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Embryonic diapause is the reversible arrest of embryo development prior to implantation under a regime of uterine control that is not well understood. Our objective was to explore uterine modifications associated with the emergence of embryonic diapause in the mink, a species in which embryonic diapause characterizes every gestation. We investigated the uterine transcriptome at reactivation using the suppressive subtractive hybridization technique. A library of 123 differentially expressed genes between uteri with blastocysts in diapause and reactivated blastocysts was generated. Among those genes, 41.5% encode for potential secreted products that are implicated in regulation of cell proliferation (14%), homeostasis (14%), protein folding (11%), electron transport chain (8%), and innate immune response (8%), therefore suggesting that these biological processes are implicated in blastocyst reactivation. Two genes, the high-mobility group nucleosome binding domain 1 ( HMGN1), a chromatin remodeling factor, and the secreted protein acidic and cystein-rich ( SPARC), which is implicated in extracellular cell-cell interactions, were submitted to more detailed analysis of expression patterns in the mink uterus at blastocyst reactivation. Expression of both HMGN1 and SPARC was increased significantly in the uterus at embryo reactivation compared with diapause, principally in the endometrial epithelium and subepithelial stroma. These results provide new insight into uterine signaling at the emergence of the blastocyst from diapause and highlight the factors HMGN1 and SPARC as potential inductors of uterine environment modifications underlying uterine signaling during emergence of the embryo from embryonic diapause.

Introduction/Background Pressure ulcer risk assessment provides an indicator of quality of care in French health establishments. The predictive value of clinical assessment tools is lower for people with spinal cord injury (SCI). We hypothesized that skin complications would be less frequent in traumatic SCI patients with tetraplegia (TSCIt) who were initially managed in French regions with a high level of specialized SCI rehabilitation experience. Material and method First, we used the most recent French epidemiological survey of patients with SCI to determine a “Level of Regional Experience in Specialized Physical Medicine and Rehabilitation” (LRE). We then studied the medical and social variables reported in the Tetrafigap survey (which compiled a cohort of TSCIt, to assess their trajectory and life conditions following the return to community life) using univariate analysis according to these LREs (Chi2 test using a significance threshold of P Results Management in high-LRE regions was associated with a lower occurrence of pressure ulcers during early treatment and in the long-term (on average, 8 years post-trauma). Conclusion Using pressure ulcers as a marker, our study demonstrated the protective link of regional experience of the early management of TSCIt. In our opinion, efforts should first prevent a dilution effect through holistic health care for SCI, within the scope of a regional organization that would link referral centers and local health care networks.

Resume But de l’etude Nous presentons une voie d’abord chirurgicale de la base du crâne, utilisant la voie transantro-maxillaire qui est connue et est utilisee depuis longtemps pour les lesions sinusiennes. Methode Etude sur cadavres injectes. Description pas a pas cette voie en condition microchirurgicale en suivant un fil conducteur represente par le nerf infra-orbitaire. Resultats Les reperes anatomiques a connaitre sont precises afin d’eviter les pieges de cette voie d’abord dont les complications specifiques sont de deux types : hemorragiques par lesion de l’artere maxillaire et nerveuses par lesion des nerfs crâniens rencontres tout au long de cette voie. Conclusion Les voies d’abord de la base du crâne sont multiples. Certaines voies transfaciales sont delabrantes. Cette voie preserve l’anatomie fonctionnelle des cavites nasales car respectant leur integrite anatomique.

OBJECTIVE The aim of this study was to compare cardiac output measurements of the non-invasive cardiac output and the pulmonary artery catheter during repeat surgery for hip replacement. METHODS In this prospective observational study, patients undergoing repeat hip surgery who needed a pulmonary artery catheter were included. A standard protocol was followed for induction, endotracheal intubation and maintenance of anaesthesia (sufentanil, etomidate, sevoflurane, cisatracurium). After endotracheal intubation, the non-invasive cardiac output was connected and a pulmonary artery catheter was inserted. Data were collected every 3 min until patients were extubated. RESULTS Ten patients were included and 2455 points of comparison recorded. Cardiac output from the pulmonary artery catheter varied from 1.7 to 8.9 L min(-1) (mean 4.1 L min(-1)) and the non-invasive cardiac output (using averaging mode) from 1.7 to 8.0 L min(-1) (mean 3.7 L min(-1)). There was a significant correlation between them (P < 0.01; bias 0.3 L min(-1); limits of agreement +1.9 and -2.5 L min(-1)), although these differed between patients. CONCLUSION The perioperative bias was small and the non-invasive cardiac output slightly underestimated cardiac output intraoperatively compared to the pulmonary artery catheter. The bias was smaller when mean cardiac output was below 3 L min(-1). Core temperature between 34.4 degrees C and 37.6 degrees C had no influence on the differences.

