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En France, la polymédication des personnes âgées est un problème majeur de santé publique. Dans ce contexte, l’essai contrôlé randomisé TEM-EHPAD étudie l’impact de l’implémentation d’une telemedication review(TDR) sur le taux d’admissions à l’hôpital chez les personnes à haut risque iatrogénique. Une étude quantitative a été réalisée pour mesurer l’acceptabilité d’une TDR auprès des médecins généralistes prenant en charge des patients âgés en EHPAD.

The increasing interest and advancements in robotic spine surgery parallels a growing emphasis on maximizing patient safety and outcomes. In addition, an increasing interest in minimally invasive spine surgery has further fueled robotic development, as robotic guidance systems are aptly suited for these procedures. This review aims to address 3 of the most critical aspects of robotics in spine surgery today: salient details regarding the current and future development of robotic systems and functionalities, the reported accuracy of implant placement over the years, and how the implementation of robotic systems will impact the training of future generations of spine surgeons. As current systems establish themselves as highly accurate tools for implant placement, the development of novel features, including even robotic-assisted decompression, will likely occur. As spine surgery robots evolve and become increasingly adopted, it is likely that resident and fellow education will follow suit, leading to unique opportunities for both established surgeons and trainees.

Orogenesis in the Variscan belt of Western Europe was followed by a major magmatic event during the Permian that formed a mafic lower crust by crystallizing pyroxenite and gabbros from mantle‐derived melts at the base of the continental crust. Partial melting of the asthenosphere left a significantly depleted mantle that was progressively incorporated into the subcontinental lithospheric mantle as the orogenic domain cooled. The potential impact of such large‐scale thermal and lithologic layering has never been taken into account in the study of the Alpine Tethys and North Atlantic rift systems that developed subsequently in Western Europe. Here we investigate via numerical modeling how a mafic heterogeneity within the lowermost part of a quartzo‐feldspathic continental crust and/or a zone of depleted mantle within the lithospheric mantle beneath a former orogenic domain could have influenced subsequent rifting. Our numerical modeling results indicate that, in a thermally equilibrated lithosphere, a mafic body within the lower continental crust or a zone of shallow depleted mantle prevents rifting of overlying weaknesses (e.g., faults and suture zones). We propose that the regional mafic lower crust beneath the Variscan orogenic domain may explain why the Tethyan and southern North‐Atlantic rift systems did not localize at former suture zones of the Western European orogenic lithosphere. Mafic underplating of the crust generally prevents rifting of overlying weaknessesThe North Atlantic and Alpine Tethys rifts avoided the underplated Variscan domain in Western Europe

Although the Wilson cycle is usually considered in terms of wide oceans floored with normal oceanic crust, numerous orogens result from the closure of embryonic oceans. We discuss how orogenic and post-orogenic processes may be controlled by the size/maturity of the inverted basin. We focus on the role of lithospheric mantle in controlling deformation and the magmatic budget. We describe the physical properties (composition, density, rheology) of three types of mantle: inherited, fertilized and depleted oceanic mantle. By comparing these, we highlight that fertilized mantle underlying embryonic oceans is mechanically weaker, less dense and more fertile than other types of mantle. We suggest that orogens resulting from the closure of a narrow, immature extensional system are essentially controlled by mechanical processes without significant thermal and lithological modification. The underlying mantle is fertile and thus has a high potential for magma generation during subsequent tectonic events. Conversely, the thermal state and lithology of orogens resulting from the closure of a wide, mature ocean are largely modified by subduction-related arc magmatism. The underlying mantle wedge is depleted, which may inhibit magma generation during post-orogenic extension. These end-member considerations are supported by observations derived from the Western Europe–North Atlantic region.

