Dairy goat doe-kid rearing systems: Farmers' motivations and a description of practices, benefits and drawbacks.

In French dairy goat systems, kids are generally separated from their mother does shortly after birth. The main drivers of this practice are related to health-especially the prevention of the Caprine Arthritis Encephalitis Virus (CAEV) transmission-and economics. However, the separation of young ruminants from their does is being increasingly questioned by society and has raised concerns about the satisfaction of their behavioral needs. Some farmers choose to leave their female kids with their does. The aims of this study were to understand their motivations for leaving kids with their does, to describe how kids are reared in this case and how farmers perceive different aspects of the impacts of this practice. Individual semi-structured interviews were carried out with 40 farmers who had implemented the kids-with-does practice for at least one year. Compared with the national database describing the French population of dairy goat farmers, the characteristics of the interviewed farmers differed from those of the general population. They were younger and had done longer studies. Their farms were smaller, mainly with rare breeds and milk was mainly processed on-farm under an organic certification system. They chose to implement this practice for different reasons: ethical considerations, improving integration of kids within the herd, saving time and increasing comfort at work or improving the kids' growth, welfare, and health. The doe-kid rearing contact practices varied greatly between farms, with some kids staying with their does from a period of 45 d to never being separated; furthermore, some kids remained with their does all day, while others remained together part of the day or for a limited time, and daily contact evolved over time. Overall, farmers were satisfied as the benefits quoted were coherent with their motivations to implement this rearing practice. Most have decided to continue the practice, though usually with changes. However, as 40% of them had only 3 years or less of experience of doe-kid rearing, some had not sufficient hindsight into long-term issues such as the transmission of CAEV. It is crucial to tackle challenges associated with this practice, i.e., potentially wild kids, health issues, and economic consequences stemming from a reduction in marketable milk.

[Impact of partial nephrectomy in a hybrid operating room on the activity of kidney cancer surgery]. / Évaluation de l'utilisation de la salle hybride sur l'activité de chirurgie en cancérologie rénale.

INTRODUCTION: Partial nephrectomy (NP) after embolization of tumor vessels (NPESH) in a hybrid room combines embolization of tumor vessels and enucleation of the tumor under laparoscopy in the same operative time. The purpose of this study was to assess the impact of the use of NPESH in the management of patients treated with surgery for a localized kidney tumor. MATERIAL AND METHODS: Using the uroCCR database, we included all consecutive patients operated in a university hospital for localized kidney tumor. From 2011 to May 2015, patients were treated by Standard Partial Nephrectomy (NPS) Laparoscopic or Open and from May 2015 to May 2019 by NPESH. We evaluated characteristics of patients, tumors, perioperative data and complications. These data were compared by Student and Khi2 tests. RESULTS: 87 NPS were performed during Period 1 and 137 NPS were performed during period 2. The ASA score of patients undergoing NPESH was higher than NPS (P<0.0001). The tumor complexity and median tumor size were similar in the two groups (P=0.852 and P=0.48). The complication rate for NPS and NPESH was 55.2% and 33.6% (P=0.002). There were less severe complications in the NEPSH group (P=0.012). The median length of stay was 8 and 4 days for the NPS and NPESH groups (P<0.0001). Positive surgical margins were 2 (2.3%) and 6 (4.6%) for the NPS and NPESH group (P=0.713). DISCUSSION: NPESH is an efficient technique compared to NPS. It seems to be an interesting alternative to limit renal ischemia, complication rate and length of stay for the management of localized kidney tumors.

Association between subclinical thyroid dysfunction and change in bone mineral density in prospective cohorts.

