[Anatomic study of the submental artery relationships for submental flap raising]. / Étude anatomique des rapports de l'artère sous-mentonnière pour le prélèvement du lambeau sous-mentonnier.

INTRODUCTION: Submental flap is useful for intra-oral reconstructions and reconstructions of the lower two thirds of the face. Dissection is delicate because of a difficult exposure under the lower rim of the mandible, numerous collateral arterial branches and the proximity of the marginal branch of the facial nerve. The aim of our work was to propose anatomical landmarks in order to facilitate the submental flap raising. MATERIAL AND METHOD: Ten bodies preserved in Biomet liquid were dissected bilaterally. The anatomic relationships between the marginal branch of the facial nerve and the mandible, the relationships of the submental artery, the amount and the location of its collateral branches were measured by means of a caliper. RESULTS: The highest marginal branch observed was located 0.5 cm above the mandibular lower rim, while the lower one was located 0.6cm below this rim. The mean length measured between the facial artery at its crossing over the mandibular rim at the level of the pre-angular notch and the origin of the submental artery was 1.5cm. The average number of collateral branches was 3.6. DISCUSSION: A skin incision made directly under the mandibular lower rim, as mentioned by some authors, may endanger the mandibular marginal branch of the facial nerve. Three positions of the submental artery in relation to the sub-maxillary gland are reported. The collateral branches are intended for gland, muscle, skin and bone. It is necessary to pay particular attention to the sub-lingual artery, an artery of big diameter that arises at 2.8cm on average from its origin and plunges towards the mouth's floor. It must not be followed at risk of clamping the thin pedicle destined to the digastric muscle. It is important to preserve the fat tissue around the submental pedicle in order to avoid venous congestion of the flap.

Determinants of vitamin D supplementation prescription in nursing homes: a survey among general practitioners.

SUMMARY: A total of 119 GPs participated to a survey aimed to assess the profile and determinants of vitamin D supplementation prescription in nursing homes. Among the respondent GPs, 65 (54.6%) systematically prescribe vitamin D to their institutionalized patients and the 54 (45.4%) others prescribe only sometimes. INTRODUCTION: The aim of this study is to assess the profile and determinants of vitamin D supplementation prescription in nursing homes. METHODS: General practitioners (GPs) having at least one patient in a nursing home in Liège, Belgium, were asked to complete the survey. RESULTS: A total of 119 GPs participated in the survey. Among the respondent GPs, 65 (54.6 %) systematically prescribe vitamin D to their institutionalized patients and the 54 (45.4%) others prescribe only sometimes. The main reasons for prescribing vitamin D cited by GPs who do so systematically are as follows: because they believe nursing home residents are mostly deficient in vitamin D status (92.1%), because they believe that vitamin D supplementation prevents osteoporotic fractures (77.8%), and because vitamin D supplementation is recommended by various scientific societies (38.1%). GPs who only prescribe vitamin D supplementation in some patients mainly do so following a diagnosis of osteoporosis (82.4%), on the basis the 25(OH)D level (78.4%), in the case of history of fracture (54.9%) or after a recent fracture (43.4%). Surprisingly, 16 physicians (31.4%) only prescribe vitamin D when they think of it. Interestingly, while 40.7% of GPs always prescribe the same dose of vitamin D, the remaining 59.3% prescribe a dose that will mainly depend on the results of the 25(OH)D level (94.0%), the patient's bone health (49.3%), or history of fracture (43.3%). CONCLUSIONS: More than half of GPs systematically prescribe vitamin D to their patients living in nursing homes. The other GPs usually prescribe vitamin D following the result of the vitamin D status or after a diagnosis of osteoporosis.

Gait speed or gait variability, which one to use as a marker of risk to develop Alzheimer disease? A pilot study.

BACKGROUND: Previous literature demonstrates the interest of gait analysis to predict cognitive decline in old people. AIMS: This pilot study aims to determine if gait speed or gait variability is a marker able to early identify, among mild cognitive impairment (MCI) subjects, those at risk to develop Alzheimer's disease (AD) in the future. METHODS: 13 MCI subjects were included in 2007. Their gait parameters (walking speed, stride length and gait frequency, regularity and symmetry) were measured in 2007 and 2008 in simple task (ST) and in dual task (DT) using a triaxial accelerometer (Locometrix(®)). Among the 13 MCI subjects included in 2007, 10 were assessed in 2008. So, 23 (13 in 2007 + 10 in 2008) gait tests were collected. In 2011, MCI people were considered as "MCI+" when they developed AD (between baseline and 2011) and as "MCI-" if they did not. Among the 23 gait tests, 15 were from MCI+ (9 gait tests in 2007 and 6 in 2008) and 8 from MCI- (4 gait tests in 2007 and 4 gait tests in 2008). Mann-Whitney non-parametric U test was used to compare gait parameters of MCI+ and MCI-. RESULTS: Gait speed, symmetry and regularity were lower in MCI+ than in MCI-. DISCUSSION: Despite the small sample size, the results presented in this original pilot study are in line as the infrequent previous literature related to this topic. The authors discuss lacks and strengths of this work. CONCLUSIONS: These results suggest that both gait speed and gait variability could be markers to early identify MCI at risk to develop AD.

