Le polyéthylène hautement réticulé de deuxième génération dopé à la vitamine E versus conventionnel dans l’arthroplastie totale de hanche : étude prospective randomisée à 3 ans minimum de recul

The purpose of this prospective randomized study was to compare the minimum 3-­year follow-­ up penetration of cementless polyethylene sockets of the same design in two configurations in a consecutive series of total hip arthroplasty.Between May 2010 and May 2011, 100 patients (100 hips) with a mean age of 70.8 ± 7.5 years were randomized (power of 80%, alpha of 5%) to receive either vitamin E doped highly cross-­ linked (group Vitamys, 0.1% vitamin E blended, 10 Mrads of gamma radiation, 50 hips) or moderately cross‐linked (group RM, 3 Mrads of gamma radiation in nitrogen, 50 hips) material. The cementless polyethylene cups were coated with pure titanium particles. All other parameters, including the 28 mm diameter metal femoral head, stem, surgical approach and postoperative course were identical in both groups. The primary criterion for evaluation was linear head penetration measurement, using the Martell system, performed by an investigator blinded to the polyethylene type. Both creep and steady state wear were measured.At the time of the minimum 3-­year follow-­up evaluation, 34 hips in the Vitamys group and 32 hips in the RM group have had complete data available for analysis (median follow‐up of 3.02 and 3.13 years, respectively). The median creep measured 0.02 mm versus 0.3 in the Vitamys and RM groups, respectively (Mann-­Whitney, p=0.04). The median steady state penetration rate from one year onwards was ‐0.097 mm/year in the Vitamys group versus 0.064 mm/year in the RM group (Mann and Whitney test, p=0.04). No complication specific to the material was recorded, and no patient was revised because of wear and/or osteolysis.This study provides the first randomized in vivo wear measurements of Vitamin E doped highly cross-­linked acetabular components. These early 3-­year follow-­up results demonstrated encouraging wear performance of vitamin E blended highly cross-­linked polyethylene. Longer term follow-­up is necessary to monitor the performance of these devices.Nous avons prospectivement randomisé 100 arthroplasties primaires totales de hanche (âge moyen 70,8 ans) afin d’analyser la résistance à l’usure in vivo d’un polyéthylène monobloc non cimenté en fonction de sa réticulation. La cupule était soit en polyéthylène hautement réticulé dopé à la vitamine E (Vitamys®, Mathys) soit en polyéthylène conventionnel (RM®, Mathys). Il n’existait aucune différence significative démographique ou opératoire entre les deux groupes.Au recul moyen de 3,08 ans, 66 hanches ont été revues, radiologiquement et cliniquement, et aucune différence fonctionnelle n’était notée. Le taux de pénétration moyen de la tête fémorale était de 0,02 mm dans le groupe Vitamys® et de 0,3 mm dans le groupe RM® (p=0,04).Le taux d’usure moyen à régime constant était de -0,097 mm/an dans le groupe Vitamys® et de 0,064 mm/an dans le groupe RM® (p=0,04). Aucune complication spécifique mécanique liée au matériau n’a été constatée.Ces résultats à 3 ans de recul ont montré d’encourageantes performances en termes d’usure du polyéthylène hautement réticulé dopé à la vitamine E. Des résultats à long terme sont nécessaires pour confirmer l’intérêt de ce polyéthylène hautement réticulé dopé à la vitamine E, notamment au niveau de l’ostéolyse et du taux de survie des implants

Routine HIV Screening in France: Clinical Impact and Cost-Effectiveness

BACKGROUND. In France, roughly 40,000 HIV-infected persons are unaware of their HIV infection. Although previous studies have evaluated the cost-effectiveness of routine HIV screening in the United States, differences in both the epidemiology of infection and HIV testing behaviors warrant a setting-specific analysis for France. METHODS/PRINCIPAL FINDINGS. We estimated the life expectancy (LE), cost and cost-effectiveness of alternative HIV screening strategies in the French general population and high-risk sub-populations using a computer model of HIV detection and treatment, coupled with French national clinical and economic data. We compared risk-factor-based HIV testing ("current practice") to universal routine, voluntary HIV screening in adults aged 18-69. Screening frequencies ranged from once to annually. Input data included mean age (42 years), undiagnosed HIV prevalence (0.10%), annual HIV incidence (0.01%), test acceptance (79%), linkage to care (75%) and cost/test (€43). We performed sensitivity analyses on HIV prevalence and incidence, cost estimates, and the transmission benefits of ART. "Current practice" produced LEs of 242.82 quality-adjusted life months (QALM) among HIV-infected persons and 268.77 QALM in the general population. Adding a one-time HIV screen increased LE by 0.01 QALM in the general population and increased costs by €50/person, for a cost-effectiveness ratio (CER) of €57,400 per quality-adjusted life year (QALY). More frequent screening in the general population increased survival, costs and CERs. Among injection drug users (prevalence 6.17%; incidence 0.17%/year) and in French Guyana (prevalence 0.41%; incidence 0.35%/year), annual screening compared to every five years produced CERs of €51,200 and €46,500/QALY. CONCLUSIONS/SIGNIFICANCE. One-time routine HIV screening in France improves survival compared to "current practice" and compares favorably to other screening interventions recommended in Western Europe. In higher-risk groups, more frequent screening is economically justifiable.Haute Autorite de Sante; the Institut de Veille Sanitaire; Sidaction; the Agence Nationale de Recherches sur le SIDA et les hepatites virales; the National Institute of Allergy and Infectious Diseases (R01 AI042006, K24 AI062476, P30 AI42851); the National Institute of Mental Health (R01 MH65869); the National Institute on Drug Abuse (R01 DA015612

