Search

Background/Aim: the aim of this study was to assess the skull vibration-induced nystagmus test (SVINT) results and vestibular residual function after horizontal semicircular canal (HSCC) plugging. Methods: In this retrospective chart review performed in a tertiary referral center, 11 patients who underwent unilateral horizontal semicircular canal plugging (uHSCCP) for disabling Menière’s disease (MD) were included. The skull vibration-induced nystagmus (SVIN) slow-phase velocity (SPV) was compared with the results of the caloric test (CaT), video head impulse test (VHIT), and cervical vestibular-evoked myogenic potentials (cVEMP) performed on the same day. Results: Overall, 10 patients had a strong SVIN beating toward the intact side (Horizontal SVIN-SPV: 8.8°/s ± 5.6°/s), 10 had a significant or severe ipsilateral CaT hypofunction, 10 had an ipsilateral horizontal VHIT gain impairment, and 3 had altered cVEMP on the operated side. Five had sensorineural hearing worsening. SVIN-positive results were correlated with CaT and horizontal VHIT (HVHIT) results (p < 0.05) but not with cVEMP. SVIN-SPV was correlated with CaT hypofunction in % (p < 0.05). Comparison of pre- and postoperative CaT % hypofunction showed a significant worsening (p = 0.028). Conclusion: SVINT results in a human model of horizontal canal plugging are well correlated with vestibular tests exploring horizontal canal function, but not with cVEMP. SVINT always showed a strong lesional nystagmus beating away from the lesion side. SVIN acts as a good marker of HSCC function. This surgical technique showed invasiveness regarding horizontal canal vestibular function.

Abstract Background Chronic kidney disease (CKD) is a global public health problem. Cell therapy using pluripotent stem cells represents an attractive therapeutic approach for the treatment of CKD. Methods We transplanted mitomycin C (MMC)-treated human induced pluripotent stem cells (hiPSCs) and renal progenitor cells (RPCs) into a CKD rat model system. The RPC and hiPSC cells were characterized by immunofluorescence and qRT-PCR. Untreated 5/6 nephrectomized rats were compared to CKD animals receiving the same amount of MMC-treated hiPSCs or RPCs. Renal function, histology, and immunohistochemistry were evaluated 45 days post-surgery. Results We successfully generated hiPSCs from peripheral blood and differentiated them into RPCs expressing renal progenitor genes (PAX2, WT1, SIX2, and SALL1) and podocyte-related genes (SYNPO, NPHS1). RPCs also exhibited reduced OCT4 expression, confirming the loss of pluripotency. After cell transplantation into CKD rats, the body weight change was significantly increased in both hiPSC and RPC groups, in comparison with the control group. Creatinine clearance (CCr) was preserved only in the hiPSC group. Similarly, the number of macrophages in the kidneys of the hiPSC group reached a statistically significant reduction, when compared to control rats. Both treatments reduced positive staining for the marker α-smooth muscle actin. Histological features showed decreased tubulointerstitial damage (interstitial fibrosis and tubular atrophy) as well as a reduction in glomerulosclerosis in both iPSC and RPC groups. Conclusions In conclusion, we describe that both MMC-treated hiPSCs and RPCs exert beneficial effects in attenuating CKD progression. Both cell types were equally efficient to reduce histological damage and weight loss caused by CKD. hiPSCs seem to be more efficient than RPCs, possibly due to a paracrine effect triggered by hiPSCs. These results demonstrate that the use of MMC-treated hiPSCs and RPCs improves clinical and histological CKD parameters, avoided tumor formation, and therefore may be a promising cell therapy strategy for CKD. Graphical abstract

