Apport de l'échocardiographie trans-œsophagienne 3D temps réel dans l'analyse de la valve mitrale (étude prospective clermontoise)

L'objectif de notre travail est d'utiliser l'imagerie trois dimensions (3D) assistée du logiciel Mitral Valve Quantification (MVQ) pour améliorer la prise en charge chirurgicale des patients souffrant d'une insuffisance mitrale (IM). Cette étude prospective totalise 23 patients souffrant d'une IM chirurgicale et 8 patients contrôles sans pathologie mitrale. L'ensemble des patients a bénéficié d'un examen échocardiographique préopératoire trans-thoracique par l'opérateur n1 puis d'une échographie trans-œsophagienne (ETO) 2D et 3D l'opérateur n2. Une modélisation de la valve mitrale est ensuite réalisée grâce au logiciel MVQ par l'opérateur n3 sans connaître les résultats des précédents examens. Dans l'analyse des lésions valvulaires mitrales, on remarque que les précisions diagnostiques sont supérieures en ETO 3D par rapport à l'ETO 2D, elle même supérieure à l'ETT. C'est d'ailleurs pour l'exploration de P1, P3, des commissures, des atteintes univalvulaires et complexes que la différence semble la plus importante. Il existe une différence significative en faveur de l'ETO 3D dans la détection des prolapsus de P1, des atteintes commissurales et univalvulaires. Nous retrouvons une corrélation et une bonne concordance entre l'ETO 2 D et les données MVQ concernant les mesures des feuillets mitraux et de l'anneau (p<0,01). Nous avons pu montrer qu'il existe une corrélation entre les mesures préopératoire 3D de l'anneau et la taille des anneaux ou prothèses mis en place chirurgicalement (p<0,05). L'ETO 3D est d'autant plus pertinente que les lésions sont complexes et permet une analyse plus précise de cette valve comparée à l'échographie bidimentionnelle. L'évaluation en 3D et sa modélisation pourraient soutenir l'acte chirurgical en permettant une réparation "personnalisée" garantissant une meilleure restauration de la physiologie valvulaire mitrale.CLERMONT FD-BCIU-Santé (631132104) / SudocSudocFranceF

Influence de l'expérience sur le contrôle postural (effet de l'expertise gymnique)

Selon les approches écologiques, les modes de coordination motrice émergent de l'interaction entre les contraintes imposées par l'environnement, la tâche et l'organisme, et sont régulés par le couplage perception-action. L'objet de ce travail est de caractériser comment la modification des propriétés de l'organisme, par l'acquisition d'une expérience spécifique, influence l'émergence et la régulation du contrôle moteur. Notre travail se propose alors d'étudier ce processus à travers l'effet de l'expérience gymnique sur d'une part, le contrôle d'une posture propre à cette activité, l'Appui Tendu Renversé (ATR), et d'autre part, sur le contrôle de la posture érigée, issue de la phylogenèse. Trois études sont présentées dans ce mémoire. La première est une analyse dynamique de la coordination mise en jeu durant le maintien de l'ATR en fonction du niveau d'expérience de la gymnastique. La seconde s'intéresse à l'influence de la pratique gymnique sur la régulation posturale en comparant les modes de contrôle de la stabilité de la posture érigée qui émergent chez des gymnastes experts et chez des non gymnastes. Enfin, la troisième étude s'attache à caractériser les modes d'adaptation fonctionnelle de la posture érigée en fonction de la configuration perceptive et de l'expérience antérieure (gymnique ou non). L'ensemble des résultats tend à montrer qu'une expérience spécifique, telle que la gymnastique, modifie le rapport fonctionnel du couplage perception-action et s'impose comme une contrainte sur les patterns de coordination impliqués dans le contrôle postural, qu'il soit spécifique ou non à la gymnastique. Les conséquences théoriques et pratiques de l'influence de l'expérience sont discutéesIn an ecological approach, coordination's modes emerge from the interaction of the constraints imposed by the environment, the task and the organism. Then, coordinations are regulated according to the perception-action coupling. The aim of this doctoral work is to characterise how the modification of the organism properties, with a specific experience, influences both the emergence and the regulation of the motor control. Three studies are presented to analyse this phenomenon with the relationship between the gymnastics experience and the postural control. First, a dynamical analysis of a gymnastics posture according to the experience level is presented. A second study is focused on the emergence of control modes of the erected posture stability and compares experts in gymnastics with non gymnasts. Last, the third study characterise the functional adaptations of the erected posture relative to the perceptive configuration and the prior experience (gymnastics or not).Our results determine that a specific experience, such as gymnastic, leads to modify the functional relation of the perception-action coupling and represents a new constraint on the patterns of coordination involved in the postural control, specific or unspecific to the gymnastics. The theoretical and pragmatic consequences of the experience influence are discussedROUEN-BU Lettres (764512101) / SudocSudocFranceF

Dynamics of expertise level: Coordination in handstand

International audienceThe aim of the present study was to investigate the effect of expertise on coordination patterns. We thus tested the coordination dynamics of two groups: experts in the handstand also having high expertise in gymnastics and experts in the handstand but only intermediate expertise in gymnastics. All participants were instructed to track a target with their ankles while maintaining the handstand. The target moved on the anterior-posterior axis according to three frequency conditions: 0.2, 0.4 and 0.6 Hz. The results showed that the suprapostural task was performed better by the group with high gymnastics expertise. Moreover, the spontaneous coordination was specific to the level of gymnastics expertise. We concluded that (i) the dynamics of coordination progress with the overall level of expertise in a sport discipline, independently of the mastery of a single skill, (ii) persistence and change are seen in related movement properties, and (iii) high expertise offers greater adaptability relative to the task

