Baseline [18F]FDG PET features are associated with survival and toxicity in patients treated with CAR T cells for large B cell lymphoma

PURPOSE

Chimeric antigen receptor (CAR) T cells have established themselves as an effective treatment for refractory or relapsed large B cell lymphoma (LBCL). Recently, the sDmax, which corresponds to the distance separating the two farthest lesions standardized by the patient's body surface area, has appeared as a prognostic factor in LBCL. This study aimed to identify [18F]FDG-PET biomarkers associated with prognosis and predictive of adverse events in patients treated with CAR T cells.

METHODS

Patients were retrospectively included from two different university hospitals. They were being treated with CAR T cells for LBCL and underwent [18F]FDG-PET just before CAR T cell infusion. Lesions were segmented semi-automatically with a threshold of 41% of the maximal uptake. In addition to clinico-biological features, sDmax, total metabolic tumor volume (TMTV), SUVmax, and uptake intensity of healthy lymphoid organs and liver were collected. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method. The occurrence of adverse events, such as cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS), was reported.

RESULTS

Fifty-six patients were included. The median follow-up was 9.7 months. Multivariate analysis showed that TMTV (cut-off of 36 mL) was an independent prognostic factor for PFS (p < 0.001) and that sDmax (cut-off of 0.15 m-1) was an independent prognostic factor for OS (p = 0.008). Concerning the occurrence of adverse events, a C-reactive protein level > 35 mg/L (p = 0.006) and a liver SUVmean > 2.5 (p = 0.027) before CAR T cells were associated with grade 2 to 4 CRS and a spleen SUVmean > 1.9 with grade 2 to 4 ICANS.

CONCLUSION

TMTV and sDmax had independent prognostic values, respectively, on PFS and OS. Regarding adverse events, the mean liver and spleen uptakes were associated with the occurrence of grade 2 to 4 CRS and ICANS, respectively. Integrating these biomarkers into the clinical workflow could be useful for early adaptation of patients management.

Academic clinician frontline-worker wellbeing and resilience during the COVID-19 pandemic experience: Were there gender differences?

Prior research suggests COVID-19 has amplified stress on Academic Clinician Frontline-Workers (ACFW). The aim of this paper is: (1) to better understand the experiences of ACFW during the COVID-19 pandemic including their mental-emotional wellbeing, academic productivity, clinical experiences, and (2) to examine any gender differences. A cross-sectional survey was administered to University of Minnesota/M Health Fairview systems' faculty February-June 2021. Of the 291 respondents, 156 were clinicians, with 91 (58 %) identifying as Frontline-Workers (ACFW). Faculty wellbeing was assessed using validated measures in addition to measures of productivity and sociodemographics. For example, ACFW reported a higher Work-Family Conflict (WFC) scores compared to non-ACFW (26.5 vs. 24.1, p = 0.057) but did not report higher Family-Work Conflict (FWC) scores (17.7 vs. 16.3, p = 0.302). Gender sub-analyses, revealed that women ACFW compared to men ACFW reported higher WFC scores (27.7 vs. 24.1, p = 0.021) and FWC (19.3 vs. 14.3, p = 0.004). Academically, ACFW reported submitting fewer grants and anticipated delays in promotion and tenure due to the COVID-19 (p = 0.035). Results suggest COVID-19 has exacerbated ACFW stress and gender inequities. Reports of anticipated delay in promotion for ACFW may pose a challenge for the long-term academic success of ACFW, especially women ACFW. In addition, women may experience higher FWC and WFC as compared to men. Schools of academic medicine should consider re-evaluating promotion/tenure processes and creating resources to support women ACFW as well as ACFW caregivers.

Prevalence of opioid and nonopioid pain management therapies among Medicare beneficiaries with musculoskeletal pain conditions from 2016 to 2019

INTRODUCTION

Pain treatment guidelines prioritize nonopioid therapies over opioid medications to prevent opioid-related harms. We examined trends in receipt and intensity of nonpharmacologic, nonopioid medication, and opioid therapies among Medicare beneficiaries.

