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Introduction: Long-term follow-up and management of orthodontic bonded retainers require a strong collaboration between orthodontists and general dental practitioners (GDPs). This study aimed to evaluate if Eastern French GDPs were aware of bonded retainers' complications and side effects and if they were willing to take part in their long-term follow-up., Methods: Two-hundred and eighteen randomly selected GDPs were invited to answer an online questionnaire. The initial sections covered their experience and management with bonded retainers. In the final sections, GDPs were asked their opinion on the responsibility for long-term follow-up of patients wearing fixed retainers and on the mutual communication between orthodontists and GDPs. Statistical analysis involved descriptive statistics and Fisher exact tests., Results: Response rate was 32.6% (n = 71). The vast majority of GDPs were familiar with loose retainers, but only 45.2% were willing to repair them. Respondents offering orthodontic services on a regular basis were more likely to insert retainers and repair loose or broken retainers (P < 0.001). Approximately 18.6% of GDPs were aware of third-order side effects encountered with unintentionally active retainers bonded to all 6 anterior teeth. For 88.8% of GDPs, permanent retention was justified, whereas 90% of the dentists refused to be responsible for long-term supervision of fixed retainers. In addition, 67.1% were interested in further training on orthodontic retention, and 92.9% would appreciate clinical guidelines., Conclusions: Knowledge about the harmful side effects of bonded retainers was evaluated as insufficient among surveyed GDPs. Long-term follow-up of patients wearing bonded retainers raises issues that should be addressed globally by enhancing mutual communication, practitioners' education, and patients' involvement., (Copyright © 2021 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Objective . Preoperative imaging in primary hyperparathyroidism (PHPT) is essential for planning of parathyroidectomy-particularly for selection of a minimally invasive approach. The objective of this cohort study was to evaluate the diagnostic precision of 3D virtual neck exploration (3D-VNE), to evaluate its impact on choice of surgical approach, and to document the correlation with long-term outcomes. Methods . 235 consecutive patients with PHPT were studied (January 2014 to December 2018), with 6-month follow-up. 220 patients had a preoperative computed tomography (CT), 172 of these had a 3D-VNE based on the CT, and 226 patients had a Tc-99m sestamibi scan. Results . Sensitivity of exact, per gland , adenoma localization was 57.09% (95% CI: 50.85-63.10%) for nonspecialized radiologist interpretation of CT scan, 58.17% (95% CI: 51.99-64.10%) for Tc-99m sestamibi scan, and 90.21% (95% CI: 85.21-93.64%) for 3D-VNE, and thereby favoring 3D-VNE compared to CT scan alone (OR 34.5, 95% CI: 9.19-290.56%, P < 2.2 × 10 -16 ) and to Tc-99m sestamibi scan (OR 16.25, 95% CI: 6.05-61.42%, P = 3.1 × 10 -15 ). Specificity was 87.38% for CT scan, 86.36% for 3D-VNE, and 90% for Tc-99m sestamibi scan ( P > .05). The cure rate was 100%. The long-term recurrence rate (RR) was 2.978%. The RR was 1.324% in the video-assisted parathyroidectomy group of 151 patients and 5.952% in the group of 84 patients with cervicotomy ( P = .0459). Conclusion. CT-based 3D-VNE proved to be the most accurate localizing study in PHPT and aided in selecting patients for targeted minimally invasive parathyroidectomy, which was associated with the lower recurrence rate. 3D-VNE could be proposed as a first-line imaging study in patients with PHPT.

