Ponctions et infiltrations articulaires [Arthrocentesis and joint infiltration]

Cet article se veut être un condensé des bases nécessaires à la pratique d'une ponction et, ou infiltration articulaire, des indications principales aux complications potentielles en passant par la description de la procédure et de ses contre-indications. La ponction du genou fait l'objet d'une description plus détaillée. Les données permettant de justifier une façon particulière de procéder ont spécifiquement été recherchées dans la littérature (Cochrane et Medline, termes de recherche : arthrocentesis ; joint aspiration). Le détail de ces données, comme par exemple le résultat d'études, ne trouve pas sa place dans ce résumé mais fait l'objet d'une publication à part. What should be known in order to practice safely a joint aspiration and/or infiltration is summarized in the following article. This summary includes various aspects, such as the indications and contraindications, the procedure itself, and the possible complications. The arthrocentesis of the knee is described in more details. Data in support of a specific modus operandi have been searched for in Cochrane and Pubmed (key words: arthrocentesis, joint aspiration). Only the conclusions of this research are exposed in this summary. A more comprehensive article will be published

Chirurgie du pied et de la cheville rhumatoïdes [Surgery of the rheumatoid foot and ankle]

Surgery of the rheumatoid foot and ankle Initial presentation of rheumatoid arthritis (RA) will be foot and ankle symptoms in 20% of cases. Eventually, 50-90% of patients will develop foot and ankle alterations. Typical deformities of the forefoot include hallux valgus and dorso-lateral dislocation of the lesser metatarso-phalangeal joints. RA involvement of the hindfoot frequently leads to plano-valgus deformity. Approximately 20% of surgery performed for RA is done at the foot and ankle. Early surgery is efficient against pain and deformity. Patient's satisfaction rate after surgery is high despite a slight higher complication rate compared to conventional foot and ankle surgery.

Cracking and Seating PCC Pavement Prior to Resurfacing, HR-527, 1986

Construction of an excellent network of primary highways across the State of Iowa has essentially been completed. The major task facing the Iowa Department of Transportation today is the maintenance and rehabilitation of that network. The most commonly utilized rehabilitation practice is asphalt concrete resurfacing. This practice will normally provide a good driving surface for at least 10 additional years. The major problem with asphalt concrete resurfacing is the reflection cracking from underlying cracks and joints in the portland cement concrete (PCC) pavement. Deterioration and spaling occur at these reflection cracks and are the limiting factor of the-effective life of the asphalt concrete resurfacing.

Laboratory Investigation of Bridge Strip Seal Joint Termination Details, SPR RB08-014, 2016

Bridge expansion joints, if not properly designed, constructed, and maintained, often lead to the deterioration of critical substructure elements. Strip seal expansion joints consisting of a steel extrusion and neoprene gland are one type of expansion joint and are commonly used by the Iowa Department of Transportation (DOT). Strip seal expansion joints are susceptible to tears and pull outs that allow water, chlorides, and debris to infiltrate the joint, and subsequently the bearings below. One area of the strip seal that is particularly problematic is where it terminates at the interface between the deck and the barrier rail. The Iowa DOT has noted that the initial construction quality of the current strip seal termination detail is not satisfactory, nor ideal, and a need exists for re-evaluation and possibly re-design of this detail. Desirable qualities of a strip seal termination detail provide a seal that is simple and fast to construct, facilitate quick gland removal and installation, and provide a reliable, durable barrier to prevent chloride-contaminated water from reaching the substructure. To meet the objectives of this research project, several strip seal termination details were evaluated in the laboratory. Alternate termination details may not only function better than the current Iowa DOT standard, but are also less complicated to construct, facilitating better quality control. However, uncertainties still exist regarding the long-term effects of using straight-through details, with or without the dogleg, that could not be answered in the laboratory in the short time frame of the research project.

