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OBJECTIVES The transient breath holding sign (TBHS) is a clinical sign often associated with magnetic resonance imaging (MRI) spine traumatic lesions. The aims of this study were to prospectively evaluate the TBHS in the detection of thoracolumbar lesions in a large cohort of children and to establish a comprehensive strategy on the use of MRI in spine traumas in children. STUDY DESIGN All conscious 5- to 16-year-old patients admitted for a spine trauma in our institution were prospectively included in the study. All patients were asked for the TBHS and underwent a full spine MRI. Sensitivity and specificity of the TBHS were derived from the confusion matrix. All MRI lesions were analyzed and classified. RESULTS One hundred ninety-eight patients were included. The sensitivity of the TBHS was 92%, the specificity was 83%, the positive predictive value was 83%, and the negative predictive value was 91%. The x-rays missed 67% of the vertebrae injured in the MRI. The MRI lesions consisted in an upper end plate injury, in the sagittal plane only, in 90% of the cases. The vertebral canal and the spinal cord were never injured. CONCLUSIONS This study confirms that the TBHS is a relevant clinical tool that should be added in the routine questionnaire after any trauma at admission. Magnetic resonance imaging should be restricted to patients with a TBHS positive at admission. A single T2 Short T1 Inversion Recovery (STIR) sagittal sequence seems sufficient to make the diagnosis and could replace the use of standard x-rays in pediatric spine traumas.

During industrialization, humans have been exposed to increasing numbers of foreign chemicals. Failure of the immune system to tolerate drugs, cosmetics, and other skin products causes allergic contact dermatitis, a T cell-mediated disease with rising prevalence. Models of αβ T cell response emphasize T cell receptor (TCR) contact with peptide-MHC complexes, but this model cannot readily explain activation by most contact dermatitis allergens, which are nonpeptidic molecules. We tested whether CD1a, an abundant MHC I-like protein in human skin, mediates contact allergen recognition. Using CD1a-autoreactive human αβ T cell clones to screen clinically important allergens present in skin patch testing kits, we identified responses to balsam of Peru, a tree oil widely used in cosmetics and toothpaste. Additional purification identified benzyl benzoate and benzyl cinnamate as antigenic compounds within balsam of Peru. Screening of structurally related compounds revealed additional stimulants of CD1a-restricted T cells, including farnesol and coenzyme Q2. Certain general chemical features controlled response: small size, extreme hydrophobicity, and chemical constraint from rings and unsaturations. Unlike lipid antigens that protrude to form epitopes and contact TCRs, the small size of farnesol allows sequestration deeply within CD1a, where it displaces self-lipids and unmasks the CD1a surface. These studies identify molecular connections between CD1a and hypersensitivity to consumer products, defining a mechanism that could plausibly explain the many known T cell responses to oily substances.

Background: Patients with decompensated cirrhosis (DC) and/or hepatocellular carcinoma (HCC) have a high symptom burden and mortality and may benefit from palliative care (PC) and hospice interventions. Objective: Our aim was to search published literature to determine the impact of PC and hospice interventions for patients with DC/HCC. Methods: We searched electronic databases for adults with DC/HCC who received PC, using a rapid review methodology. Data were extracted for study design, participant and intervention characteristics, and three main groups of outcomes: healthcare resource utilization (HRU), end-of-life care (EOLC), and patient-reported outcomes. Results: Of 2466 results, eight were included in final results. There were six retrospective cohort studies, one prospective cohort, and one quality improvement study. Five of eight studies had a high risk of bias and seven studied patients with HCC. A majority found a reduction in HRU (total cost of hospitalization, number of emergency department visits, hospital, and critical care admissions). Some studies found an impact on EOLC, including location of death (less likely to die in the hospital) and resuscitation (less likely to have resuscitation). One study evaluated survival and found hospice had no impact and another showed improvement of symptom burden. Conclusion: Studies included suggest that PC and hospice interventions in patients with DC/HCC reduce HRU, impact EOLC, and improve symptoms. Given the few number of studies, heterogeneity of interventions and outcomes, and high risk of bias, further high-quality research is needed on PC and hospice interventions with a greater focus on DC.

