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Background The effect of laparoscopic sleeve gastrectomy (LSG) on gastroesophageal reflux disease (GERD) remains discordant and highly related to the surgical technique. GERD and weight regain are probably understudied by prospective clinical studies depending on different technical factors. Objectives The purpose of this article is to evaluate the effect of extent to which the antrum is resected on GERD following LSG but also on early complications and short-term weight loss results. Setting University Hospital, France. Methods Patients were randomly assigned in group A (172 patients), LSG with antral resection, or group B (174 patients), LSG with antral preservation. The baseline characteristics collected were demographic characteristics and anthropometric data (age, sex, body mass index), presence of GERD clinical characteristics, ± pH-metry, postoperative complications, or gastrin level. Results A total of 279 patients underwent LSG and they were included in the final analysis. The GERD analyzed at 3 months postoperatively by pH-metry was observed for 57.8% in group A and for 52.4% of patients in group B (P = .4819). There was no statistically significant difference (P = .3755) between the 2 groups at 1 year after surgery (group A, 49.5% versus group B, 43.6%). The gastrin serum level was analyzed 1 year after surgery for a total of 107 patients. For group A, the mean gastrin level was 97.4 ± 85.9 pg/mL, which was inferior compared with group B (150.6 ± 152.4 pg/mL) with no statistical difference (P = .067). The recorded excess weight loss for group A was 79.67% (± 28.88) with no statistically significant difference with group B 74.46% (± 36.61) (P = .3678). The mortality rate was nil. We recorded 5 cases of staple line leakage (3 in group A and 2 in group B); 11 patients presented bleeding (3 in group A and 8 group B), and 4 patients presented with gastric stenosis (2 in group A and 2 in group B). Conclusions The antrum preservation has no significant difference in terms of reflux, weight loss, or complications at 3 or 12 months following LSG. The only significant difference was achieved for nausea and vomiting symptoms, which were more significant for the antrum resection group. Further clinical trials with newer procedures will indicate the factors that can diminish the reflux following LSG. Furthermore, the conservation of a large part of the antrum may be helpful to convert the sleeve to another bariatric procedure (transit bipartition).

Objective To assess the benefit of isokinetic strengthening of the upper limb (UL) in patients with chronic stroke as compared to passive mobilization. Design Randomized blinded assessor controlled trial. Setting Physical Medicine and Rehabilitation departments of 2 university hospitals. Participants Patients (N=20) with incomplete hemiplegia (16 men; mean age, 64y; median time since stroke, 32mo). Interventions A 6-week comprehensive rehabilitation program, 3d/wk, 3 sessions/d. In addition, a 45-minute session per day was performed using an isokinetic dynamometer, with either isokinetic strengthening of elbow and wrist flexors/extensors (isokinetic strengthening group) or passive joint mobilization (control group). Main Outcome Measures The primary endpoint was the increase in Upper Limb Fugl-Meyer Assessment (UL-FMA) score at day 45 (t1). Secondary endpoints were increases in UL-FMA scores, Box and Block Test scores, muscle strength, spasticity, and Barthel Index at t1, t2 (3mo), and t3 (6mo). Results Recruitment was stopped early because of excessive fatigue in the isokinetic strengthening group. The increase in UL-FMA score at t1 was 3.5±4.4 in the isokinetic strengthening group versus 6.0±4.5 in the control group ( P =.2). Gains in distal UL-FMA scores were larger (3.1±2.8) in the control group versus 0.6±2.5 in the isokinetic strengthening group ( P =.05). No significant group difference was observed in secondary endpoints. Mixed models confirmed those results. Regarding the whole sample, gains from baseline were significant for the UL-FMA at t1 (+4.8; P P =.013) and t2. Conclusions In a comprehensive rehabilitation program, isokinetic strengthening did not show superiority to passive mobilization for UL rehabilitation. Findings also suggest a sustained benefit in impairments and function of late UL rehabilitation programs for patients with stroke.

