Total and partial ossiculoplasty in children: Audiological results and predictive factors.

OBJECTIVE: To assess ossiculoplasty results in children and screen for predictive factors of efficacy. PATIENTS AND METHODS: Seventy five children undergoing ossiculoplasty between 2001 and 2014 in a pediatric ENT department were included. The following data were collected and analyzed: demographic data, surgical indication, history of tympanoplasty, contralateral ear status (healthy, affected), preoperative hearing thresholds, surgical technique, intraoperative findings, and ossicular chain status at eardrum opening. Audiological results were reported according to American Academy of Otolaryngology-Head and Neck Surgery guidelines. RESULTS: Forty eight patients were included in the total ossicular reconstruction prosthesis (TORP) group. Mean age at surgery was 9.9years. Mean follow up was 2.7years. Mean air-bone gap (ABG) closure to within 20dB was achieved in 40% of cases at medium term (12 to 18 months after surgery). Air conduction (AC) threshold ≤30dB was achieved in 68% of cases. AC threshold improved by 14.6dB and 8.7dB at medium and long-term follow-up, respectively. A significant correlation was found between success rate and absence of history of tympanoplasty. The success rate was higher for primary than for revision procedures. Twenty seven children were included in the partial ossicular reconstruction prosthesis (PORP) group. Mean age was 9.5years, and mean follow-up 2.6years. Mean air-bone gap (ABG) closure to within 20dB was achieved in 75% of cases at medium term. AC threshold ≤30dB was achieved in 75% of cases AC threshold improved by 9.3dB and 5dB at medium and long-term follow-up, respectively. No predictive factors for success were found in the PORP group. CONCLUSION: The present study suggested that total ossiculoplasty leads to better results when performed in first-line. It also confirmed that functional outcome is better in partial than total ossicular reconstruction prosthesis.

Key features of bone and joint infections following the implementation of reference centers in France.

OBJECTIVES: French reference centers for bone and joint infections (BJI) were implemented from 2009 onwards to improve the management of complex BJIs. This study compared BJI burden before and after the implementation of these reference centers. PATIENTS AND METHODS: BJI hospital stays were selected from the 2008 and 2013 national hospital discharge database using a validated algorithm, adding the new complex BJI code created in 2011. Epidemiology and economic burden were assessed. RESULTS: BJI prevalence increased in 2013 (70 vs. 54/100,000 in 2008). Characteristics of BJI remained similar between 2008 and 2013: septic arthritis (50%), increasing prevalence with age and sex, case fatality 5%, mean length of stay 17.5 days, rehospitalization 20%. However, device-associated BJIs increased (34 vs. 26%) as well as costs (€421 million vs. €259 in 2008). Similar device-associated BJI characteristics between 2008 and 2013 were: septic arthritis (70%), case fatality (3%), but with more hospitalizations in reference centers (34 vs. 30%) and a higher cost per stay. Among the 7% of coded complex BJIs, the mean length of stay was 22.2 days and mean cost was €11,960. CONCLUSIONS: BJI prevalence highly increased in France. Complex BJI prevalence assessment is complicated by the absence of clinical consensus and probable undercoding. A validation of clinical case definition of complex BJI is required.

[Management of obstetric cholestasis in France: A national survey of obstetrical practice]. / Prise en charge de la cholestase intrahépatique gravidique en France : enquête nationale des pratiques auprès des gynécologues-obstétriciens.

OBJECTIVE: Intrahepatic cholestasis of pregnancy (ICP) is the most commonly encountered pregnancy-specific liver disease. This condition, with no proven maternal morbidity, has been associated with an increased risk of prematurity and intrauterine fetal death. There is, to date, no scientific obstetrical guideline for clinical practice in France. The objective of our study was to precise, in this situation, how French obstetricians manage patients suffering from ICP. METHODS: We carried out, during 2010, a national descriptive practice survey of ICP management in France in association with the "Collège national des gynécologues-obstétriciens français". An inquiry form with 27 multiple-choice questions was sent to all obstetricians and gynecologist officiating in a maternity hospital recorded by the French Ministry of Health. The participants answered questions regarding diagnosis, perinatal management and treatment of ICP. Only the first answer received from each maternity hospital was analyzed. RESULTS: Of the 575 maternity hospitals, 275 (41.6%) responded after one mail recovery. Among them, almost half used a standardized management protocol for ICP. In most of the cases, perinatal management was performed by obstetricians alone (73%), and in only 20% of the cases in collaboration with the specialist in hepatology. Induction of labor at 37-38 weeks was the most common policy for the majority of respondents (92.4%). CONCLUSION: This is the first French national survey for ICP management. This study demonstrated that ICP is, in most of the cases, managed by the obstetrician alone, and that fetal risks warrants an active management with induction of labor in late pregnancy.

Ultrafast acoustics in the middle UV range: coherent phonons at higher frequencies and in smaller objects.

We show that the propagation of coherent acoustic phonons generated by femtosecond optical excitation can be clearly resolved using a probe laser in the middle UV (MUV) range. The MUV probe is easily produced from a high-repetition-rate femtosecond laser and a homemade frequency tripler. We present various experimental results that demonstrate efficient and high frequency detection of acoustic phonons. Thus, we show that the MUV range offers a unique way to reach higher frequencies and probe smaller objects in ultrafast acoustics.

[Relationship between asthma or asthma-related symptoms and school problems among French children attending kindergarden]. / Relation entre l'asthme ou les signes respiratoires évocateurs d'asthme et les difficultés scolaires chez les enfants d'école maternelle.