BACKGROUND: Subclinical hyperthyroidism (SHyper) has been associated with increased risk of hip and other fractures, but the linking mechanisms remain unclear. OBJECTIVE: To investigate the association between subclinical thyroid dysfunction and bone loss. METHODS: Individual participant data analysis was performed after a systematic literature search in MEDLINE/EMBASE (1946-2016). Two reviewers independently screened and selected prospective cohorts providing baseline thyroid status and serial bone mineral density (BMD) measurements. We classified thyroid status as euthyroidism (thyroid-stimulating hormone [TSH] 0.45-4.49 mIU/L), SHyper (TSH < 0.45 mIU/L) and subclinical hypothyroidism (SHypo, TSH ≥ 4.50-19.99 mIU/L) both with normal free thyroxine levels. Our primary outcome was annualized percentage BMD change (%ΔBMD) from serial dual X-ray absorptiometry scans of the femoral neck, total hip and lumbar spine, obtained from multivariable regression in a random-effects two-step approach. RESULTS: Amongst 5458 individuals (median age 72 years, 49.1% women) from six prospective cohorts, 451 (8.3%) had SHypo and 284 (5.2%) had SHyper. During 36 569 person-years of follow-up, those with SHyper had a greater annual bone loss at the femoral neck versus euthyroidism: %ΔBMD = -0.18 (95% CI: -0.34, -0.02; I2 = 0%), with a nonstatistically significant pattern at the total hip: %ΔBMD = -0.14 (95% CI: -0.38, 0.10; I2 = 53%), but not at the lumbar spine: %ΔBMD = 0.03 (95% CI: -0.30, 0.36; I2 = 25%); especially participants with TSH < 0.10 mIU/L showed an increased bone loss in the femoral neck (%Δ BMD = -0.59; [95% CI: -0.99, -0.19]) and total hip region (%ΔBMD = -0.46 [95% CI: -1.05, -0.13]). In contrast, SHypo was not associated with bone loss at any site. CONCLUSION: Amongst adults, SHyper was associated with increased femoral neck bone loss, potentially contributing to the increased fracture risk.

[Management of metastatic renal cell carcinomass]. / Prise en charge des métastases du cancer du rein.

The management of metastatic renal cell carcinoma had changed over the last ten years with the apparition of new treatments and advances in surgery and ablative techniques. The therapies for metastatic patients have also been personalized and different prognostic groups have been established to adapt the treatment to the severity of the disease. Surgical excision, radiotherapy or ablative therapy could be proposed for patients with isolated metastasis and good condition to delay the systemic therapy initiation. Until 2006, in case of metastatic renal cell carcinoma, immunotherapy (IL-2 and TNF-alpha) was proposed. Targeted therapies acting on angiogenesis mechanisms have also been developed. Recently, immunotherapy has revolutionized the therapeutic management and has improved the overall survival of patients with metastatic renal carcinoma. For each patient, a multidisciplinary management is organized with a personal therapeutic project. This global management needs coordination with the medical team and also need a good communication with the patient, his entourage and his doctor.

[Value of Doppler ultrasound for the assessment of carotid artery invasion by tumours of the upper aerodigestive tract]. / Intérêt de l'échographie Doppler dans l'évaluation de l'envahissement de l'artère carotidienne dans les tumeurs des voies aérodigestives supérieures.

The diagnosis of invasion of the carotid axis preoperatively is extremely helpful and determines the therapeutic approach as well as the prognosis for patients with tumours of the upper aerodigestive tract. A review of literature to refine the radiological choice between the different existing techniques is provided. It appears that echography gives excellent results.

Le diagnostic d'un envahissement de l'axe carotidien en période préopératoire est très utile et détermine l'attitude thérapeutique de même que le pronostic des patients présentant une tumeur des voies aérodigestives supérieures. A l'aide de cas cliniques, les différentes techniques d'imagerie ont été évaluées et une revue de littérature a été réalisée pour affiner le choix de la méthode radiologique. Il apparaît que l'échographie est particulièrement performante.

Recalcitrant hypocalcemia after total thyroidectomy and bariatric surgery.

