Migration study of phthalates from non-food plastic containers used in food preservation

Phthalate acid esters (PAE) are used as additives in the formulation of plastics, to increase their flexibility and transparency. They can migrate from plastic packaging to food, then cause endocrine disruption in consumers. This migration depends on the conditions of use defined for each plastic. Non-food plastics are likely to release more PAE than food-grade plastics. In Cameroon, non-food grade plastics such as old paint buckets are used by people to preserve liquid food. The present work aimed at studying the conditions and mechanism of migration of total PAE from paint buckets to pap. For this purpose, the effects of seven factors were determined through Plackett-Burman experimental design. The interactions of the most influential factors were determined through a full factorial design. The conditions of the migration of total PAE were obtained via face-centered composite design. Then experimental results of migration kinetics were modelled according to equations of pseudo-first order, pseudo-second order and intra-particle diffusion. The results revealed that the most influential factors were pH, temperature and contact time. The effects of these factors are non-linear, and their interactions have to be considered. When pap is preserved in paint buckets according to the conditions: temperature of pap >70 °C, pH of pap ≤4 or ≥10 and contact time > 2 h, as is the case in donut shops in Cameroon, the amount of total PAE released is greater than 50 μg/L. Migration of total PAE from paint buckets to pap is best described by the pseudo-second order model.

Identification of early symptoms of endometriosis through the analysis of online social networks: A social media study

Objective

Endometriosis is a complex full-body inflammation disease with an average time to diagnosis of 7-10 years. Social networks give opportunity to patient to openly discuss about their condition, share experiences, and seek advice. Thus, data from social media may provide insightful data about patient's experience. This study aimed at applying a text-mining approach to online social networks in order to identify early signs associated with endometriosis.

Methods

An automated exploration technique of online forums was performed to extract posts. After a cleaning step of the built corpus, we retrieved all symptoms evoked by women, and connected them to the MedDRA dictionary. Then, temporal markers allowed targeting only the earliest symptoms. The latter were those evoked near a marker of precocity. A co-occurrence approach was further applied to better account for the context of evocations.

Results

Results were visualised using the graph-oriented database Neo4j. We collected 7148 discussions threads and 78,905 posts from 10 French forums. We extracted 41 groups of contextualised symptoms, including 20 groups of early symptoms associated with endometriosis. Among these groups of early symptoms, 13 were found to portray already known signs of endometriosis. The remaining 7 clusters of early symptoms were limb oedema, muscle pain, neuralgia, haematuria, vaginal itching, altered general condition (i.e. dizziness, fatigue, nausea) and hot flush.

Conclusion

We pointed out some additional symptoms of endometriosis qualified as early symptoms, which can serve as a screening tool for prevention and/or treatment purpose. The present findings offer an opportunity for further exploration of early biological processes triggering this disease.

Exploration of the core protein network under endometriosis symptomatology using a computational approach

BACKGROUND

Endometriosis is defined by implantation and invasive growth of endometrial tissue in extra-uterine locations causing heterogeneous symptoms, and a unique clinical picture for each patient. Understanding the complex biological mechanisms underlying these symptoms and the protein networks involved may be useful for early diagnosis and identification of pharmacological targets.

METHODS

In the present study, we combined three approaches (i) a text-mining analysis to perform a systematic search of proteins over existing literature, (ii) a functional enrichment analysis to identify the biological pathways in which proteins are most involved, and (iii) a protein-protein interaction (PPI) network to identify which proteins modulate the most strongly the symptomatology of endometriosis.

RESULTS

Two hundred seventy-eight proteins associated with endometriosis symptomatology in the scientific literature were extracted. Thirty-five proteins were selected according to degree and betweenness scores criteria. The most enriched biological pathways associated with these symptoms were (i) Interleukin-4 and Interleukin-13 signaling (p = 1.11 x 10^-16), (ii) Signaling by Interleukins (p = 1.11 x 10^-16), (iii) Cytokine signaling in Immune system (p = 1.11 x 10^-16), and (iv) Interleukin-10 signaling (p = 5.66 x 10^-15).