Background: In survival analysis, data can be modeled using either a multiplicative hazards regression model (such as the Cox model) or an additive hazards regression model (such as Lin's or Aalen's model). While several diagnostic tools are available to check the assumptions underpinning each type of model, there is no defined procedure to fit these models optimally. Moreover, the two types of models are rarely combined in survival analysis. Here, we propose a strategy for optimal fitting of multiplicative and additive hazards regression models in survival analysis., Methods: This section details our proposed strategy for optimal fitting of multiplicative and additive hazards regression models, with a focus on the assumptions underpinning each type of model, the diagnostic tools used to check these assumptions, and the steps followed to fit the data. The proposed strategy draws on classical diagnostic tools (Schoenfeld and martingale residuals) and less common tools (pseudo-observations, martingale residual processes, and Arjas plots)., Results: The proposed strategy is applied to a dataset of patients with myocardial infarction (TRACE data frame). The effects of 5 covariates (age, sex, diabetes, ventricular fibrillation, and clinical heart failure) on the hazard of death are analyzed using multiplicative and additive hazards regression models. The proposed strategy is shown to fit the data optimally., Conclusions: Survival analysis is improved by using multiplicative and additive hazards regression models together, but specific steps must be followed to fit the data optimally. By providing different measures of the same effect, our proposed strategy allows for better interpretation of the data.

Introduction: Healthcare systems worldwide have been battling the ongoing COVID-19 pandemic. Eosinophils are multifunctional leukocytes implicated in the pathogenesis of several inflammatory processes including viral infections. We focus our study on the prognostic value of eosinopenia as a marker of disease severity and mortality in COVID-19 patients., Methods: Between 1 March and 30 April 2020, we conducted a multicenter and retrospective study on a cohort of COVID-19 patients (moderate or severe disease) who were hospitalized after presenting to the emergency department (ED). We led our study in six major hospitals of northeast France, one of the outbreak's epicenters in Europe., Results: We have collected data from 1035 patients, with a confirmed diagnosis of COVID-19. More than three quarters of them (76.2%) presented a moderate form of the disease, while the remaining quarter (23.8%) presented a severe form requiring admission to the intensive care unit (ICU). Mean circulating eosinophils rate, at admission, varied according to disease severity ( p < 0.001), yet it did not differ between survivors and non-survivors ( p = 0.306). Extreme eosinopenia (=0/mm 3 ) was predictive of severity (aOR = 1.77, p = 0.009); however, it was not predictive of mortality (aOR = 0.892, p = 0.696). The areas under the Receiver operating characteristics (ROC) curve were, respectively, 58.5% (CI95%: 55.3-61.7%) and 51.4% (CI95%: 46.8-56.1%) for the ability of circulating eosinophil rates to predict disease severity and mortality., Conclusion: Eosinopenia is very common and often profound in cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Eosinopenia was not a useful predictor of mortality; however, undetectable eosinophils (=0/mm 3 ) were predictive of disease severity during the initial ED management.

The aim of this systematic review and meta-analysis was to compare self-ligating brackets (SLBs) considered as a whole to conventional brackets (CBs). An electronic search was performed in three databases (PubMed, MEDLINE via Web of Science, Cochrane Library) from their origin up to June 2017. Additional articles were hand searched from January 2006 to June 2017. This meta-analysis was restricted to randomized controlled trials (RCTs) and split mouth design studies (SMDs). No distinction was made between active and passive SLBs. The following variables were investigated : treatment duration, number of visits, alignment rate, rate of space closure, perception of discomfort during the initial phase of treatment, pain experience during wire insertion or removal, bond failure rate, time to ligate in or to untie an archwire, periodontal indices, occlusal outcomes, transverse arch dimensional changes and root resorption. 25 RCTs and 9 SMDs were finally selected. It was more painful to insert or remove a 0.019× 0.025 SS archwire in/from SLBs. It was significantly quicker to insert or remove an archwire from SLBs. There was less bleeding on probing with SLBs 4 or 5 weeks after bonding. All other variables did not exhibit any significant difference between SLBs and CBs. Out of the 31 comparisons between self-ligating and conventional brackets, 9 only revealed statistically significant differences. This meta-analysis contradicts most of the promotional statements put forward by the distributors.

