTFEQ) were used to identify possible eating disorders. Results. Obesity was noted in 77% of the pediatric population, while 23% were overweight. Only 40% of patients practiced sporting activity, while 60% had sedentary behavior on weekends. The KIDMED score calculation showed low adherence to the Mediterranean diet (RM), in 83% of the population. Although the ADO-BED questionnaire indicated a low risk of binge episodes in 97% of patients, CTFEQ data revealed that 67% had signs of loss of eating control, 7% had cognitive restriction, and 7% had emotional eating. Conclusion. Poor dietary habits, associated with sedentary lifestyle, are observed in the studied overweight pediatric population. These results highlight the need for nutritional intervention and psychological care for these patients. [Introduction. L'obésité est devenue l'un des troubles nutritionnels les plus répandus, caractérisé par un excès de tissu adipeux avec des conséquences physiques et psychosociales, affectant négativement la qualité de vie. Objectif. Etudier la qualité de l’alimentation et identifier les troubles des conduites alimentaires (TCA) chez une population pédiatrique, souffrant de surcharge pondérale. Population et méthodes. Trente patients (16 filles/14 garçons), âgés de 5 à 17 ans, ont été recrutés au niveau du Service de Pédiatrie du CHU d’Oran. Les paramètres anthropométriques ont été mesurés. Le niveau d'activité physique (NAP) ainsi que la qualité de l'alimentation par l’indice KIDMED ont été évalués. Le Binge Eating Scale (ADO-BED) et le Child-Three Factor Eating Questionnaire (CTFEQ) ont été utilisés afin d’identifier d’éventuels TCA. Résultats. L'obésité était observée chez 77% de la population pédiatrique, alors que 23% présentaient un surpoids. Seuls 40% des patients pratiquaient une activité sportive, tandis que 60% avaient un comportement sédentaire le week-end. Le calcul du score KIDMED a montré une adhésion faible au régime méditerranéen (RM) chez 83% de la population. Bien que le questionnaire ADO-BED ait indiqué un faible risque d'épisodes hyperphagiques chez 97% des patients, les données du CTFEQ ont révélé que 67% présentaient des signes de perte de contrôle alimentaire, 7% une restriction cognitive, et 7% une alimentation émotionnelle. Conclusion. De mauvaises habitudes alimentaires, associées à un mode de vie sédentaire, sont observées chez la population pédiatrique en surcharge pondérale. Ces résultats soulignent la nécessité d'une intervention nutri-tionnelle et d'une prise en charge psychologique pour ces patients.]

It is uncommon to observe a nonunion of an isolated ulnar shaft fracture after surgical treatment; therefore, complications due to this nonunion are very rare. Adults are more likely to develop nonunions compared to children. We report the case of a 34-year-old man, who had a left ulnar shaft fracture, treated with a screwed plate. Four months later, a septic nonunion occurred causing a type 3 Monteggia equivalent lesion with a lateral dislocation of the radial head. We describe the consecutive methods of treatment that resulted in complete bone consolidation. The case report aims to underline the diagnostic particularities and the therapeutic challenges of this rare complication.

Face transplantation became a reality with the first case performed in 2005. Facial tissue allograft procurement is technically complex and time-intensive. Brain-dead deceased donors are frequently, if not always, multiorgan donors. Every effort should be made during face allograft recovery to minimize any risk to the recovery of lifesaving solid organs. Some programs require the procurement of a myofascial vascularized skin graft to function as a sentinel flap allowing frequent monitoring for rejection without negatively impacting the esthetics of the face graft. Up till now, the flap used has been the radial forearm flap. Procuring the radial forearm flap places the procuring team in close proximity to the head and torso, where the face recovery and the solid organ recovery teams would require unhindered access. Here, we present the posterior tibial artery flap as an alternative flap that would provide benefits to the coordination of the multiple teams working to procure organs from a deceased donor.

