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We consider a conventional α – Ω -dynamo model with meridional circulation that exhibits typical features of the solar dynamo, including a Hale-cycle period of around 20 years and a reasonable shape of the butterfly diagram. With regard to recent ideas of a tidal synchronization of the solar cycle, we complement this model by an additional time-periodic α -term that is localized in the tachocline region. It is shown that amplitudes of some decimeters per second are sufficient for this α -term to become capable of entraining the underlying dynamo. We argue that such amplitudes of α may indeed be realistic, since velocities in the range of m s −1 are reachable, e.g., for tidally excited magneto–Rossby waves.

Objectives. Muscle shortening and spastic cocontraction in ankle plantar flexors may alter gait since early childhood in cerebral palsy (CP). We evaluated gastrosoleus complex (GSC) length, and gastrocnemius medialis (GM) and peroneus longus (PL) activity during swing phase, in very young hemiparetic children with equinovalgus. Methods. This was an observational, retrospective, and monocentric outpatient study in a pediatric hospital. Ten very young hemiparetic children (age 3 ± 1 yrs) were enrolled. These CP children were assessed for muscle extensibility (Tardieu scale XV1) in GSC (angle of arrest during slow-speed passive ankle dorsiflexion with the knee extended) and monitored for GM and PL electromyography (EMG) during the swing phase of gait. The swing phase was divided into three periods (T1, T2, and T3), in which we measured a cocontraction index (CCI), ratio of the Root Mean Square EMG (RMS-EMG) from each muscle during that period to the peak 500 ms RMS-EMG obtained from voluntary plantar flexion during standing on tiptoes (from several 5-second series, the highest RMS value was computed over 500 ms around the peak). Results. On the paretic side: (i) the mean XV1-GSC was 100° (8°) (median (SD)) versus 106° (3°) on the nonparetic side (p=0.032, Mann–Whitney); (ii) XV1-GSC diminished with age between ages of 2 and 5 (Spearman, ρ = 0.019); (iii) CCIGM and CCIPL during swing phase were higher than on the nonparetic side (CCIGM, 0.32 (0.20) versus 0.15 (0.09), p<0.01; CCIPL, 0.52 (0.30) versus 0.24 (0.17), p<0.01), with an early difference significant for PL from T1 (p=0.03). Conclusions. In very young hemiparetic children, the paretic GSC may rapidly shorten in the first years of life. GM and PL cocontraction during swing phase are excessive, which contributes to dynamic equinovalgus. Muscle extensibility (XV1) may have to be monitored and preserved in the first years of life in children with CP. Additional measurements of cocontraction may further help target treatments with botulinum toxin, especially in peroneus longus.

BACKGROUND: The aim of this study was to report on changes in the diagnostic assessment, patterns of care and survival over time for pancreatic cancers. METHODS: A total of 2986 cases of pancreatic cancer from the Digestive Cancer Registry of Burgundy (France) over a 30-year period (1976–2005) were considered. Non-conditional logistic regressions were carried out to identify the factors associated with resection for cure and with the use of chemotherapy. A multivariate relative survival analysis was carried out. RESULTS: Diagnostic procedures have changed. Ultrasonography and computed tomography progressively have become the major diagnostic procedures. There was a slight improvement in stage: the proportion of stage I–II was 2.8% in the 1976–1980 period and 8.8% in the 2001–2005 period ( P <0.001). There was a similar trend in the proportion of cases resected for cure, the corresponding percentages being 4.5 and 11.3%, respectively ( P <0.001). The 5-year relative survival increased from 2.0 to 4.2% ( P <0.001). In the multivariate relative survival analysis, the period remained a significant prognostic factor. Stage, sex, age and histology were independent prognostic factors. CONCLUSION: Over a 30-year period, there were minor changes in the stage at diagnosis, resection for cure and prognosis of pancreatic cancers, although there were improvements in the diagnostic modalities. Pancreatic cancer still represents a major challenge in oncology.

Evaluation of new drug combinations is needed to improve patients' prognosis in advanced hepatocellular carcinoma (HCC). The purpose of this study was to evaluate the safety and efficacy of the capecitabine–oxaliplatine combination (XELOX) in HCC patients. First-line chemotherapy with XELOX regimen consisting of a 3-week cycle of intravenous oxaliplatin (130 mg m −2 ) on Day 1, and oral capecitabine twice daily from Days 1–14 (1000 mg m −2 ) was administered in patients with measurable, unresectable HCC. Fifty patients (male, 88%; median age, 68 years) received a total of 295 cycles (median, 6) of treatment. Disease control (three partial responses, 29 stable diseases) rate was 72% (95% CI 57–83%). Median overall and median progression-free (PFS) survival was 9.3 months and 4.1 months, respectively. Progression-free survival rates at 6 and 12 months were 38% (95% CI 26–52%) and 14% (95% CI 7–26%), respectively. Main grade 3–4 drug-related toxicities included diarrhoea (16%), elevation of aminotransferases and/or bilirubin (16%), thrombocytopenia (12%), and neurotoxicity (6%). Capecitabine plus oxaliplatin regimen showed modest anti-tumour activity with tolerable toxicities in patients with advanced HCC. However, the manageable toxicity profile and the encouraging disease control rate deserve further attention for this convenient, outpatient-based chemotherapy regimen.

