A glimpse into the early origins of medieval anatomy through the oldest conserved human dissection (Western Europe, 13^th c. A.D.)

INTRODUCTION: Medieval autopsy practice is very poorly known in Western Europe, due to a lack of both descriptive medico-surgical texts and conserved dissected human remains. This period is currently considered the dark ages according to a common belief of systematic opposition of Christian religious authorities to the opening of human cadavers. MATERIAL AND METHODS: The identification in a private collection of an autopsied human individual dated from the 13(th) century A.D. is an opportunity for better knowledge of such practice in this chrono-cultural context, i.e. the early origins of occidental dissections. A complete forensic anthropological procedure was carried out, completed by radiological and elemental analyses. RESULTS: The complete procedure of this body opening and internal organs exploration is explained, and compared with historical data about forensic and anatomical autopsies from this period. During the analysis, a red substance filling all arterial cavities, made of mercury sulfide (cinnabar) mixed with vegetal oil (oleic and palmitic acids) was identified; it was presumably used to highlight vascularization by coloring in red such vessels, and help in the preservation of the body. CONCLUSIONS: Of particular interest for the description of early medical and anatomical knowledge, this “human preparation” is the oldest known yet, and is particularly important for the fields of history of medicine, surgery and anatomical practice

Human papillomavirus testing in women with mild cytologic atypia

International audienceObjective: To evaluate the efficiency of human papillomavirus (HPV) testing by Hybrid Capture II (Digene Diagnostics Inc., Silver Spring, MD) with regard to detecting biopsy-confirmed cervical intraepithelial neoplasia (CIN) or high-grade CIN in women with mild atypia, compared with the efficiencies of polymerase chain reaction (PCR), Southern blot hybridization, and cytology.Methods: We prospectively studied 378 women with atypical squamous cells of undetermined significance (ASCUS) (n = 111) or low-grade squamous intraepithelial lesions (SILs) (n = 267) demonstrated by referral cytology. We did repeat cytology, sampling for detection of HPV DNA by Hybrid Capture II, PCR, and Southern blot hybridization, and colposcopic evaluation with cervical biopsies.Results: All participants underwent the Hybrid Capture II test and 320 underwent the three HPV tests. Sensitivities of Hybrid Capture II for detecting CIN and high-grade CIN (0.81 and 0.86, respectively) were similar to those of cytology (0.83 and 0.82, respectively) and PCR (0.77 and 0.95, respectively), and higher than those of Southern blot hybridization (0.48 and 0.45, respectively). Compared with cytology, combined triage with Hybrid Capture II improved sensitivities for detecting CIN (0.94 versus 0.83, P < .001) and high-grade CIN (0.96 versus 0.85), though the latter difference was not significant (P = .17). In women with ASCUS, sensitivities of combined triage and cytology for detecting CIN were 0.94 and 0.71, respectively (P = .01), and sensitivities of the two methods for detecting high-grade CIN were 0.92 and 0.66, respectively (P = .13). The increase in sensitivity was lower among women with low-grade SILs; for these women, cytology had high sensitivity (0.86 for CIN and 1.00 for high-grade CIN). The specificity of combined triage was significantly lower than that of cytology in both groups.Conclusion: Compared with repeat cytology, combined triage with HPV testing markedly improves sensitivity for detecting CIN in women with ASCUS, but at the expense of specificity

Surveillance system of severe influenza cases admitted to the regional ICU,2009-2015

