Higher preoperative range of motion is predictive of good mid-term results in the surgical management of osteochondral lesions of the talus: a prospective multicentric study.

INTRODUCTION: Osteochondral lesions of the talus (OLT) are a frequent cause of pain in young patients and a new CT arthrographic classification system of OLT was recently proposed to help guide the choices of and standardize the indications for surgical treatment. The primary hypothesis was that this algorithm would result in a postoperative AOFAS score of ≥ 80/100. The secondary hypothesis was to identify the preoperative factors of successful surgery. METHODS: This was a prospective observational multicenter study. Eighty-six patients who underwent surgery for OLT after at least 6 months of unsuccessful conservative management were included for a mean follow-up of 15 months (12-36). Forty-nine patients with stage 1 OLT underwent microperforation, 2 patients with stage 2 OLT underwent a lift, drill, fill, and fix graft procedure with screw fixation, and 35 patients with stage 3 OLT were treated with mosaicplasty. RESULTS: After a follow-up of at least 1 year, 56 patients (65%) had an AOFAS score > 80 and the mean AOFAS score was 82 (16-100). A lower BMI (p = 0.038), a higher preoperative range of motion in the ankle (p = 0.033), higher preoperative AOFAS and FAOS scores (p = 0.001 and p = 0.011), and the presence of a preoperative bone bruise on MRI (p = 0.020) were good prognostic factors on univariate analysis. The presence of grade 1 osteoarthritis on the Van Dijk classification was predictive of a poor prognosis (p = 0.044). Multivariate analysis showed that a good preoperative range of motion (OR = 1.080 [1.020-1.150] p = 0.01) was predictive of a positive outcome, while grade 1 osteoarthritis was predictive of a poor outcome (OR = 0.147 [0.036-0.603] p = 0.008). The postoperative AOFAS decreased in six patients and 17 patients had at least one complication: six dysthesias of the superficial fibular nerve, two of the sural nerve, and nine stage 1 complex regional pain syndromes. CONCLUSION: The new algorithm for OLT resulted in a postoperative AOFAS score of ≥ 80/100 in 65% of cases. The positive predictive factors of a successful postoperative outcome were the presence of a good preoperative range of motion and the absence of preoperative osteoarthritis. LEVEL OF EVIDENCE: Level II.

Long-term stability of basilar mandible osteotomy: Chin Wing.

The Chin Wing is a modified genioplasty extended along the basilar border and the angles of the mandible. This technique may be a better choice than standard genioplasty for correction of lip incompetence, retrogenia and high angle position associated with hyperdivergent cases. Our objective was to analyse the overall movement realized during surgery and the long-term stability of this procedure. Ten patients underwent a Chin Wing surgery from June 2018 to August 2019. All patients were operated on by the same surgeon. We performed a preoperative (PO), an immediate postoperative (POI), and an over 6 months postoperative (PO6) Cone Beam Computed Tomography (CBCT) for every patient. 3D reconstructions were performed for each CBCT with Proplan software. We were thus able to determine by subtractions acquired and resorbed bone volume. Some section plans were chosen in order to perform 2D measurements. The CBCT volume comparisons reveal a gain of 7.6cc between the PO and the POI, for a bone resorption of 2.5cc between POI and PO6 (33% of the volume gained). In 2D evaluation, we observe an average resorption of 1.7 mm corresponding to approximately 20% of the height gained, at the level of the mandibular angle. Given the low bone resorption we can consider Chin Wing stable over time. The important quantity of mobilized bone and the basilar rotational movement may explain over-standing aesthetic and functional outcome, compared to classical genioplasty.

CT scan study of the mandibular nerve intra-mandibular path.

INTRODUCTION: It is mandatory to know the anatomic path of the mandibular nerve and its intra-mandibular connections for numerous odontology, stomatology, and maxillofacial surgical procedures. We present a computed tomography study of the mandibular nerve intra-mandibular path. PATIENTS AND METHOD: The computed tomography of 14 mandibles was performed (vestibulo-lingual cross-section) and four landmarks were defined behind the mental foramen. At each landmark, we measured the distance between the alveolar canal and the two cortical layers in the vestibulo-lingual plane, and the distance between the alveolar canal and the alveolar crest, and the inferior border of the mandible in the vertical plane. RESULTS: In the vestibulo-lingual plane, the mandibular nerve is located close to the vestibular cortical layer, then to the lingual cortical before it exits. In the crestal plane, it is located at the superior third of the inferior border of the mandible. DISCUSSION: In spite of anatomical variability, there is a globally common path which means that the utmost caution should be taken by performing systematic imaging before undertaking any surgery close to the nerve.

