Rotator cuff tears after 70years of age: A prospective, randomized, comparative study between decompression and arthroscopic repair in 154 patients

SummaryIntroductionArthroscopic repair of rotator cuff tears leads to better clinical outcomes than subacromial decompression alone; however the former is rarely proposed to patients above 70years of age. Our hypothesis was that arthroscopic repair would be superior to decompression in patient 70years or older. The primary goal was to compare the clinical results obtained with each technique. The secondary goal was to analyze the effects of age, tendon retraction and fatty infiltration on the outcome.MethodsThis was a prospective, comparative, randomized, multicenter study where 154 patients were included who were at least 70years of age. Of the included patients, 143 (70 repair and 73 decompression) were seen at one-year follow-up; these patients had an average age of 74.6years. Shoulders had a complete supraspinatus tear with extension limited to the upper-third of the infraspinatus and Patte stage 1 or 2 retraction. Clinical outcomes were evaluated with the Constant, ASES and SST scores.ResultsAll scores improved significantly with both techniques: Constant +33.81 (P<0.001), ASES +52.1 (P<0.001), SST +5.86 (P<0.001). However, repair led to even better results than decompression: Constant (+35.85 vs. +31.8, P<0.05), ASES (+56.09 vs. +48.17, P=0.01), SST (+6.33 vs. +5.38, P=0.02). The difference between repair and decompression was not correlated with age; arthroscopic repair was also better in patients above 75years of age (Constant, ASES and SST scores P<0.01). There was no significant correlation between the final outcomes and initial retraction: Constant (P=0.14), ASES (P=0.92), SST (P=0.47). The difference between repair and decompression was greater in patients with stages 0 and 1 fatty infiltration (Constant P<0.02) than in patients with stages 2 and 3 fatty infiltration (Constant P<0.05).ConclusionThere was a significant improvement in all-clinical scores for both techniques 1year after surgery. Repair was significantly better than decompression for all clinical outcomes, even in patients above 75years of age. The difference observed between repair and decompression was greater in patients with more retracted tears and lesser in patients with more severe fatty infiltration.Level of proofII (prospective, randomized study with low power)

A cross sectional survey on UK older adult’s attitudes to ageing, dementia and positive psychology attributes

BackgroundWith an increasingly ageing population worldwide, the predominant attitude towards ageing is still negative. Negative stereotypes have detrimental effects on individuals’ physical and mental health. Evidence is required about factors that may predict and change these views. This study aimed to investigate if an older person’s attitude towards dementia, their belief in a just world and sense of coherence is associated with their attitudes to ageing. MethodsA 25-min online survey was completed by 2,675 participants aged 50 or over who were current residents of the United Kingdom (UK). Questions included demographics, overall health, dementia carer, dementia relative status and retirement status. Standardised scales used were the Attitudes to Ageing Questionnaire (AAQ), Dementia Attitudes Scale (DAS), Just World Scale (JWS) and Sense of Coherence Scale-13 (SOC). Data was analysed with descriptive, two-tailed bivariate Pearson’s correlations, simple, and hierarchical regression analyses. ResultsAttitudes to dementia, just world beliefs, and sense of coherence were all significantly positively correlated with AAQ-Total, with SOC sub-scale “Meaningfulness” showing the strongest correlation. In a hierarchical regression model, higher scores on SOC-Meaningfulness, DAS-Total and belief in a just world for oneself all predicted more positive attitudes to ageing. ConclusionsThe more positive an individual’s attitude to dementia and the stronger they hold the belief that the world is just and coherent, the more likely they are to display positive attitudes to ageing. This initial evidence helps create a greater understanding of the factors that drive attitudes and stigma and may have implications for public health messaging

Arthroscopic repair of the rotator cuff: Prospective study of tendon healing after 70 years of age in 145 patients

