[Supply of sterile medical devices to an interventional technical platform via mobile RFID technology]. / Approvisionnement d'un plateau technique interventionnel en dispositifs médicaux stériles via la technologie RFID mobile.

This work presents the eight-month assessment of the mobile RFID (radio frequency identification) technology implementation for the management of sterile medical devices in an interventional cardiology department. Several indicators dedicated to stock management, organizational impact (within the pharmacy and the department) and economic impact were collected. The scope of MDS tracked by RFID was defined as well as the new supply circuit. In total, 297 (83%) references were managed by RFID. At eight months, the number of MDS units in stock has decreased by 35% and the number of overstocked references by more than 50%. The value of the inventory decreased by €30,196 (17%) in three months from an initial amount of €17,995. This decrease has been maintained at eight months. The average time spent by the pharmacy technician (PPH) was 66min/d. The paramedical team gained 180min/week. By integrating the cost of the equipment, the annual subscription and the PPH cost, the benefit is estimated at €9555 the first year (then €17,155 the following years). To conclude, RFID has allowed a significant reduction of the stock and its control over time while securing the supply circuit adjusted to the activity. The limits are the absence of interface between the dedicated software and the ordering software as well as the consequent time dedicated by the PPH to this new management mode.

[The flexibility of family medicine]. / La flexibilité en médecine générale.

We are a European academic group of family doctors and we propose a definition of flexibility in family medicine. A review of the literature shows that flexibility and complexity are emerging concepts in the field of family practice. The outcomes of a workshop at the WONCA-Europe congress in 2014 are discussed. The flexibility is a capability of the general practitioner to deal with complex clinical situations in a biomedical and societal changing world. Flexibility is framed by ethics. It could improve the quality of care, be useful against burnout and used in medical research. In conclusion, family medicine should adopt a specific definition of the flexibility describing its specificity, a useful and teachable capacity.

In vitro approaches to pharmacological screening in the field of atopic dermatitis.

In vitro models are valuable for evaluating potential active ingredients and other molecules used in medications for atopic dermatitis (AD). However, finding appropriate in vitro models can be problematic. Our strategy was to set up different in vitro models that would mimic the pathomechanisms of AD. We describe five such models - the AD keratinocyte model, the AD reconstructed human epidermis model, the adaptive immunity model, the innate immunity model and the pruritus model - which we have used to evaluate a new ingredient for emollients derived from a biological extract. The models chosen provide useful data for the pharmacological characterization of active ingredients in adjunctive treatments for AD.

Controlled general anaesthesia for subthalamic nucleus stimulation in Parkinson's disease.

OBJECTIVE: To report the short-term (1 year) and long-term (5 years) outcome of patients with Parkinson's disease (PD) with subthalamic nucleus (STN) stimulation operated upon under controlled general anaesthesia (GA). METHODS: 213 consecutive patients with PD were included between January 2000 and March 2009 and operated upon under a particular type of GA with close control of the level of sedation allowing intraoperative recordings. 188 patients were assessed 1 year postoperatively. 65 patients also completed the long-term observation period and were evaluated 5 years postoperatively. RESULTS: The Unified PD Rating Scale III score in the 'Off drug--On stim' condition was improved at 1 year and 5 years by 61% and 37%, respectively, (p<0.001). Motor complications decreased at short-term and long-term by 68% and 65%, respectively, for dyskinesia and by 52% and 48%, respectively, for fluctuations, (p<0.001). Dopaminergic treatment could also be reduced at short-term and long-term by 46% and 49%, respectively (p<0.001). There was no significant modification of mood and cognition assessments (Mattis scale and Beck depression inventory) at 1 year and 5 years. Concerning the main adverse events related to the surgery, we report four haematomas (1.9%) with two deaths (0.9%), eight cases of transient confusion (3.7%) and no epileptic seizure. CONCLUSIONS: Our results confirm that STN stimulation performed under controlled GA is efficient and has similar short-term and long-term motor effects than intervention under local anaesthesia. Furthermore, this specific procedure is not associated with more adverse events. The success of such an intervention requires strict anaesthetic monitoring and accurate STN identification.

A marketed fermented dairy product containing Bifidobacterium lactis CNCM I-2494 suppresses gut hypersensitivity and colonic barrier disruption induced by acute stress in rats.