Biostatistics are omnipresent in the scientific and medical literature and are an essential skill for any health student. We have developed a practical training tool - GMRC Shiny stats - an interactive application specifically dedicated to medical data statistical analysis. The application has been designed to provide an analysis workflow corresponding to the usual progression of an experienced statistician during data analysis. The most common statistical analyses can be performed (descriptive statistics, inferences according to frequentist methods, survival analyses, correlation, agreement measurements, etc.). GMRC Shiny stats is intuitive and user-friendly and assists students in choosing the most appropriate statistical tests. With all these functionalities, students can learn statistical analysis by doing. Getting involved in the statistical analysis and processing of their own data is likely to improve their biostatistics skills., (Copyright © 2020 Académie Nationale de Pharmacie. Published by Elsevier Masson SAS. All rights reserved.)

The aim of this study was to produce a prognostic model to help predict posttransplant survival in patients transplanted with grade-3 acute-on-chronic liver failure (ACLF-3). Patients with ACLF-3 who underwent liver transplantation (LT) between 2007 and 2017 in 5 transplant centers were included (n = 152). Predictors of 1-year mortality were retrospectively screened and tested on a single center training cohort and subsequently tested on an independent multicenter cohort composed of the 4 other centers. Four independent pretransplant risk factors were associated with 1-year mortality after transplantation in the training cohort: age ≥53 years (P = .044), pre-LT arterial lactate level ≥4 mml/L (P = .013), mechanical ventilation with PaO 2 /FiO 2  ≤ 200 mm Hg (P = .026), and pre-LT leukocyte count ≤10 G/L (P = .004). A simplified version of the model was derived by assigning 1 point to each risk factor: the transplantation for Aclf-3 model (TAM) score. A cut-off at 2 points distinguished a high-risk group (score >2) from a low-risk group (score ≤2) with 1-year survival of 8.3% vs 83.9% respectively (P < .001). This model was subsequently validated in the independent multicenter cohort. The TAM score can help stratify posttransplant survival and identify an optimal transplantation window for patients with ACLF-3., (© 2020 The American Society of Transplantation and the American Society of Transplant Surgeons.)

Background: To assess the risks of local and distant failure and overall survival time in patients treated with hypofractionated stereotactic radiotherapy (HFSRT) to the postoperative cavity for brain metastases (BMs) compared with patients treated with adjuvant whole-brain radiation therapy (WBRT)., Methods: Between July 2005 and February 2015, 196 non-randomized patients with 202 resected BMs were treated with post-operative WBRT or HFSRT at a single institution. The propensity score was included as a covariate to compare the interval to local failure, distant brain failure and overall survival time. The matching covariates consisted of the age, Karnofsky performance status, primary disease, number of BMs, extracranial disease status and presence or absence of extracranial metastases., Results: In total, 110 patients (54.5%) received adjuvant WBRT, and 92 HFSRT procedures (45.5%) were delivered after surgery. A Cox model adjusted on the propensity score showed that the brain distant failure was significantly associated with treatment modality. Compared with WBRT, the patients who received HFSRT had a significantly greater risk of developing distant brain recurrence [HR =3.37 (2.13-5.33), P<0.001]. No difference was observed in local failure (HR =1.16, P=0.77) between the groups. In the propensity-matched cohort, the effect of treatment on survival was not significant (P=0.14), but it depended on the time. Within the first 20 months, the patients treated with WBRT had a 2 times higher risk of death than did patients treated with HFSRT [HR =2.17 (1.42-3.32), P=0.0003]., Conclusions: Compared with the standard WBRT after the resection of BMs, stereotactic radiotherapy to the surgical bed produced a comparable local control rate to that of WBRT with a survival advantage in the first 20 months.

Nocturnal Legs Cramps are a frequent disorder, which have a negative impact on quality of life, particularly among patients over 60 years old. Lifestyle factors such as alcohol consumption have been shown to be associated with Nocturnal Leg Cramps. This study aimed to explore the association between nocturnal leg cramps and a sedentary lifestyle among elderly patients. A case-control study was conducted with a Bayesian approach for sensitivity analysis. Patients over 60 years old consulting their family doctor were recruited in the Alsace region, France. Cases were matched with controls free from cramps for age, sex, medical history and medications known to trigger cramps. The level of physical activity was assessed using the Dijon Physical Activity Score (DPAS). We performed univariate and multivariate analyses adjusting for alcohol consumption. 272 participants were matched into 136 pairs. 11% of all were sedentary persons. Adjusting for alcohol consumption, we observed an association between Nocturnal Leg Cramps and a sedentary lifestyle OR = 9.84 (95% credibility interval [1.74; 101.9]; posterior probability 99.68%). Our findings represent an additional argument to promote physical activity to patients over 60 years old. They also highlight the need to develop and evaluate physical activity interventions in the treatment of Nocturnal Legs Cramps.

