Global disparities in surgeons’ workloads, academic engagement and rest periods: the on-calL shIft fOr geNEral SurgeonS (LIONESS) study

: The workload of general surgeons is multifaceted, encompassing not only surgical procedures but also a myriad of other responsibilities. From April to May 2023, we conducted a CHERRIES-compliant internet-based survey analyzing clinical practice, academic engagement, and post-on-call rest. The questionnaire featured six sections with 35 questions. Statistical analysis used Chi-square tests, ANOVA, and logistic regression (SPSS® v. 28). The survey received a total of 1.046 responses (65.4%). Over 78.0% of responders came from Europe, 65.1% came from a general surgery unit; 92.8% of European and 87.5% of North American respondents were involved in research, compared to 71.7% in Africa. Europe led in publishing research studies (6.6 ± 8.6 yearly). Teaching involvement was high in North America (100%) and Africa (91.7%). Surgeons reported an average of 6.7 ± 4.9 on-call shifts per month, with European and North American surgeons experiencing 6.5 ± 4.9 and 7.8 ± 4.1 on-calls monthly, respectively. African surgeons had the highest on-call frequency (8.7 ± 6.1). Post-on-call, only 35.1% of respondents received a day off. Europeans were most likely (40%) to have a day off, while African surgeons were least likely (6.7%). On the adjusted multivariable analysis HDI (Human Development Index) (aOR 1.993) hospital capacity > 400 beds (aOR 2.423), working in a specialty surgery unit (aOR 2.087), and making the on-call in-house (aOR 5.446), significantly predicted the likelihood of having a day off after an on-call shift. Our study revealed critical insights into the disparities in workload, access to research, and professional opportunities for surgeons across different continents, underscored by the HDI

The value of reconstructive surgery in the management of refractory jaw osteoradionecrosis: a single-center 10-year experience

Mandibular osteoradionecrosis (mORN) is a severe complication of head and neck irradiation. International consensus on the management of mORN is currently lacking. The present study sought to evaluate the effectiveness and benefits of early reconstructive surgery (resection of the diseased bone and immediate reconstruction with a free flap) in treatment-refractory mORN. A single-center retrospective study was carried out of operations performed in a French university medical center between 2003 and 2013 inclusive. For each patient, the surgical modalities and postoperative outcomes were recorded. A total of 55 operations (19 marginal resections and 36 segmental resections) were performed, and the overall success rate was 92.3%. Relative to marginal resections, segmental resections were associated with longer operating times (440±62min vs. 531±72min, respectively; P<0.05 in Student's t-test), a longer length of hospital stay (16.5±6.5 days vs. 25.6±11.3 days, respectively; P<0.05), and a higher complication rate (26.3% vs. 63.9%, respectively; P<0.05 in Fisher's test). Given the unpredictable progression of treatment-refractory mORN and the risk-benefit ratio observed here, the value of early reconstructive surgery with curative intent should be reassessed

Role of "revascularisation surgery" in the management of mandibular osteoradionecrotic lesions: A report of 21 years of experience.

INTRODUCTION : Osteoradionecrosis (ORN) of the jaw is one of the main complications of the head and neck irradiation characterised by hypoxia, hypovascularisation and hypocellularity of the bone.1 In 2008, D'Hauthuille introduced the notion of “revascularisation surgery” in which a biological aspect is brought into play by introducing healthy and well‐vascularised bone into the irradiated tissue.2 The author described the efficacy of radical surgery with immediate reconstruction making use of extrinsic and intrinsic faculties of the free flap to vascularise remaining pathologic tissues. Our study aimed to report 21 years of “revascularisation surgery,” based on reported effectiveness and complication rates, for the specific management of mandibular osteoradionecrosis. [...

Treatment of mandibular osteoradionecrosis by periosteal free flaps.

