Le rôle des états prothrombotiques dans l’AVC du jeune adulte

Introduction: Au moins 30% des AVC ischémiques chez les jeunes demeurent inexpliqués malgré une investigation extensive. Le rôle de certains états prothrombotiques (ÉP) dans la thrombose artérielle reste incertain, possiblement à cause du petit nombre de patients, de populations hétérogènes ou d’ÉP analysés individuellement dans les études antérieures, alors que leur prévalence est basse. Méthodologie : Étude cas-témoins sur une cohorte rétrospective (2002-2011). Les patients âgés de ≤50ans lors d’un AVC ischémique furent identifiés sur une base de données hospitalière. Après exclusion des individus ayant une investigation étiologique incomplète, un syndrome antiphospholipide ou aucun ÉP testé, la cohorte fut divisée en groupes cas (AVC idiopathique) et témoins (étiologie identifiée). La prevalence de chaque ÉP fut comparée entre les groupe, ainsi que la présence de ≥2 ÉP (analyse primaire), sans et avec ajustement pour les facteurs de risque non-prothrombotiques (régression logistique). En analyse de sous-groupe, la présence de ≥1 ÉP fut comparée entre les cas avec versus sans foramen ovale perméable (FOP), entre les cas ou contrôles porteurs d’un FOP avec versus sans migraine, de même qu’entre les cas versus témoins de sexe féminin en incluant la contraception orale parmi les ÉP. Résultats : 502 jeunes avec AVC ischémique furent identifiés. Après exclusion de 108 patients, 184 cas et 210 témoins furent comparés, (âge moyen : 39,2 ans, 51% hommes). La prévalence des ÉP ne différait pas entre les cas et contrôles : déficits en protéine S (0,6%), protéine C (3,4%), antithrombine (1,2%), mutation de la prothrombine (2,5%), facteur V Leiden (4,6%), et anticardiolipines (titre 15-40 unités GPL ou MPL; 3,3%). La présence de ≥2 ÉP n’était pas associée à l’AVC idiopathique, avant (p=0,48) ou après ajustement (p=0,74). La présence de ≥1 ÉP ne différait pas entre les sous-groupes étudiés. Conclusion: Il n’y a pas d’association entre les ÉP, isolés ou en association, avec l’AVC ischémique idiopathique chez les jeunes, même en presence de FOP ou de migraine.

Une nouvelle méthode pour estimer la torsion géométrique en scoliose idiopathique de l’adolescent

