Real-life evaluation of the treatment of actinic keratoses by textile photodynamic therapy (FLUXMEDICARE® device).

INTRODUCTION: Actinic keratoses (AK) are a common precancerous skin condition in dermatology practice. Photodynamic therapy (PDT) with ALA or MAL is an effective but painful treatment of fields of cancerization particularly when conventional illumination sources and irradiation rates are used. Two prior studies showed that illumination with textile PDT was not inferior to conventional PDT. FLUXMEDICARE® (FLX-PDT) is the first medical device marketed with textile based lighting . We performeda real-life study to evaluate efficacy and tolerance of this device. METHODS: We carried out a single-center retrospective study. We collected data from patients treated with FLX-PDT with MAL for AKs localized on scalp and temples between November 2018 and November 2019. The primary endpoint was complete clearance rate (CR) at 3 months-follow up. RESULTS: Data of 39 patients were reviewed in the study, with a total of 417 AKs. The CR rate was 72.6 % (95 %CI 67.9-77.0) at 3 months-follow up and 67.5 % (95 %CI 61.2-73.3) at 6 months-follow up. The median pain felt during the session was 0 and there wasn't erythema after the session for 64.1 %. CONCLUSION: Our real-life study confirms efficacy and safety of textile PDT by FLUXMEDICARE device in the treatment of scalp and temples AKs, with excellent tolerance and minimal pain reported.

Intraoperative neuromonitoring by vagus nerve stimulation in thyroid surgery: Clinical assessment of recurrent and superior laryngeal nerves.

Intraoperative neuromonitoring of the laryngeal nerves during thyroidectomy is a reliable method to assess nerve function. After identification of the cricothyroid ligament, a bipolar electrode is selectively inserted through the ligament into the thyroarytenoid muscle (TAM) and cricothyroid muscle (CTM). Vagus nerve stimulation then allows precise monitoring of the recurrent laryngeal nerve and the external branch of the superior laryngeal nerve (EBSLN) in the TAM and CTM, respectively. A significant muscle response (greater than 100µV) is 100% predictive of preserved laryngeal mobility, while the absence of a muscle response is 70% predictive of vocal fold paralysis with 100% sensitivity and 98% specificity. A significant thyroarytenoid muscle response is only recorded ipsilateral to the stimulation with a shorter latency on the right side. A concomitant TAM and CTM response to vagus nerve stimulation or EBSLN stimulation is observed in more than 70% of cases.

Cancer-related cognitive impairment: an update on state of the art, detection, and management strategies in cancer survivors.

BACKGROUND: Advances in diagnostic and therapeutic strategies in oncology have significantly increased the chance of survival of cancer patients, even those with metastatic disease. However, cancer-related cognitive impairment (CRCI) is frequently reported in patients treated for non-central nervous system cancers, particularly during and after chemotherapy. DESIGN: This review provides an update of the state of the art based on PubMed searches between 2012 and March 2019 on 'cognition', 'cancer', 'antineoplastic agents' or 'chemotherapy'. It includes the most recent clinical, imaging and pre-clinical data and reports management strategies of CRCI. RESULTS: Evidence obtained primarily from studies on breast cancer patients highlight memory, processing speed, attention and executive functions as the most cognitive domains impaired post-chemotherapy. Recent investigations established that other cancer treatments, such as hormone therapies and targeted therapies, can also induce cognitive deficits. Knowledge regarding predisposing factors, biological markers or brain functions associated with CRCI has improved. Factors such as age and genetic polymorphisms of apolipoprotein E, catechol-O-methyltransferase and BDNF may predispose individuals to a higher risk of cognitive impairment. Poor performance on neuropsychological tests were associated with volume reduction in grey matter, less connectivity and activation after chemotherapy. In animals, hippocampus-based memory and executive functions, mediated by the frontal lobes, were shown to be particularly susceptible to the effects of chemotherapy. It involves altered neurogenesis, mitochondrial dysfunction or brain cytokine response. An important next step is to identify strategies for managing cognitive difficulties, with primary studies to assess cognitive training and physical exercise regimens. CONCLUSIONS: CRCI is not limited to chemotherapy. A multidisciplinary approach has improved our knowledge of the complex mechanisms involved. Nowadays, studies evaluating cognitive rehabilitation programmes are encouraged to help patients cope with cognitive difficulties and improve quality of life during and after cancer.

