Spatial Mobility of the Visually Handicapped Active Person: A Descriptive Study

Specific aspects of mobility and spatial orientation of the visually handicapped have attracted the attention of researchers for a quarter of a century; generally speaking, their work can be placed in four fields of study. First, interest has been focused on the capacity of blind people to move unaided in various spatial settings and to mentally map an environment. A second preoccupation revealed by the literature has been the spatial information transmitted to the visually handicapped by tactile maps, by adapted sign system and by electronic guidance systems. Other projects have focused on the environment in which visually handicapped move and on the environmental aspects that affect their mobility. Finally, some researchers have investigated how the development of technical aids has facilitated the mobility of blind people.

Prognosis for deliveries in face presentation: a case-control study

PURPOSE

To estimate the maternal and fetal prognosis for attempted vaginal deliveries of fetuses in face compared with vertex presentations. To evaluate the factors associated with a cesarean during labor for fetuses in face presentation.

METHODS

This case-control study collected all the cases of face presentation in a university hospital level-3 maternity ward between 22 and 42 weeks of gestation over a 16-year period. For each case, we selected three control cases with vertex presentations delivered the same day. Cesareans before labor were excluded.

RESULTS

We compared 60 attempted vaginal deliveries of fetuses in face presentation with 174 of fetuses in vertex presentation. The cesarean rate during labor was more than three times higher for the face presentations (31.7 vs 9.2%, P < 0.0001). Arterial pH values and Apgar scores were similar in both sets of newborns. After logistic regression, the factors associated with a cesarean during labor were nulliparity and early diagnosis of the presentation (i.e., before 5 cm dilatation). The initial position (mentum-anterior vs. transverse or posterior) was not significantly associated with the mode of delivery.

CONCLUSIONS

In face presentations, attempted vaginal delivery triples the cesarean risk. Nonetheless, more than two-thirds of these women give birth vaginally without any impairment of neonatal condition.

Angular resolution expected from iCHORD orientation maps through a revisited ion channeling model

Crystalline orientation maps are obtained in a Focused Ion Beam (FIB) microscope using the ion CHanneling ORientation Determination (iCHORD) method, which relies on the channeling phenomenon observed in ion-induced secondary electron images. The current paper focuses on the angular resolution that can be expected from such orientation maps, obtained using a revisited ion channeling model. A specific procedure was developed to evaluate the angular resolution, based on the distribution of orientation errors when evaluating controlled sample disorientation. The main advantage is that no external reference is required. An angular resolution of 1° is obtained on a nickel based sample using standard acquisition conditions. This value fulfills most of the needs in terms of microstructural characterization usually carried out by Electron Back Scattered Diffraction.

Abstract OT3-07-03: Positive behavior change and weight loss in breast cancer survivors on hormonal adjuvant therapy: An energy balance research in cancer (EnBaR) prospective study

BACKGROUND: Observational studies have repeatedly linked obesity to increased cancer incidence, recurrence, and mortality, leading to cancer treatment guidelines that call for maintenance of a healthy body weight, regular physical activity (PA) regardless of body mass index (BMI), and modest weight loss for overweight and obese cancer survivors (CS). Despite these recommendations, newly published reports suggest that more than 70% of CS are overweight or obese, and only 1/3 engage in the recommended levels of PA. Although trials have demonstrated that energy balance (EB) interventions are feasible in CS, it has been concluded that ongoing behavioral support is needed to implement and sustain changes in weight and PA. Through the subsequent Energy Balance Research (EnBaR) the incorporation of a weight management and PA program focused on ongoing behavioral support for breast cancer survivors (BCS) as an effective method for implementation of lifestyle modifications will be investigated.

TRIAL DESIGN: This is a single-arm prospective observational study investigating if implementation of an EB Program for BCS is an effective intervention for producing lifestyle behaviors. Eligible subjects must be female BCS ≥18 years with BMI ≥25 who are initiating hormonotherapy (HT) as their only oncology treatment modality. Subjects will consult with a Registered Dietitian (RD) to establish goals based on specified interventions for reducing overall BMI at the time of initiating their prescribed HT. Subjects will subsequently receive telephone calls from the RD at bi-monthly intervals to discuss the established points of intervention, answering questions proposed by the RD from a set intervention measurement scale. Patients will also report for body composition analysis performed by the RD via InBody at Baseline, Day 90, and Day 180. InBody is a validated tool that utilizes direct segmental multi-frequency bioelectrical impedance analysis (DSM-BIA) to provide a highly accurate report of an individual's body composition.

AIMS: Determine change in Percent Body Fat (PBF) and BMI during adjuvant hormone treatment for breast cancer patients.