We investigate lithosphere necking using two‐dimensional thermo‐mechanical numerical simulations without strain softening or weakening mechanisms. The models have an initial small sinusoidal perturbation of the Moho depth, whose wavelength corresponds to the model width. Applied boundary conditions (constant extension velocity or bulk extension rate) and initial model width significantly impact the necking dynamics. For constant bulk extension rates, wider models generate more intense necking with locally higher strain rates, whereas for constant velocity extension, models evolution is similar independent on their initial width. However, the width of the final necking zones ranges consistently between 45 and 105 km, independent on the type of applied boundary conditions and the initial Moho wavelength. The modeled widths are similar to along dip necking zones widths of natural rifted margins that formed during a single, unidirectional, and relatively continuous extensional event (e.g., Iberia‐Newfoundland margins, Porcupine Basin, Gulf of Aden). When the crust is mechanically decoupled from the mantle by a weak ductile lower crust, models exhibit three characteristic stages: (1) distributed thinning and extension associated with progressive subsidence; (2) upper mantle necking compensated by flow of the weak lower crust, which hampers both crustal thinning and subsidence at the rift center; and (3) crustal necking associated with fast subsidence after the mantle has necked. Decoupled models display regions of relatively thick crust on one or both sides of the rift center, comparable to the Galicia, Rockall, Hatton, and Porcupine Banks along the North Atlantic rifted margins. Modeled and natural necking zones widths are consistent without need for strain softening or weakening mechanismsBoundary conditions type and initial Moho wavelength do not impact modeled necking zones widthAsynchronous and depth‐dependent crust/mantle necking results in a complex surface topography evolution

Nous décrirons la morphologie de la moelle épinière, des méninges spinales, du ligament dentelé, des principaux faisceaux médullaires et enfin la vascularisation artérielle et veineuse afin de comprendre la symptomatologie et les troubles occasionnés par les tumeurs intramédullaires responsables de tableau de compression de la moelle. Nous aborderons enfin de façon succincte la technique chirurgicale pour ces tumeurs de moelle.

Knowledge of the encephalon anatomy is crucial for neurosurgical practice, especially the main cortical functional structures and their connections. General organisation of the encephalon is presented with frontal, parietal, occipital, temporal, limbic and insular lobes and their Brodmann correspondence. Secondly, subcortical anatomy will be presented with main white matter fasciculi in three separated categories: association, commissural and projection fibers. Main association fibers are inferior occipitofrontal fasciculus, superior longitudinal fasciculus, arcuate fasciculus, inferior longitudinal fasciculus, uncinate fasciculus, and cingulum. Commissural fibers include anterior commissure, corpus callosum and fornix. Projection fibers are internal capsule and optic radiations.

Cette étude prospective consécutive monocentrique évalue les résultats d’une arthrodèse par voie combinée pour le traitement des spondylolisthésis isthmiques L5–S1, utilisant une cage intersomatique en polyétherétherkétone (PEEK) par voie antérieure et une ostéosynthèse postérieure par vis pédiculaires. Entre 2010 et 2014, 27 patients adultes ont été traités d’un spondylolisthésis isthmique L5–S1 (de haut et de bas grades) par voie combinée avec un suivi minimum d’un an. L’évolution clinique a été évaluée : échelle visuelle analogique (EVA), score d’Oswestry (ODI) et échelle d’incapacité fonctionnelle pour l’évaluation des lombalgies (EIFEL). L’évaluation radiologique faite par deux observateurs était basée sur : incidence pelvienne, version pelvienne, lordose lombaire, lordose segmentaire, hauteurs discales, axe vertébral sagittal, ratio spinal vertical axis(SVA)/distance sacro-fémorale (SFD) et sur l’obtention de la fusion par le scanner à un an. Les pertes sanguines, la durée de chirurgie et les complications ont également été recueillies. L’âge moyen était 47,7 ans (±16,9). Les scores EVA, ODI et EIFEL ont été significativement améliorés passant respectivement de 7,58 (±1,45), 48,00 (±19,25), 15,32 (±4,67) en préopératoire à 3,84 (±2,55) ; 28,7 (±19,58) ; 7,76 (±7,21) à un an postopératoire (p=0,05). Le recul moyen de la série était de 3,3 ans. La fusion a été constatée dans 100 % des cas. Les hauteurs discales, la lordose segmentaire L5–S1, la version pelvienne, le glissement moyen, les hauteurs discales antérieure et postérieure ont été modifiées de façon significative passant respectivement de 20,1° ; 22,6° ; 35,3 % ; 26,4 % ; 17,9 % à 29,5° ; 20,6° ; 20,3 % ; 64,4 % ; 36,3 % en postopératoire. Cette procédure remplit les objectifs requis de la chirurgie des spondylolisthésis isthmiques L5–S1 de l’adulte.

