We tried to adhere to the ‘rule of 10’ meaning not including more than one variable per event (Peduzzi et al 1996). Therefore, a maximum of 11 baseline variables were included in the analysis for the total population and a total of 12 variables were included for the analyses

on the non-recovered participants at 3 months follow-up. First, a univariate model was constructed for each of the prognostic factors separately. Second, factors with a p value < 0.15 on the Wald test in univariate models were entered into backward multivariate selection model. Linear regression models were constructed for the potential prognostic factors at baseline and three months follow-up for the outcome measures recovery and pain during running. Selleck SP600125 Logistic regression models were constructed for the use of baseline and three months variables for the outcome measures instability and re-sprains. The results of each linear regression is presented as a beta (β) with a 95% confidence interval (95% Cl) and the result of each logistic regression Entinostat is presented as an odds ratios (OR) with 95% CL Table 1 presents the patient characteristics and potential

prognostic factors of the study population at baseline. Of the 102 participants, 64 (63%) contacted a general practitioner and 38 (37%) an emergency department physician. A total of 49 (48%) participants visited a physical therapist in addition to usual care, and 53 (52%) participants received usual care only. Nine of these participants did not participate in both the 3 month and 12 month follow-up measurements. These nine participants did not differ significantly from participants who completed the 12 month study period regarding their injury grade, re-injuries, and subjective recovery at the earlier follow-up points. The flow of participants through the study is presented in Figure 1. Table 2 presents data on recovery,

instability, re-sprains, Ankle Function Score, and pain intensity at baseline, 3 months and 12 months. At 3 months, 75% of the participants reported incomplete recovery, and Sodium butyrate this decreased to 53% at 12 months. At 12 months, 55% of the participants still reported a feeling of instability. In total 24% of the participants reported at least one re-sprain during the first three months compared with 28% during the 12 months of follow-up. About 15% of all participants experienced pain during rest at 3 months follow-up, decreasing to 10% at 12 months. After 12 months, 8% of the participants still experienced pain during walking, while 22% still experienced some pain during running at the 12 month follow-up. Prognostic factors for outcome at 12 months: The Ankle Function Score (β = 0.024, 95% CI 0.01 to 0.05) was univariately associated with recovery at the 12 month follow-up, but this did not reach statistical significance ( Table 3).

(2010) [17], and are caused by the overflow metabolism. High lactate concentrations may be prevented by using other carbon sources like fructose or galactose AP24534 [8] and [17]. The ammonia concentration was around 1 mM at the end of the cultivations, which is at an acceptable level that does not inhibit cell growth [21]. Since media was not changed prior to virus culture, these lactate and ammonia concentrations were present at virus infection. The use of VP-SFM during cell and virus culture appeared beneficial for virus yields when compared to cultivation using serum containing medium during cell culture and M199 during virus culture. In earlier studies

[1], using the latter media, d-antigen levels reported for production at 350-L scale were 120, 25 and 56 DU mL−1 for respectively Sabin poliovirus type 1, 2 and 3. The use of VP-SFM resulted in a 1.5 times higher level of antigenic product concentration using batch cultivations and 4 fold when using a recirculation culture prior to virus infection. It should be noted that here virus cultures were carried out using spent media. Regarding the nutrient and waste metabolite concentrations it might be even more beneficial to change the media prior to virus culture or to feed possible depleted nutrients during virus culture. This type of optimization may result in a favourable host cell metabolic condition with respect to virus

production. Differences in d-antigen yield per cell between batch or semi-batch and perfusion or recirculation were observed (Fig. 5). At higher cell densities the virus yield per cell decreased. This selleck chemicals llc might be an example others of the so-called “cell

