Proportionate universalism intervention is effective for tackling nutritional social gradient in adolescents: the PRALIMAP-INÈS mixed randomised trial

OBJECTIVE

This study aimed to investigate the effectiveness of proportionate universalism intervention to reduce the slope of the nutritional social gradient in adolescents.

STUDY DESIGN

A mixed (experimental and quasi-experimental) multicentre trial.

METHODS

Data from 985 adolescents of the PRALIMAP-INÈS trial (North-eastern France, 2012-2015) were analysed. For this, adolescents were split into five social classes according to the Family Affluence Scale: Highly Less Advantaged (H.L.Ad; n = 33), Less Advantaged (L.Ad; n = 155), Intermediate (Int; n = 404), Advantaged (Ad; n = 324) and Highly Advantaged (H.Ad; n = 69). The overweight care management was a standard care for all and a strengthened one adapted to the social class of adolescents. The main outcome was the 1-year change of the body mass index z-score (BMIz) slope. Other nutritional outcomes were BMI, ΔBMI_p95 (BMI minus 95th percentile of the WHO reference), %BMI_p95 (percent of 95th percentile of the WHO reference), leisure-time sport, consumption of fruits and vegetables and consumption of sugary foods and drinks.

RESULTS

The inclusion data confirmed a weight social gradient expressed by a significant BMIz linear regression coefficient (β = -0.09 [-0.14 to -0.04], P < 0.0001). The higher the social class, the lower the BMIz. The 1-year BMIz linear regression coefficient was -0.07 [-0.12 to -0.02], corresponding to a significant weight social gradient reduction of 23.3% (β = 0.021 [0.001 to 0.041]; P = 0.04). Consistent results were found for other nutritional outcomes.

CONCLUSIONS

PRALIMAP-INÈS shows that proportionate universalism intervention is effective to reduce the adolescents' nutritional social gradient and suggests that equitable health programmes and policies are a realistic goal.

Economic evaluation of a school-based strategy to prevent overweight and obesity in French adolescents: insights from the PRALIMAP randomised trial

OBJECTIVES

This study aimed to provide cost-effectiveness and budget impact analyses of a school-based overweight/obesity screening and care prevention strategy among adolescents.

STUDY DESIGN

Cost-effectiveness and budget impact analyses.

METHODS

Data from 3538 adolescents who participated in a school-based randomised controlled trial in the Northeast of France were used. Costs (from a public payer's perspective) included screening for overweight and obesity and subsequent care. Effectiveness was measured as the change in body mass index (kilogram per square metre), prevalence of overweight/obesity, moderate physical activity energy expenditure, duration and frequency and total sitting time. The incremental cost-effectiveness ratio was calculated, and a budget impact analysis was conducted.

RESULTS

The screening and care strategy resulted in an incremental cost-effectiveness ratio of €1634.48 per averted case of overweight/obesity and €255.43 per body mass index unit decrease. The costs for increasing moderate physical activity by 1000 metabolic equivalent of task-min/week, duration by 60 min/week and frequency 1 day/week were €165.28, €39.21 and €93.66 per adolescent, respectively. Decreasing total sitting time by 60 min/week had a cost of €8.49 per adolescent. The cost of implementing the strategy nationally was estimated to be €50.1 million with a payback period from 3.6 to 7.3 years.

CONCLUSIONS

The screening and care strategy could be an efficient way to prevent overweight and obesity among adolescents. Future studies should investigate how the current results could be achieved in schools with different settings and thus justify its relevance for overweight and obesity prevention to policy-makers.

Application of Deep Learning to IVC Filter Detection from CT Scans

IVC filters (IVCF) perform an important function in select patients that have venous blood clots. However, they are usually intended to be temporary, and significant delay in removal can have negative health consequences for the patient. Currently, all Interventional Radiology (IR) practices are tasked with tracking patients in whom IVCF are placed. Due to their small size and location deep within the abdomen it is common for patients to forget that they have an IVCF. Therefore, there is a significant delay for a new healthcare provider to become aware of the presence of a filter. Patients may have an abdominopelvic CT scan for many reasons and, fortunately, IVCF are clearly visible on these scans. In this research a deep learning model capable of segmenting IVCF from CT scan slices along the axial plane is developed. The model achieved a Dice score of 0.82 for training over 372 CT scan slices. The segmentation model is then integrated with a prediction algorithm capable of flagging an entire CT scan as having IVCF. The prediction algorithm utilizing the segmentation model achieved a 92.22% accuracy at detecting IVCF in the scans.