Erdheim-Chester disease is a rare form of non-Langerhans cell histiocytosis. It is an inflammatory disorder associated with BRAF V600Emutation in 50% of cases. This multisystem disease is rarely associated with spinal involvement. Neurological involvement is an independent predictive factor of poor prognosis. The diagnosis is histopathological based on CD68-positive and CD1A-negative histiocytes. Treatment with interferon-alpha is an independent predictor of survival in Erdheim-Chester disease and vemurafenib has also been shown to be effective for BRAF V600Emutation. We report a clinical case of a 51-year-old patient with multiple and rare locations of Erdheim-Chester disease, particularly at the sphenoid sinus.

Le schwannome isolé du nerf oculomoteur est rare chez l’enfant en dehors des neurofibromatoses. Une adolescente de 13ans avec antécédent de migraine était hospitalisée pour migraine ophtalmique invalidante avec diplopie oblique. L’examen neuro-ophtalmologique notait une ophtalmoplégie incomplète droite et une amblyopie ipsilatérale à 8/10. L’examen cutané était sans particularité. L’imagerie par résonance magnétique (IRM) crânio-encéphalique montrait un schwannome nodulaire (isosignal-T1 et isosignal-T2) sur la portion cisternale du nerf oculomoteur droit. L’angioscanner, réalisé secondairement, ne montrait aucune malformation vasculaire. Le traitement consistait en une corticothérapie et des antalgiques, avec régression totale des symptômes initiaux en 3 semaines. Des contrôles radiocliniques itératifs, tous les 2ans, étaient satisfaisants. La radiochirurgie discutée initialement fut écartée en raison de l’évolution favorable.

Surgery is the recommended treatment for unique significant cerebellar metastasis, particularly in cases of hydrocephalus. Complications of posterior fossa surgery are associated with high risk of morbidity and mortality. We present a unique case of unexpected peroperative rupture of a cerebellar superior artery aneurysm during posterior fossa surgery.

Cone beam computed tomography has become an essential tool in the diagnosis and planning for implant dentistry. New hardware and software developments have emerged to help implant surgeons to successfully adopt and use different systems in patients requiring prosthetically driven implant dentistry. However, there is the need to develop an adequate planning protocol that includes appropriate acquisition/data manipulation, appropriate use of software tools for interpretation, and appropriate application of such systems during implant surgery. This article examines essential characteristics of the entire implant-guided surgery planning process and points out potential sources of error that could affect clinical accuracy outcomes.

We use numerical modelling to investigate reactivation of inherited Offset Weak Zones (OWZ) in continental crust and Mantle Weak Zones (MWZ) to form offset rift basins during continental rifting and breakup. Offset rift basins are basins that are set off/offset from the main rift/locus of breakup. Weak zones embedded in a stiff layer are preferentially and rapidly reactivated, whereas the same zones are either ignored or slowly reactivated when embedded in pliable layers. Here stiffimplies a nonlinear flow law with a high stress exponent (n??>?~??10,000), a plastic material, and pliablemeans a low stress exponent (n?~?2–5) as in ductile, power-law creep of rocks. Whether offset rift basins form during rifting of a composite lithosphere (i.e., comprising stiff and pliable layers) depends on the competition between necking instabilities that develop at the weak zones in the stiff layers, and the coupling between the stiff and pliable layers. Stiff/cratonic lithosphere results in early localization of the deformation at the MWZ, rapid necking and breakup without developing offset rift basins. In contrast, warm pliable lithosphere develops significant offset basins and has protracted rifting because the MWZ is now embedded in a pliable layer. We also investigate the influence of OWZ dip, sedimentation, and the sensitivity of reactivation to the distance from OWZ to the MWZ, and to the size of the MWZ. A tectonic rifting styles diagram is used to show that the model results agree with natural examples. Offset rift basins develop by reactivation of inherited crustal weak zonesReactivation depends on the stiffness of the layer containing the weak zoneStiff/Pliable lithospheric layeringproduces both narrow and wide rifts

