[Are abdominal aortic aneurysm screening guidelines followed? Prospective study in Dunkerque's hospital emergency room]. / Les recommandations de dépistage de l'anévrysme de l'aorte abdominale sont-elles respectées ? Étude prospective aux urgences de Dunkerque.

AIM OF THE STUDY: Are the recommendations issued by the Haute Autorité de santé in 2012 on screening for abdominal aortic aneurysm (AAA) being applied? METHOD: We interviewed the target patients, ex. male patients aged 65 to 75, smokers or former smokers, or as young as 50 in the event of a family history of AAA in the parents or siblings, entering the emergency room of Dunkerque between May 7 and December 31, 2015. We asked them if they had had an abdominal aortic ultrasound, or an abdominal ultrasound, or an arterial Doppler ultrasound of the lower limbs, and when, to see if they had had an AAA test since November 2012. RESULTS: We included 55 patients and excluded 5 of 180 eligible patients (31 %). It was not possible to conclude for 4 patients due to missing data. Thirteen of 46 patients (28.3 %, 95 % CI [16.0-43.5]) have had AAA ultrasound screening since November 2012; 33 have not (71.7 %, 95 % CI [56.5-84.0]) and no screening was offered. Of the 13 patients screened, 7 were screened by the attending physician (53.9 %, 95 % CI [25.1-80.8]) and 6 by another specialist (46.2 %, 95 % CI [19.2-74.9]). CONCLUSION: AAA screening in our population is low. Physicians should be urged to publicize and implement the November 2012 French recommendations to reduce AAA-related mortality.

[Neonatal hyperthyroidism: A sometimes challenging diagnosis]. / L'hyperthyroïdie néonatale : un diagnostic parfois difficile.

Graves disease complicates two pregnancies out of 1000 and when it is known before pregnancy, it warrants careful monitoring of the fetus and the newborn. We report on a case of neonatal hyperthyroidism, which revealed a previously unknown maternal thyroid disease. In this situation, neonatal signs can be misinterpreted, delaying the diagnosis. Neonatal hyperthyroidism is, however, a therapeutic emergency because of the risk of cardiac and neurological complications. The neonatologist must identify thyroid disease in the absence of a maternal history in order to promptly start therapy.

H.E.S.S. Limits on Linelike Dark Matter Signatures in the 100 GeV to 2 TeV Energy Range Close to the Galactic Center.

A search for dark matter linelike signals iss performed in the vicinity of the Galactic Center by the H.E.S.S. experiment on observational data taken in 2014. An unbinned likelihood analysis iss developed to improve the sensitivity to linelike signals. The upgraded analysis along with newer data extend the energy coverage of the previous measurement down to 100 GeV. The 18 h of data collected with the H.E.S.S. array allow one to rule out at 95% C.L. the presence of a 130 GeV line (at l=-1.5°, b=0° and for a dark matter profile centered at this location) previously reported in Fermi-LAT data. This new analysis overlaps significantly in energy with previous Fermi-LAT and H.E.S.S. RESULTS: No significant excess associated with dark matter annihilations was found in the energy range of 100 GeV to 2 TeV and upper limits on the gamma-ray flux and the velocity weighted annihilation cross section are derived adopting an Einasto dark matter halo profile. Expected limits for present and future large statistics H.E.S.S. observations are also given.

Search for Dark Matter Annihilations towards the Inner Galactic Halo from 10 Years of Observations with H.E.S.S.

