[Burnout syndrome among third year medical students in Caen: Prevalence and associated factors]. / Syndrome de burn out chez les étudiants en pré-externat de la faculté de médecine de Caen : prévalence et facteurs associés.

BACKGROUND: Burnout syndrome is a reality in health professions. Many studies report a growing and alarming exhaustion among doctors and residents in France. However, medical studies deemed to be stressful, medical students could be also affected by this syndrome. Few studies are conducted in France at this stage of training, so we will focus our study on the sensitivity to burnout syndrome of students in pre-clerkship. METHODS: This is a descriptive cross-sectional study involving 312 students in their third year of medical school in Caen, France. These students answered a questionnaire about their lifestyle and their course, and two pre-established questionnaires, the MBI-test with the emotional exhaustion subscale (EE score) tracking burnout and the GHQ-28 evaluating psychiatric morbidity not psychotic. RESULTS: More than 4 in 10 (42.6%) students had a high EE score and a positive GHQ-28 score. More than one student in two (59.8%) had a moderate to high emotional exhaustion score. Likewise for the GHQ-28 score, 53.4% of students had a positive score. In addition, nearly one in three students (29.8%) felt threatened by burnout. Finally, various factors appeared to be related to burnout: female gender, wanting to stop studying, lack of support or changes in appetite. CONCLUSION: Burnout is a reality and many factors are associated with it. The study has allowed us to study its factors more closely to get a better understanding but many parameters remain uncertain and deserve more investigation. However, we must continue to act and implement care and support for students at risk. In the same way, it is necessary to sensitize and train students for a primary prevention against burnout from the first cycle of medical studies.

[Stereophotogrammetry and facial surgery: Principles, applications and prospects]. / Photographie 3D en chirurgie de la face : principes, intérêts et perspectives.

The clinical examination of the face needs a reliable, objective and innocuous tool. Stereophotogrammetry for a medical use has been available for more than fifteen years but its popularity is still limited by a high cost. We hereby define the principles of stereophotogrammetry, its fields of application in facial surgery and the prospects, which might soon be offered by a wider access to this technique.

[Alberic Pont, the great war and the "broken faces"]. / Albéric Pont, la grande guerre et les gueules cassées.

The First World War and the number of facial injuries made specialized trauma centers necessary. Alberic Pont was trained both in medicine and dentistry. He founded in Lyon one of the first French specialized wards, which received more than 7000 soldiers overall. Through his charisma, his skills, his creativity and his generosity, he must be considered as a symbol among the pioneers of maxillo-facial surgery, which was then at its early stage. The centenary of World War I is the occasion to shed light on this man who dedicated his career to those who were renamed "broken faces".

Effects of repeated low-dose exposure of the nerve agent VX on monoamine levels in different brain structures in mice.

In a previous report, alterations of the serotonin metabolism were previously reported in mice intoxicated with repeated low doses of soman. In order to better understand the effects induced by repeated low-dose exposure to organophosphorus compounds on physiological and behavioural functions, the levels of endogenous monoamines (serotonin and dopamine) in different brain areas in mice intoxicated with sublethal dose of (O-ethyl-S-[2(di-isopropylamino) ethyl] methyl phosphonothioate) (VX) were analysed by HPLC method with electrochemical detection. Animals were injected once a day for three consecutive days with 0.10 LD50 of VX (5 µg/kg, i.p). Neither severe signs of cholinergic toxicity nor pathological changes in brain tissue of exposed animals were observed. Cholinesterase (ChE) activity was only inhibited in plasma (a maximum of 30% inhibition 24 h after the last injection of VX), but remained unchanged in the brain. Serotonin and dopamine (DA) metabolism appeared significantly modified. During the entire period of investigation, at least one of the three parameters investigated (i.e. DA and DOPAC levels and DOPAC/DA ratio) was modified. During the toxic challenge, an increase of the serotonin metabolism was noted in hippocampus (HPC), hypothalamus/thalamus, pons medulla and cerebellum (CER). This increase was maintained 4 weeks after exposure in HPC, pons medulla and CER whereas a decrease in cortex 3 weeks after the toxic challenge was observed. The lack of correlation between brain ChE activity and neurochemical outcomes points out to independent mechanisms. The involvement in possibly long-lasting behavioural disorders is discussed.

Foliar application of methyl jasmonate and methyl jasmonate supported on nanoparticles: Incidence on grape phenolic composition over two seasons.

