François Delvaux

Inhaled fluticasone reduces bronchial responsiveness and airway inflammation in cats with mild chronic bronchitis.

This study investigated the effect of inhaled fluticasone on lower airway inflammation and bronchial responsiveness (BR) to inhaled carbachol in cats with very mild, chronic bronchitis (n=5) that were compared with healthy cats serving as controls (n=6). Chest radiographs, BR tests performed non-invasively by barometric whole body plethysmography (BWBP) and bronchoalveolar lavage (BAL) were performed before and after treatment. BR was quantified by calculating the concentration of carbachol inducing bronchoconstriction (C-Penh300%), defined as a 300% increase of baseline Penh, an index of bronchoconstriction obtained by BWBP. BAL fluid was analyzed cytologically and the oxidant marker 8-iso-PGF2α was determined. At test 1, healthy cats and cats with bronchitis were untreated, whereas for test 2 inhalant fluticasone (250 μg once daily) was administrated for 2 consecutive weeks to cats with bronchitis. Control cats remained untreated. Inhaled fluticasone induced a significant increase in C-Penh300% and a significant decrease of BAL fluid total cells, macrophages, neutrophils and 8-iso-PGF2α in cats with bronchitis, whilst untreated control cats did not show significant changes over time. This study shows that a 2-week fluticasone treatment significantly reduced lower airway inflammation in very mild bronchitis. BR could be successfully monitored in cats using BWPB and decreased significantly in response to inhaled fluticasone. 8-Iso-PGF2α in BAL fluid was responsive to treatment and appeared as a sensitive biomarker of lower airway inflammation in cats.

Bronchodilators in bronchoscopy-induced airflow limitation in allergen-sensitized cats.

This study investigated the effect of bronchoscopy and bronchoalveolar lavage (BAL) on respiratory function, determined by barometric whole-body plethysmography (BWBP), of healthy and allergen-sensitized cats. Furthermore, the efficacy of inhaled bronchodilators in preventing changes in respiratory function was determined. For test 1, 18 healthy experimental cats were investigated on day 1 by BWBP. On day 2, the cats underwent BWBP after sedation (medetomidine), after anesthesia induction (propofol), and after bronchoscopy and BAL. Enhanced pause (Penh) was significantly increased after bronchoscopy and BAL (1.64 +/- 0.17 versus 1.23 +/- 0.07, P < .05). For test 2, 6 cats were sensitized to ovalbumin (OVA), 6 cats were sensitized to Ascaris suum (AS), and 6 cats served as controls. On day 0, OVA- and AS-sensitized cats underwent an inhaled allergen challenge, whereas controls were exposed to saline. On days 1 and 2, the same protocol as described for test 1 was repeated. Post-BAL Penh of the AS-sensitized cats was significantly higher than at test 1 (2.28 +/- 0.22 versus 1.69 +/- 0.33, P < .05) and was correlated with BAL fluid neutrophil count (r = 0.55, P < .05). During tests 3, 4, and 5, the same protocol as used for test 2 was applied to each cat group, with the animals being randomly treated before sedation with inhaled salbutamol (200 microg), ipratropium bromide (40 microg), or a combination of both (200 + 40 microg). Post-BAL Penh of the AS-sensitized group was significantly decreased after the salbutamol + ipratropium bromide treatment (1.56 +/- 0.18 versus 2.28 +/- 0.22, P < .05). This study suggests that bronchoscopy and BAL induce airflow limitation in cats, which is more severe in the presence of lower airway inflammation. Inhaled salbutamol + ipratropium bromide reduce BAL-induced bronchoconstriction in AS-challenged cats and might be recommended as preventive treatment of asthmatic cats undergoing bronchoscopy.

An immunohistochemical study of the inflammatory infiltrate associated with nasal carcinoma in dogs and cats.

