Metabolic syndrome and the phenotype of multiple sclerosis

BACKGROUND

Comorbidities, particularly vascular comorbidities, have been shown to exacerbate the progression of disability in multiple sclerosis (MS). Metabolic syndrome (MetS) is a cluster of conditions including abdominal obesity, insulin resistance, atherogenic dyslipidemia, and vascular dysfunction, which contribute to vascular morbidity and chronic inflammation.

OBJECTIVE

To describe the characteristics of MetS in a cohort of MS patients and evaluate its relationship with the MS phenotype.

METHODS

A monocentric cohort study was conducted on MS patients, collecting demographic, clinical, radiological, and therapeutic data, as well as metabolic data including waist circumference, blood pressure, serum triglycerides, high-density lipoprotein cholesterol, and fasting blood glucose.

RESULTS

Among the 84 patients included in the study, 27% were diagnosed with MetS. MetS was found to be associated with secondary progressive MS (SPMS). Patients with SPMS had a higher prevalence of MetS compared to those with relapsing-remitting MS (RRMS), even after adjusting for disease duration. While MetS was associated with Expanded Disability Status Scale (EDSS) progression in the 3-year period according to univariate analysis, it did not show a significant association with disease activity.

CONCLUSION

This study provides evidence supporting the connection between MetS and the progression of disability in MS, independent of disease relapse activity.

[Vaccination status and factors associated with pneumococcal vaccination in geriatric short-stay care]

Nearly two-thirds of geriatric short-stay patients were eligible for pneumococcal vaccination. Among patients eligible for vaccination, less than 5 % had received at least one injection of pneumococcal vaccine on admission. We found no modifiable factors associated with vaccination status, but several avenues for improving vaccination coverage.

NSAIDs for Pain Control During the Peri-Operative Period of Hip Fracture Surgery: A Systematic Review

BACKGROUND

Hip fracture (HF) mostly affects older adults and is responsible for increased morbidity and mortality. Non-steroidal anti-inflammatory drugs (NSAIDs) are part of the peri-operative multimodal analgesic management, but their use could be associated with adverse events in older adults. This systematic review aimed to assess outcomes associated with NSAIDs use in the peri-operative period of HF surgery.

METHODS

This systematic review was conducted according to the PRISMA guidelines. Three databases (PubMed/EMBASE/Cochrane Central) were used to search for clinical trials and observational studies assessing efficacy, safety and impact of NSAIDs use on non-specific post-operative outcomes, such as functional status and post-operative complications.

RESULTS

Among the 1320 references initially identified, four provided data on efficacy, four on safety and six on non-specific post-operative outcomes (three randomized controlled clinical trials, three observational studies). Mean study population ages ranged from 68 to 87 years. Two studies found that NSAIDs were effective on pain control, but two studies found conflicting results on opioid sparing. No increased risk of acute kidney injury was observed, while results concerning bleeding risk and delirium were conflicting. No study has found any effect of NSAIDs use on walk recovery. Quality of evidence was high for pain control, but low to very low for all the other studied outcomes.

CONCLUSIONS

The use of NSAIDs may be effective for pain control in the peri-operative period of HF surgery. However, safety data were conflicting with low levels of certainty. Further studies are needed to assess their benefit-risk balance in this context. The research protocol was previously registered on PROSPERO (registration number: CRD42021237649).

Implementation of clinical medication review in a geriatric ward to reduce potentially inappropriate prescriptions among older adults

PURPOSE

The impact of several pharmaceutical interventions to reduce the use of potentially inappropriate medications (PIMs) and potentially omitted medications (POMs) has been recently studied. We aimed to determine whether clinical medication review (CMR) (i.e. a systematic and patient-centred clinical assessment of all medicines currently taken by a patient) performed by a geriatrician and a pharmacist added to standard pharmaceutical care (SPC) (i.e. medication reconciliation and regular prescription review by the pharmacist) resulted in more appropriate prescribing compared to SPC among older inpatients.

METHODS

A retrospective observational single-centre study was conducted in a French geriatric ward. Six criteria for appropriate prescribing were chosen: the number of PIMs and POMs as defined by the STOPP/STARTv2 list, the total number of drugs prescribed, the number of administrations per day and the number of psychotropic and anticholinergic drugs. These criteria were compared between CMR and SPC group using linear and logistic regression models weighted on propensity scores.