METHODS

Using a 20% national random sample of Medicare data from 2016 to 2019, we identified fee-for-service beneficiaries with ≥2 diagnoses of back, neck, fibromyalgia, or osteoarthritis/joint pain annually. We excluded beneficiaries with cancer. We calculated annual proportions of beneficiaries who received physical therapy (PT), chiropractic care, gabapentin, and opioids, overall and in demographic, geographic, and clinical subgroups. We estimated the intensity of therapies using the annual number of visitsor prescription fills, prescription days' supply, and opioid dose.

RESULTS

During 2016-2019, PT receipt increased (22.8% to 25.5%) and the mean number of visits among recipients of PT went from 12 to 13. Chiropractic receipt (~18%) and mean annual visits (~10) remained unchanged. The prevalence of gabapentin receipt was stable at ~22% and the mean annual number of fills was unchanged though gabapentin days increased slightly. Opioid prescribing decreased (56.7% to 46.5%) and reductions in opioid dose and duration were observed. Opioid receipt was high among beneficiaries who were under 65 years, American Indian/Alaska Native, Black/African American, or had opioid use disorder (OUD), in whom nonpharmacologic therapies were also received the least.

CONCLUSION

Utilization of nonopioid therapies lagged opioids among Medicare beneficiaries with musculoskeletal pain, with limited changes from 2016 to 2019. As opioid prescribing declines and alternative pain therapy receipt remains low, there are potential increasing risks of pain going untreated or undertreated and individuals seeking illicit opioids to alleviate their pain.

Dimensions, application, and outcomes of person-centered self-management interventions for those living with type 2 diabetes: A scoping review

OBJECTIVES

To explore which dimensions of the person-centered approach (PCA) are adopted in self-management interventions, how they are applied, and its outcomes.

METHODS

A review team carried out a scoping review using the methodology of Arksey and O'Malley on diabetes mellitus type 2, person-centered care, and self-management.

RESULTS

Of the 364 titles identified, 22 articles were included in this review. No study contained all five dimensions described by the person-centered framework. Some dimensions seemed difficult to assess, mainly having a sympathetic presence and engagement. The application of the five PCA dimensions are presented. Although the authors claimed their intervention to be person-centered, none used a specific tool to measure person-centered care in a holistic way.

CONCLUSION

Although the guidelines recommend a PCA to professionals, there is a gap with practice, professionals having difficulty adopting and measuring this approach.

PRACTICE IMPLICATIONS

Some strategies to facilitate the adoption of a PCA with people living with type 2 diabetes are proposed. These can help researchers and clinicians develop a PCA, by identifying the care delivery processes necessary to provide it. It seems important for researchers to measure whether their intervention is truly person-centered, using holistic tools and combining different methods (observation, questionnaire, interview).

Psychological distress in frequent users of primary health care and emergency departments: a scoping review

INTRODUCTION

Frequent users of healthcare services are a small proportion of patients with disproportionately high healthcare usage. A wide array of factors, including psychological distress, leads to frequent use of healthcare services. There is no existing synthesis of research on frequent use and psychological distress in the general population. This scoping review aimed to compare psychological distress between frequent and non-frequent users and to examine the association between psychological distress and frequent use of healthcare services in primary care and emergency department (ED) services.

METHODS

A scoping review was performed following the five steps defined by Arksey and O'Malley. A search strategy was developed with an information specialist in five databases (Medline, PsycINFO, CINAHL, SCOPUS, and PubMed) for articles in English published between 1963 and October 2018. To be included, studies had to be quantitative, have taken place in a primary care or ED setting, have documented frequent use, and have measured psychological distress in patients. Two team members independently gathered the data for each of the included studies. Results were collated, summarized, and reported using narrative synthesis.

RESULTS

Seven studies met the inclusion criteria. Psychological distress in primary care is generally higher in frequent users, and increased psychological distress scores are associated with frequent use. Both studies set in EDs reported noteworthy findings, stating that frequent users reported higher levels of psychological distress and that psychological distress was associated with frequent use.

CONCLUSION

Psychological distress is prevalent in frequent users and has a significant association with frequent use. As such, psychological distress should be evaluated by physicians to prevent or reduce frequent use and to identify candidates for interventions.

