Autologous breast reconstruction by means of microsurgical abdominal flaps is an very well described technique. The flap harvest dissection under inguinal ligament would cause the risk of parietal ...weakening in this zone and postoperative bulging. The goal of our study is to investigate whether the deep inferior epigastric artery diameter remains constant from its exit of the external iliac artery to its entrance in the rectus muscle sheath.
One hundred arteries were studied on fifty preoperative computed tomographic angiographies made before a DIEAP flap for breast reconstruction. We measured the caliber of the left and right deep inferior epigastric arteries at these two landmarks. The length of this artery between these was also calculated. This data were collected with specific angiography reconstruction.
At the caudal landmark, the mean DIEA diameter was 2.1±0.27mm on the left side and 2.1±0.31mm on the right side. At the cephalic landmark, the mean DIEA diameter was 2.0±0.28mm on the left and 2.0±0.27mm on the right side (P=0.00035 at left side; P=0.0089 at right side). The mean pedicle length between the two landmarks was 22.3±2.85mm on the left side and 22.2±2.98mm on the right side.
This computed tomographic angiography study showed that the diameter of DIEA is equivalent at its origin and at the lateral border of muscle. Flap harvest without dissection under inguinal ligament provides sufficient pedicle length and caliber to allow for comfortable and reliable sutures.
La reconstruction mammaire autologue au moyen de lambeaux abdominaux microchirurgicaux est une technique très bien décrite. La dissection par prélèvement du lambeau sous le ligament inguinal entraînerait un risque d’affaiblissement pariétal dans cette zone et de déhiscence pariétale postopératoire. Le but de notre étude est d’étudier si le diamètre de l’artère épigastrique inférieure profonde (AEIP) reste constant depuis sa sortie de l’artère iliaque externe jusqu’à son entrée dans la gaine du muscle grand droit.
Cent artères ont été étudiées sur 50 tomoangiographies préopératoires réalisées avant un lambeau DIEAP en vue d’une reconstruction mammaire. Nous avons mesuré le calibre des artères épigastriques inférieures profondes gauche et droite à ces deux points repère. La longueur de cette artère entre ces derniers a également été calculée. Ces données ont été recueillies avec une reconstruction tomoangiographique spécifique.
Au niveau du repère caudal, le diamètre moyen de l’AEIP était de 2,1±0,27mm du côté gauche et de 2,1±0,31mm du côté droit. Au niveau du repère céphalique, le diamètre moyen de l’AEIP était de 2,0±0,28mm à gauche et de 2,0±0,27mm à droite (p=0,00035 à gauche ; p=0,0089 à droite). La longueur moyenne du pédicule entre les deux points repère était de 22,3±2,85mm du côté gauche et de 22,2±2,98mm du côté droit.
Cette étude d’angiographie tomographique informatisée a montré que le diamètre de l’AEIP est équivalent à son origine et au bord latéral du muscle. Le prélèvement d’un lambeau de DEIAP sans dissection sous le ligament inguinal fournit une longueur de pédicule et un calibre suffisants pour permettre des sutures confortables et fiables.
► Model simulations were used to evaluate the afforestation of boreal open woodlands. ► Boreal afforestation scenarios simulated were low C-intensive mitigation activities. ► Net positive C balance ...within 8 years with understory planted Jack pine trees. ► Large scale boreal afforestation in Québec could give significant offset potential.
To mitigate greenhouse gas and comply with cap-and-trade systems, the carbon capture and storage (CCS) is presently unviable for industrials dealing with low concentration of CO2 emissions. Alternatively, a new offset opportunity is being analysed in Canada: the afforestation of open woodlands (OWs) in the boreal territory. The results obtained from model simulations (with CBM-CFS3) showed that afforestation of boreal OWs can be a low C-intensive mitigation activity, in particular when understory planting is the chosen silvicultural approach, so that only 8–12 years are needed to reach a net positive C balance with the afforestation of OWs. A large-scale afforestation of boreal OWs – scheduled at 20kha per year during 20 years for a maximum of 400kha – could provide capped industrials with a significant offset potential, for instance up to nearly 8% offset of all Québec industrial process emissions (2009 data) after 45 years. In spite of a certain number of issues that can contribute to the uncertainty of the real environmental and economical benefits from the afforestation of OWs as a mitigation activity – most of which issues are discussed in this paper – this study presented a first glimpse at the extent to which the afforestation of boreal OWs in Québec can provide large emitters with eventually substantial and efficient GHG offset potential, especially those emitters tied up with incompressible GHG emissions.
