Associations among environmental exposure to trace elements and biomarkers of early kidney damage in the pediatric population.

BACKGROUND: In kidney damage, molecular changes can be used as early damage kidney biomarkers, such as Kidney Injury Molecule-1 and Neutrophil gelatinase-associated lipocalin. These biomarkers are associated with toxic metal exposure or disturbed homeostasis of trace elements, which might lead to serious health hazards. This study aimed to evaluate the relationship between exposure to trace elements and early damage kidney biomarkers in a pediatric population. METHODS: In Tlaxcala, a cross-sectional study was conducted on 914 healthy individuals. The participants underwent a medical review and a socio-environmental questionnaire. Five early damage kidney biomarkers were determined in the urine with Luminex, and molybdenum, copper, selenium, nickel, and iodine were measured with ICP-Mass. RESULTS: The eGFR showed a median of 103.75 mL/min/1.73 m2. The median levels for molybdenum, copper, selenium, nickel, and iodine were 24.73 ng/mL, 73.35 ng/mL, 4.78 ng/mL, 83.68 ng/mL, and 361.83 ng/mL, respectively. Except for molybdenum and nickel, the other trace elements had significant associations with the eGFR and the early kidney damage biomarkers. Additionally, we report the association of different exposure scenarios with renal parameters. DISCUSSION: and Conclusions. Among the explored metals, exposure to Cu and iodine impairs renal function. In contrast, Se may manifest as a beneficial metal. Interactions of Mo-Se and Mo-Iodine seem to alter the expression of NGAL; Mo-Cu for CLU; Mo-Cu, Mo-Se, and Mo-iodine for Cys-C and a-1MG; and Mo-Cu and Mo-iodine for KIM-1; were noticed. Our study could suggest that trace element interactions were associated with early kidney damage biomarkers.

Short-stem total hip arthroplasty is equivalent to a standard-length stem procedure in an unselected population at mid-term follow-up.

PURPOSE: Limitations of standard-length femoral stems persist, including proximal-distal mismatch, non-ideal load transfer, loss of bone tissue, and perioperative fracture. Symbol® (Dedienne Santé, France) is a metaphyseal-engaging short-stem implant designed to address these issues in total hip arthroplasty (THA). While short stems have been well studied in selected and younger patients, it is unclear whether they offer advantages in an unselected population. We hypothesized that short femoral stems offer similar mid-term survivorship at five year minimum follow-up and function score to standard-length femoral stems, in an unselected patient population. METHODS: We retrospectively reviewed a continuous unselected cohort of patients who undergone THA by one surgeon with a standard-length stem between November 2013 and October 2015, and a short stem between November 2015 and March 2017. We compared modified Harris Hip Score and Oxford Scores with a minimum follow-up of five years and procedural factors that could be associated with worse results with a short stem design. RESULTS: There was no difference in survival rate between the two groups. Average Harris Hip Score and Oxford Scores at the last follow-up were comparable. A multivariate linear regression was performed to assess the relationship between modified Harrys Hip Score at five years post-operatively and the explanatory variables: age, body mass index, physical status score ASA (American Society of Anesthesiologists), and HHS pre-op. None was associated with the standard-length stem but for the short stem. CONCLUSION: Short-stem implants provide good survival rate at mid-term; nevertheless, a steep learning curve is necessary to optimize the metaphyseal filling of the implant, especially for osteoporotic bone.

Value of arthroscopy in the management of acute lesions of the distal tibiofibular joint.

PURPOSE: Managing the distal tibiofibular (DTF) joint remains a challenge despite recent developments. Ankle arthroscopy is emerging as a diagnostic and therapeutic means. Our study aimed to compare preoperative imaging data and arthroscopic data, with the hypothesis that imaging alone is insufficient to evaluate acute laxity, and with arthroscopy as the reference examination. METHODS: All patients treated in 2023 in our department for an acute isolated DTF lesion were included prospectively. Preoperative radiographic and MRI imaging were compared with arthroscopic data. RESULTS: Ten patients were treated. For five patients, the instability was doubtful after carrying out an appropriate imaging assessment (X-rays of both ankles, MRI). For four of these five patients, instability was confirmed by arthroscopy. Arthroscopy was useful for suturing the anterior bundle of the DTF joint for two patients and allowed for verifying the reduction in the sagittal and coronal planes for two patients. No complications were detected. CONCLUSIONS: Arthroscopy in isolated acute DTF lesions seems to provide a diagnostic and therapeutic advantage. Its use may allow for exhaustive assessment and complete repair of lesions. It must be offered as soon as possible; a delay in specialized imaging may delay therapeutic care.