PROBLEM: Patients with Roux en Y gastric bypass (RYGBP) who undergo total thyroidectomy may be at increased risk for recalcitrant symptomatic hypocalcemia. METHODS: All patients who underwent total thyroidectomy with a history of preceding RYGBP from 2007 to 2012 were identified retrospectively. Cases were matched 2:1 for age, gender, and BMI to a control group undergoing total thyroidectomy without previous RYGBP during the same study period. RESULTS: Age and body mass index were equivalent between cases (n = 14) and controls (n = 23). A comparison between groups demonstrated that cases had a significantly higher incidence of symptomatic hypocalcemia resulting in paresthesia and tetany (38% vs. 0%; P <0 .01), received intravenous calcium more often (18% vs. 0%; P < 0.01), and had longer hospital stays (2.2 vs. 1.2 days, P = 0.02) than controls. CONCLUSIONS: Physicians and surgeons need to be aware of this complication and take measures to identify and prevent it, and patients should be informed. In this patient population, calcium levels should be closely monitored and early calcium and vitamin D spplementation should be initiated preemptively.

Chemoradiation for advanced oral and (pharyngo) laryngeal carcinoma: single institution outcome analysis.

AIM: Chemoradiation ( CRT) is a valuable treatment option for(pharyngo)laryngeal squamous cell cancer and a palliative cure in advanced oral cancers. However, toxicity is scarcely reported. Therefore, efficacy, acute and toxic effects of chemoradiation for advanced head and neck squamous cell carcinomas were evaluated, using retrospective study. METHODS: Previously untreated patients with stage III-IV head and neck squamous cell carcinomas were included. Radiotherapy consisted of 70 Gy/7 weeks/35 fractions. All patients received concurrent Cisplatin 40 mg/m2 weekly. RESULTS: The most common acute toxic effects were dysphagia and mucositis. Dysphagia and xerostomia remained problematic during follow-up. Loco regional disease control was respectively 91% and 98% after 6 months. The median overall survival (calculating starting form the end of the treatment) was 33 months (range 0-111months). The 5-year disease specific survival was 41%. CONCLUSION: The results indicated that concurrent chemoradiotherapy for advanced head and neck squamous cell carcinoma is associated with high locoregional control and disease-specific survival. However, significant acute and long-term toxic effects occur, and organ preservation appears not necessarily equivalent to preservation of function in pharyngolaryngeal cancers.

Association of peripheral neuropathy with circulating advanced glycation end products, soluble receptor for advanced glycation end products and other risk factors in patients with type 2 diabetes.

BACKGROUND: The pathogenesis of diabetic peripheral neuropathy remains uncertain and nonenzymatic glycoxidation is one of the contributing mechanisms. The aim of this study was to assess the respective relationship of diabetic peripheral neuropathy with glycoxidation, compared with other identified risk factors, in patients with type 2 diabetes. METHODS: We included 198 patients with type 2 diabetes and high risk for vascular complications. Circulating concentrations of three advanced glycation end products (carboxymethyllysine, methyl-glyoxal-hydroimidazolone-1, pentosidine) and of their soluble receptor (sRAGE) were measured. Peripheral neuropathy was assessed by the neuropathy disability score and by the monofilament test and defined as either an abnormal monofilament test and/or a neuropathy disability score ≥6. Multivariate regression analyses were performed adjusting for potential confounding factors for neuropathy: age, gender, diabetes duration, current smoking, systolic blood pressure, waist circumference, height, peripheral arterial occlusive disease, glycated haemoglobin, estimated glomerular filtration rate and lipid profile. RESULTS: Prevalence of peripheral neuropathy was 20.7%. sRAGE and carboxymethyllysine were independently and positively associated with the presence of peripheral neuropathy. No significant association was found between peripheral neuropathy and methyl-glyoxal-hydroimidazolone-1 or pentosidine. Waist circumference, height and peripheral arterial occlusive disease were independently associated with peripheral neuropathy. CONCLUSIONS: Carboxymethyllysine and sRAGE were independently associated with peripheral neuropathy in patients with type 2 diabetes. Although the conclusions are limited by the absence of a healthy control population, this study confirms the relationship between advanced glycoxidation and diabetic peripheral neuropathy, independently of other risk factors.

Influence of peripheral vascular calcification on efficiency of screening tests for peripheral arterial occlusive disease in diabetes--a cross-sectional study.

