Opinions of Students on the Contribution of the DIVA 3D Virtual Dissection Table to the Teaching of Anatomy at the Faculty of Medicine and Odontostomatology of Bamako

Objective: Study the contribution of the DIVA 3D dissection table in the teaching of anatomy at the Faculty of Medicine and Odontology of Bamako. Material and Methods: This was a qualitative study carried out from November 1 to December 30, 2023 at the clinical and morphological anatomy laboratory of the Faculty of Medicine and Odontostomatology of Bamako. Included in this study were students who participated in practical and tutorial sessions. The variables studied during this study were: the previous performance of dissection on a cadaver by the students, the opinion of the students on dissection on a cadaver, the replacement of dissection on a cadaver by virtual dissection in the absence of a body, the level student satisfaction. Results: We surveyed 130 participants. The average age was 22 ± 0.2 years with extremes of 17 and 29 years. 95.3% of participants were students. According to 66.7% of participants, virtual dissection is a good palliative in the absence of a corpse. 95.3% of participants found using the virtual dissection table easy with an average of 7.88 ± 1.4. The overall assessment was well rated by 99.3% of participants. Conclusion: According to the results of this study, the virtual dissection table should be improved by integrating commented videos. The use of the DIVA 3D virtual dissection table during practical and tutorial sessions is well appreciated by the students. We believe that the teaching of anatomy using 3D digital technology should be included in the study programs of the Faculty of Medicine and Odontostomatology.

3D Vector Reconstruction of the Typical Cervical Vertebra from Anatomical Sections of Korean Visible Human at the Laboratory of Clinical and Digital Anatomy of Paris Descartes University

Aim: To carry out a 3D vector reconstruction of the typical cervical vertebra from anatomical sections of the “Korean Visible Human” for educational purposes. Material and Methods: The anatomical subject was a 33-year-old Korean man who died of leukemia. He was 164 cm tall and weighed 55 kg. This man donated his body to science. Her body was frozen and cut into several anatomical sections after an MRI and CT scan. These anatomical sections were made using a special saw called a 0.2 mm thick cryomacrotome. Thus 8100 cuts were obtained. Only the sections numbered 940 to 1200 were used for our study. A segmentation by manual contouring of the different parts of the typical cervical vertebra was made using the software Winsurf version 3.5 on a laptop PC running Windows 7 equipped with a Ram of 8 gigas. Results: Our 3D vector model of the typical cervical vertebra is easily manipulated using the Acrobat 3DPDF interface. Each part of the vertebra accessible in a menu can be displayed, hidden or made transparent, and 3D labels are available as well as educational menus for learning anatomy. Conclusion: This original work constitutes a remarkable educational tool for the anatomical study of the typical cervical vertebra and can also be used as a 3D atlas for simulation purposes for training in therapeutic gestures.

3D Vector Reconstruction of the Muscles of the Ventral Region of the Neck from Anatomical Sections of Korean Visible Human at the Paris Descartes Anatomy Laboratory

Objective: To carry out a 3D vector reconstruction of the muscles of the ventral region of the neck from anatomical sections of the “Korean Visible Human” for educational purposes. Materials and Methods: The anatomical subject was a 33-year-old Korean man who died of leukemia. He was 164 cm tall and weighed 55 kgs. The anatomical sections were made in 2010 after an MRI and a CT scan. A special saw (cryomacrotome) made it possible to make cuts 0.2 mm thick on the frozen body, i.e. 5960 cuts. Sections numbered 1500 to 2000 (or 500 cuts covering the neck) were used for our study. A segmentation by manual contouring of each anatomical element of the anterior neck region was done using Winsurf version 3.5 software on a laptop PC running Windows 7 equipped with an 8 gigabyte RAM. Results: We modeled the sternocleidomastoid muscles, the supra-hyoid muscles, the infra-hyoid muscles and the muscle structures of the anterior neck region, the aero-digestive axis of the anterior neck region and the vasculo-nervous axis of the neck. This model is easily manipulated using the Acrobat 3Dpdf interface. Each item accessible in a menu can be displayed, hidden or made transparent, and 3D labels are available as well as educational menus for learning anatomy. This vector model has been integrated into the Diva3d virtual dissection table, a new educational tool used by universities and medical schools to learn anatomy. This model was also uploaded to the Sketchfab? website and 3D printed using an ENDER? pro 3 printer. Conclusion: This original work constitutes a remarkable educational tool for the anatomical study of the anterior neck region and can also be used as a 3D atlas for simulation purposes for training in therapeutic gestures.