La scoliose idiopathique de l’adolescent (SIA) est une déformation tridimensionnelle (3D) de la colonne vertébrale. Pour la plupart des patients atteints de SIA, aucun traitement chirurgical n’est nécessaire. Lorsque la déformation devient sévère, un traitement chirurgical visant à réduire la déformation est recommandé. Pour déterminer la sévérité de la SIA, l’imagerie la plus utilisée est une radiographie postéroantérieure (PA) ou antéro-postérieure (AP) du rachis. Plusieurs indices sont disponibles à partir de cette modalité d’imagerie afin de quantifier la déformation de la SIA, dont l’angle de Cobb. La conduite thérapeutique est généralement basée sur cet indice. Cependant, les indices disponibles à cette modalité d’imagerie sont de nature bidimensionnelle (2D). Celles-ci ne décrivent donc pas entièrement la déformation dans la SIA dû à sa nature tridimensionnelle (3D). Conséquemment, les classifications basées sur les indices 2D souffrent des mêmes limitations. Dans le but décrire la SIA en 3D, la torsion géométrique a été étudiée et proposée par Poncet et al. Celle-ci mesure la tendance d’une courbe tridimensionnelle à changer de direction. Cependant, la méthode proposée est susceptible aux erreurs de reconstructions 3D et elle est calculée localement au niveau vertébral. L’objectif de cette étude est d’évaluer une nouvelle méthode d’estimation de la torsion géométrique par l’approximation de longueurs d’arcs locaux et par paramétrisation de courbes dans la SIA. Une première étude visera à étudier la sensibilité de la nouvelle méthode présentée face aux erreurs de reconstructions 3D du rachis. Par la suite, deux études cliniques vont présenter la iv torsion géométrique comme indice global et viseront à démontrer l’existence de sous-groupes non-identifiés dans les classifications actuelles et que ceux-ci ont une pertinence clinique. La première étude a évalué la robustesse de la nouvelle méthode d’estimation de la torsion géométrique chez un groupe de patient atteint de la SIA. Elle a démontré que la nouvelle technique est robuste face aux erreurs de reconstructions 3D du rachis. La deuxième étude a évalué la torsion géométrique utilisant cette nouvelle méthode dans une cohorte de patient avec des déformations de type Lenke 1. Elle a démontré qu’il existe deux sous-groupes, une avec des valeurs de torsion élevées et l’autre avec des valeurs basses. Ces deux sous-groupes possèdent des différences statistiquement significatives, notamment au niveau du rachis lombaire avec le groupe de torsion élevée ayant des valeurs d’orientation des plans de déformation maximales (PMC) en thoraco-lombaire (TLL) plus élevées. La dernière étude a évalué les résultats chirurgicaux de patients ayant une déformation Lenke 1 sous-classifiées selon les valeurs de torsion préalablement. Cette étude a pu démontrer des différences au niveau du PMC au niveau thoraco-lombaire avec des valeurs plus élevées en postopératoire chez les patients ayant une haute torsion. Ces études présentent une nouvelle méthode d’estimation de la torsion géométrique et présentent cet indice quantitativement. Elles ont démontré l’existence de sous-groupes 3D basés sur cet indice ayant une pertinence clinique dans la SIA, qui n’étaient pas identifiés auparavant. Ce projet contribue dans la tendance actuelle vers le développement d’indices 3D et de classifications 3D pour la scoliose idiopathique de l’adolescent.

Scoliosis curve type classification from 3D trunk image

Adolescent idiopathic scoliosis (AIS) is a deformity of the spine manifested by asymmetry and deformities of the external surface of the trunk. Classification of scoliosis deformities according to curve type is used to plan management of scoliosis patients. Currently, scoliosis curve type is determined based on X-ray exam. However, cumulative exposure to X-rays radiation significantly increases the risk for certain cancer. In this paper, we propose a robust system that can classify the scoliosis curve type from non invasive acquisition of 3D trunk surface of the patients. The 3D image of the trunk is divided into patches and local geometric descriptors characterizing the surface of the back are computed from each patch and forming the features. We perform the reduction of the dimensionality by using Principal Component Analysis and 53 components were retained. In this work a multi-class classifier is built with Least-squares support vector machine (LS-SVM) which is a kernel classifier. For this study, a new kernel was designed in order to achieve a robust classifier in comparison with polynomial and Gaussian kernel. The proposed system was validated using data of 103 patients with different scoliosis curve types diagnosed and classified by an orthopedic surgeon from the X-ray images. The average rate of successful classification was 93.3% with a better rate of prediction for the major thoracic and lumbar/thoracolumbar types.

Scoliosis Follow-Up Using Noninvasive Trunk Surface Acquisition

Adolescent idiopathic scoliosis (AIS) is a musculoskeletal pathology. It is a complex spinal curvature in a 3-D space that also affects the appearance of the trunk. The clinical follow-up of AIS is decisive for its management. Currently, the Cobb angle, which is measured from full spine radiography, is the most common indicator of the scoliosis progression. However, cumulative exposure to X-rays radiation increases the risk for certain cancers. Thus, a noninvasive method for the identification of the scoliosis progression from trunk shape analysis would be helpful. In this study, a statistical model is built from a set of healthy subjects using independent component analysis and genetic algorithm. Based on this model, a representation of each scoliotic trunk from a set of AIS patients is computed and the difference between two successive acquisitions is used to determine if the scoliosis has progressed or not. This study was conducted on 58 subjects comprising 28 healthy subjects and 30 AIS patients who had trunk surface acquisitions in upright standing posture. The model detects 93% of the progressive cases and 80% of the nonprogressive cases. Thus, the rate of false negatives, representing the proportion of undetected progressions, is very low, only 7%. This study shows that it is possible to perform a scoliotic patient's follow-up using 3-D trunk image analysis, which is based on a noninvasive acquisition technique.

