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Resume Le traitement des petites lesions cancereuses laryngees (T1 et T2) repose sur la chirurgie partielle, endoscopique ou externe et la radiotherapie. Outre l’imperatif carcinologique ces techniques doivent au maximum preserver les fonctions de respiration, de deglutition et de phonation. Objectif Analyser les fonctions de respiration, de deglutition et de phonation chez des patients traites par laryngectomie supra-cricoidienne et reconstruction a l’aide des muscles sous-hyoidiens. Materiels et methodes Notre travail consistait a analyser les fonctions de respiration, de deglutition et de phonation chez 37 patients traites dans deux instituts entre 2005 et 2015. Nous avons inclus tous les patients beneficiant de ce type de reconstruction avec un recul d’au moins un an par rapport a la chirurgie. L’etude de la fonction respiratoire consistait a noter l’existence ou non d’une tracheotomie et a mesurer le debit inspiratoire de pointe. La preservation ou non des unites crico-arytenoidiennes, le delai de maintien de la sonde nasogastrique et le remplissage de l’auto-questionnaire DHI 30 etaient recueillis pour analyser la fonction de deglutition. La phonation etait appreciee a l’aide de l’auto-questionnaire VHI 30. Resultats Nos resultats montrent un taux de chirurgie initiale sans tracheotomie de 64,9 % (13 patients) avec une reprise rapide de l’alimentation orale (delai moyen d’ablation de la sonde de 13 jours). Le score moyen au VHI 30 etait de 28,3 et de 2,7 au DHI 30. La valeur moyenne du debit inspiratoire de pointe etait de 203,3 mL/mn. Conclusion La laryngectomie supra-cricoidienne avec reconstruction a l’aide des muscles sous-hyoidiens est une technique alternative pour le traitement des petites lesions cancereuses laryngees. Sa realisation permet d’offrir des suites fonctionnelles simples.

This letter establishes sufficient conditions for the sparse multiple measurement vector (MMV) or row-sparse matrix approximation problem for the Rank Aware Row Thresholding (RART) algorithm. Using the rank aware selection operator to define RART results in discrete MUltiple SIgnal Classification (MUSIC) from array signal processing. When the sensing matrix is drawn from the random Gaussian matrix ensemble, we establish that the rank of the row-sparse measurement matrix in the noiseless row-sparse recovery problem allows RART (MUSIC) to reduce the effect of the log ⁡ ( n ) penalty term that is present in traditional compressed sensing results and simultaneously provides a row-rank deficient recovery result for MUSIC. Empirical evidence shows that Thresholding closely matches RART in successful row-sparse approximation. The theoretical and empirical evidence provides further support for the conjecture that the thresholding operator in more sophisticated greedy algorithms is the source of their observed rank awareness.

Treatment of small laryngeal cancerous lesions (T1 and T2) is based on partial endoscopic or open surgery and radiotherapy. In addition to the oncological imperative, these techniques must optimally preserve the functions of breathing, swallowing and phonation. Objective To analyze the above functions in patients treated with supracricoid laryngectomy and reconstruction using infrahyoid muscle. Materials and methods Breathing, swallowing and phonation were analyzed in 37 patients treated in two institutes between 2005 and 2015. All patients undergoing the above type of reconstruction with a minimum 1 year's follow-up were included. Respiratory study noted any tracheotomy and measured peak inspiratory flow. Preservation of cricoarytenoid units and nasogastric intubation time, and DHI-30 self-administered questionnaire results were collected to analyze swallowing function. Phonation was assessed on the VHI-30 self-administered questionnaire. Results The rate of primary surgery without tracheotomy was 64.9% (13 patients), with rapid resumption of oral feeding (mean intubation time, 13 days). Mean VHI score was 28.3 and mean DHI 30 score 2.7. Mean peak inspiratory flow was 203.3 mL/min. Conclusion Supracricoid laryngectomy with reconstruction using subhyoid muscle is an alternative technique for the treatment of small laryngeal cancerous lesions, providing uncomplicated functional outcome.

Resume Contexte La spondylodiscite cervicale est une complication rare mais severe de la chirurgie pharyngee. Materiel et Methode Cette etude retrospective, multicentrique rapportait, au sein du groupe francais d’etude des tumeurs de la tete et du cou (GETTEC), les patients atteints d’une spondylodiscite cervicale apres chirurgie trans-orale robotisee (TORS), d’une tumeur maligne pharyngee entre janvier 2010 et janvier 2017. Objectifs Decrire les cas de spondylodiscite cervicale apres TORS, definir les signes d’alerte de cette complication potentiellement letale, ainsi que la prise en charge optimale. Resultats Un total de 7 patients de 6 centres differents etaient inclus dans notre etude. Les carcinomes etaient des stades T1 ou T2, localises a la paroi pharyngee posterieure. Tous les patients presentaient des facteurs de risque de spondylodiscite. Le delai diagnostique moyen etait de 12,6 jours. Le delai moyen entre la chirurgie et le diagnostic de spondylodiscite etait de 2,1 mois (de 20 jours a 4,5 mois). Le symptome principal etait la cervicalgie (87 %). Les infections etaient polymicobiennes ; les germes etaient identifies dans 5 cas, traites par antibiotherapie intraveineuse. Un geste chirurgical de decompression medullaire etait realise dans 3 cas. Le suivi a montre 4 evolutions favorables et 3 deces. Le taux de mortalite etait de 43 %. Conclusion Cette etude multicentrique francaise est en faveur d’une mortalite severe de la spondylodiscite cervicale dans les suites d’une TORS, meme en cas de resection limitee. Les chirurgiens doivent evoquer ce diagnostic devant une cervicalgie persistante, un defaut de cicatrisation de la paroi pharyngee posterieure, une asthenie, une fievre, un syndrome inflammatoire. L’IRM est l’examen radiologique le plus performant pour confirmer ce diagnostic.