BACKGROUND: Fermented milk (FM) containing Bifidobacterium lactis CNCM I-2494 and yogurt strains improves irritable bowel syndrome (IBS) symptoms in constipated IBS patients. In rats, stressful events exacerbate IBS symptoms and result in the alteration of gut sensitivity and permeability via epithelial cell cytoskeleton contraction. In a stress model, we aimed at evaluating the effect of B. lactis CNCM I-2494 as a pure strain or contained in an FM product on visceral sensitivity and the impact of this FM on intestinal barrier integrity. METHODS: Visceral sensitivity was analyzed in rats subjected to partial restraint stress (PRS). Rats received during 15 days the B. lactis as a pure strain (10(6) to 10(10) CFU mL(-1)), B. lactis in an FM product (10(8) CFU g(-1), diluted or not), or a control product. Gut paracellular permeability, colonic occluding and Jam-A proteins, and blood endotoxin levels were determined in rats receiving B. lactis in an FM product submitted or not to a PRS. KEY RESULTS: The FM product showed a dose-dependent inhibitory effect on stress-induced visceral hypersensitivity. A similar antihyperalgesic effect was observed at 10(10) CFU mL(-1) of pure B. lactis administration. The FM product prevented the increase in intestinal permeability induced by PRS and restored occludin and JAM-A expressions to control levels. The FM product abolished the increase concentration of blood endotoxin induced by PRS. CONCLUSIONS & INFERENCES: This study illustrates that a probiotic food containing B. lactis CNCM I-2494 strain reduces visceral hypersensitivity associated with acute stress by normalizing intestinal epithelial barrier via a synergistic interplay with the different probiotic strains and/or metabolites contained in this product.

Anti-inflammatory properties of a new undecyl-rhamnoside (APRC11) against P. acnes.

Acne vulgaris is a skin disease affecting pilosebaceous glands in which Propionibacterium acnes (P. acnes) induced inflammation plays a central role. In order to develop new therapies against the inflammatory events, we evaluated the modulating effect of a new undecyl-rhamnoside, APRC11, on different markers of the inflammation. For this purpose, normal human keratinocytes taken from five healthy donors were pre-incubated for 24 h with APRC11 or Zinc Gluconate (Zn) which was used as reference molecule for its anti-inflammatory properties. Then, keratinocytes were stimulated with P. acnes Membrane Fraction for 6 h, in the presence of either APRC11 or Zn. Different markers were evaluated at mRNA level using a Luminex-based Quantigene array system and at protein level using an ELISA test and a Luminex array system. Results showed that P. acnes significantly increased the expression of IL-1α, IL-1RA, IL-8 and MMP-9. A 24-h treatment with APRC11 prior to the P. acnes stimulation down-regulated the P. acnes-induced cytokines over expression (IL-1α, IL-8 and MMP-9) and up-regulated IL-1RA level in a similar manner than Zn. These regulations were noted at both protein and mRNA levels. In conclusion, the new undecyl-rhamnoside APRC11 is able to down-regulate the expression of molecules implicated in cutaneous inflammation and whose expression is induced by P. acnes, confirming its potential interest in inflammatory acne.

Universal newborn hearing screening in the Champagne-Ardenne region: a 4-year follow-up after early diagnosis of hearing impairment.

INTRODUCTION: Permanent congenital hearing loss is one of the most frequent congenital anomaly at birth. Universal newborn hearing screening (UNHS) was introduced in numerous countries in order to allow an early diagnosis and intervention for congenital hearing impairment. OBJECTIVE: First aim of this study is to evaluate the accuracy of early diagnosis of hearing impairment after UNHS. Second aim is to discuss the auditory intervention proposed after this diagnosis. Last aim is to evaluate the relevance of UNHS for early diagnosis and intervention. MATERIALS AND METHODS: Prospective study. UNHS program was introduced in the entire French region of Champagne-Ardenne in January 2004. Forty-one children have benefited of an early diagnosis of hearing impairment until June 2007. They were included in an intervention program consisting of an audiometric follow-up and an auditory intervention. This program was conducted until June 2008. RESULTS: There were 28 males patients and 13 females patients. The diagnosis of hearing aid impairment was carried at an average age of 3.2-month. The auditory follow-up allowed confirming the initial diagnosis of deafness for the majority of the children as for their degree of hearing loss. Auditory intervention was heterogeneous depending on degree of hearing loss of the children. CONCLUSION: This UNHS program demonstrates its validity and feasibility for early diagnosis and intervention of congenital hearing impairment. It brought a major impact on the management of congenital hearing impairment in Champagne-Ardenne.