Field Evaluation of Cold In-Place Recycling of Asphalt Concrete, HR-303, Construction Report, 1990

There are still many vintage portland cement concrete (PCC) pavements, 18 ft wide (5.4 m), dating back to pre-World War II era in use today. Successive overlays have been placed to cover joints and to improve rideability. The average thickness of the existing asphalt cement concrete (ACC) along route E66 in Tama County, Iowa, was 6.13 in. (15.6 cm). The rehabilitation strategy called for widening the base using the top 3 in. (7.6 cm) of the existing ACC by a recycling process involving cold milling and mixing with additional emulsion/rejuvenator. The material was then placed into a widening trench and compacted to match the level of the milled surface. This project was undertaken to develop a rehabilitation methodology to widen these older pavements economically and to have a finished surface capable of carrying traffic with little or no additional work.

Adding tobacco to cannabis: its frequency and likely implications.

INTRODUCTION: Young cannabis users are at increased risk of later cigarette initiation and progression to nicotine addiction. The present study addresses the frequency at which mulling (adding tobacco to cannabis smoked as joints) is performed and in which way this practice varies according to cigarette smoking status. METHODS: Data were issued from the Swiss 2007 European School Survey Project on Alcohol and other Drugs (ESPAD). A total of 881 past month cannabis users (mean age 15 years, boys 60.1%) were inquired on mulling using an anonymous self-administered questionnaire. Participants were further grouped according to their cigarette smoking status (daily, occasional, former, and never-smokers). RESULTS: Four of every 5 cannabis users depicted mulling as frequently performed. The highest occurrence was found among daily cigarette smokers (DSC; 90.3%), while former cigarette smokers reported the lowest (58.9%). The multinomial logistic regression showed DSC more likely reporting mulling as frequent compared with never-smokers (risk ratio = 3.56 [95% CI 1.55-8.21]). Conclusions: Mulling appears to be a very common process among young cannabis users, especially among concomitant cigarette smokers. Nevertheless, the majority of cigarette abstainers also reported frequently adding tobacco to the cannabis they smoke. Because it may represent a significant exposition to nicotine, mulling should be taken into account when assessing substance use among adolescents and in supporting their quitting attempts.

Mutations in the TGFβ binding-protein-like domain 5 of FBN1 are responsible for acromicric and geleophysic dysplasias.

Geleophysic (GD) and acromicric dysplasia (AD) belong to the acromelic dysplasia group and are both characterized by severe short stature, short extremities, and stiff joints. Although AD has an unknown molecular basis, we have previously identified ADAMTSL2 mutations in a subset of GD patients. After exome sequencing in GD and AD cases, we selected fibrillin 1 (FBN1) as a candidate gene, even though mutations in this gene have been described in Marfan syndrome, which is characterized by tall stature and arachnodactyly. We identified 16 heterozygous FBN1 mutations that are all located in exons 41 and 42 and encode TGFβ-binding protein-like domain 5 (TB5) of FBN1 in 29 GD and AD cases. Microfibrillar network disorganization and enhanced TGFβ signaling were consistent features in GD and AD fibroblasts. Importantly, a direct interaction between ADAMTSL2 and FBN1 was demonstrated, suggesting a disruption of this interaction as the underlying mechanism of GD and AD phenotypes. Although enhanced TGFβ signaling caused by FBN1 mutations can trigger either Marfan syndrome or GD and AD, our findings support the fact that TB5 mutations in FBN1 are responsible for short stature phenotypes.

Comparison of cannabinoid concentrations in oral fluid and whole blood between occasional and regular cannabis smokers prior to and after smoking a cannabis joint.

