Cell Interaction and Mechanobiological Modeling of Bone Remodeling Process

According to the structural and metabolic demands of the body, proportionate and accurate bone quantities are resorbed and formed, establishing what is known as bone remodeling process. This physiological process requires a highly coordinated regulation through a complex interconnected network involving several cells from diverse origins, in addition to various hormones, cytokines, growth factors and signaling pathways. One of the main factors initiating the remodeling process is the mechanotransduction mechanism, through which osteocytes translate the mechanical stimuli subjected to the bone into biochemical signals, generating thereby the activation of osteoclasts and osteoblasts that govern bone resorption and formation. This mechanically-induced behavior of bone tissue has been the target of computational modeling and numerical simulations, to address biomechanical questions and provide information that is not amenable to direct measurements. In this context, the current chapter aims to review the coupling and mechanotransduction mechanisms spearheading the remodeling process, in addition to the main mathematical models developed over recent years and their use in bone numerical simulations based on the finite element method

The Effects of Eccentric and Plyometric Training Programs and Their Combination on Stability and the Functional Performance in the Post-ACL-Surgical Rehabilitation Period of Elite Female Athletes

BackgroundThe standard method to treat physically active patients with anterior cruciate ligament (ACL) rupture is ligament reconstruction surgery. The rehabilitation training program is very important to improve functional performance in recreational athletes following ACL reconstruction.ObjectivesThe aims of this study were to compare the effects of three different training programs, eccentric training (ECC), plyometric training (PLYO), or combined eccentric and plyometric training (COMB), on dynamic balance (Y-BAL), the Lysholm Knee Scale (LKS), the return to sport index (RSI), and the leg symmetry index (LSI) for the single leg hop test for distance in elite female athletes after ACL surgery.Materials and MethodsFourteen weeks after rehabilitation from surgery, 40 elite female athletes (20.3 ± 3.2 years), who had undergone an ACL reconstruction, participated in a short-term (6 weeks; two times a week) training study. All participants received the same rehabilitation protocol prior to the training study. Athletes were randomly assigned to three experimental groups, ECC (n = 10), PLYO (n = 10), and COMB (n = 10), and to a control group (CON: n = 10). Testing was conducted before and after the 6-week training programs and included the Y-BAL, LKS, and RSI. LSI was assessed after the 6-week training programs only.ResultsAdherence rate was 100% across all groups and no training or test-related injuries were reported. No significant between-group baseline differences (pre-6-week training) were observed for any of the parameters. Significant group-by-time interactions were found for Y-BAL (p < 0.001, ES = 1.73), LKS (p < 0.001, ES = 0.76), and RSI (p < 0.001, ES = 1.39). Contrast analysis demonstrated that COMB yielded significantly greater improvements in Y-BAL, LKS, and RSI (all p < 0.001), in addition to significantly better performances in LSI (all p < 0.001), than CON, PLYO, and ECC, respectively.ConclusionIn conclusion, combined (eccentric/plyometric) training seems to represent the most effective training method as it exerts positive effects on both stability and functional performance in the post-ACL-surgical rehabilitation period of elite female athletes

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

The Effect of Whole-Body Electromyostimulation Program on Physical Performance and Selected Cardiometabolic Markers in Obese Young Females

