Performance of serum apolipoprotein-A1 as a sentinel of Covid-19

BACKGROUND

Since 1920, a decrease in serum cholesterol has been identified as a marker of severe pneumonia. We have assessed the performance of serum apolipoprotein-A1, the main transporter of HDL-cholesterol, to identify the early spread of coronavirus disease 2019 (Covid-19) in the general population and its diagnostic performance for the Covid-19.

METHODS

We compared the daily mean serum apolipoprotein-A1 during the first 34 weeks of 2020 in a population that is routinely followed for a risk of liver fibrosis risk in the USA (212,297 serum) and in France (20,652 serum) in relation to a local increase in confirmed cases, and in comparison to the same period in 2019 (266,976 and 28,452 serum, respectively). We prospectively assessed the sensitivity of this marker in an observational study of 136 consecutive hospitalized cases and retrospectively evaluated its specificity in 7,481 controls representing the general population.

RESULTS

The mean serum apolipoprotein-A1 levels in the survey populations began decreasing in January 2020, compared to the same period in 2019. This decrease was highly correlated with the daily increase in confirmed Covid-19 cases in the following 34 weeks, both in France and USA, including the June and mid-July recovery periods in France. Apolipoprotein-A1 at the 1.25 g/L cutoff had a sensitivity of 90.6% (95%CI84.2-95.1) and a specificity of 96.1% (95.7-96.6%) for the diagnosis of Covid-19. The area under the characteristics curve was 0.978 (0.957-0.988), and outperformed haptoglobin and liver function tests. The adjusted risk ratio of apolipoprotein-A1 for survival without transfer to intensive care unit was 5.61 (95%CI 1.02-31.0; P = 0.04).

CONCLUSION

Apolipoprotein-A1 could be a sentinel of the pandemic in existing routine surveillance of the general population. NCT01927133, CER-2020-14.

Prevention of dark-cutting (DFD) beef in penned bulls at the abattoir

There is a large body of evidence indicating that activities associated with regrouping of bulls before slaughter, which leads to physical exhaustion mainly from mounting, are primary factors inducing dark-cutting (DFD) in beef. The aim of this study was to test several methods to control activity when regrouping cannot be avoided. Fifty bulls previously individually tied for at least 16 months were drafted into groups of five animals and released in a pen at the abattoir. After 18 to 22 h they were slaughtered. According to environmental conditions in the pen, the bulls were divided into four groups: Control group (n = 10, no experimentation); Electricity group (n = 10, an electric fence was constructed above the pen so that a mounting bull would receive an electric shock); Darkness group (n = 10, the whole stall was in darkness); and Combination group (n = 20, both treatments, of the electricity and darkness groups were applied). During the first hour of penning the behaviour of the bulls was videorecorded. After slaughter meat quality characteristics were measured. Dark-cutting was found in Control (70%), Electricity (30%) and Darkness (70%) groups, but not in the Combination group (0%). No treatment altered the repertoire of agonistic activity, but under the combined treatments the number of agonistic interactions was significantly lower than in any other group.

Primary care physicians' knowledge, attitudes, beliefs and practices regarding childhood obesity: a systematic review

Obesity is an important public health issue with an epidemic spread in adolescents and children, which needs to be tackled. This systematic review of primary care physicians' knowledge, attitudes, beliefs and practices (KABP) regarding childhood obesity will help to implement or adjust the actions necessary to counteract obesity. Eligible studies were identified through a systematic database search for all available years to 2007. Articles were selected if they included data on primary care physicians' KABP regarding childhood obesity: 130 articles were assessed and eventually 11 articles covering the period 1987-2007 and responding to the inclusion criteria were analyzed. The included studies showed that almost all physicians agreed on the necessity to treat childhood obesity but they believed to have a low self-efficacy in the treatment and experienced a negative feeling regarding obesity management. There was a large heterogeneity in the assessment of childhood obesity between the different studies but the awareness of the importance of using body mass index increased over the years among physicians. Almost all studies noted that physicians recommended dietary advice, exercise or referral to a dietician. From this review, it is obvious that there is a need for education of primary care physicians to increase the uniformity of the assessment and to improve physicians' self-efficacy in managing childhood obesity. Multidisciplinary treatment including general practitioners, paediatricians and specialized dieticians appears to be the way to counteract the growing obesity epidemic and thus, primary care physicians have to initiate, coordinate and obviously participate in obesity prevention initiatives.

[Maxillofacial fractures. Surgical and prosthetic procedures]

A patient presented complex fractures of the face and skull with leg trauma after a traffic accident. Maxillofacial repair used sophisticated procedures: bone grafts, muscle flaps and multiple osteotomies. After reconstructing the mid face and the mandibular repair, bone implants were used to stabilize the maxillary prosthesis. The psychological and functions problems raised in this case are discussed considering the occupational and social outcome.

[Osteosynthesis using intrafocal nailing of low subcondylar fractures in adults. Surgical technics and initial results]

We describe a method for fixation of condylar fractures using a Kirschner pin. A retromandibular approach is used. This protocol was evaluated in 12 consecutive patients.