A new diffractometer for diffuse scattering studies on the ID28 beamline at the ESRF

A new diffractometer is now available to the general user community at the ESRF. The new diffractometer is a side station of the high-resolution inelastic X-ray scattering spectrometer on beamline ID28 and is located in the same experimental hutch. Both instruments can be operated simultaneously. The new diffractometer combines a fast and low-noise hybrid pixel detector with a variable diffraction geometry. The beam spot on the sample is 50 µm × 50 µm, where focusing is achieved by a combination of Be lenses and a KB mirror. Wavelengths from 0.5 to 0.8 Å can be used for the diffraction experiments. The setup is compatible with a variety of sample environments, allowing studies under non-ambient conditions. The diffractometer is optimized to allow a rapid survey of reciprocal space and diffuse scattering for the identification of regions of interest for subsequent inelastic scattering studies, but can also be employed as a fully independent station for structural studies from both powder and single-crystal diffraction experiments. Several software packages for the transformation and visualization of diffraction data are available. An analysis of data collected with the new diffractometer shows that the ID28 side station is a state-of-the-art instrument for structural investigations using diffraction and diffuse scattering experiments.

Mechanisms of resonant low frequency Raman scattering from metallic nanoparticle Lamb modes

The low frequency Raman scattering from gold nanoparticle bimodal assemblies with controlled size distributions has been studied. Special care has been paid to determining the size dependence of the Raman intensity corresponding to the quadrupolar Lamb mode. Existing models based on a microscopic description of the scattering mechanism in small particles (bond polarizability, dipole induced dipole models) predict, for any Raman-active Lamb modes, an inelastic intensity scaling as the volume of the nanoparticle. Surprisingly experimental intensity ratios are found to be anomalously much greater than theoretical ones, calling into question this scaling law. To explain these discrepancies, a simple mechanism of Raman scattering, based on the density fluctuations in the nanoparticles induced by the Lamb modes, is introduced. This modeling, in which the nanoparticle is described as an elastic isotropic continuous medium-as in Lamb theory, successfully explains the major features exhibited by low frequency Raman modes. Moreover this model provides a unified picture for any material, suitable for handling both small and large size ranges, as well as non-resonant and resonant excitation conditions in the case of metallic species.

Mechanical Coupling in Gold Nanoparticles Supermolecules Revealed by Plasmon-Enhanced Ultralow Frequency Raman Spectroscopy

Acoustic vibrations of assemblies of gold nanoparticles were investigated using ultralow frequency micro-Raman scattering and finite element simulations. When exciting the assemblies resonantly with the surface plasmon resonance of electromagnetically coupled nanoparticles, Raman spectra present an ultralow frequency band whose frequency lies below the lowest Raman active Lamb mode of single nanoparticles that was observed. This feature was ascribed to a Raman vibration mode of gold nanoparticle "supermolecules", that is, nanoparticles mechanically coupled by surrounding polymer molecules. Its measured frequency is inversely proportional to the nanoparticle diameter and sensitive to the elastic properties of the interstitial polymer. The latter dependence as well as finite element simulations suggest that this mode corresponds to the out-of-phase semirigid translation (l = 1 Lamb mode) of each nanoparticle of a dimer inside the matrix, activated by the mechanical coupling between the nanoparticles. These observations were permitted only thanks to the resonant excitation with the coupling plasmon excitation, leading to an enhancement up to 10(4) of the scattering by these vibrations. This enhanced ultralow frequency Raman scattering thus opens a new route to probe the local elastic properties of the surrounding medium.

Superfluid high REynolds von Kármán experiment

The Superfluid High REynolds von Kármán experiment facility exploits the capacities of a high cooling power refrigerator (400 W at 1.8 K) for a large dimension von Kármán flow (inner diameter 0.78 m), which can work with gaseous or subcooled liquid (He-I or He-II) from room temperature down to 1.6 K. The flow is produced between two counter-rotating or co-rotating disks. The large size of the experiment allows exploration of ultra high Reynolds numbers based on Taylor microscale and rms velocity [S. B. Pope, Turbulent Flows (Cambridge University Press, 2000)] (Rλ > 10000) or resolution of the dissipative scale for lower Re. This article presents the design and first performance of this apparatus. Measurements carried out in the first runs of the facility address the global flow behavior: calorimetric measurement of the dissipation, torque and velocity measurements on the two turbines. Moreover first local measurements (micro-Pitot, hot wire,…) have been installed and are presented.

