Risk factors for return visits and rehospitalizations to the child emergency psychiatric unit: A retrospective study over 2 years at Saint-Étienne University Hospital.

PURPOSE: This retrospective study aimed to achieve a better understanding of risk factors leading children and adolescents hospitalized in an emergency psychiatric ward to return visits, and to propose preventive devices. METHOD: From January 2, 2010 through February 29, 2012, 180 children and adolescents younger than 17 years were hospitalized in a total of 261 stays in the emergency psychiatric ward of University hospital of Saint-Étienne (France). We assessed clinical and sociodemographic characteristics of these patients and traced any of their return visits to the same unit through December 31, 2012. Risk factors for patients' repeated visits were calculated using multivariate analysis, and the cumulative incidence of returns using the Kaplan-Meier method for censored data. We used confidence interval of relative risk, considering 0.05 to reflect significance. RESULTS: Over the 2 years of the study, 77 (42.8%) of the 180 patients revisited the emergency psychiatric ward; 62 (80.7%) of these required further hospitalizations. Multivariate analysis linked the patients' psychiatric history (RR=2.5) and pursuit of vocational education (RR=4) with the risk of return. Return visits rose from 27.2% at 6 months to 41.2% at 2 years. CONCLUSION: Knowledge of risk factors would allow implementation of secondary or tertiary preventive devices. Students could undergo early screening of psychiatric pathologies using mobile screening teams which would save money, avoid hospitalizations, and when necessary, facilitate both hospitalization and return visits.

Reactivity and structural evolution of urchin-like Co nanostructures under controlled environments.

In situ transmission electron microscopy (TEM) of samples in a controlled gas environment allows for the real time study of the dynamical changes in nanomaterials at high temperatures and pressures up to the ambient pressure (105 Pa) with a spatial resolution close to the atomic scale. In the field of catalysis, the implementation and quantitative use of in situ procedures are fundamental for a better understanding of the behaviour of catalysts in their environments and operating conditions. By using a microelectromechanical systems (MEMS)-based atmospheric gas cell, we have studied the thermal stability and the reactivity of crystalline cobalt nanostructures with initial 'urchin-like' morphologies sustained by native surface ligands that result from their synthesis reaction. We have evidenced various behaviors of the Co nanostructures that depend on the environment used during the observations. At high temperature under vacuum or in an inert atmosphere, the migration of Co atoms towards the core of the particles is activated and leads to the formation of carbon nanostructures using as a template the initial multipods morphology. In the case of reactive environments, for example, pure oxygen, our investigation allowed to directly monitor the voids formation through the Kirkendall effect. Once the nanostructures were oxidised, it was possible to reduce them back to the metallic phase using a dihydrogen flux. Under a pure hydrogen atmosphere, the sintering of the whole structure occurred, which illustrates the high reactivity of such structures as well as the fundamental role of the present ligands as morphology stabilisers. The last type of environmental study under pure CO and syngas (i.e. a mixture of H2 :CO = 2:1) revealed the metal particles carburisation at high temperature.

What is the influence of tonsillectomy on the level of periodontal pathogens on the tongue dorsum and in periodontal pockets.

BACKGROUND: For periodontal treatment, the full mouth disinfection approach suggests disinfection of oral soft tissues, such as tongue and tonsils concomitant to scaling and root planning since patients might benefit from treatment of these oral niches either. Periodontopathogenes in tonsillar tissue support this hypothesis. This prospective controlled clinical study investigated the change in the oral flora of patients who underwent tonsillectomy. Pockets were tested for eleven bacterial species before and six weeks after the surgical intervention. METHODS: Fifty generally healthy adults were included in this study. The test group consisted of 25 patients with tonsillectomy. The control group included 25 patients with otorhinolarynologic surgery without involvement of the oral cavity. Clinical parameters such as probing pocket depth, bleeding-on-probing index and plaque index were registered the evening before surgery. Also bacterial samples from the gingival sulcus and dorsum linguae were taken, and an additional sample from the removed tonsils in the test group. Six weeks after the intervention microbial samples of pockets and tongue were taken again. Data were tested for significant differences using Wilcoxon rank and Whitney-u-test. RESULTS: No relevant intra- or intergroup differences were found for the change of the eleven investigated species. CONCLUSION: Based on the results of the present study, tonsillectomy does not seem to have an immediate relevant effect on the bacterial flora of tongue or periodontium. This study design was approved by the ethical committee of Zurich (KEK-ZH-Nr.2013-0419). TRIAL REGISTRATION: The trial was retrospectively registered in the German Clinical Trials Register ( DRK00014077 ) on February 20, 2018.

