Le lait contient de nombreuses hormones. Pour certaines hormones les concentrations dans le lait sont plus élevées que dans le plasma. Les hormones du lait peuvent soit provenir du sang, et dans ce ...cas elles sont transportées à travers les cellules épithéliales mammaires, soit être synthétisées par le tissu mammaire. Cet article envisage les rôles possibles de ces hormones sur le fonctionnement de la cellule épithéliale mammaire et sur la physiologie du nouveau-né. Il souligne l’importance d’une transmission d’information hormonale par l’alimentation lactée entre la mère et le jeune.
Purpose
A degenerative meniscus lesion is a slowly developing process typically involving a horizontal cleavage in a middle-aged or older person. When the knee is symptomatic, arthroscopic partial ...meniscectomy has been practised for a long time with many case series reporting improved patient outcomes. Since 2002, several randomised clinical trials demonstrated no additional benefit of arthroscopic partial meniscectomy compared to non-operative treatment, sham surgery or sham arthroscopic partial meniscectomy. These results introduced controversy in the medical community and made clinical decision-making challenging in the daily clinical practice. To facilitate the clinical decision-making process, a consensus was developed. This initiative was endorsed by ESSKA.
Methods
A degenerative meniscus lesion was defined as a lesion occurring without any history of significant acute trauma in a patient older than 35 years. Congenital lesions, traumatic meniscus tears and degenerative lesions occurring in young patients, especially in athletes, were excluded. The project followed the so-called formal consensus process, involving a steering group, a rating group and a peer-review group. A total of 84 surgeons and scientists from 22 European countries were included in the process. Twenty questions, their associated answers and an algorithm based on extensive literature review and clinical expertise, were proposed. Each question and answer set was graded according to the scientific level of the corresponding literature.
Results
The main finding was that arthroscopic partial meniscectomy should not be proposed as a first line of treatment for degenerative meniscus lesions. Arthroscopic partial meniscectomy should only be considered after a proper standardised clinical and radiological evaluation and when the response to non-operative management has not been satisfactory. Magnetic resonance imaging of the knee is typically not indicated in the first-line work-up, but knee radiography should be used as an imaging tool to support a diagnosis of osteoarthritis or to detect certain rare pathologies, such as tumours or fractures of the knee.
Discussion
The present work offers a clear framework for the management of degenerative meniscus lesions, with the aim to balance information extracted from the scientific evidence and clinical expertise. Because of biases and weaknesses of the current literature and lack of definition of important criteria such as mechanical symptoms, it cannot be considered as an exact treatment algorithm. It summarises the results of the “ESSKA Meniscus Consensus Project” (
http://www.esska.org/education/projects
) and is the first official European consensus on this topic. The consensus may be updated and refined as more high-quality evidence emerges.
Level of evidence
I.
A Cu6Sn5 layer is an integral part of many electronic interconnections. Here we show that, although primary Cu6Sn5 is not a potent nucleant for Sn, the Cu6Sn5 layer plays a key role in Sn nucleation ...and microstructure formation in solder joints. Combining thermal analysis, FIB-tomography and EBSD, we show that conical cavities are present between the scallops of the Cu6Sn5 layer that act as geometric nucleation sites for Sn, that Sn grows from the Cu6Sn5 layer, and that reproducible nucleation orientation relationships (ORs) exist between Cu6Sn5 and Sn. With these ORs, a near-random distribution of Sn orientations is predicted from joint to joint even for Cu6Sn5 layers with a strong 0001 fibre texture. It is shown that the nucleation undercooling is strongly affected by manipulation of the Cu6Sn5 layer shape, and that it is possible to prevent nucleation on the Cu6Sn5 layer by adding more potent nucleants.
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Purpose
Medial open-wedge high tibial osteotomy (MOWHTO) is an accepted option in the treatment of medial compartment osteoarthritis of the knee in young and active patients. Functional results are ...closely correlated to the correction of the mechanical axis of the lower limb. Although several angular and geometrical methods and values have been proposed in the past, the ideal target is still debated. In addition, it is important to have a deep correlation between the planned correction and the achieved correction after surgery. The aim of the present systematic review was to identify the ideal coronal correction after MOWHTO and the most accurate method to achieve it.
Methods
A systematic review of the literature was completed on July 3rd 2020 in the Pubmed, Medline, Cochrane Reviews, and Google Scholar databases using the Medical Subject Headings (MeSH) terms: “high tibial osteotomy” AND “accuracy” OR “planning”.
