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Background: Stroke, diabetes, and coronary heart disease (CHD) remain leading causes of death in the United States and are largely attributable to lifestyle behaviors. Integrative medicine can provide a supportive partnership that focuses on improving health by identifying and implementing lifestyle changes based upon personal values and goals.Objective: This prospective observational study was designed to assess the effectiveness of an integrative medicine intervention on modifiable disease risk, patient activation, and psychosocial risk factors for stroke, diabetes, and CHD.Design: Sixty-three adults participated in a 3-day comprehensive, multimodal health immersion program at Duke Integrative Medicine, Duke University Medical Center, Durham, North Carolina. Participants received follow-up education, physician support, and telephonic health coaching between the immersion program and the endpoint 7 to 9 months later.Primary Outcome Measures: Psychosocial functioning, readiness to change health behaviors, and risk of developing diabetes, stroke, and CHD were assessed at baseline and endpoint.Results: Although cardiac risk remained unchanged (P = .19) during the study period, risk of diabetes (P = .02) and stroke (P < .01) decreased significantly. Perceived stress remained unchanged, but improvements were seen in mood (P < .05) and relationship satisfaction (P < .004). Patients became more activated towards self-management of health (P <.001), endorsed greater readiness to change health behaviors (P <.01), and reported increased aerobic exercise (P <.001) and stretching (P = .006) following the intervention.Conclusion: An integrative health model can help patients become more engaged in self-management of health and support them in making and maintaining healthy lifestyle changes. These findings provide support for use of an integrative health model in adult disease risk reduction. [ABSTRACT FROM AUTHOR]

Introduction: Non-small cell lung cancer (NSCLC) is often associated with compromised lung function. Real-world data on the impact of surgical approach in NSCLC patients with compromised lung function are still lacking. The objective of this study is to assess the potential impact of minimally invasive surgery (MIS) on 90-day post-operative mortality after anatomic lung resection in high-risk operable NSCLC patients., Methods: We conducted a retrospective multicentre study including all patients who underwent anatomic lung resection between January 2010 and October 2021 and registered in the Epithor database. High-risk patients were defined as those with a forced expiratory volume in 1 s (FEV 1 ) or diffusing capacity of the lung for carbon monoxide ( D LCO ) value below 50%. Co-primary end-points were the impact of risk status on 90-day mortality and the impact of MIS on 90-day mortality in high-risk patients., Results: Of the 46 909 patients who met the inclusion criteria, 42 214 patients (90%) with both preoperative FEV 1 and D LCO above 50% were included in the low-risk group, and 4695 patients (10%) with preoperative FEV 1 and/or preoperative D LCO below 50% were included in the high-risk group. The 90-day mortality rate was significantly higher in the high-risk group compared to the low-risk group (280 (5.96%) versus 1301 (3.18%); p<0.0001). In high-risk patients, MIS was associated with lower 90-day mortality compared to open surgery in univariate analysis (OR=0.04 (0.02-0.05), p<0.001) and in multivariable analysis after propensity score matching (OR=0.46 (0.30-0.69), p<0.001). High-risk patients operated through MIS had a similar 90-day mortality rate compared to low-risk patients in general (3.10% versus 3.18% respectively)., Conclusion: By examining the impact of surgical approaches on 90-day mortality using a nationwide database, we found that either preoperative FEV 1 or D LCO below 50% is associated with higher 90-day mortality, which can be reduced by using minimally invasive surgical approaches. High-risk patients operated through MIS have a similar 90-day mortality rate as low-risk patients., Competing Interests: Conflict of interest statement: The statistical analysis in this work was financially supported by the Marc Laskar grant. J-M. Baste and P-B. Pagès receive consulting fees from Medtronic and from Intuitive Surgical. P-A. Thomas is a consultant for Ethicon Endosurgery, AstraZeneca and Europrisme. A. Seguin-Givelet is a speaker for AstraZeneca and Medtronic. H. Etienne, J. Iquille, P.E. Falcoz, L. Brouchet, J-P. Berthet, F. Le Pimpec Barthes, J. Jougon, M. Filaire, V. Anne, S. Renaud, T. D'Annoville, J.P. Meunier, C. Jayle, C. Dromer, A. Legras, P. Rinieri, S. Jaillard, V. Margot, M. Dahan and P. Mordant have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright ©The authors 2024.)