CONCLUSION

Our study identified some key proteins with the ability to modulate endometriosis symptomatology. Our findings indicate that both pro- and anti-inflammatory biological pathways may play important roles in the symptomatology of endometriosis. This approach represents a genuine systemic method that may complement traditional experimental studies. The current data can be used to identify promising biomarkers for early diagnosis and potential therapeutic targets.

Time-dependent blood eosinophilia count increases the risk of kidney allograft rejection

Background

Growing evidence suggest that type 2 immune effectors play a role in solid organ transplantation. The aim of this study was to evaluate the impact of blood count eosinophils (BCEo) on immunological outcomes in kidney transplant recipients with stable graft function after 3 months post-transplant.

Method

We performed cause-specific Cox model considering BCEo, the use of calcineurin inhibitors and systemic corticoids as time-dependent explicative variables on a prospective cohort of 1013 kidney transplant patients who experienced kidney allograft rejection and/or the appearance of de novo donor specific antibodies after excluding common causes of increased BCEo..

Findings

BCEo ≥ 0.3 G/L was associated with a 3-fold increased risk of rejection independent of immunosuppressive regimen after 3 months post-transplant in patients without pre-transplant DSAs and with CNI-based immunosuppression. No association between BCEo either with donor specific antibodies or graft survival was noticed.

Interpretation

These observations in this large cohort support the hypothesis of eosinophils in allo-immunity in human and claim for further mechanistic research.

Funding

This study was supported by the French National Research Agency, The “Institut de Recherche en Santé Respiratoire des Pays de la Loire” and the University hospital of Nantes.

Nasal chemosensory tests: biomarker between dementia with Lewy bodies and Parkinson disease dementia

BACKGROUND

Dementia with Lewy bodies (DLB) and Parkinson disease dementia (PDD) are progressive and disabling neurodegenerative disorders, which are often misdiagnosed due to theirs overlapping clinical and paraclinical features. Nevertheless, their adequate management requires an accurate differential diagnosis. The main aim of this study was to investigate the usefulness of olfactory and trigeminal nasal testing for the differential diagnosis between DLB and PDD.

METHODS

Odor thresholds to three odorants differentially activating the olfactory and trigeminal systems were assessed in patients with DLB, PDD and healthy controls (n = 20 per group).

RESULTS

Odor thresholds were significantly different between the three groups of subjects. More precisely, we found that DLB patients had significantly lower detection threshold performances compared to PDD patients. Moreover, using a standard canonical discriminant analysis, we confirmed a plain differentiation between the three groups.

CONCLUSIONS

The current study highlights that DLB patients have very poor olfactory and trigeminal detection threshold performances, which are significantly lower, compared to PDD patients. These results suggest that olfactory testing, using odorants that stimulate both the olfactory and trigeminal systems, could constitute an interesting biomarker and contribute to the differential diagnosis of PDD and DLB patients. Further researches, notably on olfacto-trigeminal interactions, are warranted in these populations to support our findings.

Incidence of lung cancer in males and females in Algeria: The lung cancer registry in Algeria (LuCaReAl)

BACKGROUND

Lung cancer is a major cause of death worldwide. However, few data on incidence, histologic types and mortality rates of lung cancer were available for Algeria.

METHODS

LuCaReAl is an ongoing descriptive, non-interventional, national, multicenter, prospective and longitudinal study conducted in Algeria, among oncologists and pulmonologists in public community and university hospitals. Median and interquartile ranges are displayed.

RESULTS

Between July 2016 and July 2017, 897 patients were included. Overall incidence of lung cancer was 3.4 [3.2;3.6] cases per 100,000 inhabitants; overall incidence by sex was 5.8 [5.4;6.2] for males and 1.0 [0.8;1.1] for females. Adenocarcinoma was the most common histologic type of cancer. Most tumors were diagnosed at Stage IV.

