Personalized Nutrition by Prediction of Glycemic Responses

Elevated postprandial blood glucose levels constitute a global epidemic and a major risk factor for prediabetes and type II diabetes, but existing dietary methods for controlling them have limited efficacy. Here, we continuously monitored week-long glucose levels in an 800-person cohort, measured responses to 46,898 meals, and found high variability in the response to identical meals, suggesting that universal dietary recommendations may have limited utility. We devised a machine-learning algorithm that integrates blood parameters, dietary habits, anthropometrics, physical activity, and gut microbiota measured in this cohort and showed that it accurately predicts personalized postprandial glycemic response to real-life meals. We validated these predictions in an independent 100-person cohort. Finally, a blinded randomized controlled dietary intervention based on this algorithm resulted in significantly lower postprandial responses and consistent alterations to gut microbiota configuration. Together, our results suggest that personalized diets may successfully modify elevated postprandial blood glucose and its metabolic consequences. VIDEO ABSTRACT.

Electron acceleration by a wake field forced by an intense ultrashort laser pulse

Plasmas are an attractive medium for the next generation of particle accelerators because they can support electric fields greater than several hundred gigavolts per meter. These accelerating fields are generated by relativistic plasma waves-space-charge oscillations-that can be excited when a high-intensity laser propagates through a plasma. Large currents of background electrons can then be trapped and subsequently accelerated by these relativistic waves. In the forced laser wake field regime, where the laser pulse length is of the order of the plasma wavelength, we show that a gain in maximum electron energy of up to 200 megaelectronvolts can be achieved, along with an improvement in the quality of the ultrashort electron beam.

Potential role of indolelactate and butyrate in multiple sclerosis revealed by integrated microbiome-metabolome analysis

Multiple sclerosis (MS) is an immune-mediated disease whose precise etiology is unknown. Several studies found alterations in the microbiome of individuals with MS, but the mechanism by which it may affect MS is poorly understood. Here we analyze the microbiome of 129 individuals with MS and find that they harbor distinct microbial patterns compared with controls. To study the functional consequences of these differences, we measure levels of 1,251 serum metabolites in a subgroup of subjects and unravel a distinct metabolite signature that separates affected individuals from controls nearly perfectly (AUC = 0.97). Individuals with MS are found to be depleted in butyrate-producing bacteria and in bacteria that produce indolelactate, an intermediate in generation of the potent neuroprotective antioxidant indolepropionate, which we found to be lower in their serum. We identify microbial and metabolite candidates that may contribute to MS and should be explored further for their causal role and therapeutic potential.

Péri-implantite ou carcinome épidermoïde?

INTRODUCTION

Squamous cell carcinoma developed around dental implants has seldom been described. It simulates peri-implantitis. The authors present two cases and a literature review.

CASE REPORTS

A 70 year-old woman presented with an exophytic tumor developed around dental implants placed in the anterior part of the mandible. Panoramic X-rays showed major osteolysis, especially around the distal abutment implants. A 72 year-old patient, smoker, presented with chronic lichen planus; he was carrying two implants supporting an overdenture with ball-attachments, placed 15 years before. He presented with an ulcerated symphyseal tumor, bone loss around implant in position 43. The implant had been spontaneously pushed out. In both cases the diagnosis was squamous cell carcinoma.

DISCUSSION

Few cases of squamous cell carcinoma developed around dental implants have been reported. They initially mimic peri-implantitis. The carcinogenic role of the implant has never been established. Another hypothesis is the migration of malignant cells, originating from a mucosal tumor, through the sulcus. Risk factors for squamous cell carcinoma (smoking or alcohol consumption, precancerous lesions) are an indication for a permanent follow-up. Biopsies will prove the diagnosis.

Impact social sur de jeunes adultes du traitement standardisé de fentes labiomaxillopalatines unilatérales complètes traitées dans l’enfance