A longitudinal twin study of physical aggression during early childhood: evidence for a developmentally dynamic genome

BACKGROUND

Physical aggression (PA) tends to have its onset in infancy and to increase rapidly in frequency. Very little is known about the genetic and environmental etiology of PA development during early childhood. We investigated the temporal pattern of genetic and environmental etiology of PA during this crucial developmental period.

METHOD

Participants were 667 twin pairs, including 254 monozygotic and 413 dizygotic pairs, from the ongoing longitudinal Quebec Newborn Twin Study. Maternal reports of PA were obtained from three waves of data at 20, 32 and 50 months. These reports were analysed using a biometric Cholesky decomposition and linear latent growth curve model.

RESULTS

The best-fitting Cholesky model revealed developmentally dynamic effects, mostly genetic attenuation and innovation. The contribution of genetic factors at 20 months substantially decreased over time, while new genetic effects appeared later on. The linear latent growth curve model revealed a significant moderate increase in PA from 20 to 50 months. Two separate sets of uncorrelated genetic factors accounted for the variation in initial level and growth rate. Non-shared and shared environments had no effect on the stability, initial status and growth rate in PA.

CONCLUSIONS

Genetic factors underlie PA frequency and stability during early childhood; they are also responsible for initial status and growth rate in PA. The contribution of shared environment is modest, and perhaps limited, as it appears only at 50 months. Future research should investigate the complex nature of these dynamic genetic factors through genetic-environment correlation (r GE) and interaction (G×E) analyses.

[Hydroxyurea-induced pneumonia]

INTRODUCTION

Hydroxyurea is an antimetabolite drug used in the treatment of myeloproliferative disorders. Common adverse effects include haematological, gastrointestinal cutaneous manifestations, and fever. Hydroxyurea-induced pneumonitis is unusual.

CASE REPORT

A female patient was treated with hydroxyurea for polycythemia vera. She was admitted 20 days after commencing treatment with a high fever, productive cough, clear sputum and nausea. A chest CT-scan showed diffuse ground-glass opacities. Microbiological investigations were negative. The symptoms disappeared a few days after discontinuation of the drug and rechallenge led to a relapse of symptoms.

CONCLUSION

Our case and 15 earlier cases of hydroxyurea-induced pneumonitis are reviewed. Two patterns of this disease may exist: an acute febrile form occurring within 1 month of introduction of hydroxyurea and a subacute form without fever. Even if uncommon, one should be aware of this complication of hydroxyurea.

Load-sensitive adhesion factor expression in the elderly with skiing: relation to fiber type and muscle strength

We hypothesized that 12 weeks of downhill skiing mitigates the functional deficits of knee extensor muscles in elderly subjects due to the specific recruitment of fast motor units during forceful turns on the slope. Downhill skiing led to a 1.4-fold increase in the mean cross-sectional area of slow (P=0.04)- and fast (P=0.08)-type muscle fibers. Fold changes in the expression of the structural component of focal adhesions, gamma-vinculin, were correlated with alterations in concentric force (r=0.64). Hypertrophy of fast fibers was more pronounced in women than in men (1.7 vs 1.1). Gender-specific structural-functional adjustments of knee extensor muscles and attached patellar tendon were reflected by altered expression of pro- vs de-adhesive proteins and a number of correlations. The de-adhesive protein tenascin-C was selectively increased in women compared with men (1.7 vs 1.1) while the content of the adhesive collagen XII was specifically reduced in women. The pro-adhesive focal adhesion kinase showed a specific increase in men compared with women (1.9 vs 1.1). Our findings indicate that quantitatively matched adaptations in slow and fast motor units of extensor muscle underlie the preventive effect of skiing against sarcopenia and support that hypertrophy and reinforcement of fiber adhesion operate in the improvement of muscle strength.