In the terrestrial crustacean Armadillidium vulgare, a large size range exists in natural populations within which males and females could potentially mate. Because of continuous growth far beyond sexual maturity, the largest individuals can be nearly ten times the live mass of the smallest sexually mature individuals. In this study, we explored the influence of male and female body mass on the mating behaviour and success. Starting with a representative panel of males and females in which females are significantly larger than males in average, we followed the sexual behaviour of 23 groups of 20 mixed-sex virgin animals under conditions comparable with natural field situation during the early breeding season. We found a correlation between paired individuals showing an assortative pairing. During pairing male stimulates female and duration of stimulation is determinant for pairing follow-up: efficient stimulation is correlated with female size and not with male size. In consequence, pairs in mating show a reversed size dimorphism between male and female where female are about 20% smaller. Largest females were not mated. During copulation behaviour, the quantity of sperm transferred is positively correlated with copulation duration. Stored sperm can be used for immediate breeding by the female and stored in the spermatheca for future breeding. The last option allows to largest females in the field to continue breeding without additional mating, avoiding the lack of availability of large males able to stimulate them efficiently., (Copyright © 2019 The Authors. Published by Elsevier B.V. All rights reserved.)

Objective: The objective of this study was to determine the prevalence and identify risk factors for obstetric anal sphincter injuries (OASIS), and to determine the prevalence of episiotomy and whether it is protective for the posterior perineum., Study Design: This is a retrospective case-control study carried out in a level 2 maternity unit and a level 3 maternity unit between 1 January 2006 and 31 December 2015. The sample population included all vaginal deliveries at term of a living singleton foetus in cephalic presentation. The case group comprised patients with an OASIS. The control group comprised patients without OASIS. Statistical analysis was subdivided into descriptive and inferential parts., Results: 42,626 patients were included in the study of whom 496 were cases of OASIS, i.e. a rate of 1.2%. The overall episiotomy rate was 10.0%, which reflects a restrictive practice. Episiotomy doesn't appear to be a statistically significant protective factor for OASIS (OR=0.89-95%CI [0.68-1.16]). The principal independent risk factors for OASIS were nulliparity (ORa=4.19-95%CI [3.03-5.84] - p<0.001), previous caesarean (ORa=5.59-95%CI [3.68-8.44] - p<0.001), uterine fundal height greater than 32cm (ORa=1.35-95%CI [1.03-1.77] - p=0.03), gestational or pre-pregnancy diabetes (ORa=1.76-95%CI [1.22-2.46] - p=0.002), birthweight of more than 3500g (ORa=1.48-95%CI [1.17-1.87] - p=0.001), assisted delivery (ORa=1.81-95%CI [1.18-2.86] - p=0.007), and use of a second instrument or obstetrical manoeuvre (ORa=1.93-95%CI [1.05-3.30] - p=0.02)., Conclusion: Episiotomy doesn't appear to be a statistically significant protective factor on the perineal prognosis. A deeper understanding of the factors which promote OASIS and greater awareness of them would improve the perineal prognosis of parturient women., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Introduction: In routine practice, it is often necessary to use shorter screws in L5 than L4. The present study measured L5 versus L4 vertebral pedicles, to guide surgical strategy., Material and Method: CT or MRI scans for 95 patients were analyzed. Radiographic measurements (anteroposterior diameter (APD), pedicle length (PL) and pedicle width (PW)) were taken by a spine surgeon. Statistical analysis used R 3.4.3 software., Results: Ninety-five patients were included: 48 female (50.53%), 47 male (49.47%); mean age, 57 years (range, 19-85 years). Univariate analysis found a strong correlation between right and left PL values in L4 and L5. Right and left values were pooled, obtaining a mean L4 PL of 55.34mm (range, 54.23-56.45mm) and L5 PL of 51.80mm (44.81-58.80) and L4 PW of 10.48mm (10.06-10.91) and L5 PW of 9.90mm (7.43-12.39). Multivariate analysis disclosed significant effects of age and gender, with greater age and male gender associated with greater anteroposterior vertebral diameter. Mean anteroposterior