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L’hyperphagie boulimique ou binge eating disorder (BED) est le trouble du comportement alimentaire le plus répandu. Il est caractérisé par une prise incontrôlée d’aliments riches en calories, comme le gras et/ou le sucre. Les recherches cliniques et précliniques sur cette pathologie montrent le développement d’une réponse inflammatoire induite par des régimes riches en gras et/ou en sucre. Cette réaction inflammatoire se propage au système nerveux central, en particulier aux structures cérébrales impliquées dans les circuits de la récompense et de la prise alimentaire, via l’axe intestin–cerveau. Les mécanismes neuro-inflammatoires sont associés à une modulation, entre autres, du système endocannabinoïde. Celui-ci est également impliqué dans la régulation de la prise alimentaire, de la récompense et dans le contrôle de la douleur. Les comorbidités associées au BED favorisent l’obésité mais incluent également des troubles de l’humeur (anxiété, dépression notamment). Le binge eating pourrait aussi être un facteur de risque majeur de l’apparition de douleurs chroniques, sous-tendues par des mécanismes neuroinflammatoires. Des recherches futures dans le domaine permettront de développer des stratégies de traitement de cette pathologie, en considérant ces comorbidités.

Supplemental Digital Content is available in the text., Background: Cardiac involvement among hospitalized patients with severe coronavirus disease 2019 (COVID-19) is common and associated with adverse outcomes. This study aimed to determine the prevalence and clinical implications of COVID-19 cardiac involvement in young competitive athletes. Methods: In this prospective, multicenter, observational cohort study with data from 42 colleges and universities, we assessed the prevalence, clinical characteristics, and outcomes of COVID-19 cardiac involvement among collegiate athletes in the United States. Data were collected from September 1, 2020, to December 31, 2020. The primary outcome was the prevalence of definite, probable, or possible COVID-19 cardiac involvement based on imaging definitions adapted from the Updated Lake Louise Imaging Criteria. Secondary outcomes included the diagnostic yield of cardiac testing, predictors for cardiac involvement, and adverse cardiovascular events or hospitalizations. Results: Among 19 378 athletes tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, 3018 (mean age, 20 years [SD, 1 year]; 32% female) tested positive and underwent cardiac evaluation. A total of 2820 athletes underwent at least 1 element of cardiac triad testing (12-lead ECG, troponin, transthoracic echocardiography) followed by cardiac magnetic resonance imaging (CMR) if clinically indicated. In contrast, primary screening CMR was performed in 198 athletes. Abnormal findings suggestive of SARS-CoV-2 cardiac involvement were detected by ECG (21 of 2999 [0.7%]), cardiac troponin (24 of 2719 [0.9%]), and transthoracic echocardiography (24 of 2556 [0.9%]). Definite, probable, or possible SARS-CoV-2 cardiac involvement was identified in 21 of 3018 (0.7%) athletes, including 15 of 2820 (0.5%) who underwent clinically indicated CMR (n=119) and 6 of 198 (3.0%) who underwent primary screening CMR. Accordingly, the diagnostic yield of CMR for SARS-CoV-2 cardiac involvement was 4.2 times higher for a clinically indicated CMR (15 of 119 [12.6%]) versus a primary screening CMR (6 of 198 [3.0%]). After adjustment for race and sex, predictors of SARS-CoV-2 cardiac involvement included cardiopulmonary symptoms (odds ratio, 3.1 [95% CI, 1.2, 7.7]) or at least 1 abnormal triad test result (odds ratio, 37.4 [95% CI, 13.3, 105.3]). Five (0.2%) athletes required hospitalization for noncardiac complications of COVID-19. During clinical surveillance (median follow-up, 113 days [interquartile range=90 146]), there was 1 (0.03%) adverse cardiac event, likely unrelated to SARS-CoV-2 infection. Conclusions: SARS-CoV-2 infection among young competitive athletes is associated with a low prevalence of cardiac involvement and a low risk of clinical events in short-term follow-up.

Background: In patients with psychotic disorders, sleep spindles are reduced, supporting the hypothesis that the thalamus and glutamate receptors play a crucial etio-pathophysiological role, whose underlying mechanisms remain unknown. We hypothesized that a reduced function of NMDA receptors is involved in the spindle deficit observed in schizophrenia. Methods: An electrophysiological multisite cell-to-network exploration was used to investigate, in pentobarbital-sedated rats, the effects of a single psychotomimetic dose of the NMDA glutamate receptor antagonist ketamine in the sensorimotor and associative/cognitive thalamocortical (TC) systems. Results: Under the control condition, spontaneously-occurring spindles (intra-frequency: 10-16 waves/s) and delta-frequency (1-4Hz) oscillations were recorded in the frontoparietal cortical EEG, in thalamic extracellular recordings, in dual juxtacellularly recorded GABAergic thalamic reticular nucleus (TRN) and glutamatergic TC neurons, and in intracellularly recorded TC neurons. The TRN cells rhythmically exhibited robust high-frequency bursts of action potentials (7 to 15 APs at 200-700Hz). A single administration of low-dose ketamine fleetingly reduced TC spindles and delta oscillations, amplified ongoing gamma-(30-80Hz) and higher-frequency oscillations, and switched the firing pattern of both TC and TRN neurons from a burst mode to a single AP mode. Furthermore, ketamine strengthened the gamma-frequency band TRN-TC connectivity. The antipsychotic clozapine consistently prevented the ketamine effects on spindles, delta- and gamma-/higher-frequency TC oscillations. Conclusion: The present findings support the hypothesis that NMDA receptor hypofunction is involved in the reduction in sleep spindles and delta oscillations. The ketamine-induced swift conversion of ongoing TC-TRN activities may have involved at least both the ascending reticular activating system and the corticothalamic pathway., Schizophrenia Research, Elsevier, In press

