Impact de la solidarisation des couronnes implanto-portées sur le remodelage osseux péri-implantaire : étude clinique prospective avec suivi à 5 ans

Introduction : L'étude présentée cherchait à mettre en évidence un éventuel lien entre la solidarisation des couronnes et la cratérisation osseuse autour de ces implants. Méthodes : il s’agissait d’une étude prospective sur les implants courts pour le traitement des édentements postérieurs libres mandibulaires. Le traitement correspondait à la mise en place de prothèses scellées sur des implants. Le nombre d'implants posés était identique au nombre de dents à remplacer. La perte osseuse autour des implants était mesurée radiologiquement lors de la mise en place chirurgicale puis tous les ans jusqu'à la cinquième année. La comparaison de la perte osseuse moyenne autour des implants solidarisés versus implants non solidarisés était faite au moyen d'un test t de comparaison de deux moyennes avec des variances égales en prenant l'hypothèse qu'il n'y a pas de différence entre les couronnes solidarisées ou non. Résultats : À 5 ans, les données de 89 implants ont été évaluées. 100 % des implants étaient encore en place. La cratérisation était de 0,69 mm en moyenne (sd. 1.29) et ne semblait pas différente en fonction des paramètres étudiés. Conclusion : Malgré les limites de cette étude, il semblerait qu'il y ait peu d’impact de la solidarisation des couronnes sur la cratérisation péri-implantaire

Nebulized hypertonic saline 3% for 1 versus 3 days in hospitalized bronchiolitis: a blinded non-inferiority randomized controlled trial

International audienceBACKGROUND:The use and optimal duration of treatment with nebulized hypertonic saline (HS) in infants hospitalized for acute bronchiolitis is unclear. The objective was to compare the efficacy of 1 versus 3 days of nebulized 3% HS at 72 h of treatment. We conducted a blinded non-inferiority randomized controlled trial including infants aged less than 12 months old, hospitalized for a moderate bronchiolitis.METHODS:Nebulisations of 3% HS for 1 day were followed by either the continuation of 3% HS (HS3d group) or switched to 0.9% normal isotonic saline (HS1d group) for 2 days Randomization was performed according to a predefined list with a 1:1 ratio, obtained with a random generator number with blocks.. Main outcome was mean Wang clinical severity score (CSS) after 72 h of treatment.RESULTS:One hundred sixteen infants (HS1d n = 59 and HS3d n = 57), were included over two epidemic seasons from 2014 to 2016, but recruitement did not reach the planned sample size. The difference for the Wang CSS score in the HS3d vs HS1d group was 0.71 [IC 90% 0.1; 1.3], above the precluded value of 0.4 set in the protocol defining the non-inferiority of shorter treatment duration. Clinical remission was more rapidly obtained in the HS3d than in HS1d (2.3 ± 1.6 vs 2.9 ± 1.4 days, p = 0.04), with a non-significant tendency for less need of nutritional support and supplemental oxygen in HS3d group. Clinical worsening and treatment intolerance were similar in the 2 groups.CONCLUSIONS:Despite being underpowered, results seem not to be in favour of reducing the duration of nebulised HS treatment from 3 to 1 day in acute moderate bronchiolitis.TRIAL REGISTRATION:Clinical trials NCT02538458, October 2014

Contribution of the ELFG test in algorithms of non-invasive markers towards the diagnosis of significant fibrosis in chronic hepatitis C.