Abstract Robot-assisted partial nephrectomy (RAPN) is the standard of care for small, localized kidney tumors. This surgery is conducted within a short hospital stay and can even be performed as outpatient surgery in selected patients. In order to allow early rehabilitation of patients, an optimal control of postoperative pain is necessary. High-pressure pneumoperitoneum during surgery seems to be the source of significant pain during the first hours postoperatively. Our study is a prospective, randomized, multicenter, controlled study which aims to compare post-operative pain at 24 h between patients undergoing RAPN at low insufflation pressure (7 mmHg) and those operated on at standard pressure (12 mmHg) using the AirSeal system. This trial is registered in the US National Library of Medicine Trial Registry (NCT number: NCT05404685).

The construction industry presents significant high risks of injury and fatality to its workforce. Adopting prevention through design (PtD) principles is reported to have high potential for mitigating such risks and improving safety outcomes. PtD seeks to assess and reduce workplace hazards during the design phase, minimizing unsafe construction conditions. Despite its potential benefits, the construction industry encounters challenges in effectively utilizing PtD. Thus, the implementation of PtD in the US construction industry is limited, and designers’ awareness remains low. This evident lack of utilization warrants further examination of the contributing factors. The goal of this study is to identify and rank PtD utilization barriers in the United States (US) construction industry. This study pinpointed 12 pivotal barriers to PtD implementation through a systematic literature review. These barriers were categorized into industry-, project-, designer-, and client-related domains. Furthermore, they were grouped into three clusters based on their influence on PtD implementation from the most to the least influence, based on an expert matter questionnaire. This study also compared the experts’ rankings of the identified barriers with their citation frequencies in the reviewed articles. Among other observations, this study found that the lack of PtD professional training and formal education for project stakeholders negatively impacts the likelihood of PtD utilization and exacerbates several other barriers. Therefore, it is advisable to prioritize addressing this barrier by allocating the necessary resources and efforts to efficiently address it. Construction industry stakeholders with a vested interest in advancing PtD applications are encouraged to leverage the insights this study provides to expedite the adoption of PtD.

Abstract Background CRISPR/Cas9 editing systems are currently used to generate mutations in a particular gene to mimic a genetic disorder in vitro. Such “disease in a dish” models based on human pluripotent stem cells (hPSCs) offer the opportunity to have access to virtually all cell types of the human body. However, the generation of mutated hPSCs remains fastidious. Current CRISPR/Cas9 editing approaches lead to a mixed cell population containing simultaneously non-edited and a variety of edited cells. These edited hPSCs need therefore to be isolated through manual dilution cloning, which is time-consuming, labor intensive and tedious. Methods Following CRISPR/Cas9 edition, we obtained a mixed cell population with various edited cells. We then used a semi-automated robotic platform to isolate single cell-derived clones. Results We optimized CRISPR/Cas9 editing to knock out a representative gene and developed a semi-automated method for the clonal isolation of edited hPSCs. This method is faster and more reliable than current manual approaches. Conclusions This novel method of hPSC clonal isolation will greatly improve and upscale the generation of edited hPSCs required for downstream applications including disease modeling and drug screening. Graphical Abstract

Objective: To compare the effects of intravenous (IV) Paracetamol and intravenous (IV) Ketorolac in pain management of patients with renal colic presenting to the emergency department (ED). Study Design: Quasi-experimental study. Place and Duration of Study: Emergency Department, Combined Military Hospital, Rawalpindi Pakistan, from Jan to Jul 2021. Methodology: Eighty patients were included in the study who were selected and divided into two groups, one receiving Paracetamol 1 g intravenous (PC-Group) and the other receiving Ketorolac 30 mg IV (KET-Group). Their effect was compared using differences in visual analogue scale (VAS) before and after giving analgesia. Record of vital signs pre and post-drug administration, adverse effects and need for rescue analgesia was maintained (Nalbuphine). If further analgesia was required, 100 mg intravenous was used as the rescue drug. Results: Ketorolac (KET) Group had a mean age of 37.60±14.56 years, while the Paracetamol (PC) Group had a mean age of 43.2 ± 16.05 years. There was no statistically significant difference in the reduction of pain intensity after giving the drug in the respective study Groups (p=0.09). Adverse effects (p=0.17) and the need for rescue analgesia (p=0.34) were also comparable between the two Groups. Conclusion: The use of either intravenous-PC or intravenous-KET in patients with renal colic had similar analgesic effects with no significant difference in side effects and need for rescue analgesia.

