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Aim - Left atrial size is correlated with left ventricle diastolic dysfunction grade and chronicity. We used echocardiography Doppler parameters to assess the relation between the type of left atrium dilatation (symmetrical or asymmetrical) and left ventricular diastolic dysfunction in patients with nonvalvular atrial fibrillation. Methods - We enrolled prospectively 70 patients in stable sinus rhythm and 100 patients with nonvalvular AF and left atrium area more than 20 cm2. Asymmetrical remodelling defined as basal dimension measured at the left atrium posterior wall greater than the mitral annular dimension was correlated with the parameters of the left ventricular diastolic dysfunction and left atrium function. Results - Asymmetrical remodelling was detected in 64% of patients: 46% in AF and 54% in stable SR (p=0.04); it was associated with LA dilatation degree and atrial fibrillation presence. Asymmetrical remodelling in atrial fibrillation patients was significantly correlated with: peak E' wave (r=0.72); L wave (r=0.87); peak systolic (r=0.75) and diastolic pulmonary vein waves (r=0.81). Conclusions - Echocardiography Doppler parameters of left ventricular diastolic dysfunction are correlated with left atrium asymmetric structural remodeling. Left atrial dilatation in atrial fibrillation is frequently associated with asymmetric structural remodelling which is related to LA dilation degree. [ABSTRACT FROM AUTHOR]

Summary: Objective: To assess and compare, clinically and electrophysiologically, the effects on muscle innervation and spasticity of selective anaesthetic nerve block and selective neurotomy of the motor-nerve branch to the soleus muscle in patients with spastic equinus foot. Methods: Eleven hemiplegic patients were studied before and after anaesthetic tibial-nerve block, and at two months and one year after tibial nerve neurotomy. Triceps surae spasticity and strength, walking speed, gait kinematics of the ankle, maximal amplitude of the H reflex and of the M-response and the Hmax/Mmax ratio of the soleus muscle, and the mean motor unit action potential area and motor unit number estimation (MUNE) of the soleus muscle were calculated on the normal and spastic side. Results: Spasticity and equinovarus improved in a similar fashion after tibial nerve block and neurotomy. The soleus Hmax/Mmax ratio decreased by 42% after tibial nerve block and 77% after neurotomy. The soleus MUNE decreased by 52% after tibial nerve block and by 86% after neurotomy. Conclusion: Diagnostic nerve block predicts the spasticity and gait improvement, which is expected after neurotomy. The clinical improvement was similar after block and neurotomy. Nerve block is associated with a 50% decrease in the soleus Hmax/Mmax ratio and soleus MUNE. The median 80% neurotomy is associated with an 80% decrease in the soleus Hmax/Mmax ratio and soleus MUNE. [Copyright &y& Elsevier]

The in-situ microstructure evolution of a standard black enamel and the stress evolution during thermal treatments are investigated through the deposition of the enamel on a model, inert Si substrate. The sintering of the glass frit by viscous flow results in the formation of pores. The crystallization of the glass frit constituting the enamel has been observed to affect the rheological properties of the enamel, increasing its relative viscosity, and leading to an increase in the stress regeneration temperature during cooling. It was observed that an increase in elastic stress in the enamel during cooling, due to a thermal expansion mismatch between the enamel and the substrate, resulted in the initiation and propagation of cracks when tensile stress reached 170 MPa. It was found that viscous flow at high temperatures during subsequent thermal cycles promotes self-healing of previously formed cracks. [ABSTRACT FROM AUTHOR]

Human hair is a biological material constantly exposed to different external factors,such as humidity, sunrays, temperature, chemical treatments, etc. All these treatments influence and modify its physical behaviour. Studying the biophysical properties of human hair is very important in both dermatology to provide useful markers for the diagnosis of hair disorders and in cosmetics to develop better hair-care products. Water is one of the external factors whose action on the mechanical behaviour of hair is the most visible. To understand the role of water in the biophysical behaviour of hair, it is essential to study its influence on alpha-keratin, which composes the major part of the structure of hair. The influence of water on the biomechanical behaviour of hair has been studied using relaxation tests. The generalised Maxwell model was used to analyse rheological results. The results indicate a modification of the rheological behaviour of hair before and after immersion in water and during ambient air-drying. Finally, a correlation between the rheological results and the chemical bond structure of hair is discussed. [ABSTRACT FROM AUTHOR]