A Comprehensive Review of Machine Learning Used to Combat COVID-19

Coronavirus disease (COVID-19) has had a significant impact on global health since the start of the pandemic in 2019. As of June 2022, over 539 million cases have been confirmed worldwide with over 6.3 million deaths as a result. Artificial Intelligence (AI) solutions such as machine learning and deep learning have played a major part in this pandemic for the diagnosis and treatment of COVID-19. In this research, we review these modern tools deployed to solve a variety of complex problems. We explore research that focused on analyzing medical images using AI models for identification, classification, and tissue segmentation of the disease. We also explore prognostic models that were developed to predict health outcomes and optimize the allocation of scarce medical resources. Longitudinal studies were conducted to better understand COVID-19 and its effects on patients over a period of time. This comprehensive review of the different AI methods and modeling efforts will shed light on the role that AI has played and what path it intends to take in the fight against COVID-19.

MicroScope: an integrated platform for the annotation and exploration of microbial gene functions through genomic, pangenomic and metabolic comparative analysis

Large-scale genome sequencing and the increasingly massive use of high-throughput approaches produce a vast amount of new information that completely transforms our understanding of thousands of microbial species. However, despite the development of powerful bioinformatics approaches, full interpretation of the content of these genomes remains a difficult task. Launched in 2005, the MicroScope platform (https://www.genoscope.cns.fr/agc/microscope) has been under continuous development and provides analysis for prokaryotic genome projects together with metabolic network reconstruction and post-genomic experiments allowing users to improve the understanding of gene functions. Here we present new improvements of the MicroScope user interface for genome selection, navigation and expert gene annotation. Automatic functional annotation procedures of the platform have also been updated and we added several new tools for the functional annotation of genes and genomic regions. We finally focus on new tools and pipeline developed to perform comparative analyses on hundreds of genomes based on pangenome graphs. To date, MicroScope contains data for >11 800 microbial genomes, part of which are manually curated and maintained by microbiologists (>4500 personal accounts in September 2019). The platform enables collaborative work in a rich comparative genomic context and improves community-based curation efforts.

MicroScope-an integrated resource for community expertise of gene functions and comparative analysis of microbial genomic and metabolic data

The overwhelming list of new bacterial genomes becoming available on a daily basis makes accurate genome annotation an essential step that ultimately determines the relevance of thousands of genomes stored in public databanks. The MicroScope platform (http://www.genoscope.cns.fr/agc/microscope) is an integrative resource that supports systematic and efficient revision of microbial genome annotation, data management and comparative analysis. Starting from the results of our syntactic, functional and relational annotation pipelines, MicroScope provides an integrated environment for the expert annotation and comparative analysis of prokaryotic genomes. It combines tools and graphical interfaces to analyze genomes and to perform the manual curation of gene function in a comparative genomics and metabolic context. In this article, we describe the free-of-charge MicroScope services for the annotation and analysis of microbial (meta)genomes, transcriptomic and re-sequencing data. Then, the functionalities of the platform are presented in a way providing practical guidance and help to the nonspecialists in bioinformatics. Newly integrated analysis tools (i.e. prediction of virulence and resistance genes in bacterial genomes) and original method recently developed (the pan-genome graph representation) are also described. Integrated environments such as MicroScope clearly contribute, through the user community, to help maintaining accurate resources.

Current recommendations for assessing the reliability of a measurement tool: a survival guide for orthopaedic surgeons

Previous standards for assessing the reliability of a measurement tool have lacked consistency. We reviewed the most current American Society for Testing and Materials and International Organisation for Standardisation (ISO) recommendations, and propose an algorithm for orthopaedic surgeons. When assessing a measurement tool, conditions of the experimental set-up and clear formulae used to compile the results should be strictly reported. According to these recent guidelines, accuracy is a confusing word with an overly broad meaning and should therefore be abandoned. Depending on the experimental conditions, one should be referring to bias (when the study protocol involves accepted reference values), and repeatability (sr, r) or reproducibility (SR, R). In the absence of accepted reference values, only repeatability (sr, r) or reproducibility (SR, R) should be provided.

TAKE HOME MESSAGE

Assessing the reliability of a measurement tool involves reporting bias, repeatability and/or reproducibility depending on the defined conditions, instead of precision or accuracy.