ObjectiveThe study aimed at: i) analyses the regional characteristics and riskfactors of severe influenza, taking into account dominant circulatingvirus(es) ii) estimate the regional completeness of the surveillancesystem.IntroductionEvery year, circulating influenza viruses generate a significantnumber of deaths. During the 2009 pandemic influenza A(H1N1),a national non mandatory surveillance system of severe influenzacases admitted to intensive care units(ICU) was set up in France.This surveillance is regionally driven by the regional offices (CIRE)of Santé publique France, the French Public Health Agency. Thisreport provides epidemiologic analysis of the recorded data sincethe implementation of surveillance in the Centre-Val de Loire regionover seasons 2009-10 to 2015-16 in regard of influenza epidemicsdynamics.MethodsSurveillance was carried out each year from October to April.Descriptive and analytic analyses were conducted to comparepopulation characteristics, pre-existing risk factors and the clinicaldata according to influenza season and dominant circulatinginfluenza virus(es). Logistic regressions were performed to identifyfactors associated with an increased risk of acute respiratory distresssyndrome (ARDS) or death. Two capture-recapture analyses wereperformed to establish the completeness of the surveillance systemin the region. The first one was realized on all cases, using two datasources (hospital records/surveillance data) and the second one, onlyon deaths, using three data sources(additional source: medical deathcertificates).ResultsFrom 2009-10 to 2015-16, the outbreak of influenza epidemicswas started more and more late. The number of severe influenzacases reported in the Loire Valley varied from 19 in 2010-11 to 75 in2014-15. Overall, the most affected population was adults, from 41%in 2011-12 to 83% in 2009-10. However seniors (more than 65 yearsold) represented an important part of patients during three epidemics:50% in 2011-12 and around 45% during the two last seasons;during these epidemics, men, (60%-68%), were more affected thanwomen. Patients’ pre-existing risk factors were mainly: being olderthan 65 years old and suffering of cardiac or pulmonary diseases.The comparison by dominant viruses over the seasons revealed thatwhen A(H1N1) virus prevailed, severe influenza occurred mainlyin adults patients with any type of pre-existing risk factors whereaswhen A(H3N2) virus prevailed, seniors with pre-existing pulmonarydisease were the most affected. More than a third of patientsdeclared an ARDS. The overall observed lethality was close to 16%.ARDS occurred more frequently in patients who were middle-aged(45-64 years), immunocompromised or infected with A(H1N1).Pre-existing pulmonary disease was a protective factor. Risk factorsassociated with death were being older than 65 years, male and havingdeclared an ARDS. The completeness of this surveillance system wasestimated by capture-recapture methods at 59% for severe influenzacases and 40% for death cases.ConclusionsThe epidemiology of severe influenza and epidemics dynamics inthe Centre-Val de Loire follow the national trends. Every season ischaracterized by the same dominant virus at national and regionallevels in intensive care units. Influenza epidemics 2009-10 and2014-15 were particularly long and severe, the first dominatedby the A(H1N1)pdm09 virus and the second by the A(H3N2).Our study has demonstrated that the populations at risk of severeinfluenza differ according to the circulating virus(es). Accordingto the obtained estimations, the completeness of the surveillancesystem, based on voluntary report by physicians, can be consideredas satisfactory. Regarding influenza deaths relatively low percentageof completeness may be explained by the fact that two sources arehospital based whereas the third one, medical death certificates,includes all influenzadeaths with no information on the death place.Many patients were not vaccinated or their status was unknown. Mostcases admitted to ICU presented pre-existing risk factors includedin eligibility criteria in influenza vaccination policies. This studyoutlines the importance of vaccination as the first prevention measure

Surveillance system of severe influenza cases admitted to the regional ICU,2009-2015