Objective: To compare the “HEART (History, ECG, Age, Risk factors, Troponin), GRACE (Global Registry of Acute Coronary Events), and TIMI (Thrombolysis in Myocardial Infarction)” scores in predicting major adverse cardiac events (MACE) in patients reporting with undifferentiated cardiac chest pain to the Emergency Department (ED). Study Design: Cross-sectional validation study Duration and place of Study: Emergency Department, Combined Military Hospital, Rawalpindi Pakistan, from Jan to Jun 2021. Methodology: Two hundred and thirty-seven adult patients with atraumatic cardiac-like chest pain and non-diagnostic electrocardiogram (ECG) reporting to the ED were included in the study. HEART, GRACE and TIMI scores were calculated from the data. The number of patients with low risk was identified by each score and compared at a fixed safety level of minimum 95% sensitivity. The potential occurrence of MACE was confirmed using a telephonic follow-up six weeks after the presentation. Results: At an absolute safety level of minimum 95% sensitivity, the HEART score determined 101 patients as “low-risk” with 1.98% MACE missed. The GRACE score identified 49 “low-risk” patients with 4.08% MACE missed, and the TIMI score identified 66 “low-risk” patients with 3.03% MACE missed. Conclusion: Among the three scores under comparison, the HEART score performed better than the GRACE and TIMI scores at the same safety level and surpassed them in differentiating between those with MACE and without MACE.

Background and Objectives: To analyze the patient outcome and complication rate of axillary artery cannulation for veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in patients who could not be weaned from cardiopulmonary bypass after cardiothoracic surgery. Materials and Methods: We analyzed the data of 179 patients who were supported with VA-ECMO with femoral–axillary access (FA VA-ECMO) after cardiothoracic surgery between January 2014 and January 2019 in our department. Patients requiring central aortic cannulation and patients with respiratory failure requiring veno-venous ECMO were excluded. Primary outcomes were in-hospital mortality and 1-year survival rate of patients who were weaned from VA-ECMO support. Secondary outcomes were cannulation-related complications at the axillary site, VA-ECMO-related complications, and systemic complications. Results: In our cohort, 60 (33.5%) patients were female. Mean age was 67.0 ± 10.9 years. Overall, 78 (43.5%) patients were operated upon electively, 37 (20.7%) patients underwent urgent surgery, and 64 (35.8%) patients underwent emergency surgical treatment. Sixty-seven patients (37.4%) were resuscitated preoperatively. The mean duration of VA-ECMO support was 8.4 ± 5.1 days. Weaning from VA-ECMO was successful in 87 (48.6%) patients; 62 (34.6%) patients survived the hospital stay. The 1-year survival rate was 74%. Subclavian bleeding occurred in 24 (13.4%) patients, femoral bleeding in 4 (2.2%) patients, ischemia of the upper limb in 11 (6.1%) patients, intracerebral bleeding in 9 (5%) patients, and stroke in 19 (10.6%) patients. Conclusions: In patients with acute LV dysfunction after cardiothoracic surgery who cannot be weaned from cardiopulmonary bypass, right axillary artery cannulation is a safe and reliable method for VA-ECMO support with an acceptable complication rate.

