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Expert perspectives for transoral robotic versus laser surgery for supraglottic carcinomas
No full textInternational audienceObjective: To assess the opinion, practices, and challenges of international key opinion leaders about two minimal invasive surgical techniques in supraglottic laryngeal tumours: transoral laser microsurgery (TLM) and the transoral robotic surgery (TORS). Methods: Design of a questionnaire composed of seven sections and fifty questions covering descriptive data of participants, practitioners experience procedural sequences, considerations related to airways, feeding, and voice, intraoperative haemorrhage, postoperative management, and a comparative analysis of TLM and TORS in treating supraglottic laryngeal cancer. Results: A total of 27 head and neck surgeons replied to the survey. The experts had an average experience in laryngeal surgery of 20.0 ± 9.4 years, ranging from 5 to 36 years. We noted a significantly shorter installation time in TLM compared to TORS (19% of experts estimated the installation time of over 20 min with TLM vs 44% with TORS; p = 0.02). According to complications, the experts considered that bleeding was the major concern with supraglottic laryngeal surgery, especially intraoperative bleeding in TLM (52% in TLM vs 26% in TORS) (p = 0.09) and postoperative bleeding in TORS (56% in TORS vs 44% in TLM). Conclusion: The experts did not identify a clear superiority of one technology (TLM) over the other (TORS). The two techniques seemed equivalent to the experts, except for the control of intraoperative haemostasis and visualisation of the surgical field, where TORS was perceived as superior to TLM
Optimization of the temperature profile of cake batter in an ohmic heating – assisted printing nozzle for 3D food printing applications
No full textInternational audienceAbstract 3D printing of food has great potential for applications such as the design of customised food or the creation of innovative textures. However, printed products often do not retain their structure due to the composition of the material, especially in the case of cereal products. Cooking such products with a nozzle could be an alternative to meet this challenge. The objective of this work was to develop, with the help of a numerical model, a 3D cake batter printing nozzle in which ohmic heating is used for baking. The use of a temperature and shear rate dependent viscosity allowed the solidification of the batter during baking due to starch gelatinization. The numerical model made it possible to predict heterogeneity in temperature distribution. Optimization procedures were used to reach desired temperature profiles at the outlet of the nozzle, reducing by 17 % the electrical power used for heating and by 78 % the energy evacuated during cooling
Characterizing and comparing sensory and hedonic characteristics of products through free-comment responses to open-ended questions
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Distinct standing time response patterns to seasonal heat stress in dairy cows
No full textInternational audienceThresholds are needed to detect and identify heat stress. The response to heat stress may not differ between animals but the dynamics of the response may vary from one animal to another. In the present study, we hypothetised that, when cows are reared indoors, the standing position can be considered as an indicator of heat stress situation. From June 16th to September 15th 2024, data were collected on 158 Holstein dairy cows (parity 1 to 5), in 2 commercial farms located in a temperate climate in western France. In these farms, milking robots were used and cows were housed indoors all year long. Behavioural data (standing, time in holding areas, drinking and eating time, and walking distance) were continuoulsy recorded using the AIherd® device. Temperature, humidity, wind speed and wet bulb globe temperature were also recorded. Information was aggregated on a 4-hours basis, and behavioral data were averaged per slot. Cows were classified according to their behavioural responses using hierarchical ascending classification. Four distinct standing time response patterns were determined, with 3 common clusters: C1 (37%) shows a linear increase, C2 (21%) remains stable until reaching a peak before decreasing, and C3 (19%) increases until a peak and then stabilizes. Although Farm 2 has fan systems, dairy cows in this farm consistently showed higher standing activity (p < 0.05), despite no greater environmental stress, as Farm 1 had a higher temperature by about 0.345°C. This may be due to the barn’s larger area, layout, and the need to stand in alleys to benefit from fans. Our results indicated that standing activity is increasing while intensity of heat stress is increasing, suggesting that it could be an indirect indicator (proxy) to determine intensity of such a stress on individual basis. Including other indicators based on health status, mobility score, access to milking robot, still need to be performed, in order to improve this first classification
Imagerie de la membrane synoviale : intérêt de l’IRM et de l’échographie dans l’exploration d’une synovite chronique
No full textInternational audienceThe synovial membrane is a potential target for a wide range of pathological conditions. While joint aspiration combined with clinical findings generally allows for an accurate diagnosis, certain situations warrant further assessment through imaging techniques. In this context, magnetic resonance imaging (MRI) remains the gold standard, although musculoskeletal ultrasound also plays a valuable complementary role. This pictorial review aims to illustrate the imaging characteristics of key etiologies of chronic synovitis, including inflammatory rheumatic diseases, crystal-induced arthropathies, and synovial tumors such as pigmented villonodular synovitis and synovial chondromatosis, as well as lipoma arborescens.La membrane synoviale peut être la cible de nombreuses pathologies. Même si la ponction articulaire et l’ensemble des éléments cliniques peuvent conduire la plupart du temps à un diagnostic, certains cas nécessitent de compléter les explorations par une imagerie. Dans ce contexte, l’IRM est l’examen de référence, même si l’échographie a également son intérêt. Dans cette revue, nous décrirons l’aspect à l’imagerie des principales pathologies d’intérêt dans les synovites chroniques (rhumatismes inflammatoires, microcristallins, tumeurs synoviales (synovite villonodulaire, chondromatose synoviale) et les lipomes arborescents
Quand et comment évoquer le diagnostic d’ostéoporose ?