RESULTS

There were 137 patients included, 66 in the CMR group and 71 in the SPC group. The mean age was 87 years, the sex ratio was 0.65, the mean number of drugs prescribed was 9, the mean MMSE was 21 and at admission 242 POMs, and 363 PIMs were prescribed. Clinical medication review did not reduce the number of PIMs at discharge compared to SPC (beta = - 0.13 [- 0.84; 0.57], p = 0.71) nor did it reduce the number of drugs prescribed (p = 0.10), the number of psychotropic drugs (p = 0.17) or the anticholinergic load (p = 0.87). Clinical medication review resulted in more POMs being prescribed than in standard pharmaceutical care (beta = - 0.39 [- 0.72; - 0.06], p = 0.02). Cardiology POMs were more implemented in the medication review group (p = 0.03).

CONCLUSION

Clinical medication review did not reduce the number of PIMs but helped clinicians introduce underused drugs, especially cardiovascular drugs, which are known to be associated with morbidity and mortality risk reduction.

Atrial fibrillation diagnosis by a systematic 14-day continuous ECG-Holter in patients with high cardiovascular risk and clinical palpitation: the prospective AFTER study

Background

Atrial Fibrillation (AF) is asymptomatic in 20–30% of cases. New technologic tools for continuous ECG monitoring have been developed to detect and potentially treat AF in specific population with high cardiovascular risk.

Purpose

We aimed to evaluate the prevalence and the management of AF diagnosed in patients with no previous documented AF but with a high cardiovascular risk and clinical palpitation undergoing systematic 14-day continuous ECG-Holter monitoring and associated characteristics.

Methods

Patients were prospectively enrolled from December 2019 to December 2021 in this multicentered study, sponsored by the French National College of Cardiology. Patients needed to meet the following criteria: CHA2DS2VASc score ≥3 in women >2 in men associated with clinical palpitation without previous documented arrhythmia, particularly AF. Exclusion criteria were: previous documented AF, participation to another study that could interfere with the current study, pregnancy, previous skin intolerance to ECG-Holter electrodes. Included patients underwent a 14-day monitoring Holter-ECG to detect cardiac arrhythmia, particularly AF. Patients' characteristics, type of arrythmias and management of detected AF were described.

Results

Among the 336 included patients, 39% were men, median age was 73 [64.5–78] years, 71.5% had hypertension and 46.5% had a previous history of stroke. AF was detected in 14% of patients, among which 23.4% in the first 24 hours monitoring. In univariate analyses, older age (p=0.045) was significantly associated with AF, and a trend was observed regarding male gender (p=0.067) and less antiplatelet therapy (p=0.058). Patients with diagnosed AF had a prescription of anticoagulation therapy in 90% of cases consisting in apixaban and rivaroxaban for 72% and 28% respectively. Antiarrhythmic drugs were administered in 90% of AF patients and 13% underwent AF ablation.

Conclusions

The systematic AF screening of selected patients based on CHA2DS2VASc score ≥3 in women >2 in men associated with palpitations allows to diagnose AF in 14% of the population with a 14-day continuous ECG-Holter. This strategy seems efficient as it induced the prescription of anticoagulation and antiarrhythmic therapy in 90% of individuals.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): NATIONAL COLLEGE OF FRENCH CARDIOLOGISTS

Atrial fibrillation detection with long-term continuous Holter ECG recording in patients with high cardiovascular risk and clinical palpitations: the prospective after study

AIM

New technologic tools for continuous ECG monitoring have been developed to detect and treat atrial fibrillation (AF) in specific populations with high cardiovascular risk. We evaluated the prevalence and the management of AF diagnosed in patients with high cardiovascular risk and non-documented clinical palpitation undergoing systematic 14-day continuous ECG-Holter monitoring.

METHODS

Patients were prospectively enrolled from December 2019 to December 2021 in this multicentre study, sponsored by the French National College of Cardiology. Patients met the following criteria: CHA₂DS₂VASc score ≥ 2 in males and ≥ 3 in females and clinical palpitations without previously documented arrhythmia. Enrolled patients underwent a continuous 14-day Holter-ECG monitoring for arrhythmia detection.