Objective The aim of the current study was to assess the diagnostic accuracy of the Neuropad for detecting distal sensory peripheral neuropathy (DSPN) related to human immunodeficiency virus (HIV)-infection. Design Single-gate observational case-control study. Methods A convenience sample of 30 HIV-infected subjects with a mean age of 48.9 years (95% CI 45.6–52.3) and no other potential causes of neuropathy were recruited from the Ian Charleson Day Centre (London, UK). Sudomotor function was assessed with the Neuropad, an adhesive patch designed to measure sweat production, using a 10-min cut-off. Vibration perception threshold (VPT) testing with a neurothesiometer and the painDETECT questionnaire (PD-Q) were used as reference standard measures of DSPN. Results 16 participants with sudomotor dysfunction and 14 with healthy sudomotor function were included in analysis. Compared to VPT (>25 V) the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the Neuropad yielded 66.7%, 48.1%, 12.5% and 92.9% respectively. For the PD-Q (>12) sensitivity of the Neuropad was 100% and specificity was 58.3%, with PPV and NPV of 37.5% and 100% respectively. Conclusions The Neuropad may be a suitable screening tool for HIV-related DSPN, and can reliably exclude healthy individuals in the clinical setting. Abnormal Neuropad results require referral to confirm diagnosis. Limitations exist in the sampling method and study size. The use of reference standard measures of small nerve fibre function and continuous Neuropad quantification would strengthen future research.

Resume But Les pharyngolaryngectomies totale circulaires sont realisees pour des tumeurs evoluees du pharynx ou dans un contexte de recidive post-radique. Plusieurs procedes de reconstruction du pharynx par lambeau libres ou pedicules sont utilises et sont choisis selon l’operateur. Cette etude a pour but d’evaluer les resultats fonctionnels sur la deglutition a long terme de ces patients en fonction du type de lambeau utilise pour la reconstruction. Materiel et methode Une etude retrospective multicentrique a ete menee de janvier a septembre 2016 dans le groupe Gettec. Tous les patients operes d’une pharyngolaryngectomie totale circulaire et en remission etaient inclus et devaient remplir le questionnaire du deglutition handicap index (DHI) et avoir une fibroscopie de deglutition. 46 patients (39 hommes 7 femmes) ont ete inclus pendant cette periode. Le lambeau ante-brachial tubulise (groupe LABT) etait utilise dans 19 cas, le grand pectoral en fer a cheval (groupe LGP) dans 15 cas et le jejunum libre (groupe LJL) dans 12 cas. Resultats Le DHI moyen etait de 24 : 20 groupes LABT, 23 groupes LJL, 25 groupes LGP, sans difference significative ; 27 patients avaient une deglutition normale, 9 mixee, 8 liquide, 3 etaient alimentes par gastrostomie. La nasofibroscopie de la deglutition obtenait un pourcentage de patient avec une deglutition normale de salive et de yaourt significativement plus important pour les patients reconstruits avec un lambeau libre (LJL et LABT) par rapport au groupe LGP (p = 0,04). Conclusion Cette etude a montre que le type de lambeau de reconstruction d’une pharyngolaryngectomie totale circulaire n’a pas d’impact sur la qualite de la deglutition postoperatoire evaluee par le patient par autoquestionnaire du DHI.

Le fistole faringee corrispondono a comunicazioni tra la cavita faringea e l’esterno che si verificano nel 50% dei casi in media dopo chirurgia di exeresi faringolaringea. I fattori di rischio, come la denutrizione, l’estensione dell’exeresi o la radioterapia neoadiuvante, sono numerosi ma molto discussi. La diagnosi e clinica. Gli esami complementari sono utilizzati principalmente per rilevare sovrainfezioni, complicanze vascolari o un’evoluzione tumorale. Il transito esofago-gastro-duodenale puo essere utile per individuare una fistola incipiente prima della rialimentazione orale. Il trattamento iniziale e medico, basato sulle cure locali, e, poi, chirurgico, in caso di insuccesso. Occorre tenere conto dello stato locale e generale per fare la migliore scelta terapeutica. Misure di prevenzione devono essere utilizzate per ridurre l’incidenza delle fistole e le loro conseguenze psicologiche, estetiche ed economiche sulla prognosi e sulla qualita di vita dei pazienti.

Las fistulas faringeas son comunicaciones entre la cavidad faringea y el exterior. Se producen en el 50% de los casos en promedio tras la cirugia de reseccion faringolaringea. Existen numerosos factores de riesgo, como la desnutricion, la extension de la reseccion o la radioterapia neoadyuvante, pero son controvertidos. El diagnostico es clinico. Las pruebas complementarias se utilizan sobre todo para detectar las sobreinfecciones, las complicaciones vasculares o una evolucion tumoral. El transito esofago-gastro-duodenal puede ser util para detectar una fistula inicial antes de reanudar la alimentacion oral. El tratamiento inicial es medico, basado en los cuidados locales, y despues quirurgico si lo anterior fracasa. Hay que tener en cuenta el estado local y general para tomar la mejor decision terapeutica. Se deben utilizar medidas preventivas para reducir la incidencia de las fistulas y sus consecuencias psicologicas, esteticas, economicas, asi como sobre el pronostico y la calidad de vida de los pacientes.

Resume Objectif Les auteurs exposent les recommandations de la Societe francaise d’oto-rhino-laryngologie et de chirurgie de la face et du cou (SFORL) concernant l’actualisation de la recommandation du suivi post-therapeutique des carcinomes epidermoides des voies aerodigestives superieures de l’adulte. Ce chapitre de la recommandation concerne la recherche des metastases et des localisations metachrones œsophagiennes et bronchiques. Methodes Un groupe de travail multidisciplinaire a ete charge d’effectuer une revue de la litterature scientifique sur la thematique etudiee. A partir de ces textes et de l’experience de chacun, des recommandations ont ete redigees. Elles ont ensuite ete relues par un groupe de lecture independant du groupe de travail. Une reunion de synthese a permis d’aboutir a la version finale de la recommandation Les recommandations proposees ont ete classees en grade A, B, C ou accord professionnel selon un niveau de preuve scientifique decroissant.