3D Vector Reconstruction of the Neck Skeleton from the Anatomical Sections of Korean Visible Human at the Anatomical Laboratory of Paris Descartes

Aim: To perform a vector 3D reconstruction of the neck skeleton from the anatomical sections of the “Korean Visible Human” for educational purposes. Material and Methods: The anatomical subject was a 33-year-old Korean male who died of leukemia. It measured 164 cm and weighed 55 kgs. The anatomical cuts were made in 2010 after an MRI and a CT scan. A special saw (cryomacrotome) made it possible to make cuts on the frozen body of 0.2 mm thick or 5960 slices. Sections numbered 1500 to 2000 (500 neck sections) were used for this study. Manual contouring segmentation of each anatomical element of the anterior neck area was done using Winsurf software version 3.5 on a PC. Results: Our vector 3D neck model includes the following: cervical vertebrae, hyoid bone, sternum manubrium and clavicles. This vector model has been integrated into the virtual dissection table Diva3d, a new educational tool used by universities and medical schools to learn anatomy. This model was also put online on the Sketchfab website and printed in 3D using an ENDER 3 printer. Conclusion: This original work is a remarkable educational tool for the study of the skeleton of the neck and can also serve as a 3D atlas for simulation purposes for training therapeutic gestures.

Effectiveness and safety of apixaban and rivaroxaban vs warfarin in patients with atrial fibrillation and chronic kidney disease

BACKGROUND Randomized controlled trials(RCTs)of direct oral anticoagulants(DOACs)included a low proportion of atrial fibrillation(AF)patients with chronic kidney disease(CKD),and suggested that DOACs are safe and effective in patients with mild-to-moderate CKD.In a metanalysis of RCTs and observational studies,DOACs were associated with better efficacy(vs warfarin)in early CKD and had similar efficacy and safety profiles in patients with stages IV-V CKD.But few studies have provided data on the safety and effectiveness of each DOAC vs warfarin in patients with stage III CKD.The effectiveness and safety of DOACs in those patients are still subject to debate.AIM To assess and compare the effectiveness and safety of apixaban and rivaroxaban vs warfarin in this patient population.METHODS A cohort of patients with an inpatient or outpatient code for AF and stage III CKD who were newly prescribed apixaban and rivaroxaban was created using the administrative databases from the Quebec province of Canada between 2013 and 2017.The primary effectiveness outcome was a composite of ischemic stroke,systemic embolism,and death,whereas the primary safety outcome was a composite of major bleeding within a year of DOAC vs warfarin initiation.Treatment groups were compared in an under-treatment analysis using inverse probability of treatment weighting and Cox proportional hazards.RESULTS A total of 8899 included patients filled out a new oral anticoagulation therapy claim;3335 for warfarin and 5564 for DOACs.Compared with warfarin,15 mg and 20 mg rivaroxaban presented a similar effectiveness and safety composite risk.Apixaban 5.0 mg was associated with a lower effectiveness composite risk[Hazard ratio(HR)0.76;95%confidence interval(CI):0.65-0.88]and a similar safety risk(HR 0.94;95%CI:0.66-1.35).Apixaban 2.5 mg was associated with a similar effectiveness composite(HR 1.00;95%CI:0.79-1.26)and a lower safety risk(HR 0.65;95%CI:0.43-0.99.Although,apixaban 5.0 mg was associated with a better effectiveness(HR 0.76;95%CI:0.65-0.88),but a similar safety risk profile(HR 0.94;95%CI:0.66-1.35).The observed improvement in the effectiveness composite for apixaban 5.0 mg was driven by a reduction in mortality(HR 0.61;95%CI:0.43-0.88).CONCLUSION In comparison with warfarin,rivaroxaban and apixaban appear to be effective and safe in AF patients with stage III CKD.