RESULTS

Among the 336 included patients, 39% were male, 75% were greater than 65 years of age and 46.5% had suffered a prior stroke. AF was detected in 14% of patients, among which 23.4% were detected in the first 24 h of monitoring. Finally, age ≥ 65 years (p = 0.037) was significantly associated with AF, as well as male gender (p = 0.023) and a lower rate of antiplatelet therapy (p = 0.018). Patients with diagnosed AF had a prescription of anticoagulation therapy in 90%. Antiarrhythmic drugs were administered in 90% of AF patients and 13% underwent AF ablation.

CONCLUSIONS

The systematic AF screening of patients with palpitations and high cardiovascular risk resulted in a diagnostic yield of AF in 14% of the population with a 14-day continuous ECG-Holter monitor. This strategy resulted in the prescription of anticoagulation and antiarrhythmic therapy in 90% of the AF detected population.

Older adults’ daily activities during lockdown in France, spring 2020: a cross sectional survey

Background

The 2020 COVID-19 pandemic prompted many countries to go into lockdown for varying periods. The French population was limited to 1km around their house, with the need to have a travel declaration when going out. According to the World Federation of Occupational Therapists (2020), “populations around the world have been required to adjust and make compensations to usual routines in order to participate in ongoing or newly acquired activities that are necessary for daily life.” AIMS. In this context, we aimed to describe changes in daily activities, social contacts, and mental health and wellbeing of older adults (i.e. aged 60 or more) living in France.

Methods

We performed an online cross-sectional survey, based on the Canadian Occupational Performance Measure (COPM) for restriction of and satisfaction with daily activities, and the Cantril's ladder for mental health and wellbeing. RESULTS. Of the 512 respondents, 9% did not feel restricted at all in their daily activities, and 13% reported no change. About one third (31%) reported to have less diverse activities than usual but to be satisfied with it. Regarding social contacts, 72% of the respondents reported to have a lot more contacts than usual with their relatives. Concerning the type of activities, 2477 restricted activities could be identified, but also 2190 that were done more often during the lockdown. Most restricted ones concerned leisure (83%), especially active leisure, the most mentioned being walking. The more engaged activities also concerned leisure (73%), especially quiet recreation, the most mentioned reading. The median value of Cantril's ladder was 5 [4;7].

Conclusions

Lockdown measures led to some activity restrictions for older adults, but also offered opportunities for new engagements. Remarkably was the increase in social contacts with relatives, probably related to the use of new technologies.

Framework Implementation of the INSPIRE ICOPE-CARE program in collaboration with the World Health Organization (WHO) in the Occitania region

Introduction: Limiting the number of dependent older people in coming years will be a major economic and human challenge. In response, the World Health Organization (WHO) has developed the «Integrated Care for Older People (ICOPE)» approach. The aim of the ICOPE program is to enable as many people as possible to age in good health. To reach this objective, the WHO proposes to follow the trajectory of an individual’s intrinsic capacity, which is the composite of all their physical and mental capacities and comprised of multiple domains including mobility, cognition, vitality / nutrition, psychological state, vision, hearing. Objective: The main objective of the INSPIRE ICOPE-CARE program is to implement, in clinical practice at a large scale, the WHO ICOPE program in the Occitania region, in France, to promote healthy aging and maintain the autonomy of seniors using digital medicine. Method: The target population is independent seniors aged 60 years and over. To follow this population, the 6 domains of intrinsic capacity are systematically monitored with pre-established tools proposed by WHO especially STEP 1 which has been adapted in digital form to make remote and large-scale monitoring possible. Two tools were developed: the ICOPE MONITOR, an application, and the BOTFRAIL, a conversational robot. Both are connected to the Gerontopole frailty database. STEP 1 is performed every 4-6 months by professionals or seniors themselves. If a deterioration in one or more domains of intrinsic capacity is identified, an alert is generated by an algorithm which allows health professionals to quickly intervene. The operational implementation of the INSPIRE ICOPE-CARE program in Occitania is done by the network of Territorial Teams of Aging and Prevention of Dependency (ETVPD) which have more than 2,200 members composed of professionals in the medical, medico-social and social sectors. Targeted actions have started to deploy the use of STEP 1 by healthcare professionals (physicians, nurses, pharmacists,…) or different institutions like French National old age insurance fund (CNAV), complementary pension funds (CEDIP), Departmental Council of Haute Garonne, etc. Perspective: The INSPIRE ICOPE-CARE program draws significantly on numeric tools, e-health and digital medicine to facilitate communication and coordination between professionals and seniors. It seeks to screen and monitor 200,000 older people in Occitania region within 3 to 5 years and promote preventive actions. The French Presidential Plan Grand Age aims to largely implement the WHO ICOPE program in France following the experience of the INSPIRE ICOPE-CARE program in Occitania.