Superior laryngeal nerve in thyroid surgery: anatomical identification and monitoring.

The aim of this study was to validate a procedure to identify and preserve the external branch of the superior laryngeal nerve (EBSLN) during thyroid surgery. The present study also aimed to analyze the EBSLN and the vagus nerve activities after stimulation and demonstrate an operative association between all the laryngeal muscles. Dissection of the cervical region was performed bilaterally in four adult cadavers. In a second step, 144 patients undergoing total thyroidectomy were included. Intraoperative stimulations of the cervical vagus nerve and the EBSLN in the sternothyroid-laryngeal triangle were performed bilaterally. Potentials in the thyroarytenoid muscle and the cricothyroid muscle were registered on each side using the NIM3 Medtronic System. EBSLN was identified according to Cernea's classification as type 1 in 62.5%, type 2a in 25%, and type 2b in 12.5% of cadaver's dissection. According to Friedman's classification, 50% of EBSLN were classified type 1, 25% type 2 and 25% type 3. The EBSLN was identified in 267 cases out of 288 peroperative dissections (92.7%). Direct stimulation (1 mA) of this branch led to a recordable contraction of the cricothyroid muscle with a mean latency of 1.42 ± 0.66 ms on the right side and 1.43 ± 0.61 ms on the left side. The stimulation of the EBSLN also led to a recordable contraction of the thyroarytenoid muscle in 211 cases (73.3%) with the same latencies. A contraction of the cricothyroid muscle was also recorded when the vagus nerve was stimulated in 219 cases (76.0%). The sole visual identification of the EBSLN during thyroid surgery is not a reliable method to prevent nerve injury. Direct stimulation of the EBSLN in the sternothyroid-laryngeal triangle is a simple and rapid procedure to detect and preserve the nerve during surgery. Functional associations between vagus nerve and EBSLN in laryngeal muscles' contractions were also identified.

Chemotherapy-induced long-term alteration of executive functions and hippocampal cell proliferation: role of glucose as adjuvant.

In patients, cancer and treatments provoke cognitive impairments referred to "chemofog". Here a validated neurobehavioral animal model, the unique way to explore causal direct links between chemotherapy used in clinical practices and brain disorders, allowed investigation of the direct long-term impact of colo-rectal cancer chemotherapy on cognition and cerebral plasticity. Young and aged mice received three injections every 7 days during 2 weeks of 5-fluorouracil either alone (5-FU, 37.5 mg/kg) or in combination with oxaliplatin (3 mg/kg) or with glucose (5%). The long-term effects (from day 24 to day 60) of chemotherapy were tested on emotional reactivity, learning and memory, behavioral flexibility and hippocampal cell plasticity. 5-FU (in saline)-treated aged and also young mice exhibited specific altered cognitive flexibility and behavioral hyper-reactivity to novelty, whereas the combination 5-FU (in saline)/oxaliplatin (in glucose) did not provoke any cognitive dysfunction. We thus observed that glucose counteracted 5-FU-induced altered executive functions and hippocampal cell proliferation in vivo, and protected neural stem cells in vitro from toxicity of 5-FU or oxaliplatin. In conclusion, these data suggest that the lasting chemotherapy-induced selective impairment of executive functions, whatever the age, and associated with a reduced number of hippocampal proliferating cells, can be counteracted by co-administration with glucose.

Two pathways for electrocatalytic oxidation of hydrogen by a nickel bis(diphosphine) complex with pendant amines in the second coordination sphere.