Because the term stress is used, most often subjectively, with variousmeanings, this paper first attempts to clarify the physiological definition,andthe appropriate terms as responses in different situations. The flexibility ofnormal metabolism allows the development of responses to environmental changeswhich fluctuate regularly and predictably over daily and seasonal cycles. Thusevery deviation of a factor from its optimum does not necessarily result instress. Stress begins with a constraint or with highly unpredictablefluctuations imposed on regular metabolic patterns that cause bodily injury,disease, or aberrant physiology. Stress is the altered physiological conditioncaused by factors that tend to alter an equilibrium. Strain is any physicaland/or chemical change produced by a stress, i.e. every established condition,which forces a system away from its thermodynamic optimal state. The papersecondly summarises the Strasser's state-change concept which is preciselythat suboptimality is the driving force for acclimation (genotype level) oradaptation (population level) to stress. The paper continues with the actualknowledge on the mechanisms of stress recognition and cell signalling. Briefly:plasma membranes are the sensors of environmental changes; phytohormones andsecond messengers are the transducers of information from membranes tometabolism; carbon balance is the master integrator of plant response; betwixtand between, some genes are expressed more strongly, whereas others arerepressed. Reactive oxygen species play key roles in up- and down-regulation ofmetabolism and structure. The paper shows finally that the above concepts canbeapplied to plant tissue cultures where the accumulating physiological andgenetical deviations (from a normal plant behaviour) are related to thestressing conditions of the in vitro culture media and ofthe confined environment. The hyperhydrated state of shoots and the cancerousstate of cells, both induced under conditions of stress in invitro cultures, are identified and detailed, because they perfectlyillustrate the stress-induced state-change concept. It is concluded that stressresponses include either pathologies or adaptive advantages. Stress may thuscontain both destructive and constructive elements : it is a selection factoraswell as a driving force for improved resistance and adaptive evolution.[PUBLICATION ABSTRACT]

Purpose Thoracic adolescent idiopathic scoliosis (AIS) curves (Lenke 1–4) are often characterized by hypokyphosis. Sagittal alignment remains challenging to correct, even with recent posterior segmental instrumentation. Some authors recommend anterior endoscopic release (AER) to reduce anterior column height, and facilitate thoracic kyphosis correction. The aim of this study was to assess the contribution of AER to sagittal correction in hypokyphotic AIS. Methods Fifty-six hypokyphotic (T4T12<20°) AIS patients were included. In group 1 (28 patients), patients first underwent AER, followed by posterior instrumentation and correction 5–7 days later. In group 2 (28 patients), patients underwent the same posterior procedure without AER. Posterior correction was performed in all cases using posteromedial translation and hybrid constructs consisting of lumbar pedicle screws and thoracic sublaminar bands. From radiological measurements performed using low-dose EOS radiographs, the correction of thoracic kyphosis was compared between the two groups. Results Groups 1 and 2 were comparable regarding demographic data and preoperative thoracic kyphosis (group 1: 11.7° ± 6.9° vs group 2: 12.1° ± 6.3°, p  = 0.89). Postoperative thoracic kyphosis increase averaged 18.3° ± 13.6° in group 1 and 15.2° ± 9.0° in group 2. The benefit of anterior release was not statistically significant ( p  = 0.35). Conclusion Although previous studies have suggested that thoracoscopic release improved correction compared to posterior surgery alone, the current study did not confirm this finding. Moreover, results of the current series showed that no significant benefit can be expected from AER in terms of sagittal plane improvement when the posteromedial translation technique is used, even in challenging hypokyphotic patients.

We consider a conventional α α– Ω Ω-dynamo model with meridional circulation that exhibits typical features of the solar dynamo, including a Hale-cycle period of around 20 years and a reasonable shape of the butterfly diagram. With regard to recent ideas of a tidal synchronization of the solar cycle, we complement this model by an additional time-periodic α α-term that is localized in the tachocline region. It is shown that amplitudes of some decimeters per second are sufficient for this α α-term to become capable of entraining the underlying dynamo. We argue that such amplitudes of α α may indeed be realistic, since velocities in the range of m s−1 are reachable, e.g., for tidally excited magneto–Rossby waves.

