Adverse Effects of Botulinum Toxin type-A injections in masticatory muscles on underlying bone and cartilage: a literature review

Botulinum toxin type A (BTA) injections in masticatory muscles are used to treat numerous clinical conditions. This neurotoxin causes atrophy and transient paralysis of the concerned muscles.The aim of this review is to gather and define the effects of BTA injections in masticatory muscles on the underlying cartilage and bone structures.Electronic search of Medline and Google scholar databases covering the period between January 2007 and July 2019 was carried out. Eligible articles were selected according to the inclusion/exclusion criteria. Fourteen articles were included. BTA injections may cause short term reduction of cortical bone thickness and trabeculation. On the long term, cartilage volume reduction and bone volume loss were evident on the condyle and mandibular angle, at bothinjected and non-injected mandibular bone structures. Bone mineral density remained unaffected when only one masticatory muscle was injected but was reduced when several masticatory muscles were treated with BTA. Several cellular and molecular alterations were noticed in some articles.Because of evidence of irreversible negative effects of BTA on the underlying structures, possible muscle, bone and cartilage volume reduction should be communicated to the patients prior to any intervention. Further studies are needed to fully understand the cellular mechanisms and molecular responses behind this phenomenon

RÔLE DE L'OCCUPATION DU SOL VIS À VIS DE LA MODÉLISATION DES FLUX ENERGÉTIQUES ET HYDRIQUES EN MILIEU URBAIN ET PÉRIURBAIN

National audienceLe projet Rosenhy vise à étudier l’impact de l’occupation du sol sur la modélisation météorologique et hydrologique en termes de flux énergétiques et hydriques, en milieu urbain et périurbain. Trois sites appartenant aux observatoires français OTHU et ONEVU sont au centre de ce projet. Le quartier urbain hétérogène du Pin sec (Nantes), imperméabilisé à environ 45%, a fait l’objet d’une campagne expérimentale durant le mois de juin 2012, visant à estimer les flux de chaleur sensible et latente avec une haute résolution spatiale et temporelle par rapport aux mesures réalisées en continu sur ce site depuis 5 ans. Deux bassins versant périurbains (La Chézine à Nantes et l’Yzeron à Lyon), avec un taux d’imperméabilisation moins important (environ 10%) mais grandissant depuis plusieurs décennies, sont aussi étudiés. Ces deux derniers sites bénéficient d’un suivi hydrométéorologique depuis 10 ans pour la Chézine et 15 ans pour l’Yzeron. Sur ces trois sites, différentes sources de données d’occupation du sol à différentes résolutions sont disponibles :différentes bases de données géographiques communément utilisées par la communauté scientifique et les collectivités et des données télédétectées (multispectrales et hyperspectrales). L’utilisation de ces données en entrée de différents modèles météorologiques et hydrologiques implique un travail d’analyse et de classification pour adapter les informations aux besoins des modèles. Dans ce projet, les différents modèles adaptés au milieu urbain ou périrubain sont évalués et améliorés. Ainsi, les modèles hydrologiques périrubains sont en développement pour prendre en compte les différentes pratiques de gestion des eaux pluviales existantes (noues, toitures végétalisées, ...). L’utilisation conjointe des données simulées par les différents modèles aidera à déterminer le rôle de la part des surfaces naturelles et artificielles sur les bilans énergétique et hydrique en milieu plus ou moins urbanisé. Le milieu périurbain étant en évolution, le projet s’intéressera aussi à des scénarios d’urbanisation prospectifs en regardant d’une part l’impact de la densification sur les scénarios construits pour l’Yzeron lors du projet AVuPUR (ANR-VMCS, 2008-2011) et d’autre part, en réfléchissant conjointement avec Nantes Métropole, aux possibles voies d’évolution sur le bassin de la Chézine

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Decisions that hasten death: double effect and the experiences of physicians in Australia