Introduction A previous study demonstrated that the reproducibility of the Crowe (Cr), the Hartofilakidis (Ha) and the modified Cochin (Co) classifications were comparable. However, there were differences with a trend that suggested the influence of experience. Therefore, we performed a prospective study to investigate whether experience influenced the reproducibility of the commonly used developmental dysplasia of the hip (DDH) classifications. Hypothesis The hypothesis was that the intra- and inter-observer reproducibility scores would be higher in the senior group than the junior group, and particularly for the modified Co classification. Methods Four seniors and four residents classified 104 A/P pelvic radiographs (200 hips) two times using the Cr, Ha and Co classification systems. Results For intra-observer reproducibility, the average weighted concordance coefficients [95% confidence intervals] were for the senior and the junior groups: 92.2 [88.6–95.7] and 92.6 [87.9–97.2] for Cr, 92.1 [88.7–94.6] and 92.0 [87.7–96.3] for Ha, 94.2 [91.8–96.6] and 94.1 [91.5–96.6] for Co. The average weighted Kappa (95% confidence intervals) were 0.8 [0.71–0.88] and 0.79 [0.68–0.89] for Cr, 0.77 [0.74–0.81] and 0.75 [0.62–0.88] for Ha, 0.82 [0.76–0.89] and 0.80 [0.74–0.87] for Co. The junior inter-observer reproducibility multi-rater Kappa (list A:list B) were 0.57:0.50 (Cr), 0.47:0.53 (Ha), 0.42:0.42 (Co). Senior multi-rater Kappa were 0.53:0.49 (Cr), 0.40:0.34 (Ha), 0.40:0.43 (Co). Conclusions Contrary to our hypothesis, the experience of the observer did not affect the intra- and inter-observer reproducibility of the three classification systems.

Recently discovered scattered light from molecular cloud cores in the wavelength range 3-5 {\mu}m (called "coreshine") seems to indicate the presence of grains with sizes above 0.5 {\mu}m. We aim to analyze 3.6 and 4.5 {\mu}m coreshine from molecular cloud cores to probe the largest grains in the size distribution. We analyzed dedicated deep Cycle 9 Spitzer IRAC observations in the 3.6 and 4.5 {\mu}m bands for a sample of 10 low-mass cores. We used a new modeling approach based on a combination of ratios of the two background- and foreground-subtracted surface brightnesses and observed limits of the optical depth. The dust grains were modeled as ice-coated silicate and carbonaceous spheres. We discuss the impact of local radiation fields with a spectral slope differing from what is seen in the DIRBE allsky maps. For the cores L260, ecc806, L1262, L1517A, L1512, and L1544, the model reproduces the data with maximum grain sizes around 0.9, 0.5, 0.65, 1.5, 0.6, and > 1.5 {\mu}m, respectively. The maximum coreshine intensities of L1506C, L1439, and L1498 in the individual bands require smaller maximum grain sizes than derived from the observed distribution of band ratios. Additional isotropic local radiation fields with a spectral shape differing from the DIRBE map shape do not remove this discrepancy. In the case of Rho Oph 9, we were unable to reliably disentangle the coreshine emission from background variations and the strong local PAH emission. Considering surface brightness ratios in the 3.6 and 4.5 {\mu}m bands across a molecular cloud core is an effective method of disentangling the complex interplay of structure and opacities when used in combination with observed limits of the optical depth., Comment: 23 pages, 18 figures, accepted for publication in A&A

Introduction The management of pressure sores in neuro-injured patients at the Nantes University Hospital was organized for 30 years in a medical-surgical care chain. The last ten years of this activity are traced in this retrospective study. Patients and methods All records of patients who had a surgical flap to cover pressure sore between 1 January 2004 and 31 December 2014 were analysed to synthesize results. Results One hundred and thirteen men and 49 women (n = 162) were operated of 250 flaps. This was mainly spinal cord injured patients (78%). Patients were divided into two groups: pressure ulcer(s) single or multiple (several lesions operated at the same time or later). There were 67% of ischial lesions, 20% of sacral lesions and 12% trochanteric lesions. The most used flap was that of gluteus maximus (82%) for the ischial and sacral lesions, then comes the tensor fascia lata (12%) for trochanteric lesions. Feature of our series (unlike others [1] ), the hamstring's flap is only used as a last resort (6%) in multirecidivist patients. The complication rate delaying delivery to the chair in theoretical time of six weeks is 35%, to be analysed according to age, general health, the size and number of initial lesions. However, the rate of recurrence after healing of the flap is only 10%. Discussion A medical and surgical management, long and sometimes complex [2] , but our long-term results are satisfactory regarding to the low recurrence rate.

Brominated flame retardants (BFRs) are incorporated into various consumer products to prevent flame propagation. These compounds leach into the domestic environment, resulting in chronic exposure and contamination. Pregnancy failure is associated with high levels of BFRs in human follicular fluid, raising serious questions regarding their impact on female reproductive health. The goal of this study is to elucidate the effects of an environmentally relevant BFR mixture on female rat ovarian functions (i.e., folliculogenesis and steroidogenesis). A BFR dietary mixture formulated to mimic the relative BFR congener levels in North American house dust was administered to adult female Sprague-Dawley rats from 2 to 3 wk before mating until Gestational Day 20; these diets were designed to deliver nominal doses of 0, 0.06, 20, or 60 mg/kg/day of the BFR mixture. Exposure to BFRs triggered an approximately 50% increase in the numbers of preantral and antral follicles and an enlargement of the antral follicles in the ovaries of the dams. A significant reduction in the expression of catalase, an antioxidant enzyme, and downregulation of the expression of insulin-like factor 3 (Insl3) and 17alpha-hydroxylase (Cyp17a1) were observed in the ovary. In addition, BFR exposure affected steroidogenesis; we observed a significant decrease in circulating 17-hydroxypregnenolone and an increase in testosterone concentrations in BFR-exposed dams. Thus, BFRs target ovarian function in the rat, adversely affecting both folliculogenesis and steroidogenesis.