No full textInternational audienceWhen and how to diagnose osteoporosis? Pourquoi ?Forte prévalence de la maladie : après 50 ans 1 femme sur 2 et 1 homme sur 5 ont une ostéoporoseles fractures ostéoporotiques sont associées à des douleurs et à une impotence fonctionnelle Les fractures ostéoporotiques sont associées à une augmentation du risque de nouvelle fracture Les fractures ostéoporotiques sévères (Cf. infra) sont associées à une augmentation de la mortalité (1 femme sur 6 et 1 homme sur 4 vont décéder dans l'année qui suit une fracture de hanche) Intérêt de diagnostiquer et traiter une ostéoporose pour prévenir la survenue de fractures Pour qui ?Chez la femme et l'homme après une fracture par fragilité. La fracture par fragilité est : une fracture qui survient à la suite d'un traumatisme à basse cinétique : fracture après chute de sa hauteur à l'arrêt ou à la marche ou fracture spontanée. Quel que soit le site de fracture (sauf le crâne, la face, les vertèbres au-dessus de T4, l'avant-pied et la main). Quelle que soit la sévérité de la fracture. Les fractures sévères sont associées à une augmentation de la mortalité. Ce sont les</div
Post-graduate training honeybee health and medicine for veterinarians in France
No full textInternational audienceSince 2005, the National Veterinary Schools of Nantes and Alfort have proposed a post-graduate training in Honeybee Health. The “Honeybee Health and Medicine” program was created to develop diagnostic skills and provide expertise to veterinarians. The certification aims to provide veterinarians the following skills: Observation and interpretation of colony disorders; Diagnosis of Honey Bee colony diseases and health troubles and collecting relevant samples; Assessment of the human, material and wildlife environment of a beekeeping farm; Prevention of the spreading of regulated diseases by implementing and supervising control measures; Prescription of appropriate veterinary drugs; Understanding relevant regulation; Acting as an official vet in the beekeeping field. The training includes 200 hours of theoretical and practical training: Honey Bee biology and colony life; Practical handling, Sampling, and diagnosis; Health disorders and troubles; Regulations; Implementation of Honeybee colonies health audits (and sanitary audits of the beekeeping practices and technics). To date, 289 veterinarians have been graduated. Their diversity and nationwide distribution have created a unique Honeybee health network. The Ministry of Agriculture officially recognized this program in 2014. The graduated veterinarians (working in private practice, administration, diagnostic laboratories, and pharmaceutical industry) carry out key missions: Protecting and treating Honeybee colonies; Implementation of studies, Field surveys, and epidemiological surveillance; Self guarding food safety and public health; Protecting the environment; Advancing research and training. Since 2024, the diploma has been certified by all four French National Veterinary Schools. To improve accessibility and recognition, a submission will be made to the “National Authority for Regulating and Financing Vocational Training” for registration in the “specific repertory”
Qu’est-ce qu'une « FakeMed » ? Réponses d'un collectif de médecins français
No full textInternational audienceBackgroundThe “FakeMed” concept, designing “fake or misleading” medicines is often used in narratives aiming to “fight against misinformation about unconventional health care practices (UCHP)” and to “prevent patients from therapeutic and/or sectarian drifts” according to the French Collective NoFakeMed. Despite its media hype, the conceptual validity of this concept and its definition criteria have been poorly investigated.MethodWe analyzed the definition of “FakeMed” given by the Collective “NoFakeMed”, which has played a key role in popularizing this concept in France and completed our inquiry by directly asking some of its representatives.ConclusionOur analyses show that “FakeMed” is itself a misleading concept (e.g., a kind of fake definition for UCHP) based on an illusory demarcation between so-called “conventional” and “unconventional” medicines. Hence, the “FakeMed” label rather feeds misinformation instead of fighting it, the media hype contributing to mask its conceptual weaknesses. In the context of the nascent structuring of integrative medicine in France, and of the reflection on how to better regulate the practice of complementary medicines, we believe that in-depth academic reflection on concepts is preferable to militant slogans.ContexteLe concept de « FakeMed », désignant des thérapies « fausses