Introduction: The use of complementary therapies within oncology is a clinical issue, and their evaluation a methodological challenge. This paper reports the findings of a qualitative study exploring the lived experience of a French program of complementary therapies combining structured physical activity and MBSR among women with breast cancer., Methods: This French exploratory qualitative study followed the five stages of the Inductive Process to analyze the Structure of lived Experience (IPSE) approach. Data was collected from February to April 2021 through semi structured interviews. Participants, purposively selected until data saturation. Inclusion criteria were: being an adult woman with breast cancer whatever the stage who had completed their treatment and were part of the program of complementary therapies., Results: 29 participants were included. Data analysis produced a structure of experience based on two central axes: 1) the experience these women hoped for, with two principal expectations, that is to take care of their bodies and themselves, and to become actors in their own care; and 2) an experience of discovery, first of themselves and also in their relationship with the exterior, whether with others, or in society, and in the relationships with health-care providers., Conclusions: Our results from this French study reinforce the data described in other western countries about the needs of women receiving care in oncology departments for breast cancer: they need to be informed of the existence of supportive care in cancer by the health-care professionals themselves, to be listened to, and to receive support care. A systematic work of reflexivity about this redundancy in our results and in the qualitative literature, led us to question what impeded the exploration of more complex aspects of the experience of this women-the inherently emotional and anxiety-inducing experience of cancer, especially anxiety about its recurrence and of death-and to suggest new research perspectives to overcome these methodological and theoretical obstacles., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Sibeoni et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objectives: To quantify and describe flare-ups of house dust mite allergic rhinitis (HDM-AR) which had occurred during the last 12 months in a population of adults and children candidate for Allergen ImmunoTherapy (AIT). Next, to identify associated clinical features., Materials and Methods: This was an observational, multicenter, cross-sectional study that included patients aged ≥ 5 years with HDM-AR eligible for AIT and without prior AIT for at least 12 months. Flare-ups were all period with impairment of quality of life (QoL) and requiring a change in their usual treatment. Data were collected using medical records and patient questionnaires. Variables associated with the occurrence of ≥ 2 AR flare-ups were identified., Results: 1,701 patients were included (average age: 23 years, 51.5% males, 30.4% children, 17.7% adolescents and 51.9% adults). Severe and persistent AR affected 70.9% of them and 53.7% showed polysensitization. Asthma was associated with AR in 34.4% and was well-controlled in 58.5%. The occurrence of at least one AR flare-up in the year was reported by 77.7%, with an annual rate in the whole population of 2.6 ± 3.9 and a duration of 14.1 ± 17.1 days. Deeply or moderately AR-related degraded QoL was experienced by 39.5% and 64.6%, respectively. The occurrence of ≥ 2 AR flare-ups was reported by 54.5% and was associated with polysensitization, AR intermittence and severity., Conclusion: AR flare-ups are frequent and impair QoL in HDM-allergic patients, suggesting that it could be considered as therapeutic targets., Competing Interests: Ludovic de Gabory: Honoraria/Consulting: ALK-SAS, AstraZeneca, Chiesi, GlaxoSmithKline, Integra Life Science, Laboratoire de la Mer, Laboratoire Chemineau, Medtronic, Sanofi Genzyme, Zambon. Sabine Amet: ALK SAS corporate employee Annelore Le Maux: ALK SAS corporate employee Jean-Pierre Meunier: Manager of the CRO Axonal, which was designated by ALK to conduct the trial Antoine Chartier: ALK SAS corporate employee Cécile Chenivesse: Grants from AstraZeneca, Santelys Personal fees from ALK SAS, AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Novartis, Sanofi-Regeneron, TEVA Congress support from ALK SAS, AstraZeneca, Boehringer Ingelheim, GlaxoSmithKlein, Novartis, Pierre Fabre, Pfizer, Roche, TEVA, (Copyright: © 2023 de Gabory et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Glioblastoma is considered the most common malignant primary tumor of central nervous system. In spite of the current standard and multimodal treatment, the prognosis of glioblastoma is poor. For this reason, new therapeutic approaches need to be developed to improve the survival time of the glioblastoma patient. In this study, we performed a preclinical experiment to evaluate therapeutic efficacy of 166 Ho microparticle suspension administered by microbrachytherapy on a minipig glioblastoma model. Twelve minipigs were divided in 3 groups. Minipigs had injections into the tumor, containing microparticle suspensions of either 166 Ho (group 1; n = 6) or 165 Ho (group 2; n = 3) and control group (group 3; n = 3). The survival time from treatment to euthanasia was 66 days with a good state of health of all minipigs in group 1. The median survival time from treatment to tumor related death were 8.6 and 7.3 days in groups 2 and control, respectively. Statistically, the prolonged life of group 1 was significantly different from the two other groups (p < 0.01), and no significant difference was observed between group 2 and control (p=0.09). Our trial on the therapeutic effect of the 166 Ho microparticle demonstrated an excellent efficacy in tumor control. The histological and immunohistochemical analysis showed that the efficacy was related to a severe 166 Ho induced necrosis combined with an immune response due to the presence of the radioactive microparticles inside the tumors. The absence of reflux following the injections confirms the safety of the injection device., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Khoshnevis, Brown, Belluco, Zahi, Maciocco, Bonnefont-Rebeix, Pillet-Michelland, Tranel, Roger, Nennig, Oudoire, Marcon, Tillement, Louis, Gehan, Bardiès, Mariani, Muzio, Meunier, Duchemin, Michel, N’Tsiba, Haddad, Buronfosse, Carozzo and Ponce.)

Background: The COVID-19 pandemic has directly impacted the field of child and adolescent psychiatry, affecting all aspects of the lives of children and their families and increasing their risk of distress and mental health issues, especially among children with preexisting psychiatric disorders. Child and adolescent psychiatrists (CAPs) across the world have had to adapt their practice, due to lockdown and social distancing measures. This study aimed to explore how CAPs experienced their clinical practice in these singular conditions., Methods: This exploratory international qualitative study used the Inductive Process to analyse the Structure of lived Experience (IPSE) approach, which is a five-stage inductive process used to explore the lived experience of participants in depth and to analyze their structure of lived experience. This study took place from March through July 2020 through individual in-depth video interviews. The sample size was determined according to the principles of theoretical sufficiency., Results: 39 CAPs from 26 countries participated (age range 32-70 years; 23 women). Data analysis produced a structure of lived experience comprising three central axes of experience: (1) lost in space, lost in time, describing CAPs' experience of disorganization of their clinical practice in the dimensions of lived time and lived space, (2) the body-of CAPs and patients-underlining their disconcerting experience of both sensory aspects and the non-embodied encounter during clinical practice, and (3) unpleasant emotions, with angst and loneliness the two main feelings coloring their clinical practice experience., Conclusions: This analysis of the structure of lived experience of CAPs went beyond the sole context of the pandemic and revealed key aspects of what usually organizes CAP clinical practice. It identified two blind spots or conceptual voids within the child and adolescent psychiatry field: first, the intrinsic therapeutic function of a CAP clinical practice and, second, the important diagnostic and therapeutic function of the embodied encounter during CAP consultations. Beyond the context of COVID-19, further research should investigate these aspects to better define what a CAP does in practice and to increase both attractiveness and recruitment in this specialty., (© 2021. The Author(s).)

