Baseline physiological data from anesthetized pigs in a VX intoxication model.

Over the past fifty years, swine models have been used for organophosphorus intoxication studies. Among these studies and others on the swine model in general, some physiological data, especially cholinesterase activity highly impacted by organophosphorus compounds like nerve agent VX, still need to be completed. To support and compare our model to others, we have published the experimental protocol, the physiological values of 31 juvenile anesthetized pigs, and the 6h-follow-up of six supplementary anesthetized control animals and 7 VX-intoxicated pigs. We reported hemodynamics and respiratory parameters, blood levels in several biochemical parameters, blood gas, and complete blood count and compared them to the literature. We also focused on tissue and blood cholinesterase activities and detailed them for acetylcholinesterase and butyrylcholinesterase. After establishing a broad physiological data set consistent with the literature, we reported several cardio-respiratory parameters that seem more affected by an organophosphate intoxication, like heart rate, arterial blood pressure, cardiac output, and respiratory rate. Within the blood, oxygen saturation (SpO2), lactatemia, base excess, and glycemia can also be measured and associated with the other parameters to evaluate the life-threatening status. This swine model is currently used to develop and evaluate medical countermeasures against organophosphate nerve agent intoxications.

Traditional healers or bonesetters ("rebouteux") in France: A survey of their practice, profile, and customers.

BACKGROUND: In France, many people consult "bonesetters" for several medical reasons. Little is known about them. We aimed to investigate the practices of traditional healers in France as well as their profile and that of their customers. METHODS: This was a survey carried out in Metropolitan France. A 33-item questionnaire developed by a multidisciplinary group was sent to a sample of 148 traditional healers found on the Internet and by word of mouth. RESULTS: Of the 148 questionnaires sent, 89 (60.1 %) were returned and 67 (45.3 %) were analyzed: 51.5 % (n = 34) of respondents were men, and the mean (±standard deviation) age was 51.6 ±â€¯11.6 years. The respondents considered that they had received a gift of healing and were mainly magnetic healers (68.2 %). They became aware of this gift at a mean age of 19.9 ±â€¯14.1 years. The traditional healers practiced mainly in rural areas (54.5 %), at home (59.1 %), and used their hands to transmit energy (95.5 %). They advertised their practice mainly by word of mouth (89.4 %) and had a predominantly female clientele (78.1 %). Various diseases were treated, with the most frequent being subjective complaints (pain, stress, fatigue, insomnia) and dermatological complaints (eczema, accidental and post-herpes-zoster burns, psoriasis, and warts). Most respondents considered their activities to be complementary to conventional medicine, and 10.9 % considered them more effective. Some indicated that they did not consider themselves "healers" but rather "providers of relief". DISCUSSION: The results of this survey provide a better understanding of this network of local care that revolves around medicine.

Rewiring cattle trade movements helps to control bovine paratuberculosis at a regional scale.

Paratuberculosis is a worldwide disease mainly introduced through trade. Due to the low sensitivity of diagnostic tests, it is difficult to protect herds from purchasing infected animals. Our objective was to assess if rewiring trade networks to promote risk-based movements could reduce the spread of Mycobacterium avium subsp. paratuberculosis (MAP) between dairy cattle herds at a regional scale. Two levels of control strategies were assessed. At the between-herd scale, trade rewiring aimed to prevent animals from high-risk herds moving into low-risk herds. At the within-herd scale, complementary additional measures were considered based on the herd infection status, aiming to limit the within-herd spread by reducing calf exposure to adult faeces and culling more rapidly after positive test results. We used a stochastic individual-based and between-herd mechanistic epidemiological model adapted to the 12,857 dairy cattle herds located in Brittany, western France. We compared the regional spread of MAP using observed trade movements against a rewiring algorithm rendering trade movements risk-based. All females over two years old were tested. Based on the results, and taking into account the low test sensitivity, herds were annually assigned one of three statuses: A if the estimated true prevalence was below 7%, B if it ranged from 7 to 21 %, C otherwise. We also identified herds with a high probability of being MAP-free (AAA herds that had obtained an A status over three consecutive years) to assess the effect of decreasing their risk of purchasing infected animals on MAP regional spread. We showed that movement rewiring to prevent the sale of animals from high to low-prevalence herds reduces MAP regional spread. Targeting AAA herds made it possible to minimize the control effort to decrease MAP regional spread. However, animals purchased by AAA herds should have a moderate to high probability of being MAP-free, especially if the risk of purchasing animals from herds of unknown status cannot be managed. Improved hygiene and early culling of positive animals were relevant complementary on-farm control options to further decrease MAP spread. Future studies should identify how to define herd statuses to target optimal control measure combinations that could reduce the spread of MAP on a regional scale most effectively.