We used the IRAM 30m telescope to observe the frequency range [86-116]GHz towards the central regions of the starburst galaxies M83, M82, and NGC253, the AGNs M51, NGC1068, and NGC7469, and the ULIRGs Arp220 and Mrk231. Assuming LTE conditions, we calculated the column densities of 27 molecules and 10 isotopologues. Among others, we report the first tentative detections of CH3CHO, HNCO, and NS in M82 and, for the first time in the extragalactic medium, HC5N in NGC253. Halpha recombination lines were only found in M82 and NGC253. Vibrationally excited lines of HC3N were only detected in Arp220. CH3CCH emission is only seen in the starburst-dominated galaxies. By comparison of the fractional abundances among the galaxies, we looked for the molecules that are best suited to characterise the chemistry of starbursts, AGNs and ULIRGs, as well as the differences among galaxies within the same group., Comment: 24 pages, 6 figures, 12 tables. Accepted for publication in Astronomy and Astrophysics

Resume Objectif Le but de cette etude est d’evaluer l’exposition du personnel soignant d’un service d’IRM pediatrique au sevoflurane, dans des locaux qui ne sont pas destines a des actes d’anesthesie. L’environnement particulier lie a cette activite : manque de place, gestes techniques lourds, champ magnetique intense, rend les techniques d’evaluation classiques delicates voire impossibles a mettre en œuvre. Le dispositif de prelevement passif Gabie ® , particulierement simple d’utilisation, a ete utilise et valide a l’aide de techniques de prelevement traditionnelles. Methode La concentration atmospherique en sevoflurane est mesuree a l’aide de trois techniques differentes : prelevement actif sur tube de charbon (methode de reference) en ambiance, prelevement passif individuel sur badge Gabie ® et suivi en ligne de la concentration ambiante par analyseur infrarouge a effet photoacoustique. Les resultats de chacune des techniques sont rapportes a la meme periode de reference afin de pouvoir etre compares. Resultats Les resultats obtenus montrent un fort niveau d’exposition du personnel soignant. La comparaison des resultats obtenus par prelevements actif et passif permet de montrer qu’il n’existe pas de difference significative entre ces deux techniques d’evaluation. D’autre part, le suivi continu en temps reel de la concentration a l’aide de l’analyseur infrarouge permet d’identifier l’origine des emissions et donc d’envisager des actions permettant de les reduire. Les mesures ont mis en evidence de fortes emissions au niveau du masque, un dispositif de captage des gaz expires a donc ete mis en place. Cette mesure, accompagnee d’une modification du systeme de ventilation du local, a permis de reduire le niveau d’exposition d’un facteur quatre et d’atteindre des valeurs proches des recommandations. Conclusion L’exposition aux gaz anesthesiques est importante lorsque les actes d’anesthesie sont pratiques dans des locaux qui ne sont pas destines a cet effet. La mise en place de moyens simples de captage et d’aeration reduit cependant cette exposition de maniere significative. L’utilisation du badge Gabie ® pour l’evaluation de l’exposition aux gaz anesthesiques fluores constitue un outil simple et performant. Il est notamment utilisable dans des environnements ne permettant pas l’utilisation d’autres techniques de mesures (milieu sterile, champ magnetique...).

Single crystals of hexagonal HfFe 6 Ge 6 -type HoMn 6 Sn 6− x Ga x compounds (0.14⩽ x ⩽1.89) have been obtained by a flux method and studied by magnetisation measurements. All the compounds order ferrimagnetically (308⩽ T c ⩽386 K) with moments lying in the (0 0 1) plane and undergo a moment reorientation transition at lower temperatures (156⩽ T SR ⩽195 K). At 5 K, the moments are aligned along an intermediate direction (44⩽ φ c ⩽50°). These results are discussed and compared with the neutron diffraction results related to the isotypic TmMn 6 Sn 6− x Ga x and TbMn 6 Sn 6− x Ga x series where a change of the easy direction is observed with increasing gallium contents.

Objectifs Les escarres associees a des lesions de l’uretre chez le patient blesse medullaire representent un veritable challenge therapeutique pour le chirurgien urologue, plasticien, orthopediste et le medecin reeducateur. Il existe tres peu de donnees sur la prise en charge de ces complications. Le but de ce travail etait de rapporter les resultats de la prise en charge urologique des fistules uretro-perineales avec escarre chez les patients blesses medullaires. Methodes Une etude nationale, descriptive, retrospective et multicentrique dans 9 services de chirurgie urologique ou de medecine physique readaptation (MPR). Nous avons inclus un total de 64 patients blesses medullaires ayant une escarre sacree ou perineale associee a une fistule uretro-perineale entre 2002 et 2016. Les donnees sociodemographiques, le suivi MPR et neuro-urologique et les donnees pre- et postoperatoires des derivations urinaires et des chirurgies d’escarres ont ete recueillis puis analyses. Resultats L’âge median etait de 45,9 ans (IQR = 38,7–53,0), le suivi median de 16,5 mois (IQR = 8,7–51,3). Le sex-ratio H/F etait = 5,7 avec l’absence de suivi neuro-urologique dans 55,7 %. Les auto-sondages intermittents, une sonde a demeure et une cystostomie a demeure etaient retrouves chez 31,3 % (n = 20), 25,0 % (n = 16) et 20,3 % (n = 13) des patients et 51,6 % (n = 33) etaient incontinents. Les complications majeures etaient : l’osteite (46,9 %, n = 30) et la gangrene de Fournier (20,3 %, n = 13). Une chirurgie pour derivation urinaire etait realisee dans 95,3 % (n = 61) des cas. Elle etait non continente (DUNC) dans 79,7 % (n = 51) avec un Bricker le plus souvent (90,2 %). Le taux de complications post-operatoires precoces majeures (Clavien III–V) etait de 21,3 % (n = 13). Une re-intervention a distance etait necessaire dans 29,5 % (n = 18), la plus frequente etait le drainage des voies excretrices (16,3 %) et une DUNC sans cystectomie etait systematiquement associee a un pyocyste (n = 6/6). Enfin 54,7 % (n = 35) des patients beneficiaient d’une chirurgie d’escarre avec une cicatrisation dans 80 % (n = 28). Conclusion En cas d’escarres associees a des lesions de l’uretre chez le blesse medullaire, une prise en charge adaptee avec derivation urinaire et cystectomie si possible, puis chirurgie de recouvrement cutane associee eventuellement a un geste orthopedique permet la cicatrisation dans la majorite des cas. De plus, une prevention par un suivi neuro-urologique et un mode mictionnel adapte sont preponderants pour prevenir ces complications du decubitus.