CONCLUSION

The first results from the LuCaReAl study in Algeria showed that most patients are diagnosed with lung cancer at an advanced stage. The ongoing follow-up will next provide data on the survival and mortality rates.

Neonatal management of aortic coarctation with ventricular septal defect: a systematic review and meta-analysis

INTRODUCTION

Neonatal management of aortic coarctation with ventricular septal defect is still under debate between the one-stage full repair by sternotomy versus the staged repair of the coarctation first by thoracotomy (with or without banding the pulmonary artery) followed later by subsequent closure of the ventricular septal defect.

EVIDENCE ACQUISITION

The aim of this review was to synthesize the evidence in literature since 1980 for the neonatal population. A meta-analysis compared mortality between the two strategies.

EVIDENCE SYNTHESIS

The analysis did not find a superiority of a strategy over the other regardless of the surgical era studied. Recoarctation rates of both strategies are presented and a management algorithm is suggested.

CONCLUSIONS

Instead of comparing between the two strategies, a case-adapted management considering the anatomy of the ventricular septal defect and of the aortic arch is discussed to address this association of lesions though presenting with a wide range of settings.

Appropriateness of Therapeutic Antibiotic Prescriptions by Lebanese Dentists in the Management of Acute Endodontic Abscesses

The misuse of antibiotics in dentistry is a serious concern especially in regards to the emergence of antibiotic resistance. The objective of the study was to evaluate the appropriateness of antibiotics prescriptions by Lebanese dentists to patients with endodontic abscesses and their compliance with the guidelines of the American Association of Endodontists (AAE) and the European Society of Endodontology (ESE). The treating dentists recorded clinical information from 127 patients diagnosed with acute or chronic endodontic abscess. The information also included the type of antibiotic prescribed, dosage, and duration of the prescription. Prescriptions were not given to 14/20 patients with an acute endodontic abscess despite the presence of an indication to prescribe. All the prescriptions given to patients with an acute endodontic abscess were inappropriate according to the ESE and AAE guidelines. Antibiotics were also prescribed unnecessarily to 17/42 patients with a chronic endodontic abscess. This study concluded that antibiotics prescriptions by Lebanese dentists for the management of endodontic abscesses were inappropriate. Penicillin V potassium (VK) was not available in Lebanon when the study was conducted. Only broad-spectrum antibiotics were prescribed. This finding raises concerns about the emergence of antibiotic resistance.

[Experimentation of targeted cardio-neurovascular risk screening in pharmacies]

OBJECTIVES

Pharmacists' involvement in the screening of cardio-neurovascular diseases could enhance the prevention of cardio-neurovascular risk factors. This research-action assesses the pertinence of targeted screening for cardio-neurovascular risk in pharmacies.

METHODS

This study was carried out within Lens-Hénin over the course of four months. The model included: the tracking of patients, excluding those with known cardio-neurovascular disease, with risk factors according to their age, sex, weight, family history of cardio-neurovascular diseases, smoking status; Screening for cardio-neurovascular risk with blood pressure measuring, blood total cholesterol, HDL cholesterol and the glycaemia by capillary blood sampling as well as the abdominal perimeter and the BMI. Patients were oriented according to results of screening.

RESULTS

471 patients were screened, 218 (46%) had at least two risks, 236 (50%) had a cholesterol value greater than or equal 2 g/L, 176 (37.4%) had a blood pressure greater than or equal to limit value l, 104 (22%) patients had a BMI value greater than or equal to 30 kg/m2, 217 (46%) had an abdominal perimeter value greater than or equal to limit value and 17 (5.3%) patients had impaired fasting blood glucose. 373 (79%) patients were moved toward their general practitioner and at least 68 (18%) consulted.

CONCLUSION

This research-action of targeted screening for cardiovascular risk in pharmacies proves to be relevant. The reproduction of a similar study in other territories is under consideration.

Parkinson disease in eldery patients: lessons from odour detection thresholds on olfacto-trigeminal interaction

BACKGROUND

Human nasal chemosensation is mediated by two separate, though interacting sensory pathways: the trigeminal and olfactory systems. Trigeminal sensitivity and olfacto-trigeminal interactions have not yet been well studied in idiopathic Parkinsons disease (IPD).