Objectives A 10-year retrospective study investigated factors for survival and laryngeal preservation in advanced laryngeal, hypopharyngeal or epilaryngeal neoplasia. Material and method Two hundred and forty-six patients with advanced cancer of the larynx (17.48%), hypopharynx (48.78%) or epilarynx (33.74%) undergoing primary organ-sparing treatment were included from 1998 to 2008. Treatment comprised chemotherapy followed by radiation therapy for 92.68% of patients, isolated radiation therapy for 1.6% and concomitant or sequential radiation-chemotherapy for 5.7%. General health status, history and tumor status were recorded. Factors influencing survival were analyzed by Kaplan-Meier estimator, log-rank test and Cox models. Results Median overall survival of the population was 2.3 years and median laryngeal preservation 0.99 years in male patients and 2 years in female patients. Survival correlated significantly with body mass index (BMI; P = 0.0004), WHO performance status (P = 0.0064), alcohol consumption (P = 0.0004) and cessation (P

Resume Objectif Etude retrospective sur 10 ans avec recherche de facteurs influencant la survie et la preservation laryngee chez les patients souffrant d’une neoplasie avancee du larynx, de l’hypopharynx ou de la margelle. Patients et methode Entre 1998 et 2008, nous avons inclus 246 patients porteurs d’un cancer avance du larynx (17,48 %), de l’hypopharynx (48,78 %) ou de la margelle laryngee (33,74 %) qui ont beneficie en premiere intention d’un protocole de preservation d’organe (PPO). Celui-ci a ete effectue pour 92,68 % des patients par chimiotherapie puis radiotherapie, 1,6 % ont eu une radiotherapie exclusive, 5,7 % une radiochimiotherapie concomitante ou sequentielle. Des criteres sur l’etat general des patients, leurs antecedents et leur tumeur ont ete releves. Les facteurs influencant la survie ont ete etudies avec la methode de Kaplan-Meier, le test de Log-Rank et le modele de Cox. Resultats La mediane de survie brute de notre population est de 2,3 ans et pour la preservation laryngee, celle-ci est de 0,99 an pour les hommes et de 2 ans pour les femmes. Il existe un lien statistiquement significatif entre la survie et l’IMC du patient (p = 0,0004), l’etat general (stade OMS) (p = 0,0064), la consommation (p = 0,0004) et le sevrage alcoolique (p Conclusion Outre les criteres deja connus, ce travail met en exergue l’importance de l’etat general et nutritionnel de nos patients lors de leur prise en charge.

Resume Introduction L’osteoradionecrose mandibulaire (ORN) est une complication severe souvent irreversible de la radiotherapie, liee a un echec de la cicatrisation. L’association pentoxifylline – tocopherol diminue la fibrose superficielle induite par la radiotherapie. La potentialisation avec le clodronate (PENTOCLO) semble donner de bons resultats dans les ORN mandibulaires. Les objectifs de ce travail sont d’etudier l’efficacite et la tolerance du traitement par PENTOCLO. Methodes Etude retrospective chez 27 patients âges de 65 ± 12 ans, pris en charge pour une ORN mandibulaire secondaire a une irradiation de cancer de la tete et du cou, traitee par le protocole PENTOCLO entre janvier 2010 et mars 2011. Le critere de jugement principal etait la regression de l’exposition osseuse jusqu’a cicatrisation complete. L’evaluation etait clinique par la mesure de l’ulceration muqueuse et radiologique (panoramique dentaire) avant traitement, apres traitement desinfiltrant antibiotique-corticoides a un mois (M1), puis apres 3, 6, 12 mois de PENTOCLO. Resultats Une amelioration de l’ulceration muqueuse etait observee chez 16/21 patients a 3 mois et 12/17 patients a 6 mois de PENTOCLO. La cicatrisation a ete obtenue chez 16 patients. Le delai de cicatrisation median a ete de 82 jours (32–266), plus court apres chirurgie et radiotherapie (49 jours) et plus long apres radiochimiotherapie (169 jours). La cicatrisation radiologique semble etre plus tardive que la cicatrisation clinique avec 9 ameliorations/20 patients a 3 mois. La tolerance et l’efficacite du traitement etaient evaluees par un examen clinique endobuccal, l’alimentation, le poids et la prise d’antalgiques. Il n’y a peu pas d’arret de traitement lie aux effets secondaires. Conclusion Le protocole PENTOCLO a permis une regression clinique et radiologique de l’ORN. Parallelement, les indications operatoires lourdes ont regresse. Des etudes prospectives avec etude de la qualite de vie devraient permettre de consolider ces resultats preliminaires.

Objective To present the guidelines of the French Oto-Rhino-Laryngology – Head and Neck Surgery Society (SFORL) concerning the management of somatic pain induced by the treatment of head and neck cancer, and in particular the management of early and late post-surgical pain. Methods A multidisciplinary work group conducted a review of the scientific literature on the study topic. An editorial group subsequently read the resulting guidelines before validation. Results It is recommended to prevent onset of pain caused by malpositioning on the operating table, as well as pain related to postoperative care. During surgery, it is recommended to spare nerve and muscle structures as far as possible to limit painful sequelae. Management of early postoperative pain upon tumor resection and flap harvesting sites requires patient-controlled analgesia by morphine pump. Physical therapy is recommended after flap harvesting to minimize painful sequelae. Conclusion Preventive and curative measures should be undertaken for appropriate management of post-surgical pain in the treatment of head and neck cancers.

Objectives The authors present the section of the guidelines of the French Otorhinolaryngology Head and Neck Surgery Society (SFORL) for the management of somatic pain induced by head and neck cancer treatment concerning management of pain following radiation therapy and chemotherapy. Methods A multidisciplinary work group was entrusted with a literature review. Guidelines were drawn up based on the articles retrieved and the group members’ experience. They were read over by an editorial group independent of the work group. A coordination meeting drew up the final version. Guidelines were graded A, B or C or as expert opinion in decreasing order of level of evidence. Results Particular care should be given to detection and early adapted treatment of pain induced by radiation therapy and/or chemotherapy, to improve quality of life in head and neck cancer patients.