A cross-over controlled administration study of smoked cannabis was carried out on occasional and heavy smokers. The participants smoked a joint (11 % Δ9-tetrahydrocannabinol (THC)) or a matching placebo on two different occasions. Whole blood (WB) and oral fluid (OF) samples were collected before and up to 3.5 h after smoking the joints. Pharmacokinetic analyses were obtained from these data. Questionnaires assessing the subjective effects were administered to the subjects during each session before and after the smoking time period. THC, 11-hydroxy-THC (11-OH-THC) and 11-nor-9-carboxy-THC (THCCOOH) were analyzed in the blood by gas chromatography or liquid chromatography (LC)-tandem mass spectrometry (MS/MS). The determination of THC, THCCOOH, cannabinol (CBN), and Δ9-tetrahydrocannabinolic acid A (THC-A) was carried out on OF only using LC-MS/MS. In line with the widely accepted assumption that cannabis smoking results in a strong contamination of the oral cavity, we found that THC, and also THC-A, shows a sharp, high concentration peak just after smoking, with a rapid decrease in these levels within 3 h. No obvious differences were found between both groups concerning THC median maximum concentrations measured either in blood or in OF; these levels were equal to 1,338 and 1,041 μg/L in OF and to 82 and 94 μg/L in WB for occasional and heavy smokers, respectively. The initial WB THCCOOH concentration was much higher in regular smokers than in occasional users. Compared with the occasional smokers, the sensation of confusion felt by the regular smokers was much less while the feeling of intoxication remained almost unchanged.

Revisit of multiple epiphyseal dysplasia: ethnic difference in genotypes and comparison of radiographic features linked to the COMP and MATN3 genes.

Multiple epiphyseal dysplasia (MED) is a genetically heterogeneous group of diseases characterized by variable degrees of epiphyseal abnormality primarily involving the hip and knee joints. The purpose of this study was to investigate the frequency of mutations in individuals with a clinical and radiographic diagnosis of MED and to test the hypothesis that characteristic radiological findings may be helpful in predicting the gene responsible. The radiographs of 74 Korean patients were evaluated by a panel of skeletal dysplasia experts. Six genes known to be associated with MED (COMP, MATN3, COL9A1, COL9A2, COL9A3, and DTDST) were screened by sequencing. Mutations were found in 55 of the 63 patients (87%). MATN3 mutations were found in 30 patients (55%), followed by COMP mutations in 23 (41%), and COL9A2 and DTDST mutations in one patient (2%) each. Comparisons of radiographic findings in patients with COMP and MATN3 mutations showed that albeit marked abnormalities in hip and knee joints were observed in both groups, the degree of involvement and the morphology of dysplastic epiphyses differed markedly. The contour of the pelvic acetabulum, the presence of metaphyseal vertical striations, and/or the brachydactyly of the hand were also found to be highly correlated with the genotypes. The study confirms that MATN3 and COMP are the genes most frequently responsible for MED and that subtle radiographic signs may give precious indications on which gene(s) should be prioritized for mutational screening in a given individual.

Fitness to drive and cannabis: Experimental and real-life case study validation of two blood THCCOOH thresholds to distinguish occasional users from heavy smokers

Introduction: THC-COOH has been proposed as a criterion to help to distinguish between occasional from regular cannabis users. However, to date this indicator has not been adequately assessed under experimental and real-life conditions. Methods: We carried out a controlled administration study of smoked cannabis with a placebo. Twenty-three heavy smokers and 25 occasional smokers, between 18 and 30 years of age, participated in this study [Battistella G et al., PloS one. 2013;8(1):e52545]. We collected data from a second real case study performed with 146 traffic offenders' cases in which the whole blood cannabinoid concentrations and the frequency of cannabis use were known. Cannabinoid levels were determined in whole blood using tandem mass spectrometry methods. Results: Significantly high differences in THC-COOH concentrations were found between the two groups when measured during the screening visit, prior to the smoking session, and throughout the day of the experiment. Receiver operating characteristic (ROC) curves were determined and two threshold criteria were proposed in order to distinguish between these groups: a free THC-COOH concentration below 3 μg/L suggested an occasional consumption (≤ 1 joint/week) while a concentration higher than 40 μg/L corresponded to a heavy use (≥ 10 joints/month). These thresholds were successfully tested with the second real case study. The two thresholds were not challenged by the presence of ethanol (40% of cases) and of other therapeutic and illegal drugs (24%). These thresholds were also found to be consistent with previously published experimental data. Conclusion: We propose the following procedure that can be very useful in the Swiss context but also in other countries with similar traffic policies: If the whole blood THC-COOH concentration is higher than 40 μg/L, traffic offenders must be directed first and foremost toward medical assessment of their fitness to drive. This evaluation is not recommended if the THC-COOH concentration is lower than 3 μg/L. A THC-COOH level between these two thresholds can't be reliably interpreted. In such a case, further medical assessment and follow up of the fitness to drive are also suggested, but with lower priority.

