Hand and wrist Osteo-articular bone defect: induced membrane technique indications.

Bone defect in the hand and wrist is the result of 3 main causes: traumatic, infectious or tumoral. Whatever the cause and possibility of emergency management, the site (hand or wrist) and anatomical location (articular or diaphyseal) guide the choice of surgical technique and timing. Functional sequelae do not vary, and the ultimate objective is not so much to fill a defect but to give a useful and accepted finger, hand or wrist.

[Impact of AMARA VIEW™ interface on upper airway during nocturnal non invasive ventilation]. / Impact de l'interface AMARA VIEW™ sur les voies aériennes supérieures au cours de la ventilation non invasive nocturne.

INTRODUCTION: Nasal masks can result in mouth leaks with implications on sleep quality. To reduce these leaks, oronasal masks are proposed. It has been shown that an oronasal mask can induce obstructive events in the upper airways (UA). Because of its fit around the nose, the Amara View™ facial mask may have less consequence on UA obstruction. METHODS: This retrospective study assessed the impact of the Amara View™ mask on UA. The study was conducted on patients with chronic respiratory failure treated by home NIV with standard facial mask. Replacement of the standard facial mask by an Amara View™ mask was performed when the residual apnea hypopnea index recorded from the ventilator software exceeded 5/h. All patients underwent nocturnal respiratory polygraphy when on NIV with a standard facial mask and with an Amara View™ mask. Respiratory polygraphic traces were interpreted following the analysis methods published by the SomnoNIV Group. RESULTS: Seven patients were studied. Although nocturnal oxygen saturation was similar between both masks, the index of UA obstruction without ventilatory blunting was significantly lower during NIV with the Amara View™ mask compared to the standard facial mask (P=0.01). CONCLUSIONS: Nocturnal NIV using an Amara View™ facial interface may avoid UA obstruction without ventilatory command blunting.

Impact of two-level filtering on emergency medical communication center triage during the COVID-19 pandemic: an uncontrolled before-after study.

BACKGROUND: Rapid access to emergency medical communication centers (EMCCs) is pivotal to address potentially life-threatening conditions. Maintaining public access to EMCCs without delay is crucial in case of disease outbreak despite the significant increased activity and the difficulties to mobilize extra staff resources. The aim of our study was to assess the impact of two-level filtering on EMCC performance during the COVID-19 outbreak. METHODS: A before-after monocentric prospective study was conducted at the EMCC at the Nantes University Hospital. Using telephone activity data, we compared EMCC performance during 2 periods. In period one (February 27th to March 11th 2020), call takers managed calls as usual, gathering basic information from the caller and giving first aid instructions to a bystander on scene if needed. During period two (March 12th to March 25th 2020), calls were answered by a first-line call taker to identify potentially serious conditions that required immediate dispatch. When a serious condition was excluded, the call was immediately transferred to a second-line call taker who managed the call as usual so the first-line call taker could be rapidly available for other incoming calls. The primary outcome was the quality of service at 20 s (QS20), corresponding to the rate of calls answered within 20 s. We described activity and outcome measures by hourly range. We compared EMCC performance during periods one and two using an interrupted time series analysis. RESULTS: We analyzed 45,451 incoming calls during the two study periods: 21,435 during period 1 and 24,016 during period 2. Between the two study periods, we observed a significant increase in the number of incoming calls per hour, the number of connected call takers and average call duration. A linear regression model, adjusted for these confounding variables, showed a significant increase in the QS20 slope (from - 0.4 to 1.4%, p = 0.01), highlighting the significant impact of two-level filtering on the quality of service. CONCLUSIONS: We found that rapid access to our EMCC was maintained during the COVID-19 pandemic via two-level filtering. This system helped reduce the time gap between call placement and first-line call-taker evaluation of a potentially life-threatening situation. We suggest implementing this system when an EMCC faces significantly increased activity with limited staff resources.

Analysis of Au-Pd driving forces via the effective site energy model: LRO, antisites and enthalpy of permutation.

Recently we have developed a new energetic model based on the determination of the energies on each site of random solid solutions after relaxation as a function of both the local composition and the nominal concentration. It allows to determine the main thermodynamics driving forces of disordered alloys. Here, we extend the effective site energy model to ordered alloys and illustrate the results for the Au c Pd1-c system. As a first step, we show the ability of this energetic model to reproduce the hierarchy of ordered phases. Then, we derive general mean-field analytic formulae for ordered systems and get the phase diagram. We determine the relative role of the cohesive effect, the chemical effect and the size effect and find that the chemical effect differs significantly between the disordered state and the ordered state. Finally, we link the energy formation of antisite to the permutation enthalpy and give the driving forces for the formation of antisite.

