Anterior Bone Loss in Cervical Disc Arthroplasty

Study Design Retrospective, longitudinal observational study. Purpose To describe the natural history of anterior bone loss (ABL) in cervical disc arthroplasty (CDA) and introduce a classification system for its assessment. Overview of Literature ABL has recently been recognized as a complication of CDA, but its cause and clinical effects remain unknown. Methods Patients with non-keeled CDA (146) were retrospectively reviewed. X-rays were examined at 6 weeks, 3, 6, 9, 12, 18, and 24 months, and annually thereafter for a minimum of 5 years. These were compared with the initial postoperative X-rays to determine the ABL. Visual Analog Scale pain scores were recorded at 3 months and 5 years. Neck Disability Index was recorded at postoperative 5 years. The natural history was determined and a classification system was introduced. Results Complete radiological assessment was available for 114 patients with 156 cervical disc replacements (CDRs) and 309 endplates (average age, 45.3 years; minimum, 28 years; maximum, 65 years; 57% females). ABL occurred in 57.1% of CDRs (45.5% mild, 8.3% moderate, and 3.2% severe) and commenced within 3 months of the operation and followed a benign course, with improvement in the bone stock after initial bone resorption. There was no relationship between ABL degree and pain or functional outcome, and no implants were revised. Conclusions ABL is common (57.1%). It occurs at an early stage (within 3 months) and typically follows a non-progressive natural history with stable radiographic features after the first year. Most ABL cases are mild, but severe ABL occurs in approximately 3% of CDAs. ABL does not affect the patients’ clinical outcome or the requirement for revision surgery. Surgeons should thus treat patients undergoing CDA considering ABL

Surgery for Locally recurrent rectal cancer with sacrum involvement

La prise en charge des récidives locales de cancer du rectum (RLCR) est complexe. Il n’existe pas de réel consensus quant aux indications chirurgicales et à la technique opératoire. L’obtention de marges de résection saines (R0) apparaît comme le principal facteur pronostic de survie en cas d’indication chirurgicale. L’objectif de cette étude est de présenter et d’évaluer la prise en charge chirurgicale que nous proposons en cas de RLCR avec envahissement sacré. Nous rapportons les résultats d’une étude rétrospective, monocentrique, à propos de 15 patients ayant bénéficié d’une chirurgie d’exérèse de RLCR avec envahissement du sacrum. L’indication chirurgicale était retenue après discussion lors d’une réunion de concertation pluridisciplinaire dédiée à la prise en charge des tumeurs complexes du pelvis. La technique chirurgicale était une sacrectomie partielle, ou une corticotomie antérieure sacrée, associée à la pelvectomie afin d’effectuer une exérèse monobloc de la tumeur. La survie globale et la survie sans récidive étaient rapportées. L’évaluation de la qualité de vie était faite par le questionnaire SF-12. Nous avons inclus 13 hommes et 2 femmes avec un âge moyen de 62 ans. La durée de suivi moyenne était de 18,5 mois. 10 sacrectomies partielles et 5 corticotomies antérieures ont été réalisées. La durée opératoire moyenne était de 416 minutes. Nous avons obtenu des marges de résection saines dans 74% des cas. La survie globale au dernier suivi était de 73%. Le taux de complications majeures (selon la classification de Dindo-Clavien) était de 26,6%. Au dernier suivi, le score moyen de la composante mentale du SF12 était 53,7. Il était de 44,6 pour la composante physique. Bien que les résections sacrées associées aux pelvectomies soient difficiles, cette étude montre que l’on peut obtenir des taux de satisfaisants de résection R0 et de survie globale. La qualité de vie des patients ne semble pas trop altérée par cette intervention. La corticotomie antérieure est une alternative fiable en cas d’atteinte sacrée haute.The management of locally recurrent rectal cancer (LRRC) is challenging. There is no consensus about surgical indications. Until recently, LRRC with sacral involvement were considered as non-surgical and palliative procedures were common. Clear resection margins appear to be the most important prognosis factor in case of surgical procedure. The purpose of this study was to present and evaluate our surgical procedure in case of sacral involvement. We report the results of a retrospective study on 15 patients treated by surgical resection of LRRC with sacral involvement. Suitability for surgery was assessed by a multidisciplinary meeting. Partial sacrectomy or high subcortical sacrectomy were performed as part of surgical procedures including pelvic exenteration allowing “en-bloc” tumor removal. Overall survival and disease-free survival are reported. Quality of life was evaluated by the SF-12 score at last follow-up. 13 men and 2 females were included with a mean age of 62 years. Median follow-up was 18,5 months. 10 partial sacrectomies and 5 high subcortical sacrectomies were performed. Mean operation-length was 416 minutes. We obtained clear resection margins in 74%. Overall survival was 73% at last follow-up. Major complications rate according to Dindo-Clavien classification was 26,6%. Mean mental component from SF12 was 53,7. Mean physical component from SF12 was 44,6. Although sacral resection combined with pelvic exenteration is a challenging procedure, this study shows that we obtained good R0 rate and overall survival. Quality of life seems to not be much altered by this surgery. High subcortical sacrectomy is a reliable alternative in case of high sacrum involvement

