Influence of the primary cleft palate closure on the future need for orthognathic surgery in unilateral cleft lip and palate patients.

The aim of the study was to determine the influence of the dissection of the palate during primary surgery and the type of orthognathic surgery needed in cases of unilateral total cleft. The review concerns 58 children born with a complete unilateral cleft lip and palate and treated between 1994 and 2008 at the appropriate age for orthognathic surgery. This is a retrospective mixed-longitudinal study. Patients with syndromes or associated anomalies were excluded. All children were treated by the same orthodontist and by the same surgical team. Children are divided into 2 groups: the first group includes children who had conventional primary cleft palate repair during their first year of life, with extensive mucoperiosteal undermining. The second group includes children operated on according to the Malek surgical protocol. The soft palate is closed at the age of 3 months, and the hard palate at 6 months with minimal mucoperiosteal undermining. Lateral cephalograms at ages 9 and 16 years and surgical records were compared. The need for orthognathic surgery was more frequent in the first than in the second group (60% vs 47.8%). Concerning the type of orthognathic surgery performed, 2- or 3-piece Le Fort I or bimaxillary osteotomies were also less required in the first group. Palate surgery following the Malek procedure results in an improved and simplified craniofacial outcome. With a minimal undermining of palatal mucosa, we managed to reduce the amount of patients who required an orthognathic procedure. When this procedure was indicated, the surgical intervention was also greatly simplified.

Use of a renal-specific oral supplement by haemodialysis patients with low protein intake does not increase the need for phosphate binders and may prevent a decline in nutritional status and quality of life.

BACKGROUND: Protein-energy wasting is a frequent and debilitating condition in maintenance dialysis. We randomly tested if an energy-dense, phosphate-restricted, renal-specific oral supplement could maintain adequate nutritional intake and prevent malnutrition in maintenance haemodialysis patients with insufficient intake. METHODS: Eighty-six patients were assigned to a standard care (CTRL) group or were prescribed two 125-ml packs of Renilon 7.5(R) daily for 3 months (SUPP). Dietary intake, serum (S) albumin, prealbumin, protein nitrogen appearance (nPNA), C-reactive protein, subjective global assessment (SGA) and quality of life (QOL) were recorded at baseline and after 3 months. RESULTS: While intention to treat analysis (ITT) did not reveal strong statistically significant changes in dietary intake between groups, per protocol (PP) analysis showed that the SUPP group increased protein (P < 0.01) and energy (P < 0.01) intakes. In contrast, protein and energy intakes further deteriorated in the CTRL group (PP). Although there was no difference in serum albumin and prealbumin changes between groups, in the total population serum albumin and prealbumin changes were positively associated with the increment in protein intake (r = 0.29, P = 0.01 and r = 0.27, P = 0.02, respectively). The SUPP group did not increase phosphate intake, phosphataemia remained unaffected, and the use of phosphate binders remained stable or decreased. The SUPP group exhibited improved SGA and QOL (P < 0.05). CONCLUSION: This study shows that providing maintenance haemodialysis patients with insufficient intake with a renal-specific oral supplement may prevent deterioration in nutritional indices and QOL without increasing the need for phosphate binders.