[Noninvasive ventilation for acute respiratory failure in a pulmonary department]. / Ventilation non invasive dans l'insuffisance respiratoire aiguë en service de pneumologie.

INTRODUCTION: Noninvasive ventilation (NIV) is considered as the first choice treatment for selected patients with acute respiratory failure (ARF), but many hospitals are forced to start NIV on medical wards. METHODS: The aim of this retrospective study was to assess the outcomes of NIV initiated for ARF on a respiratory ward and to find the criteria predictive of failure. All patients were treated in a four-bed ward specifically dedicated to NIV. Failure of NIV was defined as the need for intubation and transfer to ICU, or death. RESULTS: Among 105 admissions with ARF, 49 episodes needed NIV. These episodes were divided into 2 groups: PaCO2<45mmHg (10) and PaCO2>45mmHg (39). The overall failure rate of NIV and overall in-hospital mortality rate were 26.5% and 17% respectively. On multivariate analysis, SAPS II and respiratory acidosis with a pH less than 7.30 were significantly associated with failure of NIV. CONCLUSIONS: NIV is practicable and is effective in the management of mild to moderate ARF on a respiratory ward. However, patients with respiratory acidosis and a pH less than 7.30 are at risk of NIV failure.

Phase diagrams of nanoalloys: influence of size and morphology.

The size dependence of the phase diagram of nanoalloys with a tendency to phase separate is investigated. As the critical temperature may depend on both the size and the morphology of the nanoparticles, we consider nanowires with different cross-sections and also nanotubes with different circumferences. The variation of the critical temperature with the length of all these nanoparticles is systematically studied using Monte Carlo simulations based on an Ising model. A non-monotonic variation of the critical temperature is observed as a function of the length. The maximal value of the critical temperature is reached when the length and the circumference of the nanoparticles are similar. The phase diagrams obtained within two thermodynamic ensembles (the canonical ensemble and the pseudo grand canonical ensemble) are compared and discussed in terms of the behaviour of a single particle or an assembly of nanoparticles in mutual equilibrium with each other.

Ageing of out-of-equilibrium nanoalloys by a kinetic mean-field approach.

This study describes the ageing of bimetallic nanoparticles using a kinetic mean-field method which provides the time evolution of the concentration for each site. We consider the cuboctahedron of 309 atoms in the Cu-Ag system, which is a prototype of systems with a strong tendency to phase separate. Starting from an initial homogenous configuration, we investigate the evolution towards the equilibrium configuration at different temperatures. Surprisingly, at low temperature, the kinetics exhibits a first transition towards an onion-like configuration followed by a second transition towards the equilibrium core-shell configuration. An analysis of the kinetics of the formation and then of the dissolution of the onion-like structure allows us to identify the main paths of the kinetic process.

Penetration of daptomycin into bone and synovial fluid in joint replacement.

Daptomycin exhibits clinical activity in the treatment of infections with Gram-positive organisms, including infections due to methicillin-resistant Staphylococcus aureus. However, little is known about its penetration into bone and synovial fluid. The aim of our study was to assess the penetration of daptomycin into bone and synovial fluid after a single intravenous administration. This study was conducted in 16 patients who underwent knee or hip replacement and received a single intravenous dose of 8 mg of daptomycin per kg of body weight prior to surgery. Plasma daptomycin concentrations were measured 1 h after the end of daptomycin infusion and when bone fragments were removed. Daptomycin concentrations were also measured on bone fragments and synovial fluid collected at the same time during surgery. All samples were analyzed with a diode array-high-performance liquid chromatography (HPLC) method. After a single-dose intravenous infusion, bone daptomycin concentrations were above the MIC of daptomycin for Staphylococcus aureus in all subjects, and the median bone penetration percentage was 9.0% (interquartile range [IQR], 4.4 to 11.4). These results support the use of daptomycin in the treatment of Staphylococcus aureus bone and joint infections.

Iodine status has no impact on thyroid function in early healthy pregnancy.