Background In the short-term, laparoscopic sleeve gastrectomy has been shown to be effective for the treatment of the type 2 diabetes in patients with severe obesity. There are few data with greater follow-up. Our aim was to evaluate the results of laparoscopic sleeve gastrectomy on the control of type 2 diabetes in patients with severe obesity at 5 years at the University Hospital, France. Methods From a total of 355 patients with severe obesity operated between January 2006 and June 2010, 52 (15%) had a diagnosis of type 2 diabetes before undergoing laparoscopic sleeve gastrectomy. Results There were 31 females (60%) and 21 males (40%), with a mean age of 51 ± 10 years (range 27–67) with a mean body mass index of 48 ± 10 kg/m 2 (range 35–82). The mean duration of type 2 diabetes was 10.8 ± 10.8 years before bariatric operation. The preoperative glycated hemoglobin was 8 ± 2% (range 5.9–12.8) in 45 patients; 17 patients (38%) had levels of glycated hemoglobin ≥9%. Three patients (6%) required insulin alone, 4 (8%) were taking oral antidiabetic medicine and insulin, and the remaining 45 patients (87%) were taking only oral antidiabetic medicines. The complete data regarding weight loss at 5-year follow-up were obtained for 46 patients, yielding an overall follow-up rate of 89%. The prolonged remission of type 2 diabetes achieved at 1 year that persisted at 5 years of follow-up was present in 9 patients (17%). No patient with complete remission of their type 2 diabetes required insulin preoperatively. Improvement of type 2 diabetes was observed in 30 patients (58%) at 1 year, which was maintained for 27 patients (52%) at 5-year follow-up. Conclusion Laparoscopic sleeve gastrectomy has demonstrated a moderate efficacy in the treatment morbidly obese patients with type 2 diabetes. Markedly increased preoperative glycated hemoglobin levels, older age, and preoperative need for insulin treatment may be the factors predicting failure of complete remission of type 2 diabetes after laparoscopic sleeve gastrectomy.

Background Sleeve gastrectomy (SG) induces acute weight loss, but its impact on the very early postoperative changes in body composition (BC) is less clear. Objectives This longitudinal study examined the BC changes in the first month after SG according to gender and anatomic site. Methods BC (lean tissue mass [LTM] and fat mass [FM]) were determined by dual-energy x-ray absorptiometry in 41 obese patients (33 women, 80.5%) just before SG and 1 month later. Setting University hospital of Montpellier, France. Results One month after SG, mean weight loss was –9.8±2.6 kg, with a significant decrease in LTM and FM (kg) ranging from –7.3% to 9.5%, depending on site. FM (kg) loss in men exceeded that in women at whole body, upper limbs, and trunk. FM (%) and the LTM/FM ratio decreased only in the trunk in men and the lower limbs in women, but the gender difference was only observed for the trunk. In women, age was positively correlated with relative FM variation (% and kg) in the lower limbs and negatively correlated with LTM and LTM/FM. In men, weight was negatively correlated with the relative LTM and FM (kg) variations in the upper limbs. Conclusion SG induces acute weight loss, but this loss comprises losses in both FM and LTM. Because excessive LTM loss can have deleterious consequences, preventive strategies should be implemented soon after bariatric surgery. The specific changes in BC are highlighted according to gender and anatomic site.

Introduction Des progres ont ete faits ces 20 a 30 dernieres annees pour comprendre et tenter de predire les sudden unexpected death in epilepsie (SUDEP). Un certain nombre de facteurs de risque ont pu etre identifies, mais aucun marqueur ou score valide n’est disponible a ce jour. Objectifs Dans ce contexte, nous avons developpe un score de risque clinique de SUDEP chez des patients souffrant d’epilepsie focale pharmacoresistante (EFPR). Patients et methodes Etude cas-temoins, incluant des temoins de la cohorte francaise REPO2MSE, et les cas de SUDEP certaines ou probables recenses dans le Reseau sentinelle mortalite epilepsie (RSME). Les patients temoins et les cas souffrant d’une EFPR ont ete inclus entre 2010 et 2019. Un score de risque simplifie a ete construit a partir des estimations issues de regressions logistiques multivariees avec validation interne par methode Bootstrap. Resultats Au total, 620 temoins et 62 SUDEP ont ete analyses. Les principaux facteurs de risques identifies etaient : la frequence des crises secondairement generalisees et les crises nocturnes tandis que la faculte de prevenir de l’arrivee d’une crise etait protecteur du risque de SUDEP. Le modele presentait une capacite discriminante elevee (AUC = 0,85, IC a 95 % : 0,80–0,91). Discussion Le score propose, le SUDEP-CARE presente un seuil de 3 avec une tres bonne sensibilite (Se = 87,1 %, IC95 % : 78,8–95,4) et une specificite correcte (Sp = 74,2 %, IC95 % : 70,7–77,6). Ce score presente des bonnes performances dans le reperage de patients a risque de SUDEP en se basant que sur des criteres cliniques simples a recueillir. Conclusion Il doit faire l’objet de validations complementaires sur des populations differentes.