[Feasibility of auditory cortical stimulation for the treatment of tinnitus. Three case reports]. / Protocole de prise en charge neurochirurgicale des acouphènes invalidants: à propos de trois cas.

UNLABELLED: Tinnitus is a public health issue in France. Around 1 % of the population is affected and 30,000 people are handicapped in their daily life. The treatments available for disabling tinnitus have until now been disappointing. We report our experience on the treatment of these patients in neurosurgery. PATIENT AND METHODS: Between 2006 and 2008, transcranial magnetic stimulation (rTMS) was performed following several supraliminal and subliminal protocols in 16 patients whose mean age was 47 years (range, 35-71). All patients underwent anatomical and functional MRI of the auditory cortex before and 18 h after rTMS, to straddle the primary and secondary auditory cortices. All patients underwent audiometric testing by an ENT physician. RESULTS: Nine patients responded with rTMS. After these investigations, two quadrapolar electrodes (Resume), connected to a stimulating device implanted under the skin (Synergy, from Medtronic), were extradurally implanted in three patients. The electrodes were placed between the primary and secondary auditory cortices. The mean follow-up was 25 months and significant improvement was found in these patients. CONCLUSION: The feasibility of cortical stimulation in symptomatic treatment of tinnitus was demonstrated by this preparatory work. The intermediate- and long-term therapeutic effects remain to be evaluated.

Vestibular function outcomes after vestibular neurectomy in Meniere disease: can vestibular neurectomy provide complete vestibular deafferentation?

OBJECTIVE: Vestibular neurectomy is considered the reference treatment of incapacitating vertigo accompanying Meniere disease, with an efficiency rate of 85-95% in most literature reports. The aim of this study is to evaluate if vestibular neurectomy can provide a complete vestibular deafferentation by investigating complete vestibular function after surgery. METHODS: Prospective study. Twenty-four patients suffering from incapacitated Meniere vertigo crisis beneficiated from a vestibular neurectomy by retrosigmoid approach. The average time between surgery and vestibular evaluation was 1 year. We performed (i) kinetic test, (ii) caloric test and (iii) vibration-induced nystagmus (VIN) at 30, 60 and 100Hz under videonystagmography recording, (iv) vestibular evoked myogenic potentials (VEMP), (v) video head impulsed test (VHIT) for each semicircular canals and (vi) an evaluation of visual vertical and horizontal subjective (VVS and HVS). RESULTS: On clinical evaluation, all the patients except one had never experienced any recurrence of vertigo crisis after surgery. The 24 patients would definitely undergo the surgery again. On vestibular evaluation, on the operated side, all patients showed a total areflexia at caloric test; 23 patients had no VEMP response; 23 patients had abolished canals response to VHIT. All the patients had VVS and HVS deviated towards the operated side; 23 patients had a high velocity VIN from 30 to 60Hz. CONCLUSION: This study proves that vestibular neurectomy can provide a complete vestibular deafferentation. We discuss this vestibular evaluation protocol and the main difficulties encounter during surgery, which could lead to partial nerve section and partial relief, and explain residual vestibular function after vestibular neurectomy.

[Internet information on head and neck oncology in French]. / Information Internet en langue française en oncologie ORL.