Analysis of scoliosis trunk deformities using ICA

This paper describes a method for analyzing scoliosis trunk deformities using Independent Component Analysis (ICA). Our hypothesis is that ICA can capture the scoliosis deformities visible on the trunk. Unlike Principal Component Analysis (PCA), ICA gives local shape variation and assumes that the data distribution is not normal. 3D torso images of 56 subjects including 28 patients with adolescent idiopathic scoliosis and 28 healthy subjects are analyzed using ICA. First, we remark that the independent components capture the local scoliosis deformities as the shoulder variation, the scapula asymmetry and the waist deformation. Second, we note that the different scoliosis curve types are characterized by different combinations of specific independent components.

Statistical model based 3D shape prediction of postoperative trunks for non-invasive scoliosis surgery planning

One of the major concerns of scoliosis patients undergoing surgical treatment is the aesthetic aspect of the surgery outcome. It would be useful to predict the postoperative appearance of the patient trunk in the course of a surgery planning process in order to take into account the expectations of the patient. In this paper, we propose to use least squares support vector regression for the prediction of the postoperative trunk 3D shape after spine surgery for adolescent idiopathic scoliosis. Five dimensionality reduction techniques used in conjunction with the support vector machine are compared. The methods are evaluated in terms of their accuracy, based on the leave-one-out cross-validation performed on a database of 141 cases. The results indicate that the 3D shape predictions using a dimensionality reduction obtained by simultaneous decomposition of the predictors and response variables have the best accuracy.

A physically based trunk soft tissue modeling for scoliosis surgery planning systems

One of the major concerns of scoliotic patients undergoing spinal correction surgery is the trunk's external appearance after the surgery. This paper presents a novel incremental approach for simulating postoperative trunk shape in scoliosis surgery. Preoperative and postoperative trunk shapes data were obtained using three-dimensional medical imaging techniques for seven patients with adolescent idiopathic scoliosis. Results of qualitative and quantitative evaluations, based on the comparison of the simulated and actual postoperative trunk surfaces, showed an adequate accuracy of the method. Our approach provides a candidate simulation tool to be used in a clinical environment for the surgery planning process.

Multimodal image fusion of anatomical structures for diagnosis, therapy planning and assistance

This paper provides an overview of work done in recent years by our research group to fuse multimodal images of the trunk of patients with Adolescent Idiopathic Scoliosis (AIS) treated at Sainte-Justine University Hospital Center (CHU). We first describe our surface acquisition system and introduce a set of clinical measurements (indices) based on the trunk's external shape, to quantify its degree of asymmetry. We then describe our 3D reconstruction system of the spine and rib cage from biplanar radiographs and present our methodology for multimodal fusion of MRI, X-ray and external surface images of the trunk We finally present a physical model of the human trunk including bone and soft tissue for the simulation of the surgical outcome on the external trunk shape in AIS.

Evaluation of Reducibility of Trunk Asymmetry in Lateral Bending

The value of the lateral bending test is important in the assessment of spinal curve mobility and prediction of surgical outcome in the treatment of adolescent idiopathic scoliosis (AIS). However, radiographic bending tests are unable to assess the reducibility of trunk asymmetry. This study aims to exploit surface topography measurement in order to evaluate the changes in shape of the trunk (a) between bending and neutral standing positions, and (b) between standing pre- and post-operative visits, in a cohort of adolescents with AIS having undergone surgical correction; and to correlate the differences measured in cases (a) and (b). Our cohort includes 13 patients with right thoracic AIS. Each patient had their 3D trunk surface digitized with a multi-head InSpeck system in standing posture (at the pre-op and post-op visits) and in maximum voluntary right and left bending (at the pre-op visit). We developed a novel trunk shape analysis method which produces a set of inclined trunk cross-sections allowing comparison between different postures. Two asymmetry indices, trunk rotation (TR) and back surface rotation (BSR), were computed in all cases and a statistical analysis was performed. Our correlation study (Pearson test) showed fair correlations in most cases between the changes in side-bending and those post-surgery, with the strongest relationship (p-value < 0.01) when combining the TR measurements from both bendings. These results provide evidence that the bending test can be used to assess trunk asymmetry reducibility. The proposed approach could provide a non-invasive trunk asymmetry reducibility test for routine clinical use in AIS surgery planning.