Aim. To assess the impact of iodine status in early pregnancy on thyroid function. Methods. Women >18 years old seen at their first prenatal consult before 12 weeks of amenorrhea and without personal thyroid history were proposed thyroid screening and were eligible if they had strictly normal thyroid tests (fT4 > 10th percentile, TSH < 2.5 mUI/L, negative anti-TPO antibodies). Evaluation included thyroid ultrasound, extensive thyroid tests, and ioduria (UIE). Results. 110 women (27.5 y, 8 weeks of amenorrhea, smoking status: 28% current smokers) were enrolled. Results are expressed as medians. UIE was 116 µg/L. 66.3% of women had iodine deficiency (ID) defined as UIE < 150. FT4 was 14.35 pmol/L; TSH 1.18 mUI/L; fT3 5 pmol/L; thyroglobulin 17.4 ng/mL; rT3 0.27 ng/mL; thyroid volume: 9.4 ml. UIE did not correlate with any thyroid tests, but correlated negatively with thyroid volume. UIE and all thyroid tests, except fT3, correlated strongly with ßhCG. Smoking correlated with higher thyroid volume and thyroglobulin and with lower rT3. Conclusions. In pregnant women selected for normal thyroid function, mild ID is present in 66% during the 1st trimester. The absence of correlation between UIE and thyroid tests at that stage contrasts with the impact of ßhCG and, to a lesser degree, maternal smoking.

Extending cluster description to bimetallic nanowires: the ideal solid solution alloy case.

We present a comprehensive study of the equilibrium properties of two codeposited species for an alloy that forms an ideal solution, on a one-dimensional chain. By use of a cluster description we provide exact formulae of the coverages, the total density of clusters, the cluster size distribution, and the chemical composition of each cluster. These analytical results, that are proved to be in agreement with Monte Carlo simulations, strongly differ from the ones derived in the mean-field framework. Indeed, we show by depicting the codeposit at the macroscopic, mesoscopic, and atomic scales, that its features are to be related to the chemical heterogeneities at the edges of the clusters.

A new composite model including metabolic syndrome, alanine aminotransferase and cytokeratin-18 for the diagnosis of non-alcoholic steatohepatitis in morbidly obese patients.

BACKGROUND: Non-invasive approaches are useful to differentiate simple steatosis from non-alcoholic steatohepatitis (NASH) in obese and morbidly obese patients. AIM: To develop a new scoring system to diagnose definitive NASH. METHODS: Preoperative clinical and biological data including serum caspase 3-generated cytokeratin-18 fragments (CK18) and surgical liver biopsies were obtained from 464 morbidly obese patients who had undergone bariatric surgery. The cohort was divided into two groups: training group (n = 310) and validation group (n = 154). Definitive NASH was defined according to Kleiner's classification with a Non-alcoholic fatty liver disease Activity Score (NAS) ≥5. RESULTS: Alanine aminotransferase (ALT), CK18 fragments and the presence of metabolic syndrome were independent predictors for discriminating patients with NAS ≥5 in the training group. These three parameters were used to carry out a scoring system for the prediction of NAS ≥5. Whereas serum CK18 fragment alone had an area under the receiver operating characteristic (AUROC) curve = 0.74, AUROC curves of the scoring system were 0.88 and 0.83 in the training group and the validation group, respectively. CONCLUSION: A simple and non-invasive composite model (the Nice Model) including metabolic syndrome, ALT and CK18 fragments is able to predict accurately a non-alcoholic fatty liver disease activity score ≥5 in morbidly obese subjects.

Predictive factors of bleeding related to post-banding ulcer following endoscopic variceal ligation in cirrhotic patients: a case-control study.

BACKGROUND: Life-threatening bleeding caused by early spontaneous slippage of rubber bands has been described after variceal ligation in cirrhotic patients. AIM: To determine the predictive factors of this complication in cirrhotic patients. METHODS: Among 605 patients, 21 patients (mean age 56.6 +/- 13.5 years) developed 23 spontaneous band slippages with bleeding on post banding ulcer, as confirmed by endoscopy. Cirrhosis was alcoholic in 13 patients (62%), post viral hepatitis in three (14%) and from other causes in five (24%). A case-control study was performed comparing 17 from these patients who presented the complication after a first ligation with 84 of the 584 controls who underwent first endoscopic variceal ligation without bleeding complication. RESULTS: Bleeding occurred 13.5 days +/- 7.3 (2-29) following ligation. Eleven patients died following the bleeding complication (52%). Using a multivariate analysis, previous upper variceal digestive bleeding [OR 12.07, 95%CI (2.3-63.43)], peptic oesophagitis [OR 8.9, 95%CI (1.65-47.8)], high platelet ratio index (APRI) score [OR 1.54, 95%CI (1.11-2.16)] and low prothrombin index [OR 0.54, 95% CI (0.31-0.94)] were independent predictive factors of bleeding. CONCLUSIONS: Bleeding related to post-banding ulcer is a rare, but severe complication. The proposed predictive factors should be looked for and minimized before variceal ligation.