Pre-diagnostic levels of adiponectin and soluble vascular cell adhesion molecule-1 are associated with colorectal cancer risk

AIM: To examine the relationships between pre-diagnostic biomarkers and colorectal cancer risk and assess their relevance in predictive models.METHODS: A nested case-control study was designed to include all first primary incident colorectal cancer cases diagnosed between inclusion in the SUpplémentation en VItamines et Minéraux AntioXydants cohort in 1994 and the end of follow-up in 2007. Cases (n = 50) were matched with two randomly selected controls (n = 100). Conditional logistic regression models were used to investigate the associations between pre-diagnostic levels of hs-CRP, adiponectin, leptin, soluble vascular cell adhesion molecule-1 (sVCAM-1), soluble intercellular adhesion molecule-1, E-selectin, monocyte chemoattractant protein-1 and colorectal cancer risk. Area under the receiver operating curves (AUC) and relative integrated discrimination improvement (RIDI) statistics were used to assess the discriminatory potential of the models. RESULTS: Plasma adiponectin level was associated with decreased colorectal cancer risk (P for linear trend = 0.03). Quartiles of sVCAM-1 were associated with increased colorectal cancer risk (P for linear trend = 0.02). No association was observed with any of the other biomarkers. Compared to standard models with known risk factors, those including both adiponectin and sVCAM-1 had substantially improved performance for colorectal cancer risk prediction (P for AUC improvement = 0.01, RIDI = 26.5%). CONCLUSION: These results suggest that pre-diagnostic plasma adiponectin and sVCAM-1 levels are associated with decreased and increased colorectal cancer risk, respectively. These relationships must be confirmed in large validation studies.

Hepatitis C virus: Virology, diagnosis and management ofantiviral therapy

Hepatitis C virus (HCV) infects approximately 170 million individuals worldwide. Prevention of HCV infection complications is based on antiviral therapy with the combination of pegylated interferon alfa and ribavirin. The use of serological and virological tests has become essential in the management of HCV infection in order to diagnose infection, guide treatment decisions and assess the virological response to antiviral therapy. Anti- HCV antibody testing and HCV RNA testing are used to diagnose acute and chronic hepatitis C. The HCV genotype should be systematically determined before treatment, as it determines the indication, the duration of treatment, the dose of ribavirin and the virological monitoring procedure. HCV RNA monitoring during therapy is used to tailor treatment duration in HCV genotype 1 infection, and molecular assays are used to assess the end-of-treatment and, most importantly the sustained virological response, i.e. the endpoint of therapy.

Recurrence and survival following microwave, radiofrequency ablation, and hepatic resection of colorectal liver metastases: A systematic review and network meta-analysis

Background: Gold standard for colorectal liver metastases(CRLM) remains hepatic resection(HR). However, patients with severe comorbidities, unresectable or deep-situated resectable CRLM are candidates for ablation. The aim of the study was to compare recurrence rate and survival benefit of the microwave ablation(MWA), radiofrequency ablation(RFA) and HR by conducting the first network meta-analysis. Data sources: Systematic search of the literature was conducted in the electronic databases. Both updated traditional and network meta-analyses were conducted and the results were compared between them. Results: HR cohort demonstrated significantly less local recurrence rate and better 3-and 5-year diseasefree(DFS) and overall survival(OS) compared to MWA and RFA cohorts. HR cohort included significantly younger patients and with significantly lower preoperative carcinoembryonic antigen(CEA) by 10.28 ng/m L compared to RFA cohort. Subgroup analysis of local recurrence and OS of solitary and ≤3 cm CRLMs did not demonstrate any discrepancies when compared with the whole sample. Conclusions: For resectable CRLM the treatment of choice still remains HR. MWA and RFA can be used as a single or adjunct treatment in patients with unresectable CRLM and/or prohibitive comorbidities.