Purpose The purposes of this study were to estimate the prevalence of Rathke cleft cysts (RCC) in a pediatric population on brain MRI, to describe their appearance, and to estimate interobserver agreement in the detection of RCC. Materials and methods The brain MRI examinations of 460 children were retrospectively reviewed by two radiologists for the presence of RCC. There were 223 boys and 237 girls with a mean age of 8.8 ± 4.3 (standard deviation [SD]) years (range: 0.1–14.9 years). When present, RCC were analyzed with respect to internal contain and further classified as serous RCC (i.e., high signal on T2-weighted sequences and iso or low signal on T1-weighted sequences) or mucosal RCC (i.e., low signal on T2-weighted sequences and high or iso signal on T1-weighted sequences). Cohen's Kappa coefficient was used to estimate interobserver agreement between the interpretations performed by the two radiologists for the presence of RCC. Results A total of 14 children had a RCC present on brain MRI, yielding a prevalence of 3.04% (14/460); of these, 3/14 RCCs (21%) were of serous type and 11/14 (79%) were of mucosal type. Interobserver agreement for the presence of RCC was strong (Kappa = 0.85; 95% CI: 0.70; 0.99). Conclusion The results of our study suggest that the prevalence of RCC in children is greater than previously described.

Introduction Gastrointestinal stromal tumors represent the most frequently encountered primary mesenchymal tumors. Whereas the liver and the peritoneum are known to be the preferential metastasis sites, no therapeutic standard has yet been established for the management of bone metastases because of their very low incidence. We report a unique example of a single humerus metastasis of a jejunal gastrointestinal stromal tumor. Case presentation We report the case of a 72-year-old European woman whose jejunal gastrointestinal stromal tumor was resected in 2013 and treated during the following 3 years with imatinib (400 mg daily). In 2018, she developed a single humeral bone lesion that was identified as a gastrointestinal stromal tumor metastasis. After 7 months of imatinib intake, reconstructive surgery was performed. Pathologists confirmed the satisfactory histological regression and assessed the complete tumor resection. The patient is still on imatinib maintenance therapy, with no recurrence reported so far. She fully recovered the upper limb function after following an appropriate rehabilitation program. Discussion Current literature and published case reports indicate that bones are one of the rarest locations of gastrointestinal stromal tumor metastasis (about 1%), with occurrence mainly in the spine. Patients initially diagnosed with gastrointestinal stromal tumor of the small intestine and stomach are more likely to suffer from bone metastasis, compared with other gastrointestinal stromal tumor locations. The median overall survival rate is higher for patients with isolated bone metastasis compared with those having liver metastasis. Metastasis occurs on average 4 years after the primary, but it may take up to 20 years, emphasizing the need for long-term clinical and radiological monitoring. Although specific guidelines for such cases have not yet been established, we suggest that a multimodal concerted approach involving surgery or radiotherapy associated with tyrosine kinase inhibitor intake should be considered. Conclusion Bones are one of the rarest locations of gastrointestinal stromal tumor metastasis. A multidisciplinary collaboration was set up to allow conservative surgery of our patient after several months of imatinib treatment. A year and a half later, the patient is still in complete remission. This specific case supports the concept of an intermediate stage between local and oligometastatic disease that should be managed with a curative aim, as much as possible.

To evaluate the obstetrical prognosis of term breech delivery in case of asymmetric pelvis.An observational, comparative, retrospective, bi-centric study of 559 patients who had a computer tomography pelvimetry prior to delivery of a term breech presentation was conducted between August 2013 and August 2019. Patients with an attempted vaginal delivery were divided into two groups: a group of asymmetric pelvis (AP) when the difference between the lengths of both oblique diameters was ≥ 1 cm and a group of symmetric pelvis (SP) when the two oblique diameters differed by 1 cm. The primary outcome was the rate of vaginal delivery. Secondary outcomes were a composite variable of neonatal and maternal morbidity and mortality.Of the 370 patients who attempted a vaginal breech delivery, 8% (n = 29) had an AP and 92% (n = 341) had a SP. In the AP group, the vaginal delivery rate was higher (93% versus 78%, p = 0.05). There was no statistically significant difference in neonatal (3% versus 1% in the AP and SP groups, respectively, p = 0.4) and maternal (17% versus 23% in the AP and SP groups, respectively, p = 0.5) morbidity and mortality.When a pelvimetry is performed before an attempt of vaginal breech delivery, a difference of less than two centimetres between both oblique diameters does not seem to reduce the rate of vaginal birth and is not an indication for an elective caesarean section.

BackgroundDifferentiating ankylosing spondylitis (AS) from osteitis condensans ilii (OCI) remains challenging for clinicians.ObjectivesThe aim of this study was to determine whether Subchondral Bone Attenuation Coefficient of the SacroIliac margins (SBAC-SI) is different in AS, OCI and diffuse idiopathic skeletal hyperostosis (DISH).MethodsA monocentric retrospective observational study was performed at a French University Hospital. Patients included were followed for AS, DISH or OCI and underwent CT scan including sacroiliac joint. Patients with tumor lesion of bone or a history of pelvic radiotherapy were excluded. AS and OCI patients were matched with a control of the same age and sex. All scans were acquired on the same CT-scan unit (Somatom 64 definition AS+, Siemens Healthineers, Erlangen, Germany), with a slice thickness of 0.625 mm. In the coronal oblique plane of the SIJ, three slices (anterior, middle and posterior) and four quadrants per joint were defined. Twenty-four identical circular regions of interest (ROIs) (30 mm2), 8 per slice, were manually placed separately subcortical to the SIJ, four on the sacral side and four on the iliac side. The distance between the circle of the ROI and the cortical bone was 2 to 3 mm. An overall score was obtained from the sum of all ROIs. For every ROI, an Attenuation Coefficient was measured and expressed in Hounsfield Unit. The total SBAC-SI score was the sum of the 24 ROI. The sacral and iliac SBAC-SI scores were the sum of the sacral or the iliac ROI.ResultsThirty AS and AS controls, 31 DISH, 29 OCI and OCI controls were included. SBAC-SI score was 9727 (±2430) in the OCI group (pConclusionSBAC-SI is significatively different between AS and OCI and could help to distinguish these two diseases.Figure 1.Distribution of the Subchondral Bone Attenuation Coefficients of the Sacroiliac Margins of the 24 ROI in the anterior (A), middle (B) and posterior (C) slices in the coronal oblique plane of the sacroiliac jointsDisclosure of InterestsNone declared