Facial feminization surgery brings a set of surgical procedures that address the three thirds of the face and aims to give feminine characteristics to a masculine face. The characteristics of the ...lower third of a male face are a long, broad chin, a prominent mandible with sharp angles (in connection with the insertions of the masseter muscles). Mandibular angle reduction is an important procedure of the male-to-female transformation. It allows to modify the appearance of the lower third of the face, reducing the bi-mandibular distance in the coronal plane and opening the mandibular angle in profile. The classical procedure uses trans-oral surgical approach. However, patients undergoing male-to-female sexual transformation frequently present a mixed indication of cervicofacial lift and angular resection. We present an innovative surgical technique associating cervicofacial lifting and mandibular angle resection using the same cutaneous surgical approach. We describe its advantages and discuss its disadvantages.
Les résultats fonctionnels et esthétiques après vaginoplastie en chirurgie de réassignation sexuelle se sont énormément améliorés au cours des dernières années. L’amélioration des techniques ...chirurgicales, des équipes expertes bien installées et un nombre croissant de demande et d’intérêt pour ce type de chirurgie expliquent entre autres ces résultats. Cependant il existe une demande croissante de chirurgie esthétique génitale, non seulement chez les femmes cis, mais aussi chez les femmes trans. Les principales insuffisances de résultats sont donc présentées et listées. Les techniques de chirurgie de révision esthétique spécifiquement indiquées sont décrites. Les labiaplasties et les clitoridoplasties apparaissent comme les deux principales demandes en chirurgie secondaire post vaginoplastie trans.
Functional and aesthetic results after vaginoplasty in sexual reassignment surgery have improved in recent years. Improved surgical techniques, well-established expert teams and a growing demand for and interest in this type of surgery are some of the reasons for these results. However, there is a growing demand for genital cosmetic surgery, not only among cis women, but also among trans women. The main shortcomings in results are therefore presented and listed. The aesthetic revision surgery techniques specifically indicated are described. Labiaplasty and clitoridoplasty appear to be the two main requests for secondary surgery following trans vaginoplasty.
Although several scores exist to assess psoriasis severity, most have marked limitations that rule out their use in routine clinical practice. A new score, the Simplified Psoriasis Index (SPI), has ...recently been developed and validated in adults in Britain for such use. It has separate components for current severity (SPI-s), psychosocial impact (SPI-p) and past history and interventions (SPI-p), and it is suitable for either professional assessment or patient self-assessment. The aim of this work was to produce a validated translation of SPI into French (as spoken in France).
The index was translated and validated using a strict methodology comprising respectively five and eight phases for the professional (proSPI) and self-administered instruments (saSPI). Translation of the saSPI instrument also involved a cognitive debriefing with five psoriasis patients.
Linguistic discrepancies and subtle differences of meaning arising during the process were closely examined. The developer of the instrument ensured conceptual accuracy. A panel of health experts guaranteed that medical terms were correctly translated. Five patients with plaque psoriasis (two female and three male of median age 45 years range: 31-78) tested the SPI-p version during cognitive interviews and found the questionnaire clear and easy to understand.
Validated French translations of both SPI instruments are now available for use in routine clinical practice. Further investigations are currently underway to validate the psychometric properties of the instrument.
East Coast fever (ECF), one of the most serious tick-borne diseases in sub-Saharan and eastern Africa, was introduced to the island of Grande Comore in 2002 through zebu import from Tanzania, ...resulting in at least a 10% loss of livestock. A participatory epidemiology initiative was launched in 2015 to gain a better understanding of ECF epidemiology. Thirty-six villages were investigated involving 36 focus group sessions and 120 individual questionnaires. Farmers’ knowledge of ECF and of priority diseases affecting the country was assessed, and the impacts of ECF and other major diseases were compared by a scoring method. The results showed that 69.4% (95% CI 51.3, 87.5%) of the farmers had good to very good knowledge of ECF. The most important cattle diseases on Grande Comore were considered to be East Coast fever, heartwater, babesiosis, and cutaneous diseases. About 58% of the farmers (95% CI 49.2, 66.8%) use curative treatments when cattle were sick. Between January and September 2015, the ECF incidence was estimated at 18.5% (95% CI 15.5, 21.4%), and 87.5% (95% CI 72.7, 100%) of the cattle infected by ECF died. The ECF incidence estimated in our study was found to be less when compared to that observed in Tanzania even though the climatic conditions in the Union of the Comoros are suitable for the biological vector of ECF, the tick species
Rhipicephalus appendiculatus
. Access to chemical treatment and its effectiveness against ECF, as well as controlling borders and organizing quarantine, are discussed.
