Turgor loss point and vulnerability to xylem embolism predict species-specific risk of drought-induced decline of urban trees.

Increasing frequency and severity of drought events is posing risks to trees' health, including those planted in urban settlements. Drought-induced decline of urban trees negatively affects ecosystem services of urban green spaces and implies cost for maintenance and removal of plants. We aimed at identifying physiological traits that can explain and predict the species-specific vulnerability to climate change in urban habitats. We assessed the relationships between long-term risk of decline of different tree species in a medium-sized town and their key indicators of drought stress tolerance, i.e. turgor loss point (TLP) and vulnerability to xylem embolism (P50 ). Starting from 2012, the study area experienced several summer seasons with positive anomalies of temperature and negative anomalies of precipitation. This trend was coupled with increasing percentages of urban trees showing signs of crown die-back and mortality. The species-specific risk of decline was higher for species with less negative TLP and P50 values. The relationship between species-specific risk of climate change-induced decline of urban trees and key physiological indicators of drought tolerance confirms findings obtained in natural forests and highlights that TLP and P50 are useful indicators for species selection for tree plantation in towns, to mitigate negative impacts of climate change.

[Diastematomyelia discovered in adulthood]. / Cas clinique. Diastématomyélie décelée à l'âge adulte.

We report a case of a 35-year-old woman with recurrent lumbar pain and left cruralgia in a post-traumatic context, for which the scanner had made possible the fortuitous diagnostic of a congenital anomaly. The diagnosis of diastematomyelia, which is more frequent in utero, is rare in adulthood and results from the implementation of an iconographic assessment. We will present the major malformations that are associated with diastematomyelia and which could evoke the presence of this malformation. The management of the anomaly is still controversial and can lead, if not done properly, to invalidating neurological deteriorations.

Nous rapportons le cas d'une patiente de 35 ans, présentant des lombocruralgies gauches chroniques dans un contexte post-traumatique, avec découverte fortuite au scanner lombaire d'une anomalie congénitale. Le diagnostic de diastématomyélie, non exceptionnel in utero, est rare à l'âge adulte et repose sur la réalisation d'un bilan iconographique. Nous exposerons les principales malformations associées qui pourraient faire suspecter ce diagnostic de diastématomyélie. La prise en charge ne fait pas encore l'objet d'un consensus et peut, si elle est mal orchestrée, se grever d'une détérioration neurologique invalidante.

[Critical appraisal of the battery of questionnaires used in the French-speaking Belgian spine rehabilitation centers for low back pain]. / Analyse critique de la batterie de questionnaires utilisée par les centres francophones belges de revalidation du rachis pour la lombalgie.

OBJECTIVES: to investigate the questionnaires used in French-speaking Belgian spine multidisciplinary rehabilitation centers for patients with low back pain and to propose a minimal core set of questionnaires based on the results of our survey and on the (inter)national guidelines. METHODS: the spine centers offering the 36 two-hour sessions defined by the Belgian national Institute for Health and disability insurance were invited to provide their battery of questionnaires. RESULTS: among the 37 identified and contacted centers, 21 participated in our survey. Results pointed out the use of questionnaires assessing pain intensity, disability, anxiety/depression and kinesiophobia in most centers as well as a huge heterogeneity regarding the questionnaires (and even the version of the questionnaire) reported and the non-systematic use of questionnaires recommended by the guidelines. CONCLUSION: taking into account the results of this survey, the present article proposes a minimal core set of questionnaires meeting the guidelines, which would make it possible to harmonize the assessments in the different centers and would facilitate the realization of multicenter studies.