A long-standing challenge in tectonics is to evaluate the role of inheritance and define the initial conditions of a geodynamic system, which are prerequisites to understand and model its evolution with some accuracy. Here we revisit the concept of “inheritance” by distinguishing “interface shape inheritance”, which includes the transient thermal state and gravitational potential energy, and “persisting inheritance”, which encompasses long-lasting structural and compositional inheritance. This new approach allows us to investigate, at each stage of a Wilson Cycle, the interplay between inheritance (innate/“genetic code”) and the physical processes at play (extension/compression, magmatism etc.). The aim of this paper is to provide a conceptual framework that integrates the role of inheritance in the study of rifts, rifted margins and collisional orogens based on the work done in the OROGEN project, which focuses on the Biscay-Pyrenean system. The Biscay-Pyrenean rift system resulted from a multistage rift evolution that developed over a complex lithosphere pre-structured by the Variscan orogenic cycle. There is a general agreement that the Pyrenean-Cantabrian orogen resulted from the reactivation of an increasingly mature rift system along-strike, ranging from mature rifted margins in the west to an immature and segmented hyperextended rift in the east. However, different models have been proposed to explain the preceding rifting and its influence on the subsequent reactivation. Results from the OROGEN project highlight the sequential reactivation of rift-inherited decoupling horizons and identify the specific role of exhumed mantle, hyperextended and necking domains during compressional reactivation. They also highlight the contrasting fate of rift segment centres versussegment boundaries during convergence, explaining the non-cylindricity of internal parts of collisional orogens. Results from the OROGEN project also suggest that the role of inheritance is more important during the initial stages of collision, which may explain the higher complexity of internal parts of orogenic systems with respect to their external parts. In contrast, when the system involved in the orogeny is more mature, the orogenic evolution is mostly controlled by first-order physical processes as described in the Coulomb Wedge theory, for instance. This may account for the simpler and more continuous architecture of external parts of collisional orogens and may also explain why most numerical models can reproduce mature orogenic architectures with a better accuracy compared to those of initial collisional stages. The new concepts developed from the OROGEN research are now ready to be tested at other orogenic systems that result from the reactivation of rifted margins, such as the Alps, the Colombian cordilleras and the Caribbean, Taiwan, Oman, Zagros or Timor.

In the United States, the demand for straight white teeth has never been more important to patients. Crowded, poorly aligned teeth are not esthetically pleasing and are difficult to keep clean. However, until recently, the process of straightening the teeth typically has involved appliances involving bands, brackets and wires that also can be difficult to clean. The desire for a cosmetic solution to misaligned teeth has led to an increase in the number of patients seeking veneers, crowns and other laboratory-fabricated cosmetic restorations. Some clinicians are not aware that there are other ways to align teeth without either significant enamel reduction or conspicuous fixed orthodontic appliances.

In this paper we generalize the concept of digital topology to arbitrary dimension n, in the context of (2n, 3n−1)-adjacency. We define an n-digital image P as an uplet (Zn, R, H), where H is a finite subset of Zn and R represents the adjacency relation in the whole lattice in a specific way. We give a natural and simple construction of polyhedral representation of P based on cubical-complex decomposition. We develop general properties which provide a link between connectivity in digital and Euclidean space. This enables us to use methods of continuous topology in studying properties related to the connectivity, adjacency graph, and borders connectivity in n-digital images.