ObjectiveThe study aimed at: i) analyses the regional characteristics and riskfactors of severe influenza, taking into account dominant circulatingvirus(es) ii) estimate the regional completeness of the surveillancesystem.IntroductionEvery year, circulating influenza viruses generate a significantnumber of deaths. During the 2009 pandemic influenza A(H1N1),a national non mandatory surveillance system of severe influenzacases admitted to intensive care units(ICU) was set up in France.This surveillance is regionally driven by the regional offices (CIRE)of Santé publique France, the French Public Health Agency. Thisreport provides epidemiologic analysis of the recorded data sincethe implementation of surveillance in the Centre-Val de Loire regionover seasons 2009-10 to 2015-16 in regard of influenza epidemicsdynamics.MethodsSurveillance was carried out each year from October to April.Descriptive and analytic analyses were conducted to comparepopulation characteristics, pre-existing risk factors and the clinicaldata according to influenza season and dominant circulatinginfluenza virus(es). Logistic regressions were performed to identifyfactors associated with an increased risk of acute respiratory distresssyndrome (ARDS) or death. Two capture-recapture analyses wereperformed to establish the completeness of the surveillance systemin the region. The first one was realized on all cases, using two datasources (hospital records/surveillance data) and the second one, onlyon deaths, using three data sources(additional source: medical deathcertificates).ResultsFrom 2009-10 to 2015-16, the outbreak of influenza epidemicswas started more and more late. The number of severe influenzacases reported in the Loire Valley varied from 19 in 2010-11 to 75 in2014-15. Overall, the most affected population was adults, from 41%in 2011-12 to 83% in 2009-10. However seniors (more than 65 yearsold) represented an important part of patients during three epidemics:50% in 2011-12 and around 45% during the two last seasons;during these epidemics, men, (60%-68%), were more affected thanwomen. Patients’ pre-existing risk factors were mainly: being olderthan 65 years old and suffering of cardiac or pulmonary diseases.The comparison by dominant viruses over the seasons revealed thatwhen A(H1N1) virus prevailed, severe influenza occurred mainlyin adults patients with any type of pre-existing risk factors whereaswhen A(H3N2) virus prevailed, seniors with pre-existing pulmonarydisease were the most affected. More than a third of patientsdeclared an ARDS. The overall observed lethality was close to 16%.ARDS occurred more frequently in patients who were middle-aged(45-64 years), immunocompromised or infected with A(H1N1).Pre-existing pulmonary disease was a protective factor. Risk factorsassociated with death were being older than 65 years, male and havingdeclared an ARDS. The completeness of this surveillance system wasestimated by capture-recapture methods at 59% for severe influenzacases and 40% for death cases.ConclusionsThe epidemiology of severe influenza and epidemics dynamics inthe Centre-Val de Loire follow the national trends. Every season ischaracterized by the same dominant virus at national and regionallevels in intensive care units. Influenza epidemics 2009-10 and2014-15 were particularly long and severe, the first dominatedby the A(H1N1)pdm09 virus and the second by the A(H3N2).Our study has demonstrated that the populations at risk of severeinfluenza differ according to the circulating virus(es). Accordingto the obtained estimations, the completeness of the surveillancesystem, based on voluntary report by physicians, can be consideredas satisfactory. Regarding influenza deaths relatively low percentageof completeness may be explained by the fact that two sources arehospital based whereas the third one, medical death certificates,includes all influenzadeaths with no information on the death place.Many patients were not vaccinated or their status was unknown. Mostcases admitted to ICU presented pre-existing risk factors includedin eligibility criteria in influenza vaccination policies. This studyoutlines the importance of vaccination as the first prevention measure

Spatial analysis of SS population coverage based on emergency regional healthcare

ObjectiveTo analyse population coverage of syndromic surveillance(SS)based on emergency care data by studying i)the attractiveness ofrespectively SOS Médecins (Emergency care general practitioners)and Hospital emergency departments in the Centre-Val de Loireregion and ii) the contribution of ecological deprivation factors inemergency access to healthcare.IntroductionSOS Médecins France (SOS Med) is the first private and permanentnetwork of general practitioners providing emergency care in France.Besides Hospital emergency departments (HED), SOS Med istherefore a major source of data for detecting and measuring near-real-time health phenomena. The emergency services provided by theSOS Med have been subject to important changes in the recent years.Their services are enriched by a medical consultation center togetherwith extended working hours. Besides, the south of the region ismarkedly affected by a declining number of medical practitionersThis study was conducted to analyze the regional population coverageof emergency healthcare data provided by HED and SOS Med tothe French syndromic surveillance system (SurSaUD®) takinginto account distance, health care offer, demographic factors andecological deprivation factors.MethodsAn analysis of the activities and geographic attraction was carriedout based on the data respectively provided by the three regional SOSMed and three HED (Bourges, Orléans and Tours). Quasi-Poissonregression modelling was used to identify the factors influencing theattractiveness of each organization. Next, the findings were refinedthrough spatial analysis of the attractiveness of HED and SOS Medand analysis of the contribution of deprivation based on socio-economical and healthcare facilities ecological indexes.ResultsIn terms of age group, children under 2 years required the largestservice consultations as well as seniors over 75 who sought moreemergency visits at home. The SOS Med were almost always active inurban areas and at least once in two due to continuity of care. So theyare an efficient source of general medical care given present workhours. Distance as an influential factor may explain the differencesin attraction to the support type. The extent of the attraction appearsin 36% SOS Med Bourges and 14% for SOS Med Orleans. Addthe extent of attraction for SOS, remote consultation for SOS Medassociations are a good use of care in general practice in present workhours scheme.In terms of monitoring of epidemics, we note that the SOSMédecins associations are most active in winter, particularly duringthe seasonal epidemics of influenza. This can be explained by the factof patient referrals during calls. The most serious cases are redirectedto the ED and cases of general medicine to the SOS Médecins.It is also important to note that the attraction of ED ofCHR Orléanscovers more or less important a large part of the regional territory,which is not visible to the ED ofCH Bourges. It should neverthelessbe noted that theCHR Orleansa larger bed capacity than theCH Bourges.ConclusionsThis research has analysed the changes taking place in the SOSmédecins associations in the Centre-Val de Loire region. Findingsshows that these associations help ensure access to general medicalcare in a context of strongly reduced medical demography althoughwith an uneven, primarily urban, geographical coverage. Withbetter knowledge of the geographic span and sources and types ofemergency care provision, further research can be undertaken tofurther refine and interpret the data