[Mycetoma of the foot: a case report]. / Mycétome actino-mycosique du pied, à propos d'un cas.

Mycetoma is a chronic inflammatory cutaneous and subcutaneous pathology caused by either a fongic (eumycetoma) or bacterial (actinomycetoma) infection, which lead to a granulomatous tumefaction with multiple sinuses. When localized in the foot this infection is named "Madura foot". This infection is endemic to tropical and subtropical regions and rarely occurs in western countries. A historical case in Europe of a foot mycetoma evolving since 20 years without any treatment is presented. A histopathologic diagnosis of actinomycetoma has been done in 1987. The patient presented a severe Staphylococcus aureus chronic osteitis leading to a trans-tibial amputation. This case allows to present this infection which, even if rarely presented in France, can be meet especially among a migrant's population.

[Superficial ulnar artery while harvesting a radial forearm flap]. / Artère ulnaire superficielle, découverte fortuite lors du prélèvement d'un lambeau antébrachial radial.

Forearm vascular anatomical variations are common and may have complications during flaps harvesting. This article describes the presence of an ulnar superficial artery, revealed while harvesting a radial forearm flap. The prevalence of this anatomical variation is between 0.7 and 9.4%. It may have important consequences while covering loss of substance with a radial forearm flap. Unknown, there is a risk of vascular injury which may lead to distal ischemia of the upper limb. Preoperative diagnosis can anticipate this risk and harvest a fascio-cutaneous flap centered on a perforator of this artery.

Managing longitudinal melanonychia.

Longitudinal melanonychia (LM) is a pigmented band extending from the matrix to the distal edge of a nail. It is caused by increased production of melanin within the matrix, and integration into the nail plate. The origin of this production is usually benign, due to activation, hyperplasia or proliferation of melanocytes normally present in the matrix. In some cases, however, LM is the manifestation of a subungual melanoma, the diagnosis of which must be made early. Biographical, clinical and dermoscopic criteria make it possible to suspect melanoma and decide whether to perform biopsy. None of these criteria, however, are specific and definitive diagnosis requires pathologic examination of a matrix biopsy. The biopsy technique should enable reliable histological study while limiting the risk of secondary nail dystrophy. Initial resection should ideally involve the entire lesion. Complete elevation of the nail plate enables the lesion to be precisely located. Lesions up to 3 mm can be removed by longitudinal resection biopsies without significant sequelae. In more extensive lesions, incision or tangential ("shave") biopsy can be performed without impairing prognosis. In clinical presentations strongly suggestive of melanoma, immediate complete resection of the entire nail unit may be proposed.

The development of chlorophyll-based markers in poultry diets to aid detection of fluorescent fecal contamination.