The aims of this study were to characterize the inflammatory infiltrate associated with nasal carcinoma in dogs and cats and to determine whether this differed between the two species or with different types of carcinoma. Sections from fixed tissue biopsy samples of intranasal carcinoma from 31 dogs and six cats were labelled immunohistochemically to detect expression of the T-lymphocyte marker CD3, class II molecules of the major histocompatibility complex (MHC II), the myelomonocytic antigen MAC387 and immunoglobulin (Ig) G, IgA and IgM within the cytoplasm of plasma cells. All canine carcinomas were heavily infiltrated by MAC387(+) neutrophils, with smaller numbers of MAC387(+) macrophages. T cells were particularly prominent in the infiltrate associated with transitional carcinoma, and in such tumours were frequently mixed with MHC II(+) cells having macrophage or dendritic cell morphology. IgG(+) and IgA(+) plasma cells were detected at the peripheral margins of all types of canine carcinoma. In contrast, feline intranasal carcinoma was invariably associated with a marked infiltration of CD3(+) T cells. The feline tumour infiltrates contained sparse neutrophils and macrophages and few IgG(+) and IgA(+) plasma cells. These findings suggest that qualitatively different immune responses are induced in response to specific types of canine intranasal carcinoma, and that the canine and feline immune response to these neoplasms is also distinct.

Return-To-Play criteria after hamstring injury: actual medicine practice in professional soccer

Background Return-to-play (RTP) criteria after a sport injury represent a key point in order to decrease the risk of subsequent re-injury. Objective To analyze how clinicians decide, in their daily practice, when a hamstring injured professional soccer player is fully able to get back to competitive activities. Methods Thirty-seven doctors for French and Belgian professional soccer clubs filled in a questionnaire formulated with multiple choice questions. Results Nearly 80% of the questioned doctors declared to use at least 7 criteria in order to assess players ability to return to competitive soccer after a hamstring injury. The most important ones are: complete pain relief, normalized muscle strength assessment, subjective feeling reported by the player, normalized flexibility and achievement of a specific soccer test. For some of these criteria, most notably muscle strength assessment, there is a lack of consensus about the choice of assessment parameters and the limit value allowing doctors to authorize or forbid RTP. Our study also highlighted the interest for clinicians to consider the opinion of physical therapists and physical trainers. Conclusion After a hamstring injury, clinicians for professional soccer clubs assess players ability to return to full sport according to a “criteria-approach” instead of a “timed-based” approach. However, even if the scientific evidence about this topic is not sufficient at the moment, the implementation, in daily practice, of scientifically demonstrated assessment parameters and limit values should help the RTP decision and decrease the risk of re-injury.

Cross-cultural Adaptation and Validation of the Victorian Institute of Sport Assessment-Patella Questionnaire for French-Speaking Patients With Patellar Tendinopathy

Study Design Clinical measurement study. Background The Victorian Institute of Sport Assessment-Patella (VISA-P), originally developed in English, assesses the severity of patellar tendinopathy symptoms. To date, no French version of the questionnaire exists. Objectives The aim of our study was to translate the VISA-P into French and verify its psychometric properties. Methods The translation and cultural adaptation were performed according to international recommendations in 6 steps: initial translation, translation merging, back translation to the original language, use of an expert committee to reach a prefinal version, test of the prefinal version, and expert committee appraisal of a final version. Afterward, the psychometric properties of the final French version (VISA-PF) were assessed in 92 subjects, divided into 3 groups: pathological subjects (n = 28), asymptomatic subjects (n = 22), and sports-risk subjects (n = 42). Results All members of the expert committee agreed with the final version. On a scale ranging from 0 to 100, with 100 representing an asymptomatic subject, the average ± SD scores on the VISA-PF were 53 ± 17 for the pathological group, 99 ± 2 for the healthy group, and 86 ± 14 for the sports-risk group. The test-retest reliability of the VISA-PF was excellent, with good internal consistency. Correlations between the VISA-PF and divergent validity of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) were low, and the correlation coefficient values measured between the VISA-PF scores and converged items of the SF-36 were higher. Conclusion The VISA-PF is understandable, valid, and suitable for French-speaking patients with patellar tendinopathy. J Orthop Sports Phys Ther 2016;46(5):384-390. Epub 21 Mar 2016. doi:10.2519/jospt.2016.5937.