Brominated flame retardants (BFR) are primarily used as flame retardant additives in insulating materials. These lipophilic compounds can bioaccumulate in animal tissues, leading to human exposure via food ingestion. Although their concentration in food is not yet regulated, several of these products are recognised as persistent organic pollutants; they are thought to act as endocrine disruptors. The present study aimed to characterise the occurrence of two families of BFRs (hexabromocyclododecane (HBCDD) and polybrominated diphenyl ethers (PBDE)) in hen eggs and broiler or pig meat in relation to their rearing environments. Epidemiological studies were carried out on 60 hen egg farms (34 without an open-air range, 26 free-range), 57 broiler farms (27 without an open-air range, 30 free-range) and 42 pig farms without an open-air range in France from 2013 to 2015. For each farm, composite samples from either 12 eggs, five broiler pectoral muscles or three pig tenderloins were obtained. Eight PBDE congeners and three HBCDD stereoisomers were quantified in product fat using gas chromatography–high-resolution mass spectrometry, or high-performance liquid chromatography–tandem mass spectrometry, respectively. The frequencies of PBDE detection were 28% for eggs (median concentration 0.278 ng/g fat), 72% for broiler muscle (0.392 ng/g fat) and 49% for pig muscle (0.403 ng/g fat). At least one HBCDD stereoisomer was detected in 17% of eggs (0.526 ng/g fat), 46% of broiler muscle (0.799 ng/g fat) and 36% of pig muscle (0.616 ng/g fat). Results were similar in concentration to those obtained in French surveillance surveys from 2012 to 2016. Nevertheless, the contamination of free-range eggs and broilers was found to be more frequent than that of conventional ones, suggesting that access to an open-air range could be an additional source of exposure to BFRs for animals. However, the concentration of BFRs in all products remained generally very low. No direct relationship could be established between the occurrence of BFRs in eggs and meat and the characteristics of farm buildings (age, building materials). The potential presence of BFRs in insulating materials is not likely to constitute a significant source of animal exposure as long as the animals do not have direct access to these materials.

Introduction: Most cochlear implants are currently compatible with magnetic resonance imaging (MRI) up to 3 T. Nevertheless, this does not completely eliminate the risk of serious accidents. Implant displacements and other adverse events with compatible implants have been reported in the literature. Case reports: Among the six patients who had MRI after receiving implants at our center, we report three cases with adverse events related to the examination. The first case was complicated by magnet displacement with partial demagnetization. The second case showed total demagnetization, which necessitated removal and reimplantation of the implant. The third case involved severe pain sensation which disrupted the MRI scan. The smallest artifact was found with 3D MRI angiography, and largest artifact was found with diffusion and T2 FLASH. Discussion: Moving the patient into the MRI apparatus must be supervised by an otorhinolaryngology specialist or an experienced radiologist. It is important to consider the magnetic field directions, so that angle between the implant magnetic fields and the MRI B0 always remains less than or equal to 90°. In addition, we recommend the use of an “arrow drawing” to facilitate the orientation of the magnetic field directions. Furthermore, to prevent magnet displacement, we recommend systematic use of a protective splint in addition to bandaging. Keywords: MRI, Cochlear implant, Risk

Dairy systems are a source of pollutant emissions, such as greenhouse gases (GHG) and NH3 that are associated with impacts on the environment. Gas emissions in barns are related mainly to diet intake and chemical composition, N excretion and manure management. A reduction in dietary N is known to be an effective way to reduce N excretion and the resulting NH3 emissions. However, most studies consider manure in liquid form with frequent removal from the barn. In deep litter systems, several processes can occur during the accumulation of solid manure that result in variable gas emissions. The objective of this experiment was to investigate the influence of the interaction between dietary CP (low or high) and manure management (liquid or solid) on gas emissions (NH3, N2O, CH4) at the barn level. Dietary treatments provided either low (LowN; 12% CP) or high (HighN; 18% CP) degradable protein to modify the amount of total ammonia nitrogen (TAN) excreted. The cows were housed for two 8-week periods in two mechanically ventilated rooms equipped to manage manure either in liquid (LM; slurry) or solid form (SM; deep litter). In the LM treatment, N balance was measured for 4 days. As expected, animals fed the LowN diet ingested 35% less N and excreted 65% less N in their urine, with no reduction in faecal N excretion and N secretion in milk. On the LowN diet, excretion of urea-N and NH3-N emissions were reduced regardless of the manure management. On the HighN diet, urinary urea-N excretion was three times as high, while NH3-N emissions were 3.0 and 4.5 times as high in LM and SM, respectively. Manure management strongly influenced CH4-C emissions, which were 30% higher in SM than in LM, due to the accumulation of litter. Moreover, gas emissions from solid manure increased over the accumulation period, except for NH3 on the LowN diet. Finally, our results suggest that methods used for national inventories would become more accurate by considering the variability in TAN excretion, which is the primary factor that influences NH3 emissions.