Intragastric band migration is a rare and late complication of laparoscopic -adjustable gastric banding and should be recognized by all digestive surgeons. Endoscopic removal is most commonly performed, but surgery is an alternative in cases of endoscopic failure. Many different procedures have been reported. We show here (see Video ) a fully laparoscopic endogastric procedure through two 5-mm antral gastrotomies. This technique can also be used to remove benign endogastric tumors. The procedure is safe and provides a large endogastric operative area, with no particular morbidity. Endogastric removal through a fully laparoscopic approach should be considered as the first alternative to endoscopic approach.

Purpose In the last few years several reports stressed the importance of sagittal alignment in adolescent idiopathic scoliosis (AIS) patients. It was recently reported that T1 slope, defined as the angle between the superior endplate of T1 and the horizontal, correlates strongly with overall sagittal parameters. The aim of this study was to assess the impact of T1 parameters (T1-slope and T1-tilt) on sagittal alignment of AIS hypokyphotic patients preoperatively and postoperatively. Methods Twenty-nine AIS patients with <20° preoperative hypokyphosis were included in a retrospective study. Surgery systematically comprised hybrid construct with screws below T11, sublaminar bands at thoracic level and a lamino-laminar claw on the upper instrumented vertebra. Preoperative, postoperative and 2-year follow-up radiological assessment included Cobb angle, T1 slope, T1 sagittal tilt, regional sagittal parameters and pelvic parameters. Results In the series as a whole, coronal Cobb angle was significantly reduced postoperatively (58° vs. 17°; p  < 0.001), thoracic kyphosis significantly improved (12.4° vs. 25.6°; p  < 0.001) and cervical lordosis significantly restored (6.2° kyphosis vs. 4.1° lordosis; p  < 0.001). There was a significant modification in T1-slope (10.2° vs. 18.2°; p  < 0.001). Preoperatively, T1 slope was significantly correlated with T1 tilt ( r  = 0.427; p  = 0.029). Postoperatively, T1 slope was significantly correlated with T1 tilt ( r  = 0.549; p  = 0.002), thoracic kyphosis ( r  = 0.535, p  = 0.005) and cervical lordosis ( r  = −0.444, p  = 0.03). Restoration of cervical lordosis was significantly correlated to changes of T1-slope ( r  = −0.393, p  = 0.032), which was significantly correlated to postoperative thoracic kyphosis. Conclusion According to these results, T1 seems to be of major interest in postoperative modifications of sagittal alignment. T1 slope and sagittal tilt are good indicators of postoperative changes for regional (cervical lordosis and thoracic kyphosis) and global parameters. We therefore consider these parameters as essential in the assessment of AIS patients. Further studies and correlation with clinical scores will, however, be necessary in order to confirm the present findings.

Purpose Surgical adolescent idiopathic scoliosis (AIS) management can be associated with loss of thoracic kyphosis and a secondary loss of lumbar lordosis leading to iatrogenic flatback. Such conditions are associated with poorer clinical outcomes during adulthood. The aim of this study was to evaluate sagittal plane reciprocal changes after posterior spinal fusion in the setting of AIS. Methods Thirty consecutive adolescents (mean age 14.6 years) with AIS Lenke 1, 2 or 3 were included in this retrospective study with 2 year follow-up. Full-spine standing coronal and lateral radiographs were obtained preoperatively, at 3 and 24 months postoperatively. Coronal Cobb angle, thoracic kyphosis (TK) and lumbar lordosis (LL) were measured. Surgical procedure was similar in all the cases, with use of pedicular screws between T11 and the lowest instrumented vertebra (≥L2), sublaminar hooks applied in compression at the upper thoracic level and sub-laminar bands and clamps in the concavity of the deformity. Statistical analysis was done using t test and Pearson correlation coefficient. Results Between preoperative and last follow-up evaluations a significant reduction of Cobb angle was observed (53.6° vs. 17.2°, p  < 0.001). A significant improvement of the instrumented thoracic kyphosis, TK (19.7° vs. 26.2°, p  < 0.005) was noted, without difference between 3 and 24 months postoperatively. An improvement in lumbar lordosis, LL (43.9° vs. 47.3°, p  = 0.009) was also noted but occurred after the third postoperative month. A significant correlation was found between TK correction and improvement of LL ( R  = 0.382, p  = 0.037), without correlation between these reciprocal changes and the amount of coronal correction. Conclusion Results from this study reveal that sagittal reciprocal changes occur after posterior fusion when TK is restored. These changes are visible after 3 months postoperatively, corresponding to a progressive adaptation of patient posture to the surgically induced alignment. These changes are not correlated with coronal plane correction of the deformity. In the setting of AIS, TK restoration is a critical goal and permits favorable postural adaptation. Further studies will include pelvic parameters and clinical scores in order to evaluate the impact of the noted reciprocal changes.