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Introduction: The classic pathophysiology of acute osteomyelitis in children described by Trueta has a metaphyseal infection as the starting point. This hypothesis was recently brought into question by Labbé's study, which suggested a periosteal origin. Thus, we wanted to study this disease's pathophysiology through early MRI examinations and to look for prognostic factors based on abnormal findings., Material and Methods: This was a prospective, multicentre study that included cases of long bone osteomyelitis in children who underwent an MRI examination within 7days of the start of symptoms and within 24hours of the initiation of antibiotic therapy. We also collected clinical, laboratory and treatment-related data., Results: Twenty patients were included, including one with a bifocal condition. The lower limb was involved in most cases (19/21). Staphylococcus aureus was found most frequently. Metaphyseal involvement was present in all cases. No isolated periosteal involvement was found in any of the cases. No prognostic factors were identified based on the various abnormal findings on MRI., Conclusion: Our study supports the metaphyseal origin of acute osteomyelitis in children., Level of Evidence: II., (Copyright © 2016. Published by Elsevier Masson SAS.)

Background: The retina as a model system with extensive information on genes involved in development/maintenance is of great value for investigations employing deep sequencing to capture transcriptome change over time. This in turn could enable us to find patterns in gene expression across time to reveal transition in biological processes., Methods: We developed a bioinformatics pipeline to categorize genes based on their differential expression and their alternative splicing status across time by binning genes based on their transcriptional kinetics. Genes within same bins were then leveraged to query gene annotation databases to discover molecular programs employed by the developing retina., Results: Using our pipeline on RNA-Seq data obtained from fractionated (nucleus/cytoplasm) developing retina at embryonic day (E) 16 and postnatal day (P) 0, we captured high-resolution as in the difference between the cytoplasm and the nucleus at the same developmental time. We found de novo transcription of genes whose transcripts were exclusively found in the nuclear transcriptome at P0. Further analysis showed that these genes enriched for functions that are known to be executed during postnatal development, thus showing that the P0 nuclear transcriptome is temporally ahead of that of its cytoplasm. We extended our strategy to perform temporal analysis comparing P0 data to either P21-Nrl-wildtype (WT) or P21-Nrl-knockout (KO) retinae, which predicted that the KO retina would have compromised vasculature. Indeed, histological manifestation of vasodilation has been reported at a later time point (P60)., Conclusions: Thus, our approach was predictive of a phenotype before it presented histologically. Our strategy can be extended to investigating the development and/or disease progression of other tissue types.

Introduction: Tibial intercondylar eminence fracture rarely occurs in childhood. Its treatment requires anatomic reduction to provide knee stability and a rigid fixation to minimize postoperative immobilization time., Hypothesis: Arthroscopy combined with fluoroscopy with intra-epiphyseal ASNIS screw fixation can meet the requirements of this treatment., Material and Methods: The series comprised 24 patients (mean age: 11 years) with Meyers and McKeever type II tibial intercondylar eminence fractures (n=15) or type III (n=9), operated on between 2011 and 2013. Fixation with 4-mm ASNIS screws was placed arthroscopically. The demographic data, associated lesions, radiological union, stability, functional result, and the Lysholm score were evaluated., Results: With a mean follow-up of 2 years, the mean Lysholm score was 99.3 for type II and 98.6 for type III fractures. At the 6th postoperative week, range of motion in the operated knees was identical to the healthy knees. At the 12th postoperative week, there was no sign of anterior laxity. Twelve cases included meniscal entrapment, but no significant difference was observed in the functional results., Discussion, Conclusion: ASNIS screw fixation under arthroscopy can be successfully applied in the treatment of types II and III tibial intercondylar eminence fractures in children. This technique provides excellent stability, allows early weigh-tbearing, and preserves function of the knee and its growth., Level of Evidence: IV, retrospective study., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Several studies in adults having observed the effect of eye movements on postural control provided contradictory results. In the present study, we explored the effect of various oculomotor tasks on postural control and the effect of different postural tasks on eye movements in eleven children (7.8 ± 0.5 years) and nine adults (30.4 ± 6.3 years). To vary the difficulty of the oculomotor task, three conditions were tested: fixation, prosaccades (reactive saccades made toward the target) and antisaccades (voluntary saccades made in the direction opposite to the visual target). To vary the difficulty of postural control, two postural tasks were tested: Standard Romberg (SR) and Tandem Romberg (TR). Postural difficulty did not affect oculomotor behavior, except by lengthening adults' latencies in the prosaccade task. For both groups, postural control was altered in the antisaccade task as compared to fixation and prosaccade tasks. Moreover, a ceiling effect was found in the more complex postural task. This study highlighted a cortical interference between oculomotor and postural control systems.

Introduction: Congenital paraesophageal hernia (CPEH) is the least common congenital diaphragmatic hernia. We performed an extensive review to further define this entity., Methods: A retrospective study of children with CPEH (types II-IV hiatal hernias) treated at two children's hospitals over a 25-year period (1988-2013) was performed., Results: Fourteen patients were diagnosed at a median age of 35 days (range 0-500), with one prenatal diagnosis. The most common symptoms were emesis in type II hernias (50%), and respiratory distress in types III and IV hernias (75% and 50%, respectively). Gastroesophageal reflux was concomitantly diagnosed in 50%, while concurrent congenital anomalies existed in 36%. A correct initial diagnosis was made in only 29% of cases. The diagnosis was most often established by UGI study (64%). The method of repair was laparoscopy in 21%, and laparotomy in 71%. An antireflux procedure was done in 13 (93%) patients. Long-term follow up data was available for 86% of patient. During follow-up, one patient recurred and one required sequential pneumatic esophageal dilations. There were no mortalities., Conclusions: CPEH is a rare entity often associated with gastroesophageal reflux disease and other congenital anomalies. Prognosis is excellent, but awareness of this anomaly may lead to earlier diagnosis., (Copyright © 2015 Elsevier Inc. All rights reserved.)

In eukaryotes, gene expression requires splicing, which starts with the identification of exon-intron boundaries by the small, nuclear RNA (snRNAs) of the spliceosome, aided by associated proteins. In the mammalian genome, <1% of introns lack canonical exon-intron boundary sequences and cannot be spliced by the canonical splicing machinery. These introns are spliced by the minor spliceosome, consisting of unique snRNAs (U11, U12, U4atac, and U6atac). The importance of the minor spliceosome is underscored by the disease microcephalic osteodysplastic primordial dwarfism type 1 (MOPD1), which is caused by mutation in U4atac. Thus, it is important to understand the expression and function of the minor spliceosome and its targets in mammalian development, for which we used the mouse as our model. Here, we report enrichment of the minor snRNAs in the developing head/central nervous system (CNS) between E9.5 and E12.5, along with enrichment of these snRNAs in differentiating retinal neurons. Moreover, dynamic expression kinetics of minor intron-containing genes (MIGs) was observed across retinal development. DAVID analysis of MIGs that were cotranscriptionally upregulated embryonically revealed enrichment for RNA metabolism and cell cycle regulation. In contrast, MIGs that were cotranscriptionally upregulated postnatally revealed enrichment for protein localization/transport, vesicle-mediated transport, and calcium transport. Finally, we used U12 morpholino to inactivate the minor spliceosome in the postnatal retina, which resulted in apoptosis of differentiating retinal neurons. Taken together, our data suggest that the minor spliceosome may have distinct functions in embryonic versus postnatal development. Importantly, we show that the minor spliceosome is crucial for the survival of terminally differentiating retinal neurons., (© 2014 Wiley Periodicals, Inc.)