A nickel bis(diphosphine) complex containing pendant amines in the second coordination sphere, [Ni(P(Cy)2N(t-Bu)2)2](BF4)2 (P(Cy)2N(t-Bu)2 = 1,5-di(tert-butyl)-3,7-dicyclohexyl-1,5-diaza-3,7-diphosphacyclooctane), is an electrocatalyst for hydrogen oxidation. The addition of hydrogen to the Ni(II) complex gives three isomers of the doubly protonated Ni(0) complex [Ni(P(Cy)2N(t-Bu)2H)2](BF4)2. Using the pKa values and Ni(II/I) and Ni(I/0) redox potentials in a thermochemical cycle, the free energy of hydrogen addition to [Ni(P(Cy)2N(t-Bu)2)2](2+) was determined to be -7.9 kcal mol(-1). The catalytic rate observed in dry acetonitrile for the oxidation of H2 depends on base size, with larger bases (NEt3, t-BuNH2) resulting in much slower catalysis than n-BuNH2. The addition of water accelerates the rate of catalysis by facilitating deprotonation of the hydrogen addition product before oxidation, especially for the larger bases NEt3 and t-BuNH2. This catalytic pathway, where deprotonation occurs prior to oxidation, leads to an overpotential that is 0.38 V lower compared to the pathway where oxidation precedes proton movement. Under the optimal conditions of 1.0 atm H2 using n-BuNH2 as a base and with added water, a turnover frequency of 58 s(-1) is observed at 23 °C.

Application of gastrointestinal modelling to the study of the digestion and transformation of dietary glycidyl esters.

Glycidyl esters (GEs) are known to be formed during vegetable oil processing. Because of their structure, it has been hypothesised that GEs, like fatty acid esters of chloropropanols (MCPD esters), may be accepted as substrates by gut lipases to release the epoxide glycidol. If confirmed such a hypothesis would be important for risk assessment since glycidol is considered as a genotoxic carcinogen. In the present study, biotransformation was investigated using static and dynamic gastrointestinal models. During the experiments, aliquots were analysed for non-digested GEs using liquid chromatography-time-of-flight-mass spectrometry (LC-ToF-MS). In the static model, a fast hydrolysis of GEs was observed as a result of lipase action. Lipase was very efficient at pH 4.8, and totally inhibited at very low pH (1.7). In the absence of lipase, GEs were found to be relatively stable. The potential impact of food matrix was studied using milk in a dynamic model simulating human physiological conditions. The fast, pH-dependent hydrolysis of GEs was further confirmed. The possible transformation of the digestion products was then investigated using gas chromatography coupled to mass spectrometry (GC-MS), mainly the epoxide ring-opening to glycerol followed by additional reactions. In any conditions applied, neither 2- nor 3-mono-chloropropanediol (2- nor 3-MCPD) were formed, indicating that a ring-opening of the epoxide group of GEs or glycidol followed by a reaction with chloride was unlikely. A small transformation of glycidol into glycerol was observed after longer incubation time correlated with a low pH. This suggested that ring-opening and reaction with water is possible in strongly acidic conditions. Overall, it is concluded that GEs are rapidly digested by gut lipases to form glycidol. Consequently, GEs should be considered as sources of glycidol exposure. In addition, risk assessment of GEs can likely rely on hazard identification and characterisation data specific for glycidol.

[Diagnosis and therapeutic pathways in head and neck cancers]. / Parcours de soins du patient présentant un carcinome epidermoïdes des voies aéro-digestives supérieures.

BACKGROUND: Cancers of uppers aero-digestives tracts represent, infrequency, the 5th cancer in the French population. Most of them (about 70%) are diagnosed at an advanced stage (stage III or IV) while they are associated with a poor prognosis (only 40% five year survival). The objective of our study was to analyze the care pathway of patients with cancers of uppers aero-digestives tracts in order to target efforts to improve the survival of these patients. METHODS: It was a descriptive and retrospective study, on medical files, on the health care pathway of patients with cancers of uppers aero-digestives tracts cared in the Head and Neck surgery department of Val de Grâce in Paris and Percy in Clamart between January 2004 and December 2006. The patients were adults with squamous cell carcinoma of uppers aero-digestives tracts. RESULTS: One hundred thirty-eight files of patients were analyzed. Fifty-five percent of patients were diagnosed at an advanced stage. On average patients have waited two months and twenty-one days before consulting a doctor for the first time. The time interval between the specialist consultation and the start of treatment was on average 7 weeks. The overall 5-year survival rate was 61%. CONCLUSION: Squamous cell carcinoma of uppers aero-digestives tracts remains serious and has a poor diagnosis, even in a population with a high social-cultural level. The long time interval before the first consultation may be reduced by improving health education among the general practitioner (primary and secondary prevention), and by establishing health care public campaigns. This would allow earlier diagnosis, more conservative therapeutic opportunities and therefore a better prognosis.

