Transforaminal versus intra-articular facet steroid injections for the treatment of cervical radiculopathy : a randomized, double-blinded, controlled study

Cette étude a été subventionnée par le Fonds de recherche du Québec - Santé (FRQ-S, grant # 21230 – 2)Les infiltrations foraminales cervicales sont associées à un risque de complications neurologiques majeures. Cette étude compare l’efficacité des infiltrations facettaires, plus sécuritaires, à celle des infiltrations foraminales dans le traitement de la cervico-brachialgie secondaire à une spondylose et/ou à une hernie discale, à 4 semaines post traitement. Cinquante-six sujets ont été randomisés pour recevoir une infiltration foraminale (15 hommes, 13 femmes ; âge moyen 52 ans) ou facettaire (8 hommes, 20 femmes ; âge moyen 44 ans). L’issue principale était l’intensité de la douleur mesurée sur une échelle visuelle analogique (0 – 100). Les issues secondaires étaient le Neck Disability Index et le Medication Quantitative Scale. Suivant les analyses en intention-de-traiter et en intention-du-protocole, pour un score de douleur initial moyen, une réduction significative de l’intensité de la douleur a été observée avec les infiltrations facettaires [45.3% (95%CI: 21.4; 69.2) et 37.0% (95%CI: 9.2; 64.7)] contrairement aux infiltrations foraminales [9.8% (95%CI: +11.5; 31.2) et 17.8% (95%CI: +6.6; 42.2)]. Les infiltrations facettaires ont procuré une amélioration cliniquement (mais non statistiquement) significative du Neck Disability Index [24.3% (95%CI: +2.9; 51.5) et 20.7% (95%CI: +6.2; 47.6),], contrairement aux infiltrations foraminales [9.6% (95%CI: +15.2; 34.4) et 12.8% (95%CI: +11.2; 36.7)]. Les infiltrations facettaires étaient au moins aussi efficaces que les infiltrations foraminales pour un score initial de douleur ≤ 60, alors que l’analyse de non infériorité n’était pas concluante pour un score initial ≥ 80, de même que pour le Neck Disability Index. Les infiltrations n’ont pas été associées à une réduction du score de Medication Quantitative Scale. Les infiltrations facettaires sont efficaces dans le traitement de la névralgie cervico-brachiale et représentent une alternative valable et plus sécuritaire aux infiltrations foraminales.Transforaminal corticosteroid injections can be performed in the management of cervical radiculopathy but carry the risk of catastrophic complications. This study compares the efficacy of transforaminal and facet corticosteroid injections at 4 weeks post treatment. We randomly assigned 56 subjects to receive CT-guided transforaminal (15 men, 13 women; mean age 52 years; range 28 – 72 years) or facet (8 men, 20 women; mean 44 years; range 26 – 60 years) injections. The primary outcome was pain severity rated on a visual analog scale (0-100). Secondary outcome measures were the Neck Disability Index and the Medication Quantitative Scale. In the intention-to-treat and as-treated analyses, for a mean baseline score, facet injections demonstrated a significant pain score reduction of 45.3% (95%CI: 21.4; 69.2) and 37.0% (95%CI: 9.2; 64.7), while transforaminal injections showed nonsignificant pain score reduction of 9.8% (95%CI: +11.5; 31.2) and 17.8% (95%CI: +6.6; 42.2). While facet injections demonstrated an improvement in Neck Disability Index score of [24.3% (95%CI: +2.9; 51.5); 20.7% (95%CI: +6.2; 47.6),] as opposed to transforaminal injections [9.6% (95%CI: +15.2; 34.4); 12.8% (95%CI: +11.2; 36.7)], the results did not reach statistical significance. Noninferiority of facet to transforaminal injections was demonstrated for baseline pain score ≤ 60, while noninferiority analysis was inconclusive for baseline pain score ≥ 80 and for the Neck Disability Index score. Neither intervention showed a significant medication intake score reduction over time. Facet injections are effective for the treatment of cervical radiculopathy and represent a valid and safer alternative to transforaminal injections