OBJECTIVES

The aim of this study was to assess odour detection thresholds in elderly IPD patients, and compare them to the odour detection thresholds of healthy controls. Finally, we investigated potential interactions between trigeminal and olfactory sensitivity.

METHODS

89 IPD patients aged over 65 and 89 matched healthy participants were enrolled in the study. Odour detection thresholds to 3 stimuli differentially activating olfactory and trigeminal afferents (Phenyl-ethyl alcohol, n-Butanol and Pyridine) were assessed, using an ascending staircase, binary forced-choice procedure.

RESULTS AND CONCLUSION

Detection threshold scores were able to discriminate between elderly IPD and controls. Pyridine was less effective than the two other odorants, suggesting that trigeminal pathway is less impaired than the olfactory system. We found that the detection thresholds were significantly different between IPD patients with good autonomy, and patients with impaired autonomy.

Prophylactic and Therapeutic Antibiotic Patterns of Lebanese Dentists for the Management of Dentoalveolar Abscesses

INTRODUCTION

General dentists issue approximately 10% of antibiotic prescriptions across the global medical community consummation. The use of antibiotics for the management of dentoalveolar infections should be considered only in the presence of an increased risk of a systemic involvement or to prevent metastatic infections. This study aimed to investigate the prophylactic and therapeutic antibiotic prescription patterns of Lebanese dentists for the management of dentoalveolar abscesses. The aim was to evaluate the influence of the patients' medical condition and clinical signs data on the patterns of antibiotics prescription.

MATERIALS AND METHODS

Only patients with a dentoalveolar abscess were included in the study. Age, medical history, reason for consultation, clinical signs and symptoms, diagnosis, type of local treatment, and type of antibiotherapy were collected for each patient attending dental clinics in Beirut. The data were analyzed with chi-square test and multivariate regression.

RESULTS

Out of the 563 initial patients, 127 were selected for the study and received a local treatment. The patient's medical condition and age did not affect the decision to prescribe antibiotics 36.2% patients with pain and 11.8% patients with swelling were prescribed antibiotics. Pain and swelling contributed to a higher level of antibiotic prescription compared to other signs and symptoms. Antibiotics were prescribed inappropriately to 51.76 and 38.10% among patients with an acute or chronic dentoalveolar abscess respectively. The main prescribed antibiotic was amoxicillin.

CONCLUSION

This study showed that dentists often did not follow the current prophylactic and therapeutic antibiotic prescription guidelines.

CLINICAL SIGNIFICANCE

Antibiotics prescriptions in dentistry will be more pertinent, leading to a decrease in inadequacy of prescriptions, microbial resistance, and the development of multiresistant germs against antibiotics.

Body mass index and childhood obesity classification systems: A comparison of the French, International Obesity Task Force (IOTF) and World Health Organization (WHO) references

AIM

This study aims to compare three body mass index (BMI)-based classification systems of childhood obesity: the French, the International Obesity Task Force (IOTF) and the World Health Organization (WHO) references.

METHODS

The study involved 1382 schoolchildren, recruited from the Lille Academic District in France in May 2009 aged 8.4±1.7 years (4.0-12.0 years). Their mean height and body mass were 131.5±10.9cm and 30.7±9.2kg, respectively, resulting in a BMI of 17.4±3.2kg/m(2). The weight status was defined according to the three systems considered in this study. The agreement between these references was tested using the Cohen's kappa coefficient.