Introduction Celiac disease (CD) is an enteropathy that requires a gluten-free diet (GFD), a restriction often generating nutritional imbalances Objective. to assess the nutritional status of a pediatric CD population. Population and methods. Among 84 CD patients recruited, 64 were retained (37 F/27M) and aged 1-

Deep learning (DL), often called artificial intelligence (AI), has been increasingly used in Pathology thanks to the use of scanners to digitize slides which allow us to visualize them on monitors and process them with AI algorithms. Many articles have focused on DL applied to prostate cancer (PCa). This systematic review explains the DL applications and their performances for PCa in digital pathology. Article research was performed using PubMed and Embase to collect relevant articles. A Risk of Bias (RoB) was assessed with an adaptation of the QUADAS-2 tool. Out of the 77 included studies, eight focused on pre-processing tasks such as quality assessment or staining normalization. Most articles (n = 53) focused on diagnosis tasks like cancer detection or Gleason grading. Fifteen articles focused on prediction tasks, such as recurrence prediction or genomic correlations. Best performances were reached for cancer detection with an Area Under the Curve (AUC) up to 0.99 with algorithms already available for routine diagnosis. A few biases outlined by the RoB analysis are often found in these articles, such as the lack of external validation. This review was registered on PROSPERO under CRD42023418661.

Abstract Over recent decades, gene therapy, which has enabled the treatment of several incurable diseases, has undergone a veritable revolution. Cell therapy has also seen major advances in the treatment of various diseases, particularly through the use of adult stem cells (ASCs). The combination of gene and cell therapy (GCT) has opened up new opportunities to improve advanced therapy medicinal products for the treatment of several diseases. Despite the considerable potential of GCT, the use of retroviral vectors has major limitations with regard to oncogene transactivation and the lack of physiological expression. Recently, gene therapists have focused on genome editing (GE) technologies as an alternative strategy. In this review, we discuss the potential benefits of using GE technologies to improve GCT approaches based on ASCs. We will begin with a brief summary of different GE platforms and techniques and will then focus on key therapeutic approaches that have been successfully used to treat diseases in animal models. Finally, we discuss whether ASC GE could become a real alternative to retroviral vectors in a GCT setting.

Introduction /objectives - Partial remission, in type 1 diabetes, has beneficial effects on acute and chronic complications. The aim of the study was to describe partial remission and identify its predictive factors in a cohort of children and adolescents with type 1 diabetes. Methods - Children and adolescents under 15 years, admitted between June 2013 and July 2014, having started insulin treatment within a month before admission were studied. Results - One hundred and seventeen new consecutive cases were analyzed. At admission, sex ratio was 0.86, age was 8.2 ± 4.3 years (27%

Background - The goal of the educational groups for adolescents with type 1 diabetes (T1D) is to offer a relaxation to these young people, to allow them to meet each other and share their experiences and, on the other hand, to practice group education as ongoing education programs. The purpose of this work was to evaluate the effectiveness of this kind of continuing education. Methods - Seventy-seven adolescents with T1D were assessed, before and after a 5-day educational program, on HbA1c, knowledge of T1D, quality of life, experience of the disease, therapeutic adherence and autonomy, and the perception of their health status. Results - Adolescents were aged 13.57 ± 1.46 years. HbA1c decreased from 8.64 ± 2.44% at baseline with 36.36% at the target threshold of 7.5%; to 8.09 ± 2.28% (p

Introduction - The objective of this study is to evaluate the contribution of codified nursing support in improving the diabetes control of adolescents with persistent metabolic imbalance. Patients and methods - This randomized controlled trial compared 2 groups of 12-17 year old adolescents with T1D, with HbA1c ≥ 9% and

IntroductionPlasma free hemoglobin is the gold standard for monitoring hemolysis in extracorporeal membrane oxygenation (ECMO) but its routine use has some limitations. Carboxyhemoglobin (HbCO) is also a marker of intravascular hemolysis. We aimed to investigate HbCO as a marker of both hemolysis and oxygenator dysfunction in patients supported by ECMO.MethodsRetrospective analysis of patients on ECMO in an adult ICU in a tertiary hospital. HbCO was recorded every 6 h in the 48 h before and after oxygenator change in adult patients on ECMO support with an oxygenator dysfunction and replacement.ResultsThe investigation of 27 oxygenators replacements in 19 patients demonstrated that HbCO values progressively increased over time and then significantly decreased after oxygenator change. Median oxygenator lifespan was 14 days [interquartile range (IQR) 8–21] and there was no correlation between HbCO and oxygenator lifespan [Spearman coefficient 0.23 (p = 0.23)]. HbCO values at oxygenator change [HbCO median 2.7 (IQR 2.5–3.5)] were significantly higher than the HbCO values 1 week before [HbCO median 2.07 (IQR 1.86–2.8)] (p value < 0.001).ConclusionOur data highlight the potential role of HbCO as a novel marker for ECMO oxygenator dysfunction.