Tools to address the mismatch between technological and phenolic maturity of grapes are needed. Application of elicitors could be an effective alternative. This work compares the effect of the application of methyl jasmonate (MeJ) in conventional form and, as a novelty, in the form of MeJ-doped nanoparticles (ACP-MeJ) on the phenolic composition of Tempranillo grapes. Results showed that, regardless of season, both treatments increased the grape total phenols content. In 2019, most of the anthocyanins, and to a lesser extent the flavanols, increased with the application of MeJ, and several hydroxycinnamic acids increased in the grapes treated with ACP-MeJ, with dose 10 times lower than those of the MeJ conventional. In 2020, anthocyanins were not affected by the treatments, but total flavanols, flavonols, hydroxybenzoic acid, and stilbenes increased after ACP-MeJ application. Thus, foliar application of ACP-MeJ could serve to increase grape phenolic composition, reducing maturity decoupling and the environmental impact.

[Zygomatic bone repositioning osteotomies]. / Ostéotomies de repositionnement de l'os zygomatique.

INTRODUCTION: The main morphological sequels of zygomatic bone fractures are lack of zygomatic projection and enopthalmia. They may be corrected by zygomatic osteotomy which is a difficult operation because of modified anatomic landmarks. Onlay bone or alloplastic grafts are preferred. TECHNICAL NOTE: Zygomatic osteotomies are performed through three surgical approaches: superior palpebral, sub-ciliary, and upper vestibular, followed by repositioning with osteosynthesis micro-plates. They allow reconstruction with an adequate projection in three dimensions. Surgery is usually associated with a bone graft of the orbital floor. DISCUSSION: Zygomatic osteotomy is a simple, reproducible technique, but it requires a good bone exposure. The esthetic results are satisfactory with an uneventful outcome. This surgical procedure is a good alternative to isolated techniques of autologous bone grafting or alloplastic material reconstruction which have sometimes disappointing and short lasting results due to graft resorption.

[Severe vascular complications of Le Fort I osteotomy]. / Complications vasculaires graves de l'ostéotomie de Le Fort I.

INTRODUCTION: Le Fort I osteotomy is a common orthognathic procedure. This surgery presents risk of severe vascular complications because of local anatomy. The aim of our study was to collect data on vascular complications of Le Fort I osteotomies performed in our department, describe the diagnostic and therapeutic aspects, and discuss prevention. PATIENTS AND METHODS: A retrospective analysis was made on the files of patient having undergone Le Fort 1 osteotomy, between 1998 and 2007. Severe vascular complications were recorded, defined as postoperative hemorrhagic or ischemic complications severe enough to require a specific procedure. RESULTS: Nine hundred and sixteen patient files were included (39% male and 61% female patients, mean-age: 24.42 years; range: 13 to 59 years). Five patients presented with severe hemorrhagic complication. There was no ischemic complication. Three hemorrhagic episodes occurred in the immediate postoperative phase. In two cases, delayed hemorrhagic complication occurred, diagnosed as a pseudo-aneurysm by angiography. These were treated by hyperselective embolization. DISCUSSION: Vascular complications of Le Fort I osteotomies are rare (0.55% in our series). They are most frequently hemorrhagic complications.

[Pre-implantation bone graft coffering technique for posterior mandibular edentulism: between onlay grafting and regeneration]. / Technique du coffrage en greffe osseuse préimplantaire mandibulaire postérieure : entre apposition et régénération.

BACKGROUND: Pre-implant placement posterior mandibular bone grafts remain a challenge for maxillofacial surgeons. We present a coffering technique we prefer using in this localization. SURGICAL PROCEDURE: This original technique involves creating a sagittal mandibular groove in which a graft harvested from the retromolar region is wedged vertically, after being sharpened in a bone mill. Reconstruction of the alveolar region itself is achieved by filling up the space between this vestibular coffer and the residual alveolar ridge with particulate bone graft from the bone mill. RESULTS: A hundred patients were operated with this technique by the same team from 2005 to 2010. The treatment failed for four patients at 3 post-operative months. No alteration of inferior alveolar nerve was observed. DISCUSSION: This coffering technique seems to be fully adequate in case of a posterior mandibular atrophy with a narrow ridge and sufficient bone height. This technique has several assets. Guided bone regeneration is associated with the use of exclusively autologous bone grafts. It may be performed under local anesthesia. The donor site is close, and the regenerated bone is of good quality. Implant placement must be achieved from 4 to 6 months after graft surgery. The drawbacks of the technique are related to donor site possibilities, and to the alveolar ridge height. Morbidity is low.

