Does low-energy sweetener consumption affect energy intake and body weight? A systematic review, including meta-analyses, of the evidence from human and animal studies.

By reducing energy density, low-energy sweeteners (LES) might be expected to reduce energy intake (EI) and body weight (BW). To assess the totality of the evidence testing the null hypothesis that LES exposure (versus sugars or unsweetened alternatives) has no effect on EI or BW, we conducted a systematic review of relevant studies in animals and humans consuming LES with ad libitum access to food energy. In 62 of 90 animal studies exposure to LES did not affect or decreased BW. Of 28 reporting increased BW, 19 compared LES with glucose exposure using a specific 'learning' paradigm. Twelve prospective cohort studies in humans reported inconsistent associations between LES use and body mass index (-0.002 kg m(-)(2) per year, 95% confidence interval (CI) -0.009 to 0.005). Meta-analysis of short-term randomized controlled trials (129 comparisons) showed reduced total EI for LES versus sugar-sweetened food or beverage consumption before an ad libitum meal (-94 kcal, 95% CI -122 to -66), with no difference versus water (-2 kcal, 95% CI -30 to 26). This was consistent with EI results from sustained intervention randomized controlled trials (10 comparisons). Meta-analysis of sustained intervention randomized controlled trials (4 weeks to 40 months) showed that consumption of LES versus sugar led to relatively reduced BW (nine comparisons; -1.35 kg, 95% CI -2.28 to -0.42), and a similar relative reduction in BW versus water (three comparisons; -1.24 kg, 95% CI -2.22 to -0.26). Most animal studies did not mimic LES consumption by humans, and reverse causation may influence the results of prospective cohort studies. The preponderance of evidence from all human randomized controlled trials indicates that LES do not increase EI or BW, whether compared with caloric or non-caloric (for example, water) control conditions. Overall, the balance of evidence indicates that use of LES in place of sugar, in children and adults, leads to reduced EI and BW, and possibly also when compared with water.

Regulation of p53 under hypoxic and inflammatory conditions in periodontium.

OBJECTIVES: Different studies suggest that inflammation as well as hypoxia leads to an increase of p53 protein levels. However, the implication of p53 during oral inflammatory processes is still unknown. The aim of this study was therefore to investigate the effect of hypoxia and inflammation on p53 regulation in human periodontium in vitro and in vivo. MATERIALS AND METHODS: Under hypoxic and normoxic conditions, human primary periodontal ligament (PDL) fibroblasts (n = 9) were stimulated with lipopolysaccharides (LPS) from Porphyromonas gingivalis (P.g.), a periodontal pathogenic bacterium. After different time points, cell viability was tested; p53 gene expression, protein synthesis, and activation were measured using quantitative RT-PCR, immunoblotting, and immunofluorescence. Moreover, healthy and inflamed periodontal tissues were obtained from 12 donors to analyze p53 protein in oral inflammatory diseases by immunohistochemistry. RESULTS: LPS-P.g. and hypoxia initially induced a significant upregulation of p53 mRNA expression and p53 protein levels. Nuclear translocation of p53 after inflammatory stimulation supported these findings. Hypoxia first enhanced p53 levels, but after 24 h of incubation, protein levels decreased, which was accompanied by an improvement of PDL cell viability. Immunohistochemistry revealed an elevation of p53 immunoreactivity in accordance to the progression of periodontal inflammation. CONCLUSIONS: Our data indicate that p53 plays a pivotal role in PDL cell homeostasis and seems to be upregulated in oral inflammatory diseases. CLINICAL RELEVANCE: Upregulation of p53 may promote the destruction of periodontal integrity. A possible relationship with carcinogenesis may be discussed.

[Progressive pseudorheumatoid chondrodysplasia. Case report]. / La chondrodysplasie pseudorhumatoïde progressive. A propos d'un cas.