Results
28 studies were included; 18 were focused on computer-assisted surgery (CAS) and 10 on patient-specific instrumentation (PSI). There were 598 patients in the CAS group and 501 in the control group; the rate of outliers was 16% and 38.2% respectively (
P
= 0.04), while there was no significant difference between the two groups (SMD = − 0.10; 95% CI 1.31 to 1.12;
P
= n.s.) in terms of coronal accuracy. Likewise, there were 318 patients in the PSI group and 40 in the control group; the rate of outliers was 15% and 40% respectively (
P
= 0.98), while there was no significant difference between the two groups (SMD = 0.01; 95% CI 0.58 to 0.59;
P
= 0.98).
Conclusions
A statistically significant reduced outlier rate and a non-significant increased accuracy emerged with the use of CAS when compared to the traditional surgical technique, whereas the results of PSI were still inconclusive. In addition, it emerged clearly that no consensus still exists on the ideal correction target to be achieved after surgery.
Level of evidence
III.
The growth mechanisms of primary Cu6Sn5 are studied in Sn-Cu alloys and solder joints by combining EBSD, FIB-tomography and synchrotron radiography. With increasing cooling rate and Cu content, ...Cu6Sn5 crystals developed from faceted hexagonal rods to grooved rods, in-plane branched faceted crystals and, finally, to nonfaceted dendrites. This range of growth morphologies has been rationalised into a kinetic microstructure map. Cu6Sn5 hexagonal rods grew along 0001 bounded by {101¯0} facets and Cu6Sn5 dendrites branched along in the {101¯0} planes. The faceted to nonfaceted transition indicates a kinetic interface roughening transition and a gradual change in mechanism from lateral growth governed by anisotropic attachment kinetics to continuous growth governed by diffusion and curvature. Finally, it is shown that the full range of Cu6Sn5 morphologies that grew for different composition and cooling rate combinations in bulk alloys can be engineered to grow in solder joints made with a single composition (Sn-0.7 wt%Cu/Cu) by altering the peak temperature and the cooling rate.
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Introduction Le syndrome de Cushing est une affection rare dans la population générale (incidence d’1 cas par an et par million). Les cas survenant au cours d’une grossesse sont exceptionnels : moins ...de 150 cas décrits, dans la majorité en lien avec un adénome cortisolique. Observation Nous rapportons le cas d’une patiente de 32 ans suivie pour grossesse gémellaire, hospitalisée à 24 SA pour pré-éclampsie sévère nécessitant une extraction fœtale en urgence avec mort fœtale in utero d’un des jumeaux. La persistance après délivrance d’une HTA sévère, d’une hypokaliémie majeure et la présence de signes d’hypercorticisme (vergetures pourpres, hirsutisme) rétrospectivement apparus dès le 4e mois font évoquer le diagnostic d’hypercorticisme. L’hypercorticisme ACTH-indépendant est confirmé devant un cortisol libre urinaire à 10 N, une cortisolémie clampée entre 300 et 400 ng/mL sur le nycthémère (bilan réalisé en réanimation). Le scanner retrouvait une masse surrénalienne droite de 3 cm (densité spontanée 13 UH, wash out absolu 64 %), fixant au PET18 FDG (SUV max 9,8), sans localisation distante. Le diagnostic de corticosurrénalome est porté après surrénalectomie (score WEISS à 3, Ki67 5 %, limites d’exérèse en zones saines). Discussion Le diagnostic d’hypercorticisme durant la grossesse est difficile à poser en raison de symptômes peu spécifiques et des difficultés d’interprétations des résultats hormonaux. À l’inverse de la population générale où la principale étiologie est hypophysaire, les causes surrénaliennes sont les plus fréquentes chez la femme enceinte. L’activation des récepteurs LH/hCG à la surface des surrénales pendant la grossesse pourrait être en cause..
Abstract Restoration of normal hip biomechanics is a key goal of total hip arthroplasty (THA) and favorably affects functional recovery. Furthermore, a major concern for both the surgeon and the ...patient is preservation or restoration of limb length equality, which must be achieved without compromising the stability of the prosthesis. Here, definitions are given for anatomic and functional limb length discrepancies and for femoral and hip offset, determined taking anteversion into account. Data on the influence of operated-limb length and offset on patient satisfaction, hip function, and prosthesis survival after THA are reviewed. Errors may adversely impact function, quality of life, and prosthetic survival and may also generate conflicts between the surgeon and patient. Surgeons rely on two- or three-dimensional preoperative templating and on intraoperative landmarks to manage offset and length. Accuracy can be improved by using computer-assisted planning or surgery and the more recently introduced EOS imaging system. The prosthetic's armamentarium now includes varus-aligned and lateralized implants, as well as implants with modular or custom-made necks, which allow restoration of the normal hip geometry, most notably in patients with coxa vara or coxa valga. Femoral anteversion must also receive careful attention. The most common errors are limb lengthening and a decrease in hip offset. When symptoms are caused by an error in length and/or offset, revision arthroplasty may deserve consideration.