[Modelization of bone graft reconstruction for posterior mandibular segment using the Simplant® software]. / Modélisation des techniques de reconstruction par greffes osseuses des secteurs mandibulaires postérieurs avec le logiciel Simplant(®).

INTRODUCTION: Pre-implant reconstruction techniques of edentulous molar mandibular ridges take into account the height and the width of the initial ridge, but not the initial geometry. The Simplant(®) software allows modeling these techniques by taking into account this geometry. TECHNICAL NOTE: Four surgical techniques for crestal volume reconstruction (apposition, interposition, distraction, formwork) were used on seven hemi-mandibles and modeled with the Simplant(®) software. This reconstructed volume was visualized according to the initial crestal geometry. The average gain in height was 4.1mm for the onlay graft, 2.3mm for the interposition graft, 4mm for distraction, 5.1mm for the boxing. The average gain of crestal width was -0.3mm for the onlay graft, 1mm for the interposition, -0.5mm for the distraction, and 1.3mm for the boxing. DISCUSSION: Modeling with the Simplant(®) software shows that boxing technique gives the closest bone reconstruction to the ideal crestal geometry, whatever the initial crestal geometry.

Posterior auricular artery helix root free flap-part I: radio-anatomical study.

Full-thickness defects of the distal nose are an ongoing surgical challenge. Among the available techniques, pre-auricular chondrocutaneous free flaps based on the superficial temporal artery (STA) have good aesthetic and functional outcomes. However they often require autologous venous grafts. The aim of this radio-anatomical study was to evaluate the feasibility of the helix root free flap based on the posterior auricular artery (PAA). Vascular lengths, diameters, and networks were investigated in flaps harvested from cadavers. The perfusion of the flaps was studied by injecting patent blue. Some flaps were also injected with contrast agent and studied by angiography and computed tomography. Ten flaps from seven fresh cadavers were dissected and analysed. The mean length of the PAA was 114.2 mm and the mean diameter was 2.2 mm. Perfusion was investigated in six flaps and considered good in three of these. The study results demonstrate the feasibility of PAA-based helix root free flaps. This alternative technique provides an 11 cm pedicle with vessels of appropriate calibre, facilitating any potential microsurgery. The scar is mostly hidden behind the ear. This PAA-based helix root free flap could be a reliable and promising single-stage procedure to repair complex defects of the alae nasi.

Dental implants and free fibula flap: 23 patients.

INTRODUCTION: Mandibular reconstruction with a microvascular free fibula flap (MFF) is an elegant solution to restore the anatomic arch, oral functions, and facial esthetics. But the thin cutaneous tissue, the thickness of subcutaneous tissues, the absence of a pelvilingual and vestibular groove, and the fragility of soft tissues complicate dental prosthetic stabilization. Implants may restore prosthetic functionality. A lot has been published on osteointegration with a MFF, but few studies have been aimed at the prosthetic aspect, final goal of any oral reconstruction. The aim of this retrospective study was to present the results of oral reconstruction with implant supported prostheses after mandibular reconstruction with a MFF. PATIENTS AND METHOD: Twenty-three patients underwent mandibular reconstruction: 17 men and six women with a mean age of 46 years (17-66). Fourteen patients (60.8%) underwent radiotherapy before reconstruction. Mandibular osteoradionecrosis was the indication for reconstruction in seven patients. Each patient was assessed by dentascan. Implants were placed under general anesthesia. Postoperative clinical and radiographic controls were made regularly. Transmucous abutments were placed after six postoperative months and the prosthetic phase was initiated one month later. The criteria for implant and prosthetic success were assessed. RESULTS: Seventy-five implants were placed, on average 3.2 per patient, with an 80% success rate. Three implants (4%) were not used for prosthesis placement. Ten permanent prostheses and 13 removable prostheses were placed. The mean delay before implant loading was 7.6 months (6-10) and the mean follow-up was 27.5 months (1-71). Occlusion was considered as "satisfactory" for 69.6% of patients. For 57% of patients, the quality of surrounding soft tissues was considered as "satisfactory". For 74% of patients, oral rehabilitation was "satisfactory". DISCUSSION: The implant supported prosthesis after MFF mandibular reconstruction, on an irradiated site or not, gives satisfactory results despite the thickness and mobility of soft tissues, and despite scar contracture and the absence of keratinization. Implant placement must be performed after a prosthetic planning. Using radiosurgical guides, despite their cost and difficult adaptation, would certainly improve the technique greatly.

Influence of seaweed foliar application to Tempranillo grapevines on grape and wine phenolic compounds over two vintages.

