Surgical outcomes of deep sclerectomy versus Baerveldt aqueous shunt implantation following initial failed deep sclerectomy

Purpose: To examine the efficacy and safety of repeat deep sclerectomy (DS) versus Baerveldt shunt (BS) implantation as second line surgery following failed primary DS. Methods: Fifty one patients were prospectively recruited to undergo BS implantation following failed DS and 51 patients underwent repeat DS, for which data was collected retrospectively. All eyes had at least one failed DS. Surgical success was defined as IOP≤21mmHg and 20% reduction in IOP from baseline. Success rates, number of glaucoma medications (GMs), IOP, and complication rates were compared between the two groups at year 1, post-operatively. Results: Mean age, sex and the proportion of glaucoma subtypes were similar between groups. Preoperatively IOP was significantly lower in DS group vs BS group (18.8mmHg vs 23.8mmHg, p<0.01, two sample t-test). Postoperatively IOP was significantly higher in DS group than BS group (14.6mmHg vs 12.0mmHg, p<0.01, two-sample t-test). In the DS group, 47% of eyes did not achieve 20% reduction in IOP from baseline, as a result the success rates were significantly lower in eyes with DS (51%) than in eyes with BS (88%) (p=0.02, log-rank test). Preoperatively the number of GMs used in DS and BS groups were similar (2.2 vs 2.7 p=0.02, two sample t-test). Postoperatively there remained no significant difference in GMs between groups (0.9 vs 1.1, p= 0.58, two sample t-test). Complication rates were similar between the two groups (12% vs 10%). Conclusions: Baerveldt tube implantation was more effective in lowering IOP than repeat deep sclerectomy in eyes with failed primary DS, at year one. Complications were minor and infrequent in both groups

Long-term clinical outcome after sirolimus-stent implantation for in sirolimus-eluting stent restenosis

Rapport de synthèse : But: la resténose intra-stent au sirolimus (SAS) reste un problème clinique. Parmi tes diverses approches thérapeutiques disponibles aujourd'hui aucune n'a la primauté car tes résultats à moyen terme restent relativement médiocres. Méthodologie: les patients souffrant d'une resténose intra-SAS chez lesquels un second SAS a été implanté comme traitement de cette resténose ont été inclus dans ce registre. Lors d'ischémie clinique ou électrique après implantation d'un SAS les malades chez lesquels l'angioplastie au ballon seul ne donnait pas un résultat satisfaisant ont bénéficié de l'implantation d'un stent actif dans un stent actif. Résultats: vingt-sept patients sont inclus dans ce registre. La resténose était de type focale dans 34% des cas, diffuse dans 59% des cas et proliférative dans 7% des cas. La procédure a été un succès chez tous les patients sans complications aiguës durant l'hospitalisation. A 14±7 mois, on dénombre 8 (30%) événements cardiaques majeurs (1 mort, 1 infarctus du myocarde, 4 revascularisations additionnelles de la lésion, 1 revascularisation additionnelle du vaisseau cible). Un patient a subi un pontage aorto-coronarien. Dix-neuf patients (70%) ont évolué sans aucun problème. Conclusion: en conclusion, l'implantation d'un SAS pour traiter une resténose intra-SAS est réalisable avec un très bon résultat immédiat. Cependant, l'incidence d'un événement cardiaque majeur reste élevée à long terme.

Structure of the glycosyl-phosphatidylinositol membrane anchor of the Leishmania major promastigote surface protease.

In common with many other plasma membrane glycoproteins of eukaryotic origin, the promastigote surface protease (PSP) of the protozoan parasite Leishmania contains a glycosyl-phosphatidylinositol (GPI) membrane anchor. The GPI anchor of Leishmania major PSP was purified following proteolysis of the PSP and analyzed by two-dimensional 1H-1H NMR, compositional and methylation linkage analyses, chemical and enzymatic modifications, and amino acid sequencing. From these results, the structure of the GPI-containing peptide was found to be Asp-Gly-Gly-Asn-ethanolamine-PO4-6Man alpha 1-6Man alpha 1-4GlcN alpha 1-6myo-inositol-1-PO4-(1-alkyl-2-acyl-glycerol). The glycan structure is identical to the conserved glycan core regions of the GPI anchor of Trypanosoma brucei variant surface glycoprotein and rat brain Thy-1 antigen, supporting the notion that this portion of GPIs are highly conserved. The phosphatidylinositol moiety of the PSP anchor is unusual, containing a fully saturated, unbranched 1-O-alkyl chain (mainly C24:0) and a mixture of fully saturated unbranched 2-O-acyl chains (C12:0, C14:0, C16:0, and C18:0). This lipid composition differs significantly from those of the GPIs of T. brucei variant surface glycoprotein and mammalian erythrocyte acetylcholinesterase but is similar to that of a family of glycosylated phosphoinositides found uniquely in Leishmania.