AIMS: Pulse palpation and ankle brachial index are recommended to screen for peripheral arterial occlusive disease in people with diabetes. However, vascular calcification can be associated with false negative tests (arteriopathy present despite normal screening tests). We therefore studied the impact of peripheral vascular calcification on the performance of these tests. METHODS: This cross-sectional study included 200 people with diabetes at high risk of cardiovascular disease. The main exclusion factor was an estimated glomerular filtration rate < 30 ml/min. Peripheral arterial occlusive disease was diagnosed by colour duplex ultrasonography and peripheral vascular calcification scored by computed tomography scan. We measured sensitivity, specificity, predictive values, accuracy and likelihood ratios of pulse palpation and ankle brachial index, and looked for the impact of calcification on false negative tests (arteriopathy present despite normal screening tests). RESULTS: Ankle brachial index alone had poor sensitivity and negative predictive value and high negative likelihood ratio. Pulse palpation had higher sensitivity and negative predictive value. An abnormal pulse palpation, defined by weak or missing pulses, combined with an abnormal ankle brachial index, had the highest sensitivity and negative predictive value (92.3 and 89.8%, respectively). Vascular calcification score was higher in patients with false negative tests, for both pulse palpation and ankle brachial index (P < 0.0001 for all). Ankle systolic blood pressure was higher in patients with false negative tests for pulse palpation (P = 0.004). CONCLUSIONS: Below-knee vascular calcification gave a high rate of false negative results for ankle brachial index. Refined pulse palpation combined with ankle brachial index remained the best strategy to screen for peripheral arteriopathy.

Influence of peripheral arterial occlusive disease on the Neuropad(®) test performance in patients with diabetes.

AIMS: The specificity of the Neuropad(®) test to screen for peripheral neuropathy is moderate, but this test has several advantages, such as self-use, educative value and good sensitivity. Use of the Neuropad is usually contra-indicated in the presence of peripheral arterial occlusive disease, a condition associated with skin dryness. The aim of this study was to assess the influence of peripheral arterial occlusive disease on the performance of the Neuropad for screening peripheral neuropathy, and to compare it with the monofilament test. METHODS: We included 200 patients with diabetes. Peripheral neuropathy was defined by a neuropathy disability score ≥ 6. The Neuropad was determined as normal or abnormal at 10 and 20 min, respectively, and its performance was compared in patients with and without peripheral arterial occlusive disease diagnosed by colour duplex ultrasonography. The performances of the Neuropad and of the monofilament test were compared. RESULTS: Prevalences of peripheral neuropathy and of peripheral arterial occlusive disease were 15.8 and 44%, respectively. At 10 min, sensitivity and negative predictive value were high (93.8 and 95.1%), while specificity and positive predictive value were poor (23.2 and 18.9%). The Neuropad performance was not significantly different between patients with and without arteriopathy. Between 10 and 20 min, there was significant loss of sensitivity and gain in specificity. The Neuropad at 10 min was more sensitive but less specific than the monofilament test. CONCLUSIONS: The reliability of the Neuropad is not significantly different in the presence or absence of peripheral arterial occlusive disease.

Bisphosphonates and their clinical implications in endodontic therapy.

This review gives an overview of the factors that may play a role in the development of osteonecrosis of the jaw in patients treated with bisphosphonates (BPs) and undergoing nonsurgical endodontic treatment as well as some recommendations for its prevention. BPs are a widely prescribed group of drugs for diverse bone diseases. The occasional but devastating adverse effect of these drugs has been described as bisphosphonate-related osteonecrosis of the jaw (BRONJ). As this condition is debilitating and difficult to treat, all efforts should be made to prevent its occurence in patients at risk. The main triggering event is considered to be dental extraction. Even though nonsurgical endodontic treatment appears to be a relatively safe procedure, care remains essential. After an overview of this class of drugs, the clinical presentation, epidemiology and pathogenesis of BRONJ, as well as the possible risk factors associated with its development after nonsurgical endodontic treatment will be described. Finally, several strategies will be proposed for the prevention of BRONJ during nonsurgical endodontic treatment.

The effect of hyperbaric oxygen therapy on treatment of wound complications after oral, pharyngeal and laryngeal salvage surgery.