[Post-transfusion hepatitis C. From screening to compensation]

In France, during the last decades preceding the 1990s, 100,000 to 400,000 blood recipients may have been infected by hepatitis C. Since 1990, thanks to advances in transfusion safety, the risk of hepatitis C contamination has become extremely low. Given the natural history of the disease, it can be a long time unnoticed. Thus, even today, a significant part of infected individuals do not know their serological status. Through several periods and several campaigns, we present the various means used for the detection of post-transfusion hepatitis C at the Caen University Hospital. These methods have been introduced as a result of legislation or through arrangements made by the institution. They were made possible through the action of haemovigilance system, monitoring adverse reactions related to blood products and of blood products traceability which helps to realise special researches in case of suspected transfused blood products. In addition to posttransfusion hepatitis C detection, we are discussing available victim ways to be indemnified for the injury suffered by contamination by hepatitis C.

[Successful treatment of resistant Fusarium solani keratitis with liposomal amphotericin B]

INTRODUCTION

The prognosis for Fusarium keratitis is poor. Effective drugs to treat this infection are therefore needed.

CASE REPORT

A patient presented Fusarium solani keratitis. The infection regressed with topical amphotericin B and intravenous voriconazole. Topical steroids were introduced. There was reactivation and extension of the infection, invading the anterior chamber. Steroids were discontinued and the antifungal treatment was restarted but there was continued deterioration. Recovery was achieved without surgery, with topical voriconazole, topical liposomal amphotericin B, topical natamycin, intravenous liposomal amphotericin B, and intravenous voriconazole.

CONCLUSION

Combined orally and topically administered voriconazole is a promising therapy when the minimum inhibitory concentration is approximately 2 microg/ml. Liposomal amphotericin B seems to be the most effective drug for the different infection stages. Posaconazole is a useful alternative but further investigations must be pursued.

[Acute alcoholic intoxication at the hospital: a clinical stake. A prospective study of one year in a general hospital]

INTRODUCTION

Acute alcoholic intoxications (AAI) are frequent in hospitals. This entails some difficulties to caregivers and their clinical approach is little developed in France. This study aimed at estimating perception of alcohol consumption of hospitalized people with positive alcohol blood test at admission. Alcohol measurements were nonsystematic and ordered by a physician. Then this study assessed the role of a clinical interview the day after an AAI.

METHODS

Each person admitted with a positive alcohol blood test was systematically met by a professional in addictology, referring to a procedure in process for 10 years in this hospital. A prospective collection of the data was performed during 2006.

RESULTS

Nine hundred and seventy-three episodes were identified corresponding to 758 persons (78% of men and 22% of women). The average alcohol blood level was 2.06+/-1.18g/L. Eighty-five percent of those patients were admitted and 52% were interviewed. Damage due to alcohol was identified for 69% and a misuse of alcohol for 92% (19% abuse, 73% dependence according to the DSM IV), without significant correlation to alcohol blood level.

CONCLUSION

Blood alcohol level assay at the hospital admission, when the test has been medically recommended, targets a misusing alcohol group of people. These patients need addictologic care, after a first toxicological stage. This study confirms that in such a case a discussion offer is possible and agreed by diseased people. This offer is a first step towards people who could not express explicitly their need for help and constitute an opportunity to care.

Acuité visuelle un et deux ans après kératoplastie transfixiante pour kératocône

PURPOSE

To quantify the visual outcome obtained in patients operated on for penetrating keratoplasty for keratoconus (KC) after 1 and 2 years.

PATIENTS

and methods: The files from consecutive keratoconus patients operated on for PKP after more than 2 years of follow-up were retrospectively studied. The demographic charts, the KC stage, and the surgical features were noted. The best corrected visual acuities (BSCVA) were analyzed at the initial examination and after 1 and 2 years of follow-up.