The study of seaweeds is increasing in viticulture due to their implications on plant protection and grape quality. This trial aimed to study the effects of foliar applications of an Ascophyllum nodosum extract at low (0.25%, v v-1) and high (0.50%, v v-1) dosages on grape and wine phenolic compounds in 2017 and 2018. In grapes, seaweed biostimulation increased the content of malvidin-3-glc, myricetin-3-glc and myricetin-3-gal in 2017 season. Moreover, both treatments improved the synthesis of trans-piceid and total stilbenes in both seasons. Sensory analysis revealed that 2017 wines had more color than the 2018 wines, which coincided with color intensity parameters. Therefore, seaweed applications to grapevines improved stilbenes content in grapes independently of the season and its effects on the rest of phenolic compounds in grapes and wines depended strongly of season factor.

[Intraosseous arteriovenous malformations]. / Les malformations artérioveineuses intra-osseuses.

Intraosseous arteriovenous maxillomandibular malformations are rare. The diagnosis is primarily clinical (children with pulsatile osseous tumefaction, bleeding at cingulum), completed with imaging techniques (TDM and/or MRI). Arteriography is indicated only at the time of therapeutic management. The evolution may vary greatly (four levels: quiescence, expansion, destruction, decompensation) and usually evolves because of hormonal changes or trauma. Radiotherapy and vascular ligatures are no longer recommended. The best treatment is direct or transarterial embolization. Surgical resection, when feasible, must be thorough. It is indicated in case of failure or recurrence after embolization.

Seaweed foliar applications at two dosages to Tempranillo blanco (Vitis vinifera L.) grapevines in two seasons: Effects on grape and wine volatile composition.

The effects of seaweed applications to grapevines on grape and wine volatile composition are currently unknown. The aim of this work was to study the influence of seaweed foliar applications (Ascophyllum nodosum) to a Tempranillo blanco vineyard on grape and wine volatile composition. A low (Ld) and a high dosage (Hd) of the seaweed fertilizer was applied in two consecutive seasons (2017-2018). The most abundant family of varietal volatile compounds in Tempranillo blanco grapes was C13 norisoprenoid. Hd treatment tended to increase the concentration of certain C6 compounds in grapes in both seasons, whereas Ld application tended to decrease 2-phenylethanol and 2-phenylethanal content in grapes with a season dependence. Season factor affected to the concentration of most of the volatile compounds in grapes due to the differences on rainfall, which affected to the weight of 100 berries and physico-chemical parameters. Yeast assimilable nitrogen (YAN) in musts could have affected the concentration of most of the wine volatile compounds. According to odor activity values (OAV), Tempranillo blanco wines were characterized as floral, fruity, banana, pear, among others aroma compounds.

Study of must and wine amino acids composition after seaweed applications to Tempranillo blanco grapevines.

Recently, A.O.C. Rioja have selected and enlisted the Tempranillo blanco as a new grapevine variety to be cultivated in this area. This is the first report that studies amino acid and ammonium composition of grape juice and wine from Tempranillo blanco. The aim was to study the effect of foliar application of a seaweed extract to a Tempranillo blanco vineyard on must and wine amino acids and ammonium content. The results suggested that Tempranillo blanco behaved as an arginine accumulator variety. Biostimulation after seaweed applications at a high dosage (Hd) to the grapevines increased the concentration of several amino acids in the 2017 season, while scarcely affected their content in 2018. Phenylalanine, precursor of several volatile and phenolic compounds, was increased in both seasons after Hd applications. Season was the most important factor in the variability of the must and wine amino acids concentration, followed by treatment and its interaction.

[Pulmonary complications of transfusion (TACO-TRALI)]. / Complications pulmonaires de la transfusion (TACO-TRALI).

Pulmonary oedemas occurring during or after a blood transfusion appear as the most frequent serious immediate incidents in the French hemovigilance database. They include transfusion-associated circulatory overload (TACO) and transfusion-related acute lung injury (TRALI). TACO are a major cause of transfusion-related death in France. TRALI are more and more recognized and notified. In no case, pooled fresh frozen plasma (100 donations) treated with solvent-detergent were involved in French TRALI cases. A logigrame will allow hemovigilance officers to better classify pulmonary oedemas in e-fit, the French hemovigilance database.

[Surgical site infections in orthognathic surgery and risk factors associated]. / Les infections du site opératoire en chirurgie orthognathique et leurs facteurs de risque.