International audienceBackground and Objectives: Whole-body electromyostimulation is under investigation as a potential aid for obesity-related health problems, supplementing a comprehensive, evidence-based obesity management strategy that includes lifestyle, diet, and exercise. The study investigated the impact of a whole-body electromyostimulation training program on physical performance and cardiometabolic markers in young obese females. Materials and Methods: Twenty-eight obese females, aged over 18 years with BMI over 30 and body fat over 28% and no underlying health conditions or medication, were divided into a whole-body electromyostimulation group (15 participants) and a control group (13 participants). The whole-body electromyostimulation program lasted 12 weeks, with two 20 min sessions weekly, using bipolar, rectangular current. Assessments pre and post intervention included body composition, blood pressure, lipid profile, C-reactive protein levels, maximal oxygen consumption, and jumping and sprint performance. Two-way ANOVA and t-tests were used for analysis. Results: Statistical analysis revealed significant (group × time) interactions for body composition, systolic blood pressure, maximal oxygen consumption, jumping and sprint performance, and plasma levels of lipids and C-reactive protein. Post hoc analyses for the whole-body electromyostimulation group indicated improvements in body composition indices (p < 0.01), systolic blood pressure (p = 0.003), maximal oxygen consumption (p = 0.010), and both jumping and 30 m sprint performance (p < 0.001 and p = 0.001, respectively) after the intervention. Furthermore, plasma levels of lipids (p < 0.01) and C-reactive protein (p = 0.002) showed significant improvements following the training program. In contrast, no significant changes were observed for these variables in the control group. Conclusions: A 12-week whole-body electromyostimulation program significantly improved body composition (skeletal muscle mass, body mass index, body fat, and waist circumference), physical performance (maximal oxygen consumption, jumping and sprint performance), and certain cardiometabolic (plasma level of lipids) and inflammatory markers (C-reactive protein) in obese young women. Further research is needed to explore the broader effects of whole-body electromyostimulation on physical and cardiometabolic health

The effects of different rehabilitation training modalities on isokinetic muscle function and male athletes’ psychological status after anterior cruciate ligament reconstructions

Abstract Background Previously, researchers reported performance enhancements following long-term plyometric training in athletes with anterior cruciate ligament reconstruction (LCA). However, the effects of combined eccentric and plyometric training on measures of isokinetic strength and psychological statues in male athletes have not been examined yet. Knowledge on the effects of combined eccentric and plyometric training help to better plan and program rehabilitations sessions and thus return-to-sports. Objective This study sought to compare the effects of three different rehabilitation training programs, eccentric training (ECC), plyometric training (PLYO), or combined eccentric and plyometric training (COMB), on psychological measures (kinesiophobia [TSK-CF], functional knee assessment, knee injury and osteoarthritis outcome score [KOOS], international knee documentation committee 2000 questionnaire [IKDC], and knee flexor and extensor isokinetic muscle performance (peak torque [PT], total work, ratio [R-HQ], and ratio of total work [R-TW]) at different angular velocities post ACL surgery in male elite athletes. Methods Forty elite male athletes from different sports (e.g., athletics, team sports) with ACL reconstruction participated in this study. The study started after a 14-weeks post-surgery rehabilitation program, which was identical for all subjects. After this initial rehabilitation period, athletes were randomly assigned to three experimental groups, ECC (n = 10), PLYO (n = 10), and COMB (n = 10), and a control group (CON: n = 10). Testing was conducted pre- and post-the 6-weeks intervention period and included the TSK-CF, KOOS, and IKDC. Peak torque of the knee extensors/flexors was tested at 90, 180, 240 °/s, after the 6-weeks training program only. Results Participants’ adherence rate was 100% across all groups and none reported any training or test-related injury. No significant between-group baseline differences (pre-6-weeks intervention) were observed for any of the reported psychological and muscle strength parameters. Significant group-by-time interactions were found for TSK-CF (p = 0.001, d = 2.85), KOOS (p = 0.001, d = 1.31), and IKDC (p = 0.001, d = 1.07). The post-hoc analyses indicated that COMB showed larger pre-post improvements for all psychological variables (p < 0.001, d = 2.95 to 13.15), compared with PLYO, ECC, and CON. Contrast analyses demonstrated that COMB yielded significantly greater improvements compared with CON, PLYO, ECC for all isokinetic parameters at all three angular velocities (all p < 0.001, d = 0.99 to 4.61). Conclusion The results showed that COMB induced greater gains for measures of psychological status and isokinetic muscle strength compared with single-mode PLYO and ECC in elite male athletes during a post-surgery ACL rehabilitation period. Accordingly, it is recommended to implement COMB as an effective rehabilitation means to improve knee function in male elite athletes. Trial registration This study does not report results related to health care interventions using human participants and therefore it was not prospectively registered

