A professional and institutional organization based on the "Aller vers" dynamic / Un acteur professionnel et institutionnel fondé sur la dynamique du « Aller Vers ¼

The French Union for Oral Health (UFSBD) embodies a professional initiative in institutional form, based on the philosophy of "Aller vers" (going toward). Based on plural representation, it brings together a variety of dentists, who are representative of the diversity of practices, whether in urban or rural areas, as employees or independent practitioners, or in local practice or hospital contexts. Proximity to the public is the very essence of its action and gives it a good understanding of realities on the ground. Since its creation, the UFSBD has been engaged in an ever-evolving collective mission, adapting its efforts to the changing needs of society and citizens. Its bold approach goes beyond the traditional boundaries of dental practice, by reaching out to the most vulnerable people and those furthest from the health system. This translates into an inclusive, proactive, and local approach. This dynamic has played a decisive role in advocating, since the 1990s, the recognition of oral health as an essential component of general health. Despite the obstacles and the time required to change mentalities, the UFSBD persevered, particularly regarding the challenge that periodontal diseases represent for oral health. Challenges persist, particularly with regard to access to prevention for populations at risk, population aging, and the integration of oral health into overall care pathways. However, the main objective remains that oral health regains its place as an undeniable national priority. Indeed, the mouth is at the heart of general health and can play an essential transversal role in public health.

L'Union Française pour la Santé Bucco-dentaire (UFSBD) incarne une initiative professionnelle sous forme institutionnelle qui repose sur la philosophie du « Aller Vers ¼. Fondée sur une représentation plurielle, elle réunit une diversité de Chirurgiens-dentistes, qui sont représentatifs de la diversité des pratiques, que ce soit en milieu urbain ou rural, en tant que salariés ou praticiens libéraux, dans des contextes citadins ou hospitaliers. Cette proximité avec les populations est l'essence même de son action et lui donne une bonne vision des réalités de terrain. Depuis ses débuts, l'UFSBD s'est engagée dans une mission collective en constante évolution, adaptant ses efforts aux besoins changeants de la société et des citoyens. Son approche audacieuse dépasse les frontières traditionnelles des cabinets dentaires, en se lançant à la rencontre des populations les plus vulnérables et éloignées du système de santé. Cela se traduit par une approche inclusive, proactive et de proximité. Cette dynamique a joué un rôle déterminant en plaidant, depuis les années 90, pour la reconnaissance de la santé bucco-dentaire en tant que composante essentielle de la santé générale. Malgré les freins et le temps nécessaire des plaidoyers pour faire évoluer les mentalités, l'UFSBD a persévéré, en particulier dans le défi que représentent les maladies parodontales pour la santé bucco-dentaire. Des défis perdurent, notamment en ce qui concerne l'accès à la prévention pour les populations à risques, le vieillissement de la population et l'intégration de la santé bucco-dentaire dans les parcours de soins globaux. Cependant, l'objectif principal demeure que la santé bucco-dentaire retrouve sa place de priorité nationale incontestable. En effet, la bouche est au cœur de la santé générale et peut jouer un rôle transversal essentiel en santé publique.

Plastic used in in vitro fertilization procedures induces massive placental gene expression alterations.

BACKGROUND: The exposure to plastic derivatives during human life is deleterious. Infants conceived using ART (IVF or ICSI) have twice as many risks of major birth defects compared to naturally conceived infants. Could plastic ware used during ART trigger defects in the fetal development? METHODS: Three groups of blastocysts were transferred to pseudopregnant mice. One was obtained after IVF and embryo development in plastic ware, the second in glass ware. The third, was obtained in vivo by natural mating. On day 16.5 of pregnancy, females were sacrificed and fetal organs collected for gene expression analysis. Fetal sex was determined by RT-PCR. RNA was extracted from a pool of five placental or brain samples coming from at least two litters from the same group and analyzed by hybridisation onto the mouse Affymetrix 430.2.0 GeneChips, confirmed by RT-qPCR for 22 genes. FINDINGS: This study highlights a major impact of plastic ware on placental gene expression (1121 significantly deregulated genes), while glassware was much closer to in vivo offspring (only 200 significantly deregulated genes). Gene Ontology indicated that the modified placental genes were mostly involved in stress, inflammation and detoxification. A sex specific analysis revealed in addition a more drastic effect on female than male placentas. In the brains, whatever the comparison, less than 50 genes were found deregulated. INTERPRETATION: Embryos incubated in plastic ware resulted in pregnancy with massive alterations of placental gene expression profile in concerted biological functions. There were no obvious effects on the brains. Besides other effects, this suggests that plastic ware in ART could be a cause of the increased level of pregnancy disorders observed recurrently in ART pregnancies. FUNDING: This study was funded by two grants from the Agence de la Biomedecine in 2017 and 2019.