Pulmonary emphysema is characterized by the destruction of alveolar septa and irreversible airflow limitation. Cigarette smoking is the primary cause of this disease development. It induces oxidative stress and disturbs lung physiology and tissue homeostasis. Alveolar type II (ATII) cells have stem cell potential and can repair the denuded epithelium after injury; however, their dysfunction is evident in emphysema. There is no effective treatment available for this disease. Challenges in this field involve the large complexity of lung pathophysiological processes and gaps in our knowledge on the mechanisms of emphysema progression. It implicates dysregulation of various signaling pathways, including aberrant inflammatory and oxidative responses, defective antioxidant defense system, surfactant dysfunction, altered proteostasis, disrupted circadian rhythms, mitochondrial damage, increased cell senescence, apoptosis, and abnormal proliferation and differentiation. Also, genetic predispositions are involved in this disease development. Here, we comprehensively review studies regarding dysregulated cell signaling, especially in ATII cells, and their contribution to alveolar wall destruction in emphysema. Relevant preclinical and clinical interventions are also described.

In Mali, hepatocellular carcinoma (HCC) is the third and sixth most common cancer in men and women, respectively. Mali comprises several distinct climato-ecological zones. Most studies to date have been conducted in the sub-Sahelian zone of southern Mali, including the capital city Bamako. In this part of the country, the main risk factors for HCC are chronic hepatitis B virus (HBV) carriage and dietary exposure to aflatoxins, a well-known hepatocarcinogen. Data are scarce for other ecological zones, but our preliminary data from 721 blood donors in the area of Timbuktu, presented in this study, suggest that chronic HBV carriage is also endemic in the northern Saharan zone of Mali. For further study, 29 healthy HBV chronic carrier volunteers were recruited from the blood transfusion center in Timbuktu. Successful viral genotyping in 20 volunteers revealed HBV genotype E in 13 cases and D in 7 cases, suggesting that this geographical and anthropological transition zone may also represent a transition zone between HBV genotypes that dominate sub-Saharan and northern Africa, respectively. Sequencing of circulating cell-free plasma DNA (cfDNA) from donors did not reveal the presence of the TP53 R249S mutation in these donors, a marker of dietary exposure to aflatoxins in sub-Saharan Africa. These results suggest that the geo-epidemiological distribution of the risk factors for HCC is not uniform across Mali, but is dependent upon climatic, socioeconomic and anthropological factors that might have an impact on patterns of chronic liver disease and cancer.

Background: Cigarette smoke is the main risk factor of pulmonary emphysema development, which is characterized by alveolar wall destruction. Mitochondria are important for alveolar type II (ATII) cell metabolism due to ATP generation. Methods: We isolated ATII cells from control non-smoker and smoker organ donors, and after lung transplant of patients with emphysema to determine mitochondrial function, dynamics and mitochondrial (mt) DNA damage. Findings: We found high mitochondrial superoxide generation and mtDNA damage in ATII cells in emphysema. This correlated with decreased mtDNA amount. We also detected high TOP1-cc and low TDP1 levels in mitochondria in ATII cells in emphysema. This contributed to the decreased resolution of TOP1-cc leading to accumulation of mtDNA damage and mitochondrial dysfunction. Moreover, we used lung tissue obtained from areas with mild and severe emphysema from the same patients. We found a correlation between the impaired fusion and fission as indicated by low MFN1, OPA1, FIS1, and p-DRP1 levels and this disease severity. We detected lower TDP1 expression in severe compared to mild emphysema. Interpretation: We found high DNA damage and impairment of DNA damage repair in mitochondria in ATII cells isolated from emphysema patients, which contribute to abnormal mitochondrial dynamics. Our findings provide molecular mechanisms of mitochondrial dysfunction in this disease. Fund: This work was supported by National Institutes of Health (NIH) grant R01 HL118171 (B.K.) and the Catalyst Award from the American Lung Association (K.B.). Keywords: COPD, Emphysema, Lung, DNA damage, Alveolar type II cells, Mitochondria