A randomised controlled trial comparing highly cross-linked and contemporary annealed polyethylene after a minimal eight-year follow-up in total hip arthroplasty using cemented acetabular components

Most published randomised controlled trials which compare the rates of wear of conventional and cross-linked (XL) polyethylene (PE) in total hip arthroplasty (THA) have described their use with a cementless acetabular component.

We conducted a prospective randomised study to assess the rates of penetration of two distinct types of PE in otherwise identical cemented all-PE acetabular components.

A total of 100 consecutive patients for THA were randomised to receive an acetabular component which had been either highly XL then remelted or moderately XL then annealed.

After a minimum of eight years follow-up, 38 hips in the XL group and 30 hips in the annealed group had complete data (mean follow-up of 9.1 years (7.6 to 10.7) and 8.7 years (7.2 to 10.2), respectively). In the XL group, the steady state rate of penetration from one year onwards was -0.0002 mm/year (sd 0.108): in the annealed group it was 0.1382 mm/year (sd 0.129) (Mann–Whitney U test, p < 0.001). No complication specific to either material was recorded.

These results show that the yearly linear rate of femoral head penetration can be significantly reduced by using a highly XLPE cemented acetabular component.

Cite this article: Bone Joint J 2015;97-B:1458–62.

An unreported cause of early postoperative dislocation following total hip revision: massive intra-capsular oedema related to inferior vena cava filter thrombosis

Inferior vena cava (IVC) filters are widely used to prevent pulmonary embolism (PE) in patients with an absolute or relative contraindication for anticoagulants, during the peri-operative period of trauma or total joint replacement. No complication specific to the orthopaedic's aspect of this practice has been described. We report the case of a patient who had major femoral head/cup separation mimicking dislocation following revision total hip arthroplasty related to massive intra-capsular oedema produced by IVC filter thrombosis. The patient could be successfully treated non-operatively. Orthopaedic surgeons should identify and refer patients with a complicated IVC filter, to identify any migration or occlusion, and also be aware that removable filters must not be kept in situ, once the high-risk phase of developing PE is past.

Elucidation of molecular and elementary composition of organic and inorganic substances involved in 19th century wax sculptures using an integrated analytical approach

Wax sculptures contain several materials from both organic and inorganic nature. These works of art are particularly fragile. Determining their chemical composition is thus of prime importance for their preservation. The identification of the recipes of waxy pastes used through time also provides valuable information in the field of art history. The aim of the present research was to develop a convenient analytical strategy, as non-invasive as possible, that allows to identify the wide range of materials involved in wax sculptures. A multi-step analytical methodology, based on the use of complementary techniques, either non- or micro-destructive, was elaborated. X-ray fluorescence and micro-Raman spectroscopy were used in a non-invasive way to identify inorganic pigments, opacifiers and extenders. The combination of structural and separative techniques, namely infrared spectroscopy, direct inlet electron ionisation mass spectrometry and high temperature gas chromatography, was shown to be appropriate for unravelling the precise composition of the organic substances. A micro-chemical test was also performed for the detection of starch. From this study it has been possible to elucidate the composition of the waxy pastes used by three different sculptors at the end of the 19th century. Complex and elaborated recipes, in which a large range of natural substances were combined, were highlighted.

Characterisation of wax works of art by gas chromatographic procedures

To identify the various natural and synthetic substances used by sculptors at the end of the 19th century, several contemporary reference samples were investigated by high temperature gas chromatography (HT GC) and HT GC-MS. Using specific chromatographic conditions and minimising sample preparation, we could separate, detect and identify a wide range of biomolecular markers covering a great variety of molecular weights and volatilities, with a minimum amount of sample, in a single run. Beeswax, spermaceti, carnauba, candellila and Japan waxes as well as pine resin derivatives, animal fats, paraffin, ozokerite and stearin, used as additives in wax works of art, were chemically investigated. In the case of low volatile compounds, transbutylation was performed. The structure of long-chain esters of spermaceti was elucidated for the first time by HT GC-MS analysis. Such a method was then carried out on 10 samples collected on a statuette of Junon by Antoine-Louis Barye (Louvre Museum, Paris, France) and on a sculpture by Aimé-Jules Dalou (Musée de la Révolution Française, Vizille, France). The analytical results obtained provide new data on the complex recipes elaborated by sculptors at the end of the 19th century.

[Perioperative management of asplenic patients]

OBJECTIVE

In 2003, asplenia had involved 250000 patients in France. These patients are at risk of severe infection, mostly with capsulated bacteria as pneumococci, meningococci and Haemophilus. The higher mortality and morbidity due to infection in asplenic patient led in June 2003 a French expert committee to propose preventive management based on vaccination and antibioprophylaxis.

