Diagnostic imaging of equine thoracolumbar disorders

Equine thoracolumbar conditions represent a major cause of poor performance and locomotor disorders in sports and race horses. Advances in diagnostic imaging during the last 15 years allow today to diagnose most equine back lesions in the standing sedated horse. Radiography is the first choice imaging modality due to its high diagnostic performance. Ultrasonography is a complementary modality to further investigate back soft tissues and the caudal lumbar area not evaluable radiographically in the standing horse. Bone scintigraphy is a more complex and expensive technique and is usually dedicated to complicated clinical cases. The most frequent injuries diagnosed using these 3 modalities are kissing spines, osteo-arthrosis of the synovial intervetebral joints, vertebral spondylosis and muscle injuries. Clinical significance of these lesions should be interpreted with care considering the clinical signs exhibited by the horse but also its sports or racing useLes affections vertébrales thoracolombaires représentent une cause fréquente de baisse de performances et/ou de troubles locomoteurs chez les chevaux de sport et de courses. Le développement des techniques d’imagerie ces 15 dernières années permet aujourd’hui au vétérinaire équin de diagnostiquer un grand nombre de lésions affectant la colonne thoracolombaire sur le cheval debout tranquillisé. La radiographie du dos du cheval constitue la modalité d’imagerie de premier choix par sa capacité diagnostique élevée. L’échographie complète la radiographie dans l’exploration des tissus mous et de la région lombaire caudale, cette dernière n’étant pas accessible par radiographie sur le cheval debout. La scintigraphie, technique plus onéreuse et plus contraignante, est envisagée pour des cas cliniques complexes. Les lésions les plus fréquemment diagnostiquées avec ces techniques d’imagerie sont représentées par les conflits et fractures des processus épineux, les arthroses synoviales intervertébrales, les spondyloses vertébrales et les lésions musculaires. La signification clinique de ces lésions doit être évaluée en considérant les signes cliniques du patient mais également sa discipline sportiv

Interest of magnetic resonance imaging in the diagnosis of equine locomotor disorders

Magnetic Resonance Imaging (MRI) is the current gold standard in human medicine for locomotor apparatus imaging. This paper presents the interest of MRI in the diagnosis of equine locomotor disorders, based on patients examined at the CIRALE centre with a C-shape low-field system (0.2 T). The protocols used and indications of this technique are described. The diagnostic interest of MRI is then presented by anatomical entities. MRI is a very reliable technique to identify bone lesions which are radiologically invisible. Compared to ultrasonography, MRI provides images of all soft tissues in the foot, with greater tissue discrimination within the lesions. The downside, however, is that a general anesthesia is necessary to obtain diagnostic images of high quality. Moreover, current MRI systems are able to visualise only the distal segments of the limbs (including carpus and tarsus), the head, and the cervico-cranial hinge. The development of MRI systems designed to examine a standing horse is an interesting avenue of research, which would overcome these limitations.L'Imagerie par Résonance Magnétique (IRM) est aujourd'hui en médecine humaine la technique d'imagerie de référence pour l'appareil locomoteur. L'objectif de cet article est de présenter les apports de l'IRM dans le diagnostic des affections locomotrices du cheval à partir des patients examinés au CIRALE à l'aide d'une machine bas champ (0,2 T) avec une configuration en C. Les protocoles utilisés et les indications de cet examen sont décrits. Les apports de l'IRM au plan diagnostic sont ensuite présentés par type de formation anatomique. L'IRM permet notamment d'identifier, avec une grande fiabilité, des lésions osseuses qui ne sont pas visibles en radiographie. Elle présente, par rapport à l'échographie, la capacité d'imager l'ensemble des tissus mous du pied et permet une meilleure discrimination tissulaire au sein des lésions. En revanche, l'IRM requiert une anesthésie générale pour obtenir des images de grande qualité diagnostique. D'autre part, seules les régions distales des membres (jusqu'au carpe et tarse inclus), la tête et la région cervicale crâniale peuvent être examinées sur les machines actuelles. Pour pallier ces limites, le développement de machines IRM permettant l'imagerie sur cheval debout représente une voie de recherche intéressante