La judiciarisation des patients psychiatriques : éléments de réflexion et applications pratiques

Parmi les solutions possibles en réponse aux gestes violents des patients psychiatriques, la judiciarisation demeure une alternative souvent méconnue qui peut pourtant s'avérer bénéfique et efficace. Comment choisir de façon éclairée, la judiciarisation face à la violence de certains patients ? Lorsque l'on opte pour cette voie, comment s'applique-t-elle et quelles sont les démarches à suivre ? Pour répondre à ces questions, il nous est apparu essentiel d'engager d'abord une réflexion plus globale sur l'utilisation de la sanction en psychiatrie. Nous évoquons ensuite les avantages et les inconvénients du processus de judiciarisation. Finalement, nous présentons les modalités d'application de la judiciarisation telles qu'elles ont été conçues et réfléchies à la clinique de dangerosité de l'Institut Philippe Pinel de Montréal.Prosecution of psychiatric patients: elements of reflections and practical applications Among possible solutions in response to violent behaviours of psychiatric patients, prosecution might not be an alternative as well-known. This measure may be potentially beneficial for patients. How can prosecution be chosen as an option when faced with violent patients? When this option is considered, how should it be applied and what are the different steps to follow? To answer these questions, it appeared essential to first proceed to a comprehensive reflection on the recourse of sanction in psychiatry. We then describe advantages and disadvantages of the judicial process. Finally, we illustrate applications as they were conceived and elaborated at the Clinique de dangerosité de l'Institut Philippe Pinel de Montréal.La judiciarisación de patientes siquiátricos: Elementos de reflexión y aplicacíones practicas Entre las soluciones posibles para responder a los gestos violentos de los patientes siquiátricos, la judiciarisación queda una alternativa frecuentemente desconocida la cual puede sin embargo revelarse benéfica y eficaz. ¿Como escoger de manera iluminada la judiciarisación frente a la violencia de ciertos patientes? Cuando se opta por este camino, ¿como se aplica y cuales son los pasos a seguir? Para responder a estas preguntas, nos pareció esencial empeñar primero una reflexión más global sobre la utilisación de la sanción en siquiatría. Después, evocamos las ventajas y los inconvenientes del proceso de judiciarisación. Finalmente, presentamos las modalidades de aplicación de judiciarisación tal como han sido conceptualisadas y reflexionadas en la clinica de peligrosidad del Instituto Philippe Pinel de Montréal

Comparison of inulin with urea as dilutional markers of bronchoalveolar lavage in healthy and heaves-affected horses.

Solute analysis in bronchoalveolar lavage fluid involves the use of dilutional markers to correct for variable recovery of pulmonary epithelial lining fluid (PELF). Urea is the best characterised endogenous marker, whereas inulin appears to meet the requirements of an exogenous marker. In horses, the use of inulin has never been investigated and the impact of lower airway diseases such as heaves, on PELF recovery is unknown. In this study, five healthy and five heaves-affected horses underwent airway endoscopy and bronchoalveolar lavage. PELF recovery from bronchoalveolar lavage was calculated by the inulin and the urea method. The inulin method was compared to the urea method and differences between healthy and heaves-affected horses were analysed. From a technical and analytical point of view, inulin fulfilled the requirements of a marker of dilution as well as urea. When both healthy and heaves-affected horses groups were pooled together, PELF recovery calculated by the inulin method was significantly higher than by the urea method (6.43+/-4.08% versus 0.789+/-0.299%, P < 0.005). No significant differences were observed between healthy and heaves-affected horses, neither by the inulin nor by the urea method. Inulin did not present major advantages over urea, but the combined use of both markers can improve the standardisation of studies comparing PELF compounds, by providing upper limits (inulin dilution) and lower limits (urea dilution) of PELF recovery.Peer reviewe

Quantitative MRI in patients with gluteal tendinopathy and asymptomatic volunteers : initial results on T1- and T2*-mapping diagnostic accuracy and correlation with clinical assessment