STATS/TARGET ACCRUAL: To assess % change in BMI and PBF between baseline and 180 days, one-sample t-tests will be used. Assuming an average (avg) baseline BMI of 33.7 with a standard deviation of 8.5; a sample of 120 patients will yield 89.4% power using a two-sided t-test to detect a 13% reduction in BMI to an avg of 29.32 and 82.8% power to detect a 12% reduction to an avg BMI of 29.656. Similarly, a t-test will have 83.7% power to detect a 12% decrease in % change in PBF assuming an avg baseline PBF of 41.36 with a standard deviation 10.5. The power calculations were accomplished by generating simulations of size 10,000 replications conducted at the 0.025 significance level using the TTEST procedure of SAS 9.4 [SAS Institute Inc., Cary, NC, USA]. The calculations assume a linear correlation of 0.5 between the baseline and Day 180 measurements and are Bonferroni corrected to maintain a familywise error of 0.05 for the primary analysis. All statistical analyses will be conducted using SAS 9.4. Statistical significance will be defined as p &lt; 0.05.

Citation Format: Scheuer R, Bendinger GM, Ensor Jr. JE, Nixon D, Randolph K, McGuirec E, Rados K, McNight JE, Pabbathi H, Panicker R, Johnson AT, Langlois C, Lammersfeld C, Alvarez RH. Positive behavior change and weight loss in breast cancer survivors on hormonal adjuvant therapy: An energy balance research in cancer (EnBaR) prospective study [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr OT3-07-03.

Abstract P4-19-05: Efficacy of screening and treatment of breast cancer patients reporting high level of distress

Background: Cancer patients (pts) are burdened by symptoms related to the disease itself or to the toxicities of treatment. A recent meta-analysis has shown that anxiety is the most common mental health issue among cancer survivors [Mitchell AJ, 2013]. The ASCO clinical oncology guideline adaptation recommends all health care providers routinely screen for the presence of emotional distress and symptoms of anxiety from the point of diagnosis onward [Andersen BL, 2014]. Consensus-based recommendations have been published to help cancer centers meet the American College of Surgeons Commission on Cancer's accreditation requirement to screen for distress [Pirl, 2014] At our comprehensive community cancer center we perform distress screening using the M.D. Anderson Symptom Inventory (MDASI), composed of 27 questions. Pts who report moderate and severe levels of distress (≥5) on the MDASI are identified and referred for therapeutic interventions offered by the facility's integrative oncology services.

Materials and Methods: The MDASI is an assessment tool that captures pts' perceived symptom burden for real-time clinical intervention, taken at the point of no intervention (baseline) and every 21 days or greater. The 27-question MDASI is comprised of the M.D. Anderson Symptom Inventory (MDASI), a validated 19-item assessment instrument, with a Symptom Inventory Tool (SIT) added by our center of 8 questions and a free-text box. Symptoms are rated “at the worst” on an 11-point numeric scale ranging from 0 (“none present”) to 10 (“as bad as you can imagine”), as experienced by the patient in the past 24 hours.

Results: Over a ten-month period (9/1/2014 to 6/30/2015), 247 breast cancer (BC) pts completed the MDASI at intake and again ≥ 21 days after. Analysis of their initial surveys identified 69 pts (27.9%) who rated their distress as ≥ 5 (1st MDASI mean = 6.83), scores which would have initiated a support system response with referrals to integrative medicine services for intervention. Second MDASI results from these 69 BC pts revealed an average 2.29 distress score reduction (2nd MDASI mean = 4.48), with 51 pts (73.9%) reporting a decrease in distress, 7 pts (10.1%) having no change, and 11 pts (15.9%) reporting increased distress. More specifically, the group with decreased distress levels documented a mean distress score of 3 on their 2nd MDASI, averaging a significant 4-point diminution of distress for three-fourths of the BC pts heavily burdened by this symptom. The integrative services most utilized by these pts were Nutrition Therapy (100%), Spiritual Care (96.1%), Mind-Body Counseling (82.4%), Rehabilitation Therapy (41.2%), Acupuncture (35.3%), and Massage Therapy (35.3%).

Conclusions: Distress is a relevant symptom reported by cancer pts. This study demonstrates that early intervention in BC pts using integrative oncology approaches reduced distress in 74% of cases.

Citation Format: Daneker SR, Bendinger GM, Thomas JW, Smith E, Kendrick D, Hartman S, Gordon C, Barber K, Langlois C, Pabbathi H, McKnight JE, Johnson AT, Lammersfeld C, Denny D, Markman M, Alvarez RH. Efficacy of screening and treatment of breast cancer patients reporting high level of distress [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-19-05.

A Dietary Supplement Containing Cinnamon, Chromium and Carnosine Decreases Fasting Plasma Glucose and Increases Lean Mass in Overweight or Obese Pre-Diabetic Subjects: A Randomized, Placebo-Controlled Trial

BACKGROUND

Preventing or slowing the progression of prediabetes to diabetes is a major therapeutic issue.