BACKGROUND: The impact of chronic respiratory symptoms on school performance has been studied less than its impact on children's health. Our survey explored the relationship between chronic respiratory symptoms and school problems among children attending kindergarten. It assessed the impact of school absenteeism, sport practise in a club and health care access for school problems among pupils with chronic respiratory symptoms. METHODS: A population-based study was carried out by school physicians on a representative sample of pupils attending third-year kindergarten, in Alsace - France. Assessments included school problems, sociodemographic and health care access characteristics. Health conditions, notably chronic respiratory symptoms, were asked to include the pupils in one of the three study groups: physician-diagnosed asthma, asthma-related symptoms not associated with diagnosed asthma, and without current health problems (controls). Logistic regression was used to compare the odds ratio of school problems for the three study groups, overall and stratified by income. RESULTS: The 2,632 included pupils aged 5 to 6 Years, were assigned to the three groups according to their respiratory status: 179 with diagnosed asthma, 176 with asthma related symptoms and 2,277 healthy pupils. Diagnosed asthma was not linked with school problems. The overall association between asthma related symptoms and school problems was significant (OR=1.5, 95% CI: 1.0-2.2). After adjustment, this association persisted among pupils whose mother's education level was intermediary (technical or vocational diploma) (OR=2.3, 95% CI: 1.2-4.6). Among the diagnosed asthma group, pupils practising a sport in a club had less school problems than those not taking part in sports (ORadjusted=0.2, 95% CI: 0.03-0.8). CONCLUSION: In our study, asthmatic children were not at higher risk of school problems. So developing programs preventing school problems which focus on asthmatic children is not needed. Among the pupils having a mother with an intermediary education level, asthma-related symptoms were associated with school problems. It is important to identify unknown asthmatics to institute to treatment for their respiratory symptoms in order to prevent the consequences of the functional impact of asthma on their scholarship.

[Asthma among children attending kindergarten in Alsace in 1998: prevalence and medical management]. / L'asthme chez les enfants scolarisés en grande section d'école maternelle en Alsace en 1998: prévalence et prise en charge médicale.

UNLABELLED: Asthma is one of the most frequent disease in childhood. The objectives of this survey were to study asthma and asthma related symptoms epidemiology in preschool children and to analyse their medical management. METHODS: A cross-sectional survey was conducted in 1998 in Alsace-France by school doctors, on a randomized sample of 2,765 pupils attending third year kindergarten. The first questionnaire accessed diagnosed asthma and asthma related symptoms history, and school absenteeism. The cumulative prevalence was estimated for diagnosed asthma on the period since birth and for asthma related symptoms unassociated with diagnosed asthma for the past 12 months. Parents who reported diagnosed asthma or asthma related symptoms unassociated with diagnosed asthma of their children were interviewed with a supplemental questionnaire examining clinical patterns, health care and asthma-related hospitalization. RESULTS: Prevalence of asthma was 6.5%. Prevalence of asthma related symptoms unassociated with a diagnosis of asthma was 7.2%. The "chesty" pupils school absenteeism was important. Most of the patients (91.3%) had a mild disease form. One third of them were not getting specific treatment. The drugs mostly prescribed were inhaled bronchodilators for acute episodes of asthma and antihistamines in prophylactic treatment. The rate of asthma-related hospitalization was 11.9%. Severe clinical pattern was statistically related to treatment and asthma-related hospitalization. CONCLUSION: Asthma prevalence is high in children attending nursery school in Alsace. This disease is still nowadays undiagnosed, underinvestigated and undertreated.

[Pharmacists' role in smoking cessation activities in Alsace]. / L'aide au sevrage tabagique assurée par les pharmaciens d'Alsace.

In May 1999, France launched a plan to implement a range of tobacco control measures focusing on reducing tobacco use. This study evaluated two professional assistance measures for smoking cessation included in the plan: the over-the-counter sale of nicotine substitutes and replacement therapies and pharmacist training. The article describes the role of pharmacies in smoking cessation and analyses the impact of training on professional practices. The survey was conducted in the year 2000 through a mail poll sent to a random representative sample of 290 pharmacies in the French region of Alsace selected from the Ministry of Health's FINESS database. The cross-sectional survey requested data on the pharmacy and its staff, as well as its role in tobacco prevention and its practices regarding individual smoking cessation interventions (capacity to provide assistance once information is obtained on the patient's smoking status, assessment of the patient's tobacco dependence and their will to quit smoking, initial prescription of a nicotine substitute, and provision of practical advice on maintaining smoking cessation and medical care recourse). Among a total of 82 respondents, 85% proclaimed having provided smoking cessation activities and 37% had undergone training. All of the pharmacies had been declared as tobacco prevention areas. For the pharmacies offering smoking cessation assistance, the methods and activities were in accordance with best practice standards. A comparison between the group of trained pharmacists and those who were untrained did not show any significant difference for the items concerning professional practice. In spite of certain barriers linked to pharmaceutical practice, improvements in the quality of smoking cessation assistance activities provided by pharmacists are possible, such as providing confidential space to advise the client, knowing when referral to a doctor is necessary, and organising personalized follow-up according to the customer's needs.

Rhizobium meliloti regulatory gene fixJ activates transcription of R. meliloti nifA and fixK genes in Escherichia coli.

When present in Escherichia coli on the multicopy expression vector pUC19, a Rhizobium meliloti regulatory gene, fixJ, belonging to a two-component regulatory system, activated the expression of two R. meliloti symbiotic genes, nifA and fixK. Primer extension by reverse transcription showed that FixJ stimulates nifA expression in E. coli by activating pnifA.