Quality of life, physical performance and nutritional status in older patients hospitalized in a cardiology department

Objectives Quality of life(QoL) is a priority outcome in older adults suffering from cardiovascular diseases. Frailty and poor nutritional status may affect the QoL through mobility disorders and exhaustion. The objective of this study was to determine if physical frailty and nutritional status were associated with QoL, in older cardiology patients. Methods Cross sectional, observational study conducted in a cardiology department from a university hospital. Participants(n = 100) were aged 70 and older. Collected data included age, sex, cardiac diseases, New York Heart Association(NYHA) classification, comorbidities(Charlson Index) and disability. A Short Physical Performance Battery(SPPB), including walking speed assessment was performed;handgrip strength were measured as well as Fried’s frailty phenotype. Nutritional status was assessed using the Mini Nutritional Assessment(MNA) and Body Mass Index(BMI), inflammation by C-reactive protein(CRP). QoL was assessed using the EORTC–QLQ questionnaire. Univariate and multivariate analyses were performed to study the associations between all recorded parameters and QoL. Results In participants(mean age: 79.3 ± 6.7 years;male: 59%), Charlson index, arrhythmia, heart failure, NYHA class III-IV, MNA, disability, walking speed, SPPB score, frailty and CRP were significantly associated with QoL in univariate analysis. Multivariate analysis showed that NYHA class III-IV(P < 0.001), lower MNA score(P = 0.03), frailty(P < 0.0001), and higher CRP(P < 0.001) were independently associated with decreased QoL. Conclusions Frailty, nutritional status and inflammation were independently associated with poor QoL. Further studies are needed to assess the efficacy of nutritional and physical interventions on QoL in this population.

IN VITRO EFFECTS OF PRESERVED OR PRESERVATIVE -FREE ANTIGLAUCOMA MEDICATIONS ON HUMAN COMPLEMENT SYSTEM

Purpose: Antiglaucoma drugs have been associated with con-junctival and trabecular inflammatory cell infiltrates. However, the underlying mechanisms are still poorly understood. The aim of this study was to assess the effects of antiglaucoma medica-

Epileptic seizure prediction based on EEG spikes detection of ictal-preictal states

Epileptic seizures are known for their unpredictable nature.However,recent research provides that the transition to seizure event is not random but the result of evidence accumulations.Therefore,a reliable method capable to detect these indications can predict seizures and improve the life quality of epileptic patients.Seizures periods are generally characterized by epileptiform discharges with different changes including spike rate variation according to the shapes,spikes,and the amplitude.In this study,spike rate is used as the indicator to anticipate seizures in electroencephalogram(EEG) signal.Spikes detection step is used in EEG signal during interictal,preictal,and ictal periods followed by a mean filter to smooth the spike number.The maximum spike rate in interictal periods is used as an indicator to predict seizures.When the spike number in the preictal period exceeds the threshold,an alarm is triggered.Using the CHB-MIT database,the proposed approach has ensured92% accuracy in seizure prediction for all patients.

The Vision of France, Germany, and the European Union on Future Hydrogen Energy Research and Innovation

Hydrogen(H2)is an essential vector for freeing our societies from fossil fuels and effectively initiating the energy transition.Offering high energy density,hydrogen can be used for mobile,stationary,or industrial applications of all sizes.This perspective on the crucial role of hydrogen is shared by a growing number of countries worldwide(e.g.,China,Germany,Japan,Republic of Korea,Australia,and United States),which are publishing ambitious roadmaps for the development of hydrogen and fuel cell technologies,supported by substantial financial efforts.