After surgical correction of esophageal atresia with or without tracheoesophageal fistula, esophageal body motility dysfunction has been reported in nearly all patients. Using high-resolution esophageal manometry before surgical repair in 2 children with isolated tracheoesophageal fistula, we sought to determine whether dysmotility was present before any surgical insult to test the hypothesis that dysmotility associated with esophageal atresia with or without tracheoesophageal fistula is related to intrinsic primary factors linked to abnormal development of the esophagus. Both had an abnormal esophageal motility: one exhibited hypomotility with distal contraction, whereas the other showed a complete aperistalsis pattern. This suggests that esophageal dysmotility is congenital in nature rather than secondary to surgery.

Introduction: The dominant eye is defined as the one we unconsciously choose when we have to perform monocular tasks. In the field of clinical neuro-ophthalmology, it is well-established that ocular dominance plays a key role in several eye diseases. Furthermore, the accurate quantification of ocular dominance is crucial with regard to certain surgical techniques. However, classical preoperative tests cannot determine the amount of ocular dominance., Materials and Methods: In order to obtain further insight into the phenomenon of ocular dominance, we study its influence at behavioral and neurophysiological levels (experiments 1 and 2). Based on these new data, we suggest a method to improve quantification of ocular dominance (experiment 3)., Results: We demonstrate that ocular dominance has an influence on hand movements and on interhemispheric transfer time. Moreover, we show that an analysis of the dynamics of saccades allows us to sort out participants with strong or weak ocular dominance., Conclusion: In conclusion, this better understanding of the phenomenon of ocular dominance, coupled with the analysis of saccadic dynamics, might, in the short or medium term, lead to the establishment of a quick and straightforward battery of tests allowing determination of the amount of ocular dominance for each patient., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Introduction: Pseudotumoral soft tissue masses in children and adolescents are a frequent reason for consultation and a diagnostic dilemma. Soft tissue malignancies are relatively uncommon, unlike the large number of benign lesions that may be seen in the superficial tissue and that can be diagnosed with clinical characteristics., Materials and Methods: This retrospective study concerns 161 children and adolescents less than 20 years old, referred for a soft tissue mass between 2007 and 2011. It describes their epidemiology, clinical characteristics, and course of care to validate a diagnostic strategy for such masses., Results: Final diagnoses were malignant tumors (44%), benign tumors (32%), and pseudotumoral lesions (24%). Clinical features were similar between these three groups except for age and tumor location, with more benign thoracic masses in younger children. Clinical and radiological association led to an accurate diagnosis for 50% of benign masses and with cytological analysis contribution in 79% of benign tumors and 86% of pseudotumoral lesions. Malignant tumors were suspected in only 39% of cases with radiological exams and in 89% after fine-needle aspiration, an essential additional diagnostic tool. Final diagnoses were formally established through simple standard clinical and radiological evaluation in 19 patients (11.8%; benign tumors, seven patients; malformations, eight patients; post-traumatic lesions, two patients; infection and inflammation, one patient each); ultrasound exam in five patients (3.1%; hemangioendotheliomas, two patients, fascial dehiscence, hemangioma, and vascular malformation, one patient each); MRI in four patients (2.5%; three vascular malformations and one lipoma); CT in two cases (1.2%; vascular malformation and myositis ossificans), and radiological examinations associated with cell aspiration in 15 cases (9.3%; ten benign tumors and five malignant tumors)., Conclusions: A multidisciplinary approach should be requested from oncological, radiological, and pathologic experts to optimize soft tissue mass management as soon as initial investigations start. The authors advise a diagnostic strategy for children with pseudotumoral soft tissue masses., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Objectives: To introduce the key concepts and terms associated with precision medicine and support understanding of future developments in the field by providing an overview and history of precision medicine, related ethical considerations, and nursing implications., Data Sources: Current nursing, medical and basic science literature., Conclusion: Rapid progress in understanding the oncogenic drivers associated with cancer is leading to a shift toward precision medicine, where treatment is based on targeting specific genetic and epigenetic alterations associated with a particular cancer., Implications for Nursing Practice: Nurses will need to embrace the paradigm shift to precision medicine, expend the effort necessary to learn the essential terminology, concepts and principles, and work collaboratively with physician colleagues to best position our patients to maximize the potential that precision medicine can offer., (Copyright © 2014 Elsevier Inc. All rights reserved.)

In order to further our understanding of action-blindsight, four hemianopic patients suffering from visual field loss contralateral to a unilateral occipital lesion were compared to six healthy controls during a double task of verbally reported target detection and saccadic responses toward the target. Three oculomotor tasks were used: a fixation task (i.e., without saccade) and two saccade tasks (eliciting reflexive and voluntary saccades, using step and overlap 600 ms paradigms, respectively), in separate sessions. The visual target was briefly presented at two different eccentricities (5° and 8°), in the right or left visual hemifield. Blank trials were interleaved with target trials, and signal detection theory was applied. Despite their hemifield defect, hemianopic patients retained the ability to direct a saccade toward their contralesional hemifield, whereas verbal detection reports were at chance level. However, saccade parameters (latency and amplitude) were altered by the defect. Saccades to the contralesional hemifield exhibited longer latencies and shorter amplitudes compared to those of the healthy group, whereas only the latencies of reflexive saccades to the ipsilesional hemifield were altered. Furthermore, healthy participants showed the expected latency difference between reflexive and voluntary saccades, with the latter longer than the former. This difference was not found in three out of four patients in either hemifield. Our results show action-blindsight for saccades, but also show that unilateral occipital lesions have effects on saccade generation in both visual hemifields.

Previous studies have demonstrated a left perceptual bias while looking at faces, due to the fact that observers mainly use information from the left side of a face (from the observer's point of view) to perform a judgment task. Such a bias is consistent with the right hemisphere dominance for face processing and has sometimes been linked to a left gaze bias, i.e. more and/or longer fixations on the left side of the face. Here, we recorded eye-movements, in two different experiments during a gender judgment task, using normal and chimeric faces which were presented above, below, right or left to the central fixation point or on it (central position). Participants performed the judgment task by remaining fixated on the fixation point or after executing several saccades (up to three). A left perceptual bias was not systematically found as it depended on the number of allowed saccades and face position. Moreover, the gaze bias clearly depended on the face position as the initial fixation was guided by face position and landed on the closest half-face, toward the center of gravity of the face. The analysis of the subsequent fixations revealed that observers move their eyes from one side to the other. More importantly, no apparent link between gaze and perceptual biases was found here. This implies that we do not look necessarily toward the side of the face that we use to make a gender judgment task. Despite the fact that these results may be limited by the absence of perceptual and gaze biases in some conditions, we emphasized the inter-individual differences observed in terms of perceptual bias, hinting at the importance of performing individual analysis and drawing attention to the influence of the method used to study this bias.

