OPTN/SRTR 2018 Annual Data Report: Kidney.

Despite the ongoing severe mismatch between organ need and supply, data from 2018 revealed some promising trends. For the fourth year in a row, the number of patients waiting for a kidney transplant in the US declined and numbers of both deceased and living donor kidney transplants increased. These encouraging trends are tempered by ongoing challenges, such as a large proportion of listed patients with dialysis time longer than 5 years. The proportion of candidates aged 65 years or older continued to rise, and the proportion undergoing transplant within 5 years of listing continued to vary dramatically nationwide, from 10% to nearly 80% across donation service areas. Increasing trends in the recovery of organs from hepatitis C positive donors and donors with anoxic brain injury warrant ongoing monitoring, as does the ongoing discard of nearly 20% of recovered organs. While the number of living donor transplants increased, racial disparities persisted in the proportion of living versus deceased donors. Strikingly, the total number of kidney transplant recipients alive with a functioning graft is on track to pass 250,000 in the next 1-2 years. The total number of pediatric kidney transplants remained steady at 756 in 2018. Deeply concerning to the pediatric community is the persistently low level of living donor kidney transplants, representing only 36.2% in 2018.

Modulatory effect of inulin with soya isoflavones on plasma lipid profile and liver SCD-18 index in rats with induced type-2 diabetes mellitus.

Obesity and type-2 diabetes are often associated with nonalcoholic fatty liver disease (NAFLD). Soya isoflavones act as antidiabetic agents and protect against NAFLD. There are data suggesting that inulin may increase the plasma concentration and effect of soya isoflavones. The aim of the present study was to compare the effect of soya isoflavones, as opposed to the effect of soya isoflavones with inulin, on plasma lipid profile, liver morphology, and liver fatty acids in rats with induced type-2 diabetes mellitus. Data were collected on thirty-six male Sprague-Dawley rats divided into control and diabetic groups. Animals in the diabetic (DM) group were on a high-fat diet and were injected with low doses of streptozotocin. Animals in the control groups were fed a regular diet and were injected with a buffer. After the injections, the animals were divided into three groups of nondiabetic rats (nDM)-controls (c-nDM), rats treated with isoflavones (IS-nDM), and rats treated with isoflavones plus inulin (IS+IN-nDM)-and three parallel diabetic (DM) subgroups: controls (c-DM), rats treated with isoflavone (IS-DM), and rats treated with isoflavones plus inulin (IS+IN-DM). Hepatic steatosis and fibrosis were examined using hematoxylin-eosin staining and Mallory's trichrome methods respectively. Liver fatty acids were extracted and analyzed by gas chromatography. A lipid blood test was performed. The study showed significant changes in liver fatty acids, liver morphology, and plasma lipid profile. The estimated SCD-18 index significantly decreased in both the control and DM groups after isoflavone supplementation. The level of liver steatosis and fibrosis also decreased after isoflavone supplementation in the DM groups. The plasma lipid profile showed increased levels of HDL-C after isoflavone supplementation in the DM groups. These results support the protective use of isoflavones in liver steatosis and as beneficial to plasma lipid profile in individuals with diabetes. A novelty of this work is its comparison of supplementation using soya isoflavones with supplementation using both soya isoflavones and inulin. Surprisingly, additional supplementation with inulin modulates the positive effect of isoflavones.

OPTN/SRTR 2017 Annual Data Report: Kidney.

Many positive trends in kidney transplantation were notable in 2017. Deceased donor kidney transplant rates and counts continued to rise, the kidney transplant waiting list declined for the third year in a row after decades of growth, and both short- and long-term allograft survival continued to improve year over year. In total, more than 220,000 patients were living in the United States with a functioning allograft. With 3 years of data available since implementation of the new kidney allocation system, better prediction of longer-term results of the allocation policy changes became possible. The data also reveal several areas in need of improvement and attention. Overall, the challenge of providing adequate access to kidney transplant persisted nationally, with additional dramatic regional variation. The proportion of living donor kidney transplants in both adults and children continued to fall, and racial disparities in living donor kidney transplant grew in the past decade.