INTRODUCTION: Radiation therapy alone, or combined with chemotherapy, are both used for cancer in the head and neck. This can lead to damage of tissue cells and vasculature. Surgery in such compromised tissues has increased complication rates, because wound healing with angiogenesis and fibroplasias requires normal cell growth conditions. Hyperbaric oxygen therapy raises oxygen levels in hypoxic tissue, stimulates angiogenesis and fibroplasia. In this report, we review the clinical value of hyperbaric oxygen therapy for major wounds that had shown no signs of healing as well as fistulas after salvage surgery in patients treated with (chemo)radiation of the head and neck regions. METHODS: In this retrospective study, 16 patients with soft-tissue wounds without signs of healing after salvage surgery, after radiation, and most after chemotherapy were treated in the head and neck regions with hyperbaric oxygen therapy. The patients were treated by HBO2, 2.5 bars 90 minutes daily, usually 20 treatments. RESULTS: The healing processes seemed to be initiated and accelerated by HBO2. Fourteen of the 16 patients healed completely. There were no life-threatening complications. CONCLUSION: Radiotherapy and combined chemoradiation therapy leads to damage of tissue cells and vasculature. Salvage surgery in such tissues has an increased complications rate, because wound healing requires angiogenesis and fibroplasias, all of which are jeopardized. Hyperbaric oxygen therapy raises oxygen levels in hypoxic tissue, stimulates angiogenesis and fibroplasias and is an effective and powerful treatment for postoperative wounds in oral, pharyngeal and laryngeal carcinomas surgery.

Oxygen reduction in the strict anaerobe Desulfovibrio vulgaris Hildenborough: characterization of two membrane-bound oxygen reductases.

Although Desulfovibrio vulgaris Hildenborough (DvH) is a strictly anaerobic bacterium, it is able to consume oxygen in different cellular compartments, including extensive periplasmic O2 reduction with hydrogen as electron donor. The genome of DvH revealed the presence of cydAB and cox genes, encoding a quinol oxidase bd and a cytochrome c oxidase, respectively. In the membranes of DvH, we detected both quinol oxygen reductase [inhibited by heptyl-hydroxyquinoline-N-oxide (HQNO)] and cytochrome c oxidase activities. Spectral and HPLC data for the membrane fraction revealed the presence of o-, b- and d-type haems, in addition to a majority of c-type haems, but no a-type haem, in agreement with carbon monoxide-binding analysis. The cytochrome c oxidase is thus of the cc(o/b)o3 type, a type not previously described. The monohaem cytochrome c553 is an electron donor to the cytochrome c oxidase; its encoding gene is located upstream of the cox operon and is 50-fold more transcribed than coxI encoding the cytochrome c oxidase subunit I. Even when DvH is grown under anaerobic conditions in lactate/sulfate medium, the two terminal oxidase-encoding genes are expressed. Furthermore, the quinol oxidase bd-encoding genes are more highly expressed than the cox genes. The cox operon exhibits an atypical genomic organization, with the gene coxII located downstream of coxIV. The occurrence of these membrane-bound oxygen reductases in other strictly anaerobic Deltaproteobacteria is discussed.

Hypertension is an independent predictor of mean platelet volume in patients with acute ischaemic stroke.

INTRODUCTION: Mean platelet volume (MPV) was shown to be significantly increased in patients with acute ischaemic stroke, especially in non-lacunar strokes. Moreover, some studies concluded that increased MPV is related to poor functional outcome after ischaemic stroke, although this association is still controversial. However, the determinants of MPV in patients with acute ischaemic stroke have never been investigated. SUBJECTS AND METHODS: We recorded the main demographic, clinical and laboratory data of consecutive patients with acute (admitted within 24 h after stroke onset) ischaemic stroke admitted in our Neurology Service between January 2003 and December 2008. MPV was generated at admission by the Sysmex XE-2100 automated cell counter (Sysmex Corporation, Kobe, Japan) from ethylenediaminetetraacetic acid blood samples stored at room temperature until measurement. The association of these parameters with MPV was investigated in univariate and multivariate analysis. RESULTS: A total of 636 patients was included in our study. The median MPV was 10.4 ± 0.82 fL. In univariate analysis, glucose (ß= 0.03, P= 0.05), serum creatinine (ß= 0.002, P= 0.02), haemoglobin (ß= 0.009, P < 0.001), platelet count (ß=-0.002, P < 0.001) and history of arterial hypertension (ß= 0.21, P= 0.005) were found to be significantly associated with MPV. In multivariate robust regression analysis, only hypertension and platelet count remained as independent determinants of MPV. CONCLUSIONS: In patients with acute ischaemic stroke, platelet count and history of hypertension are the only determinants of MPV.

