Modeling subsurface contaminant transport from a former open-pit uranium mine in fractured granites (La Ribière, France): Reducing uncertainties with geophysics.

The long-term management of tailings from former uranium (U) mines requires an in-depth understanding of the hydrogeological processes and water flow paths. In France, most of the legacy U mines are located in fractured crystalline (plutonic) rocks, where the intrinsic subsurface heterogeneity adds to the uncertainties about the former extraction and milling activities and the state of the mine when production was ceased. U ores were mainly processed by sulfuric acid leaching, leading to high-sulfate-content mill tailings now contained in several tailing storage facilities (TSFs). The La Ribière site, located in western central France, is a former open-pit and underground U mine, closed in 1992 and used to store mill tailings. This site is being used as a test case to establish a workflow in order to explain and predict water flow and subsurface contaminant transport. A conceptual model of water flow and sulfate transport, at the scale of the La Ribière watershed, is first developed based on available information and hydrogeochemical monitoring. Recent geophysical investigations allows refining this model. Electrical Resistivity Tomography (ERT) proves to be efficient at localizing the extent of the highly conductive sulfate plume inherited from the U-mill tailings, but also at imaging the weathering profile. Magnetic Resonance Sounding (MRS), despite the limited signal intensity due to the low porosity in crystalline rocks, gives some insight into the porosity values, the depth of the fractured layer and the location of the low-porosity ore-processing muds. Based on this conceptual model, a 3D flow and non-reactive transport model with the METIS code is developed and calibrated. This model allows predicting the evolution of the sulfate plume, but will also be used in future investigations, to build reactive transport models with simplified hydrogeology for U and other reactive contaminants.

Metal ion release after hip resurfacing arthroplasty and knee arthroplasty: a retrospective study of one hundred ninety-five cases.

PURPOSE: Hip arthroplasty with metal-on-metal bearings like hip resurfacing results in the release of metallic ions. In parallel, like every metallic implant, knee arthroplasty implants undergo passive corrosion. We analyzed blood levels of cobalt and chromium ions in patients who have a hip resurfacing arthroplasty and compared them to patients who have undergone knee arthroplasty at a minimum follow-up of one year. The hypothesis was that there is no difference in the ion release between hip resurfacing and knee arthroplasty. METHODS: Sixty-three patients who underwent knee arthroplasty were compared to a cohort of 132 patients who underwent hip resurfacing. The blood levels of cobalt and chromium ions were determined preoperatively and at six and 12 months postoperatively and then compared between groups. We analyzed the relationship between ion release and the change in clinical outcome scores (Harris Hip score, Oxford Hip score, Merle D'Aubigné Postel score, Oxford Knee score, International Knee Society score), the BMI, sex, physical activity, implant size and inclination of the acetabular implant (hip resurfacing patients only). Mixed linear models were used to assess the changes in ion blood levels over time. RESULTS: The cobalt blood levels were higher in the first 6 months in the resurfacing group (0.87 ug/L vs 0.67 ug/L; p = 0.011), while it was higher in the knee arthroplasty group at 12 months (1.20 ug/L vs 1.41 ug/L; p = 0.0008). There were no significant differences in chromium levels during the follow-up period. CONCLUSION: The increase in metal ion release after knee arthroplasty is as high as after hip resurfacing at the one year follow-up. The monitoring of this parameter probably should not be recommended in case of good clinicals outcomes.

Cryogenic sensor enabling broad-band and traceable power measurements.

Recently, great progress has been made in the field of ultrasensitive microwave detectors, reaching even the threshold for utilization in circuit quantum electrodynamics. However, cryogenic sensors lack the compatibility with broad-band metrologically traceable power absorption measurements at ultralow powers, which restricts their range of applications. Here, we demonstrate such measurements using an ultralow-noise nanobolometer, which we extend by an additional direct-current (dc) heater input. The tracing of the absorbed power relies on comparing the response of the bolometer between radio frequency and dc-heating powers traced to the Josephson voltage and quantum Hall resistance. To illustrate this technique, we demonstrate two different methods of dc-substitution to calibrate the power that is delivered to the base temperature stage of a dilution refrigerator using our in situ power sensor. As an example, we demonstrate the ability to accurately measure the attenuation of a coaxial input line between the frequencies of 50 MHz and 7 GHz with an uncertainty down to 0.1 dB at a typical input power of -114 dBm.