Interactions between learning and immunity in Drosophila melanogaster

Learning and immunity are two adaptive traits with roles in central aspects of an organism's life: learning allows adjusting behaviours in changing environments, while immunity protects the body integrity against parasites and pathogens. While we know a lot about how these two traits interact in vertebrates, the interactions between learning and immunity remain poorly explored in insects. During my PhD, I studied three possible ways in which these two traits interact in the model system Drosophila melanogaster, a model organism in the study of learning and in the study of immunity. Learning can affect the behavioural defences against parasites and pathogens through the acquisition of new aversions for contaminated food for instance. This type of learning relies on the ability to associate a food-related cue with the visceral sickness following ingestion of contaminated food. Despite its potential implication in infection prevention, the existence of pathogen avoidance learning has been rarely explored in invertebrates. In a first part of my PhD, I tested whether D. melanogaster, which feed on food enriched in microorganisms, innately avoid the orally-acquired 'novel' virulent pathogen Pseudomonas entomophila, and whether it can learn to avoid it. Although flies did not innately avoid this pathogen, they decreased their preference for contaminated food over time, suggesting the existence of a form of learning based likely on infection-induced sickness. I further found that flies may be able to learn to avoid an odorant which was previously associated with the pathogen, but this requires confirmation with additional data. If this is confirmed, this would be the first time, to my knowledge, that pathogen avoidance learning is reported in an insect. The detrimental effect of infection on cognition and more specifically on learning ability is well documented in vertebrates and in social insects. While the underlying mechanisms are described in detail in vertebrates, experimental investigations are lacking in invertebrates. In a second part of my PhD, I tested the effect of an oral infection with natural pathogens on associative learning of D. melanogaster. By contrast with previous studies in insects, I found that flies orally infected with the virulent P. entomophila learned better the association of an odorant with mechanical shock than uninfected flies. The effect seems to be specific to a gut infection, and so far I have not been able to draw conclusions on the respective contributions of the pathogen's virulence and of the flies' immune activity in this effect. Interestingly, infected flies may display an increased sensitivity to physical pain. If the learning improvement observed in infected flies was due partially to the activity of the immune system, my results would suggest the existence of physiological connections between the immune system and the nervous system. The basis of these connections would then need to be addressed. Learning and immunity are linked at the physiological level in social insects. Physiological links between traits often result from the expression of genetic links between these traits. However, in social insects, there is no evidence that learning and immunity may be involved in an evolutionary trade-off. I previously reported a positive effect of infection on learning in D. melanogaster. This might suggest that a positive genetic link could exist between learning and immunity. We tested this hypothesis with two approaches: the diallel cross design with inbred lines, and the isofemale lines design. The two approaches provided consistent results: we found no additive genetic correlation between learning and resistance to infection with the diallel cross, and no genetic correlation in flies which are not yet adapted to laboratory conditions in isofemale lines. Consistently with the literature, the two studies suggested that the positive effect of infection on learning I observed might not be reflected by a positive evolutionary link between learning and immunity. Nevertheless, the existence of complex genetic relationships between the two traits cannot be excluded. - L'apprentissage et l'immunité sont deux caractères à valeur adaptative impliqués dans des aspects centraux de la vie d'un organisme : l'apprentissage permet d'ajuster les comportements pour faire face aux changements de l'environnement, tandis que l'immunité protège l'intégrité corporelle contre les attaques des parasites et des pathogènes. Alors que les interactions entre l'apprentissage et l'immunité sont bien documentées chez les vertébrés, ces interactions ont été très peu étudiées chez les insectes. Pendant ma thèse, je me suis intéressée à trois aspects des interactions possibles entre l'apprentissage et l'immunité chez la mouche du vinaigre Drosophila melanogaster, qui est un organisme modèle dans l'étude à la fois de l'apprentissage et de l'immunité. L'apprentissage peut affecter les défenses comportementales contre les parasites et les pathogènes par l'acquisition de nouvelles aversions pour la nourriture contaminée par exemple. Ce type d'apprentissage repose sur la capacité à associer une caractéristique de la nourriture avec la maladie qui suit l'ingestion de cette nourriture. Malgré les implications potentielles pour la prévention des infections, l'évitement appris des pathogènes a été rarement étudié chez les invertébrés. Dans une première partie de ma thèse, j'ai testé si les mouches, qui se nourrissent sur des milieux enrichis en micro-organismes, évitent de façon innée un 'nouveau' pathogène virulent Pseudomonas entomophila, et si elles ont la capacité d'apprendre à l'éviter. Bien que les mouches ne montrent pas d'évitement inné pour ce pathogène, elles diminuent leur préférence pour de la nourriture contaminée dans le temps, suggérant l'existence d'une forme d'apprentissage basée vraisemblablement sur la maladie générée par l'infection. J'ai ensuite observé que les mouches semblent être capables d'apprendre à éviter une odeur qui était au préalable associée avec ce pathogène, mais cela reste à confirmer par la collecte de données supplémentaires. Si cette observation est confirmée, cela sera la première fois, à ma connaissance, que l'évitement appris des pathogènes est décrit chez un insecte. L'effet détrimental des infections sur la cognition et plus particulièrement sur les capacités d'apprentissage est bien documenté chez les vertébrés et les insectes sociaux. Alors que les mécanismes sous-jacents sont détaillés chez les vertébrés, des études expérimentales font défaut chez les insectes. Dans une seconde partie de ma thèse, j'ai mesuré les effets d'une infection orale par des pathogènes naturels sur les capacités d'apprentissage associatif de la drosophile. Contrairement aux études précédentes chez les insectes, j'ai trouvé que les mouches infectées par le pathogène virulent P. entomophila apprennent mieux à associer une odeur avec des chocs mécaniques que des mouches non infectées. Cet effet semble spécifique à l'infection orale, et jusqu'à présent je n'ai pas pu conclure sur les contributions respectives de la virulence du pathogène et de l'activité immunitaire des mouches dans cet effet. De façon intéressante, les mouches infectées pourraient montrer une plus grande réactivité à la douleur physique. Si l'amélioration de l'apprentissage observée chez les mouches infectées était due en partie à l'activité du système immunitaire, mes résultats suggéreraient l'existence de connections physiologiques entre le système immunitaire et le système nerveux. Les mécanismes de ces connections seraient à explorer. L'apprentissage et l'immunité sont liés sur un plan physiologique chez les insectes sociaux. Les liens physiologiques entre les caractères résultent souvent de l'expression de liens entre ces caractères au niveau génétique. Cependant, chez les insectes sociaux, il n'y a pas de preuve que l'apprentissage et l'immunité soient liés par un compromis évolutif. J'ai précédemment rapporté un effet positif de l'infection sur l'apprentissage chez la drosophile. Cela pourrait suggérer qu'une relation génétique positive existerait entre l'apprentissage et l'immunité. Nous avons testé cette hypothèse par deux approches : le croisement diallèle avec des lignées consanguines, et les lignées isofemelles. Les deux approches ont fournies des résultats similaires : nous n'avons pas détecté de corrélation génétique additive entre l'apprentissage et la résistance à l'infection avec le croisement diallèle, et pas de corrélation génétique chez des mouches non adaptées aux conditions de laboratoire avec les lignées isofemelles. En ligne avec la littérature, ces deux études suggèrent que l'effet positif de l'infection sur l'apprentissage que j'ai précédemment observé ne refléterait pas un lien évolutif positif entre l'apprentissage et l'immunité. Néanmoins, l'existence de relations génétiques complexes n'est pas exclue.