The aim of this paper is to review the literature on direct geniculo-extrastriate pathways with special attention to 3D extrastriate visual areas. A literature review was realized using PubMed and Google Scholar. “Lateral geniculate nucleus”, “geniculo-extrastriate pathways” and “white matter fiber tracts” were among the keywords used. Existence of geniculo-extrastriate connections was first hypothesized by the clinical observations of Riddoch’s syndrome in patients with striate cortex (primary visual area, V1) lesions. Robust histological proof of geniculo-extrastriate pathways exists in monkeys. In humans, these pathways were tested through functional magnetic resonance imaging (fMRI), electro- and magneto-physiological paradigms. Conversely, only indirect proof of the connection between lateral geniculate nucleus and V5 exists. To our knowledge there were not any anatomical studies of geniculo-extrastriate connections in humans. Few human studies take interest in geniculo-extrastriate pathways. Only indirect proof of geniculo-extrastriate pathways exists in humans.

Less than one thousand years dating of the youngest volcanic episode of the Teide volcano (Canary Islands, Spain) has been performed using the K/Ar Cassignol technique. Analyses of about 20 g of pure alkali-feldspar yielded a weighted mean age of 800±300 years. Stratigraphic, historic and archeomagnetic dating validate this age and rule out the hypothesis of the presence of significant excess argon contamination for this flow. Our result shows that the last effusive activity of the Teide volcano took place shortly before European settlement in Tenerife Island. This study confirms that the Cassignol technique can be applied with success for historic dating and demonstrates that it can now even be extended to the last millennium.

Introduction Childhood acquired brain injury (ABI) is responsible for severe cognitive and behavioural disorders, sometimes leading to violent and/or offending behaviours. The aim of this study was to review the cases of patients treated in a rehabilitation unit dedicated to children with ABI, who subsequently demonstrated behaviors leading to an intervention of the police and/or the justice, and identify any common characteristics. Methods Retrospective inventory of patients with ABI treated in a single rehabilitation department, who subsequently had contact with the police/justice following offenses. We collected demographic factors, type and severity of ABI, initial neurological examination, first and last neuropsychological assessment, type of schooling pre- and post-injury, and data from their offenses. Results Searches retrieved 40 patients (36 boys): 34 traumatic brain injury (TBI; 27 severe), 4 brain tumours, 1 frontal hemorrhagic stroke and 1 anoxia; mean age at injury was 9.7 years [SD = 4; (2.1–15.7)]. In 88% of cases, none of the parents had graduated from high school. Half of the children had previous school difficulties and 30% had repeated a grade. Overall, children sustained severe injuries, with impaired neurological function, major cognitive deficits [mean initial full-scale IQ 73.1 (SD = 12.8)] without significant improvement [77.4 (SD = 13.4) at the last assessment]. The processing speed index was particularly low [73.2 (±15.4)] and did not improve over time. 76% had behavioural disorders already evident during hospitalization. Upon discharge, 62% required adapted and/or specialized schooling. After an average follow-up of 8 and a half years, only 6 patients still followed an ordinary curriculum and 8 were not attending school anymore. Four girls were victims, and among 36 boys, all were perpetrators, but 3 had been victims previously. The offenses were mainly cases of violence (56%), but also entailed thefts, traffic offences, sexual assaults, drug use and vandalism. Discussion Children with ABI who suffer or commit offenses are mainly boys, from very low socioeconomic background, with pre-injury academic and social difficulties, who sustained severe TBI. They suffer very severe and disabling cognitive deficits and behavioral disorders. Multidisciplinary care and follow-up of those children more at risk is essential in the long-term.

The authors report the results of a series of 59 microdissections of the region of the foramen magnum. These dissections were made under the strict conditions of a surgical approach using an operating microscope. The major anatomic structures of the medullo-spinal junction are arranged mainly at its lateral aspect. The customary surgical approaches to the posterior cranial fossa give ready access to the cerebello- and latero-medullary cisterns. The description of the neurovascular structures contained therein assumes a particular importance because of the relative frequency of lesions developing at this level. This study deals particularly with the vertebral a. (VA), the inferior posterior cerebellar a. (IPCA), the cranial nn. IX (glossopharyngeal n.), X (vagus n.), XIc and XIs (cranial and spinal accessory n.) and XII (hypoglossal n.). The anatomy of this posterior and lateral region is characterised by the contrast between the relatively uniform course of the VA and the variable course of the IPCA, a true guideline whose very irregular arrangement accounts for the diversity of its relations with the last four cranial nn.