OBJECTIVES

Our aim was to evaluate the effects of 4-month treatment with a dietary supplement containing cinnamon, chromium and carnosine in moderately obese or overweight pre-diabetic subjects, the primary outcome being change in fasting plasma glucose (FPG) level. Other parameters of plasma glucose homeostasis, lipid profile, adiposity and inflammatory markers were also assessed.

METHODS

In a randomized, double-blind, placebo-controlled study, 62 subjects with a FPG level ranging from 5.55 to 7 mmol/L and a body mass index ≥ 25 kg/m(2), unwilling to change their dietary and physical activity habits, were allocated to receive a 4-month treatment with either 1.2 g/day of the dietary supplement or placebo. Patients were followed up until 6 months post-randomization.

RESULTS

Four-month treatment with the dietary supplement decreased FPG compared to placebo (-0.24 ± 0.50 vs +0.12 ± 0.59 mmol/L, respectively, p = 0.02), without detectable significant changes in HbA1c. Insulin sensitivity markers, plasma insulin, plasma lipids and inflammatory markers did not differ between the treatment groups. Although there were no significant differences in changes in body weight and energy or macronutrient intakes between the two groups, fat-free mass (%) increased with the dietary supplement compared to placebo (p = 0.02). Subjects with a higher FPG level and a milder inflammatory state at baseline benefited most from the dietary supplement.

CONCLUSIONS

Four-month treatment with a dietary supplement containing cinnamon, chromium and carnosine decreased FPG and increased fat-free mass in overweight or obese pre-diabetic subjects. These beneficial effects might open up new avenues in the prevention of diabetes.

TRIAL REGISTRATION

ClinicalTrials.gov NCT01530685.

Fully Crystalline Faceted Fe-Au Core-Shell Nanoparticles

Fe-Au core-shell nanoparticles displaying an original polyhedral morphology have been successfully synthesized through a physical route. Analyses using transmission electron microscopy show that the Au shell forms truncated pyramids epitaxially grown on the (100) facets of the iron cubic core. The evolution of the elastic energy and strain field in the nanoparticles as a function of their geometry and composition is calculated using the finite-element method. The stability of the remarkable centered core-shell morphology experimentally observed is attributed to the weak elastic energy resulting from the low misfit at the Fe/Au (100) interface compared to the surface energy contribution.

Arizona Alzheimer's Registry: Strategy and Outcomes of a Statewide Research Recruitment Registry

BACKGROUND

The Arizona Alzheimer's Consortium (AAC) created the Arizona Alzheimer's Registry, a screening and referral process for people interested in participating in Alzheimer's disease related research. The goals of the Registry were to increase awareness of Alzheimer's disease research and accelerate enrollment into AAC research studies.

METHODS

Participation was by open invitation to adults 18 and older. Those interested provided consent and completed a written questionnaire. A subset of Registrants underwent an initial telephone cognitive assessment. Referral to AAC sites was based on medical history, telephone cognitive assessment, and research interests.

RESULTS

A total of 1257 people consented and 1182 underwent an initial cognitive screening. Earned media (38.7%) was the most effective recruitment strategy. Participants had a mean age of 68.1 (SD 10.6), 97% were Caucasian, had 15.2 (SD 2.7) mean years of education, and 60% were female. 30% reported a family history of dementia and 70% normal cognition. Inter-rater agreement between self-reported memory status and the initial telephone cognitive assessment had a kappa of 0.31-0.43. 301 were referred to AAC sites.

CONCLUSION

IThe Registry created an infrastructure and process to screen and refer a high volume of eager Registrants. These methods were found to be effective at prescreening individuals for studies, which facilitated AAC research recruitment. The established infrastructure and experiences gained from the Registry have served as the prototype for the web-based Alzheimer's Prevention Registry, a national registry focusing on Alzheimer's disease prevention research.

Asthma control assessment in a pediatric population: comparison between GINA/NAEPP guidelines, Childhood Asthma Control Test (C-ACT), and physician's rating

BACKGROUND

Guidelines recommend regular assessment of asthma control. The Childhood Asthma Control Test (C-ACT) is a clinically validated tool.

AIM

To evaluate asthma control according to GINA2006, NAEPP, pediatrician's assessment (PA), and C-ACT in asthmatic children visiting their ambulatory pediatrician or tertiary care pediatric pulmonologist.

METHODS

Demographic data, treatment, and number of severe exacerbations during the previous year were collected. Control was assessed using (i) strict GINA 2006 criteria, (ii) GINA without taking into account the exacerbation item, (iii) NAEPP criteria, and (iv) PA. Children and parents filled out the C-ACT.