Minimum five-year wear rate of metal-on-highly cross-linked polyethylene in primary total hip arthroplasty

PURPOSE: Highly cross-linked polyethylenes (PE) have been developed with encouraging results in terms of wear. Another body of the literature has indicated potential catastrophic failures related to reduced fatigue properties and oxidation. Each PE available on the market has its own processing characteristics. The aim of this retrospective study was to evaluate the minimum five-year wear properties of an original highly cross-linked PE in a consecutive series of primary THAs. METHODS: Between August 2005 and December 2007, 80 patients with a mean age of 62.7 years were included. All patients had a 28-mm CoCr femoral head articulating with a highly cross-linked insert (Highcross®, Medacta SA) that was 100 Mrads gamma radiated, remelted at 150 °C, and ethylene oxide sterilized. The primary criterion for evaluation was the femoral head penetration, as measured by Hip Analysis Suite software. The steady state wear was also calculated. Functional results were evaluated according to the WOMAC score. RESULTS: Complete data were available for analysis in 67 patients at a mean follow-up of 5.5 years. The mean femoral head penetration was 0.128 ± 0.62 mm and the steady state wear was-0.025 ± 0.22 mm/year. The WOMAC score significantly decreased from 16.5 ± 5.93 pre-operatively to 4.12 ± 5.5 at the latest follow-up (p <0.001). CONCLUSIONS: The minimal five-year results of this retrospective study indicate that this particular highly cross-linked and remelted polyethylene had a low wear rate. Longer-term results are needed to warrant that these mid-term data will generate less osteolysis and resultant aseptic loosening

Reporting of heterogeneity of treatment effect in cohort studies: a review of the literature

Abstract Background This article corresponds to a literature review and analyze how heterogeneity of treatment (HTE) is reported and addressed in cohort studies and to evaluate the use of the different measures to HTE analysis. Methods prospective cohort studies, in English language, measuring the effect of a treatment (pharmacological, interventional, or other) published among 119 core clinical journals (defined by the National Library of Medicine) in the last 16 years were selected in the following data source: Medline. One reviewer randomly sampled journal articles with 1: 1 stratification by journal type: high impact journals (the New England Journal of Medicine, JAMA, LANCET, Annals of Internal Medicine, BMJ and Plos Medicine) and low impact journal (the remaining journals) to identify 150 eligible studies. Two reviewers independently and in duplicate used standardized piloted forms to screen study reports for eligibility and to extract data. They also used explicit criteria to determine whether a cohort study reported HTE analysis. Logistic regression was used to examine the association of prespecified study characteristics with reporting versus not reporting of heterogeneity of treatment effect. Results One hundred fifty cohort studies were included of which 88 (58%) reported HTE analysis. High impact journals (Odds Ratio: 3.5, 95% CI: 1.78–7.5; P < 0.001), pharmacological studies (Odds Ratio: 0.26, 95% CI: 0.13–0.51; P < 0.001) and studies published after 2014 (Odds Ratio: 0.5, 95% CI: 0.25–0.97; P = 0.004) were associated with more frequent reporting of HTE. 27 (31%) studies which reported HTE used an interaction test. Conclusion More than half cohort studies report some measure of heterogeneity of treatment effect. Prospective cohort studies published in high impact journals, with large sample size, or studying a pharmacological treatment are associated with more frequent HTE reporting. The source of funding was not associated with HTE reporting. There is a need for guidelines on how to perform HTE analyses in cohort studies

Additional file 1: of Reporting of heterogeneity of treatment effect in cohort studies: a review of the literature

The Newcastle-Ottawa Quality Assessment Score [35]. (DOCX 11 kb

Mucoceles of the anterior ventral surface of the tongue and the glands of Blandin-Nuhn: 5 cases

