[Treatment of malar mounds by direct excision]. / Traitement des poches malaires par résection cutanée directe.

OBJECTIVES: The treatment of malar mounds is challenging. We report a case series of direct excision of malar mounds and review the existing literature. MATERIAL AND METHODS: The procedure is carried out under local anesthesia with light sedation. A pinch test allows to estimate the width of the resection. The skin is resected, and if needed, some of the sub-orbicularis oculi fat. The orbicularis muscle is not closed, and the skin is closed in two layers. RESULTS: Eight patients were treated by the same surgeon between January and December 2013. The ages ranged from 41 to 74, with an average of 53. The patients were highly satisfied. The results were considered excellent for 5 patients and good for 3. There were no complications, in particular no scleral show, no ectropion, and no hematoma. CONCLUSION: Direct excision of malar mounds is simple, efficient, and reproducible. The scars are most often inconspicuous, in particular in the elderly.

[Intraoperative verification of a perforator flap vascularization by indocyanine green angiography]. / Vérification peropératoire de la vascularisation d'un lambeau perforant par angiographie au vert d'indocyanine.

After Koshima and Soeda first described perforator flaps in 1988, Wei has improved the technique by describing the "free style perforator flap". These flaps have the advantage of being performed on all skin perforators and in reducing donor site morbidity. The disadvantage, however is that the size of their angiosome is not defined and the evaluation of their relay on the experience of the surgeon. An evaluation of the size of an angiosome by conducting intraoperative angiography is proposed. Intraoperative angiography is performed after injection of indocyanine green. Stimulation of the indocyanine green by infrared causes the emission of fluorescent radiation. This fluorescence is then detected by a specific camera that displays real-time visualization of the skin's perfusion. We present the case of a 39-year-old patient who had an open tibial pilon fracture, for which we performed a pedicled propeller flap based on a posterior tibial perforator. Angiography was used to determine accurately the optimal skin perfusion of the propeller flap, which was based on a perforator from the posterior tibial artery. Angiography identified several levels of skin perfusion with a high fluorescence, intermediate and absent. The non-vascularized part of the skin paddle was resected. Given the unreliability of this technique, hypoperfused area was retained. Debridment of this area, however was necessary at day 5 postoperative with repositionning of the flap. Indocyanine green angiography may be a useful decision-making tool for intraoperative surgeon. It allows to adjust the size of the propeller flap's skin paddle to it angiosome. However, this evaluation method needs to be improved with the introduction of a quantitative threshold.

Unveiling how vitrification affects the porcine blastocyst: clues from a transcriptomic study.

BACKGROUND: Currently, there is a high demand for efficient pig embryo cryopreservation procedures in the porcine industry as well as for genetic diversity preservation and research purposes. To date, vitrification (VIT) is the most efficient method for pig embryo cryopreservation. Despite a high number of embryos survives in vitro after vitrification/warming procedures, the in vivo embryo survival rates after embryo transfer are variable among laboratories. So far, most studies have focused on cryoprotective agents and devices, while the VIT effects on porcine embryonic gene expression remained unclear. The few studies performed were based on vitrified/warmed embryos that were cultured in vitro (IVC) to allow them to re-expand. Thus, the specific alterations of VIT, IVC, and the cumulative effect of both remained unknown. To unveil the VIT-specific embryonic alterations, gene expression in VIT versus (vs.) IVC embryos was analyzed. Additionally, changes derived from both VIT and IVC vs. control embryos (CO) were analyzed to confirm the VIT embryonic alterations. Three groups of in vivo embryos at the blastocyst stage were analyzed by RNA-sequencing: (1) VIT embryos (vitrified/warmed and cultured in vitro), (2) IVC embryos and (3) CO embryos. RESULTS: RNA-sequencing revealed three clearly different mRNA profiles for VIT, IVC and CO embryos. Comparative analysis of mRNA profiles between VIT and IVC identified 321, differentially expressed genes (DEG) (FDR < 0.006). In VIT vs. CO and IVC vs. CO, 1901 and 1519 DEG were found, respectively, with an overlap of 1045 genes. VIT-specific functional alterations were associated to response to osmotic stress, response to hormones, and developmental growth. While alterations in response to hypoxia and mitophagy were related to the sum of VIT and IVC effects. CONCLUSIONS: Our findings revealed new insights into the VIT procedure-specific alterations of embryonic gene expression by first comparing differences in VIT vs. IVC embryos and second by an integrative transcriptome analysis including in vivo control embryos. The identified VIT alterations might reflect the transcriptional signature of the embryo cryodamage but also the embryo healing process overcoming the VIT impacts. Selected validated genes were pointed as potential biomarkers that may help to improve vitrification.

