Le muscle strié squelettique est un tissu fascinant qui permet d’assurer les fonctions essentielles à notre existence : se mouvoir, maintenir sa posture, se nourrir, communiquer ou tout simplement respirer. De nombreuses situations, engendrant principalement une hypoactivité, peuvent provoquer un déconditionnement musculaire caractérisé par une perte de masse et de force ainsi qu’un développement d’infiltrations graisseuses (IMAT), altérant ainsi la fonction musculaire. Le développement d’IMAT est également observé lorsque les processus de régénération musculaire sont altérés. Les fibro-adipogenic progenitors (FAPs) représentent la population de cellules souches principalement impliquée dans le développement d’IMAT. L’interaction entre FAPs et cellules satellites/immunitaires semble être un trio indispensable pour une régénération optimale, sans développement d’IMAT. Au regard de la littérature scientifique, une modulation du niveau d’activité contractile permet de faire varier le niveau d’expression de nombreuses cytokines impliquées dans la modulation des FAPs et donc dans l’apparition d’IMAT. Nos travaux ont contribué à l’accroissement des connaissances scientifiques relatives à la thématique des infiltrations graisseuses et à leurs exacerbations dans des situations d’hypoactivité ou de régénération musculaire. Nous avons montré que 3 jours d’hypoactivité chez l’homme, induite par le modèle novateur de dry immersion, suffisent à augmenter le contenu musculaire en IMAT. Dans un contexte de régénération musculaire, induite par le modèle glycérol chez la souris, nous avons démontré une inhibition de l’apparition des IMAT en diminuant les contraintes mécaniques appliquées au muscle lésé. Nous avons également précisé le rôle de l’axe TNFα/TGF-β1, et donc celui des processus inflammatoires nécessaires dans l’apoptose des FAPs afin de limiter le développement des IMAT dans ce modèle. Ces trois études ouvrent de nombreuses perspectives, afin i) de préciser le rôle des IMAT dans la dysfonction musculaire, ii) de définir les mécanismes de régulation qui contrôlent le développement et l’accumulation d’IMAT. / Skeletal muscle is a fascinating tissue that ensures core functions: moving, maintaining postures, feeding, communicating or just breathing. Many situations, associated with hypoactivity, are able to involve muscle deconditioning defined by a loss of mass and strength, as well as fat infiltration development (IMAT), altogether impairing muscle function. IMAT development occurs also with disrupted regeneration processes. Fibro-adipogenic progenitors (FAPs) appear as the main stem cell population involved in IMAT development. The interaction between FAPs and satellite/immune cells seems to be a crucial trio for an efficient regeneration, without IMAT development. According to the literature, the degree of contractile activity is able to affect the expression levels of different cytokines involved in FAPs fate, and therefore in IMAT accumulation. Our work contributed to increase scientific knowledge on muscle fatty infiltrations and their exacerbations in hypoactivity or regeneration situations. We showed that 3 days of hypoactivity in human, induced by the innovative model of dry immersion, are sufficient to promote an increase in IMAT content. In a context of muscle regeneration, induced by the mouse glycerol model, we highlighted an almost complete inhibition of IMAT accumulation by decreasing mechanical constraints applied to the injured muscle. We also investigated the role of the TNFα/TGF-β1 axis, and therefore the potential role of the inflammatory stage in FAPs apoptosis and inhibition of IMAT development. Our work open up new prospects 1°) clarifying the role of IMAT in muscle dysfunction, and 2°) defining the underlying mechanisms controlling IMAT development and accumulation.