Incidents of foodborne illness associated with consuming undercooked or raw chicken are often linked to 2 causative pathogens: Campylobacter spp. or Salmonella spp. Numerous studies have shown that contamination of carcasses results when pathogens are transferred from the intestinal tract or fecal material on feet and feathers to the dressed carcass. Ultraviolet spectral imaging to detect surface fecal and ingesta contamination on poultry carcasses may provide a solution to aid detection. However, poultry diets do not provide sufficiently high levels of natural fluorophores for this system to be reliable. This study investigated the potential of chlorophyll-based feed additives to improve fluorescence of the feces and narrow the excitation and emission wavelengths to aid in the development of a simple visualization system. Twenty-four hens (Gallus gallus domesticus) were allocated at random to 1 of 4 treatments: control (C, no marker), Zn chlorophyllin, Mg chlorophyllin, or Fe chlorophyllin. All markers were incorporated into mash before pelleting at a rate of 1 g/kg of DM. The experiment consisted of two 4 × 4 Latin squares with each period consisting of 2 wk. Feces were collected and extracted in acetone:water (50:50; vol/vol) with fecal fluorescence emission spectra determined using a Jasco FP-6200 Spectrofluorometer with excitation at 382 nm. A main peak evolved at wavelength 670 nm with the total area under the peak used as fluorescence intensity. Following 7 d of marker supplementation, the 3 markers improved the fluorescence intensity by ×14.8, 12.8, and 6.9 for Fe, Mg, and Zn chlorophyllin, respectively, compared with the control. The addition of feces containing Mg chlorophyllin to chicken carcass increased detection of the feces compared with feces with no marker. Also, due to the plain background of chicken skin, a simple image at 675 nm with appropriate thresholds would allow detection of contaminated carcasses at the current slaughter line speed without the need of expensive hyperspectral imaging.

[The persistent sciatic artery aneurysm. A rare and painful buttock mass]. / Anévrisme de l'artère sciatique persistante. Une cause rare de masse fessière douloureuse.

The persistent sciatic artery is a rare cause of painful buttock mass with L5-S1 radicular signs. A 56-year-old man presents a right painful buttock mass with L5-S1 radicular symptoms for 3 years. The surgical exploration found a pulsatile vascular mass like a persistent sciatic artery aneurysm. This vascular pathology is a misunderstood embryogenesis anomaly. The treatment aims to avoid serious complications. This pathology must be known from plastic surgeon.

[Botulinum toxin type A contribution in the treatment of Raynaud's phenomenon due to systemic sclerosis]. / Intérêt de la toxine botulinique de type A dans le traitement des syndromes de Raynaud sévères secondaires à la sclérodermie systémique.

AIMS: Raynaud's phenomenon is a vasospastic disorder of the extremities that can lead, in the hands, to pain, disability, ischemic ulcers and digital chronic ischemia. Medical and surgical current treatments are not fully effective while causing side effects. Recent studies have emphasized the value of botulinum toxin type A (BTX A) in the management of primary Raynaud's phenomenon. The originality of Raynaud's syndrome secondary to systemic sclerosis is to combine both arterial vasospasm and sclerosis of the arterial wall, what is supposed to reduce BTX A effects. The purpose of this work is to evaluate BTX A efficiency in patients with Raynaud's phenomenon secondary to systemic sclerosis. PATIENTS AND METHOD: We performed a prospective study for 12 months. Patients with severe Raynaud's phenomenon due to systemic sclerosis were injected with BTX A in the two hands. Evolution of ischemic ulcers, QuickDASH Score, O2 partial pressure, pain were measured before and 30 days after injection. RESULTS: We treated 18 patients. Thirty days after injection, we noticed a complete healing of ulcers, QuickDASH Score was improved from 39.4 to 20, as the O2 partial pressure from 16 to 42 mmHg and the pain from VNS from 6/10 to 2/10. CONCLUSION: BTX A appears to improve significantly Raynaud's phenomenon symptomatology in patients with systemic sclerosis despite the component of arterial sclerosis.

Stochastic simulation of successive waves of COVID-19 in the province of Barcelona.

Analytic compartmental models are currently used in mathematical epidemiology to forecast the COVID-19 pandemic evolution and explore the impact of mitigation strategies. In general, such models treat the population as a single entity, losing the social, cultural and economical specificities. We present a network model that uses socio-demographic datasets with the highest available granularity to predict the spread of COVID-19 in the province of Barcelona. The model is flexible enough to incorporate the effect of containment policies, such as lockdowns or the use of protective masks, and can be easily adapted to future epidemics. We follow a stochastic approach that combines a compartmental model with detailed individual microdata from the population census, including social determinants and age-dependent strata, and time-dependent mobility information. We show that our model reproduces the dynamical features of the disease across two waves and demonstrates its capability to become a powerful tool for simulating epidemic events.