Return to military duty following anterior cruciate ligament reconstruction is associated with preoperative Body Mass Index and postoperative physiotherapy.

PURPOSE: To determine the rate and time of return to duty following anterior cruciate ligament reconstruction (ACLR) in military members, and to determine whether their outcomes are influenced by patient characteristics or surgical parameters. METHODS: We prospectively assessed 280 military members that underwent ACLR. 27 were excluded due to multi-ligamentous injuries or revision surgery, two did not provide informed consent and 62 were lost to follow-up. Patient demographics, pre-injury physical workload, complications and whether/when patients resumed duty and sports were noted, as well as clinical outcomes at a minimum follow-up of one year, including Knee Injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee score (IKDC), Lysholm, and Tegner scale. RESULTS: The final cohort of 189 military members (82% men) had mean age of 25.5 ± 3.4 (range,19-38) at ACLR. At 3.3 ± 1.6 years (range, 1.0-6.3), the Tegner score was 6.1 ± 2.0, Lysholm was 87.0 ± 13.7, IKDC was 80.1 ± 15.7, and KOOS was 81.1 ± 14.8. Only 144 patients (76%) resumed duty, at 9.5 ± 5.3 months (range,1-28), and 141 patients (75%) resumed sport, at 10.2 ± 6.2 months (range,1-35). Multivariable analysis revealed that return to duty was less likely in patients with higher BMI (OR,0.89;p = 0.025), but more likely in patients that followed military physiotherapy (OR,2.76;p = 0.017) and with higher pre-injury physical workload (OR,3.93;p = 0.010). CONCLUSION: At a follow-up of 3.3 ± 1.6 years, 76% returned to duty at 9.5 ± 5.3 months, and 75% returned to their main sport at 10.2 ± 6.2 months. Patients with higher BMI are significantly less likely to resume military duty and sports; those that followed military physiotherapy were most likely to resume duty, while those that had greater pre-injury physical workload were more likely to both resume duty and sport.

Hip arthroplasty dislocation risk calculator: evaluation of one million primary implants and twenty-five thousand dislocations with deep learning artificial intelligence in a systematic review of reviews.

PURPOSE: This paper aims to provide an overview of the possibility regarding the artificial intelligence application in orthopaedics to predict dislocation with a calculator according to the type of implant (hemiarthroplasty, standard total hip arthroplasty, dual mobility, constrained cups) after primary arthroplasty. MATERIAL AND METHODS: Among 75 results for primary arthroplasties, 26 articles were reviews on dislocation after hemiarthroplasty, 40 after standard total hip arthroplasty, seven about primary dual-mobility arthroplasty (DM THA), and two reviews about constrained implants. Although our search method for systematic reviews covers ten years (2012-2022), none for dual mobility was published before 2016, showing a recent explosion of original articles on this subject. A total of 1,069,565 implants and 26,488 dislocations in primary arthroplasties are included in these 75 reviews. We used a supervised learning model in which models assign objects to groups as input and artificial neural network (ANN) with nodes, hidden layers, and output layers. We considered only four implant types as the input layer. We considered the patient's factors (indication for THA, demographics, spine surgery, and neurologic disease) as the second input values (hidden layer). We considered the implant position as the third input (hidden layer) property including head size, combined anteversion, or spinopelvic alignment. Surgery-related factors, approach, capsule repair, etc. were the fourth input values (hidden layer). The output was a post-operative dislocation or not within three months. RESULTS: The accuracy for predicting dislocation with this systematic review was 95%. Dislocation risk, based on the type of implant, was wide-ranging, from 0 to 3.9% (mean 0.31%) for the 3045 DM THA, from 0.2 to 1.2% (overall 0.91%) for the 457 constrained liners, from 1.76 to 4.2% (mean 2.1%) for 895,734 conventional total hip arthroplasties, and from 0.76 to 12.2% (mean 4.5%) for 170,329 hemiarthroplasties. In the conventional THA group, many factors increase the risk of dislocation according to the calculator, and only a few (big head, anterior approach) decrease the risk, but not very significantly. In the hemiarthroplasty group, many factors can increase the risk of dislocation until 30%, but none could decrease the risk. According to the calculator, the DM THA and the constrained liner markedly decreased the risk and were not affected by implant position, spine surgery, and spinopelvic position. CONCLUSION: To our knowledge, this study is the first to yield an implant-specific dislocation risk calculator that incorporates the patient's comorbidities, the position of components, and surgery factors affecting instability risk.