The inner region of the Milky Way halo harbors a large amount of dark matter (DM). Given its proximity, it is one of the most promising targets to look for DM. We report on a search for the annihilations of DM particles using γ-ray observations towards the inner 300 pc of the Milky Way, with the H.E.S.S. array of ground-based Cherenkov telescopes. The analysis is based on a 2D maximum likelihood method using Galactic Center (GC) data accumulated by H.E.S.S. over the last 10 years (2004-2014), and does not show any significant γ-ray signal above background. Assuming Einasto and Navarro-Frenk-White DM density profiles at the GC, we derive upper limits on the annihilation cross section ⟨σv⟩. These constraints are the strongest obtained so far in the TeV DM mass range and improve upon previous limits by a factor 5. For the Einasto profile, the constraints reach ⟨σv⟩ values of 6×10^{-26} cm^{3} s^{-1} in the W^{+}W^{-} channel for a DM particle mass of 1.5 TeV, and 2×10^{-26} cm^{3} s^{-1} in the τ^{+}τ^{-} channel for a 1 TeV mass. For the first time, ground-based γ-ray observations have reached sufficient sensitivity to probe ⟨σv⟩ values expected from the thermal relic density for TeV DM particles.

Modelling gastric evacuation in gadoids feeding on crustaceans.

A mechanistic, prey surface-dependent model was expanded to describe the course and rate of gastric evacuation in predatory fishes feeding on crustacean prey with robust exoskeletons. This was accomplished by adding a layer of higher resistance to the digestive processes outside the inner softer parts of a prey cylinder abstraction and splitting up the prey evacuation into two stages: an initial stage where the exoskeleton is cracked and a second where the prey remains are digested and evacuated. The model was parameterized for crustaceans with different levels of armour fed to Atlantic cod Gadus morhua or whiting Merlangius merlangus and recovered from the stomachs at different post-prandial times. The prey species were krill Meganyctiphanes norvegica; shrimps and prawns Crangon crangon, Pandalus borealis, Pandalus montagui and Eualus macilentus; crabs Liocarcinus depurator and Chionoecetes opilio. In accordance with the apparent intraspecific isometric relationship between exoskeleton mass and total body mass, the model described stage duration and rate of evacuation of the crustacean prey independently of meal and prey sizes. The duration of the first stage increased (0-33 h) and the evacuation rate of both stages decreased (by a half) with increasing level of the crustacean armament in terms of chitin and ash. A common, interspecific parameterization of the model within each of the categories krill, shrimp and crab can probably be used if the contents of chitin and ash are similar among prey species per prey category. The model offers a simple way for estimating evacuation rates from stomach content data in order to obtain food consumption rates of wild fishes, provided that information about digestion stage of crustacean prey is available.

Olfactory function in acute traumatic brain injury.

OBJECTIVE: Traumatic brain injury (TBI) represents a significant public health problem and is associated with a high rate of mortality and morbidity. Although TBI is amongst the most common causes of olfactory dysfunction the relationship between injury severity and olfactory problems has not yet been investigated with validated and standardized methods in the first days following the TBI. METHODS: We measured olfactory function in 63 patients admitted with TBI within the first 12 days following the trauma by means of the Sniffin' Sticks identification test (quantitative assessment) and a parosmia questionnaire (qualitative assessment). TBI severity was determined by means of the Glasgow Coma Scale (GCS) and by duration of post-traumatic amnesia (PTA) as measured by the Galveston Orientation and Amnesia Test. RESULTS: Poor olfactory scores correlated with a longer amnesia period, but not with GCS scores. Further, we observed higher parosmia scores in assault victims than in victims of falls or motor vehicle collisions. CONCLUSIONS: We show that PTA is intimately related to olfactory problems following a TBI. Thus, a thorough evaluation of olfaction is essential in order to detect posttraumatic olfactory dysfunction and to take appropriate actions early on to help the individual deal with this impairment.

Olfactory and executive dysfunctions following orbito-basal lesions in traumatic brain injury.