Background Atypical Hemolytic Uremic Syndrome (aHUS) is an ultra-rare disease that potentially leads to kidney graft failure due to ongoing Thrombotic Microangiopathy (TMA). The aim was evaluating the frequency of TMA after kidney transplantation in patients with aHUS in a Brazilian cohort stratified by the use of the specific complement-inhibitor eculizumab. Methods This was a multicenter retrospective cohort study including kidney transplant patients diagnosed with aHUS. We collected data from 118 transplant centers in Brazil concerning aHUS transplanted patients between 01/01/2007 and 12/31/2019. Patients were stratified into three groups: no use of eculizumab (No Eculizumab Group), use of eculizumab for treatment of after transplantation TMA (Therapeutic Group), and use of eculizumab for prophylaxis of aHUS recurrence (Prophylactic Group). Results Thirty-eight patients with aHUS who received kidney transplantation were enrolled in the study. Patients’ mean age was 30 years (24–40), and the majority of participants was women (63% of cases). In the No Eculizumab Group (n = 11), there was a 91% graft loss due to the TMA. The hazard ratio of TMA graft loss was 0.07 [0.01–0.55], p = 0.012 in the eculizumab Prophylactic Group and 0.04 [0.00–0.28], p = 0.002 in the eculizumab Therapeutic Group. Conclusion The TMA graft loss in the absence of a specific complement-inhibitor was higher among the Brazilian cohort of kidney transplant patients. This finding reinforces the need of eculizumab use for treatment of aHUS kidney transplant patients. Cost optimization analysis and the early access to C5 inhibitors are suggested, especially in low-medium income countries.

Dengue infection (DI) is the most important arboviral infection in the world. The majority of immunocompetent patients will have asymptomatic or mild infections, but the degree of dengue severity in kidney transplant recipients (KTx) is unknown. In this study, we report the clinical profile and outcomes of 39 dengue cases in KTx. From a total of 1,186 KTx outpatients in follow-up we reviewed clinical and laboratory records of 60 (5%) patients admitted with suspected DI initially screened by NS-1, IgM, and when possible, multiplex nested PCR. The prevalence of DI in KTx was 3% (39/1,118), with symptoms leading to hospital admission being fever, myalgia, malaise, and headache. Laboratory tests showed leucopenia, thrombocytopenia, and liver enzyme elevation. DI was confirmed by positivity of NS-1 (33%), IgM (69%), and/or RT-PCR (59%). Twenty-three patients (59%) had dengue with warning signs, and 15% had severe dengue, 2 of them with a fatal course. Acute graft dysfunction occurred in 59% (mean nadir serum creatinine: 2.9 ± 2.6mg/dL), 4 of them requiring dialysis. CMV coinfection diagnosed in 19% of the cases and patients was associated with worse clinical presentation. Our results suggest that KTx with DI presented initial physical and laboratorial profile similar to the general population. However, DI in KTx seems to have a higher risk for graft dysfunction, severe dengue, and death. Because CMV coinfection aggravates the DI clinical presentation and recovery, it must be evaluated in all cases.

Cutaneous squamous cell of the skin is a common neoplasm that frequently arises from precancerous actinic keratoses. Here, the authors carry out genomic analysis on matched sets of human lesions and compare with those in ultraviolet treated mice and identify conserved drivers of tumour development.

