Comment le Brexit va-t-il influcencer la place financière de Londres ?

Londres est incontestablement un pilier de la finance mondiale ; la masse d’acteurs qui y est implantée, dotant la place et ses industries financières d’une polyvalence et d’une profondeur exceptionnelles, ont fait de la City un pôle financier incontournable. Les raisons de ce succès peuvent être déterminées grâce à l’Histoire : la puissance économique et commerciale précoce du Royaume-Uni, couplée à un cadre régulatoire solide mais attractif, font partie des facteurs expliquant l’essor de la place londonienne. La City se développe ensuite grâce à son propre succès, attirant les sociétés financières et autres acteurs grâce aux conditions créées par l’effet « cluster », soit le noeud de facteurs qui joue en faveur de la place financière : parmi eux, les plus importants sont certainement la liquidité créée par la présence des concurrents et partenaires financiers, l’accès à la main d’oeuvre qualifiée (elle-même attirée par ces sociétés) et la présence des services professionnels complémentaires, tels que les services légaux et d’audit notamment. Mais ce cercle vertueux, expliquant le succès présent de Londres par son succès passé, n’est pas à l’abri d’une rupture qui pourrait grandement menacer le développement futur de la place. Or, l’acceptation du référendum « Brexit » le 24 juin 2016 menace de rompre ce cercle vertueux. En effet, selon l’issue des négociations entre le Royaume-Uni et l’Union Européenne, les conséquences peuvent être dramatiques pour le centre financier londonien. En nous penchant sur les politiques de négociation des deux parties, nous nous rendons compte que l’issue du Brexit est difficilement prévisible ; les volontés du gouvernement britannique de maintenir les meilleures relations commerciales possibles tout en maîtrisant son immigration sont incompatibles avec l’inflexibilité de l’Union Européenne sur l’immuabilité des quatre libertés de mouvement. Ce travail vise donc à évaluer les conséquences que peuvent avoir différents scénarios d’accords commerciaux sur la place britannique et ses industries financières. À l’aide de ces scénarios, nous sommes en mesure de proposer des recommandations pour protéger la place londonienne et soutenir sa croissance. Ainsi, prioriser les considérations commerciales aux dépens du contrôle de l’immigration et chercher à implémenter un accord de transition lors des négociations avec l’UE, conclure des accords de libre échange avec les grandes puissances économiques, assouplir les régulations spécifiques à certaines industries financières et communiquer sur tout changement entrant en vigueur sont les recommandations principales qui permettraient de maintenir les conditions cadres de la place londonienne, voire même de les améliorer afin de solidifier la City et favoriser son développement futur

Improved Postoperative Kneeling Ability in Posterior Stabilized Total Knee Arthroplasty with Medialised Dome-Patella Resurfacing: A Retrospective Comparative Outcome Analysis.

OBJECTIVES This investigation aimed to evaluate if the modifications to prosthesis designs improve patients' clinical and functional outcomes after total knee arthroplasty (TKA), with a special focus on pain and kneeling ability. METHODS Retrospective and comparative analysis of consecutive patients who were treated with posterior stabilized TKA using two different prostheses designs (single surgeon, single vendor). Group 1 received a traditional design TKA (PFC Sigma; DePuy, Inc., Warsaw, IN) with conventional dome-patella resurfacing and group 2 received a modern design implant (Attune; DePuy, Inc., Warsaw, IN), with medialised dome-patella resurfacing. Functional outcome (range of motion: ROM) and the Oxford Knee Score (OKS) were collected preoperatively, at 4-6 weeks and 12 months following surgery. RESULTS Ninety-nine participants were included. Of these, 30 received traditional design implants, and 69 the modern design knee implants. The comparison between the two implants showed a statistically significant increased total OKS and kneeling ability in the modern design cohort at 1-year follow-up compared to the traditional design cohort (p < 0.01). In the modern design group, 53% (N=37) could kneel easily or with little difficulty, compared to 30% (N=9) in the traditional design group. No statistically significant differences in ROM or the OKS pain component were seen. CONCLUSION The incorporation of a medialized dome-patella in modern knee implant design may offer advantages over traditional designs, as seen in improved total OKS and kneeling ability at one-year follow-up. Further research with larger cohorts is needed to confirm these findings and explore the broader impact of implant design changes on patient outcomes. LEVEL OF EVIDENCE Clinical Study, Level III

Les chemins de fer vicinaux de la Haute-Saône de l’extension (1878-1912) au déclin (1918-1938) : un modèle de desserte d’un département en mutation économique

Le département de la Haute-Saône doit son nom au cours supérieur de la rivière Saône qui le traverse dans sa totalité. La Saône occupe une large dépression bordée au Nord et au Sud par des plateaux d’altitude moyenne. A l’Est, leur faciès devient plus montagneux puisque la retombée méridionale des Vosges occupe toute cette façade du département qui culmine à plus de 1 200 m au ballon de Servance, tandis que le point le plus bas est, à l’extrême Ouest du département, à 191 m d’altitude où conf..