density effect” first described by Wood et al. [22] and observed for different virus cultivation systems [16], [20], [23] and [24]. In several cases nutrient limitation or the presence of inhibitory factors may have caused this effect [16], [23] and [24]. In others, the cause remains to be found [20] and [25]. Here, the concentrations of the main nutrients, glucose and glutamine, and waste products, lactate and ammonia, were at less favourable levels during batch or semi-batch, while the highest specific product yields were observed under these conditions. We thus concluded that these concentrations are less relevant when compared with other phenomena that influence the cells ability to produce virus. These other aspects could be the growth rate at virus infection, the presence of multilayers, or the capacity (surface space) to continue growth after virus infection. Cell growth rates at time of virus infection were lower under all high cell density strategies compared to the growth rates observed in batch cultivations and thus do not explain for the difference in cell specific d-antigen yield observed between semi-batch and perfusion or recirculation cultures. Possibly, the presence of a multilayer has a more important negative effect.

In contrast, the exercising animals showed over time significantly less exploration behavior (walking and rearing). A remarkable observation was that during the second half of the novelty exposure these rats showed a progressive increase in lying and resting/sleeping behavior (Droste et al., 2007 and Collins et al., 2009). We concluded that exercising rats are substantially quicker in assessing a new environment regarding its potential dangers (and

opportunities) and after this assessment has been made these animals return to their normal behavior for this time of the day (early morning) which is resting and sleeping. This rapid assessment capability in the physically active animals is most likely the result of enhanced cognitive abilities in combination with a reduced state of anxiety. These Selleckchem DAPT observations underscore the benefit of regular physical activity for boosting resilience. To obtain insight into the molecular mechanisms underlying

the behavioral changes brought about by regular physical exercise we investigated the role of the signaling molecules pERK1/2 and pMSK1/2 and the IEG product c-Fos after forced swimming. As a detailed survey of pERK1/2 and pMSK1/2 had never been undertaken before, we assessed the immuno-reactivity of these molecules in many nuclei throughout the brain focusing on those brain regions known to AC220 purchase be involved in the stress response. In control (sedentary) rats at baseline, the number of pERK1/2-positive (pERK+) neurons was very low in the neocortex, except for the moderate numbers found in the piriform cortex (Collins A. & Reul J.M.H.M, unpublished). At 15 min after the start of forced swimming (15 min,

25 C water) the number of pERK+ neurons had moderately to strongly increased in the cingulate, somatosensory, motor, perirhinal, these prelimbic and infralimbic cortex but not in the piriform cortex. Moderate to strong increases were observed in the lateral septal nucleus, nucleus accumbens, locus coeruleus and dorsal raphe nucleus whereas no effects or small effects were observed in the magnocellular and parvocellular neurons of the hypothalamic PVN, central, medial and lateral nucleus of the amygdala, globus pallidus, caudate putamen, and median raphe nucleus. In the hippocampus, as shown before (Gutierrez-Mecinas et al., 2011), strong increases in pERK+ neurons were selectively found in the dorsal blade of the dentate gyrus (Fig. 2) whereas no or only small increments were found in the ventral blade of the dentate gyrus, CA1, CA2 and CA3 (Collins A. & Reul J.M.H.M, unpublished). In the neocortex of sedentary rats, the number of pMSK1/2-positive (pMSK+) neurons (presenting as nuclear staining) was low under baseline conditions except in the piriform cortex where numbers were already high under these conditions.

5%) refused to participate, three (1.5%) were missed due to staff anticipating an early discharge date, and 53 (26%) were recruited. The baseline characteristics of participants are shown in Table 1. Two participants were wrongly recruited into the randomised controlled trial (ie, they met the minimum criteria); however they continued through the duration of the trial. All participants commenced the intervention to which they were originally

allocated. Two participants in the experimental group completed fewer than four of the six classes scheduled in the protocol: one was recovering from cranioplasty, and one failed to attend. Three participants in the control group completed fewer than four of the classes, all due to failure to attend. The circuit class provided a sufficient cardiorespiratory exercise dosage for 15/53 (28%, 95% CI 18 to 42) of the participants in the observational study screening assay according to the heart rate reserve criteria, and for 33/53 (62%, 95% CI 49 to 74) of participants according to the caloric expenditure criteria. Overall, participants spent