France has a population of about 60 million peoples and each ten years data about the standard of living are collected by the central bureau of statistics, we considered the collection of data on 5000 households in 1999 in our geographical area would afford a unique opportunity to compare the equivalent status of French adults with repaired cleft of the lip and palate (CLP). Aspects of social adjustment were investigated in a sample of 82 French adults 18-35 years old with repaired complete unilateral cleft of the lip and palate (CLP). All subjects received a standardized regimen of care from the Burgundy cleft palate team of Dijon. The investigation, based on response to a questionnaire, partly replicated a national survey of social and economic life in the population (Standard of living survey Burgundy, INSEE France 1999), so that adults with complete clefts could be compared with a large control sample of the same age. The control group was constituted by subjects between 18 and 35 years in the standard of living survey Burgundy 1999, INSEE France, they were taken from a regional probability sample of households. This report covers education, employment, and marriage. The significant difference between groups was assessed by: Student's t-test or analysis of variance for continuous variables and chi2 test for categorical variables. The results demonstrated that there are significant differences in educational attainment and employment between adults with cleft of the lip and palate and other people. Fewer with cleft of the lip and palate marry, and when they marry they do so later in life, scholarship history showed significant delay in the cleft of the lip and palate group, independence regarding housing was lower in the cleft of the lip and palate group. If cleft of the lip and palate adults functioned within normal limits with regard to employment. However, levels of income were substantively lower than control groups. It would appear that cleft subjects experience some limitation in their ability to secure vocational and economic rewards from society. As a conclusion we can say regarding our results that the cleft of the lip and palate group, even with the smallest degree of malformation (unilateral without associated malformation), showed a significant delay in the independence process.

[Natal teeth: apropos of five cases]

INTRODUCTION

The normal eruption of primary teeth begins with mandibular incisors about the age of 6 months. There are several qualifiers used to describe prematurely erupted teeth. Massler and Savara defined "natal teeth" as teeth present at birth and "neonatal teeth" as teeth erupted within the first month of life. The aim of this study, based on 5 cases, is to present clinical and structural characteristics, etiology, management techniques, complications and a review of the literature for natal teeth.

MATERIAL AND METHODS

Our study is a retrospective study of 17,000 infants who were examined in the Neonatal Department of Children Hospital between 1984 and 2001. The material consisted of 5 infants with natal teeth, identified by the pediatrician. We analyzed the family history, the pregnancy history, the gender, the etiology, the complete examination of the infant, the clinical, the structural characteristics, the complications and the management of the teeth.

RESULTS

We found 4 boys and 1 girl, 2 of the newborns were premature, all of them observed to have natal teeth. The incidence was 1: 3,400 births. There were 14 natal teeth, 10 incisors (70%) and 4 canines (30%), no molar was found. Nine of the teeth (6 incisors and 3 canines) were maxillary (65%) and 5 (4 incisors and 1 canine) were mandibular (35%). No morphological syndrome was discovered. Most of the teeth were mobile in all directions and were extracted because of the possibility of aspiration, the difficulty in feeding and the ulceration of the ventral surface of the tongue.

DISCUSSION

According to the literature, this phenomenon is rare and the incisors are the teeth most commonly involved. Natal teeth are more common than neonatal teeth and nearly 90% of these teeth are the normal primary teeth. The presence of natal teeth is due to several factors related to an unknown cause of disturbed biological chronology. There is no conclusive evidence of a correlation between early eruption and systemic disorders, but some investigators suggest that natal teeth may be associated with certain syndromes. We must keep in mind that radiographic examination is essential for the differential diagnosis between supernumerary and normal primary teeth. The supernumerary teeth should always be extracted but the decision to extract a normal mature natal tooth should be done according to scientific knowledge, mobility of the tooth, local or general complications and parental opinion.

Traitement chirurgical des fractures du condyle mandibulaire de l'adulte en France en 2005

INTRODUCTION

The authors had for aim to present the latest trends in the surgical management of mandibular condylar fractures in France, in 2005.

MATERIAL AND METHODS

One hundred maxillofacial surgeons were questioned on the surgical management of condylar fractures and indications. Results were presented at the 41st Congress of Stomatology and Maxillofacial surgery.

RESULTS

The overall reply rate was 70%. Condylar fractures are generally managed in teaching hospitals. Open reduction and fixation was deemed appropriate in low subcondylar fractures in 76% of the cases, in 10% for diacapitular fractures. Therapeutic details and indications were a matter of huge variability.

DISCUSSION

This survey highlighted the absence of any consensus as far as condylar fractures are concerned. It seems that the higher the fractures are, the lesser they are approached.

Le lambeau ostéomusculaire de muscle latissimus dorsi avec bord latéral de scapula: étude anatomique et application clinique

The goal of the reconstruction of complex defects of the leg is to restore morphology, trophicity and function. The purpose of our study was to analyse the reliability of the latissimus dorsi scapula flap in this indication. We realized an anatomical study on 12 cadaver dissections. The presence of the angular artery was found to be constant with four types of origins described in this article. The same technique was applied on three patients presenting a complex tissue loss of the middle third of the tibia. This clinical application confirmed the validity of the technique.

