How long should arthroscopic clavicular resection be in acromioclavicular arthropathy? A radiological-clinical study (with computed tomography) of 18 cases at a mean 4 years’ follow-up

AbstractIntroductionEndoscopic clavicular resection is a common procedure, but few studies have analyzed predictive factors for outcome.Hypotheses1) Computed tomography (CT) of clavicular resection is reproductible; 2) Functional outcome correlates with resection length; 3) Other factors also influence outcome.Material and methodsPatients operated on between 2005 and 2010 were called back to establish functional scores (Constant, Simple Shoulder Test [SST], satisfaction) and undergo low-dose bilateral comparative computed tomography (CT) centered on the acromioclavicular joints. The assessment criteria were resection edge parallelism and resection length, measured using OsiriX® software. Radiological and clinical data were correlated.Results18 out of 21 patients (85%: 3 female, 15 male) were assessed. Mean age at surgery was 49 years (range, 40–62 yrs); mean follow-up was 4.2 years (1.6–7.2 yrs). Mean Constant score rose from 57.7 (25–85) to 70.2 (30–96); mean postoperative SST was 9.3 (3–12). 11 patients had very good and 4 poor results. CT resection length was reproducible, with intraclass, intra- and interobserver correlation coefficients >95%. There was no significant correlation between articular resection length on CT and functional scores (P=0.2). Functional scores were negatively influenced by an occupational pathologic context (P<0.01) and by associated tendinopathy.Discussion and conclusionLow-dose CT enabled reproducible analysis of clavicular resection. The hypothesized correlation between resection length and functional result was not confirmed. Work accidents and occupational disease emerged as risk factors.Level of evidenceSingle-center retrospective analytic cohort study. Level 4, guideline grade C

Petit guide pratique pour la gestion des projets d'assainissement : fascicule 1 : les réseaux

L'étude et la mise en œuvre de canalisations d'assainissement doivent répondre à un nombre croissant d'exigences techniques, économiques et environnementales . Le guide apporte des recommandations essentielles pour une gestion rigoureuse des projets à même de répondre à de telles exigences. Il aborde successivement les points suivants : la prise de commande, les différentes contraintes (la loi sur l'eau, les aides au financement, les contraintes d'urbanisme, la coordination générale des réseaux, les études techniques préalables, l'hygiène et la sécurité de chantier, l'exploitation future du réseau), l'ordonnancement du projet, les dossiers techniques, la dévolution des travaux, la préparation de chantier, la qualité de mise en œuvre des remblais, la réception des travaux

Additive fiber-cerclages in proximal humeral fractures stabilized by locking plates: No effect on fracture stabilization and rotator cuff function in human shoulder specimens

Background and purpose The effect of additive fiber-cerclages in proximal humeral fractures stabilized by locking plates on fracture stabilization and rotator cuff function is unclear. Here it was assessed in a human cadaver study

Interplay between n-3 and n-6 long-chain polyunsaturated fatty acids and the endocannabinoid system in brain protection and repair.

The brain is enriched in arachidonic acid (ARA) and docosahexaenoic acid (DHA), long-chain polyunsaturated fatty acids (LCPUFA) of the n-6 and n-3 series, respectively. Both are essential for optimal brain development and function. Dietary enrichment with DHA and other long-chain n-3 PUFA, such as eicosapentaenoic acid (EPA) have shown beneficial effects on learning and memory, neuroinflammatory processes and synaptic plasticity and neurogenesis. ARA, DHA and EPA are precursors to a diverse repertoire of bioactive lipid mediators, including endocannabinoids. The endocannabinoid system comprises cannabinoid receptors, their endogenous ligands, the endocannabinoids, and their biosynthetic and degradation enzymes. Anandamide (AEA) and 2-archidonoylglycerol (2-AG) are the most widely studied endocannabinoids, and are both derived from phospholipid-bound ARA. The endocannabinoid system also has well established roles in neuroinflammation, synaptic plasticity and neurogenesis, suggesting an overlap in the neuroprotective effects observed with these different classes of lipids. Indeed, growing evidence suggests a complex interplay between n-3 and n-6 LCPUFA and the endocannabinoid system. For example, long-term DHA and EPA supplementation reduces AEA and 2-AG levels, with reciprocal increases in levels of the analogous endocannabinoid-like DHA and EPA-derived molecules. This review summarises current evidence of this interplay and discusses the therapeutic potential for brain protection and repair