Revision hip arthroplasty dislocation risk calculator: when to select dual mobility, large heads, constrained liners, or a standard head size? Testing one hundred thousand hip revisions with artificial intelligence.

PURPOSE: Preventing dislocation with large head (≥ 36 mm), dual mobility, or constrained acetabular liner is another option than a standard (≤ 32 mm). Many other dislocations risk factors than size of the femoral head exist after hip arthroplasty revision. Predicting dislocation with a calculator according to the implant, to the indication of revision, and to patient's risks could allow a better surgery decision. METHODS: Our search method covers the period from 2000 to 2022. A total of 470 relevant citations on hip major revision (cup or stem or both revisions) were identified with artificial intelligence comprising 235 publications of 54,742 standard heads comprising 142 publications of 35,270 large heads, comprising 41 publications of 3945 constrained acetabular components, and 52 publications of 10,424 dual mobility implants. We considered four implant types (standard, large head, dual mobility, or constrained acetabular liner) as the entry layer of the artificial neural network (ANN). Indication for revision THA was the second hidden layer. Demographics, spine surgery, and neurologic disease were the third layer. Implant revision, reconstruction process as next input (hidden layer). Surgery-related factors, and so on. The output was a postoperative dislocation or not. RESULTS: Of the 104,381 hips that underwent a major revision, a second revision for dislocation was performed for 9234 hips. In each implant group, dislocation remained the first cause of revision. The rate of second revision for dislocation as a percentage of first revision procedures was significantly higher in the standard head group (11.8%) than in the constrained acetabular liner group (4.5%), the dual mobility group (4.1%), and the large head group (6.1%). Instability of a previous THA, infection, or periprosthetic fracture as the indication for revision was increased risk factors as compared with aseptic loosening. One hundred variables were used to create the calculator with the best parameter combination of data and ranking the different factors, according to the four implant types (standard, large head, dual mobility, or constrained acetabular liner). CONCLUSION: The calculator can be used as a tool to identify patients at risk for dislocation after hip arthroplasty revision and individualize recommendations to select another option than a standard head size.

Subchronic oral exposure of tungsten induces myofibroblast transformation and various markers of kidney fibrosis.

Tungsten is a naturally occurring transition element used in a broad range of applications. As a result of its extensive use, we are increasingly exposed to tungsten from our environment, including potable water, since tungsten can become bioaccessible in ground sources. The kidneys are particularly susceptible to tungsten exposure as this is the main site for tungsten excretion. In this study, we investigated the prolonged effects of tungsten on the kidneys and how this may impact injury and function. When mice were exposed to tungsten in their drinking water for 1 mo, kidney function had not significantly changed. Following 3-mo exposure, mice were presented with deterioration in kidney function as determined by serum and urine creatinine levels. During 3 mo of tungsten exposure, murine kidneys demonstrated significant increases in the myofibroblast marker α-smooth muscle actin (αSMA) and extracellular matrix products: fibronectin, collagen, and matricellular proteins. In addition, Masson's trichrome and hematoxylin-eosin (H&E) staining revealed an increase in fibrotic tissue and vacuolization of tubular epithelial cells, respectively, from kidneys of tungsten-treated mice, indicative of renal injury. In vitro treatment of kidney fibroblasts with tungsten led to increased proliferation and upregulation of transforming growth factor ß1 (TGFß1), which was consistent with the appearance of fibroblast-to-myofibroblast transition (FMT) markers. Our data suggest that continuous exposure to tungsten impairs kidney function that may lead to the development of chronic kidney disease (CKD).

Intestinal UDP-Glucuronosyltransferase 1A1 and Protection against Irinotecan-Induced Toxicity in a Novel UDP-Glucuronosyltransferase 1A1 Tissue-Specific Humanized Mouse Model.