The means for judging optimal tension during tendon transfers are approximate and not very quantifiable. The purpose of this study was to demonstrate the feasibility of quantitatively assessing muscular mechanical properties intraoperatively using ultrasound elastography (shear wave elastography [SWE]) during extensor indicis proprius (EIP) transfer. We report two cases of EIP transfer for post-traumatic rupture of the extensor pollicis longus muscle. Ultrasound acquisitions measured the elasticity modulus of the EIP muscle at different stages: rest, active extension, active extension against resistance, EIP section, distal passive traction of the tendon, after tendon transfer at rest and then during active extension. A preliminary analysis was conducted of the distribution of values for this modulus at the various transfer steps. Different shear wave velocity and elasticity modulus values were observed at the various transfer steps. The tension applied during the transfer seemed close to the resting tension if a traditional protocol were followed. The elasticity modulus varied by a factor of 37 between the active extension against resistance step (565.1 kPa) and after the tendon section (15.3 kPa). The elasticity modulus values were distributed in the same way for each patient. The therapeutic benefit of SWE elastography was studied for the first time in tendon transfers. Quantitative data on the elasticity modulus during this test may make it an effective means of improving intraoperative adjustments.

Elastosonography is an evolution of ultrasound that maps the biomechanical and elastic properties of tissues by measuring their stiffness. Over the past five years, the number of studies on elastosonography in tendon pathologies raised. Indeed, this technique is promising, but how can radiologists use it in daily practice? The purpose of this review article is to summarize the data available to date about elastosonography focused on the calcaneal tendon in order to provide physicians with an overview that may help them understand and use elastosonography routinely. The physical principles of elastosonography are described. The aspects of normal, physiological and pathologic calcaneal tendon are discussed. Transient Shear Wave Elastography (SWE), which is the most recent elastosonographic technique, allowed to quantify tendon stiffening when tendon stress increases, confirmed tendon softening in case of tendinopathy, and shown tendon strength loss when calcaneal tendon is completely ruptured. SWE is still a wide research field on viscoelastic properties of normal, pathologic, aging and operated calcaneal tendon.

BackgroundIn schizophrenia, sleep spindles are reduced, supporting the hypothesis that the thalamus and glutamate receptors play a crucial etio-pathophysiological role, whose underlying mechanisms remain unknown. We hypothesized that a reduced function of NMDA receptors is involved in the psychosis-related spindle deficit.MethodsAn electrophysiological multisite cell-to-network exploration was used to investigate, in sleeping rats, the effects of a ketamine-induced psychosis-relevant transition state in the sensorimotor and associative/cognitive thalamocortical (TC) systems.ResultsUnder the control condition, spontaneously-occurring spindles (intra-frequency: 10-16 waves/s) and delta-frequency (1-4Hz) oscillations were recorded in the EEG of the frontoparietal cortex, in thalamic extracellular recordings (n=16), in dual juxtacellularly recorded GABAergic thalamic reticular nucleus (TRN) and glutamatergic TC neurons (n=8), and in intracellularly recorded TC neurons (n=8). The TRN cells rhythmically exhibited robust high-frequency bursts of action potentials (7 to 15 APs at 200-700 Hz). A single administration of low-dose ketamine fleetingly reduced TC spindles and delta oscillations, amplified ongoing gamma-(30-80Hz) and higher-frequency oscillations, and switched the firing pattern of both TC and TRN neurons from a burst mode to a single AP mode. Furthermore, ketamine strengthened the gamma-frequency band TRN-TC connectivity (n=11). The antipsychotic clozapine consistently prevented the ketamine effects on spindles, delta- and gamma-/higher-frequency TC oscillations (n=7).ConclusionThe present findings support the hypothesis that NMDA receptor hypofunction is involved in the psychosis-related reduction in sleep spindles and delta oscillations. The ketamine-induced swift conversion (from burst to single APs) of ongoing TC-TRN activities may have involved both the ascending reticular activating system and the corticothalamic pathway.LAY ABSTRACTSchizophrenia is a chronic debilitating disease. Sleep disturbances associated with a reduction in spindles are observed as warning signs prior to the first psychotic episode. Every spindle is a short-lasting (~0.5 s) set of bioelectric sinusoidal waves at the frequency of 10-16 Hz generated within the thalamus. Sleep spindles, easily identifiable in a scalp electroencephalogram, occur hundreds of times during sleep and are implicated in cognition like memory processes. For this reason, spindles are seen as an electro-biomarker of the quality of sleep and cognitive performance. In patients at high risk of psychotic transition, the density (number/time unit) of spindles is reduced. The underlying mechanisms of this change are unknown. Glutamate-mediated neurotransmission in the thalamus plays a key role in the generation of spindles and the etiology of schizophrenia. Therefore, we tested the hypothesis that a reduced function of glutamate receptors at the thalamic level is involved in the psychosis-related reduction in spindles. Using cell-to-network neurophysiological methods in sleeping rats, we demonstrate that systemic administration of the NMDA glutamate receptor antagonist, ketamine, significantly decreases spindle density. This effect is consistently prevented by the widely used antipsychotic drug, clozapine. These original findings support the hypothesis of the involvement of a reduced function of NMDA glutamate receptors in the sleep spindle deficit observed in psychosis-related disorders. The present findings lay the foundation for the development of innovative therapies aimed at preventing psychotic, bipolar, and depressive disorders.HIGHLIGHTSLow-dose ketamine has a fast onset arousal promoting effect.Ketamine fleetingly reduces, in the first-/higher-order thalamocortical systems, sleep spindles and slow-waves, and amplifies gamma- and higher-frequency oscillations.Ketamine switches the firing pattern from a burst mode to a single action potential mode in both the glutamatergic thalamocortical neurons and the GABAergic thalamic reticular nucleus neurons.Ketamine strengthens the gamma-frequency band connectivity between thalamocortical and thalamic reticular nucleus neurons.The reference antipsychotic clozapine consistently prevents the ketamine effects.