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

L'acquiescement à la vie ou la morale dans l'œuvre de Thomas Bernhard

The thematic study of Thomas Bernhard’s works aims at declaiming against the too widely-held idea that he is a pessimistic writer. The analysis of Thomas Bernhard’s morale takes into account the philosophical and psychological dimensions but still includes a large part to his search for happiness, in the relations with others, as well as in the approach to nature and the relation of the individual with himself. The influence of Johannes Freumbichler, both a writer and the author's grandfather, is also analyzed in order to bring to the fore both the basis of the bernhardian morale and the personal evolution of the author in his apprehension of existential values. moreover the study deals with the meaning that Thomas Bernhard endows life with, paying a particular attention to the numerous forms of expressing passion and its various effects but without neglecting the historical context in which the works lie and which undeniably constitutes a source of provocation for the author. Lastly the meaning of death, both omnipresent and prelude to freedom, allows to show the incredible existential strength which sustains the author.L’étude thématique de l'œuvre de Thomas Bernhard vise à dénoncer la renommée d'écrivain pessimiste trop largement accordée à l'auteur. L’analyse de la morale de Thomas Bernhard prend en compte les dimensions philosophiques et psychologiques en réservant une large place au thème de la recherche du bonheur, tant dans les relations avec autrui, dans l'approche de la nature, que dans la relation de l'individu à soi-même. L’influence de Johannes Freumbichler, écrivain et grand-père de l'auteur, est également analysée dans le but de mettre en évidence les fondements de la morale bernhardienne, mais aussi l'évolution personnelle de l'auteur dans son appréhension des valeurs existentielles. L’étude porte par ailleurs sur le sens que thomas Bernhard confère à la vie, en accordant une attention particulière aux multiples formes d'expression de la passion et à ses divers effets, sans négliger le contexte historique dans lequel s'inscrit l'œuvre, et qui constitue indéniablement une source de provocation pour l'auteur. Enfin, la signification de la mort, omniprésente et prélude à la liberté, permet de compléter la démonstration de l'incroyable force existentielle qui anime l'auteur

Qu'attendent les médecins généralistes du Loir-Et-Cher d'une équipe mobile de gériatrie ambulatoire ? (une étude qualitative)

TOURS-BU Médecine (372612103) / SudocSudocFranceF

Interagir avec un pair pour autoréguler son développement de compétences

peer reviewedFondé sur les commentaires de 215 étudiants de huit Masters français et belges organisés selon une approche par compétences (APC), ce chapitre explore les perceptions d’utilité que les étudiants ont de l’organisation formelle d’interactions en binômes pour autoréguler leur développement de compétences, et ce plus particulièrement lors de la phase d’autoévaluation. L’analyse repose sur les cadres théoriques de l’approche par compétences et de l’autorégulation. Les résultats sont discutés dans la perspective de l’amélioration des éléments de contexte que sont la structure de la situation, les interventions de l’équipe enseignante et les interactions entre pairs pour favoriser l’autorégulation des apprentissages.Based on feedback from 215 students from eight French and Belgian Masters organized according to a competency-based approach, this chapter explores the perceptions that students have of the formal organization of interactions in pairs to self-regulate their competence development, particularly during the self-assessment phase. The analysis relies on the theoretical frameworks of the competency-based approach and self-regulation. The results are discussed from the perspective of improving the following context elements in order to promote self-regulation of learning : the situation structure, the teaching team interventions and the peer interactions

Site-directed mutants of human myeloperoxidase. A topological approach to the heme-binding site.

Two site-directed mutants of human promyeloperoxidase, MPO(His416----Ala) and MPO(His502----Ala), have been expressed in Chinese hamster ovary cells and purified. Overall purification yields and apparent molecular masses of the mutant proteins were similar to those of the wild-type enzyme. Both mutant species were analyzed spectroscopically to check the presence of the hemic iron in the proteins and were assayed for peroxidase activity. The data show that substitution of His502 leads to the loss, or to an inappropriate configuration, of the heme together with the loss of activity, suggesting that this residue could be the proximal His involved in the binding to the iron centers. On the other hand, substitution of His416 by alanine had no effect on either of the studied parameters.Journal Articleinfo:eu-repo/semantics/publishe