Medial coracoclavicular ligament revisited: an anatomic study and review of the literature

The medial coracoclavicular ligament (MCCL), up to now rarely reported in the literature, was studied in a formol-fixed cadaver by means of dissection, morphometry, and light microscopy. This entity represents a true ligament within the coracoclavicular fascia. Although longer and narrower than its lateral counterpart, the medial coracoclavicular ligament follows the same morphological pattern, including the cartilage at the level of the coracoidal attachment. Its clinical significance and implications together with a review of the literature is presente

Management des contradictions et santé au travail : exploration en pays de lean management

Atteindre des performances durables est un enjeu majeur dans un monde confronté à une complexité croissante et à des risques multiples. Dans ce contexte, la santé des travailleurs est régulièrement pointée comme étant le symptôme du caractère non durable ou non tenable de certains modèles productifs regroupés en particulier sous le terme de lean management (management au plus juste). En étudiant trois entreprises ayant adopté ce type d'organisation mais présentant des différences notables en termes de santé au travail notre propos est de comprendre en quoi certains aspects du management peuvent contribuer à corriger les effets prétendument délétères du lean management et expliquer les différences observées. Plus précisément, cette étude se focalise sur la manière dont les trois entreprises managent les problèmes et contradictions potentiellement générateurs de stress auxquels doivent faire face leurs membres. Deux angles d'étude sont privilégiés : l'équipement de l'organisation en termes d'espaces de discussion d'une part, le positionnement et les caractéristiques du management intermédiaire d'autre part.Santé ; lean management ; performance ; management intermédiaire

End-to-End Personalized AAL Services for Elderly with Chronic Conditions

In the recent years, the number of the elderly living with chronic diseases (e.g., high blood pressure, diabetes, etc.) is continuously growing, potentially affecting their independence. Therefore, many efforts have been given in AAL applications for supporting the monitoring activities and, particularly, focusing to the issue of gathering continuous information at home, standardizing formats, extracting further information from raw sensors data using different techniques to reconstruct a context. One aspect that is rather important but less developed in current investigation is the design of personalized end-to-end services for classes of users of such technology being them either primary user (old people) or secondary users (medical doctors, caregiver, relatives)

Steps Toward End-to-End Personalized AAL Services

In Ambient Assisted Living research and development, a significant effort has been dedicated to issues like gathering continuous information at home, standardizing formats in order to create environments more easily, extracting further information from raw data using different techniques to reconstruct context. An aspect relatively less developed but also important is the design of personalized end-to-end services for technology users being them either primary (older people) or secondary (medical doctors, caregiver, relatives). This paper explores an effort, internal to the EU project GIRAFFPLUS, for designing such services starting from a state-of-the-art continuous data gathering infrastructure. The paper presents the general project idea, the current choices for the middleware infrastructure and the pursued direction for a set of services personalized to different classes of users

Bowel function and quality of life after superior mesenteric nerve plexus transection in right colectomy with D3 extended mesenterectomy

Background: The aim of this study was to ascertain the impact of injury to the superior mesenteric nerve plexus caused by right colectomy with D3 extended mesenterectomy as performed in the prospective multicenter trial: “Safe Radical D3 Right Hemicolectomy for Cancer through Preoperative Biphasic Multi-detector Computed Tomography” in which all soft tissue surrounding the superior mesenteric vessels from the level of the middle colic artery to that of the ileocolic artery was removed. Methods: Bowel function and gastrointestinal quality of life in two consecutive cohorts that underwent right colectomy with and without D3 extended mesenterectomy were compared. Main outcome measures were the Diarrhea Assessment Scale (DAS) and Gastrointestinal Quality of Life Index (GIQLI). The data were collected prospectively through telephone interviews. Results: Forty-nine patients per group, comparable for age, sex, length of bowel resected but with significantly shorter follow-up time in the experimental group, were included. There was no difference in total DAS scores, subscores or additional questions except for higher bowel frequency scores in the D3 group (p = 0.02). Comparison of total GIQLI scores and subscales showed no difference between groups. Regression analysis with correction for confounding factors showed 0.48 lower bowel frequency scores in the D2 group (p = 0.022). Within the D3 group presence of jejunal arteries cranial to the D3 dissection area showed 1.78 lower DAS scores and 0.7 lower bowel frequency scores. Conclusions: Small bowel denervation after right colectomy with D3 extended mesenterectomy leads to increased bowel frequency but does not impact gastrointestinal quality of life. Individual anatomical variants can affect postoperative bowel function differently despite standardized surgery.acceptedVersio