After national legislation in 1990, Bologna decided to equip itself with an area-wide government. Seen against the background of Italian administration and politics which has, for many decades, been characterised by the reluctance, even opposition, of local governments to the country's many territorial planning reforms, the very existence of this institution represents an innovation which merits explanation. The formation of the institution is examined through its process of legitimisation. This involves highlighting the collective representations and social codes activated, even created, by certain political figures with a view to legitimising this public action. The authors insist on the fact that the process of legitimisation can only be understood within the context of the political and social relationships which structure an urban area such as Bologna and which have evolved considerably in recent years, particularly as a result of social segmentation and differentiation, hitherto limited in a region where the Italian Communist Party has been the preponderant influence since 1946.

Mammalian embryonic diapause is a phenomenon defined by the temporary arrest in blastocyst growth and metabolic activity within the uterus which synchronously becomes quiescent to blastocyst activation and implantation. This reproductive strategy temporally uncouples conception from parturition until environmental or maternal conditions are favourable for the survival of the mother and newborn. The underlying molecular mechanism by which the uterus and embryo temporarily achieve quiescence, maintain blastocyst survival and then resume blastocyst activation with subsequent implantation remains unknown. Here, we show that uterine expression of Msx1 or Msx2 , members of an ancient, highly conserved homeobox gene family, persists in three unrelated mammalian species during diapause, followed by rapid downregulation with blastocyst activation and implantation. Mice with uterine inactivation of Msx1 and Msx2 fail to achieve diapause and reactivation. Remarkably, the North American mink and Australian tammar wallaby share similar expression patterns of MSX1 or MSX2 as in mice — it persists during diapause and is rapidly downregulated upon blastocyst activation and implantation. Evidence from mouse studies suggests that the effects of Msx genes in diapause are mediated through Wnt5a, a known transcriptional target of uterine Msx . These studies provide strong evidence that the Msx gene family constitutes a common conserved molecular mediator in the uterus during embryonic diapause to improve female reproductive fitness.

Resume Introduction La neuromyotonie est une complication tardive et tres rare de la radiotherapie consistant en episodes de contractions musculaires toniques involontaires avec retard a la relaxation. Observation Nous rapportons l’observation d’un patient de 68 ans qui presenta une neuromyotonie du masseter 6 ans apres irradiation pour cancer de l’amygdale. Conclusion Cette observation souligne l’importance de ne pas meconnaitre ce diagnostic qui conduit a un traitement par carbamazepine tres souvent efficace.

Objective Traumatic lower limb amputation is rare in pediatric population, and surgeons always try limb salvage. But rarely, later amputation occurred when the traumatic limb is painful. It is a difficult and irreversible decision needed a multidisciplinary approach. We report how we managed a programmed trans-tibial amputation on 13-years-old boy, 20 months after a foot trauma. Observations Our patient is an adolescent victim of a left foot crash. The first checkup showed a degloving injury, dislocation of the interphalangeal joints and of all toes. Foot salvage was decided, but necrotic evolution required minor distal amputation and frequent dressings and skin grafts. Despite physiotherapy, orthosis (anti-equinus orthosis, orthopedics sole, orthopedics shoes) an equinus appeared. Moreover, he presented intense neuropathic foot pain, which required drugs, TENS and psychologic counseling. The foot presented secondary ulcerations requiring surgical cushioning. Seventeen months after trauma, the boy presented a painful, non-functional and ulcerative foot with important impact on quality of life (QOL). After multidisciplinary consultations, the boy and his parents decided a trans-tibial left amputation. A specific multidisciplinary preparation lasted 3 months: he met amputees, psychologist with and without his mother, certified prosthetist orthoptist, specialists of physical and functional rehabilitation, pediatric surgeon. Twenty months after trauma, trans-tibial amputation was carried out. One month after amputation: he walked with crutches, 3 months after: walked and could walks up and down the stairs. One year after: he had no pain, took no drug, got a satisfied gait on quantitative 3D gait analysis (3D GA), practices several sports, says that he has a “normal” teenager life, has an objective “normal” participation. Discussion/Conclusion There is no case on literature reported on late amputation on child after a trauma. So, there is no recommendations to prepare amputation or to know what can we expected from it. We report a specific preparation and objective results (QGA, participation, QOL). This experience can be useful for team facing this particular and difficult situation.

