All posts by Courtney

Objective: The purpose of this examine was to make use of voxel-based MRI post-processing in detection of delicate FCD in drug-resistant operculoinsular epilepsy sufferers with unfavourable presurgical MRI, and by combining magnetoencephalography (MEG) to enhance the localization of epileptogenic zone. 

Methods: Operculoinsular epilepsy sufferers with a unfavourable presurgical MRI had been included in this examine. MRI post-processing was carried out utilizing a Morphometric Analysis Program (MAP) on T1-weighted volumetric MRI.

Clinical data together with semiology, MEG, scalp electroencephalogram (EEG), intracranial EEG and surgical technique was retrospectively reviewed. The pertinence of MAP-positive areas was confirmed by surgical consequence and pathology. 

Results: A complete of 20 sufferers had been identified with operculoinsular epilepsy had non-lesional MRI throughout 2010-2018, of which 11 sufferers with resective surgical procedures had been included. MEG confirmed clusters of single equal present dipole (SECD) in inferior frontal areas in 5 sufferers and temporal-insular/ frontal-temporal-insular/parietal-insular areas in 5 sufferers.

Four out of 11 sufferers had optimistic MAP outcomes. The MAP optimistic fee was 36.4%.

The optimistic areas had been in insular in one affected person and operculoinsular areas in three sufferers. Three of the 4 sufferers who had been MAP-positive bought seizure-free after efficiently resect the MAP-positive and MEG-positive areas (the pathology outcomes had been FCD IIb in two sufferers and FCD IIa in one affected person). 

Conclusions: MAP is a useful gizmo in detection the epileptogenic lesions in sufferers with MRI-negative operculoinsular epilepsy. Notably, in order to make a proper surgical regime choice, MAP outcomes ought to all the time be interpreted in the context of the affected person’s anatomo-electroclinical presentation.

Surgery of renal artery aneurysms: A monocentric retrospective examine

To report the outcomes of standard surgical procedure for renal artery aneurysms (RAA) in our middle.We retrospectively reviewed the recordsdata of all of the sufferers operated for RAA between 2009 and 2018 in our middle. We collected demographic, organic (renal perform), morphological (CT-scan), and practical (ultrasound examination, resistance index) pre and postoperative knowledge.

Clinical and paraclinical operative knowledge had been examined. Results had been expressed as common ± customary deviation or median and extremes.26 aneurysms had been operated in 20 kidneys (10 proper kidneys) amongst 19 sufferers, together with 13 (68%) ladies with a mean age of 55 (±12) years.

Three (16%) sufferers offered an aneurysm in a single kidney. The discovery of the aneurysm was fortuitous in 14 (74%) sufferers. One Marfan affected person was operated after a postpartum rupture. The median diameter of the operated aneurysms was 22 mm (7-48), and 23 (90%) had been hilar aneurysms.

Arterial restore was carried out in situ in 16 (80%) kidneys. The surgical procedure consisted of a direct arterial restore in 21 circumstances (81%), together with 4 resections and anastomosis, 12 aneurysmorraphies, and 5 complicated reconstructions. Four arterial replacements had been carried out (one prosthetic graft, two femoral grafts, and one inner iliac graft). The common length of renal clamping was 30.5 (±17.3) min.

Postoperative renal perform was unchanged in all of the sufferers besides one (5.2%) who required two days of postoperative dialysis. The resistance index of all of the operated kidneys was regular (0.66±0.08) at discharge. Sixteen (70%) of the 23 aneurysms examined, anatomo–pathology concluded to a dysplastic origin.

At three months, a scientific CT-scan objectified the patency of 95% of the arterial reconstructions however with three stenoses > 50%. One stenosis > 80% was handled at seven months by balloon angioplasty. Only one operated kidney offered a loss of viability of its higher pole. The imply length of follow-up was 54 ± 35 months.

By the top of the follow-up, major and secondary patency charges evaluated by Doppler ultrasound had been 90 and 95%, respectively.Conventional surgical procedure usually carried out in situ stays a positive and efficient therapy for RAA. This difficult surgical procedure for a uncommon illness ought to be carried out in experimented facilities.

Psychological factors Happen to Be Thought to play a leading role in the disposition, beginning, or class of various physical disorders. Stress is defined as a disorder that occurs when someone perceives the requirements of a scenario that surpasses his tools and can raise the body’s vulnerability to specific ailments, Implementing an immunosuppressive effect. An upgrade consists of the consequences of emotional strain in these diseases which are directly correlated with immunological mechanisms like infections, autoimmune disorders and neoplasms, in addition to its impact on cardiovascular ailments. It’s noted that timely emotional interventions might help regulate the stress response and enhance health behavior, teaching people more adaptive procedures to translate life’s challenges with much more powerful answers.