Pre-existing arterial stiffness can predict hypotension during induction of anaesthesia in the elderly.

BACKGROUND: The aim of the present study was to establish whether elevated carotid-femoral pulse wave velocity (c-fPWV), an indicator of aortic stiffness, assessed before surgery, is correlated with variations in arterial pressure (AP) during induction of anaesthesia in elderly patients undergoing non-cardiovascular surgery. METHODS: c-fPWV was measured with the PulsePen(®) device during pre-surgical anaesthetic evaluation. Monitoring included electrocardiography, pulse oximetry, non-invasive AP, heart rate, bispectral index (BIS), and oxygen concentration during induction of anaesthesia with propofol and remifentanil. Anaesthesia was induced so as to maintain BIS values between 40 and 50. RESULTS: Forty-five patients, aged [mean (sd)] 71.1 (5.8) yr, were studied. The mean value of c-fPWV was 12.1 (3.9) m s⁻¹. There was no correlation between hypotension during anaesthesia induction and total dosage or rate of administration of propofol or remifentanil. In univariate analysis, only age and PWV significantly correlated with the decreases in AP, and the association between c-fPWV and a decrease in AP was also seen in multivariate analysis (r = 0.36, P< 0.05). Patients classified as having 'high stiffness' (c-fPWV ≥ 12.9 m s⁻¹) had 25% further decrease in systolic AP during anaesthesia induction than those with lower PWV [75.2 (5.7) vs 60.2 (4.2) mm Hg, P < 0.05]. CONCLUSIONS: Increased aortic stiffness, as assessed by PWV measured during preoperative anaesthetic evaluation, is associated with more pronounced hypotension during induction of anaesthesia. Measurement of aortic stiffness in the elderly may thus represent a valid indicator of the risk of hypotension during anaesthesia induction.

Do farming conditions influence brominated flame retardant levels in pig and poultry products?

Brominated flame retardants (BFR) are primarily used as flame retardant additives in insulating materials. These lipophilic compounds can bioaccumulate in animal tissues, leading to human exposure via food ingestion. Although their concentration in food is not yet regulated, several of these products are recognised as persistent organic pollutants; they are thought to act as endocrine disruptors. The present study aimed to characterise the occurrence of two families of BFRs (hexabromocyclododecane (HBCDD) and polybrominated diphenyl ethers (PBDE)) in hen eggs and broiler or pig meat in relation to their rearing environments. Epidemiological studies were carried out on 60 hen egg farms (34 without an open-air range, 26 free-range), 57 broiler farms (27 without an open-air range, 30 free-range) and 42 pig farms without an open-air range in France from 2013 to 2015. For each farm, composite samples from either 12 eggs, five broiler pectoral muscles or three pig tenderloins were obtained. Eight PBDE congeners and three HBCDD stereoisomers were quantified in product fat using gas chromatography-high-resolution mass spectrometry, or high-performance liquid chromatography-tandem mass spectrometry, respectively. The frequencies of PBDE detection were 28% for eggs (median concentration 0.278 ng/g fat), 72% for broiler muscle (0.392 ng/g fat) and 49% for pig muscle (0.403 ng/g fat). At least one HBCDD stereoisomer was detected in 17% of eggs (0.526 ng/g fat), 46% of broiler muscle (0.799 ng/g fat) and 36% of pig muscle (0.616 ng/g fat). Results were similar in concentration to those obtained in French surveillance surveys from 2012 to 2016. Nevertheless, the contamination of free-range eggs and broilers was found to be more frequent than that of conventional ones, suggesting that access to an open-air range could be an additional source of exposure to BFRs for animals. However, the concentration of BFRs in all products remained generally very low. No direct relationship could be established between the occurrence of BFRs in eggs and meat and the characteristics of farm buildings (age, building materials). The potential presence of BFRs in insulating materials is not likely to constitute a significant source of animal exposure as long as the animals do not have direct access to these materials.