Giant cell tumors (GCT) are benign primary bone tumors, locally aggressive, affecting in long bones in young adults during the third decade. It is rare to experience this lesion in skeletally immature patients. GCT are related to a risk of local recurrence and malignant transformation. We report a rare case of a giant cell tumor of the thoracic spine in a skeletally immature girl presenting with a painful right scoliosis. MRI, CT scan, and bone scintigraphy were discordant and the percutaneous biopsy non-contributive. A marginal “en bloc” resection was performed and revealed the GCT. Based on a literature review, the diagnosis and the surgical management of this case are discussed.

Adolescent idiopathic scoliosis is a 3D spine deformity that worsens during the whole growth. New methods for spinal growth modulation with flexible spinal implants have been described to avoid progression of the deformity during growth spurt. The main limitations are that no specific ancillaries and devices are available, which makes the surgery technically demanding.We have developed a new method of spinal growth tethering using minimal invasive videothoracoscopic approach. Fixation is performed with staples and synthetic ligament on the lateral aspect of vertebral bodies on main curvature convexity. Patients with progressive thoracic idiopathic scoliosis despite the brace treatment were included. The clinical and radiological examinations were compared before and 2 years after surgery.Six patients with flexible thoracic curves with a mean age 11.2 ± 1.2 years and a mean Cobb angle 45° ± 10° (35-60) were operated. All were skeletally immature. At last follow-up, the Cobb angle was stable. None of the patient underwent fusion.The procedure allowed a stabilization of the deformity during growth spurt. Validated devices and further studies with longer term follow-up are needed to confirm the efficiency of this technique. This small cohort of patients is a source of reflection for further medical devices developments.Level 4 case series comparing to not randomized studies.

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Atopic dermatitis is a common pruritic skin disease in which barrier dysfunction and cutaneous inflammation play a role in pathogenesis. Mechanisms underlying the associated inflammation are not fully understood, and while CD1a-expressing Langerhans cells are known to be enriched within lesions, their role in clinical disease pathogenesis has not been studied. Here we observed that house dust mite (HDM) generates neolipid antigens for presentation by CD1a to T cells in the blood and skin lesions of affected individuals. HDM-responsive CD1a-reactive T cells increased in frequency after birth and showed rapid effector function, consistent with antigen-driven maturation. To define the underlying mechanisms, we analyzed HDM-challenged human skin and observed allergen-derived phospholipase (PLA2) activity in vivo. CD1a-reactive T cell activation was dependent on HDM-derived PLA2 and such cells infiltrated the skin after allergen challenge. Filaggrin insufficiency is associated with atopic dermatitis, and we observed that filaggrin inhibits PLA2 activity and inhibits CD1a-reactive PLA2-generated neolipid-specific T cell activity from skin and blood. The most widely used classification schemes of hypersensitivity, such as Gell and Coombs are predicated on the idea that non-peptide stimulants of T cells act as haptens that modify peptides or proteins. However our results point to a broader model that does not posit haptenation, but instead shows that HDM proteins generate neolipid antigens which directly activate T cells. Specifically, the data identify a pathway of atopic skin inflammation, in which house dust mite-derived phospholipase A2 generates antigenic neolipids for presentation to CD1a-reactive T cells, and define PLA2 inhibition as a function of filaggrin, supporting PLA2 inhibition as a therapeutic approach.

Le LCPC a organise et participe a un concours de prevision du comportement d'un ouvrage en Terre Armee dans le cadre des Journees Nationales de Geotechnique et de Geologie de l'Ingenieur en 2008. On presente deux modelisations numeriques par elements finis effectuees par le LCPC pour repondre a ce concours : la premiere a ete realisee a partir de motifs predefinis et la deuxieme utilise un modele homogeneise. Dans un premier temps, on compare les resultats des calculs effectues avant les mesures, entre eux et avec les donnees experimentales. On a ensuite cherche, pour les deux modelisations, a estimer l'influence des caracteristiques mecaniques du sol et de l'interface sur le comportement de l'ouvrage. On a egalement essaye de recaler a posteriori differents parametres sur la base des mesures, notamment sur la base d'essais d'extraction d'armatures dans l'ouvrage experimental. Une fois parvenu a un calage juge satisfaisant, on a utilise les modeles pour simuler la reponse du mur a un nouveau chargement statique vertical plus eleve que celui applique pour le concours. (A). (Titre en anglais :Study of the behaviour of a Reinforced Earth wall : influence of the soil/reinforcement interface in modelling).