Abstract: Background: Although the reliability of cyclosporine (CyA) concentration at 2 (C2) hours postdosing has been established for kidney, liver, and heart transplant recipients, its use in lung cases remains to be validated. We investigated the relationship between CyA dual time point monitoring and long-term functional outcomes after lung transplantation. Methods: We included data from 38 lung transplant recipients receiving CyA, azathioprins, and steroids in the study. CyA dosages were based on the trough concentrations. CyA concentrations at 0 (C0) and 2 (C2) hours postdosing were obtained at 1, 2, 3, 6, 9, 12, 15, 18, and 24 months postoperative. We retrospectively compared average CyA level (C0 and C2) during the first 3 posttransplantation months with forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), forced expiratory flow 25%–75 % (FEF 25–75), creatinine, systolic blood pressure (SBP), and diastolic blood pressure (DBP) using regression analysis via generalized estimating equations (GEE). Results: Only improvement in FVC (P = .033) and deterioration of SBP (P < .001) were related to C0 monitoring. No correlation was observed between C0 and FEV1 (P = .13), FEF 25–75 (P = .48), creatinine (P = .07), and DBP (P = .97). Nor was any relationship observed between C2 concentrations and FEV1 (P = .64), FVC (P = .38), FEF 25–75 (P = .09), creatinine (P = .95), SBP (P = .73), or DBP (P = .51). Conclusion: There was a lack of a relationship between CyA concentrations (C0 and C2) and functional outcomes among de novo lung transplantations except for a positive correlation of 0 value with long-term improved FVC and increased SBP. This study suggested that C2 determinations may not improving lung recipient management. [Copyright &y& Elsevier]

Background Neuromuscular blocking agents have always shown wide inter-individual variability when it comes to their duration of action. This prevents clinicians from anticipating the evolution of the neuromuscular block for any given patient. With this study, we aimed to assess the nature of the relationships existing between different time course parameters used to describe paralysis onset and offset. Methods Sixty American Society of Anesthesiologists ( ASA) score III-IV anaesthetised patients were randomised to receive a single equipotent dose (2 ED95) of either rocuronium, mivacurium or atracurium. We used acceleromyography to monitor neuromuscular transmission. We described the relationships between the time-interval measurements of: onset, the first response ( T1) reappearance, T1 25% of control, train-of-four ratio 0.25 and 0.75. Pearson correlation coefficients were calculated. Results We found no significant relationships between onset and any of the four parameters used to describe the offset. On the other hand, we showed strong and highly significant linear relationships between all the parameters describing the offset for each of the muscle relaxants studied (correlation coefficients ranging from 0.850 to 0.992). Conclusions We evidenced strong linear correlations between the four offset time course parameters of spontaneous recovery after a single neuromuscular blocking agents ( NMBAs) bolus. Such relationships open up new clinical perspectives concerning quantitative neuromuscular transmission monitoring: the scope of individual valuable anticipation of the patient's recovery. [ABSTRACT FROM AUTHOR]

Objective: To compare whole-body MRI (WB-MRI) and axial skeleton MRI (AS-MRI) in detecting and measuring bone metastases in patients with prostate cancer (PCa).Methods: WB-MRI and AS-MRI examinations were performed in 60 patients with PCa at high risk of metastases. Two radiologists separately categorised the AS-MRI and WB-MRI as negative or positive for metastases, and measured focal metastases using the "Response evaluation criteria in solid tumours" (RECIST) criteria transposed to bone. One radiologist reviewed all examinations 2 months later. Inter- and intraobserver agreements in establishing the presence/absence of metastases were calculated. Bland-Altman plots were used to assess measurement agreement between AS-MRI and WB-MRI.Results: Strong to perfect inter- and intraobserver agreements were found between AS-MRI and WB-MRI in defining the presence/absence of bone metastases. There were no patients with isolated "peripheral" metastases at WB-MRI, missed at AS-MRI. There was no difference in lesion count between the two radiologists. AS-MRI and WB-MRI provided statistically equivalent RECIST values for one radiologist and slightly lower values at AS-MRI for the other.Conclusions: In our series of PCa patients, AS-MRI and WB-MRI were equivalent in determining the presence/absence of bone metastases and provided similar evaluation of the metastatic burden. [ABSTRACT FROM AUTHOR]

There is theoretical evidence that specific airway conductance (SGaw) could be more reliable than forced expiratory volume in 1 s (FEV1) for assessing changes in airway calibre. We investigated the changes in FEV1 and SGaw when assessing bronchial responses to occupational agents. SGaw and FEV1 were measured during inhalation challenges with various occupational agents in 174 consecutive subjects investigated for possible occupational asthma. A decline in SGaw of 50% or greater was documented in 77 of 90 subjects (86%) who showed a ≥20% fall in FEV1 and in 11 of 84 subjects (13%) who failed to demonstrate such a fall in FEV1. Among subjects who developed a ≥20% fall in FEV1, those who failed to develop a ≥50% decline in SGaw had a lower baseline SGaw than those who did. Among the group without a ≥20% fall in FEV1, a ≥50% decrease in SGaw was associated with either an ‘intermediate’ fall in FEV1 (between 15 and 17% from baseline value) ( n = 4), a significant postchallenge increase in nonspecific bronchial hyper-responsiveness to histamine ( n = 2), or both features ( n = 3). A decline in SGaw of 50% or greater may provide useful complementary evidence of a bronchial response during challenges that produce equivocal results in FEV1. [ABSTRACT FROM AUTHOR]

Presents a study which compared the efficacy of a Chilli internal circuit cooled tip catheter to a conventional tip catheter with a double temperature sensor in the cavotricuspid isthmus ablation. Study population and methods; Results and discussion; Conclusion.