OBJECTIVE: Internet has become the first place where patients go when seeking information on their disease. The type and the quality of the medical information available on French-language websites is poorly known, especially in the field of head and neck surgery. The purpose of this study was to evaluate the quality of these sites. MATERIALS AND METHODS: We entered six keywords-"cancer du larynx", "cancer de l'amygdale", "cancer de la thyroïde", "carcinome papillaire de la thyroïde", "cancer de la langue", and "cancer de la parotide"-in two different search engines and, for each keyword, the first 50 websites were reviewed using the tool called DISCERN. With two head and neck surgeons, we rated their contents in terms of quality and comprehension. RESULTS: On 600 websites only 95 (16%) contained information that proved to be somewhat useful to patients. According to our scoring system, 8% of websites were found to be excellent, 24% good, 14% fairly good, 15% mediocre, 27% poor, and 12% very poor. Just over 60% of the websites were found to be clear. The study also showed that the order in which these websites were ranked in the search engine, their affiliation, the target population, or who financed them had little impact on quality. The websites were more likely to be high quality if they were managed by doctors and had bibliographical references as well as a date indicating a recent website update. CONCLUSION: This study again shows that the search for medical information on the Internet is time-consuming and often disappointing: very few websites provide information that is both clear and exhaustive. However, we also found that very few websites contained information that was seriously inaccurate. Given the growing popularity of the Internet, a high-quality French-language website specializing in head an neck surgery would be highly beneficial to patients, as would an ENT portal that would take them to selected websites, saving time and providing a guarantee of quality.

[Secondary superficial siderosis of the central nervous system: report of three cases]. / Sidérose superficielle secondaire du système nerveux central : à propos de trois cas et revue de la littérature.

BACKGROUND: Superficial siderosis (SS) is an under-recognized entity. It is due to repeated microhemorrhages in the subarachnoid spaces resulting in a deposit of hemosiderin at the surface of the central nervous system and/or the cranial nerves. The origin of microhemorrhages remains unknown in almost one third of cases and therefore no treatment can be recommended. Through a literature review and new observations, our goal is to detail the outcome of patients with a recognized etiology of SS and treated surgically. METHODS: Series of three cases and review of the literature. RESULTS: We present three patients with symptomatic SS for whom the origin of microhemorrhages was found. The first two patients complained of longstanding ataxia and neurosensory deafness while the third patient presented with urinary retention, vertigo, diplopia and facial paresis. Neuroradiological explorations revealed a left temporoparietal cavernoma, a fronto-orbital arterio-venous malformation and a cauda equina myxopapillary ependymoma respectively. Surgical resection of the source of hemorrhage was performed in all cases. All outcomes were good with improvement of their SS-related symptoms. These cases are discussed and the current literature is reviewed. CONCLUSION: It is important to recognize SS since the treatment of the bleeding source may prevent further deterioration and may even in some cases improve the clinical condition.

Vestibular rehabilitation therapy.

Dizziness and balance disorders are frequent complaints in the general population. Vestibular rehabilitation exercises have been shown to be efficient in controlled studies, provided that a precise, individual diagnosis has previously been made. Depending on the pathology, a subject with a peripheral vestibular pathology can benefit from manoeuvres aiming at dislodging or repositioning otoliths, from non-specific muscles strengthening techniques, from techniques for vestibular-ocular or vestibular-cervical stabilisation of gaze, or from physical exercises aimed at strengthening proprioceptive afferents, inhibiting a sensory predominance, or improving spatial orientation and navigation. These analytical exercises should then be implemented in an ecological context in order to favour transfer to daily-living activities. These physical exercises can enable the development of compensation strategies following vestibular damage (habituation, adaptation and substitution).

Increased faecal serine protease activity in diarrhoeic IBS patients: a colonic lumenal factor impairing colonic permeability and sensitivity.

OBJECTIVES: Diarrhoea-predominant irritable bowel syndrome (IBS-D) is characterised by elevated colonic lumenal serine protease activity. The aims of this study were (1) to investigate the origin of this elevated serine protease activity, (2) to evaluate if it may be sufficient to trigger alterations in colonic paracellular permeability (CPP) and sensitivity, and (3) to examine the role of the proteinase-activated receptor-2 (PAR-2) activation and signalling cascade in this process. PATIENTS AND METHODS: Faecal enzymatic activities were assayed in healthy subjects and patients with IBS, ulcerative colitis and acute infectious diarrhoea. Following mucosal exposure to supernatants from control subjects and IBS-D patients, electromyographic response to colorectal balloon distension was recorded in wild-type and PAR-2(-/-) mice, and CPP was evaluated on colonic strips in Ussing chambers. Zonula occludens-1 (ZO-1) and phosphorylated myosin light chain were detected by immunohistochemistry. RESULTS: The threefold increase in faecal serine protease activity seen in IBS-D patients compared with constipation-predominant IBS (IBS-C) or infectious diarrhoea is of neither epithelial nor inflammatory cell origin, nor is it coupled with antiprotease activity of endogenous origin. Mucosal application of faecal supernatants from IBS-D patients in mice evoked allodynia and increased CPP by 92%, both of which effects were prevented by serine protease inhibitors and dependent on PAR-2 expression. In mice, colonic exposure to supernatants from IBS-D patients resulted in a rapid increase in the phosphorylation of myosin light chain and delayed redistribution of ZO-1 in colonocytes. CONCLUSIONS: Elevated colonic lumenal serine protease activity of IBS-D patients evokes a PAR-2-mediated colonic epithelial barrier dysfunction and subsequent allodynia in mice, suggesting a novel organic background in the pathogenesis of IBS.