Angiotensin converting enzyme 2 (ACE2) seems to be a central actor in the pathophysiology of SARS-Cov-2 infection. First, it acts as the receptor for the virus and permits its attachment to cells expressing ACE2. Second, the relative deficiency of ACE2 during infection could be linked to several clinical features encountered during the disease, like ARDS and coagulation abnormalities. This study explores the strong link between ACE2 and the majority of risk factors for the severe evolution of COVID-19. It seems that all these risks factors are linked to an increased level of ACE2 and/or imbalance in ACE/ACE2.

Summary: Photoreceptor degenerative diseases are a major cause of blindness for which cell replacement is one of the most encouraging strategies. For stem cell-based therapy using human induced pluripotent stem cells (hiPSCs), it is crucial to obtain a homogenous photoreceptor cell population. We confirmed that the cell surface antigen CD73 is exclusively expressed in hiPSC-derived photoreceptors by generating a fluorescent cone rod homeobox (Crx) reporter hiPSC line using CRISPR/Cas9 genome editing. We demonstrated that CD73 targeting by magnetic-activated cell sorting (MACS) is an effective strategy to separate a safe population of transplantable photoreceptors. CD73+ photoreceptor precursors can be isolated in large numbers and transplanted into rat eyes, showing capacity to survive and mature in close proximity to host inner retina of a model of photoreceptor degeneration. These data demonstrate that CD73+ photoreceptor precursors hold great promise for a future safe clinical translation. : Gagliardi and colleagues show the possibility of isolating a homogeneous and functional population of photoreceptors from human induced pluripotent stem cells by targeting of a single surface antigen, CD73. Transplanted human cells are able to be incorporated into a host retina, generating mostly cone photoreceptors. Keywords: retina, photoreceptor, organoids, cell sorting, neurodegeneration, transplantation, iPSC, cell therapy

Abstract Background Traumatic injury is the fourth leading cause of death globally. Half of all trauma deaths are due to bleeding and most of these will occur within 6 h of injury. Haemorrhagic shock following injury has been shown to induce a clotting dysfunction within minutes, and this early trauma-induced coagulopathy (TIC) may exacerbate bleeding and is associated with higher mortality and morbidity. In spite of improved resuscitation strategies over the last decade, current transfusion therapy still fails to correct TIC during ongoing haemorrhage and evidence for the optimal management of bleeding trauma patients is lacking. Recent publications describe increasing the use of Viscoelastic Haemostatic Assays (VHAs) in trauma haemorrhage; however, there is insufficient evidence to support their superiority to conventional coagulation tests (CCTs). Methods/design This multicentre, randomised controlled study will compare the haemostatic effect of an evidence-based VHA-guided versus an optimised CCT-guided transfusion algorithm in haemorrhaging trauma patients. A total of 392 adult trauma patients will be enrolled at major trauma centres. Participants will be eligible if they present with clinical signs of haemorrhagic shock, activate the local massive haemorrhage protocol and initiate first blood transfusion. Enrolled patients will be block randomised per centre to either VHA-guided or CCT-guided transfusion therapy in addition to that therapy delivered as part of standard care, until haemostasis is achieved. Patients will be followed until discharge or 28 days. The primary endpoint is the proportion of subjects alive and free of massive transfusion (less than 10 units of red blood cells) at 24 h. Secondary outcomes include the effect of CCT- versus VHA-guided therapy on organ failure, total hospital and intensive care lengths of stay, health care resources needed and mortality. Surviving patients will be asked to complete a quality of life questionnaire (EuroQol EQ-5DTM) at day 90. Discussion CCTs have traditionally been used to detect TIC and monitor response to treatment in traumatic major haemorrhage. The use of VHAs is increasing, but limited evidence exists to support the superiority of these technologies (or comparatively) for patient-centred outcomes. This knowledge gap will be addressed by this trial. Trial registration ClinicalTrials.gov, ID: NCT02593877 . Registered on 15 October 2015. Trial sponsor Queen Mary University of London The contact person of the above sponsor organisation is: Dr. Sally Burtles, Director of Research Services and Business Development, Joint Research Management Office, QM Innovation Building, 5 Walden Street, London E1 2EF; phone: 020 7882 7260; Email: sponsorsrep@bartshealth.nhs.uk Trial sites Academic Medical Centre, Amsterdam, The Netherlands Kliniken der Stadt Köln gGmbH, Cologne, Germany Rigshospitalet (Copenhagen University Hospital), Copenhagen, Denmark John Radcliff Hospital, Oxford, United Kingdom Oslo University Hospital, Oslo, Norway The Royal London Hospital, London, United Kingdom Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, United Kingdom Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom Sites that are planning to start recruitment in mid/late 2017 Nottingham University Hospitals, Queen’s Medical Centre, Nottingham, United Kingdom University of Kansas Hospital (UKH), Kansas City, MO, USA Protocol version: 3.0/14.03.2017 (Additional file 1)