Morphological and functional asymmetry of the human recurrent laryngeal nerve.

PURPOSE: The aim of the current study was to analyze some parameters that are involved in nerve conduction in the right and left recurrent laryngeal nerves (RLNs) in humans. We have studied two morphological parameters such as the length of the two nerves, and the total intraperineural area (TIPA) from necropsies, and one functional parameter such as the latency of the thyroarytenoid muscle from operated patients. METHODS: The morphological parameters of six white female adult cadavers were analyzed. The RLNs were totally removed on both sides with the vagus nerve from their origin to the entrance in the larynx at the cricothyroid joint. The lengths were measured with the help of a digitalized caliper. Selected sections were obtained from each third of the RLNs for histological analysis. The TIPA was estimated at each selected level using digitized images of nerve sections and a manual micrometer. All the measurements were carried out by specialists in histology. The intraoperative vagal nerve stimulations were conducted using the NIM3 Medtronic(®) monitoring system (Medtronic Xomed Inc., Jacksonville, FL, USA) in ten adult patients without laryngeal or nervous disease during thyroid gland surgery. The evocated laryngeal electromyography was performed with the Medtronic bipolar needle electrode directly inserted into the thyroarytenoid muscle. The direct vagal nerve stimulation was achieved with the Medtronic stimulation from 0.5 to 1 mA. The latency of the thyroarytenoid muscle was recorded on the NIM-response monitor. RESULTS: The mean lengths of the left and right RLNs were, respectively, 136.6 and 75.0 mm with a mean difference of 61.6 mm (range 50-75 mm). The quantitative comparison of the TIPA between proximal segments of the left and right RLN showed no significant difference. The distal and proximal TIPA ratio demonstrated differences between the left and right RLN, respectively, 53.76 and 38.88 % without any statistical meaning. The comparison of the TIPA of the distal segments of the RLNs showed no significant difference. The intraoperative vagal nerve stimulation (0.5 and 1 mA) displayed a mean latency of the right and left thyroarytenoid muscle, respectively, of 3.55-3.68 and 5.90-5.98 ms with a mean difference of 2.35-2.30 ms (range 1.75-3.30 ms). CONCLUSION: If length and latency asymmetry of the right and left RLNs in humans can be demonstrated, the synchronicity of the vocal folds requiring precise controlled variations within intrinsic laryngeal muscles needs further investigations.

A synthetic nickel electrocatalyst with a turnover frequency above 100,000 s⁻¹ for H2 production.

Reduction of acids to molecular hydrogen as a means of storing energy is catalyzed by platinum, but its low abundance and high cost are problematic. Precisely controlled delivery of protons is critical in hydrogenase enzymes in nature that catalyze hydrogen (H(2)) production using earth-abundant metals (iron and nickel). Here, we report that a synthetic nickel complex, [Ni(P(Ph)(2)N(Ph))(2)](BF(4))(2), (P(Ph)(2)N(Ph) = 1,3,6-triphenyl-1-aza-3,6-diphosphacycloheptane), catalyzes the production of H(2) using protonated dimethylformamide as the proton source, with turnover frequencies of 33,000 per second (s(-1)) in dry acetonitrile and 106,000 s(-1) in the presence of 1.2 M of water, at a potential of -1.13 volt (versus the ferrocenium/ferrocene couple). The mechanistic implications of these remarkably fast catalysts point to a key role of pendant amines that function as proton relays.

Cognitive training with photographs as a new concept in an education campaign for self-detection of melanoma: a pilot study in the community.

BACKGROUND: Cognitive education using only photographs has been shown to be more effective than the ABCD algorithm to improve melanoma recognition in the general population. OBJECTIVE: The aim of this study was to assess the feasibility and acceptability of a campaign based on cognitive education by photographs instead of the usual ABCD algorithm. METHODS: Brochures including a panel of photographs of melanoma and moles were mailed, supported by a media campaign and followed by a telephone survey of a representative sample of the district population. RESULTS: Among the 855 people interviewed, 38% recalled the campaign and 13% had actually read the brochures. Among the 13%, 99% found them useful, 52% reassuring and 40% anxiety provoking, while 92% agreed that using images of skin cancer was the best way to recognize melanoma. Sixty-four percent declared that this campaign had prompted them to examine their own moles, 39% were prompted to check moles of family members, and only 11% would immediately visit a doctor. CONCLUSION: This pilot study shows that a melanoma campaign based exclusively on images is well accepted in the community, and is associated with a favourable impact on self-surveillance, while limiting overflow of unjustified consultations. We recommend this innovative concept be applied to large scale campaigns.