Specific alterations in NKG2D+ T lymphocytes in relapsing-remitting and progressive multiple sclerosis patients.

BACKGROUND: T lymphocytes exhibit numerous alterations in relapsing-remitting (RRMS), secondary progressive (SPMS), and primary progressive multiple sclerosis (PPMS). The NKG2D pathway has been involved in MS pathology. NKG2D is a co-activating receptor on subsets of CD4+ and most CD8+ T lymphocytes. The ligands of NKG2D are expressed at low levels in normal tissues but are elevated in MS postmortem brain tissues compared with controls. Whether the NKG2D pathway shows specific changes in different forms of MS remains unclear. METHODS: We performed unsupervised and supervised flow cytometry analysis to characterize peripheral blood T lymphocytes from RRMS, SPMS, and PPMS patients and healthy controls (HC). We used an in vitro microscopy approach to assess the role of NKG2D in the interactions between human CD8+T lymphocytes and human astrocytes. RESULTS: Specific CD8+, CD4+, and CD4-CD8- T cell populations exhibited altered frequency in MS patients' subgroups. The proportion of NKG2D+ T lymphocytes declined with age in PPMS patients but not in RRMS and HC. This reduced percentage of NKG2D+ cells was due to lower abundance of γδ and αß CD4-CD8- T lymphocytes in PPMS patients. NKG2D+ T lymphocytes were significantly less abundant in RRMS than in HC; this was caused by a decreased frequency of CD4-CD8- and CD8+ T lymphocytes and was not linked to age. Blocking NKG2D increased the motility of CD8+ T lymphocytes co-cultured with astrocytes expressing NKG2D ligand. Moreover, preventing NKG2D from interacting with its ligands increased the proportion of CD8+ T lymphocytes exhibiting a kinapse-like behavior characterized by short-term interaction while reducing those displaying a long-lasting synapse-like behavior. These results support that NKG2D participates in the establishment of long-term interactions between activated CD8+ T lymphocytes and astrocytes. CONCLUSION: Our data demonstrate specific alterations in NKG2D+ T lymphocytes in MS patients' subgroups and suggest that NKG2D contributes to the interactions between human CD8+ T lymphocytes and human astrocytes.

IL-27 shapes the immune properties of human astrocytes and their impact on encountered human T lymphocytes.

BACKGROUND: Interleukin-27 (IL-27) can trigger both pro- and anti-inflammatory responses. This cytokine is elevated in the central nervous system (CNS) of multiple sclerosis (MS) patients, but how it influences neuroinflammatory processes remains unclear. As astrocytes express the receptor for IL-27, we sought to determine how these glial cells respond to this cytokine and whether such exposure alters their interactions with infiltrating activated T lymphocytes. To determine whether inflammation shapes the impact of IL-27, we compared the effects of this cytokine in non-inflamed and inflamed conditions induced by an IL-1ß exposure. MAIN BODY: Transcriptomic analysis of IL-27-exposed human astrocytes showed an upregulation of multiple immune genes. Human astrocytes increased the secretion of chemokines (CXCL9, CXCL10, and CXCL11) and the surface expression of proteins (PD-L1, HLA-E, and ICAM-1) following IL-27 exposure. To assess whether exposure of astrocytes to IL-27 influences the profile of activated T lymphocytes infiltrating the CNS, we used an astrocyte/T lymphocyte co-culture model. Activated human CD4+ or CD8+ T lymphocytes were co-cultured with astrocytes that have been either untreated or pre-exposed to IL­27 or IL-1ß. After 24 h, we analyzed T lymphocytes by flow cytometry for transcription factors and immune molecules. The contact with IL-27-exposed astrocytes increased the percentages of T-bet, Eomes, CD95, IL-18Rα, ICAM-1, and PD-L1 expressing CD4+ and CD8+ T lymphocytes and reduced the proportion of CXCR3-positive CD8+ T lymphocytes. Human CD8+ T lymphocytes co-cultured with human IL-27-treated astrocytes exhibited higher motility than when in contact with untreated astrocytes. These results suggested a preponderance of kinapse-like over synapse-like interactions between CD8+ T lymphocytes and IL-27-treated astrocytes. Finally, CD8+ T lymphocytes from MS patients showed higher motility in contact with IL-27-exposed astrocytes compared to healthy donors' cells. CONCLUSION: Our results establish that IL-27 alters the immune functions of human astrocytes and shapes the profile and motility of encountered T lymphocytes, especially CD8+ T lymphocytes from MS patients.

