Prognostic factors to succeed in surgical treatment of chronic acromioclavicular dislocations

AbstractIntroductionTreatment of chronic acromioclavicular joint dislocation (ACJD) remains a poorly known and controversial subject. Given the many surgical options, it is not always easy to determine which steps are indispensable.MethodsThis article reports a multicenter prospective study. The clinical and radiological follow-up involved a comparative analysis of the preoperative and postoperative data at 1 year, including pain (visual analogue scale), subjective functional incapacity (QuickDASH), and the objective Constant score, as well as a comparative analysis of vertical and horizontal movements measured on simple x-rays.ResultsBased on a series of 140 operated ACJDs, we included 24 chronic ACJDs. The mean time to surgery was 46 weeks (range, 1 month to 4 years). The patients’ mean age was 41 years, with a majority of males (75%), 72% of whom participated in recreational sports. Professionally, 40% of the subjects had jobs involving manual labor. We noted 40% grade III, 24% grade IV, and 36% grade V injury according to the Rockwood classification. In 92% of cases, coracoclavicular stabilization was provided by a double button implant, reinforced with a biological graft in 88% of the cases. In 29%, millimeters to centimeters of the distal clavicle were resected and acromioclavicular stabilization was associated in 54%. We observed complications in 33% of the cases. At 1 year postoperative, 21 patients underwent clinical and radiological follow-up (87.5%). Only 35% of the patients were satisfied or very satisfied, whereas 100% of them would recommend the operation. Full-time work was resumed in 91% of the cases and all sports could be resumed in 86%. The pre- and postoperative values at 1 year changed as follows: the mean Constant score improved from 61 to 87 (p=0.00002); the subjective QuickDASH score decreased from 41 to 9 (p=0.00002); and radiologically significant reduction of the initial displacement was observed in the vertical plane (p<10−3) and the horizontal plane (p=0.022).ConclusionIn this study, the favorable prognostic factors found were: time to surgery less than 3 months (p=0.02), associated acromioclavicular stabilization, and postoperative immobilization with a sling extended to 6 weeks. However, resection of the distal clavicle did not influence the final result.Level of proofLevel II prospective non-randomized comparative study

Spallation Neutron Production by 0.8, 1.2 and 1.6 GeV Protons on various Targets

Spallation neutron production in proton induced reactions on Al, Fe, Zr, W, Pb and Th targets at 1.2 GeV and on Fe and Pb at 0.8, and 1.6 GeV measured at the SATURNE accelerator in Saclay is reported. The experimental double-differential cross-sections are compared with calculations performed with different intra-nuclear cascade models implemented in high energy transport codes. The broad angular coverage also allowed the determination of average neutron multiplicities above 2 MeV. Deficiencies in some of the models commonly used for applications are pointed out.Comment: 20 pages, 32 figures, revised version, accepted fpr publication in Phys. Rev.

A step towards cinacalcet testing for the diagnosis of primary hyperparathyroidism: comparison with the standardized intravenous calcium loading. A pilot study

International audienceObjective : A calcium load to suppress parathyroid hormone (PTH) secretion can help to perform the diagnosis in some case of primary hyperparathyroidism (PHPT) with atypical presentation. A similar test with calcimimetic, which avoids hypercalcaemia, would be of interest. Our proof of concept study was conducted to compare firstly the results of a single‐dose cinacalcet testing with those of the standardized short‐time calcium load in healthy control (HC) and secondly the results of the single‐dose cinacalcet testing in HC and in PHPT.Methods : Twelve HCs received in a random order, at a 2‐week interval, either 0·33 mmol/kg calcium gluconate intravenously for 3 h, or a single oral dose of 30 mg or 60 mg cinacalcet. Twelve PHPTs received 30 mg cinacalcet and twelve other PHPTs 60 mg cinacalcet orally. Calcaemia and serum PTH levels were measured basally and then hourly for 6 h.Results : In HC, plasma calcium did not significantly change after cinacalcet intake, whereas calcaemia rose up to 3·47 ± 0·05 mmol/l (mean ± SEM) at the end of the calcium load. PTH dropped from basal level to a similar extend (≥80%) with 60 mg cinacalcet and calcium load, whereas the decrease was significantly lesser (P < 0·01) with 30 mg cinacalcet. In PHPT, serum PTH levels dropped by 44·8 ± 6·9% and 58·2 ± 5·3% 1 h after the respective intake of 30 and 60 mg cinacalcet. One hour after the oral intake of 60 mg cinacalcet, serum PTH levels were <8 ng/l in HC and ≥8 ng/l in PHPT.Conclusion : Sixty milligrams of cinacalcet provides similar results as the standardized calcium load test; PHPT patients have a lower response to 60 mg cinacalcet than HC

Relations between present vertical movements an sedimentary infilling in the Isère valley (Western Alps)

International audienc

Trame verte et bleue et espèces volantes. Note d’enjeux et de problématique

Ce rapport dresse un état des lieux des enjeux liés aux déplacements des espèces volantes, en particulier des oiseaux et des chauves-souris, confrontés à des obstacles spécifiques situés dans la strate aérienne. Il décrit ces principaux obstacles (éoliennes, lignes électriques, bâti, aéronefs), en présentant les potentiels problèmes rencontrés (dérangement, collisions, électrocutions, barotraumatisme, etc.) et en synthétisant les mesures de gestion préconisées pour les limiter. Il termine par un bilan de la prise en compte actuelle de cette problématique dans la Trame verte et bleue, en particulier aux échelles nationale (ON TVB) et régionale (SRCE) et conclut par une mise en perspective sur la nécessité de développer une trame aérienne en France

Trame verte et bleue et espèces volantes. Note d’enjeux et de problématique

Ce rapport dresse un état des lieux des enjeux liés aux déplacements des espèces volantes, en particulier des oiseaux et des chauves-souris, confrontés à des obstacles spécifiques situés dans la strate aérienne. Il décrit ces principaux obstacles (éoliennes, lignes électriques, bâti, aéronefs), en présentant les potentiels problèmes rencontrés (dérangement, collisions, électrocutions, barotraumatisme, etc.) et en synthétisant les mesures de gestion préconisées pour les limiter. Il termine par un bilan de la prise en compte actuelle de cette problématique dans la Trame verte et bleue, en particulier aux échelles nationale (ON TVB) et régionale (SRCE) et conclut par une mise en perspective sur la nécessité de développer une trame aérienne en France

Etalement urbain et changements globaux : l'urgence de considérer les sols et l'eau dans un modèle intégratif

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Deuteron stripping on beryllium target in the 100-2300 MeV energy range

Cross sections for stripping and dissociation of deuterons interacting with Be targets in the 100-2300 MeV energy range have been measured. Comparisons with model calculations suggest a dominant contribution of the stripping process. It is also shown that the deuteron break-up cross section exhibits the same energy dependence as the nucleon-nucleon cross section