Prise en charge d'adolescents souffrant d'anorexie mentale: le rôle des parents, une approche basée sur l'évidence [Adolescents with an eating disorder: an evidence-based approach on the role of parents].

L'adolescence est une période de grands changements et de ce fait potentiellement de grande vulnérabilité. Ainsi, les bouleversements physiques et psychiques induits par les processus pubertaires sont un terrain propice à l'émergence d'un trouble des conduites alimentaires (TCA). La thérapie familiale selon Maudsley, ou family based treatment (FBT), a émergé en parallèle aux avancées neurobiologiques, qui confirment une origine multifactorielle des troubles du comportement alimentaire. Cette thérapie replace les parents au centre de la prise en charge des adolescents souffrant d'un TCA avec comme grand atout, une approche basée sur l'évidence scientifique. Adolescence is a time of great change and therefore, potentially of great vulnerability. Thus, physical and psychological changes induced by pubertal processes are fertile ground for the emergence of an eating disorder (ED). Family therapy according to Maudsley or "family based treatment" (FBT) has emerged in parallel with neurobiological advances confirming a multifactorial origin of eating disorders. This therapy places parents at the centre of care for adolescents with EDs. Its great asset is the evidence-based approach underpinning the therapy.

Probabilistic base calling of Solexa sequencing data.

BACKGROUND: Solexa/Illumina short-read ultra-high throughput DNA sequencing technology produces millions of short tags (up to 36 bases) by parallel sequencing-by-synthesis of DNA colonies. The processing and statistical analysis of such high-throughput data poses new challenges; currently a fair proportion of the tags are routinely discarded due to an inability to match them to a reference sequence, thereby reducing the effective throughput of the technology. RESULTS: We propose a novel base calling algorithm using model-based clustering and probability theory to identify ambiguous bases and code them with IUPAC symbols. We also select optimal sub-tags using a score based on information content to remove uncertain bases towards the ends of the reads. CONCLUSION: We show that the method improves genome coverage and number of usable tags as compared with Solexa's data processing pipeline by an average of 15%. An R package is provided which allows fast and accurate base calling of Solexa's fluorescence intensity files and the production of informative diagnostic plots.

Cancers cutanés envahissant la base du crâne [Skin cancers infiltrating the skull base].

Squamous cell and basocellular carcinoma of the face have an excellent prognosis. Nevertherless, a small proportion therefore of these cancers differs by a much more aggressive behavior, caracterised by a tendency to infiltrate the deep facial soft tissues and facial bones. The invasion of the craniofacial skeleton and the intracranial structures follows the embryonic fusion lines or the facial sensitive or motor nerves, sometimes years after the initial treatment. The development of craniofacial surgery, reconstruction techniques and conformational radiotherapy allows us now to offer curative guided treatments, for these advanced staged tumors with a remaining limited prognosis. A therapeutic benefit implies a rigorous selection of these patients.

Psychiatrie de l'enfant et de l'adolescent : une approche basée sur les preuves

L'approche basée sur les preuves, dérivée de I'evidence based medicine anglo-saxonne, offre une vision élargie de la pédopsychiatrie en permettant aux thérapeutes de s'extraire de la stricte soumission aux conclusions de la recherche pour donner à la pratique, dans une certaine mesure, la possibilité de valider des choix de prise en charge pluridisciplinaires. Alors que l'evidence based médecine s'est imposée dans la plupart des spécialités médicales, elle tarde à s'implanter en psychiatrie de l'enfant et de l'adolescent. Cet ouvrage fait donc le point sur les connaissances actuelles et propose une approche plus globale fondée sur les preuves. Les 13 chapitres qui le composent couvrent une grande partie des troubles pédopsychiatriques en y intégrant des sujets d'ouverture comme l'alliance thérapeutique, les soins sous contrainte ou les équipes mobiles. Un chapitre consacré aux médicaments psychotropes utilisés chez l'enfant et l'adolescent permet d'offrir un aperçu complet des moyens thérapeutiques à disposition pour chacun de ces troubles.

Gamma Knife radiosurgery in benign skull base tumors after planned subtotal resection: preliminary results in combined approaches

