Pédiatrie. 3. Traitement du membre supérieur dans les hémiparésies congénitales: progrès et perspectives [Pediatrics. Upper limb treatment in congenital hemiparesis: progress and perspectives].

Congenital hemiparesis is one of the most frequent pediatric motor disorders. Upper limb rehabilitation of the hemiparetic child has considerably evolved during the last decade by the use of focal chemical denervation (intramuscular botulinum toxin) and the introduction of novel rehabilitation techniques such as constraint induced movement therapy or robotic reeducation.

La démarche diagnostique des troubles cognitifs chez l'âgé

Cet article retrace une recherche qualitative pluridisciplinaire. Les cinq auteurs - anthropologues, médecin psychiatre, psychologue et sociologue - ont développé une collaboration autour d'une problématique récurrente chez les personnes âgées: les troubles cognitifs associés à l'âge, les difficultés à les diagnostiquer et à communiquer le diagnostic aux patients et à leurs proches. Huit patients et leurs proches se sont rencontrés séparément lors de deux séries d'entretiens sur l'annonce du diagnostic Mild Cognitive Impairment (MCI). Les résultats montrent que la communication du diagnostic MCI n'insuffle pas un tournant dans la trajectoire des patients. Les propos des experts semblent n'avoir qu'un faible impact sur la compréhension qu'ont les patients et leurs accompagnants de la santé mentale des sujets diagnostiqués.

Recent skin injuries in children with motor disabilities.

OBJECTIVE: To determine the frequency of recent skin injuries in children with neuromotor disabilities and its association with disability. DESIGN: Cross-sectional study of 168 children with neuromotor disabilities aged 2-16 years. SETTING: Two outpatient child rehabilitation centres. MAIN OUTCOME MEASURES: Children were classified as unrestricted walkers, restricted walkers or wheelchair dependent. Each participant's body surface was systematically examined for recent skin injuries with the exception of the anal-genital area. RESULTS: The mean age of our sample was 7.8 (SD 3.7) years with a 3:2 male/female ratio. Overall, 64% had cerebral palsy, 17% a neuromuscular disease and 19% other motor disabilities. Participants had on average 5.3 (SD 4.5) recent skin injuries (max 19), of which 2.5 were bruises (SD 3.3, max 16), 2.4 were abrasions, scratches or cuts (SD 3.0, max 16) and 0.4 were pressure lesions (SD 0.8, max 4). There was a significant decrease in the frequency of recent skin injuries and of bruises with increasing severity of motor disability. Most of this variation was accounted for by injuries to the lower limbs. There were no significant effects of gender, learning disabilities or other comorbidities. CONCLUSIONS: Children with neuromotor disabilities present a progressive reduction in the number of skin injuries with decreasing mobility. Therefore, recent skin injuries in this population which are unusual by their number, appearance or distribution, should raise at least the same level of suspicion for physical abuse as in children without disabilities.

Morphing Romania and Moldova Province

"Morphing Romania and the Moldova Province" gives a short insight of cartograms. Digital cartograms provide potential to move away from classical visualization of geographical data and benefit of new understanding of our world. They introduce a human vision instead of a planimetric one. By applying the Gastner-Newman algorithm for generating density-equalising cartograms to Romania and its Moldova province we can discuss the making of cartograms in general.

A comparison of pain scales in Thai children.

Three commonly used pain scales, the visual analogue scale, the Wong-Baker Faces Pain Scale, and the Faces Pain Scale Revised were administered to 122 Thai children, of whom half were HIV infected, in order to assess their validity. These scales presented moderate to good correlation and moderate agreement, sufficient for valid use in Thai children.

Metabolic syndrome and the risk of cardiovascular disease in older adults.

OBJECTIVES: The purpose of this study was to assess whether metabolic syndrome (MetSyn) predicts a higher risk for cardiovascular events in older adults. BACKGROUND: The importance of MetSyn as a risk factor has not previously focused on older adults and deserves further study. METHODS: We studied the impact of MetSyn (38% prevalence) on outcomes in 3,035 participants in the Health, Aging, and Body Composition (Health ABC) study (51% women, 42% black, ages 70 to 79 years). RESULTS: During a 6-year follow-up, there were 434 deaths overall, 472 coronary events (CE), 213 myocardial infarctions (MI), and 231 heart failure (HF) hospital stays; 59% of the subjects had at least one hospital stay. Coronary events, MI, HF, and overall hospital stays occurred significantly more in subjects with MetSyn (19.9% vs. 12.9% for CE, 9.1% vs. 5.7% for MI, 10.0% vs. 6.1% for HF, and 63.1% vs. 56.1% for overall hospital stay; all p < 0.001). No significant differences in overall mortality was seen; however, there was a trend toward higher cardiovascular mortality (5.1% vs. 3.8%, p = 0.067) and coronary mortality (4.5% vs. 3.2%, p = 0.051) in patients with MetSyn. After adjusting for baseline characteristics, patients with MetSyn were at a significantly higher risk for CE (hazard ratio [HR] 1.56, 95% confidence interval [CI] 1.28 to 1.91), MI (HR 1.51, 95% CI 1.12 to 2.05), and HF hospital stay (HR 1.49, 95% CI 1.10 to 2.00). Women and whites with MetSyn had a higher coronary mortality rate. The CE rate was higher among subjects with diabetes and with MetSyn; those with both had the highest risk. CONCLUSIONS: Overall, subjects over 70 years are at high risk for cardiovascular events; MetSyn in this group is associated with a significantly greater risk.

Lung Function and Risk for Heart Failure Among Older Adults: The Health ABC Study.