Background: We present the results of a prospective series of 60 patients treated for neuromuscular spinal deformities with an original spinopelvic construct using two sacral screws and two iliac screws. Clinical and radiological results obtained with this new surgical technique were studied and discussed according to the epidemiological data and relevant literature., Methods: From January 2008 to June 2010, the clinical data of every patient who underwent spinopelvic fixation for treatment of a neuromuscular spinal deformity were recorded prospectively., Results: Sixty patients were operated on during the study period. Spinal correction and fusion was performed by posterior approach. In six patients with a residual spinopelvic imbalance more than 15° on lateral preoperative bending films, an anterior release of the thoracolumbar junction was performed on the same day, before posterior correction. Preoperative pelvic obliquity (PO) ranged from 4° to 44° (mean 21.6°). Postoperative pelvic obliquity ranged from 0° to 14 (mean 4.6°). No significant loss of correction was noted at the last follow-up. One patient died 3 months after the initial procedure due to respiratory compromise. 11 patients had early postoperative infections of the posterior approach., Conclusions: Despite a high rate of infectious complications, optimal correction of pelvic obliquity requires extension of spinal instrumentation to the pelvis. Spinopelvic fixation remains a difficult challenge in neurological patients with hypotrophy. We think that pelvic fixation with the "T construct" did provide effective and improved spinal stabilization in these patients, while reducing the need for a postoperative cast or brace. As a result, patients had a favourable postoperative course with early mobilization and return to a comfortable sitting position.

In the mammalian genome, each histone family contains multiple replication-dependent paralogs, which are found in clusters where their transcription is thought to be coupled to the cell cycle. Here, we wanted to interrogate the transcriptional regulation of these paralogs during retinal development and aging. We employed deep sequencing, quantitative PCR, in situ hybridization (ISH), and microarray analysis, which revealed that replication-dependent histone genes were not only transcribed in progenitor cells but also in differentiating neurons. Specifically, by ISH analysis we found that different histone genes were actively transcribed in a subset of neurons between postnatal day 7 and 14. Interestingly, within a histone family, not all paralogs were transcribed at the same level during retinal development. For example, expression of Hist1h1b was higher embryonically, while that of Hist1h1c was higher postnatally. Finally, expression of replication-dependent histone genes was also observed in the aging retina. Moreover, transcription of replication-dependent histones was independent of rapamycin-mediated mTOR pathway inactivation. Overall, our data suggest the existence of variant nucleosomes produced by the differential expression of the replication-dependent histone genes across retinal development. Also, the expression of a subset of replication-dependent histone isotypes in senescent neurons warrants re-examining these genes as "replication-dependent." Thus, our findings underscore the importance of understanding the transcriptional regulation of replication-dependent histone genes in the maintenance and functioning of neurons.

Processing of mRNAs including, alternative splicing (AS), mRNA transport and translation regulation are crucial to eukaryotic gene expression. For example, >90% of the genes in the human genome are known to undergo alternative splicing thereby expanding the proteome production capacity of a limited number of genes. Similarly, mRNA export and translation regulation plays a vital role in regulating protein production. Thus, it is important to understand how these RNA binding proteins including alternative splicing factors (ASFs) and mRNA transport and translation factors regulate these processes. Here we report the expression of an ASF, serine-arginine rich splicing factor 10 (Sfrs10) and a mRNA translation regulation factor, CUGBP, elav like family member 4 (Celf4) in the developing mouse retina. Sfrs10 was expressed throughout postnatal (P) retinal development and was observed progressively in newly differentiating neurons. Immunofluorescence (IF) showed Sfrs10 in retinal ganglion cells (RGCs) at P0, followed by amacrine and bipolar cells, and at P8 it was enriched in red/green cone photoreceptor cells. By P22, Sfrs10 was observed in rod photoreceptors in a peri-nuclear pattern. Like Sfrs10, Celf4 expression was also observed in the developing retina, but with two distinct retinal isoforms. In situ hybridization (ISH) showed progressive expression of Celf4 in differentiating neurons, which was confirmed by IF that showed a dynamic shift in Celf4 localization. Early in development Celf4 expression was restricted to the nuclei of newly differentiating RGCs and later (E16 onwards) it was observed in the initial segments of RGC axons. Later, during postnatal development, Celf4 was observed in amacrine and bipolar cells, but here it was predominantly cytoplasmic and enriched in the two synaptic layers. Specifically, at P14, Celf4 was observed in the synaptic boutons of rod bipolar cells marked by Pkc-α. Thus, Celf4 might be regulating AS early in development besides its known role of regulating mRNA localization/translation. In all, our data suggests an important role for AS and mRNA localization/translation in retinal neuron differentiation., (Copyright © 2013 Elsevier B.V. All rights reserved.)

A lot of studies published on the ten last years showed a decrease of fertility among HIV positive women. The present research aims to see if this decrease is linked to an ovarian failure, using AMH as principal marker of ovarian function. In this pilot study, 54 HIV-positive and 39 HIV-negative women were compared on the basis of their ovarian function, fecundity and possible ovarian failure. A blood sample was taken for hormonal titrations, HIV seropositivity, viral load and CD4 T cell count. An interview explored demographic characteristics, obstetrical and infectious history, and menstrual characteristics. This study was performed in Burkina Faso between January and February 2008. There is no significant difference after adjusting for age of AMH level between the two groups. However, in our study, 5.5% of HIV positive women had a premature menopause, which is a significant variation from the premature menopause rates of the African population, which is 1.4%. In conclusion, this study put the HIV impact on ovarian function into perspective but the high premature menopause rates could suggest an ovarian attack by the virus or the treatment.

The goal of the study was to examine the effect of different types of eye movements on postural stability. Ten healthy young adults (25 ± 3 years) participated in the study. Postural control was measured by the TechnoConcept© platform and recorded in Standard Romberg and Tandem Romberg conditions while participants performed five oculomotor tasks: two fixation tasks (central fixation cross, without and with distractors), two prosaccade tasks toward peripheral targets displayed 4° to the left or to the right of the fixation cross (reactive saccades induced by a gap 0 ms paradigm and voluntary saccades induced by an overlap 600 ms paradigm) and one antisaccade task (voluntary saccade made in the opposite direction of the visual target). The surface, the length, and the mean speed of the center of pressure were analyzed. We found that saccadic eye movements improved postural stability with respect to the fixation tasks. Furthermore, antisaccades were found to decrease postural stability compared to prosaccades (reactive as well as voluntary saccades). This result is in line with the U-shaped nonlinear model described by Lacour et al. (Neurophysiol Clin 38:411-421, 2008), showing that a secondary task performed during a postural task could increase (prosaccade task) or decrease (antisacade task) postural stability depending on its complexity. We suggest that the different degree of attentional resources needed for performing prosaccade or antisaccade tasks are, most likely, responsible for the different effect on postural control.