RESULTS

The prevalence of overweight was higher with the WHO references (20.0%) in comparison with the French references (13.8%; P<0.0001) and the IOTF (16.2%; P≤0.01). A similar result was found with obesity (WHO: 11.6% vs. IOTF: 6.7%; or French references: 6.7%; P<0.0001). Agreement between the three references ranged from "moderate" to "perfect" (0.43≤κ≤1.00; P<0.0001). Kappa coefficients were higher when the three references were used to classify children as obese (0.63≤κ≤1.00; P<0.0001) as compared to classification in the overweight (obesity excluded) category (0.43≤κ≤0.94; P<0.0001). When sex and age categories (4-6 years vs. 7-12 years) were considered to define the overweight status, the lowest kappa coefficient was found between the French and WHO references in boys aged 7-12 years (κ=0.28; P<0.0001), and the highest one in girls aged 7-12 years between the French references and IOTF (κ=0.97; P<0.0001). As for obesity, agreement between the three references ranged from 0.60 to 1.00 (P<0.0001), with the lowest values obtained in the comparison of the WHO references against French references or IOTF among boys aged 7-12 years (κ=0.60; P<0.0001).

CONCLUSION

Overall, the WHO references yield an overestimation in overweight and/or obesity within this sample of schoolchildren as compared to the French references and the IOTF. The magnitude of agreement coefficients between the three references depends on of both sex and age categories. The French references seem to be in rather close agreement with the IOTF in defining overweight, especially in 7-12-year-old children.

Does biological maturity actually confound gender-related differences in physical activity in preadolescence?

AIM

To examine: (i) if maturity-related gender differences in moderate-to-vigorous physical activity (MVPA) depend on how maturity status is defined and measured; and (ii) the influence of maturity level on compliance with PA recommendations.

METHODS

The study involved 253 children (139 boys) aged 9.9 ± 0.9 years, with mean stature and weight of 1.39 ± 0.08 m and 35.8 ± 8.8 kg respectively. Their PA was evaluated using an Actigraph accelerometer (Model 7164). Maturity was assessed using the estimated age at peak height velocity (APHV) and a standardized APHV by gender (i.e. centred APHV).

RESULTS

Boys engaged in significantly more MVPA than girls (P < 0.0001). There was a significant correlation between the centred APHV and MVPA in boys (r = 0.20; P = 0.016), but not in girls (r = 0.13; P = 0.155). An ancova controlling for the estimated APHV showed no significant interactions between gender and APHV, and the main effect of gender on MVPA was negated. Conversely, there was a significant main effect of APHV on MVPA (F 1,249 = 6.12; P = 0.014; η p (2) = 0.024). Only 9.1% of children met the PA recommendations, including 14.4% of boys and 2.6% of girls (P < 0.01). This observation also applies in both pre-APHV (12.7% of boys vs. 2.4% of girls, P < 0.001) and post-APHV children (23.8% of boys vs. 3.4% of girls, P < 0.0001). No differences in PA guidelines were observed between pre-APHV and post-APHV children.

CONCLUSIONS

Among prepubescent children, the influence of biological maturity on gender differences in PA may be a function of how maturity status is determined. The most physically active prepubescent children were those who were on time according to APHV.

Optimizing the taste-masked formulation of acetaminophen using sodium caseinate and lecithin by experimental design

In a previous study of ours, the association of sodium caseinate and lecithin was demonstrated to be promising for masking the bitterness of acetaminophen via drug encapsulation. The encapsulating mechanisms were suggested to be based on the segregation of multicomponent droplets occurring during spray-drying. The spray-dried particles delayed the drug release within the mouth during the early time upon administration and hence masked the bitterness. Indeed, taste-masking is achieved if, within the frame of 1-2 min, drug substance is either not released or the released amount is below the human threshold for identifying its bad taste. The aim of this work was (i) to evaluate the effect of various processing and formulation parameters on the taste-masking efficiency and (ii) to determine the optimal formulation for optimal taste-masking effect. Four investigated input variables included inlet temperature (X1), spray flow (X2), sodium caseinate amount (X3) and lecithin amount (X4). The percentage of drug release amount during the first 2 min was considered as the response variable (Y). A 2(4)-full factorial design was applied and allowed screening for the most influential variables i.e. sodium caseinate amount and lecithin amount. Optimizing these two variables was therefore conducted by a simplex approach. The SEM and DSC results of spray-dried powder prepared under optimal conditions showed that drug seemed to be well encapsulated. The drug release during the first 2 min significantly decreased, 7-fold less than the unmasked drug particles. Therefore, the optimal formulation that performed the best taste-masking effect was successfully achieved.