Resume Objectif Les auteurs exposent les recommandations de la Societe francaise d’oto-rhino-laryngologie et de chirurgie de la face et du cou (SFORL) concernant la prise en charge des douleurs somatiques induites par les traitements des cancers des voies aero-digestives superieures, et plus particulierement les outils necessaires a la definition et a l’evaluation initiale des differents types de douleurs. Methodes Un groupe de travail multidisciplinaire a ete charge d’effectuer une revue de la litterature scientifique sur la thematique etudiee. A partir de ces textes et de l’experience de chacun, des recommandations ont ete redigees. Elles ont ensuite ete relues par un groupe de lecture independant du groupe de travail. Une reunion de synthese a permis d’aboutir a la version finale de la recommandation. Les recommandations proposees ont ete classees en grade A, B, C ou accord professionnel selon un niveau de preuve scientifique decroissant. Resultats Il est recommande d’eliminer en priorite une recidive tumorale devant une douleur qui reapparait ou se modifie apres le traitement d’un cancer des voies aero-digestives superieures. Il est recommande d’utiliser les outils de depistage des douleurs neuropathiques et les echelles d’evaluation de la douleur pour evaluer l’intensite de la douleur et l’efficacite du traitement. Des seances de reeducation fonctionnelle doivent etre prescrites pour limiter les douleurs musculo-squelettique, prevenir les ankyloses et les attitudes vicieuses. Une psychotherapie et des techniques psychocorporelles, lorsqu’elles sont disponibles, doivent etre proposees au patient douloureux chronique. En cas de douleur complexe rebelle, il est necessaire d’adresser le patient a une equipe pluridisciplinaire (structure douleur). Conclusion La prise en charge des douleurs somatiques induites par les traitements des cancers des voies aero-digestives superieures necessite avant tout de differencier et d’evaluer l’intensite des differents types de douleurs impliquees, de leur retentissement fonctionnel et de leur composante emotionnelle.

Objectives The authors present the guidelines of the French Oto-Rhino-Laryngology- Head and Neck Surgery Society (Societe francaise d’oto-rhino-laryngologie et de chirurgie de la face et du cou [SFORL]) for the management of somatic pain induced by head-and-neck cancer treatment, and in particular the instruments needed for the definition and initial assessment of the various types of pain. Methods 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 final version was established in a coordination meeting. The guidelines were graded as A, B, C or expert opinion, by decreasing level of evidence. Results The priority is to eliminate tumoral recurrence when pain reappears or changes following head-and-neck cancer treatment. Neuropathic pain screening instruments and pain assessment scales should be used to assess pain intensity and treatment efficacy. Functional rehabilitation sessions should be prescribed to reduce musculoskeletal pain and prevent ankylosis and postural disorder. Psychotherapy and mind-body therapy, when available, should be provided in case of chronic pain. In case of recalcitrant complex pain, referral should be made to a multidisciplinary pain structure. Conclusion The management of somatic pain induced by head-and-neck cancer treatment above all requires identifying and assessing the intensity of the various types of pain involved, their functional impact and their emotional component.

Resume Contrairement aux autres localisations des VADS, les cancers de l’oropharynx sont en augmentation, notamment du fait de leur association avec l’infection a HPV. Leur prise en charge est pluridisciplinaire. De nouvelles techniques telles que la chirurgie trans-orale robotisee et la radiotherapie conformationnelle en modulation d’intensite permettent de reduire les toxicites et la morbidite de leur prise en charge. Les stades precoces peuvent etres traites par une modalite therapeutique unique (chirurgie ou radiotherapie) avec un taux de survie a 5 ans superieur a 80 %. Les stades avances necessitent quant a eux une association therapeutique avec un taux de survie inferieure a 40 %.

Resume Objectif Etude de patients atteints d’un cancer glottique classe T1N0M0 ou T2N0M0 traites par radiotherapie exclusive. Confronter nos resultats a ceux de la litterature en termes de survie et de resultats fonctionnels. Methode Etude retrospective des tumeurs laryngees neoplasiques classees T1N0M0 ou T2N0M0 traitees par radiotherapie exclusive et diagnostiquees entre le 1 er janvier 2000 et le 31 decembre 2010. Evaluation des taux de survie, de recidive et de preservation laryngee. Lieu CLCC Francois Baclesse et CHU de Caen. Patients Cinquante-neuf patients (53 hommes et six femmes) suivis pour un carcinome larynge (57 carcinomes epidermoides, deux carcinomes verruqueux) dont 51 T1N0M0 et huit T2N0M0. Traitement par radiotherapie exclusive (dose moyenne de 70 Grays limitee au cartilage thyroide pour 57 patients, avec irradiation des aires ganglionnaires pour deux patients). Resultats Dans notre serie, cinq (9,8 %) patients avec un carcinome larynge T1N0M0 et trois (37,5 %) avec une tumeur classee T2N0M0 ont recidive, soit un taux global de recidive de 13,6 %. Sur les huit recidives, trois ont evolue sur le plan ganglionnaire uniquement (N), deux ont recidive uniquement sur le site tumoral initial (T) et trois ont recidive localement et au niveau ganglionnaire (T et N). Leur traitement a consiste pour trois d’entre elles en une laryngectomie totale de rattrapage avec curage cervical bilateral, deux recidives ont ete traitees par curage cervical bilateral et radiotherapie sensibilisee, une par chimiotherapie seule, une par curage cervical et radiotherapie cervicale. Le dernier patient avec recidive est decede avant tout autre traitement. Le taux de preservation laryngee etait de 94,9 %. Conclusion En comparaison avec la litterature, le traitement par radiotherapie exclusive des cancers larynges classes T1T2N0M0 donne de tres bons resultats, avec un taux de preservation laryngee egal a 95 %.