Introduction Un programme de depistage des multimorbidites dans les rhumatismes inflammatoires chroniques (RIC) a ete mis en place depuis 2014 au CHU de Montpellier avec actuellement plus de 1500 patients depistes. L’objectif de ce travail etait d’evaluer l’impact reel de ce programme a moyen terme sur les parametres clinicobiologiques des patients qui ont ete revus. Patients et methodes Une consultation de suivi ou une hospitalisation de jour (HDJ) ont ete realisees pour la reevaluation du bilan initial de depistage & prevention a partir de 2016-2017. Le suivi des recommandations initialement emises et celles emises lors du suivi ont ete collectees lors d’une consultation systematique dediee a 1 an ou en HDJ (a 1 an, 2 ans ou 5 ans). Resultats Le delai median entre le depistage initial et la visite de suivi etait de 24 mois [12,0 ; 36,0]. Les caracteristiques des 198 patients reevalues etaient identiques a celles de l’ensemble des patients depistes dans notre programme. Les recommandations initiales ont ete appliquees chez 60/104 patients avec recommandation (57,7 %) pour la dyslipidemie (avec prescription de statine pour 8/60), 30/34 (88,3 %) pour l’HTA (introduction ou modification de traitement chez 9/30), 17/21 (80,9 %) pour le diabete (prescription de traitement pour 5/18), 65/87 (74,7 %) pour la consultation cardiologique (introduction traitement anti aggregant plaquettaire chez 4/60), 25/33 (75,8 %) pour les explorations pneumologiques, 8/20 (40 %) pour la polysomnographie (3/8 traitements), 61/85 (71,8 %) pour l’osteoporose (9 introductions de traitement). De plus, 78/114 (68,4 %) des patients ont suivi les recommandations vaccinales, 59/99 (59,6 %) ont mis a jour leurs depistages neoplasiques. Le sevrage tabagique a ete realise chez 19/58 patients (32,8 %). Au cours du suivi, parmi les patients chez qui une recommandation avait ete emise, le cholesterol LDL et total diminuaient significativement (−0,23 g/l ±0,38, n = 26, p = 0,01 et −0,25 g/l ± 0,47, n = 21, p = 0,03) avec une tendance similaire sur l’ensemble des patients (−0,08± 0,30 g/l de LDL, n = 76, p = 0,07). Le pourcentage de patients ayant une pression arterielle anormale etait significativement moindre lors du suivi (68 % vs 84 % a l’inclusion, p = 0,002) avec 6 patients ayant une pression systolique normale parmi les 12 dont la PAS etait initialement > 140 mmHg et 3 patients ayant une pression diastolique normale parmi les 4 dont la PAD etait initialement > 90 mmHg. L’IMC n’etait pas significativement different entre les deux evaluations. Parmi les patients initialement en surpoids, 3/45 avaient un IMC Conclusion L’evaluation a moyen terme du bilan depistage & prevention montre l’interet du programme de depistage et de son suivi avec une bonne application des recommandations et une amelioration objective de plusieurs criteres de multimorbidites.

Background Children with multiple cafe-au-lait macules (CALMs) may be followed for years before a second National Institutes of Health clinical criterion of neurofibromatosis type 1 (NF1) develops to confirm the diagnosis. Objective We sought to assess the prevalence of nevus anemicus (NA) in NF1 and its association with neuro-ophthalmologic complications. Methods This was a prospective multicenter case-control study of 210 consecutive patients with multiple CALMs. Patients with NF1 were matched for age, sex, and center with control subjects. We documented the number, location, and morphologic appearance of NA; dermatologic features of NF1; magnetic resonance imaging results; and family history. Results In all, 77 (51%) patients with NF1 had NA compared with 6 (2%) control subjects. NA was not detected in 26 patients with other genodermatoses associated with CALMs. Patients with NF1 and NA were younger than those without NA (median age: 17 years) ( P = .002). NA was mostly localized to the upper anterior aspect of the chest. NA was not significantly linked with other clinical manifestations of NF1, including optic glioma and unidentified bright objects. Limitations A potential referral bias associated with tertiary care centers is a limitation. Conclusions NA appears to have a high prevalence and specificity in NF1 and might serve as a marker for NF1 in children with multiple CALMs.