PURPOSE To assess the normal values of the antero-posterior (AP) diameter of the posterior interosseous nerve (PIN) of the elbow as it passes beneath the arcade of Frohse and to search for PIN-diameter differences between the upstream, entry point and downstream of the arcade. MATERIAL AND METHODS Thirty asymptomatic patients prospectively underwent bilateral B-mode ultrasound of the PIN of the elbow. There were 15 men and 15 women with a mean age of 30.2±5.31 (SD) years (range: 26-43 years). Of these, 23 patients were right-handers (23/30; 77%) and 7 were left handers (7/30; 23%). AP diameter of the PIN was measured in long axis at three different locations including the entry point of the arcade, 5-mm upstream and 5-mm downstream the arcade. A comparison between the three measurements was performed using paired t-test. RESULTS The mean AP diameters of the PIN were 0.83±0.21 (SD) mm (range: 0.43-1.31mm), 0.6±0.17 (SD) mm (range: 0.29-1.16mm) and 0.49±0.13 (SD) mm (range: 0.26-0.86mm) at 5-mm upstream, entry point of the arcade and 5-mm downstream the arcade of Frohse, respectively. Significant drops in PIN diameter were found between upstream and the arcade (-0.23mm; 27%; P

International audience; Purpose: The purpose of this study was twofold. First, to compare the contrast between spinal multiple myeloma (MM) focal lesions and surrounding bone marrow obtained on T2-weighted Dixon fat-only MR images to that obtained on T1-weighted spin-echo images. Second, to search for correlation between bone marrow fat fraction assessed by T2-weighted Dixon sequence and International Myeloma Working Group myeloma defining events.Materials and methods: A total of 39 patients with 112 focal MM lesions were included. There were 25 men and 14 women with a mean age of 68.8±9.8 [SD] years (range: 49-88 years). Contrast between focal MM lesions and surrounding bone marrow was calculated on T1-weighted spin-echo and T2-weighted Dixon (including water-only and fat-only) images. Contrast between focal MM lesions and bone marrow was compared using ANOVA and post-hoc Tukey tests. Correlation between bone marrow fat fraction and myeloma defining events was assessed using Spearman's correlation test.Results: MM lesion contrast was greater on T2-weighted Dixon (F (2;93)=35.10) than on T1-weighted images (P

This article reviews the risk-adjustment models underpinning the National Healthcare Safety Network (NHSN) standardized infection ratios. After first describing the models, the authors focus on hospital intensive care unit (ICU) designation as a variable employed across the various risk models. The risk-adjusted frequency with which ICU services are reported in Medicare fee-for-service claims data was compared as a proxy for determining whether reporting of ICU days is similar across hospitals. Extreme variation was found in the reporting of ICU utilization among admissions for congestive heart failure, ranging from 25% in the lowest admission hospital quartile to 95% in the highest. The across-hospital variation in reported ICU utilization was found to be unrelated to patient severity. Given that such extreme variation appears in a designation of ICU versus non-ICU utilization, the NHSN risk-adjustment models’ dependence on nursing unit designation should be a cause for concern.

Resume Buts de l’etude Une reunion de concertation pluridisciplinaire (RCP) dediee a la prise en charge des sarcomes a ete instauree en Franche-Comte en 2010. Les buts de l’etude sont : (a) evaluer la prise en charge des sarcomes par confrontation a la revue de la litterature ; (b) evaluer l’influence de la RCP sur la prise en charge des sarcomes par les hopitaux au niveau regional. Materiel et methode Il s’agit d’une etude retrospective unicentrique de 2010 a 2015 chez des patients presentant un sarcome des tissus mous peripheriques et etablie a partir d’une base de donnees NetSarc (Reseau national des sarcomes) et du dossier communicant de cancerologie. Une base de donnees CleanWeb® specialement dediee est creee. Resultats Quarante-sept patients sont inclus : dix sarcomes au niveau du membre superieur, quarante-sept patients ont ete inclus, 26 au niveau des membres inferieurs, 11 au niveau du tronc. Quarante patients ont ete operes : dix hors CHRU, 28 en CHRU et deux en centre coordinateur. Quatre-vingt-dix pour cent des patients pris en charge au CHRU etaient conformes aux recommandations. Aucun patient opere en dehors du CHRU ne beneficiait d’une prise en charge conforme aux recommandations. On constate une augmentation du nombre de dossiers adresses par les hopitaux hors CHRU discute en RCP avant tout traitement. Conclusion La creation d’une RCP dediee au sarcome ameliore la prise en charge de ces tumeurs et diminue les prises en charge inadaptees en sensibilisant les medecins au niveau regional.