Multilevel Analysis of Trunk Surface Measurements for Noninvasive Assessment of Scoliosis Deformities.

Study Design. Reliability study. Objectives. To assess between-acquisition reliability of new multilevel trunk cross sections measurements, in order to define what is a real change when comparing 2 trunk surface acquisitions of a same patient, before and after surgery or throughout the clinical monitoring. Summary of Background Data. Several cross-sectional surface measurements have been proposed in the literature for noninvasive assessment of trunk deformity in patients with adolescent idiopathic scoliosis (AIS). However, only the maximum values along the trunk are evaluated and used for monitoring progression and assessing treatment outcome. Methods. Back surface rotation (BSR), trunk rotation (TR), and coronal and sagittal trunk deviation are computed on 300 cross sections of the trunk. Each set of 300 measures is represented as a single functional data, using a set of basis functions. To evaluate between-acquisition variability at all trunk levels, a test-retest reliability study is conducted on 35 patients with AIS. A functional correlation analysis is also carried out to evaluate any redundancy between the measurements. Results. Each set of 300 measures was successfully described using only 10 basis functions. The test-retest reliability of the functional measurements is good to very good all over the trunk, except above the shoulders level. The typical errors of measurement are between 1.20° and 2.2° for the rotational measures and between 2 and 6 mm for deviation measures. There is a very strong correlation between BSR and TR all over the trunk, a moderate correlation between coronal trunk deviation and both BSR and TR, and no correlation between sagittal trunk deviation and any other measurement. Conclusion. This novel representation of trunk surface measurements allows for a global assessment of trunk surface deformity. Multilevel trunk measurements provide a broader perspective of the trunk deformity and allow a reliable multilevel monitoring during clinical follow-up of patients with AIS and a reliable assessment of the esthetic outcome after surgery.

Changes in Trunk Appearance After Scoliosis Spinal Surgery and Their Relation to Changes in Spinal Measurements

Study Design Retrospective study of surgical outcome. Objectives To evaluate quantitatively the changes in trunk surface deformities after scoliosis spinal surgery in Lenke 1A adolescent idiopathic scoliosis (AIS) patients and to compare it with changes in spinal measurements. Summary of Background Data Most studies documenting scoliosis surgical outcome used either radiographs to evaluate changes in the spinal curve or questionnaires to assess patients health-related quality of life. Because improving trunk appearance is a major reason for patients and their parents to seek treatment, this study focuses on postoperative changes in trunk surface deformities. Recently, a novel approach to quantify trunk deformities in a reliable, automatic, and noninvasive way has been proposed. Methods Forty-nine adolescents with Lenke 1A idiopathic scoliosis treated surgically were included. The back surface rotation and trunk lateral shift were computed on trunk surface acquisitions before and at least 6 months after surgery. We analyzed the effect of age, height, weight, curve severity, and flexibility before surgery, length of follow-up, and the surgical technique. For 25 patients with available three-dimensional (3D) spinal reconstructions, we compared changes in trunk deformities with changes in two-dimensional (2D) and 3D spinal measurements. Results The mean correction rates for the back surface rotation and the trunk lateral shift are 18% and 50%, respectively. Only the surgical technique had a significant effect on the correction rate of the back surface rotation. Direct vertebral derotation and reduction by spine translation provide a better correction of the rib hump (22% and 31% respectively) than the classic rod rotation technique (8%). The reductions of the lumbar Cobb angle and the apical vertebrae transverse rotation explain, respectively, up to 17% and 16% the reduction of the back surface rotation. Conclusions Current surgical techniques perform well in realigning the trunk; however, the correction of the deformity in the transverse plane proves to be more challenging. More analysis on the positive effect of vertebral derotation on the rib hump correction is needed. Level of evidence III.