RESULTS

Five hundred and twenty-five children completed the survey (mean age: 7.7 years; 28% ≤ 6 years). 78% had a controller treatment. 58% reported ≥ 1 severe exacerbation. C-ACT was ≤ 19 in 29.5%. Control was not achieved in 76.5%, 55%, 40%, and 34% according to GINA 2006 guidelines, NAEPP guidelines, GINA 2006 without exacerbation criteria, and PA, respectively. C-ACT was significantly lower in children ≤ 6 years old (P = 0.002) or with severe exacerbations (P < 0.0001). According to PA, 89% of patients with a C-ACT > 21 were controlled and 85% of patients with a C-ACT < 17 not controlled.

CONCLUSION

We observed discrepancies between the different tools applied to assess asthma control in children, and the impact of age and exacerbations. Cutoff point of 19 of C-ACT was not associated with the best performance compared to PA. Assessment of control should take into account symptoms and lung function as suggested by the latest GINA guidelines as well as exacerbation over a long period.

[Genetic syndromes that mimic congenital infections: report of 2 cases]

Genetic syndromes that mimic congenital infections must be recognized because of the associated risk of recurrence. We describe a male infant who was born with the association of intra-uterine growth retardation, microcephaly, intracranial calcifications, white matter abnormalities, microphtalmy, bilateral cataract, and hearing loss. Congenital cytomegalovirus (CMV) infection was suspected, but serologic CMV markers were not decisive (IgG+/IgM-). His half-sister (same father) presented a similar phenotype. Therefore, the diagnosis of congenital CMV infection was questioned and a genetic hypothesis was suggested. In 1983, Baraitser et al. first described two brothers with microcephaly and intracranial calcifications and negative TORCH analysis. Later, a number of authors reported children in whom detailed investigation failed to objectively confirm an intra-uterine infective agent. Clinical features include severe postnatal microcephaly, seizures, and pronounced developmental arrest. These cases have been considered to define a distinct autosomal recessive disorder first named pseudo-Torch syndrome. The family described herein is different from the cases previously described with a suspected autosomal dominant inheritance, severe ophtalmological abnormalities, and unusual brain imaging.

Distinct regulation of adiponutrin/PNPLA3 gene expression by the transcription factors ChREBP and SREBP1c in mouse and human hepatocytes

BACKGROUND & AIMS

The adiponutrin/PNPLA3 (patatin-like phospholipase domain-containing protein 3) variant I148M has recently emerged as an important marker of human fatty liver disease. In order to understand the role of the adiponutrin/PNPLA3 protein, we investigated the regulation of its expression in both human and mouse hepatocytes.

METHODS

Adiponutrin/PNPLA3 and lipogenic enzyme expression was determined by real-time PCR analysis in a wide panel of analysis in vivo in the mouse liver and in vitro in murine hepatocytes and human hepatocyte cell lines infected with ChREBP or SREBP1c-expressing adenoviruses.

RESULTS

We show that in the mouse liver, adiponutrin/PNPLA3 gene expression is under the direct transcriptional control of ChREBP (carbohydrate-response element-binding protein) and SREBP1c (sterol regulatory element binding protein1c) in response to glucose and insulin, respectively. In silico analysis revealed the presence of a ChoRE (carbohydrate response element) and of a SRE (sterol response element) binding site on the mouse adiponutrin/PNPLA3 gene promoter. Point mutation analysis in reporter gene assays identified the functional response of these two binding sites in the mouse adiponutrin/PNPLA3 promoter. In contrast, in human immortalized hepatocytes and in HepG2 hepatoma cells, only SREBP1c was able to induce adiponutrin/PNPLA3 expression, whereas ChREBP was unable to modulate its expression.

CONCLUSIONS

All together, our results suggest that adiponutrin/PNPLA3 is regulated by two key factors of the glycolytic and lipogenic pathways, raising the question of its implication in the metabolism of carbohydrates and lipids.

Ostwald ripening in nanoalloys: when thermodynamics drives a size-dependent particle composition

Ostwald ripening has been broadly studied because it plays a determinant role in the evolution of cluster size during both chemical and physical synthesis of nanoparticles. This thermoactivated process causes large particles to grow, drawing material from the smaller particles, which shrink. However, this phenomenon becomes more complex when considering the coarsening of metallic alloy clusters. The present experimental and theoretical investigations show that the relative composition of CoPt nanoparticles can be strongly modified during high temperature annealing and displays a size-dependent behavior. This compositional change originates from the higher evaporation rate of Co atoms from the nanoparticles. More importantly, this effect is expected in all alloy clusters containing species with different mobilities.