Adenylyl cyclase 8 is central to glucagon-like peptide 1 signalling and effects of chronically elevated glucose in rat and human pancreatic beta cells.

AIMS/HYPOTHESIS: Glucose and incretins regulate beta cell function, gene expression and insulin exocytosis via calcium and cAMP. Prolonged exposure to elevated glucose (also termed glucotoxicity) disturbs calcium homeostasis, but little is known about cAMP signalling. We therefore investigated long-term effects of glucose on this pathway with special regard to the incretin glucagon-like peptide 1 (GLP-1). METHODS: We exposed INS-1E cells and rat or human islets to different levels of glucose for 3 days and determined functional responses in terms of second messengers (cAMP, Ca(2+)), transcription profiles, activation of cAMP-responsive element (CRE) and secretion by measuring membrane capacitance. Moreover, we modulated directly the abundance of a calcium-sensitive adenylyl cyclase (ADCY8) and GLP-1 receptor (GLP1R). RESULTS: GLP-1- or forskolin-mediated increases in cytosolic calcium, cAMP-levels or insulin secretion were largely reduced in INS-1E cells cultured at elevated glucose (>5.5 mmol/l). Statistical analysis of transcription profiles identified cAMP pathways as major targets regulated by glucose. Quantitative PCR confirmed these findings and unravelled marked downregulation of the calcium-sensitive adenylyl cyclase ADCY8 also in rat and in human islets. Re-expression of ADCY8, but not of the GLP1R, recovered GLP-1 signalling in glucotoxicity in INS-1E cells and in rat islets. Moreover, knockdown of this adenylyl cyclase showed that GLP-1-induced cAMP generation, calcium signalling, activation of the downstream target CRE and direct amplification of exocytosis by cAMP-raising agents (evaluated by capacitance measurement) proceeds via ADCY8. CONCLUSIONS/INTERPRETATION: cAMP-mediated pathways are modelled by glucose, and downregulation of the calcium-sensitive ADCY8 plays a central role herein, including signalling via the GLP1R.

Hydrogen oxidation catalysis by a nickel diphosphine complex with pendant tert-butyl amines.

A bis-diphosphine nickel complex with tert-butyl functionalized pendant amines [Ni(P(Cy)(2)N(t-Bu)(2))(2)](2+) has been synthesized. It is a highly active electrocatalyst for the oxidation of hydrogen in the presence of base. The turnover rate of 50 s(-1) under 1.0 atm H(2) at a potential of -0.77 V vs. the ferrocene couple is 5 times faster than the rate reported heretofore for any other synthetic molecular H(2) oxidation catalyst.

Treatment of mycotic aneurysms with involvement of the abdominal aorta: single-centre experience in 44 consecutive cases.

OBJECTIVE: To review our management of mycotic aneurysms involving the abdominal aorta over the past 2 decades to assess the safety and efficacy of in-situ and extra-anatomic repair combined with antibiotic treatment. MATERIALS AND METHODS: From March 1990 to August 2008, 44 patients with a mycotic aneurysm involving the abdominal aorta were treated at our University Hospital. For all patients, we recorded the aetiology, clinical findings and anatomic location of the aneurysm, as well as bacteriology results, surgical and antibiotic therapy and morbidity and mortality. RESULTS: Twenty-one (47.7%) of the mycotic aneurysms had already ruptured at the time of surgery. Free rupture was present in nine patients (20.5%). Contained rupture was observed in 12 patients (27.3%). Urgent surgery was performed in 18 cases (40.9%). Revascularisation was achieved by in-situ reconstruction in 37 patients (84.1%), while extra-anatomic reconstruction was performed in six patients (13.6%). One patient (2.3%) was treated with a combined in-situ and extra-anatomic reconstruction. In one case (2.3%), endovascular aneurysm repair (EVAR) was performed. In-hospital mortality was 22.7%, 50% in the extra-anatomic reconstruction group and 18.9% in the in-situ repair group. One-third (33.3%) of our patients, who presented with a ruptured mycotic aneurysm died in the peri-operative period. This mortality was 13% in the patient-group presenting with an intact aneurysm. Of the 34 surviving patients, 12 patients (27.3% of surviving patients died after discharge from our hospital. In half of these patients, an acute cardiac event was to blame. Three patients (8%) showed re-infection after in-situ reconstruction. CONCLUSION: Management of mycotic aortic aneurysms remains a challenging problem. The results of surgery depend on many factors. In our experience, in-situ repair remains a feasible and safe treatment option for patients who are in good general condition at the time of surgery.