Resume Introduction Avec la mise en œuvre du contrat de bon usage dans les etablissements de sante, la prescription medicale dediee aux dispositifs medicaux (DM), par analogie aux medicaments, pourrait permettre de securiser et de garantir leur bon usage. Materiel et methode Nous avons cherche a mettre en place une prescription informatisee en nous appuyant sur deux exemples de DM aux caracteristiques distinctes : la therapie des plaies par pression negative (TPN) et les endoprotheses coronaires a liberation de principe actif. Resultats En partenariat avec les equipes medicales, nous avons elabore un protocole informatise integrant l’ensemble des informations indispensables a la bonne utilisation de la TPN. Pour les endoprotheses coronaires a liberation de principe actif, nous nous sommes bases sur un questionnaire informatique preexistant que nous avons optimise afin que les informations portant sur le prescripteur, le patient, les caracteristiques de la lesion, le type de stents et surtout l’indication soient mentionnees. Discussion et conclusion La prescription informatisee de DM potentiellement a risque comme la TPN apparait etre premierement, un support interessant pour la planification et la mise en œuvre des soins, deuxiemement, un element cle du dossier patient. Pour les dispositifs medicaux implantables (DMI) hors groupe homogene de sejour (GHS), tels que les endoprotheses coronaires a liberation de principe actif, la prescription nominative, meme a posteriori de l’implantation, apparait desormais comme incontournable pour suivre les indications en vue de leur remboursement. Enfin, a travers cette nouvelle approche, les pharmaciens hospitaliers responsables des DM introduisent une nouvelle activite de pharmacie clinique.

Objectif Evaluer de facon prospective l’interet de la TEP/TDM a la F18-choline (FCH) pour la localisation preoperatoire d’adenome parathyroidien chez des patients atteints d’une hyperparathyroidie primaire et presentant un bilan d’imagerie conventionnel consistant en une echographie cervicale et une TEMP/TDM au Tc99m-sestaMIBI (MIBI), negatif ou non concluant. Materiel et methode Vingt patients eligibles ont beneficie d’une TEP/TDM a la FCH. Le resultat etait considere positif, negatif ou non concluant. Les caracteristiques des foyers ont ete notees. Le geste chirurgical a ete adapte au resultat de la TEP/TDM a la FCH (chirurgie mini-invasive, exploration cervicale bilaterale ou autre en cas de foyer ectopique ou multiple). Les donnees TEP ont ete confrontees aux donnees chirurgicales et anatomopathologiques et au suivi biologique post-operatoire. Resultats Les taux moyens de calcemie et PTH preoperatoire etaient, respectivement, de 2,75 ± 0,22 mmol/L et 98,1 ± 38,4 pg/mL. L’examen TEP/TDM a la FCH a ete considere positif pour 17 patients (85 %), non concluant pour 2 (10 %) patients et negatif pour 1 (5 %) patient, revelant au total 22 foyers (21 en position habituelle et 1 ectopique) de taille moyenne 13,4 mm [6,3–37,0]). La chirurgie, adaptee au resultat TEP chez 19 (95 %) patients, a consiste en 16 chirurgies mini-invasives, 1 exploration cervicale bilaterale pour foyers multiples bilateraux et 2 autres types de chirurgie. Le patient avec TEP negative a beneficie d’une exploration cervicale bilaterale. L’analyse anatomopathologique a retrouve 20 lesions presentant un adenome chez 17 patients. Au total, la sensibilite, par lesion et par patient, d’un examen TEP/TDM a la FCH pour detecter un adenome parathyroidien est, respectivement, de 95,0 % (95 %CI : 75,1–99,9) et 94,4 % (95 %CI : 72,7–99,9), avec des valeurs positives predictives de 90,5 % (95 %CI : 89,6–91,3) et 89,5 % (95 %CI : 88,4–90,5). La calcemie moyenne post-operatoire etait de 2,39 ± 0,19 mmol/L. Conclusion La TEP/TDM a la FCH permet de guider la parathyroidectomie avec succes chez la majorite des patients atteints d’une hyperparathyroidie primaire avec imagerie conventionnelle negative ou non concluante. Clinicaltrial NCT02432599

Classification may help clinicians to understand the main physiopathological process underlying neuromusculoskeletal pain and thus improve its management. Such classification should help not just clinicians’ decisions to propose appropriate treatments with expected outcomes but also improve clinician-patient communication through a better understanding of pain mechanisms and their repercussions on quality of life. Smart et al. have developed a 3-category classification for NMSP using a Delphi survey to generate expert, consensus-derived lists of clinical criteria associated with a dominance of nociceptive pain (NP), peripheral neuropathic pain (PNP) and central sensitization pain (CSP) among low back pain (LBP) patients. These authors then developed a cross-sectional, between patients study that resulted in three published papers. 4

A major enterprise in compressed sensing and sparse approximation is the design and analysis of computationally tractable algorithms for recovering sparse, exact or approximate, solutions of underdetermined linear systems of equations. Many such algorithms have now been proven to have optimal-order uniform recovery guarantees using the ubiquitous Restricted Isometry Property (RIP). However, it is unclear when the RIP-based sufficient conditions on the algorithm are satisfied. We present a framework in which this task can be achieved; translating these conditions for Gaussian measurement matrices into requirements on the signal's sparsity level, length, and number of measurements. We illustrate this approach on three of the state-of-the-art greedy algorithms: CoSaMP, Subspace Pursuit (SP), and Iterative Hard Thresholding (IHT). Designed to allow a direct comparison of existing theory, our framework implies that, according to the best known bounds, IHT requires the fewest number of compressed sensing measurements and has the lowest per iteration computational cost of the three algorithms compared here., Comment: 31 pages, 3 figures

A generic tool for analyzing sparse approximation algorithms is the restricted isometry property (RIP) introduced by Candès and Tao (2005) [11]. If R(k, n, N) is the RIP constant with support size k for an n × N measurement matrix, we investigate the trend of reducing the support size of the RIP constants for qualitative comparisons between sufficient conditions. For example, which condition is easier to satisfy, R(4k, n, N) < 0.1 or R(2k, n, N) < 0.025? Using a quantitative comparison via phase transitions for Gaussian measurement matrices, three examples from the literature of such support size reduction are considered. In each case, utilizing a larger support size for the RIP constants results in a sufficient condition for exact sparse recovery that is satisfied by a significantly larger subset of Gaussian matrices.

