Time and spatial trends of operated cryptorchidism in France and environmental hypotheses: a nationwide study from 2002 to 2014.

STUDY QUESTION: Is there an evolution in the risk of operated cryptorchidism in France and does local geographical environment appear as an important trigger for this defect? SUMMARY ANSWER: We observed an increase of the risk of operated cryptorchidism in boys under the age of 7 years during the period 2002-2014 and a strong spatial heterogeneity, with the detection of spatial clusters suggesting environmental factors. WHAT IS KNOWN ALREADY: Epidemiologic data on cryptorchidism are scarce and its etiology is poorly understood. As part of the testicular dysgenesis syndrome, cryptorchidism is suspected to be a male genital developmental disorder caused by endocrine disruptor chemical (EDC) exposure during the prenatal period. STUDY DESIGN, SIZE, DURATION: This was a retrospective and descriptive study using data from the French national hospital discharge database, in the 2002-2014 study period. We built an indicator to reflect incident cases of operated cryptorchidism in boys under the age of 7 years in metropolitan France, with an algorithm using specific codes for diseases (ICD-10 codes) and surgical acts (CCAM codes). PARTICIPANTS/MATERIALS, SETTING, METHODS: The study population was composed of 89 382 new cases of operated cases of cryptorchidism in boys under the age of 7 years. We estimated the temporal evolution of the incidence rate. We fitted a spatial disease-mapping model to describe the risk of cryptorchidism at the postcode scale. We used Kulldorff's spatial scan statistic and Tango's flexibly shaped spatial scan statistic to identify spatial clusters. MAIN RESULTS AND THE ROLE OF CHANCE: The estimated increase in the incidence of operated cryptorchidism from 2002 to 2014 was equal to 36.4% (30.8%; 42.1%). Cryptorchidism displayed spatial heterogeneity and 24 clusters (P < 0.0001) were detected. The main cluster was localized in a former coal mining and metallurgic area in northern France, currently an industrial area. The cluster analysis suggests the role of shared socio-economic and environmental factors that may be geographically determined and intertwined. The industrial activities identified in the clusters are potentially the source of persistent environmental pollution by metals, dioxins and polychlorinated biphenyls. LIMITATIONS, REASONS FOR CAUTION: The indicator we used reflects operated cases of cryptorchidism, with an under-evaluation of the health problem. We cannot exclude a possible role of the evolution and local differences in surgical practices in the observed trends. Our inclusion of boys under 7 years of age minimized the biases related to differences in practices according to age. Regarding the environmental hypothesis, this is an exploratory study and should be considered as a hypothesis-generating process for future research studies. WIDER IMPLICATIONS OF THE FINDINGS: To our knowledge, this is the first descriptive study to address nationwide trends of operated cryptorchidism with detection of spatial clusters, with a very large sample allowing great statistical power. Our results generate plausible environmental hypotheses, which need to be further tested. STUDY FUNDING/COMPETING INTEREST(S): This study was entirely funded by Santé publique France, the French National Public Health Agency. All authors declare they have no actual or potential competing financial interest. TRIAL REGISTRATION NUMBER: N/A.

Early symptoms and long-term clinical outcomes of distal limb's cutaneous arterio-venous malformations: a retrospective multicentre study of 19 adult patients.

INTRODUCTION: Cutaneous arterio-venous malformations (AVM) are high-flow vascular malformations made up of a direct link between arteries and veins without intermediary capillary space. 'Distal limb's AVM', which mean involving hands or feet, are rare and their functional prognosis is often poor. Little is known about their early clinical symptoms. The objectives of this study were to identify early clinical symptoms of distal limb's cutaneous AVMs and to determine their long-term clinical outcome. METHODS: A retrospective study was carried out including adult patients who had distal limb's AVM, who were followed up between January 2000 and November 2013 in two regional tertiary care centres. The information was collected from patients' clinical records and completed by a structured telephone questionnaire. RESULTS: Nineteen patients were included in the study: four (21%) with foot AVM and 15 (79%) with hand AVM. The first clinical symptoms were as follows: swelling (47%), pain (47%), one or several venous dilatations (37%) and rarely abnormal skin colour, hyperthermia and pulsating sensation. The median diagnosis delay was 9 years after the onset of first manifestations. Amongst the 17 patients who underwent a treatment, 53% had embolotherapy session(s), 12% surgery and 35% had both. After an average follow-up of 57.6 months, 31% of the 13 patients contacted who were receiving treatment were in complete remission; 31% had partial remission; 15% had relapse after initial improvement and 23% had treatment failure. Overall, 74% of patients had a serious development of the AVM: 37% had digital or hand amputation, and 42% remained symptomatic and/or unstable. CONCLUSION: This study suggests that initial manifestations of distal limb's AVMs are discreet and non-specific, leading to a diagnosis delay of about 10 years, with poor prognosis. Doctors should evoke the diagnosis earlier, when these symptoms are shown: pain and/or swelling, sometimes with a large vein.