ou trompeuses », est souvent utilisé dans des discours visant à « lutter contre la désinformation sur les pratiques de soins non conventionnelles (UCHP) » et à « prévenir les dérives thérapeutiques et/ou sectaires », selon le collectif français NoFakeMed. Malgré sa forte diffusion médiatique, la validité conceptuelle de ce terme et ses critères de définition ont été peu étudiés.MéthodeNous avons analysé la définition de « FakeMed » donnée par le collectif « NoFakeMed », qui a joué un rôle clé dans la popularisation de ce concept en France, et avons complété notre enquête en interrogeant directement certains de ses représentants.ConclusionNos analyses montrent que « FakeMed » est en soi un concept trompeur (il offre par exemple, une définition trompeuse des UCHP) basé sur une démarcation illusoire entre les traitements dits « conventionnels » et « non conventionnels ». Ainsi, l’étiquette « FakeMed » alimente plutôt la désinformation qu'elle ne la combat, la diffusion médiatique dont ce terme bénéficie contribuant à masquer ses insuffisances conceptuelles. Dans le contexte de la structuration naissante de la médecine intégrative en France et de la réflexion sur la manière de mieux réguler la pratique des thérapies complémentaires, une réflexion académique approfondie sur les concepts serait préférable à des slogans militants
Effects of a 3-week Inpatient Rehabilitation for Neurogenic Thoracic Outlet Syndrome on Strength, Pain, and Function: A Prospective Study
No full textInternational audienceBackground: Neurogenic thoracic outlet syndrome (NTOS) is due to the compression of the brachial plexus and is responsible for upper limb pain, strength loss and fatigability, which are responsible for daily life impairment. We assessed prospectively the effect of a 3-week inpatient rehabilitation on upper limb strength and endurance, and to assess pain and function in patients with NTOS.Methods: Among patients with NTOS, 220 addressed to rehabilitation were included. Patients performed a shoulder isokinetic testing of the rotator cuff and an isometric hand strength measurement, at the beginning and the end of the rehabilitation, and at 24 weeks. Patients completed a QuickDASH questionnaire, and pain was evaluated with a numeric rating scale (NRS). Sick leave rate was also assessed.Results: Out of 220 patients, 182 performed the 3 evaluations: 78% were female, mean age was 40.7 ± 9.7 years. Initially, symptomatic upper limbs had significantly less strength than asymptomatic upper limbs. At 24 weeks, the rotators strength had increased from 13 to 18% on symptomatic shoulders, and from 4 to 12.5% on asymptomatic shoulders; the rotators endurance increased from 35% to 39% on symptomatic shoulders and from 20% to 22% on asymptomatic shoulders (P ≤ 0.001). The grip and key-pinch measures increased by 22% and 13%, on symptomatic hands, respectively, and by 12% and 8%, on asymptomatic hands, respectively (P ≤ 0.001). The QuickDASH decreased from 57 ± 14% to 30 ± 19% (P ≤ 0.001) and the NRS from 5.6 ± 1.8 to 2.4 ± 2.0 (P ≤ 0.001). The sick leave rate decreased from 66 to 43% (P ≤ 0.0001).Conclusion: Three weeks of inpatient rehabilitation for NTOS permitted to recover significant bilateral upper limb strength and endurance, both on hands and shoulders, with a maintenance of the results at 24 weeks. These results were associated to a significant reduction of pain and impairment
Climate change and food safety: From impacts, modelling approaches to mitigation strategies
No full textInternational audienceClimate change poses a threat to the food supply chain through its impacts on food security and food safety. The current lecture follows the impact-modelling-mitigation paradigm, reflecting three main objectives that link food safety and climate change. First, present an overview of its food safety impacts in the different supply chains. The effect on both microbial hazards and chemical hazards associated with the fisheries and poultry sectors will be discussed. This section of the lecture highlights the role of rain and floods as vectors of spreading microbial contamination and chemical hazards in agricultural areas. Second, different modelling approaches quantifying the impact on microbial growth and prevalence will be elaborated. These are, namely, predictive microbiology incorporation, climate-contamination events modelling, and dimension reduction approach. Third, mitigation strategies will be proposed to be implemented by different food safety actors in the food supply chain. These strategies need to be sustainable, complement existing food safety programs, and be supported by proactive systems