Objectifs : examiner les questionnaires utilisés dans les centres francophones belges de revalidation multidisciplinaire du rachis pour la prise en charge des patients lombalgiques et proposer une batterie de questionnaires minimale basée sur les résultats de cette étude et sur les recommandations (inter)nationales. Matériel et méthodes : les centres proposant le programme de 36 séances de 2 heures défini dans la nomenclature de l'INAMI (Institut National d'Assurance Maladie Invalidité), ont été invités à nous fournir leur batterie de questionnaires. Résultats : parmi les 37 centres identifiés et contactés, 21 ont participé à l'enquête. Si celle-ci met en évidence l'utilisation de questionnaires évaluant l'intensité de la douleur, l'incapacité fonctionnelle, l'anxiété/dépression et la kinésiophobie dans les différents centres, elle révèle également une grande hétérogénéité en termes de questionnaires (et même de version du questionnaire) utilisés et la non-utilisation systématique des questionnaires recommandés par les guides de pratique clinique. Conclusion : compte tenu des résultats de l'enquête, cet article propose une batterie minimale de questionnaires répondant aux guidelines, qui permettrait d'harmoniser les évaluations dans les différents centres et faciliterait la réalisation d'études multicentriques.

[Innovations in physical and rehabilitation medicine]. / Innovations en médecine physique et réadaptation.

Over the last decade, Physical and Rehabilitation Medicine (PRM) is a medical specialty that has evolved considerably in the various fields that concern it : from the management of low back pain and lumbosciatalgia or osteoporosis in a multidisciplinary manner, through the use of new technologies in neuro-locomotor rehabilitation and robotisation in amputee patients for example, the development of regenerative medicine and prevention in sports traumatology and, finally, the progress of electrophysiology techniques for the diagnosis of small-fibre neuropathies. These various advances will be discussed in this article.

Au cours de la dernière décennie, la Médecine Physique et Réadaptation (MPR) est une spécialité médicale qui a fortement évolué dans les différents domaines qui la concernent : de la prise en charge des lombalgies et lombosciatalgies ou encore de l'ostéoporose de manière pluridisciplinaire, en passant par l'utilisation des nouvelles technologies en rééducation neuro-locomotrice et de la robotisation en rééducation, chez les patients amputés par exemple, le développement de la médecine à vocation régénérative et la prévention en traumatologie du sport et, enfin, les progrès des techniques d'électrophysiologie pour le diagnostic des neuropathies à petites fibres. Ces différentes avancées seront abordées dans cet article.

[Myositis ossificans located at the chest wall]. / Myosite ossifiante circonscrite de la paroi thoracique.

We report the clinical case of a classic bone pathology with a surprising and original chest wall topography, so far not described. Myositis ossificans is a benign pseudo-tumoral pathology. Medical imaging therefore constitutes an essential tool for an accurate diagnosis.

Nous rapportons le cas clinique d'une pathologie osseuse assez classique, mais de topographie pariétale thoracique surprenante et originale, non décrite à ce jour. La myosite ossifiante est une pathologie pseudo-tumorale bénigne. L'imagerie médicale constitue une ressource essentielle au diagnostic.

[Platelet-rich plasma (PRP) and disc lesions: A review of the literature]. / Plasma riche en plaquettes (PRP) et lésions discales : revue de la littérature.

The spine has been the subject of extensive clinical research since it is the source of many painful complaints. However, there is little scientific evidence concerning the therapeutic proposals. During the course of life, the intervertebral disc degenerates, which over time diminishes its damping capacity and facilitates the expulsion of the nucleus pulposus through the annulus fibrosus. The degeneration of the intervertebral disc (DDI) is the origin of some back pain and various specific treatments have been developed. These include the infiltration at the center of the intervertebral disc of plasma rich platelet (PRP), composed of multiple growth factors which act on the disc degeneration. This treatment is recent and less invasive than surgery. Preliminary results seem promising. However, many gray areas and several parameters remained to be clarified. In an attempt to do this, a literature review was conducted based on bibliographic databases Pubmed, Medline and Scopus® using the following Mesh terms : PRP, platelet-rich plasma, intradiscal disc degeneration, disc, intradiscal, discogenic. This analysis reveals that at the present time, no reported study has a sufficient perspective to judge the effectiveness of the infiltration of PRP. Early harvest results will be used to set the limits of this treatment. Accordingly, it is therefore currently recommended to introduce PRP injection as a complementary solution to comprehensive care of the spine. Future research will need to generate randomized controlled studies including comparing the results with conservative treatment and measure the cost-benefit relationship.

