Total knee arthroplasty in valgus knee

SummaryTotal knee arthroplasty (TKA) in valgus knee has the reputation of being more difficult than in well aligned or varus knee, and there is no management consensus. Results on a continuous series of 100 TKAs on valgus knee were compared to the literature data, to define surgical strategy adapted to the various types of valgus knee

Les compléments neurophysiologiques du diagnostic

Neurophysiological complements of autism diagnosis Research presented show relationships between behavioral and cognitive disorders and underlying cerebral functional abnormalities, on the basis of non invasive electrophysiological investigations (electroencephalography, cortical evoked potentials). Three types of disturbances are studied: sleep problems, intolerance to change and atypical visual processing of human faces. The complementarity of clinical and neurophysiological approaches is crucial at the levels of functional diagnosis, therapeutic and educative interventions

Total ankle arthroplasty - total ankle arthroplasty in Western France: influence of volume on complications and clinical outcome

INTRODUCTION: Total ankle arthroplasty (TAA) has become an alternative to ankle arthrodesis in the treatment of advanced osteoarthritis. "The difficulty of performing a total ankle replacement and the corresponding steep learning curve" has resulted in a proposal "to limit ankle replacement to centers that have performed at least ten total ankle replacements for at least 3 years". The aim of this study was to evaluate the influence of the frequency of TAA procedures on the complications and outcome of these arthroplasties. MATERIALS AND METHODS: This retrospective series included 183 cases who underwent surgery between 1997-2010 in eight centers: three high volume centers performed at least five TAA per year (100 cases) and six low volume centers performed less than five TAA per year (78 cases). RESULTS: The clinical assessment was performed in 133 cases that were reviewed after a mean 39 months ± 29 of follow-up. The preoperative AOFAS score was 33 ± 4 and 77 ± 15 at the final follow-up. The five-year survival rate was 86%. No significant difference was found between the groups for the AOFAS score or implant survival at the final follow-up. The high volume centers experienced more complications (45% versus 13%) but fewer implant failures (8% versus 13%) overall compared to the low volume centers. DISCUSSION: The outcome of TAA depends mainly upon the pertinence of the indication and the associated procedures that may be necessary. Rather than limiting TAA to high volume reference centers, we suggest that the assessment of each case within a predetermined area should be done in a network. This would determine the degree of specialization required for each TAA case and provide all patients with safe and equal access to this therapeutic option. LEVEL OF EVIDENCE: IV - Retrospective study

Functional morphological imaging of autism spectrum disorders: Current position and theories proposed

AbstractAutism is a pervasive disorder of childhood development. Polymorphous clinical profiles combining various degrees of communication and social interaction with restricted and stereotyped behaviour are grouped under the heading of ‘autism spectrum disorders’ (ASD). Many teams are trying to pick out the underlying cerebral abnormalities in order to understand the neuronal networks involved in relationships with others. Here we review the morphological, spectroscopic and functional abnormalities in the amygdala-hippocampal circuit, the caudate nuclei, the cerebellum, and the frontotemporal regions, which have been described in subjects with ASD. White matter abnormalities have also been described in diffusion tensor imaging, leading to suspected damage to the subjacent neural networks, such as mirror neurones or the social brain

Xq27 FRAXA locus is a strong candidate for dyslexia: evidence from a genome-wide scan in French families.

Dyslexia is a frequent neurodevelopmental learning disorder. To date, nine susceptibility loci have been identified, one of them being DYX9, located in Xq27. We performed the first French SNP linkage study followed by candidate gene investigation in dyslexia by studying 12 multiplex families (58 subjects) with at least two children affected, according to categorical restrictive criteria for phenotype definition. Significant results emerged on Xq27.3 within DYX9. The maximum multipoint LOD score reached 3,884 between rs12558359 and rs454992. Within this region, seven candidate genes were investigated for mutations in exonic sequences (CXORF1, CXORF51, SLITRK2, FMR1, FMR2, ASFMR1, FMR1NB), all having a role during brain development. We further looked for 50 UTR trinucleotide repeats in FMR1 and FMR2 genes. No mutation or polymorphism co-segregating with dyslexia was found. This finding in French families with Dyslexia showed significant linkage on Xq27.3 enclosing FRAXA, and consequently confirmed the DYX9 region as a robust susceptibility locus. We reduced the previously described interval from 6.8 (DXS1227–DXS8091) to 4 Mb also disclosing a higher LOD score

Metabolomics Study of Urine in Autism Spectrum Disorders Using a Multiplatform Analytical Methodology