[Universal hearing screening in the Champagne-Ardenne regions: results and consideration after 55 000 births from January 2004 to June 2007]. / Dépistage auditif systématique en région Champagne-Ardenne: résultats et réflexion à propos des 55 000 enfants nés entre janvier 2004 et juin 2007.

AIM: This study presents the results of the Universal Newborn Hearing Screening (UNHS) experience in Champagne-Ardenne from January 2004 to June 2007. MATERIALS AND METHODS: A UNHS program was introduced in the entire French region of Champagne-Ardenne in January 2004. Developed upon a strong demand from public and private medical institutions, the program's aim is the early detection and treatment of bilateral profound or severe hearing loss. The program is composed of 2 steps: the first test is realised in maternity and consists of automated OtoAcoustic Emissions (aOAE). When absent in both ears at first test (positive screening test), the child is referred to a second test 15 days after maternity discharge (aOAE or automated Auditory Brainstem Response (aABR)). If the second test is still failed (positive screening test), the child is referred to a diagnostic procedure (Auditory Brainstem Response) realised by a paediatrician ENT in a reference centre. The UNHS program differs for newborns in Neonatal Intensive Care Units where aABR is realised at first test because of the high frequency of auditory neuropathy in this population. All results are collected in the Regional Neonatal Screening Centre, in charge of the UNHS follow-up. RESULTS: 53 930 newborns benefited from the UNHS program, which represent 98.7% of the 54 790 births in the region during this period. 591 newborns had a positive first test (no aOAE responses) and were referred to the second test. 532 had a negative second test and 46 had a positive second test. 22 children could not have the second test: 4 children deceased, 9 were lost to follow-up (the families moved outside the region) and 9 families refused the second test. The 46 neonates were referred to the diagnostic ABR test and 42 of those 46 babies were diagnosed with neonatal bilateral hearing losses before the age of 6 months. CONCLUSION: This UNHS experience demonstrates that such UNHS programs are feasible and reliable, at least in a region as wide as Champagne-Ardenne. It achieved to diagnose 42 hearing impaired children, who could benefit from an early intervention for their handicap.

[Evaluation of neuro-oncology information for French speaking patients on the Internet]. / Evaluation de l'information sur Internet destinée aux patients francophones en neuro-oncologie.

OBJECTIVE: Internet has become the first place where patients go to when seeking information about their disease. Little is known about the type and the quality of the medical information available on French-speaking websites, especially in the field of neuro-oncology. The purpose of this study was to evaluate the quality of these sites. MATERIALS AND METHODS: We entered six key words "glioblastome", "méningiome", "métastase cérébrale", "neurinome de l'acoustique", "adénome à prolactine" and "lymphome primitif cérébral" into 2 different search engines and, for each key word, the first fifty websites were reviewed using the tool "DISCERN", and with the help of two neuro-oncologists, we rated their content in terms of quality and comprehension. RESULTS: On 612 websites only 110 (18%) contained information that proved to be somewhat useful to patients. The average score for quality was 32, which is considered to be <>. According to our scoring system, 1.8% of websites were found to be "excellent", 11.8% "good", 24.5% "fairly good", 15.4% "average", 32.7% "poor" and 13.6% "very poor". Just over 50% of the websites were found to be clear. The study also showed that the order in which these websites were ranked in the search engine, their affiliation, their target or who financed them had little impact on quality. The websites were more likely to be of high quality if they were managed by doctors and had bibliographical references as well as a date indicating a recent website's update. DISCUSSION AND CONCLUSION: This study shows that the search for medical information on the Internet is time consuming and often disappointing: very few websites provide information that is both clear and exhaustive. However, we also found that very few websites contained information that was seriously inaccurate. Given the growing popularity of the Internet, patients could certainly benefit from a high quality French speaking website that would specialize in cerebral tumors, as well as from a neuro-oncological portal that would take them to selected websites as it would save time and would be a guarantee for quality.