Fertilization, but Not Post-Implantation Development, Can Occur in the Absence of Sperm and Oocyte Beta1 Integrin in Mice.

Fertilization is a complex process that requires successive stages and culminates in the adhesion/fusion of gamete membranes. If the question of the involvement of oocyte integrins has been swept away by deletion experiments, that of the involvement of sperm integrins remains to be further characterized. In the present study, we addressed the question of the feasibility of sperm-oocyte adhesion/fusion and early implantation in the absence of sperm ß1 integrin. Males and females with ß1 integrin-depleted sperm and oocytes were mated, and fertilization outcome was monitored by a gestational ultrasound analysis. Results suggest that although the sperm ß1 integrin participates in gamete adhesion/fusion, it is dispensable for fertilization in mice. However, sperm- and/or oocyte-originated integrin ß1 is essential for post-implantation development. Redundancy phenomena could be at the origin of a compensatory expression or alternative dimerization pattern.

A fertilin-derived peptide improves in vitro maturation and ploidy of human oocytes.

OBJECTIVE: To analyze the effect of a cyclic fertilin-derived peptide (cFEE) on in vitro maturation of human oocytes. DESIGN: Randomized study. SETTING: Fertility center in an academic hospital. PATIENT(S): Not applicable. INTERVENTION(S): Human immature germinal vesicle-stage oocytes (n = 1,629) donated for research according to French bioethics laws were randomly allocated to groups treated with 1 or 100 µM of cFEE or to a control group. They were incubated at 37 °C in 6% CO2 and 5% O2, and their maturation was assessed using time-lapse microscopy over 24 hours. In vitro maturated metaphase II oocytes were analyzed for chromosomal content using microarray comparative genomic hybridization, and their transcriptomes were analyzed using Affymetrix Clariom D microarrays. MAIN OUTCOME MEASURE(S): The percentage of oocytes undergoing maturation in vitro was observed. Aneuploidy and euploidy were assessed for all chromosomes, and differential gene expression was analyzed in oocytes treated with cFEE compared with the control to obtain insights into its mechanism of action. RESULT(S): cFEE significantly increased the percentage of oocytes that matured in vitro and improved euploidy in meiosis II oocytes by the up-regulation of FMN1 and FLNA genes, both of which encode proteins involved in spindle structure. CONCLUSION(S): cFEE improves human oocyte maturation in vitro and reduces aneuploidy. It may prove useful for treating oocytes before fertilization in assisted reproductive technology and for in vitro maturation in fertility preservation programs to improve oocyte quality and the chances for infertile couples to conceive.

Cyclic fertilin-derived peptide stimulates in vitro human embryo development.

OBJECTIVE: To study the cyclic fertilin peptide effects on preimplantation human embryogenesis. Cyclic fertilin peptide reproduces the structure of the binding site of the sperm Fertilin ß (also named A Disintegrin and Metalloprotease 2: ADAM2) disintegrin domain. It binds to the oocyte membrane and increases sperm-oocyte fusion index in human and fertilization rate in mouse, providing healthy pups. It also improves human oocyte maturation and chromosome segregation in meiosis I and binds to human embryo blastomeres, suggesting that it has a membrane receptor. DESIGN: Thawed human embryos at the 3 to 4 cells stage were randomly included in a dose-response study with cyclic fertilin peptide. Inner cell mass (ICM), trophectoderm (TE), and total cell numbers were evaluated in top- and good-quality blastocysts. SETTING: The study was performed in an academic hospital and research laboratory. PATIENT(S): Human embryos donated for research. This project was approved by the French "Agence de la Biomédecine." INTERVENTION(S): Immunofluorescence and tissue-specific gene expression analysis, using Clariom D microarrays, were performed to study its mechanism of action. MAIN OUTCOME MEASURE(S): Cyclic fertilin peptide improves blastocyst formation by almost 20%, the concentration of 1 µM being the lowest most efficient concentration. It significantly increases twice the TE cell number, without modifying the ICM. It increases the in vitro hatching rate from 14% to 45%. RESULT(S): Cyclic fertilin peptide stimulates TE growth. In the ICM, it induces transcriptional activation of intracellular protein and vesicle-mediated transport. CONCLUSION(S): Cyclic fertilin peptide dramatically improves human embryo development potential. It could be used to supplement culture medium and improve the in vitro human embryo development. Starting supplementation immediately after fertilization, instead of day 2, could significantly upgrade assisted reproductive technology outcome.