Mandibular osteoradionecrosis (ORN) is one of the most serious complications of radiotherapy of the head and neck, and is characterised by hypoxia, hypovascularisation, and hypocellularity. Periosteal free flaps have intrinsic osteogenic, and extrinsic neoangiogenic, properties that are related to the periosteum. Our objective was to present our experience with the use of periosteal free flaps in the treatment of ORN (Notani class I or II) that are refractory to conservative management or have a large area of bone (≥2 cm) exposed. We organised a single-centre, retrospective study between 2003 and 2013 and describe the management of 11 patients (4 women and 7 men) who were being treated for refractory mandibular ORN. Thirteen periosteal free flaps were used: inner femoral condylar periosteum (n = 4), iliac crest (n = 1), external brachial with humeral periosteum (n = 1), and forearm with radial periosteum (n = 7). During follow-up we found three acute complications (haematoma, partial necrosis, and total vascular necrosis) that required immediate construction of a second periosteal free flap. There were also two chronic complications (fistula and post-traumatic fracture). With only one progressive lesion identified, the ORN was stopped in 11/12 patients. Two examples of osteoconduction were identified on postoperative images at six months and two years. Because of its osteoconductive and neoangiogenic capacities, the periosteal free flap seems to offer a real biological dimension to the treatment of ORN, and its efficiency favours its early revascularisation

Leukocytosis, prognosis biomarker in locally advanced head and neck cancer patients after chemoradiotherapy

Objective: To study the prognostic value of leukocyte increase in a retrospective cohort of locally advanced head and neck squamous cell carcinoma (HNSCC) patients receiving definitive concurrent cisplatin and radiation. Materials and methods: Clinical records of consecutive previously untreated locally advanced HNSCC patients treated in our Institution between March 2006 and October 2012 by concurrent cisplatin (100 mg/m2, every 3 weeks) and radiation (70 Gy in 7 weeks) were collected. The prognostic value of pretreatment leukocyte increase was examined, with focus on patterns of relapse and survival. Leukocytosis and neutrophilia were defined as a leukocyte count or a neutrophils count exceeding 10 and 7.5 G/L, respectively. Results: We identified 193 patients, all treated with concurrent cisplatin-based chemoradiotherapy. Respectively 24% and 20% patients displayed baseline leukocytosis or neutrophilia. Mean leukocyte count were significantly more elevated in current smokers, patients with performance status (PS) >0, T4 and less in HPV + tumor. The 5-year actuarial overall survival (OS) and progression-free survival (PFS) were 56% and 51% respectively. In univariate analysis, both leukocytosis and neutrophilia were strongly associated with worse OS and PFS (p < 0.001). In multivariate analysis, N classification, HPV/p16, smoking status and leukocytosis were associated with worse OS and PFS. Patients with <3 cycles of cisplatin had worse survival. Conclusion: In locally advanced HNSCC treated with concurrent cisplatin and radiation, baseline leukocytosis predicts OS and PFS. In addition with HPV status, this independent biomarker could help identifying patients with high risk of tumor relapse. Keywords: Head and neck cancer, Squamous cell carcinoma, Concurrent chemoradiation, Prognostic factor, Biomarkers, Neutrophilia, Leukocytosi

Co-transplantation of Wharton`s jelly mesenchymal stem cell-derived osteoblasts with differentiated endothelial cells does not stimulate blood vessel and osteoid formation in nude mice models

A major challenge in bone tissue engineering is the lack of post-implantation vascular growth into biomaterials. In the skeletal system, blood vessel growth appears to be coupled to osteogenesisâEuro"suggesting the existence of molecular crosstalk between endothelial cells (ECs) and osteoblastic cells. The present study (performed in two murine ectopic models) was designed to determine whether co-transplantation of human Wharton`s jelly mesenchymal stem cell-derived osteoblasts (WJMSC-OBs) and human differentiated ECs enhances bone regeneration and stimulates angiogenesis, relative to the seeding of WJMSC-OBs alone. Human WJMSC-OBs and human ECs were loaded into a silicate-substituted calcium phosphate (SiCaP) scaffold and then ectopically implanted at subcutaneous or intramuscular sites in nude mice. At both subcutaneous and intramuscular implantation sites, we observed ectopic bone formation and osteoids composed of host cells when WJMSC-OBs were seeded into the scaffold. However, the addition of ECs was associated with a lower level of osteogenesis, and we did not observe stimulation of blood vessel ingrowth. in vitro studies demonstrated that WJMSC-OBs lost their ability to secrete vascular endothelial growth factor and stromal cell-derived factor 1âEuro"including when ECs were present. In these two murine ectopic models, our cell-matrix environment combination did not seem to be optimal for inducing vascularized bone reconstruction

Early formative objective structured clinical examinations for students in the pre-clinical years of medical education: A non-randomized controlled prospective pilot study.