Resume A l’heure actuelle, la consultation en routine de l’imagerie en coupe en peroperatoire necessite un contact physique avec une interface ce qui peut etre source de fautes d’asepsie et de perte de temps. L’apparition recente de dispositifs permettant d’interagir avec l’ordinateur sans contact physique comme le Leap Motion ® (societe Leap Motion, San Francisco, Etats-Unis) trouve alors en chirurgie un domaine d’application tres interessant mais peut se heurter a des problemes de configuration et d’ergonomie afin de s’adapter au praticien, au logiciel d’imagerie et a l’environnement chirurgical. L’objectif de cet article est de proposer une configuration facile du Leap Motion ® en neurochirurgie sur PC pour une utilisation optimisee avec le logiciel d’imagerie PACS Carestream ® Vue PACS v11.3.4 (Carestream Health, Inc., Rochester, Etats-Unis) par l’intermediaire d’un plug-in et d’une video de demonstration.

Quadriceps tendon avulsions are typically treated by reattaching the tendon through bone tunnels, with or without tendon or hardware augmentation. The operated knee joint can be moved right away; however, tendon grafting or tension banding will be required to protect the repair, and the hardware must be removed later on. The goal of this study was to evaluate the clinical and functional outcomes when suture anchors are used to reattached torn quadriceps tendon, and also to assess tendon healing using MRI. Thirteen consecutive patients with avulsed quadriceps tendons were operated and then followed prospectively. The surgical technique consisted of tendon reattachment using at least three anchors, in addition to intratendinous weaving of the sutures. Weight bearing was allowed while using a splint. Rehabilitation was initiated immediately after surgery according to a set protocol. Eleven patients were followed for a mean of 14.7 months. Two retears occurred in patients who did not wear the splint. Eighty-two per cent of patients were satisfied or very satisfied with the outcome. The mean knee flexion was 124.5°. All patients were able to return to their pre-injury activity levels. The mean time for clinical and functional recovery was 3 months. MRI performed 6 months after the surgical repair revealed good tendon healing. This was the first prospective study performed on quadriceps avulsion patients undergoing suture anchor repair. Prior clinical case reports have shown that this method leads to predictable clinical and functional results. Our results were comparable to those in published cases. The procedure is simpler when only suture anchors are used. Tendon healing was observed on MRI in all cases. This simple, reproducible technique is free of the drawbacks associated with the typical repair augmentation.

La leche materna es unica desde los puntos de vista biologico y nutricional. Su composicion evoluciona constantemente para responder mejor a las necesidades del nino hasta los 6 meses. En paises como Francia, la cultura del biberon esta sustituyendo progresivamente a la de la lactancia materna (LM) como lo senalan los ultimos datos epidemiologicos. En dicho pais, aunque las tasas de inicio de la LM son del 76-86% dependiendo de las regiones, solo el 22% de los lactantes se mantienen con lactancia materna exclusiva a los 6 meses. En las sociedades industrializadas, las madres jovenes pocas veces han visto a otras madres amamantar antes de hacerlo ellas mismas. Con las altas precoces de la maternidad, muchas mujeres se encuentran desampararas frente a innumerables dificultades menores. Los centros de recursos (proteccion maternal en infantil [PMI], pediatras, generalistas, consultores en lactancia, asociacion de apoyo, etc.) tendran entonces un papel importante, pero no deben difundir consejos inadecuados y/o contradictorios. ?Cuanto se debe interrumpir la lactancia por un episodio agudo de fiebre, una prescripcion de un farmaco, un pezon doloroso o, peor, una renuncia a la LM tras un nacimiento prematuro? El mejor modo para comenzar y continuar la LM sin dolor es acercarse a los ultimos conocimientos sobre la fisiologia de la lactacion.

Resume Introduction Les modeles en 3-dimensions (3D) sont apparus dans le domaine medical il y a une vingtaine d’annees. Le developpement recent d’imprimantes 3D grand public explique le regain d’interet pour cette technologie. Nous decrivons les modalites techniques et pratiques de cet outil chirurgical, illustrees par des exemples concrets. Note technique Le logiciel OsiriX ® (version 5.8.5, Geneve, Suisse) a ete utilise pour la reconstruction 3D surfacique de la zone d’interet, la generation et l’exportation d’un fichier « .stl ». Le logiciel NetFabb ® (version Basic 5.1.1, Lupburg, Allemagne) a assure la preparation du fichier « .stl ». L’imprimante etait un modele Up plus 2 Easy 120 ® (PP3DP, Beijing TierTime Technology Co. Ltd., Chine), utilisant un depot de filament thermoplastique. Le logiciel Up ! ® a permis de calibrer l’impression selon les besoins. Resultats Le premier cas illustrait l’interet de l’impression 3D dans l’etage facial superieur (sinus frontal et toit orbitaire). Le second cas concernait la preconformation du materiel d’osteosynthese pour une fracture complexe de l’etage facial moyen grâce au « mirroring ». Le troisieme cas montrait la preconformation d’une attelle de reconstruction pour mandibulectomie interruptrice. Discussion Les imprimantes 3D actuelles sont faciles d’utilisation et representent une solution prometteuse pour le prototypage medical. L’impression 3D aura rapidement une place indeniable, compte tenu de ses avantages : partage d’informations, simulation, aide a l’intervention, pedagogie.