[Horseshoe kidney stones: benefit of flexible ureterorenoscopy with holmium laser]. / Calculs urinaires et rein en fer à cheval: place de l'urétérorénoscopie souple-laser.

OBJECTIVES: We aim to assess the outcome of the flexible ureterorenoscopy (F-URS) with holmium laser in treating horseshoe kidney (HSK) stones. PATIENTS AND METHODS: We reviewed retrospectively the records of 18 patients with HSK stone (18 renal units) who underwent F-URS using holmium laser from December 2004 to October 2009. The mean age was 37.7±6.9 years. The F-URS used after the extracorporeal shock wave lithotripsy (ESWL) failure in eight patients (44.4%) and four patients (22.2%) had PCNL failure. The follow up visit range were between 4 and 6 weeks with plain radiograph (KUB) and renal ultrasound or non contrast computed tomography scan (NCCT). Success rate was defined as stone free or residual fragment less than 3 mm. Use of auxiliary procedures like ESWL were considered as treatment failure. RESULTS: Eighteen patients, three females and 15 males with mean age was 37.7±6.9 years with HSK calculi underwent ureteroscopic management. The presenting symptoms were renal colic, urinary tract infection or hematuria. We found different HSK stone location (11 mixed calyceal, three mixed pelvic and calyceal and four pelvic). The average stone burden was 15.5±7.3 mm and the mean operative time was 112±9.4 minutes. All over procedures were 27, with mean average of 1.5 procedures per patient. The success rate was 89%. CONCLUSION: The F-URS with holmium laser is an efficient minimal invasive procedure in treating HSK stones.

Assessing the incidence of nerve injuries according to different mandibular osteotomies including Wing osteotomies.

We use currently 3 types of new mandibular osteotomies (a shortened Bilateral Sagittal Split Osteotomy (BSSO), associated or not with Chin Wing or Mini Wing). Chin osteotomy is a modified genioplasty extended along the basilar border and the angles of the mandible. These osteotomies are associated with a risk of inferior alveolar nerve (IAN) damage. We prospectively studied 113 consecutive patients operated on by the same surgeon who underwent one of the following procedures: (1) isolated BSSO, (2) BSSO with a Chin Wing, (3) BSSO with a Mini Wing, (4) isolated Chin Wing. We analyzed rates of IAN damage and impact on the patients' life by using a subjective questionnaire administered at the patient's 1 year follow up appointment between June 2018 and August 2019. Sixty-seven patients underwent isolated BSSO, 24 BSSO with Mini Wing, 13 BSSO with Chin Wing, and 9 Chin Wing only. Our analysis reveals that nerve damage is greater in the BSSO group associated with Chin Wing (50% vs. 21.6%; p=0.006). However, there is no significant difference between nerve damage in the Mini wing group and the isolated BSSO group (27.1% vs. 21.6%; p=0.432). In the isolated Chin Wing group, the inferior alveolar nerve damage rate was 11%. There is no significant difference between the groups with regard to the impact of the nerve damage on the patients' life. In case of BSSO with concomitant Wing osteotomy, we conclude that Mini Wing osteotomies cause less nerve related morbidity than Chin Wing.

The intermediate length BSSO: Finding the balance between the classical and short designs.

Bilateral Sagittal Split Osteotomy (BSSO) is performed in orthognathic surgery to treat cases of dento-skeletal malformation. We present a shorter BSSO variant that allows for the realization of all orthognathic movements. This line respects the basilar rim and allows to modify the position of the mandibular angles. The splitting is more natural, separating the mandible into two anatomical subunits: the rising branch and the horizontal branch. This variant layout may also be associated with Chin Wing genioplasty.

Mini wing osteotomy: A variant of chin wing osteotomy.