Development of ELISAs for detecting domoic acid, okadaic acid, and saxitoxin and their applicability for the detection of marine toxins in samples collected in Belgium.

Okadaic acid, a diarrhetic shellfish poison, domoic acid, an amnesic shellfish poison, and saxitoxin, a paralytic shellfish poison, are three of the best-known marine biotoxins. The mouse bioassay is the method most widely used to detect many of these toxins in shellfish samples, but animal welfare concerns have prompted researchers to seek alternative methods of detection. In this study, three direct competitive enzyme-linked immunosorbent assays (ELISAs), each based on antibodies raised in rabbits against a conjugate of the analyte of interest, were developed for marine biotoxin detection in mussel, oyster, and scallop. One assay was for okadaic acid, one for saxitoxin, and one for domoic acid usually detected and quantified by high-performance liquid chromatography-ultraviolet light (HPLC-UV). All three compounds and a number of related toxins were extracted quickly and simply from the shellfish matrices with a 9 : 1 mixture of ethanol and water before analysis. The detection capabilities (CCbeta values) of the developed ELISAs were 150 microg kg(-1) for okadaic acid, 50 microg kg(-1) for domoic acid, and 5 microg kg(-1) or less for saxitoxin. The assays proved satisfactory when used over a 4-month period for the analysis of 110 real samples collected in Belgium.

Reduction of oxygen catalyzed by nickel diphosphine complexes with positioned pendant amines.

Nickel(II) bis(diphosphine) complexes that contain positioned bases in the second coordination sphere have been found to catalyze the reduction of O(2) with H(2) to selectively form water. The complexes also serve as electrocatalysts for the reduction of O(2) with the addition of a weak acid. In contrast, a closely related nickel diphosphine complex without the positioned bases is catalytically inactive for O(2) reduction. These results indicate that pendant bases in synthetic catalysts for O(2) reduction can play a similar role to proton relays in enzymes, and that such relays should be considered in the design of catalysts for multi-electron and multi-proton reactions.

Assessment of a percutaneous iliosacral screw insertion simulator.

BACKGROUND: Navigational simulator use for specialized training purposes is rather uncommon in orthopaedic and trauma surgery. However, it reveals providing a valuable tool to train orthopaedic surgeons and help them to plan complex surgical procedures. PURPOSE: This work's objective was to assess educational efficiency of a path simulator under fluoroscopic guidance applied to sacroiliac joint percutaneous screw fixation. MATERIALS AND METHODS: We evaluated 23 surgeons' accuracy inserting a guide-wire in a human cadaver experiment, following a pre-established procedure. These medical trainees were defined in three prospective respects: novice or skilled; with or without theoretical knowledge; with or without surgical procedure familiarity. The screw insertion in the human cadaver was performed in two different settings: either without prior training for a first group (G1) or after simulator guidance in the second group (G2). Analysed criteria for each tested surgeon included the number of intraoperative X-rays taken in order to achieve the surgical procedure as well as an iatrogenic index reflecting the surgeon's ability to detect any hazardous trajectory at the time of performing said procedure. RESULTS: An average number of 13 X-rays was required for wire implantation by the G1 group. G2 group, assisted by the simulator use, required an average of 10 X-rays. A substantial difference was especially observed within the novice sub-group (N), with an average of 12.75 X-rays for the G1 category and an average of 8.5 X-rays for the G2 category. In the second sub-group of operators devoid of procedural knowledge (P-), a significant difference was found, since 12 X-rays appeared on average required in the G1 group versus six in the G2 group. Finally, within the sub-group of operators with technical knowledge (T+), a significant difference also was found since an average of 16 X-rays was required in the G1 versus an average 10.8 X-rays in the G2 group. As far as the iatrogenic index is concerned, we were unable to observe any significant difference between the groups. DISCUSSION: Despite some methodological variations, we were able to demonstrate the simulator's efficiency in familiarizing the operator with the use of a 2D imaging system as a first step facilitating the procedure conduct in the real 3D patient environment. Novice surgeons (N) having a good lumbosacral joint anatomy knowledge although devoid of specific surgical technique knowledge were the ones who most benefited from this guiding tool. Analysis of the training data collected during simulator's use helps orientating the prospective surgeon toward possession of not yet acquired learning points. This educational program can easily be extended to any other percutaneous technique requiring fluoroscopic control guidance. LEVEL OF EVIDENCE: Level III prospective diagnostic study.