OBJECTIVES:: To determine the protective effect of gel padded glove on median nerve compression in the carpal tunnel. METHODS:: Median nerve conduction parameters, skin temperature, laser Doppler flowmetry and pain modifications were measured during and after a 30-min carpal tunnel external compression protocol performed with and without glove in a random order on six healthy volunteers. RESULTS:: Compression induced a rapidly reversible increase in sensory and motor distal latencies, a decrease in sensory amplitude, finger laser Doppler flowmetry and hand skin temperature supporting the hypothesis of a reversible conduction block of ischemic origin. There was no statistical difference between the tests (with or without glove) except for pain that was significantly reduced by glove protection. CONCLUSION:: Gel padded glove does not seem to have a protective effect on the carpal tunnel syndrome induced by compression but provides significant comfort.Spinal Cord (2001) 39, 215–222. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Basiliximab (BAS), an interleukin-2 monoclonal antibody, has shown promising results as induction therapy in liver and kidney transplantation. We compared the efficacy and patient tolerability of BAS and antithymocyte globulin (ATG) in lung transplantation (LTx). Patients and Methods: The study included 37 patients in two groups (ATG and BAS, respectively). The indication for LTx was emphysema in 62.6% of patients in group 1 and 57.1% of patients in group 2. Mean (SD) patient characteristics compared in the two groups included age (52.0 [9.8] vs 54 [10.6] years), height (172.0 [10.1] vs 169 [7.55] cm), and weight (73.9 [15.3] vs 64.4 [14.2] kg) (P = .049). Induction therapy after LTx in the two groups was as follows: in 16 transplantation procedures (eight single and eight bilateral) performed between April 1998 and December 2002, ATG, 3 mg/kg/d for 3 days, was administered, and in 21 transplantation procedures (15 single and 6 bilateral) performed between January 2003 and July 2005, BAS, 20 mg on days 0 and 4, was given. Dosages of cyclosporine, azathioprine, and steroids for maintenance therapy were equivalent in the two groups. We retrospectively compared patient tolerability, occurrence of acute rejection or infection (from bacteria, cytomegalovirus [CMV], or Aspergillus), and outcomes between the two groups during 2 years of follow-up. Results: No cytokine-mediated reaction was observed in either group; however, there was a difference in hematologic effects. On day 2, mean (SD) platelet count was significantly lower in the ATG group at 113,500 (56,400)/mm3 vs 151,900 (57,300)/mm3 (P = .046). Because of severe thrombocytopenia, three patients could not be given ATG on day 3. The overall incidence of aspergillosis (18.8% vs 19.0%) and CMV infection (31% vs 57%) was similar in the two groups. However, when the recipient was CMV-positive and the donor was CMV-negative, the there was a clear trend (33.3% vs 88.9%). The number of acute rejection episodes was similar (43.8% vs 52.4%). Survival increased by 20% in the BAS group (P = .03). Conclusion: In LTx, safety of BAS use is as good as or better than that of ATG, with no difference in acute rejection episodes or infections, with the possible exception of increased reactivation of CMV infection. Thus, BAS could be an alternative to ATG as induction therapy in LTx; however, further studies are necessary. [Copyright &y& Elsevier]

Abstract: Objectives: The effect of family history of hypertension (FHxHT), as a genetic factor predisposing to some ischemic stroke subtypes and independently of hypertension as risk factor, has never been studied. Methods: A positive FHxHT was searched in 472 patients (312 men, 160 women; mean [S.D.] age, 67.9 [11.4] years) consecutively admitted for a first-ever ischemic stroke (348) or transient ischemic attack (TIA) (124) due to small vessel disease (SVD, 180), large vessel disease (156), or cardioembolism (136). In this population and in three age bands, the genetically transmitted vascular risk factors, age, gender and the ischemic stroke subtypes were compared between those with and without a positive FHxHT. Results: None of the risk factors was associated with a positive FHxHT, except for hypertension in the whole population (68.9% vs. 48.7%; p =0.001) and in the <65 year-old patients (72.5% vs. 39.5%; p <0.001). Regarding the stroke subtypes, a positive FHxHT was only associated with SVD in the subgroup of <65 year-old patients (odd ratios (OR), 2.07; 95% confidence interval (CI), 1.01 to 4.25; p =0.045). However, this finding disappeared in a logistic regression analysis, which only retained hypertension as independently associated with SVD. Conclusions: FHxHT is not an independent genetic factor predisposing to some aetiological stroke subtypes. [Copyright &y& Elsevier]