Background. Donors after brain death develop a systemic proinflammatory state that may predispose the kidneys to injury after transplantation. Because it is not known whether this inflammatory environment similarly affects the kidneys from expanded criteria donor (ECD) and standard criteria donors (SCD), we sought to evaluate differences in the gene expression of inflammatory cytokines in preimplantation biopsies (PIBx) from ECD and SCD kidneys. Methods. Cytokines gene expression was measured in 80 PIBx (SCD, 52; ECD, 28) and associated with donor variables. Results. Normal histology and chronic histological lesions were not different between both types of kidneys. ECD kidneys showed significant increase in the transcripts of MCP-1, RANTES, TGF-β1, and IL-10 when compared with SCD. Kidneys presenting normal histology had similar inflammatory profile except by a higher expression of RANTES observed in ECD (P = 0.04). Interstitial fibrosis and tubular atrophy (interstitial fibrosis and tubular atrophy ≥ 1) were associated with higher expression of TGF-β1, RANTES, and IL-10 in ECD compared with SCD kidneys. Cold ischemia time of 24 hours or longer was significantly associated with upregulation of FOXP3, MCP-1, RANTES, and IL10, whereas longer duration of donor hospitalization significantly increased gene expression of all markers. High FOXP3 expression was also associated with lower level of serum creatinine at 1 year. Donor age was not associated with any of the transcripts studied. Conclusions. PIBx of ECD exhibit a higher gene expression of inflammatory cytokines when compared with SCD kidneys. This molecular profile may be a specific ECD kidney response to brain death and may help to predict the posttransplant outcomes of ECD recipients.

The therapeutic effect of induced pluripotent stem cells (iPSs) on the progression of chronic kidney disease (CKD) has not yet been demonstrated. In this study, we sought to assess whether treatment with iPSs retards progression of CKD when compared with bone marrow mesenchymal stem cells (BMSCs). Untreated 5/6 nephrectomized rats were compared with CKD animals receiving BMSCs or iPSs. Renal function, histology, immunohistochemistry, and gene expression were studied. Implanted iPSs were tracked by the SRY gene expression analysis. Both treatments minimized elevation in serum creatinine, significantly improved clearance, and slowed down progression of disease. The proteinuria was reduced only in the iPS group. Both treatments reduced glomerulosclerosis, iPSs decreased macrophage infiltration, and TGF-β was reduced in kidneys from the BMSC group. Both types of treatments increased VEGF gene expression, TGF-β was upregulated only in the iPS group, and IL-10 had low expression in both groups. The SRY gene was found in 5/8 rats treated with iPSs. These 5 animals presented tumors with histology and cells highly staining positive for PCNA and Wilms’ tumor protein antibody characteristics of Wilms’ tumor. These results suggest that iPSs may be efficient to retard progression of CKD but carry the risk of Wilms’ tumor development.

Un des intérêts de la méthanisation est qu'elle peut participer à un recyclage extrêmement rentable des déchets. De fait, les collectivités ont un rôle à jouer dans ce processus car elles génèrent de nombreux types de déchets. Mais dans quelles mesures leur participation est-elle actuellement intéressante ? La volonté d'aboutir à une plus grande efficacité induit des changements de comportement de la part des foyers et des institutions. Quels sont-ils?

