In vivo and in vitro findings have shown that plasma of patients with idiopathic nephrotic syndrome (INS) contain factors that increase glomerular permeability to proteins. The effects of these ...factors on proteoglycan synthesis by glomerular cells are unknown. To investigate the effect of plasma from patients with INS (n = 23) and other glomerulopathies (n = 12) on the amount of proteoglycans synthesized by cultured rat mesangial cells and human glomerular epithelial cells, glomerular cells were cultured for 24 h with plasma from patients or control subjects, and incorporation of Na2(35)SO4 in chondroitin dermatan sulfate and heparan sulfate was assessed using a cationic nylon membrane. The mean ratio of glycosaminoglycan produced by rat mesangial cells when in contact with plasma (5%) from INS patients to the amount produced when in contact with control plasma was 0.70+/-0.06. The mean ratio of heparan sulfate was 0.58+/-0.08. The decrease of heparan sulfate production was present in the cellular and in the extracellular fraction. It was observed when the cells were in contact with plasma from patients in relapse but not when in remission. No decrease of heparan sulfate production was observed with four of the five patients with membranous glomerulonephritis (ratio of 1.27+/-0.03), IgA nephropathy (n = 5, ratio of 1.27+/-0.03), and membranoproliferative glomerulonephritis (n = 2, ratio of 1.39+/-0.34). When human glomerular epithelial cells were exposed to 5% plasma from INS patients in relapse (n = 9), the mean ratio of heparan sulfate was 0.62+/-0.06 in the cellular fraction and 0.72+/-0.08 in the medium. When in contact with plasma from patients in remission, no difference of glycosaminoglycan production was observed. A factor present in plasma from patients with INS during initial episodes or relapses is able to decrease the proteoglycan production of glomerular cells.
This paper presents preliminary results on anonymization and obfuscation techniques to preserve users' privacy in context-aware service provisioning. The techniques are based on generalizing request ...parameters as well as the context data provided to the application. Local context semantic aggregation is used to improve the quality of service that can be achieved while preserving privacy. The paper also shows how the software architecture of the CARE middleware can be extended to implement the proposed techniques.
Éditer des recommandations pour la pratique clinique concernant la prévention des complications liées à la chirurgie prothétique du prolapsus génital, par le Collège national des gynécologues et ...obstétriciens français (CNGOF), fondées sur les preuves disponibles.
Revue de la littérature portant sur des articles en français et en anglais issus de Medline, PubMed et de la Cochrane database en utilisant des mots clés (
mesh ;
pelvic organ prolapse ;
cystocele ;
rectocele ;
uterine prolapse ;
complications ;
adverse event ;
sacral colpopexy ;
extrusion ;
infection…).
Comme pour toute chirurgie, il est recommandé de proposer un sevrage tabagique périopératoire (accord d’experts) et de respecter les mesures de prévention des infections nosocomiales, notamment des infections du site opératoire (réglementaire). Il n’y a pas d’argument pour recommander la prescription systématique d’estrogènes locaux ou généraux avant ou après une chirurgie prothétique du prolapsus, quelle que soit la voie d’abord (grade C). Une antibioprophylaxie est recommandée, quelle que soit la voie d’abord (accord d’experts). Il est recommandé de rechercher une infection urinaire préopératoire et de la traiter (accord d’experts). Les premiers cas doivent être réalisés sous la direction d’un chirurgien expérimenté pour la technique considérée (grade C). En cas de plaie rectale peropératoire, il est recommandé de ne pas poser de prothèse synthétique non résorbable inter-recto-vaginale (accord d’experts). La mise en place d’une prothèse synthétique non résorbable inter-vésico-vaginale peut être envisagée après suture jugée satisfaisante d’une plaie vésicale (accord d’experts). Pour la cure de prolapsus par voie vaginale, si un renfort prothétique est mis en place, il est recommandé d’utiliser une prothèse en polypropylène monofilament tricoté macroporeux (grade B). Il est recommandé de ne pas utiliser de polyester par voie vaginale (grade B). Lors de la mise en place d’une prothèse synthétique par voie vaginale pour traiter un prolapsus génital, une hystérectomie est possible mais non recommandée systématiquement (accord d’experts). Il est recommandé de limiter au maximum la colpectomie lors de la mise en place d’une prothèse par voie vaginale (accord d’experts). La voie d’abord à privilégier pour la promontofixation est la cœlioscopie (grade C). Il est recommandé de ne pas insérer et suturer les prothèses par voie vaginale lors des promontofixations (grade B). Pour la promontofixation, il est recommandé de ne pas utiliser de polyester enduit de silicone, de prothèse biologique en derme porcin, de
fascia lata de cadavre, de polytétrafluoroéthylène (grade B). Il est recommandé d’utiliser du polyester non enduit de silicone ou du polypropylène (grade C). La fixation de la prothèse au promontoire peut être réalisée par des fils ou des tackers (grade C). Une péritonisation est recommandée pour recouvrir les prothèses (grade C). Si une hystérectomie est décidée, il est recommandé de réaliser une subtotale (grade C).
