Lambeau chimérique fémoro-trochléaire médial pour la reconstruction du scaphoïde et du lunatum

Conservative treatment of non-union with necrosis of the proximal pole of the scaphoid and Kienböck's disease in stage IIIA and IIIB requires bone revascularization. Usual surgical techniques are often outdated, especially in the presence of bone fragmentation and only palliative options remain. Reconstruction of the proximal pole of the scaphoid and the lunate with a micro anastomosed free flap of the femoral trochlea is an effective alternative. A total of 10 patients, with a median age of 30 years, underwent reconstruction of the proximal pole of the scaphoid (n = 8) or of the lunate (n = 2) by free trochlear-medial femoral flap. A retrospective review of clinical and radiological data was performed with a median follow-up time of 23 months. The functional parameters were good, compatible with the gestures of everyday life. Residual postoperative pain (VAS) had a median of 0. The median flexion was 47.5 °, the median extension was 42.5 °. The median gripping force (Grip) was 38.3 kg, an increase of 33% compared to preoperative. The median upper limb functional scores were 5.8 for the DASH score and 11 for the PWRE score. The morbidity at the donor site was low with a median residual pain (VAS) in the knee at 0. No osteoarthritis progression was found. The medial femorotrochlear flap is a reliable and durable option in scaphoid or lunate reconstructions for young and active patients with high functional demands.Le traitement conservateur des pseudarthroses avec nécrose du pôle proximal du scaphoïde et de la maladie de Kienböck au stade IIIA et IIIB nécessite une revascularisation osseuse. Les techniques chirurgicales habituelles sont souvent dépassées en particulier en présence d’une fragmentation osseuse et seules des options palliatives subsistes. La reconstruction du pole proximal du scaphoïde et du lunatum par lambeau libre micro anastomosé de trochlée fémorale est une alternative efficace. Un total de 10 patients, de 30 ans d’âge médian, ont bénéficié d’une reconstruction du pôle proximal du scaphoïde (n=8) ou du lunatum (n=2) par lambeau libre fémoro-trochléaire-médial. Une revue rétrospective des données cliniques et radiologiques a été faite avec un délai de suivi médian de 23 mois. Les paramètres fonctionnels étaient bons, compatibles avec les gestes de la vie courante. La douleur post-opératoire résiduelle (EVA) avait une médiane à 0. La médiane de flexion était à 47,5°, la médiane d’extension à 42,5°. La force (Grip) de serrage médiane était de 38,3kg, en augmentation de 33% par rapport au pré-opératoire. Les scores fonctionnels médians pour le membre supérieur étaient de 5,8 pour le score DASH et 11 pour le score PWRE. La morbidité au site donneur était faible avec une douleur résiduelle (EVA) médiane au genou à 0. Aucune évolution arthrosique n’a été retrouvée. Le lambeau fémoro-trochléaire médial est une option fiable et durable dans les reconstructions du scaphoïde ou du lunatum pour les patients jeunes et actifs à forte demande fonctionnelle

The impact of new technologies on online sales

PEAK Sport is a brand very well known for its basketball products. It is a brand implemented in various countries and which is very well known all over the world thanks to its ambassadors composed of former and current NBA players such as Tony Parker or Lou Williams. On the French market, the brand is selling its products to B2C and B2B customers through two different channels. However, as the market is becoming more and more competitive with the arrival of new brands, PEAK is looking for innovative and original ideas or tools to first, keep its position within the market and second, to improve and strengthen its relation and link with its customers. As the brand was looking for innovative tools, it invested in Augmented Reality with 3D scans and 3D filters with two objectives in mind: improve the conversion rate, so the sales, and increase its brand awareness on social networks. As these were the two objectives of the brand, it is the objective of the thesis as well to determine what is the impact of these tools on the sales and the brand awareness after a few months of implementation. The goal is to end up with an answer for both objectives as well as with solutions to change things if needed. The research has mainly been conducted with the descriptive research which helped as it is the best suited to provide a solution and appropriate responses. A population of customers has been selected depending on different criteria’s. Once the sampling was done, the questionnaire, composed of 13 questions, was sent. In addition to the questionnaire, participant observation thanks to the time spent within the brand helped with the understanding of the tools implemented, of insight data and results, as well as with the understanding of the market overall. Based on the results of the research, the impact on the sales is limited while the one on the brand awareness is much more visible. However, the period during the study has been done had a huge impact on the results. Indeed, with the pandemic, the sport market has been extremely impacted so the sales as well. It is then difficult to judge the impact of the tools on the sales when such an event is also impacting the results. Overall, the conclusion is that the tools implemented are innovative and will surely have an impact in the time to come, but that it is too soon to definitely determine their impact due to different factors which impacted the study