vertebral length was significantly shorter in L5 than L4 by 3.57mm (range, 4.08-3.06mm)., Discussion: Anteroposterior pedicle length was shorter in L5 than L4, in line with the literature. This answers the surgeon's question: "Should pedicle screws be shorter in L5 than L4?". From these results, it seems logical to use an L5 screw that is 5mm shorter than in L4, to secure good intra-body screw fixation., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Dysfunction of virus-specific CD4 + T cells in chronic human infections is poorly understood. We performed genome-wide transcriptional analyses and functional assays of CD4 + T cells specific for human immunodeficiency virus (HIV) from HIV-infected people before and after initiation of antiretroviral therapy (ART). A follicular helper T cell (T FH cell)-like profile characterized HIV-specific CD4 + T cells in viremic infection. HIV-specific CD4 + T cells from people spontaneously controlling the virus (elite controllers) robustly expressed genes associated with the T H 1, T H 17 and T H 22 subsets of helper T cells. Viral suppression by ART resulted in a distinct transcriptional landscape, with a reduction in the expression of genes associated with T FH cells, but persistently low expression of genes associated with T H 1, T H 17 and T H 22 cells compared to the elite controller profile. Thus, altered differentiation is central to the impairment of HIV-specific CD4 + T cells and involves both gain of function and loss of function.

Aim: Identified Palliative Care Beds (Lits Identifiés Soins Palliatifs - LISPs) is a French specificity. Primarily created to integrate palliative care culture into conventional hospital units, the relevance of this measure became a controversial issue. Nowadays, hospital teams continue to frequently encounter complex situations regarding medical care for palliative patients. To the best of our knowledge, there is only one study, a quantitative one, bridging the gap about that subject. It showed failure in practicing palliative care work around LISP. Our study is based on a qualitative method that complements the quantitative study. It aimed to describe difficulties that limit palliative care practices in managing adult patients in LISP., Method: This qualitative exploratory survey was conducted with a sample of health service professionals (n=20), from senior physicians to caregivers. Each semi-structured interview included open questions regarding their experiences, feelings and difficulties with palliative care practices on LISP. It also included closed questions concerning interviewee's demographics and career course. The data for this research were submitted to a two-stage analysis: first, a global review of each interview was performed to identify trends. Then, a detailed breakdown, question by question, was implemented., Results: From a quantitative perspective, the interviews revealed 305 difficulties, indicating the gaps and barriers limiting the implementation of a palliative approach in these services. From a qualitative perspective, five topics raised our attention by their recurrence in discourses: (1) partial knowledge about palliative care definition and legislation mostly due to a lack of training; (2) need for time; (3) need for human resources; (4) need for communication; (5) hard time in transitioning from curative to palliative care., Perspective: This survey gives the opportunity to understand health service professionals' difficulties in practicing palliative care in conventional medical services. It raises the central issue of the pricing reform on the health institutes activity. It also provides angles of inquiry to improve LISP effectiveness. This qualitative and descriptive study was designed to explore difficulties in practicing palliative care around LISP. Nevertheless, according to the size of the sample, results will need to be confirmed by a more extensive qualitative survey., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Background: The efficacy of antitumour necrosis factor alpha (anti-TNF-α) treatment is well recognised in rheumatoid arthritis (RA) but remains controversial in systemic lupus erythematosus (SLE). Therefore, the role of anti-TNF-α treatment in 'Rhupus', a disease sharing features of RA and SLE, is still debated., Objective: To evaluate the efficacy and tolerance of anti-TNF-α in patients with rhupus., Methods: Fifteen patients with rhupus with Disease Activity Score 28 (DAS 28) >3.2 despite conventional disease-modifying