Notre expérience du couple métal-métal (MoM) dans le resurfaçage (RTH) et les prothèses totales de hanche avec tête de grand diamètre (PTH-GD) présentant un suivi minimum de 10 ans : À propos de 215 cas.

peer reviewedIntroduction : Au début des années 2000, le couple métal-métal (MoM) a connu un regain d’intérêt pour les prothèses de resurfaçage (PR) ainsi que pour les prothèses totales de hanche (PTH) utilisant des megatêtes (> 36 mm) (MT). Depuis 2011, il n’a cessé d’alimenter les débats suite au taux d’échecs à court et moyen termes anormalement élevé dans certains études. Des prothèses particulières ont dès 2010 jeté le discrédit sur ce couple dans son ensemble, imposant un suivi radio-clinique et biologique attentif de ces patients. Matériel et méthodes : Entre 2003 et 2009, 215 prothèses MoM ont été implantées dans notre service. Nous avons revu avec un recul d’au-moins 10 ans (10 – 21 ans ; moyenne 15,2 ans) 142 patients porteurs d’implants DUROM (68 MT, 74 PR), 60 patients porteurs d’implants BHR (15 MT, 45 PR) et 13 patients porteurs d’implants ASR (12 MT, 1 PR). 38 patients perdus de vue ou décédés d’une cause sans relation avec les implants (27 DUROM, 8 BHR et 3 ASR) mais présentant un suivi minimum de 10 ans ont été inclus dans l’étude. Nous avons établi pour chaque groupe de prothèse le score de Harris (HHS) en préopératoire et au dernier suivi , le taux de survie des implants ainsi qu’un historique détaillé des complications ayant mené à une reprise chirurgicale. Résultats : Pour le groupe DUROM, les HHS étaient de 52,9 en préopératoire et 96,5 ; au dernier suivi, nous dénombrons 14 reprises, 7 sur méga-tête (10,3 %) et 7 sur resurfaçage (9,5 %). Pour le groupe BHR, les HHS étaient de 52,4 en préopératoire et 96,2 ; au dernier suivi, nous dénombrons 6 reprises, 1 sur méga-tête (6,7 %) et 5 sur resurfaçage (11,1 %). Pour le groupe ASR, les HHS étaient de 51,3 en préopératoire et 93,1 ; au dernier suivi, nous dénombrons 2 reprises sur méga-tête (15,4 %) et pas de reprise de notre unique resurfaçage (0,0 %). Les principales causes de reprise sont pour les PR une cobaltémie élevée sans symptôme clinique (2 cas), un descellement cotyloïdien (3 cas), un conflit antérieur (3 cas) et un cas de luxation ; pour les MT un descellement (3 cas), une infection (3 cas) et la présence d’une pseudotumeur (2 cas). Les autres indications de reprises étaient des ossifications hétérotopiques, une bursite trochantérienne, une fracture périprothétique ainsi qu’une suspicion d’allergie au métal. Discussion : Les résultats de notre étude semblent montrer un faible pourcentage d’échec lié spécifiquement à l’utilisation du couple MoM à grand diamètre : 3 % (7/215 cas). Selon notre expérience, toute une classe d’implants qui aurait pu conserver une place dans des indications bien spécifiques s’est vue condamnée probablement à tort. Conclusion : Il semble important d’étudier ces implants non pas en tant que classe globale mais en séparant resurfaçaces, mégatêtes et fabricants en raison de la spécificité des métallurgies

Immobilisation versus immediate mobilisation after intrauterine insemination: randomised controlled trial

Objective To evaluate the effectiveness of 15 minutes of immobilisation versus immediate mobilisation after intrauterine insemination

Finite element analysis of the effect of cementing concepts on implant stability and cement fatigue failure

Background and purpose Two contradictory cementing techniques (using an undersized stem versus a canal-filling stem) can both lead to excellent survival rates, a phenomenon known as the “French paradox”. Furthermore, previous studies have indicated that the type of bone supporting the cement mantle may affect implant survival. To further evaluate the mechanical consequences of variations in cementing technique, we studied the effect of implant size and type of bone supporting the cement mantle on the mechanical performance of cemented total hip arthroplasty, using finite element analysis

