Customized and non-customized live-born birth-weight curves of single and uncomplicated pregnancies from the Burgundy perinatal network. Part I - methodology.

OBJECTIVES: To establish non-customized and customized birth-weight curves of single and uncomplicated pregnancies according to gestational age. MATERIALS AND METHODS: We used data for 64,173 mother-infants pairs from the Burgundy perinatal network database (France) over the period 2005-2013. A validated procedure was used to link mothers with their newborns, and maternal and fetal pathologies likely to affect birth weight were excluded. Multiple regression analysis with covariate selection was used to build a customized growth curve with maternal and fetal parameters. RESULTS: Using this methodology, three different curves were generated: an unadjusted curve for birth weight, named B0, an curve adjusted for fetal gender, named B1 and a curve adjusted for fetal and maternal parameters (fetal gender, maternal height, weight and parity), named B2. CONCLUSION: We present curves showing an original distribution of birth weights for the French population in order to improve the diagnosis of small for gestational age. These curves are not based on the Gardosi in utero growth model but on actual birth weights, thus limiting bias. Nevertheless, the minimum gestational age was 25weeks as there was an insufficient number of live-borns in small gestational ages.

[Evolution in styles of romantic and interpersonal attachment in depressed adult women during hospitalization]. / Évolution des styles d'attachement romantique et interpersonnel au cours de l'hospitalisation chez des femmes adultes déprimées.

INTRODUCTION/OBJECTIVE: Bowlby (1984) regarded attachment as a model of psychological vulnerability to depression. Since then, a large number of studies have considered vulnerability to depression in light of the idea of attachment style. Attachment styles correspond to two dimensions observed in relationships (anxiety and avoidance) evoking ideally the internal operating models of self and other respectively, as first described by Bowlby (1984). Two types of adult attachment styles are evaluated in our study: romantic attachment (Hazan and Shaver, 1987) and interpersonal attachment (Bartholomew and Horowitz, 1991). The existing literature indicates that depression is associated with the insecure attachment styles, in both romantic an interpersonal relationships. Nevertheless, a question remains concerning the nature of the link between attachment style and depression: are attachment styles stable and independent of the depression or are they modified as the depression evolves? The aim of the present study was to investigate the relationships between attachment and depression in adult women hospitalized for depression; following up the evolution in their romantic and interpersonal attachment styles from the beginning to the end of their hospitalization. METHODOLOGY: The study population consisted of 50 women hospitalized for an episode of major depression (Axis I, DSM IV). Individuals exhibiting bipolar disorders and other pathologies linked to depression were not included in the population. Sixty-eight percent of the depressed women in our population had previously experienced depressive episodes and 42% of them also exhibited a personality disorder (Axis II, DSM IV). The clinical group participated in two psychological investigations, one at the beginning (T1) and one at the end of the hospitalization (T2), including each time a clinical interview during which the depression as well as the romantic (ECR, 1998) and interpersonal (RQ, 1991) attachment styles were evaluated. STUDY RESULTS: Our findings showed that depression is positively correlated with the "avoidant" dimension of the romantic attachment style and negatively with the "secure" dimension of the interpersonal attachment style. Between the beginning and the end of hospitalization, only the "secure" and "fearful" dimensions of the interpersonal attachment styles were modified, whereas the styles of romantic attachment remained stable. In terms of the links between attachment styles and the evolution of depression during hospitalization (between T1 and T2), we noted that an increase in security of attachment was correlated with a decrease in the depressive symptomatology. Conversely, the other romantic and interpersonal attachment styles were not linked with the evolution of the depressive symptomatology. DISCUSSION/CONCLUSION: Our results confirm that romantic and interpersonal styles of attachment constitute factors of vulnerability to depression. But more importantly, these findings open up new perspectives in terms of the nature of the relationships between attachment styles and depression. They provide matter for discussion concerning the stability or the change in romantic and interpersonal attachment styles. Indeed, we have revealed the stable and independent nature of romantic attachment styles in relation to depressive symptomatology. On the contrary, security in the interpersonal attachment style was shown to be a factor of change, associated with the evolution of the depressive symptomatology in progress. In the quest to take combined account of romantic and interpersonal attachment styles and their links with the evolution of depression, the present study results in a new understanding of depression, viewed from the perspective of the model of attachment in adults.

When less means more: evolutionary and developmental hypotheses in rodent molars.

Tooth number in rodents is an example of reduction in evolution. All rodents have a toothless diastema lacking canine and most premolars present in most other mammals. Whereas some rodent lineages retained one premolar (p4), many others lost it during evolution. Recently, an 'inhibitory cascade' developmental model (IC) has been used to predict how the first molar (m1) influences the number and relative sizes of the following distal molars (m2 and m3). The model does not, however, consider the presence of premolars, and here we examine whether the premolar could influence and constrain molar proportions during development and evolution. By investigating a large data set of both extinct and extant rodent families over more than 40 million years, we show that the basal phenotype is characterized by the presence of premolars together with equally sized molars. More recent rodent families, with and without premolar, show more unequal molar sizes. Analysing molar areas, we demonstrated that (i) rodents harbour almost all the molar proportions known in mammals, and the IC model can explain about 80% of taxa in our data set; (ii) proportions of molars are influenced by the presence or absence of p4; and (iii) the most variable teeth in the dental row are m1 and m3, whether p4 is present or not. Moreover, m1 can represent up to half of the total molar area when p4 is absent. We hypothesize that p4 loss during evolution released the constraint on m1 development, resulting in a more variable size of m1 and thereby having an indirect effect on the evolution of the whole molar row.