Background Interventional radiology includes a range of minimally invasive image-guided diagnostic and therapeutic procedures that have become routine clinical practice. Each procedure involves a percutaneous needle insertion, often guided using computed tomography (CT) because of its availability and usability. However, procedures remain complicated, in particular when an obstacle must be avoided, meaning that an oblique trajectory is required. Navigation systems track the operator’s instruments, meaning the position and progression of the instruments are visualised in real time on the patient’s images. A novel electromagnetic navigation system for CT-guided interventional procedures (IMACTIS-CT®) has been developed, and a previous clinical trial demonstrated improved needle placement accuracy in navigation-assisted procedures. In the present trial, we are evaluating the clinical benefit of the navigation system during the needle insertion step of CT-guided procedures in the thoraco-abdominal region. Methods/design This study is designed as an open, multicentre, prospective, randomised, controlled interventional clinical trial and is structured as a standard two-arm, parallel-design, individually randomised trial. A maximum of 500 patients will be enrolled. In the experimental arm (navigation system), the procedures are carried out using navigation assistance, and in the active comparator arm (CT), the procedures are carried out with conventional CT guidance. The randomisation is stratified by centre and by the expected difficulty of the procedure. The primary outcome of the trial is a combined criterion to assess the safety (number of serious adverse events), efficacy (number of targets reached) and performance (number of control scans acquired) of navigation-assisted, CT-guided procedures as evaluated by a blinded radiologist and confirmed by an expert committee in case of discordance. The secondary outcomes are (1) the duration of the procedure, (2) the satisfaction of the operator and (3) the irradiation dose delivered, with (4) subgroup analysis according to the expected difficulty of the procedure, as well as an evaluation of (5) the usability of the device. Discussion This trial addresses the lack of published high-level evidence studies in which navigation-assisted CT-guided interventional procedures are evaluated. This trial is important because it addresses the problems associated with conventional CT guidance and is particularly relevant because the number of interventional radiology procedures carried out in routine clinical practice is increasing. Trial registration ClinicalTrials.gov identifier: NCT01896219. Registered on 5 July 2013. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2049-6) contains supplementary material, which is available to authorized users.

Objectifs L’atherome des axes iliaques est frequent chez les patients en attente de transplantation renale. Chez certains patients cette atheromatose rend la strategie chirurgicale difficile notamment concernant le choix du site d’anastomose. Le bilan standard ne permet pas toujours une evaluation optimale. L’objectif de ce travail a ete de developpe un outil d’evaluation de l’atheromatose par reconstruction tridimensionnelle en imagerie et impression 3D multi-tissue. Methodes Les donnees DICOM issus de la tomodensitometrie sans injection ont ete importees dans le logiciel open source 3D-slicer pour generer un modele 3D en format STL (STereoLithography). Les seuils de −20HU (Unite Hounsfield) pour caracteriser les portions de vaisseaux normales et de + 300HU pour les portions avec des plaques atheromateuses calcifiees ont ete utilises. Le modele a ensuite ete imprime grâce a’une imprimante multi-jet (Scalia, Cryla groupe, Besancon, France), permettant des couches de 0,028 microns d’une resine d’elastomere transparente souple (28 Shore A) pour l’aspect de vaisseaux non pathologique et des couches de resine dure opaque (Acrylonitrile butadiene styrene [ABS]) pour les plaques atheromateuses calcifies. Resultats La concordance entre le modele d’impression 3 D et la realite a ete analysee par 6 urologues tous experimentes en transplantation selon les criteres suivants : taille, aspect visuel, toucher, interet pour la planification chirurgicale, interet global. La taille a ete evaluee a 8/10, aspect visuel 3/10, toucher 8/10, interet pour la planification chirurgicale 8/10 et l’interet global 8/10. Tous les urologues interroges seraient prets a utiliser cet outil pour l’evaluation des patients presentant une arteriopathie severe ( Fig. 1 ). Conclusion l’impression 3D peut etre un outil d’evaluation pre-transplantation chez certains receveurs selectionnes. L’interet clinique de cet outil doit maintenant etre evalue de maniere prospective.

SPIRIT 2013 checklist: recommended items to address in a clinical trial protocol and related documents. (DOC 122 kb)

To estimate fetal absorbed doses for pregnant women pelvimetry, a comparative study between EOS imaging system and low-dose spiral CT-scanner was carried out. For this purpose three different studies were investigated: in vivo, in vitro and Monte Carlo calculations.In vivo dosimetry was performed, using OSL NanoDot dosimeters, to determine the dose to the skin of twenty pregnant women. In vitro studies were established by using a cubic phantom of water, in order to estimate the out of field doses. In the latter study, OSLDs were placed at depths corresponding to the lowest, average and highest position of the uterus. Monte Carlo calculations of effective doses to high radio-sensitive organs were established, using PCXMC and CTExpo software suites for EOS imaging system and CT-scanner, respectively.The EOS imaging system reduces radiation exposure 4 to 8 times compared to the CT-scanner. The entrance skin doses were 74% (p-values0.01) higher with the CT-scanner than with the EOS system. In the out of field region, the measured doses of the EOS system were reduced by 80% (p-values0.02). Monte Carlo calculations confirmed that effective doses to organs are less accentuated for EOS than for CT pelvimetry.The EOS system is less irradiating than the CT exam. The out-of-field dose which is significant, is lower in the EOS than in the CT-scanner and could be reduced even further by optimizing the time used for image acquisition.

A multidisciplinary meeting (RCP) dedicated to the treatment of sarcoma was established in Franche-Comte in 2010. The goals of the study are: (a) To evaluate the treatment of sarcomas by confrontation with the existing literature; (b) To evaluate the influence of the multidisciplinary meeting on the management of sarcomas by hospitals at the regional level.This is a retrospective single center study from 2010 to 2015 on patients with sarcoma and peripheral soft tissue drawn from a Netsarc database (National Network of sarcomas) and communicating cancer record. A database Cleanweb especially dedicated is created.Forty-seven patients were included: ten sarcomas at the upper member 26 to the lower limbs, 11 on the trunk. Forty patients were operated on: ten out of the university hospital, 28 at the university hospital and two in a coordinating center. Ninety percent of patients treated at the university hospital were in accordance with the recommandations. None of the patients operated out of the university hospital benefited from medical care in accordance to the recommendations. There is an increase in the number of files sent by the hospitals out of the university hospital discussed in multidisciplinary meeting, before treatment.The creation of a dedicated multidisciplinary meeting sarcoma improves the medical management of these tumors and decreases inappropriate medical managements thanks to a better education of the regional physicians.