Illusory movements prevent cortical disruption caused by immobilization.

Enforced limb disuse strongly disrupts the cortical networks that are involved in sensorimotor activities. This disruption causes a cortical reorganization that may be functionally maladaptive. In this study, we used functional magnetic resonance imaging (fMRI) to investigate whether it is possible to prevent this reorganization by compensating for the lack of actual kinesthetic perception with illusory movements induced by "neuromimetic" proprio-tactile feedback that is artificially delivered during immobilization. Sixteen healthy volunteers were equipped for five days with full-hand ortheses that prevented them from performing finger and hand movements but allowed for kinesthetic and tactile sensations. Eight participants received a twice-daily proprio-tactile treatment consisting of the perception of kinesthetic sensations resembling those felt during actual movements generated by miniature vibrators set in the ortheses at the finger and wrist levels. Eight untreated participants received no stimulation. The effects of hand immobilization and treatment were assessed by fMRI during a calibrated voluntary hand movement task and hand tactile stimulation before cast placement and immediately after cast removal. We found that the sensorimotor network was preserved in subjects who underwent this treatment during hand immobilization, while the sensorimotor network of untreated subjects was significantly altered. These findings suggest that sensory feedback and associated movement perception may counteract disuse-induced cortical plastic changes through recruitment of a large part of the cortical network used for actual performed movement. The possibility of guiding cortical plasticity with proprioceptive augmented feedback is potentially relevant for rehabilitation efforts.

A flexible quantitative methodology for the analysis of gene-flow between conventionally bred maize populations using microsatellite markers.

Previous studies of gene-flow in agriculture have used a range of physical and biochemical markers, including transgenes. However, physical and biochemical markers are not available for all commercial varieties, and transgenes are difficult to use when trying to estimate gene flow in the field where the use of transgenes is often restricted. Here, we demonstrate the use of simple sequence repeat microsatellite markers (SSRs) to study gene flow in maize. Developing the first quantitative analysis of pooled SSR samples resulted in a high sampling efficiency which minimised the use of resources and greatly enhanced the possibility of hybrid detection. We were able to quantitatively distinguish hybrids in pools of ten samples from non-hybrid parental lines in all of the 24 pair-wise combinations of commercial varieties tested. The technique was used to determine gene flow in field studies, from which a simple model describing gene flow in maize was developed.

Case report: pseudotendon formation after a type III flexor digitorum profundus avulsion.

BACKGROUND: Avulsion of the flexor digitorum profundus tendon is a common injury to the hand that virtually always requires surgical repair for restoration of normal finger function. CASE DESCRIPTION: We report a case of a Type III flexor digitorum profundus tendon avulsion in which the patient refused surgery yet attained nearly full active ROM and an excellent functional result via the formation of a pseudotendon, as observed on MRI obtained 2.5 years after the initial injury. LITERATURE REVIEW: There are no reported cases of restoration of normal finger function after pseudotendon formation in a flexor digitorum profundus tendon avulsion injury. PURPOSES AND CLINICAL RELEVANCE: This case shows the potential for pseudotendon to not only form but have adequate tensile strength to restore function in certain types of flexor tendon injuries.

[Treatment of hand ischemia with arterialization of the venous system of the hand: report of three cases]. / Traitement de la main en ischémie chronique par artérialisation du système veineux superficiel : à propos de trois cas.

INTRODUCTION: Hand ischemia is a rare phenomenom of various etiologies among which can be found Raynaud's phenomenon and autoimmune arteritis. The limitations of symptomatic medical treatment and the frequent plurisegmental and distal affection of arteries make the management of chronic hand ischemia difficult. The arterialization of the superficial venous system, which consists in redirecting the arterial flow to the fingertip through the dorsal venous system, could be an interesting alternative to the disappointing results of medical therapy and surgical sympathectomy. The authors present here the preliminary results of this technique. PATIENTS AND METHOD: We carried out a retrospective study analyzing the indications, the operative technique and results of three hands operated on two patients. An arteriography was carried out on each patient prior to perform the arterialization of the superficial venous system, in order to make sure that none of the patients was eligible for a technique of direct re-vascularization. RESULTS: Postoperatively, for each patient, the following points were evaluated: pain reduction, ulcer healing, and then we tried to obtain a more objective assessment by performing angio-MRI. CONCLUSION: This last resort technique in management of critical ischemia of the fingers led to an immediate and lasting improvement of symptoms in all the patients treated. This technique seems reliable and reproducible in selected cases aiming to re-vascularize hands that have reached the stage of critical ischemia. This treatment option should be known by hand surgeons, and distributed to internists who usually manage these patients.