No increase in drug dispensing for acute gastroenteritis after Storm Klaus, France 2009.

During the night of 23-24 January 2009, Storm Klaus hit south-western France and caused power outages affecting 1,700,000 homes and stopping numerous pumping and drinking water disinfection systems. In France, medicalized acute gastroenteritis (MAGE) outbreaks are monitored by analysing the daily amount of reimbursements of medical prescriptions, registered in the French National Health Insurance database, at the 'commune' administrative level. As AGE is suspected to be associated with perturbations to water supply systems as well as power outages, Storm Klaus provided an opportunity to test its influence on the incidence of MAGE in the communes of three affected French departments (administrative areas larger than communes). The geographical exposure indicator was built by using the mapping of the water distribution zones, the reported distribution/production stoppages and their duration. Irrespective of exposure class, a relative risk of MAGE of 0.86 (95% confidence 0.84-0.88) was estimated compared with the 'unexposed' reference level. Although these results must be considered with caution because of a potential marked decrease in global medical consultation probably due to impassable roads, they do not suggest a major public health impact of Klaus in terms of increased MAGE incidence.

Ultrasonic assisted cross-flow ultrafiltration of starch and cellulose nanocrystals suspensions: characterization at multi-scales.

This study investigates for the first time the behaviors of starch and cellulose nanocrystals (SNC and CNC) suspensions which are simultaneously subjected to pressure, shear flow and ultrasound (US) during cross-flow ultrafiltration. This multi-forces process was characterized from macro-scales to nano-scales, with a custom designed "SAXS Cross-Flow US-coupled Filtration Cell". In addition, rheological behaviors of SNC samples at different concentrations/temperatures have been investigated. In both cases (ultrafiltration of SNC and CNC suspensions), better performances were observed with US. The in-situ SAXS measurements revealed that for SNC suspensions, no structure change occurred at the length scales range from 10 to 60nm in this multi-forces process, while CNC particles exhibited an ordered arrangement within the concentrated layer during the same process. SNC particles accumulated on the membrane surface forming a "fragile" concentrated layer which was removed very quickly by subsequent applied US. In contrary, the CNC particles accumulation was very severe, the additional ultrasonic force led to a disruption but not a totally removal of the CNC concentrated layer.

Verneuil's disease, innate immunity and vitamin D: a pilot study.

BACKGROUND: Verneuil's disease is a chronic inflammatory skin disease of the follicles in apocrine glands rich area of the skin (axillary, inguinal, anogenital) and is associated with a deficient skin innate immunity. It is characterized by the occurrence of nodules, abscesses, fistulas, scars. Recently, vitamin D has been shown to stimulate skin innate immunity. OBJECTIVE: The primary objective of the study was to assess whether Verneuil's disease was associated with vitamin D deficiency. The secondary objective was to determine whether vitamin D supplementation could improve inflammatory lesions. METHODS: First, 25(OH) vitamin D3 serum levels in patients with Verneuil's disease followed at Nantes University Hospital were compared to those of healthy donors from the French Blood Bank. Then, a pilot study was conducted in 14 patients supplemented with vitamin D according to their vitamin D level at baseline at months 3 and 6. The endpoints at 6 months were decreased by at least 20% in the number of nodules and in the frequency of flare-ups. RESULTS: Twenty-two patients (100%) had vitamin D deficiency (level <30 ng/mL) of whom 36% were severely deficient (level <10 ng/mL), having correlation with the disease severity (P = 0.03268) vs. 20 controls with vitamin D deficiency (91%) of whom 14% were severely deficient. In 14 patients, the supplementation significantly decreased the number of nodules at 6 months (P = 0.01133), and the endpoints were achieved in 79% of these patients. A correlation between the therapeutic success and the importance of the increase in vitamin D level after supplementation was observed (P = 0.01099). CONCLUSION: Our study shows that Verneuil's disease is associated with a major vitamin D deficiency, correlated with the disease severity. It suggests that vitamin D could significantly improve the inflammatory nodules, probably by stimulating the skin innate immunity. A larger randomized study is needed to confirm these findings.

[CLOVES syndrome: a malformational syndrome closely resembling Proteus syndrome]. / Syndrome CLOVES: un syndrome malformatif proche du syndrome de Protée.