A study of 84 homemade toothpaste recipes and the problems arising from the type of product.

Objective Growing consumer mistrust of a number of ingredients used in industry has led to the development of a trend for homemade products. This now affects all types of sectors, but particularly the hygiene sector for shampoo and toothpaste products. The aim of this work is therefore to study recipes found on the internet for these types of products in order to assess risks associated with their use.Materials and methods Eighty-four recipes were collected from the internet and their composition was analysed.Results None of the 84 formulas analysed contained any fluoride salts, well known for their oral health benefits. Eighty percent did not contain a foaming agent either, which is very useful in the cleaning function of toothpastes. Furthermore, the quantities of substances to be used were usually expressed in tablespoons or teaspoons, measures which are imprecise and could, for example, lead someone to use large quantities of an abrasive agent such as calcium carbonate.Conclusions Attention should be drawn to homemade toothpaste recipes that contain no fluoride and whose abrasivity, purity and microbial contamination cannot be verified.

Impact of autofluorescence-based identification of parathyroids during total thyroidectomy on postoperative hypocalcemia: a before and after controlled study.

BACKGROUND: The clinical impact of intraoperative autofluorescence-based identification of parathyroids using a near-infrared camera remains unknown. METHODS: In a before and after controlled study, we compared all patients who underwent total thyroidectomy by the same surgeon during Period 1 (January 2015 to January 2016) without near-infrared (near-infrared- group) and those operated on during Period 2 (February 2016 to September 2016) using a near-infrared camera (near-infrared+ group). In parallel, we also compared all patients who underwent surgery without near-infrared during those same periods by another surgeon in the same unit (control groups). Main outcomes included postoperative hypocalcemia, parathyroid identification, autotransplantation, and inadvertent resection. RESULTS: The near-infrared+ group displayed significantly lower postoperative hypocalcemia rates (5.2%) than the near-infrared- group (20.9%; P < .001). Compared with the near-infrared- patients, the near-infrared+ group exhibited an increased mean number of identified parathyroids and reduced parathyroid autotransplantation rates, although no difference was observed in inadvertent resection rates. Parathyroids were identified via near-infrared before they were visualized by the surgeon in 68% patients. In the control groups, parathyroid identification improved significantly from Period 1 to Period 2, although autotransplantation, inadvertent resection and postoperative hypocalcemia rates did not differ. CONCLUSION: Near-infrared use during total thyroidectomy significantly reduced postoperative hypocalcemia, improved parathyroid identification and reduced their autotransplantation rate.

Diagnostic value of conventional chest radiography in intrathoracic goiters-retrospective analysis of 2570 patients.

PURPOSE: Since intrathoracic goiters (IG), either cervico-mediastinal goiters (CMGs) or mediastinal nodules (MNs), can lead to sternotomies and/or evitable reoperations, their detection is mandatory before thyroid surgery. A systematic screening by CT scan or MRI is not conceivable because of their expensiveness. We tested if conventional chest radiography (CCR) could remain a good screening tool for IG before thyroid surgery. METHODS: In this retrospective study (2554 patients), CCR usefulness was evaluated in relation with patients' complaints, clinical examination, neck US, and anatomical and surgical findings. RESULTS: CMGs (n = 67) and MNs (n = 42) were symptomatic in 10 and 5 patients, respectively. Clinical examination or neck US suspected their existence in 25 and 13 and 45 and 17 patients, respectively. Among the 50 IG detected by CCR (42 CMGs and 8 MNs), 4 CMGs and 2 MNs were missed by clinical examination or neck US. CCR failed to detect IG in 59 patients (54%): 25 CMGs (37%) and 34 MNs (80%). Twenty-eight IG (9 CMGs and 19 MNs) were discovered during surgery. CCR resulted in false positive in 88 out of 2445 patients (3.5%). CCR potentially avoided reoperation in two patients (a maximum saving of 6160 €, whereas the total cost of CCR was 54,895 €). CONCLUSIONS: CCR should not be used routinely for the preoperative detection of IG. Surgeons should preferably use clinical examination or neck US and directly perform CT scan when a mediastinal extension is suspected.

A Novel Mutant Allele of Pw1/Peg3 Does Not Affect Maternal Behavior or Nursing Behavior.