Most of percutaneous coronary interventions are performed on stabilized patients. Although these procedures have recently been challenged for this type of patient following the publication of the recent Courage study in 2007 (which in fact has only confirmed previous studies), their efficacy is now well established for lowering the frequency of episodes of angina and increasing the performance under load in stabilized high risk patients. In practice, the evaluation of patients (case by case) is essential to establish their risk (low, intermediate or high) in order to offer the most suitable treatment. The aim of this paper is to overview the indications, limitations and results of coronary angioplasties performed in stabilized patients in France in 2009.

Acquired Immunodeficiency Syndrome (AIDS), first recognised in the USA in 1981, and the infective agent responsible, Human Immunodeficiency Virus (HIV), has established itself as a worldwide pandemic in the intervening 27 years. Whilst some education providers have set up services dedicated to caring for patients affected by HIV, it is likely that osteopaths, particularly those situated in urban centres, are increasingly likely to be working with patients and colleagues, or have friends affected by this chronic infectious disease. This masterclass paper aims to summarise the points of interface where HIV-infection affects the neuromusculoskeletal system and may complicate everyday presentations and their clinical management by osteopaths and other manual therapists. Details of the pathophysiology of HIV-infection, drug therapy and medical management of the infection itself are beyond the scope of this paper. Suggested online resources are, however, given where such information can usefully be located.

Resume Le developpement majeur de la cardiologie interventionnelle coronaire au cours des 20 dernieres annees a ete basee sur des evolutions technologiques majeures aux premiers rangs desquels se retzouvent les stents coronaires pharmacologiquement actifs ou pas. A partir de donnees obtenues dans les differents registres et observatoires mis en place par le Groupe Atherome et Cardiologie Interventionnelle de la Societe Fran,caise de Cardiologie, nous avons pu etudier l'evolution numerique de cette technique qui a pris la premiere place dans la strategie de revascularisation. Entre 1991 et 2006 le nombre de coronarographies a double, et les angioplasties coronaires ont quadruple avec un taux de stenting de l'ordre de 95 % dont 50 % environ de stents actifs en 2006. En comparaison avec l'Europe, avec 1 830 angioplasties par million d'habitants, la France se situe dans la moyenne ≪ haute ≫, europeenne eu egard aux disparites importantes existant entze les differents pays.

The results of near-infrared Fourier transform Raman spectral examination of cement minerals, several commercial Portland cements, and hydrating Portland cements are critically examined. It is shown that structured fluorescent effects dominate the observed spectra for C 3 S, C 2 S, and cement, and none of the bands generated by this mode of examination is a true Raman band. The apparent bands for the Portland cements are in different positions to those for the individual cement minerals. The fluorescence-derived spectra for different cements are similar to each other but vary enormously in intensity for different cements. Hydration progressively reduces the intensity of the bands, but does not generate bands at new locations. It is tentatively suggested that the fluorescence effect may be somehow associated with the status of the cement components as orthosilicates (i.e., composed of isolated silica tetrahedra. Samples of high-purity C 2 S exhibit the fluorescence effect, but samples of CS (wollastonite) of similar purity do not. The latter are metasilicates (i.e., composed of linked chains of silica tetrahedra). They exhibit normal Raman Stokes and anti-Stokes bands.

La ticlopidine ou le clopidogrel associes a l'aspirine ont permis de diminuer de facon significative le risque d'evenements majeurs apres implantation de stent. Cependant, la necessite d'un pretraitement reste discutee. Le but de ce travail a ete de determiner l'influence du pretraitement par les thienopyridines sur les evenements cardiaques majeurs (deces, infarctus, necessite de nouvelle revascularisation par angioplastie ou pontage, recurrence angineuse, thrombose de stent) au cours de l'hospitalisation dans une population de patients inclus de facon prospective dans 2 registres multicentriques visant a analyser le devenir de patients recevant un stent (S670 et S7, Medtronic) sur des arteres coronaires natives de diametre egal ou superieur a 3 mm. Sur les 2929 patients inclus dans les 2 registres au cours des annees 1999 et 2000, 1205 se presentaient avec un angor instable (41 %). 50,2 % des patients etaient pretraites par la ticlopidine ou le clopidogrel depuis au moins 6 heures ; les anti GPIIb-IIIa ont ete utilises dans 13,9 % des procedures. Un evenement cardiaque majeur a ete retrouve dans 2 % de la population. Les facteurs correles avec la survenue d'un evenement en analyse uni- et multivariee etaient : l'âge superieur a 73 ans (RR : 2,37 ; 95 % CI : 1,05-5,36, p < 0,037), un antecedent d'infarctus (RR: 2,56; 95 % CI: 1,08-6,11, p < 0,34); le pretraitement etait correle avec la diminution des evenements (RR: 0,389; 95 % CI: 0,16-0,95, p < 0,038). Chez les patients n'ayant pas recu d'anti GPIIb-IIIa, seuls l'âge et l'absence de pretraitement restaient significatifs pour la prediction d'evenements.

The Ian Charleson Day Centre Osteopathic Clinic is a unique provision of osteopathic care by The British School of Osteopathy within the setting of a hospital outpatient facility for patients with HIV-infection. It also represents a unique collaboration between a UK osteopathic education provider and a hospital trust. Educational and clinical aims of the service are described along with an outline of its development and implementation. A descriptive summary of audit figures is provided giving an outline of the clinic population. Finally, financial and structural barriers and the importance of establishing cost-effectiveness are explored and the educational value of such a service discussed.