Effets de la stimulation magnétique transcrânienne dans la maladie de Parkinson avec déficits cognitifs légers

Beaucoup de patients atteints de la maladie de Parkinson (MP) peuvent souffrir de troubles cognitifs dès les étapes initiales de la maladie et jusqu’à 80% d’entre eux vont développer une démence. Des altérations fonctionnelles au niveau du cortex préfrontal dorsolatéral (CPFDL), possiblement en relation avec le noyau caudé, seraient à l’origine de certains de ces déficits cognitifs. Des résultats antérieurs de notre groupe ont montré une augmentation de l’activité et de la connectivité dans la boucle cortico-striatale cognitive suite à la stimulation magnétique transcrânienne (SMT) utilisant des paramètres « theta burst » intermittent (iTBS) sur le CPFDL gauche. Pour cette étude, 24 patients atteints de la MP avec des troubles cognitifs ont été séparées en 2 groupes : le groupe iTBS active (N=15) et le groupe sham (stimulation simulée, N=9). Une batterie neuropsychologique détaillée évaluant cinq domaines cognitifs (attention, fonctions exécutives, langage, mémoire et habiletés visuo-spatiales) a été administrée lors des jours 1, 8, 17 et 37. Le protocole iTBS a été appliqué sur le CPFDL gauche durant les jours 2, 4 et 7. Les scores z ont été calculés pour chaque domaine cognitif et pour la cognition globale. Les résultats ont montré une augmentation significative de la cognition globale jusqu’à 10 jours suivant l’iTBS active, particulièrement au niveau de l’attention, des fonctions exécutives et des habiletés visuo-spatiales. Cet effet sur la cognition globale n’est pas répliqué dans le groupe sham. Ces résultats suggèrent donc que l’iTBS peut moduler la performance cognitive chez les patients atteints de MP avec des déficits cognitifs.

Biochemical Effect of Dicarboxylic Acids on Oxalate Metabolism in Experimental Rats and Studies on Oxalate Degrading Bacteria

The current study is an attempt to find a means of lowering oxalate concentration in individuals susceptible to recurrent calcium oxalate stone disease.The formation of renal stone composed of calcium oxalate is a complex process that remains poorly understood and treatment of idiopathic recurrent stone formers is quite difficult and this area has attracted lots of research workers. The main objective of this work are to study the effect of certain mono and dicarboxylic acids on calcium oxalate crystal growth in vitro, isolation and characterization of oxalate degrading bacteria, study the biochemical effect of sodium glycollate and dicarboxylic acids on oxalate metabolism in experimental stone forming rats and To investigate the effect of dicarboxylic acids on oxalate metabolism in experimental hyperoxaluric rats. Oxalic acid is one of the most highly oxidized organic compound widely distributed in the diets of man and animals, and ingestion of plants that contain high concentration of oxalate may lead to intoxication. Excessive ingestion of dietary oxalate may lead to hyperoxaluria and calcium oxalate stone disease.The formation of calcium oxalate stone in the urine is dependent on the saturation level of both calcium and oxalate. Thus the management of one or both of these ions in individuals susceptible to urolithiasis appears to be important. The control of endogenous oxalate synthesis from its precursors in hyperoxaluric situation is likely to yield beneficial results and can be a useful approach in the medical management of urinary stones. A variety of compounds have been investigated to curtain endogenous oxalate synthesis which is a crucial factor, most of these compounds have not proved to be effective in the in vivo situation and some of them are not free from the toxic effect. The non-operative management of stone disease has been practiced in ancient India in the three famous indigenous systems of medicine, Ayurveda, Unani and Siddha, and proved to be effective.However the efficiency of most of these substances is still questionable and demands further study. Man as well as other mammals cannot metabolize oxalic acid. Excessive ingestion of oxalic acid can arise from oxalate rich food and from its major metabolic precursors, glycollate, glyoxylate and ascorbic acid can lead to an acute oxalate toxicity. Increasedlevels of circulating oxalate, which can result in a variety of diseases including renal failure and oxalate lithiasis. The ability to enzymatically degrade oxalate to less noxious Isubstances, formate and CO2, could benefit a great number of individuals including those afflicted with hyperoxaluria and calcium oxalate stone disease.