Dans le cadre du programme SharedIt de Springer Nature, une version de l'article est accessible gratuitement, en lecture seule, à cette adresse : https://rdcu.be/cjHMSObjective To determine if T1- and T2*-mapping of the gluteal tendons can discriminate between participants with and without clinical findings of gluteal tendinopathy (GT) and if they correlate with clinical assessment. Materials and methods This prospective study was conducted between January and December 2016. MRI of the hip included spin echo, short-T1 inversion recovery, variable-flip angle, and variable echo-time gradient echo sequences. MRI studies were reviewed independently by two radiologists. Two other readers segmented the gluteal tendons and T1, mono- (T2*m) and biexponential T2* (short (T2*s) and long (T2*l) components) were computed. Results Ten participants with GT (median age; interquartile range: 63 (57–67) years, all women) and 9 participants without GT (57 (55–59) years, 8 women) (P = 0.06) were enrolled. The sensitivity and specificity of reader 1 for disease classification were 40% (95% confidence interval (CI): 17–61%) and 70% (CI: 47–91%), and those of reader 2 were 70% (CI: 43–86%) and 80% (CI: 53–96%), with fair inter-reader agreement (Kappa = .38). T1 values could not discriminate between the two groups. The gluteal tendons T2*m and T2*s showed diagnostic accuracy ranging from .80 to .89. The posterior gluteus medius tendon T2*m and T2*s respectively showed sensitivity and specificity of 90%, and strong correlation (Spearman’s rho = −.71; P = 0.02) with the Lower Extremity Functional Scale score. Conclusion Quantitative MRI could help gain new insight into healthy and diseased gluteal tendons to allow better diagnosis and treatment stratification for patients

SARS-CoV-2 infection among employees working from home and on site: An occupational study in Switzerland.

During the COVID-19 pandemic, many companies implemented working from home to mitigate the spread of the disease among their employees. Using data from Corona Immunitas Nestlé, a seroepidemiological study conducted among employees from two Nestlé sites in Switzerland, we aimed to investigate whether there was a difference in SARS-CoV-2 infection rates between employees working most of the time from home and employees mobilized in a workplace equipped with a specialized occupational safety unit and strict sanitary measures. We also investigated whether this association was modified by household size, living with children, vulnerability, worries about an infection, and worries about adverse health consequences if infected. Data were collected between 8 December 2020, and 11 February 2021. Previous SARS-CoV-2 infections were ascertained by the presence of anti-SARS-CoV-2 IgG antibodies in the blood. Of the 425 employees included (53% women; mean age 42 years ranging between 21 and 64 years), 37% worked most of the time from home in 2020 and 16% had been infected with SARS-CoV-2. Participants who worked most of the time from home in 2020 had slightly higher odds of being infected with SARS-CoV-2 compared to participants who never or only sometimes worked from home (adjusted OR 1.29, 95% CI 0.73-2.27). The association was stronger in participants living alone or with one other person (adjusted OR 2.62, 95% CI 1.13-6.25). Among participants living with two or more other persons (adjusted OR 0.66, 95% CI 0.30-1.39) and among vulnerable participants (adjusted OR 0.53, 95% CI 0.13-1.93), working from home tended to be associated with lower odds of infection. In conclusion, in a context of strict sanitary measures implemented in the workplace, employees working from home did not seem to be at lower risk of infection compared to those working on site, especially if living alone or with one other person

Capteur en Optique Intégrée à Base de Verres de Chalcogénures pour la Détection de Polluants dans le Moyen-Infrarouge