< 20 mins in their heart rate training zone (mean 13 min, SD 14) but expended > 300 kcal (mean 377 kcal, SD 137), as presented in Table 2. The intensity of the circuit class was low (mean 34.3% heart rate reserve, SD 16.7) and the duration was long (mean 52.1 minutes, SD 3.1). DAPT manufacturer Figure 2 presents the within-subject variability between classes during the baseline period. Four out of 15 participants whose average time in the heart rate training zone was > 20 minutes had at least one class where they exercised below threshold for a cardiorespiratory fitness training effect. Conversely, 7 of 38 participants whose average time

in the heart rate training zone was < 20 minutes had at least one class where they exercised above threshold for a cardiorespiratory fitness training effect. Twelve of the 53 participants were not able to spend any time in their heart rate training zone for any classes. There was no significant difference between the experimental group and the control group for the time spent in the heart rate training zone during the intervention period or during the re-assessment out period. The mean time spent in the heart rate training zone during the intervention period was 10.9 minutes (SD 10.8) for the experimental group versus 6.1 minutes (SD 7.5) for the control group; mean difference 4.8 minutes (95% CI –1.4 to 10.9). The mean time spent in the heart rate training zone during the re-assessment period was 8.3 minutes (SD 8.9) for the experimental group versus 7.1 minutes (SD 9.4) for the control group; mean difference 1.9 minutes (95% CI –4.4 to 8.3), as presented in Figure 3. The smallest clinically important between-group difference chosen for this trial was 33% of the total exercise time spent in the heart rate training zone.

2 and 16

The biogenic entities are found to secrete large amount of proteins which are found to be responsible for metal ion reduction and morphology control.17 In different microorganisms, various enzymes are believed to take part in the bioreduction process involving the transport of electrons from certain electron donors to metal electron acceptors. Some studies of non-enzymatic reduction mechanism suggested that some organic functional groups of microbial cell walls could be responsible for the bioreduction process.18 All the above mechanisms selleck chemical could result in the intracellular or extracellular complexation and the deposition of metal nanoparticles. Biogenic nanoparticles are toward a greener approach and environment friendly with no toxic hazardous chemical employed in synthesis protocol with synthesis process taking place at ambient temperature and pressure conditions.19, 20 and 21 Mean while marine microorganisms are reported to reduce the metallic ions and convert them into phosphates, sulfides, carbonates, and/or intracellularly sequester CH5424802 chemical structure them with low molecular weight such as cysteine rich proteins glutathione or phytochelatins which are induced upon

exposure to metals in biological system.22, 23, 24, 25 and 26 The metal peptide interaction is another incentive to use the biosynthetic route for nanoparticle synthesis as capping of metal nanoparticles by peptides such as phytochelatins prevents aggregation into bulk crystals, thus yielding stable nanoparticles.27 The variable biodiversity in the marine environment with that of the terrestrial environment influence researchers to exploit marine flora in array of applications, the interference between marine microbial systems and nanotechnology has opened a new avenue by employing marine microorganism in synthesis of nanoparticles.

Based on the literature pursued it is reported that when two isolates of marine actinomycetes i.e., Streoptomyces parvulus SSNP11 GBA3 and Streptomyces albidoflavus CNP10 challenged with silver nitrate and incubate at 30 °C .The bioreduction of the silver ions was associated with metabolic processes utilizing nitrate by reducing nitrate to nitrite and ammonium. The produced silver nanoparticles exhibited maximum absorbance at 400–410 nm in UV–Vis spectroscopy. The reaction products were analyzed using transmission electron microscopy, X-ray diffraction (XRD) and Fourier transform infrared spectroscopy. The study also reported that the production of silver nanoparticles was both intra and extracellular. The report also suggested that exposure to varying temperature, pH and substrate concentration influences, directly or indirectly, the rate of nanoparticles fabrication. 28 Similarly six fungal strains were isolated from marine mangrove sediment from Parangipettai.