STUDY DESIGN

Update article.

DATA SYNTHESIS

For vaccination, two vaccines against pneumococci are available. The first one, the antipolysaccharide (Pneumo 23) is recommended for adults. It is effective for the majority of the serotypes even if its efficacy can be variable. The second one a conjugated pneumococcal vaccine (Prenevar) is used for children under two years because it has higher activity on antibiotic resistant strains therefore increasing antibiotic prophylaxis efficiency. When splenectomy is required, vaccination against pneumococci, Haemophilus (b type) and C meningococci must be performed at least 15 days before surgery, in order to get better immune stimulation. In case of emergency, vaccines have to be administrated within 30 days after surgery. Antibioprophylaxis is based on cefazolin injection before splenectomy and by postoperative intravenous amoxicillin administration. As soon as oral intake is allowed, antibioprophylaxis is continued for at least two years in adults and five years in children. Both antibiotic and vaccination have been reported to reduce pneumococcus infections.

Prevalence rate of urinary incontinence in community-dwelling elderly individuals: the Veneto study

BACKGROUND

Urinary incontinence (UI) is a common problem in elderly people, due mainly to functional impairments and concurrent medical diseases. Few studies, however, have assessed the prevalence of UI in noninstitutionalized individuals. The objectives of the present work were to estimate the prevalence of UI in a community-based population of elderly Italians and to determine the associated physical, social, and psychological factors.

METHODS

A random sample of noninstitutionalized men (n = 867) and women (n = 1531), aged 65 years and older, from the Veneto region of northeastern Italy, were interviewed at home, using an extensive multidisciplinary questionnaire, to assess their quality of life and social, biological, and psychological correlates.

RESULTS

The prevalence rate of UI was of 11.2% among men and of 21.6% among women. Among those reporting the condition, approximately 53% of women and 59% of men reported experiencing incontinence daily or weekly. Association of UI was found for participants older than 70 years in both men (odds ratio [OR] 2.49, 95% confidence interval [CI] 1.45-4.28) and women (OR 1.49, 95% CI 1.11-2.02). Three of the medical conditions investigated were associated with increases in the odds in women, namely chronic obstructive pulmonary disease (OR 1.53, 95% CI 1.11-2.12), Parkinsonism (OR 2.27, 95% CI 1.14-4.54), and hip fracture (OR 1.38,95% CI 1.02-1.88), whereas chronic diarrhea was the only condition associated with UI in men (OR 6.92, 95% CI 2.22-21.5). Participants with a physical disability were two times more likely to report incontinence, and the odds were increased by 50% in women who had sleep disturbances.

CONCLUSIONS

Incontinence is highly prevalent in the Italian elderly population, and several common chronic conditions are significantly associated with it. Moreover, very few people with incontinence seek health care or are aware of potential treatments.

Low back pain and disability in older women: independent association with difficulty but not inability to perform daily activities

BACKGROUND

Low back pain is a highly prevalent chronic condition, yet little is known about the disabling effects of this common problem in older adults. This study examines the relationship between the presence and severity of low back pain and disability in older women.

METHODS

The study population was 1,002 disabled older women participating in a population-based prospective study of disablement. Key outcome measures of disability included level of difficulty and inability to perform the following daily activities: light housework, shopping, walking one-quarter mile, climbing stairs, lifting, and activities of daily living (ADLs).

RESULTS

Forty-two percent of participants reported they had low back pain for at least one month in the year before baseline. The prevalence of severe back pain decreased markedly with age (10% of those > or = 85 yr versus 23% in each of the two younger 10 yr age groups). After multivariate adjustments, women with severe back pain were 3 to 4 times more likely than other women to have a lot of difficulty with light housework or shopping. There was also an increased likelihood of difficulty with mobility tasks and basic ADLs among those with severe back pain. No associations were found between back pain and being unable to perform any of the daily activities studied, indicating possible differences in disablement processes leading to functional difficulties versus functional incapacity.

CONCLUSIONS

There was a strong association between back pain and functional difficulties in older women, pointing to the need for further research using longitudinal methods.