A functional conditional symmetry test for a GARCH-SM model: Power asymptotic properties

In this paper we consider the empirical process of the errors appearing in a generalized autoregressive conditional heteroskedastic with stochastic mean (GARCH-SM) model. Various functional tests of conditional symmetry can be built on the basis of the limiting distribution of this process. In particular, a Cramér–von Mises-type test is considered. Its theoretical power is studied under fixed and local alternatives. Using the Karhunen–Loève decomposition, the limiting law of the latter is approximated by a chi-square distribution under both null and alternative hypotheses. The local power under a sequence of alternatives is also computed.

Enzymatically degraded Eurylon 6 HP-PG: ethylcellulose film coatings for colon targeting in inflammatory bowel disease patients

Objectives

Film coatings based on blends of Eurylon 6 HP-PG (a hydroxypropylated and pregelatinized high amylose starch) and ethylcellulose were to be evaluated as promising coating materials for site-specific drug delivery to the colon of patients suffering from inflammatory bowel diseases.

Methods

Pellet starter cores containing 60% 5-aminosalicylic acid were prepared by extrusion/spheronization and coated with different Eurylon 6 HP-PG : ethylcellulose blends at various coating levels. Drug release was measured in media simulating the contents of the upper gastrointestinal tract (in the presence and absence of enzymes) as well as in media simulating the contents of the colon.

Key findings

5-Aminosalicylic acid release could effectively be suppressed in 0.1 N HCl and phosphate buffer pH 6.8, optionally containing pepsin or pancreatin, but occurred as soon as the pellets came into contact with culture medium inoculated with faecal samples from inflammatory bowel disease patients. This can be attributed to the partial degradation of the starch derivative by enzymes secreted by bacteria present in the colon of these patients.

Conclusions

The presented drug delivery system is adapted to the pathophysiological conditions in inflammatory bowel disease patients. Furthermore, drug release remained unaltered upon 1 year open storage.

[An alternative method to describe an "obesogenic" environment for children: Relevance of a multiple correspondence analysis (MCA) (corrected)]

The purpose of this study was to describe an "obesogenic" environment for a group of schoolchildren using a multiple correspondence analysis (MCA) as an alternative approach to traditional methodological choices. MCA is applicable even for small samples. Ninety-one children (39 girls and 52 boys) aged 10.0 +/- 0.9 years were randomly recruited from two French public schools. Data on their family context, parental involvement, television time and their eating habits were obtained through questionnaires. Their level of physical activity and sedentary time were assessed using an accelerometer (MTI Actigraph model 7164) for three days, including a holiday. The data were processed using an MCA together with a technique for estimating relative risks (RRs) of overweight/obesity according to the distribution of children in the factorial plane produced by the MCA. The "obesogenic" factors appeared as four possible combinations between family environments and various behaviours with regard to physical activity, sedentary behaviour and diet. The RR of overweight/obesity was 2.64 [1.52, 4.57] (P < 0.0001) for a combined association of a "disadvantaged" family environment + low physical activity and high fat diet. The RR of overweight/obesity was 0.36 [0.14, 0.94] (P < 0.05) for an association of a "privileged" family environment + high physical activity and low fat diet. Thus, MCA appears sufficiently robust and relevant to effectively guide etiological hypotheses and decisions about individual and collective intervention strategies.

Actigraph-defined moderate-to-vigorous physical activity cut-off points among children: statistical and biobehavioural relevance

AIM

To compare Actigraph-defined moderate-to-vigorous physical activity (MVPA) cutpoints among children, combining statistical and biobehavioural analyses.

METHODS

One hundred and thirteen children aged 10.0 +/- 0.8 years wore accelerometer for three days. The time they spent in MVPA was estimated using 10 thresholds ranged from 3000 to 3900 cpm. A statistical construct including 45 Bland and Altman pairwise analyses was used to compare the 10 estimates of MVPA. A regression was performed to develop an equation relating mean differences to the between-cutpoint gaps.