The mixture was stirred for 0.5 h at RT and then ethyl/benzyl halides

(0.01 mol) was added to the mixture and the solution was further stirred for 3–4 h. After SB203580 the reaction completion, verified by TLC, the product was precipitated after the addition of cold distilled water. 2–3 mL aq. Na2CO3 was added to make basic pH of 9. The product was filtered off, washed with distilled water and recrystallized from methanol. Light brown amorphous solid; Yield: 79%; M.P. 84–86 °C; Molecular formula: C19H24ClNO3S; Molecular weight: 381; IR (KBr, ѵmax/cm−1): 3078 (Ar C H stretching), 1621 (Ar C C stretching), 1369 (S O stretching); 1H NMR (400 MHz, CDCl3, ppm): δ 7.76 (d, J = 8.8 Hz, 2H, H-2′ & H-6′), 7.60 (d, J = 2.0 Hz, 1H, H-6), 7.49 (d, J = 8.8 Hz, 2H, H-3′ & H-5′), 6.99 (dd, J = 8.8, 2.0 Hz, 1H, H-4), 6.64 (d, J = 8.8 Hz,

1H, H-3), 3.57 (s, 3H, CH3O-2), 3.60 (q, J = 7.2 Hz, 2H, H-1′’), 1.19 (s, 9H, (CH3)3C-4′), Rho kinase inhibition 0.99 (t, J = 7.2 Hz, 3H, H-2′’); EI-MS: m/z 383 [M + 2]+, 381 [M]+, 366 [M-CH3]+, 350 [M-OCH3]+, 317 [M-SO2]+, 197 [C10H13SO2]+, 156 [C7H7ClNO]+. Light grey amorphous solid; Yield: 81%; M.P. 118–120 °C; Molecular formula: C18H22ClNO3S; Molecular weight: 367; IR (KBr, ѵmax/cm−1): 3080 (Ar C H stretching), 1614 (Ar C C stretching), 1367 (S O stretching); 1H NMR (400 MHz, CDCl3, ppm): δ 7.35 (d, J = 2.8 Hz, 1H, H-6), 6.95 (dd, J = 8.8, 2.8 Hz, 1H, H-4), 6.79 (s, 2H, H-3′ & H-5′), 6.66 (d, J = 8.8 Hz, 1H, H-3), 3.76 (s, 3H, CH3O-2), 3.39 (q, J = 7.2 Hz, 2H, H-1′’), 2.57 (s, 6H, CH3-2′ & CH3-6′), 2.28 (s, 3H, CH3-4′), 0.99 (t, J = 7.2 Hz, 3H, H-2′’); EI-MS: m/z 369 [M + 2]+, 367 [M]+, 352 [M-CH3]+, 336 [M-OCH3]+,

