Safety and efficacy of a 6-month home-based exercise program in patients with facioscapulohumeral muscular dystrophy

Background: Previous randomized controlled trials investigating exercise training programs in facioscapulohumeral muscular dystrophy (FSHD) patients are scarce and of short duration only. This study assessed the safety and efficacy of a 6-month home-based exercise training program on fitness, muscle, and motor function in FSHD patients. Methods: Sixteen FSHD patients were randomly assigned to training (TG) and control (CG) groups (both n = 8) in a home-based exercise intervention. Training consisted of cycling 3 times weekly for 35 minutes (combination of strength, high-intensity interval, and low-intensity aerobic) at home for 24 weeks. Patients in CG also performed an identical training program (CTG) after 24 weeks. The primary outcome was change in peak oxygen uptake (VO 2 peak) measured every 6 weeks. The principal secondary outcomes were maximal quadriceps strength (MVC) and local quadriceps endurance every 12 weeks. Other outcome measures included maximal aerobic power (MAP) and experienced fatigue every 6 weeks, 6-minute walking distance every 12 weeks, and muscle characteristics from vastus lateralis biopsies taken pre- and postintervention. Results: The compliance rate was 91% in TG. Significant improvements with training were observed in the VO 2 peak (+19%, P = 0.002) and MAP by week 6 and further to week 24. Muscle endurance, MVC, and 6-minute walking distance increased and experienced fatigue decreased. Muscle fiber cross-sectional area and citrate synthase activity increased by 34% (P = 0.008) and 46% (P = 0.003), respectively. Dystrophic pathophysiologic patterns were not exacerbated. Similar improvements were experienced by TG and CTG. Conclusions: A combined strength and interval cycling exercise-training program compatible with patients' daily professional and social activities leads to significant functional benefits without compromising muscle tissue

Faut-il réaliser une échographie en urgence pour les entorses aigües de la cheville ?

TOULOUSE3-BU Santé-Centrale (315552105) / SudocSudocFranceF

Imagerie des tumeurs des tissus mous

Cette thèse est un travail collégial qui a pour but de fournir un ouvrage de référence sur les tumeurs des tissus mous, édité dans les pays francophones. Cet ouvrage décrit de manière systématique et didactique l'ensemble des tumeurs des tissus mous recensées par l'organisation mondiale de la santé. Il traite de leurs caractéristiques radiologiques mais aussi épidémiologiques, cliniques, anatomo-pathologiques et thérapeutiques. Il est illustré par plus de 500 figures issues des bases de données des CHU de Montpellier et de Toulouse. Un chapitre, portant sur les tumeurs périvasculaires, a été sélectionné afin d'illustrer l'ensemble de ce travail de thèse.TOULOUSE3-BU Santé-Centrale (315552105) / SudocSudocFranceF

Long term improvement of knee osteoarthritis after injection of single high/very high volume of very pure PRP: A retrospective analysis of patients optimally managed in dedicated centers

Introduction: PRP is gaining increasing interest for pain relief and improvement of joint function in patients with knee osteoarthritis (KOA) but practices and results remain heterogeneous limiting its adoption as standard of care. Current international recommendations are to collect real-life evidence of efficacy with a systematic monitoring of PRP quality and patients' outcomes. We aimed to analyze the response of patients presenting KOA and treated with standardized PRP injection in routine care. We also investigated the potential contributing factors including patient's phenotype and PRP characteristics. Methods: Patients with symptomatic KOA and that failed first-line therapy received a single injection of a qualified PRP prepared using medical devices allowing to recover a high/very high volume of very pure PRP. Visual analogue scale (VAS) and Western Ontario and McMaster Osteoarthritis Index (WOMAC) score were recorded at baseline and during 18 months follow-up. Results: 431 patients had available follow-up data at 3 months, 291 at 6 months, 137 at 12 months and 44 at 18 months. PRP induced a significant decrease of WOMAC score at all follow up endpoints (29.2 ± 19.2 at 3 months, p < 0.001 and 25.9 ± 19.7 at 12 months, p < 0.01, compared to 39.7 ± 18.9 at baseline). Similar results were observed for pain VAS (38.9 ± 23.3 at 3 months, p < 0.001 and 35.3 ± 24.1 at 12 months, p < 0.05, compared to 56.0 ± 20.7 at baseline). Changes at 12 months were correlated to baseline scores and to the level of improvement at 3 months. The proportion of OMERACT OARSI responders reached 56.2 % for the total cohort and 60.4 % for severe patients at 6 months. Treatment failure occurred for 8.4 % of patients. Age, BMI or Kellgren–Lawrence grade did not impact on efficacy. Conclusion: This real-life study evidences the clinical benefit of a standardized high or very high-volume injection of very pure PRP in patients with KOA, including those with a severe grade. It opens perspectives in the positioning of such strategy to delay arthroplasty and provide insights on factors able to anticipate long term efficacy