[Interest of tricuspid annular displacement (TAD) in evaluation of right ventricular ejection fraction]. / Evaluation de la fraction d'éjection ventriculaire droite par la mesure du déplacement de l'anneau tricuspide via l'utilisation du tricuspid annular displacement (TAD).

INTRODUCTION: The ultrasound assessment of RV structure and function is often sub-optimal. The range of excursions of the mitral or tricuspid annulus measured in millimetre by 2D or TM-mode in centimetre per second by DTI-mode echocardiography has been shown to reflect the systolic function of both ventricles. METHODS: We studied a new technique based on a tissue tracking algorithm that is ultrasound beam angle independent for automated detection of tricuspid annular displacement (TAD) (QLAB, Philips Medical Imaging). Twenty-six patients (pts) referred for magnetic resonance imaging (MRI) and 44 control subjects underwent a complete transthoracic echocardiography. MRI of the right ventricular ejection fraction (RVEF) was correlated by linear regression with TAD. Sixteen pts (61.5%) exhibited right ventricular systolic dysfunction (MRI RVEF<40%). RESULTS: The MRI RVEF was positively correlated with TAD (R(2)=0,65; p<0,0001). A value of TAD <14mm predicted right ventricular dysfunction with a sensitivity of 87.5% and a specificity of 90%. Most of (90%) healthy subjects exhibited TAD values exceeding this cut-off point (mean: 16.9+/-1.64mm; range: 13.3 to 24.8mm). Negative correlation was found between TAD and age (R(2)=0,36; p<0,0001). CONCLUSION: Our study is the first to correlate TAD with MRI RVEF. TAD is a simple, rapid, and non-invasive tool for right ventricular systolic function assessment.

[Anatomy of the female pelvis on MRI: value of intravaginal contrast]. / Anatomie pelvienne en IRM: apport du contraste vaginal.

PURPOSE: Prospective monocentric study to determine the feasibility, tolerability and diagnostic value of intravaginal contrast to assess female pelvic anatomy on MRI. MATERIALS AND METHODS: Forty-nine consecutive women referred for MRI evaluation of the pelvis, irrespective of the indication, were included in this study. The MR imaging protocol consisted of axial and sagittal T2W images before and after intravaginal instillation of sterile US gel. Eight anatomical regions were analyzed and their visibility graded from 1 to 4 (1=excellent; 4=non-visualized) by 3 radiologists without and with intravaginal gel. The value of intravaginal gel was determined by calculating the difference in the visibility index for each anatomical region by the Wilcoxon and khi2 tests. Inter-observer agreement was also determined using the kappa test. RESULTS: Two women declined vaginal opacification resulting in an acceptance rate of 96%. The gel instillation procedure had a duration of less than 3 minutes on average and was well tolerated by all patients. Intravaginal gel allowed significantly improved visualization of all anatomical regions (p<0.001); improvement between 0.5 and 2.5 points on average per anatomical region. Inter-observer agreement significantly improved after gel instillation increasing from 72% to 92%. CONCLUSION: Intravaginal instillation of US gel is simple, noninvasive, well-accepted and well-tolerated by patients. It increases visibility of pelvic anatomical structures with improved inter-observer agreement.

Bridging the gap between adult and paediatric outcomes in HIV-1 vertically infected children: a single-centre comparison with adult data.

UNLABELLED: Prognosis of HIV-1 infection dramatically improved during the last decade. Meanwhile, treatment-induced virological success has always been different in adult and children patients. AIM: To compare 10 years of follow up in HIV-1 vertically infected children and adult patients. METHODS: Monocentric retrospective longitudinal analysis of vertically HIV-1-infected children and adult patients followed in the Nice University Hospital between 1999 and 2008. Immunological, virological and antiretroviral treatment data were recorded. RESULTS: Forty children and 1752 adult patients were included. Between 1996 and 2008, the percentage of children receiving HAART increased from 3.2% to 91%. Mean CD4% in the paediatric group remained stable between 29 +/- 8.1% in 1998 and 30 +/- 9.4% in 2008. Mean adult CD4-cell count significantly increased from 410 in 1998 to 556 cells/mL in 2008. Logistic regression analysis showed that the children-to-adult difference for indetectability (HIV PCR-RNA below 400 copies/mL) was significant (p < 0.0001) with an odds ratio of 0.61 (CI(95th): 0.52-0.72). Year-to-patient interaction was also significant with a decreasing divergence over time (p: 0.038). CONCLUSION: Nowadays as in adult patients, the control of HIV-1 replication is achieved in nearly eight of 10 children and the percentage of patients with severe immunodeficiency dramatically decreased compared with the mid 1990s.