L’application de ces recommandations devrait limiter les risques de complications liées à la chirurgie prothétique du prolapsus.
To provide guidelines for clinical practice from the French College of Gynaecologists and Obstetricians (CNGOF), based on the best evidence available, concerning the adverse events related to surgical procedures involving the use of prosthetic meshes.
French and English-language articles from Medline, PubMed, and the Cochrane Database were searched, using key words (mesh ; pelvic organ prolapse ; cystocele ; rectocele ; uterine prolapse ; complications ; adverse event ; sacral colpopexy ; extrusion ; infection…).
As with any surgery, it is recommended to provide a perioperative smoking cessation (expert opinion) and comply with the prevention of nosocomial infections (regulatory requirement). There is no evidence to recommend routine local or systemic estrogen therapy before or after prolapse surgery using mesh, regardless of the surgical approach (grade C). Antibiotic prophylaxis is recommended, regardless of the approach (expert opinion). It is recommended to seek a pre-operative urinary tract infection and treat it (expert opinion). The first cases should be made under the guidance of an experienced surgeon in the relevant technique (grade C). It is recommended not to place a non-absorbable synthetic mesh into the rectovaginal septum when a rectal injury occurs (expert opinion). The placement of a non-absorbable synthetic mesh into the vesicovaginal septum may be considered after the suture of a bladder injury if the suture is considered to be satisfactory (expert opinion). If a synthetic mesh is placed by vaginal route, it is recommended to use a macroporous polypropylene monofilament mesh (grade B). It is recommended not to use polyester mesh for vaginal surgery (grade B). It is allowed to perform a hysterectomy associated with the placement of a non-absorbable synthetic mesh placed by vaginal route but this is not routinely recommended (expert opinion). It is recommended to minimize the extent of the colpectomy (expert opinion). Laparoscopic approach is recommended for sacral colpopexy (grade C). It is recommended not to place and suture meshes by vaginal route when a sacral colpopexy is performed (grade B). It is recommended not to use silicone-coated polyester, porcine dermis,
fascia lata, and
polytétrafluoroéthylène meshes (grade B). It is recommended to use polyester (without silicone coating) or polypropylene meshes (grade C). Suture of the meshes to the promontory can be performed using thread/needle or tacker (grade C). A peritonization is recommended to cover the meshes (grade C). If hysterectomy is required, it is recommended to perform a subtotal hysterectomy (grade C).
Implementation of this guideline should decrease the prevalence of complications related to surgical procedures involving the use of prosthetic meshes.
Os autores descrevem as lesões anatômicas de quatro casos de angiostrongilíase abdominal, destacando as modificações arteriais peculiares a esta parasitose.
Abdominal angiostrongyliasis is a zoonotic infection caused by Angiostrongylus costaricensis, a nematode with an intra-vascular location in the mesentery. Our objective was to address several aspects ...of the natural history of this parasitosis, in a longitudinal clinical and seroepidemiological study. A total of 179 individuals living in a rural area with active transmission in southern Brazil were followed for five years (1995-1999) resulting in yearly prevalence of 28.2%, 4.2%, 10%, 20.2% and 2.8% and incidences of 0%, 5.9%, 8% and 1.5%, respectively. Both men and woman were affected with higher frequencies at age 30-49 years. In 32 individuals serum samples were collected at all time points and IgG antibody reactivity detected by ELISA was variable and usually persisting not longer than one year. Some individual antibody patterns were suggestive of re-infection. There was no association with occurrence of abdominal pain or of other enteroparasites and there was no individual with a confirmed (histopathologic) diagnosis. Mollusks were found with infective third-stage larvae in some houses with an overall prevalence of 16% and a low parasitic burden. In conclusion, abdominal angiostrongyliasis in southern Brazil may be a frequent infection with low morbidity and a gradually decreasing serological reactivity.
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