Embryonic diapause is an evolutionary strategy to ensure that offspring are born when maternal and environmental conditions are optimal for survival. In many species of carnivores, obligate embryonic diapause occurs in every gestation. Reciprocal embryo transplant studies indicate that embryo arrest during diapause is conferred by uterine conditions and is due to a lack of specific factors necessary for continued development. In previous studies, global gene expression analysis revealed reduced uterine expression during diapause of a cluster of genes in the mink that regulate the abundance of polyamines, including ornithine decarboxylase 1 (ODC1). In addition, in vivo inhibition of the conversion of ornithine to the polyamine, putrescine, induced a reversible arrest in mink embryonic development and an arrest in trophoblast cell proliferation in vitro. Previous studies have implicated prolactin as the principal endocrine signal to terminate diapause. In this study, uterine expression of both the progesterone and estrogen receptors remained low at reactivation whilst the prolactin receptor was expressed at all times. Treatment of mink uterine epithelial cells with varying doses of prolactin indicated that this hormone induces ODC1 expression in the uterus via pSTAT1 and mTOR, thereby regulating uterine polyamine levels. In addition, we performed global gene expression analysis on mink embryos to further explore dynamic changes during diapause and found 94 genes upregulated at reactivation from diapause. Three polyamine-related genes, including ODC1, were also upregulated at reactivation from diapause. To establish whether polyamines mitigate escape from embryonic diapause, we collected mink embryos in diapause and incubated them in vitro with putrescine. Increase in embryo volume, the first indication of emergence from diapause, was observed within the first 5 days of culture in all viable embryos treated with putrescine, and the duration of embryo survival was increased threefold. Concomitant increases were also observed in both the total number of cells and the proportion of dividing cells in putrescine-treated embryos whilst control embryos remained in the diapause state. In further studies, inhibition of polyamine synthesis abrogated proliferation in cells derived from the inner cell mass of the mink embryo, while putrescine induced dose-dependent increases in cell division. We conclude that supplementation of embryos in diapause with putrescine results in their escape from developmental dormancy. These results provide strong evidence that obligate diapause in vivo is caused by the paucity of polyamines necessary for activation of the embryo after prolactin-induced termination of diapause.

On sait actuellement que le pronostic d’une fracture de membre depend au moins autant de l’etat des parties molles perifracturaires que des lesions osseuses proprement dites. La situation superficielle du segment jambier explique la frequence des traumatismes a ce niveau et la vulnerabilite des structures anatomiques lesees. La connaissance de l’anatomie du segment jambier donne un outil indispensable au clinicien dans sa demarche diagnostique pour preciser au mieux le bilan lesionnel; secondairement, elle l’aide a raisonner logiquement dans ses choix therapeutiques face aux lesions pluritissulaires.

Based on coordinates derived from three series of anatomic sections, the authors propose a view for tomographic investigation, applicable in MRI and ultrasound, which reconstructs the ideal image of the suprarenal gland in its quadrilateral as described by Testut. This "anatomic" view is 45 degrees vertical and oblique, intermediate between the sagittal and frontal views, which it can advantageously replace. A new aspect of suprarenal tomography, recalling the image of a triskele, is described in the context of this view.

International audience; AIM OF THE STUDY: To prove in vivo and on cadaveric lungs, the constancy of the collateral type of distribution for the right and left pulmonary arteries as described in classical books and modern studies; to estimate the frequency of the main branches observed and define an arterial tree of reference set up with the most common branches for reading the CT pulmonary angiographies. PATIENTS AND METHODS: Sixty three-dimensional reconstructions of pulmonary arterial trees (right: 30; left: 30) using the Volume Rendering Technique (VRT) performed from CT angiographic studies of 30 patients without bronchial, arterial or pulmonary pathology. Dissection of 16 pulmonary arteries from eight fresh cadavers injected with latex. Finally, 76 pulmonary arteries (right: 38; left: 38) were examined. RESULTS: The most common division of the pulmonary artery is a collateral distribution but in seven cases from 38 (18.4%) at right and one case from 38 (2.6%) at left the artery ended in two or three terminal lobar trunks which provided the segmental arteries. The mediastinal artery for the upper right lobe was always found, with a complementary scissural artery in 89.5% of cases; a middle lobar trunk was observed in 22 of the 38 right lungs (57.9%). On the left tree, four different but usually not coexisting mediastinal arteries were identified for the upper lobe, three for the culmen and one for the lingula; six various scissural arteries were noted, three for the culmen and three for the lingula; the segment 6 received one or two segmental arteries, exceptionally three. An arterial tree of reference could be defined for both sides. CONCLUSION: The division in terminal lobar trunks of the pulmonary arteries is a variation demonstrated for the first time. The data obtained from 3D reconstruction imaging in vivo are in conformity with the results of studies performed on injected cadaveric lungs for this point and to define the arterial tree of reference.

Many controversies mark the long road of the history of anatomy. The hand is not exempt of them. Even Galen's clear thinking, founded on the strict determinism between the structure of an organ and its function, and based on animal dissection, was criticized. In view of the structural complexity of the hand, we will limit our study to one of the most symptomatic conceptual disagreements: whether the human thumb has two or three phalanges, according to whether we include the first metacarpus, or if the thumb's first phalanx is considered as the initial element. According to the latter theory, there is a missing element in the first digital row, and this missing element is the metacarpus. This theory is ancient and its evolution throughout history is discussed in our study. Finally, we explain the origin and bases of the reasoning that led us to suggest the word 'metaphalanx' to designate the first metacarpus.

Delayed implantation, a reversible arrest in embryo development while the embryo is at the blastocyst stage, provides an interesting window for observation of the preparation for implantation on both the embryonic and maternal sides. The American mink (Mustela vison) is a species in which delayed implantation is a normal aspect of embryo development as it consistently occurs at each breeding season. We used a transcriptome-wide approach to screen global gene expression and to identify new key genes expressed in the uterus and in the endometrium at the resumption of the embryo development, after delayed implantation. By using the suppressive subtractive hybridization (SSH) technique, two libraries of differentially expressed cDNAs, one at the uterine level and a second one at the blastocyst level, were successfully generated. Candidate genes from those two libraries were selected and their differentially expressed pattern of expression between reactivation and delayed implantation was investigated by real-time PCR and immunolocalization.