The human UDP-glucuronosyltransferases (UGTs) represent an important family of drug-metabolizing enzymes, with UGT1A1 targeting the conjugation and detoxification of many exogenous substances, including pharmaceutical drugs. In this study we generated humanized UGT1A1 mice expressing the human UGT1A1 gene in either liver (hUGT1A1HEP ) or intestine (hUGT1A1GI ), enabling experiments to examine tissue-specific properties of UGT1A1-specific glucuronidation. Hepatic and intestinal tissue-specific expression and function of UGT1A1 were demonstrated. Although the liver is considered a major organ for detoxification, intestinal UGT1A1 is an important contributor for drug clearance. Mice were challenged with irinotecan (CPT-11), a prodrug hydrolyzed by carboxylesterases to form the active metabolite 7-ethyl-10-hydroxycamptothecin (SN-38) and detoxified by UGT1A1. Humanized UGT1A1HEP mice that have no intestinal UGT1A1 displayed a greater lethality rate when exposed to CPT-11 than hUGT1A1GI mice. When exposed to a low dose of CPT-11 (10 mg/kg), hUGT1A1HEP mice displayed greater intestinal inflammatory (IL-1ß and IL-6) insult in addition to p53-triggered apoptotic responses. In vitro studies with intestinal crypt organoids exposed to CPT-11 confirmed the results observed in vivo and indicated that CPT-11 impacts stemness, apoptosis, and endoplasmic reticulum (ER) stress in organoids deficient in UGT1A1. When we examined the induction of ER stress in organoids with thapsigargin, an inhibitor of sarco/endoplasmic reticulum Ca2+ ATPase, apoptosis and the caspase surge that occurred in hUGT1A1HEP mice were blocked in hUGT1A1GI organoids. This study reveals the importance of intestinal UGT1A1 in preventing inflammation, apoptosis, and loss of stemness capacity upon systemic challenge with an important chemotherapeutic agent. SIGNIFICANCE STATEMENT: Hepatic and intestinal UGT1A1 play a key role in the metabolism and detoxification of endogenous and exogenous compounds. The use of tissue-specific humanized models expressing UGT1A1 in liver or intestine has confirmed the relevance of the intestinal tract in the detoxification of irinotecan. Mechanistic studies using intestinal organoids highlighted the importance of UGT1A1 in reducing inflammation, apoptosis, and loss of stemness. These new models provide valuable tools for studying tissue-specific glucuronidation of substances that are metabolized by human UGT1A1.

Fish oil replacement prevents, while docosahexaenoic acid-derived protectin DX mitigates end-stage-renal-disease in atherosclerotic diabetic mice.

Diabetic nephropathy (DN) remains the major cause of end-stage renal disease (ESRD). We used high-fat/high-sucrose (HFHS)-fed LDLr-/- /ApoB100/100 mice with transgenic overexpression of IGFII in pancreatic ß-cells (LRKOB100/IGFII) as a model of ESRD to test whether dietary long chain omega-3 polyunsaturated fatty acids LCω3FA-rich fish oil (FO) could prevent ESRD development. We further evaluated the potential of docosahexaenoic acid (DHA)-derived pro-resolving lipid mediators, 17-hydroxy-DHA (17-HDHA) and Protectin DX (PDX), to reverse established ESRD damage. HFHS-fed vehicle-treated LRKOB100/IGFII mice developed severe kidney dysfunction leading to ESRD, as revealed by advanced glomerular fibrosis and mesangial expansion along with reduced percent survival. The kidney failure outcome was associated with cardiac dysfunction, revealed by reduced heart rate and prolonged diastolic and systolic time. Dietary FO prevented kidney damage, lean mass loss, cardiac dysfunction, and death. 17-HDHA reduced podocyte foot process effacement while PDX treatment alleviated kidney fibrosis and mesangial expansion as compared to vehicle treatment. Only PDX therapy was effective at preserving the heart function and survival rate. These results show that dietary LCω3FA intake can prevent ESRD and cardiac dysfunction in LRKOB100/IGFII diabetic mice. Our data further reveals that PDX can protect against renal failure and cardiac dysfunction, offering a potential new therapeutic strategy against ESRD.

Evaluation of intraoperative ketamine on the prevention of severe rebound pain upon cessation of peripheral nerve block: a prospective randomised, double-blind, placebo-controlled study.