One of the key control points in the trafficking of the T cell effector subsets, Th1 and Th2, to sites of inflammation is their migration out of the bloodstream. The mechanism by which the cells initially adhere to the endothelium is dependent on the selectin family of adhesion molecules. Only polarised Th1 cells are capable of binding P-selectin despite both Th1 and Th2 cells expressing PSGL-1, the P-selectin ligand. This may be due to a secondary modification of PSGL-1 that is present on Th1 but not Th2 cells. One key modification of PSGL-1 is the alpha3 fucosylation of the O-glycans. To address whether the binding of Th1 and Th2 cells may be regulated by fucosylation, we have studied the expression of the alpha3 fucosyltransferases, FucT-IV and VII, using in vitro differentiated mouse T cells. Messenger RNA levels for both FucT-IV and VII were found to be higher in Th1 than Th2 cells. alpha3 fucosyltransferase enzyme activities were also elevated in Th1 cells. The increased expression of the alpha3 fucosyltransferases in Th1 cells correlated with the ability of Th1, but not Th2, cells to bind to P-selectin. Thus, the regulation of the binding of effector T cells to the endothelium, and subsequent trafficking to inflammatory sites, may be controlled by the fucosylation state of PSGL-1 mediated by the selective expression of the alpha3 fucosyltransferases.

The raw data from a sample of 75 sturgeon (45 listed as shovelnose and 30 described as Alabama sturgeon) were examined to determine if there were two distinct species in this sample. Earlier work by the authors (AAB, PDB, WMH) concluded that the Alabama and shovelnose were indistinguishable based on principal component analyses of the meristic and mensural data. In our present work we perform formal Bayesian sharp hypothesis testing on the distinct principal components from the two groups (Alabama vs. Shovelnose). The question of inference on the difference of two normal means when both the variances are unknown is the celebrated Behrens-Fisher Problem. This methodology applied in the Bayesian context leads to coherent inference on the sharp null hypothesis for the difference of the two component means. Realistic prior parameters are engaged in conjugate normal prior distributions which when combined with the sampling distributions lead to the usual prior to posterior constructs. We further derive the Bayes Factor or Weighted Likelihood Ratio (WLR) for inference on our sharp null hypotheses. The evaluation of the WLR for the prior structure requires at most one dimensional quadratures which are easily computed because the integrands are products of known density functions with familiar properties.

A series of 18 monoclonal antibodies directed to complement regulatory proteins were investigated by flow cytometry and immunoblotting. Seventeen antibodies are directed against a phosphatidyl inositol-linked glycoprotein since they show a dual population of erythrocytes from a paroxysmal nocturnal haemoglobinuria (PNH) patient. From this group, 6 antibodies revealed a 65-70 kDa band on immunoblots allowing their identification as anti-DAF (Decay Accelerating Factor; CD55 antigen), and 11 bound to a 20 kDa molecule corresponding to MIRL (Membrane Inhibitor of Reactive lysis, CD59 antigen). One antibody revealed an homogeneous population from the PNH patient and bound to a 200 kDa band on immunoblot that might corresponds to the CR1 (Complement Receptor type 1; CD35).

Both the B cell–surface trigger(s) and the intracellular molecular mechanism(s) of somatic hypermutation in immunoglobulin (Ig) variable region genes remain unknown, partly because of the lack of a simple and reproducible in vitro model. Here, we show that upon surface immunoglobulin cross-linking followed by coculture with activated cloned T cells, the Burkitt's lymphoma cell line BL2 is induced to mutate its IgVH gene. Repeated activation of BL2 cells increased the frequency of mutation. The in vitro–induced mutations, which do not affect the IgM constant region, are point mutations distributed over the entire VHDJH gene segment and do not show evidence of antigen-driven selection.

Thirteen monoclonal antibodies directed to red cell and white cell differentiation antigens have been analysed by flow cytometry and immunoblotting. Nine were identified as CD44 (2D3-1, -2, -3, -4), CD 47 (2D3-5 and -6), CD 58 (2D7 and -8), CD99 (2D3-9), whereas four (2D3-11, -12, -13, and 14) could not be characterised.

For years, individuals have been challenging the noncompetition agreements they entered into with their employers on the basis that the agreements violate public policy. However, in a competitive marketplace, courts and legislatures in many jurisdictions are reluctant to invalidate otherwise reasonable noncompetition agreements. Perhaps they are right, at least when it comes to the general class of nonprofits and to nonprofits that are protecting their interests against for-profit entities. As for charitable — or § 501(c)(3) — nonprofits that are attempting to protect their interests against other charitable nonprofits, however, the decision-making bodies should reconsider their position. Unlike traditional for-profit entities, whose main goal is profit maximization, charitable nonprofits are organized and operated to benefit some greater good. As a result, charitable nonprofits receive donations from individuals and corporations, as well as tax breaks from the government, which are unavailable to for-profit entities. At the same time, charitable nonprofits use many of the same tools that for-profit firms utilize to maximize profits, including noncompetition agreements. Thus, charitable nonprofits are able to benefit from an anti-competition, profit-maximizing tool while also reaping the rewards of their tax-exempt status. In short, charitable nonprofits (wrongly) enjoy the best of both the for-profit and nonprofit worlds. This article discusses the unique nature of the charitable nonprofit’s mission and the tax benefits conferred on charitable nonprofits by the federal and state governments. It then discusses noncompetition agreements and demonstrates that charitable nonprofits’ use of noncompetition agreements is contrary to their mission and tax-exempt status, as well as to the public interest. Finally, the article proposes an amendment to the federal tax code that would render unenforceable any language in a noncompetition agreement that prevents an individual from leaving the employment of one charitable nonprofit for employment at another.