[Patient treated with sub-mental intubation for maxillofacial trauma]. / Intubation sub-mentale chez un patient victime d'un traumatisme maxillo-facial.

Maxillo-facial traumas are frequent and most often occur in young patients. Naso-tracheal or orotracheal intubation may be contraindicated in case of combined occlusal fracture and nasal or ethmoido-nasal fracture. This study was carried out a clinical case of a patient treated at the Lille University Hospital for a maxillofacial trauma associating fracture of nose and maxilla. The purpose was to assess the reliability of submental intubation as an alternative to tracheotomy. Submental intubation is a reliable single and safe technique allowing an one-stage surgical treatment in case of complex association of fractures without using tracheotomy. Its use should be implemented on a larger scale.

[Screening for frailty: a benefit for both patients and physicians]. / Dépister la fragilité: un bénéfice pour le patient et pour le soignant.

Preventing the increasing number of depending persons is a novel priority in European Union health policy. One of the means to succeed relies on identifying, among elderly persons, those at risk of dependency, also named "the frail elderly". Screening for frailty is also useful to better assess the physiological reserves of the elderly before any therapeutic decision, as early as the first consultation. Researchers currently work on developing a new simple tool allowing a distinction between frail and robust persons. Since frailty is partly reversible, the global geriatric evaluation, in a one-day clinic, will lead to a personalized program to prevent or reverse frailty by a multidisciplinary approach.

[Oxidative stress, antioxydants and the ageing process]. / Quelle place pour le stress oxydant et les antioxydants dans le processus du vieillissement?

Antioxidant supplementation in the form of pills is thought to slow down the aging process through the "free radical" scavenger activity of these compounds. The idea arose from the "Free Radical Theory of Ageing" (FRTA), initially developed by Harman in 1956. In the present paper, we present some arguments against this theory. One of the most pertinent is that "free radicals", more properly renamed as reactive oxygen species (ROS), play important biological roles in defense mechanisms of the organism as illustrated, in particular, by the hormesis phenomenon. Surprisingly, a moderate production of ROS has been shown to extend the life span in animals.

The cumulative effect of small dietary changes may significantly improve nutritional intakes in free-living children and adults.

BACKGROUND/OBJECTIVES: The ELPAS (Etude Longitudinale Prospective Alimentation et Santé) study was an 8-month randomized controlled dietary modification trial designed to test the hypothesis that family dietary coaching would improve nutritional intakes and weight control in 2026 free-living children and parents. It resulted in significant nutritional changes, with beneficial effects on body mass index in adults. In these ancillary analyses, we investigated dietary changes throughout the intervention. SUBJECTS/METHODS: Before the study, modeling analyses were carried out on the French Association Sucre Produits Sucrés Consommation et Communication (ASPCC) food-consumption database to identify the most efficient dietary intervention strategy. During the study, all participants performed monthly three nonconsecutive 24-h dietary recalls: this allowed for measuring changes in the number of servings per day and serving size for each targeted food category throughout the intervention. RESULTS: Modeling analyses showed that targeting only the 10 main foods contributing to fat and carbohydrate intakes did not allow for reaching the ELPAS nutritional goals. As a result, it was decided to target more foods and to propose several types of dietary advice (such as change in serving size, change in cooking method, food substitution). This strategy led to many appropriate dietary changes during the intervention, but only a few of them reached significance. The mean number of servings per day was indeed significantly modified for only 7% of the targeted food categories in children and 17% in parents. The mean serving size was modified for only 12% of targeted food categories in children and 9% in parents. CONCLUSIONS: The cumulative effect of small dietary changes may induce significant nutritional improvements, with limited burden for populations.

Stunting is a major risk factor for overweight: results from national surveys in 5 Arab countries.

We analysed data on overweight and stunting from large national surveys performed between 2001 and 2004 in 5 Arab countries (Djibouti, Libyan Arab Jamahiriya, Morocco, Syrian Arab Republic and Yemen). Overweight and stunting were defined according to new WHO growth standards. Overweight ranged from 8.9% in Yemen to 20.2% in Syrian Arab Republic. The risk ratio (RR) for overweight in stunted children ranged from 2.14 in Djibouti to 3.85 in Libyan Arab Jamahiriya. RR ranged from 0.76 in mildly stunted children of Yemen to 7.15 in severely stunted children in Libyan Arab Jamahiriya. Etiological fraction in the population ranged from 7.49% to 69.76%.