Theiler's virus infection of 129Sv mice that lack the interferon alpha/beta or interferon gamma receptors.

The Daniels strain of Theiler's virus causes a persistent infection of the white matter of spinal cord of susceptible mice, with chronic inflammation and primary demyelination. Inbred 129Sv mice are resistant to this infection; they present with mild encephalomyelitis and clear the infection within a matter of days. A very different outcome was observed with inbred 129Sv mice whose receptors for interferon alpha/beta or interferon gamma had been inactivated by homologous recombination. The former presented severe encephalomyelitis with acute infection of neurons, particularly in brain and hippocampus, and extensive infection with necrosis of the choroid plexus. Most animals died of this acute disease. The latter, presented the same early encephalomyelitis as the control 129Sv mice. However, they remained persistently infected and developed a very severe late infection of the white matter with extensive primary demyelination. This late disease looked like an exacerbated form of the chronic demyelinating disease observed in susceptible inbred mice such as the SJL/J or FVB strains. Our results show that the two interferon systems play nonredundant roles in the resistance of the 129Sv mouse to the infection by Theiler's virus. They also lend support to the notion that the Ifg gene is involved in the resistance/susceptibility of inbred strains of mice to persistent infection by this picornavirus.

Five-year mortality in patients with diabetic foot ulcer during 2009-2010 was lower than expected.

AIM: Mortality rates are decreasing in patients with diabetes. However, as this observation also concerns patients with diabetic foot ulcer (DFU), additional data are needed. For this reason, our study evaluated the 5-year mortality rate in patients with DFU during 2009-2010 and identified risk factors associated with mortality. METHODS: Consecutive patients who attended a clinic for new DFU during 2009-2010 were followed until healing and at 1 year. Data on mortality were collected at year 5. Multivariate Cox proportional-hazards model was used to identify mortality risk factors. RESULTS: A total of 347 patients were included: mean age was 65±12 years, diabetes duration was 16 [10; 27] years; 13% were on dialysis; and 7% had an organ transplant. At 5 years, 49 patients (14%) were considered lost to follow-up. Total mortality rate at 5 years was 35%, and 16% in patients with neuropathy. On multivariate analyses, mortality was positively associated with: age [hazard ratio (HR): 1.05 (1.03-1.07), P<0.0001]; duration of diabetes [HR: 1.02 (1.001-1.03], P=0.03]; PEDIS perfusion grade 2 vs. 1 [HR: 2.35 (1.28-4.29), P=0.006)]; PEDIS perfusion grade 3 vs. 1 [HR: 3.14 (1.58-6.24), P=0.001); and ulcer duration at year 1 [HR 2.09 (1.35-3.22), P=0.0009]. CONCLUSION: Mortality rates were not as high as expected despite the large number of comorbidities, suggesting that progress has been made in the health management of these patients. In particular, patients with neuropathic foot ulcer had a survival rate of 84% at 5 years.

Unusual presentation of adenoid cystic carcinoma of the maxillary antrum.

Unusual presentation of adenoid cystic carcinoma of the maxillary antrum. Adenoid cystic carcinoma (ACC) is a rare tumour which affects mainly the major and accessory salivary glands. It is an aggressive neoplasm characterized by early neural invasion and a high incidence of local recurrence and distant metastases, which may develop years after the initial resection. Surgery followed by radiotherapy seems to be the best treatment. Based on a well-illustrated case of extensive maxillary ACC involving the palate, orbit floor, and pterygo-palatine fossa, we discuss the prognosis and the importance of an early diagnosis of ACC.