MR imaging of coarctation of the aorta and its postoperative complications in adults: assessment with spin-echo and cine-MR imaging

To evaluate the ability of ECG-gated spin-echo (SE)-MR imaging vs. cine-MR imaging to assess coarctation of the aorta, 11 patients aged 15-45 years, with known or suspected coarctation of the aorta, and five patients suspected of re-stenosis or postoperative false-aneurysms after coarctation repair were examined by multisection SE-MR imaging and single-section multiphase cine-MR imaging on a 1.0 Tesla device. Aortography was performed in 15, and surgery in 14 of these 16 patients. Qualitatively, the location, severity, and length of the coarctation were shown in all cases with MR imaging, as well as the relationship with the arteries arising from the aortic arch. The respective sensitivities and specificities in the assessment of severity of stenoses were 86% and 100% for SE MR images, and 100% and 100% for cine-MR images. Cine-MR imaging was superior to SE imaging in stenosis diameter assessment with contrast angiography as reference, as well as to identify the site of leakage in cases of postoperative pseudoaneurysm. Pre-stenotic dilation or post-stenotic aneurysm, collateral channels, and associated malformations were better identified on SE images. Quantitatively, a better stenosis diameter correlation was found between cine-MR images and angiography than between SE-MR images and angiography (r=0.99 vs. r=0.78; p=0.001 vs. p=0.004), related to overestimation of stenoses with SE-MR imaging. The use of a combination of spin-echo and cine-MR imaging correlates well with conventional angiographic findings in this small series of patients with coarctation of aorta or postoperative pseudoaneurysmal complications. Cine-MRI can provide anatomic information that is equivalent to angiography for surgical planning.

Education and the risk of physical disability and mortality among men and women aged 65 to 84: the Italian Longitudinal Study on Aging

BACKGROUND

Most studies report that people with higher education enjoy better health and longer life. Although it is well known that most risk factors are more common among individuals with a lower level of education, the underlying mechanism of this association is not fully understood. The objective of this study was to assess the association between education, disability, and mortality.

METHODS

We analyzed data on 1,817 men and 1,643 women, aged 65-84 years, to assess the association of educational level with physical disability and mortality adjusting for age, sex, smoking habit, occupation, and major chronic conditions.

RESULTS

The association between educational level and disability was characterized by a dose-response effect, with the relative odds significantly decreased by about 30%, 60%, and 79% in those with 4 or 5, 6 to 8, and more than 8 years of education, compared to those with 3 or less years of education. Death rates were lower among persons with 4 or more years of education compared to those with less education. However, after adjusting for disability status, education was no longer associated with mortality (RR=0.97, CI=0.65-1.43).

CONCLUSIONS

The strong association of low education with disability found in this study may explain the inverse association with mortality reported in previous studies. Disability, indeed, seems to be the mediator between education and mortality and might be due to the higher severity level of diseases, leading to death, in the lower educated group.

High body fatness, but not low fat-free mass, predicts disability in older men and women: the Cardiovascular Health Study

Using data from the Cardiovascular Health Study, we studied the relation between body composition (fat mass and fat-free mass, assessed by bioelectrical impedance) and self-reported, mobility-related disability (difficulty walking or stair climbing) in 2714 women and 2095 men aged 65-100 y. In a cross-sectional analysis at baseline (1989-1990), disability was reported by 26.5% of the women and 16.9% of the men. A positive association was observed between fat mass and disability. The odds ratio for disability in the highest quintile of fat mass was 3.04 (95% CI: 2.18, 4.25) for women and 2.77 (95% CI: 1.82, 4.23) for men compared with those in the lowest quintile. Low fat-free mass was not associated with a higher prevalence of disability. In a longitudinal analysis among persons not reporting disability at baseline, 20.3% of the women and 14.8% of the men reported disability 3 y later. Fat mass at baseline was predictive of disability 3 y later, with odds ratios of 2.83 (95% CI: 1.80, 4.46) for women and 1.72 (95% CI: 1.03, 2.85) for men in the highest quintile of fat. The increased risk was not explained by age, physical activity, chronic disease, or other potential confounders. Low fat-free mass was not predictive of disability. The results showed that high body fatness is an independent predictor of mobility-related disability in older men and women. These findings suggest that high body fatness in old age should be avoided to decrease the risk of disability.

Prevalence rates of hearing impairment and comorbid conditions in older people: the Veneto Study

OBJECTIVES

To investigate the prevalence rate of hearing impairment, assessed by both the Sanders' questionnaire and the speech audiometry test, and its association with health-related factors in the older population of the Veneto region of Italy.

DESIGN

A cross-sectional survey.

SETTING

A community-based population.