The use of body mass index for measurement of fat mass in children is highly dependant on abdominal fat.

We examined the relationship between body fat and body mass index (BMI) in a multiethnic population of obese children. BMI z-scores were compared to DEXA measures of whole body composition and regional fat distribution. Fat mass index (FMI) was best predicted by the equation: 1/[(0.159- 0.013 x percentile of total abdominal fat)- (0.01 x BMI z-score)], where percentile of abdominal fat ranges from 1 to 5. Predicted FMI had high agreement with FMI measured by DEXA. There were no detectable differences in this relation between different ethnic groups. Both BMI and abdominal fat should be used as a proxy to determine adiposity.

The use of body mass index for measurement of fat mass in children is highly dependant on abdominal fat

We examined the relationship between body fat and body mass index [BMI] in a multiethnic population of obese children. BMI z-scores were compared to DEXA measures of whole body composition and regional fat distribution. Fat mass index [FMI] was best predicted by the equation: 1/[[0.159 - 0.013 x percentile of total abdominal fat] - [0.01 x BMI z-score]], where percentile of abdominal fat ranges from 1 to 5. Predicted FMI had high agreement with FMI measured by DEXA. There were no detectable differences in this relation between different ethnic groups. Both BMI and abdominal fat should be used as a proxy to determine adiposity

Stunting is a major risk factor for overweight: results from national surveys in 5 Arab countries

We analysed data on overweight and stunting from large national surveys performed between 2001 and 2004 in 5 Arab countries [Djibouti, Libyan Arab Jamahiriya, Morocco, Syrian Arab Republic and Yemen]. Overweight and stunting were defined according to new WHO growth standards. Overweight ranged from 8.9% in Yemen to 20.2% in Syrian Arab Republic. The risk ratio [RR] for overweight in stunted children ranged from 2.14 in Djibouti to 3.85 in Libyan Arab Jamahiriya. RR ranged from 0.76 in mildly stunted children of Yemen to 7.15 in severely stunted children in Libyan Arab Jamahiriya. Etiological fraction in the population ranged from 7.49% to 69.76%

Human bocavirus, a newly discovered parvovirus of the respiratory tract.

Human Bocavirus is a newly discovered parvovirus. This virus is the fourth most frequently detected virus among symptomatic children with respiratory infection. Human Bocavirus is present worldwide and is a probable cause of symptomatic respiratory infection, although Koch's postulates are not all fulfilled. In this article, we propose an overview of the main clinical data about this virus, two years after its discovery. In addition, we discuss some hypotheses about its tropism for the lung in young children.

Outcome and long-term growth after extensive small bowel resection in the neonatal period: a survey of 87 children.

UNLABELLED: This retrospective study aims to analyze the outcome, the prognosis factors and the long-term growth of children after extensive small bowel (SB) resection in the neonatal period. PATIENTS AND METHODS: 87 children, born between 1975 and 1991 who had undergone extensive neonatal small bowel resection, were followed up over a mean period of 15 years. Anatomical data influencing PN dependency and duration were analyzed. Data on height and weight were collected and compared using growth standards. Final heights were studied for patients who achieved their puberty and compared to predicted height based on Tanner's formula. Patients were analyzed according to PN weaning and growth: children still receiving PN (group A), patients weaned from initial PN but requiring PN once again or enteral feeding (group B), and children with permanent intestinal autonomy (group C). RESULTS: The overall survival is 89.7 %, depending on the date of birth. The duration of PN-dependency varies according to the intestinal length and the presence of the ileocaecal valve (ICV). All patients who remain PN dependent had less than 40 cm of small bowel and/or the absence of ICV. Patients in group B had a mean small bowel length of 35 +/- 19 cm, resection of the ICV in 50 % of cases, and a PN duration of 47.4 +/- 23.8 months. There was a significant decrease in height and weight gain within the 4 years after cessation of PN, requiring enteral or parenteral feeding. Patients in group C had a mean small bowel length of 57 +/- 19 cm, presence of ICV in 81 % of cases and a PN duration of 16.1 +/- 11.4 months. After PN weaning, they grow up normally with normal puberty and final height as predicted from genetic target height. CONCLUSION: PN duration is influenced by the length of residual SB and the absence of ICV. With good anatomic prognosis factors and short duration of initial PN, normal long-term growth may be predicted. Conversely, poor anatomical factors and protracted initial PN require careful monitoring of growth and may sometimes require nutritional support to be restarted. The last group, permanently dependent on PN, might be candidates for intestinal transplantation.

[Should the prevention of obesity be demedicalised?]. / Faut-il démédicaliser la prévention de l'obésité?