Untreated growth hormone deficiency with extremely short stature, bone dysplasia, cleft lip--palate and severe mental retardation in a 26-year-old man with a de novo unbalanced translocation t(1;12)(q24;q24)

We report on a 26-year-old patient presenting with extremely short stature (height 72cm, weight 6.5kg, OFC 42.5cm), facial dysmorphism, cleft lip--palate, severe mental retardation and de novo 1q24.2--q25.2 and 12q24.31 interstitial deletion. He was the only child of non-consanguineous parents and his birth length was 43cm. He had severe feeding difficulties and required enteral nutrition until the age of 3 years. Standard cytogenetic analysis showed an apparently balanced de novo translocation t(1;12)(q24;q24). Endocrine studies at 11 years of age for severe growth retardation revealed multiple pituitary hormone deficiency with severe growth hormone deficiency, but the child was untreated because of associated mental retardation. At 26 years of age, he could not walk or speak and had no signs of puberty. Investigations revealed spondylo-epi-metaphyseal dysplasia with severe osteoporosis, enlarged aorta when compared to the patient's size and apparently normal pituitary development. High resolution karyotype showed a 1q24-q25 deletion, and comparative genomic hybridization studies confirmed the 1q interstitial deletion. FISH studies of both breakpoints using PACs and BACs enabled us to further characterize the 1q interstitial deletion (1q24.2-1q25.2) and also revealed a 12q24.31 interstitial microdeletion. This case is compared with previously reported patients with similar deletions, but the untreated pituitary deficiency could also be responsible in part for the severity of the growth deficiency. This observation is of interest for two reasons. First, these deletions could be a clue in the search for a gene responsible for growth hormone deficiency/midline defects. Second, it shows the importance of molecular cytogenetics in the study of de novo apparently balanced translocation with abnormal phenotype.

La recherche du ganglion sentinelle dans le mélanome malin cutané de bas stade est-elle réellement peu invasive ?

AIM

The aim of this study was to analyze outcome in patients enrolled in sentinel node biopsy procedure in early-staged cutaneous melanoma.

MATERIAL AND METHODS

Therefore a prospective study was conducted enrolling patients presenting with early-staged cutaneous melanoma. Our study focused on age and sex, duration from diagnosis to treatment, duration of hospitalization, dressing care and work inability in current follows. Duration from scintigraphy to surgery was analyzed and compared to sensibility of the procedure. What is more we observed rate and kind of complications and economical consequences, increasing duration of dressing care and work inability. The authors aimed at evaluating costs of SLN procedure including hospitalization, lymphoscintigraphy, general anaesthesia, costs of dressings, inability and overcosts of complications.

RESULTS

Forty-five patients were enrolled in our study (sex-ratio 1/2) mean aged 60 years old. Duration from diagnosis to treatment was mean 36 days. Sensibility of the procedure was excellent in trunk and limbs cases, lower in head and neck. In current cases patients were mean hospitalized three days, underwent 20 days of dressings and work inability depended on further interferon treatment. Complications occurred in 25% as seroma or local infections requiring antibiotherapy. Duration to healing was then 45 days increasing inability. Global costs of SLN procedure were significantly higher than previous wait and watch policy.

CONCLUSION

SLN biopsy is an expensive and invasive procedure with a high rate of complications. It defers melanoma treatment, only way to gain survival.

Calciphylaxie : une complication grave et méconnue de l'insuffisance rénale chronique terminale. À propos de deux cas

Calciphylaxis presents like subcutaneous lesions with livedo reticularis leading to necrotic and painful ulcers, predominantly in the lower limbs and the abdomen. They initially simulate dermohypodermitis. Biology reveals secondary hyperparathyroidism, phosphocalcic metabolism abnormalities and state of hypercoagulability. Histological signs are constant: calcifications in the media of small and sub-cutaneous arteries, intimal hyperplasia and intravascular thrombosis. This complication occurs in 4% of end-stage renal disease patients. Its prognostic is awful with a rate of mortality of 60% due to sepsis. Treatment is based upon the normalization of phosphocalcic rates and local debridement.

Chirurgie esthétique et qualité de vie subjective avant et quatre mois après l'opération

AIMS

To evaluate the improvement in the subjective quality of life and mental health after Aesthetic surgery on the basis of indices of patient satisfaction.

METHOD

The population consisted of 25 women who had requested cosmetic surgery (mean age: 34.76) including 19 for breast augmentation and 6 for abdominal plastic surgery. After giving their written consent, the subjects took part in a psychological evaluation conducted at two different times: the first at the time of the second medical consultation and the second 4 months after surgery. In each case, the psychological evaluation consisted of a clinical interview and two questionnaires: the subjective quality of life profile (SQLP) and the general health questionnaire (GHQ12).