Background & Aims: Malnutrition affects 5-10% of elderly people living in the community. A few studies suggest that nutritional intervention may reduce health care costs. The present study included malnourished elderly patients living at home. It aimed to compare health care costs between patients that were prescribed ONS by their general practitioner and those who were not, and to assess the effect of ONS prescription on the risk of hospitalisation., Methods: This prospective multicentre observational study included malnourished patients ≥70 years old who lived at home. Patients were defined as malnourished if they presented with one or more of the following criteria: weight loss ≥5% in 1 month, weight loss ≥10% in 6 months, BMI <21 kg/m 2 , albuminemia <35 g/L or Short-Form MNA ≤ 7. Their general practitioners prescribed an ONS, or not, according to their usual practice. Health care costs were recorded during a 6-month period. Other collected data were diseases, disability, self-perception of current health status, quality of life (QoL), nutritional status, appetite and compliance to ONS. A propensity score method was used to compare costs and risk of hospitalisation to adjust for potential confounding factors and control for selection bias., Results: We analysed 191 patients. At baseline, the 133 patients (70%) who were prescribed ONS were more disabled (p < 0.001) and had poorer perception of their health (p = 0.02), lower QoL (p = 0.04) and lower appetite (p < 0.001) than the 58 patients (30%) who were not prescribed ONS. At 6 months, appetite had improved more in the ONS prescription group (p = 0.001). Weight change was not different between groups. Patients prescribed ONS were more frequently hospitalised (OR 2.518, 95% CI: [1.088; 5.829] hosp; p = 0.03). Analyses of adjusted populations revealed no differences in health care costs between groups. In the ONS prescription group, we identified that health care costs were lower (p = 0.042) in patients with an energy intake from ONS ≥ 500 kcal/d (1389 ± 264 €) vs. < 500 kcal/d (3502 ± 839 €). The risk of hospitalisation was reduced 3 and 5 times when the intake from ONS was ≥30 g of protein/day or ≥500 kcal/d, respectively., Conclusions: ONS prescription in malnourished elderly patients generated no extra heath care cost. High energy and protein intake from ONS was associated with a reduced risk of hospitalisation and health care costs., (Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The electronic and optical properties of neutral oxygen vacancies, also called oxygen deficient centers (ODC(I)s), have been investigated in pure and germanium doped silica (both amorphous and α-quartz) through first-principles calculations. By means of density functional theory and many-body perturbation theory (GW approximation and the solution of the Bethe-Salpeter equation), we obtain the atomic and electronic structures as well as the optical absorption spectra of pure and Ge-doped silica in the presence of ODCs (SiODC(I)s and GeODC(I)s); our study allows us to interpret and explain the very nature of the optical features in experimental absorption spectra. The theoretical optical absorption signatures of these defects show excellent agreement with experiments for the SiODC(I)s, i.e. two absorption bands arise around 7.6 eV due to transitions between the defect levels. Our theoretical results also explain the experimental difficulty in measuring the GeODC(I) absorption band in Ge-doped silica, which was in fact tentatively assigned to a broad and very weak absorption signature, located between 7.5 and 8.5 eV. The influence of Ge-doping induced disorder on the nature of the defect-related optical transitions is discussed. We find that even if the atomic and electronic structures of SiODC(I) and GeODC(I) defects are relatively similar, the slight network distortion induced by the presence of the Ge atom, together with the increase in the Ge-Si bond asymmetry, completely changes the nature of the optical absorption edge.

Few data report the prevalence in actual clinical settings of lipodystrophy (LD), and in particular of facial lipoatrophy (LA), in HIV-infected patients treated with long-term antiretroviral therapy (ART). A French, multicenter, cross-sectional, observational study was conducted in HIV-infected patients on continuous ART for more than 12 months. The main objective was to assess the prevalence of facial LA in this population. Additional objectives were to make the same assessments for nonfacial LA and lipohypertrophy. The presence of LD signs, type, and severity was assessed by clinicians and compared with patient self-evaluations through two questionnaires. A total of 2,131 assessable patients had a median age of 46 years and a median time on ART of 10 years. Physicians diagnosed facial LA in 54% of patients and these subjects had received ART for a longer duration than those without LA. Thymidine analog usage was associated with an increased likelihood of facial LA, but 28% of patients recently treatment-initiated (1-5 years) were also affected. At other sites, LA and lipohypertrophy were diagnosed in 59% and 57% of cases, respectively. The concordance between physician and patient assessments was good for facial and buttocks LA. In this study, facial LA affects more than half of the subjects and is frequent even among the most recently treated patients. The prevalence of facial LA significantly increases with the duration of ART, with male gender, hepatitis C virus (HCV) coinfection, and non-African origin being independent risk factors. Lipohypertrophy is frequent and appears early after ART initiation.