Summary An important, well known property of the rabbit haemorrhagic disease virus is its ability to agglutinate human red blood cells. Accordingly, red cells from human adult donors were agglutinated despite their blood group ABO status, and treatments with proteases or glycosidases did not prevent agglutination. However, we discovered that the cells from human umbilical cords or foetuses were not agglutinated. In order to identify the viral receptor on human erythrocytes, glycolipids and glycoproteins from adult red cells were separated and tested for their potency in inhibiting agglutination. The bulk of the biological activity was associated with the highly glycosylated glycolipids (polyglycosylceramides), whereas a lower but significant activity was also associated with neutral glycolipids. No activity was found in the lipid-free sialoglycoprotein fractions. All these data strongly suggest that the RHDV receptor on human red cells corresponds to a development antigen which is not expressed on foetal cells and is mainly carried by glycolipids. Faint activity was also found in membranes from sheep red cells, suggesting that a similar glycolipid component is carried by these animal cells.

Capillary ion electrophoresis (CIE) is a capillary electrophoretic technique which has been developed for the rapid analysis of low-molecular-mass inorganic and organic ions. Anion and cation analysis of wastewater samples from a meat processing plant will be discussed. The wastewater samples were collected above, at point of discharge, and at various points downstream from the plant. The purpose of the analysis was to investigate dilution effects of the wastewater as it mixes with the stream water. CIE allows for rapid analysis times (typically less than 5 min) with little sample preparation required.

The authors describe an interdisciplinary undergraduate course exploring multiple intersections of economics and religion, using a variety of textual sources, exercises, and teaching methods from both fields. They conclude that such a course can be valuable for both majors and non-majors, although for different reasons. Economics majors may gain a greater awareness of the philosophical underpinnings and ethical implications of their social science, while non-economists may gain an appreciation for the many ways in which the economic way of thinking affects and can be applied to aspects of their everyday lives.

Blood B lymphocytes obtained from Plasmodium falciparum-immune Saimiri monkeys were assayed for their in vitro differentiation in immunoglobulin-secreting cells upon restimulation with P. falciparum-parasitized Saimiri red blood cells. Selected culture conditions enabled appropriately stimulated blood B cells to secrete 3F11/G10+ IgG, detected in the supernatants by means of a dot immunobinding assay. Primed blood B lymphocytes from P. falciparum-immune Saimiri monkeys were thus able to secrete IgG when restimulated by parasitized red blood cells in the presence of T cell- and monocyte-derived cytokines (recombinant human cytokines). These primed blood B cells, which were able to differentiate, were shown to secrete antibodies reactive with P. falciparum-infected red blood cells, as detected by means of an indirect immunofluorescence assay, and reactive with P. falciparum-infected red blood cell extracts, as detected by means of Western blot analysis. Furthermore, due to the possibility of discriminating between IgG subtypes in the squirrel monkey (3F11/G10+::3A2/G6+ IgG [associated with protection against the blood stages of P. falciparum] vs. 3F11/G10+::3E4/H8+ IgG [usually not functionally associated with protection]), we have attempted to estimate the respective proportions of each IgG subtype. In defined culture conditions, Saimiri monkey blood B cells preferentially secrete 3F11/G10+::3E4/H8+ IgG in response to parasitized red blood cells. We therefore discuss the conditions that would render this assay suitable for the selection, among P. falciparum blood stage antigens, of those that have major B-cell epitopes.

When used as a polyclonal activator of blood immunocompetent cells in the squirrel monkey, pokeweed mitogen (PWM) failed to induce lymphoproliferation unless either autologous or human serum was added to the culture medium, instead of a serum assumed to be deprived of Ig such as foetal bovine serum. We thus attempted to delineate activation processes initiated by PWM and which required both monocytes and native Ig molecules. For instance, the physical presence of live monocytes within lymphocyte suspensions vs. paraformaldehyde-fixed monocytes or products of monocytic origin was an absolute prerequisite for inducing squirrel monkey lymphocytes to proliferate in the presence of PWM. In addition, a combination of monocytes and native Ig were further shown to induce lymphocytes to proliferate in the presence of PWM. We therefore questioned whether Fc gamma R on the surface of monocytes vs. Fc gamma R expressed by other cells were involved in the initiation of PWM-driven lymphoproliferation. PWM may represent a useful tool for studies of Fc gamma R-mediated immunological processes.

But de la presentation Jusqu’au debut des annees 1990, la chirurgie laryngee etait la principale therapeutique utilisee dans la prise en charge des carcinomes epidermoides avances du larynx et de l’hypopharynx. L’alternative a ce traitement mutilant a repose sur l’apparition de nouveaux protocoles dits de « preservation laryngee » que sont la radiotherapie exclusive ou la radiotherapie en association avec de la chimiotherapie (concomitante ou alternee). Plusieurs facteurs ont montre un impact sur la survie et la preservation laryngee (stade OMS, consommation alcoolique, stade TNM, etc.). Notre travail a cherche a montrer l’influence sur la survie et la preservation laryngee d’un facteur rarement etudie : l’indice de masse corporelle (IMC). Materiel et methodes Nous avons recueilli les donnees de 246 patients porteurs d’un carcinome epidermoide localisee soit au larynx (17,48 %), soit a l’hypopharynx (48,78 %) soit a la margelle laryngee (33,74 %) chez qui un protocole de preservation d’organe (PPO) a ete decide en RCP. Les facteurs determinant de la survie ont ete etudie avec la methode de Kaplan-Meier, le test de log-Rank et le modele de Cox. Resultats La mediane de survie brute des patients masculin est de 2,16 ans et pour les femmes 6,48 ans. Nous avons mis en evidence un impact statistiquement significatif entre la survie et l’IMC du patient ( p = 0,0004), l’etat general (stade OMS) ( p = 0,0064), la consommation ( p = 0,0004) et le sevrage alcoolique ( p p = 0,0038), la mobilite laryngee initiale (p = 0,0002) et l’evaluation en fin de chimiotherapie ( p p = 0,016), le stade OMS lors de la premiere consultation ( p = 0,0005), le bilan endoscopique initial permettant d’evaluer la mobilite laryngee ( p p = 0,0009). Conclusion Outre les criteres deja connus dans la litterature, cette etude a montre l’importance de l’etat general et nutritionnel des patients lors de leur prise en charge initiale.