Validity and reliability of the French translation of the VISA-A questionnaire for Achilles tendinopathy

Abstract Purpose: The Victorian Institute of Sport Assessment – Achilles tendinopathy questionnaire (VISA-A) evaluates the clinical severity of Achilles tendinopathy. The aim of this study was to translate the VISA-A into French and to study the reliability and validity of this French version, the VISA-AF. Method: The VISA-A was translated into French to produce the VISA-AF using a validated methodology in six steps. Thereafter, several psychometric properties of this French version such as test–retest reliability, internal consistency, construct validity and floor and ceiling effects were evaluated. Therefore, we recruited 116 subjects, distributed into 3 groups: pathological patients (n = 31), at-risk athletes (n = 63) and healthy people (n = 22). Results: The final version of the VISA-AF was approved by an expert committee. On a scale ranging from 0 to 100, the average scores of the VISA-AF obtained were 59 (± 18) for the pathological group, 99 (± 1) for the healthy group and 94 (± 7) for the at-risk group. The VISA-AF shows excellent reliability, low correlations with the discriminant subscales of the SF-36 and moderate correlations with the convergent subscales of the SF-36. Conclusions: The French version of the VISA-A is equivalent to its original version and is a reliable and valid questionnaire for French-speaking patients with Achilles tendinopathy. Implication for Rehabilitation The VISA-AF questionnaire is a reliable translation of the original VISA-A, from English into French, which is one of the most widespread languages in the world. The VISA-AF questionnaire is now a valid instrument that can be used by clinicians and researchers to assess the severity of pain and disability of French-speaking subjects with Achilles tendinopathy. The VISA-AF is a questionnaire to assess the severity of Achilles tendinopathy symptoms but is not a diagnostic tool.

Comparison of 4 point-of-care blood gas analyzers for arterial blood gas analysis in healthy dogs and dogs with cardiopulmonary disease

Objective – To compare blood gas results obtained from 4 point-of-care (POC) blood gas analyzers under routine working conditions in order to determine their interchangeability. Design – Prospective study. Setting – University teaching hospital. Animals – Arterial blood samples from 34 dogs, 22 presented for cardiorespiratory disease and 12 healthy experimental Beagles. Measurements – Each sample was analyzed by 4 POC blood gas analyzers in a random order: Cobas b-123 POC system, IRMA TruPoint, Idexx VetStat, and ABL80 FLEX. Values obtained for pH, partial pressure of oxygen (PO2), and partial pressure of carbon dioxide (PCO2) were compared between analyzers using a statistical mixed linear model and the Bland–Altman method; P < 0.05 was set as the level of significance. One sample was also repeatedly measured 5 times on each machine to calculate and compare intra-analyzer variance for each measured variable using Fisher-statistics. Results – PO2 and PCO2 values were significantly higher when measured with the Idexx and IRMA machine than with Cobas and ABL80 (PO2: P < 0.001; PCO2: P < 0.05). pH values were significantly higher when measured with the Idexx instrument than with others’ devices (P < 0.01). An interaction between health status and results delivered by devices was found only for PO2 values. There was no significant difference in intraanalyzer variance between the 4 machines, for any of the measured variables. Conclusions – PO2, PCO2, and pH differed significantly between the 4 analyzers. Differences in PO2 results were substantial and clinically relevant. All 4 analyzers displayed good intra-analyzer variance. Consequently, serial blood gas analysis should be performed on a single device and interpreted in accordance of the device’s specific reference intervals. (J Vet Emerg Crit Care 2016; 00(0): 1–8) doi: 10.1111/vec.12469

The risk factors for the rupture of the anterior cruciate ligament of the knee: the neuromuscular state

A ll au th or s ab id e by th e A ss oc ia o n fo r M ed ic al E th ic s (A M E) e th ic al ru le s of d is cl os ur e. Abstract Introduction Multiple factors act conjointly to in luence the risk of injury of the anterior cruciate ligament of the knee. An understanding of neuromuscular factors remains necessary, although this does not guarantee a complete analysis of the risks of injury to the anterior cruciate ligament. Women have a greater risk of injury to the anterior cruciate ligament in comparison to men. This can be explained by an increase in the internal rotation of the hip, coupled with an increase in the external rotation of the tibia and increased muscular activation of the quadriceps (with a concomitant decrease in hamstring activity) during landing or pivotal movements. In addition, muscular fatigue of the hamstrings and a weak hamstring/ quadriceps ratio could contribute to the risk of injury to the anterior cruciate ligament. Finally, a lack of relative joint stiffness can also constitute a risk factor of injury to the anterior cruciate ligament in women. Other potential neuromuscular risk factors could also be highlighted. Screening for these risk factors, for example, by means of a functional jump-landing test, together with an isokinetic test, could help to recommend new prevention protocols. The aim of this review was to discuss the risk factors for the rupture of the anterior cruciate ligament of the knee. Conclusion Thanks to an overall knowledge of all the possible risk factors (intrinsic and extrinsic, modi iable or not), sports people who are predisposed to a recurrence of rupture of the anterior cruciate ligament could be identi ied. However, the hypothetical neuromuscular factors reported till date do not offer a complete understanding of this risk.