RESULTS

The results of the study revealed the benefits of cosmetic surgery for the patients' subjective quality of life. The subjects' mental health and quality of life improved on a number of dimensions: physical health, pain, physical appearance, social life and inner life. Improved physical health during the postoperative period was associated with the quality of the relations with the doctor whereas deterioration in health was associated with excessively high initial expectations concerning the relations with doctors and physical health.

[Dynamic external traction system for management of distal displaced fractures of the head of the proximal phalanx]

INTRODUCTION

Phalangeal fractures are generally underestimated injuries, but result in pain, stiffness, instability, degenerative arthritis and loss of finger function. Treatment varies from open reduction with internal fixation giving perfect anatomical reduction but a risk of side effects, to orthopaedic treatment with variable results. Unstable fractures must be fixed rigidly to minimize joint immobilization. It is this concept of solid fixation and early mobilization, which directed us in the choice of dynamic external distraction in the management of these fractures.

MATERIAL AND METHOD

The authors present a prospective study of twelve patients treated for unstable fractures of the proximal interphalangeal joint by closed reduction and dynamic external distractor, we describe this simple device created with pins and rubber bands and examine the functional clinical results.

RESULTS

The average follow-up period was 7.5 months. We only noted one pin-track infection. Three patients complained of pain at postoperative follow up. In this series, the total active motion varied from 70 degrees to 120 degrees (average 94.16 degrees), the mean lack of extension was 5.6 degrees (from 0 to 15 degrees). Ten patients had good mobility and were satisfied.

DISCUSSION

Different traction devices for the management of displaced intraarticular phalangeal fractures have been reported. Most of them are complex to construct and expensive. The traction system is simple to assemble, economical and it allows early active motion of the affected digits. We consider that it is an effective mode of treatment for the management of complex intraarticular phalangeal fractures.

[Use of nasolabial flap for mouth floor reconstruction]

SUBJECT

Oral cavity cancers represent 30% of the cephalic extremity tumors. Their resection requires in the majority of the cases a reconstruction by soft tissue. The reconstruction must be simple by bringing some reliable, hairless, thin, resistant tissue to radiation therapy, with a limited morbidity and an acceptable scar ransom.

PURPOSE

The purpose of our study is to define the place and the limits of nasolabial flap in the reconstruction of the anterior floor of the mouth after tumoral resection compared to the other surgical and microsurgical techniques.

MATERIAL AND METHOD

We retrospectively studied patients with oral cancerous lesions of the anterior floor of the mouth reconstructed by nasolabial flap between 1997 and 2002. The patients benefited from a surgical resection of the tumor by respecting the safety margins, with an immediate reconstruction allowing the restoring of the oral functions. We tried to describe the limits of this flap and discussed its modalities of vascularization.

RESULTS

Fifty-three flap procedures were performed on 47 patients; forty-one have received a unilateral and 6 a bilateral nasolabial flap. The majority of tumors were squamous cell carcinomas (50 cases). The average age of patients were 64.8 years (45-78 years) with 40 men (75%) and 13 women (25%). A radical neck lymph nodes dissection with facial artery ligation was realized for 21 patients (15 ipsilateral and 3 bilateral) without affecting the outcome. As complications, we noted one complete necrosis and two partial necrosis of the flap, two postoperative wound complications with dehiscence as well as a massive local recurrence of initial tumor in one patient.

CONCLUSION

The nasolabial flap represents a simple functional and morphological option to other pedicled or microsurgically anastomosed flaps for the reconstruction of intermediate-sized mouth floor defects.

[Tumoral calcinosis of the plantar forefoot: a case report and review of the literature]

Tumoral calcinosis of the plantar forefoot is an uncommon benign condition resulting from deposits of hydroxyapatite crystals in periarticular soft tissue. The pathogenic mechanism remains to be clarified. This condition is generally observed in young subjects and a hereditary pattern is often discovered. We report the clinical, radiological, and biological findings in a case of right forefoot tumoral calcinosis observed in a sixteen-year-old girl and describe the surgical treatment and pathology results. Based on this case and a review of the literature, we discuss the different pathogenic hypotheses as well as the appropriate diagnostic and therapeutic approach.

Predictions for the energy loss of light ions in laser-generated plasmas at low and medium velocities

The energy loss of light ions in dense plasmas is investigated with special focus on low to medium projectile energies, i.e., at velocities where the maximum of the stopping power occurs. In this region, exceptionally large theoretical uncertainties remain and no conclusive experimental data are available. We perform simulations of beam-plasma configurations well suited for an experimental test of ion energy loss in highly ionized, laser-generated carbon plasmas. The plasma parameters are extracted from two-dimensional hydrodynamic simulations, and a Monte Carlo calculation of the charge-state distribution of the projectile ion beam determines the dynamics of the ion charge state over the whole plasma profile. We show that the discrepancies in the energy loss predicted by different theoretical models are as high as 20-30%, making these theories well distinguishable in suitable experiments.