Overexpression of Dyrk1A Is Implicated in Several Cognitive, Electrophysiological and Neuromorphological Alterations Found in a Mouse Model of Down Syndrome

Down syndrome (DS) phenotypes result from the overexpression of several dosage-sensitive genes. The DYRK1A (dual-specificity tyrosine-(Y)-phosphorylation regulated kinase 1A) gene, which has been implicated in the behavioral and neuronal alterations that are characteristic of DS, plays a role in neuronal progenitor proliferation, neuronal differentiation and long-term potentiation (LTP) mechanisms that contribute to the cognitive deficits found in DS. The purpose of this study was to evaluate the effect of Dyrk1A overexpression on the behavioral and cognitive alterations in the Ts65Dn (TS) mouse model, which is the most commonly utilized mouse model of DS, as well as on several neuromorphological and electrophysiological properties proposed to underlie these deficits. In this study, we analyzed the phenotypic differences in the progeny obtained from crosses of TS females and heterozygous Dyrk1A (+/-) male mice. Our results revealed that normalization of the Dyrk1A copy number in TS mice improved working and reference memory based on the Morris water maze and contextual conditioning based on the fear conditioning test and rescued hippocampal LTP. Concomitant with these functional improvements, normalization of the Dyrk1A expression level in TS mice restored the proliferation and differentiation of hippocampal cells in the adult dentate gyrus (DG) and the density of GABAergic and glutamatergic synapse markers in the molecular layer of the hippocampus. However, normalization of the Dyrk1A gene dosage did not affect other structural (e.g., the density of mature hippocampal granule cells, the DG volume and the subgranular zone area) or behavioral (i.e., hyperactivity/attention) alterations found in the TS mouse. These results suggest that Dyrk1A overexpression is involved in some of the cognitive, electrophysiological and neuromorphological alterations, but not in the structural alterations found in DS, and suggest that pharmacological strategies targeting this gene may improve the treatment of DS-associated learning disabilities

Une nouvelle voie d'abord pour la neurolyse endoscopique du nerf suprascapulaire à l'incisure spinoglénoïdale : étude cadavérique préliminaire

International audienceThe suprascapular nerve (SSN) can become compressed at its 2 scapular attachments: the suprascapular and the spinoglenoid notch. The objective of this study was to describe a new arthroscopic approach for SSN neurolysis at the spinoglenoid notch. Ten cadaver shoulders were used. Two were dissected to simulate the “classical” arthroscopic approach and to help in the creation of a new “direct medial retrospinal” approach. Eight other shoulders were used to validate this new approach, with control of the whole juxta-glenoid course of the SSN as criterion of success. The retrospinal posterior approach allowed the entire juxta-glenoid segment of the SSN to be explored in 6 cases out of 8. One exploration was incomplete, another not feasible. SSN neurolysis at the spinoglenoid notch was feasible in cadavers on a retrospinal approach. © 2017 Elsevier Masson SASIntroduction Le nerf suprascapulaire (NSS) peut être comprimé à ses 2 points de fixation scapulaire : incisure suprascapulaire et incisure spinoglénoïdale (ISG). L’objectif de ce travail est de décrire un nouvel abord endoscopique pour la neurolyse du NSS à l’ISG.Méthode Dix épaules ont été utilisées. Deux épaules ont été disséquées pour simuler le trajet des voies d’abord endoscopiques « classiques » et aider à la création d’une nouvelle voie dite « médiale rétrospinale directe ». Huit autres épaules ont permis de valider cette nouvelle voie avec comme critère de réussite le contrôle de la totalité du trajet juxtaglénoïdien du NSS.Résultats La voie postérieure rétrospinale a permis d’explorer tout le segment juxtaglénoïdien du NSS dans 6 cas sur 8. Une exploration a été incomplète, une autre non réalisable.Conclusion La neurolyse du NSS à l’ISG est possible sur cadavre par l’utilisation d’une voie rétrospinale