Resume Objectif : la genioplastie, habituellement pratiquee en fin de croissance, isolee ou associee a d’autres osteotomies est validee pour traiter l’exces vertical. Notre objectif est d’evaluer si la genioplastie a un âge plus precoce a un impact sur la croissance mandibulaire. Methodes : il s’agit d’une etude prospective comparative. Vingt-cinq adolescents, hyperdivergents, ventilateurs buccaux, ont ete inclus apres orthodontie et traitement ORL. Ils sont divises en deux groupes selon l’âge pubertaire, precoce (groupe 1 : Stade de Tanner 3, n = 12) ou tardif (groupe 2 : Stade de Tanner 4–5, n = 13). La genioplastie a ete proposee dans les deux groupes. Une comparaison cephalometrique a ete realisee sur la population globale et pour chaque groupe, avant-apres genioplastie (a un, six, 12, 18 mois). Resultats : en postoperatoire immediat, il existe au sein de chaque groupe une variation significative de toutes les mesures cephalometriques dans le sens d’une diminution du sens vertical et d’une augmentation sagittale. Dix-huit mois apres la chirurgie, seul le groupe 1 montre une augmentation significative de SNPog. L’augmentation de SNB et la rotation mandibulaire anterieure sont aussi significativement plus importantes dans le groupe 1. Il existe une difference significative de direction de croissance mandibulaire entre la periode pregenioplastie (18 mois d’orthodontie) et post-genioplastie (18 mois de surveillance postoperatoire). Conclusion : la genioplastie precoce permet une reorientation de la croissance mandibulaire favorable a la correction orthopedique de la Classe II hyperdivergente.

The relationship between bone mass and muscle mass may be due to the site-specific effects of loading on bone in adults and to lifestyle, nutritional, and hormonal factors. Another hypothesis is that the maintenance with aging of both appendicular muscle and bone mass may be determined by factors independent of all these previous factors, including genetic factors. In 160 healthy men aged 20 to 72years, we recorded femoral neck bone mineral density (FN BMD), relative appendicular skeletal muscle mass [RASM; appendicular skeletal muscle mass (kg)/height (cm)], age, body mass, maximum grip and knee extension strength, lifetime physical activities, calcium intake, tobacco smoking, and serum parathyroid hormone (PTH), estradiol (E2), free testosterone, dehydroepiandrosterone sulphate (DHEAS), insulin-like growth factor (IGF-I), sex hormone-binding globulin (SHBG), calcium, 25(OH) vitamin D, albumin, and creatinine clearance. The correlation between FN BMD and RASM (that includes upper and lower limb muscle mass) was of slightly greater magnitude than that between FN BMD and the relative upper limb muscle mass and between FN BMD and the relative leg muscle mass (r=0.39; p< or =0.001 versus r=0.36; p< or =0.001 and r=0.34; p< or =0.001, respectively). The stepwise multiple linear regression model showed that FN BMD was significantly associated with RASM (15% of FN BMD variance, p

Oxidative stress is commonly observed in the elderly and could be involved in age-related diseases. However, the determinants of superoxide anion overproduction are not clearly understood. Superoxide anion production was evaluated using a lucigenin-based chemiluminescence method in 478 elderly subjects (304 women, 174 men; 79.5+/-7.1 years). Homocysteine (HCy) metabolism (homocysteinemia, vitamin B12, plasma, and erythrocyte folates), inflammation (CRP, fibrinogen, alpha-1 acid glycoprotein), lipid parameters (total cholesterol, triglycerides, HDL and LDL cholesterol), and nutritional parameters (albumin, transthyretin) were determined. The results show that HCy levels (p0.001) and superoxide anion production (p=0.04) increase with aging, but CRP does not. Highest HCy (20 microM) (OR 1.83 (1.09-3.07), p=0.02) and CRP over 5 mg/L (adjusted OR 2.01 (1.15-3.51), p=0.01) are the main determinants in superoxide anion production in the elderly. These clinical data are confirmed in an in vitro study using THP-1 monocyte-like cells. Incubation with HCy thiolactone (HTL) (0-200 microM) and LPS (0-20 ng/ml) dramatically enhances NADPH oxidase expression and activation. Moreover, a synergic action was evidenced for low concentrations of HTL (20 microM) and LPS (5 ng). Taken together, the clinical data and in vitro experiments support the hypothesis that moderate homocysteinemia and low-grade inflammation synergically enhance NADPH oxidase activity in the elderly.