High day-to-day glucose variability: a frequent phenomenon in children and adolescents with type 1 diabetes attending summer camp.

BACKGROUND: Day-to-day glucose variability may cause difficulty for patients trying to adjust their insulin dosages and for healthcare providers when they have to make recommendations. The aim of this research was to evaluate the frequency of high variability in a population of diabetic children and adolescents attending summer camp. METHODS AND RESULTS: The mean of the daily differences (MODD) in glucose concentrations was calculated from continuous glucose monitoring (CGM) over five consecutive days in 6 diabetic patients. This index was correlated to the MODD calculated from pre-meal and bedtime blood glucose (BG) measurements (r=0.87). We used the MODD calculated on these four BG measurements for five consecutive days to evaluate day-to-day glucose variability in 100 young diabetic patients treated with glargine and ultrarapid analogue insulin. Only one child had a MODD value lower than 36mg/dl, considered a threshold for high day-to-day variability, and 94 children had a MODD value higher than 45mg/dl. The median value was 78mg/dl. The expected positive correlation between the MODD and its standard deviation (r=0.32, P<0.01) suggested that the greater the day-to-day variability, the more variable the variability across five consecutive days. CONCLUSIONS: The estimation of MODD from four pre-meal BG values correlated to that from CGM, and may represent a simple index of day-to-day glycaemic variability. High day-to-day glucose variability in glucose profile is frequently observed in diabetic children attending summer camp.

[Osteochemonecrosis of the jaws and bisphosphonates: a case report and literature review]. / Ostéochimionécrose maxillo-mandibulaire et bisphosphonates. A propos d'un cas et revue de la littérature.

Jaws osteonecrosis were, in most cases, caused by external irradiation. It was otherwise a rare occurrence. However, bisphosphonates have recently been associated with osteonecrosis of the mandible or the maxilla. Bisphosphonates are widely used in the treatment of osteoporosis, multiple myeloma and osteolytic bone metastases. They inhibit bone resorption by osteoclasts and disrupt the bone turnover. The so-caused bone expositions are painful and prone to surinfection. Even after cessation of the bisphosphonates, the results of medical and surgical treatment are very inconsistent. A thorough dental check-up is recommended before initiating a course of bisphosphonates.

Assessing multiple goods and services derived from livestock farming on a nation-wide gradient.

Livestock farming is an essential activity in many rural areas, where it contributes to the maintenance of soil fertility and farmland biodiversity, as well as to a set of social public goods including food security, rural vitality and culture. However, livestock sustainability assessments tend to focus primarily on environmental and economic dimensions; therefore, these valuations might be limited because they do not consider the complete set of associated goods and services (GS). Hence, a need exists to recognise the multiple contributions provided by livestock to human well-being and society. The objective of this study was to analyse the provision of multiple GS derived from livestock across regions in France and empirically demonstrate sets of GS that repeatedly appeared together. We designated these multiple GS provided by livestock as contributions to productive, environmental, rural vitality and cultural benefits that human populations derive directly or indirectly from livestock agroecosystems. First, we combined expert knowledge with results of a literature review to define a bundle of GS provided by livestock. We then described indicators that quantified each good or service and screened national databases to determine the availability of supporting data. Finally, we assessed the GS and their relationships (synergies or trade-offs) on a nation-wide gradient in France at the department level (Nomenclature of Territorial Units for Statistics 3). Four main categories of GS were considered: provisioning (e.g. food quantity and quality), environmental quality (e.g. biodiversity, landscape heterogeneity, water quality), rural vitality (e.g. employment, rural dynamism) and culture (e.g. gastronomy and landscape heritage). Four major types of GS bundles were identified, which suggested strong contrasts among French rural areas in terms of the nature of the GS that occurred together and their levels of provision. GS bundles in France had a non-random spatial distribution. This study represents an initial step towards developing a methodology to consider GS bundles provided by livestock. Nonetheless, further research is needed to understand socio-economic, environmental, political and geographic determinants of the composition of GS bundles.