anti-rheumatic drugs were included in an open-label study. Patients were monitored at months (M) 3, 6, 12, 24 and 60 with SLE Disease Activity Index (SLEDAI) and DAS 28. Statistical analyses were performed using Bayesian methods and Prob >97.5% was considered significant., Results: Twelve patients were treated with etanercept for a median duration of 62.5 (range: 6-112) months and three patients by adalimumab during 36.0 (range: 4-52) months. At baseline, median DAS 28 and SLEDAI were 5.94 (4.83-8.09) and 6 (4-8), respectively. DAS 28 and SLEDAI decreased significantly after 3 months, respectively, to 3.70 (1.80-6.42) and 4 (0-6) (Prob >99.9%, for both). These changes persisted at M6, M12, M24 and M60 (Prob >99.9%, for all). Median prednisone dose decreased significantly from 15 (5-35) mg/day to 5 (0-20) mg/day after 6 months and over the follow-up (Prob >99.9%, for all). Tolerance was acceptable, with a severe infection rate of 3.0 per 100 patient-years., Conclusion: This pilot study suggests that anti-TNF-α is effective in patients with rhupus with refractive arthritis and has an acceptable safety profile., Competing Interests: Competing interests: FD reports personal fees from Gilead outside the submitted work. LS reports personal fees from AbbVie, Pfizer, Roche and Roche Chugai, outside the submitted work. LA reports consulting fees from Amgen, GSK, Lilly and AstraZeneca. TM reports personal fees from GSK and Merck, during the conduct of the study. J-EG reports research grants and consulting fees from AbbVie, BMS, MSD, UCB, Pfizer and Roche. JS reports personal fees from AbbVie, BMS, MSD, UCB, Pfizer, Roche, Novartis, GSK, Actelion, Amgen and Hospira, during the conduct of the study, and consultancies and speaking fees from AbbVie, Roche, Pfizer, Merck, UCB, Novartis, BMS and Actelion. CS reports personal fees from AbbVie and Pfizer, outside the submitted work.

Background: With the steady increase of endovascular procedures involving the aortic arch (AA), an actual depiction of its anatomy has become mandatory. It has also become necessary to evaluate the natural evolution of the AA morphology as part of the evaluation of endovascular devices durability. The objective of this study was to perform a morphological and anatomical study of the AA and of the supra aortic trunks (SAT) in healthy patients, with an evaluation of their evolution with time, with a specific orientation applied to endovascular therapies of the AA., Methods: Sixty-one patients (31 men, mean age 50.8 [18-82]) with a normal anatomy were included in the study. Measurements included the diameters of the AA and SAT in 17 locations, their distance and angulation based on computed tomography angiography data. Statistical analysis focused on descriptive statistics, differences between genders, as well as correlations with age., Results: Aortic diameters (mean ± SD) were 29.5 ± 3.9 mm at the ascending aorta, 28.6 ± 3.9 mm at the innominate artery (IA), 27.1 ± 3.2 mm at the left common carotid artery (LCCA), 25.3 ± 3.0 mm at the left subclavian artery (LSCA), 23.9 ± 3.3 mm at the descending aorta. Mean angulation of the AA was 82° (95% confidence interval [CI]: 78.95-85.19°), mean angulation between LSCA/LCCA was -5.7° (95% CI: -0.9 to 18.7°) and -1.8° (95% CI: 5.4-26.4°) between LCCA/IA. Mean distance between the LSCA and the LCCA was 14.3 mm (95% CI: 13-15.6 mm) and 21.8 mm (95% CI: 20.3-23.4 mm) between LCCA and IA. All diameters of the AA increased with age (P < 0.05). Men had diameters statistically (P < 0.05) greater than women except at the LCCA ostium level. A statistically significant increase of the distances between the LSCA and the LCCA, between the LSCA and the IA and between the IA and the LCCA was found with age, P = 0.027, <0.01 and 0.012 respectively., Conclusions: This study allows obtaining accurate information of the AA and the SAT anatomy. It enabled to obtain a better understanding of the three-dimensional aspects of the AA, confirmed the variability and heterogeneity of the SAT disposition, and discussed the principles of vascular aging., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Introduction: The aim of this study is to assess the attractiveness in the smile arch of different vertical positions of the incisal edges of the maxillary lateral incisors., Material and Methods: A frontal photograph of a Caucasian woman's smile was digitally modified to obtain an image with the incisal edges of the maxillary lateral incisors symmetrically tangent to the smile arch. These