Detection and identification of plasma progesterone metabolites in the female Florida manatee (Trichechus manatus latirostris) using GC/MS/MS.

Florida manatees (Trichechus manatus latirostris) have relatively low peripheral concentrations of progesterone (P4). The objective of this study was to determine if these relatively low P4 concentrations are associated with a high ratio of progestin metabolites and to document metabolite concentrations from individual blood samples obtained from manatees during diestrus or pregnancy. Metabolites known to exist in elephants-terrestrial manatee relatives-were targeted. These included 5alpha-reduced progestins (5alpha-pregnane-3,20-dione [5alpha-DHP] and 3alpha-hydroxy-5alpha-pregnan-20-one [5alpha-P3-OH]) and 17alpha-hydroxyprogesterone (17alpha-OHP), which occurs in Asian elephants. An additional, inactive metabolite, 20alpha-hydroxyprogesterone (20alpha-OHP), indicative of P4 overproduction, was also targeted. Progesterone itself was the predominant progestin detected in pregnant and nonpregnant manatee plasma (n = 10) using gas chromatography-mass spectrometry with tandem quadrupole detectors (GC/MS/MS). Progesterone concentrations in pregnant females varied from early (moderate to high) through mid and late (low) pregnancy. Progesterone concentrations ranged from low to high in nonpregnant, nonlactating females. The most commonly detected metabolite was 5alpha-P3-OH (n = 7), which occurred in pregnant (lower limit of detection [LLOD] to high) and nonpregnant (trace to high) females. The 5alpha-DHP metabolite was also detected in pregnant (LLOD to moderate) and nonpregnant (low) females. The 17alpha-OHP metabolite was not detected in any tested female. The 20alpha-OHP metabolite was detected in one nonpregnant, nonlactating, captive female (LLOD). Metabolites were most prevalent during early pregnancy, concurrent with maximum P4 concentrations. Based on their concentrations in peripheral circulation, we inferred that these metabolites may have, opposite to elephants, a limited physiologic role during luteal, pregnant, and nonpregnant phases in the manatee.

Prefracture syndrome of the hip fracture: a case control study.

BACKGROUND: Hip fractures result from both bone fragility and trauma, more often a sideways fall. Spontaneous hip fractures have been described; in such cases, patients reported pain ("prefracture" syndrome) in the hip region for weeks before the fracture. OBJECTIVES: To identify the proportion of patients who had a pain in the hip region before a hip fracture, to compare this proportion to the one observed in controls and to describe the characteristics of this pain. PATIENTS AND METHODS: For a period of 6 months, each subject (>65 years) treated for hip fracture was prospectively recruited in an orthopaedic surgery department. Exclusion criteria were: alterations of cognitive functions (defined by a mini mental state <20), refusal, and fractures related to bone metastasis or multiple myeloma. Subjects were compared to sex-matched controls consulting in an acute care geriatrics unit. They were asked about the occurrence of pain in hip region before the fracture and its characteristics. RESULTS: Thirty-eight patients (31 women, 7 men, mean age 83.1 [+/-7.6]) were included and were compared to 38 sex-matched controls (31 women, 7 men, mean age 82.7 [+/-6.9]). Among the 38 patients with hip fracture, 10 (26.3%) reported a pain in the hip region, compared with 2 (5.3%) in the control group (p=0.01). CONCLUSION: A better recognition of "prefracture" pain in the elderly may allow adequate management and treatment of patients, in order to avoid a proportion of hip fractures.