Combining moiré patterns and high resolution transmission electron microscopy for in-plane thin films thickness determination

This paper reports the coupling of HRTEM and moiré pattern observations, allowing the determination of the thickness ratio of two superimposed crystals. Pseudo-lattice fringes are observed using identical TEM experimental conditions as for observing moiré patterns. The pseudo-lattice spacing is first calculated in the dynamical theory framework in two beam conditions. This approach shows a linear behavior of the spacing as a function of the thickness ratio of the two crystals. The roles of sample crystallographic orientation and sample thickness on the thickness ratio determination are discussed from multi-beam simulations. Finally, the method is applied on a bimetallic CuAg core-shell nanoparticle of a known structure. It is demonstrated that for this particle, the thickness ratio of Cu and Ag can be determined with an error that results in a precision less than 0.75 nm on the Cu and Ag thicknesses. The advantages of the technique are the use of an in-plane sample configuration and a single HRTEM image.

Unexpected neurological sequelae following propofol anesthesia in infants: Three case reports

Propofol is a widely used hypnotic agent for induction and maintenance of pediatric anesthesia with a well known safety profile. Experimental in vitro studies suggest that propofol may be toxic to developing neurons. We report the cases of three infants who underwent surgery before 2 months of age for different benign pathologies. Propofol was used for induction and maintenance of anesthesia in all cases. The three patients developed convulsions with similar clinical characteristics (cluster of recurrent clinical and subclinical seizures) between the 23th and 30th hours following anesthesia. Clinical and electroencephalographic improvement was obtained between the third and fourth day of management in pediatric intensive care unit. The seizures never recurred, and the three patients underwent further uneventful general anesthesia without propofol. Follow-up of the three patients disclosed unexpected neurological dysfunction: progressive microcephaly (head circumferences were normal at birth), developmental impairment with cognitive and behavioural disturbances in two cases, and bilateral symmetrical white-matter abnormalities on cerebral magnetic resonance imaging.

CONCLUSION

The causal relationship between propofol anesthesia and the neurological symptoms of our patients remains difficult to ascertain, but we believe that pediatricians, anesthetists and intensive care-givers should be aware of this possible adverse reaction that has never been described before.

[Proteins sharing PNPLA domain, a new family of enzymes regulating lipid metabolism]

Genome sequencing technologies led to tremendous breakthrough in biology uncovering numerous genes unknown so far and thus opening the field of deep investigations to understand their associated biological functions. As a matter of fact, functional genomics have been progressively replacing sequence genomics with as a main objective to yield insight into cellular physiology. Recently, an emerging group of genes coding for proteins bearing a common domain termed patatin (PNPLA domain) have been discovered. Members of this new enzymatic family displaying lipase and transacylase properties appeared to have major roles in the regulation of lipid metabolism. The aim of this review is to make an overview on the latest discoveries concerning this new family of proteins and their relationship with lipid metabolism, physiology of mammals and their potential involvement in human pathology.

[Acute motor deficit in childhood: diagnosis management]

Acute motor deficit is not uncommon in childhood, with various neurological etiologies. Pertinent semiological analysis allows correct diagnosis management, with adequate paraclinical investigations. The authors describe this clinical diagnosis strategy. The most common clinical situations and various etiologies are presented; paraclinical investigations confirming the diagnosis are discribed, with specific attention to central nervous system imaging according to the most recent sequences.

Size and shape effects on the order-disorder phase transition in CoPt nanoparticles

Chemically ordered bimetallic nanoparticles are promising candidates for magnetic-storage applications. However, the use of sub-10 nm nanomagnets requires further study of possible size effects on their physical properties. Here, the effects of size and morphology on the order-disorder phase transition temperature of CoPt nanoparticles (T(C)(NP)) have been investigated experimentally, using transmission electron microscopy, and theoretically, with canonical Monte Carlo simulations. For 2.4-3-nm particles, T(C)(NP) is found to be 325-175 degrees C lower than the bulk material transition temperature, consistent with our Monte Carlo simulations. Furthermore, we establish that T(C)(NP) is also sensitive to the shape of the nanoparticles, because only one dimension of the particle (that is, in-plane size or thickness) smaller than 3 nm is sufficient to induce a considerable depression of T(C)(NP). This work emphasizes the necessity of taking into account the three-dimensional morphology of nano-objects to understand and control their structural properties.

Le tube laryngé à usage unique LTD™: un nouveau dispositif supralaryngé

OBJECTIVES

Clinical study of a new supraglottic single use airway device, the LTD with evaluation of insertion, efficiency during intermittent positive pressure ventilation and side effects.

STUDY DESIGN

Prospective, open clinical study.

PATIENTS AND METHODS

Fifty adult patients [33 years (26-55)] were scheduled for elective surgery (orthopaedic, plastic or maxillo-facial) under general anaesthesia less than two hours in dorsal position. No patient presented clinical sign of difficult airway management or risk of regurgitation. We studied easiness and delay for insertion, oro-pharyngeal leak pressure, peak airway pressure with positive pressure ventilation and side effects during the first 24 hours.