BACKGROUND: Pain after resolution of peripheral nerve block, known as 'rebound pain' (RP), is a major problem in outpatient surgery. The primary objective was to evaluate the benefit of intraoperative ketamine at an anti-hyperalgesic dose on the incidence of rebound pain after upper limb surgery under axillary plexus block in ambulatory patients. The secondary objective was to better understand the rebound pain phenomenon (individual risk factors). METHODS: In this prospective, double-blind study, patients were randomised to receive either a single dose of i.v. ketamine (0.3 mg kg-1) or a placebo. Preoperative mechanical temporal summation and central sensitization inventory were applied to question underlying central sensitisation. Pain catastrophising and Douleur Neuropathique 4 questionnaires were used. Rebound pain was defined as pain intensity score >7 (numeric rating scale, 0-10) after block resolution. Postoperative pain was recorded at Days 1, 4, and 30 after discharge. RESULTS: A total of 109 subjects completed the study, and 40.4% presented with rebound pain. Ketamine administration did not reduce rebound pain incidence or intensity. Temporal summation and central sensitisation inventory scores did not differ between subjects with and without rebound pain. The predictive risk factors were bone surgery (odds ratio [OR]=5.2; confidence interval [CI], 1.9-14.6), severe preoperative pain (OR=4.2; CI, 1.5-11.7), and high pain catastrophising (OR=4.8; CI, 1.0-22.3). At Day 30, the average daily pain was higher in the rebound pain group involving neuropathic characteristics. CONCLUSION: Ketamine at an anti-hyperalgesic dose showed no benefit on rebound pain development. Although central sensitisation might not be involved, preoperative pain intensity, and catastrophising stand as risk factors. Because rebound pain remains frequent despite adequate procedure-specific postoperative analgesia, future studies should focus on patient-specific pain management.

Should proximal ruptures of the anterior rectus femoris muscle be treated surgically?

PURPOSE: No therapeutic consensus has been established about proximal ruptures of the rectus femoris muscle. The objective of this literature review is to determine a therapeutic course of action. METHODS: We conducted a literature review on the PubMed database using the following keywords (in French and English, respectively): "quadriceps/quadriceps", "droit antérieur/rectus femoris", "proximal/proximal", "chirurgie/surgical", "avulsion/avulsion". We collected 266 articles, 36 of them were selected, which were related to our topic: proximal rupture of the anterior rectus femoris. Patients with a proximal rupture of the rectus femoris, minor or major patient of traumatic origin were included in this study. Patients injured at another lesion level, or non-traumatic lesions of the proximal rectus femoris (tendinitis without ruptures, tumor or others) were excluded. For each patient, the indications, the type of treatment and the functional result were analyzed, with the time to recovery and the level of recovery from sports and professional activities (same sport/profession or not, same level or not) as the main criterion of judgment. Fisher exact test was used for statistical comparison. RESULTS: The aims of conservative treatment are to be pain free for the patient, to fight hematoma and to rehabilitate the injury as quickly as possible. The surgical techniques are varied, with most consisting of either a reinsertion of the musculo-tendon stump or a resection of the scar tissue with myo-tendino-aponeurotic suture in place. The functional results are good for the majority of the treatments proposed, but the conservative treatment has a shorter recovery time (3 months vs. 4 months for the best surgical results). Highly displaced bone avulsion is the only indication for first-line surgical treatment. CONSLUSION: The main disadvantage of conservative treatment is the risk of residual pain beyond 3 months (10%), justifying an MRI to guide secondary surgical treatment. We propose a treatment plan for proximal rupture of the proximal rectus femoris rupture.

Gorham Stout disease: 3 additional cases with 2 very rare polyostotic diseases.

Gorham Stout disease is a very rare monostotic or polyostotic osteolysis and physiopathology of the osteolysis is not yet fully understood. Three new cases are reported with their evolution and treatment. Among these 3 cases, two are very rare cases of polyostotic involvement. One patient finally deceased from respiratory complications despite limb amputation. The two others are alive. Both needed final reconstruction with massive bone allograft for one and with a prosthesis for the other. Monostotic osteolysis is the most frequent presentation of Gorham Stout disease and extensive polyostotic osteolysis is very rare. Treatment methods vary from one clinic to another, from drug treatment to surgical treatment with or without radiotherapy. Sometimes, as a last solution, an amputation of the affected limb is performed. The prognosis depends on the affected region and the reponse to various treatments. Chylothorax seems to be a factor of poor prognosis.

Does the choice of the optic portal influence the radiographic and early functional results in acute acromioclavicular disjunctions?