Preseason Strength Assessment of the Rotator Muscles and Shoulder Injury in Handball Players

CONTEXT   Few researchers have identified intrinsic risk factors for shoulder injury in team handball players by analyzing measurements of maximal isokinetic rotator muscle strength. OBJECTIVE   To identify possible intrinsic risk factors for shoulder injury by analyzing measurements of maximal isokinetic rotator muscle strength. DESIGN   Cross-sectional study. SETTING   Male team handball senior divisions (the highest level) in France and Belgium. PATIENTS OR OTHER PARTICIPANTS   A total of 108 male high-level handball players (age = 24 ± 4 years, height = 189 ± 6 cm, mass = 87 ± 11 kg) were enrolled. MAIN OUTCOME MEASURE(S)   All players completed a preseason questionnaire and performed a bilateral isokinetic assessment of the shoulder rotator muscles. On a monthly questionnaire, players reported any shoulder injury that they sustained during the season. RESULTS   On the preseason questionnaire, 51 of 108 (47%) participants reported a history of dominant-shoulder injury. A total of 106 participants completed the in-season questionnaire, with 22% (n = 23) reporting a shoulder injury on their dominant side during the subsequent season. Fourteen percent (n = 15) sustained microtraumatic injuries, and 8% (n = 8) described a traumatic injury. Backcourt players had a 3.5-times increased risk of injury during the new season compared with players in other positions. Among the isokinetic results, no risk factor for further injury was identified in handball players with microtraumatic injuries. For traumatic injuries, the concentric maximal strength developed by the internal rotators at high speed (240°/s) in the dominant shoulder was a protective factor against the risk of further injury. CONCLUSIONS   These results can potentially identify intrinsic risk factors for shoulder injury and may be used to determine potential interventions for reducing this risk in handball players.

ECCENTRIC TRAINING FOR ELBOW HYPERMOBILITY

Background Patients with hypermobility suffer from joints problems and chronic pain is the most frequently reported symptom. Objective Eccentric muscle strengthening could be very important to protect hypermobile joints. Design Case report. Setting Amateur tennis player. Patient A girl (16 y.o.) affected by an Ehler-Danlos syndrome presented pain in the right elbow and the right wrist after a season of tennis. Interventions Her training consisted of wrist prono-supination and flexion-extension muscle group reinforcement and proprioceptive training. To protect the wrist against excessive load, the eccentric strengthening exercises of prono-supinator and flexor-extensor muscles of elbow and wrist were undertaken gradually, at increasing speeds within a limited range of motion in flexion and extension, on an isokinetic device after an evaluation. She was also given an orthesis restricting the joint range of motion of the wrist. Main outcome measurements The evaluation was made by isokinetic evaluation, visual analog scale and MOS-SF36 questionnaire before and after training. Results The patient rapidly noted a decrease in pain and an increase in the stability of her right arm even when playing tennis. Isokinetic evaluation objectified a significant improvement in maximal torque in flexion-extension muscles of the right elbow. She was also given individualized home exercises. Conclusions The goal of this eccentric training is to avoid hypermobility by using the muscles as a protective brake in the control of joint positioning. Muscles can be reinforced in eccentric mode with starting position at the maximum length of these muscles when unstreched. The exercises can be carried out safely on an isokinetic device, at slow speed and limited range of joint motion to avoid risk of luxation. Thus, in this case report, the eccentric exercises using an isokinetic device were effective to safely reinforce the muscles as a protective brake for joint hypermobility and prevent pain during practicing tennis.