[THE MALADAPTIVE BELIEFS OF PATIENTS WITH LOW BACK PAIN. A NARRATIVE REVIEW]. / LES CROYANCES DÉLÉTÈRES DES PATIENTS LOMBALGIQUES. Revue narrative de la literature.

OBJECTIVE: to summarize the knowledge regarding the maladaptive beliefs of patients with non-specific low back pain. METHODS: a narrative literature review on these beliefs was conducted by an international and multidisciplinary team of experts in the field. RESULTS: these beliefs, which can result in negative consequences on functioning and on patient prognosis, have various origins: family and friends, media, previous experience and/or health care professionals' messages. The latter, who have a considerable and enduring influence, have the potential to change and correct the patients' misbeliefs; however, they can also reinforce them in case of inappropriate messages and attitudes. Informing and educating the patient (by means of reassurance, explanations of the non-systematic association pain-injury, encouragement to get and stay physically active) are the basis of treatment. Taking into account the consequences of some words which may be misinterpreted, the results of imaging should be wisely discussed with the patient. Pain neurophysiology education and cognitive behavioral therapy (i.a., in vivo graded exposure techniques) are effective additional treatments. CONCLUSIONS: Misbeliefs are frequent in patient with low back pain. They do need to be looked for and corrected.

[Epithelioid hemangioma, a rare bone tumor]. / Le cas clinique du mois. Hémangiome épithélioïde, une tumeur osseuse rare.

A case of pathological hip fracture associated with an epithelioid hemangioma is reported. Epithelioid hemangioma is a benign tumor, rarely localized in a bone. When the tumor is found on the skeleton, it generally involves a long bone. X-ray does not permit the differenciation of epithelioid hemangioma from other, malignant, vascular tumors. Therefore, the diagnosis requires surgery. Although no consensus treatment guidelines exist, the curettage--filling is most often proposed.

Trunk muscle profile in elite tennis players with and without low back pain.

AIM: The aim of this study was to compare tennis players with and without low back pain (LBP) and healthy sedentary participants regarding the trunk muscle strength and flexibility. METHODS: Thirty-eight male elite tennis players and 22 healthy sedentary male students (24.8±4.0 years) participated in this investigation. Tennis players were divided into two groups: 11 players (27.8±5.5 years) with current LBP and 27 players (24.3±5.9 years) without LBP. Maximal isometric strength of trunk extensor, rotator, flexor and lateralflexor muscles was assessed by means of specific trunk dynamometers. Pelvic and lumbar flexion mobility were measured by means of inclinometer technique. RESULTS: Comparison of tennis players with and without LBP revealed no significant difference regarding trunk muscle strength and ratio or lumbar spine flexibility (all P>0.05). In comparison with sedentary participants, the tennis players showed a sport-specific profile determined by a non-dominant trunk lateralflexors (P=0.02, F=4.05) and rotators (P=0.03, F=3.62) strength significantly higher than the dominant side. CONCLUSION: In the current study, comparison of tennis players with and without LBP showed no significant difference regarding trunk strength and spine flexibility. Trunk profile of tennis players showed selective unilateral strength increase of the non-dominant trunk lateralflexors and rotators. This finding could result from the forehand and the service action which involves simultaneously left trunk rotators and lateralflexors, in right-handed players, to generate power. In order to confirm that trunk muscle imbalance has no influence on LBP, further studies should study the effectiveness of a programme aiming to normalize strength ratios in tennis players with LBP.