Background and Objective: Infusion containing lorazepam is used by geriatric department to limit anxiety disorders in the elderly. Currently, these infusions are prepared according to demand by the nursing staff, but the preparation in advance in a centralized service could improve quality of preparation and time management. The aim of this study was to investigate the long-term stability of this infusion in polypropylene syringes stored at 5 ± 3°C. Then, results obtained were compared with stability data of lorazepam in syringes stored at room temperature, glass bottles at 5 ± 3°C, and glass bottles at room temperature. Method: Eight syringes and 6 bottles of infusion were prepared by diluting 1 mL lorazepam 4 mg in 23 mL of NaCl 0.9% under aseptic conditions. Five syringes and 3 bottles were stored at 5 ± 3°C and 3 syringes and 3 bottles were stored at room temperature for 30 days. During the storage period, particle appearance or color change were periodically checked by visual and microscope inspection. Turbidity was assessed by measurements of optical density (OD) at 3 wavelengths (350 nm, 410 nm, 550 nm). The stability of pH was also evaluated. The lorazepam concentrations were measured at each time point by high-performance liquid chromatography with ultraviolet detector at 220 nm. Results: Solutions were physically unstable in syringes at 5 ± 3°C after 4 days: crystals and a drop of OD at 350 nm were observed. However, pH was stable. After 2 days, solutions were considered as chemically unstable because a loss of lorazepam concentration higher than 10% was noticed: the lower 1-sided confidence limit at 95% was below 90% of the initial concentration. To assess temperature and polypropylene influence, results were compared with those obtained for syringes at room temperature and bottles at 5 ± 3°C and room temperature. Precipitation, drop of OD at 350 nm, and chemical instability were observed in all conditions. Conclusion: Solutions of lorazepam were unstable after 2 days in syringes at 5 ± 3°C. Preparation in advance appears, therefore, not possible for the clinical use. Storage conditions (temperature and form) do not improve the stability. [ABSTRACT FROM AUTHOR]

Introduction/Background Patients with chronic hemiparesis following stroke or traumatic brain injury (TBI) often necessitate a quadripod crutch to improve the balance during gait. The quadripod crutch, by inducing a 3-step gait participates to an asymmetric and slow walking speed. This study aims to assess changes in gait parameters and balance in patients using a quadripod crutch with small wheels (Wheeleo) compared with a classical quadripod crutch. Material and method Prospective, multicentre, randomised study comparing Wheeleo and quadripod crutch (NCT02279069). Thirty-two ambulatory adults with spastic hemiparesis following stroke or TBI necessitating a quadripod crutch for walking participated to the study. The walking speed (WS), the frequency of the 2-step gait, the physiological cost index (PCI) and the number of therapist interventions to control the balance during a 10-meter walking test (10mWT) and a 6-minutes walking test (6MWT) were assessed with a Wheeleo and a quadripod crutch at comfortable and maximal WS. The cadence (during a 10mWT) and the distance (during a 6MWT) were also monitored. The patient satisfaction was assessed by a VAS scale. Results When using a Wheeleo, improvements in WS, cadence, frequency of a 2-step gait, PCI and distance were observed at comfortable and maximal WS. The number of therapist interventions to control the balance remained unchanged. Conclusion Improvements in WS, cadence, distance, 2-step gait, energy cost and patient satisfaction were achieved in hemiparetic adults using a Wheeleo crutch without additional fall risk. [ABSTRACT FROM AUTHOR]

Background Ascertaining the presence of asthma through the assessment of nonspecific bronchial hyperresponsiveness ( NSBH) is a key step in the diagnosis of occupational asthma ( OA). We aimed at investigating whether indices of airway inflammation including fractional exhaled nitric oxide (Fe NO) and sputum eosinophils would be useful adjuncts to the measurement of NSBH in diagnosing OA defined as a positive specific inhalation challenge ( SIC). Methods The study included 240 consecutive subjects with a suspicion of OA who completed a SIC, of whom 133 showed a positive response. The sensitivity, specificity, and predictive values of NSBH, and Fe NO, as well as sputum eosinophil counts assessed at baseline of the SIC were determined. Results A concentration of histamine inducing a 20% decline in FEV1 ( PC20) ≤16 mg/mL showed a sensitivity of 87% and a specificity of 36%. A Fe NO level ≥25 ppb and a sputum eosinophil count ≥2% provided lower sensitivity rates (47% and 39%, respectively) than the PC20 value. Eight of the 17 subjects without baseline NSBH despite a positive SIC showed a sputum eosinophil count ≥2%, a Fe NO level ≥25 ppb, or both outcomes. Combining either a PC20 value ≤16 mg/ mL or a Fe NO ≥25 ppb increased the sensitivity to 91%. Using either a PC20 ≤16 mg/ mL or a sputum eosinophil count ≥1% increased the sensitivity to 94%. Conclusion Adding the assessment of Fe NO level and sputum eosinophils to NSBH improves the identification of subjects who may have OA and require further objective testing before excluding the possibility of OA. [ABSTRACT FROM AUTHOR]