Measuring and monitoring equity in access to deceased donor kidney transplantation.

The Organ Procurement and Transplantation Network monitors progress toward strategic goals such as increasing the number of transplants and improving waitlisted patient, living donor, and transplant recipient outcomes. However, a methodology for assessing system performance in providing equity in access to transplants was lacking. We present a novel approach for quantifying the degree of disparity in access to deceased donor kidney transplants among waitlisted patients and determine which factors are most associated with disparities. A Poisson rate regression model was built for each of 29 quarterly, period-prevalent cohorts (January 1, 2010-March 31, 2017; 5 years pre-kidney allocation system [KAS], 2 years post-KAS) of active kidney waiting list registrations. Inequity was quantified as the outlier-robust standard deviation (SDw ) of predicted transplant rates (log scale) among registrations, after "discounting" for intentional, policy-induced disparities (eg, pediatric priority) by holding such factors constant. The overall SDw declined by 40% after KAS implementation, suggesting substantially increased equity. Risk-adjusted, factor-specific disparities were measured with the SDw after holding all other factors constant. Disparities associated with calculated panel-reactive antibodies decreased sharply. Donor service area was the factor most associated with access disparities post-KAS. This methodology will help the transplant community evaluate tradeoffs between equity and utility-centric goals when considering new policies and help monitor equity in access as policies change.

Frequency and predictors of post-stroke delirium in PRospective Observational POLIsh Study (PROPOLIS).

Delirium is the most common and serious neurobehavioral complication in acute hospital admissions. Some patients develop signs of delirium but do not meet all diagnostic criteria. Stroke is a major risk factor for delirium. The aim of this prospective study was to build a predictive model for delirium and subsyndromal post-stroke delirium. Patients with stroke were screened for delirium during the first 7 days after admission. Delirium was diagnosed according to DSM-V criteria. Baseline demographic, biochemical, stroke-related data, medications used, neurological deficit, and premorbid cognitive and functional impairment were assessed. 750 consecutive stroke patients (71.75 ± 13.13 years) were recruited; 203 (27.07%) had delirium. In predictive model for delirium MoCA score and white blood count on admission, neglect, vision deficits, physical impairment, and higher comorbidity prior to stroke had the highest predictive value. Subsyndromal delirium was diagnosed in 60 patients. MoCA score and potassium level on admission, and urinary tract infection during hospitalization had the highest predictive value for its development. Delirium occurs in one-fourth of admissions due to stroke; subsyndromal delirium is less prevalent and affects less than one per ten patients. The hyperactive form is the most rare type of delirium. The factors best predicting delirium are easily assessed in everyday practice and their co-occurrence in patients with stroke should alert the treating physician of high risk of delirium.

OPTN/SRTR 2016 Annual Data Report: Kidney.

Data from 2016 show ongoing positive trends in short- and long-term allograft survival, and a decrease in the number of active listed candi- dates for the first time in more than a decade, with a concomitant in- crease in deceased donor kidney transplants. Transplant rates that had changed dramatically for some groups after implementation of the new kidney allocation system in 2014 are stabilizing, allowing for evaluation of new steady states and trends. Many challenges remain in adult kid- ney transplantation, including stagnant rates of living donor transplant, geographic disparities in access to transplant, racial disparities in living donor transplant, and overall a continuing demand for kidneys that far outpaces the supply. For pediatric recipients, a decline in the proportion of living donor transplants is of concern. In 2016, only 34.2% of pediatric transplants were from living donors, compared with 47.2% in 2005. The number of related donors decreased dramatically over the past decade, and the number of unrelated directed transplants performed in pediatric candidates remained low (50).

[The features of diagnosis and treatment of traumatic and non-traumatic pulmonary bleeding]. / Osobennosti diagnostiki i lecheniia legochnogo krovotecheniia travmaticheskoi i netravmaticheskoi étiologii.