Prevalencia de patología cardíaca en la enfermedad de Chagas: años 2004-2012. Programa y Red de Chagas de CABA / Prevalence of cardiac pathology in Chagas disease: 2004 -2012. Program and Chagas CABA network

El Instituto Universitario de Ciencias de las Salud ha mostrado un particular compromiso con la formación de sus estudiantes en la estrategia de Atención Primaria de la Salud, con las prácticas asistenciales dedicadas al 1er nivel de atención ambulatoria y a las patologías prevalentes en ese ámbito. Del mismo modo se han desenvuelto las actividades de formación en investigación. Como exponente de esa orientación, la revista Ciencias de la Salud publicó en el Vol. 2, N°1, 2011:4-9, el artículo “Prevalencia de la Enfermedad de Chagas” de Érica G. Morais, que había obtenido el premio “Futuros Líderes”, otorgado por el Curso Anual Internacional de Investigación en Ciencias de la Salud (IUCS-AMA, Prof. Carlos Álvarez Bermúdez). Aquella investigación formaba parte de un proyecto más amplio realizado en el Hospital Teodoro Álvarez entre 2004 y 2012, en el que participaron un conjunto de investigadores, que compartieron la autoría de la actual publicación. El Dr. Jorge Mitelman, Prosecretario de Ciencia y Técnica del IUCS e integrante de ese equipo, preparó además una reseña sobre la jornada del INCOSUR, realizada en abril del presente año, describiendo asimismo el proceso de desarrollo de la Ciudad de Buenos Aires, como área no endémica, para encarar las consecuencias de la enfermedad de Chagas

Lumbar functional instability: a critical appraisal of the literature.

The goals of this paper were to define the concept of instability, to describe the way it can be assessed, to report on impairments of the spine stabilization system in patients with low back pain (LBP), to cite the recommended exercises and, lastly, to examine the results of programs based on lumbar stabilization. Patients suffering from lumbar instability appear to belong to a particular subgroup of subjects with LBP. In the literature, several definitions of lumbar instability have been proposed. Radiological instability, for instance, differs from functional instability. Diagnosis remains difficult: the relevance of static and dynamic radiographs appears limited whereas several signs and clinical instability tests have been described in the literature but remain controversial. The functional stability system of the spine consists of three interdependent components: the passive, the active and the neuromuscular subsystems. The benefits of lumbar stabilization programs for LBP patients have been underlined. Lumbar stabilization exercises are aimed at sensorimotor reprogrammation of spine stabilizer muscles intended to improve their motor control skill and delay of response and consequently to compensate for weakness of the passive stabilization system.

Anticuerpos antirreceptores a neurotransmisores y su correlacion con la alteracion de la dispersión del QT y de la variabilidad de la frecuencia cardiaca / Anticorpos anti-receptores a neurotransmissores e sua correlação com a alteração da dispersão do QT e da variabilidade da frequência cardíaca

Objetivos: Estudiar la asociación entre las alteraciones de la variabilidad de la frecuencia cardiaca (VFC); dispersión del QT y la presencia de anticuerpos antirrecptores a neurotransmisores en la enfermedad de Chagas (con o sin cardiopatia). Material y Métodos: En uma muestra de 241 individuos, se incluyeron 108 pacientes chagásicos en período indeterminado; 102 con cardiopatía grupo A (clasificación del consejo de Enfermedad de Chagas y Miocardiopatías Infecciosas Dr. Salvador Mazza) y 31 controles no chagásicos. En ellos la infección se detectó con tres reacciones sorológicas positivas, se determinó la presencia de IgG anti-RA con el método ELISA y alteraciones de la VFC por Holter de 24 hs y la dispersión del QT por medición electrocardiografica. Métodos estadísticos: Chi cuadrado; Odd Ratio; prueba de Mantel y Haenszel; regresión logística múltiple. Resultados: El 31 por cento de los indeterminados (34 casos) presentan AcsRN positivos. De estos pacientes 20 (58 por cento) tienen valores iguales o mayores a 654 mseg en la DQT y 23 (67 por cento) tienen valores iguales o menores a 100 ms en la DS de la SDNN...