Cortical morphology predicts placebo response in multiple sclerosis.

Despite significant insights into the neural mechanisms of acute placebo responses, less is known about longer-term placebo responses, such as those seen in clinical trials, or their interactions with brain disease. We examined brain correlates of placebo responses in a randomized trial of a then controversial and now disproved endovascular treatment for multiple sclerosis. Patients received either balloon or sham extracranial venoplasty and were followed for 48 weeks. Venoplasty had no therapeutic effect, but a subset of both venoplasty- and sham-treated patients reported a transient improvement in health-related quality of life, suggesting a placebo response. Placebo responders did not differ from non-responders in total MRI T2 lesion load, count or location, nor were there differences in normalized brain volume, regional grey or white matter volume or cortical thickness (CT). However, responders had higher lesion activity. Graph theoretical analysis of CT covariance showed that non-responders had a more small-world-like CT architecture. In non-responders, lesion load was inversely associated with CT in somatosensory, motor and association areas, precuneus, and insula, primarily in the right hemisphere. In responders, lesion load was unrelated to CT. The neuropathological process in MS may produce in some a cortical configuration less capable of generating sustained placebo responses.

[Asthma and scuba diving: Creation and evaluation of a website (For doctors, asthmatics and diving instructors)]. / Asthme et plongée sous-marine : création et évaluation d'un site internet (à destination des médecins, plongeurs asthmatiques et moniteurs de plongée).

INTRODUCTION: Scuba diving has long been strictly contraindicated for asthmatics; this contraindication has been questioned in recent years. Our objective was to provide a website, evaluated by its users, for doctors, diving instructors and asthmatics. MATERIALS AND METHODS: Creation of the site Asthme-Plongee.com based on a peer-reviewed literature review, then distribution of a questionnaire in summer 2018 to diving clubs, general practitioner groups, pulmonologists and FFESSM federal offices, and via social networks. RESULTS: Our sample consisted of 413 assessors, including 264 health professionals (63.9%), 74 asthmatics (17.9%) and 92 diving instructors (22.3%), spread over the entire territory of France. The structure of the website, the clarity of the information written and its relevance were generally appreciated by the entire population with a median score of 8/10. The site was found useful: 72.9% of respondents thought they would visit it later. CONCLUSION: Faced with a growing number of amateur divers, it seems essential to raise awareness of current recommendations and good diving practices.

Bolometer operating at the threshold for circuit quantum electrodynamics.

Radiation sensors based on the heating effect of absorbed radiation are typically simple to operate and flexible in terms of input frequency, so they are widely used in gas detection1, security2, terahertz imaging3, astrophysical observations4 and medical applications5. Several important applications are currently emerging from quantum technology and especially from electrical circuits that behave quantum mechanically, that is, circuit quantum electrodynamics6. This field has given rise to single-photon microwave detectors7-9 and a quantum computer that is superior to classical supercomputers for certain tasks10. Thermal sensors hold potential for enhancing such devices because they do not add quantum noise and they are smaller, simpler and consume about six orders of magnitude less power than the frequently used travelling-wave parametric amplifiers11. However, despite great progress in the speed12 and noise levels13 of thermal sensors, no bolometer has previously met the threshold for circuit quantum electrodynamics, which lies at a time constant of a few hundred nanoseconds and a simultaneous energy resolution of the order of 10h gigahertz (where h is the Planck constant). Here we experimentally demonstrate a bolometer that operates at this threshold, with a noise-equivalent power of 30 zeptowatts per square-root hertz, comparable to the lowest value reported so far13, at a thermal time constant two orders of magnitude shorter, at 500 nanoseconds. Both of these values are measured directly on the same device, giving an accurate estimation of 30h gigahertz for the calorimetric energy resolution. These improvements stem from the use of a graphene monolayer with extremely low specific heat14 as the active material. The minimum observed time constant of 200 nanoseconds is well below the dephasing times of roughly 100 microseconds reported for superconducting qubits15 and matches the timescales of currently used readout schemes16,17, thus enabling circuit quantum electrodynamics applications for bolometers.