INTRODUCTION: Surgical site infections (SSI) in orthognathic surgery are considered infrequent and without any important consequence for the final operative result. A procedure of epidemiological surveillance was implemented to determine the frequency of SSI in orthognathic surgery and to better document their risk factors. MATERIAL AND METHOD: This prospective study included all interventions in our orthognathic surgery department between September 1(st) 2006 and August 31(st) 2007. SSI and their risk factors were documented for up to one year of follow-up. Risk factors were correlated to SSI using monovariate and multivariate analyses. RESULTS: Ten (7%) out of 143 consecutive interventions in orthognathic surgery were complicated by a SSI. All the SSI were secondary to a mandibular ramus sagittal split osteotomy. The two significantly correlated risk factors with the SSI in multivariate analysis were the length of surgery and the type of antibiotic prophylaxis. DISCUSSION: This rate of SSI correlates to published data. To decrease this rate, it would be necessary, in association with the usual precautionary measures, to limit the operating time and to recommend an antibioprophylaxis combining amoxicillin plus clavulanic acid (Augmentin).

3D Bioprinting:principles, fantasies and prospects.

Conventional three-dimensional (3D) printing techniques have been growing in importance in the field of reconstructive surgery. Three-dimensional bioprinting is the adaptation of 3D printing techniques to tissue engineering, through the use of a bio-ink containing living cells and biomaterials. We hereby describe the principles of bioprinting, its main current limitations, and the prospects of this technique. A PubMed/MEDLINE search was performed. A total of 40 publications were included. To date, most of the tissues have been printed with promising results in vitro (e.g., skin, cartilage, and muscle). The first animal studies are promising for small-scale defects. Vascularization issues are the main limitation to printing large constructs. Once the barrier of vascularization is overcome, printing organs and composite tissues of any size could be possible, opening the doors for personalized medicine based on medical imaging. Printing custom-made autologous grafts or flaps could minimize donor site morbidity and maximize the morphological results. Considering the potential future applications of bioprinting in the field of reconstructive surgery, one has to be aware of this tool, which could drastically change our practice.

Unusual cystic lesion of the eyebrow: A case report of malignant chondroid syringoma.

INTRODUCTION: Malignant chondroid syringomas, also known as cutaneous malignant mixed tumors, are rare neoplasms that most frequently occur on the torso or extremities of women. Here, we present an illustrated case of a facial malignant chondroid syringoma. MATERIALS AND METHODS: A 32-year-old female patient with no notable medical history presented with an approximately 1cm-wide, painless, palpably-mobile subcutaneous nodule, suggestive of a sebaceous cyst, just above the middle third of the right eyebrow. The nodule had grown steadily over six months. She had no palpable cervical lymphadenopathies. RESULTS: Anatomic pathology of the enucleated nodule found an adnexal sudoriparous tumor measuring 6×10mm and indicative of a malignant chondroid syringoma. Cervicofacial computed tomography and positron emission tomography scans showed no near or distant lymph node involvement. A second intervention for wide excision around the original enucleation lesion (+1cm) was validated in a multidisciplinary, cancerology-dermatology consultation. The eyebrow was reconstructed with a temporally-harvested fasciocutaneous island flap. DISCUSSION: Malignant chondroid syringomas are very rare and thus no standardized treatment has been established for them. Only 12 craniofacial localizations have been described to date. Radiation therapy and chemotherapy have not been shown effective for this malignancy, leaving only wide excision as a therapeutic option. A high and sustained (as much as 20 years after the initial diagnosis) risk of recurrence or metastasis necessitates prolonged patient follow-up.

Effects on chlorophyll and carotenoid contents in different grape varieties (Vitis vinifera L.) after nitrogen and elicitor foliar applications to the vineyard.

Photosynthetic pigments, including carotenoids are important secondary metabolites, which play a key role in photosynthesis. There is little information about the effects of nitrogen and elicitor applications on chlorophyll and carotenoid concentrations in grapes. The aim of this work was therefore to study the effects of the foliar application of nitrogen sources and elicitors to Tempranillo, Garnacha and Graciano (Vitis vinifera L.) grapevines on chlorophyll and carotenoid contents. The results showed that ß-carotene and lutein were the most abundant carotenoids in all the samples, ranging from 1336 and 227 to 7054 and 1382 µg/g, respectively. The applied treatments had greater impact on chlorophyll and carotenoid contents in Tempranillo grapes than in Graciano and Garnacha varieties. The content of chlorophyll was determined by the variety factor, while the concentration of carotenoids was influenced by the interaction of variety and treatment factors, depending on the type of foliar application.