Wireless capsule pH monitoring: does it fulfil all expectations?

pH monitoring has been used as a diagnostic tool in gastro-oesophageal reflux disease (GERD) for many years. Recent studies have shown that wireless capsule pH monitoring is better tolerated and interferes less with daily activities as compared to traditional catheter-based pH monitoring. Moreover, prolonged recording time (48 h instead of 24 h) is possible with wireless pH monitoring. The main secondary effect of wireless capsule pH monitoring is induction of thoracic discomfort in 10-65% of the patients, which can vary from mild foreign body sensation to severe chest pain. Sensitivity and specificity of wireless capsule monitoring is comparable to that of traditional pH monitoring. It has not been proven yet that better tolerability and a longer recording time increases the diagnostic yield of wireless capsule monitoring in GERD.

Immunomarquage des collagènes I, III et IV, de la laminine et de la fibronectine dans la capsule cristallinienne humaine [Immunolabelling of collagen types I, III and IV, laminin and fibronectin in the human lens capsule].

PURPOSE: To localize collagen types I, III, and IV, laminin and fibronectin in the anterior human lens capsule. MATERIAL AND METHODS: Twenty-one anterior capsules were sampled by capsulorhexis during extracapsular cataract extraction (mean age 71.5). All capsules were labelled by an immunostaining specific for each antibodies. Immunostaining of four capsules was revealed with immunoperoxydase and seventeen using indirect immunofluorescence. RESULTS: Labelling of collagen types I and III was observed throughout the entire thickness of the capsule for each technique, the strongest labelling was found in the base of the epithelial cells with immunofluorescence. Collagen type IV was observed at the base of the epithelial cells whichever technique was used. Laminin could be detected in the inner layer of the capsule, using immunoperoxydase or immunofluorescence. No specific labelling was found for fibronectin using the two techniques. CONCLUSIONS: Different kinds of collagens have been found in capsules, more particularly the type III. The latter does not appear on other ocular basement membrane. Because of this uneven distribution in the capsule's thickness, each collagen might have a specific function.

Modélisation et implantation d'un guichet virtuel pour les administrations publiques

Dans le cadre de ce travail de thèse intitulé, nous avons étudié les impacts des nouvelles technologies de l?information et de la communication sur les administrations publiques. Notre objectif principal était de modéliser un guichet virtuel puis d?en implémenter un prototype. Nous avons donc dans un premier temps étudié une sélection de réalisations internationales et suisses dans le domaine, ainsi que des travaux de recherche visant à développer des modèles pour un état électronique. Nous avons ensuite travaillé sur la base des résultats d?une enquête de terrain menée au sein d?une administration cantonale et auprès de citoyens. Ces données de base nous ont permis de définir un modèle de guichet virtuel, qui couvre les aspects statiques et dynamiques d?un tel système. Enfin nous avons utilisé le modèle abstrait pour définir l?architecture théorique de notre prototype de guichet virtuel, avant d?effectuer certains choix technologiques et de l?implémenter.

Fast Blue and Diamidino Yellow as retrograde tracers in peripheral nerves: efficacy of combined nerve injection and capsule application to transected nerves in the adult rat

Capsule application of Diamidino Yellow (DY) to the cut end of the sciatic nerve immediately followed by capsule application of Fast Blue (FB) resulted in approximate to 95% double-labelled dorsal root ganglion neurones (DRGn) and motoneurones (Mn). Nerve injection of DY followed either immediately or 2 months later by capsule application of FB resulted in approximate to 90% double-labelled DRGn and Mn, indicating that DY and FB label similar populations of DRGn and Mn, and that insignificant DY fading occurred during this period. Inversing the order of application, however, i.e. nerve injection of FB followed immediately by capsule application of DY, resulted in double labelling in only approximate to 10% of the DRGn and Mn. These percentages increased to 70% of the DRGn and 60% of the Mn when the FB injection was followed 1 or 2 months after by the DY application, indicating that DY uptake is blocked by recent administration of FB. The results indicate that DY and FB might be useful for sequential labelling before and after nerve injury as a tool to investigate the accuracy of sensory and motor regeneration.

Anomalous optical and electrical recovery process of photoquenched EL2 defect produced by oxygen and boron ion implantation in gallium arsenide

The optical and electrical recovery processes of the metastable state of the EL2 defect artificially created in n‐type GaAs by boron or oxygen implantation are analyzed at 80 K using optical isothermal transient spectroscopy. In both cases, we have found an inhibition of the electrical recovery and the existence of an optical recovery in the range 1.1-1.4 eV, competing with the photoquenching effect. The similar results obtained with both elements and the different behavior observed in comparison with the native EL2 defect has been related to the network damage produced by the implantation process. From the different behavior with the technological process, it can be deduced that the electrical and optical anomalies have a different origin. The electrical inhibition is due to the existence of an interaction between the EL2 defect and other implantation‐created defects. However, the optical recovery seems to be related to a change in the microscopic metastable state configuration involving the presence of vacancies