How to Manage Frail Older Adults in the Community? Proposal of a Health Promotion Program Experienced in a City of 16,638 Inhabitants in France

BACKGROUND

Health promotion programs could prevent and delay frailty and functional decline. However, in practice, the planning and establishment of such a program is a challenge for health care providers. We report an experimental model of screening and management for frail elderly conducted in Cugnaux, city of 16,638 inhabitants in France, by the Toulouse Gerontopole and the social care service of the Cugnaux City Hall.

METHODS

A frailty screening self-administered questionnaire (FiND questionnaire) was sent to community-dwelling residents of 70 years old and over of Cugnaux. The completed questionnaires were analyzed and the subjects were classed into three groups: robust, frail, mobility disability, based on their score. Frail subjects and those with mobility disability invited to undergo a frailty assessment in the premises of the town hall realized by a nurse in order to identify the causes of their frailty and propose them a personalized intervention plan (PIP).

RESULTS

The FiND questionnaire was sent to the residents of Cugnaux of 70 years old and over (n=2,003). After two mailings, 860 (42.9%) completed questionnaires were received. Mean age of the responders was 79.0 ± 6.2 years and 59.6% women (n= 511). According to the questionnaires analysis, 393 (45.7%) were robust, 212 (24.6%) frail, 240 (27.9%) had a mobility disability and 15 (1.7%) could not be classified due to missing data. 589 (68.5%) subjects accepted to be contacted by the Gerontopole nurse. The assessment by the nurse was proposed to frail subjects and those with mobility disability (n=313). Until 31 December 2016, 136 patients have been evaluated. The mean age was 80.1±5.4 and most patients were women (69.9%). The mean ADL score was 5.8±0.5 and the IADL showed a mean score of 6.9±1.7. According to Fried definition of frailty, 76 patients (55.9%) were pre-frail, and 35 (25.7%) frail. Concerning the frailty domains identified, 75 patients (55.1%) showed the alteration of physical performance, 70 (51.5%) thymic disorders and 46 (33.8%) sensory disorders. Preventive interventions proposed in the PIP were mostly physical interventions (86.8%, n=118) followed by cognitive (61.8%, n=84) and nutritional (39.7%, n=54) interventions.

DISCUSSION

This project shows the feasibility to implement a care model in the community. It permitted a large identification of frail elderly people in the city population, insuring their assessment and clinical follow up to maintain their capacities and referring them to social services.

Anterior pituitary cell networks

Both endocrine and non-endocrine cells of the pituitary gland are organized into structural and functional networks which are formed during embryonic development but which may be modified throughout life. Structural mapping of the various endocrine cell types has highlighted the existence of distinct network motifs and relationships with the vasculature which may relate to temporal differences in their output. Functional characterization of the network activity of growth hormone and prolactin cells has revealed a role for cell organization in gene regulation, the plasticity of pituitary hormone output and remarkably the ability to memorize altered demand. As such, the description of these endocrine cell networks alters the concept of the pituitary from a gland which simply responds to external regulation to that of an oscillator which may memorize information and constantly adapt its coordinated networks' responses to the flow of hypothalamic inputs.

Reducing "iatrogenic disability" in the hospitalized frail elderly

BACKGROUND

Hospitalization is the first cause of functional decline in the elderly: 30 to 60% of elderly patients lose some independence in basic activities of daily living (ADL) during a stay in hospital. This loss of independence results from the acute condition that led to admission, but is also related to the mode of management.

OBJECTIVE

This paper is a review of the literature on functional decline in elderly hospitalized patients. It is the first stage in a project aiming to prevent dependence that is induced during the course of care.

METHODS

During a 2-day workshop in Monaco, a task force of 20 international experts discussed and defined the concept of "iatrogenic disability".