International audience; The aim of this study was to evaluate the osseointegration of titanium implants (Ti-6Al-4V, noted here TA6V) and poly(etheretherketone) PEEK implants induced by a BMP-2-delivering surface coating made of polyelectrolyte multilayer films. The in vitro bioactivity of the polyelectrolyte film-coated implants was assessed using the alkaline phosphatase assay. BMP-2-coated TA6V and PEEK implants with a total dose of 9.3 μg of BMP-2 were inserted into the femoral condyles of New Zealand white rabbits and compared to uncoated implants. Rabbits were sacrificed 4 and 8 weeks after implantation. Histomorphometric analyses on TA6V and PEEK implants and microcomputed tomography on PEEK implants revealed that the bone-to-implant contact and bone area around the implants were significantly lower for the BMP-2-coated implants than for the bare implants. This was confirmed by scanning electron microscopy imaging. This difference was more pronounced at 4 weeks in comparison to the 8-week time point. However, bone growth inside the hexagonal upper hollow cavity of the screws was higher in the case of the BMP-2 coated implants. Overall, this study shows that a high dose of BMP-2 leads to localized and temporary bone impairment, and that the dose of BMP-2 delivered at the surface of an implant needs to be carefully optimized. Statement of Significance The presentation of growth factors from material surfaces currently presents significant challenges in academia, clinics and industry. Applying osteoinductive factors to different types of implants, made of metals or polymers, may improve bone repair in difficult situations. Here, we show the effects of an osteoinductive coating made of polyelectrolyte multilayer films on two widely used materials, titanium TA6V alloys and PEEK implants, which were implanted in the rabbit femoral condyle. We show that a too high dose of BMP-2 delivered from the screw surface has a negative short-term effect on bone regeneration in close vicinity of the screw surface. In contrast, bone formation was increased at early times in the empty spaces around the screw. These results highlight the need for future dose-dependence studies on bone formation in response to osteoinductive coatings.

Context The primary goal of traditional treatment and rehabilitation programs is to safely return athletes to full functional capacity. Nontraditional activities such as rock climbing or rodeo are typically less training structured and coach structured; individualism, self-determination, and autonomy are more prevalent than observed in athletes in National Collegiate Athletic Association (NCAA)-sponsored sports. The limited research available on nontraditional athletes has provided the athletic trainer little insight into the coping skills and adaptations to stressors that these athletes may bring into the clinical setting, especially among the growing number of women participating in these types of activities. A better understanding of the pain-coping traits of nontraditional competitors would enhance insight and triage procedures while heading off potential athlete-related risk factors in the clinical setting. Objective To quantify and compare pain-coping traits among individual-sport women athletes participating in nontraditional versus traditional NCAA-structured competition, with relevance to optimal treatment and rehabilitation. Design Cross-sectional study. Setting Data collected during each participant's respective group meeting before seasonal activity. Participants or Other Participants A total of 298 athletes involved in either nontraditional, non-NCAA individual sports (n = 152; mean age = 20.2 ± 1.3 years; downhill skiing, martial arts, rock climbing, rodeo, skydiving, telemark skiing) or traditional NCAA sports (n = 146; mean age = 20.3 ± 1.4 years; equestrian, golf, swimming/diving, tennis, track). Main Outcome Measure(s) All participants completed the Sports Inventory for Pain, a sport-specific, self-report instrument that measures pain-coping traits relevant to competition, treatment, and rehabilitation. Trait measures were direct coping, cognitive, catastrophizing, avoidance, body awareness, and total coping response. Data were grouped for analyses by type of athlete (nontraditional, traditional). Results We found a significant main effect for type of athlete (Wilks' λ F6,291 = 12.922; P = .0001). Nontraditional sport athletes scored lower on direct coping (P = .0001), cognitive (P = .0001), catastrophizing (P = .0001), and total coping response (P = .0001) than traditional athletes. Conclusions Women participating in nontraditional individual-sport activity revealed less pronounced pain-coping traits than women participating in more coach-structured, traditional NCAA sports. Sport and medical personnel should consider the type of athlete when prescribing training, treatment, and rehabilitation for optimal performance and return to play.