The mini wing is a variant of the chin wing osteotomy. Its design extends from the chin region to the horizontal branch of the mandible as in a traditional chin wing. However, the posterior most cut ends on the upper part of the mandibular notch. It corresponds to a shortened chin wing that respects the basilar edge of the mandible. Its advantage is the capacity to associate it with a bilateral sagittal split osteotomy (BSSO) in the global management of dento-skeletal deformity. There is no contraindication to the realization of a mini wing. Contrarily to the traditional chin wing, a very low positioned inferior alveolar nerve (IAN) is not a contraindication to the mini wing.

[Prevalence and severity of erectile dysfunction in a population with coronary insufficiency: monocentric study]. / Prévalence et sévérité de la dysfonction érectile dans une population d'insuffisants coronariens : étude monocentrique.

PURPOSE: To study prevalence and severity of erectile dysfunction (ED) in a population of men treated in emergency for a coronaropathy. MATERIAL: The files of 200 patients who underwent a coronarography in urgency before the 1st of January 2007 were reviewed retrospectively. The following data were collated: epidemiological data and detailed breakdown of affected coronary arteries. The following patients were excluded from the current study: age over 65, past history of prostate surgery or pelvic external beam radiation therapy. The international index of erectile function (IIEF-5) questionnaire was sent by regular mail. Patients were classified according to the severity of ED: "no ED" between 21 and 25 inclusive, "mild ED" less than 21, "moderate ED" less than 17 and "strong ED" less than 10. RESULTS: Overall, 78 patients were included with a median age of 58 years. Prevalence of DE was 0.82 and median length of evolution was 9 months before coronary syndrome. Forty-nine patients (62.8%) had an ED classified between moderate and strong. ED was significantly associated with the group of patients smoking more than 20 cigarettes a day for at least 10 years (N = 44; P = 0.01) and with the group of patients older than 60 years (N = 38; P = 0.02). There was an association between the severity of the coronary disease and an ED classified between moderate and strong (P = 0.03). CONCLUSION: This study corroborates the existence of a strong link between ED and coronary disease, notably in patients under 65 years of age. In addition, it seems that the severity of ED is directly related with the anatomical severity of coronary disease.

Intercomparison of passive dosimetry technology at EDF facilities in France.

Since the spring of 1999, new French radiation protection legislation has allowed the use of passive dosemeters, other than the silver emulsion film badge, for the measurement of H(p)(10). Faced with the eventual obsolescence of its dosimetry system, Electricité de France (EDF, the French electricity provider) initiated a comparative study of passive dosemeters, based on different technologies, that had received accreditation by national laboratories and regulatory bodies, namely: TLD, RPL and OSL. An extended field study in nuclear power stations and medical X-ray departments has shown that all technologies provide compatible dosimetric estimates. It also showed that the selected dosemeters based on RPL and OSL technologies gave better results due to their energy responses and to a lower detection threshold compliant with the new regulation. A final suggestion to implement a new OSL based dosimetric system is made due to its overall performance and to its lower cost of implementation.

Presence of estrogen binding sites and growth-stimulating effect of estradiol in the human myelogenous cell line HL60.

In the present study, we investigated the effects of estrogens on the growth of the HL60 line in vitro and the presence of estrogen binding sites in the same cells. Cell proliferation was estimated by cell counts, [3H]thymidine incorporation, and determination of the percentage of cells in the S phase by flow cytometry. Cells maintained in a medium containing physiological concentrations of estradiol (10(-9) M, 10(-8) M, 10(-7) M) exhibited a growth stimulation, shown by an increase in the percentage of cells in the S phase, whereas a pharmacological concentration (10(-6) M) produced a growth inhibition. Furthermore, the addition of the specific antihormone, tamoxifen, inhibited the stimulating effect of the estrogens. Receptor analysis showed the presence of specific estrogen-binding sites with an apparent dissociation constant of about 5.3 X 10(-10) M. The effect of estrogen was therefore associated with the presence of estrogen receptors in the human leukemic cell line HL60.

Morphofunctional modifications associated with the inhibition by estradiol of MtTF4 rat pituitary tumor growth.