OBJECTIVE: To study the acute relationship between olfactory function and traumatic brain injury (TBI), cognitive functions and outcome. METHODS: Sixty-two patients with TBI were evaluated within the first 2 weeks following TBI. The Sniffin'Sticks identification test was used to assess olfaction. A neuropsychological evaluation was carried out to assess attention, verbal fluency, naming, memory, problem-solving and mental flexibility. The extended Glasgow Outcome Scale (GOSE) and the Disability Rating Scale (DRS) were rated at discharge from acute care. RESULTS: Traumatic lesions located in the basal frontal area resulted in odour identification scores that were significantly lower than when lesions were elsewhere (p < 0.001). A significant positive correlation was shown between odour identification scores and mental flexibility scores (p = 0.004) and patients with hyposmia had worse performances on executive tests measuring problem-solving, verbal fluency and mental flexibility (p < 0.01). Moreover, the odour identification score and the DRS total score were related (p = 0.019). CONCLUSIONS: These findings add information regarding acute olfactory status following TBI and provide evidence on the importance of assessing olfaction very early post-TBI in order to plan intervention and determine what accident prevention advice will be required for home or work re-integration.

Constraints on an annihilation signal from a core of constant dark matter density around the milky way center with H.E.S.S.

An annihilation signal of dark matter is searched for from the central region of the Milky Way. Data acquired in dedicated on-off observations of the Galactic center region with H.E.S.S. are analyzed for this purpose. No significant signal is found in a total of ∼9 h of on-off observations. Upper limits on the velocity averaged cross section, ⟨σv⟩, for the annihilation of dark matter particles with masses in the range of ∼300 GeV to ∼10 TeV are derived. In contrast to previous constraints derived from observations of the Galactic center region, the constraints that are derived here apply also under the assumption of a central core of constant dark matter density around the center of the Galaxy. Values of ⟨σv⟩ that are larger than 3×10^{-24} cm^{3}/s are excluded for dark matter particles with masses between ∼1 and ∼4 TeV at 95% C.L. if the radius of the central dark matter density core does not exceed 500 pc. This is the strongest constraint that is derived on ⟨σv⟩ for annihilating TeV mass dark matter without the assumption of a centrally cusped dark matter density distribution in the search region.

"Reposition-flap": A therapeutic alternative in fingertips amputations.

After trans-phalanx fingertips amputations, there is usually a therapeutic problem related to the distal fragment quality. Replantation is not always possible. The aim of this study was to propose the "reposition-flap" surgical procedure as an alternative solution to various surgical strategies for distal stump coverage. It consisted in the association of a bone fragment osteosyntesis and a pedicular local flap implementation. Between 2001 and 2011, the reposition-flap surgical procedure was retrospectively tested in two hand trauma centers. We reviewed a cohort of 51 patients divided in two groups. The first one (20 patients) was the "reposition-flap" group, the second (31 patients) had a coverage with an other surgical procedure (simple regularisation or local flap). Sensibility, pulp trophicity, fingers mobility, digital length, nail appearance and radiologic consolidation of each patient were reviewed. "Reposition-flap" allowed 80% length of phalanx conservation. In comparison with regularisation, the aesthetic aspects of the nail's finger (no claw) were improved with this surgical procedure. However, the Quick DASH average revealed significant statistical differences instead of the statistics obtained with the mobility of the IPD and the sensitivity of the pulp. This procedure gave best aesthetic and functional results.

Capped guanidino-α-cyclodextrin first synthesis based on intramolecular Staudinger-Aza-Wittig (SAW) reaction.

An intramolecularly promoted SAW reaction between a phosphinimide and an isocyanate intermediate led to an original bridged trisubstituted ((A,C),E)-α-cyclodextrin. The latter was in a second step converted into a new capped (ACE)-(guanidino)-α-cyclodextrin.

Alterations in gill structure in tropical reef fishes as a result of elevated temperatures.