Background: Esophageal dysmotility, a considerable issue following esophageal atresia (EA) repair, has been reported but has not been precisely described and characterized. Using high-resolution esophageal manometry (HREM), we characterized the esophageal motility patterns in children with repaired EA and compared these patterns of dysmotility with symptomatology., Methods: HREM was performed as an outpatient procedure in patients with repaired EA. The tracings were analyzed using the software provided by the company and were then reviewed visually. Charts were reviewed for medical/surgical histories and symptoms were assessed by a standardized questionnaire., Results: Forty patients (25 boys, 15 girls) with a median age of 8 years (11 months-18 years) underwent an HREM. Thirty-five patients had type C EA and 5 had type A EA. Only 7 patients were asymptomatic at the time of the examination. HREM results were abnormal in all of the patients. Three different esophageal motility patterns were derived from HREM tracing analysis: aperistalsis (15 patients, 38%), pressurization (6 patients, 15%), and distal contractions (19 patients, 47%). Distal contractions pattern was found exclusively in type C EA. Dysphagia was encountered in the 3 groups. Gastroesophageal reflux disease-related symptoms predominated in the aperistalsis group., Conclusions: HREM improves our understanding and allows precise characterization of esophageal dysmotility in patients who have undergone EA repair.

Background: Contracture of the wrist and extrinsic finger flexor and pronator muscles is a common consequence of central nervous system disorders. The proximal release of the extrinsic flexor and pronator muscles was first described by Page and Scaglietti for a Volkmann contracture. The aim of the present study was to assess the amount of increase in extension and the improvements in global hand function that can be expected following this lengthening procedure in patients with central nervous system disorders., Method: A single-center retrospective review of patients with central nervous system lesions and contractures of the wrist and extrinsic finger flexor and forearm pronator muscles, causing aesthetic, hygienic, or functional impairment, was carried out. The Page-Scaglietti technique was used for all interventions. Before the operation, motor nerve blocks were used to distinguish between spasticity and contractures with surgical intervention only for contractures. The Zancolli and House classifications were used to evaluate improvements., Results: Data from fifty-four hands and fifty patients (thirty-five men and fifteen women) were evaluated. The mean duration of follow-up (and standard deviation) was 26 ± 21 months (range, three to 124 months). The mean gain (and standard deviation) in wrist extension with fingers extended was 67° ± 25° (range, -10° to 110°). Preoperatively, no hands were classified as Zancolli Group 1, whereas twenty-five hands were classified as Zancolli Group 1 at the latest follow-up review. Ten nonfunctional hands (rated as House Group 0 or Group 1) became functional as a supporting hand postoperatively. Zancolli and House classifications increased significantly (p < 0.01) postoperatively. In twelve cases, a partial recurrence of the deformity occurred. In seven of these cases, surgery unmasked spasticity or contracture of the intrinsic muscles, which required further intervention., Conclusion: The Page-Scaglietti technique appears to improve range of motion and function in people with wrist and finger contractures due to central nervous system disorders.

Scoliosis is a common deformity in many types of neuromuscular disease. Severe spinal curvature can cause difficulty in sitting. Conservative and surgical treatment of neuromuscular scoliosis differs from idiopathic scoliosis, being more complex and with a higher complications rate. Non-surgical measures rarely fully control progressive scoliosis, but aim to prevent spinal deformities secondary to muscular hypotonia or contracture. Twenty-four hour bracing should be adjusted throughout growth, and may induce functional impairment and loss of independence. Corrective surgery requires multidisciplinary management and perioperative screening. Pelvic obliquity is commonly associated with neuromuscular scoliosis, making sitting difficult: correction needs to be considered during surgical planning. The goal of surgical correction is to obtain and maintain a well-balanced spine above a well-positioned pelvis. Preoperative multidisciplinary assessment enables potential problems of terrain to be anticipated. Respiratory function investigation will guide possible non-invasive perioperative ventilation. Nutritional and psychosocial assessment should also be incorporated in this preparation, as should overall postoperative care. Implementing this overall strategic planning can achieve a good surgical and functional result in the vast majority of cases., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Words presented to the right visual field (RVF) are recognized more readily than those presented to the left visual field (LVF). Whereas the attentional bias theory proposes an explanation in terms of attentional imbalance between visual fields, the attentional advantage theory assumes that words presented to the RVF are processed automatically while LVF words need attention. In this study, we exploited coupling between attention and saccadic eye movements to orient spatial attention to one or the other visual field. The first experiment compared conditions wherein participants had to remain fixated centrally or had to make a saccade to the visual field in which subsequent verbal stimuli were displayed. The orienting of attention by saccade preparation improved performance in a lexical decision task in both the LVF and the RVF. In the second experiment, participants had to make a saccade either to the visual field where verbal stimuli were presented subsequently or to the opposite side. For RVF as well as for LVF presentation, saccade preparation toward the opposite side decreased performance compared to the same side condition. These results are better explained by the attentional bias theory, and are discussed in the light of a new attentional theory dissociating two major components of attention, namely preparation and selection., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Purpose: Hemispheric specialization in saccadic control is still under debate. Here we examine the latency, gain, and peak velocity of reactive and voluntary leftward and rightward saccades to assess the respective roles of eye and hand dominance., Methods: Participants with contrasting hand and eye dominance were asked to make saccades toward a target displayed at 5°, 10°, or 15° left or right of the central fixation point. In separate sessions, reactive and voluntary saccades were elicited by Gap-200, Gap-0, Overlap-600, and Antisaccade procedures., Results: Left-right asymmetries were not found in saccade latencies but appeared in saccade gain and peak velocity. Regardless of the dominant hand, saccades directed to the ipsilateral side relative to the dominant eye had larger amplitudes and faster peak velocities., Conclusions: Left-right asymmetries can be explained by naso-temporal differences for some subjects and by eye dominance for others. Further investigations are needed to examine saccadic parameters more systematically in relation to eye dominance. Indeed, any method that allows one to determine ocular dominance from objective measures based on saccade parameters should greatly benefit clinical applications, such as monovision surgery.

Purpose: Magnetic resonance imaging (MRI) has been successfully used in the determination of the adequacy of the surgical reduction of congenitally dislocated hips in children. We present the results of a prospective series of patients treated conservatively. MRI was performed in all hips after positioning was deemed adequate on radiographs after spica cast application. The goal of this study was to evaluate the usefulness of MRI in this indication., Methods: After the study was approved by our local ethics committee, 31 patients for a total of 36 dislocated hips were included. After the traction period, hip testing was performed and a hip spica cast was applied under general anaesthesia. All children had MRI within 1 week of reduction, without the need for contention or general anaesthesia. Hip reduction was assessed on axial and coronal MRI images., Results: The concentric reduction of the hip was confirmed in 30 cases out of 36. In three cases, the dislocation was retrospectively suspected on radiographs and then confirmed. In the three remaining cases, hip dislocation was only diagnosed on MRI., Conclusions: MRI screening of congenitally dislocated hips after reduction procedures is a safe and reliable procedure to assess the concentric reduction of the hip. Even in doubtful cases, MRI detected persistent hip dislocations and was conducive to iterative reduction and satisfactory outcome and result.

