Emergency treatment of a ruptured huge omphalocele by simple suture of its membrane

Background

Emergency repair of incarcerated incisional hernia with associated bowel obstruction in potentially or contaminated field is technically challenging due to edematous, inflamed and friable tissues with occasional need for concurrent bowel resection and carries high rates of post-operative infectious complications. The aim of this study was to retrospectively assess the wound related morbidity of use of permanent prosthetic mesh in emergency repair of incarcerated incisional hernia with associated bowel obstruction. We also describe a new technique of leaving the mesh exposed to heal by secondary intention with granulation tissue.

Methods

Between 2000 and 2010 a total of 60 patients underwent emergency surgery for incarcerated incisional hernia with associated bowel obstruction with placement of permanent prosthetic mesh. The wound was closed after hernia repair in 55 patients while it was left open to granulate in 5 patients.

Results

In the group of patients with primary wound closure, 11 patients developed superficial surgical site infection, 5 developed deep wound infection and one patient had cellulitis. These patients were treated with wound debridement and antibiotics. Mesh removal was required in one patient. There were no infections in the group of patients who had their surgical wounds left open. One patient in this group died on the fifth postoperative day from septicemia.

Conclusion

Use of permanent prosthetic mesh in emergency repair of incarcerated incisional hernia with associated bowel obstruction. in contaminated field is associated with high risk of wound infection.     

Consistent Condom Use during Casual Sex among Long-Truck Drivers in Togo

BackgroundIn 2008, the proportion of truck drivers who were not systematically protected during sex was 63% with casual partners and 60% with sex workers. Despite the high level of knowledge on HIV/AIDS and the growing awareness of the existence of the risk of HIV infection, condom use always encounters resistance among truck drivers in Togo. We sought to document the factors associated with condom use during casual sex among trucks’ drivers in Togo.MethodsThis was an analytical cross-sectional study conducted in 2010 and targeted truckers at truck station on the two main roads of Togo, Lomé-Cinkassé and Kodjoviakopé-Sanvee Condji.ResultsIn this study, 1,782 trucks’ drivers and their helpers were interviewed. All were men, and their mean age was 28.8 ± 8.8 years. Trucks’ drivers were doing an average of 3 stops on their journeys and 1,229 (69%) of them had at least two years of experience in the work. Of the 1,782 trucks’ drivers, only 620 (34.8%) had consistently used condoms during casual sex in the last three months. In multivariate analysis, predictors were: education level (primary schooling: OR = 1.54; p = 0.002; Secondary schooling and higher OR = 1.38; p = 0.036), good knowledge of ways of HIV transmission (OR = 1.53; p = 0.000), tested for HIV (OR = 1.67, p = 0.000), duration in the profession (2–5 years: OR = 1.43, p = 0.008; more than 5 years: OR = 1.38, p = 0.027), and HIV risk’s perception (OR = 1.44, p = 0.000).ConclusionThese results highlight factors associated with consistent condom use during casual sex by truck drivers in Togo. This is a key population group at high risk of HIV transmission toward which the national HIV/AIDS control program should strengthen the HIV prevention strategies.     

Regulation of the V-ATPase along the endocytic pathway occurs through reversible subunit association and membrane localization

The lumen of endosomal organelles becomes increasingly acidic when going from the cell surface to lysosomes. Luminal pH thereby regulates important processes such as the release of internalized ligands from their receptor or the activation of lysosomal enzymes. The main player in endosomal acidification is the vacuolar ATPase (V-ATPase), a multi-subunit transmembrane complex that pumps protons from the cytoplasm to the lumen of organelles, or to the outside of the cell. The active V-ATPase is composed of two multi-subunit domains, the transmembrane V(0) and the cytoplasmic V(1). Here we found that the ratio of membrane associated V(1)/Vo varies along the endocytic pathway, the relative abundance of V(1) being higher on late endosomes than on early endosomes, providing an explanation for the higher acidity of late endosomes. We also found that all membrane-bound V-ATPase subunits were associated with detergent resistant membranes (DRM) isolated from late endosomes, raising the possibility that association with lipid-raft like domains also plays a role in regulating the activity of the proton pump. In support of this, we found that treatment of cells with U18666A, a drug that leads to the accumulation of cholesterol in late endosomes, affected acidification of late endosome. Altogether our findings indicate that the activity of the vATPase in the endocytic pathway is regulated both by reversible association/dissociation and the interaction with specific lipid environments.     