The authors have proposed to analyze retrospectively the clinical-morphological profile of a consistent group of lung carcinomas treated surgically. The studied material consisted of clinical and pathological medical records from 364 patients confirmed histopathologically with lung carcinoma after surgical intervention. Five main groups were defined based on the histopathological criteria and then compared. The assessment of clinical data, in spite of a wide range of clinical expressions, revealed some particular features for each of the defined groups. The morphological data outlined also different behavioral profiles for each of the histopathological types of lung carcinoma. These results showed that malignant epithelial tumors of the lung are still a major challenge from the detection until the therapeutic intervention and, therefore, the preoperative clinical-morphological investigation is crucial for a better adjustment of the therapeutic act according to the individual profile of each type of tumor.

Background and Objectives: GRAZAX(®) (Phleum Pratense, 75,000 SQ-T/2,800 BAU, ALK, Denmark), an SQ-standardized grass allergy sublingual immunotherapy tablet for the desensitization of grass pollen-induced rhinoconjunctivitis, has been developed to facilitate patient access to specific immunotherapy (SIT), while minimizing the risk of serious treatment-related adverse events. As a minimum duration of 3 years is recommended for SIT treatment, the GRAAL trial aimed to assess the safety profile of GRAZAX(®) in real-world conditions during long-term treatment of patients with grass pollen-induced allergic rhinoconjunctivitis (ARC)., Methods: A multicentre, prospective, open-label, observational trial was conducted over three consecutive grass pollen seasons from November 2007 to October 2010 in France. A total of 130 physicians included 628 patients with previously documented ARC. Patients received one tablet daily (no up-titration) for at least 4 months before the expected start of the pollen season (pre-season), which was then maintained throughout the entire season (co-season). The primary endpoint was safety and tolerability (immediate, i.e. each year at first tablet administration, and long-term) after pre- and co-seasonal exposure to GRAZAX(®)., Results: Patients were treated for an average of 5.5 months per year. After administration of the first tablet, immediate tolerable reactions (defined as benign, local, of short duration [<30 minutes] and not requiring any symptomatic treatment) were experienced by 54.6%, 38.4% and 33.6% of the patients during the first, second and third years of treatment, respectively. Immediate intolerable reactions (required study discontinuation, symptomatic medication or lasted >30 minutes) occurred in 14 patients (2.2%) during GRAZAX(®) initiation, and one patient (0.3%) at treatment reintroduction during the second year. Adverse events considered to be related to GRAZAX(®) were reported by 46.2%, 14.4% and 1.8% of patients, during the first, second and third years of treatment, respectively. The most frequently reported adverse events were mild-to-moderate local events (at the oral and pharyngeal mucosa levels). These symptoms mainly occurred within the first month of treatment initiation and subsequent tablet reintroduction., Conclusion: Daily administration of GRAZAX(®) for three consecutive years was generally safe and well tolerated. An improvement in the incidence of adverse events related to treatment was observed at reintroduction of GRAZAX(®) and during the course of treatment., Trial Registration: http://clinicaltrials.gov (NCT01433510).

Aim: To evaluate the impact of chronic bronchitis in patients identified among subjects at risk of chronic obstructive pulmonary disease (COPD) but currently free from any known chronic respiratory disorder, visiting a general practitioner for an acute respiratory episode., Method: A multicentre, cross-sectional survey carried out in primary care., Results: Primary care practitioners (n = 772) examined 14,030 patients with acute cough (male: 56.9%, age 50.6 ± 16.5 years). Of these, 3,615 were at risk of COPD (> 40 years and tobacco use > 10 pack-years) and constituted the study population: 79.8% reported current symptoms of chronic bronchitis. Compared to patients without chronic bronchitis, they were older, more frequently exposed to occupational pollutants or to passive smoking, had more tobacco use (p < 0.001), reported dyspnoea > Grade 2 more frequently, and had poorer quality of life as assessed by the EuroQOL-5D questionnaire., Conclusions: In this survey, previously unrecognised chronic bronchitis was diagnosed in a high proportion of at-risk patients with acute respiratory episodes. Chronic bronchitis was associated with significantly poorer health status. Acute respiratory illness could be an appropriate opportunity for screening those patients at risk of COPD with lung function testing.

More and more research are being done on food bolus formation during mastication. However, the process of bolus formation in the mouth is difficult to observe. A mastication simulator, the Artificial Masticatory Advanced Machine (AM2) was developed to overcome this difficulty and is described here. Different variables can be set such as the number of masticatory cycles, the amplitude of the mechanical movements simulating the vertical and lateral movements of the human lower jaw, the masticatory force, the temperature of the mastication chamber and the injection and the composition of saliva. The median sizes of the particles collected from the food boluses made by the AM2 were compared with those of human boluses obtained with peanuts and carrots as test foods. Our results showed that AM2 mimicked human masticatory behavior, producing a food bolus with similar granulometric characteristics., (Copyright (c) 2010 Elsevier Ltd. All rights reserved.)

We present a theoretical study of the ambient refractive index sensing characteristics of long period gratings in bare and metal-coated D-shaped fibers. An equivalent rectangular core waveguide method based on the first-order perturbation theory has been used to study the modal behavior of the waveguide. Power coupling corresponding to dual resonance in both cases has been investigated, and an optimum metal thickness giving maximum sensitivity has been found to exist. The study shows that the dual resonances can be shifted to lower wavelengths by increasing (decreasing) the metal thickness (core to flat surface separation). Further, an optimum combination of metal thickness and core to flat surface separation, corresponding to maximum sensitivity, has been presented for different cladding modes and their relative performance has been discussed. It has been shown theoretically that detection of refractive index changes as small as 1.67x10(-7) RIU in the ambient region is possible using the optimized parameters. The study should find application in realizing highly sensitive biochemical sensors.