303 [M-SO2]+, 183 [C9H11SO2]+, 156 [C7H7ClNO]+. Dark grey amorphous solid; Yield: 89%; M.P. 102–104 °C; Molecular formula: C16H18ClNO4S; Molecular weight: 355; IR (KBr, ѵmax/cm−1): 3056 (Ar C H stretching), 1603 (Ar C C stretching), 1369 (S O stretching); 1H NMR (400 MHz, CDCl3, ppm): δ 7.62 (d, J = 8.8 Hz, next 2H, H-2′ & H-6′), 7.18–7.22 (m, 2H, H-4 & H-6), 6.90 (d, J = 8.8 Hz, 2H, H-3′ & H-5′), 6.71 (d, J = 8.4 Hz, 1H, H-3), 3.84 (s, 3H, CH3O-4′), 3.56 (q, J = 7.2 Hz, 2H, H-1′’), 3.45 (s, 3H, CH3O-2), 1.02 (t, J = 7.2 Hz, 3H, H-2′’); EI-MS: m/z 357 [M + 2]+, 355 [M]+, 340 [M-CH3]+, 324 [M-OCH3]+, 291 [M-SO2]+, 171 [C7H7OSO2]+, 156 [C7H7ClNO]+. Blackish grey amorphous solid; Yield: 66%; M.P. 86–88 °C; Molecular formula: C17H19ClNO4S; Molecular weight: 367; IR (KBr, ѵmax/cm−1): 3084 (Ar C H stretching), 1607 (Ar C C stretching), 1351 (S O stretching), 1719 (C O stretching); 1H NMR (400 MHz, CDCl3, ppm): δ 7.99 (d, J = 8.0 Hz, 2H, H-2′ & H-6′), 7.78 (d, J = 8.0 Hz, 2H, H-3′ & H-5′), 7.48 (d, J = 2.4 Hz, 1H, H-6), 7.03 (dd, J = 8.0, 2.4 Hz, 1H, H-4), 6.71 (d, J = 8.0 Hz, 1H, H-3), 3.41 (s, 3H, CH3O-2), 3.30 (q, J = 7.2 Hz, 2H, H-1′’), 2.50 (s, 3H, CH3CO-4′), 1.00 (t, J = 7.

We examined the effect of a Western-type

cholesterol-rich diet on lipid metabolism in the triple NOSs GPCR Compound Library mw null mice (56). The high-cholesterol diet for 3 months significantly increased serum LDL cholesterol levels in all the wild-type and single, double, and triple NOSs genotypes examined as compared with a regular diet. Intriguingly, when compared with the wild-type genotype, the serum LDL cholesterol levels in the high-cholesterol diet were significantly and markedly elevated only in the triple NOSs null genotype, but not in any single or double NOSs null genotypes (Fig. 7A), and this was associated with remarkable atherosclerosis (Fig. 7B) and sudden cardiac death, which occurred mainly in 4-5 months after the high-cholesterol diet. Hepatic LDL receptor expression and hepatic levels of sterol regulatory element-binding protein-2 (SREBP-2) which is a transcriptional factor that controls LDL receptor gene expression (57) were markedly reduced only in the triple NOSs null genotype, accounting for the diet-induced dyslipidemia in the genotype. These results suggest that complete disruption of all NOSs causes severe dyslipidemia, atherosclerosis, and sudden cardiac death in response to a high-fat diet in mice in vivo through the down-regulation of the hepatic LDL receptor, demonstrating

the critical role of NOSs in maintaining lipid homeostasis. Nephrogenic diabetes insipidus is characterized by an inability to concentrate urine despite this website normal or elevated plasma concentrations of an anti-diuretic hormone, vasopressin. The triple NOSs null mice showed prominent polyuria, polydipsia, and blunted renal responsiveness to exogenous vasopressin (Fig. 8) (30). Vasopressin stimulates adenylate cyclase, increases cAMP production, and activates cAMP-dependent protein kinase via V2 receptor Rolziracetam in renal collecting duct principal

cells. Phosphorylation of aquaporin-2 by the kinase in turn leads to translocation of aquaporin-2 from cytoplasmic vesicles to the apical plasma membrane, thereby increasing water permeability and reabsorption. In the kidney of the triple NOSs null mice, reduced vasopressin-induced cAMP production, decreased membranous aquaporin-2 water channel expression, and tubuloglomerular lesion formation (renal tubular apoptosis and regeneration, glomerulosclerosis, and glomerular thrombi) were noted. All of these are consistent with the characteristics of nephrogenic diabetes insipidus, suggesting a crucial role of NOSs in the pathogenesis of nephrogenic diabetes insipidus. Chronic unilateral ureteral obstruction (UUO) is a well-characterized model of experimental obstructive nephropathy, culminating in renal tubular apoptosis, interstitial fibrosis, and glomerulosclerosis (58) and (59). These alterations are also a common feature of a variety of kidney disorders, including chronic kidney disease (CKD) and end-stage renal disease (60).