Obesity prevalence is rapidly growing, particularly in children and young adolescents. It is proved to be important to prevent it within a public health strategy. Primary prevention of obesity should not be focused on obesity itself, but should be part of a global public health national policy, targeted to improve the nutritional status of the community, to reduce the risk for chronic diseases, to improve the health status and the quality of life of the general population. This overall prevention programme should be conducted on a large scale, at all level of the country infrastructure and sectors of society, and should acquired a strong local and regional support from communities, consumers and government, but it has also to be particularly focused on young subjects (and their family and school workers), especially in groups with low socio-economic status. Secondary prevention should be particularly focused on children with a high-risk for obesity and/or those with potential associated risk factors. Medical involvement is of a particular importance in this secondary prevention, to identify and to manage these at-risk children and young adolescents. The various approaches from a paediatrician, a physician specialised in human nutrition, a sociologist and a consumer representative are presented in this review.

Prepubertal growth in children with long-term parenteral nutrition.

In children who depend on long-term parenteral nutrition (PN), a major goal is to obtain optimal growth. The aim of this retrospective study was to analyze growth in children on long-term cyclic nocturnal home PN, over at least 8 years before puberty. Nine boys and 7 girls were studied. Their mean age at the time of study was 11 years with a mean PN duration of 10.5 (8.6-16.4) years. Diseases were short bowel syndrome (5), intractable diarrhea (4), chronic intestinal pseudo-obstruction (4) and long segment Hirschsprung's disease (3). In each child, periods of at least 2 years were analyzed: either periods of regular growth (R: height gain >50th percentile), or slow growth (S: height gain < or =25th percentile). Results were expressed as mean +/- SD. Comparisons were performed using either Student's test for unpaired data or Wilcoxon's test for paired data. PN provided a mean of 224 +/- 80 mg nitrogen/kg/day and 43 +/- 14 kcal/kg/day equivalent to 50% of recommended supplies. At the time of study, the population presented with weight (W) = -0.7 +/- 0.8 SD and height (H) = -1.5 +/- 1.3 SD. The difference between W and expected W for H (W/H) was significant (p < 0.002). W/H ratio was 105 +/- 11%. For the total PN duration, weight gain was +0.2 +/- 1.5 SD and height loss was -0.75 +/- 1.4 SD. An excess weight gain occurred in parallel with the deflection of height gain. Of the 16 children, regular prepubertal growth was achieved in 4 only. The other 12 showed alternate periods of R and S. In 8 of them, 26.5 years of R and 33.5 years of S were compared, each child being his own control. PN nitrogen and energy supplies were significantly higher during R periods than during S periods. In the absence of any disease or treatment explaining the failure to thrive, inadequate PN supplies, especially in terms of nitrogen supply, are thought to be responsible for a negative nitrogen balance and slowed growth. In case of any deflection away from the individual growth curve, it is recommended to adjust the PN supply early, especially nitrogen supply.

[Arterial rigidity and endothelial dysfunction in obese children]. / Rigidité artérielle et dysfonction endothéliale chez l'enfant obèse.

Obesity is a cardiovascular risk factor in adults. Poorly is known about effect of obesity on cardiovascular system in children. Mechanical properties of a great elastic trunk, the common carotid artery (CCA) and endothelium function of the brachial artery were studied in 130 obese children (age: 12 +/- 3 years, body mass index (BMI): 29 +/- 5.5 kg/m2, without hypertension (115 +/- 19/58 +/- 8 mmHg). These patients had a vascular high resolution echographical analysis. Cross sectional compliance (CSC), cross sectional distensibility (CSD) and incremental elastic modulus (Einc) were analysed at the CCA site. The brachial artery dilation was measured after hyperthemia (flow mediated dilation, FMD), an endothelium dependent function and after sublingually glyceryl trinitrate (GTNMD), an independent endothelium function. Fat mass composition and distribution were assessed by dual-energy X-ray absorptiometry in 70 patients. In 50 obese patients an oral glucose tolerance test was done to determine insulin resistance. The obese children had significantly lower CSC and CSD than the healthy controls (respectively 0.12 +/- 0.04 vs 0.14 +/- 0.05 mm2.mmHg-1; p < 0.05 and 0.5 +/- 0.2 vs 0.8 +/- 0.4 mmHg(-1).10(-2); p < 0.001). Obese children had higher value than the controls for Einc (2.4 +/- 0.4 vs 1 +/- 0.24 mmHg.10(3); p < 0.001) that correlated poorly with fasting insulin concentrations (r = 0.34; p < 0.06) and BMI (r = 0.34; p < 0.01). FMD was significantly lower in obese children than in controls (6 +/- 3 vs 8 +/- 4%, p < 0.01) without modification of GTNMD (17 +/- 6 vs 18 +/- 7%, NS). These two parameters were respectively correlated with the android fat distribution (r = 0.36; p < 0.01; r = 0.49; p < 0.001). The CCA stiffness of obese children is linked to the amount of the overweight and to insulin resistance. The android fat distribution is related to endothelium dysfunction.