Introduction et but de l’étude Après conception et mise à disposition dans notre service d’un logiciel permettant une représentation graphique de l’adéquation de la prescription de nutrition artificielle, nous avons souhaité évaluer l’impact de cet outil sur nos habitudes de prescription. Matériel et méthodes Le logiciel informatique (« NutriREAD-2.12.8 », programmé en Visual Basic- Excel ® ) fut mis à disposition (réseau) sur chaque ordinateur de chevet des patients, avec accès aisé et facultatif lors de la rédaction du traitement quotidien par les médecins du service (30 lits ; six médecins seniors ; sept médecins juniors). Après encodage des données anthropométriques, du status rénal (+ support éventuel) et métabolique, du type et débit des solutions d’alimentation artificielle (entérale [E]/parentérale [P]) et des autres apports caloriques (propofol, perfusions glucosées,…) le programme permet une visualisation immédiate de la conformité de la prescription (apports/besoins caloriques et protéiques, rapport caloricoazoté, rapport glucidolipidique) aux recommandations récentes (SFNEP, Sfar, SRLF 2014). Pour évaluer l’impact de l’outil, nous avons analysé les prescriptions journalières de nutrition artificielle exclusive des patients ayant séjourné plus de 10 jours dans le service au cours des 6 mois précédant (« groupe avant » ; n = 44) et suivant (« groupe après » ; n = 34) la mise à disposition du programme. Les 3 premiers jours d’alimentation artificielle (implémentation progressive), ainsi que les jours correspondant à des modifications de prescription dues aux complications digestives ou aux procédures (intubation et chirurgie) ont été systématiquement exclus. L’analyse statistique (test de Mann-Whitney) a porté sur les caractéristiques générales des deux groupes, la quantité prescrite de calories, protéines, et rapport caloricoazoté, ainsi que sur le pourcentage de journées où le patient a bénéficié d’une prescription adéquate (calories, protéines, rapport caloricoazoté) avant et après l’implémentation du logiciel. Résultats et analyse statistique Les deux groupes étaient comparables en termes d’âge, de poids, d’indice de masse corporelle, de durée de séjour, de type d’alimentation artificielle (E/P), de besoins en agents vasoactifs, de complications digestives, d’insuffisance rénale et de recours à la ventilation mécanique ou à l’hémofiltration. Le recours à la dialyse était plus fréquent dans le groupe avant. Le Tableau 1 présente les modifications de prescriptions aux deux temps de l’étude. Conclusion La simple mise à disposition d’un outil informatique a permis d’améliorer la qualité de la prescription d’alimentation artificielle au sein de notre service de réanimation. Singulièrement, le programme a permis de détecter et corriger des prescriptions protéiques trop fréquemment inférieures aux recommandations, qui s’accompagnaient de rapports caloricoazotés excessifs. [ABSTRACT FROM AUTHOR]

Background Recombinant Hevea brasiliensis ( rHev b) natural rubber latex ( NRL) allergen components have been developed to assess the patients' allergen sensitization profile and to improve the diagnosis of NRL allergy. Objective To examine whether the determination of specific IgE ( sIgE) reactivity to a panel of recombinant allergen components would be helpful for diagnosing NRL-induced occupational asthma ( OA) in predicting the outcome of a specific inhalation test. Methods sIgE levels to NRL extract and 12 recombinant NRL allergen components were assessed in 82 subjects with OA ascertained by a positive specific inhalation challenge ( SIC) with NRL gloves and in 25 symptomatic subjects with a negative challenge. Results The sensitivity, specificity, positive predictive value, and negative predictive value of a NRL- sIgE level ≥0.35 kUA/l as compared to the result of SICs were 94%, 48%, 86%, and 71%, respectively. The positive predictive value increased above 95% when increasing the cutoff value to 5.41 kUA/l. Subjects with a positive SIC showed a significantly higher rate of sIgE reactivity to rHev b 5, 6.01, 6.02, and 11 than those with a negative SIC. A sIgE sum score against rHev b 5 plus 6.01/6.02 ≥ 1.46 kUA/l provided a positive predictive value >95% with a higher sensitivity (79%) and diagnostic efficiency (Youden index: 0.67) as compared with a NRL- sIgE ≥5.41 kUA/l (49% and 0.41, respectively). Conclusion In suspected OA , high levels of sIgE against rHev b 5 combined with rHev b 6.01 or 6.02 are the most efficient predictors of a bronchial response to NRL. [ABSTRACT FROM AUTHOR]