Few data exist on the feasibility and reliability of measuring muscular atrophy in 2 dimensions (2D) by ultrasonography (US) and elasticity with shear wave elastography (SWE) in spastic muscles.Fourteen patients with chronic stroke took part in 2 intersession reliability experiments performed with 1-week intervals between sessions. Pennation angle (PA), muscle thickness (MT), and shear elastic modulus (µ) were measured in spastic gastrocnemius medialis (GM) muscles at rest and at maximal passive stretching in paretic and nonparetic legs.On the paretic side, the coefficient of variation (CV) in GM was 6.30% for MT and 6.40% for PA at rest and was 7.53% and 8.26% for MT and PA, respectively, at maximal passive stretching. The reliability of the µ measurement was good only for GM at rest on the paretic side (CV = 9.86%).2D US associated with SWE shows promise for assessing structural changes in muscles. With some methodological adaptations, this approach could help guide spasticity treatment. Muscle Nerve 57: 222-228, 2018.

Air transport systems evaluation infrastructure (IESTA) is an evaluation facility for air transport systems that is currently being developed by Onera in Toulouse, France. The project aims at building a generic simulation platform, designed to ease the integration of new or existing models in order to assess air transport concepts. The first IESTA application, Clean Airport, allows the assessment of the effects of innovative concepts with regard to air traffic noise and chemical pollution on the airports' surroundings. An effective simulation capability has been built and achieved by integrating Onera's expertise in physical modelling. This article gives an overview of the resulting model toolbox architecture, the first outputs and the validation walkthrough.

In France, the screening for human T-cell leukemia/ lymphoma virus type 1 and 2 (HTLV-1 and HTLV-2) during the donation of human milk has been carried out from 1992 with the application of the circular DGS 24 November 1992. The screening for antibodies against these viruses is regulated and done systematically during every donation of milk. Breast feeding being the main mode of transmission of the HTLV-1, the last ministerial decree of 25 August 2010 has made the screening test compulsory for the anonymous donation and for the personalized donation (of a mother for her own child) from all women including those affected by the infection. The milk delivered by milk banks is pasteurized (62.5 °C for 30 minutes) before freezing at -18 °C, which inactivates the pathogens. This double means of prevention of the transmission of the HTLV-1 paradoxically seems disproportionate in the absence of any precautionary measure in the case of direct breast-feeding and the use of mother's raw milk. Indeed, in most neonatal intensive care units in maternity hospitals, unpasteurized milk is administered to the neonates without any systematic preliminary testing of the serological HTLV-1 status of the mother. An increased sensitization of the community of the obstetricians, midwives and neonatologists by the Association of the Milk Banks of France (ADLF) and the Societe de pathologie exotique could address the issue of screening for HTLV-1 in "donated" milk and breast-feeding.

Le ligament scapholunaire (SL) est une structure anatomique essentielle du carpe et sa lesion est prejudiciable a moyen et long termes. L’objectif est une analyse comparee de la cinematique scapholunaire sur des pieces anatomiques dont le SL est sain, puis lese et enfin repare par ancres souples. Sur 6 poignets sains, 3 billes en acier etaient inserees dans le scaphoide, lunatum, radius et 3e metacarpe afin de definir des reperes locaux. La reconstruction 3D du radius a l’aide d’un TDM prealable a permis de definir les axes du poignet — flexion-extension (FE), radio-ulnaire (RU) et prono-supination. Le banc d’essai permettait des mouvements passifs du poignet de 30° de flexion a 60° d’extension et de 20° d’inclinaison radiale a 30° ulnaire. Des radiographies bi-planaires a faible dose etaient realisees tous les 10° pour chaque configuration — SL sain, lese, apres reparation par des ancres souples a la partie posterieure (I1) puis anterieure (I2) du ligament. Les coordonnees des billes etaient recuperees sur les radiographies. A partir des coordonnees et du repere d’interpretation du poignet, des routines Matlab ont permis de calculer la cinematique des os. La mesure des amplitudes de mouvements a pu etre realisee pour tous les axes, en rotation et translation, et pour chaque configuration du poignet. Lors des mouvements FE du poignet, les amplitudes moyennes (degre) pour les 6 sujets, du scaphoide suivant FE pour les configurations saines, lesees, I1 et I2 etaient respectivement de 63,82+, 72,97+, 65,61 et 62,72. Pour le lunatum de 47,05+, 47,31+, 49,63 et 52,90. L’amplitude moyenne du deplacement transversal (mm) entre scaphoide et lunatum — 0,85+, 1,07+, 0,71 et 0,86. Les resultats sont concordants avec la litterature, en termes de differences d’amplitudes entre les poignets sains et leses et de variabilite interindividuelle. Malgre le faible effectif de notre population, nos resultats mettent en evidence, a l’instar d’autres equipes, une amelioration de la cinematique du scaphoide par la reparation ligamentaire combinee, anterieure et posterieure. Par contre cela semble moins evident pour la cinematique du lunatum. Cette etude cadaverique ouvre la voie a une technique d’evaluation des moyens de reparation du SL. Les perspectives d’avenir sont l’evaluation de la cinematique in vivo et la personnalisation des traitements par la modelisation en elements finis.

La chirurgie bariatrique est aujourd’hui au premier plan du traitement des obesites severes et morbides. Les benefices de l’intervention peuvent toutefois s’averer temporaires quand celle-ci fait l’impasse sur les determinants psychologiques du surpoids. Nous avons investigue la question de l’elaboration psychique de la perte chez des sujets ayant subi cette chirurgie. Nos resultats suggerent que l’apparition et le maintien de certaines obesites pourraient etre lies a la capacite de l’individu a elaborer « le signifiant perte » en regard de renoncements objectaux anterieurs.