Progression and variation of competitive 100 and 200m performance at the 2021 European Swimming Championships.

Competitive progressions are necessary to ensure that peak performance occurs when medals are decided. This study aimed to: i) study the coefficient of variation (CV) and performance changes (%Δ) among swimmers who participated in different rounds (i.e., heats, semi-finals and finals); ii) study the CV changes as a function of FINA-points. A total of 1447 performances were analysed in the 100 and 200 m-races during the Budapest 2021 European-Championships. Linear mixed-effects models were applied for total and split-times to obtain intra-athlete CV and %Δ. The FINA-points were studied with two-way ANOVA and Pearson's correlation assessed the relations with CV. The CV in 100 m-races was: 0.48 ± 0.21% for males and 0.50 ± 0.20% for females (Δ = -0.66%); in 200 m-races: 0.63 ± 0.36% and 0.60 ± 0.34% (Δ = -0.82%). There were differences in FINA-points between strokes and distances (p < 0.02) associated with higher CV for the 200 m-races (r = 0.37; p = 0.003), indicating changes in performance over the rounds. Swimmers' finalists performed easier during the heats by going slower in the first 50 m-lap; however, some of them would have little chance of qualifying during major championships because some events were below FINA-points world-standards.

Outcomes of ulnar shortening osteotomy using a new compression plate.

Ulnar impaction syndrome (UIS) is a frequent cause of ulnar-sided wrist pain. Several open and arthroscopic surgery techniques have been described. Ulnar shortening osteotomy (USO) is often the method of choice. It has the advantage of leveling the distal radioulnar joint extra-articularly while maintaining the integrity of the soft tissues that stabilize the joint. This retrospective study reports the short-term outcomes of 20 patients who underwent surgery between 2013 and 2015. USO was performed with a locked plate and a new compression device (Alians®, Newclip™, Haute Goulaine, France). Preoperative and postoperative ulnar variance were measured on wrist X-rays in neutral pronation-supination. Functional outcomes were evaluated with the QuickDASH score and the pain on VAS (visual analog scale). Postoperative range of motion and grip strength were compared to those of the contralateral wrist. The average follow-up was 16 months (4 to 28 months). Preoperative ulnar variance was positive with an average of 4mm (1-11mm). The average length of the final ulna shortening was 3.5mm (1.5-6mm); the mean time to union was 4 months (3-12 months). The average QuickDASH was 12 and pain had decreased 2.4mm on the VAS. The results achieved with this new compression plate designed specifically for USO are similar to those described in the literature. This kind of device has an easily reproducible technique and can reduce the operative time. LEVEL OF EVIDENCE: IV.

[A new technique of intrafocal pinning for phalangeal neck fractures in children]. / Une nouvelle technique d'embrochage intrafocal des fractures de cols de phalanges chez l'enfant.