Tropical regions are expected to be some of the most affected by rising sea surface temperatures (SSTs) because seasonal temperature variations are minimal. As temperatures rise, less oxygen dissolves in water, but metabolic requirements of fish and thus, the demand for effective oxygen uptake, increase. Gill remodelling is an acclimation strategy well documented in freshwater cyprinids experiencing large seasonal variations in temperature and oxygen as well as an amphibious killifish upon air exposure. However, no study has investigated whether tropical reef fishes remodel their gills to allow for increased oxygen demands at elevated temperatures. We tested for gill remodelling in five coral reef species (Acanthochromis polyacanthus, Chromis atripectoralis, Pomacentrus moluccensis, Dascyllus melanurus and Cheilodipterus quinquelineatus) from populations in northern Papua New Guinea (2° 35.765' S; 150° 46.193' E). Fishes were acclimated for 12-14 days to 29 and 31°C (representing their seasonal range) and 33 and 34°C to account for end-of-century predicted temperatures. We measured lamellar perimeter, cross-sectional area, base thickness, and length for five filaments on the 2nd gill arches and qualitatively assessed 3rd gill arches via scanning electron microscopy (SEM). All species exhibited significant differences in the quantitative measurements made on the lamellae, but no consistent trends with temperature were observed. SEM only revealed alterations in gill morphology in P. moluccensis. The overall lack of changes in gill morphology with increasing temperature suggests that these near-equatorial reef fishes may fail to maintain adequate O2 uptake under future climate scenarios unless other adaptive mechanisms are employed.

The hand in systemic diseases other than rheumatoid arthritis.

This review outlines the skin, vascular and musculoskeletal symptoms affecting the hand during systemic inflammatory diseases other than rheumatoid arthritis. Skin lesions are diagnosed clinically and their symptomatology is documented through an extensive series of photographs. These conditions may require specific care before a surgical procedure can be performed. Vascular lesions are also diagnosed clinically and their symptomatology is described in detail. It is important to recognize that acrocyanosis is always benign. The surgeon should be able to distinguish between primary, but benign Raynaud's disease and secondary Raynaud's syndrome, which has a high risk of finger necrosis. Current preventative and curative treatments for finger necrosis are described. The clinical, radiological, progressive and therapeutic features of musculoskeletal lesions are reviewed, namely those associated with psoriatic arthritis, systemic sclerosis and lupus.

Prey exoskeletons influence the course of gastric evacuation in Atlantic cod Gadus morhua.

This study examined the effects of prey exoskeleton characteristics on gastric evacuation patterns in Atlantic cod Gadus morhua. Three distinct stages were highlighted in the gastric evacuation of crustacean prey characterized by a robust exoskeleton. The experiments confirmed that the three shrimp species, Pandalus borealis, Pandalus montagui and Eualus macilentus, and the crab Chionoecetes opilio, were evacuated from the stomach at different rates. The duration of all stages increased with increasing ash (and carbonate) content of the fresh prey. Thickness, chemical composition and morphology of the prey exoskeleton all affected gastric evacuation: duration of initial delay, overall evacuation rate and a decreased evacuation rate at the end of the process. The power exponential function (PEF), with its shape parameter, described the course of evacuation for these prey types well, especially the initial delay. The PEF does not, however, allow describing evacuation by the current stomach content mass independent of meal size, which limits its usefulness in estimating consumption rates of wild G. morhua. To predict and describe gastric evacuation of prey with a robust exoskeleton, it is therefore suggested that the square-root function be expanded with an initial lag phase, coupled to the mechanistically based cylinder model of gastric evacuation.

Search for photon-linelike signatures from dark matter annihilations with H.E.S.S.

Gamma-ray line signatures can be expected in the very-high-energy (E(γ)>100 GeV) domain due to self-annihilation or decay of dark matter (DM) particles in space. Such a signal would be readily distinguishable from astrophysical γ-ray sources that in most cases produce continuous spectra that span over several orders of magnitude in energy. Using data collected with the H.E.S.S. γ-ray instrument, upper limits on linelike emission are obtained in the energy range between ∼ 500 GeV and ∼ 25 TeV for the central part of the Milky Way halo and for extragalactic observations, complementing recent limits obtained with the Fermi-LAT instrument at lower energies. No statistically significant signal could be found. For monochromatic γ-ray line emission, flux limits of (2 × 10(-7) -2 × 10(-5)) m(-2) s(-1) sr(-1) and (1 × 10(-8) -2 × 10(-6)) m(-2) s(-1)sr(-1) are obtained for the central part of the Milky Way halo and extragalactic observations, respectively. For a DM particle mass of 1 TeV, limits on the velocity-averaged DM annihilation cross section ⟨σv⟩(χχ → γγ) reach ∼ 10(-27) cm(3)s(-1), based on the Einasto parametrization of the Galactic DM halo density profile.