This paper describes a new way of preparing nanometric powders of uranium oxide, to fit the needs of studies on UO2 oxidation, through the electrochemical reduction of U(VI) into U(IV). These powders ...can also be doped with radionuclides if necessary. The precipitation of oxides Occurs in reducing and anoxic conditions. This original method makes it possible to synthesize nanometric UO2 powders with a calibrated size, as well as the Th- and La-doped UO2 powders with a predefined composition. The powder characterization by the X-ray diffraction, X-ray photoelectron spectroscopy and transmission electron Microscopy shows the formation of spherical crystallites of UO2+x, (Th,U)O2+x and (La,U)O2+x phases. The composition can be defined by the initial Th/(Th+U) and La/(La+U) ratios in solution and the particle size can be controlled by varying the pH.
Use of a latissimus dorsi (LD) flap has been widely described for upper limb reconstruction. However, donor site sequelae have led to the development of muscle-sparing techniques for the LD flap. We ...present the technical principles of a muscle-sparing LD flap and its use as a pedicled flap to reconstruct the distal third of the arm.
L’utilisation du lambeau de grand dorsal (GD) est largement décrite pour la couverture des pertes de substance du membre supérieur. Les séquelles du site donneur de ce lambeau ont entraînées le développement de techniques avec épargne musculaire. Nous présentons ici les principes techniques du lambeau de GD avec épargne musculaire et son utilisation en lambeau pédiculé pour la couverture du tiers distal du bras.
Tick-borne diseases (TBD) occur in many temperate countries and are economically important in most tropical and subtropical areas, affecting dairy and beef cattle, as well as small ruminants. Four ...major tick-borne diseases have been detected in eastern and southern Africa: East Coast fever (ECF) caused by Theileria parva, Theiler 1904, anaplasmosis caused by either Anaplasma marginale, Theiler 1910, Anaplasma centrale, Theiler 1911, or Anaplasma ovis, Bevan 1912, babesiosis caused by Babesia bovis, Babes 1988 and Babesia bigemina, Smith & Kilborne 1893, and heartwater caused by Ehrlichia ruminantium Cowdry 1925. A cross-sectional survey was undertaken to determine the antibody prevalence of these TBDs and to identify the risk factors for TBD infections in the Union of the Comoros. In 2016 and 2017, 903 individual animal serum samples were collected from 429 separate farms, where the farmers answered individual questionnaires. The antibody prevalence of anaplasmosis, babesiosis (B. bigemina) and heartwater was determined by enzyme-linked immunosorbent assays (ELISA) and the antibody prevalence of ECF was assessed using an immunofluorescence antibody test (IFAT). The relationship between TBD seropositivity and livestock-related variables was assessed by multivariate analyses with standard logistic regression models. The results showed that these four TBDs were present in the Union of the Comoros with a global antibody prevalence of 15% (95% CI 12.7%; 17.3%) for anaplasmosis, 9.2% (95% CI 6.5%, 11.9%) for B. bigemina babesiosis, 5.3% (95% CI 3.2%, 7.4%) for ECF and 4.6% (95% CI 3.2%, 6%) for heartwater. We compared these findings with the abundance and distribution of several tick species known to be TBD vectors and we found a significant correlation between Rhipicephalus appendiculatus and ECF, and between Amblyomma variegatum and heartwater. We also found that two major variables were significantly correlated with B. bigemina antibody prevalence (“island” and “breeding area”), four variables were significantly correlated with anaplasmosis antibody seroprevalence (“island”, “number of cattle per farmer”, “number of farmers per village” and “breeding area”), two were significantly correlated with ECF antibody prevalence (“number of farmers in village” and “presence of ticks”), and three were significantly correlated with heartwater (“island”, “number of cattle per farmer” and “number of farmers in the village”). Our findings confirmed livestock exposure to the four targeted TBDs of major concern for livestock development. Consequently, raising farmers' awareness and setting up a period of quarantine should be considered a priority.
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