We present the case of a 17-year-old patient suffering from progressive pseudorheumatoid chondrodysplasia from whom 2 total hip prostheses and 2 total knee prostheses were necessary. We have to do with a recessive autosomal genetic disorder characterized by a lysis of the articular cartilage. This leads to an early degeneration of the joints. The clinic is mainly characterized by various complaints such as joint pain, stiffness, limitation or swelling causing a significant motor disability from childhood. The first joints affected are situated in the hands, later followed by the hips, elbows and knees. The X-rays show severe, multifocal articular degenerative modifications which are unusual for the age. The genetic mutation concerns the WISP 3 gene actively expressed by articular chondrocytes and located on chromosome 6. The differential diagnosis is done with a series of rheumatologic disorders in children and autoimmune diseases. We mainly retain the juvenile rheumatoid arthritis. A symptomatic medical treatment can be undertaken first. However, given the evolving nature of the pathology, a joint replacement surgery is needed once the child's growth is finished (second decade of life).

[The reverse shoulder arthroplasty]. / La prothèse totale d'épaule inversèe.

The reverse shoulder arthroplasty indications are cuff tears arthropaty, revision of anatomic prosthesis and traumatology. The reverse shoulder arthroplasty doesn't need a rotator cuff integrity to be functional. However, complications are not rare (dislocation, descellement, infection...). The patient selection has to be rigorous. In any case, patient must be older than seventy years.

[Wrist perilunate dislocation]. / Les luxations périlunaires du carpe.

Carpal perilunate dislocations are rare and underdiagnosed because of an ignorance of the pathology and an inappropriate incidence of radiography. The carpus is composed of two rows of bones and 33 ligaments. These ligaments are fundamental for wrist stability. Typically, the injury occurs in young male adults exposed to high-energy trauma with a wrist in hyperextension. The diagnosis is easy with a physical examen and standard postero-anterior and lateral radiographs. The Witvoët and Allieu classification of the perilunate dislocations is the most used. This classification is composed of three grades. The treatment is usually surgical and has to be realised in a short delay to minimize the important complications.

[The shoulder cuff tears]. / Les lesions de la coiffe des rotateurs de l'épaule.

The cuff tears are frequent. The cuff has a fundamental role for the shoulder stabilisation. Shoulder impingement causes pathologies from simple tendinosis to rupture with excentric arthritis. Classicaly, we describe three stades. It is fundamental to have a good knowledge of the stades and to evaluate them with clinical examination and provocating tests. The radiologic examen is very important to confirm the pathology and to evaluate the lesions. Each stade has a surgical treatment if the conservative treatment gives bad results. Choice of the surgical procedure depends of the patient age and lesion types. Most of surgical procedures are arthroscopics techniques. Open surgery is reserved to massive or arthritis lesions.

Proliferative changes in the epithelium of the human lithiasic gallabladder.

Surgical specimens from 9 normal human gallbladders and from 9 lithiasic gallbladders were incubated in vitro with [3H]thymidine. Autoradiography was used to observe the cells in DNA synthesis in the mucosal epithelium. The percentages of labeled cells (labeling index) and of mitotic figures (mitotic index) were estimated. In the normal gallbladder, the labeling index was low and mitotic figures were exceptional; the labeled cells in the epithelium were observed against the basal membrane. In the lithiasic gallbladder, the labeling index was 23 times higher (P less than 0.01) and a definite number of mitotic figures was seen; the uptake of [3H]thymidine was not restricted to basal epithelial cells and occurred at any level of the mucosa. Our data showed that the proliferative activity was increased in the mucosa of the human lithiasic gallbladder. To the extent that the labelled cells against the basal membrane in the normal gallbladder represent the epithelial progenitors, our results also indicated modifications in the spatial distribution of labeled cells in the lithiasic gallbladder mucosa. Such concomitant quantitative and qualitative changes in cell kinetics could have a parallel in known precancerous conditions in the digestive tract.

DNA synthesis index: higher for human gallbladders with cholesterol gallstones than with pigment gallstones.

[3H]dThd uptake by the gallbladder epithelium was estimated in 33 patients with cholesterol stones, in 13 patients with pigment stones, and in 12 gallbladders without stones. Proliferative parameters were estimated by autoradiography after in vitro incubation with [3H]-dThd. Stones were identified by quantitative infrared spectroscopy. The degree of inflammation of the gallbladder wall was estimated by a histologic scoring method. In the gallbladders containing cholesterol stones the DNA synthesis index (1.39 +/- 0.28%) was higher (P less than .01) than in the gallbladders without stones (0.19 +/- 0.04%). No significant increase in proliferative parameters was found in the gallbladders with pigment stones (0.24 +/- 0.06%). No correlation was found between total stone number, weight or volume, and the DNA synthesis index. No evidence was observed that inflammation could influence the epithelial cell proliferation. Something in the bile of patients with cholesterol stones rather than the physical presence of stones may be the cause of the variations observed.