A comparison of ondansetron with metoclopramide in the prophylaxis of chemotherapy-induced nausea and vomiting: a randomized, double-blind study. International Emesis Study Group.

The efficacy of ondansetron was compared with metoclopramide in the prophylaxis of nausea and vomiting induced by cyclophosphamide greater than or equal to 500 mg/m2 in combination with doxorubicin greater than or equal to 40 mg/m2 or epirubicin greater than or equal to 40 mg/m2. complete anti-emetic protection in the 24 h following chemotherapy was achieved in 26 of 40 (65%) patients treated with ondansetron compared with 17 of 42 (41%) patients treated with metoclopramide. Severe nausea was present in 3% of patients in the ondansetron group and 31% in the metoclopramide group. A worst day analysis of control of emesis and nausea on days 2 and 3 following chemotherapy also demonstrated ondansetron to be more effective than metoclopramide. Both treatments were well tolerated. Ondansetron is more effective as an anti-emetic than metoclopramide in this type of cytostatic therapy.

Mammographic feature enhancement by computerized image processing.

Mammographic detection of early breast cancer from X-ray film mammograms requires optimal radiological or image processing techniques. We present an image processing approach based on feature adaptive neighborhood processing with a tunable contrast-enhancement function to enhance mammographic features. This procedure brings out the features in the image with little or no enhancement of the noise. Results show that the proposed technique is intelligently tunable to the requirements of enhancement of specific mammographic features such as microcalcifications, soft-tissue characteristics, etc.

[Prognosis of chronic post-traumatic thoracic aorta aneurysms in 15 patients (author's transl)]. / Pronostic de l'anévrisme post-traumatique chronique de l'aorte thoracique. A propos de 15 observations.

False chronic post-traumatic aneurysms of the ascending aorta were detected in 15 patients. These aneurysms were false because only a few cells were present in their walls: it is only after survival for more than 3 weeks tht one can speak of chronic aneurysms, and only 5% of the injured patients survived for this period of time. The lesions show marked progression for one year, but rupture of apparently quiescent aneurysms may occur up to 20 years after the initial injury. The prognosis of these lesions is therefore comparable with that of other aortic aneurysms. Cardiovascular surgery has progressed to such an extent, and the risks are so low (0% in this series), that surgical correction should be systematically considered.

[A French questionnaire to assess quality of life of the aphasic patient: the SIP-65]. / Un outil francophone de mesure de la qualité de vie de l'aphasique: le SIP-65.

OBJECTIVES: To develop and demonstrate validity and reliability of a aphasic-adapted version of the Sickness Impact Profile (SIP-136), a generic widespread questionnaire used to measure quality of life (QoL). DESIGN: Survey, outpatient oral interviews. POPULATION: Aphasic people from 20 to 80 years old, with a time from stroke or trauma of more than 12 months, living at home for more than six months, able to understand the questions with a Z-score profile at Boston Diagnostic Aphasia Examination above average for oral comprehension. METHOD: 1. Developments of the short version of the SIP-136, from a first sample of aphasic people; 35 patients were included with a mean time from stroke or trauma of 17 months. This first step consisted in excluding the least relevant items and/or subscales, rewriting some items to make them easier to understand, studying redundancy by multiple components analysis (MCA) and deleting some redundant items. 2. Validity compared with initial SIP-136 and reliability (inter-rater and test-retest) from a second sample of 55 aphasic people (mean time from stroke or trauma = 23 months). RESULTS: - 1. The first step of development led to a short version with eight subscales and 65 items (SIP-65) exploring physical, psychological and social components of QoL; it took about 16 min to fill it, less than half of the time necessary for the SIP-136. 2. Linear correlation of the responses between SIP-65 and SIP-136 was good: r = 0.97; p < 10(-6). SIP-65 demonstrated a good test-retest (r = 0.97; p < 10(-6)) and inter-rater (r = 0.92; p < 10(-6)) reliability. DISCUSSION AND CONCLUSION: SIP-65, a short version of SIP-136, is feasible and clinically sound and must be recommended to assess health-related functional status of French aphasic people.