Background: This retrospective study compared the fast-track colon surgery program to conventional perioperative care and assessed factors that influence postoperative length of stay. Design: This retrospective study included 124 fast-track and 119 conventional care colon surgical patients. Exclusion criteria were primary rectal disease, stoma, American Society of Anesthesiologists score IV, and Association Française de Chirurgie index 3 or 4. Laparoscopy was the preferred approach. Variables influencing length of stay were analyzed by multivariate linear and logistic regression. Results: Overall mortality and complication rates were not significantly different between groups (fast-track vs. controls 0 vs. 0.8 %, 30.6 vs. 38.6 % respectively). As expected, median length of stay was significantly reduced in fast-track patients (3 vs. 6 days, p < 0.001), but emergency readmission rate was higher (16.9 vs. 7.6 %, p = 0.026), although rehospitalization rates were similar (8 vs. 4.2 %, not significant). Independent risk factors of increased length of stay were identified as age >69 years ( p = 0.001), laparotomy ( p = 0.011), and conventional perioperative care ( p < 0.001). Conclusions: The introduction of a fast-track program reduced postoperative length of stay without increasing complication rate. This study proposes a modulation of the program according to patient age and surgical approach. [ABSTRACT FROM AUTHOR]

β-Cell plasticity governs the adjustment of β-cell mass and function to ensure normoglycemia. The study of how β-cell mass is controlled and the identification of alternative sources of β-cells are active fields of research. β-Cell plasticity has been implicated in numerous physiological and pathological conditions. We developed a mice model in which we induced major β-cell mass atrophy by implanting insulin pellets (IPI) for 7 or 10 days. The implants were then removed (IPR) to observe the timing and characteristics of β-cell regeneration in parallel to changes in glycemia. Following IPR, the endocrine mass was reduced by 60% at day 7 and by 75% at day 10, and transient hyperglycemia was observed, which resolved within 1 wk. Five days after IPR, enhanced β-cell proliferation and an increased frequency of small islets were observed in 7-day IPI mice. β-Cell mass was fully restored after an additional 2 days. For the 10-day IPI group, β-cell and endocrine mass were no longer significantly different from those of the control group at 2 wk post-IPR. Furthermore, real-time quantitative PCR analysis of endocrine structures isolated by laser capture microdissection indicated sequentially enhanced expression of the pancreatic transcription factors β2/NeuroD and Pdx-1 post-IPR. Thus, our data suggest this mouse model of β-cell plasticity not only relies on replication but also involves enhanced cell differentiation plasticity. [ABSTRACT FROM AUTHOR]

Aim Altemeier's procedure (perineal rectosigmoidectomy) is the operation of choice for rectal prolapse in the elderly. The aims of this prospective observational study were to evaluate its long-term actuarial recurrence risk and the influence of the length of rectosigmoid resection and associated levatorplasty on recurrence rate and continence. Method The perioperative and long-term data for all patients undergoing Altemeier's procedure since 1992 were analysed with regard to mortality, morbidity, continence, anorectal function and recurrence rate. Results Sixty patients [median age 77 years (35-98)] underwent rectosigmoid resection [median length of bowel 14 (6-60) cm] with associated levatorplasty in 21 (35%). Overall mortality and morbidity were 1.6 and 11.6%, respectively. Manometry showed increased anal sphincter basal pressure and maximal squeeze pressure. We observed a decrease in postoperative rectal compliance ( P = 0.002). Age, gender, prolapse duration before surgery, levatorplasty and length of resection had no statistically significant relationship with recurrence. Continence improved in 62% and was stable over a median follow-up of 48 (1-186) months. Continence was positively related to a short length of bowel resection, but not to decreased rectal compliance. Actuarial recurrence was 14% at 4 years. Conclusion The long-term recurrence rate after the Altemeier procedure was low and not linked to resection length or to levatorplasty. Improvement in continence was stable over time. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: Videolaryngoscope techniques are more and more in use and tend to modify our approach for patients difficult to intubate. We compared two techniques, Airtraq™ and Glidescope™ with direct laryngoscopy, with special emphasis on ease of access to airway (Intubation Difficulty Score - IDS score, duration and success of intubation) and the impact on hemodynamic variables among patients with a BMI of more than 30. Study design: Prospective study randomised with minimisation technique. Material and methods: Eighty patients have been allocated by minimisation to four groups: two groups being intubated with Airtraq™, each one with a different investigator, and two with Glidescope™ videolaryngoscope technique. Induction of anesthesia was standardly performed with total intravenous anesthesia with remifentanil, propofol in TCI mode and rocuronium in bolus. Following parameters were recorded : intubation success based on intubation time and desaturation level, its duration, its impact on hemodynamic variables, IDS score and possible dental lesions. Results: Intubation success was 100% for Glidescope™ and 80.6% for Airtraq™ (P =0.009). Airtraq™ allowed a better visualisation of the vocal cords (lower Cormack and Lehane score) than Glidescope™. In contrast, alternative intubation techniques were significantly more often used in the Airtraq™ group. No difference could be detected between both systems on hemodynamic parameters. Conclusions: In obese patients, Glidescope™ allows intubation relatively easily without rescue techniques. [Copyright &y& Elsevier]