A pilot study of oral fleroxacin given once daily in patients with bone and joint infections.

The object of this open-label, noncomparative, multicenter study was to evaluate the efficacy and safety of 400 mg of fleroxacin administered orally once daily for 2-12 weeks to patients with bone and joint infections (osteomyelitis, septic arthritis, and prosthetic joint infection). A total of 90 adult patients (56 men and 34 women) were treated at 11 centers. Patients returned on days 5-9 of treatment, subsequently every 2 weeks during treatment, and 0-3 days and 28-42 days (compulsory follow-up) after treatment for assessment of bacteriologic, clinical, and safety parameters. A total of 19 patients (13 with osteomyelitis, 5 with septic arthritis, and 1 with prosthetic joint infection) were bacteriologically evaluable. Staphylococcus aureus was the predominant pathogen isolated in all evaluable infections. Of the 13 patients with osteomyelitis, 11 (85%) were bacteriologically cured and 10 (77%) were clinically cured. Three of the five patients with septic arthritis and the single patient with a prosthetic joint infection were both bacteriologically and clinically cured. Clinical adverse events related to fleroxacin were reported by 25 (28%) of the 90 patients. Most of these events involved the digestive system (primarily constipation and nausea) and the central nervous system (primarily insomnia and headache). The majority of these were of mild or moderate intensity and occurred during the first 2 weeks of treatment. Adverse events led to premature discontinuation of treatment in seven patients. Bone and joint infections continue to represent a therapeutic challenge. Treatment is based mainly on surgical procedures (drainage, sequestrectomy, ablation of implants, and implantation of cement impregnated with antibiotics) and on parenteral administration of antibiotics, requiring hospitalization of the patient. Fleroxacin, a new fluoroquinolone, has proven in vitro activity against bacteria involved in bone and joint infections. Its oral, once-daily administration, which eliminates hospitalization and its attendant costs, makes this drug an effective outpatient treatment of bone and joint infections.

A 'made in one piece' skeleton in a 22-year-old man suffering from sickle cell anaemia.

A 22-year-old African male with known sickle cell anaemia was referred by a Congolese medical centre with a request to improve his poor physical condition. He was unable to walk, stand or sit because his large joints and his spine were either ankylosed or very rigid. Radiographs showed joint fusion from the third to the fifth cervical vertebrae, of both hips, of the left knee, and a bilateral osteonecrosis of the humeral head. There was no scintigraphic evidence for an active osteomyelitis (99mTc-MDP (methyldiphosphonate) bone scan, Tc monoclonal antigranulocyte scan and 99mTc sulphur colloid scan). To improve his mobility the right femoral head was resected in June 1997; 14 days later the left femoral head was resected. Four months after the resection of the right hip, a right uncemented total hip prosthesis was implanted on this side. One month later the same type of hip arthroplasty was performed on the left side. During the postoperative rehabilitation period the patient regained autonomy. We have found no previous reports of such severe and multiple joint complications in a single patient suffering from sickle cell anaemia.

[Digestive lesions caused by radiotherapy after surgery (author's transl)]. / Lésions digestives occasionnées par un traitement radiothérapique adjuvant à la chirurgie.

Between 1968 and 1972, 33 patients with carcinoma of the colon or the rectum underwent a radical surgical procedure followed by adjuvant irradiation therapy. One month after surgery, 6,000 rads were delivered in 6 to 7 weeks. Five of these patients presented later a radiotherapy ileitis, colitis or rectitis. One of them developed a rectitis of the anastomotic area with important diarrheas treated by drugs only; a second presented bowel subobstructions induced by a radiotherapy ileitis and died in cachexy a few months later. The 3 other patients underwent surgery again; one of them for adhesions in the anastomotic area: a definite left colostomy was realized for a stenosic rectitis in the second patient; the last patient underwent surgery 4 times again and died from a rupture of the iliaca artery. Discussion on the observations made at surgery and on the surgical pathology data could explain the high rate of these iatrogenic lesions induced by radiotherapy.