Several studies have examined postural control in dyslexic children; however, their results were inconclusive. This study investigated the effect of a dual task on postural stability in dyslexic children. Eighteen dyslexic children (mean age 10.3±1.2 years) were compared with eighteen non-dyslexic children of similar age. Postural stability was recorded with a platform (TechnoConcept®) while the child, in separate sessions, made reflex horizontal and vertical saccades of 10° of amplitude, and read a text silently. We measured the surface and the mean speed of the center of pressure (CoP). Reading performance was assessed by counting the number of words read during postural measures. Both groups of children were more stable while performing saccades than while reading a text. Furthermore, dyslexic children were significantly more unstable than non-dyslexic children, especially during the reading task. Finally, the number of words read by dyslexic children was significantly lower than that of non-dyslexic children and, in contrast to the non-dyslexic children. In line with the U-shaped non-linear interaction model, we suggest that the attention consumed by the reading task could be responsible for the loss of postural control in both groups of children. The postural instability observed in dyslexic children supports the hypothesis that such children have a lack of integration of multiple sensorimotor inputs.

Background: We present the results of a prospective series of 15 patients treated for neuromuscular spinal deformities with an original spinopelvic construct using two sacral screws and two iliac screws. Results were compared to a prospective cohort of 62 patients treated for neuromuscular spinal deformities by spinopelvic fixation using iliosacral screws., Methods: From November 2005 to June 2007, the clinical data of every patient who underwent spinopelvic fixation for treatment of a neuromuscular spinal deformity were recorded prospectively., Results: Fifteen patients weighting less than 35 kg were operated on with a special segmental construct using two sacral screws and two iliac screws for pelvic anchorage. Sixty-two patients had spinopelvic fixation using iliosacral screws. Severity of the curve (Cobb angle) and reducibility were statistically equal in both groups. Operative time and blood loss were statistically identical in both groups. Curve correction was similar in both groups and postoperative pelvic obliquity ranged between 2° and 4°. No significant loss of correction was noted at the last follow-up. Fifteen patients had early postoperative infection of the posterior wound requiring re-operation., Conclusions: Despite a high rate of infectious complications, optimal correction of pelvic obliquity requires extension of spinal instrumentation to the pelvis. Pelvic fixation with the "T-construct" did provide effective and improved spinal stabilization in these patients, while reducing the need for a postoperative cast or brace. As a result, patients had a favorable postoperative course with early mobilization and return to a comfortable sitting position.

Saccadic adaptation maintains saccade accuracy and has been studied with targeting saccades, i.e. saccades that bring the gaze to a target, with the classical intra-saccadic step procedure in which the target systematically jumps to a new position during saccade execution. Post-saccadic visual feedback about the error between target position and the saccade landing position is crucial to establish and maintain adaptation. However, recent research focusing on two-saccade sequences has shown that exploring saccades, i.e. saccades that explore an object, resists this classical intra-saccadic step procedure but can be adapted by systematically changing the main parameter used for their coding: stimulus size. Here, we adapted an exploring saccade and a targeting saccade in two separate experiments, using the appropriate adaptation procedure, and we tested whether the adaptation induced on one saccade type transferred to the other. We showed that whereas classical targeting saccade adaptation does not transfer to exploring saccades, the reciprocal transfer (i.e., from exploring to targeting saccades) occurred when targeting saccades aimed for a spatially extended stimulus, but not when they aimed for an isolated target. These results show that, in addition to position errors, size errors can drive adaptation, and confirm that exploring vs. targeting a stimulus leads to two different motor planning modes., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Carcinoma of the breast is rarely encountered in the male population and is even less prevalent in the pediatric male population. Studies have suggested an association between male breast carcinoma and gynecomastia, but conflicting results have been shown. Only 3 cases of carcinoma in situ associated with bilateral gynecomastia during puberty have been described in the literature. Here, we present the case of a 15-year-old boy with bilateral gynecomastia who was found to have synchronous bilateral ductal carcinoma in situ., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Purpose: To compare the amount, the retention, and the extinction of saccadic adaptation in two groups: 9 adults (23-36 years old) and 9 children (11-14 years old)., Methods: The paradigm used was a classical double-step target to elicit the shortening of saccade gains in response to a 2° backward step (20% of target eccentricity). Two conditions were run in the pre- and postadaptation phases without and with postsaccadic visual feedback, to allow examination of the retention and the extinction of saccadic adaptation., Results: Adaptation of reactive saccades occurred in children as well as adults. Both groups showed a progressive shortening of saccade amplitude and good retention. The main difference concerned the speed of extinction, i.e., return to baseline, which was slower for children., Conclusions: Cerebral structures involved in human short-term adaptation of reactive saccades are functional in regard to adaptive shortening of saccade amplitude. Divergent patterns in the extinction of adaptation between children and adults suggested that lengthening of saccade gain is not yet well established in children. Further investigation is needed to clarify whether processes responsible for backward adaptation are mature before those for forward adaptation.

Introduction: Today, thanks to the HAART, HIV has become a chronic disease. In most cases, HIV positive women are of reproductive age and at present, the vertical transmission rate is around 0.1% for women with an undetectable viral load. So, it is normal that the question of seropositive women's desire to have children is on the table., Methods: In this experimental study, 50 HIV-seropositive and 44 seronegative women were interviewed about their desire to have children. Some of the questions asked were: "How many children did you want to have before you got married/at 15 years of age if you aren't married?" "How many children would you like to have today, considering your present situation?". In case of a difference between "before" and "now", we asked them: "What are the reasons for this difference?". This study was performed in Burkina Faso., Results: The positive women tend to desire more children "before" and fewer children "now" than negative women (OR: 1.33; C.I. 95%: 0.86-2; p= 0.19 vs OR: 0.78; C.I. 95%: 0.51-1.21; p= 0.27). 62% of HIV positive women mention multiple reasons directly linked to their seropositivity to explain the difference between "before" and "now". 70% of HIV positive women still want to have children. We have noted that the positive women who still want children are more likely to be younger (p < 0.05 by Two-Sample T tests), in a relationship (p < 0.01 by Chi-Square Test) and to have been diagnosed earlier than the positive women who don't want any children (p=0.01 by Wilcoxon Rank Sum Test)., Conclusion: Even if the results of this pilot study are preliminary, they show that HIV positive and negative women have a relatively similar desire for children, even though seropositive women seem to want fewer children than their uninfected counterparts. Most of the reasons which reduce HIV positive women's desire to have children are directly linked to HIV. This is why getting these women informed about materno-fetal transmission risks and existing treatments is really important to give them the opportunity to make a conscious choice.

The role of surgery remains central in the management of malignant bone tumors in children and adolescents. The current chemotherapies have demonstrated their efficiency (and limits) and made possible to avoid amputation in more than 90% of cases without worsening the prognosis. Advances in imaging (MRI) and understanding the mechanisms of tumor progression have led to more accurate resections with more frequent epiphyseal conservations. At the same time, new techniques have emerged that allows to consider more "organic" reconstructions. Therefore, we can better and more often preserve growth, hoping for a better long-term functional outcome. Experience also allows to review older techniques (arthroplasties…). The choice of reconstruction depends on many factors (age, presence of secondary localizations, chemotherapy tolerance, socioeconomic context…) and can only be conceived as part of multidisciplinary evaluations.

