Randomized controlled trial of compressive cryotherapy versus standard cryotherapy after total knee arthroplasty: pain, swelling, range of motion and functional recovery.

BACKGROUND: After total knee arthroplasty (TKA), patients have limited knee range of motion (ROM), trophic changes and pain. Cryotherapy and compression are recommended in the literature, but no study has shown that cryotherapy and compression combined leads to better results than cryotherapy alone. The primary objective was to compare knee ROM after 21 days of rehabilitation post-TKA between patients who underwent rehabilitation with compressive cryotherapy with those who had cryotherapy alone. The secondary objectives were to compare other trophic, pain and functional outcomes. METHODS: Forty patients were randomized into two groups: Standard Cryotherapy (SC = 20, median age 77 years), which applied cold packs along with their rehabilitation; and Compressive Cryotherapy (CC = 20, median age 76 years), which received cold compression. Knee joint's passive and active ROM (primary outcome) were measured with a goniometer. Knee's circumference, fluctuation test, pain at rest and during activity, 6-minute walking test (6MWT) and KOOS questionnaire were secondary outcomes. The groups were compared on D1 (baseline) and D21 of rehabilitation. A survival analysis has compared the groups on D1, D8, D15, D21. RESULTS: All subjects had a significant improvement in all the parameters on D21 relative to D1 (p < .05), except for pain at rest (p = .065 for CC and p = .052 for SC). On D21, the CC group had a significantly larger improvement in the joint effusion (p = .002), pain during activity (p = .005), 6MWT (p = .018) and KOOS (p = .004) than the SC group. Based on the survival analysis, the CC group had significantly faster improvement in the joint ROM (p = .011 for flexion and p = .038 for extension) and knee circumference (p = .013) than the SC group. CONCLUSIONS: Both cryotherapy methods improved joint ROM, trophic changes, pain and function. Adding dynamic compression to a cryotherapy protocol provided further benefits: a significantly faster improvement in passive knee flexion ROM, a greater reduction of swelling, and pain during activity. Similarly, walking distance and KOOS questionnaire were significantly better for CC. TRIALS REGISTRATION: The study was registered in the ClinicalTrials.gov database on 14/09/2023 (identifier: NCT06037824).

Description of the first isolates of guinea fowl corona and picornaviruses obtained from a case of guinea fowl fulminating enteritis.

Guinea fowl fulminating enteritis has been reported in France since the 1970s. In 2014, a coronavirus was identified and appeared as a possible viral pathogen involved in the disease. In the present study, intestinal content from a guinea fowl involved in a new case of the disease in 2017 was analysed by deep sequencing, revealing the presence of a guinea fowl coronavirus (GfCoV) and a picornavirus (GfPic). Serial passage assays into the intra-amniotic cavity of 13-day-old specific pathogen-free chicken eggs and 20-day-old conventional guinea fowl eggs were attempted. In chicken eggs, isolation assays failed, but in guinea fowl eggs, both viruses were successfully obtained. Furthermore, two GfCoV and two GfPic isolates were obtained from the same bird but from different sections of its intestines. This shows that using eggs of the same species, in which the virus has been detected, can be the key for successful isolation. The consensus sequence of the full-length genomes of both GfCoV isolates was highly similar, and correlated to those previously described in terms of genome organization, ORF length and phylogenetic clustering. According to full-length genome analysis and the structure of the Internal Ribosome Entry Site, both GfPic isolates belong to the Anativirus genus and specifically the species Anativirus B. The availability of the first isolates of GfCoV and GfPic will now provide a means of assessing their pathogenicity in guinea fowl in controlled experimental conditions and to assess whether they are primary viral pathogens of the disease "guinea fowl fulminating enteritis".RESEARCH HIGHLIGHTSFirst isolation of guinea fowl coronaviruses and picornaviruses.Eggs homologous to the infected species are key for isolation.Isolates available to precisely evaluate the virus roles in fulminating enteritis.First full-length genome sequences of guinea fowl picornaviruses.

Evaluation of vaccination strategies to control an avian influenza outbreak in French poultry production networks using EVACS tool.

France recently faced two epizootic waves of highly pathogenic avian influenza (HPAI) in poultry (H5N6 in 2015-2016 and H5N8 in 2016-2017), mainly in the fattening duck production sector. Vaccination against avian influenza (AI) is currently not authorised in France even though its potential benefits were discussed during these epizootic events. The objective of this work was to evaluate the potential efficiency of different vaccination strategies that could be applied against AI in France. The EVACS tool, which is a decision support tool developed to evaluate vaccination strategies, was applied in several French poultry production sectors: broiler, layer, turkey, duck and guinea fowl. EVACS was used to simulate the performance of vaccination strategies in terms of vaccination coverage, immunity levels and spatial distribution of the immunity level. A cost-benefit analysis was then applied based on EVACS results to identify the most efficient strategy. For each sector, vaccination protocols were tested according to the production type (breeders/production, indoor/outdoor), the integration level (integrated/independent) and the type of vaccine (hatchery vaccination using a recombinant vaccine/farm vaccination using an inactivated vaccine). The most efficient protocols for each sector were then combined to test different overall vaccination strategies at the national level. Even if it was not possible to compare vaccination protocols with the two vaccines types in "foie gras" duck, meat duck and guinea fowl production sectors as no hatchery vaccine currently exist for these species, these production sectors were also described and included in this simulation. Both types of vaccination (at hatchery and farm level) enabled protective immunity levels for the control of AI, but higher poultry population immunity level was reached (including independent farms) using hatchery vaccination. We also showed that hatchery vaccination was more efficient (higher benefit-cost ratio) than farm vaccination. Sufficient and homogeneously spatially distributed protective levels were reached in the overall poultry population with vaccination strategies targeting breeders, chicken layers and broilers and turkeys, without the need to include ducks and guinea fowls. However, vaccination strategies involving the highest number of species and production types were the most efficient in terms of cost-benefit. This study provides critical information on the efficiency of different vaccination strategies to support future decision making in case vaccination was applied to prevent and control HPAI in France.