[Collagenase injection in Dupuytren's disease, evaluation of the ultrasound assisted technique].

Since October 2011, the enzymatic lysis of Dupuytren's cord was introduced in Switzerland (Xiapex(®), Auxilium Pharmaceuticals, Pfizer). Here we present our first university experience and underline the major role of ultrasound during the injection. Between December 2011 and February 2013, 52 injections were performed to eliminate 43 Dupuytren's cords in 33 patients. The mean age of the patients was 64.4 ± 8.5 years. Complications were documented for each patient. Before, directly after and after a minimum of 6 months post-injection, the contracture of the treated joint was measured with use of a goniometer. The DASH score was evaluated after a minimum of 6 months and the patients were asked to subjectively evaluate the outcome of the treatment (very good, good, mild, poor) and whether they would reiterate it if necessary. Four skin defects, one lymphangitis, and one CRPS were responsible for a complication rate of 18%. There was no infection and no tendon rupture in the series. The mean MCP joint contracture was respectively 36.8 ± 27.4°, 3.5 ± 7.8° (gain of mobility compared to the preoperative situation 33.3°, P<0.001), and 8.4 ± 13.9° (gain 28.4°, P<0.001) respectively before, just after and at the long-term clinical control. The mean PIP joint contracture was respectively 36.5 ± 29.1°, 5.9 ± 6.7° (gain 30.6°, P<0.001), and 15.1 ± 13.8° (gain 21.4°, P<0.001) respectively before injection, just after and at the long-term clinical control. The DASH score decreased from 24 ± 14 to 7 ± 9 (P<0.001). Eighty-one per cent of the patients were satisfied or very satisfied of the treatment. All but two would reiterate the treatment if necessary. Ultrasound is able to target the injection of collagenase in order to reduce complications. The short-term results of this non-invasive therapy are very promising however comparison with conventional procedures is difficult as the long-term results are lacking.

Federalism and the Concept of Political Territoriality: Towards an Analytical Framework for Comparative Territorial Politics

The core issues comparative territorial politics addresses are how and why territory is used to delimit, maintain, or create political power; and with what kind of consequences for efficiency (output) and legitimacy (input). The aim of this article is to integrate various research strands into the comparative study of territorial politics, with federal studies at its core. As an example of a conceptual payoff, ‘political territoriality’ refers the observer to three dimensions of the strategic use of areal boundaries for political power. By focusing on territory as a key variable of political systems, the actors, processes and institutions are first analytically separated and continuously measured, enhancing internal validity, and then theoretically integrated, which allows more valid external inferences than classic, legal-institutionalist federal studies. After discussing the boundaries and substance of comparative territorial politics as a federal discipline, political territoriality is developed towards an analytical framework applicable to politics at any governmental level. The claims are modest: political territoriality does not serve so much as an explanatory concept as rather an ‘attention-directing device’ for federal studies.

Steroidogenesis of the testis - new genes and pathways

Defects of androgen biosynthesis cause 46,XY disorder of sexual development (DSD). All steroids are produced from cholesterol and the early steps of steroidogenesis are common to mineralocorticoid, glucocorticoid and sex steroid production. Genetic mutations in enzymes and proteins supporting the early biosynthesis pathways cause adrenal insufficiency (AI), DSD and gonadal insufficiency. The classic androgen biosynthesis defects with AI are lipoid CAH, CYP11A1 and HSD3B2 deficiencies. Deficiency of CYP17A1 rarely causes AI, and HSD17B3 or SRD5A2 deficiencies only cause 46,XY DSD and gonadal insufficiency. All androgen biosynthesis depends on 17,20 lyase activity of CYP17A1 which is supported by P450 oxidoreductase (POR) and cytochrome b5 (CYB5). Therefore 46,XY DSD with apparent 17,20 lyase deficiency may be due to mutations in CYP17A1, POR or CYB5. Illustrated by patients harboring mutations in SRD5A2, normal development of the male external genitalia depends largely on dihydrotestosterone (DHT) which is converted from circulating testicular testosterone (T) through SRD5A2 in the genital skin. In the classic androgen biosynthetic pathway, T is produced from DHEA and androstenedione/-diol in the testis. However, recently found mutations in AKR1C2/4 genes in undervirilized 46,XY individuals have established a role for a novel, alternative, backdoor pathway for fetal testicular DHT synthesis. In this pathway, which has been first elucidated for the tammar wallaby pouch young, 17-hydroxyprogesterone is converted directly to DHT by 5α-3α reductive steps without going through the androgens of the classic pathway. Enzymes AKR1C2/4 catalyse the critical 3αHSD reductive reaction which feeds 17OH-DHP into the backdoor pathway. In conclusion, androgen production in the fetal testis seems to utilize two pathways but their exact interplay remains to be elucidated.

Invitation à la topologie algébrique. Tome II. Cohomologie, variétés

Ce Tome II introduit la cohomologie, qui est une théorie duale de l'homologie, et examine les liens avec cette dernière ainsi que les divers produits construits sur les modules d'homologie et de cohomologie. Nous étudions en détail les variétés topologiques avec ou sans bord, définissons sur celles-ci au moyen de l'homologie une notion d'orientation et la comparons avec les définitions classiques d'orientation pour les variétés différentiables ou triangulables. Nous exposons les théorèmes de dualité de Poincaré, Alexander et Lefschetz et en déduisons les propriétés des formes d'intersection et de la signature des variétés. Le dernier chapitre du livre présente les résultats fondamentaux concernant la différentiabilité et la triangulabilité des variétés, obtenus depuis les années soixante du siècle dernier, tant en grandes dimensions qu'en dimension quatre. Nous discutons également la conjecture de Poincaré classique et ses généralisations. Bien que des démonstrations complètes de ces résultats soient hors de portée d'un ouvrage tel que le nôtre, nous nous sommes attachés à rendre leurs énoncés compréhensibles. Cette vue d'ensemble, et les références à la littérature qui l'accompagnent, fournissent une introduction aux développements récents dans ce riche domaine de la topologie.

Le temps de la défiguration. À propos de la versification dans Les Pâques à New York

Cet article est une première contribution à une nouvelle compréhension de la versification de Cendrars, qui a été décrite comme appartenant au «vers libre classique» (Roubaud). Dans Les Pâques à New York, la fréquence des alexandrins réguliers incite à ramener des vers apparemment non réguliers au schéma de l’alexandrin. Il s’ensuit une défiguration de l’alexandrin qui fait écho sur le plan thématique à celle du Christ, dont les Pâques n’indiquent que la passion et non la résurrection.