Exposure of the coracoid process during arthroscopic stabilization of acute acromioclavicular disjunctions (ACDs) can be achieved either by passing an extra- articular optical portal through the subacromial space or by an intra-articular optical route through the glenohumeral joint with opening of the rotator interval. The objective of our study was to compare the impact on the functional results of these two optical routes. This was a retrospective, multicentre study that included patients operated on for an acute acromioclavicular disjunction arthroscopically. The treatment consisted of surgical stabilization under arthroscopy. The surgical indication was retained for an acromioclavicular disjunction of grade 3, 4 or 5, according to the Rockwood classification. Group 1, which consisted of 10 patients, was operated on with an extra-articular subacromial optical route, and group 2, which consisted of 12 patients, was operated on with an intra-articular optical route with opening of the rotator interval according to the habits of the surgeon. A follow-up of 3 months was performed. The functional results were evaluated for each patient using the Constant score, Quick DASH, and SSV. The delays in returning to professional and sports activities were also noted. A precise postoperative radiological analysis made it possible to analyse the quality of the radiological reduction. No significant difference between the two groups was found between the Constant score (88 vs. 90; p = 0.56), Quick DASH (7 vs. 7; p = 0.58), or SSV (88 vs. 93; p = 0.36). The times to return to work (6.8 weeks vs. 7.0 weeks; p = 0.54) and sports activities (15.6 weeks vs. 19.5 weeks; p = 0.53) were also comparable. The quality of the radiological reduction was satisfactory in the two groups and did not depend on the approach. No clinically or radiologically significant differences between the extra-articular and intra-articular optical portals in the surgical treatment of acute ACDs were found. The optical route can be chosen according to the habits of the surgeon.

Dietary fat and low fiber in purified diets differently impact the gut-liver axis to promote obesity-linked metabolic impairments.

Selecting the most relevant control diet is of critical importance for metabolic and intestinal studies in animal models. Chow and LF-purified diet differentially impact metabolic and gut microbiome outcomes resulting in major changes in intestinal integrity in LF-fed animals which contributes to altering metabolic homeostasis. Dietary fat and low fiber both contribute to the deleterious metabolic effect of purified HF diets through both selective and overlapping mechanisms.

Evaluation of virtual reality combining music and a hypnosis session to reduce anxiety before hand surgery under axillary plexus block: A prospective study.

AIMS: Preoperative anxiety, which can affect postoperative recovery, is often present in patients undergoing surgery under loco-regional anaesthesia (LRA). Minimising preoperative anxiety with premedication can be effective but results in drug-related side effects. Therefore, the use of non-pharmacological techniques should be encouraged. METHODS: We evaluated whether a virtual reality (VR) incorporating music and a hypnosis session, provided during the performance of LRA, can reduce preoperative anxiety. Fifty patients scheduled for elective hand surgery under an axillary plexus block were enrolled (March-June 2019). The primary outcome measure was the change in the Amsterdam Anxiety and Preoperative Information Scale (APAIS) questionnaire 5 min after the VR session as compared to before the VR session. The secondary outcome measures were the visual analog scale (VAS) for anxiety before and 2 h after the surgery and the Evaluation du Vécu de l'ANesthésie-LocoRégionale (EVAN-LR) satisfaction score. RESULTS: Data from 48 patients were analysed. The APAIS score as well as VAS for anxiety were significantly reduced after a VR session (p < .001 for both scores). Patients were very satisfied (EVAN-LR: 92 (88, 94)). CONCLUSIONS: The use of VR incorporating music and a hypnosis session could be an effective tool in the management of a patient's preoperative anxiety during the performance of an axillary plexus block.

Recognizing Manual Activities Using Wearable Inertial Measurement Units: Clinical Application for Outcome Measurement.

The ability to monitor activities of daily living in the natural environments of patients could become a valuable tool for various clinical applications. In this paper, we show that a simple algorithm is capable of classifying manual activities of daily living (ADL) into categories using data from wrist- and finger-worn sensors. Six participants without pathology of the upper limb performed 14 ADL. Gyroscope signals were used to analyze the angular velocity pattern for each activity. The elaboration of the algorithm was based on the examination of the activity at the different levels (hand, fingers and wrist) and the relationship between them for the duration of the activity. A leave-one-out cross-validation was used to validate our algorithm. The algorithm allowed the classification of manual activities into five different categories through three consecutive steps, based on hands ratio (i.e., activity of one or both hands) and fingers-to-wrist ratio (i.e., finger movement independently of the wrist). On average, the algorithm made the correct classification in 87.4% of cases. The proposed algorithm has a high overall accuracy, yet its computational complexity is very low as it involves only averages and ratios.