Insect trypanosomatids: the need to know more

Of ten recognized trypanosomatid genera, only two -- pathogenic Trypanosoma and Leishmania -- have been actively investigated for any length of time while the plant flagellates -- Phytomonas -- have recently begun to attract attention due to their role as agricultural parasites. The remaining genera that comprise parasites associated with insects have been largely neglected except for two or three containing popular isolates. This publication reviews current knowledge of trypanosomatids from insects.

Renal responses to three types of renin-angiotensin system blockers in patients with diabetes mellitus on a high-salt diet: a need for higher doses in diabetic patients?

Objective Activation of the renal renin-angiotensin system in patients with diabetes mellitus appears to contribute to the risk of nephropathy. Recently, it has been recognized than an elevation of prorenin in plasma also provides a strong indication of risk of nephropathy. This study was designed to examine renin-angiotensin system control mechanisms in the patient with diabetes mellitus.Methods We enrolled 43 individuals with type 2 diabetes mellitus. All individuals were on a high-salt diet to minimize the contribution of the systemic renin-angiotensin system. After an acute exposure to captopril (25 mg), they were randomized to treatment with either irbesartan (300 mg) or aliskiren (300 mg) for 2 weeks.Results All agents acutely lowered blood pressure and plasma aldosterone, and increased renal plasma flow and glomerular filtration rate. Yet, only captopril and aliskiren acutely increased plasma renin and decreased plasma angiotensin II, whereas irbesartan acutely affected neither renin nor angiotensin II. Plasma renin and angiotensin II subsequently did increase upon chronic irbesartan treatment. When given on day 14, irbesartan and aliskiren again induced the above hemodynamic, renal and adrenal effects, yet without significantly changing plasma renin. Irbesartan at that time did not affect plasma angiotensin II, whereas aliskiren lowered it to almost zero.Conclusion The relative resistance of the renal renin response to acute (irbesartan) and chronic (irbesartan and aliskiren) renin-angiotensin system blockade supports the concept of an activated renal renin-angiotensin system in diabetes, particularly at the level of the juxtaglomerular cell, and implies that diabetic patients might require higher doses of renin-angiotensin system blockers to fully suppress the renal renin-angiotensin system. J Hypertens 29: 2454-2461 (C) 2011 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.

Determining An Appropriate Framework for Assessing Older Peoples Need for Free Nursing - Project Report (March 2005) (PDF 1276 KB)

Evaluation of the nursing needs assessment tool and associated systems and processes.

New Targeting Social Need Action Plan 2000 (PDF 2000 KB)

This report sets out New Targeting Social Need actions for 2000.

Tackling Equality and Targeting Social Need - Improving the Infrastucture (PDF 101 KB)

This paper considers two recent initiatives in Northern Ireland relating to targeting social need and inequalities. While the paper deals with each separately they should be seen as complementary. Therefore, many of the points made in relation to one are also pertinent to the other. åÊ

DHSSPS Strategy for Children in Need (PDF 326 KB)

Developing the Strategy

Immunodéficience commune variable: ce qu'il faut savoir [Common variable immune deficiency: what you need to know].

Common variable immune deficiency is the most frequent primary immune deficiency, characterized mainly by a disorder of B lymphocytes differentiation and a deficit in immunoglobulins. The clinical manifestations include recurrent infections, non-infectious lung and digestive involvements, autoimmune diseases, and an increased susceptibility to cancers. Recent breakthroughs have been made in the understanding of some genetic mechanisms of the disease. Replacement therapy with intravenous immunoglobulins remains the treatment of choice, which allows significant improvement in the survival and quality of life. However progress should be made in the understanding of the pathophysiology and in the early detection of this disease, since a delay in the diagnosis may have harmful consequences in terms of morbidity and mortality.

Tackling Equality and Targeting Social Need (PDF 80 KB)

Statistics Users Council Annual Conference This paper considers two recent initiatives in NI relating to targeting social need, and inequalities. While the paper deals with each separately they should be seen as complementary. Therefore, many of the points made in relation to one are also pertinent to the other. åÊ