AIM: To analyze an efficacy of differentiated approach for pulmonary bleeding of different etiology and severity. MATERIAL AND METHODS: The study included 134 cases of pulmonary bleeding for the period 2006-2015 including 53 patients with traumatic and 81 with non-traumatic etiology. Men/women ratio was 2.7:1, mean age was 43 years. Comparative retrospective analysis of X-ray and CT data in diagnosis of bleeding source was performed. Bronchoscopy was used to confirm these data. There were 43 endovascular examinations including 40 cases of bronchial arteriography (BAG). RESULTS AND DISCUSSION: X-ray and CT-signs of bleeding source were detected more often in case of traumatic pulmonary bleeding (62.3% and 93%) compared with non-traumatic (27.2 and 54%; p<0.05). Bronchoscopy revealed ongoing pulmonary bleeding in 40 (30%) patients, completed - in 94 (70%) patients. Indirect angiographic signs were the most frequent for pulmonary bleeding origin: hypervascularization (32.6%), bronchial-pulmonary shunts (23.2%) and bronchial artery dilatation (20.9%). 17 patients with ongoing bleeding underwent bronchial obstruction with adequate hemostasis in all cases. Endovascular interventions included bronchial arteries embolization (EBA) (33), occlusion of intercostal arteries (3) and segmental branches of low-lobar pulmonary artery (1), aortic stenting (1). Early efficacy of EBA was 97% with 2 month recurrence of pulmonary bleeding near 12.5%. Ongoing traumatic pulmonary bleeding was an indication for emergency thoracotomy in 18.9% compared with 12.3% for non-traumatic bleeding when surgery was made after endoscopic and endovascular hemostasis. CONCLUSION: Differentiated approach depending on etiology and severity of pulmonary bleeding improves outcomes and reduces the number of operations for ongoing severe bleeding.

Fenofibrate subcellular distribution as a rationale for the intracranial delivery through biodegradable carrier.

Fenofibrate, a well-known normolipidemic drug, has been shown to exert strong anticancer effects against tumors of neuroectodermal origin including glioblastoma. Although some pharmacokinetic studies were performed in the past, data are still needed about the detailed subcellular and tissue distribution of fenofibrate (FF) and its active metabolite, fenofibric acid (FA), especially in respect to the treatment of intracranial tumors. We used high performance liquid chromatography (HPLC) to elucidate the intracellular, tissue and body fluid distribution of FF and FA after oral administration of the drug to mice bearing intracranial glioblastoma. Following the treatment, FF was quickly cleaved to FA by blood esterases and FA was detected in the blood, urine, liver, kidney, spleen and lungs. We have also detected small amounts of FA in the brains of two out of six mice, but not in the brain tumor tissue. The lack of FF and FA in the intracranial tumors prompted us to develop a new method for intracranial delivery of FF. We have prepared and tested in vitro biodegradable poly-lactic-co-glycolic acid (PLGA) polymer wafers containing FF, which could ultimately be inserted into the brain cavity following resection of the brain tumor. HPLC-based analysis demonstrated a slow and constant diffusion of FF from the wafer, and the released FF abolished clonogenic growth of glioblastoma cells. On the intracellular level, FF and FA were both present in the cytosolic fraction. Surprisingly, we also detected FF, but not FA in the cell membrane fraction. Electron paramagnetic resonance spectroscopy applied to spin-labeled phospholipid model-membranes revealed broadening of lipid phase transitions and decrease of membrane polarity induced by fenofibrate. Our results indicate that the membrane-bound FF could contribute to its exceptional anticancer potential in comparison to other lipid-lowering drugs, and advocate for intracranial delivery of FF in the combined pharmacotherapy against glioblastoma.

Open rhinoplasty: influence of incisions, alar resection, and columellar strut on final appearance of the tip.