Background: Open transumbilical pyloromyotomy (UMBP) and laparoscopic pyloromyotomy (LAP) have been compared on different outcomes, but postoperative pain as a primary end point had never been assessed. The aim of this study was to compare the use of analgesia in UMBP and LAP patients., Methods: Infants with hypertrophic pyloric stenosis treated by UMBP in 2008-2009 were matched with LAP-treated infants. Demographics, type and use of analgesia, and length of stay were recorded. Statistical analysis was performed using the Fisher exact test., Results: Each group contained 19 patients (N = 38) with comparable demographics and no comorbid condition. Bupivacaine was injected intraoperatively in all UMBP and 89% of LAP infants. There was a trend toward increased acetaminophen use in LAP infants (79% vs 58%, P = .61) in the recovery room. There was no difference in opiates use (3 UMBP vs 1 LAP, P = .60). In the ward, more UMBP patients received acetaminophen (78% vs 53%, P = .03). This difference was significant. Mean postoperative length of stay was similar in both groups., Conclusion: Our study suggests that UMBP infants might experience more postoperative pain in the ward, without any impact on various outcomes. A prospective study with a larger sample size should be undertaken to verify these findings., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Purpose: We present the results of the use of a protocol of inhalational oxygen/nitrous oxide mixtures associated with oral opioids on a prospective cohort of 33 children undergoing local care for acute but limited burned skin lesions., Methods: All the children were orally administered 0.4 mg/kg morphine chlorydrate, and nitrous oxide was administered as an equimolar mixture (50% N2O, 50% O2) via a face mask during the procedure. Pain and comfort of the patient were evaluated by the use of a validated behavioural score. After the end of the procedure, child and parent satisfactions were noted., Results: Mean age was 3 years 6 months (10 months-11 years). A successful detersion procedure was performed in all the cases. Behavioural score was 6 in 15 cases out of 33, comprising between 7 and 9 in 15 patients and 10 in three patients. Subjective satisfaction of pain management was noted in 16 out of 20 patients after the procedure. Subjective satisfaction of the parents was noted in all the cases., Discussion: Our study demonstrates that the use of a simple protocol of inhalational oxygen/nitrous oxide mixtures associated with oral opioids could be safe and effective. This association was well tolerated without any adverse effect.

Purpose: The use of 2-octylcyanoacrylate (OCA) has been evaluated for the treatment of nail bed injuries in adults. We propose to validate this technique in a continuous paediatric population of 30 children., Methods: Patients with nail bed injuries associated with displaced fractures of the distal phalanx were excluded from the study. However, parcellar fractures of the tuft were included. After removal of the nail, wound detersion and anatomic positioning of the nail bed was done and maintained under the nail plate using a single dose of OCA. Follow-up evaluation was done at day 7 and 1 and 3 months., Results: The mean delay between the trauma and the surgery was 13.5 h. The nail bed lesion was a single transversal wound in 27 cases. A pulpar wound was associated in 22 cases. At 3 months control (final follow-up), no pain or functional impairment was noted. The cosmetic result was excellent for the patient and his family in 30 out of 31 cases. It was excellent for the surgeon in 25 cases and good in six cases., Conclusions: In the OCA technique, meticulous primary detersion and exact anatomic positioning of the damaged nail bed is mandatory before applying the cyanoacrylate adhesive. In our experience, we found that the OCA technique provided a fast and safe result in nail bed lesions. The final cosmetic appearance, function and patient satisfaction were good in our series. In these lesions, discomfort and inconvenience associated with suture removal could be avoided by the use of OCA.

Introduction: Congenital longitudinal deficiency of the tibia is a rare and often syndromic anomaly. Amputation is usually the preferred treatment option in complete absence of the tibia; however, a conservative management might be implemented in partial forms or in case of amputation refusal. Our experience with the Ilizarov fixator, convinced us this device was the best suited for progressive correction of lower limbs length discrepancies and articular or bone angular limb deformities (ALD). The aim of this study is to highlight the interest of the Ilizarov fixator in the multistage conservative treatment of congenital tibial deficiencies., Material and Methods: A retrospective study was conducted in nine patients suffering from Type I or II congenital tibial deficiencies (Jones) and sequentially managed using the Ilizarov technique. The functional outcome after treatment completion was then clinically assessed., Results: The different stages of correction were recorded for each individual patient. Patients were assessed at a mean follow-up of 18,3 years (4-32 years). The mean maximum knee flexion was 35 degrees (0 degrees -90 degrees ) in type I deficiencies and 118 degrees (90 degrees -140 degrees ) in type II deficiencies. One patient underwent amputation and a bilateral knee arthrodesis was performed in another case., Discussion: Few series in the literature report a comparable length of follow-up period in the conservative management of severe congenital tibial deficiencies. In our study, the Ilizarov fixator provided satisfactory progressive corrections of severe congenital tibial deficiencies., Level of Evidence: Level IV therapeutic retrospective study., (2009 Elsevier Masson SAS. All rights reserved.)

Introduction: Traumatic transepiphyseal separation of the upper femoral epiphysis is a rare lesion of the hip in children., Case Report: We report a case of conservative treatment of transepiphyseal separation of the upper femoral epiphysis following tonic/clonic seizures in a 5-month-old child. Magnetic resonance imaging confirmed the diagnosis The fracture was maintained with hip spica cast for 6 weeks. At the age of 2, complete healing of the lesion including femoral neck remodeling was noted on frontal and lateral radiographs. There was no radiological evidence of AVN or premature closure of the physis. He continues to be followed up., Discussion: Because of the remodeling potential in young children, we assume not to perform additional reduction procedures in such traumatic lesions.

Introduction: Various treatment options are in use to address severe knee flexion contractures in children. Their success depends on an adequate selection of the proper one applying to each individual anatomical situation., Hypothesis: Applied to limb deformity, the Ilizarov technique combines progressive correction, to joint structures flexibility restitution in case of severe knee flexion contracture. We review a continuous series of popliteal pterygium syndrome patients managed with this technique., Patients and Methods: Medical records of eight children (11 knees), consecutively treated between 1986 and 2007, were reviewed. Knee flexion ranged from 40 to 120 degrees. Contracture (> 90 degrees) was extremely severe in 10 cases. Progressive correction was gained by Ilizarov external fixation. Complications during and following articular chain distraction-lengthening were noted. Follow-up ranged from 1 to 21 years., Results: Surgical realignment was rendered particularly complex by the popliteal cutaneous band itself, partly responsible of the joint stiffness and sciatic nerve shortening. Deformities were corrected by the Ilizarov technique. Complete extension was obtained in all cases. In six cases, flexion contracture reccurrence required to repeat the correction, using the same technique, at a mean interval of 3-4 years. During follow-up, four evolutive partial posterior tibial dislocations and one complete dislocation were diagnosed, all associated with recurrence of the flexion contracture., Level of Evidence: Level IV. Therapeutic Study.

Purpose: Magnetic resonance imaging (MRI) quantification of the rotation of the spinal cord in patients with thoracic idiopathic scoliosis could also be used to detect different spinal cord rotational patterns., Methods: Ten patients with a thoracic or thoracolumbar scoliosis had axial T2-weighted MRI. The rotation of the spinal cord and vertebra were measured. The rotational data of the spinal cord and vertebra was compared to other collated data using non-parametric tests., Results: The vertebral tile was measured from 3 degrees to 32 degrees and the spinal cord tilt was measured from 3 degrees to 39 degrees. The spinal cord tilt was statistically correlated with the Cobb angle and the antero-posterior or and transverse diameter of the spinal cord., Conclusion: We showed that, even in case of moderate curve with very limited angular values and vertebral rotation, a significant spinal cord rotation occurred. However, our findings are very limited to discuss some hypothesis about scoliosis pathogeny or progression mechanism.