ARF1 regulates Nef-induced CD4 degradation

BACKGROUND: The HIV Nef protein downregulates CD4 through sequential connection with clathrin-coated pits and the COP1 coatomer, resulting in accelerated endocytosis and lysosomal targeting. RESULTS: Here we report that the small GTPase ARF1 controls the Nef-induced, COP-mediated late-endosomal targeting of CD4. We find that Nef binds ARF1 directly and can recruit the GTPase onto endosomal membranes. Furthermore, a complex comprising Nef, ARF1, and betaCOP can be immunoprecipitated from cells expressing the viral protein. Residues in a C-terminal loop of the viral protein facilitate both these interactions and the targeting of Nef and CD4 to acidic late endosomes, whereas other residues primarily involved in mediating CD4 endocytosis are dispensable for this process. Finally, a dominant-negative ARF1 mutant blocks the migration of the Nef-CD4 complex to lysosomes. CONCLUSIONS: Our results support a model in which ARF1 is the immediate downstream partner of Nef for CD4 lysosomal targeting.     

Decay-accelerating factor binding determines the entry route of echovirus 11 in polarized epithelial cells

The interaction between echovirus 11 strain 207 (EV11-207) and decay-accelerating factor (DAF or CD55) at the apical surface of polarized Caco-2 cells results in rapid transport of the virus to tight junctions and in its subsequent uptake. A virus mutant (EV11-207R) which differs at 6 amino acids and whose affinity for DAF is apparently significantly lower remains at the apical surface, from where its uptake occurs. Binding of EV11-207 to DAF and its transport to tight junctions result in a loss of function of the junctions. In contrast, the mutant virus EV11-207R is not transferred to tight junctions, nor does it impair the integrity of these junctions. Cholesterol depletion from the apical membrane leads to DAF aggregation and, presumably, internalization and inhibits infection by EV11-207. However, infection by EV11-207R is significantly less sensitive to cholesterol depletion than infection by EV11-207, confirming the DAF requirement for EV11-207, but not EV11-207R, to infect cells. These data strongly indicate that in the case of infection of polarized epithelial cells by echovirus 11, DAF binding appears be a key determinant in the choice of entry pathway, at least in cell culture.     

Above-ground biomass and vegetation attributes in the forest-savannah mosaic of Togo,West Africa

Despite the increasing interest in the role of African savannah and woodlands on the global carbon cycle, little is known about the above-ground biomass (AGB) and the factors affecting it in these ecosystems in West Africa. We estimated AGB in different vegetation types of a forest–savannah mosaic in Togo, and we investigated the relationship between AGB, structural and diversity attributes. We also assessed the effects of using the ≥5 or ≥10 cm diameter threshold on AGB estimates. We sampled tree diameter, height and species of all trees ≥5 cm diameter following standardised protocols in 160 plots of 50 × 20 m (50 × 10 m for riparian). Above-ground biomass (AGB) (all trees ≥5 cm diameter) ranged from 6.2 Mg/ha in shrub savannah to 292 Mg/ha in riparian forest and showed significant differences between vegetation types. Differences in AGB were related to structural attributes, with little influence of diversity attributes. The effects of minimum tree diameter size (5 or 10 cm) on AGB estimates were negligible. At a landscape level, closed-canopy and open forests stored important quantities of carbon. We highlight the importance of the forest–savannah mosaic as a large carbon pool, which could be released if converted to another land cover type.