SummaryIntroductionThe level of activity of patients older than 70 years is tending to increase, as are their expectations in terms of joint function recuperation. It has not been proven that rotator cuff repair healing is satisfactory in the elderly. The main hypothesis of this study was: repair of supraspinous lesions in patients older than 70 years is reliable in terms of both clinical results and healing. The secondary hypothesis was: tendon healing is significantly correlated with the Constant, ASES, and SST scores as well as with age, tendon retraction, and fatty infiltration.Material and methodsMulticenter prospective study on 145 patients older than 70 years, with 135 patients reviewed at 1 year (93%). The mean age was 73.9 years. Full-thickness tears of the supraspinatus extended at most to the upper third of the infraspinatus and retraction limited to Patte stages 1 and 2 were included. Clinical assessment was carried out in accordance with the Constant, ASES, and SST scores. Healing was evaluated with ultrasound.ResultsA significant improvement was noted in the Constant (44/76)+31.5 (P<0.0001), ASES (35/90)+54.4 (P<0.0001), and SST (3.5/10)+6.6 (P>0.0001) scores at 1 year of follow-up. The healing rate was 89% with 15 re-tears, nine of which were stage 1 and six stage 2. The clinical result was not correlated with patient age (Constant, P=0.24; ASES, P=0.38; SST, P=0.83) nor with the retraction stage (Constant, P=0.71; ASES, P=0.35; SST, P=0.69) or the stage of fatty infiltration (P>0.7). Healing was correlated with the quality of the clinical result (Constant, P=0.02; ASES, P=0.03) and age (P=0.01) but was not correlated with retraction or the fatty infiltration stage (P>0.3).Discussion/conclusionArthroscopic repair significantly improves the clinical results, even in patients older than 70 years. The clinical results are not correlated with age (but deterioration of the result was not noted after 75 years) or frontal retraction (but the study only included retractions limited to stages 1 and 2). The healing rate is satisfactory, but this study is limited to small ruptures of the supraspinatus, and the postoperative ultrasound analysis probably inferior to CT imaging with contrast agent injection, often used as the reference. Healing proves to be correlated with the quality of the clinical result and patient age

Analysis of natural variants of the hepatitis C virus internal ribosome entry site reveals that primary sequence plays a key role in cap-independent translation

The HCV internal ribosome entry site (IRES) spans a region of ∼340 nt that encompasses most of the 5′ untranslated region (5′UTR) of the viral mRNA and the first 24–40 nt of the core-coding region. To investigate the implication of altering the primary sequence of the 5′UTR on IRES activity, naturally occurring variants of the 5′UTR were isolated from clinical samples and analyzed. The impact of the identified mutations on translation was evaluated in the context of RLuc/FLuc bicistronic RNAs. Results show that depending on their location within the RNA structure, these naturally occurring mutations cause a range of effects on IRES activity. However, mutations within subdomain IIId hinder HCV IRES-mediated translation. In an attempt to explain these data, the dynamic behavior of the subdomain IIId was analyzed by means of molecular dynamics (MD) simulations. Despite the loss of function, MD simulations predicted that mutant G266A/G268U possesses a structure similar to the wt-RNA. This prediction was validated by analyzing the secondary structure of the isolated IIId RNAs by circular dichroism spectroscopy in the presence or absence of Mg2+ ions. These data strongly suggest that the primary sequence of subdomain IIId plays a key role in HCV IRES-mediated translation

In vitro evaluation of skin sensitization to xenobiotic : Relevance of a reconstructed human epidermis/ THP-1 cells co-culture