Amplitude Variables of Circle on the Pedagogic Pommel Horse in Gymnastics

International audienceThe movement amplitude is a key component of numerous elements in gymnastics. The purpose of the present study is to highlight the most pertinent amplitude variable of the circle performed on the pedagogic pommel horse. Twelve gymnasts (6 expert gymnasts vs. 6 nonexpert gymnasts) performed 10 circles on this event. A Vicon 512 system was used to record the 3-dimensional position of 11 markers fixed on the gymnasts. Our results revealed than 4 amplitude variables permitted us to significantly discriminate the levels of performance of the gymnasts (p < 0.05): shoulder extension in front phase, body alignment, shoulder diameter, and ankle diameter. In a training perspective, this result could help coaches focus their advice and pedagogic situations on the pertinent technical criteria. Then, a stepwise discriminant analysis performed on the 4 previously selected variables showed that 2 variables allowed us to accurately discriminate the circle amplitude: ankle diameter and body alignment. These 2 variables can be used by coaches as a specific index to objectively determine the performance levels of gymnasts and to measure improvement in movements after specific training

Amplitude Variables of Circle on the Pedagogic Pommel Horse in Gymnastics

International audienceThe movement amplitude is a key component of numerous elements in gymnastics. The purpose of the present study is to highlight the most pertinent amplitude variable of the circle performed on the pedagogic pommel horse. Twelve gymnasts (6 expert gymnasts vs. 6 nonexpert gymnasts) performed 10 circles on this event. A Vicon 512 system was used to record the 3-dimensional position of 11 markers fixed on the gymnasts. Our results revealed than 4 amplitude variables permitted us to significantly discriminate the levels of performance of the gymnasts (p < 0.05): shoulder extension in front phase, body alignment, shoulder diameter, and ankle diameter. In a training perspective, this result could help coaches focus their advice and pedagogic situations on the pertinent technical criteria. Then, a stepwise discriminant analysis performed on the 4 previously selected variables showed that 2 variables allowed us to accurately discriminate the circle amplitude: ankle diameter and body alignment. These 2 variables can be used by coaches as a specific index to objectively determine the performance levels of gymnasts and to measure improvement in movements after specific training

Amplitude Variables of Circle on the Pedagogic Pommel Horse in Gymnastics

International audienceThe movement amplitude is a key component of numerous elements in gymnastics. The purpose of the present study is to highlight the most pertinent amplitude variable of the circle performed on the pedagogic pommel horse. Twelve gymnasts (6 expert gymnasts vs. 6 nonexpert gymnasts) performed 10 circles on this event. A Vicon 512 system was used to record the 3-dimensional position of 11 markers fixed on the gymnasts. Our results revealed than 4 amplitude variables permitted us to significantly discriminate the levels of performance of the gymnasts (p < 0.05): shoulder extension in front phase, body alignment, shoulder diameter, and ankle diameter. In a training perspective, this result could help coaches focus their advice and pedagogic situations on the pertinent technical criteria. Then, a stepwise discriminant analysis performed on the 4 previously selected variables showed that 2 variables allowed us to accurately discriminate the circle amplitude: ankle diameter and body alignment. These 2 variables can be used by coaches as a specific index to objectively determine the performance levels of gymnasts and to measure improvement in movements after specific training

Amplitude Variables of Circle on the Pedagogic Pommel Horse in Gymnastics

International audienceThe movement amplitude is a key component of numerous elements in gymnastics. The purpose of the present study is to highlight the most pertinent amplitude variable of the circle performed on the pedagogic pommel horse. Twelve gymnasts (6 expert gymnasts vs. 6 nonexpert gymnasts) performed 10 circles on this event. A Vicon 512 system was used to record the 3-dimensional position of 11 markers fixed on the gymnasts. Our results revealed than 4 amplitude variables permitted us to significantly discriminate the levels of performance of the gymnasts (p < 0.05): shoulder extension in front phase, body alignment, shoulder diameter, and ankle diameter. In a training perspective, this result could help coaches focus their advice and pedagogic situations on the pertinent technical criteria. Then, a stepwise discriminant analysis performed on the 4 previously selected variables showed that 2 variables allowed us to accurately discriminate the circle amplitude: ankle diameter and body alignment. These 2 variables can be used by coaches as a specific index to objectively determine the performance levels of gymnasts and to measure improvement in movements after specific training

Fertiloscopy in women with unexplained infertility: Long-term cumulative pregnancy rate

International audienceFertiloscopy is as safe as laparoscopy in literature, but we don't know its relevance in women with unexplained infertility (UI). Our objective was to assess the effects of fertiloscopy procedures on the outcomes of subsequent pregnancy occurrences in patients with UI

Detection of Borrelia-burgdorferi in Biological Samples Using the Polymerase Chain-reaction Assay

Oligonucleotide primers were used in the polymerase chain reaction assay to amplify specific DNA regions of the Borrelia burgdorferi 49-kb linear plasmid. One set of primers identifies a 442-bp DNA fragment in the OspA gene and a second pair of amplimers, a 176-bp DNA piece located in the OspB gene. The last set of primers, OspBpc3/pc4, outperformed the other pair in discriminating pathogenic North American or European isolates from related bacterial species, detected down to 4 spirochaetes, and was suitable for the identification of B. burgdorferi in biological samples, such as synovial and cerebrospinal fluids