Adverse Wear in MOM Hip-Arthroplasty Related to the Production of Metal Fragments at Impingement Sites

Metal on metal (MOM) bearings were reintroduced as resurfacing arthroplasty (RA) for the younger, more active patient and were later incorporated into total hip arthroplasty (THA). Early results were encouraging. However, recent publications identified adverse tissue responses to metal debris, such that the majority of MOM designs have been abandoned due to the increase in cobalt-chromium (CoCr) debris and associated metal ions. Reports of MOM THA cited risks that included acetabular cups with high-inclination angles, i.e. “edge-loading”, and “trunnionosis”. Hip impingement was also a cited risk in one MOM study, with “type-IV” wear noted to be a sliding/impaction type of wear, characterized by deep scratches. Sliding/impaction wear mechanisms produced at impingement are not well represented in current MOM literature. Therefore, our objective in this review was to consolidate evidence for impingement risks. We hypothesize that hip impingement and subluxation with metal-backed acetabular cups can trigger wear mechanisms that result in, 1) femoral-neck notching, 2) release of large metal particles, 3) production of uniquely large scratches, defined as “microgrooves” on heads and cups, 4) formation of “polar” and “basal” microgrooves precisely aligning with cup profiles during impingement, and 5) equatorial microgrooves relate to soft-tissue sites of impingement. Relevant risk scenarios were evaluated and included hip impingement in both sitting and standing postures, head subluxation, wear patterns defining in-vivo component positions, and evidence for circulating metal fragments. The study relied on mapping of wear patterns to deduce in-vivo positioning of devices and relied on surrogate femoral stems of the same brand to simulate neck-cup impingement. EOS imaging techniques were used to analyze functional-sitting and functional-standing postures and prove existence of hip impingement sites in patients. The study identified 8-risk scenarios for wear damage on MOM bearings. The microgrooves on femoral-heads crossing the main-wear area (polar) and non-wear regions (basal) aligned well with cuprim profiles at impingement sites. This may represent the first description of such large scratches (40 - 300 μm wide) we termed microgrooves, that formed on femoral heads at sites representative of prosthetic impingement. As an abrasive wear process, similar to the formation of femoral-neck notches, these would have been acquired over millions of gait cycles. The pitting and linear microgrooves crossing the non-wear areas of heads (basal) represented the ingress sites of circulating metal particles. Similar micro-grooves were evident in acetabular cups, also signifying 3rd-body abrasion by large metal particles. Hip impingement and head subluxation were implicated by the unequivocal evidence of 3rd-body abrasive wear as the triggering events producing large metal fragments. One caveat regarding retrieval studies is that such damage may be only representative of failed MOM devices. This study demonstrated that emerging technologies such as EOSTM x-ray analyses can reveal subtle changes in implant positioning using patient shifts in functional postures (sitting, standing, hyper-extension, etc.), and thereby assess impingement/subluxation risks in the clinical setting before failure occurs.

Differential Sensibility of Information Processing Capacity with Age: Effects of Physical Activity and Task Complexity

Study aim: Movement control systems are altered by the aging process. Numerous researches have explained the changes that occur with aging, and many of those changes are related to central nervous system (CNS) effects. This article evaluates the impact of age, the practice of regular physical activity, and the task complexity on decision-making ability. Methods: 120 healthy male subjects volunteered to participate in this study. They included 60 young adults (i.e., 30 sedentary and 30 active) (age: 24.35 ± 2.82 years), as well as 60 older adults (age: 66.42 ± 4.06 years) (i.e., 30 sedentary and 30 active). They performed two types of tasks (i.e., simple and complex) to measure reaction time (RT). Subjects perceive visual stimuli through the computer screen. Results: Our results showed that older active subjects have lower RT than older sedentary subjects (p i.e., simple or complex). Conclusions: Physical activity improves the decision making ability in older subjects.