[Deglutition disorders in the elderly. Evaluation methods]. / Les troubles de la déglutition du sujet âgé. Procédés d'évaluation.

FROM DISCOVERY TO CLINICAL DIAGNOSIS: Dysphagia is easy to diagnose in its acute stage and when complicating a known neurological disease. However diagnosis may be greatly delayed when expressed by respiratory or nutritional symptoms, or when the patient presents cognitive disorders, as is frequent in the elderly. In such instances, simple tests such as the water test are clearly indicated. However, although they are reliable for diagnosing dysphagia, they are not precise in diagnosis of inhalation. Clinical examination is essential for diagnosing the etiology of the disorder. In the absence of clinical orientation, a nasofibroscopy is mandatory and digestive endoscopy debatable. SPECIALIZED EXAMINATIONS: The first-line supplementary examination is a videoradiography. It consists in the patient swallowing a liquid or solid barium sulfate bolus. This detects any anatomical or functional abnormalities. It is the examination of choice for the diagnosis of inhalation and its mechanism. Videoendoscopy is complementary to videoradiography. It can be conducted in first intention in patients who cannot be transported to the radiology unit. It provides precise information on glottal closing and pharyngeal contraction. IMPACT ON MANAGEMENT: In a restricted number of patients, the precise knowledge of the mechanism of dysphagia can help to orientate specific treatment. In others, such examinations will orient re-education, postural adaptation and the modification of food texture. In many patients, precise diagnosis of the mechanism at the origin of dysphagia has no impact on the management of dysphagia.

[Value of plethysmography in the respiratory function evaluation of coal miners in Lorraine]. / Intérêt de la phéthysmographie dans le bilan fonctionnel respiratoire du mineur de charbon lorrain.

The results of body plethysmography in 607 coalminers from Lorraine, France, are analysed. The relationship between radiological aspects and tobacco consumption are discussed. When progressive massive fibrosis (PMF) is absent, total lung capacity (TLC) and slow vital capacity (VC) are related with profusion, but remain independant of X-ray type and tobacco consumption. Tobacco alters flows and FEV1/VC results. A 20% incidence of residual volume (RV) inflation is observed unrelated to X-ray aspect. When PMF is present, TLC results are more contrasted (8.9% restrictive defects, 5.7% hyperinflation) and obstructive pattern follows X-ray progression. Tobacco consumption induces more RV and functional residual capacity inflation. These results strongly support the fact that the effects of dust exposure vary with smoking. Consequently, the interactions between pneumoconiotic fibrosis and distension appear to be reflected by plethysmography. This method is useful for determining each functional pattern. It may also be of pronostic value but this needs to be confirmed by further studies.

[Internalized and externalized disorders in children witness to conjugal violence and their associated variables: a literature review.]. / Les troubles extériorisés et intériorisés des enfants témoins de violence conjugale et leurs variables associées : une recension des écrits.

This article presents a literature review on externalized and internalized disorders in children who are witness to conjugal violence as well as the major variables associated with the development of these disorders. Among these variables, there are age and gender of the child, the type of violence they witness, maternal stress, educational skills of parents as well as physical and sexual abuse. The limits of major studies published over the last two decades are also exposed. Finally, new avenues of research that might shed new light on a more recent knowledge of the issue, are proposed.

Genetic and non-genetic parameters related to embryo production in superovulated Large White (LW) gilts.