It is worth noting that even if the relative risk of intussusception does not vary with age, the number of excess

vaccine-associated cases (i.e., attributable risk) will be greater with first doses given at 15 weeks of age and older because of the higher baseline rates of natural intussusception among older infants. Additionally, based on ecological data, some researchers hypothesized that the temporary increase in intussusception following RotaShield vaccination was offset by lower risk later in infancy as vaccination may have triggered intussusception in predisposed infants [29]. This hypothesis has yet to be substantiated. The parent rhesus rotavirus strain (RRV) in RotaShield had several unique biological properties that might PF-2341066 have increased the risk of intussusception in vaccinated infants. RRV is one of the few rotavirus strains capable of causing disease across a range of species [30] and is capable of causing severe and sometimes fatal hepatitis in strains of inbred mice [31]. Selleckchem Icotinib The gut-associated lymphoid tissue is invaded more by RRV

than the rhesus-human or bovine-human reassortant strains [32] and RotaShield had an increased overall reactogenicity profile, including greater rates of fever, mild diarrhea, and vomiting, compared with the currently available RV1 and RV5 vaccines [4], [5], [33], [34], [35], [36] and [37]. RRV replicates well in the human gut and is shed by over 80% of vaccine recipients after the first dose during the period of increased risk of intussusception.

However, existing data cannot prove that these unique features of RotaShield made it more likely to cause intussusception compared with other rotavirus vaccines, and so large pre-licensure safety trials for the two currently available rotavirus vaccines, RV1 and RV5, CYTH4 were conducted and specifically powered to assess the level of risk of intussusception that was seen with RotaShield. In a phase 3 safety study of RV1 conducted in 11 Latin American countries with 63,000 enrolled infants, 13 confirmed cases of intussusception were identified within 31 days of receiving the first or second dose of vaccine, 6 in the RV1 group and 7 in the placebo group, with no clustering within 7 or 14 days after the dose, resulting in a relative risk (RR) of 0.85 (95% confidence interval (CI): 0.30, 2.42) [5]. For RV5, a large, randomized double-blind placebo controlled study conducted in 12 countries with almost 70,000 enrolled infants, 6 confirmed intussusception cases occurred within 0–42 days after any dose and 5 confirmed cases in the placebo group resulting in a RR of 1.6 (95% CI: 0.4, 6.4) [4]. There were no cases within the 42 days after dose 1 in the RV5 group and 1 in the placebo [4].

Four weeks later, the between-group difference was 18 seconds in favour of the

experimental group (95% CI 9 to 26). In this study of people with chronic non-specific low back pain, significantly greater reductions in disability and pain were obtained immediately after treatment by the participants who received genuine Kinesio Taping than by those who received a sham application. The functional endurance Idelalisib research buy of the trunk muscles was also substantially improved after the application of the taping for one week. The range of trunk flexion showed borderline improvement but fear of movement was not improved by the taping. The benefits of the week-long taping intervention on pain and trunk muscle endurance were maintained at a similar magnitude four weeks later, but the other outcomes did not show significant effects when reassessed four weeks after the treatment. People with low back pain typically rate an improvement of 6 points on the Oswestry scale as at least ‘moderately’ better (Fritz and Irrgang 2001) and this has therefore been considered a ‘worthwhile effect’ (Lewis et al 2011). Some authors recommend an even higher threshold (Ostelo and de Vet 2005). Our estimate of the effect of the taping on disability measured on the Oswestry scale

did include 6 points at the upper confidence limit. However, the best estimate was that the Dabrafenib Oswestry score is only improved by 4 points by the taping, and it is possible that the average effect is as low as 2 points. Our estimate of the effect of taping on the Oswestry score