Resume Le lambeau de latissimus dorsi est le lambeau le plus ancien et le plus utilise en reconstruction mammaire. Son pedicule vasculaire a deja pu faire l’objet d’une dissection anterieure a l’occasion du curage axillaire. L’eventualite d’une lesion du pedicule, pouvant etre a l’origine d’une necrose du lambeau, nous fait realiser a titre systematique une echographie preoperatoire du pedicule. Le calibre et la qualite du flux vasculaire sont analyses de facon bilaterale et comparative. Entre 1994 et 2004, 74 patientes avec un curage axillaire unilateral ont beneficie d’une exploration du pedicule en vue de la realisation d’un lambeau de latissimus dorsi du cote opere. Chez 12,2 % des patientes, une modification du pedicule a ete retrouvee par rapport au cote sain avec une diminution du calibre chez 9,5 % et une stenose chez 2,7 %. La stenose est une contre-indication absolue a la levee du lambeau. Le taux de complication a type de necrose (partielle ou totale) de la serie est nul alors que celui de la litterature est d’environ 3 %. A notre sens, l’exploration systematique du pedicule par echographie et l’exclusion des pedicules stenoses permettent d’ameliorer la fiabilite deja elevee du lambeau de latissimus dorsi.

La leche materna tiene cualidades inigualables en el plano nutricional, biologico e inmunologico, y su composicion evoluciona constantemente para responder lo mejor posible a las necesidades del nino hasta los 6 meses. En las sociedades industriales, es raro que las madres primerizas hayan visto a otras madres amamantar antes de hacerlo ellas mismas («transmision gestual del amamantamiento»). Cuando la madre permanece muy poco tiempo en la maternidad, muchas veces se encuentra desamparada frente a las pequenas dificultades inevitables. En estos casos los centros de consejo y ayuda (lactarios, consultores sobre lactancia, asociaciones de apoyo, etc.) tienen un papel importante de apoyo en el inicio y la continuacion de la lactancia materna. Sin embargo, los consejos a menudo contradictorios del entorno de las madres, asi como de los profesionales de la salud, pueden constituir un obstaculo importante para el buen desarrollo de la lactancia. Puede haber interrupciones de la lactancia por una simple rinitis, una prescripcion farmacologica o una linfangitis. Las unicas contraindicaciones reales son la galactosemia en el recien nacido y seropositividad de la madre para el virus de inmunodeficiencia humana (VIH) y el virus de la leucemia T humana (HTLV) (en los paises industrializados). El respeto de las diez condiciones del exito de la lactancia materna (OMS/UNICEF) asegura las mayores probabilidades de que la lactancia comience y se prolongue sin «dolor». Aunque esta situacion no implica ninguna prohibicion alimentaria, puede constituir una buena oportunidad para limitar el cafe o el te y para suprimir todo consumo de alcohol y tabaco. Ademas, no es incompatible con la reanudacion del trabajo. No constituye una contracepcion infalible.

Bone metastases are the most common cause of pain in cancer patients. Pain management in cancer patients, often revealing the disease and always present at advanced stages, is an important and difficult task. Pain is not always properly controlled by high doses of specific medication, radiation therapy or chemotherapy. When these therapies do not provide adequate pain relief, percutaneous neurolysis, infiltrations, alcoholizations and cementoplasty may be considered. More recently RF ablation has been proposed. On weight-bearing bones, RF can be combined with acrylic cement injection. The authors present here this very effective new technique which is complementary to classical pain management techniques.

La prise en charge de la douleur cancereuse souvent revelatrice et toujours presente a un moment donne de la maladie est un challenge therapeutique en particulier a un stade evolue. La composante douloureuse ne repond pas toujours aux antalgiques majeurs, a la chimiotherapie et a la radiotherapie. Quand ces traitements sont depasses, les infiltrations, neurolyses, alcoolisations, la vertebroplastie, la cimentoplastie et la radiofrequence par voie percutanee sont des methodes elegantes et efficaces venant en complement des traitements classiques. Les auteurs presentent ici leur expertise dans ces nouvelles techniques sous controle tomodensitometrique qu’ils ont contribue a mettre au point.

Currently, cross-sectional imaging viewing is used in routine practice whereas the surgical procedure requires physical contact with an interface (mouse or touch-sensitive screen). This type of contact results in a risk of lack of aseptic control and causes loss of time. The recent appearance of devices such as the Leap Motion(®) (Leap Motion society, San Francisco, USA) a sensor which enables to interact with the computer without any physical contact is of major interest in the field of surgery. However, its configuration and ergonomics produce key challenges in order to adapt to the practitioner's requirements, the imaging software as well as the surgical environment. This article aims to suggest an easy configuration of the Leap Motion(®) in neurosurgery on a PC for an optimized utilization with Carestream(®) Vue PACS v11.3.4 (Carestream Health, Inc., Rochester, USA) using a plug-in (to download at: https://drive.google.com/?usp=chrome_app#folders/0B_F4eBeBQc3ybElEeEhqME5DQkU) and a video tutorial (https://www.youtube.com/watch?v=yVPTgxg-SIk).

In the frame of IRSN's French radioactivity observatory, aerosol samples are collected in a ten-days basis in different locations and measured by gamma spectrometry. For some studies, it is necessary to have the average of a radionuclide in aerosol samples, i.e. monthly or annually. Gamma spectrometry measurement of artificial radionuclides such as 137 Cs is becoming more difficult due to decreasing radioactivity levels. Individual measurements are sometimes below the minimum detectable activity (MDA) even when low-background measurement procedures are used. In these cases, how can a MDA in an average computation be taken into account? In order to acquire this mean value, the analysis can be performed on the annual spectrum corresponding to a running sum of each individual spectrum. As for the sample, the summing is applied for the background spectrum. In this way, the 137 Cs concentration in aerosols corresponding to the annual mean value is obtained. For aerosols collected in La Reunion, a mean concentration of 0.029 ± 0.010 µBq.m -3 for 137 Cs is obtained, when 25 measurement results on 26 samples are below the MDA. For radionuclides always detected, a good agreement between summing spectrum results and computed mean value is observed.