The aim of this study was to identify genetic and non genetic factors which might affect results of embryo production of Large White (LW) cyclic gilts from data collected in one herd during 6 years. Donors (n=1060) were synchronized with a progestogen treatment and luteolysis was induced 13-15 days later by 2 injections of cloprostenol. To stimulate follicular development 800IU eCG was then injected 24h later, followed by 500IU hCG 48h later. Donors were inseminated twice; depending on the onset of oestrus, the interval between hCG treatment and first insemination (hCGAI1) was either 24 or 41 h. Embryos were collected at 5-6 days after the 1st AI by flushing uterine horns. Traits of interest were the number of corpora lutea (CL), the number of flushed embryos (FE), the number of transferable embryos (TE) and the number of unfertilized embryos (UE). The average number of TE was 18.8 ± 9.0. The main sources of variation for CL, FE and TE were the season (P≤0.002) and hCGAI1 (P≤0.001) effects. For the interval of 24h of hCGIA1 the number of TE was increased by 4 compared with the TE obtained for the 41 h interval of hCGIA1. Maternal and paternal genetic effects were estimated using restricted maximum likelihood methodology applied to the univariate animal model, whereas genetic covariance components were estimated in bivariate models. Estimates of maternal heritability were 0.45 for CL, 0.32 for FE, 0.29 for TE and 0.05 for UE whereas for the paternal effect, heritabilities were very low (<0.06). Genetic correlation between CL, FE and TE variables were very high (>0.89) for the maternal effect. A breeding scheme based on CL selection in response to superovulation could thus improve the number of transferable embryos.

Selection of impubertal gilts by ultrasonography optimizes their oestrus, ovulatory and fertility responses following puberty induction by PG600.

In a group of gilts, occurrence of puberty is spread over several weeks. The optimal time to apply puberty induction is therefore difficult to define, as treatment of puberal gilts is meaningless. Changes in uterine aspect around puberty can be detected by ultrasonography. Two experiments were carried out to assess the effect of PG600(®) (400 UI of eCG and 200 UI hCG) administration to 6 months old gilts shown to be impubertal by ultrasonography on cyclicity and reproductive performance. Impubertal Large White gilts (n=94) were treated with either PG600 or solvent (controls). Administration of PG600 to impubertal gilts increased significantly the proportion of females displaying pubertal uterine ultrasound images 3 days after treatment (100% versus 65% in controls). The number of days to puberty was significantly reduced in gilts injected with PG600 (3.3 days) versus controls (4.7 days). In gilts of the PG600 group, ovulation rate was higher at the 1st oestrus compared to the 2nd, while this did not happen in controls. Progesterone concentrations were higher at mid-luteal phase in the PG600 treated gilts compared to controls (significant treatment by time interaction). Similar proportions of gilts returned to oestrus (89% versus 74% for controls). Following insemination at the 2nd oestrus, pregnancy rate and number of live embryos were unaffected by treatment. The combination of ultrasonography and PG600 optimizes the use of exogenous hormones by targeting treatment to gilts that need it, therefore facilitating the introduction of gilts into all in/all out system.

[Morbidity and mortality conferences in anaesthesia and intensive care: experience feedback from Nancy university hospital]. / Revues de morbi-mortalité (RMM) en anesthésie-réanimation : retour d'expérience au CHU de Nancy.

OBJECTIVES: Assessment of the morbidity mortality conferences (MMC) durableness in the Anaesthesiology and Surgical Intensive Care Department of the Urban Hospitals of Nancy University Hospital; evaluation of the proportion of medical education in the corrective actions implemented, and research for improvement ways. PATIENTS: All the cases of death and near-death in the operating room and all the cases deemed to be instructive or useful for security improvement. METHOD: Retrospective analysis of MMC activity since its initiation in 2005. RESULTS: Durability of MMC and good attendance rate have been sustained over time. As in the USA, MMCs result firstly in resident's education and continued medical education actions. Medical education actions represent 75% of all corrective measures, followed by changes in practices (62%), in procedures (48%) and in organisation (5%). DISCUSSION: The development process of a culture of the safety has been initiated and perpetuated. Some ways of improvement have been proposed: MMC must certainly be widened as well regarding to the categories of addressees, as the topics (any event deemed to be noteworthy for the safety of care) or the time scale of the analysis. Others propositions: preparation of the presentations with a colleague experienced in MMC; participation of external MMC experts; monitoring of local markers of security of care and of corrective measures efficiency; inclusion of MMC cases presentation in the trainees pedagogic objectives.