PARTICIPANTS

2398 noninstitutionalized individuals aged 65 years and older residing in the Veneto region of Italy.

MEASUREMENTS

Prevalence rates of hearing impairment and odds ratios for its association with potential risk factors.

MAIN RESULTS

The prevalence of self-reported hearing impairment at home was 8.1% in men and 7.4% in women, and in a social environment it was 11.1% and 9.3%, respectively. Women were less likely to report hearing difficulties in both environments, and increased risks were found for depression, age, and poor self-rated health. Participants with diabetes or cognitive impairment had increased odds only at home, in contrast to people with a low education level, who had increased odds only in a social environment. The prevalence assessed by speech audiometry was 19% in both sexes. Increased age, diabetes, and poor self-rated health were associated with impaired speech intelligibility, cognitive impairment was associated with 4-fold increased odds among past users of alcohol, and men with a low education level were about three times as likely as others to have hearing impairment.

CONCLUSIONS

Speech audiometry testing detected a higher prevalence of hearing impairment than use of a self-reported questionnaire and was associated with poor self-rated health, history of diabetes, and cognitive impairment among past users of alcohol and among men with low levels of education. The association between hearing deficit and depressive symptomatology was confirmed only with self-reported hearing impairment.

Muscle mass and fat mass in relation to bone mineral density in very old men and women: the Framingham Heart Study

Aim of the study was investigate the cross-sectional relationship between body composition and bone mineral density (BMD) in very old men and women. The study sample consisted of 504 women and 285 men, aged 72-93 yr, participating in examination 22 (1992-1993) of the Framingham Heart Study. Total body BMD, regional BMD, and soft-tissue body composition was measured by dual-energy X-ray absorptiometry. Both muscle mass and percentage body fat were positively associated with total body BMD in women. After adjustment for age, physical activity, smoking status, estrogen use, and thiazide use, BMD increased with increasing tertile of muscle mass (p = 0.007) and with increasing tertile of percentage body fat (p = 0.0001) in women. In men muscle mass, not percentage body fat, was positively associated with BMD. After adjustment for potential confounders, BMD remained associated with muscle mass only (p = 0.02). These results were similar for leg BMD and arm BMD. The study suggests that the influence of muscle and fat mass on bone mineral density is different between very old men and women.

Body fat and skeletal muscle mass in relation to physical disability in very old men and women of the Framingham Heart Study

BACKGROUND

Low muscle mass has been assumed to be associated with disability, but no studies confirming this association have been published. High body weight and high body mass index, both rough indicators of body fatness, have been shown to increase the risk for disability; however, the specific role of body fatness has not been studied.

METHODS

The relations of skeletal muscle mass and percent body fat with self-reported physical disability were studied in 753 men and women aged 72 to 95 years. Cross-sectional data from biennial examination 22 (1992-1993) of the Framingham Heart Study were used. Body composition was assessed by dual-energy x-ray absorptiometry. Disability was scored as any versus none on a 9-item questionnaire.

RESULTS

Total body and lower extremity muscle mass were not associated with disability in either men or women. However, a strong positive association between percent body fat and disability was observed. The odds ratio for disability in those in the highest tertile of body fatness was 2.69 (95% confidence interval 1.45-5.00) for women and 3.08 (1.22-7.81) for men compared to those in the lowest tertile. The increased risk could not be explained by age, education, physical activity, smoking, alcohol use, estrogen use (women only), muscle mass, and health status. Analyses restricting disability to mobility items gave similar results.

CONCLUSIONS

In contrast to current assumptions, low skeletal muscle mass was not associated with self-reported physical disability. Persons with a high percent body fat had high levels of disability. Because it cannot be ruled out that persons with low skeletal muscle mass dropped out earlier in the study, prospective studies are needed to further assess the relationship between body composition and physical disability.

[Recent progress in psychosensory rehabilitation of low vision. The third method for the prevention of blindness]

Functional strabism amblyopia is no more a problem: before 2 years old, they are cured in 95%. On the other and, low vision population beyond any medical or surgical treatment is increasing dramatically: over a million persons are concerned. Low vision is usually a consequence of age related macular degeneration related to the increase of life-span. Diabetic retinopathy, severe glaucoma, vitreoretinal disorders and chorioretinal diseases are also important blindness causes. Only a psychosensorial rehabilitation allow persons to see differently by developing functional vision thanks to the development of sensorial neurophysiology and cognitive psychology. This rehabilitation can only take place in well defined institution with a polyvalent team because such institution are so rare in France (4/33 Sweden) the authors ask National Academy of Medicine to beg public authority to create low vision rehabilitation center.