Hip survival after plain core decompression alone versus bone morphogenetic protein and/or bone marrow reinjection with core decompression for avascular osteonecrosis of the femoral head: a retrospective case control study in ninety two patients.

INTRODUCTION: Injecting bone marrow or bone morphogenetic protein 7 (BMP) during core decompression for avascular osteonecrosis (AVN) may improve survival. We hypothesized that adding a complementary technique (injection of BMP and/or non-concentrated bone marrow) to core decompression would reduce the number of patients requiring a subsequent total hip arthroplasty (THA). METHODS: We retrospectively reviewed 92 cases from 2003 to 2018 with a minimum of 2 years of follow-up and an average follow-up of 64 months (24-204). Twenty-four patients had a core decompression (CD) (26.1% (24/92)), 25 had a CD associated with reinjection of bone marrow and BMP (rhBMP7) (27.2% (25/92)), and 43 patients had a CD with bone marrow reinjection (46.7% (43/92)). RESULTS: Hip survival after CD was 66.3% (61/92) at two years and 59.8% (55/92) at 10 years. CD with bone marrow and BMP reinjection had a better hip survival at ten years (HR: 0.492 (CI95%: 0.254-0.952) p = 0.035). A volume of necrosis greater than 30% (HR = 12.97 (CI95 [3.88-43.3] (p < 0.001))) and a Kerboul angle greater than 60° (HR: 12.5 (CI95 [2.84-54.6] (p < 0.001))) were risk factors for a subsequent THA. CONCLUSIONS: CD is an interesting non-invasive technique to preserve the native hip after AVN of the femoral head. Reinjection of bone marrow and/or BMP improved CD hip survival.

Safety and efficacy of venoplasty in MS: A randomized, double-blind, sham-controlled phase II trial.

OBJECTIVE: To determine the safety and efficacy of balloon vs sham venoplasty of narrowing of the extracranial jugular and azygos veins in multiple sclerosis (MS). METHODS: Patients with relapsing or progressive MS were screened using clinical and ultrasound criteria. After confirmation of >50% narrowing by venography, participants were randomized 1:1 to receive balloon or sham venoplasty of all stenoses and were followed for 48 weeks. Participants and research staff were blinded to intervention allocation. The primary safety outcome was the number of adverse events (AEs) during 48 weeks. The primary efficacy outcome was the change from baseline to week 48 in the patient-reported outcome MS Quality of Life-54 (MSQOL-54) questionnaire. Standardized clinical and MRI outcomes were also evaluated. RESULTS: One hundred four participants were randomized (55 sham; 49 venoplasty) and 103 completed 48 weeks of follow-up. Twenty-three sham and 21 venoplasty participants reported at least 1 AE; one sham (2%) and 5 (10%) venoplasty participants had a serious AE. The mean improvement in MSQOL-54 physical score was +1.3 (sham) and +1.4 (venoplasty) (p = 0.95); MSQOL-54 mental score was +1.2 (sham) and -0.8 (venoplasty) (p = 0.55). CONCLUSIONS: Our data do not support the continued use of venoplasty of extracranial jugular and/or azygous venous narrowing to improve patient-reported outcomes, chronic MS symptoms, or the disease course of MS. CLINICALTRIALSGOV IDENTIFIER: NCT01864941. CLASSIFICATION OF EVIDENCE: This study provides Class I evidence that for patients with MS, balloon venoplasty of extracranial jugular and azygous veins is not beneficial in improving patient-reported, standardized clinical, or MRI outcomes.

Mitigating the photocurrent persistence of single ZnO nanowires for low noise photodetection applications.