The MtTF4 pituitary tumor has been induced in Fischer rats by chronic estrogen administration. Recently, we reported that sustained pharmacological treatment of Fischer rats with 17 beta-estradiol inhibited the growth of the MtTF4 tumor transplanted s.c. The present work describes the associated morphofunctional changes occurring in the tumor during 17 beta-estradiol inhibition. It is shown that a 7-day 17 beta-estradiol treatment resulted in an increase of the surface area of cells, nuclei, nucleoli, Golgi complexes, and rough endoplasmic reticulum and an increase in the number of euchromatin-rich nuclei. Flow cytometry analysis of DNA distribution suggested that estradiol affects the cell progression through the early S phase. The ratio of RNA to DNA increased significantly, reflecting cell hypertrophy. Moreover, there was a significant increase in tumor prolactin concentration and a marked enhancement in the intensity of the immunocyto-chemical reaction with rat prolactin antiserum. On the other hand, cell mitoses were dramatically decreased. These morphofunctional changes indicate that the inhibition of the tumor growth by estradiol is accompanied by an evolution of the tumor cell population towards a more differentiated state. However, it cannot be decided whether 17 beta-estradiol induces a shift from a proliferative state to a differentiated state or whether 17 beta-estradiol treatment results in a selection of a subpopulation of tumor cells that are slow growing and more differentiated.

Flow cytometry for separation of keratinocyte subpopulations from the viable epidermis.

Human epidermal cell suspensions were analyzed and sorted with flow cytometry. The desmosome and differentiation-related KM48 monoclonal antibody was used for indirect immunofluorescence and permitted staining of keratinocytes at various stages of the cell maturation. Intensity of the staining correlated with the degree of differentiation. Three sorting gates were chosen to obtain subpopulations which varied distinctly in KM48 expression. The flow cytometry-sorted cells were characterized by their ultrastructural appearance and by the bullous pemphigoid antigen expression. According to the ultrastructure criteria, about 50% of the cells obtained from the "IF negative" gate were basal layer keratinocytes (45.5% expressed bullous pemphigoid antigen); 90% of the "intermediate" gate cells were spinal layer keratinocytes, and over 80% of the cells sorted through the "strongly IF positive" gate were of the granular layer type. The method of keratinocyte separation proposed allows samples to be obtained for further biochemical and functional studies on keratinocyte subpopulations in normal and pathologic skin.

Sequencing of the ovine interleukin-8-encoding cDNA using the polymerase chain reaction.

The nucleotide (nt) sequence encoding the ovine homologue of interleukin-8 (IL-8) was determined. The mRNA is 1494-nt long with an ORF of 101 codons. The long 3' non-coding element contains several ATTTA repeats implicated in the swift turnover of other chemokine mRNAs. The encoded protein of 11 kDa before processing, and 9 kDa as mature protein, contains the Cys-Xaa-Cys motif common to alpha-chemokines, and has conserved amino acids (aa) at positions identified as receptor contact sites for IL-8. Identities with other published IL-8 aa sequences are: dog, 91%; pig, 87%; rabbit, 84%; human, 78%; guinea pig, 69%. A 49% aa identity is also found with a chicken embryo fibroblast protein.

Flow cytometry sorting of unlabelled epidermal Langerhans cells using forward and orthogonal light scatter properties.

A variety of techniques based on the presence of specific markers has been proposed to enrich Langerhans cells from epidermal cell suspensions. Computer analysis of multiparameter flow cytometry records involving forward angle and orthogonal scattered light and immunofluorescence of epidermal cells allowed us to determine the scattering properties of Langerhans cells. Unlabelled cells sorted according to these properties were shown to be Langerhans cells by electron microscopy and/or subsequent labelling by anti-HLA-DR monoclonal antibody. The relevance of this method is discussed to sorting viable Langerhans cells which may be used in functional studies and for establishing long-term culture.

Flow cytometry analysis of T lymphocytes in sarcoidosis.

To examine the immunologic alterations in patients with sarcoidosis we characterized the cell cycle phase of T lymphocytes that were collected from peripheral blood and from bronchoalveolar lavage fluid. T-cell DNA and RNA contents were measured at the single cell level using flow cytometry after staining with the metachromatic fluorochrome acridine orange. T-enriched lymphocyte suspensions were obtained from peripheral blood and from bronchoalveolar lavage in 17 patients with histologically-proved sarcoidosis (10 patients, stage I and 7 patients, stage II) and in 4 patients with acute extrinsic hypersensitivity pneumonitis (AEHP). The percentages of cells in the S + (GS + M) phase in the peripheral blood of the patients with sarcoidosis did not differ from those of healthy control subjects. With bronchoalveolar lavage, however, elevated numbers of T cells in the S + (G2 + M) phase were found in the patients with AEHP and in those with stage II sarcoidosis when compared to patients with stage I sarcoidosis. The cellular RNA content of T lymphocytes from the peripheral blood showed a typical bimodal distribution without difference between patients and control subjects. Conversely, T lymphocytes obtained by bronchoalveolar lavage from patients with AEHP and sarcoidosis had a homogeneous low RNA content which differed from that of T lymphocytes from the blood from that of in vitro phytohemagglutinin-stimulated lymphocytes. These findings provide a new approach to the study of the mechanisms of local T-cell activation in sarcoidosis.