A novel biochemical sensor based on a submicrometer size, high core-cladding index difference, silica core Si-SiO(2) waveguide with a Bragg grating written in its cladding region is proposed and analyzed. Waveguide parameters are optimized to obtain maximum sensitivity, and for lower refractive index samples, an optimum core width is found to exist for both the TE and the TM mode configurations. Owing to the high index contrast at the Si-SiO(2) interface, the structure is much more sensitive while operating in the TM mode configuration, showing extremely high sensitivity [200-740 nm refractive index units (RIU)] for the ambient refractive indices between 1.33 and 1.63, which is of the order of most surface plasmon polariton (SPP) based biosensors. Further, unlike SPP based sensors, the proposed structure is free from any metallic layer or bulky prism and hence easy to realize. Owing to its simple structure and small dimensions, the proposed device could be easily integrated with planar lightwave circuits and could be used for lab-on-a-chip applications.

Specklegram in multimode fiber has successfully been used as a sensor for detecting mechanical disturbance. Speckles in a multimode pure silica grapefruit fiber are observed and compared to that of a step-index multimode fiber, showing different features between them. The sensitivities to external disturbance of two kinds of fiber were measured, based on single-multiple-single mode (SMS) fiber structure. Experimental results show that the grapefruit fiber shows higher sensitivity than does the step-index multimode fiber. The transmission spectrum of the grapefruit fiber was measured as well, showing some oscillation features that are significantly different from that of a step-index multimode fiber. The experiments may provide suggestions to understand the mechanisms of light propagation in grapefruit fibers.

The aim of the study was to assess the ability of a dynamic in vitro model to determine the digestibility of OM, CP, and starch compared with a validated, static, in vitro method and in vivo ileal digestibility obtained from growing pigs fitted with a T-cannula. Five experimental diets with different carbohydrate types and level were assessed: a standard corn-based diet (ST) or the same diet with coarse ground corn (CC), 8% sugar beet pulp (BP), 10% wheat bran (WB), or 8% sugar beet pulp and 10% wheat bran (HF). In the in vivo experiment, diets CC and HF reduced (P = 0.015) ileal digestibility of OM compared with the ST diet. The inclusion of sugar beet pulp reduced (P = 0.049) ileal CP digestibility of the BP diet. This reduction was not statistically significant when sugar beet pulp was combined with the wheat bran in the HF diet. No differences were shown for in vivo starch digestibility among diets. With the static in vitro method, the OM disappearance was greater than that observed in the in vivo experiment. In this static method, the BP and HF diets reduced (P = 0.004 and < 0.001, respectively) the disappearance of the OM compared with the ST diet. The coarse grinding of corn did not alter OM digestibility but decreased (P = 0.005) the starch digestibility. The R(2) between the in vivo results and the static in vitro methods for OM and starch digestibility was 0.99 when the CC diet was not considered. The dynamic in vitro model yielded OM and CP digestibility coefficients comparable with those obtained in vivo for the ST and CC diets. However, the values were considerably affected by the incorporation of the fibrous ingredients. Diets BP, WB, and HF had decreased (P = 0.009, 0.058, and 0.004, respectively) OM digestibility compared with the ST diet. Protein digestibility was also decreased (P < 0.001, P = 0.019, and P = 0.003, respectively) with the BP, WB, and HF diets compared with the ST diet. However, digestibility was decreased to a greater extent in the BP diet than in the WB and HF diets, both of which contained wheat bran. The R(2) between the dynamic in vitro model and the in vivo results for CP digestibility was 0.99 when the CC diet was not considered. No differences were detected for starch digestibility among the diets with the dynamic in vitro model. This dynamic in vitro model yielded ileal digestibility results comparable with those obtained in vivo for CP and OM with a corn-soybean diet, or with a diet including coarse corn, but it underestimated digestibility when fibrous ingredients were included in the diet.

Background: Allergic rhinitis (AR) and asthma are inflammatory conditions of the airways that often occur concomitantly. This observational, cross-sectional, national study was undertaken to describe the frequency and severity of AR in asthmatic patients. The impact of AR on the quality of life and the therapeutic management of patients in everyday general medical practice were also assessed., Methods: From April to October 2005, 1906 French general practitioners (GP) participated in the study. Each physician had to fill out a questionnaire (including the Juniper Asthma Control Questionnaire and a Rhinitis Questionnaire) for up to 10 consecutive adult asthmatic patients. The first three patients with a confirmed diagnosis of AR (Allergic Rhinitis and its Impact on Asthma classification) were asked to complete the Juniper Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ)., Results: A total of 14,703 patient questionnaires and 4335 auto-questionnaires were analysed. Patients presented with intermittent (45%), mild (25%), moderate (25%) and severe (4%) persistent asthma. The frequency of AR in asthmatic patients was 55.2% (CI: 95%, 54.4-56.0%). Allergic rhinitis was mild for 54% and moderate/severe for 46% of patients. The frequency and severity of AR increased with the severity of asthma (P < 0.001). Moreover, AR was associated with worse asthma control whatever be the severity of asthma (P < 0.001). The global RQLQ scores of AR patients worsened with the severity of asthma (P < 0.001). Prescription of anti-asthma treatments significantly increased with the severity of AR. The majority of AR patients (81%) were treated for rhinitis., Conclusions: This survey suggested that AR was associated with more severe asthma, more difficulty to control asthma and substantial impairment of quality of life. The high frequency of AR in asthma patients requires that these conditions should be recognized and managed by GP.