Association of insulin-like growth factor-I with body composition, weight history, and past health behaviors in the very old: the Framingham Heart Study

OBJECTIVES

We examined correlates of insulin-like growth factor-I (IGF-I), an indicator of growth hormone levels, to identify factors associated with higher levels of IGF-I in old age.

DESIGN

Nested study of cross-sectional correlates and early-life predictors of IGF-I level.

SETTING

A longitudinal cohort study, the Framingham Heart Study.

PARTICIPANTS

A total of 790 men and women (mean age 78.5, range 72-94), who had weight, waist and hip circumferences measured at the time of IGF-I measurement.

MEASUREMENTS

Association of IGF-I with weight, fat distribution, functional status, nutritional indicators, and past health behaviors was assessed. We also examined IGF-I in relation to body composition derived from dual energy X-ray absorptiometry.

RESULTS

IGF-I levels declined with age in both men and women. However, low IGF-I did not show expected associations with low lean mass and increased body fat. Current functional status and grip strength were not associated with IGF-I Low IGF-I was associated with weight loss in men; the strongest associations were with indicators of poorer nutritional status in both men and women. Levels of IGF-I in old age did not vary by past health behaviors.

CONCLUSION

Although IGF-I declined with age, these data from the Framingham Heart Study did not show expected cross-sectional associations of weight, body fat, and lean mass. The strongest associations were between IGF-I and nutritional indicators. These results suggest caution may be warranted with regard to use of IGF-I as an indicator of growth hormone.

Progressive versus catastrophic disability: a longitudinal view of the disablement process

BACKGROUND

There is little epidemiologic data on the development of disability over time in older persons. This study uses prospective data from cohorts followed annually for 6 to 7 years to identify persons who developed severe disability and to characterize the time course of their disabling process and subsequent mortality.

METHODS

Incidence rates of severe disability, defined as need for help in three or more activities of daily living (ADLs), were estimated for 6,640 persons who had not reported severe disability at baseline and at the first four annual follow-up visits. Among persons developing severe disability, those who reported no need for help in ADLs in previous interviews were defined as cases of catastrophic disability, and those who had previously reported some disability in ADLs were defined as cases of progressive disability.

RESULTS

Overall, 212 subjects developed progressive and 227 developed catastrophic disability. The rates of progressive disability and catastrophic disability were 11.3 and 12.1 cases per 1,000 person-years, respectively. For both types of disability, incidence rates increased exponentially with age, but the increase was steeper for progressive disability. At ages 70-74, less than 25% of severe disability was progressive, while over age 85 progressive disability represented more than half of severe disability. Incidence rates of total and both types of severe disability were similar in men and women. Mortality after severe disability onset was extremely high. Survival was unrelated to age at disability onset and type of disability but was significantly longer in women than in men (median 3.44 vs 2.12 years; p < .0001).

CONCLUSION

Tracking the development of disability provides new and important insights into the disability experience in older men and women that are potentially relevant in planning preventive, intervention, and long-term care strategies.

Mechanism of activation of guanine nucleotide exchange factor by insulin

Insulin increases activity of the guanine nucleotide exchange factor (GEF) in Rat-1 fibroblasts transfected with human insulin receptors (HIRc cells), thereby promoting formation of the active form of p21Ras (p21Ras•GTP). In order to identify the upstream molecules mediating this aspect of insulin action, we selectively removed some of these molecules by immunoprecipitation and examined GEF activity in the post-immunoprecipitation lysated of the insulin-treated HIRc cells. The removal of Shc or Grb-2 depleted GEF activity from the cell lysates, whereas immuno-precipitation of the insulin receptors, IRS-1, PLCγ and GAP, were without effect. In summary, the current data demonstrate that a majority of cellular Ras GEF activity after insulin stimulation is associated with Shc and involves interactions among Shc, Grb-2 and Sos.