Delayed implantation, a reversible arrest in embryo development while the embryo is at the blastocyst stage, provides an interesting window for observation of the preparation for implantation on both the embryonic and maternal sides. The American mink (Mustela vison) is a species in which delayed implantation is a normal aspect of embryo development as it consistently occurs at each breeding season. We used a transcriptome-wide approach to screen global gene expression and to identify new key genes expressed in the uterus and in the endometrium at the resumption of the embryo development, after delayed implantation. By using the suppressive subtractive hybridization (SSH) technique, two libraries of differentially expressed cDNAs, one at the uterine level and a second one at the blastocyst level, were successfully generated. Candidate genes from those two libraries were selected and their differentially expressed pattern of expression between reactivation and delayed implantation was investigated by real-time PCR and immunolocalization.

A surgical and anatomic approach to the skull base using the transmaxillary route is presented. This route is well-known and used for a long time for sinus conditions.This study was performed on injected cadavers. This study describes step by step this approach in microsurgical conditions following a vital lead: the infraorbital nerve.Anatomical landmarks are located in order to avoid complications. These complications are on one hand, hemorrhages by vascular lesions and on the other, definitive nerve palsy.Several skull base approaches exist, transfacial routes produce cosmetic damages. This route preserves the functional anatomy of the nose because it preserves the integrity of the lateral wall of the nasal cavity.

Introduction Botulinum toxin is a second-line treatment for neurogenic detrusor overactivity [1] . The primary objective of this study was to compare the duration of efficacy of botulinum toxin intradetrusor injections (BTI) at a dose of 200 IU (only dosage approved by marketing authorisation (MA) in 2011) versus a dose of 300 IU (dose previously used). Methods Retrospective review of a prospective cohort of all patients receiving BTI between 24 August 2011 (date of MA) and 1st March 2014 in Nantes, divided into 2 groups. Group 1 had already received BTI at a dose of 300 IU before the MA and group 2 initiated treatment at a dose of 200 IU. Results One hundred and thirty-four patients were followed for a mean of 4.7 years. In group 1 ( n = 83), the duration of efficacy was decreased in 49.7% of patients ( n = 41) at the 200 IU dose and the dose was subsequently increased to 300 IU in these patients. In group 2 ( n = 51), 37.3% of patients ( n = 19) failed to respond to a dose of 200 IU and the dose was increased to 300 IU. The mean duration of efficacy of BTI was significantly lower at 200 IU (7.7 months) compared to 300 IU (10.0 months) ( P = 0.001598). In group 1, a shorter previous duration of efficacy at 300 IU was a prognostic factor for failure of the 200 IU dose ( P = 0.0004421). Conclusion In this study, the duration of efficacy of BTI was longer at a dose of 300 IU than at a dose of 200 IU. In other studies this result was not identified [2] , but is worthing discussing because of the benefit to the patient.

Biomonitoring of solvents using the unchanged substance in urine as exposure indicator is still relatively scarce due to some discrepancies between the results reported in the literature. Based on the assessment of toluene exposure, the aim of this work was to evaluate the effects of some steps likely to bias the results and to measure urinary toluene both in volunteers experimentally exposed and in workers of rotogravure factories.Static headspace was used for toluene analysis. o-Cresol was also measured for comparison. Urine collection, storage and conservation conditions were studied to evaluate possible loss or contamination of toluene in controlled situations applied to six volunteers in an exposure chamber according to four scenarios with exposure at stable levels from 10 to 50 ppm. Kinetics of elimination of toluene were determined over 24 h. A field study was then carried out in a total of 29 workers from two rotogravure printing facilities.Potential contamination during urine collection in the field is confirmed to be a real problem but technical precautions for sampling, storage and analysis can be easily followed to control the situation. In the volunteers at rest, urinary toluene showed a rapid increase after 2 h with a steady level after about 3 h. At 47.1 ppm the mean cumulated excretion was about 0.005% of the amount of the toluene ventilated. Correlation between the toluene levels in air and in end of exposure urinary sample was excellent (r = 0.965). In the field study, the median personal exposure to toluene was 32 ppm (range 3.6-148). According to the correlations between environmental and biological monitoring data, the post-shift urinary toluene (r = 0.921) and o-cresol (r = 0.873) concentrations were, respectively, 75.6 microg/l and 0.76 mg/g creatinine for 50 ppm toluene personal exposure. The corresponding urinary toluene concentration before the next shift was 11 microg/l (r = 0.883).Urinary toluene was shown once more time a very interesting surrogate to o-cresol and could be recommended as a biomarker of choice for solvent exposure.

Vascular endothelial growth factor (VEGF) is an essential angiogenic signaling element that acts through its two tyrosine kinase receptors, inducing both proliferation of endothelial cells and vascular permeability. Given the importance of vasculogenesis and angiogenesis to early pregnancy, it is of interest to understand the mechanisms regulating vascular development at this stage. We previously demonstrated that VEGF and receptors are up-regulated during embryo implantation in an unique animal model, the mink, a species displaying obligate embryonic diapause. Herein we examined the role of prostaglandin E2 (PGE(2)) as a regulator of VEGF during early pregnancy and established the mechanisms of this regulation. We demonstrate that activated embryos secrete PGE(2) and that expression of PGE synthase protein in the uterus is dependent upon direct contact with invading trophoblast cells during implantation. Using mink uterine stromal cells transfected with mink VEGF promoter driving the luciferase reporter gene, we show that PGE(2) induces promoter transactivation and that this response can be eliminated by blockade of protein kinase A. Treatment with antagonists to PGE(2) receptors EP2 and EP4 eliminated the PGE(2)-induced response in transfected cells. Deletional studies of the promoter revealed that a region of 99 bp upstream of the transcription start site is required for PGE(2)-induced transactivation. Mutation of an AP2/Sp1 cluster, found within the 99 bp, completely eliminated the PGE(2) response. Furthermore, chromatin immunoprecipitation assays confirmed binding of the AP2 and Sp1 transcription factors to the endogenous mink VEGF promoter in uterine cells. PGE(2) stimulated acetylation of histone H3 associated with the promoter region containing the AP2/Sp1 cluster. Taken together, these results demonstrate that PGE(2) plays an important role in regulating uterine and thus placental vascular development, acting through its receptors EP2 and EP4, provoking protein kinase A activation of AP2 and Sp1 as well as acetylation of histone H3 to transactivate the VEGF promoter.