Aim: The management of large lesions of the skull base, such as vestibular schwanommas (VS), meningiomas (MEN) or pituitary adenomas (PA), is challenging, with microsurgery remaining the main treatment option. Planned subtotal resection is now being increasingly considered to reduce the risk of neurological deficits following complete resection. The residual part of the tumor can then be treated with Gamma Knife Radiosurgery (GKR) to achieve long-term growth control. Methods: This case series documents early results with planned subtotal resection followed by GKR in Lausanne University Hospital, between July 2010 and March 2012. There were 24 patients who underwent surgery, with 22 having already undergone GKR and 2 waiting for GKR. We analyzed clinical symptoms for all patients, as well as audiograms, ophthalmological and endocrinological tests, when indicated. Results: Nine patients had VS surgery (mean diameter 35 mm; range 30-44.5) through a retrosigmoid approach. There were no post-operative facial nerve deficits. Of the 3 patients whom had useful hearing pre-operatively, this improved in 2 and remained stable in 1. Four patients with clinoid MEN (mean diameter 26.5 mm; range 17-42) underwent subtotal resection of the tumor, and the component in the cavernous sinus was later treated with GKR. The visual status remained stable in 3 patients and one had complete visual recovery. 4 patients underwent subtotal resection of petro-clival MEN (mean diameter 36 mm; range 32-42): 3 had House-Brackmann (HB) grade 2 facial function that recovered completely; one continues to have HB grade 4 facial deficit following surgery. Of the 7 patients with PA (mean diameter 34.5 mm; range 20-54.5), 2 had acromegaly, the others were non functional PA. Six patients underwent trans-sphenoidal surgery, while one patient had a transcavernous sinus resection of the tumor (with prior staged trans-sphenoidal surgery). Visual status improved in 3 patients while the others remained stable. Two patients had transient diabetes insipidus following surgery. Up to now, no additional deficit or worsening has been reported after GKR. Conclusions: Our data suggest that planned subtotal resection has an excellent clinical outcome with respect to preservation of cranial nerves, and other neurological functions, and a good possibility of recovery of many of the pre-operative cranial nerve dysfunctions. The results in terms of tumor control following GKR need further long-term evaluation.

Cruveilhier's legacy to skull base surgery: premise of an evidence-based neuropathology in the 19th century.

OBJECTIVES: Jean Cruveilhier has always been described as a pioneer in pathological anatomy. Almost nothing has been reported concerning his exceptional methodology allying pre-mortem clinical description and syndromic classification of neurological and neurosurgical diseases, and post-mortem meticulous dissections. Cruveilhier's methodology announced the birth of the anatomoclinical method built up by Jean-Martin Charcot and the neurological French school during the 19th century. The aim of our work is to extract the quintessence of Cruveilhier's contributions to skull base pathology through his cogent clinical descriptions coupled with exceptional lithographs of anterior skull base, suprasellar and cerebello-pontine angle tumors. METHODS: We reviewed the masterwork of Jean Cruveilhier on pathological anatomy and we selected the chapters dedicated to central nervous system pathologies, mainly skull base diseases. A systematic review was performed on Pubmed/Medline and Google Scholar using the keywords "Jean Cruveilhier", "Skull base pathology", "Anatomoclinical method". RESULTS: Among his descriptions, Cruveilhier dedicated large chapters to neurosurgical diseases including brain tumors, cerebrovascular pathologies, malformations of the central nervous system, hydrocephalus, brain infections and spinal cord compressions. CONCLUSION: This work emphasizes on the role of Jean Cruveilhier in the birth of the anatomoclinical method particularly in neuroscience during a 19th century rich of epistemological evolutions toward an evidence-based medicine, through the prism of Cruveilhier's contribution to skull base pathology.

The oceanic base of slope record of the Permian-Triassic crisis: view from Tethys (Oman)

The Oman Mountains provide some of the best sections of Permian and Triassic sediments from ocean sea floor to base-of-slope environments related to the distal South Tethyan margin. The central part of the range exposes the Buday'ah section of oceanic sediments in the so-called "Hawasina allochtons". The locality of Wadi Maqam in the north-western part of the Oman Mountains is among places where the thick Permian-Triassic base-of-slope sediments is exposed (Baud et al., 2001). Overlying 400 m of middle Permian limestones and dolomites, the upper Permian sediments consist of 50 m of ≈ 10 cm thick beds of cherts and dolomites rich in sponge spicules. The top of the Permian units is well bioturbated lime mudstone-wackestone, devoid of cherts and dated as late Changhsingian (Krystyn in Richoz et al., 2005). The boundary yellow shales are overlain by very thinly bedded, laminated microbial platy lime mudstone with H. parvus. The dramatic loss of the burrowing infauna indicates the appearance of oxygen-poor water. These Induan sediments are about 25 m thick and show at the top the first calcirudites, commonly clast-supported (edge-wise conglomerates), and are characterized by tabular clasts representing the sub- in situ reworking of the laminated, platy calcilutite. The very thick Smithian overlying litho-unit (up to 900 m) marks the onset on the base-of-slope of a deep-marine basin in which carbonate submarine fan deposits developed This very thick unit consists essentially of platy limestones, calcarenites and calcirudites. It comprises mainly grey-beige calcilutite, laminated and flaggy, interbedded with sparse beds of fine-grained calcarenite in cm beds. Channelized beds of intraformational calcirudite are also part of this succession which constitutes the greater part of the outcrop available. During the Spathian to Anisian, the sedimentation changes to terrigenous mudstone and siltstone that ended with Ladinian radiolarites.