incisal edges were then moved vertically by 0.5 mm increments. The value was considered positive for an occlusal shift and negative for a gingival shift. Four other images were obtained by moving the incisal edges from +0.5 mm to -1.5 mm. The five images were rated on a visual analog scale by three groups of evaluators: orthodontists, dentists and laypersons. A statistical analysis was performed., Results: Laypersons preferred first lateral incisors tangent to the smile arch, second a +0.5 mm shift, and third a -0.5 mm shift. Orthodontists and dentists preferred first a -0.5 mm shift and second a null shift., Conclusions: The aesthetic perception of the smile, as regard to the vertical relationships between the incisal edges of the anterior teeth, differs between laypersons and professionals but remains homogenous between orthodontists and dentists. The most consensual aesthetic situation, from both professionals' and laypersons' points of view, is the geometry in which the incisal edges of the maxillary lateral incisors are tangent to the smile arch., (© EDP Sciences, SFODF, 2017.)

Background & Objective: The majority of studies assessing the rupture rate of breast implants were performed by the breast implant manufacturing industry with questionable independence. After repetitive removals of ruptured implants from the same model, our team decided to assess the rupture rate and the estimated risk thereof for most of the silicone gel-filled implants we have used since they regained market approval in France in 2001., Methods: Our study is a retrospective cohort of 809 patients operated in our University Hospital from 2001 to 2013 for cosmetic or reconstructive goals. We could track 1561 implants, 90% of them from the same manufacturer, Allergan (Irvine, CA, USA). For each of those, we gathered their exact reference, date of implantation, surgical approach, status, last follow-up visit or the eventual date, and cause of removal., Results: Of 225 explanted devices, only 27 were ruptured, all from the Allergan brand. Risks of removal for rupture were estimated: 0.5% at 1000 days, 6% at 2000 days, and 14% at 3000 days. Risks were significantly different between the models from this same manufacturer. One of the range of macro-textured round implants showed risks of removal for rupture of 33% at 3000 days compared to 6% for the anatomically shaped range., Conclusions: These results suggest a qualitative discrepancy among the different ranges of breast implants of a single manufacturer within the same timeframe of implantation. To determine the in vivo lifespan of the implants that we use more precisely and sooner, we suggest that each removed implant should be analyzed for wear and tear, independently from the industry., (Copyright © 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Background: Ultrasonography is a well-established efficient diagnostic tool for ileocolic intussusceptions in children. It can also be used to control hydrostatic reduction by saline enemas. This reduction method presents the advantage of avoiding radiations. Parents can even stay with their children during the procedure, which is comforting for both. The purpose of this study was to present our 20 years' experience in intussusception reductions using saline enema under ultrasound control and to assess its efficiency and safety., Material and Methods: This retrospective single center study included patients with ileocolic intussusceptions diagnosed by ultrasound between June 1993 and July 2013. We excluded the data of patients with spontaneous reduction or who underwent primary surgery because of contraindications to hydrostatic reduction (peritonitis, medium or huge abdominal effusion, ischemia on Doppler, bowel perforation). A saline enema was infused into the colon until the reduction was sonographically confirmed. The procedure was repeated if not efficient. Light sedation was practiced in some children., Results: Eighty-tree percent of the reductions were successful with a median of 1 attempt. Reduction success decreased with the number of attempts but was still by 16% after 4 attempts. The early recurrence rates were 14.5%, and 61.2% of those had a successful second complete reduction. Forty-six patients needed surgery (11 of them had a secondary intussusception). Sedation multiplies success by 10. In this period, only one complication is described., Conclusion: Ultrasound guided intussusception reduction by saline enema is an efficient and safe procedure. It prevents exposure of