The aim of this study was to develop sustained release microspheres of capsicum oleoresin as an alternative to in-feed additives. Two spray-cooling technologies, a fluidized air bed using a spray nozzle system and a vibrating nozzle system placed on top of a cooling tower, were used to microencapsulate 20% of capsicum oleoresin in a hydrogenated, rapeseed oil matrix. Microencapsulation was intended to reduce the irritating effect of capsicum oleoresin and to control its release kinetics during consumption by the animal. Particles produced by the fluidized air bed process (batch F1) ranged from 180 to 1,000 microm in size. The impact of particle size on release of capsaicin, the main active compound of capsicum oleoresin, was studied after sieving batch F1 to obtain 4 formulations: F1a (180 to 250 microm), F1b (250 to 500 microm), F1c (500 to 710 microm), and F1d (710 to 1,000 microm). The vibrating nozzle system can produce a monodispersive particle size distribution. In this study, particles of 500 to 710 microm were made (batch F2). The release kinetics of the formulations was estimated in a flow-through cell dissolution apparatus (CFC). The time to achieve a 90% dissolution value (T90%) of capsaicin for subbatches of F1 increased with the increase in particle size (P < 0.05), with the greatest value of 165.5 +/- 13.2 min for F1d. The kinetics of dissolution of F2 was slower than all F1 subbatches, with a T90% of 422.7 +/- 30.0 min. Nevertheless, because CFC systems are ill suited for experiments with solid feed and thus limit their predictive values, follow-up studies were performed on F1c and F2 using an in vitro dynamic model that simulated more closely the digestive environment. For both formulations a lower quantity of capsaicin dialyzed was recorded under fed condition vs. fasting condition with 46.9% +/- 1.0 vs. 74.7% +/- 2.7 for F1c and 32.4% +/- 1.4 vs. 44.2% +/- 2.6 for F2, respectively. This suggests a possible interaction between capsaicin and the feed matrix. Moreover, 40.4 +/- 3.9% of the total capsaicin intake in F2 form was dialyzed after 8 h of digestion when feed had been granulated vs. 32.4 +/- 1.4% when feed had not been granulated, which suggests that the feed granulation process could lead to a partial degradation of the microspheres and to a limitation of the sustained release effect. This study demonstrates the potential and the limitations of spray-cooling technology to encapsulate feed additives.

The aim of this study was to develop sustained release plant extracts as a potential alternative to antibiotic growth promoters for growing pigs. Pellets with a core based on microcrystalline cellulose and 3 active compounds (eugenol, carvacrol, and thymol) were prepared using rotary fluidized-bed technology. Two particle sizes were produced that had a mean size of approximately 250 and 500 mum. Results show the process was able to produce pellets with a spherical and homogenous form when 10% of the active compounds were incorporated into the core. When active compounds were increased to 20%, the pellet became stickier, and the yield decreased from 90 to 65%. Different amounts of coating in the form of an aqueous-based ethylcellulose (EC) dispersion (Surelease) were applied to the core to modify the release of active compounds. The efficacy of the coating was evaluated in vitro using a flow-through cell apparatus. The time to achieve 50 and 90% dissolution increased with the increase in particle size (P < 0.05) and the increase in EC-coating level from 10 to 20% (wt/wt; P < 0.05), indicating the ability of the process to slow release depending on particle size and the amount of polymer applied. Differences in the release of the active compounds were observed in the same formulation of pellets, except for the formulation with small 10%-EC-coated particles, in which the active compounds were rapidly dissolved (more than 85% in 15 min or less). For all other formulations, the dissolution time for eugenol was always faster than for thymol or carvacrol. The close monitoring of plant extract behavior in the gastrointestinal tract could become a key factor in the continued use of phyto-molecules as alternatives to antibiotic growth promoters and in optimizing the balance between cost and efficacy. Different microencapsulation technologies can be used, of which the rotary fluidized bed warrants consideration because of the quality of the products obtained.

The driving mechanism of a scanning mirror can cause significant impairment of expanded beam properties, which we investigated for several scanning waveforms. Engineering on the scanning waveform is then carried out by a scanned CO2 laser beam technique to enlarge the uniform heating region for stretching and sintering of silica fibers. Details of the derivation are given. A simple thermal model is presented to account for the relationship between the scanning beam profile and the taper shape. Fusion profiles are also compared for various scanning waveforms. The corresponding scanned beam power distributions are determined experimentally, which enables us to determine precise power density conditions for CO2 laser fusion.

Objectives: Surgery remains the standard option to treat symptomatic or complicated aneurysms of the extracranial internal carotid arteries (EICA). When located more distally to the EICA, surgery appears to be very invasive and disabling. Endovascular treatment of high aneurysmal EICA has been poorly reported. We report our experience in this particular field., Methods: We treated five EICA endovascularly, using covered stents and stentgrafts in four patients, two males and two females. One male was treated bilaterally. The average age was 59.2 years (39-80). Three patients were symptomatic (two transient ischemic attack and one stroke). Patients were followed by duplex scan, CT scan, or angio MR., Results: Protecting devices were used in two cases. No in-hospital complication was observed. During follow-up (3.6 +/- 1.3 years), no adverse event was observed and all devices remained patent at duplex scan and angiography. One early endoleak was observed and treated with covered stent extension. No sign of in-stent stenosis was observed. All the aneurysmal sacs thrombosed., Conclusion: Covered stents and stentgrafts allow a less invasive approach to treat highly located internal carotid aneurysms. Larger series are needed to assess the role of covered stents in treating aneurysmal EICA as first choice.