National audienceLe Moyen Infra-Rouge (MIR) est la région spectrale comprise entre 3 et 20 µm. Cette gamme de longueurs d’onde est connue pour contenir des transitions vibrationnelles fondamentales caractéristiques d’espèces moléculaires en phase liquide ou gazeuse. De nombreuses substances telles que le toluène, le méthanol, l’éthanol, l’acétone, le glucose, le dioxyde de carbone peuvent être caractérisées par spectroscopie infrarouge grâce à leur signature spectrale d’absorption. Cette technique est ainsi une des plus appropriées parmi les techniques classiques d’analyse pour l’identification et la caractérisation structurelle des espèces moléculaires. Les disponibilités récentes de plateformes optiques présentant de faibles pertes de propagation et de sources émettant dans le MIR, notamment des QCL ont été la clé du développement d’études destinées à la réalisation de capteurs optiques fonctionnant dans la gamme spectrale du MIR. Par ailleurs, les capteurs en optique intégrée sont devenus une excellente alternative pour la détection in situ car ils présentent certains avantages sur les autres types de capteurs, tels que l'intégration des éléments dans un dispositif compact. Ils sont actuellement utilisés dans divers domaines sociétaux tels que la santé, la défense et l’environnement.Il existe différents matériaux transparents dans le MIR (le silicium, le germanium, l’arséniure de galium ou encore les verres de chalcogénures) susceptibles de constituer la plateforme optique de ces capteurs intégrés. Les verres de chalcogénures (ChGs) sont des matériaux semi-conducteurs composés par les éléments du groupe VIa (sélénium (Se), tellure (Te) ou soufre (S)). Ils forment des verres lorsqu’ils sont mélangés à un ou plusieurs autres éléments tels que le galium (Ga), le germanium (Ge), l’antimoine (Sb), le silicium (Si) ou le phosphore (P). Ces verres de ChGs se distinguent par leur transparence étendue dans l’infrarouge: certaines compositions transmettent jusqu’à 20 µm. Typiquement, leur transmission dans le MIR a été caractérisée jusqu’à 12 µm pour les sulfures, à 16 µm pour les séléniures et à 18 µm pour les tellures. Certains travaux ont montré la fabrication et la caractérisation de capteurs optiques dans le proche infra-rouge. Dans cet article, nous proposons de tirer profit de la transparence élevée de ces matériaux dans le MIR pour fabriquer un capteur spectroscopique à onde évanescente fonctionnant dans cette gamme spectrale.

Comment concilier développement économique et environnement ?

Rapport du Conseil économique pour le développement durable (France), consultable ici : http://www.developpement-durable.gouv.fr/IMG/pdf/Comment_concilier_developpement_economique_et_environnement.pd

Diagnostic accuracy of ultrasonography, MRI and MR arthrography in the characterisation of rotator cuff disorders: A systematic review and meta-analysis

Background Different diagnostic imaging modalities, such as ultrasonography (US), MRI, MR arthrography (MRA) are commonly used for the characterisation of rotator cuff (RC) disorders. Since the most recent systematic reviews on medical imaging, multiple diagnostic studies have been published, most using more advanced technological characteristics. The first objective was to perform a meta-analysis on the diagnostic accuracy of medical imaging for characterisation of RC disorders. Since US is used at the point of care in environments such as sports medicine, a secondary analysis assessed accuracy by radiologists and nonradiologists. Methods A systematic search in three databases was conducted. Two raters performed data extraction and evaluation of risk of bias independently, and agreement was achieved by consensus. Hierarchical summary receiver-operating characteristic package was used to calculate pooled estimates of included diagnostic studies. Results Diagnostic accuracy of US, MRI and MRA in the characterisation of full-thickness RC tears was high with overall estimates of sensitivity and specificity over 0.90. As for partial RC tears and tendinopathy, overall estimates of specificity were also high (\u3e0.90), while sensitivity was lower (0.67â 0.83). Diagnostic accuracy of US was similar whether a trained radiologist, sonographer or orthopaedist performed it. Conclusions Our results show the diagnostic accuracy of US, MRI and MRA in the characterisation of fullthickness RC tears. Since full thickness tear constitutes a key consideration for surgical repair, this is an important characteristic when selecting an imaging modality for RC disorder. When considering accuracy, cost, and safety, US is the best option