[Late results of the surgical treatment of temporomandibular joint ankylosis in children]

Long-term outcome after surgical treatment of temporomandibular joint ankylosis is not always satisfactory in children. Interposition of a temporalis muscle flap is insufficient to ensure good functional results if the surgical procedure is not followed by careful active and passive physiotherapy. The results can be evaluated only after the child has grown.

[Moebius syndrome: therapeutic proposals from 2 cases]

Moebius syndrome is a congenital bilateral palsy of the sixth and seventh cranial nerves. It results a total absence of facial expression and a severe strabismus. Social life is greatly disturbed. Other anomalies may be associated, especially other cranial palsies and Poland syndrome. The etiology of this syndrome isn't clearly established. Stem necrosis secondary to a vascular deficiency is often admitted. We report two observations. We emphasize the importance of a complete maxillo-facial treatment including maxillo-mandibular anomaly. Both patient underwent orthognathic surgery. The first one for class II and the second for class III anomaly. One patient underwent a facial reanimation by temporal muscle transfer. Orthognathic surgery must be realized prior to facial reanimation. A correction of the strabismus is possible. Moebius syndrome is a rare (200 observations) but very severe malformation. Maxillofacial surgery is able to improve the morphological and relational aspect of Moebius syndrome.

[The keratocyst or epidermoid cyst: the current state of understanding apropos of a case with intracranial involvement]

The authors report a case of penetration of an odontogenic keratocyst into the skull base. There is significant controversy about what is the optimum surgical treatment for the odontogenic keratocyst. Diagnosis, mode of growth and recurrence of keratocyst are still a great deal of interest. This paper reports the recent advances in the subject.

Brain processing of stimulus deviance during slow-wave and paradoxical sleep: a study of human auditory evoked responses using the oddball paradigm

Auditory evoked potentials (AEPs) to frequent (90%) and deviant (10%) tones were recorded during both wakefulness and all-night sleep in eight drug-free volunteers. During presleep waking (10:00-11:00 p.m.), deviant stimuli elicited, in all subjects, a prominent "P300" wave of parieto-central topography, culminating at 344 ms (average), which was absent in response to frequent tones. This "presleep P300" was delayed and reduced relative to values obtained during full wakefulness (3:00-7:00 p.m.) in a control group. Passage from waking to sleep stage I was characterized by a progressive attenuation and delay of the P300 wave in response to deviant stimuli, without major changes in AEP morphology as compared to the waking state. Thus, in terms of cognitive evoked potentials (EPs), sleep stage I appeared more as a "weak" state of wakefulness than a true phase of sleep. During sleep stages II, III, and IV, both frequent and deviant tones evoked AEPs that closely resembled K-complexes. Responses to rare stimuli were four-to-five times larger than those to frequent tones, this likely being the result of K-complex habituation to monotonous stimuli. During paradoxical sleep (PS), AEP morphology again became comparable to that of wakefulness. Notably, a "P3" wave with similar topography as the waking P300 appeared in response to deviant stimuli exclusively. Thus, even though the brain seems able to detect stimulus deviance during all sleep stages, only during stage I and PS were the electrophysiological counterparts of deviance detection comparable to those of the waking state. Our results support the view that PS is not a state of "sensory isolation"; failure to respond to external stimuli during this stage may depend upon mechanisms occurring only after the sensory input has undergone cognitive analysis.

[The gastro-omental flap: a secreting mucous flap for reconstruction of the oropharynx and the oral cavity]

The gastro-omental flap consists of a patch taken from the greater curvature of the stomach and the bordering omentum. It is based on the right gastro epiploic vessels and is used as a free flap for intraoral reconstruction after resection of oral carcinoma. Twenty patients underwent gastro-omental flap. The operative technique is described. The evaluation consisted in questioning, chemism on the salivary flow and biopsies. There is no morbidity related with the donor site. The gastro-omental flap avoids post irradiation xerostomia. Oral irritation and bleeding of the flap may occur.

[Full thickness reconstruction of the anterior chest wall with osteomusculocutaneous flap of the latissimus dorsi muscle]

Full thickness chest wall reconstruction must restore a leak-free and semirigid chest wall that allows good respiratory function. We present five consecutive cases of chest wall reconstruction with skeletal frame reconstruction by an osteomusculocutaneous latissimus dorsi flap. This flap allows transfer of the 11th and 12th ribs. The chest wall resection was performed for chest wall sarcomas (four cases) and radionecrosis (one case). The functional results are good. The bone scan showed the good vitality of the transferred ribs. This flap has the advantages of an autologous vascularized bone transfer. It is a useful flap for large full thickness chest wall reconstructions that need a skeletal frame reconstruction.

[Reconstruction of the lower abdominal wall after extensive full-thickness excision]

The reconstruction of major inferior abdominal wall defects is a rare but difficult problem. We present five consecutive cases of reconstruction following major excision for the treatment of tumors (3 cases) and radionecrosis (2 cases). The immediate reconstruction was performed by fasciomyocutaneous flaps of the thigh, pedicled on the tensor fascia lata (4 cases) or the rectus femoris (1 case). The functional results of the abdominal reconstruction are good. The sequelae of the donor site are mainly aesthetic; the function of the thigh is not affected by the harvest. These two flaps are very reliable. The rectus femoris flap has muscle throughout the extent of the flap and may be preferred in contaminated wounds or postradiation ulcers. It also allows the midline to be reached more easily.