This study aimed to assess long-term function after total perineal reconstruction (TPR) with dynamic graciloplasty (DG) and systematic Malone appendicostomy (MA) adjunction after abdominoperineal excision (APR) for rectal cancer. From 1999 to 2004, TPR using DG and MA was performed in 10 patients [seven women; median age 40 (range 28-55) years] after APR for rectal cancer (cT2 in one patient, cT3 in six patients and cT4 in three patients). We prospectively recorded early and late morbidity, mortality, oncological outcome, functional results (using the modified Working Party on Anal Sphincter Replacement 'WPASR' scoring system) and quality of life (QoL; using the European Organisation for Research and Treatment of Cancer 'EORTC' QLQ-C30 and QLQ-CR38 questionnaires). There was no procedure-related mortality. One patient required intra-abdominal re-operation. Nine patients required local and multiple revisions [there was one coloperineal anastomosis (CPA) stenosis, five CPA mucosal prolapse, three stenosis related to graciloplasty, two MA stenosis and one MA reflux]. After a median follow up of 78 months, there was no local recurrence and six patients were alive and disease-free. Regarding the functional results, the median modified WPASR score, of 8, after a follow up of 78 months, was good. The overall QoL scores remained stable over time. In carefully selected patients who want to avoid definitive abdominal colostomy after APR for rectal cancer, reconstruction involving MA and DG after APR for low rectal cancer is followed by good long-term function and QoL. [ABSTRACT FROM AUTHOR]

BACKGROUND: Calcium levofolinate infusions could be prepared in advance by a centralized intravenous additive service (CIVAS) to improve safety and time management. OBJECTIVE: To investigate the effect of freezing, microwave thawing and long-term storage at 5 +/- 3 degrees C on the stability of calcium levofolinate in 5% dextrose solution. METHODS: Solutions of 250 mL of 5% dextrose in polyolefin bags (n = 5) containing approximately 400 mg of calcium levofolinate were prepared under aseptic conditions and frozen for 95 days at -20 degrees C. The solutions were then thawed using microwaves and stored at 5 +/- 3 degrees C for 1 month. The calcium levofolinate concentrations were measured by high performance liquid chromatography (HPLC). Visual inspection was performed and pH was measured periodically during the storage at 5 +/- 3 degrees C. Stability of the solution was defined as a concentration remaining superior to 90% of the initial concentration by regression analysis as recommended by the Food and Drug Administration (FDA). RESULTS: No colour change or precipitation in the solutions was observed. Calcium levofolinate infusions were stable when stored at 5 +/- 3 degrees C during 1 month after freeze-thaw treatment. Throughout this period, the lower confidence limit of the estimated regression line of concentration-time profile remained above 90% of the initial concentration. Slight change in pH values from 6.52 +/- 0.01 to 6.50 +/- 0.01 during storage time did not affect retention time on HPLC and has no clinical consequence, the solutions remaining in the acceptable range for perfusion (4

Background: Calcium levofolinate infusions could be prepared in advance by a centralized intravenous additive service (CIVAS) to improve safety and time management. Objective: To investigate the effect of freezing, microwave thawing and long-term storage at 5 ± 3 °C on the stability of calcium levofolinate in 5% dextrose solution. Methods: Solutions of 250 mL of 5% dextrose in polyolefin bags ( n = 5) containing approximately 400 mg of calcium levofolinate were prepared under aseptic conditions and frozen for 95 days at −20 °C. The solutions were then thawed using microwaves and stored at 5 ± 3 °C for 1 month. The calcium levofolinate concentrations were measured by high performance liquid chromatography (HPLC). Visual inspection was performed and pH was measured periodically during the storage at 5 ± 3 °C. Stability of the solution was defined as a concentration remaining superior to 90% of the initial concentration by regression analysis as recommended by the Food and Drug Administration (FDA). Results: No colour change or precipitation in the solutions was observed. Calcium levofolinate infusions were stable when stored at 5 ± 3 °C during 1 month after freeze-thaw treatment. Throughout this period, the lower confidence limit of the estimated regression line of concentration-time profile remained above 90% of the initial concentration. Slight change in pH values from 6·52 ± 0·01 to 6·50 ± 0·01 during storage time did not affect retention time on HPLC and has no clinical consequence, the solutions remaining in the acceptable range for perfusion (4 ≤ pH ≤ 10). Conclusion: Under the conditions of this study, calcium levofolinate in 5% dextrose infusion may be prepared, frozen in advance by CIVAS, and then microwave thawed before use. Such treatment extends long-term stability and releases pharmacist’s time for major activities such as checking medication order errors. [ABSTRACT FROM AUTHOR]