BACKGROUND: The aim of this study is to analyze scientifically the results of a rhinoplasty is a difficult task because of the multiplicity of surgical procedures and the subjective nature of the nose's beauty. Nevertheless, we wanted to evaluate open rhinoplasty by relying on objective and subjective criteria. METHODS: From 2004 to 2011, a total of 155 patients underwent open septorhinoplasty at our hospital. After excluding patients lost to follow-up and those who underwent orthognathic surgery, 55 patients were included in the study. The evaluation was based on the clinical record, the standardized photographs, and the consultation of control. We studied in particular the nasolabial angle (NLA), the Goode ratio (projection/length of nose), and patient satisfaction using the rhinoplasty outcome evaluation form. RESULTS: The columella-transalar incision tended to close the NLA (p = 0.001) and lowered the Goode ratio (p = 0.01), in contrast to the Réthi incision. The resection of the alar cartilages logically induced closure of the NLA (p = 0.02) and a decrease of nose projection (p = 0.001), whereas the use of a columellar strut induced a projection increase (p = 0.01). CONCLUSION: Despite the existence of unavoidable measures bias, we confirmed a number of assumptions that had never been demonstrated statistically. Furthermore, we found that the incision used could affect the final result of a rhinoplasty. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Post-fracture pharmacotherapy for women with osteoporotic fracture: analysis of a managed care population in the USA.

UNLABELLED: Pharmacologic therapy is recommended to reduce future fracture risk. We examined osteoporosis medications dispensed to older women after first fracture. Only 23 % received therapy during the first year post-fracture. Prior osteoporosis therapy, a prior osteoporosis diagnosis, and older age were good predictors of post-fracture osteoporosis therapy. INTRODUCTION: Pharmacologic therapy is recommended after osteoporotic fracture to reduce future fracture risk. The objective of this retrospective study was to examine osteoporosis therapy dispensed to women post-fracture. METHODS: We identified women ≥50 years old in a large administrative claims database from 2003 to mid-2012 who were continuously enrolled 2 years before (baseline) and 1 year after first osteoporotic fracture. Exclusions were Paget's disease or malignant neoplasm. Pre- and post-fracture osteoporosis therapies (oral and parenteral) were assessed overall and by fracture site. RESULTS: A total of 47,171 women of mean (SD) age of 63 (10) years were eligible; fractures included 8 % hip, 17 % vertebral, 73 % non-hip/non-vertebral, and 3 % multiple fracture sites. Only 18 % received osteoporosis therapy within 90 days and 23 % within 1 year post-fracture. Overall, 19 % of women had a prior osteoporosis diagnosis; 20 % had received osteoporosis therapy during baseline. Of 37,649 (80 %) women without baseline therapy, only 9 % initiated pharmacologic therapy within 1 year. The adjusted odds ratio (OR) of therapy within 1 year post-fracture was significantly greater for women who had received baseline osteoporosis therapy (versus none) and who had vertebral (OR 12.7, 95 % confidence interval (CI) 11.2-14.5), hip (15.2, 12.5-18.7), or non-hip/non-vertebral fracture (34.4, 31.7-37.3). Other significant predictors included pre-fracture osteoporosis diagnosis (1.6, 1.4-1.7) and older age (OR range, 1.3-1.7). Treatment adherence was significantly better among women with baseline osteoporosis diagnosis. CONCLUSIONS: The substantial post-fracture treatment gap represents an important unmet need for women with osteoporotic fractures. Fracture liaison or adherence programs could lead to improved post-fracture treatment rates.

[Squamous cell carcinomas of the ear: factors of gravity and surgical treatment, about 30 cases]. / Carcinomes spinocellulaires de l'oreille : facteurs de gravité et traitement chirurgical, à propos de 30 cas.