PURPOSE: To compare resective surgery and medical therapy in a cost-effectiveness analysis in a multicenter cohort of adult patients with partial intractable epilepsy. POPULATION AND METHODS: Adult patients with partial, medically intractable, potentially operable epilepsy were eligible and followed every year over five years. Effectiveness was defined as one year without seizure. The long-term costs and effectiveness were extrapolated over the patients' lifetime with a Markov model. Productivity (indirect costs) and quality of life (QOLIE-31, SEALS) were also assessed. Changes before and after surgery were compared between the two groups. RESULTS: Two hundred and eighty-nine patients were included (119 with surgery, 161 medically treated, six not eligible, three lost to follow-up). One year after surgery, 81% of the patients were seizure-free; at two and three years, this rate was 78%. In the medical group, these rates were 10, 18, and 15%, respectively. The cost of the explorations was euro 8464; including surgery, it was euro 19,700. In the medical group, the average annual direct costs were between 3500 and euro 6000. At two years after surgery, the annual direct cost decreased to euro 2768, at three years, it was euro 1233, predominately antiepileptic drug costs. Surgery became cost-effective between seven and eight years. In the surgical group, all the quality-of-life scores improved at one year after surgery and were stable during the second and third years. CONCLUSION: Surgical therapy was cost-effective at the middle term even though indirect costs were not considered.

Introduction We examined the effects of active walk training 3 days per week, for 24 weeks on isokinetic peak torque (PT) and mean power (MP) of the knee extensors and flexors of osteopenic sedentary old women. Methods The population was composed by 121 women (65.5 ± 4.2 years) with 5.3 (± 1.7) to the Physical Activity Scale for the Elderly (PASE) and 86% of the theoretical distance of the 6-minute walk test (6MWT). The women were eligible to participate if they had no medical contraindication and were not diagnosed with major motor and neurocognitive dysfunctions. The isokinetic performance of the knee extensors and flexors in both limbs was measured on Biodex System 3® in concentric/concentric condition on 80° range of motion. The experimental protocol consisted in 5 maximal effort performed at 60°/sec, 60 second of rest interval and 5 maximal effort at 180°/sec. After 5 minutes of rest, identical paradigm was performed on contro-lateral side. Experimental group performed aerobic walk training: (1) between 60 and 80% of maximal heart rate; (2) with a distance between 1500 to 4500 meters at the end of the training; (3) with a total time effort between 25 to 45 minutes at the end of the training. Results Our results showed significant increase of PT of hamstring in dominant side at 180°/sec (p Discussion Our results indicate a moderate effects of the aerobic walk training performed during 6 months on the peak torque and the mean power of isokinetic knee extensors and flexors in old sedentary women.

Objective The sensori-motor impairment of upper limb (UL) affects more than 50% of patients after stroke. The objective of this work was to study the efficiency of isokinetic muscle strengthening (IMS) in the chronic phase of stroke in this population. Material/Patients and methods The patients underwent 6 weeks of outpatient rehabilitation, 3 days per week, combining physiotherapy (twice/day) and occupational therapy every day. The program was completed by 30 minutes elbow and wrist concentric slow speed IMS of flexor and extensor muscles, in the study group versus 30 minutes passive mobilisation of the joints carried out by the same isokinetic dynamometer in the control group. Inclusion criteria Age > 18 years, post stroke period > 6 months, muscle strength > 2/5 manual testing, spasticity Principal judgement criteria The UL Fugl Meyer (FM) score gain at the end of the program (6 weeks). Secondary criteria FM at 3 and 6 months, Box and Block test, Barthel Index and measures of muscle strength at 6 weeks, 3 and 6 months. Results Twenty patients were included: 16 men, 13 left hemiplegia, 16 ischemic strokes, average age 63. The gain in the FM score at 6 weeks was comparable between the two groups: 3.5 point (±4.4) versus +6 (±4.5) in the control group (P = 0.224). We have not observed shoulder pain or increase spasticity. No significant differences between the two groups has been demonstrated on secondary endpoints. All patients improved their FM score (4.7; P Discussion - Conclusion Combined with an intensive multidisciplinary rehabilitation program, IMS of UL is not more efficient than passive mobilisation of the wrist and elbow late after stroke. Our study also suggests the value of an intensive, out-patient rehabilitation treatment program in chronic phase after stroke, in cases of mild to moderate motor deficit of UL, remains beneficial over 6 months post-program.