Parental imprinting is a mammalian-specific form of epigenetic regulation in which one allele of a gene is silenced depending on its parental origin. Parentally imprinted genes have been shown to play a role in growth, metabolism, cancer, and behavior. Although the molecular mechanisms underlying parental imprinting have been largely elucidated, the selective advantage of silencing one allele remains unclear. The mutant phenotype of the imprinted gene, Pw1/Peg3, provides a key example to illustrate the hypothesis on a coadaptation between mother and offspring, in which Pw1/Peg3 is required for a set of essential maternal behaviors, such as nursing, nest building, and postnatal care. We have generated a novel Pw1/Peg3 mutant allele that targets the last exon for the PW1 protein that contains >90% of the coding sequence resulting in a loss of Pw1/Peg3 expression. In contrast to previous reports that have targeted upstream exons, we observe that maternal behavior and lactation are not disrupted upon loss of Pw1/Peg3. Both paternal and homozygous Pw1/Peg3 mutant females nurse and feed their pups properly and no differences are detected in either oxytocin neuron number or oxytocin plasma levels. In addition, suckling capacities are normal in mutant pups. Consistent with previous reports, we observe a reduction of postnatal growth. These results support a general role for Pw1/Peg3 in the regulation of body growth but not maternal care and lactation.

Surgical management of primary hyperparathyroidism in older adults.

OBJECTIVES: To compare the feasibility, safety, and outcome of parathyroidectomy in the management of primary hyperparathyroidism (PHPT) in individuals aged 75 and older with that of those younger than 50. DESIGN: Retrospective chart review. SETTING: Department of Endocrine Surgery, Hospital Paul Desbief (Marseille, France). PARTICIPANTS: Individuals who underwent surgery from June 2005 to February 2013 (N = 526) had a clinical examination and laboratory and imaging assessments to diagnose PHPT. MEASUREMENTS: The clinical and biochemical characteristics and surgery outcomes of individuals younger than 50 (n = 80) were compared with the characteristics and outcomes of those aged 75 and older (n = 89). RESULTS: Most of the participants did not have any specific signs of PHPT, and the diagnosis of PHPT was established in some participants during routine clinical and laboratory examination. Nephrolithiasis and osteitis fibrosa cystica were observed only in the younger group. Urinary calcium decreased with age. Nine participants aged 75 and older did not undergo surgery (four declined, five had medical contraindications). Conventional surgery through transverse cervicotomy was used in the majority of participants. Cure rate was excellent (158/160), with few and reversible minor complications. The coexistence of thyroid lesions was significantly higher in the older (47.5%) than in the younger group (32.3%). Nodules and multinodular goiters were removed in the majority of participants during the parathyroidectomy procedure. CONCLUSION: With the exception of a few cases with severe associated comorbidities, parathyroidectomy is safe and curative and should be considered as first-line choice for older adult with PHPT.

Evaluation of quantitative measurement of thyroglobulin mRNA in the follow-up of differentiated thyroid cancer.

Detection of thyroid cancer by thyroglobulin (Tg) assay in peripheral blood is useful in the absence of residual thyroid tissue, but it requires thyrotropin stimulation for maximal sensitivity and is affected by circulating antithyroglobulin antibodies. To avoid these drawbacks, thyroglobulin mRNA (Tg mRNA) assay in circulating blood has been proposed. Initial studies showed that Tg mRNA assay was more positive in patients with metastasis than in cured patients. Further studies showed controversial data. We measured Tg mRNA in 26 patients undergoing levothyroxine (LT(4)) suppressive therapy after total thyroidectomy for thyroid cancer and in 11 controls. The stage of the cancer was defined according to the findings of the latest whole-body (131)I scan and serum Tg performed under LT(4) withdrawal. Patients were classified as cured (negative scan, negative stimulated Tg, 8 patients), with metastasis (positive scan in extrathyroid bed regions, positive Tg, 7 patients), with thyroid remnants (positive scan in thyroid bed, positive Tg, 8 patients), and discordant cases (negative scan, positive Tg, 3 patients). RNA was extracted from blood and analyzed by quantitative reverse transcription-polymerase chain reaction (RT-PCR) using two sets of primers and internal probes specific for Tg mRNA. This method allowed the detection of Tg mRNA in thyroid biopsies. Tg mRNA was undetectable in all control subjects and in all patients with cured cancer, positive in 1 of 8 patients with thyroid remnants, and in only 1 of 7 patients with metastasis. In conclusion, our data do not support the usefulness of Tg mRNA measurements in blood for monitoring thyroid cancer.