Renouveler la macroéconomie postkeynésienne ? Les modèles stock-flux cohérent et multi-agents

Le numéro 16 de la Revue de la régulation nous donne à nouveau l’occasion d’un échange avec le courant postkeynésien (après le n° 10). Il illustre les liens tissés entre ces approches et permet à des chercheurs d’orientations différentes, souvent complémentaires, de travailler ensemble. Le dossier, coordonné par Mickaël Clévenot et Edwin Le Héron, invite à explorer les nouvelles voies de la modélisation macroéconomique postkeynésienne. >> lire la suite Issue 16 of the Revue de la regulation offers another occasion (after Issue 10) for exchanges with the post-Keynesian school of thought. It illustrates the connections between these frameworks and allows researchers with different, but often complementary, orientations to work together. The dossier, edited by Mickaël Clévenot and Edwin Le Heron, invites us to explore emerging directions in post-Keynesian macroeconomic modeling. >> read mor

Déployer les études de genre en économie politique

L’importance particulière de ce numéro tient à l’effort qu’il a entrepris d’explorer un domaine « invisible » pour les sciences économiques : le rôle du genre dans l’organisation économique des entreprises et dans l’organisation de la discipline. C’est un paradoxe. Sur les questions de genre, il existe en effet une littérature scientifique continue depuis les débuts de l’économie politique, pourtant son développement reste limité. Est-ce à dire que ces questions sont marginales en économie ? Ou au contraire qu’elles dérangent, dans le champ académique comme dans le champ économique ? La productivité n’a pas de sexe, pas plus que l’avantage comparatif, diront sans doute certains. Mais certaines le contestent, et pas seulement des femmes. Lire la suite >

High Risk of Anal and Rectal Cancer in Patients With Anal and/or Perianal Crohn’s Disease

International audienceBackground & AimsLittle is known about the magnitude of the risk of anal and rectal cancer in patients with anal and/or perineal Crohn’s disease. We aimed to assess the risk of anal and rectal cancer in patients with Crohn’s perianal disease followed up in the Cancers Et Surrisque Associé aux Maladies Inflammatoires Intestinales En France (CESAME) cohort.MethodsWe collected data from 19,486 patients with inflammatory bowel disease (IBD) enrolled in the observational CESAME study in France, from May 2004 through June 2005; 14.9% of participants had past or current anal and/or perianal Crohn’s disease. Subjects were followed up for a median time of 35 months (interquartile range, 29–40 mo). To identify risk factors for anal cancer in the total CESAME population, we performed a case-control study in which participants were matched for age and sex.ResultsAmong the total IBD population, 8 patients developed anal cancer and 14 patients developed rectal cancer. In the subgroup of 2911 patients with past or current anal and/or perianal Crohn’s lesions at cohort entry, 2 developed anal squamous-cell carcinoma, 3 developed perianal fistula–related adenocarcinoma, and 6 developed rectal cancer. The corresponding incidence rates were 0.26 per 1000 patient-years for anal squamous-cell carcinoma, 0.38 per 1000 patient-years for perianal fistula–related adenocarcinoma, and 0.77 per 1000 patient-years for rectal cancer. Among the 16,575 patients with ulcerative colitis or Crohn’s disease without anal or perianal lesions, the incidence rate of anal cancer was 0.08 per 1000 patient-years and of rectal cancer was 0.21 per 1000 patient-years. Among factors tested by univariate conditional regression (IBD subtype, disease duration, exposure to immune-suppressive therapy, presence of past or current anal and/or perianal lesions), the presence of past or current anal and/or perianal lesions at cohort entry was the only factor significantly associated with development of anal cancer (odds ratio, 11.2; 95% CI, 1.18-551.51; P = .03).ConclusionsIn an analysis of data from the CESAME cohort in France, patients with anal and/or perianal Crohn’s disease have a high risk of anal cancer, including perianal fistula–related cancer, and a high risk of rectal cancer