Optimized centrifugation preparation of the platelet rich plasma: Literature review.

Nowadays, the Platelet Rich Plasma (PRP) is frequently used for its therapeutic effects on wound healing, and this due to secretion of many growth factors. However, no standardized procedure has been set up. The aim of this article is to check the various preparations (centrifugation time and speed). This review recorded all the international articles published between 2007 and 2018, for which the assessment criteria were the platelet concentration and/or the growth factor release rate. A multitude of protocols has been looked at with a simple or double centrifugation. All of them have shown an increase in the platelet concentration allowing a therapeutic effect. However, when the centrifugation force is extended, platelets can possibly be altered. The diversity of methods can be linked to the use of various centrifuges. A procedure with simple centrifugation would be a good compromise for the day-to-day use of the PRP in surgery.

Virtual 3D planning of osteotomies for craniosynostoses and complex craniofacial malformations.

INTRODUCTION AND OBJECTIVES: Computer-assisted surgery has been more and more widely used in craniofacial surgery in recent years. It is useful in many situations: stereolithographic models, surgical simulations of osteotomies and bone repositioning, and cutting guides and customized implants. The present paper argues that computer-assisted surgery is particularly useful in complex cases such as rare malformations, or to address the sequelae of previous surgeries. The various advantages of the technique are emphasized from a surgical and from a teaching standpoint. MATERIALS AND METHODS: Forty cases of various computer-assisted surgeries were analyzed, allowing a comprehensive review of outcomes in cases such as craniosynostosis, complex craniosynostosis, hypertelorism, craniosynostosis sequelae and cranio-facial and orbital trauma. RESULTS: Results were promising in all of the cases reviewed, except in a few cases for which computer-assisted surgery with cutting guides may not be necessary. In these specific cases, the pedagogical input is nevertheless interesting for residents and students. CONCLUSION: Computer-assisted surgery is revolutionizing the surgical approach to complex craniofacial malformations, as well as easing management of less complex ones. It is likely that in the years to come this technique will supersede previous ones. However, using this technique implies being willing to rely on a non-human device. We need to consider computer-assisted surgery as a tool that can change surgical practices. The surgeon can rely on it, yet nothing will replace his/her eye and experience. It is the combination of both this experience and the appropriate use of computer-assisted surgery that, ultimately, leads to successful surgery.

Addressing hypertelorism: Indications and techniques.

From its first descriptions in the early 1920s to today's use of cutting guides via computer-assisted surgery, surgical techniques to address hypertelorism have progressed. The present article aims to provide historical background and an overview of the development of surgical techniques during the late 20th century and in recent years. First, a historical overview identifies the most important surgical advances leading to the present state of the art. Each major surgical innovation is described, to explain the changes in this surgical field, according to the type of approach. Then, a precise description of today's most recent practices is provided, with particular emphasis on the spectacular advances deriving from computer-assisted surgery. A thorough description of the use of cutting guides throughout the surgical phase is given.

Management of isolated and complex craniosynostosis residual deformities: What are the maxillofacial tools?