Assessment of topographic brachial plexus nerves variations at the axilla using ultrasonography.

BACKGROUND: The aim of this study was to describe topographic variations in the arrangement of the four main brachial plexus nerves at the junction of the axilla and the upper part of the arm. METHODS: In 153 patients undergoing upper arm surgery using axillary block, we studied nerve arrangements with a three-step approach, combining: (A) cross-sectional ultrasound imaging using a 12 MHz linear ultrasound probe; (B) distal shift of the ultrasound scanhead from the axilla to the elbow joint following the paths of individual nerves; and (C) identifying the distal motor response to electrical nerve stimulation of each nerve. These results were then converted into a 12-section pie chart with the axillary artery (AA) as the axis. RESULTS: The order of the nerves around the AA was median, ulnar, radial, and musculocutaneous in all cases. The most frequent arrangement was observed in 65% of the patients. Five less frequent variations were observed in 4-20% of the patients, with four other variations seen in <2% of the patients. In 78% of the cases, the four nerves were seen separately using static ultrasound imaging. The musculocutaneous nerve was close to the artery in 18% of the patients. CONCLUSIONS: Topographic variations of the four main nerves at the axilla were found to be numerous, the most frequent arrangement being seen in less than two-thirds of the patients. Four separate nerves were seen on static ultrasound imaging at this sectional level of the axilla in only 78% of the cases.

[Who are the recipients of labile blood products? A multicenter nation-wide study--a "donation day." Blood banks, health facilities]. / Qui sont les receveurs de produits sanguins labiles (PSL)? Une étude nationale multicentrique - un jour donné. Etablissement de transfusion sanguine (ETS) - établissements de santé (ES).

During the years 1994-2001, a progressive decrease of the number of blood units transfused has been reported in France. In contrast, since 2002, there is an increasing number of blood units issuing (+7.6% between 2001 and 2006) and this must be investigated. On behalf of the French Society of Blood Transfusion, the "Recipients" working group promoted a nation wide survey with the support of the regional blood transfusion centres. This survey was aimed at describing the profiles of the transfused patients: socio-demographical patterns, and reasons of the blood transfusion (main and associated diagnoses). A cross-sectional survey was designed. All the patients who received a blood unit during a specific day were considered as the population of the study. They were identified by the regional transfusion centres by means of the "individual issuing form". Survey forms were fully filled for 90% of the patients. It has been considered as a good answer rate. Seven thousand four hundred and twenty-two blood units, delivered to 3450 patients were analyzed. Three groups of pathologies were found as a reason of transfusion: haematology-oncology (52.70% of the prescriptions) with 892 patients (27.8%) for haematological malignancies; surgical procedures (23.99%); intensive care and medicine procedures (21.92%). More than 50% of the recipients are 70 years old and more. This result is explained by the age distribution of inpatients. In a context of lack of donors and consequently difficulties to provide patients with optimal number of blood units, this study is helpful. Variability of blood unit issuings must be detected, analyzed and monitored in real time by the actors of the transfusion process, using computerized dashboards: the blood units provider (in order to adjust the strategy of blood units provision) and the health care establishment as well as care blood components prescribers (reasons of blood transfusion and evaluation of practices).

[Intravenous thrombolysis with rt-PA in stroke: experience of the Nice stroke unit]. / Thrombolyse intraveineuse par rt-PA des accidents vasculaires cérébraux ischémiques : l'expérience de l'unité neurovasculaire de Nice.

INTRODUCTION: Intravenous thrombolysis with rt-Pa in stroke has been approved in France since 2002. We report an evaluation of our practice. We have tried to identify predictive factors of dependence and death, and to compare our results with the data of the literature. PATIENTS AND METHOD: All patients treated with intravenous rt-PA within the first 270min after the stroke onset were included. Univariate, then multivariate analyses were performed to determine the variables influencing the functional outcome at 3 months follow-up, according to a dichotomy established from the modified Rankin scale. RESULTS: One hundred and forty-two patients were included in this study (mean initial National Institute of Health Stroke Scale [NIHSS]: 15). Fifty percent had a Rankin score higher than 2 at 3 months follow-up. NIHSS above 12, glycemia of at least 120mg/l, and systolic blood pressure above 160mmHg at admission were identified as independent predictive factors of poor functional outcome. Less than 4 points decrease of NIHSS proved to be a simple and early predictor of poor functional outcome at 3 months follow-up. CONCLUSIONS: In terms of safety and efficacy the data issuing from the daily activity of our stroke unit are comparable with those of clinical trials.