In severe forms of osteogenesis imperfecta, multiple compression fractures of the spine, as well as vertebral height shortening could be responsible for an increased thoracic kyphosis or a diminished lumbar lordosis. Theses progressive changes in sagittal shapes of the trunk could be responsible for a global sagittal trunk imbalance. We compare the parameters of sagittal spinopelvic balance in young patients with OI to those parameters in a control group of healthy volunteers. Eighteen patients with osteogenesis imperfecta were compared to a cohort of 300 healthy volunteers. A standing lateral radiograph of the spine was obtained in a standardized fashion. The sacral slope, pelvic tilt, pelvic incidence, lumbar lordosis, thoracic kyphosis, T1 and T9 sagittal offset were measured using a computer-assisted method. The variations and reciprocal correlations of all parameters in both groups according to each other were studied. Comparison of angular parameters between OI patients and control group showed an increased T1T12 kyphosis in OI patients. T1 and T9 sagittal offset was positive in OI patients and negative in control group. This statistically significant difference among sagittal offsets in both groups indicated that OI patients had a global sagittal balance of the trunk displaced anteriorly when compared to the normal population. Reciprocal correlations between angular parameters in OI patients showed a strong correlation between lumbar lordosis (L1L5 and L1S1) and sacral slope. The T9 sagittal offset was also strongly correlated with pelvic tilt. Pelvic incidence was correlated with L1S1 lordosis, T1 sagittal offset and pelvic tilt. In OI patients, the T1T12 thoracic kyphosis was statistically higher than in control group and was not correlated with other shape (LL) or pelvic (SS, PT or PI) parameters. Because isolated T1T12 kyphosis increase without T4T12 significant modification, we suggest that vertebral deformations worsen in OI patients at the upper part of thoracic spine. Further studies are needed to precise the exact location of most frequent vertebral deformities.

Purpose: Many surgical techniques have been published on how to treat congenital pseudoarthrosis of the tibia (CPT). We combined Ilizarov's fixator with intramedullary nailing of the tibia and developed a procedure which combines the advantages of both methods: Ilizarov's high fusion rate with alignment control and the protection against refracture provided by the intramedullary nail. The results of this approach are presented and discussed., Material and Methods: Seven boys and three girls aged 3-14 years (mean age 8 years 2 months) were treated using our combined technique. In six cases, the CPT was associated with neurofibromatosis. Two strategies were adopted: in six cases, a compression was applied on the bone defect, and in four cases, segmental bone transportation was performed before the compression procedure. The final follow-up (1.2-6.6 years) included a clinical and radiological examination., Results: Tibial union was achieved in nine cases without bone grafting. In one case, tibial union still remains uncertain, despite intertibiofibular bone grafting and additional compression procedures. Thirteen overall complications were noted, including three valgus deformity of the ankle. Bone transportation failed to achieve complete limb lengthening in three cases. One deep infection occurred 4 years after removal of the external fixator. The treatment for this included nail removal and antibiotic therapy for 3 months. Despite a permanent protection of orthosis, a refracture occurred 2 years after nail removal, reverting to the initial level of pseudarthrosis. Another surgical attempt using the same method was then performed with a satisfactory result., Conclusions: The association of Ilizarov's technique and intramedullary nailing achieved and maintained tibial union in nine of ten patients at final follow-up. It also allowed correction of axial deformities and prevented refracture. Despite the short duration of the follow-up and a high rate of complications in our series, this method can be useful in many cases of CPT in which healing has failed to occur despite many previous surgeries.

Background: The role of the posterior talofibular ligament (PTFL) in the clubfoot deformity remains unclear. We conducted an anatomical study to precise its topography and role in maintaining tibiotalar equinus in patients with clubfoot deformity., Methods: Ten ankles were dissected using a wide posterior exposure. The PTFL was identified at the posterior aspect of the ankle and its relations with other anatomical structures were noted., Results: After opening of the tibiotalar and subtalar joints, the superior aspect of the PTFL was clearly seen, running horizontally from the fibula to a prominent tubercle on the posterior surface of the talus. The tibiotalar and subatalar joint capsules joined together laterally on the posterior edge of the PTFL and medially on the posterior part of the talus. A fibrous structure identified as being the "tibial slip" was noted in four cases between the posterior medial aspect of the lateral malleolus and the tibiotalar posterior capsule. Two different groups of fibers were identified inside the PTFL., Conclusions: Correcting the equinus and inversion of the talus needed an extensive release of soft tissues of the posterior part of the ankle. Our description of both short anterior and long posterior fibers of the PTFL improved our comprehension of functional anatomy of this ligament. We have found that PTFL is part of a posterior joint complex between the tibiotalar and subtalar joint. The posterior joint complex is a heritage of ankle evolution from a prehensile to a weight-bearing joint pattern. The inferior tibiofibular transverse ligament, the tibial slip and the calcaneofibular ligament are interpreted as derivatives of this ancestral meniscus and stabilize the weight-bearing ankle. Because the posterior fibers of the PTFL and the tibial slip are part of the complex, they should be excised like the posterior capsules during clubfoot surgery.

Purpose: To assess the efficacy and safety of a heavy silicone oil (Densiron 68 a mixture of perfluorohexyloctane (F(6)H(8)) with silicone oil as temporary internal tamponade in selected retinal detachments treated with large inferior retinectomy., Methods: Complicated retinal detachments with severe posterior and anterior proliferative vitreoretinopathy (PVR) were included in this study. In all cases, a large inferior retinectomy involving the inferior quadrants was performed. Densiron 68 was injected at the end of surgery after perfluorocarbon injection. A minimum follow-up of 6 months was required in order to be included in this retrospective study., Results: Twenty-seven patients were operated on with a mean follow-up of 57.5 weeks. Twenty-three patients presented a posterior PVR > CP6 and 26 patients an anterior PVR > CA5. Heavy silicone oil was removed in 19 patients after a mean follow-up of 14 weeks. At the 4-week follow-up visit, only one retinectomy was reopened by a recurrent inferior retinal detachment with PVR CP3. Finally, anatomical success was achieved in 25 of the 27 patients (92.5%) after Densiron 68 removal at the last follow-up. The main adverse effect was inflammatory reaction with fibrin accumulation in the anterior chamber (40.7%)., Conclusion: Densiron 68 appeared to be an efficient endotamponade agent in selected retinal detachments treated with large inferior retinectomy. It avoids fluid accumulation under the inferior retina and seems to limit the rate of inferior retinectomy reopening.

Diphosphine sulfides derived from 2,2'-biphosphole have been efficiently synthesized in an enantiomerically pure form by a four step synthetic sequence. These S,S-ligands were used for the first time in Pd-catalyzed asymmetric allylic alkylation. Good yields and enantiomeric excess up to 73% were obtained.