RESULTS

One hundred and two eyes from 98 patients were analyzed, including 83 grade 4 (81%) and 19 grade 3 (18%) cases of KC. The mean preoperative BSCVA was 0.08 on the decimal chart, which increased to 0.5 and 0.6 1 and 2 years after penetrating keratoplasty (p<0.001, respectively). The mean keratometric astigmatism was 3.80+/-2.9 D and 3.94+/-2.3 D for the grade 3 and 4 KC, respectively, after 1 year and 2.52+/-1.9 D and 3.34+/-2.2 D after 2 years (NS). At this time point, 81% of the eyes had less than 5 D astigmatism.

CONCLUSION

One and 2 years after penetrating keratoplasty, a mean BSCVA of 0.5 and 0.6 could reasonably be expected in keratoconus patients and three-quarters of patients can be expected to see better than 0.5 after 2 years.

[Fish proteins moderate triacylglycerols, activities of hepatic triacylglycerol lipase and tissue lipoprotein lipases in hypertensive and diabetic rats]

Fish proteins effect compared with casein was determined on triacylglycerols (TG) metabolism and activities of hepatic triacylglycerol lipase (HTGL) and tissue lipoprotein lipases (LPL), in SHR and diabetic SHR. Two groups of rats (n=24) were fed, 2 months, diet containing 20% casein (CAS) or 20% fish proteins (FP). One month before sacrifice, diabetes was induced in one group of rats by a single intraperitoneal injection of streptozotocin (STZ) (60 mg/kg of body weight). FP vs. CAS showed a significant decrease of TG concentrations in plasma (-41%) and liver (-66%), in SHR-STZ. VLDL-LDL mass, which represented the amount of apolipoproteins, TG, phospholipids (PL), unesterified cholesterol (UC), and cholesteryl esters (CE), decreased by 21 and 16% with FP vs. CAS, in SHR and SHR-STZ, respectively, and was concomitant with its low TG. Indeed, TG values was 1.35- and 1.82-fold lower in SHR and SHR-STZ, respectively. In HDL2, a TG diminution of 13% was noted, in SHR with FP vs. CAS. In SHR-STZ with FP, TG and PL were enhanced by 11% and 27%, respectively compared to SHR. HTGL activity decreased by 22% in SHR fed FP compared to those fed CAS. In SHR-STZ with CAS vsSHR, this activity was decreased by 21%. LPL activity in heart was enhanced by 19% in SHR-STZ vs. SHR with FP, when that of muscle was diminished 1.5-fold in SHR with FP vs. CAS and 1.8-fold in SHR-STZ vs. SHR with CAS. Adipose LPL activity was 1.36-fold higher in SHR with FP than CAS. In conclusion, it appears that fish proteins have a hypotriglyceridemic effect, which the mechanism can differ in SHR or SHR-STZ. It may be of interest to propose these fish proteins as lipid metabolism regulator in diseases with hypertriglyceridemia.

[Acanthamoeba stromal keratitis: epidemiology and prognosis factors]

PURPOSE

Early treatment of amebic stromal keratitis can change patients' final visual and esthetic prognosis. The aim of this study was to review all proven Acanthamoeba stromal keratitis cases presenting at our ophthalmology emergency department over the past 3 years, in order to delineate the incidence and the factors still leading to this serious complication.

PATIENTS

and methods: All cases of Acanthamoeba stromal keratitis confirmed with a parasitology examination and treated between January 2000 and December 2002 were recorded. During this period of time, eight patients were identified with this condition. Their charts, as well as biomicroscopic, therapeutic, and outcome data were analyzed.

RESULTS

All patients were referred in a second or third intention. Only one patient did not usually wear contact lenses. Six patients had an associated bacterial abscess. The typical amebic annular infiltrate was only observed in one patient. Three patients received an effective antiamebic treatment in the 15 days following the first symptoms and five patients 1 month or more after. An emergency keratoplasty was carried out in one patient. Finally, visual acuity was lower than 5/10 in all cases. The patients treated in the first 15 days had the best final visual acuity.

DISCUSSION

Soft contact lenses are still responsible for the majority of serious amebic corneal complications. Late diagnosis remains the main cause of Acanthamoeba stromal keratitis development, particularly in the absence of contact lens history, because of the delay in treatment.