Treatment of craniosynostosis is complex and has greatly progressed in recent decades. From the early stages in the 1950s to today's most recent techniques, surgeons have faced the challenge of overcoming the deformities often caused by such invasive, complex surgeries. In the most recent years, new techniques have been developed that address surgical sequelae, including those of surgery performed in childhood. After a general introduction on craniosynostosis, the present paper describes the various types of deformity that may result from complex surgery and offers an overview of the various tools available to surgeons. An explanation of each indication and procedure is given.

School-age human figure drawings by very preterm infants: Validity of the Draw-a-Man test to detect behavioral and cognitive disorders.

Detecting an abnormal developmental trajectory in very preterm infants remains challenging. The objective of this study was to determine the correlation between the Draw-a-Man test (DAMT) and behavioral and cognitive disabilities in very preterm infants. From the school-age follow-up of the Premag study, which evaluated the neuroprotective effect of prenatal magnesium sulfate before 33 weeks of gestation, 281 human figure drawings were assessed (mean age, 11 years). Behavioral and cognitive disabilities were associated with delayed DAMTs but test performance indicators were insufficient to use DAMT as a screening or a diagnostic test.

Severe macroglossia after posterior fossa and craniofacial surgery in children.

Massive swelling of the tongue can occur after posterior fossa and craniofacial surgery. Several hypotheses have been proposed to explain the occurrence of such severe postoperative macroglossia, but this phenomenon is still poorly understood. Severe postoperative macroglossia can be a life-threatening condition due to upper airway obstruction. Three cases of severe postoperative macroglossia that occurred after cervical spine, craniofacial, and posterior fossa surgical procedures are reported here. These cases required specialized maxillofacial management and a prolonged stay in the intensive care unit. Causal factors involved in this condition are reported, in order to highlight appropriate prevention and treatment options adapted to the management of paediatric patients. An overview of the current literature on severe postoperative macroglossia in paediatric populations is also provided.

Speech evaluation after intravelar veloplasty. How to use Borel-Maisonny classification in the international literature?

OBJECTIVE: Comparing functional outcomes after velar repair appeared to be difficult because of the absence of international standardized scale. Moreover most of the studies evaluating speech after cleft surgery present multiple biases. The aim of our study was to assess speech outcomes in a homogeneous group of patients, and to define an equivalence table between different speech scales. MATERIALS AND METHODS: Patients with isolated cleft lip and palate (CLP), operated in our unit by the same senior surgeon were included. All patient were operated according to the same protocol (cheilo-rhinoplasty and intravelar veloplasty at 6 months, followed by a direct closure of the hard palate at 15 months). Speech evaluation was performed after 3 year-old and before the alveolar cleft repair. Borel-Maisonny scale and nasometry were used for speech evaluation. RESULTS: Twenty-four patients were included: 17 unilateral CLP and 7 bilateral CLP. According to the Borel-Maisonny classifications, 82.5% were ranged phonation 1, 1-2 or 2b. Nasometry were normal in almost 60% of cases. CONCLUSIONS: This study showed the efficiency of our protocol, and intravelar veloplasty. Moreover we proposed an equivalence table for speech evaluation scale.

Salivary scintigraphy for Sjögren's syndrome in patients with xerostomia: A retrospective study.

OBJECTIVES: The value of salivary gland scintigraphy in the diagnosis of Sjögren's syndrome remains controversial. The primary aim of this study was to estimate the diagnostic accuracy of salivary gland scintigraphy in the diagnosis of Sjögren's syndrome among 237 patients with xerostomia. METHODS: We retrospectively compared eight scintigraphy parameters between 106 Sjögren patients and 131 non-Sjögren patients. RESULTS: Seven of the eight parameters were significantly decreased in patients with Sjögren; however, their diagnostic accuracy was low, with areas under the curves (AUCs) ranging from 0.58 (95% CI 0.50-0.65) to 0.63 (95% CI: 0.55-0.70). The prestimulatory oral activity index allowed discrimination between primary and secondary Sjögren's syndrome (AUC 0.73, 95% CI: 0.62-0.84), and the secretion velocity for parotid glands allowed discrimination between patients with Sjögren and burning mouth syndrome (AUC 0.71, 95% CI 0.59-0.82). CONCLUSION: The accuracy of scintigraphy parameters for the diagnosis of Sjögren's syndrome among patients with xerostomia was low; however, some functional indices appeared to assist discrimination between primary and secondary SS patients and between subgroups of patients with different causes of xerostomia.