Introduction: Mucoceles are cystic diseases of the oral mucosa. The most common are ranula and mococeles of the lower lip. Blandin and Nuhn mucoceles, which develop at the ventral side of the tongue, are rare benign lesions. They are often misdiagnosed and sometimes confused with ranula. The recommended treatment is a complete surgical excision of the gland.Patients and methodsWe describe 5 clinical cases managed in service between 2009 and 2016. Clinical cases are presented in order to detail their clinical history, paraclinical and treatment.Results: The clinical appearance is a longitudinal swelling of the ventral surface of the tongue, parallel to the frenulum. The volume of the swelling is variable; it is normally around 30 × 10 mm. The paraclinical (ultrasound, CT, MRI, or ponction) could be performed. CT showed an cyst located on the ventral surface of the tongue, with liquid density. Blandin and Nunh mucocele were strictly anechogenic. MRI confirms the liquid content of this cyst (low T1signal, high T2signal and no post-contrast-enhanced). The resection of Blandin and Nuhn glands should respect the sublingual gland, the lingual nerve and the lingual veins in the mouth floor.Conclusion: This study demonstrates that Blandin and Nuhn mucoceles must be understood and recognised to propose complete excision of the Blandin and Nuhn gland and avoid recurrence

Importance of Early Diagnosis and Care in Knee Dislocations Associated with Vascular Injuries

International audienceBackground: Arterial injury secondary to acute knee dislocation (KD) is a rare but devastative complication. The aim of this study is to evaluate functional sequelae and factors of poor prognosis.Methods: A retrospective monocentric series of consecutive KD with acute ischemia by popliteal artery injury was analyzed between 2005 and 2017. The main outcome was the amputation rate.Results: Sixteen dislocations were included. Nine (56%) were due to public road accidents, 5 (31%) were due to falls from height, and 2 (13%) were due to sports injuries. Dislocation had occurred in the posterior location in 8 (50%) cases. Regarding arterial injury, there were 7 (44%) ruptures, 7 (44%) dissections, and 2 (13%) isolated thromboses. Eleven (69%) KDs with vascular trauma were associated with signs of acute ischemia. Revascularization was achieved by anatomical venous bypass in 14 (88%), resection and direct anastomosis in one (6%), and isolated thrombectomy in one (6%). Median time to surgery (time between trauma and vascular repair) was 7 hours (3.25-60.92 hours). Primary revascularization was performed in 12 (75%) cases. In three cases (19%), orthopedic reduction and stabilization were performed first. In one case, (6%) three-step management with vascular shunt at first, then with knee stabilization, and finally vascular bypass was carried out. Stabilization was achieved by using an external fixator in 13 (82%) cases, by open reduction and internal fixation in one case (6%), by ligamentoplasty in one (6%), and by using a long leg cast in one (6%). Fasciotomy was required in 12 (75%) cases. Two patients had early vascular complications, and 2 had early systemic complications. Three secondary transfemoral amputations were performed. Median follow-up duration was 23 months. No secondary amputation was recorded. At the end of follow-up, functional outcomes were evaluated using the Oxford Knee Score (OKS). The median OKS was 30 versus the pretrauma median OKS of 47 (P < 0.00028). No risk factor associated with limb amputation has been highlighted.Conclusions: Analysis of these results provided indications for therapeutic management of this condition. This study shows poor functional outcomes because of severity of vascular lesion in patients with orthopedic trauma but with healthy arteries

Partial recovery of visual function in a blind patient after optogenetic therapy

International audienc

Mapping the genomic landscape of inherited retinal disease genes prioritizes genes prone to coding and noncoding copy-number variations

Purpose Part of the hidden genetic variation in heterogeneous genetic conditions such as inherited retinal diseases (IRDs) can be explained by copy-number variations (CNVs). Here, we explored the genomic landscape of IRD genes listed in RetNet to identify and prioritize those genes susceptible to CNV formation. Methods: RetNet genes underwent an assessment of genomic features and of CNV occurrence in the Database of Genomic Variants and literature. CNVs identified in an IRD cohort were characterized using targeted locus amplification (TLA) on extracted genomic DNA. Results: Exhaustive literature mining revealed 1,345 reported CNVs in 81 different IRD genes. Correlation analysis between rankings of genomic features and CNV occurrence demonstrated the strongest correlation between gene size and CNV occurrence of IRD genes. Moreover, we identified and delineated 30 new CNVs in IRD cases, 13 of which are novel and three of which affect noncoding, putative cis-regulatory regions. Finally, the breakpoints of six complex CNVs were determined using TLA in a hypothesis-neutral manner. Conclusion: We propose a ranking of CNV-prone IRD genes and demonstrate the efficacy of TLA for the characterization of CNVs on extracted DNA. Finally, this IRD-oriented CNV study can serve as a paradigm for other genetically heterogeneous Mendelian diseases with hidden genetic variation