Report of an ad-hoc international task force to develop an expert-based opinion on early and short-term rehabilitative interventions (after the acute hospital setting) in covid-19 survivors

No abstract available.publishe

Identifying nurses' rewards: a qualitative categorization study in Belgium

BACKGROUND: Rewards are important in attracting, motivating and retaining the most qualified employees, and nurses are no exception to this rule. This makes the establishment of an efficient reward system for nurses a true challenge for every hospital manager. A reward does not necessarily have a financial connotation: non-financial rewards may matter too, or may even be more important. Therefore, the present study examines nurses' reward perceptions, in order to identify potential reward options. METHODS: To answer the research question "What do nurses consider a reward and how can these rewards be categorized?", 20 in-depth semi-structured interviews with nurses were conducted and analysed using discourse and content analyses. In addition, the respondents received a list of 34 rewards (derived from the literature) and were asked to indicate the extent to which they perceived each of them to be rewarding. RESULTS: Discourse analysis revealed three major reward categories: financial, non-financial and psychological, each containing different subcategories. In general, nurses more often mentioned financial rewards spontaneously in the interview, compared to non-financial and psychological rewards. The questionnaire results did not, however, indicate a significant difference in the rewarding potential of these three categories. Both the qualitative and quantitative data revealed that a number of psychological and non-financial rewards were important for nurses in addition to their monthly pay and other remunerations. In particular, appreciation for their work by others, compliments from others, presents from others and contact with patients were highly valued. Moreover, some demographical variables influenced the reward perceptions. Younger and less experienced nurses considered promotion possibilities as more rewarding than the older and more senior ones. The latter valued job security and working for a hospital with a good reputation higher than their younger and more junior colleagues. CONCLUSION: When trying to establish an efficient reward system for nurses, hospital managers should not concentrate on the financial reward possibilities alone. They also ought to consider non-financial and psychological rewards (in combination with financial rewards), since nurses value these as well and they may lead to a more personalized reward system

The genome of the seagrass Zostera marina reveals angiosperm adaptation to the sea

Seagrasses colonized the sea(1) on at least three independent occasions to form the basis of one of the most productive and widespread coastal ecosystems on the planet(2). Here we report the genome of Zostera marina (L.), the first, to our knowledge, marine angiosperm to be fully sequenced. This reveals unique insights into the genomic losses and gains involved in achieving the structural and physiological adaptations required for its marine lifestyle, arguably the most severe habitat shift ever accomplished by flowering plants. Key angiosperm innovations that were lost include the entire repertoire of stomatal genes(3), genes involved in the synthesis of terpenoids and ethylene signalling, and genes for ultraviolet protection and phytochromes for far-red sensing. Seagrasses have also regained functions enabling them to adjust to full salinity. Their cell walls contain all of the polysaccharides typical of land plants, but also contain polyanionic, low-methylated pectins and sulfated galactans, a feature shared with the cell walls of all macroalgae(4) and that is important for ion homoeostasis, nutrient uptake and O-2/CO2 exchange through leaf epidermal cells. The Z. marina genome resource will markedly advance a wide range of functional ecological studies from adaptation of marine ecosystems under climate warming(5,6), to unravelling the mechanisms of osmoregulation under high salinities that may further inform our understanding of the evolution of salt tolerance in crop plants(7)

Children Base Their Investment on Calculated Pay-Off

To investigate the rise of economic abilities during development we studied children aged between 3 and 10 in an exchange situation requiring them to calculate their investment based on different offers. One experimenter gave back a reward twice the amount given by the children, and a second always gave back the same quantity regardless of the amount received. To maximize pay-offs children had to invest a maximal amount with the first, and a minimal amount with the second. About one third of the 5-year-olds and most 7- and 10-year-olds were able to adjust their investment according to the partner, while all 3-year-olds failed. Such performances should be related to the rise of cognitive and social skills after 4 years