[Systematic hearing screening for newborns in the Champagne-Ardennes region: 32,500 births in 2 years of experience]. / Dépistage auditif néonatal systématique en région Champagne-Ardenne: à propos de 30500 naissances en deux années d'expérience.

OBJECTIVES: To report a Universal Newborn Hearing Screening (UNHS) program developed in the Champagne-Ardennes region in 2004-2005. METHODS: A team of ENT specialists and pediatricians set up a UNHS program designed to reduce the age of diagnosis and care of bilateral congenital deafness. The program was mainly based on automated acoustic otoacoustic emissions and a strict follow-up by the Regional Neonatal Screening Center. RESULTS: In 2004 and 2005, 29,944 neonates from 30,518 births were screened (98.11%). Of the neonates screened, 409 (1.38%) failed the test and were referred. The average retest delay was 2 weeks. Eleven were lost to follow-up, 371 (94%) had a successful second test on one or both ears, 27 (7%) failed the test a second time and had a diagnosis of ABR. Twenty-four cases of bilateral deafness were identified early, 14 of which had no risk factors. One of the children lost to follow-up was actually deaf, which was diagnosed at 18 months of age. Since the beginning of the UNHS program, the average age of diagnosis was lowered to less than 3 months. CONCLUSION: Our experience tends to demonstrate that UNHS is possible and the program allows an early diagnosis of bilateral congenital hearing loss.

[Intraventricular schwannoma: a case report]. / Schwannome intraventriculaire: à propos d'un cas.

Ventricular schwannomas are very uncommon. We report such a tumor in the right lateral ventricle of a 16-year-old young man. The various etiopathogenic hypotheses are discussed.

Blood-brain barrier-specific properties of a human adult brain endothelial cell line.

Establishment of a human model of the blood-brain barrier has proven to be a difficult goal. To accomplish this, normal human brain endothelial cells were transduced by lentiviral vectors incorporating human telomerase or SV40 T antigen. Among the many stable immortalized clones obtained by sequential limiting dilution cloning of the transduced cells, one was selected for expression of normal endothelial markers, including CD31, VE cadherin, and von Willebrand factor. This cell line, termed hCMEC/D3, showed a stable normal karyotype, maintained contact-inhibited monolayers in tissue culture, exhibited robust proliferation in response to endothelial growth factors, and formed capillary tubes in matrix but no colonies in soft agar. hCMEC/D3 cells expressed telomerase and grew indefinitely without phenotypic dedifferentiation. These cells expressed chemokine receptors, up-regulated adhesion molecules in response to inflammatory cytokines, and demonstrated blood-brain barrier characteristics, including tight junctional proteins and the capacity to actively exclude drugs. hCMEC/D3 are excellent candidates for studies of blood-brain barrier function, the responses of brain endothelium to inflammatory and infectious stimuli, and the interaction of brain endothelium with lymphocytes or tumor cells. Thus, hCMEC/D3 represents the first stable, fully characterized, well-differentiated human brain endothelial cell line and should serve as a widely usable research tool.

An anatomical study of the vestibulocochlear anastomosis (anastomosis of Oort) in humans: preliminary results.

Von Oort first described the vestibulocochlear anastomosis in 1918, and there have been very few anatomical studies of it. It is located at the bottom of the internal auditory meatus and links the saccular nerve to the cochlear nerve. The aim of this study was to investigate the micro-anatomical characteristics of this anastomosis. We dissected 10 human temporal bones from five heads. We found the vestibulocochlear anastomosis in seven of the specimens, of which six were clearly visible. We were unable to uncover it in three specimens due to dissection problems. Its length was evaluated to be between 0.5 and 1 mm, with a diameter of 0.5 mm. The vestibulocochlear anastomosis could be the pathway for the nerve fibers of the cochlear efferent system, whose description remains incomplete. However, no anatomist, histologist or physiologist has demonstrated this function. From the results of this study, it seems likely that the vestibulocochlear anastomosis exists. Other studies are necessary to link it to the efferent system.