INTRODUCTION: Phalangeal neck fractures are unusual, occurring mainly in children. This study aims at assessing the results of treatment of this type of fracture and presents a new technique for displaced fractures namely intrafocal pinning. PATIENTS AND METHODS: From January 2001 to January 2007, we treated 49 children (32 boys and 17 girls) with 52 phalangeal neck fractures. The patients were aged between three months and 14 years (average seven years). Five fractures were open but without nerve, artery or tendon damage. The 32 undisplaced or minimally displaced fractures were treated by closed methods. Thirteen displaced fractures (of which three were secondary displacements) were treated with an intrafocal pinning technique inspired by the Kapandji technique for distal radius fractures. Seven fractures (five open and two closed but displaced) were treated using standard osteosynthesis techniques (temporary arthrodesis, crossed K wires or cerclage). RESULTS: We reviewed the patients an average of 18 months later. We classified the results according to Barton's classification: excellent, good, fair and bad. Among the 13 fractures treated with an intrafocal pinning technique, 11 gave excellent results and two gave good results. We did not find any infection, tendon rupture, phalangeal head osteonecrosis or nonunion. We had to reoperate on one proximal phalanx thumb fracture because of delayed consolidation. DISCUSSION: Percutaneous reduction of the displacement and pinning seems to give the best results for the treatment of displaced fractures. The surgeon aims at getting the best anatomical result whilst limiting soft tissue damage. The proposed technique seems to give good results as it allows a percutaneous reduction of the displacement and an effective means of holding the reduction. Open fractures have a poorer prognosis.

In situ insight into the unconventional ruthenium catalyzed growth of carbon nanostructures.

We report on the in situ analysis of the growth process of carbon nanostructures catalyzed by Ru nanoparticles using syngas, a mixture of hydrogen and CO, as the carbon source at a medium temperature (500 °C). The structural modifications of the dual nanotube/nanoparticle system and the general dynamics of the involved processes have been directly followed during the growth, in real time and at the atomic scale, by transmission electron microscopy in an environmental gas cell at atmospheric pressure. After a reduction step under hydrogen and syngas, the particles became very active for the carbon growth. The growth rate is independent of the particle size which mainly influences the nanotube wall thickness. Other subtle information on the general behavior of the system has been obtained, as for instance the fact that the regular changes in the direction of the particle originate generally from the particle shape fluctuation. The main result is the evidence of a new growth mode in relation to the presence and the high instability of the ruthenium carbide phase which acts as a carbon reservoir. For the first time, a relaxation oscillation of the growth rate has been observed and correlated with the metal-carbide structural transition at the particle sub-surface.

[Costochondral autograft as a salvage procedure after failed trapeziectomy in trapeziometacarpal osteoarthritis]. / Autogreffe de cartilage costal après échec d'une trapézectomie-ligamentoplastie.

We report the case of a 48-year-old woman who underwent a revision procedure to insert a costochondral autograft after failed trapeziectomy-ligamentoplasty. Clinical outcome was assessed at 3, 6, 12, and 24 months and compared with the preoperative situation. Pain (VAS), force (key pinch and grasp), writing capacity, use of an ignition key, and range of motion of the trapeziometacarpal joint in abduction and opposition were noted. The VAS demonstrated improvement in pain and the patient was able to use an ignition key but grasp force and joint range of motion remained unchanged. There was no complication at the graft harvesting site. This technique appears to be a useful salvage method after failed trapiezectomy.

A scaling method to individualise muscle force capacities in musculoskeletal models of the hand and wrist using isometric strength measurements.

Because the force-generating capacities of muscles are currently estimated using anatomical data obtained from cadaver specimens, hand musculoskeletal models provide only a limited representation of the specific features of individual subjects. A scaling method is proposed to individualise muscle capacities using dynamometric measurements and electromyography. For each subject, a strength profile was first defined by measuring net moments during eight maximum isometric contractions about the wrist and metacarpophalangeal joints. The capacities of the five muscle groups were then determined by adjusting several parameters of an initial musculoskeletal model using an optimisation procedure which minimised the differences between measured moments and model estimates. Sixteen volunteers, including three particular participants (one climber, one boxer and one arthritic patient), were recruited. Compared with the initial literature-based model, the estimated subject-specific capacities were on average five times higher for the wrist muscles and twice as high for the finger muscles. The adjustments for particular subjects were consistent with their expected specific characteristics, e.g. high finger flexor capacities for the climber. Using the subject-specific capacities, the model estimates were markedly modified. The proposed protocol and scaling procedure can capture the specific characteristics of the participants and improved the representation of their capacities in the musculoskeletal model.