CONCLUSION

The catastrophic consequences of this complication justify a systematic treatment against ameba in each case of suspected diagnosis. An early and effective treatment of the stromal amebic keratitis can increase the final visual prognosis.

Antioxidant status in alcohol-related diabetes mellitus in Beninese subjects

In the present study, we investigated the antioxidant status in diabetes mellitus, related or not to alcohol consumption. A total of 38 type 1, 48 type 2 and 42 alcohol-related diabetic patients were selected. Total antioxidant status was assessed through the oxygen radical absorbance capacity of the plasma and the determination of enzymatic and non-enzymatic antioxidant molecules. Serum triglycerides, total cholesterol and HDL-cholesterol concentrations were determined and the lipid peroxydation was evaluated by measuring thiobarbituric acid reactive substances (TBARS) assay. Plasma total antioxidant capacity was more decreased in alcohol-related diabetes than that in type 1 and type 2 diabetes, regardless of the complications (retinopathy and renal failure). Plasma vitamin E concentrations were significantly decreased whereas those of vitamin C increased in all of the diabetic patients compared to the controls, irrespective to the complications. In addition, superoxide dismutase and glutathione peroxidase activities were reduced in all the patients (type 1, type 2 and alcohol-related), irrespective to the complications. Glutathione reductase activity was diminished in type 1 and alcohol-related, but not in type 2, diabetic patients. Glutathione (GSH) concentrations significantly decreased in all diabetic patients with a significant decrease in alcohol-related diabetic patients. Excessive alcohol consumption appears as an oxidative aggravating factor in diabetes mellitus. Besides, alcohol-related diabetes highly resembles to type 1 diabetes as far as the antioxidant parameters are concerned.

TheDrosophila ACP65A cuticle gene: Deletion scanning analysis ofcis-regulatory sequences and regulation by DHR38

The regulatory sequences of the Drosophila ACP65A cuticle gene were analyzed in vivo in transgenic flies, using both fusion genes constructs and transposase-mediated deletions within a P element containing ACP65A regulatory sequences fused to the lacZ gene (deletion scanning). The sequences located between -594 and +161 are sufficient to confer both temporal and spatial expression specificities, indicating the presence of tissue-specific enhancers and response elements to hormone-induced factors. In addition, timing of expression and tissue-specificity appear to be controlled by distinct cis-regulatory elements, which suggests the existence of independent hormonal and tissue-specific signaling pathways. Gain and loss of function studies also implicate DHR38, the Drosophila homolog of the vertebrate NGFI-B-type nuclear receptors, as an important activator of the ACP65A gene.

[Transportation in blood transfusion]

Equipment including vehicles, packaging, cool packs and temperature indicators must be valid, well maintained and checked. Documentation, operating instructions, transportation forms, contracts and conventions must be established and regularly updated in accordance with regulation. Staff must get consistent, specific and qualified training.

[Effect of fish protein on blood pressure, glycemia and plasma and urinary parameters in spontaneously hypertensive rats (SHR) and diabetic SHR]

Fish protein (FP) effect compared to casein (CAS) was studied on blood pressure (BP) evolution and glycemia in part, and on plasma lipid, angiotensine II and aldosterone concentrations and urinary aldosterone on the other hand, in SHR and in SHR with streptozotocin-induced diabetes (SHR-STZ). Two groups of rats (6 SHR and 6 SHR-STZ) were fed for 2 months diet containing 20% CAS or 20% FP. One month before sacrifice, diabetes was induced into one group of rats by a single intraperitonealy injection of streptozotocin (STZ). The results showed that FP diminished blood pressure (-9%) in SHR, compared with CAS. In contrast, FP enhanced significantly blood pressure in SHR-STZ vs SHR (p<0.01). There was no effect on glycemia with fish protein. FP compared to CAS involved a diminution (-41%) and (-17%) of total cholesterol and (-26%) and (-9%) of phospholipids in SHR and SHR-STZ, respectively. Moreover, a decrease of triacylglycerols (-21%) was noted in SHR-STZ with FP vs CAS. In SHR, plasma aldosterone and angiotensine II concentrations were reduced (-62%) and (-64%) and urinary aldosterone amounts were enhanced with FP compared to CAS (p<0.05). In SHR-STZ group, aldosterone value was fivefold lower in plasma and twofold higher in urine with FP compared to CAS. A significant enhancement of urinary aldosterone was noted in SHR-STZ vs SHR whatever diet-consumed. In conclusion, FP has a beneficial effect on blood pressure by modulating the hypertension markers i.e. plasma total cholesterol, angiotensine II and aldosterone, in SHR group, and on total cholesterol and triglycerids in SHR-STZ. FP reduces plasma aldosterone by its enhanced urinary excretion. It is necessary to specify the action mode of FP in order to propose it as nutritional complement in the degenerative diseases such as hypertension and diabetes.