Genetics and history of Sub-Saharan Africa

This paper aims to review the contribution of genetic data to the prehistory and history of sub·Saharan African peoples. The authors review briefly paleontologic data, which give limited information about modern Homo sapiens sapiens origins and isolation of present African gene pools. Most linguistic and archaeological theories about African peoples'prehistory are then confronted with the most informative genetic data available. Rhesus, Gm, HLA, and DNA data are analyzed. Their frequent haplotypes are compared between populations by means of genetic distances and average linkage clustering. Despite heterogeneities between the quality and the quantity of data provided by different genetic systems, some clear conclusions can be drawn. Genetic differentiation clearly paranels the clustering of major linguistic families. These families of populations seem genetically homogeneous, suggesting either relatively recent origins or long-term important and continuous intragroup migrations. The well-known divergence between the historical theories suggested by immunological and DNA data about the relationship between Africa and other gene pools is discussed. Decisive conclusions about African origins of modern humans either from fossil or from DNA data seem very premature. An alternative hypothesis issued from overall genetic variation is proposed

Challenging Ancient DNA Results About Putative HLA Protection or Susceptibility to <i>Yersinia pestis</i>

In a recent article, Immel et al. (Immel A, Key FM, Szolek A, Barquera R, Robinson MK, Harrison GF, Palmer WH, Spyrou MA, Susat J, Krause-Kyora B, et al. 2021. Analysis of genomic DNA from medieval plague victims suggests long-term effect of Yersinia pestis on human immunity genes. Mol Biol Evol. 38:4059–4076) extracted DNA from 36 individuals dead from plague in Ellwangen, Southern Germany, during the 16th century. By comparing their human leukocyte antigen (HLA) genotypes with those of 50 present-day Ellwangen inhabitants, the authors reported a significant decrease of HLA-B*51:01 and HLA-C*06:02 and a significant increase of HLA-DRB1*13:01/13:02 frequencies from ancient to modern populations. After comparing these frequencies with a larger sample of 8,862 modern Germans and performing simulations of natural selection, they concluded that these changes had been driven by natural selection. In an attempt to provide more evidence on such stimulating results, we explored the HLA frequency patterns over all of Europe, we predicted binding affinities of HLA-B/C/DRB1 alleles to 106,515 Yersinia pestis-derived peptides, and we performed forward simulations of HLA genetic profiles under neutrality. Our analyses do not sustain the conclusions of HLA protection or susceptibility to plague based on ancient DNA.</p

Sacral hiatus corticosteroid injection in the management of radicular pain in adults

International audienceRadicular pain is a common reason for patients to consult at back pain clinics. While epidural steroid injections are widely done, some aspects are still controversial. The epidural space can be accessed via a transforaminal approach, an interlaminar route or by passing through the sacral hiatus. The aim of this article is to describe the epidural injection technique through the sacral hiatus that our team uses and to report our experience with it. Beyond the treatment effect, sacral hiatus corticosteroid injection can be useful as a diagnostic test or as an interim solution. Image-guided injection is recommended to ensure optimal positioning of the needle below S3. Sacral hiatus corticosteroid injection is a relevant alternative for treating lumbar radiculopathy in adults

Paysage au pluriel

Qu’est-ce au juste qu’un paysage ? Pourquoi lui accorde-t-on aujourd’hui tant d’importance ? Rarement naturel, presque toujours façonné par l’homme, il est dans nos sociétés le fruit d’une histoire vieille de quatre siècles au cours de laquelle se sont peu à peu élaborés, transmis, modifiés des modèles paysagers qui déterminent notre perception de l’espace. Récemment le paysage est aussi devenu un enjeu social, écologique et économique... voire électoral. Le contrôler, c’est bien sûr contrôler l’espace, mais, plus largement, le devenir de notre société et de ses valeurs. Il est également un marché potentiel, avec ses professionnels, ses stratégies d’intervention, ses systèmes d’expertise qui jouent souvent de l’ambiguïté entre crise paysagère et crise sociale, et du consensus qui assimile de plus en plus le paysage à un patrimoine à sauvegarder, ou tout au moins à gérer. Finalement, le paysage fonctionne comme un symbole, une représentation, dont chacun use à des fins différentes. Et qui mieux que l’ethnologue peut témoigner de la force et parfois de la violence des symboles ? Ces dix-huit articles sont pour la plupart issus d’un appel d’offres initié par la mission du Patrimoine ethnologique (ministère de la Culture), avec la participation du SRETIE (ministère de l’Environnement)