RESULTS

1- "Iatrogenic disability" was defined by the task force as the avoidable dependence which often occurs during the course of care. It involves three components that interact and have a cumulative effect: a) the patient's pre-existing frailty, b) the severity of the disorder that led to the patient's admission, and lastly c) the hospital structure and the process of care. 2- The prevention of "iatrogenic disability" involves successive stages. - becoming aware that hospitalization may induce dependence. Epidemiological studies have identified at-risk populations by the use of composite scores (HARP, ISAR, SHERPA, COMPRI, etc). - considering that functional decline is not a fatality. Quality references have already been defined. Interventions to prevent dependence in targeted populations have been set up: simple geriatric consultation teams, single-factor interventions (aimed for example at mobility, delirium, iatrogenic disorders) or multidomain interventions (such as GEM and ACE units, HELP, Fast Track, NICHE). These interventions are essentially centered on the patient's frailty and have limited results, as they take little account of the way the institution functions, which is not aimed at prevention of functional decline. The process of care reveals shortcomings: lack of geriatric knowledge, inadequate evaluation and management of functional status. The group suggests that interventions must not only identify at-risk patients so that they may benefit from specialized management, but they must also target the hospital structure and the process of care. This requires a graded "quality approach" and rethinking of the organization of the hospital around the elderly person.

Ligamentoplasty of the forearm interosseous membrane using the semitendinosus tendon: anatomical study and surgical procedure

Total longitudinal disruptions of the interosseous membrane can allow proximal radius migration and are seen in Essex-Lopresti lesions. We propose an original technique of ligamentoplasty using the semitendinosus tendon. The graft corresponds to the forearm rotation axis for an optimized isometry and longitudinal stabilization. Our ligamentoplasty technique was performed on ten fresh frozen right forearms. We successively assessed the innocuousness, efficiency and resistance of the ligamentoplasty. The ligamentoplasty induced neither passive limitation of pronation-supination nor neurovascular lesions. It prevented from radius proximal migration. The mean load to failure was 28 kg at both ulnar and radial sides of the graft. Our technique is original for the type and position of the graft. It seems safe, efficient and resistant enough for in vivo procedures. This technique decreases longitudinal loads on the radius. It should be indicated in patients with Essex-Lopresti syndrome, in association with radial head internal fixation or arthroplasty.

Comparison of the efficacy of a synthetic dog-appeasing pheromone with clomipramine for the treatment of separation-related disorders in dogs

Sixty-seven dogs that showed signs of distress when separated from their owners (destructiveness, excessive vocalisation and house soiling) and hyperattachment were used in a randomised, blind trial to assess the potential value of a dog-appeasing pheromone in reducing the unacceptable behaviours. For ethical reasons, there was no placebo group and the effects of the pheromone were compared with the effects of clomipramine which is regularly used to treat this type of problem. The undesirable behaviours decreased in both groups, but the overall assessment by the owners indicated that there was no significant difference between the two treatments, although there were fewer undesirable events in the dogs treated with the pheromone, and the administration of the pheromone appeared to be more convenient.

L’électrostimulation surimposée à la contraction musculaire volontaire présente-t-elle un intérêt physiologique chez les sujets âgés ?

OBJECTIVE

To analyze the physiological effects of electrical stimulation with voluntary muscle contraction exercise in postmenopausal women.

MATERIALS AND METHODS

Thirty-two females aged 62 to 75 years were randomly assigned to three groups to perform four activity sessions for six weeks: group ME (N =11) climbed up and down stairs, group ES (N =11) practised electrostimulation, and group ME + ES (N = 10) undertook both activities. Physiological adaptations of body composition (lean and fat masses and bone mineral density), muscular strength (isometric and dynamic), vertical jump and posturokinetic activities (balance and gait) were analysed.

RESULTS

For the three groups, the isometric strength at angle 100 degrees (average increase right and left legs, ME: 19 N.m; ES: 4.5 N.m; ME + ES: 11.5 N.m), the dynamic strength at speed 60 degrees.s(-1) (average increase right and left leg, ME: 15 N.m; ES: 14 N.m; ME+ES: 18.5 N.m) and the vertical jump (ME: 23 mm; ES: 16 mm; ME + ES: 34 mm) increased contrary in the body composition and posturokinetic activities. Nevertheless, the group ME + ES adapted differently on some parameters of bone mineral density (P < 0.05) and dynamic strength (P < 0.01) in relation to the groups ES and ME.