INTRODUCTION: Squamous cell carcinomas (SCC) of the ear are known for their aggressiveness. The aim of this study was to investigate factors of gravity while freeing the therapeutic requirements. PATIENTS AND METHODS: This is a retrospective study of 28 patients (30 ears) operated for SCC. The characteristics of the lesion, the presence of metastasis, treatment modalities and histologic findings were collected. Local recurrences and metastasis are identified with a mean follow-up time of 37months (17-110months). RESULTS: The lesion size was less than 2cm in 19 cases (63.3%) and greater than or equal to 2cm in 11 cases (36.7%). Macroscopic resection margins were 5, 7 or 10mm. The resections were histologically incomplete in 4 cases (13%) requiring further surgery. Six cases had local recurrence (20%): three with pulmonary or lymph node metastases (10%) and one death (3.3%). In these 6 cases of recurrence, the surgical margins were 6.3mm on average, the initial lesion measured always greater than 2cm (100%). Three quarters of incomplete resections have recurrent despite a surgical revision in healthy margin. CONCLUSION: Our study confirms the data of literature, namely the pejorative character of a lesion greater than 2cm and incomplete resection. The HAS recommendations seem minimal regarding the ear. In case of injury by more than 2cm and with a proximal location on the ear pinna, only amputation of the ear allows satisfactory cancer control.

iHWG-µNIR: a miniaturised near-infrared gas sensor based on substrate-integrated hollow waveguides coupled to a micro-NIR-spectrophotometer.

A miniaturised gas analyser is described and evaluated based on the use of a substrate-integrated hollow waveguide (iHWG) coupled to a microsized near-infrared spectrophotometer comprising a linear variable filter and an array of InGaAs detectors. This gas sensing system was applied to analyse surrogate samples of natural fuel gas containing methane, ethane, propane and butane, quantified by using multivariate regression models based on partial least square (PLS) algorithms and Savitzky-Golay 1(st) derivative data preprocessing. The external validation of the obtained models reveals root mean square errors of prediction of 0.37, 0.36, 0.67 and 0.37% (v/v), for methane, ethane, propane and butane, respectively. The developed sensing system provides particularly rapid response times upon composition changes of the gaseous sample (approximately 2 s) due the minute volume of the iHWG-based measurement cell. The sensing system developed in this study is fully portable with a hand-held sized analyser footprint, and thus ideally suited for field analysis. Last but not least, the obtained results corroborate the potential of NIR-iHWG analysers for monitoring the quality of natural gas and petrochemical gaseous products.

Anti-leukemic mechanisms of pegylated arginase I in acute lymphoblastic T-cell leukemia.

New treatments for adults with acute lymphoblastic T-cell leukemia (T-ALL) are urgently needed, as the current rate of overall remission in these patients is only about 40 percent. We recently showed the potential therapeutic benefit of the pegylated-human-arginase I (peg-Arg I) in T-ALL. However, the mechanisms by which peg-Arg I induces an anti-T-ALL effect remained unknown. Our results show the induction of T-ALL cell apoptosis by peg-Arg I, which associated with a global arrest in protein synthesis and with the phosphorylation of the eukaryotic-translation-initiation factor 2 alpha (eIF2α). Inhibition of eIF2α phosphorylation in T-ALL cells prevented the apoptosis induced by peg-Arg I, whereas the expression of a phosphomimetic eIF2α form increased the sensibility of T-ALL cells to peg-Arg I. Phosphorylation of eIF2α by peg-Arg I was mediated through kinases PERK and GCN2 and down-regulation of phosphatase GADD34. GCN2 and decreased GADD34 promoted T-ALL cell apoptosis after treatment with peg-Arg I, whereas PERK had an unexpected anti-apoptotic role. Additional results showed that phospho-eIF2α signaling further increased the anti-leukemic effects induced by peg-Arg I in T-ALL-bearing mice. These results suggest the central role of phospho-eIF2α in the anti-T-ALL effects induced by peg-Arg I and support its study as a therapeutic target.

[The transverse musculocutaneous gracilis free flap: Innovative autologous breast reconstruction]. / Le lambeau de gracilis à palette transversale : une nouvelle technique de reconstruction mammaire autologue.