a young child to a significant amount of radiation, with similar success rate. We had very low complication rate (1/270 cases or 3‰). The success rate could be increased by standardized procedures including: systematic sedation, trained radiologists, accurate pressure measurement, and number and duration of attempts., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Purpose: Selection of patients for resection of synchronous liver metastases (LM) and peritoneal carcinomatosis (PC) of colorectal cancer (CRC) remains a debated issue since morbidity of this surgery is not negligible. We aimed to define overall survival (OS) prognostic criteria in patients undergoing PC surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) and LM resection., Methods: This monocentric and comparative study included all consecutive patients operated for LM (LM group, n = 77), PC (HIPEC group, n = 18) and PC + LM (LM + HIPEC group, n = 9) from January 2007 to May 2011. Characteristics of the 3 groups were prospectively collected and retrospectively compared., Results: Median follow-up was 56,5 months. Major morbidity and mortality were respectively 14% and 3%. Two-year disease free and overall survival rates were respectively 23% and 76%. There were significantly more Dindo grade III-IV complications in LM + HIPEC group. In multivariate analysis, grade II and III preoperative chemotherapy-induced toxicity and size of LM were identified as poor OS prognostic factors whereas response to preoperative chemotherapy significantly increases OS. OS was not different (p = 0.235) between the 3 groups., Conclusion: Toxicity to preoperative chemotherapy and size of LM were identified as poor prognostic factors in patients undergoing simultaneous PC and LM surgery. These criteria could help in better selecting patients for such extensive surgery., (Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.)

Aim: To analyze the reliability of endocervical curettage (ECC) in the diagnosis of high-grade cervical intraepithelial neoplasia and cervical cancer, and to identify risk factors associated with diagnostic underestimation., Materials and Methods: A retrospective study was carried-out involving 445 patients who underwent ECC for: endocervical lesion incompletely visible on colposcopy or inaccessible to biopsy; atypical glandular cells on smear, or discrepancy between colposcopic impression and cytological abnormalities., Results: Comparison between ECC and final diagnosis showed a perfect match in 362 patients (81.3%). For 189 patients with pre-cancerous or cancerous endocervical lesions, the sensitivity, specificity, and positive and negative predictive values were 87.3%, 96.9%, 95.4% and 91.9%, respectively. No clinical, cytological or colposcopic characteristics were associated with significantly increased risk of diagnostic underestimation with ECC., Conclusion: ECC is a very reliable tool for reducing the number of unnecessary treatments, without increasing the risk of allowing some lesions to evolve into cancer., (Copyright© 2015 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.)

Background: Given the discordant results of studies that have reported cases of RLS associated with brainstem stroke and the absence of RLS in large series describing the clinical spectrum of brainstem infarctions, we decided to assess RLS in all patients admitted for brainstem stroke., Methods: All patients who were consecutively referred to the Strasbourg stroke unit for brainstem infarction were prospectively evaluated for RLS. The different parameters analyzed were the topography of the ischemic lesions (magnetic resonance imaging), the different symptoms (sensory, motor, cerebellar, cranial nerves and dysarthria) and the NIH stroke scale. Statistical analyses used the Bayesian paradigm., Results: Thirty patients have been included, and RLS was observed in three patients (10%). Two patients suffered from an exacerbation of symptoms anterior to the stroke, and the other patient a de novo, but transient, RLS. Patients with stroke-induced sensory symptoms have a higher risk to develop brainstem stroke-related RLS as compared to patients without sensory symptoms., Conclusion: The results suggest that RLS should be systematically screened in patients affected with brainstem stroke, especially in the case of stroke-induced sensory symptoms. Clinicians should be aware of this association, especially as efficient treatments are available and allow improving the management of patients affected with stroke.