CONCLUSION

Electrostimulation with voluntary muscle contraction exercise could induce different physiologic adaptations compared with electrostimulation or voluntary muscle contraction exercise alone.

Effects of brisk walking on static and dynamic balance, locomotion, body composition, and aerobic capacity in ageing healthy active men

This work analyses the short-term physiological and neurophysiological effects of a brisk walking programme in ageing, healthy, active men. Twenty-one men 63 to 72 years of age were recruited and separated into 2 groups. One group performed a walking programme (WP) (n = 11) and another served as control (C) group (n = 10). The walking programme lasted for twelve weeks and included five sessions per week. Several parameters were assessed before and after the programme for the WP group. The same tests were performed (separated by twelve weeks) in group C. During each assessment, the subjects were put through static and dynamic balance tests, spatio-temporal gait analysis, body composition measurements and determination of aerobic capacity and bone mineral density. The statistic analysis showed a significant improvement in dynamic balance performance, especially in lateral sway when the subjects kept their eyes open, an increase of VO(2) max and loss of fat mass in the WP group. However, no alterations appeared in spatiotemporal gait characteristics, static balance performance, lean mass or bone mineral density (total body and hip). According to these results, this walking programme may have positive effects on preventing ageing subjects from falling.

Neuromuscular effects of three training methods in ageing women

AIM

The present study aimed to compare the effects of 3 strength development methods on muscular mass and muscular strength in healthy ageing women.

METHODS

Thirty-two healthy women, 62 to 75 years old were randomised into 3 groups. The 3 groups performed 4 sessions a week of strength development for 6 weeks. The 1(st) group (SC) climbed up and down 300 stairs per session. The 2(nd) group (ES) followed an electrostimulation programme on the quadriceps muscles. The 3(rd) group (SC+ES) combined stair climbing with electrostimulation. Before and after the 3 programmes, the muscular mass of the leg was assessed using a biphotonic absorptiometry machine. Isometric (angle 20 degrees and 100 degrees ) and isokinetic (60 degrees /s and 240 degrees /s) knee extension torque was measured using an isokinetic dynamometer.

RESULTS

None of the programmes changed the muscular mass. All 3 groups increased isometric (angle 20 degrees, p<0.001; angle 100 degrees, p<0.003) and isokinetic (60 degrees /s, p<0.0001; 240 degrees /s, p<0.0001) knee extension torque. None of the programmes appeared more efficient than the others for muscular mass or muscular strength.

CONCLUSION

Six weeks of activity (SC, ES or SC+ES) improved the isometric and dynamic muscular strength in ageing healthy women. However, this period was too short to change the muscular mass. None of the activities presented a real advantage over the others in ageing women.

Comparison between three strength development methods on body composition in healthy elderly women

The effects of three strength development methods (during 6 weeks) were assessed on the body composition in 32 women, 62 to 75 years old and randomised in 3 groups. The first group (SC) has climbed and come down 300 stairs per session. The second group (ES) followed an electrostimulation programme on quadriceps muscles. The third group (SC+ES) has combined the stairs climbing with electrostimulation. Body composition and bone mineral density (BMD) was assessed using Absorptiometry machine before and after the programmes. None of the programmes has increased significantly BMD. Nevertheless, the SC+ES group BMD enhanced more on the trochanter (p<0,05) and the two legs (p<0,05) than the SC and ES groups BMD (interaction group/time). The combined activity (SC+ES) would deserve to be tested on a longer period.

Cholesterol reduction and increased cardiovascular fitness following a 12 weeks brisk walking

The effects of a walking training programme were assesed on 10 healthy, active men aged 63-69 years. Serum lipids, pulse and blood pressure, maximum oxygen consumption (VO2 max) and anthropometric parameters, were measured before and after this programme. There was a significant fall in LDL (p<0.02) and mean diastolic BP (p<0.005). In spite of the subjects's initial good level of fitness there was still an 8% rise in the mean VO2 max of the group. There was also a significant loss of body fat (P<0.01). These positive physiological effects suggest that brisk walking can be considered as a a useful activity for improving the fitness and general health in this age-range.

Are there differences in postural regulation according to the level of competition in judoists?