and its confidence limits is relatively small in comparison to the range of possible scores on the Oswestry Disability Index (0 to 100) and in comparison to the baseline scores of the study participants, which ranged from 22 to 35. Similarly, our estimate of the effect of the taping on the Roland-Morris score at one week – an improvement of 1.2 points (95% CI 0.4 to GPX6 2.0) – is below the minimum clinically worthwhile effect of 2.5 to 5 points, which has been derived for this outcome from people with non-specific low back pain for at least 6 weeks (Beurskens et al 1996). Therefore, our estimates of the average effect of the taping on disability may not be considered worthwhile by typical patients with chronic non-specific low back pain. The effect of the taping on pain was also relatively small. Our best estimate of the effect (ie, an improvement of 1.2 cm on a 10- cm VAS) was below the minimum clinically worthwhile effect of 2 cm (Hagg et al 2003), although the upper limit of the 95% CI did reach this threshold. Although the effect on pain was mild, it was long-lasting, being sustained for four weeks after the end of the therapy. The mechanism by which one week of taping would cause a long-lasting reduction in pain is not clear. Perhaps the week of taping engendered a greater confidence in the participants to remain active despite their pain.

Le classement par rang médian national des disciplines choisies à l’issue des ECN 2012 montre

un attrait des étudiants pour les spécialités chirurgicales Venetoclax comme l’ophtalmologie ou médicales comme la néphrologie ou la médecine interne. “
“La sclérodermie systémique (ScS) est une affection chronique du tissu conjonctif qui se caractérise par l’existence de manifestations vasculaires, au premier rang desquelles le phénomène de Raynaud, et plus rarement des complications viscérales comme l’hypertension artérielle pulmonaire (HTAP) et la crise rénale sclérodermique, par la survenue de manifestations fibrosantes, intéressant avant tout la peau et le poumon, mais pouvant toucher tous les viscères, et par la détection d’auto-anticorps spécifiques de la maladie [1]. Sa prévalence varie de3 à 24 cas pour 100 000 habitants [2] and [3]. Elle est plus élevée aux États-Unis et en Australie qu’en Europe et au Japon. La ScS touche trois femmes pour un homme avec des extrêmes allant de 1 à 15. Elle débute rarement avant l’âge de 20 ans, et on observe un pic de fréquence entre 45 et 60 ans [3]. Plusieurs SCR7 cost critères diagnostiques

ont été proposés. Si longtemps ceux de l’American College of Rheumatology (ACR) [4] sont restés les critères de référence, leur manque de sensibilité a amené à en élaborer de nouveaux, les critères de l’ACR/EULAR qui viennent de paraître [5] and [6]. Ils sont plus sensibles et plus spécifiques que ceux de l’ACR et utilisent des paramètres qui intéressent la main comme les doigts boudinés ou la sclérodactylie (4 points au total), les cicatrices ou dépressions pulpaires (3 points) et les télangiectasies (2 points). Le score total est calculé en ajoutant le poids maximum (score) dans chaque catégorie. Les patients

dont le score total est ≥ 9 sont classés comme ayant une ScS. La main constitue une cible privilégiée de la ScS [7]. La maladie évolue en trois phases consécutives : • à la phase précoce, en particulier dans les formes diffuses, l’œdème des doigts (doigts gonflés) et des mains prédomine, souvent associé Montelukast Sodium ou pouvant précéder la survenue du phénomène de Raynaud (figure 1). Au cours de cette période, des arthralgies impliquant les articulations des doigts sont souvent présentes, constituant quelquefois la plainte majeure du patient. L’œdème limite l’amplitude du mouvement des articulations métacarpo-phalangiennes (MCP) et inter-phalangiennes proximales (IPP), et des manifestations du phénomène de Raynaud peuvent entraîner la survenue d’ulcères digitaux (UD) dès cette phase très précoce [8]. Ces UD, associés aux autres anomalies, contribuent à la survenue de douleurs et d’une perte de la fonction de la main [1]. À ce stade très précoce, les crissements tendineux peuvent déjà être observés [9] ; Figure 1.  Phénomène de Raynaud. Phase cyanique La main est une cible privilégiée au cours de la ScS. Toutes les structures anatomiques peuvent être touchées [12].