Screening for primary hyperparathyroidism before thyroid surgery: A prospective study.

BACKGROUND: Misdiagnosed primary hyperparathyroidism (PHPT) during thyroid surgery may lead to a difficult reoperation. Because PHPT is often asymptomatic, calcium measurements have been recommended before thyroid surgery, but no study has focused on the results of a prospective PHPT screening. METHODS: The prospective study of 748 patients consisted of 2-step screening of calcium measurement in all patients (normal range, 2.2 to 2.6 mmol/L, 8.8 to 10.4 mg/dL). If the calcium level was greater than 2.49 mmol/L (9.9 mg/dL), parathyroid hormone level (PTH; normal range, 11 to 65 pg/mL) and second calcium measurements were obtained. Positive screening was defined by 2 calcium levels greater than 2.49 mmol/L (9.9 mg/dL) and PTH level greater than 49 pg/mL. In patients with negative screening, we evaluated the number of parathyroid incidentalomas. In patients with positive screening, we rated parathyroid adenomas discovered as "easily accessible" or "requiring specific dissection." We assumed that the former could have been incidentally found by a surgeon unaware of calcium value. The cost estimation was based on French national health system databases. RESULTS: In the 9 patients with positive screening, 9 had parathyroid adenomas, 3 of them requiring specific dissection. In the 739 patients with negative screening, 12 had surgical incidentalomas and 2 had postoperative PHPT diagnosis. CONCLUSIONS: Our screening was not exhaustive, but it avoided a reoperation for missed PHPT in 3 patients. Population screening cost less than 3 reoperations. Other strategies, more exhaustive and/or cost-effective, should be investigated.

Cirugía laparoscópica de las glándulas suprarrenales: técnica transperitoneal / Adrenal disease by laparoscopic surgery: transperitoneal technique

Entre enero y diciembre de 1994, fueron operados por videolaparoscopía 15 pacientes con patología suprarrenal. Todos los casos fueron abordados por vía transperitoneal y cuyos detalles técnicos se describen en el presente trabajo. No hubo mortalidad. La morbilidad fue mínima y sólo un paciente con un tumor de Cushing maligno convertido. La suprarrenalectomía por videolaparaoscopía es una técnica factible, segura y menos dolorosa, pero en donde deben al menos en el momento actual respetarse las indicaciones que son por ahora los tumores de 8 cm y no malignos

Cirugía laparoscópica de las glándulas suprarrenales: técnica transperitoneal / Adrenal disease by laparoscopic surgery: transperitoneal technique

Entre enero y diciembre de 1994, fueron operados por videolaparoscopía 15 pacientes con patología suprarrenal. Todos los casos fueron abordados por vía transperitoneal y cuyos detalles técnicos se describen en el presente trabajo. No hubo mortalidad. La morbilidad fue mínima y sólo un paciente con un tumor de Cushing maligno convertido. La suprarrenalectomía por videolaparaoscopía es una técnica factible, segura y menos dolorosa, pero en donde deben al menos en el momento actual respetarse las indicaciones que son por ahora los tumores de 8 cm y no malignos (AU)

El hiperparatiroidismo primario en la década actual / Primary hyperparathyroidism: results of an 2 years study

Entre enero de 1991 y diciembre de 1992, fueron operados 149 pacientes de un hiperparatiroidismo primario (HPT 1º), descubierto por una hipercalcemia habitual en el 44,7 por ciento de los casos y confirmado en todos por el dosaje de la PTH 1-84. En caso de primera cervicotomía, la certeza quirúrgica de nuestra institución (99,3 por ciento) nos hizo prescindir de la imagenología pre-operatoria. No hubo mortalidad y la morbilidad fue mínima. El euparatiroidismo fue obtenido en el 96,8 por ciento de los pacientes (100 por ciento de los adenomas solitarios). Estos buenos resultados nos motivan a proponer la cirugía en todas las formas de HPT 1º, aum en los casos asintomáticos o moderados

El hiperparatiroidismo primario en la década actual / Primary hyperparathyroidism: results of an 2 years study

Entre enero de 1991 y diciembre de 1992, fueron operados 149 pacientes de un hiperparatiroidismo primario (HPT 1º), descubierto por una hipercalcemia habitual en el 44,7 por ciento de los casos y confirmado en todos por el dosaje de la PTH 1-84. En caso de primera cervicotomía, la certeza quirúrgica de nuestra institución (99,3 por ciento) nos hizo prescindir de la