The aim of this work was to study the posturokinetic capacities and use of visual information by judoists according to their level of competition. Twenty male judoists aged between 16 and 19 took part. They were separated into two groups: those that competed at regional level and those that competed at national and international level. Static balance was measured on a force platform. No difference was seen between the two groups. However, it seems that visual information is more important to the higher level judoists. Perhaps the level of competition influences the sensory canals involved in balance.

Feasibility [corrected] of regular physical exercise for patients with moderate to severe Alzheimer disease

BACKGROUND

Physical activity delays loss of autonomy in the elderly. In patients with Alzheimer disease (AD), physical activity could be a useful strategy in therapeutic management by delaying loss of functional independence and the usual complications of the disease.

OBJECTIVE

To determine, using standardized tools, the effects on autonomy (ADL, IADL), cognitive function (MMS), nutritional status (MNA), behavioral problems (NPI) and risk of falls (Tinetti test) of a physical exercise program in patients with AD.

DESIGN

Twenty-three subjects (13 men and 10 women, aged 71-92 years, mean 78 years) with AD (mean MMS 16, range 1-23) carried out for a mean of 7 weeks (5-12 weeks) a program of endurance exercise (walking, exercise bicycle) adapted to their individual capacities. Standardized gerontological evaluation was performed before and after the study.

RESULTS

No significant change in autonomy (ADL, IADL) was observed. There was an improvement in the MNA (p<0.001) and the MMS (p<0.001). Risk of falls (p<0.01) and behavioral problems (p<0.05) decreased. These results were obtained without increasing family workload.

CONCLUSION

We suggest that physical activity is a therapeutic option which can reduce nutritional and behavioral complications and risk of falls in subjects with AD.

[Falls, frailty and osteoporosis in the elderly: a public health problem]

INTRODUCTION

Elderly people can be subdivided into three groups: healthy elderly persons (65-70% of the population), elderly subjects with diseases (about 5%) and frail old people. Frailty represents "age-related physiologic vulnerability resulting from impaired homeotasic stock and a reduced capacity of the organism to withstand stress". It could lead elderly subjects to pathological, barely reversible, ageing.

CURRENT KNOWLEDGE AND KEY POINTS

One of the main objective of geriatricians is to develop useful screening tools to identify people at high risk, thus allowing them to benefit from preventive interventions as early as possible. It has been suggested that the decline in homeostatic stock involves numerous physiological systems. Those at the core of frailty would be neuromuscular changes resulting in sarcopenia, neuroendocrine dysregulation, and immune disorders. A recent study has shown that increased levels of interleukin 6 is a risk factor for frailty.

FUTURE PROSPECTS AND PROJECTS

Work in progress aimed at identification of at-risk patients should: lead to early detection; draw attention on underestimated fields such as the nutritional status, sarcopenia, or gait disorders; promote the development of the standardized gerontological evaluation in order to identify the different components of frailty; and promote the development of non-pharmacological programmes including physical training, nutritional managing, and optimal social life.

Functional characterization of the secondary actin binding site of myosin II

The role of the interaction between actin and the secondary actin binding site of myosin (segment 565-579 of rabbit skeletal muscle myosin, referred to as loop 3 in this work) has been studied with proteolytically generated smooth and skeletal muscle myosin subfragment 1 and recombinant Dictyostelium discoideum myosin II motor domain constructs. Carbodiimide-induced cross-linking between filamentous actin and myosin loop 3 took place only with the motor domain of skeletal muscle myosin and not with those of smooth muscle or D. discoideum myosin II. Chimeric constructs of the D. discoideum myosin motor domain containing loop 3 of either human skeletal muscle or nonmuscle myosin were generated. Significant actin cross-linking to the loop 3 region was obtained only with the skeletal muscle chimera both in the rigor and in the weak binding states, i.e., in the absence and in the presence of ATP analogues. Thrombin degradation of the cross-linked products was used to confirm the cross-linking site of myosin loop 3 within the actin segment 1-28. The skeletal muscle and nonmuscle myosin chimera showed a 4-6-fold increase in their actin dissociation constant, due to a significant increase in the rate for actin dissociation (k(-)(A)) with no significant change in the rate for actin binding (k(+A)). The actin-activated ATPase activity was not affected by the substitutions in the chimeric constructs. These results suggest that actin interaction with the secondary actin binding site of myosin is specific for the loop 3 sequence of striated muscle myosin isoforms but is apparently not essential either for the formation of a high affinity actin-myosin interface or for the modulation of actomyosin ATPase activity.