In this work, we investigate the optoelectronic properties of zinc oxide (ZnO) nanowires, which are good candidates for applications based on integrated optics. Single ZnO nanowire photodetectors were fabricated with ohmic contacts. By taking current transient measurements in different atmospheres (oxygen, air, vacuum and argon), and at various temperatures, we point out the importance of surface effects on the electrical behaviour. Results confirm that oxygen chemisorption is responsible for the existence of a high photoconductive gain in these devices, and for the first time a two step process in the photocurrent rise transient is reported. A maximum gain of G = 7.8 × 107 is achieved. However, under certain conditions, the persistence of the photocurrent can last up to several hours and as such may prevent the device from operating at useful rates. From a knowledge of the photocurrent response mechanisms, we establish a method to restore the photodetector to its initial state, with very low dark current, by applying an appropriate gate voltage sequence. This advances the state of the art for these detectors towards commercial applications.

Faba bean (Vicia faba) inclusion in dairy cow diets: Effect on nutrient digestion, rumen fermentation, nitrogen utilization, methane production, and milk performance.

The objective of this study was to determine the effect of replacing on isonitrogenous and isoenergetic basis soybean meal (SBM) and corn grain with ground or rolled faba bean (FB; Vicia faba major var. Baie-Saint-Paul) in dairy cow diets (17% of diet dry matter) on nutrient digestion, rumen fermentation, N utilization, methane production, and milk performance. For this purpose, 9 lactating cows were used in a replicated 3 × 3 Latin square design (35-d period) and fed (ad libitum) a total mixed ration (forage:concentrate ratio = 59:41 on a dry matter basis). In the concentrate portion, SBM and corn grain (control diet) were completely and partially replaced, respectively, with either ground or rolled FB. Ruminal degradability (in sacco) of crude protein was higher for ground FB (79.4%) compared with SBM (53.3%) and rolled FB (53.2%). Including FB in the diet did not affect dry matter intake, milk production, and milk composition. Experimental treatment had no effect on total volatile fatty acid concentration, acetate-to-propionate ratio, and protozoa numbers. Compared with cows fed the control diet, ruminal NH3 concentration increased and tended to increase for cows fed ground FB and rolled FB, respectively; however, we found no difference in ruminal NH3 concentration between the 2 processed FB. Apparent total-tract digestibility of crude protein was similar between cows fed the control diet and cows fed rolled FB and tended to increase for cows fed ground FB compared with cows fed the control diet. Feeding rolled FB decreased CP digestibility compared with feeding ground FB. Urinary and manure (feces + urine) N excretion (g/d or as a proportion of N intake) were not affected by the inclusion of FB in the diet. Enteric CH4 production was similar among the experimental diets. Results from this study show that including FB (17% of dietary dry matter) at the expense of SBM and corn grain in the diet had no effect on milk production, N excretion, and enteric CH4 production of dairy cows.

Characterization by Scanning Precession Electron Diffraction of an Aggregate of Bridgmanite and Ferropericlase Deformed at HP-HT.

Scanning precession electron diffraction is an emerging promising technique for mapping phases and crystal orientations with short acquisition times (10-20 ms/pixel) in a transmission electron microscope similarly to the Electron Backscattered Diffraction (EBSD) or Transmission Kikuchi Diffraction (TKD) techniques in a scanning electron microscope. In this study, we apply this technique to the characterization of deformation microstructures in an aggregate of bridgmanite and ferropericlase deformed at 27 GPa and 2,130 K. Such a sample is challenging for microstructural characterization for two reasons: (i) the bridgmanite is very unstable under electron irradiation, (ii) under high stress conditions, the dislocation density is so large that standard characterization by diffraction contrast are limited, or impossible. Here we show that detailed analysis of intracrystalline misorientations sheds some light on the deformation mechanisms of both phases. In bridgmanite, deformation is accommodated by localized, amorphous, shear deformation lamellae whereas ferropericlase undergoes large strains leading to grain elongation in response to intense dislocation activity with no evidence for recrystallization. Plastic strain in ferropericlase can be semiquantitatively assessed by following kernel average misorientation distributions.

Diagnostic accuracy of the alpha defensin lateral flow device (Synovasure) for periprosthetic infections in microbiologically complex situations: A study of 42 cases in a French referral centre.