To compare the prevalence of cardiovascular risk factors (CVRF) in patients with superior vestibular neuritis (SVN) versus the general French population, and to examine the possibility of vascular etiology in acute superior vestibular deficit. A single-center retrospective study compared the prevalence of hypercholesterolemia, hypertension, diabetes, smoking, cardiovascular disease and atrial fibrillation between patients with SVN and the French general population. Inclusion criteria comprised: rotatory vertigo lasting several days, without hearing impairment or neurological signs, with anterior and lateral semicircular canal involvement on video-Head-Impulse-Test (vHIT). A senior radiologist analyzed superior vestibular nerve and inner ear structure enhancement on cerebellopontine MRI. One hundred and eighteen cases of SVN were included from May 2016 to February 2020. Statistical analyses concerned 106 cases. The SVN population had significantly less hypercholesterolemia (RR = 0.40) than the general French population. There was no significant difference concerning other CVRFs. Superior vestibular nerve enhancement was observed on 84% of MRIs. Prevalence of CVRF was not higher in patients with SVN than in the general population. The present study highlighted involvement of the superior vestibular nerve more than of the anterior vestibular artery in SVN. [ABSTRACT FROM AUTHOR]

Tout projet de méthanisation agricole a besoin de déchets très fermentescibles et doit pouvoir valoriser au mieux la chaleur issue de la cogénération pour améliorer sa rentabilité. Cet article montre que les collectivités produisent de nombreux déchets organiques : déchets verts, déchets de la restauration collective, fraction organique des ordures ménagères, boues de station d'épuration urbaines, algues vertes... Malgré cette diversité, assez peu de déchets peuvent être utilisés pour la méthanisation agricole car ils doivent à la fois cumuler les avantages d'un potentiel méthanogène élevé, être triés, si possible source de redevance et les gisements ne doivent pas être trop atomisés, ni trop loin, autant de facteurs difficiles à réunir. Cependant des exemples, témoignages d'opportunités, et des marges de progrès existent. Parallèlement au traitement d'une partie de leurs déchets, les collectivités disposent d'un large parc de bâtiments avec des besoins thermiques parfois très élevés pour leur chauffage et eau chaude sanitaire. La valorisation de l'énergie thermique produite par la méthanisation agricole peut toutefois se heurter à des contraintes de distance et à la densification de l'habitat engendrant un coût élevé du réseau de chaleur. Les liens pouvant unir collectivités et agriculture au travers de la méthanisation peuvent cependant constituer des opportunités. Ces dernières doivent s'envisager au cas par cas selon le territoire concerné.

La préservation de l’environnement est actuellement au coeur des débats dans l’évolution des systèmes de production laitière. Le défi des années futures réside dans la fourniture de produits laitiers tout en assurant les performances sociales, économiques et environnementales, c'est-à-dire la durabilité des systèmes de production. En matière d’environnement, une attention toute particulière doit être portée à la limitation des risques de pollution vers l'eau, vers l'air et à la préservation de la biodiversité. Les systèmes d'élevage herbivore français, largement basés sur la prairie, présentent pour cela un réel atout du fait du lien au sol et de la part importante de fourrages dans l’alimentation du troupeau. Peu liée aux caractéristiques structurelles, l’efficience environnementale passe notamment par l’optimisation du recyclage du carbone et de l’azote au sein des systèmes de production. Alors que la variabilité des impacts environnementaux entre exploitations de systèmes différents (plaine vs montagne) est faible, une forte variabilité est observée entre exploitations d’un même système. Ceci démontre que les pratiques efficientes sur le plan technique, relatives à la gestion optimale des effectifs animaux, à une sobriété énergétique, etc. ont des incidences environnementales et économiques favorables. C’est pourquoi, une partie significative des exploitations d'élevage d'herbivores françaises devrait pouvoir être considérée à hautes performances environnementales et économiques sans remise en cause lourde du système de production. Par ailleurs l’élevage laitier, qui intervient pour réduire les pertes vers l’air et vers l’eau, est garant du stockage de carbone et de la biodiversité. Au-delà de la production de lait et de viande, l’élevage laitier joue dès lors un rôle majeur dans la préservation de l’environnement.