Calcium polyuronate dressing supplemented with zinc and manganese (trionic®) in necrotizing dermohypodermitis of the extremities: a randomized multicentre study.

Background. For the burn surgeon, the treatment of necrotizing soft tissue infections is one of the most demanding surgical emergencies, requiring "radical excisions" of the infected tissue and reconstruction. During the infection period, the excised sites are treated with application of gauzes soaked in saline solution. When the septic period is over, the excision sites are usually covered by sterile paraffin gauze dressing. Our aim was to evaluate a new calcium polyuronate dressing enriched with zinc and manganese ions (test group) versus the reference therapeutic combination (control group) from the septic period to the grafting of skin. Materials and methods. A multicentre, prospective, controlled, randomized clinical trial was conducted from November 2003 to July 2005. The primary endpoint was the waiting period for carrying out the skin graft and the percentage of grafted patients at 28 days after the last excision. The secondary endpoints were blood loss, exudates amounts, and pain during dressing changes. Results. Twenty-five patients were included, 14 with the new dressing and 11 with the reference therapeutic combination. The average waiting period for skin graft was 18 days in the test group versus 27.1 days in the control group (p = 0.128). All the patients in the test group received their grafts within 28 days after the last excision, compared with 60% (p = 0.043) in the control group. Bleeding during dressing change was statistically lower in the test group: 45.5% of the patients did not bleed compared with 0% in the control group (p = 0.045). Treatments were well tolerated. Conclusion. The properties of this new calcium polyuronate enriched with zinc and manganese ions seem to accelerate granulation tissue development, allowing skin grafting earlier in favourable conditions with less bleeding and less pain during dressing renewal.

[The temporal and spatial position of "hallucinatory stories". A study of the spatial and temporal position in the narratives of schizophrenic patients hearing voices]. / La position temporelle et spatiale dans les "histoires hallucinées". Etude de la position spatiale et temporelle dans les discours de patients schizophrènes entendant des voix.

INTRODUCTION: Hallucinations are often defined as perceptions when there is no object to perceive. However, clinical practitioners only have access to what their patients tell them about their hallucinations. By cooperating in the construction of a meaning for the hallucination, practitioner and patient can reach a common ground. This "co-construction" produces "hallucinatory stories" that are narratives, which revolve around this phenomenon. This raises the question of where the voices are temporally and spatially in the structure of the narrative. METHODS: Fourteen patients meeting the DSM-IV schizophrenia criteria were included and took part in a filmed standardized interview. The markers of temporal and spatial localization were listed and their occurrence in the narrative calculated (Student t test and Wilcoxon test). RESULT: The results revealed that: a significant difference between the present perfect tenses. There is a distinction between what is happening now and what has happened in the past; a significant difference between the markers of temporal localization such as accomplishment and position. The hallucinatory phenomena repeat themselves. Furthermore, the subjects' judgements concerning the moment at which the hallucinatory phenomenon arises are objective and are accompanied by a temporal reference associated with their story; a significant difference between the markers of spatial localization, with relative positions being preferred. The voices constitute a distinct, autonomous spatial reference for hallucination subjects. CONCLUSION: The narrative makes it possible to give the hallucinatory voices a place in the subject's story. The "hallucinatory stories" represent a transition from the private to the intersubjective world, a way for subjects to appropriate these experiences. When articulated in words, this experience is a product distinct from the self. This distinction between self and non-self, the hallucinating patient and his/her voices, seems to be conveyed in part by the markers of temporal and spatial position.

[Is muscle the best coverage for leg Gustilo IIIb fractures? A retrospective comparative study]. / Le muscle est-il la meilleure couverture pour les fractures ouvertes de jambe Gustillo IIIb ? Etude rétrospective comparative.

UNLABELLED: Well-vascularized muscle flaps have been the traditional gold standard for coverage of open fracture of the lower extremity. The last 15 years have brought the fasciocutaneous and perforator flaps and raised the issue of the type of coverage required for open fracture of the lower extremity. In recent years, in selected compromised patient, we have been using nonmuscular flaps for reconstruction. The goal of this study is to compare the results of fasciocutaneous reconstruction to those of classical muscular flaps. PATIENTS AND METHODS: A comparative retrospective study, including all patients from 2002 to 2006 requiring a coverage of a Gustillo III b fracture of the lower extremity, is done. The type of flaps, the fracture localization, the infection rate, the time required for consolidation of the fracture and the complication rate are reviewed. An independent university laboratory verified the statistical analysis. RESULTS: Twenty patients have experienced coverage by muscular flaps and 18 by fasciocutaneous flaps. We found a skin fistula and a chronic infection in the muscular-flap group, and two skin fistulae in the fasciocutaneous flaps group. The overall surgical results were comparable, except the bony union delay shorter in the fasciocutaneous flaps group. CONCLUSION: Muscle coverage is not mandatory to cover bone in the lower leg. The fasciocutaneous flaps can provide a good alternative for muscle-flap coverage. There is no significant difference as far as consolidation and infection are concerned, between the coverage by muscular or fasciocutaneous flaps.