Effective notch method assessment of misalignment for fatigue loaded welds

 The objective of this thesis work was to assess axial misalignment in fatigue loaded welds using the effective notch method. As a result, the fatigue behaviour of non-load carrying cruciform fillet welded joint under cyclic tensile loading has been studied. Various degrees of axial misalignment have been found in one series of non-load carrying cruciform fillet welded joints used in a laboratory investigation. As a result, it was important to carry out a comprehensive investigation since axial misalignment forms part of thequality of fatigue loaded structure and can reduce the fatigue strength. To extend the study, the correlation between fatigue strength and stress ratio, as well as stress concentration factor, were also studied. Moreover, a closer investigation of place of crack initiation and its dependence on weld sequence and imperfections of test specimen (angular distortion) was studied. For the fatigue class calculations, FEM (finite element method) and the effectivenotch approach are used. The addressed variable is the axial misalignment whichis introduce by modeling the entire joint. Fracture mechanics based calculations are also used and quantitatively compared with effective notch and experimental results.

Statistical variation of weld profiles and their expected influence on fatigue strength

The general objective of this study was to conduct astatistical analysis on the variation of the weld profiles and their influence on the fatigue strength of the joint. Weld quality with respect to its fatigue strength is of importance which is the main concept behind this thesis. The intention of this study was to establish the influence of weld geometric parameters on the weld quality and fatigue strength. The effect of local geometrical variations of non-load carrying cruciform fillet welded joint under tensile loading wasstudied in this thesis work. Linear Elastic Fracture Mechanics was used to calculate fatigue strength of the cruciform fillet welded joints in as-welded condition and under cyclic tensile loading, for a range of weld geometries. With extreme value statistical analysis and LEFM, an attempt was made to relate the variation of the cruciform weld profiles such as weld angle and weld toe radius to respective FAT classes.

Hitsauksen joustava laadunhallinta tilauskonepajassa

Diplomityön tavoitteena oli hitsauksen laadunhallinnan kuvaaminen ja kehittäminen ISO 9001 laadunhallintajärjestelmän ja uudistetun hitsauksen laatuvaatimusstandardin SFS-EN ISO3834-2:n mukaisesti tilauskonepajaan. Diplomityö koostuu teoriaosasta ja käytännön osasta. Teoriaosassa on käsitelty yleisiä laadunhallintaan liittyviä asioitasekä hitsauksen laadunhallintaan liittyviä asioita. Tarkastelun kohteina ovat olleet laadunhallinnan vaikutukset kilpailukykyyn sekä laadunhallinnan työkalut. Hitsauksen laadunhallintaa on käsitelty hitsatun rakenteen ja hitsausliitoksen laatuvaatimuksien, hitsaukseen vaikuttavien viranomaismääräysten sekä työturvallisuuden näkökulmista. Käytännön osassa kerrotaan hitsauksen laatujärjestelmän rakentamisesta Lievestuoreella sijaitsevaan TTP-Yhtiöt Oy:n tilauskonepajaan. Yrityksen hitsaustoiminnan nykytilanne arvioitiin ja sen pohjaltalaadittiin hitsauksen laatukäsikirja. Hitsauksen laatukäsikirja rakennettiin noudattaen hitsauksen laatuvaatimusstandardia SFS-EN ISO 3834-2 ja käyttäen apuna yrityksen ISO 9001:2000 laatukäsikirjaa. Tilauskonepajassa hitsauksen toimintajärjestelmältä vaaditaan joustavuutta, koska asiakkaiden hitsaustyölle asettamat vaatimukset vaihtelevat suuresti. Diplomityössä kuvataan esimerkin avulla hitsausohjeiden laatiminen, joka muodostaa yhden keskeisen osa-alueen hitsauksen laadunhallintajärjestelmästä. Hitsauksen laatujärjestelmän rakentamisen aikana hitsaushenkilöstöä informoitiin laatujärjestelmän edellyttämistä toimenpiteistä ja muutoksista luentojen avulla. Työn tuloksena saatiin myös yrityksen hitsaustoimintojen kehittämiseen, tehostamiseen sekä henkilökunnan koulutukseen liittyviä jatkotoimenpiteitä esille.