Cardiac valve replacement in relapsing polychondritis. A review

Cardiac valve replacement is a rare but not exceptional eventuality in patients with relapsing polychondritis. One case requiring aortic and mitral valve replacement and its follow up is described. From the review of the literature an additional twenty patients who required cardiac valve replacement are analyzed. The mean delay between the first onset of relapsing polychondritis and operation was 6.51 years and the mean age at operation was 38.8 years. There was a preponderance of male patients (73.7%). Aortic and mitral valves were replaced in 100% and 28.5% of patients, respectively. During the four first postoperative years 23.8% of them were reoperated for periprosthetic leak or aortic aneurysm, and during the same period 52.6% died of a cardiovascular cause. Immunosuppressive agents should be employed in patients with relapsing polychondritis and cardiovascular involvement because they seem to be more effective than steroids in severe forms of the disease. Therefore, we recommend close and prolonged follow up: firstly because there can be early paravalvular prosthetic leakage due to the friability of the tissue to which it has been anchored; secondly because aortic aneurysms occur frequently in relapsing polychondritis, may be multiple, may involve all parts of the aorta and result in fatal rupture even in asymptomatic patients; and thirdly because there can be a fatal outcome due to other organ involvement, like airway obstruction, acute glomerulonephritis, or systemic vasculitis. Prophylactic composite graft replacement of the ascending aorta associated with replacement of the aortic valve and re-implantation of the coronary arteries could avoid the need for reoperation in these high risk patients.

Thoracic aortic dissection: diagnosis with transesophageal echocardiography versus MR imaging

PURPOSE

To compare transesophageal echocardiography (TEE) and magnetic resonance (MR) imaging in the diagnosis of dissection of the thoracic aorta.

MATERIALS AND METHODS

Thirty-one consecutive patients with clinically suspected aortic dissection and 10 postoperative patients underwent transesophageal color Doppler echocardiography and MR imaging. Imaging results were compared at independent double-blind readings. Final diagnosis was obtained from consensual review of all corroborative studies.

RESULTS

MR imaging depicted the intimal flap in 95% of aortic dissections; TEE, in 86% (P < .05). In surgical patients, the sensitivity of MR in detection of residual dissection was 100% versus 86% with TEE (P < .05). The inferior extent of the dissected lumen was seen only with MR imaging. False-positive results occurred in two cases with TEE and in one with MR imaging.

CONCLUSION

MR imaging is superior to TEE in the evaluation and follow-up of dissection of the thoracic aorta. Because the availability of MR is limited, however, TEE should remain the standard modality for diagnosis.

[Thromboses of heart valve prostheses: predisposing and prognostic factors based on a study of 41 patients]

Forty one patients were admitted with a diagnosis of prosthetic valve thrombosis. One patient was thrombolyzed successfully, and 40 underwent surgical procedures. In 13 cases, prosthetic valve thrombosis occurred in the first month after valve replacement. 18 patients were in functional class IV of the NYHA classification. Among the thrombosed prostheses, 91% were mechanical, and 61% in mitral position. Adequacy of anticoagulation was the most important risk factor, as this treatment was inappropriate in 20 patients. In 10 other patients, it had been changed for medical (bleeding events, pregnancy) or surgical (non cardiac surgery) reasons. The perioperative mortality rate was high (32.4%). It was 12% in patients in functional class II and 46% in those in class IV (p < 0.05). This underlines the value of early diagnosis, in which echocardiography, especially with a transesophageal probe, takes a major place, allowing prompt surgical treatment.

Management of giant coronary artery aneurysm with fistulization into the right atrium

A giant right coronary artery aneurysm communicating with the right atrium is reported. Its diagnosis using echocardiography, computed tomography of the chest, and angiography is illustrated. The operative management of this rare cardiac pathology is described. The role of operation in such a large aneurysm is emphasized.

Effect of positioning on the breathing pattern of preterm infants

Respiration, as judged by gas exchange and pulmonary function, is improved in preterm infants kept in the prone rather than the supine position. The influence of position on the breathing pattern as documented by the pneumogram was studied in 14 stable preterm infants with recent clinical apnoea. Ten of the infants had oximetry and nasal flow studies simultaneously with the impedance pneumogram. Each infant had consecutive nocturnal pneumograms, one in the prone, one in the supine position. The infants were kept for more than six hours in the assigned position. A significant increase in apnoea density and in periodic breathing was found in the supine v the prone position (mean (SE) 4.5 (0.7)% v 2.5 (0.5)%, and 13.6 (3.2)% v 7.7 (2.2)%, respectively). There was no positional difference in the incidence of bradycardia and prolonged apnoea. The examination of obstructive apnoea, mixed apnoea, and cyanotic spells did not reveal a consistent disparity between the two positions. These findings indicate an increase in central apnoea in preterm infants kept predominantly in the supine position. Possible relations of positional changes to lung mechanics are discussed. When evaluating pneumograms, attention must be given to the position in which they were performed.