Objective: Hepatitis E virus (HEV) has been scarcely investigated in the Indian Ocean. Following a nationwide serosurvey among blood donors, we conducted a population-based serosurvey to assess the magnitude of HEV exposure on Reunion Island. Methods: Four hundred and sixty-six archived frozen human sera from the 2009 CoPanFlu-RUN cohort were analysed using the Wantai HEV IgG enzyme immunoassay. HEV seropositivity was defined as an IgG titre ≥5 UI/ml. Raw and weighted seroprevalences were assessed to account for the discrepancy between the CoPanFlu-RUN subset and the general community. Prevalence proportion ratios (PPR) were measured using log-binomial models. Results: The raw and the weighted seroprevalences of HEV were 9.01% (95% CI 6.41–11.61) and 6.73% (95% CI 4.47–8.98), respectively. The presence of HEV IgG antibodies was associated with increasing age (P

Introduction - Diabetes in children is undergoing a profound change in terms of frequency and decrease in age in the last twenty years worldwide. Algeria is particularly impacted by the epidemic to the point of appearing in the ‘top 10’ 2016 of countries with very high incidence of type 1 diabetes (T1D). Our study aims to present the epidemiological evolution of T1D in children through a recruitment of 45 years in the register of the department of Oran. Materials and Methods - The reference population is that of the department of Oran. New cases of T1D are children under 15 years old coming from front-line units and pediatric departments. Registration was centralized at the level of the «C» pediatric unit of Oran University Hospital since 1973 with an assessment close to 100%. Results - From January 1st, 1973 to December 31st, 2017, 2358 T1D new cases aged less than 15 years at T1D diagnosis have been registered. The average annual incidence under 15 years old for the last 5 years 2013-2017 is 31.12± 3.60 cases per 100 000 with an annual evolution average of 12.78% in the last 25 years. The annual evolution average of pediatric age groups are 15.03, 15.50 and 9.10%, respectively for children of [0-4], [5-9] and [10-14] years old. The incidence per 1 000 live births shows a risk of contracting T1D in the first 15 years of life of around 3.5. At December 31, 2017, the prevalence was 207 for 100 000 equivalent to 1 T1D for 482 children under 15,. The sex-ratio for all cases is 0.99 (1175 boys / 1183 girls), but undergoes cyclical variations with extremes of 0.80 and 1.14 between the periods 1978-1997 and 1998- 2007 (p= 0.02). The winter/summer seasonality, significant from 1973 to 2014 in favor of winter months is no longer available starting from 2015. Conclusion - In agreement with other teams, we confirm the outsized increase in the incidence of T1D and the rejuvenation of the age at onset in children under 15 in our country. This evolution, mainly related to environmental problems poses new difficulties to families and teams in charge of the disease.