BACKGROUND: CLOVES syndrome (Congenital Lipomatous asymmetric Overgrowth of the trunk with lymphatic, capillary, venous, and combined-type Vascular malformations, Epidermal nevi, Skeletal anomalies) is a sporadic malformational syndrome that has recently been described (mutation of PIK3CA), with asymmetric body hypertrophy, lipomatous hamartoma of the trunk and numerous malformations. PATIENTS AND METHODS: We report a case of CLOVES syndrome initially diagnosed as Proteus syndrome, revealed by infection of a dorsal lipomatous hamartoma. The patient presented with both right lower limb hypertrophy and capillary and venous-lymphatic malformations, associated with dorsal capillary malformations, left cervico-facial hypertrophy, and cervical epidermal hamartoma, all of which are consistent with Proteus syndrome. Imaging of the dorsal lipomatous hamartoma associated with capillary as well as underlying venous-lymphatic malformations and syringomyelia resulted in subsequent correction of the earlier diagnosis of Proteus syndrome to that of CLOVES syndrome. DISCUSSION: Several malformational syndromes are associated with tissue hypertrophy, hamartoma and vascular malformations. Diagnosis of CLOVES syndrome may be delayed due to its fairly close phenotypic similarity to Proteus syndrome. Nevertheless, the prognosis and complications differ. Our case underlines the importance of considering a diagnosis of CLOVES syndrome in the presence of lipomatous hamartoma with hemi-hypertrophy and epidermal hamartoma, in order to enable adequate follow-up with specific monitoring for the possible complications associated with this disease.

Application of the white rot fungus Phanerochaete chrysosporium in biotreatment of bagasse effluent.

Biotreatment of bagasse effluent using Phanerochaete chrysosporium (white rot fungus) is investigated. This study confirmed that lignin is the major pollutant component in this effluent followed by different carbohydrates. The treatment conditions must be very proper, especially in terms of biomass culture to achieve a successful treatment. The best conditions of temperature, biomass concentration, pH and duration for biotreatment of this effluent were 35°C, 552 mg l(-1), 6 and 5 to 9 days, respectively. Under these conditions, a 9 days long treatment reduced by 98.7% the original biochemical oxygen demand (of 2,780 mg l(-1)) and by 98.5% the dissolved chemical oxygen demand (initial 4,200 mg l(-1)). Moreover, fungal treatment reduced total dissolved solids from 3,950 to 575 mg l(-1) and color from 560 mg l(-1) PtCo to 111 mg l(-1) PtCo.

Guided waves in a plate with linearly varying thickness: experimental and numerical results.

The aim of this work is to give experimental and numerical results on the behaviour of guided waves that propagate downslope in a free elastic plate with slowly linearly varying thickness. We show experimentally the propagation of adiabatic modes, which are guided waves that adapt to the varying thickness of the plate. As the thickness is decreasing, a given guided wave will reach its thickness cut-off. When this happens, we show that two phenomena occur: the reflection of this wave and its propagation backward in the plate, its conversion into a different guided wave which goes on propagating downslope in the plate. The numerical study is done with the software Ansys, based on the finite element method. The results obtained confirm the experimental ones.

A survey of the intestinal helminths of refugees in Juba, Sudan.

A parasitological survey of refugees based in Juba, Sudan, involving 241 faecal samples, revealed that 66% of the population harboured intestinal helminths. The most commonly found infection was hookworm (36%), followed by Schistosoma mansoni (26%), Strongyloides stercoralis (20%), Hymenolepis nana (11%), Ascaris lumbricoides (1.2%), Trichuris trichiura (0.8%) and Taenia sp. (0.4%). Many of the specimens (42%) harboured a single infection, 21% had double, 2% triple and 1% quadruple infections. Parasite prevalences and intensities were analysed in relation to age, sex, religion and occupation: females (70%) were found to be more infected than males (64%); Muslims (50%) were less infected than Christians (68%) and agriculturalists (90%) were the most infected occupational group.

Oxygen consumption after cardiac surgery--a comparison between calculation by Fick's principle and measurement by indirect calorimetry.

Oxygen consumption calculated by Fick's principle (cVO2) was compared to oxygen consumption measured (mVO2) by indirect calorimetry (Deltatrac Metabolic Computer) in 10 patients in the post-operative period after cardiac surgery. For 50 pairs of measurements the mean difference (mVO2-cVO2) was 34 +/- 27 ml/min.m2. The limits of agreement were -20 ml/min.m2 to 88 ml/min.m2. These results showed that cVO2 and mVO2 were not interchangeable in this study.

[Postoperative thyrotoxic crisis during beta blockade: an atypical picture of generalized muscle deficiency]. / Crise thyrotoxique postopératoire sous bêta-bloquants: tableau atypique de déficit musculaire généralisé.

The case is reported of a 42 year old female patient with Graves disease who presented with an atypical thyroid storm after subtotal thyroidectomy. Surgery was indicated because of poor patient compliance with the medical treatment, and its partial failure. High doses of propranolol (240 mg a day) were given for 5 days preoperatively. Anaesthesia and surgery were uneventful however, towards the end of the first postoperative day, a severe myopathic syndrome started, with neither fever nor tachycardia. Respiratory failure and pneumonia occurred 24 h later. This was deemed to be due to an atypical thyroid storm. The patient was intubated and ventilated, and treated with high doses of propranolol (320 mg a day). Muscle strength began returning to normal on the 4th postoperative day, being completely normal 2 months later. Even though a particularly severe form of thyrotoxic myopathy appeared to be the most likely cause of this temporary muscle disorder, beta-blockers may have been involved. Their potential role is discussed.