La dermatite de contact allergique (DCA) est une réaction exacerbée du système immunitaire cutané vis-à-vis d’un allergène de contact. La prévalence de la DCA étant de 20 % au sein de la population mondiale, il est important d’identifier les composés allergisants. Différentes réglementations européennes, telles que le règlement REACh ou la directive cosmétique, interdisent l’utilisation de test sur l’animal. C’est dans ce contexte que différentes méthodes alternatives ont été développées pour évaluer la sensibilisation cutanée. La stratégie actuelle d’évaluation du potentiel sensibilisant consiste à réaliser un ensemble de tests alternatifs, chacun mimant un évènement clé du mécanisme : l’hapténisation, l’activation des kératinocytes ou des cellules dendritiques.Cependant, ces tests utilisent principalement des monocultures et ne prennent donc pas en compte les interactions cellulaires qui peuvent avoir lieu in vivo. De plus, les évaluations de la pénétration et du métabolisme cutanés sont négligées dans les tests développés.Afin de mimer la fine orchestration des événements intervenant lors de la sensibilisation cutanée, nous proposons un modèle d’épiderme humain reconstruit (RhE) co-cultivé avec la lignée cellulaire THP-1, servant de substitut aux cellules dendritiques. Nous avons caractérisé, et étudié la pertinence de ce modèle à l’aide de molécules chimiques de référence. Ce travail a permis l’identification de biomarqueurs, tels que CD54, IL-8 et CCL3, spécifiques à l’évaluation in vitro de la sensibilisation cutanée des xénobiotiques.Allergic contact dermatitis is an exacerbated reaction of skin immune system toward contact allergen. The prevalence of DCA being 20 % among the world population, it is important to identify allergens. Different European regulations such as the REACh regulation or the cosmetic directive prohibit the use of the test on animals. It is in this context that different methods have been developed to evaluate skin sensitization. The current sensitization potential assessment strategy consists of a set of alternative tests, each of which reproduce a key event of the mechanism: the haptenation, the activation of keratinocytes or dendritic cells.However, these tests are mainly based on monocultures and therefore do not account for the cellular crosstalk that happen in vivo. In addition, the evaluations of skin penetration and metabolism are neglected in the developed tests.In order to mimic the fine orchestration of the events involved in skin sensitization, we propose a model of reconstructed human epidermis (RhE) co-cultivated with the THP-1 cell line, as a substitute for dendritic cells. We have characterized and studied the relevance of this model using reference chemical molecules. This work has enabled the identification of biomarkers, such as CD54, IL-8 and CCL3, specific to the in vitro evaluation of skin sensitization to xenobiotics

Evaluation in vitro de la sensibilisation cutanée aux xénobiotiques : Pertinence d’un modèle de co-culture épiderme reconstruit humain/cellules THP-1

Allergic contact dermatitis is an exacerbated reaction of skin immune system toward contact allergen. The prevalence of DCA being 20 % among the world population, it is important to identify allergens. Different European regulations such as the REACh regulation or the cosmetic directive prohibit the use of the test on animals. It is in this context that different methods have been developed to evaluate skin sensitization. The current sensitization potential assessment strategy consists of a set of alternative tests, each of which reproduce a key event of the mechanism: the haptenation, the activation of keratinocytes or dendritic cells.However, these tests are mainly based on monocultures and therefore do not account for the cellular crosstalk that happen in vivo. In addition, the evaluations of skin penetration and metabolism are neglected in the developed tests.In order to mimic the fine orchestration of the events involved in skin sensitization, we propose a model of reconstructed human epidermis (RhE) co-cultivated with the THP-1 cell line, as a substitute for dendritic cells. We have characterized and studied the relevance of this model using reference chemical molecules. This work has enabled the identification of biomarkers, such as CD54, IL-8 and CCL3, specific to the in vitro evaluation of skin sensitization to xenobiotics.La dermatite de contact allergique (DCA) est une réaction exacerbée du système immunitaire cutané vis-à-vis d’un allergène de contact. La prévalence de la DCA étant de 20 % au sein de la population mondiale, il est important d’identifier les composés allergisants. Différentes réglementations européennes, telles que le règlement REACh ou la directive cosmétique, interdisent l’utilisation de test sur l’animal. C’est dans ce contexte que différentes méthodes alternatives ont été développées pour évaluer la sensibilisation cutanée. La stratégie actuelle d’évaluation du potentiel sensibilisant consiste à réaliser un ensemble de tests alternatifs, chacun mimant un évènement clé du mécanisme : l’hapténisation, l’activation des kératinocytes ou des cellules dendritiques.Cependant, ces tests utilisent principalement des monocultures et ne prennent donc pas en compte les interactions cellulaires qui peuvent avoir lieu in vivo. De plus, les évaluations de la pénétration et du métabolisme cutanés sont négligées dans les tests développés.Afin de mimer la fine orchestration des événements intervenant lors de la sensibilisation cutanée, nous proposons un modèle d’épiderme humain reconstruit (RhE) co-cultivé avec la lignée cellulaire THP-1, servant de substitut aux cellules dendritiques. Nous avons caractérisé, et étudié la pertinence de ce modèle à l’aide de molécules chimiques de référence. Ce travail a permis l’identification de biomarqueurs, tels que CD54, IL-8 et CCL3, spécifiques à l’évaluation in vitro de la sensibilisation cutanée des xénobiotiques

Evaluation in vitro de la sensibilisation cutanée aux xénobiotiques : Pertinence d’un modèle de co-culture épiderme reconstruit humain/cellules THP-1