Protective effect of single-dose adjuvanted pandemic influenza vaccine in children.

BACKGROUND: During the first wave of A/California/7/2009(H1N1) influenza, high rates of hospitalization in children under 5 years were seen in many countries. Subsequent policies for vaccinating children varied in both type of vaccine and number of doses. In Canada, children 36 months to <10 years received a single dose of 0.25 ml of the GSK adjuvanted vaccine (Arepanrix) equivalent to 1.9 microg HA. Children 6 months to 35 months received two doses as did those 36-119 months with chronic medical conditions. METHOD: We conducted a community-based case-control vaccine effectiveness (VE) review of children under 10 years with influenza like illness who were tested for H1N1 infection at the central provincial laboratory. Laboratory-confirmed influenza was the primary outcome, and vaccination status the primary exposure to assess VE after a single 0.25-ml dose. RESULTS: If vaccination was designated to be effective after 14 days, no vaccinated child had laboratory-confirmed influenza compared to 38% of controls. The VE of 100% was statistically significant for children <10 years of age and <5 years considered separately. If vaccination was considered effective after 10 days, VE dropped to 96% overall but was statistically significant and over 90% in all age subgroups, including those under 36 months. CONCLUSIONS: A single 0.25-ml dose of the GSK adjuvanted vaccine (Arepanrix) protects children against laboratory-confirmed pandemic influenza potentially avoiding any increased reactogenicity associated with second doses. Adjuvanted vaccines offer hope for improved seasonal vaccines in the future.

[Non-traumatic osteoarthritis of the distal radio-ulnar joint: a consecutive series of 11 wrists with 42 months follow-up]. / Arthrose non traumatique radio-ulnaire distale: à propos d'une série continue de 11 poignets revus avec un recul moyen de 42 mois.

PURPOSE OF THE STUDY: Non-traumatic osteoarthritis of the distal radio-ulnar joint is generally observed in a context of chondrocalcinosis and can lead to rupture of the extensor tendons. We reviewed patients operated on in our unit between 1986 and 1988 for this condition in order to examine modalities of surgical care. MATERIAL AND METHODS: Eleven patients who underwent surgery for non-traumatic osteoarthritis of the distal radio-ulnar joint were included in the study. Demographic data, clinical signs, joint amplitudes, radiologically identified lesions, peroperative macroscopic features, and results of the microscopic examinations of the synovectomy specimen were recorded. Injury to the extensor tendons and surgical procedures used for repair were noted. Outcome was assessed clinically (pain, stability of the ulnar stump, active extension of the fingers, pronation-supination, flexion-extension) and radiologically. RESULTS: The series included 11 wrists in 8 women, mean age 73.2 years. The underlying cause was chondrocalcinosis in 9 cases and primary osteoarthritis in 2. All patients had painful pronation-supination and 9 of them had ruptured extensor tendons. There was a dorsal displacement of the ulnar head in all cases. Synovectomy-realignment-stabilization was performed using the Sauvé-Kapandji procedure in 10 wrists and resection of the ulnar head using the Darrach procedure in one. Extensor tendons were repaired by side-to-side anastomosis with neighboring tendons in 6 wrists and with grafts in 3. At a mean 42 months follow-up, 7 wrists were pain free and 4 continued to have climatic pain. The ulnar stump was stable in all cases. All the patients achieved active extension of the fingers and preserved wrist mobility. DISCUSSION: According to the literature, non-traumatic osteoarthritis of the distal radio-ulnar joint is uncommon and occurs principally in the elderly patient. The most common complication being rupture of the extensor tendons. Different treatments can be discussed, but we prefer synovectomy-realignment-stabilization using the Sauvé-Kapandji method which, in light of the results obtained in this series, can regularly provide good pain relief and good functional results when associated with tendon repair as needed and as early as possible.