Nd:YAG Laser Welding of 5083 Aluminium Alloy using Filler Wire

High reflectivity and high thermal conductivity, high vapour pressure of alloyingelements as well as low liquid surface tension and low ionisation potential, make laser welding of aluminium and its alloys a demanding task.Problems that occur during welding are mainly process instabilities of the keyhole and the melt pool, increased plasma formation above the melt pool and loss of alloying elements. These problems lead to unwanted metallurgical defects like hot cracks and porosity in the weld bead andother problems concerning the shape and appearance of the weld bead. In order to minimise the defects and improve the weld quality, the process and beam parameters need to be carefully adjusted along with a consideration concerning the use of filler wire for the welding process. In this work the welding of 3,0 mm thick grade 5083 aluminium alloy plates using a 3,0 kW Nd:YAG laser with grade 5183 filler wire addition is investigated. The plates were welded as butt joints with air gap sizes 0,5 mm, 0,7mm and 1,0 mm. The analysis of the weld beads obtained from the weldedsamples showed that the least imperfections were produced with 0,7 mm air gaps at moderate welding speeds. The analysis also covered the calculation of the melting efficiency and the study of the shape of the weld bead. The melting efficiency was on average around 20 % for the melting process of the welded plates. The weld beads showed the characteristic V-shape of a laser weld and retained this shape during the whole series of experiments.

Effect of Shielding Gases in Laser Welding of Aluminium Alloys

High reflectivity to laser light, alloying element evaporation during high power laser welding makes aluminium alloys highly susceptibility to weld defects such as porosity, cracking and undercutting. The dynamic behaviour of the keyhole, due to fluctuating plasma above the keyhole and the vaporization ofthe alloying elements with in the keyhole, is the key problem to be solved for the improvement of the weld quality and stabilization of the keyhole dynamics isperhaps the single most important development that can broaden the application of laser welding of aluminium alloys. In laser welding, the shielding gas is commonly used to stabilize the welding process, to improve the welded joint features and to protect the welded seam from oxidation. The chemicalcomposition of the shielding gas is a key factor in achieving the final qualityof the welded joints. Wide range of shielding gases varying from the pure gasesto complex mixtures based on helium, argon, nitrogen and carbon dioxide are commercially available. These gas mixtures should be considered in terms of their suitability during laser welding of aluminium alloys to produce quality welds. The main objective of the present work is to study the effect of the shielding gascomposition during laser welding of aluminium alloys. Aluminium alloy A15754 was welded using 3kW Nd-YAG laser (continuous wave mode). The alloy samples were butt welded with different shielding gases (pure and mixture of gases) so that high quality welds with high joint efficiencies could be produced. It was observed that the chemical composition of the gases influenced the final weld quality and properties. In general, the mixture gases, in correct proportions, enabled better utilisation of the properties of the mixing gases, stabilized the welding process and produced better weld quality compared to the pure shielding gases.