Allergic contact dermatitis is an exacerbated reaction of skin immune system toward contact allergen. The prevalence of DCA being 20 % among the world population, it is important to identify allergens. Different European regulations such as the REACh regulation or the cosmetic directive prohibit the use of the test on animals. It is in this context that different methods have been developed to evaluate skin sensitization. The current sensitization potential assessment strategy consists of a set of alternative tests, each of which reproduce a key event of the mechanism: the haptenation, the activation of keratinocytes or dendritic cells.However, these tests are mainly based on monocultures and therefore do not account for the cellular crosstalk that happen in vivo. In addition, the evaluations of skin penetration and metabolism are neglected in the developed tests.In order to mimic the fine orchestration of the events involved in skin sensitization, we propose a model of reconstructed human epidermis (RhE) co-cultivated with the THP-1 cell line, as a substitute for dendritic cells. We have characterized and studied the relevance of this model using reference chemical molecules. This work has enabled the identification of biomarkers, such as CD54, IL-8 and CCL3, specific to the in vitro evaluation of skin sensitization to xenobiotics.La dermatite de contact allergique (DCA) est une réaction exacerbée du système immunitaire cutané vis-à-vis d’un allergène de contact. La prévalence de la DCA étant de 20 % au sein de la population mondiale, il est important d’identifier les composés allergisants. Différentes réglementations européennes, telles que le règlement REACh ou la directive cosmétique, interdisent l’utilisation de test sur l’animal. C’est dans ce contexte que différentes méthodes alternatives ont été développées pour évaluer la sensibilisation cutanée. La stratégie actuelle d’évaluation du potentiel sensibilisant consiste à réaliser un ensemble de tests alternatifs, chacun mimant un évènement clé du mécanisme : l’hapténisation, l’activation des kératinocytes ou des cellules dendritiques.Cependant, ces tests utilisent principalement des monocultures et ne prennent donc pas en compte les interactions cellulaires qui peuvent avoir lieu in vivo. De plus, les évaluations de la pénétration et du métabolisme cutanés sont négligées dans les tests développés.Afin de mimer la fine orchestration des événements intervenant lors de la sensibilisation cutanée, nous proposons un modèle d’épiderme humain reconstruit (RhE) co-cultivé avec la lignée cellulaire THP-1, servant de substitut aux cellules dendritiques. Nous avons caractérisé, et étudié la pertinence de ce modèle à l’aide de molécules chimiques de référence. Ce travail a permis l’identification de biomarqueurs, tels que CD54, IL-8 et CCL3, spécifiques à l’évaluation in vitro de la sensibilisation cutanée des xénobiotiques

Évaluation des pratiques professionnelles de la prévention et de la prise en charge des hémorragies du post-partum dans les maternités de Loire-Atlantique et de Vendée

Introduction : L'Hémorragie du Post-Partum (HPP) est une complication grave de la grossesse. En 2004, des Recommandations pour la Pratique Clinique sont élaborées par la haute Autorité de Santé. Le réseau Sécurité Naissance des Pays de Loire a souhaité évaluer les pratiques dans le domaine des HPP. Un premier audit avait permis de rappeler les recommandations aux équipes obstétricales. L'objectif de ce travail était d évaluer l'évolution de la qualité de la prévention et de la prise en charge des HPP dans chaque maternité de ces 2 départements. Matériels et méthodes : Un audit des pratiques par observation de dossiers a été réalisé dans 13 maternités. Dix dossiers d accouchements voie basse (AVB) sans hémorragie et un maximum de 10 AVB compliqués d HPP nécessitant une transfusion ont été étudiés dans chaque établissement. L'analyse de critères a permis d évaluer la conformité au référentiel. Résultats : Pour la prévention, 130 dossiers sont analysés. Le taux de conformité global est de 69,4 %. Quatre groupes d'HPP sont identifiés sur un total de 69 dossiers. 6 % d hémorragie sont méconnues. Le taux de conformité global est de 82,9 % dans le groupe des HPP d origine utérine (n=52). Conclusion : Des améliorations ont été notées. Il reste encore des perfections à envisager. L'EPP doit continuer et s'intensifier pour une meilleure sécurité de nos patientes. Les réseaux de santé pourraient y trouver une place précieuse.NANTES-BU Médecine pharmacie (441092101) / SudocSudocFranceF