International audience; Adolescent idiopathic scoliosis is a 3D spine deformity that worsens during the whole growth. The treatments available are bracing during the whole growth to avoid progression of the deformity and surgical fusion of the spine at skeletal maturity for the most severe curves. Recent advances in flexible spinal implants have given rise to new expectations in the management of progressive scoliosis with growth modulation without fusion. For the first time, treatment allows us to expect a correction of progressive curves without fusion. This review discusses the recent developments in the field of spinal growth modulation techniques and discusses the pros and cons of the medical devices used in this indication.

L’analyse par des methodes numeriques du comportement des ouvrages renforces par inclusions est difficile et couteuse lorsque l’on veut modeliser explicitement les renforcements. Une approche alternative consiste a remplacer le massif renforce par un materiau equivalent constitue par la superposition de plusieurs milieux continus. Contrairement aux theories d’homogeneisation « classiques », cette methode permet la prise en compte de cinematiques differentes pour chacun des milieux qui constituent le materiau equivalent, et donc de representer le glissement relatif du sol et des inclusions de renforcement. Elle est en outre plus simple et plus rapide a mettre en œuvre.L’intregration de ce modele dans le progiciel CESAR-LCPC a ete entreprise. La version actuelle du code permet le calcul elastoplastique d’ouvrages bidimensionnels et tridimensionnels, dans le cas ou seuls les efforts de traction-compression dans les inclusions sont pris en compte, et ou la cinematique de chaque materiau constituant est supposee identique. On presente ici les resultats obtenus pour l’etude de deux ouvrages renforces (analyse tridimensionnelle du tassement d’une fondation carree reposant sur des pieux, etude de la convergence d’un tunnel boulonne), mettant en evidence la pertinence et l’efficacite de la methode.

Introduction La douleur post operatoire (DPO) et les nausees vomissements post-operatoires (NVPO) sont les principaux facteurs de morbidites lies a l’anesthesie ambulatoire. Des recommandations ad hoc ont ete formalisees (SFAR 2009). Le suivi de la qualite des soins et de la satisfaction des patients en ambulatoire a ete recommande (HAS 2010). Cependant, ces donnees sont encore peu disponibles en France. Materiel et methodes Dans notre institution, une ordonnance standardisee d’antalgiques (pallier 1 et 2 voire 3) est remise et expliquee des la consultation pre anesthesique en fonction de la DPO predite. Un protocole gere la DPO et les NVPO avant le retour au domicile. L’evaluation est realisee par appel telephonique du patient a J1 post operatoire : des questions en lien avec la litterature recente lui sont posees ( Tableau 1 ), par les infirmieres de l’unite. Resultats Sur les 11104 interventions realisees en ambulatoire de janvier a decembre 2013, 5741 questionnaires ont ete completes (les actes d’endoscopie digestives ont ete exclus). Ces interventions chirurgicales concernent 8 groupes de specialite (chirurgie viscerale, gastroenterologie et proctologie (10 %) ; gynecologie (7 %) ; chirurgie maxillofaciale, ORL et stomatologie (17 %) ; ophtalmologie (20 %) ; orthopedie (32 %) ; chirurgie plastique (1 %) ; urologie (5 %) ; chirurgie vasculaire et thoracique (7 %). Discussion L’incidence des NVPO a domicile est extremement faible par rapport a la litterature recente (au-dessus de 20 %) [1] . L’evaluation precise (avec outil de mesure reproductible) de la DPO au domicile est rare. Deux etudes anciennes [2] , [3] rapportent une ENS ≥ 4 dans plus de 30 % des cas. Ces differences sont probablement expliquees par l’evolution des pratiques. En ce qui concerne la satisfaction globale des patients, elle est elevee, tout comme dans la majorite des etudes.

Les discontinuités des géomatériaux (fissures, fractures ou joints dans les massifs rocheux) peuvent être prises en compte dans une modélisation par éléments finis au moyen d'éléments "joints". Il s'agit d'éléments à épaisseur nulle proposés initialement par Goodman et al (1968). Des éléments joints à quatre noeuds ont été introduits dans le code CESAR-LCPC. Ces éléments permettent de prendre en compte un comportement élastique non linéaire ou un comportement élastoplastique avec plasticité parfaite obéissant au critère de Mohr-Coulomb. Des exemples d'application de ce modèle à la stabilité des massifs rocheux et à l'homogénéisation du comportement des roches fissurées sont donnés. L'extension à un comportement endommageable est en cours.