BACKGROUND: Joint aspiration is currently the reference standard test for diagnosing periprosthetic joint infection (PJI) despite the high rate of false-negative results, of which a major cause is the fastidious nature of some microorganisms. A rapid diagnostic test that detects alpha defensin (Synovasure™, Zimmer, Warsaw, IN, USA) in joint fluid can provide the diagnosis of PJI within a few minutes across the full spectrum of causative organisms (including mycobacteria and yeasts). Its performance in detecting bacterial infections is unaltered by concomitant antibiotic therapy. Few studies of Synovasure™ have been conducted by groups that were involved in designing the test, which has not been validated in France. Assessments in referral centres where complex microbiological situations are common hold considerable interest. The objective of this prospective study was to determine the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and causes of error of Synovasure™ used to diagnose periprosthetic infection in complex microbiological situations. HYPOTHESIS: The rapid diagnostic test Synovasure™ has greater than 90% NPV for detecting periprosthetic infections in complex microbiological infections. MATERIAL AND METHODS: Synovasure™ was used 42 times in 39 patients between October 2015 and October 2017 in challenging microbiological situations [discordant joint aspiration results (n=20), negative cultures with clinical or laboratory evidence of infection, (n=21), and concomitant antibiotic therapy (n=1)]. Of the 39 patients, 23 had total knee prostheses, 13 total hip prostheses, and 3 total femoral prostheses. The reference standard to which the Synovasure™ results were compared was the PJI criteria set developed by the Musculoskeletal Infection Society (MSIS). RESULTS: Synovasure™ was negative in 30 cases with negative joint fluid cultures (30/42, 71.4%). Of the 12 (28.6%) cases with positive Synovasure™ results, only 7 (7/12, 58.3%) had positive joint fluid cultures. According to the MSIS criteria 9 cases were infected, including 8 with positive and 1 with negative Synovasure™ results. Of the 33 cases that were not infected according to MSIS criteria, 29 had negative and 3 positive Synovasure™ results; the remaining case had a positive Synovasure™ result but was excluded when metallosis was found intra-operatively. NPV was 96.7%, PPV 72.7%, sensitivity 88.9%, and specificity 90.6%. DISCUSSION: The high NPV of Synovasure™ suggests a role for this test in microbiologically complex situations as a new tool for ruling in and, most importantly, ruling out infection in doubtful cases. LEVEL OF EVIDENCE: III, prospective study of diagnostic accuracy.

Hip resurfacing before 50years of age: A prospective study of 979 hips with a mean follow-up of 5.1years.

BACKGROUND: Hip resurfacing arthroplasty (HRA) is an alternative to total hip arthroplasty (THA) for the treatment of hip osteoarthritis in patients younger than 50 years. Data on revision rates after HRA are conflicting. The National Institute for Health and Care Excellence (NICE) recommends performing only those hip arthroplasty procedures associated with 10-year revision rates no greater than 5% (0.5% per year). Follow-up studies can rapidly determine whether this criterion is met. The uncertainties surrounding revision rates after HRA prompted us to design a study of prospectively enrolled patients aiming (1) to determine the revision rate after HRA performed before 50years of age and (2) to assess the functional, radiological, and biological outcomes of HRA. HYPOTHESIS: The revision rate after HRA performed before 50years of age meets the NICE criterion. MATERIAL AND METHODS: Consecutive patients undergoing HRA before 50years of age were enrolled prospectively. The same implant was used in all patients. Functional outcomes were assessed based on the Harris Hip Score (HHS), Postel-Merle d'Aubigné (PMA) score, 12-item Oxford Hip Score (OHS), and UCLA activity score. Radiographic outcomes were assessed, and blood levels of chromium and cobalt were assayed. RESULTS: The study included 936 patients (979 HRAs) with a mean age of 42.7years (16.4-50.0years) at surgery and a mean follow-up of 5.1years (range: 3.1-9.0 years). All four mean functional scores were significantly improved at last follow-up vs. baseline: HHS, 95.9 (39.0-100) vs. 44.3 (18.0-83.0); PMA score, 17.6 (6.0-18.0) vs. 11.7 (3.0-16.0); OHS, 14.3 (12.0-37.0) vs. 40.6 (25.0-60.0); and UCLA activity score, 7.8 (2.0-10.0) vs. 5.6 (1.0-10.0) (p<0.0001). Mean cup inclination in the coronal plane was 42.1° (25.0°-68.0°). Mean blood cobalt level was significantly higher at last follow-up than at baseline (1.36µg/L [0.05-8.2µg/L] vs. 0.61µg/L [0.01-3.6]) (p<0.001). No patient experienced dislocation. Revision was required for 17 hips and involved changing the implant in 12 (1.2%). The 10-year survival rate with implant change, as the endpoint was 98.7% (95%CI, 97.6%-99.3%), indicating that the NICE criterion was easily met. DISCUSSION: The NICE criterion allows the rapid identification of prostheses with insufficient survival. HRA is theoretically associated with a high risk of aseptic mechanical loosening, as it is performed in young patients who have a high level of physical activity. Nevertheless, our study showed that implant survival after HRA was better than required by the NICE criterion. Thus, HRA is a valid alterative to THA in patients younger than 50years. LEVEL OF EVIDENCE: IV, prospective study with no control group.