Comparison of the reaction time, the Berg Scale and the ABC in non-fallers and fallers

Postural sway, reaction time, the Berg Scale and the Activities-specific Balance Confidence Scale (ABC) were administered to 80 elderly subjects (40 fallers and 40 healthy non-fallers) in order to determine reliable predictor for those at risk of falling. Non-fallers showed significantly faster reaction times when compared with fallers experimental group. Postural sway results show a higher oscillation displacement in the Y axis (lateral) than the X axis (anterior-posterior) and that fallers oscillate at a higher frequency than non-fallers. All variables were submitted to a multiple regression analysis. Only three of the four variables were found to be significant predictors of fall status. The variables in order of their inclusion are reaction time, Total Berg Balance Score and mean ABC. It was further determined that reaction time was indeed the best predictor of fall status in the present study.

[Radiation sensitivity testing and late neurological complications following radiosurgery for AVM: the use of SF2 from fibroblasts as a predictive factor]

PURPOSE

To identify SF2 as a prognostic factor of late complications from radiosurgery in patients treated for AVM.

PATIENTS AND METHODS

Five patients with AVM treated in three canadian institutions and who suffered clinically significant neurological sequelaes secondary to radiosurgery were identified. Their fibroblasts were cultured and their radiation sensitivity tested to determine the SF2 for each patient.

RESULTS

Patients who developed a neurological complication from radionecrosis, secondary to radiosurgery had an SF2 different than the two control patients with AVM and no complications and also from a group of five cancer patients without late radiation complications (P = 0.005).

CONCLUSION

Radiosurgery is an elective procedure. The identification of a subgroup of patients who are radiosensitive and at a higher risk of radiation induced complications can allow the treatment team to reduce the risk of such complications. SF2 as a new predictive factor should be incorporated in predictive models of risk from treatment of AVM by radiosurgery. This work needs to be confirmed in a larger cohort of patients.

[Why are aphakic anterior chamber intraocular lenses still implanted? Five-year incidence and implantation circumstances at the Hôtel-Dieu in Paris]

PURPOSE

To report incidence and circumstances of aphakic anterior chamber intraocular lens implantation.

METHODS

Retrospective study of medical charts of anterior chamber intraocular lens implantation in the Ophthalmology Department, Hôtel Dieu, Paris, from 1996 to 2000, investigating the number of anterior intraocular lenses (ACIOL) implanted, circumstances, and incidence during cataract extraction.

RESULTS

One hundred and forty-three ACIOLs (139 patients, 60 men, 79 women) were implanted. The mean age was 75.98+/-10.6 years [range, 35-96 years]. All ACIOLs were of open-loop design: open C-loop or Kelman lens. Four circumstances leading to ACIOL implantation were reported: extracapsular cataract extraction with intraoperative complications (94 cases), intracapsular cataract extraction (13 cases), secondary implantation (20 cases), and penetrating keratoplasty with ACIOL (9 cases). Since 1996, the number of ACIOLs implanted each year has decreased (p<0.01): 1.09% of cataract extractions performed in 1996 were implanted with ACIOLs and 0.43% in 2000. At the end of the 5-year period, 12,580 cataract extractions had been performed in our department, with a mean incidence of ACIOL implantation at 0.85%.

CONCLUSION

ACIOLs continue to be implanted in some cases in the absence of capsular support. Because of endothelial complications, they must be reserved for elderly patients. Endothelial surveillance using specular microscopy remains indispensable.