[Prevalence of hepatitis C virus in oral erosive lichen]

OBJECTIVE

An increased prevalence of hepatitis C virus (HCV)-related hepatitis has been reported in patients with lichen planus. The aim of our retrospective study was to determine whether there is a relationship between the erosive form of oral lichen planus and HCV.

PATIENTS AND METHODS

A retrospective study was conducted in a consecutive sample of 28 patients suffering from oral erosive lichen planus and seen in our department between 1992 and 1996. Anti-HCV antibodies were detected in all cases by third generation recombinant immunoblot assay. PCR was performed to detect HCV RNA in the serum sample from 19 patients.

RESULTS

Eight patients (29 p. 100) tested positive for HCV antibodies. These results were compared with the rate of HCV chronic carriers which is between 1 and 2 p. 100 in our region (Southern France). Among these 8 patients, 7 had severe chronic liver disease, and 5 of them were actively replicating the virus.

DISCUSSION

Our results suggest a strong relationship between erosive oral lichen planus and HCV-related chronic hepatitis. We conclude that patients with the erosive form of oral lichen planus should be systematically evaluated for HCV infection.

[Dietary intake recommended for elderly persons]

Recommendations for dietary intake in elderly persons must account for wide interindividual variation. We propose different recommendations for: generally self sufficient elderly persons in good health. The recommended dietary intakes are very similar to those for adults, with a few exceptions (reduced calorie intake, the importance of protein and certain vitamins or minerals: vitamins B6, D, C, calcium, zinc ...); patients with an intercurrent disease or an event causing a loss of appetite and a reduction in dietary intake. Recommendations for these subjects should aim at correcting or preventing deficiencies by the use of supplementary and complementary nutritional products; subjects in a state of protein-calorie malnutrition. Recommended dietary intake should take into account the effect of malnutrition on the digestive functions of the pancreas and the intestine in the elderly. Such recommendations must be based on the findings of numerous studies now being carried out and of which we report here the first results.

Relationship between malnutrition and falls in the elderly

Due to the multifactorial nature of falls in the elderly population, it is difficult to determine causal relationships for risk factors for falls. In some cases, other risk factors may play a role. For example, the association between poor nutrition status and falls has not been studied extensively. The association of commonly demonstrated nutritional deficiencies in the elderly with factors such as balance, gait, and mobility may lead to new insights into causes of falls in the elderly not previously established. In this article, we review how malnutrition can be a risk factor for falls, how falls can induce malnutrition, and the possible relationship between mobility and nutrition in the elderly.

Thyroid function tests in ageing and their relation to associated nonthyroidal disease

Thyroid function tests of 179 euthyroid geriatric inpatients (83 +/- 6 yr) unaffected by acute diseases or malnutrition were investigated and compared with those of 76 ambulatory healthy younger subjects (42 +/- 13 yr). Elderly population was divided in three groups, respectively: group G I (n = 37, 65-78 yr), group G II (n = 64, 79-85 yr) and group G III (n = 78, over 85 yr). Severity-of-illness index of the patients was evaluated at entry in the study protocol. While total thyroxine (TT4), free triiodothyronine (FT3) and TSH levels remained unchanged, circulating total triiodothyronine (TT3) was significantly lower (113 +/- 32 vs 150 +/- 31 ng/dl, p less than 0.05) and free thyroxine (FT4) was significantly higher (12.4 +/- 2.7 vs 10.3 +/- 2.3 pg/ml, p less than 0.05) in aged people. Furthermore, TT3 decreased significantly from 130 +/- 36 in G I to 110 +/- 33 in G II and to 108 +/- 25 in G III (p less than 0.01), and FT4 increased progressively although not significantly in the same groups. A close correlation was found between TT3 and severity index in male observations only (r = -0.43, p less than 0.01), as well as between FT4 and severity index in both sexes (r = 0.51, p less than 0.001 for men, r = 0.21, p less than 0.01 for women). These data suggest that thyroid function tests have to be cautiously interpreted in a geriatric population, particularly in relation to the severity of the clinical state, and reference values should be determined for TT3 and FT4 in the ageing process.