BACKGROUND: The impact of abnormal spirometric findings on risk for incident heart failure among older adults without clinically apparent lung disease is not well elucidated.METHODS: We evaluated the association of baseline lung function with incident heart failure, defined as first hospitalization for heart failure, in 2125 participants of the community-based Health, Aging, and Body Composition (Health ABC) Study (age, 73.6 +/- 2.9 years; 50.5% men; 62.3% white; 37.7% black) without prevalent lung disease or heart failure. Abnormal lung function was defined either as forced vital capacity (FVC) or forced expiratory volume in 1(st) second (FEV1) to FVC ratio below lower limit of normal. Percent predicted FVC and FEV1 also were assessed as continuous variables.RESULTS: During follow-up (median, 9.4 years), heart failure developed in 68 of 350 (19.4%) participants with abnormal baseline lung function, as compared with 172 of 1775 (9.7%) participants with normal lung function (hazard ratio [HR] 2.31; 95% confidence interval [CI], 1.74-3.07; P <.001). This increased risk persisted after adjusting for previously identified heart failure risk factors in the Health ABC Study, body mass index, incident coronary heart disease, and inflammatory markers (HR 1.83; 95% CI, 1.33-2.50; P <.001). Percent predicted (%) FVC and FEV 1 had a linear association with heart failure risk (HR 1.21; 95% CI, 1.11-1.32 and 1.18; 95% CI, 1.10-1.26, per 10% lower % FVC and % FEV1, respectively; both P <.001 in fully adjusted models). Findings were consistent in sex and race subgroups and for heart failure with preserved or reduced ejection fraction.CONCLUSIONS: Abnormal spirometric findings in older adults without clinical lung disease are associated with increased heart failure risk. (C) 2011 Elsevier Inc. All rights reserved. The American Journal of Medicine (2011) 124, 334-341

Skeletal muscle mitochondrial energetics are associated with maximal aerobic capacity and walking speed in older adults.

BACKGROUND: Lower ambulatory performance with aging may be related to a reduced oxidative capacity within skeletal muscle. This study examined the associations between skeletal muscle mitochondrial capacity and efficiency with walking performance in a group of older adults. METHODS: Thirty-seven older adults (mean age 78 years; 21 men and 16 women) completed an aerobic capacity (VO peak) test and measurement of preferred walking speed over 400 m. Maximal coupled (State 3; St3) mitochondrial respiration was determined by high-resolution respirometry in saponin-permeabilized myofibers obtained from percutanous biopsies of vastus lateralis (n = 22). Maximal phosphorylation capacity (ATP) of vastus lateralis was determined in vivo by P magnetic resonance spectroscopy (n = 30). Quadriceps contractile volume was determined by magnetic resonance imaging. Mitochondrial efficiency (max ATP production/max O consumption) was characterized using ATP per St3 respiration (ATP/St3). RESULTS: In vitro St3 respiration was significantly correlated with in vivo ATP (r = .47, p = .004). Total oxidative capacity of the quadriceps (St3*quadriceps contractile volume) was a determinant of VO peak (r = .33, p = .006). ATP (r = .158, p = .03) and VO peak (r = .475, p < .0001) were correlated with preferred walking speed. Inclusion of both ATP/St3 and VO peak in a multiple linear regression model improved the prediction of preferred walking speed (r = .647, p < .0001), suggesting that mitochondrial efficiency is an important determinant for preferred walking speed. CONCLUSIONS: Lower mitochondrial capacity and efficiency were both associated with slower walking speed within a group of older participants with a wide range of function. In addition to aerobic capacity, lower mitochondrial capacity and efficiency likely play roles in slowing gait speed with age.

Doré et le cinéma

Selon Ray Harryhausen, maître des effets spéciaux cinématographiques, « Gustave Doré aurait été un grand chef opérateur [...] il regardait les choses avec le point de vue de la caméra ». L'oeuvre de Doré a marqué de manière indélébile l'imaginaire filmique depuis ses origines. Et le cinéma, en retour, a « gravé » Doré dans l'imaginaire du XXe siècle. Peu de films sur la Bible, depuis la Vie et Passion de Jésus Christ produit par Pathé en 1902, qui ne se réfèrent à ses illustrations, ni d'adaptation cinématographique de Dante ou encore de Don Quichotte qui ne l'aient pris comme modèle, de Georg Wilhelm Pabst et Orson Welles à Terry Gilliam. Il n'est pas de films sur la vie londonienne et victorienne qui n'empruntent leurs décors aux visions de Londres, un pèlerinage, qu'il s'agisse de David Lean, de Roman Polanski ou de Tim Burton. Nombre de scènes oniriques, fantastiques, fantasmagoriques ont puisé dans l'oeuvre graphique de Doré, depuis le Voyage dans la lune de Georges Méliès en 1902. Si dans le domaine du dessin animé ou de l'animation, la dette de Walt Disney envers Doré est immense, ses forêts « primitives », notamment celles d'Atala, ont aussi servi aux différentes versions de King Kong, de l'original de 1933 au film de 2005 de Peter Jackson qui s'était déjà appuyé sur l'oeuvre de Doré dans Le Seigneur des anneaux. Ce chapitre vise à saisir l'étendue et la signification de cette imprégnation de l'imaginaire de Doré dans la culture de masse, de la dette explicite de Jean Cocteau envers les illustrations des Contes de Perrault dans La Belle et la bête (1945) aux réminiscences doréennes du personnage de Chewbacca dans la Guerre des Etoiles ou de la saga d'Harry Potter.