Posterior cranial vault distraction osteogenesis in craniofacial surgery: Technical note.

INTRODUCTION: Posterior cranial vault distraction is a treatment for intracranial hypertension in certain cases of craniosynostosis and faciocraniosynostosis. It allows the harmonization of the skull back and prevents turricephaly. This study presents the surgical technique. TECHNICAL NOTE: Posterior cranial vault distraction osteogenesis consists of a circular osteotomy of the skull back. Four distractors are placed on the cranial flap without detachment of the dura mater. The distraction is carried out over nearly 1 month with an objective of 20mm. The technique's effectiveness is judged on the correction of the skull back shape and the disappearance of clinical and radiological signs of intracranial hypertension. DISCUSSION: Posterior cranial vault distraction osteogenesis enables a large increase in cranial volume and a correction of the dysmorphic skull back. This easy surgery and the low rate of complications make this technique a main surgical approach in the management of faciocraniosynostosis.

[Orbitofrontal bone reconstruction with cutting guides]. / Reconstruction orbito-frontale osseuse sur mesure par guides de coupes.

INTRODUCTION: Reconstruction of craniofacial defects due to traumatic injuries is a challenge for a reconstructive surgeon, given the functional impact, the aesthetic impact and the geometric complexity of the craniofacial skeleton. The use of cutting and repositioning guides enables a new approach from the craniofacial reconstruction with bone grafts on measure. We are presented to illustrate this technique the case of a patient. OBSERVATION: The patient was 50 years old, he presented a traumatic facial sequelar: a left frontal craniofacial deformation, an enlarged left orbit with enophthalmos and valgus left zygoma. The patient had a permanent diplopia, an important aesthetic and social gene impeding daily life. Surgical planning was performed for optimal care. We performed a cranioplasty frontotemporal by bone parietal duplication, osteotomy of zygoma and intra-orbital bone graft customized using cutting guides. The bone pieces were positioned with the repositioning books. DISCUSSION: This presentation illustrates a novel application of cutting guides. This technique has the advantage of using customized autologous bone. This is the gold standard, it requires surgical experience.

Frontal cranioplasty in fronto-metaphyseal dysplasia.

INTRODUCTION: Fronto-metaphyseal dysplasia (FMD), also called Gorlin-Cohen syndrome, is a rare syndrome initially described in 1969 by Gorlin and Cohen. Patients present skeletal dysplasia, craniofacial malformations and digit abnormalities. Craniofacial phenotype of FMD is characterized by supraorbital hyperostosis, hypertelorism, down-slanting palpebral fissures, broad nasal bridge and micrognathia. Here, we report the first adult case of craniofacial reconstruction with frontal cranioplasty in a patient with FMD. OBSERVATION: A 21-year-old male patient presented with aesthetic requests related to his facial abnormalities. The patient underwent a fronto-orbital cranioplasty using a coronal approach. Orbital, frontal and nasal hyperostoses were contoured in order to obtain a symmetric result. The patient had no postoperative complication. Aesthetic results were satisfactory and stable after 6 months of follow-up. DISCUSSION: The density and the quality of craniofacial bones were normal and this may account for the stability of cranioplasty results over time. Because bone was normal, cranioplasty is safety and stable in FMD.

The Effect of Wind on Coxiella burnetii Transmission Between Cattle Herds: a Mechanistic Approach.