RESULTS

Insertion was successful in 94%. Median insertion time was 38 s (32-45). Difficulties of insertions were found in 25%. Oro-pharyngeal leak pressure, always superior than peak pressure [18 cmH2O (15-21)] increased from 26 cmH2O (22-32.5) to 34 cmH2O (29-40) at the end of the surgery. No case of gastric inflation, regurgitation or SpO2<95% were noticed. Moderate sore throat incidence was 6% in recovery room, 15% at the sixth hour and absent at the 24th hour.

CONCLUSION

The learning curve was low< or =10. Insertion is easy. The quality of airway protection allows secure positive pressure ventilation. Postoperative side effects are minor and transient.

[Predictive value and sensibility of hospital discharge system (PMSI) compared to cancer registries for thyroïd cancer (1999-2000)]

BACKGROUND

Cancer registries have a complete recording of new cancer cases occurring among residents of a specific geographic area. In France, they cover only 13% of the population. For thyroid cancer, where incidence rate is highly variable according to the district conversely to mortality, national incidence estimates are not accurate. A nationwide database, such as hospital discharge system, could improve this estimate but its positive predictive value and sensibility should be evaluated.

METHODS

The positive predictive value and the sensitivity for thyroid cancer case ascertainment (ICD-10) of the national hospital discharge system in 1999 and 2000 were estimated using the cancer registries database of 10 French districts as gold standard. The linkage of the two databases required transmission of nominative information from the health facilities of the study. From the registries database, a logistic regression analysis was carried out to identify factors related to being missed by the hospital discharge system.

RESULTS

Among the 973 standardized discharge charts selected from the hospital discharge system, 866 were considered as true positive cases, and 107 as false positive. Forty five of the latter group were prevalent cases. The predictive positive value was 89% (95% confidence interval (CI): 87-91%) and did not differ according to the district (p=0,80). According to the cancer registries, 322 thyroid cancer cases diagnosed in 1999 or 2000 were missed by the hospital discharge system. Thus, the sensitivity of this latter system was 73% (70-76%) and varied significantly from 62% to 85% across districts (p<0.001) and according to the type of health facility (p<0.01).

CONCLUSION

Predictive positive value of the French hospital discharge system for ascertainment of thyroid cancer cases is high and stable across districts. Sensitivity is lower and varies significantly according to the type of health facility and across districts, which limits the interest of this database for a national estimate of thyroid cancer incidence rate.

Contamination du lac Saint-Pierre (fleuve Saint-Laurent) par certains polluants organiques et inorganiques

L'étude s'inscrit dans le cadre d'un programme de surveillance de la dispersion des substances toxiques dans le fleuve Saint-Laurent. Elle vise à identifier la nature et le cheminement des substances toxiques dans différents compartiments du lac Saint-Pierre. D'une superficie totale de plus de 400 km2, ce lac est un élargissement du fleuve et son bassin de drainage inclut la région métropolitaine de Montréal et la région inter-nationale des Grands lacs. L'échantillonnage a porté sur l'eau, les matières en suspension, les sédiments de fond, les poissons adultes (entiers, chairs, foie, oeufs et gonades) et les poissons juvéniles (âge 0+). Des analyses chimiques ont été effectuées pour les métaux, les pesticides organochlorés, les biphényles polychlorés (PCB), les hydrocarbures aromatiques polycycliques (PAH) et les chlorobenzènes. Les résultats indiquent que la contamination du milieu aquatique par les substances toxiques est très significative. Les contaminants majeurs retrouvés dans les divers compartiments sont l'arsenic, le mercure, le plomb, les biphényles polychlorés (PCB) et les différentes formes de DDT. Les concentrations excèdent fréquemment les critères de qualité pour le mercure dans les chairs de poissons, le plomb dans l'eau et les sédiments et les PCB dans plusieurs compartiments analysés. Plusieurs pesticides organochlorés ont été détectés dans l'eau, grâce à la technique d'échantillonnage à grand volume. Cette technique permet d'estimer 1a concentration de fond et le bilan massique annuel d'un polluant. Les poissons entiers et le foie de lottes constituent par ailleurs des indicateurs de choix de la présence et de l'étendue de la contamination par les substances toxiques bioaccumulables, alors que les sédiments de fond et les poissons juvéniles permettent d'étudier leur répartition spatiale. Sauf pour le mercure, les concentrations dans les chairs sont un mauvais indicateur de la contamination du milieu; la moyenne et la variabilité des teneurs en PCB et pesticides organochlorés y sont très faibles.