Barriers and Facilitators for Conducting Implementation Science in German-Speaking Countries: Findings from the Promote ImpSci Interview Study

On a global scale, implementation science has developed considerably as a discipline in recent years. In German-speaking countries, the field has been gaining significance as well, but respective efforts in building capacity and advancing the research infrastructure are still rare. The present study investigates barriers and facilitators for conducting implementation science in German-speaking countries with the goal of formulating recommendations for creating a more supportive research infrastructure. We conducted an interview study with nine well-established implementation researchers affiliated with universities in Austria, Germany, or Switzerland. The interviews were held via Zoom or phone in November and December 2020, transcribed verbatim and analyzed using thematic analysis. Barriers that relate to characteristics of the discipline were difficulties in building a common understanding of the field and the complexity of implementation research projects. Although supportive scientific networks were important facilitators, interviewees mentioned challenges in connecting with likeminded researchers. A further barrier was the lack of opportunities for education and training in implementation science, especially in the German language. Also, participants reported a missing readiness in academia for establishing implementation science that should be addressed by advocacy of the discipline toward academic decision makers. Moreover, since most national funding agencies prioritize basic research over applied research, some interviewees named flexibility in handling research funds as a facilitator for implementation research. The results inform an agenda for promoting implementation science in German-speaking countries and can be beneficial to other countries that are currently advancing their implementation research capacity and infrastructure

Natural History of Degenerative Hip Abductor Tendon Lesions

BACKGROUND The best treatment of degenerative hip abductor tendon lesions remains largely unknown, as the natural course of the disease has not yet been reported. The aim of the present study was to investigate the natural history of symptomatic degenerative hip abductor lesions. HYPOTHESIS Nonoperatively treated hip abductor lesions progress over time, resulting in refractory hip pain and low functional outcomes. STUDY DESIGN Case series (prognosis); Level of evidence, 4. METHODS Consecutive patients with greater trochanteric pain syndrome and degenerative changes on magnetic resonance imaging (MRI) of the symptomatic hip were included. Bilateral hip MRI scans and a clinical examination were performed at a minimum follow-up of 36 months to study the type and location of hip abductor lesion. Progression of a lesion was defined as a more severe lesion as compared with the initial MRI results or if the lesion extended to another, initially not involved, trochanteric facet. The muscle's fatty infiltration (FI) was also described. RESULTS From 106 patients identified, 58 patients (64 hips) aged 66 ± 14 years (mean ± SD) agreed to return to the clinic for follow-up MRI and met the inclusion criteria. At a mean 71-month follow-up, an overall 34% (22/64) of lesions had progressed over time: from trochanteric bursitis to tendinopathy (9/64, 14%) or partial tear (5/64, 8%), from tendinopathy to partial tear (4/64, 6%), from a partial to complete tear (3/64, 4.5%), and with 1 complete tear (1/64, 1.5%) extending to another trochanteric facet. Interestingly, 90% of partial tears remained stable or transformed into a scar. Although patients with a progressive lesion experienced more trochanteric pain (visual analog scale, 4.6 vs 2.8; P = .001), the functional outcomes were comparable with patients with a stable lesion. The majority of hips with a partial tear (64%) demonstrated a progression of gluteus minimus FI from a median grade of 1 to 2, whereas only 1 hip (3%) progressed from grade 2 to 3. Only 3 hips (9%) with a partial tear had a progression of gluteus medius FI, which did not differ significantly from the contralateral unaffected side. CONCLUSION Nonoperative treatment might be a valid long-term option for degenerative hip abductor lesions, especially for partial tears, which demonstrated a low risk of clinically relevant progression or muscle FI and similar clinical outcomes to those reported in the literature for operatively treated hip abductor tendon lesions

Loss of MeCP2 disrupts cell autonomous and autocrine BDNF signaling in mouse glutamatergic neurons