There is a consensus that wind plays a key role in the transmission of Coxiella burnetii, the causative agent of Q fever, between ruminants and from ruminants to humans. However, no observational study so far has focused on the mechanisms associated with this airborne transmission. This study applied a mechanistic epidemiological approach to investigate the processes underlying the wind effect and to assess its influence on the risk for a dairy herd to become C. burnetii infected. Ninety-five dairy cattle herds located in the Finistère department (western France) were subjected to samplings of bulk tank milk and indoor dust every 4 months over a 1-year period to determine their C. burnetii status using PCR tests. A total of 27 incident herd-periods (negative-tested on both PCR tests and becoming positive-tested at least once at the subsequent sampling time) and 71 negative herd-periods were retained for analysis. Using logistic regression, we assessed the effect of (i) the cumulated number of bacteria in herds located under the main wind direction and (ii) the mean wind speed in this area, on a given herd's risk of becoming incident. Compared to herds in areas with low wind speed (≤5.5 m/s), the risk was significantly higher (OR = 3.7) in herds in areas with high wind speed (>5.5 m/s) and high bacterial load (>10), whereas it was not significantly different from unity in other situations. In agreement with our assumptions, C. burnetii transmission to a previously infection-free herd occurs only when (i) the wind transporting from infected sources and (ii) the load in the contaminated particles/aerosols generated are high enough to act jointly.

[Inferior alveolar nerve reconstruction after segmental resection of the mandible]. / Réhabilitation sensitive du nerf alvéolaire inférieur après mandibulectomie interruptrice.

INTRODUCTION: The sacrifice of inferior alveolar nerve (IAN) is usual in case of resection of mandibular tumors and is responsible for disabling sensory disorders, drooling and lip incompetence. We report the case of a reconstruction of the IAN by means of an autologous nerve graft after segmental resection of the mandible. OBSERVATION: A 27-year-old man presented with a recurrence of mandibular ameloblastoma. Treatment consisted in segmental mandibulectomy with resection of the IAN. Bone reconstruction was performed with a fibula free flap and IAN reconstruction was obtained by mean of a 7-cm nerve graft obtained from the greater auricular nerve (GAN). At the 6th postoperative month, the patient had recovered a normal sensitivity of his lower lip and chin. Latency of somatosensory evoked potentials was similar for both sides. DISCUSSION: The repair of the IAN by nerve autograft is a simple procedure that allows for good sensitive rehabilitation. The use of the GAN is well suited from its anatomy and from the moderate ear sensory sequelae.

Rapid maxillary expansion in adults: Can multislice computed tomography help choose between orthopedic or surgical treatment?

INTRODUCTION: The aim of this study was to evaluate the accuracy of Multislice Computed Tomography (MSCT) in the detection resistance areas on the midpalatal suture (MPS) and thus to evaluate if MSCT could be a help in the kind of maxillary expansion to be used (pure orthodontic or surgically-aided) for the correction of transverse maxillary deficiencies in adults. METHODS: Ten MSCT were obtained from 10 MPS removed from fresh corpses (mean age: 79.4; extreme: 70-86). Three standardized radiological regions of interest (ROI) were identified on each MPS and were classified into "open" (group 1) or "closed" (group 2) by 3 independent radiologists. The 30 ROI were then histologically analyzed according to 3 criteria: mean suture width (MSW), obliteration index (OI) and interdigitation index (Ii). RESULTS: Nine ROI were classified in group 1 (closed) and 21 in group 2 (open). On the histological examination, the mean MSW was 396.9µm in group 1 and 227.1µm in group 2. OI was 3.098% and 9.309% and Ii was 1.25 and 1.34 respectively. Statistically significant difference between the 2 groups was only found for the MSW. We conclude that MSCT allows for the evaluation of the width of the MPS, but not for the evaluation of the other possible parameters of resistance we used. Therefore, it cannot predict precisely the amount of résistance in the MPS and is not suited for the choice between pure orthodontic or surgically-aided expansion.