Status epilepticus (SE) represents one of the most common neurological emergencies, associated with high mortality and an important risk of functional sequelae in survivors. Magnetic resonance ...imaging (MRI) offers the possibility of early and noninvasive observation of seizure-induced parenchymal disturbances secondary to the epileptic process. In the present review, we propose a descriptive and comprehensive understanding of current knowledge concerning seizure-induced MRI abnormalities in SE, also called peri-ictal MRI abnormalities (PMAs). We then discuss how PMAs, as a noninvasive biomarker, could be helpful to optimize patient prognostication in SE management. Finally, we discuss alternative promising MRI approaches, including arterial spin labeling (ASL), susceptibility-weighted imaging (SWI), dynamic contrast-enhanced (DCE) MRI and dynamic susceptibility contrast (DSC) MRI that could refine our understanding of SE, particularly in non-convulsive form.
Purpose
Although the outcomes of ACL reconstruction are generally satisfying, there are several patients who do not regain their pre-injury sporting level and suffer persistent symptoms. Orthopaedic ...practice has evolved significantly over the last five years to address these drawbacks. The aim of the present survey was to analyze the changes in the approach to ACL reconstruction among a population of young ESSKA surgeons dedicated to ACL surgery.
Methods
The survey was uploaded on the ESSKA website and was accessible to members under the age of 45. The ESSKA society has 1035 U45 members involved in multiple aspects of Orthopaedic practice. One hundred and forty questionnaires were returned. Several aspects of ACL surgery were investigated at baseline and 5 years prior. They included general details such as the volume of ACL reconstructions per surgeon per year, the graft choice in cases of low and high demanding patients, the technique for femoral tunnel drilling and the preferred device for femoral fixation. The approach to the management of damage to peripheral structures, as well as meniscal ramp and root tears were also investigated.
Results
Hamstrings and quadrupled semitendinosus were the preferred graft choice in low-demanding patients (92.9%) while quadriceps tendon is gaining popularity in contact sport practitioners (from 4.3 to 10.7%). The percentage of surgeons using femoral screws had decreased from 37.9 to 29.3 while the percentage of those who used buttons increased from 52.9 to 69.3%. Extra-articular procedures (antero-lateral ligament (ALL) or lateral tenodesis have become popular. The percentage of surgeons who perform an additional peripheral reconstruction rose from 28.5 to 71.5%. Of those who perform the meniscal repair more than 50% of patients rose from 14.3 to 27.9%. Similarly, the percentage of surgeons who performed a medial meniscus ramp lesion repair rose from 29.4 to 54.7%. While the percentage of those who choose to perform a transtibial pull-out repair of lateral meniscus root tears significantly rose from 17.9 to 59.3%.
Conclusions
The present survey among under 45 years old ESSKA surgeons yields some notable findings. The new evidence on the impact of injuries on peripheral structures and menisci is stimulating surgeons towards a more anatomic approach if identified at the time of ACL reconstruction. This evidence will probably influence future research and decision-making.
Level of evidence
IV.
•AD hybrids had a multiple origin by ancient and recent hybridization events.•Only few genotypes among parental A and D haploids generated AD hybrids.•Loss of heterozygosity is a major evolutionary ...mechanism adopted by AD hybrids.
Hybrid AD strains of the human pathogenic Cryptococcus neoformans species complex have been reported from many parts of the world. However, their origin, diversity, and evolution are incompletely understood. In this study, we analyzed 102 AD hybrid strains representing 21 countries on five continents. For each strain, we obtained its mating type and its allelic sequences at each of the seven loci that have been used for genotyping haploid serotypes A and D strains of the species complex by the Cryptococcus research community. Our results showed that most AD hybrids exhibited loss of heterozygosity at one or more of the seven analyzed loci. Phylogenetic and population genetic analyses of the allelic sequences revealed multiple origins of the hybrids within each continent, dating back to one million years ago in Africa and up to the present in other continents. We found evidence for clonal reproduction and long-distance dispersal of these hybrids in nature. Comparisons with the global haploid serotypes A and D strains identified new alleles and new haploid multi-locus genotypes in AD hybrids, consistent with the presence of yet-to-be discovered genetic diversity in haploid populations of this species complex in nature. Together, our results indicate that AD hybrids can be effectively genotyped using the same multi-locus sequencing type approach as that established for serotypes A and D strains. Our comparisons of the AD hybrids among each other as well as with the global haploid serotypes A and D strains revealed novel genetic diversity as well as evidence for multiple origins and dynamic evolution of these hybrids in nature.
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