Mutations in the MECP2 gene cause the neurodevelopmental disorder Rett syndrome (RTT). Previous studies have shown that altered MeCP2 levels result in aberrant neurite outgrowth and glutamatergic synapse formation. However, causal molecular mechanisms are not well understood since MeCP2 is known to regulate transcription of a wide range of target genes. Here, we describe a key role for a constitutive BDNF feed forward signaling pathway in regulating synaptic response, general growth and differentiation of glutamatergic neurons. Chronic block of TrkB receptors mimics the MeCP2 deficiency in wildtype glutamatergic neurons, while re-expression of BDNF quantitatively rescues MeCP2 deficiency. We show that BDNF acts cell autonomous and autocrine, as wildtype neurons are not capable of rescuing growth deficits in neighboring MeCP2 deficient neurons in vitro and in vivo. These findings are relevant for understanding RTT pathophysiology, wherein wildtype and mutant neurons are intermixed throughout the nervous system

The HDAC inhibitor SAHA improves depressive-like behavior of CRTC1-deficient mice: Possible relevance for treatment-resistant depression.

Major depression is a highly complex disabling psychiatric disorder affecting millions of people worldwide. Despite the availability of several classes of antidepressants, a substantial percentage of patients are unresponsive to these medications. A better understanding of the neurobiology of depression and the mechanisms underlying antidepressant response is thus critically needed. We previously reported that mice lacking CREB-regulated transcription coactivator 1 (CRTC1) exhibit a depressive-like phenotype and a blunted antidepressant response to the selective serotonin reuptake inhibitor fluoxetine. In this study, we similarly show that Crtc1(-/-) mice are resistant to the antidepressant effect of chronic desipramine in a behavioral despair paradigm. Supporting the blunted response to this tricyclic antidepressant, we found that desipramine does not significantly increase the expression of Bdnf and Nr4a1-3 in the hippocampus and prefrontal cortex of Crtc1(-/-) mice. Epigenetic regulation of neuroplasticity gene expression has been associated with depression and antidepressant response, and histone deacetylase (HDAC) inhibitors have been shown to have antidepressant-like properties. Here, we show that unlike conventional antidepressants, chronic systemic administration of the HDAC inhibitor SAHA partially rescues the depressive-like behavior of Crtc1(-/-) mice. This behavioral effect is accompanied by an increased expression of Bdnf, but not Nr4a1-3, in the prefrontal cortex of these mice, suggesting that this epigenetic intervention restores the expression of a subset of genes by acting downstream of CRTC1. These findings suggest that CRTC1 alterations may be associated with treatment-resistant depression, and support the interesting possibility that targeting HDACs may be a useful therapeutic strategy in antidepressant development

Gender-specific hip fracture risk in community-dwelling and institutionalized seniors age 65years and older

Summary: In this study of acute hip fracture patients, we show that hip fracture rates differ by gender between community-dwelling seniors and seniors residing in nursing homes. While women have a significantly higher rate of hip fracture among the community-dwelling seniors, men have a significantly higher rate among nursing home residents. Introduction: Differences in gender-specific hip fracture risk between community-dwelling and institutionalized seniors have not been well established, and seasonality of hip fracture risk has been controversial. Methods: We analyzed detailed data from 1,084 hip fracture patients age 65years and older admitted to one large hospital center in Zurich, Switzerland. In a sensitivity analysis, we extend to de-personalized data from 1,265 hip fracture patients from the other two large hospital centers in Zurich within the same time frame (total n = 2,349). The denominators were person-times accumulated by the Zurich population in the corresponding age/gender/type of dwelling stratum in each calendar season for the period of the study. Results: In the primary analysis of 1,084 hip fracture patients (mean age 85.1years; 78% women): Among community-dwelling seniors, the risk of hip fracture was twofold higher among women compared with men (RR = 2.16; 95% CI, 1.74-2.69) independent of age, season, number of comorbidities, and cognitive function; among institutionalized seniors, the risk of hip fracture was 26% lower among women compared with men (RR = 0.77; 95% CI: 0.63-0.95) adjusting for the same confounders. In the sensitivity analysis of 2,349 hip fracture patients (mean age 85.0years, 76% women), this pattern remained largely unchanged. There is no seasonal swing in hip fracture incidence. Conclusion: We confirm for seniors living in the community that women have a higher risk of hip fracture than men. However, among institutionalized seniors, men are at higher risk for hip fracture