RESULTS

Mean differences in the MVPA estimates ranged from 1.6 to 12.8 min as a function of increment. Raw estimates of MVPA decreased according to an arithmetic sequence with a common difference of 200 cpm. This difference translates into a drop of 12% in MVPA and a misclassification of up to 5% of children. Mean differences (Y) could be predicted from increments (X) using: Y= 0.02 X (R(2)= 0.99, SEE = 0.72, p < 0.0001).

CONCLUSION

When a lack of agreement should be assumed as the between-cutpoint gap exceeds 200 cpm, statistical differences may occur earlier at 90 cpm. Yet, the current equation makes it possible to compare and adjust results from studies/interventions using diverse cutpoints for MVPA among children.

An architecture for online comparison and validation of processing methods and computerized guidelines in intensive care units

Clinical decision support systems are a combination of software techniques to help the clinicians in their medical decision making process via functionalities ranging from basic signal analysis to therapeutic planning and computerized guidelines. The algorithms providing all these functionalities must be very carefully validated on real patient data and must be confronted to everyday clinical practice. One of the main problems when developing these techniques is the difficulty to obtain high-quality complete patient records, comprising data coming both from the biomedical equipment (high-frequency signals), and from numerous other sources (therapeutics, imagery, clinical actions, etc.). In this paper, we present an infrastructure for developing and testing such software algorithms. It is based on a bedside workstation where testing different algorithms simultaneously on real-time data is possible in the ward. It is completed by a collaborative portal enabling different teams to test their software algorithms on the same patient records, making comparisons and cross-validations more easily.

Methodological approach for the evaluation of the performances of medical intensive care units

PURPOSE

The purpose of the study was to present a methodological approach enabling the comparison of clinical and economic performances of intensive care units and a graphical visualization based on these 2 dimensions.

PATIENTS AND METHODS

A retrospective analysis of a database of 666 patients admitted in intensive care units over a period of 2 consecutive months.

RESULTS

Calculation of clinical performance is based on the difference between the mortality observed and forecast from the Simplified Acute Physiology Score version 2. The evaluation of resource consumption is carried out from the measure of medical and paramedical care workload. These 2 scores are modeled on the basis of the length of stay and the severity state of the patient. The economic performance is calculated on the basis of the difference between the resource consumption observed and forecast. The graphs are constructed by taking up as coordinates the values of the clinical and economic performances of each center.

CONCLUSION

These graphs enable the identification of the most deviating intensive care units to study, for example, their organizational, technical, or human resource setup accounting for their position.

Moderate-to-vigorous physical activity among children: discrepancies in accelerometry-based cut-off points

OBJECTIVE

To highlight the discrepancies in accelerometry cut-off points of moderate-to-vigorous physical activity (MVPA) according to the definitions of Puyau et al. (MVPA(P)) and Trost et al. (MVPA(T)).

RESEARCH METHODS AND PROCEDURES

Forty-five children from 8 to 11 years old were monitored with the ActiGraph (ActiGraph, LLC, Fort Walton Beach, FL) for 3 consecutive days. Daily time spent at MVPA obtained with MVPA(P) was compared with that obtained with MVPA(T) using variability, regression, and agreement statistics. Data were then discussed with regard to physical activity recommendations.

RESULTS

The mean daily time spent at MVPA(P) (28 +/- 18 minutes) was significantly lower (p < 10(-4)) than that spent at MVPA(T) (141 +/- 39 minutes). The coefficient of determination between the two definitions was low (R(2) = 0.49 +/- 0.71). There was a lack of agreement between the two definitions, with a mean error or bias of 113 min/d. Thirty-four point eight percent and 100% of children underwent 30-minute MVPA/d with MVPA(P) and MVPA(T) definitions, respectively.