<p>Vid operation av primär total höftplastik finns det olika metoder för postoperativ smärtlindring. En tidigare genomförd studie på ett mellansvenskt sjukhus (nedan kallad ”höftprojektet”) visade att ”Local infiltration analgesia” (LIA) initialt minskade postoperativ smärta, underlättade mobilisering samt förkortade vårdtiden, jämfört med spinalt morfin. I denna studie genomfördes en långtidsuppföljning av höftprojektet med mätningar efter 6 respektive 12 veckor. Studiegruppen hade fått LIA vid operationsslutet och kontrollgruppen spinalt morfin. Båda grupperna hade en spinal bedövning under operationen. Denna långtidsuppföljning genomfördes med hjälp av journalgranskning och hade en deskriptiv och jämförande design med en kvantitativ ansats. Studiegruppen bestod av 40 patienter och kontrollgruppen 11 patienter. Studerade variabler var smärta mätt genom Visuell Analog Skala (VAS), behov av analgetika och mobilisering. Resultatet visade att det inte fanns någon signifikant skillnad mellan de båda grupperna när det gäller mobilisering under ett längre perspektiv. Det fanns dock en signifikant skillnad när det gäller smärta efter 3 månader, då studiegruppen uppgav en lägre grad av smärta än kontrollgruppen.</p> / <p>There are several methods for postoperative pain treatment after primary total hip replacement. It was shown in a earlier study at a Swedish hospital (below named as "the hip project") that "Local infiltration analgesia" (LIA) decreased pain, facilitated early postoperative mobility and earlier discharge from the hospital, compared with spinally administered morphine. Present study is a long term follow up of the hip project with two measures at 6 and 12 weeks. The study group was given LIA towards the end of the operation while the control group were given spinal morphine at the induction. Both groups had spinal analgesia during the surgery. The long term follow up was conducted by a comparative design and the data was collected from the patient’s charts and files. The variables were pain measured by Visual Analogous Scale (VAS), need of pain relieves and general mobility. The study group contained of 40 patients and the control group of 11. The result relived no significant differences between the two groups regarding long term mobility. There was, however, a significant difference in pain after 12 weeks; the study group had less pain that the control group.</p><p> </p><p> </p>

Vid operation av primär total höftplastik finns det olika metoder för postoperativ smärtlindring. En tidigare genomförd studie på ett mellansvenskt sjukhus (nedan kallad ”höftprojektet”) visade att ”Local infiltration analgesia” (LIA) initialt minskade postoperativ smärta, underlättade mobilisering samt förkortade vårdtiden, jämfört med spinalt morfin. I denna studie genomfördes en långtidsuppföljning av höftprojektet med mätningar efter 6 respektive 12 veckor. Studiegruppen hade fått LIA vid operationsslutet och kontrollgruppen spinalt morfin. Båda grupperna hade en spinal bedövning under operationen. Denna långtidsuppföljning genomfördes med hjälp av journalgranskning och hade en deskriptiv och jämförande design med en kvantitativ ansats. Studiegruppen bestod av 40 patienter och kontrollgruppen 11 patienter. Studerade variabler var smärta mätt genom Visuell Analog Skala (VAS), behov av analgetika och mobilisering. Resultatet visade att det inte fanns någon signifikant skillnad mellan de båda grupperna när det gäller mobilisering under ett längre perspektiv. Det fanns dock en signifikant skillnad när det gäller smärta efter 3 månader, då studiegruppen uppgav en lägre grad av smärta än kontrollgruppen. / There are several methods for postoperative pain treatment after primary total hip replacement. It was shown in a earlier study at a Swedish hospital (below named as "the hip project") that "Local infiltration analgesia" (LIA) decreased pain, facilitated early postoperative mobility and earlier discharge from the hospital, compared with spinally administered morphine. Present study is a long term follow up of the hip project with two measures at 6 and 12 weeks. The study group was given LIA towards the end of the operation while the control group were given spinal morphine at the induction. Both groups had spinal analgesia during the surgery. The long term follow up was conducted by a comparative design and the data was collected from the patient’s charts and files. The variables were pain measured by Visual Analogous Scale (VAS), need of pain relieves and general mobility. The study group contained of 40 patients and the control group of 11. The result relived no significant differences between the two groups regarding long term mobility. There was, however, a significant difference in pain after 12 weeks; the study group had less pain that the control group.