Background: False-negative responses to specific inhalation challenge (SIC) with occupational agents may occur. We explored whether assessing changes in sputum cell counts would help improve the identification of bronchial reactivity to occupational agents during SICs. Methods: The predictive value of the changes in sputum cell counts after a negative FEV1 response to a first challenge exposure to an occupational agent was determined using the changes in airway calibre observed during repeated challenges as the ‘gold standard’. The study included 68 subjects investigated for work-related asthma in a tertiary centre. After a control day, the subjects were challenged with the suspected occupational agent(s) for up to 2 h. All subjects who did not show an asthmatic reaction were re-challenged on the following day. Additional challenges were proposed to those who demonstrated a ≥ 2% increase in sputum eosinophils or an increase in nonspecific bronchial hyperresponsiveness to histamine after the second challenge day. Results: Six of the 35 subjects without changes in FEV1 on the first challenge developed an asthmatic reaction on subsequent challenges. ROC analysis revealed that a >3% increase in sputum eosinophils at the end of the first challenge day was the most accurate parameter for predicting the development of an asthmatic response on subsequent challenges with a sensitivity of 67% and a specificity of 97%. Conclusions: An increase in sputum eosinophils is an early marker of specific bronchial reactivity to occupational agents, which may help to identify subjects who will develop an asthmatic reaction only after repeated exposure. [ABSTRACT FROM AUTHOR]

Background: Natural rubber latex (NRL) has become as a major cause of occupational asthma (OA) in workers using NRL gloves. Few population-based studies have assessed the impact of changes in the patterns of glove usage on the incidence of NRL-induced OA. Objective: To characterize the time trends in incident cases of NRL-induced OA in Belgium and examine whether incidence rates were related to the types of gloves used in hospitals. Methods: Incident cases of NRL-induced OA were identified through a retrospective review of all claims submitted to the Workers’ Compensation Board up to December 2004. Based on the results of diagnostic procedures, the diagnosis of NRL-induced OA was categorized as definite, probable, unlikely, or indeterminate. The patterns of glove usage were characterized through a questionnaire survey of Belgian hospitals. Results: A total of 298 claims for NRL-induced OA were identified, including 127 subjects with definite OA and 68 with probable OA. Categorized by the year of asthma onset, the incident cases of definite and probable NRL-induced OA markedly decreased from 1999 onwards. The use of powdered NRL gloves fell from 80.9% in 1989 to 17.9% in 2004. Powdered NRL gloves were predominantly substituted with NRL-free gloves, especially in the case of non-sterile procedures. Conclusion: These national compensation-based data confirm that a persistent decline in the incidence of NRL-induced OA has occurred since late 1990s. This downward trend has temporally been associated with a decreasing usage of powdered NRL, further supporting a beneficial role of changes in glove policies. [ABSTRACT FROM AUTHOR]

Background Early detection of aeroallergen sensitization is important as a prognosis factor but may be more difficult in young children. Objective We sought to demonstrate that skin sensitization to aeroallergens was present in a selected group of 0–2-year-old children and that it was associated with environmental exposure and a family history of allergic disease. Methods Data on exposure and history were extracted from the files of 824 children seen in the asthma clinic and who were skin tested to a panel of aero- and food allergens. Results Forty percent of our children demonstrated atopy, 28% were sensitized to aeroallergens, the majority of which to house dust mite. Higher sensitization rates were found in children with large weals to histamine ( P<0.001) and in those who slept with soft toys [odds ratio (OR) 1.45, 95% confidence interval (CI) 1.02–2.08]. With a definition of sensitization including the size of the weal to histamine, there was a negative association with a personal history of eczema only (OR 0.66, 95% CI 0.45–0.99). There was no gender-dependent effect and no association with day-care attendance. Conclusion This is one of the largest studies to evaluate skin testing in a selected population of young children. We found a high prevalence of sensitization to aeroallergens, which was associated with exposure to soft toys. Further follow-up of this population will allow assessment of the predictive value of this sensitization. [ABSTRACT FROM AUTHOR]

Specific anti-polysaccharide antibody deficiency (SPAD) is an immune disorder. Diagnostic criteria have not yet been defined clearly. One hundred and seventy-six children evaluated for recurrent respiratory tract infections were analysed retrospectively. For each subject, specific anti-pneumococcal antibodies had been measured with two enzyme-linked immunosorbent assays (ELISAs), one overall assay (OA) using the 23-valent pneumococcal polysaccharide vaccine (23-PPSV) as detecting antigen and the other purified pneumococcal polysaccharide serotypes (serotype-specific assay, SSA) (serotypes 14, 19F and 23F). Antibody levels were measured before ( n = 176) and after ( n = 93) immunization with the 23-PPSV. Before immunization, low titres were found for 138 of 176 patients (78%) with OA, compared to 20 of 176 patients (11%) with the SSA. We found a significant correlation between OA and SSA results. After immunization, 88% (71 of 81) of the patients considered as responders in the OA test were also responders in the SSA; 93% (71 of 76) of the patients classified as responders according to the SSA were also responders in the OA. SPAD was diagnosed in 8% (seven of 93) of patients on the basis of the absence of response in both tests. Thus, we propose to use OA as a screening test for SPAD before 23-PPSV immunization. After immunization, SSA should be used only in case of a low response in OA. Only the absence of or a very low antibody response detected by both tests should be used as a diagnostic criterion for SPAD. [ABSTRACT FROM AUTHOR]