Evaluation de l'IRM pre-thérapeutique des entorses graves récentes du genou (corrélation chirurgicale et fonctionnelle subjective)

Nous avons étudié les tenants et les aboutissants de l IRM, prospectivement sur 1 an, dans les entorses graves récentes du genou, depuis la prescription (261 patients) jusqu au devenir fonctionnel à distance par enquête téléphonique (217 patients) ; pour 95 patients le compte rendu arthroscopique a été confronté aux données IRM. L analyse des prescriptions montre que la rentabilité diagnostique de l IRM dépend du degré de suspicion clinique et du niveau d expertise du prescripteur, mais cela n interfère pas dans la prise en charge du patient. L IRM est excellente pour le diagnostic des lésions des ligaments croisés. La performance de l IRM pour les lésions méniscales internes est bonne, moindre pour le ménisque externe, ce qui concorde avec les données de la littérature. Le délai de prise en charge en IRM n affecte ni la performance diagnostique de l examen, ni le délai de la chirurgie. L enquête téléphonique confirme sur un court terme le bien fondé de la stratégie thérapeutique.GRENOBLE1-BU Médecine pharm. (385162101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

[Imaging findings in Lemierre syndrome]

International audienceLemierre syndrome is a septic thrombosis of the internal jugular vein with pulmonary abscesses secondary to untreated pharyngotonsillitis due to anaerobic bacteria. It occurs in young, previously healthy patients and leads to life-threatening consequences if not treated. We illustrate the value of imaging and particularly cervical and thoracic CT in a report of three recent cases

Multi-detector CT evaluation in patients suspected of tracheobronchomalacia: Comparison of end-expiratory with dynamic expiratory volumetric acquisitions.

International audiencePURPOSE: The aim of this study was to compare dynamic expiratory imaging and end-expiratory imaging using multi-detector CT (MDCT) of the central airways in patients suspected of tracheobronchomalacia (TBM). METHODS: This study had local ethical committee approval. Seventy patients suspected of TBM were prospectively included. All patients underwent evaluation of central airways by three different low-dose MDCT acquisitions: end inspiration, end expiration, and dynamic expiration. Degree of airway collapse was measured by calculating the percentage change in the area and diameter of the airways between inspiratory and the two expiratory techniques at three levels of the trachea and in the sagittal diameter of the right and left main bronchi. Three threshold levels of percentage reduction in diameter or area (30%, 50%, and 70%) for defining TBM were evaluated. RESULTS: In the entire population, the mean percentage of airway collapse was significantly greater with dynamic expiratory imaging than with the end-expiratory imaging at three different levels: lower thoracic trachea (26% vs. 16.6%, p<0.009), right (25.2% vs. 14%, p<0.01) and left main (24.7% vs. 13.3%, p<0.01) bronchus. Whatever the threshold value for defining TBM, dynamic expiratory imaging always resulted in diagnosing TBM in more patients than end-expiratory imaging. CONCLUSIONS: Dynamic expiratory imaging shows a significantly greater degree and a significantly greater extent of airway collapse than standard end-expiratory imaging in patients suspected of TBM. Further evaluation of the clinical relevance of such findings is warranted

Identifying specific needs in adult cystic fibrosis patients: a pilot study using a custom questionnaire

International audienceAbstract Background Adult patients with cystic fibrosis (CF) experience daily physical symptoms and disabilities that can be challenging to address for health care teams. Methods We sought to identify the most frequent topics that CF adults need to discuss with health care teams using a custom questionnaire including 62 items. Results Fifty patients were included, 70% men, mean age 27.6 years, with a mean body mass index of 21.8 kg/m 2 . Mean FEV 1 % was 64% of predicted value. Forty-two percent of patients selected at least one topic. The most frequently selected topics were fatigue (20%), professional or scholar worries (18%), procreation (16%), physical activities (16%) and evolution of CF disease (16%). Women were more frequently concerned about fatigue, procreation and profession/school. Conclusions Using a custom questionnaire, we identified that CF adults express various unmet needs that extend beyond usual respiratory and nutritional concerns or treatment adherence. The interest of this questionnaire by health care team for improving therapeutic management of CF patients remains to be validated. Trial registration : The study was registered on ClinicalTrials.gov (NCT02924818) on 5th October 2016

Cereals in S.W. Anatolia since 2.3 Ma

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Unravelling the step-by-step process for farming system design to support agroecological transition

International audienceGiven the huge challenges agriculture has to face, both in Northern and Southern countries, a radical change in farming practices towards agroecology is required. Most scientific literature on the design of new farming systems describes de novo approaches, which focus on disruption and novelty, without any concern for the way to move from the current system to the innovative one. In this study, we highlight, for the first time, the particular traits of what we will call the step-by-step design approach. In this aim, we disentangled 9 case studies of practice change in commercial or experimental farms through the lens of theoretical frameworks derived from three scientific fields: design sciences, farming system research, and change pathways analysis. From data collected in each case study, and collective interactions among the authors of this paper, we identified commonalities across cases, in the aim to produce guidelines for actors willing to engage, characterize or support such design processes in the future. We thus show that step-by-step design appears as (i) a situated design process fueled by action, (ii) structured by iterative loops diagnosis-exploration-implementationassessment, fostered by learning, (iii) progressively shaping a desirable unknown, (iv) supported by specific tools, and (v) intertwining individual and collective dimensions. This approach is well adapted to manage the agroecological transition: by its temporality, by its capacity to overcome knowledge gaps through learning, by its contribution to farmers' empowerment, and by its capacity to tailor solutions to local specificities. By doing so, it allows the progressive implementation of profound systemic changes. Finally, this article provides benchmarks to encourage increased Research & Development investment in this type of approach, contributing to open innovation, to enhance the agroecological transition

The long continental sequence of Acigöl: a 2.4 Ma record in the Homo erectus area of SW Turkey.

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Proto-céréales et interactions biotiques au cours des 2,3 Ma

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Continuous presence of proto-cereals in Anatolia since 2.3 Ma, and their possible co-evolution with large herbivores and hominins

International audienceAbstract Cereals are a central resource for the human diet and are traditionally assumed to have evolved from wild grasses at the onset of the Neolithic under the pressure of agriculture. Here we demonstrate that cereals may have a significantly longer and more diverse lineage, based on the study of a 0–2.3 Ma, 601 m long sedimentary core from Lake Acıgöl (South-West Anatolia). Pollen characteristic of cereals is abundant throughout the sedimentary sequence. The presence of large lakes within this arid bioclimatic zone led to the concentration of large herbivore herds, as indicated by the continuous occurrence of coprophilous fungi spores in the record. Our hypothesis is that the effects of overgrazing on soils and herbaceous stratum, during this long period, led to genetic modifications of the Poaceae taxa and to the appearance of proto-cereals. The simultaneous presence of hominins is attested as early as about 1.4 Ma in the lake vicinity, and 1.8 Ma in Georgia and Levant. These ancient hominins probably benefited from the availability of these proto-cereals, rich in nutrients, as well as various other edible plants, opening the way, in this region of the Middle East, to a process of domestication, which reached its full development during the Neolithic