Este documento tiene como objetivo brindar propuestas de mejoramiento para evitar las infiltraciones en la presa Coltani - Tacna realizando un análisis del expediente técnico de la obra, la cual está actualmente paralizada. Estas serán realizadas por medio de la implementación de un muro impermeable conformado por Pilotes Secantes la cual es una técnica utilizada en presas de tierra para afrontar esta clase de problemas de ingeniería civil. La investigación estará dividida en secciones estratégicas para el entendimiento global, manteniendo un orden de la información. Primero, se definirán conceptos generales como los tipos de presas de tierra, sus elementos principales, requerimientos técnicos, principales fallas, técnicas de mejoramiento de suelos, infiltraciones, entre otros. Posteriormente se detallarán las características generales y específicas, tanto geológicas como geotécnicas del terreno del proyecto, recopilando la información necesaria del estudio de suelos. Luego se procederá a realizar un análisis de infiltración, mediante el uso del programa SLIDE, analizando el comportamiento del flujo del agua y caudales respuesta de la presa en su condición inicial, es decir sin la implementación del muro pantalla. Una vez analizado este comportamiento, se procederá a obtener el Caudal de Infiltración Máximo Permisible, cuyo valor servirá de base para las diferentes propuestas a considerar. Las variaciones de las alternativas para el control de infiltraciones estarán en base a dos diámetros diferentes (1.3 y 1.5m) de Pilotes Secantes con 3 posibles ubicaciones distintas, respecto a la presa (inicio, centro y final), con profundidades comprendidas entre 10 – 59m. Después se analizará el proceso constructivo de la técnica, la comparación en términos económicos respecto al costo de ejecución y se presentaran los planos y esquemas de las respectivas propuestas a considerar. Finalmente se elegirá la alternativa que presente un mayor potencial en base a la constructabilidad y costo para ser implementada como solución de la infiltración del agua en la presa Coltani. / The purpose of this document is to provide improvement proposals to avoid seepage in the Coltani - Tacna dam by analyzing the technical record of the project, which is currently paralyzed. These will be carried out through the implementation of an impermeable wall made up of Secant Piles, which is a technique used in earth dams to face this kind of civil engineering problems. The research will be divided into strategic sections for global understanding, maintaining an order of information. First, general concepts such as the types of earth dams, their main elements, technical requirements, main faults, soil improvement techniques, seepage, among others, will be defined. Subsequently, the general and specific characteristics, both geological and geotechnical, of the project land will be detailed, compiling the necessary information from the soil study. Then, a seepage analysis will be carried out, using the SLIDE program, analyzing the behavior of the water flow and response flows of the dam in its initial condition, that is, without the implementation of the screen wall. Once this behavior has been analyzed, the Maximum Permissible Seepage Flow will be obtained, whose value will serve as the basis for the different proposals to be considered. The variations of the alternatives for seepage control will be based on two different diameters (1.3 and 1.5m) of Secant Piles with 3 different possible locations, according to the dam (start, center and end), with depths between 10 - 59m. Afterwards, the construction process of the technique will be analyzed, the comparison in economic terms by the execution cost and the plans and diagrams of the respective proposals to be considered will be presented. Finally, the alternative that presents the greatest potential based on constructability and cost will be chosen to be implemented as a solution for water seepage in the Coltani dam. / Tesis

Cette étude a été subventionnée par le Fonds de recherche du Québec - Santé (FRQ-S, grant # 21230 – 2) / Les infiltrations foraminales cervicales sont associées à un risque de complications neurologiques majeures. Cette étude compare l’efficacité des infiltrations facettaires, plus sécuritaires, à celle des infiltrations foraminales dans le traitement de la cervico-brachialgie secondaire à une spondylose et/ou à une hernie discale, à 4 semaines post traitement. Cinquante-six sujets ont été randomisés pour recevoir une infiltration foraminale (15 hommes, 13 femmes ; âge moyen 52 ans) ou facettaire (8 hommes, 20 femmes ; âge moyen 44 ans). L’issue principale était l’intensité de la douleur mesurée sur une échelle visuelle analogique (0 – 100). Les issues secondaires étaient le Neck Disability Index et le Medication Quantitative Scale. Suivant les analyses en