Contrasted life trajectories: reconstituting the main population exposomes in French Guiana

In French Guiana, life expectancy is between 2 and 3 years below that of France, reflecting differences in mortality rates that are largely sensitive to primary healthcare and thus preventable. However, because poverty affects half of the population in French Guiana, global measurements of life expectancy presumably conflate at least two distinct situations: persons who have similar life expectancies as in mainland France and persons living in precariousness who have far greater mortality rates than their wealthier counterparts. We thus aimed to synthesize what is known about statistical regularities regarding exposures and sketch typical French Guiana exposomes in relation to health outcomes. We conducted a narrative review on common exposures in French Guiana and made comparisons between French Guiana and mainland France, between rich and poor in French Guiana, and between urban and rural areas within French Guiana. The most striking fact this panorama shows is that being a fetus or a young child in French Guiana is fraught with multiple threats. In French Guiana, poverty and poor pregnancy follow-up; renouncing healthcare; wide variety of infectious diseases; very high prevalence of food insecurity; psychosocial stress; micronutrient deficiencies; obesity and metabolic problems; and frequent exposure to lead and mercury in rural areas constitute a stunningly challenging exposome for a new human being to develop into. A substantial part of the population's health is hence affected by poverty and its sources of nutrition.

Superconducting atomic contacts inductively coupled to a microwave resonator

We describe and characterize a microwave setup to probe the Andreev levels of a superconducting atomic contact. The contact is part of a superconducting loop inductively coupled to a superconducting coplanar resonator. By monitoring the resonator reflection coefficient close to its resonance frequency as a function of both flux through the loop and frequency of a second tone we perform spectroscopy of the transition between two Andreev levels of highly transmitting channels of the contact. The results indicate how to perform coherent manipulation of these states.

Neonatal cleft lip repair: the anesthesiologist's point of view

Neonatal cleft lip repair is no longer an unusual procedure and several series have been published to date. We present our 3-year experience from the anesthesiologist's point of view. Preoperative evaluation, perioperative management, and postoperative problems are described. A thorough preoperative evaluation in order to exclude associated malformations (especially cardiac) and experience in neonatal anesthesia are essential for the sake of safety.

Traumatic tracheo-bronchial ruptures

A series of 18 ruptures of trachea or bronchi is reported. Gaseous semiology is predominant (pneumomediastinum and subcutaneous emphysema 72%, pneumothorax 67%). Haemoptysis is present in 28%. Assessment of the diagnosis and localization of the rupture was obtained through rigid bronchoscopy, early in the series, and then via fiberoptic endoscopy. Ignored cases in the early phase manifested themselves lately by atelectatic phenomena. Tracheal ruptures (5) were treated by direct repair (1/5) or tracheostomy (3/5) ; 1 died before surgery. Bronchial ruptures (13) were submitted to bronchoplastic procedures (7/13) or pulmonary resection (4/13). In 2 cases, no surgery was necessary or possible. Mortality (7/18) is linked with the importance of associated lesions, especially neurological ones.

[Traumatic subcutaneous ruptures of the cervical trachea (author's transl)]

Traumatic subcutaneous rupture of the cervical trachea is a rare but serious lesion that may cause death of the patient. Few cases come to treatment. This lesion results from a contusion to the anterior neck during hyperextension. It consists in a straight transection between larynx and trachea or between one of the 4 first tracheal rings, and is usually associated to multiple trauma involving the chest and head. Specific symptoms are often blurred by those of the associated lesions making diagnosis complex. This should ideally be confirmed by endoscopy or, if not feasable by cervicotomy. Emergency treatment is directed to restablishment of an adequate ventilation. Direct anastomosis by separate resorbable sutures yields excellent long-term results without stenosis. Creation of a transitory tracheotomy, when commanded by regional atresion, sometimes induces late stenosis; secondary repair is then less favorable. The rate of definitive recurrent nerve paralysis is high. There are also frequent distortions of the vocal cords with modifications of the voice and transitory palsy of the phrenic nerve. The authors draw these conclusions from one personal case and from the literature.