Second primary malignancies in thyroid cancer patients

The late health effects associated with radioiodine (¹³¹I) given as treatment for thyroid cancer are difficult to assess since the number of thyroid cancer patients treated at each centre is limited. The risk of second primary malignancies (SPMs) was evaluated in a European cohort of thyroid cancer patients. A common database was obtained by pooling the 2-year survivors of the three major Swedish, Italian, and French cohorts of papillary and follicular thyroid cancer patients. A time-dependent analysis using external comparison was performed. The study concerned 6841 thyroid cancer patients, diagnosed during the period 1934–1995, at a mean age of 44 years. In all, 17% were treated with external radiotherapy and 62% received ¹³¹I. In total, 576 patients were diagnosed with a SPM. Compared to the general population of each of the three countries, an overall significantly increased risk of SPM of 27% (95% CI: 15–40) was seen in the European cohort. An increased risk of both solid tumours and leukaemias was found with increasing cumulative activity of ¹³¹I administered, with an excess absolute risk of 14.4 solid cancers and of 0.8 leukaemias per GBq of ¹³¹I and 10⁵ person-years of follow-up. A relationship was found between ¹³¹I administration and occurrence of bone and soft tissue, colorectal, and salivary gland cancers. These results strongly highlight the necessity to delineate the indications of ¹³¹I treatment in thyroid cancer patients in order to restrict its use to patients in whom clinical benefits are expected.

Box-modeling of bone and tooth phosphate oxygen isotope compositions as a function of environmental and physiological parameters

A time-dependent box model is developed to calculate oxygen isotope compositions of bone phosphate as a function of environmental and physiological parameters. Input and output oxygen fluxes related to body water and bone reservoirs are scaled to the body mass. The oxygen fluxes are evaluated by stoichiometric scaling to the calcium accretion and resorption rates, assuming a pure hydroxylapatite composition for the bone and tooth mineral. The model shows how the diet composition, body mass, ambient relative humidity and temperature may control the oxygen isotope composition of bone phosphate. The model also computes how bones and teeth record short-term variations in relative humidity, air temperature and delta18O of drinking water, depending on body mass. The documented diversity of oxygen isotope fractionation equations for vertebrates is accounted for by our model when for each specimen the physiological and diet parameters are adjusted in the living range of environmental conditions.

[Photography as evidence, between medicine and religion]

Are we right to establish a parallel between, on the one hand, Bernadette Soubirous, the pious visionary of Lourdes, and Thérèse Martin, the nun of Lisieux, and on the other hand, the hysterical women who were shown in public by Charcot at the "Salpêtrière Hospital"? If we compare the way all of them were photographed, we bring to light something similar between two facts: I. - the attempts to give a new medical significance to religious-ordinarily speaking-poses; 2 - the attempts to give a particular religious significance to common body positions. So we are led to suggest meaningful changes in the links between medicine and religion, expressed by the language of women's bodies.

Development of a photolabile ligand for the endothelin-A receptor of endothelin

Actions of endothelin (ET) are usually mediated through the so-called endothelin-A or -B (ET(A) or ET(B))-receptors. As part of our ongoing research program, we are studying the characterization of the ET(A)-receptor using specific photolabile ligands. Starting with the ET(A)-specific antagonist TTA-386 as a leading compound we developed new ET(A)-specific antagonists containing the photolabile amino acid, p-benzoyl-phenylalanine (Bpa). Following a Bpa peptide scan, with either the L- or D-isomer, we found that D-phenylalanine-6 of TTA-386 can be substituted with either L- or D-Bpa and gives analogs showing antagonistic properties, in an ET(A)-receptor preparation (rat aorta), very similar to those of TTA-386 itself. No agonistic or antagonistic properties were measured with these derivatives in an ET(B) pharmacological preparation (guinea pig lung parenchyma). Thus, these new ligands appear as very promising probes for the characterization of the ET(A)-receptor.

An improved procedure for the preparation of the endothelin-B-receptor ligand sarafotoxin 6c

Sarafotoxin 6c (S6c) is a specific agonist for the endothelin-B- (ETB) receptor, being largely used as a standard compound in pharmacological studies related to ETB-receptors. We have developed an improved peptide synthesis prncedure. Using the Fmoc chemistry methodology and an appropriate orthogonal protection scheme, we obtained a crude peptide with a major component identified as [Cys(Acm)(1,15)]S6c. A silver salt (AgBF4) treatment of this crude material completely removed the Acm moieties without the appearance of any major side-products. The free peptide was cyclized using a Fe3+/Fe2+ oxidizing method. Besides the formation of the bridges, no other modification was observed. Thus, the peptide purification was facilitated and an excellent yield of pure sarafotoxin was obtained. The material was characterized by analytical reverse phase-high performance liquid chromatography (RP-HPLC) and matrix assisted laser desorption ionization-time of flight (MALDI-TOF) mass spectrometry. Pharmacological properties of the peptide were evaluated in an ETB preparation (guinea pig lung parenchyma strips) and were identical to those of an S6c standard.