INTRODUCTION: The transverse musculocutaneous gracilis free flap allows a wider range of indications in autologous breast reconstruction. They extend far beyond traditional dorsal, abdominal and gluteal flaps. The authors present their experience in using this innovative procedure. PATIENTS AND METHODS: The cutaneous and adipose part of the flap consists in a horizontal ellipse centered on the gracilis muscle in the upper thigh. The distal part of the muscle is released without neither visual control nor additional incision. The flap vascular pedicle is microanastomosed to the recipient internal thoracic vessels in the third intercostal space. Eleven patients, with a mean age of 44 years (29-62) and a BMI of 24 (19-32) underwent this procedure. Surgery was performed on either one side (n=6) or two (n=5), in indications of immediate (n=5) or delayed reconstruction (n=6). The main operative parameters (time, vessel diameter, pedicle length, flap volume) as well as postoperative follow-up were studied. RESULTS: Mean time of surgery was 4h33 (3-6 hours). Pedicle measured 6.2 cm (5-7.5) and diameter of the artery was 19 mm (15-30). Average weight of the flap was 344g (270-498). Two cases of partial necrosis occurred in the posterior cutaneous part of the flap (1cm(3) and 3 cm(3)). They were treated using controlled wound healing. Sequelae in the donor site proved minimal as the scar was placed in the crural crease and the gluteal fold. No major functional defect was noted after mean follow-up of six months. CONCLUSIONS: The transverse musculocutaneous gracilis free flap allows natural and durable reconstruction while reducing cosmetic and functional sequelae in the donor site. It proves to be particularly useful in bilateral immediate reconstructions following skin-sparing mastectomy. This surgical option offers new opportunities to long-limbed women without abdominal excess wishing autologous breast reconstruction.

[Management of weight loss consequences in the male chest: The amputation grafting technique with a L scar]. / Prise en charge des séquelles d'amaigrissement au niveau du thorax chez l'homme : technique d'amputation-greffe avec résultante cicatricielle en L.

INTRODUCTION: Following the upsurge in cases of morbid obesity and bariatric surgery, there is after massive weight loss effects of the thorax in man such as pseudogynecomastia extremely poorly tolerated by patients. Treatment aims to correct the excess skin while optimizing the location and quality of scars. Turning our back on techniques derived from mammoplasty, we go into these major forms for mastectomy with grafting the areolo-mammelonar plate and resulting scar in L extended if needed until the axilla. MATERIALS AND METHODS: From 2005 to 2011, we performed 12 mastectomies after massive weight loss (45 kg on average). Patients aged 19 to 64 had an average BMI of 29.2. In five patients, we had started the move by liposuction (190 cc average per side). The mastectomy was performed by placing the scar at the lower edge of the pectoralis major. The areolas previously harvested were placed on the axis of the graft within two to three centimeters above the scar. All patients were reviewed and evaluated in consultation questionnaire with an average follow up of 2 years (6 months-5 years). RESULTS: The average volume of resection was 560 g per side (55 g-2500 g), operative time 155 minutes. Complications consisted of hematoma requiring surgical revision and delayed wound healing in three over 1 month with partial areola necrosis. The overall patient satisfaction was excellent with no secondary correction request. CONCLUSION: In the major pseudogynecomastia, the option is taken immediately for a mastectomy technique which scar is located at the basis of the thorax and may include an axillary extension in L. It effectively corrects the large cutaneous and fat surplus and restores in one time a flat male chest. Satisfaction is high and patients are no more ashamed to expose their chest.

[Microsurgical venous automatic suture using double ring eversion system]. / Micro-anastomoses veineuses automatiques par double éversion et couplage sur anneaux.

UNLABELLED: The quality of microsurgical sutures is a key to success in free flaps. Automatic devices are meant to improve safety and simplify microvascular anastomoses. We present the assessment of our clinical experience using automatic suture based on double ring eversion system. MATERIAL AND METHODS: This system has been tested during an eighteen months period, in 72 consecutive venous end to end anastomoses. This technical innovation was used in 58 free flaps on a total of 52 patients. Indication for free flap was breast reconstruction (n=40), facial reconstruction (n=14), abdominal and limb reconstruction (n=4). Assessment was based on efficiency, anastomosis time, and thrombosis ratio in venous sutures. RESULTS: The mechanical system made microsurgical procedure easier. It notably decreased coupling time compared to manual sutures. At the beginning, coupling time averaged eight minutes. It decreased to five minutes for the last ten cases. In our series, we noticed two venous thromboses (2.7%). In every case, emergency revision surgery allowed saving the flap. Thrombosis did not seem specifically due to the mechanical system. CONCLUSION: Our positive experience together with good outcome published throughout literature lead us to routinely use double ring-based automatic suture. We chose this system in first line for every venous end to end anastomoses regardless of indication.