Traumatic aortic valve regurgitation is a rare complication of non-penetrating thoracic trauma. The most frequent lesion is the isolated injury of the non-coronary cusp. Actually, the transoesophageal echocardiography is the procedure of choice to confirm the diagnosis and to reveal the associated cardiovascular lesions. Surgical management with early operation is the best policy, however this surgery can be delayed for treatment of other life-threatening injuries. Up today, aortic valve replacement (AVR) was recommended to repair traumatic aortic valve regurgitation; nevertheless, in the recent international literature, the number of cases reports with conservative surgery (CS) is increasing: 10 AVR (group I) and 10 CS (group II). Analysis of the post-operative and long term periods shows good results: it confirms the excellent clinical evolution in the group I (mean time of follow-up: 18.2 +/- 16.3 months), and reveals satisfactory results in the group II for patients with isolated lesion (mean time of follow-up: 29.1 +/- 30.7 months). In conclusion, each time the traumatic aortic regurgitation is due to an isolated lesion, the conservative surgery should be performed in order to avoid aortic valve replacement and its potential complications especially in young patients with healthy valves. However, the aortic valve replacement is the safest technique for complex or multiple injuries of the aortic valve.

Purpose: The purpose of this study was to demonstrate the potential of a dynamic, multicompartmental in vitro system simulating the human stomach and small intestine (TIM-1) for studying the behavior of oral drug dosage forms under various physiological gastrointestinal conditions., Methods: Two model drug compounds were studied in TIM-1: a lyophilized Lactobacillus strain and paracetamol (acetaminophen). The Lactobacillus survival rate was determined by bacterial counting in the gastric and ileal effluents while simulating the conditions of the gastrointestinal tract of infants or adults. The availability for absorption of paracetamol from two oral dosage forms was investigated by measuring the drug concentration in jejunal dialysis fluid. The effect of gastrointestinal passage time and food intake on paracetamol absorption was also studied., Results: The Lactobacillus survival rate in both gastric and ileal effluents was higher during simulation of the infant compared to adult conditions. We also showed that (i) paracetamol absorption was faster when it was administered as a free powder than in sustained-release tablet form, (ii) a slow passage time resulted in a delay in the absorption of paracetamol, and (iii) there was a lower rate of absorption when paracetamol was ingested with a standard breakfast as opposed to water. The in vitro results were consistent with in vivo data, showing the predictive value of TIM-1., Conclusions: TIM-1 is a powerful tool for supplying valuable information about the effects of various gastrointestinal conditions on biopharmaceutical behavior and efficacy of drug delivery systems in the development of oral formulations.

The use of genetically engineered microorganisms such as bacteria or yeasts as live vehicles to carry out bioconversion directly in the digestive environment is an important challenge for the development of innovative biodrugs. A system that mimics the human gastrointestinal tract was combined with a computer simulation to evaluate the survival rate and cinnamate 4-hydroxylase activity of a recombinant model of Saccharomyces cerevisiae expressing the plant P450 73A1. The yeasts showed a high level of resistance to gastric and small intestinal secretions (survival rate after 4 h of digestion, 95.6% +/- 10.1% [n = 4]) but were more sensitive to the colonic conditions (survival rate after 4 h of incubation, 35.9% +/- 2.7% [n = 3]). For the first time, the ability of recombinant S. cerevisiae to carry out a bioconversion reaction has been demonstrated throughout the gastrointestinal tract. In the gastric-small intestinal system, 41.0% +/- 5.8% (n = 3) of the ingested trans-cinnamic acid was converted into p-coumaric acid after 4 h of digestion, as well as 8.9% +/- 1.6% (n = 3) in the stomach, 13.8% +/- 3.3% (n = 3) in the duodenum, 11.8% +/- 3.4% (n = 3) in the jejunum, and 6.5% +/- 1.0% (n = 3) in the ileum. In the large intestinal system, cinnamate 4-hydroxylase activity was detected but was too weak to be quantified. These results suggest that S. cerevisiae may afford a useful host for the development of biodrugs and may provide an innovative system for the prevention or treatment of diseases that escape classical drug action. In particular, yeasts may provide a suitable vector for biodetoxication in the digestive environment.

Traumatic aortic insufficiency is a rare occurrence after blunt chest trauma, and requires surgical treatment. Aortic valve replacement has been proposed as the procedure of choice, but primary valve repair is being performed increasingly more often. In a plead for conservative surgery, we report a case of valvuloplasty that was controlled by intraoperative aortic endoscopy. When operative conditions permit aortic valve repair, this should be carried out in order to avoid aortic valve replacement and its potential complications, especially in young patients with healthy valves. Replacement is the safest treatment for complex or multiple injuries of the aortic valve, however.

We propose to determine the optical field in multimode circular fibers by using a one-step method that measures the Wigner distribution function of a section of the field in the fiber. This method allows an estimation not only of the power carried by each mode but also of the relative phases of different modes in the fiber. An additional measurement with the same setup can even determine the propagation constants of different modes. An example is provided, and the connection of this method of field recovery to the coupling coefficient between fibers and light sources is also discussed.

The modified Duromedics-Tekna bileaflet pyrolitic carbon mechanical prosthesis was reintroduced by Baxter in 1990. This report details the first case of sudden leaflet fracture of a Tekna mitral valve five years after implantation, which was managed successfully by replacement with a St. Jude Medical mechanical prosthesis. The fracture had occurred transversely, with the fragments embolizing to the terminal aortic bifurcation and the left common femoral artery. These were localized by computed tomography and removed two days after valve replacement.