Course of dislocated posterior hip arthroplasty: A continuous 232-patient series at a mean 10 years' follow up (range, 1-22 years).

BACKGROUND: Dislocation rates in posterior total hip arthroplasty (THA) range between 2% and 5%, but long-term course (recurrence of dislocation or revision surgery) is not known, most series having short follow-up or small populations. We therefore conducted a retrospective study on a large series, to determine long-term rates of recurrence and surgical revision and recurrence risk factors. HYPOTHESIS: Long-term follow-up of a large cohort of THA dislocations enables recurrence rate and factors to be determined. MATERIAL AND METHOD: Five hundred and nine cases of THA dislocation were admitted to our center between 1994 and 2008. A hundred and twenty seven incomplete files and 150 patients who had received their THA elsewhere were excluded, leaving 232 patients: 150 female, 82 male. Mean age at THA (163 primary, 69 revision) was 63 years (range, 15-90 years), and 65 years (range 20-90 years) at first dislocation, with a mean interval to dislocation of 25 months. Minimum follow-up was 8 years up to 2016, or 1 year taking account of deaths (111 deaths). There were 46 anterior, 185 posterior and 1 multidirectional dislocations. The following potential recurrence factors were assessed: gander, age, body-mass index (BMI), etiology, surgical history, bearing diameter and type, component fixation means, dislocation direction, and time to dislocation. RESULTS: A hundred and thirty three of the 232 patients (57%) showed at least 1 recurrence, at a mean 38 months (range, 0.5-252 months); 78 experienced a second and 32 a third recurrence. Ninety-nine (43%) had only 1 dislocation, without recurrence, but 17 of these (17%) underwent reoperation for other causes. The reoperation rate was 17/232 (7%) excluding recurrent instability, and 84/232 (36%) for instability. Fourty-eight months after the first dislocation, 84/133 cases of recurrence (63%) had been reoperated on: 16 complete replacements, 18 bearing replacements, 42 dual mobility cups, one large diameter cup, seven Lefèvre retentive cups. The rate of revision surgery for instability was high, at 84/232 (36%), and higher again in relation to recurrence (84/133: 63%). Only posterior dislocation emerged as a factor for recurrence (HR=1.774, 95% CI [1.020-3.083]), the other tested factors showing no correlation.14 of the 84 revision surgeries for instability (16.6%) were followed by recurrence, without identifiable risk factors. CONCLUSION/DISCUSSION: The recurrence rate was 57%, with posterior dislocation as the only risk factor. The rate of revision surgery for recurrence was 84/232 (36%), with 14/84 revision procedures (16.6%) followed by further recurrence. LEVEL OF EVIDENCE: IV, retrospective, without control group.

Improvement of the activity measurement method for solid dosimeters emitting X-rays.

Today, there is growing interest for neutrons in the intermediate energy range between 100keV and 1MeV, which are responsible for damaging materials in reactor. To improve this deficiency, we use rhodium and niobium which, through the inelastic neutron scattering reaction, leads to the formation of 103mRh and 93mNb low-energy X-emitters. This paper describes the improvements and validation made on this type of complex measurement by X spectrometry: self-attenuation, fluorescence correction, and emission intensity were poorly known previously.

High-impact sport after hip resurfacing: The Ironman triathlon.

