Radial neck fracture in children: anatomic and functional results of Metaizeau technique

Fractures of the radial neck accounts for 1% of all childhood fractures and 5% to 10% of childhood traumatic lesions involving the elbow. Intramedullary percutaneous nail reduction (Metaizeau technique) is considered the most effective surgical technique. The purpose of this study was to identify the main clinical features of radial neck fracture in children and to evaluate the anatomical and functional results of the Metaizeau technique. In this retrospective study, we evaluated 22 patients under the age of 16 who were treated for radial neck fracture at the orthopedic and trauma surgery department of Sahloul University Hospital in Sousse over a period of 16 years from January 2001 to April 2017. Authors used Metaizeau classification. Functional results were evaluated by Mayo elbow performance score (MEPS) and the radiological evaluation was based on standard images with measurement of the residual rocker. The average age was 8.6 years (5-13 years). Seven fracture were grade III injuries and three grade IV. In the immediate postoperative period, radiological measurements showed a residual rocker less than 20° in 86.3% and more than 20° in 13.7% of cases. At an average follow-up of 13 months and a half, the MEPS score was excellent and good for 17 patients. Four types of complications were found: necrosis of the radial head in 1 case, pseudarthrosis in 1 case, periarticular calcification in 2 cases and stiff-ness of the elbow in 3 cases. Despite the small number of patients in our series, we believe that the elastic stable intramedullary pinning according to the Metaizeau technique is the treatment of choice for displaced radial neck fractures in children

Infection of Ixodes ricinus (Acari: Ixodidae) by Borrelia burgdorferi sensu lato in North Africa

Free-living adult Ixodes ricinus L. were collected in Amdoun, situated in the Kroumiry mountains in northwestern Tunisia (North Africa). Using direct fluorescence antibody assay, the infection rate of field-collected I. ricinus by Borrelia burgdorferi sensu lato was 30.5% (n = 72). No difference in infection rate was observed between male and female ticks. Spirochetes that had been isolated from I. ricinus from Ain Drahim (Kroumiry Mountains) in 1988 were identified as Borrelia lusitaniae (formerly genospecies PotiB2). This is the first identification of a genospecies of Borrelia burgdorferi sensu lato from the continent of Afric

Ten questions about antiangiogenic in hepatocellular carcinoma

La validation du sorafenib dans le carcinome hépatocellulaire (CHC) avancé a permis un progrès majeur dans la prise en charge des patients atteints de cette maladie et a entraîné un déferlement d’investigations portant sur des agents ciblés dans cette pathologie. Un concept important est que la tolérance et l’efficacité de cet agent reposent sur une sélection optimale des patients. Cependant, plusieurs questions pertinentes restent non résolues concernant l’utilisation du sorafenib en routine clinique. En effet, si le sorafenib a permis une amélioration significative de la survie globale des patients atteints d’un CHC avancé sur cirrhose Child A comparativement au placebo, ceci contraste avec de faibles taux de réponse obtenus par cette molécule selon les critères RECIST. Ainsi, de nouveaux paramètres intégrant des modifications de densité intratumorale pourraient être pris en compte en plus des critères dimensionnels pour juger de l’efficacité objective de cette drogue. Actuellement, les recherches en cours doivent définir la place des antiangiogéniques en association avec les autres approches thérapeutiques et identifier des biomarqueurs fiables prédictifs de réponse.The recent approval of sorafenib for advanced hepatocellular carcinoma (HCC) has been a breakthrough for patient care and has led to a flurry of clinical studies in HCC. Undeniably, patient selection is a crucial issue for treatment tolerance and efficacy. Routine clinical practice raised several important questions. Even if sorafenib showed a clear improvement in overall survival, minimal responses by traditional RECIST criteria were observed. Beside dimensional measurement, new parameters including intratumor density are requested for appropriate evaluation. Finally, future researches integrate antiangiogenic agents in combination with other approaches and identify reliable predictive biomarkers of response

Update on novel antiangiogenic compounds

Les antiangiogéniques de 2e génération sont, pour la majorité, des inhibiteurs de récepteurs tyrosine-kinase membranaires dont nous retenons, dans cet article, les composés ayant atteint les phases II ou III randomisées. Leur rôle consiste, soit à améliorer la puissance d’inhibition sur des cibles déjà validées (VEGFR, PDGFR, KIT), soit à étendre leur spectre d’inhibition envers des cibles supplémentaires telles que FGFR, RET ou EGFR. En dehors de leurs propriétés sur le plan biologique, les chances de succès de ces nouveaux composés reposent également sur le choix judicieux des pathologies auxquelles ils s’adresseront.The second generation of antiangiogenics mainly includes membrane tyrosine kinase receptor inhibitors. This chapter summarizes clinical results of compounds that reached phase II and/or randomized phase III clinical trials. The aims of these agents are to improve the inhibition on validated targets (VEGFR, PDGFR, KIT) or to enlarge the spectrum of inhibition toward additional targets including FGFR, RET or EGFR. Beside intrinsic biological properties, the selection of appropriate disease appears critical to ensure future success in the development of those novel compounds