Análisis comparativo de remoción de la membrana limitante interna en agujeros maculares con y sin azul tripan

Objetivo: comparar los resultados anatómicos y funcionales de los pacientes con Agujero Macular idiopático estadíos II, III y IV de Gass, quienes fueron sometidos a cirugía vitreoretiniana, con y sin uso de Azul Tripan, para la remoción de la Membrana Limitante Interna, en la Fundación Oftalmológica Nacional, Bogotá, Colombia, a partir de la revisión de historias clínicas de pacientes operados entre Enero de 2006 y Noviembre de 2009 Métodos: se realizó un estudio de cohorte retrospectivo, Los registros de historias clínicas de 32 pacientes operados de agujero macular idiopático fueron recolectados retrospectivamente a partir de 3 cirujanos. A todos los pacientes se les había realizado vitrectomía vía pars plana, se dividieron en 2 grupos aquellos con remoción de la MLI asistida con azul tripan y sin ésta. Se evaluaron variables, preoperatorias, intraoperatorias y postoperatorias. Resultados: la edad media de presentación del agujero macular fue de 61,33 años, la agudeza visual postoperatoria presentó diferencia entre los 2 grupos (p=0,008), la obtención del cierre del agujero macular utilizando azul tripan para la remoción de la membrana limitante interna no fue estadísticamente significativa (p=0,383) Conclusiones: la agudeza visual postoperatoria mejora, en los pacientes en quienes se utiliza el azul tripan para asistir la remoción de la MLI, en pacientes con agujeros maculares, en nuestro estudio la mejoría de la agudeza visual fue en promedio de 0,143. 2. No hubo diferencias entre los grupos estudiados con respecto al cierre anatómico primario del agujero macular. Se recomienda realizar estudios prospectivos, longitudinales para evaluar la asociación entre agujeros maculares, cierre anatómico primario y agudeza visual con el uso de azul tripan.

Compromiso renal en artritis idiopática juvenil (AIJ) en una población de pacientes colombianos

La artritis idiopática juvenil AIJ es la entidad más frecuente de las enfermedades reumatológicas en la infancia. No se conoce la prevalencia global del compromiso renal en los pacientes con AIJ, considerándose de rara ocurrencia. Objetivo: Describir el compromiso renal en niños con diagnóstico de artritis idiopática juvenil (AIJ) en la Clínica Infantil Colsubsidio atendidos en el periodo comprendido entre marzo de 2006 y marzo de 2010 Materiales y métodos: Estudio retrospectivo descriptivo de serie de casos. Pacientes de la Clínica Infantil Colsubsidio con diagnóstico de AIJ, con posterior revisión sistemática de las historias clínicas. Se introdujeron los datos a una base creada en Excel 2007 y se realizó el análisis estadístico con el programa estadístico STATA 10.1 Resultados: 35 pacientes del género masculino (30.43%) y 80 del femenino (69.57%). Con una mediana de edad de 7 años . La prevalencia de compromiso renal para esta población fue de 30.43%. con diferencias estadísticamente significativas en las variables relación proteinuria / creatinuria y proteinuria de 24 horas .Se realizó biopsia renal en 3 pacientes (2.61% de la población) con nefropatía de cambios mínimos. Se encontraron diferencias estadísticamente significativas en cuanto al uso de prednisolona, metotrexate oral y metotrexate intravenoso. Conclusiones: El compromiso renal representa una complicación importante y no tan infrecuente en los paciente que padecen AIJ. Se observó una mayor prevalencia en los pacientes con AIJ que usaron prednisolona y metotrexate endovenoso, sin que esto represente una asociación causal. Se sugiere la realización de un estudio prospectivo.