BACKGROUND: In Australian end-of-life care, practicing euthanasia or physician-assisted suicide is illegal. Despite this, death hastening practices are common across medical settings. Practices can be clandestine or overt but in many instances physicians are forced to seek protection behind ambiguous medico-legal imperatives such as the Principle of Double Effect. Moreover, the way they conceptualise and experience such practices is inconsistent. To complement the available statistical data, the purpose of this study was to understand the reasoning behind how and why physicians in Australia will hasten death. METHOD: A qualitative investigation was focused on palliative and critical/acute settings. A thematic analysis was conducted on semi-structured in-depth interviews with 13 specialist physicians. Attention was given to eliciting meanings and experiences in Australian end-of-life care. RESULTS: Highlighting the importance of a multidimensional approach, physicians negotiated multiple influences when death was regarded as hastened. The way they understood and experienced end-of-life care practices were affected by politico-religious and cultural influences, medico-legal imperatives, and personal values and beliefs. Interpersonal and intrapsychic aspects further emphasised the emotional and psychological investment physicians have with patients and others. In most cases death occurred as a result of treating suffering, and sometimes to fulfil the wishes of patients and others who requested death. Experience was especially subject to the efficacy with which physicians negotiated complex but context-specific situations, and was reflective of how they considered a good death. Although many were compelled to draw on the Principle of Double Effect, every physician reported its inadequacy as a medico-legal guideline. CONCLUSIONS: The Principle of Double Effect, as a simplistic and generalised guideline, was identified as a convenient mechanism to protect physicians who inadvertently or intentionally hastened death. But its narrow focus on the physician’s intent illuminated how easily it may be manipulated, thus impairing transparency and a physician’s capacity for honesty. It is suggested the concept of “force majeure” be examined for its applicability in Australian medical end-of-life law where, consistent with a multidimensional and complex world, a physician’s motivations can also be understood in terms of the emotional and psychological pressures they face in situations that hasten death

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Upper-air wind profiles investigation for tropospheric circulation study

Methods used to study the atmospheric circulation are essentially based on pressure classifications or geopotential fields. However, instead of using indirect means, a more direct measure of the atmospheric flow, i.e. the wind, appears preferable. In addition, it is admitted that, when explaining the weather variability, the combination of multiple level data can bring more information than studying just single-level characteristics. Thus, vertical profiles of wind are of great interest. The purpose of the article is twofold: first, to propose a method to classify this kind of data; second, to illustrate briefly the results obtained with the daily wind profiles acquired by upper-air soundings at a French meteorological station (Nancy), over a period of 11 years. The advantages of the method are: it is automatic and can easily be transposed in other areas; it provides a new type of information about the atmospheric circulation in the vertical dimension; it allows making easily the link between the circulation in the lower and upper troposphere

Une simulation des interactions ville-atmosphère à différentes échelles : application sur Strasbourg

Plusieurs modèles météorologiques ont été utilisés pour simuler les interactions ville-atmosphère à différentes échelles. Cette chaîne de simulation implique l’utilisation de réanalyses globales d’une résolution de 16 km comme données de forçage météorologique. Ce forçage est utilisé pour contraindre un modèle de méso-échelle qui permet d’atteindre une résolution de 250 m sur la ville grâce à la technique du grid-nesting. Finalement les champs du modèle à 250 m ont été utilisés comme forçage météorologique pour un modèle de simulation de canopée urbaine en 3D qui fonctionne avec une résolution de quelques mètres. Les outils utilisés pour atteindre cet objectif sont : les réanalyses du CEPMMT, le modèle Méso-NH & SURFEX (de Météo-France et du Laboratoire d’Aérologie) et le modèle de canopée urbaine LASER/F (Icube). Une simulation a été réalisée sur Strasbourg pour tester cette chaîne sur une période qui va du 13 au 17 août 2002. Les validations montrent que les processus de surface et atmosphériques simulés par Méso-NH & SURFEX pour la résolution de 250 m sont en accord avec les mesures de terrain. Pour s’assurer que le modèle de canopée urbaine en 3D s’intègre bien dans la chaîne de simulation, ses résultats sont comparés à ceux de SURFEX pour un quartier. Les analyses montrent que les résultats obtenus par ce modèle sont en accord avec ceux de SURFEX. L’introduction de la géométrie réelle du quartier en 3D permet même un gain appréciable pour certaines variables. Vu la cohérence des résultats obtenus, l’adjonction du modèle de canopée urbaine se justifie dans cette chaîne. Et ceci d’autant plus que ce type de modèle permet l’accès à de nouvelles informations avec un haut niveau de détails