BackgroundThe value of formative objective structured clinical examinations (OSCEs) during the pre-clinical years of medical education remains unclear. We aimed to assess the effectiveness of a formative OSCE program for medical students in their pre-clinical years on subsequent performance in summative OSCE.MethodsWe conducted a non-randomized controlled prospective pilot study that included all medical students from the last year of the pre-clinical cycle of the Université Paris-Cité Medical School, France, in 2021. The intervention group received the formative OSCE program, which consisted of four OSCE sessions, followed by debriefing and feedback, whereas the control group received the standard teaching program. The main objective of this formative OSCE program was to develop skills in taking a structured medical history and communication. All participants took a final summative OSCE. The primary endpoint was the summative OSCE mark in each group. A questionnaire was also administered to the intervention-group students to collect their feedback. A qualitative analysis, using a convenience sample, was conducted by gathering data pertaining to the process through on-site participative observation of the formative OSCE program.ResultsTwenty students were included in the intervention group; 776 in the control group. We observed a significant improvement with each successive formative OSCE session in communication skills and in taking a structured medical history (pConclusionOur findings suggest that an early formative OSCE program is suitable for the pre-clinical years of medical education and is associated with improved student performance in domains targeted by the program

Additional file 1 of Pathophysiological subtypes of mild cognitive impairment due to Alzheimer’s disease identified by CSF proteomics

Additional file 1. Supplementary materials and methods. Figure S1. General study overview. Figure S2. Biological pathways most represented by the analysed proteins in CCC and EMIF-AD cohorts are similar. Figure S3. Three cluster-solution analysis for CCC and EMIF-AD cohorts. Figure S4. Three cluster-solution analysis for the CCC and the EMIF-AD cohorts (cont.). Figure S5. AD biomarker comparison between Clusters from the CCC cohort. Figure S6. Clusters analysis of a common 55 proteins subset in both CCC and EMIF-AD cohorts

El espacio provincial en la península ibérica

En el origen de este monográfico se halla la voluntad de unos historiadores de la Antigüedad de cuestionar la validez del mapa, propuesto por E. Albertini en 1923, de la trama provincial que siguió a la reforma de Diocleciano en Hispania. Para trazarlo, E. Albertini utilizó el «principio de acomodación» que habría permitido la preservación de las estructuras territoriales romanas, en las de la Iglesia en la Alta Edad Media. Para abordar esta cuestión, se hizo necesario el diálogo con historiadores medievales. Este diálogo que abarca los siglos entre el iv y el xii ha tenido el mérito de superar la cuestión inicial para adoptar el enfoque epistemológico más fértil del «spatial turn» en el que las provincias ya no se pueden considerar únicamente como meros territorios congelados, sino como espacios marcados por la discontinuidad y la plasticidad de su uso. À l’origine de cette monographie se trouve le souci de certains historiens de l’Antiquité de contester la validité de la carte de la trame provinciale, proposée par E. Albertini en 1923, qui a fait suite à la réforme de Dioclétien en Hispanie. Pour dessiner cette carte, E. Albertini a utilisé le « principe de l’accommodement » qui aurait permis le maintien des structures territoriales romaines dans celles de l’Église au début du Moyen Âge. Pour aborder cette question, un dialogue avec les historiens médiévaux était nécessaire. Ce dialogue, qui s’étend sur plusieurs siècles, entre le ive et le xiie, a eu le mérite de dépasser la question initiale pour adopter l’approche épistémologique plus féconde du « spacial turn » dans lequel les provinces ne peuvent plus être considérées comme de simples territoires figés, mais comme des espaces marqués par la discontinuité et la plasticité de leur utilisation. At the origin of this monograph lies the concern of some historians of antiquity to challenge the validity of the map of the provincial grid, proposed by E. Albertini in 1923, which followed the reform of Diocletian in Hispania. To draw this map, E. Albertini used the "principle of accommodation" that would have allowed the Roman territorial structures to be maintained in those of the Church in the early Middle Ages. To address this question, a dialogue with medieval historians was necessary. This dialogue, which extends over several centuries, between the 4th and the 12th century, has had the merit of going beyond the initial question to adopt the more fertile epistemological approach of the "spatial turn" in which the provinces can no longer be considered as mere frozen territories, but as spaces marked by the discontinuity and plasticity of their use