AQFThe authors present the guidelines of the French Society of ENT and Head and Neck Surgery (SFORL) regarding the management of Bell's palsy in adults. After a literature review by a multidisciplinary workgroup, guidelines were drawn up based on retrieved articles and group-members' experience, then read over by an independent group to edit the final version. Guidelines were graded A, B, C or "expert opinion" according to decreasing level of evidence. Thorough ENT and neurological clinical examination is recommended in all patients presenting with peripheral facial palsy to confirm diagnosis of Bell's palsy. MRI with gadolinium enhancement should explore the entire course of the facial nerve, if possible within the first month. ENMG should be performed to assess prognosis for recovery. In confirmed Bell's palsy, corticosteroid therapy should be implemented as early as possible (ideally within 72 h) at a dose of 1 mg/kg/day for 7–10 days. Antiviral therapy should be associated to steroids in patients with severe and early-onset disease and in Ramsay-Hunt syndrome. Isolated antiviral therapy is not recommended. To date, there is no evidence that surgical facial nerve decompression provides benefit. [ABSTRACT FROM AUTHOR]

The authors present the guidelines of the French Society of Otorhinolaryngology – Head and Neck Surgery (Société française d'oto-rhino-laryngologie et de chirurgie de la face et du cou – SFORL) on the indications for cochlear implantation in children. A multidisciplinary work group was entrusted with a review of the scientific literature on the above topic. Guidelines were drawn up, based on the articles retrieved and the group members' individual experience. They were then read over by an editorial group independent of the work group. The guidelines were graded as A, B, C or expert opinion, by decreasing level of evidence. The SFORL recommends that children with bilateral severe/profound hearing loss be offered bilateral cochlear implantation, with surgery before 12 months of age. In sequential bilateral cochlear implantation in children with severe/profound hearing loss, it is recommended to reduce the interval between the two implants, preferably to less than 18 months. The SFORL recommends encouraging children with unilateral cochlear implants to wear contralateral hearing aids when residual hearing is present, and recommends assessing perception with hearing-in-noise tests. It is recommended that the surgical technique should try to preserve the residual functional structures of the inner ear as much as possible. [ABSTRACT FROM AUTHOR]

Fabry disease (FD) is an X-linked inherited lysosomal storage disease. It is a multisystem pathology that can include ENT disorders. The aim of the present study was to investigate the cochleovestibular manifestations of FD, in order to show the importance of screening and systematic ENT evaluation. A single-center retrospective study included 14 male and 23 female FD patients. Hearing impairment was defined as hearing loss greater than the 90th percentile for at least one frequency. Vestibular impairment was defined by lateral semicircular canal dysfunction. Age, ongoing enzyme replacement therapy (ERT) and organic (renal, cardiac and cerebrovascular) complications were used as severity markers. Hearing impairment was found in 62.6% of cases, mostly at high frequencies, and was associated with age, ERT, and cardiac and cerebrovascular disorder. It affected 46.7% of asymptomatic adult patients. Vestibular impairment was found in 56% of cases, associated with age; it affected two-thirds of ERT patients, more than 60% of patients with organic complications, and 50% of asymptomatic adult patients. More than half of patients had ENT involvement. All FD patients should undergo early ENT screening for diagnostic, prognostic and therapeutic purposes. Systematic complete ENT follow-up with auditory and vestibular evaluation should be performed regularly, even for heterozygous women. [ABSTRACT FROM AUTHOR]

The authors present the guidelines of the French Society of ENT and Head and Neck Surgery (SFORL) regarding indications for cochlear implantation in adults. After a literature review by a multidisciplinary workgroup, guidelines were drawn up based on retrieved articles and group-members' experience, then read over by an independent reading group to edit the final version. Guidelines were graded A, B, C or "expert opinion" according to decreasing level of evidence. There is no upper age limit to cochlear implantation in the absence of proven dementia and if autonomy is at least partial. Bilateral implantation may be proposed if unilateral implantation fails to provide sufficiently good spatial localization, speech perception in noise and quality of life, and should be preceded by binaural hearing assessment. Rehabilitation by acoustic and electrical stimulation may be proposed when low-frequency hearing persists. Quality of life should be assessed before and after implantation. [ABSTRACT FROM AUTHOR]