Spatial analysis of SS population coverage based on emergency regional healthcare

ObjectiveTo analyse population coverage of syndromic surveillance(SS)based on emergency care data by studying i)the attractiveness ofrespectively SOS Médecins (Emergency care general practitioners)and Hospital emergency departments in the Centre-Val de Loireregion and ii) the contribution of ecological deprivation factors inemergency access to healthcare.IntroductionSOS Médecins France (SOS Med) is the first private and permanentnetwork of general practitioners providing emergency care in France.Besides Hospital emergency departments (HED), SOS Med istherefore a major source of data for detecting and measuring near-real-time health phenomena. The emergency services provided by theSOS Med have been subject to important changes in the recent years.Their services are enriched by a medical consultation center togetherwith extended working hours. Besides, the south of the region ismarkedly affected by a declining number of medical practitionersThis study was conducted to analyze the regional population coverageof emergency healthcare data provided by HED and SOS Med tothe French syndromic surveillance system (SurSaUD®) takinginto account distance, health care offer, demographic factors andecological deprivation factors.MethodsAn analysis of the activities and geographic attraction was carriedout based on the data respectively provided by the three regional SOSMed and three HED (Bourges, Orléans and Tours). Quasi-Poissonregression modelling was used to identify the factors influencing theattractiveness of each organization. Next, the findings were refinedthrough spatial analysis of the attractiveness of HED and SOS Medand analysis of the contribution of deprivation based on socio-economical and healthcare facilities ecological indexes.ResultsIn terms of age group, children under 2 years required the largestservice consultations as well as seniors over 75 who sought moreemergency visits at home. The SOS Med were almost always active inurban areas and at least once in two due to continuity of care. So theyare an efficient source of general medical care given present workhours. Distance as an influential factor may explain the differencesin attraction to the support type. The extent of the attraction appearsin 36% SOS Med Bourges and 14% for SOS Med Orleans. Addthe extent of attraction for SOS, remote consultation for SOS Medassociations are a good use of care in general practice in present workhours scheme.In terms of monitoring of epidemics, we note that the SOSMédecins associations are most active in winter, particularly duringthe seasonal epidemics of influenza. This can be explained by the factof patient referrals during calls. The most serious cases are redirectedto the ED and cases of general medicine to the SOS Médecins.It is also important to note that the attraction of ED ofCHR Orléanscovers more or less important a large part of the regional territory,which is not visible to the ED ofCH Bourges. It should neverthelessbe noted that theCHR Orleansa larger bed capacity than theCH Bourges.ConclusionsThis research has analysed the changes taking place in the SOSmédecins associations in the Centre-Val de Loire region. Findingsshows that these associations help ensure access to general medicalcare in a context of strongly reduced medical demography althoughwith an uneven, primarily urban, geographical coverage. Withbetter knowledge of the geographic span and sources and types ofemergency care provision, further research can be undertaken tofurther refine and interpret the data