intention-de-traiter et en intention-du-protocole, pour un score de douleur initial moyen, une réduction significative de l’intensité de la douleur a été observée avec les infiltrations facettaires [45.3% (95%CI: 21.4; 69.2) et 37.0% (95%CI: 9.2; 64.7)] contrairement aux infiltrations foraminales [9.8% (95%CI: +11.5; 31.2) et 17.8% (95%CI: +6.6; 42.2)]. Les infiltrations facettaires ont procuré une amélioration cliniquement (mais non statistiquement) significative du Neck Disability Index [24.3% (95%CI: +2.9; 51.5) et 20.7% (95%CI: +6.2; 47.6),], contrairement aux infiltrations foraminales [9.6% (95%CI: +15.2; 34.4) et 12.8% (95%CI: +11.2; 36.7)]. Les infiltrations facettaires étaient au moins aussi efficaces que les infiltrations foraminales pour un score initial de douleur ≤ 60, alors que l’analyse de non infériorité n’était pas concluante pour un score initial ≥ 80, de même que pour le Neck Disability Index. Les infiltrations n’ont pas été associées à une réduction du score de Medication Quantitative Scale. Les infiltrations facettaires sont efficaces dans le traitement de la névralgie cervico-brachiale et représentent une alternative valable et plus sécuritaire aux infiltrations foraminales. / Transforaminal corticosteroid injections can be performed in the management of cervical radiculopathy but carry the risk of catastrophic complications. This study compares the efficacy of transforaminal and facet corticosteroid injections at 4 weeks post treatment. We randomly assigned 56 subjects to receive CT-guided transforaminal (15 men, 13 women; mean age 52 years; range 28 – 72 years) or facet (8 men, 20 women; mean 44 years; range 26 – 60 years) injections. The primary outcome was pain severity rated on a visual analog scale (0-100). Secondary outcome measures were the Neck Disability Index and the Medication Quantitative Scale. In the intention-to-treat and as-treated analyses, for a mean baseline score, facet injections demonstrated a significant pain score reduction of 45.3% (95%CI: 21.4; 69.2) and 37.0% (95%CI: 9.2; 64.7), while transforaminal injections showed nonsignificant pain score reduction of 9.8% (95%CI: +11.5; 31.2) and 17.8% (95%CI: +6.6; 42.2). While facet injections demonstrated an improvement in Neck Disability Index score of [24.3% (95%CI: +2.9; 51.5); 20.7% (95%CI: +6.2; 47.6),] as opposed to transforaminal injections [9.6% (95%CI: +15.2; 34.4); 12.8% (95%CI: +11.2; 36.7)], the results did not reach statistical significance. Noninferiority of facet to transforaminal injections was demonstrated for baseline pain score ≤ 60, while noninferiority analysis was inconclusive for baseline pain score ≥ 80 and for the Neck Disability Index score. Neither intervention showed a significant medication intake score reduction over time. Facet injections are effective for the treatment of cervical radiculopathy and represent a valid and safer alternative to transforaminal injections.

No description available.

<p>Moisture can significantly affect flexible pavement performance. As such, it is crucial to remove moisture as quickly as possible from the pavements, mainly to avoid allowing moisture into the pavement subgrade. In the 1990s the Indiana Department of Transportation (INDOT) adopted an asphalt pavement drainage system consisting of an open-graded asphalt drainage layer connected to edge drains and collector pipes to remove moisture from the pavement system.</p> <p>Over the intervening two decades, asphalt pavement materials and designs have dramatically changed in Indiana, and the effectiveness of the pavements drainage system may have changed. Additionally, there are challenges involved in producing and placing open-graded asphalt drainage layers. They can potentially increase costs, and they tend to have lower strength than traditional dense-graded asphalt pavement layers. </p> <p>Given the potential difficulties, the overall objective of this research was to evaluate the effectiveness of the INDOT’s current flexible pavement drainage systems given the changes to pavement cross-sections and materials that have occurred since the open-graded drainage layer was adopted. Additionally, the effectiveness of the filter layer and edge drains were examined.</p><p><br>Laboratory experiments were performed to obtain the hydraulic properties of field-produced asphalt mixture specimens meeting INDOT’s current specifications. The results were used in finite element modeling of moisture flow through pavement sections. Modeling was also performed to investigate the rutting performance of the drainage layers under various traffic loads and subgrade moisture conditions in combination with typical Indiana subgrade soils. The modeling results were used to develop a design tool that can assist the pavement designer in more accurately assessing the need for pavement drainage systems in flexible pavements.<br></p>