[Modified Risdon approach for non-traumatic ramus surgery]. / La voie d'abord sous-angulo-mandibulaire en dehors de la traumatologie.

INTRODUCTION: The Risdon modified approach, for mandibular surgery, is well adapted to treatment of low subcondylar fractures. According to our experience, this approach with a low rate of complications should also be considered for non-traumatic ramus surgery. MATERIAL AND METHODS: Twenty Risdon modified approaches were used in 11 patients for non-traumatic indications (seven bilateral osteotomies, four unilateral osteotomies, one biopsy, one bone graft). One patient was operated twice with the same approach. RESULTS: In all cases, the planned surgery could be performed using this approach. The only complication was a case of temporary paresis of the facial nerve's mandibular branch. The scar was always considered as quite acceptable. DISCUSSION: As for traumatology, the Risdon modified approach is an improvement for ramus non-traumatic surgery. It has a very low rate of complications, especially for the facial nerve. The intraoral approach avoids scarring, but the resulting exposure is insufficient and requires using a transcutaneous device or endoscopy. In orthognathic surgery, the wide exposure of the lateral aspect of the ramus, the corpus, and the basilar edge, facilitates important mandibular advancement.

[Bony regrowth after major erosion of the maxillary following silastic malar augmentation. Case report]. / Régénération osseuse après érosion majeure du maxillaire sur implants malaires en silicone. Cas clinique.

Alloplastic malar augmentation has become a routine procedure associated with few complications. Among them, authors have described bony erosion and resorption. The case presented here illustrates an unusual case of maxillary bone erosion after silastic malar augmentation. Implants were surgically removed and no more surgical intervention was performed. After 15 months, contrast-enhanced CT scan has showed nearly complete bony regrowth to an almost normal state. Considering resorption phenomenons following silastic chin implants, Peled et al. reported no long-term sequellae after implant removal and bony regrowth to the presurgical state after 9 months. Accordingly, we conclude that these phenomenons, even spectacular, are always reversible after implants removal and that treatment should just consist in ablation of the offending prosthetic material.

Rehabilitation, exercise therapy and music in patients with Parkinson's disease: a meta-analysis of the effects of music-based movement therapy on walking ability, balance and quality of life.

Recent evidence suggests that music-based movement (MbM) therapy may be a promising intervention to improve gait and gait-related activities in Parkinson's disease (PD) patients, because it naturally combines cognitive movement strategies, cueing techniques, balance exercises and physical activity while focussing on the enjoyment of moving on music instead of the current mobility limitations of the patient. A meta-analysis of RCTs on the efficacy of MbM-therapy, including individual rhythmic music training and partnered dance classes, was performed. Identified studies (K = 6) were evaluated on methodological quality, and summary effect sizes (SES) were calculated. Studies were generally small (total N= 168). Significant homogeneous SESs were found for the Berg Balance Scale, Timed Up and Go test and stride length (SESs: 4.1,2.2,0.11; P-values <0.01; I(2) 0,0,7%, respectively). A sensitivity analysis on type of MbM-therapy (dance- or gait-related interventions) revealed a significant improvement in walking velocity for gait-related MbM-therapy, but not for dance-related MbM-therapy. No significant effects were found for UPDRS-motor score, Freezing of Gait and Quality of Life. Overall, MbM-therapy appears promising for the improvement of gait and gait-related activities in PD. Future studies should incorporate larger groups and focus on long-term compliance and follow-up.