Stress and autoimmune diseases

The Majority of the Signs that stress Results in The beginning and course of autoimmune disorder are circumstantial as well as also the mechanics by which stressful events influence autoimmunity aren’t entirely understood. But, there are studies which have demonstrated a link between stress and autoimmune disorder.

Many autoimmune disorders share 2 common features: Immune System dysregulation and anxiety pathways. two pathways, the HPA axis and the sympathetic nervous system (SNS) regulate the immune response through the release of corticosteroids and norepinephrine (NE), respectively. These neuroimmunomediators behave on immune cells like macrophages through the alpha or beta adrenergic receptors on the face, to regulate the creation of significant regulatory cytokines, and normally act to inhibit inflammation. But under certain conditions, NE promotes inflammation during conversation with macrophage alpha-1 adrenergic receptors and the subsequent increase in production of tumor necrosis factor alpha (TNF-a). Even though macrophages do not ordinarily express the receptors, their saying on the plasma membrane of macrophages and monocytes happens in certain disease conditions. Through these mechanisms, the HPA axis as well as the SNS affect the course and development of rheumatoid arthritis (RA), which likely play significant roles in its pathogenesis. Thus, therapeutic agents acting on the modulation of neural pathways which normally govern Immune System homeostasis, can be good for the treatment of RA and other autoimmune disorders. Additionally, it has been demonstrated that a disorder of the neuroendocrine system might be among those risk factors associated with the pathogenesis of rheumatic ailments. Persistent inflammatory pressure mediated by neural and humoral signals during the active condition of this disease and autoantibodies from the arrangements of the neuroendocrine system might also take part in neuroendocrine dysfunction.

Effect of stress on autoimmune disease

The best proof of this impact of pressure on autoimmune thyroid disorder is that the association between the onset of Graves’ hyperthyroidism and improved anxiety. But, there aren’t many reports of a potential connection between tension and Hashimoto’s thyroiditis, likely because the beginning and development of the disorder are normally insidious and also the consequences of anxiety could go undetected. The pathogenesis of Graves’ ophthalmopathy is unknown, but the presence of an inflammatory response from the orbital tissues, linked to the activity of antithyroid antibodies, was shown. Lately it’s been clarified that ophthalmopathic facets might be determined by environmental variables, one of which pressure stands outside, which supports the hypothesis that the autoimmune procedures within this bronchial inflammation may be associated with environmental aspects. Patients experiencing hypothyroidism can occasionally experience anxiety attack, intense stress, palpitations, and eventually become quite emotionally obese people generating increased anxiety. This disorder, in which the thyroid gland is hypoactive, is often accompanied by exhaustion, fainting, and various levels of melancholy.

In research studies, in which numerous ecological elements such as stressful life events were researched, it was reasoned that emotional strain, measured as psychosocial stress from the household, seems to be involved in the induction or progression of diabetes-related autoimmunity from the youth, because of a union of hormonal levels and neurological signals that affect insulin sensitivity and desire, in addition to Immune system.

Viruses have proven to be one of the most efficient vehicles in transferring genetic information to eukaryotic cells. This is precisely why molecular biologists have put so much effort into modifying their genome to make them more secure (incompetent for replication, attenuation) but maintaining their ability to transfer and express recombinant genetic material. Thus, viral vectors have become a very useful tool in biomedical research both in vitro (cell cultures) and in vivo (animal experiments, gene therapy) but we must be aware that these improvements in intrinsic biosecurity of viral vectors and their commercial availability can facilitate a relaxation in the application of safe practices, circumstance that must be avoided.

Groups of viral vectors

Viruses from which the viral vectors are derived may be assigned to danger group 1 (eg adeno-associated virus, baculovirus), group 2 (eg adenovirus, herpesvirus, poxvirus) but there are also representatives to group 3 (e.g. HIV). Generally, the level of biosecurity required to work with the viral vectors is that of NCB2 but this may vary according to the proposed experimental procedure (e.g. large-scale production, animal inoculation) or the biological activity of the transgene (eg oncogene, biotoxin). ).

To correctly evaluate the risk in working with viral vectors, the following must be considered:

• the danger group of the unmodified parental virus;
• the degree of modification made to obtain the defective vector;
• the function of inactivated viral genes;
• host range and pseudotyping;
• its ability and efficiency to integrate into the genome of the host cell
• the function of the transgene.

The lab offers all research staff working with viral vectors a specific face-to-face course and informative material that can be of great help in conducting a correct risk assessment in each case. Among this material we can highlight the pathogen technical sheets (FTP), available on the intranet, and the following fact sheets:

•     Viral vectors and biosecurity level
•     Viral vector biosecurity level and cellular functions
•     Biosecurity and viral vectors
•     Biosecurity and lentiviral vectors
•     Acting in case of accidental exposure to lentiviral vector