Primary pheochromocytomas of the heart are extremely uncommon. In this report, we present the case of a patient with primary cardiac pheochromocytoma arising from the interatrial septum. Metaiodobenzylguanidine-scintigraphy was negative and diagnosis was confirmed by a positive octreotide scintiscan. The tumor was removed successfully using cardiopulmonary bypass.

On the basis of space-time duality, we propose experimental setups to implement the cross-ambiguity function optically in space and time in one and two dimensions. In space the cross-ambiguity is shown to be related to the coupling efficiency between butt-joined optical waveguides. In time it is related to the spectrogram or the frequency-resolved optical gating techniques for the characterization of optical pulses.

We propose a new method for the recovery of the refractive-index profile of a single-mode or multimode optical guided structure. We solve the inverse problem using the Wigner distribution and reduce it to the solution of a linear system of equations.

A new formulation of the classical scalar beam-propagation method is derived by use of the Wigner transform. The new method is faster than the classical beam-propagation method because no Fourier transform must be computed. An example given to illustrate the proposed method shows additional advantages.

A 68-year-old patient with chronic cirrhosis underwent surgical repair of the subrenal abdominal aorta presenting an aorto-duodenal fistula. The fistula was considered to be a primary fistula because it occurred without prior surgery and because the aorta had ruptured without formation of an aneurysm. The postoperative period was complicated by paraplegia further compromising the outcome in this severe condition. In general, there are several problems involved in the management of aorto-duodenal fistulae. Neither computed tomography of the abdomen nor gastroduodenal endoscopy are able to provide the diagnosis in all cases before surgery. Surgical treatment is most often conducted in an emergency setting requiring repair of both the digestive tract and of the vascular lesions. It is also important to recognize the risk of neurological events occurring intra-operatively. Prognosis is usually poor.

We report a case of intrapericardial inferior vena caval disruption due to goring by a bull, and we describe the surgical repair of this uncommon penetrating cardiac injury. Review of the literature indicates that, as with other penetrating cardiac injuries, this rare lesion requires aggressive treatment involving an emergency thoracotomy. The use of an atrial caval active shunt was necessary for successful surgical management, and therefore we conclude that surgical treatment of this lesion is comparable with surgical repair of hepatic veins and retrohepatic vena caval injuries incurred during blunt vascular trauma or penetrating abdominal injuries.

Mitral valve exposure is widely improved by the superior-transseptal approach (STS). The diffusion of this technique has been restricted because of the possibility of detrimental effects of sino-atrial arrhythmias, especially in patients in sinus rhythm preoperatively. Between April 1991 and December 1992, we performed mitral valve replacement (MVR) on 55 patients by an STS approach. The mean age was 57.7 +/- 11.3 years (38-75 years). 21 were reoperations and 1 patient had been operated twice. The procedure consisted in 10 MVR with a bioprosthetic valve and 45 with a mechanical valve. Associated procedures were 5 tricuspid annuloplasties, 13 aortic valve replacements, 1 tricuspid valve replacement, 4 CABG, and 1 aneurysm resection. Overall hospital mortality was 9.1 +/- 3.8% (5/55). Mortality for isolated MVR was 6.2 +/- 4.2% (2/32). 51% (28/55) were in sinus rhythm (SR) preoperatively, 43% (12/28) of them had never presented atrial fibrillation. Postoperatively among those 28 patients in SR, 20 remained in SR, 7 were in atrial fibrillation, and 1 in atrial flutter. 3.6% (2/55) needed transient electrosystolic pacing for very slow atrial fibrillation 20% (11/55) have presented a transient sino-atrial dysfunction; None of these rhythmic events had any adverse effect. Finally, the very good visibility and accessibility are the major advantages of this approach, especially in mitro-tricuspid combined procedures, in small left atrium and repeat surgery. As sino-atrial arrhythmias are transient, we think this approach can be routinely employed in MVR.

Pulse broadening calculations in monomode fibers do not include till now the phase variation of the coherent input field. Although it is correct to ignore this variation at wavelengths different from the zero material dispersion wavelength lambda(o), this effect must be taken into account for wavelengths nearly equal to lambda(o). We have found for silica-type fibers that if the relative source linewidth (Deltalambda(o))/lambdao is less than 10(-3), the phase effect largely dominates over important distances in the evaluation of the pulse broadening giving rise to a decrease of the r.m.s. output pulse width. Therefore, this effect must be relevant for the estimation of the maximum information capacity on monomode fibers.

Five children aged 6 to 15 years were studied. They presented all the biological signs of hypophosphatemic vitamin resistant rickets: normal calcemia, hypophosphatemia, decrease in phosphorus Tm and normal PTH plasma level. Two children had never been given vitamin D treatment previously. The 1.25 (OH)2D has been given in 4 doses a day, to a total of 1 microgram/day, for one year. Phosphate was administered for the same time, doses varying from 40 to 150 mg/kg/day. Bone biopsies were performed at the onset and the end of treatment. Normal growth concerning bone age was observed in 3 cases. In the two others, growth remained disturbed. Radiological recovery was observed in all cases. Treatment induced and increase in serum phosphate. Tm PO4/FG remained lower than normal and even decreased during treatment. After one year of treatment, the osteoid volumes and surfaces decreased in all cases but did not always return to normal. The thickness index of osteoid and the speed of calcification were improved in 4 cases and worsened in the 5th. In two previously untreated patients an increase in plasma PTH and in the osteoclastic surface of resorption were observed on the bone biopsy during treatment.