Increased Endocytosis of Cadmium-Metallothionein through the 24p3 Receptor in an In Vivo Model with Reduced Proximal Tubular Activity.

BACKGROUND: The proximal tubule (PT) is the major target of cadmium (Cd2+) nephrotoxicity. Current dogma postulates that Cd2+ complexed to metallothionein (MT) (CdMT) is taken up through receptor-mediated endocytosis (RME) via the PT receptor megalin:cubilin, which is the predominant pathway for reuptake of filtered proteins in the kidney. Nevertheless, there is evidence that the distal parts of the nephron are also sensitive to damage induced by Cd2+. In rodent kidneys, another receptor for protein endocytosis, the 24p3 receptor (24p3R), is exclusively expressed in the apical membranes of distal tubules (DT) and collecting ducts (CD). Cell culture studies have demonstrated that RME and toxicity of CdMT and other (metal ion)-protein complexes in DT and CD cells is mediated by 24p3R. In this study, we evaluated the uptake of labeled CdMT complex through 24p3R after acute kidney injury (AKI) induced by gentamicin (GM) administration that disrupts PT function. Subcutaneous administration of GM at 10 mg/kg/day for seven days did not alter the structural and functional integrity of the kidney's filtration barrier. However, because of PT injury, the concentration of the renal biomarker Kim-1 increased. When CdMT complex coupled to FITC was administered intravenously, both uptake of the CdMT complex and 24p3R expression in DT increased and also colocalized after PT injury induced by GM. Although megalin decreased in PT after GM administration, urinary protein excretion was not changed, which suggests that the increased levels of 24p3R in the distal nephron could be acting as a compensatory mechanism for protein uptake. Altogether, these results suggest that PT damage increases the uptake of the CdMT complex through 24p3R in DT (and possibly CD) and compensate for protein losses associated with AKI.

Cementation of proximal femoral nails of the very elderly subject in per-trochanteric fractures.

The management of pertrochanteric fractures (PTF) in the very elderly relies on early verticalisation to limit complications of the decubitus and this requires stable osteosynthesis allowing immediate full support without risk of mechanical failure. The aim of the study was to analyse the value of cementing the cervicocephalic blade during osteosynthesis with a proximal femoral nail. A prospective bicentric comparative study was con- ducted. Patients over 90 years of age with PTF were included. Centre A used a PFNA (Proximal Femoral Nail Antirotation) nail without blade cementing and Centre B used the same nail with blade cementing. The primary endpoint was the occurrence of disassembly of the osteosynthesis requiring revision surgery. Secondary endpoints were functional out- come (resumption of walking), postoperative pain and duration of surgery. Sixty-four patients were included in Centre A and 23 patients were included in Centre B. Mean age, gender, functional abilities before fracture, fracture type and tip-apex distance were comparable between the groups. Postoperative pain and duration of surgery did not show significant differences between the groups. Four patients operated on with an uncemented PFNA (6.25%) and one patient operated on with a cemented PFNA nail (4.35%) showed early dismantling. The rate of patients returning to walking was significantly higher in the cemented group (p=0.00005). No significant differences in the rate of dismantling were observed between the two groups. However, the group operated on with a cemented PFNA showed better functional recovery with a significantly higher rate of walking recovery.

[Post-operative monitoring of a patient with severe limb trauma]. / La surveillance postopératoire d'un patient traumatisé grave des membres.

In the postoperative monitoring of a patient with severe limb trauma, the nurse's objectives are multiple: prevention and screening of complications, follow-up care, compliance with postoperative instructions. Presentation of the key elements of this monitoring, which must be systematised and personalised.

[Dressing management in limb traumatology]. / La gestion des pansements en traumatologie des membres.

The nurse's role in the management of dressings in limb trauma is essential: conditioning of the patient, correct and complete assessment of the site concerned, before care is provided. She is a privileged partner in planning the follow-up. At each stage, the nurse must be aware of the tasks to be carried out so that the overall management leads to rapid and correct healing.