Le don, la greffe... et les internes de médecine générale d'Auvergne

Le thème du don d'organes est classé, depuis 2006, "priorité nationale" par la loi. Or, le médecin généraliste est directement impliqué dans la délivrance des informations relatives au don chez les jeunes de 16 à 25 ans (article R 1211-50 du code de la santé publique). L'objectif de notre étude est d'évaluer si les internes de médecine générale (IMG) d'Auvergne sont suffisamment armés et sensibilisés pour aborder, avec leurs patients, le sujet du don d'organes en vue d'une greffe. Il s'agit d'une enquête prospective réalisée en "post-internat", qui s'est déroulée sur une période de mai à juin 2012. Un questionnaire a été envoyé par mail aux IMG de la faculté de Clermont-Ferrand n'ayant pas encore validé leurs six semestres. Il comprend 18 questions divisées en 4 parties : renseignements sociodémographiques, évaluation des connaissances théoriques sur le don et la greffe d'organes, connaissance du rôle du médecin généraliste envers le don d'organes et modalités d'application, impact du questionnaire. Une explication des solutions du questionnaire a été mise à leur disposition après validation de leurs réponses. 107 des 198 IMG sollicités ont répondu au questionnaire (36H, 71F). Parmi eux, 86 étudiants déclarent avoir pour vocation l'exercice de la médecine générale. Seul 1 étudiant signale avoir bénéficié d'une formation spécifique sur le don d'organes au cours de son internat. Leurs réponses aux questions théoriques sur le don ou la greffe d'organes sont souvent erronées et/ou incomplètes. 61 IMG n'ont pas connaissance de leur rôle, en tant que futur médecin généraliste, de délivrance des informations relatives au don. 70 IMG ne se disent pas prêts à les délivrer dont 65 par manque de connaissances. 95 étudiants signalent avoir déjà exprimé leur position personnelle par rapport au don d'organes auprès de leurs proches avant la réalisation de ce questionnaire et 3 semblent s'être décidés à l'issu de celui-ci. Les IMG de Clermont-Ferrand ne semblent pas suffisamment armés et sensibilisés pour aborder le sujet du don d'organes en consultation. A travers ce questionnaire, il semble apparaître qu'une formation spécifique sur le don ou la greffe d'organes, réalisée pendant l'internat, serait utile.CLERMONT FD-BCIU-Santé (631132104) / SudocSudocFranceF

Integrated signaling network involving calcium, nitric oxide, and active oxygen species but not mitogen-activated protein kinases in bcpg1-elicited grapevine defenses

International audienceWe have already reported the identification of the endopolygalacturonase 1 (BcPG1) from Botrytis cinerea as a potent elicitor of defense responses in grapevine, independently of its enzymatic activity. The aim of the present study is the analysis of the signaling pathways triggered by BcPG1 in grapevine cells. Our data indicate that BcPG1 induces a Ca2+ entry from the apoplasm, which triggers a phosphorylation-dependent nitric oxide (NO) production via an enzyme probably related to a NO synthase. Then NO is involved in i) cytosolic calcium homeostasis, by activating Ca2+ release front internal stores and regulating Ca2+ fluxes across the plasma membrane, ii) plasma membrane potential variation, iii) the activation of active oxygen species (AOS) production, and iv) defense gene expression, including phenylalanine ammonia lyase and stilbene synthase, which encode enzymes responsible for phytoalexin biosynthesis. Interestingly enough, mitogen-activated protein kinase (MAPK) activation is independent of this regulation pathway that closely connects Ca2+, NO, and AOS

Differential effects of nonhydroxylated flavonoids as inducers of cytochrome P 450 1A and 2B isoenzymes in rat liver

International audienc

Differential effects of nonhydroxylated flavonoids as inducres of cytochrome P450 1A and 2B isozymes in rat liver

International audienc

Differential effects of nonhydroxylated flavonoids as inducers of cytochrome P450 1A and 2B isozymes in rat liver

International audienceFlavanone, flavone, and tangeretin differentially affected the activities of cytochrome P540 1A and 2B isozymes in rat liver. Flavone and, to a lesser extent, tangeretin, increased activities of ethoxyresorufin O-deethylase, methoxyresorufin O-demethylase, and pentoxyresorufin O-dealkylase (PROD), whereas flavanone mainly enhanced PROD activity. Immunoblot analysis indicated that flavone and tangeretin increased cytochrome P450 1A1, 1A2, and 2B1,2 forms, whereas flavanone only enhanced the cytochrome P450 2B isozymes. Northern blot study showed that flavone and tangeretin increased the level of the cytochrome P450 1A2 mRNAs. The concentration of the other mRNAs were slightly or not affected by flavonoids. These results suggest that the induction of P450 1A2 by flavone and tangeretin might involve a transcriptional and/or post-transcriptional mechanism