Intérêts de l'utilisation de la neurostimulation transcutanée dans les lombalgies chroniques ?

LYON1-BU Santé (693882101) / SudocSudocFranceF

Facteurs d'insertion professionnelle des personnes souffrant d'épilepsie : revue de la littérature

In a competitive working environment, support to the employment of persons suffering from epilepsy needs to be increasingly effective. The present study therefore analyzed the literature data to identify factors influencing occupational integration and assess their impact, so as to propose adapted strategies of multidisciplinary management. A PubMed and ScienceDirect search was performed using the search terms 'epilepsy', 'employment', 'employer', 'workplace' and 'work status', focusing on recent data, published between 2000 and 2014, concerning adults living in North America, Europe or Australia. The collected factors are categorized according to 3 themes. The first concerns the experience of persons suffering from epilepsy: their often impaired self-esteem, their self perception in the eyes of others, and their possible beliefs and fears concerning work. These feelings echo the perception of epilepsy in the patient's social environment, which is the topic of the second theme: persistent prejudices in the general public and stigmatization at the workplace. The last theme concerns seizures and their treatment, and particularly how their unpredictability makes them both striking and disturbing, as well as the side effects of medication. Interactions between factors influencing occupational integration may be seen as an inextricable circle involving the three themes concerning the patient, his/her social environment and the disease, each of which calls for specific management. Identifying the factors underlying the difficulties experienced by persons suffering from epilepsy should enable optimal synergy between the skills of the various partners, to give rise to a virtuous circle facilitating occupational integration.Dans un monde du travail compétitif, l'accompagnement dans l'emploi des personnes souffrant d'épilepsie (PSE) doit être de plus en plus performant. Dans ce contexte, l'objectif de ce travail était d'identifier à partir des données de la littérature les facteurs d'insertion professionnelle et d'analyser leur retentissement afin de proposer des pistes de stratégie de prise en charge pluriprofessionnelle adaptée. Une recherche sur PubMed et ScienceDirect à partir des mots clés epilepsy, employment, employer, workplace ou work status a été réalisée en ciblant les données récentes publiées entre 2000 et 2014 et s'intéressant à des adultes vivant en Amérique du Nord, en Europe ou en Australie. Les facteurs recueillis ont été classés en trois thématiques. La première s'intéresse au ressenti des PSE, leur estime d'elles-mêmes, leur perception du regard des autres et leurs éventuelles croyances ou craintes vis-à-vis du travail. Ces sentiments font écho à la perception de l'épilepsie par l'entourage du malade, que nous développerons dans notre deuxième partie, réÎlant les préjugés persistants du grand public et la stigmatisation dans le monde du travail. Les crises et leur traitement sont abordés dans une dernière partie, notamment leur caractère imprévisible qui impressionne et dérange, ainsi que les contraintes et effets secondaires des médicaments. Les multiples facteurs d'insertion professionnelle peuvent être représentés comme un cercle inextricable impliquant les trois thématiques touchant le malade, son entourage et sa maladie ; chacune appelle à un type de prise en charge spécifique. L'identification des facteurs à l'origine des difficultés de la PSE devrait permettre une articulation optimale des compétences des différents partenaires afin de faciliter son intégration professionnelle

Regional differences and metabolic changes in normal aging of the human brain: proton MR spectroscopic imaging study

BACKGROUND AND PURPOSE: Aging is recognized to originate from a diversity of mechanisms that blur the limits between normal and pathologic processes. The purpose of this study was to determine the early effect of normal aging on the regional distribution of brain metabolite concentrations, including N-acetylaspartate (NAA), a major neuronal marker, choline (Cho), and creatine (Cr). METHODS: Thirty-two healthy participants, ages 21 to 61 years, were examined by proton MR spectroscopic ( 1 H MRS) imaging. 1 H MRS imaging acquisitions were performed in two brain locations: the centrum semiovale and the temporal lobe. Thirty voxels were selected in four cerebral regions, cortical, semioval, temporal, and hippocampal, and 1 H MR spectra were processed to determine the metabolite ratios. RESULTS: With advancing age of the participants, the ratios of %NAA, NAA:Cho, and NAA:Cr were significantly decreased, whereas the ratios of %Cho and %Cr were significantly increased in the cortical, semioval, and temporal regions. On the basis of the significant metabolic difference determined by cluster analysis, two groups of 16 participants with ages ranging from 21 to 39 years (younger group) and 40 to 61 years (older group) were compared

Chronic pseudo-angina left precordial chest pain caused by a thoracic meningioma

International audienceLeft precordial chest pain (LPCP) evokes above all angina. Eliminating a cardiac origin is then always the first priority. When cardiac causes are eliminated, non-cardiac causes are sought in order to avoid leaving patients with undiagnosed or undifferentiated chest pain. There is a myriad of non-cardiac causes ranging from heartburn, panic attacks, pleurisy, pulmonary embolism, pneumothorax, Tietze syndrome, bruises and fractures of the ribs, to spine meningioma, neuroma, herniated disk and impairment of the nerve roots. Although clinical presentation and characteristics of the pain are usually helpful in diagnosing the cause, conducting magnetic resonance imaging of the spine may be of a high utility in some situations. Here we report a case of chronic angina-like LPCP, caused by a thoracic meningioma

Congenital hypomyelinating neuropathy due to the association of a truncating mutation in PMP22 with the classical HNPP deletion

International audienceCongenital hypomyelinating neuropathy appears early in life, resulting in a delay of motor and sensory development. Mutations involve genes such as myelin protein zero (MPZ), peripheral myelin protein 22 (PMP22), and early growth response 2 (EGR2). We present a patient with two compound mutations in PMP22: a point mutation causing a premature STOP codon in exon 3 was inherited from the mother on the first allele, and the "typical" PMP22 deletion in the 17p11.2-p12 region was inherited from the father on the other allele. A sural biopsy was performed at age four. The patient has been followed from 28 months to 21 years of age; he presented significant sensory disturbances, with a slight motor deficit. PMP22 mRNA quantitation showed a severe decrease of PMP22 protein. No myelin sheaths were observed in the biopsy; mesaxons failed to form. The absence of PMP22 provides new insights into the role of this protein

Optimising homeothermy in neonates: A systematic review and clinical guidelines from the French Neonatal Society

AimThermal instability is harmful on the newborn infant. We sought to draw up practical guidelines on maintaining homeothermy alongside skin-to-skin contact.MethodsA systematic analysis of the literature identified relevant studies between 2000 and 2021 in the PubMed database. Selected publications were evaluated, and their level of evidence was graded, in order to underpin the development of clinical guidelines.ResultsWe identified 7 meta-analyses and 64 clinical studies with a focus on newborn infants homeothermy. Skin-to-skin contact is the easiest and most rapidly implementable method to prevent body heat loss. Alongside skin-to-skin contact, monitoring the newborn infant's body temperature with a target of 37.0°C is essential. For newborn infants <32 weeks of gestation, a skullcap and a polyethylene bag should be used in the delivery room or during transport. To limit water loss, inhaled gases humidification and warming is recommended, and preterm infants weighing less than 1600 g should be nursed in a closed, convective incubator. With regard to incubators, there are no clear benefits for single- versus double-wall incubators as well as for air versus skin servo control.ConclusionAlongside skin-to-skin contact, a bundle of practical guidelines could improve the maintenance of homeothermy in the newborn infant