Sinistroposition of the gallbladder and common bile duct

BACKGROUND: Despite its rare incidence, few cases of left-side gallbladder have been already published. METHODS: We reported herein the case of a 29-year-old man with a left liver tumor in whom left lateral bisegmen- tectomy was mandatory. It represents the first description of a sinistroposition of both gallbladder and common bile duct. RESULTS: Surgical exploration revealed a left-side gall- bladder , located under the left lobe of the liver. During he- patic parenchyma dissection at the left side of the round liga- ment and the Rex recessus, the common bile duct was in- jured. Complete separation of hepatic pedicle structures showed that the upper biliary convergence passed on the left side of the Rex recessus before reaching the hepatoduo- denal ligament. CONCLUSION: Only careful dissection of the hepatoduo- denal ligament up to Rex recessus level prior to liver paren- chyma resection could avoid biliary tract injury during left lobectomy.

Amniotic membrane as a potent source of stem cells and a matrix for engineering heart tissue

Existing therapies for the treatment of chronic heart failure still have some limitations and there is a pressing need for the development of new therapeutic modalities. The amniotic membrane has been used for the treatment of various diseases, such as conjunctive defects;however, the mechanisms behind its repair functions are still unclear. Regenerative medicine is seeking newer alternatives and among them, biomaterials have emerged in recent years for developing and manipulating molecules, cells, tissues or organs grown in laboratories in order to replace human body parts. Many such materials have been used for this purpose, either synthetically or biologically, in order to provide new medical devices. This review provides a wider view of the regeneration potential of the use of amniotic membrane as a potential biomaterial to facilitate the implementation of new research in surgical procedures. Amniotic membrane appears to be an alternative source of stem cells as well as an excellent biomaterial for cell-based therapeutic applications in engineering heart tissue.

Screening and diagnosis of endometrial cancer in Lynch syndrome

Lynch syndrome(LS) is an autosomal dominant inherited cancer predisposition syndrome caused by a mismatch of DNA repair(MMR system). Lifetime risk of developing endometrial and ovarian cancer in LS is higher than in the general population and gynecologic screening appears interesting. Screening is based on several tests: pelvic ultrasound, endometrial biopsy and hysteroscopy for endometrial cancer, pelvic ultrasound and CA125 for ovarian cancer. Those tests appear efficient for the diagnosis of gynecologic cancers in LS. Nevertheless, screening tests have not proved clinical benefit until now, and potential problems of compliance, risk of false negative cases, and interval cancer associated with screening do justify offering prophylactic surgery to patients. Women with LS should be informed of the potential benefits and risks of screening and the importance of evaluation in case of gynecologic symptoms or abnormal bleeding. Chemoprevention by progestincontaining oral contraceptives and the treatment of premalignant lesion are available options for reducing the risk of endometrial cancer in LS population.

How to Achieve Local Resilience to Flood Risks by Increasing Solidarity: The Example of the “Syndicat Mixte” (Inter-Municipal Cooperation Structure) of the French Territory of Belfort-Montbéliard

This paper illustrates approaches to flooding risk governance in a territory where a high density of population corresponds to a high level of industrial activities and a significant development of transport infrastructures in a transboundary context between France, Germany and Switzerland. In the last few years, some fundamental changes in European official instructions about risks and especially about flooding risks occurred. Substantial public policy challenges remain in order to promote a broad-based resilient territory twinned with local knowledge of sustainable land management and civic participation in local governance. The survey is based on a GIS study and questionnaires with a representative panel of 235 stakeholders from the studied territory. Our statistical results demonstrate that, in spite of a deep-rooted mindset as regards flooding hazards, local population awareness of the territorial vulnerability is not related to important challenges. A hierarchical analysis of the data shows that the awareness of stakeholders is less related to the importance of risks when the territorial level decreases. It also highlights the decline of solidarity among neighbouring communities when the distance from the industrial axis increases. Greatly impacted by flooding risks, industrial activities of the regional basin are paradoxically not really perceived as common challenges. Such a case study illustrates how public policies need to be relevant to the adapted levels. Awareness of common issues is a central target to develop acceptance in order to provide an efficient framework of resilience, including willingness to pay to reduce the risk and solidarity in local development compensations.