[Four cases of hemorrhages after surgical repair of iatrogenic tracheal stenosis (author's transl)]. / Quatre cas d'hémorragies après réparation chirurgicale de sténose trachéale iatrogène.

In our series of 23 patients, operated 27 times, for a iatrogenic stenosis of the trachea, there were 4 deaths by hemorrhage of the innominate artery. Three resulted from shearing of the artery by the tracheal sutures. One came from erosion by a tracheostomy cannula. This fatal complication should be prevented by preserving healthy tissues between the artery and the trachea.

Triflusal versus acetylsalicylic acid: a double-blind study for the prophylaxis of deep vein thrombosis after hip surgery.

The authors report the results of a randomised double-blind study comparing the antithrombotic activity of a new anti-platelet drug (Triflusal) with that of acetylsalicylic acid (ASA). 99 patients who underwent hip surgery were included in the study (total hip replacement, osteosynthesis of a pertrochanter fracture or Moore's prosthesis for intracapsular fracture of the femoral neck). Of the 48 patients having received Triflusal, 7 (14.5%) developed deep vein thrombosis as indicated by 125I-fibrinogen isotopic scanning and confirmed by phlebography. Of the 51 patients treated with ASA, 11 (21.6%) presented the same complication as diagnosed by the same techniques. This difference is not statistically significant, considering the number of cases studied. Nevertheless, Triflusal appears to provide prevention of thromboembolic risk to patients who have undergone hip surgery, particularly total hip replacement.

[The correct placement of trans-osseous traction]. / Bien placer une traction trans-osseuse.

The author reports on the general principles of bone traction, then describes very precisely the technical steps of the installation of traction. Many useful technical tips are given, and different locations are described.

[Dislocation-dissociation of a bipolar hip prosthesis]. / Luxation-dissociation d'une prothèse biarticuleé de hanche.

The incidence of hip prosthesis dislocation ranges from 0.4% to 15% depending on the series (1, 6). In classical dislocations of hip prosthesis, the prosthetic femoral head escapes from the natural acetabular cavity or prosthetic acetabulum in case of total hip arthroplasty. In the case presented here, a bipolar hip prosthesis dislocation occurred between the small head of the prosthesis and the polyethylene. A total hip prosthesis restored good function. Only a few cases of this type have been described in the literature. The different causes are discussed.

[Transient osteoporosis of the hip and magnetic nuclear resonance]. / Ostéoporose transitoire de la hanche et résonance magnétique nucléaire.

The authors evaluated the diagnostic importance of MRI in a woman who presented with transient osteoporosis of both hips, over an interval of three years. The diagnosis was made only during the second episode with the aid of MRI. The patient recovered without sequelae.

[Subnormal functional activity in a neglected posterior dislocation of the shoulder]. / Activité fonctionnelle subnormale dans une luxation postérieure négligée de l'épaule.

The incidence of posterior shoulder dislocation ranges between 2 and 5% of glenohumeral dislocations. The mechanisms most frequently involved are trauma, grand-mal seizures and electrocutions. This lesion remains a diagnostic trap, due to paucity or even lack of clinical signs, and to the apparent normality of the anteroposterior radiograph of the shoulder. Nevertheless, careful clinical examination and an axillary radiograph often allow for a correct diagnosis. We report a case of traumatic posterior dislocation, unnoticed for 7 weeks. A satisfactory functional adaption of the dislocated shoulder to everyday life and the general condition of the patient lead us to select the notreatment option.

[Compound fracture of the ankle treated by locked retrograde transplantar nailing: a case report]. / Fracture complexe de la cheville traitée par clou transplantaire rétrograde verrouillé: un cas clinique.

The authors describe the use of a locked retrograde plantar nailing as primary treatment for a severe trauma of the ankle (trimalleolar fracture associated with posterior dislocation and a compound talus fracture).

[Ultrasonography and Doppler effect, an original method for the early and dynamic evaluation of bone callus]. / Echographie et effet Doppler, une méthode originale pour une appréciation précoce et dynamique du cal osseux.

The authors describe an original and simple method for monitoring bone healing, based upon ultrasonography and the Doppler effect. They present four cases of diaphyseal fractures followed by this method and correlated with clinical findings. This noninvasive and inexpensive method of investigation is full of prospect for the monitoring of bone healing after fracture.