The effects of pubertal status and glycemic control on the growth hormone-IGF-I axis in boys with insulin-dependent diabetes mellitus

Dysregulation of the growth hormone (GH)-insulin-like growth factor-I (IGF-I) axis in children and adolescents with insulin-dependent diabetes mellitus (IDDM) is well documented. Elevated levels of circulating GH, increased GH secretory amplitude, and decreased concentrations of IGF-I, IGFBP-3, and GHBP have been related to poor glycemic control. We proposed that pubertal maturation may be a more significant factor, potentially overriding the effects of metabolic control, especially during mid-puberty when the GH-IGF-I axis is maximally stimulated. We studied 24 male children and adolescents with IDDM over a 5 year period. Subjects were grouped both by pubertal stage (prepubertal vs mid-pubertal) and by level of glycemic control (hemoglobin A1 (<9%, 9-11.5%, and >11.5%). Twenty-four hour every 20 minute blood sampling for GH determination was analyzed using the Cluster algorithm, and static measures of IGF-I, IGFBP-3, and GHBP were obtained. When analyzed by pubertal status, we found no difference in the number of GH secretory peaks or the interval between concentration peaks. The sum of the peak heights and area under the curve were significantly greater in the mid-pubertal boys, as was the average GH nadir. Serum levels of IGF-I and IGFBP-3 were greater in the mid-pubertal boys, but levels of GHBP were higher in the prepubertal boys. When analyzed by level of glycemic control, we found no differences in the number of GH secretory peaks or interval between peaks among the 3 groups. However, the sum of the peak heights, area under the curve, and average GH nadir were all lower in the group with the intermediate level of glycemic control (HgbA1 9-11.5%); no differences were observed between the other 2 groups. This relationship persisted when the mid-pubertal subjects were analyzed separately. No differences were found among the 3 groups for levels of IGF-I, IGFBP-3, or GHBP. We conclude that normal increases in GH secretion and levels of IGF-I and IGFBP-3 occur during mid-puberty in boys with IDDM. A concomitant increase in average GH nadir may reflect an underlying effect of metabolic control. Greater GH secretion was observed in the groups with the lowest and highest levels of glycemic control. We speculate that this may be related to an increased incidence of severe hypoglycemic episodes in the group with the lowest levels of glycosylated hemoglobin, resulting in metabolic derangements similar to those with elevated glycosylated hemoglobin levels.

Presence of airborne contaminants in the wildlife of northern Québec

As part of the environmental impact studies of the Great Whale and the Nottaway-Broadback-Rupert (NBR) hydroelectric projects, Hydro-Québec collected data on the occurrence and levels of several contaminants present in wildlife from both regions between 1989 and 1991. The analyses performed included metals (mercury, arsenic, selenium, cadmium, lead, nickel and copper), polychlorinated biphenyls (PCBs as arochlors or the sum of 20-40 congeners) and organochlorine pesticides such as hexachlorobenzene (HCB), DDT, DDE, hexachlorocyclohexane (HCH), chlordane, mirex and dieldrin. Species sampled included fish (freshwater and marine), birds (waterfowl, gull and ptarmigan), terrestrial mammals (marten, mink and hare) and marine mammals (freshwater and marine seals, belugas). Most laboratory analyses were carried out on both muscle and liver tissues, but some were conducted on other tissues as well: feathers, eggs and blubber. The results indicate that numerous airborne contaminants were present in the wildlife of both the Great Whale and the NBR study areas and that their level of contamination was similar to that of other northern environments. Total mercury in muscle was high in piscivorous fish, birds and mammals (terrestrial and marine). We observed significant levels of cadmium and lead in the livers of some herbivorous terrestrial animals, such as ptarmigans and hares. Among the organochlorine contaminants analyzed, levels of PCBs and DDE in piscivorous birds (mergansers and loons) and in marine mammals (seals and belugas) were high. For some contaminants, such as mercury, cadmium, lead, PCBs and DDE, the levels observed in some species or tissues could be considered worrisome with regard to public health, if those species or tissues constitute an important part of traditional native diets.

Development of a software package for trend detection in temporal series: Application to water and industrial effluent quality data for the St. Lawrence River

Despite the considerable amount of effort and resources involved in monitoring water quality, water quality assessment and environmental follow-up are sometimes carried out with simple statistics, the main reason being the lack of appropriate statistical methods adapted to the nature of sampled water quality data.A survey of the classical methods used for trend detection and of their limitations is first presented, including the most recent non-parametric techniques adapted to the structure of the sampled data and to the possible types of trends occuring. This paper then presents an interactive user-friendly software package developed for microcomputers making use of these latest adapted techniques. Afterwards, some applications of the software are described pertaining to the concentrations measured at long-term stations on the St. Lawrence River and to the mass loadings discharged by regulated industries. Finally, conclusions are drawn about the assumptions, performance and limitations of the package as well as about the research needs to improve the usefulness and applicability of the software.