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder with no clinical biomarker. Aims of this study were to characterize a metabolic signature of ASD, and to evaluate multi-platform analytical methodologies in order to develop predictive tools for diagnosis and disease follow up. Urines were analyzed using: 1H- and 1 H-13C-NMR-based approaches and LC-HRMS-based approaches (ESI+ and ESI- on a HILIC and C18 chromatography column). Data tables obtained from the six analytical modalities on a training set of 46 urines (22 autistic children and 24 controls) were processed by multivariate analysis (OPLS-DA). Prediction of each of these OPLS-DA models were then evaluated using a prediction set of 16 samples (8 autistic children and 8 controls) and ROC curves. Thereafter, a data fusion block-scaling OPLS-DA model was generated from the 6 best models obtained for each modality. This fused OPLSDA model showed an enhanced performance (R 2Y(cum)=0.88, Q 2 (cum)=0.75) compared to each analytical modality model, as well as a better predictive capacity (AUC=0.91, p-value 0.006). Metabolites that are most significantly different between autistic and control children (p<0.05) are indoxyl sulfate, N-\u2329-Acetyl-L-arginine, methyl guanidine and phenylacetylglutamine. This multi-modality approach has the potential to contribute to find robust biomarkers and characterize a metabolic phenotype of the ASD population

Local Processing Bias Impacts Implicit and Explicit Memory in Autism

Autism spectrum disorder (ASD) is characterized by atypical perception, including processing that is biased toward local details rather than global configurations. This bias may impact on memory. The present study examined the effect of this perception on both implicit (Experiment 1) and explicit (Experiment 2) memory in conditions that promote either local or global processing. The first experiment consisted of an object identification priming task using two distinct encoding conditions: one favoring local processing (Local condition) and the other favoring global processing (Global condition) of drawings. The second experiment focused on episodic (explicit) memory with two different cartoon recognition tasks that favored either local (i.e., processing specific details) or a global processing (i.e., processing each cartoon as a whole). In addition, all the participants underwent a general clinical cognitive assessment aimed at documenting their cognitive profile and enabling correlational analyses with experimental memory tasks. Seventeen participants with ASD and 17 typically developing (TD) controls aged from 10 to 16 years participated to the first experiment and 13 ASD matched with 13 TD participants were included for the second experiment. Experiment 1 confirmed the preservation of priming effects in ASD but, unlike the Comparison group, the ASD group did not increase his performance as controls after a globally oriented processing. Experiment 2 revealed that local processing led to difficulties in discriminating lures from targets in a recognition task when both lures and targets shared common details. The correlation analysis revealed that these difficulties were associated with processing speed and inhibition. These preliminary results suggest that natural perceptual processes oriented toward local information in ASD may impact upon their implicit memory by preventing globally oriented processing in time-limited conditions and induce confusion between explicit memories that share common details

Evaluating Sex and Age Differences in ADI-R and ADOS Scores in a Large European Multi-site Sample of Individuals with Autism Spectrum Disorder

Research on sex-related differences in Autism Spectrum Disorder (ASD) has been impeded by small samples. We pooled 28 datasets from 18 sites across nine European countries to examine sex differences in the ASD phenotype on the ADI-R (376 females, 1763 males) and ADOS (233 females, 1187 males). On the ADI-R, early childhood restricted and repetitive behaviours were lower in females than males, alongside comparable levels of social interaction and communication difficulties in females and males. Current ADI-R and ADOS scores showed no sex differences for ASD severity. There were lower socio-communicative symptoms in older compared to younger individuals. This large European ASD sample adds to the literature on sex and age variations of ASD symptomatology

Demographic, clinical, and service-use characteristics related to the clinician’s recommendation to transition from child to adult mental health services

Purpose: The service configuration with distinct child and adolescent mental health services (CAMHS) and adult mental health services (AMHS) may be a barrier to continuity of care. Because of a lack of transition policy, CAMHS clinicians have to decide whether and when a young person should transition to AMHS. This study describes which characteristics are associated with the clinicians’ advice to continue treatment at AMHS. Methods: Demographic, family, clinical, treatment, and service-use characteristics of the MILESTONE cohort of 763 young people from 39 CAMHS in Europe were assessed using multi-informant and standardized assessment tools. Logistic mixed models were fitted to assess the relationship between these characteristics and clinicians’ transition recommendations. Results: Young people with higher clinician-rated severity of psychopathology scores, with self- and parent-reported need for ongoing treatment, with lower everyday functional skills and without self-reported psychotic experiences were more likely to be recommended to continue treatment. Among those who had been recommended to continue treatment, young people who used psychotropic medication, who had been in CAMHS for more than a year, and for whom appropriate AMHS were available were more likely to be recommended to continue treatment at AMHS. Young people whose parents indicated a need for ongoing treatment were more likely to be recommended to stay in CAMHS. Conclusion: Although the decision regarding continuity of treatment was mostly determined by a small set of clinical characteristics, the recommendation to continue treatment at AMHS was mostly affected by service-use related characteristics, such as the availability of appropriate services