Background: Seat belts have been proven to save lives. However, if they are not properly fitted, 'seat belt syndrome' can occur. The aim of the present study was to describe injuries encountered in Canadian children with seat belt-associated injuries., Methods: Canadian paediatricians and paediatric subspecialists were surveyed monthly through the Canadian Paediatric Surveillance Program. Children younger than 18 years of age who were restrained in motor vehicles at the time of a collision, with abdominal or thoracolumbar spine injuries, were included. The children may have been restrained in child safety seats, booster seats, or two- or three-point seat belts., Results: Twenty-eight children, between two and 16 years of age, with injuries compatible with seat belt syndrome were reported in Canada between September 2003 and August 2005. Although 12 children were younger than eight years of age, only one was restrained in a booster seat and only four of the older children were properly restrained with a three-point seat belt. Twenty-four children had abdominal injuries. Of these, 18 had stomach and/or intestinal injuries and 11 had solid organ injuries. Twelve patients had a spinal fracture, including only five Chance-type fractures. Seven patients presented with paraplegia, and none of them recovered., Conclusion: In Canada, over a two-year period, 28 children were reported to have sustained injuries consistent with seat belt syndrome; seven of these children remained paraplegic. These results emphasize the necessity to review restraints in motor vehicles to adequately protect children.

Inter-manual transfer of shape information was studied with habituation/dishabituation procedures in 2- and 6-month-old infants. Both age groups habituated to a shape repeatedly placed in one hand and dishabituated when a new shape was placed in the same hand. Subsequent testing revealed that only the 2-month olds dishabituated when the habituated shape was placed in the opposite hand and that only the 6-month olds dishabituated when a new shape was placed in the opposite hand. These results indicate that inter-manual transfer of hand information occurs by 2-months of age and that inter-manual transfer of shape information emerges between 2 and 6 months of age. The implications of the findings are discussed., ((c) 2007 Wiley Periodicals, Inc.)

Following a promising study at pilot scale a new aeration control law has been implemented at a full scale wastewater treatment plant displaying a conventional activated sludge process. The new control law is based on the direct measurements of ammonium and nitrate concentration in the biological tank by ion selective electrodes. This control law features a cascade of two Predictive Function Controls and calculates an optimal air flow rate to be provided to the biomass through fine bubble diffusers. The results obtained at the full scale plant confirmed the high performance of this control strategy allowing to substantially reduce the amount of diffused air while providing an easy means to manage the effluent quality to the plant operator., ((c) IWA Publishing 2008.)

Purpose of the Study: Injury to infrapatellar branches of the medial saphenous nerve are incriminated in disorders of the anterior aspect of the knee, particularly following bone-tendon-bone reconstruction. We demonstrated in prior anatomic work the usefulness of using a double-incision minimal approach for harvesting the patellar transplant in order to spare the nerve branches., Material and Methods: The patellar transplant is harvested via two vertical incisions, one on the apex of the patella and the other along the protrusion of the anterior tibial tubercle. After harvesting the bony transplant from the patella, discision of the patellar tendon fibers is advanced subcutaneously towards the anterior tibial tubercle, allowing extraction of the patellar graft via the tibial incision using a small forceps and respecting the peritendon. The tibial bone is then harvested. The standard anterolateral and anteromedial approaches are used for the ligament reconstruction., Results: We have conducted a case control study between this harvesting technique using the double-incision technique (42 knees) versus the conventional single incision harvesting technique. We studied the influence of the harvesting technique on anterior knee pain, the surface area of the sensorial disorders involving the anterior aspect of the knee, and kneeling problems., Discussion: Our technique has enabled a significant decrease in the surface area of sensorial disorders (7.4 cm2 versus 17.4 cm2) and problems kneeling compared with the conventional method.

Only about 50% of infants appear to be right-handed in their first year, yet only 10-12% ultimately become left-handed. Several parameters may control early changes in handedness, and we investigated the role of imitation. We wanted to see if infants, when choosing the hand to manipulate an object, were influenced by the hand used by the experimenter when demonstrating the target action. We observed infants, seated either opposite or on the lap of the experimenter who used either left or right hand. The results show that when a left-handed experimenter demonstrated the action, none of the infants consistently used a right-handed strategy to manipulate the objects, regardless of the position (lap vs. opposite), and even though most infants had shown right-handedness when first grasping the objects. Imitation may thus be part of the parameters that stabilize infant right-handedness, or, on the contrary, that drive infants towards left-handedness.

Background Context: Unstable lesions of the cervicothoracic junction present a severe clinical problem for diagnosis, treatment, and prognosis., Purpose: The objective of the present study was to evaluate the neurological and functional outcomes following surgical treatments which combine in all cases posterior reduction and stabilization., Study Design: Retrospective clinical and radiological study., Patient Samples: Between September 1996 and September 2003, 30 patients underwent surgery for unstable fracture at the cervicothoracic junction. This group included 23 patients who sustained a motor vehicle accident, 5 who had fallen from a height, 1 case of ballistic trauma, and 1 person injured by diving in shallow water. There were 22 male and 8 female patients aged between 18 and 80, with an average age of 49. In 18 cases the lesion level was vertebra C7, in 5 cases vertebra T1, in 2 cases vertebra T2, and in 5 cases vertebra T3. Neurologically, on initial clinical examination 16 patients were classified Frankel A, 6 Frankel B, 2 Frankel C, and 6 Frankel D. Surgically, all the patients underwent posterior reduction and synthesis. Posterior stabilization was performed using rods and screws 3 times, plate-screw fixation 25 times, and rods and screws at the thoracic level linked to plate-screw at the cervical level 2 times. Spinal cord compression of more than two levels was associated with 25 cases. In these 25 cases, spinal cord decompression was associated with reduction and stabilization., Outcome Measures: Clinical outcome using neurological scale of Frankel, radiological outcomes using computed tomographic (CT) scans and plain X-ray evaluations., Methods: Follow-up periods ranged from 11 to 48 months, with an average of 18 months. Seven patients died as a result of cardiopulmonary insufficiency within 4 months postoperative. Twenty-eight CT scans with sagittal and frontal slides were examined to evaluate postoperative reduction and to control screw placement., Results: The observed reductions were satisfactory in 27 cases. In one case, reduction was satisfactory in the sagittal plane but lateral translation persisted in the frontal plane. Two mechanical failures with delayed mobilization of implants occurred. Bony fusion was recorded in all cases on CT scan evaluation. Complete or partial neurological recovery was observed in only 10 of 14 patients. The initial neurological status of these 14 patients was Frankel B, C, or D., Conclusion: The surgical procedure was chosen according to the particularity of the anatomical region and the possibility of associated medullar decompression. Insertion of pedicle screws in the upper thoracic portion in T1, T2, and T3 requires a careful technique and knowledge of the posterior projection points of the pedicles and their orientation in space. The high rate of fusion observed in these patients justified posterior reduction and stabilization. The high death rate and the low rate of neurological recovery in this group of patients emphasizes the severe prognosis of unstable injuries of the cervicothoracic junction. Considering the few mechanical failures observed at the last examination, the choice of the posterior approach was appropriate as the one stage procedure. Plate synthesis is preferable in fractures that do not require extension of synthesis beyond T2, whereas screws and rods systems are more appropriate for superior thoracic injuries. Despite early diagnosis and surgical treatment, the presence of neurological or pulmonary lesions resulted in increased mortality of the operated patients.