BACKGROUND AND AIMS: We aimed to determine the best algorithms for the diagnosis of significant fibrosis in chronic hepatitis C (CHC) patients using all available parameters and tests. PATIENTS AND METHODS: We used the database from our study of 507 patients with histologically proven CHC in which fibrosis was evaluated by liver biopsy (Metavir) and tests: Fibrometer®, Fibrotest®, Hepascore®, Apri, ELFG, MP3, Forn's, hyaluronic acid, tissue inhibitor of metalloproteinase-1 (TIMP1), MMP1, collagen IV and when possible Fibroscan™. For the first test we used 90% negative predictive value to exclude patients with F≤1, next an induction algorithm was applied giving the best tests with at least 80% positive predictive value for the diagnosis of F≥2. The algorithms were computed using the R Software C4.5 program to select the best tests and cut-offs. The algorithm was automatically induced without premises on the part of the investigators. We also examined the inter-observer variations after independent review of liver biopsies by two pathologists. A medico-economic analysis compared the screening strategies with liver biopsy. RESULTS: In "intention to diagnose" the best algorithms for F≥2 were Fibrometer ®, Fibrotest®, or Hepascore® in first intention with the ELFG score in second intention for indeterminate cases. The percentage of avoided biopsies varied between 50% (Fibrotest® or Fibrometer®+ELFG) and 51% (Hepascore®+ELFG). In "per-analysis" Fibroscan™+ELFG avoided liver biopsy in 55% of cases. The diagnostic performance of these screening strategies was statistically superior to the usual combinations (Fibrometer® or Fibrotest®+Fibroscan™) and was cost effective. We note that the consensual review of liver biopsies between the two pathologists was mainly in favor of F1 (64-69%). CONCLUSION: The ELFG test could replace Fibroscan in most currently used algorithms for the diagnosis of significant fibrosis including for those patients for whom Fibroscan™ is unusable

Including osteoprotegerin and collagen IV in a score-based blood test for liver fibrosis increases diagnostic accuracy

International audienc

Characteristics of liver biopsy for each algorithm, when liver biopsy is required, and in the overall population.

<p>Characteristics of liver biopsy for each algorithm, when liver biopsy is required, and in the overall population.</p

Economic analysis.

<p>Average cost of screening per patient (in euros) of the various combinations of tests, taking 3 levels of liver biopsy cost based on published data and the cost in our hospital: 800 Euros, 1,000 Euros and 1,200 Euros. *Cost of Fibroscan, for use equivalent to 10 acts per month. * *Cost of Fibroscan, for use equivalent to 32 acts per month.</p

Study Flow Chart.

<p>N: number of chronic hepatitis C patients with test results; and the number of patients without the test or with missing test data are shown in parentheses.</p

Scores from the different tests and selected parameters for the 507 CHC patients having all the blood tests (intention to diagnose population) and the 396 CHC patients with all the blood tests and reliable Fibroscan^TM (per protocol population).

*<p>TIMP1: tissue inhibitor of metalloproteinase-1; **MM1: matrix metalloproteinase-1;</p>***<p>PIIINP: N-terminal peptide of type III procollagen.</p

A sad tale’s best for winter

Œuvre composite, Le Conte d’hiver a longtemps été une œuvre décriée par la critique. Redécouverte au début du xxe siècle, la pièce a depuis fait l’objet de nombreuses interprétations novatrices et reprises au théâtre. Ce volume s’inscrit dans ce renouveau critique, et se propose d’étudier les sources et l’identité littéraire de la pièce, la comparaison entre les arts qu’elle propose, et de se plonger dans une réflexion sur l’enfance, la parole féminine, les relations passionnelles, le libre-arbitre et les intertextes. Par ses approches critiques variées, allant de l’analyse des sources à la philosophie, en passant par des témoignages de praticiens du théâtre et l’analyse stylistique, ce volume montre toute la richesse du Conte d’hiver de Shakespeare

Proposed algorithm: automatically determined by the C4.5 program with the number of avoided liver biopsies.

<p>The bottom line gives the total number of liver biopsies avoided following one of the three most validated blood tests or Fibroscan followed by the ELFG test for those patients for whom the first test was not conclusive. N: number of patients; F: Metavir liver biopsy Fibrosis score; NPV: Negative Predictive Value with the cut-off in parentheses; PPV: Positive Predictive Value with the cut-off range in brackets. * = cut-off = >−0.32; ** = per protocol analysis.</p