BACKGROUND: Returning to high-impact sport is an increasingly frequent functional demand following hip replacement. The literature, however, is sparse on the subject and nonexistent regarding triathlon. We therefore conducted a retrospective study of hip resurfacing in triathlon players, to determine: (1) whether it is possible to return to this kind of sport; (2) if so, whether it is possible to return to the same level; and (3) how a resurfaced hip behaves under these conditions. HYPOTHESIS: Hip resurfacing allows return to competition level in long-distance triathlon. MATERIAL AND METHODS: A single-center single-operator retrospective study included patients undergoing hip resurfacing with the Conserve Plus implant inserted through a posterolateral approach, who had ceased long-distance triathlon practice due to osteoarthritis of the hip. Fifty-one of the 1688 patients undergoing resurfacing during the inclusion period were long-distance triathlon players. RESULTS: The series comprised 48 patients: 51 implants; 43 male, 5 female; mean age, 44.8 years (range, 28.2-58.9 years). At a mean 4.7 years' follow-up (range, 2.2-7.6 years), all clinical scores showed significant improvement; Merle d'Aubigné and Harris scores rose respectively from 12.3 (5-16) and 42 (37-56) preoperatively to 17.5 (13-18) and 93.2 (73-100) (P<0.001). There were no cases of dislocation or implant revision. Forty-five patients returned to sport (94%). Rates of return to swimming, cycling and running were respectively 38/48 (79%), 41/48 (85%) and 33/48 (69%). Preoperatively, all patients had taken part in at least 1 competition: 29 with distance=70.3km and 19 with distance=140.6km. At follow-up, 28 patients had taken part in an Ironman competition: 21 with distance=70.3km and 7 with distance=140.6km. Mean competition performance did not differ between pre and postoperative periods. DISCUSSION: Return-to-sport rates were good following hip resurfacing. Non-impact sports (swimming, cycling) predominated postoperatively, whereas the rate of impact sport (running) diminished. Return to competition-level sport (extreme triathlon) was possible for 28/48 patients (58%). Implant survival seemed unaffected by this high-impact sports activity at a mean 4.7 years' follow-up. LEVEL OF EVIDENCE: IV, retrospective, non-controlled.

Epidemiology of patients with MSSA versus MRSA infections of orthopedic implants: Retrospective study of 115 patients.

Factors that predict the occurrence of a surgical site infection due to methicillin-resistant Staphylococcus aureus (MRSA) are not well known; however this information could be used to modify the recommended antimicrobial prophylaxis. We carried out a retrospective study of S. aureus infections on orthopedic implants to determine: (1) whether epidemiological factors can be identified that predict a MRSA infection, (2) the impact of these factors as evidenced by the odds ratio (OR). HYPOTHESIS: Risk factors for a MRSA infection can be identified from a cohort of patients with S. aureus infections. MATERIALS AND METHODS: We identified 244 patients who experienced a S. aureus surgical site infection (SSI) in 2011-2012 documented by intraoperative sample collection. Of these 244 patients, those who had a previous SSI (n=44), those with a SSI but no orthopedic implant (n=80) or those who had the infection more than 1-year after the initial surgery (n=5) were excluded. This resulted in 115 patients (53 arthroplasty, 62 bone fixation) being analyzed for this study. There were 24 MRSA infections and 91 MSSA infections. The following factors were evaluated in bivariate and multifactorial analysis: age, sex, type of device (prosthesis/bone fixation), predisposition (diabetes, obesity, kidney failure), and environmental factors (hospitalization in intensive care unit within past 5 years, nursing home stay). RESULTS: Two factors were correlated with the occurrence of MRSA infections. (1) Nursing home patients had a higher rate of MRSA infections (67% vs. 18%, P=0.017) with an OR of 8.42 (95% CI: 1.06-66.43). (2) Patients who had undergone bone fixation had a lower rate of MRSA infections than patients who had undergone arthroplasty (13% vs. 30%, P=0.023), OR 0.11 (95% CI: 0.02-0.56). Although the sample size was too small to be statistically significant, all of the patients with kidney failure (n=4) had a MRSA infection. DISCUSSION: Since these MRSA infection risk factors are easy to identify, the antimicrobial prophylaxis could be adapted in these specific patient groups.

Therapeutic alliance and patient outcomes / Alianza terapéutica y resultados de los pacientes

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