[Boxer's fracture: Cost evaluation orthopaedic or surgical treatment]

Many methods of treatment have been proposed for fractures of the neck of the fifth metacarpal ranging from early mobilization to various surgical techniques. The aim of this retrospective study was to evaluate the functional results and the costs of closed as opposed to open treatment (Foucher's K-Wire technique).

MATERIALS AND METHODS

We conducted a retrospective study on all fractures without rotational deformity and with a palmar angulation less than 40 degrees C. Details of the patients, the fractures, functional results and the cost of management were analyzed.

RESULTS

The functional results were similar between the two groups, but surgical treatment increased the cost of treatment to 1100 euros.

CONCLUSIONS

We advocate the use of closed treatment for these fractures. The functional results are the same as with surgical management, but the costs are much reduced.

[Effect of information by images on patients' anxiety and comprehension before esthetic surgery on the abdominal wall: a prospective randomised trial with 60 patients]

Informed consent is a legal and ethical requirement before every surgical procedure especially when it comes to esthetic surgery. Obtaining a satisfactory understanding of the risks and benefits of the operation by patients remains a critical problem. This trial aimed to assess the value of visual information. Patients scheduled to undergo abdominoplasty were approached during the first preoperative consultation. All patients were given an information leaflet about the procedure and completed a Spielberger state trait anxiety inventory (state-trait inventory, STAI form Y-1): questionnaire to assess baseline anxiety. The patients were then randomly assigned to watch or not watch the information CD-Rom during the second preoperative consultation. The day before surgery the patient completed a second anxiety questionnaire and a knowledge questionnaire. 67 patients were screened, 2 declined to participate and 5 were unable to complete the form. Of the remaining 60 patients 30 were assigned to look at the CD-Rom and the remaining 30 not. The groups were similar in regards to age, sex, education and initial anxiety score. Patients who watched the CD-Rom were significantly less anxious before a esthetic surgery than those who did not (Mean STAI 45 for the "image group" [38.2-46.3] vs 55 for the "no image group" [49.9-63.8]). Furthermore they also scored higher in the knowledge questionnaire than the "no image" group as far as the purpose and the procedural details of the surgery were concerned. However statistical difference of knowledge regarding the potential complications of the procedure was not found.

Étude de la corrélation entre le coût réel d’une intervention et ses modes de facturation en France : exemple de l’ablation de matériel d’ostéosynthèse de mandibule

INTRODUCTION

economic cost is a timely topic which will have to be taken in consideration more and more for determining the appropriate indication for surgical procedures. "Health has no price, but it has a cost" is a common proverb urging us to think in terms real cost of a surgical procedure. The purpose of this study is to estimate the real cost of a usual and frequent intervention: removal of osteosynthesis material in mandibular fractures. Real cost was compared with the cost charged by the French health insurance fund.

MATERIAL AND METHODS

this retrospective study collected all the interventions concerning material removal after mandibular fractures performed in our department during 2002. The following parameters were retained: the number of consultations, the duration of occupation of the surgical unit and the recovery room, the list of materials and products used, the cost of the medical staffs and cleaning agents, the duration of hospitalization, other administrative loads and expenses.

RESULTS

a series of 30 patients was found, each patient had had three consultations, the average duration of hospitalization was 36 hours, the time of occupation of the surgical unit was 100 minutes and occupation of the recovery room was 2 hours. The total real cost of this intervention was 510 Euros, the cost estimated by the health insurance fund was 110 Euros and the cost of hospitalisation charged was 997 Euros.

CONCLUSION

these results show us the real cost of this intervention and the cost estimated by the French health insurance fund. It is highly noteworthy that the cost estimates were totally inadequate. This study leads to a discussion concerning a more global approach to the cost-benefit ratio of such an intervention as well as the indication for bioabsorbable material compared with titanium in facial traumatology.

[Acute carpal tunnel syndrome. A report of an etiological form not previously described]

Acute form of carpal tunnel syndrome is the less common presentation. Several etiologies are known as rheumatologic, hemopathic, endocrine or pregnant disorders and traumatic. Authors report a non yet described traumatic etiology, consecutive to hamate and triquetral fractures. Patient presented five hours after initial traumatism, a typical presentation of median nerve compression at wrist, with subjective and objective symptoms as pathologic Weber test. A classical median nerve release was performed in emergency. Nerve recuperation was complete two days after surgery, as usual in such pathology. This new etiology must be known; actually, nerve recuperation in acute carpal tunnel syndrome is time dependent.