The FOG remains a fascinating subject. It is not really complex physics, but reciprocity brings a purity not often encountered. If you add the serendipity behind, you confirm that it is really special.

The authors report a serial of 17 patients with complex trauma of the forearm treated in emergency by means of compound tissue reconstruction. Every patient present a cutaneous defect associated with multiple lesions or defects of the subjacent tissues. The management consisted of a large debridement with excision of all contuse tissues, a stable osteosynthesis witch permit an early mobilization of the hand and fingers, a revascularization of the hand by a by-pass procedure or a vascular bridge free flap, reconstruction of the muscles, tendons, and the nerves at the same time as possible, a coverage of the tissues by free flaps or forearm pedicle flaps and a physiotherapy by a specialized team undertaken immediately after surgery. The functional results have been evaluated satisfying in the whole serial. The authors conclude that the compound tissue reconstruction of the forearm in emergency with an early physiotherapy permits an optimal functional recovery within short period. It authorizes a rapid socioprofessional return of these patients with complex trauma of the forearm.

To describe knowledge and practices adopted by high school students to prevent occupational injuries.The study was carried out in a public school located in São Paulo, in 2003. Fifty-three evening students aged 14 to 21 years old participated the study, they were divided into two groups with and without job experience (32 and 21 students, respectively). The students answered two questions: "Why do occupational injuries occur?" and "How do you avoid occupational injuries?" Analyses were performed using the software "Quali-quanti" to structure collective discourses. ANALYSIS OF DISCOURSES: Adolescents with work experience reported that occupational injuries occur due to carelessness of the employee, bad luck of the employee, employer's negligence, lack of training, and unsafe workplace. Adolescents without work experience reported that the main causes of work injuries were carelessness of the employee and employer's negligence. Regarding the ways to protect themselves against occupational injuries, both groups reported that: they pay attention (would pay attention) and wear safety equipment (would wear) safety equipment.Adolescents from both groups showed limited knowledge about occupational injuries and prevention methods. Students "blamed the victim" to explain the injuries and considered "paying attention to work" as the best way to protect themselves. These facts showed that the culture of blaming the victim is present since adolescence and probably it is an outcome of a learning process of the society.

We report our experience with vascularized fibular transplant using the technique described by Urbaniak for the treatment of avascular necrosis of the femoral head.Sixteen patients, mean age 39 years 4 months at surgery, were evaluated at mean 3 years 6 months follow-up (minimum 15 months). Mean pain score (analog visual scale) was 6.25/10. Mean Postel-Merle-d'Aubigné (PMA) function score was 12. The Ficat classification was grade 2A (n=9) or grade 2B (n=7).There were no cases of infection or migration of the fibula. The only complication at the donor site was one case of paresia of the long extensor of the hallux which resolved spontaneously. There were five failures which required a hip prosthesis (31%). Three failures occurred early during the first 18 months. Two were late. These patients had grade 2B (n=4) or grade 2A (n=1) necrosis. At last follow-up, eleven hips had not required prosthetic revision (69%). The pain score improved in 81% of patients: mean score=2.3. Nine patients were satisfied or very satisfied (81%). Among these eleven hips, function was good or excellent in eight (72%). Walking distance was improved in nine patients, unchanged in one and worse in one. Joint motion improved in nine patients, was unchanged in one and decreased in one. Nine patients resumed their full-time job. Mean sick leave was 13.3 months. Radiographically, only two of the initial Ficat grade 2A hips remained at this stage. Likewise only one of the three hips initially rated grade 2B remained at this stage. Overall radiographic results were: failure (n=5), worsening (n=9), stabilization and no improvement (n=2). Among the nine 2A hips, one was converted to a total hip prosthesis and five femoral heads remained spheric. Among the seven 2B hips, four were converted to a total hip prosthesis and two femoral heads collapsed.At mean follow-up (3.5 years), 69% of the hips had not required total hip arthroplasty. The grade 2A hips did better but the small sample size did not allow statistical comparison. There was a clear discordance between the clinical presentation and the radiographic findings among the hips which were not treated with a prosthesis: good function score, maintained occupational and daily life activities contrasting with unfavorable radiographic evolution. Results could be improved by detailed quantification of the lesion using 3D imaging and by associating intraoperative navigation.

Neuromyotonia is a late and rare complication of radiation therapy, consisting of involuntary sustained muscle contractions with a delay in relaxation.We report the case of a 68-year-old man who developed neuromyotonia of the masseter muscle 6 years after irradiation for tonsil carcinoma.This observation underlines the importance of a correct diagnosis that can lead to an efficient treatment by carbamazepine.