[Dorsal instability of the ulnar stump following distal resection: hemi extensor-carpi-ulnaris stabilization procedure]. / Instabilité dorsale du moignon ulnaire après résection diaphysaire distale: stabilisation avec un hémi extensor-carpi-ulnaris.

Dorsal instability of the ulnar stump may be a complication of Darrach and Sauve-Kapandji procedures. Stabilizing procedures are numerous using flexor carpi ulnaris, extensor carpi ulnaris tendons or a combination of both tendons, the palmaris longus, and even synthetic or free grafts. The authors report nine cases of ulnar stump instability, five times post-traumatic and four as a result of rheumatoid arthritis. A tenodesis using a strip half of the extensor carpi ulnaris was performed in all these patients. Post-operatively eight patients were pain-free with in one case occasional pain after heavy work. All stumps were clinically stable. Forearm rotation and grip strength were maintained. Radiological dorsal ulnar subluxation was always reduced. Treatment of these instabilities should be preventive. When dorsal instability of the ulnar stump occurs, the half strip extensor carpi ulnaris tenodesis provides consistent satisfactory results in both arthritic and post-traumatic-related instability.

[Lunocapitate shortening arthrodesis after scaphoid and triquetrum resection: treatment of Watson stage III advanced scaphoid periarthrosis]. / Arthrose péri-scaphoïdienne évoluée traitée par arthrodèse raccourcissante luno-capitate après résection du scaphoïde et du triquetrum.

PURPOSE OF THE STUDY: Between 1993 and 2000, 16 patients with scaphoid periarthrosis (Watson stage III) were treated by lunocapitate shortening arthrodesis after resection of the scaphoid and triquetrum. These patients were reviewed to evaluate outcome. MATERIAL AND METHODS: Thirteen patients had antecedent trauma with scaphoid nonunion (SNAC, n=9) or scapholunate advanced collapse (SLAC, n=4). The remaining three patients had chondrocalcinosis. RESULTS: Clinical and radiological results were encouraging at a mean follow-up of 3 years (1-7 years). Fourteen patients were very satisfied and two experienced partial improvement. Persistent pain relief as well as 11% improved muscle power was achieved. Mean improvement of joint motion was 12 degrees. DISCUSSION: This technique has shown better global results than 4-corner arthrodesis. It can be applied if capitate arthrodesis is performed. Results are comparable to those of proximal row carpectomy.

Nerve repair using a composite graft of vein and denatured skeletal muscle: morphologic analysis.

Five groups of six rats each underwent sciatic resection, bridged with a 20-mm-long graft. Five different types of graft were used: (1). vein; (2). fresh muscle; (3). denatured muscle; (4). vein and fresh muscle; and (5). vein and denatured muscle. Denaturation was obtained by dry thermal shock in a microwave oven. Morphologic analysis took place at 6 months. The macroscopic appearance of the graft was continuous in all type 4 and 5 animals. Morphometric analysis within the graft revealed a significantly greater number of fibers in type 3 animals. Average fiber diameter and g ratio were higher, although not significantly, in type 5 animals. Distal to the graft, average fiber diameter and g ratio were significantly higher in type 5 rats. Denaturation by exposure to thermal shock significantly improves axonal regeneration, both quantitatively and qualitatively. The regeneration rate seems to be more rapid within denatured muscle. Denaturing muscle by exposure to thermal shock provides an excellent guide for axonal regrowth, but axonal leaks may occur. This problem is solved by a muscle-in-vein graft technique.