DISCUSSION

Comparability between studies devoted to describing children's physical activity or to assessing interventions may lack consistency according to the definition, with a real risk of misclassification.

Increased Susceptibility of Low-Density Lipoprotein to Ex Vivo Oxidation in Mice Transgenic for Human Apolipoprotein B Treated with 1 Melatonin-Related Compound Is Not Associated with Atherosclerosis Progression

Considerable evidence supports the hypothesis that LDL oxidation has an important role in atherosclerosis. It has been demonstrated that the feeding of hypercholesterolemic mice on an atherogenic diet supplemented with melatonin highly increases the surface of atherosclerotic lesions in aorta and the sensitivity of atherogenic lipoprotein to ex vivo oxidation even though high melatonin doses inhibit lipoprotein oxidation in vitro. A melatonin-related compound (DTBHB: N-[2-(5-methoxy-1H-indol-3-yl)ethyl]-3,5-di-tert-butyl-4-hydroxybenzamide) has been reported to strongly inhibit lipid peroxidation in vitro. In the present study, DTBHB treatment considerably increased the sensitivity of atherogenic lipoproteins to ex vivo oxidation but did not modify atherosclerotic lesion development in mice. Moreover, DTBHB treatment did not induce detectable lipidic alteration. These data confirm that the capacity of molecules to inhibit atherogenic lipoprotein oxidation in vitro offers no prediction of their capacity to inhibit in vivo atherosclerosis development.

Daily melatonin supplementation in mice increases atherosclerosis in proximal aorta

Considerable evidence supports the hypothesis that LDL oxidation plays an important role in atherosclerosis. Even though high melatonin doses inhibit LDL oxidation in vitro, the effect of melatonin on atherosclerosis has never been studied. We have demonstrated that the feeding of hypercholesterolemic mice with an atherogenic diet supplemented with melatonin highly increases the surface of atherosclerotic lesions in the proximal aorta. These observations occur without detectable lipidic or glucidic phenotype alteration. Melatonin treatment increased highly the sensitivity of atherogenic lipoprotein to Cu(2+) and gamma-radiolysis generated oxyradical ex vivo oxidation during the fasting period. Moreover, these altered lipoproteins were less recognized by the LDL receptor metabolic pathway of murine fibroblasts while they transferred many more cholesteryl esters to murine macrophages. This study suggests that caution should be taken as regards high melatonin dosage in hypercholesterolemic patients.

An extension of the admixture test for the study of genetic heterogeneity in hereditary multiple exostoses

Hereditary multiple exostoses (EXT) is an autosomal dominant disorder characterized by the presence of multiple cartilage-capped exostoses in the juxta-epiphyseal regions of the long bones. EXT is heterogeneous with at least three different locations currently having been identified on chromosomes 8, 11 and 19. We have tested a series of 29 EXT families for possible linkage to the three disease loci and estimated the probability of linkage of the disease to each locus in our series, by using an extension of the admixture test, which makes modelling of heterogeneous monogenic disease feasible. The maximum likelihood was obtained for proportions of 44%, 28% and 28% of families being linked to chromosome 8, 11 and 19, respectively. The a posteriori probability of linkage of the disease to EXT1, EXT2 and EXT3 was greater than 80% for 8/29, 5/29 and 3/29 families, respectively, and did not give evidence of a fourth locus for the disease. The present approach can be generalized to the investigation of genetic heterogeneity in other monogenic diseases, as it simultaneously estimates the location of each disease gene and the proportion of families linked to each locus.

Tests for genetic linkage and homogeneity

This report concerns likelihood ratio tests in a heterogeneous model for linkage, where the recombination fraction has a binomial mixture distribution with an unknown proportion of unlinked families. We consider families of unequal sizes with known or unknown phase data. In both cases, the limit distributions of the linkage test statistics are a mixture of a mass at ) and of a X2/1 distribution in equal proportions and homogeneity test statistics tend to the supremum of Gaussian processes. The critical values of the homogeneity tests are simulated, and the power functions of the linkage and homogeneity tests are compared in a simulation study.