[Interest of evaluation of professional practice for the improvement of the management of postoperative pain with patient controlled analgesia (PCA)]. / Intérêt de l'EPP pour l'amélioration de la prise en charge de la douleur postopératoire par analgésie contrôlée par le patient (ACP).

OBJECTIVES: To evaluate the daily practice of postoperative PCA in Nancy University Hospital, in continuity with a quality program of postoperative pain (POP) care conducted in 2003. TYPE OF STUDY: A retrospective audit of patient medical records. MATERIAL AND METHODS: A review of all the medical records of consecutive surgical patients managed by PCA over a 5-week period in six surgical services. Criteria studied: Evaluation of hospital means (eight criteria) and of medical and nursing staff practice (16 criteria). A second audit was conducted 6 months after the implementation of quality improvement measures. RESULTS: Assessment of the hospital means: temperature chart including pain scores and PCA drug consumption, patient information leaflet, PCA protocol, postoperative pre-filled prescription form (PFPF) for post-anaesthesia care including PCA, and optional training of nurses in postoperative pain management. EVALUATION OF PRACTICES: One hundred and fifty-nine files of a total of 176 patients were analyzed (88%). Improvements noted after 6 months: trace of POP evaluation progressed from 73 to 87%, advance prescription of PCA adjustment increased from 56 to 68% and of the treatment of adverse effects from 54 to 68%, trace of PCA adaptation by attending nurse from 15 to 43%, trace of the administration of the treatment of adverse effects by attending nurse from 24% to 64%, as did the use of PFPF from 59 to 70%. CONCLUSIONS: The usefulness of a pre-filled prescription form for post-anaesthesia care including PCA prescription is demonstrated. Quality improvement measures include: poster information and pocket guides on PCA for nurses, training of 3 nurses per service to act as "PCA advisers" who will in turn train their ward colleagues in PCA management and the use of equipment until an acute pain team is established.

Loperamide in patients with radiotherapy-induced diarrhoea.

63 patients (23--78 years) with irradiation-induced diarrhoea, the majority of them resistant to treatment with diphenoxylate, were started on 4-(p-chlorophenyl)-4-hydroxy-N,N'-dimethyl-alpha,alpha-diphenyl-1-piperidine butyramide (loperidine, Imodium) 4 mg daily. Doses were further adapted individually and the trial lasted for 3--72 days. Daily frequency and consistency of stools improved significantly, and abdominal cramps were clearly reduced. Stools became normal in 41 patients after a median time of 16.5 days (median daily dose: 4 mg), they improved in six other patients, but remained unchanged in eight and deteriorated in one patient. The remaining seven cases were not evaluated. No side-effects could be attributed to the drug.

Cyclic AMP and cyclic GMP production in normal and psoriatic epidermis.

cAMP and cGMP production was determined in normal and psoriatic (involved or uninvolved) epidermis. After homogenization, epidermal strips were incubated with saturating concentrations of ATP or GTP, respectively, for cAMP and cGMP production. Cyclic nucleotides were measured by radioimmunoassay before and after 5, 10, 20 min of incubation. The kinetics of cAMP and cGMP production were linear during the 20 min of incubation. Comparison of normal skin, uninvolved and involved psoriatic skin, prior to and after 20 min of incubation showed the following results: cAMP levels were significantly higher in normal skin than in psoriatic skin at zero time (p less than 0.01) and after incubation (p less than 0.05). cGMP levels were not significantly different in the three tissues at zero time. After incubation, psoriatic involved epidermis exhibited a higher production of cGMP than normal skin (p less than 0.05). Thus, the ratio cAMP/cGMP was higher in normal skin than in psoriatic skin at the basic level (p less than 0.05) and after incubation (p less than 0.01). These results indicate an imbalance in cyclic nucleotides metabolism in psoriatic skin without a significant difference between uninvolved and involved epidermis.