Introduction Certains systemes de navigation se comportent comme de veritables instruments de mesure et leur utilisation peroperatoire permet d’enregistrer des donnees tridimensionnelles lineaires et/ou angulaires. Le but de cette etude etait de comparer les parametres anatomiques enregistres en peroperatoire avec la hanche native et la hanche prothetique dans le but de verifier l’interet de l’utilisation d’une prothese totale de hanche a col modulaire. Materiel et Methode Vingt hanches non dysplasiques (coxarthroses centrees) ont ete operees chez 19 patients âges en moyenne de 65 ans entre janvier 2005 et janvier 2006. Pour chaque acte operatoire, nous avons utilise une prothese totale de hanche a col modulaire et un systeme d’assistance passif. Durant l’acte operatoire, huit parametres ont ete releves : le centre de rotation de la hanche native et de la hanche prothetique (3 dimensions) ; l’axe acetabulaire de la hanche prothetique avec 2 angles ; la position du femur natif et prothetique par rapport au pelvis (2 dimensions) et la rotation femorale (femur prothetique). Les patients ont ete revus avec un recul de 11 a 21 mois. Resultats Apres la mise en place de la râpe definitive dans le femur et quelle que soit la valeur de l’angle cervico-diaphysaire de la hanche native mesure sur les radiographies preoperatoires, l’ordinateur confirme generalement l’orientation du col dans le plan frontal et suggere l’utilisation d’un col modulaire avec une ante- ou une retroversion dans pres de 50 % des cas (9 hanches sur 20). Apres fraisage de l’acetabulaire et impaction de la cupule, l’ordinateur suggere l’utilisation d’un col modulaire avec une anteversion ou une retroversion dans seulement 20 % des cas (4 cas sur 20). Dans les autres cas, le col modulaire suggere est un col varise (12 cas), valgise (2 cas) ou droit (2 cas). L’inegalite de longueur des membres inferieurs n’excede pas 8 mm et le deplacement medio-lateral (offset) est tres proche de celui de la hanche native (+ 5 a – 2 mm dans tous les cas). Aucune etude statistique ne peut etre faite dans cette courte serie. Les resultats cliniques sont excellents et aucune complication n’a ete deploree. Discussion Conclusion La correlation des donnees anatomiques entre le centre de rotation de la hanche native et celui de la hanche prothetique montre clairement l’influence du col modulaire pour l’orientation dans le plan frontal. Ce parametre est etroitement lie au deplacement medio-lateral de la hanche, ainsi qu’a son deplacement cranio-podal pour ce qui est du centre de rotation de la hanche. Ces facteurs sont en effet determinants pour la reduction de l’inegalite de longueur residuelle des membres inferieurs. L’utilisation d’un col modulaire avec anteversion ou retroversion apres fraisage de l’acetabulaire est utile pour prevenir les conflits entre cupule et col prothetique. Tout se passe comme si l’utilisation du col modulaire permettait d’approcher au mieux les valeurs de lateralisation et d’abaissement cranio-podal de la hanche native.

Step-down passive avoidance acquisition and 24 h retention performance were examined in adult rats given daily doses of either 0, 1, or 5 mg/kg cadmium (Cd) (as CdCl2) via the diet. Results indicated that subjects exposed to the 5 mg/kg Cd diet were less likely to step off a safe platform onto an electrified grid floor than controls. The 1 mg/kg subjects did not differ from controls on this acquisition task. None of the groups showed differential performances on a retention test administered 24 h after acquisition training. These results are discussed in terms of recent claims that Cd exposure enhances emotional reactivity in animals.

Conditioned suppression was examined for control (N = 8) and lead-treated (N = 8) adult rats. Treated animals were exposed daily to 10 mg/kg lead administered via the diet as lead acetate. 40 days of oporant lever press training on a multiple schedule using food as reward was given. Lever press training continued for an additional 5 days but during this period subjects experienced superimposed 3 min tone presentations followed by electric shock (1.3 mA, 1.5 s duration) to a grid floor. Tone presentations were observed to be significantly more disruptive of operant steady state responding for treated subjects as compared to controls. This finding supports earlier claims that lead exposure enhances emotionality.