Upravljanje otporno na kvarove asinkronog motora zasnovano na deskriptorskom observeru

This paper presents an active Fault Tolerant Control (FTC) strategy for induction motor (IM) that ensures Field Oriented Control (FOC) and offset the effect of the sensor faults despite of the load torque disturbance. The proposed approach uses a fuzzy descriptor approach to estimate simultaneously the system state and the sensor fault. The physical model of IM is approximated by the Takagi-Sugeno (T-S) fuzzy technique in the synchronous d-q rotating frame with field-oriented control strategy. The stability conditions are analyzed using Lyapunov theory. The controller and observers gains are calculated by solving a set of Linear Matrix Inequalities (LMIs). Finally, the effectiveness of the proposed strategy have been illustrated in simulation and experimental results.U ovom radu je predstavljena strategija upravljanja otpornog na kvarove za asinkroni motor koja omogućuje vektorsko upravljanje bez pogreške uslijed kvara senzora i postojećeg poremećaja momenta tereta. Predloženi pristup koristi neizraziti deskriptor za estimaciju stanja sustava i kvara senzora. Fizikalni model asinkronog motora s vektorskim upravljanjem aproksimiran je korištenjem Takagi-Sugeno modela u rotirajućem d-q koordinatnom sustavu. Uvjeti stabilnosti analizirani us korištenjem Ljapunovljeve teorije. Konstante pojačanja regulatora i obzervera su izračunati rješavanjem skupa linearnih matričnih nejednadžbi. Učinkovitost predložene strategije je ilustrirana simulacijskim i eksperimentalnim rezultatima

Specificities and challenges of imaging response in pancreatic neuroendocrine tumors treated with targeted therapies

Les tumeurs neuroendocrines pancréatiques bien différenciées (pNET) sont richement vascularisées et ont une imagerie caractéristique au scanner. Lorsque ces tumeurs sont traitées par une thérapie ciblée, en particulier un antiangiogénique tel que le sunitinib, ces lésions présentent peu de changement de taille, mais des modifications de la densité tumorale. Les faibles taux de réponse objective (< 10 %) rapportés dans les 2 études randomisées ayant permis l’AMM pour le sunitinib et l’évérolimus dans les pNET, confirment que les critères RECIST sont insuffisants à évaluer ces thérapies ciblées, nécessitant l’exploration de nouveaux critères tels que ceux de Choi, qui intègrent les variations de densité tumorale.Well-differentiated pancreatic neuroendocrine tumors (pNET) are highly vascularized and display specific imaging patterns on CT-scans. When treated with targeted therapies such as the VEGFR inhibitor sunitinib, target lesions show limited if any variation in dimensions, but modifications in tumor density. The low rates of objective response (< 10%) reported in the 2 randomized trials leading to the approval of sunitinib and everolimus in pNET highlight the limits of RECIST criteria to evaluate the effects of targeted therapies, warranting to explore new endpoints involving variation of tumor density, such as Choi criteria

Tislelizumab in Patients with Previously Treated Advanced Hepatocellular Carcinoma (RATIONALE-208): A Multicenter, Non-Randomized, Open-Label, Phase 2 Trial

Introduction: Tislelizumab (anti-programmed cell death protein 1 antibody) showed preliminary antitumor activity and tolerability in patients with advanced solid tumors, including hepatocellular carcinoma (HCC). This study aimed to assess the efficacy and safety of tislelizumab in patients with previously treated advanced HCC. Methods: The multi-regional phase 2 study, RATIONALE-208, examined single-agent tislelizumab (200 mg intravenously every three weeks) in patients with advanced HCC with Child-Pugh A, Barcelona Clinic Liver Cancer stage B or C, and who had received one or more prior lines of systemic therapy. The primary endpoint was objective response rate (ORR), radiologically confirmed per Response Evaluation Criteria in Solid Tumors version 1.1 by Independent Review Committee. Safety was assessed in patients who received ≥1 dose of tislelizumab. Results: Between April 9, 2018 and February 27, 2019, 249 eligible patients were enrolled and treated. After a median study follow-up of 12.7 months, ORR was 13% (n = 32/249; 95% confidence interval [CI], 9–18), including five complete and 27 partial responses. Number of prior lines of therapy did not impact ORR (one prior line, 13% [95% CI, 8–20]; two or more prior lines, 13% [95% CI, 7–20]). Median duration of response was not reached. Disease control rate was 53% and median overall survival was 13.2 months. Of the 249 total patients, grade ≥3 treatment-related adverse events were reported in 38 (15%) patients; the most common was liver transaminase elevations in 10 (4%) patients. Treatment-related adverse events led to treatment discontinuation in 13 (5%) patients or dose delay in 46 (19%) patients. No deaths were attributed to the treatment per investigator assessment. Conclusion: Tislelizumab demonstrated durable objective responses, regardless of the number of prior lines of therapy, and acceptable tolerability in patients with previously treated advanced HCC