Arterial supply of the trigeminal ganglion, a micromorphological study

Background: In this study, we explored the specific microanatomical properties of the trigeminal ganglion (TG) blood supply and its close neurovascular relationships with the surrounding vessels. Possible clinical implications have been discussed. Materials and methods: The internal carotid and maxillary arteries of 25 adult and 4 foetal heads were injected with a 10% mixture of India ink and gelatin, and their TGs subsequently underwent microdissection, observation and morphometry under a stereoscopic microscope. Results: The number of trigeminal arteries varied between 3 and 5 (mean 3.34), originating from 2 or 3 of the following sources: the inferolateral trunk (ILT) (100%), the meningohypophyseal trunk (MHT) (100%), and from the middle meningeal artery (MMA) (92%). In total, the mean diameter of the trigeminal branches was 0.222 mm. The trigeminal branch of the ILT supplied medial and middle parts of the TG, the branch of the MHT supplied the medial part of the TG, and the branch of the MMA supplied the lateral part of the TG. Additional arteries for the TG emerged from the dural vascular plexus and the vascular network of the plexal segment of the trigeminal nerve. Uniform and specific intraganglionic dense capillary network was observed for each sensory trigeminal neuron. Conclusions: The reported features of the TG vasculature could be implied in a safer setting for surgical approach to the skull base, in relation to the surrounding structures. The morphometric data on TG vasculature provide anatomical basis for better understanding the complex TG blood supply from the internal and external carotid arteries

Food for pollinators: quantifying the nectar and pollen resources of urban flower meadows

Planted meadows are increasingly used to improve the biodiversity and aesthetic amenity value of urban areas. Although many ‘pollinator-friendly’ seed mixes are available, the floral resources these provide to flower-visiting insects, and how these change through time, are largely unknown. Such data are necessary to compare the resources provided by alternative meadow seed mixes to each other and to other flowering habitats. We used quantitative surveys of over 2 million flowers to estimate the nectar and pollen resources offered by two exemplar commercial seed mixes (one annual, one perennial) and associated weeds grown as 300m2 meadows across four UK cities, sampled at six time points between May and September 2013. Nectar sugar and pollen rewards per flower varied widely across 65 species surveyed, with native British weed species (including dandelion, Taraxacum agg.) contributing the top five nectar producers and two of the top ten pollen producers. Seed mix species yielding the highest rewards per flower included Leontodon hispidus, Centaurea cyanus and C. nigra for nectar, and Papaver rhoeas, Eschscholzia californica and Malva moschata for pollen. Perennial meadows produced up to 20x more nectar and up to 6x more pollen than annual meadows, which in turn produced far more than amenity grassland controls. Perennial meadows produced resources earlier in the year than annual meadows, but both seed mixes delivered very low resource levels early in the year and these were provided almost entirely by native weeds. Pollen volume per flower is well predicted statistically by floral morphology, and nectar sugar mass and pollen volume per unit area are correlated with flower counts, raising the possibility that resource levels can be estimated for species or habitats where they cannot be measured directly. Our approach does not incorporate resource quality information (for example, pollen protein or essential amino acid content), but can easily do so when suitable data exist. Our approach should inform the design of new seed mixes to ensure continuity in floral resource availability throughout the year, and to identify suitable species to fill resource gaps in established mixes

Severe Primary Hyperparathyroidism Caused by Parathyroid Carcinoma in a 13‐Year‐Old Child; Novel Findings From HRpQCT

Primary hyperparathyroidism is a condition that occurs infrequently in children. Parathyroid carcinoma, as the underlying cause of hyperparathyroidism in this age group, is extraordinarily rare, with only a few cases reported in the literature. We present a 13-year-old boy with musculoskeletal pain who was found to have brown tumors from primary hyperparathyroidism caused by parafibromin-immunodeficient parathyroid carcinoma. Our patient had no clinical, biochemical, or radiographic evidence of pituitary adenomas, pancreatic tumors, thyroid tumors, pheochromocytoma, jaw tumors, renal abnormalities, or testicular lesions. Germline testing for AP2S1, CASR, CDC73/HRPT2, CDKN1B, GNA11, MEN1, PTH1R, RET, and the GCM2 gene showed no pathological variants, and a microarray of CDC73/HRPT2 did not reveal deletion or duplication. He was managed with i.v. fluids, calcitonin, pamidronate, and denosumab prior to surgery to stabilize hypercalcemia. After removal of a single parathyroid tumor, he developed severe hungry bone syndrome and required 3 weeks of continuous i.v. calcium infusion, in addition to oral calcium and activated vitamin D. Histopathological examination identified an angioinvasive parathyroid carcinoma with global loss of parafibromin (protein encoded by CDC73/HRPT2).HRpQCT and DXA studies were obtained prior to surgery and 18-months postsurgery. HRpQCT showed a resolution of osteolytic lesions combined with structural improvement of cortical porosity and an increase in both cortical thickness and density compared with levels prior to treatment. These findings highlight the added value of HRpQCT in primary hyperparathyroidism. In addition to our case, we have provided a review of the published cases of parathyroid cancer in children