CD4 mAbs prevent progression of alloactivated CD4+ T cells into the S phase of the cell cycle without interfering with early activation signals.

Knowing that several CD4 mAbs may delay allograft rejection in the absence of circulating CD4+ lymphocyte depletion in vivo, we investigated the mechanisms whereby CD4 mAbs can interfere with the development of alloreactive T cells in the mixed lymphocyte reaction (MLR). In agreement with previous reports, CD4 mAbs of different species (mouse, rat, humanized), isotypes (IgG1, IgG2a, and IgG2b) and different epitope specificities decreased 3H-TdR incorporation in MLR, using monocyte-depleted or CD4+ T lymphocyte-enriched blood mononuclear cells as responders. Those effects were achieved at nonsaturating mAb concentration and were still demonstrable upon delayed addition of CD4 mAbs. However, CD4 mAbs decreased neither the number of blast cells nor the expression of CD25 (the alpha chain of IL-2 receptor), indicating that initial activation events leading to blast transformation were not affected. Determination of cytokine gene expression by non competitive quantitative RT-PCR and measurement of protein concentration in supernatants demonstrated that CD4 mAbs did not decrease IFN-gamma induced by alloactivation. However IL-2 concentration was decreased in all supernatants whereas IL-2 mRNA expression, only slightly decreased at 24 hr, and dropped after 72 hr. IL-5 and IL-10 mRNAs, equally expressed by stimulated or nonstimulated responder cells, were not affected by CD4 mAbs. IL-4 mRNA was not detectable. Furthermore, addition of rIL-2, rIFN-gamma or rIL-4 did not overcome proliferation inhibition. The data provide a novel insight into the mechanisms of CD4 mAbs immunosuppresssion that associates a decrease of IL-2 expression with an IL-2 resistant blockade of the progression of activated CD4+ T cells from the G1 to the S phases of the cell cycle.

An anti-lymphocyte monoclonal antibody (HB8) which cross reacts with human dermal elastic fibers.

A monoclonal antibody (MoAb) was selected during a fusion aimed at the preparation of antibodies specific for human T lymphocytes. This antibody reacted against all lymphocytes, but was not specific for the lymphoid lineage because it also detected monocytes, granulocytes and platelets. On skin sections it was found to stain specifically the microfibrillar component of the elastic fibers. This observation illustrates the unexpected specificities often found when making MoAb and, although its significance is still unexplained, provides a unique tool having potential application for anatomy, histopathology, comparative biology and vascular pathology.

Detection of OKT6-positive cells (without visible Birbeck granules) in normal peripheral blood.

The specificity of a monoclonal antibody (OKT6) for peripheral blood mononuclear cells was examined by indirect immunofluorescence and ultrastructural immunogold labelling. Some rare peripheral blood mononuclear cells (approximately 1%) expressed T6 antigen on their membrane surface, as determined by light microscopy and cytofluorometry. Electron microscopic examination of immunogold-labelled cells revealed that OKT6-positive cells were dendritic, lacking the Birbeck granules and expressed variable density of the membrane T6 antigen. The relationship of such cells with Langerhans' cells is discussed.

Early events in the experimental interstitial lung disease induced in sheep by the Visna-maedi virus.

Visna-maedi virus is a lentivirus closely related to the human immunodeficiency virus type I (HIV-I). During spontaneous infection of sheep by Visna-maedi virus an interstitial lung disease is observed. It is characterized by an alveolitis, peribronchovascular lymphoid nodules, alveolar wall thickening and myomatosis. In order to decipher the pathology of this lentiviral infection we have induced this disease in colostrum-deprived newborn lambs.