La santé à l'école

D’une conception traditionnelle fondée sur l’hygiène et la prévention des maladies à la prise en compte du bien-être global des enfants, la définition de la santé à l’école a beaucoup évolué au fil des deux derniers siècles, sous l’influence des grandes organisations internationales. Si nombre de recherches portent sur ce sujet, force est de constater que peu d’études examinent les relations établies entre les familles, l’école et les professionnels de santé. Ces trois acteurs également concernés partagent-ils les mêmes objectifs et les mêmes attentes ? Comment s’articulent les normes scolaires et les normes de santé ? Qui possède l’expertise et le pouvoir d’agir ? Le 89e dossier de la Revue internationale d’éducation de Sèvres s’intéresse aussi bien aux représentations et aux pratiques de chacun qu’aux effets des dispositifs mis en place, dans des pays aux contextes socioculturels et politiques variés. Même si les études de cas font ressortir une grande diversité de réponses et de situations, il est intéressant de souligner des éléments de convergence tels que l’approche des besoins spécifiques des enfants, l’attention portée aux troubles scolaires, la question de la prévention, ou encore la recherche du bien-être des élèves. L’équilibre entre les acteurs reste toutefois fragile et le sujet ne demande qu’à être davantage exploré. Études de cas : Allemagne, Belgique, Cameroun, Chine, Pays-Bas, Pologne, comparaison Québec-Flandre, Tunisie, Turquie. The scope of health in schools has changed significantly over the last two centuries under the influence of major international organisations: from a traditional focus on hygiene and disease prevention it has evolved to encompass children's overall wellbeing. While there is much research on this subject, few studies examine the relationships between families, schools and health professionals. While all three play a part in health education, do they share the same objectives and expectations? How do school and health standards relate to each other? Who has the expertise and the power to act? The 89th issue of the Revue internationale d'éducation de Sèvres focuses on the representations and practices of each of these actors as well as on the effects of the measures taken in ten countries with different socio-cultural and political contexts. Even if the case studies reveal a great diversity of responses and situations, it is worth highlighting elements of convergence such as a focus on the individual needs of the child, on special education needs, preventative interventions and pupils’ wellbeing. However, the balance between actors remains fragile and the topic requires further investigation. Case studies: Belgium, Cameroon, China, Germany, Netherlands, Poland, Quebec-Flanders comparison, Tunisia, Turkey. La definición de la salud en las escuelas ha conocido una notable evolución en los últimos dos siglos bajo la influencia de las grandes organizaciones internacionales, desde las concepciones tradicionales decimonónicas fundadas en la higiene y la prevención de las enfermedades hasta la consideración actual del bienestar global de los niños. Si no faltan las investigaciones sobre este particular, cabe constatar que son pocos los estudios que examinan las relaciones establecidas entre las familias, la escuela y los profesionales de la salud. ¿Comparten estos tres actores igualmente participantes del proceso los mismos objetivos y las mismas expectativas? ¿Cómo se articulan las normas escolares y las normas sanitarias? ¿Quién posee la pericia y el poder de actuar? El número 89 de la Revue internationale d’éducation de Sèvres se interesa tanto por las representaciones y las prácticas de cada uno como por los efectos de los dispositivos desarrollados en unos diez países con contextos socioculturales y políticos variados. Aunque se desprendan de los estudios de caso una gran diversidad de respuestas y de situaciones, es interesante subrayar la existencia de unos elementos de convergencia tales y como la aproximación de las necesidades específicas de los niños, la atención otorgada a los problemas escolares, el tema de la prevención o también la búsqueda del bienestar para los alumnos. Sin embargo, el equilibrio entre los actores sigue siendo frágil y el tema requiere más exploraciones. Estudios de caso: Alemania, Bélgica, Camerún, China, Países Bajos, Polonia, comparación Quebec-Flandes, Túnez y Turquía

The Mediterranean region under climate change

This book has been published by Allenvi (French National Alliance for Environmental Research) to coincide with the 22nd Conference of Parties to the United Nations Framework Convention on Climate Change (COP22) in Marrakesh. It is the outcome of work by academic researchers on both sides of the Mediterranean and provides a remarkable scientific review of the mechanisms of climate change and its impacts on the environment, the economy, health and Mediterranean societies. It will also be valuable in developing responses that draw on “scientific evidence” to address the issues of adaptation, resource conservation, solutions and risk prevention. Reflecting the full complexity of the Mediterranean environment, the book is a major scientific contribution to the climate issue, where various scientific considerations converge to break down the boundaries between disciplines