[Indications for epidural steroids in back pain and in radiculopathy]. / Indications des corticoïdes par voie péridurale dans les douleurs rachidiennes et radiculaires.

Back pain is very frequent in western countries and it represents a very high social cost. The treatment is based on five modalities: medication, physiotherapy, invasive technics, rehabilitation programs and psycho-social approaches. Several treatments may be proposed simultaneously and introduced gradually. Steroid administration by epidural injection is frequently used in Belgium, even though no prospective randomised studies have shown a real benefit over the long term. The indications for epidural injection must be carefully chosen. These include subacute pain (less than six months) in the lower limbs despite a well observed medical treatment. Patients are invited to give informed consent; the technic must be performed in an appropriate environment by an experienced physician. The initial treatment of back pain is medical. This pathology is multifactorial and the relief of symptoms is often incomplete. The patient should be urged to feel responsible for and involved in his treatment.

[Chronic pain management: a multidisciplinary approach]. / Prise en charge de la douleur chronique en equipe pluridisciplinaire.

Assessment of chronic pain is one of medicine's most difficult challenges. A structured and flexible multidisciplinary approach allows full characterisation of the various components of the pain syndrome. This then allows the use of a rational combination of pharmacologic, physical, psychological, and surgical techniques. It is essential to gain the patient's confidence, collaboration, and compliance. Patients can better manage their situation when their needs are clarified and when care is oriented toward concrete therapeutic objectives.

[Validation of an evaluation test of activities of daily living behaviour for patients with chronic low back pain]. / Validation d'un test d'évaluation du comportement gestuel du patient lombalgique chronique.

AIM: The purpose of this study was to validate an evaluation test of the gesture behaviour for patients with chronic low back pain. METHOD: Forty-four patients (19 females and 25 males) (45.7 +/- 10.8 years) with chronic low back pain (delay of pain: 9.8 +/- 9.0 years) took part in an educational back school program. They performed 3 tests at the beginning (pre-test), at the end (post-test) and three months after the back school program (control): a visual analogic scale, the Dallas questionnaire and a gesture evaluation test that is composed of three tasks for the pre-test and five tasks for the post-test and the control session. RESULTS: Our gesture test was reproducible and sensible. The mean gesture result increased significantly after the back school program (39.6 +/- 23.2 % in the pre-test and 73.4 +/- 12.5 % in the post-test, p < 0.05) and was stabilized at this high level (69 +/- 18.8 %) for the control session. The patients demonstrated abilities to transfer an appropriate gesture behaviour to new tasks. DISCUSSION AND CONCLUSION: This study validated a gesture behaviour test for the patient with chronic low back pain. The use of this test during a back school program demonstrated an immediate and long lasting effect on the appropriate gesture behaviour. However the algo-functional status was increased more belatedly and more modestly.

[How I explore ... lumbar paraspinal muscle electromyography in the assessment of radiculopathy]. / Comment j'explore ... la musculature paravertébrale lombaire dans les radiculopathies par électromyographie.

Lumbar paraspinal muscles examination is an interesting part of the electrodiagnostic evaluation of patients with suspected lumbosacral radiculopathy. However, many electromyographers hesitate to routinely include that technique in their study of lower limbs. The purpose of this paper is to specify the anatomy and electrophysiologic data of multifidus lumbar paraspinal muscle. Previous anatomic studies indicate that the medial lumbar multifidus and lumbar interspinalis muscles share unisegmental innervation by the dorsal ram of the spinal nerve. Electromyography of these muscles can improve the sensitivity of lumbosacral radiculopathy detection. Multi-MUP analysis of quantitative electromyographic parameters in lumbar paraspinal muscles, in a population of 75 healthy subjects without back pain, allowed to set up normal values for the L5 myotome.