The complex polysaccharide, heparan sulfate (HS), regulates airway development by controlling cell-cell and cell-matrix communication via interactions with a vast number of proteins e.g., growth factors. Loss of HS biosynthetic enzymes in Drosophila and mice illustrates the requirement for HS in airway morphogenesis and results in a major disruption in airway branching, and in the mouse, neonatal death. However, knowledge of HS structure within the lung is limited. HS antibodies produced by 'phage display provide a new tool for analysing HS in situ and have allowed specific HS structures to be probed in the lung.

Objectives To investigate the circumstances, manner and extent of physical examination of the lungs in adults by general medical practitioners (GPs) in the United Kingdom. Methods National Health Service research ethics committee approval was obtained. Three phases of research were undertaken. The first phase was exploratory, in which GPs responded to a series of questions using electronic voting handsets. There followed a sequence of qualitative interviews in which GP opinion was sought in greater depth. The interview transcripts were analysed thematically, with the aid of Atlas software. Finally an online Delphi study was undertaken, in which the themes that had developed in the previous phases were developed and discussed, with the aim of achievinq consensus. Results A total of 66 GPs took part in the study. GPs conducted physical examination principally to reassure patients: the diagnostic value of examination was secondary. History and first impressions were more important diagnostic tools. There was an unquestioned assumption that patients visited GPs because they wanted to be examined. The extent of the examination depended largely on whether the patient appeared ill, but was influenced by a wide range of other factors. Most GPs would usually examine the patient's chest if there was a cough, but there was a range of responses. The chance of this examination increased with the duration of symptoms, and if there was fever, dyspnoea or any adverse history. Conclusions The principal reasons that GPs examine the lungs are to reassure patients, assist in detecting pneumonia, avoid complaints and confrontation, and justify not prescribing antibiotics. The untested assertion, that patients attend to be examined, could be explored as a modification of clinical method, that includes a discussion with patients about their expectations and reassurance needs, prior to commencing physical examination. There are potential implications for undergraduate and postgraduate education.

Les impacts non transfixiants sur les gilets pare-balles sont responsables de lésions non pénétrantes potentiellement létales, regroupées sous le terme d’effets arrière (Behind Armor Blunt Trauma : BABT). De telles lésions fermées se retrouvent également lors d’impacts thoraciques de projectiles d’Armes à Létalité Réduite cinétiques (ALRc). Afin d’améliorer le pouvoir protecteur des protections balistiques et de mieux maitriser le pouvoir vulnérant des ALRc, il est nécessaire de définir un critère lésionnel permettant de prédire l’importance des lésions en cas de traumatisme thoracique fermé de type balistique. Ce critère se doit d’être bien corrélé à la gravité du traumatisme, et de pouvoir être facilement transposable à l’ensemble des systèmes d’évaluation des protections balistiques et des ALRc. La gravité du traumatisme a été définie ici par le volume de la contusion pulmonaire. L’utilisation de cette valeur nécessitait le recours au modèle animal. Or, nous avons démontré que le thorax du modèle porcin n’offrait pas le même comportement biomécanique lors de l’impact que le thorax de l’adulte jeune. Nous avons donc développé un critère, l’impulsion de pression intrathoracique maximale (PImax), basé sur la mesure de la pression intrathoracique lors de l’impact, et donc indépendant du comportement biomécanique de la paroi thoracique vis-à-vis de ses effets sur le poumon. Ce critère très bien corrélé avec le volume de la contusion pulmonaire, quelque soit le type d’impact thoracique balistique (ALRc ou BABT), a l’avantage de pouvoir être transposable aux autres moyens d’évaluations balistiques tels que les modèles numériques ou mécaniques de thorax, afin de s’affranchir de l’expérimentation animale / When non-penetrating, impacts on bulletproof jackets can lead to potentially lethal blunt injuries known as behind armor blunt trauma (BABT). Impacts of less lethal kinetic weapons (LLKW) can also lead to such injuries. To both improve the protection capabilities of the BPJ and better comprehend the ounding potential of the LLKW, we need to design a wounding criterion to predict the injury severity of ballistic blunt thoracic trauma. In one hand, this criterion has to be well correlated with the severity of the injuries, and in the other hand, it has to be easily used with all the LLKW and BPJ assessment systems in use. First, we defined the pulmonary contusion volume as the severity of the injuries. Studying the pulmonary contusion involves the use of animal experiments. But we demonstrated that the biomechanics of the chest wall are different in animals and young adults. Then, we developed the maximum pressure impulse criterion (PImax). As it is based on the intrathoracic pressure measure during the blunt impact, it is independent from the chest wall behavior. This criterion can be used with the other assessment tools as the numerical simulation mechanical chest surrogates. This can help to reduce the use of animal experiments, which is more and more expensive, heavy and questionable on the ethical aspect