Is off-label thrombolysis safe and effective in a real-life primary stroke center? A retrospective analysis of data from a 5-year prospective database

BACKGROUND

Intravenous thrombolysis (IVT) use for acute ischemic stroke (AIS) varies among countries, partly due to guidelines and product labeling changes. The study aim was to identify the characteristics of patients with AIS treated with off-label IVT and to determine its safety when performed in a primary stroke center (PSC).

METHODS

This observational, single-center study included all consecutive patients admitted to Perpignan PSC for AIS and treated with IVT and patients transferred for EVT, between January 1, 2015 and December 31, 2019. Data of patients treated with IVT according to ("in-label group") or outside ("off-label") the initial guidelines and manufacturer's product specification were compared. Safety was assessed using symptomatic intracerebral hemorrhage (SIH) as the main adverse event.

RESULTS

Among the 892 patients in the database (834 screened by MRI, 93.5%), 746 were treated by IVT: 185 (24.8%) "in-label" and 561 (75.2%) "off-label". In the "off-label" group, 316 (42.4% of the cohort) had a single criterion for "off-label" use, 197 (26.4%) had two, and 48 (6.4%) had three or more criteria, without any difference in IVT safety pattern among them. SIH rates were comparable between the "off-label" and "in-label" groups (2.7% vs. 1.1%, P=0.21); early neurological deterioration and systematic adverse event due to IVT treatment were similar in the 2 groups. "Off-label" patients had higher in-hospital (8.7% vs. 3.8%, P=0.05) and 3-month mortality rates (12.1% vs 5.4%, P<0.01), but this is explained by confounding factors as they were older (76 vs 67 years, P<0.0001) and more dependent (median modified Rankin scale score 0.4 vs 0.1, P<0.0001) at admission.

CONCLUSIONS

"Off-label" thrombolysis for AIS seems to be safe and effective in the routine setting of a primary stroke center.

A large diversity of organohalogen contaminants reach the meso- and bathypelagic organisms in the Bay of Biscay (northeast Atlantic)

Deep-sea ecosystems play a key role in the cycling and vertical transfer of matter and energy in oceans. Although the contamination of deep-sea demersal and benthic organisms by persistent organic pollutants has been proven, deep pelagic species have been far less studied. To fill these gaps, we studied the occurrence of a large variety of hydrophobic organic contaminants including polychlorinated biphenyls (PCBs), organochlorine pesticides (OCPs), legacy and alternative brominated flame retardants (BFRs) and per- and polyfluoroalkyl substances (PFASs) in crustaceans and fish species collected in the Bay of Biscay, northeast Atlantic. The results highlighted the global predominance of PCBs in fish, followed by OCPs, PFASs and PBDEs, with highly variable concentrations among species. Most of the chlorinated or brominated contaminants showed increasing concentrations with increasing δ¹⁵N values, while most PFASs showed inverse trends. The contaminant profiles and diagnostic ratios revealed species-specific metabolic capacities and peculiar contribution of highly-brominated BFRs.

Different clinical outcomes between cerebral amyloid angiopathy-related inflammation and non-inflammatory form

OBJECTIVE

Cerebral amyloid angiopathy-related inflammation (CAA-ri) is a rare manifestation related to CAA, thought to be more severe. We aimed to compare the clinical and radiological outcomes of CAA-ri and non-inflammatory CAA.

MATERIALS AND METHODS

We retrospectively included all patients with CAA-ri from 13 French centers. We constituted a sex- and age-matched control cohort with non-inflammatory CAA and similar disease duration. Survival, autonomy and cognitive evolution were compared after logistic regression. Cerebral microbleeds (CMB), intracerebral hemorrhage, cortical superficial siderosis and hippocampal atrophy were analyzed as well as CSF biomarker profile and APOE genotype when available. Outcomes were compared using Kaplan-Meier curves and log-rank tests.

RESULTS

Data from 48 CAA-ri patients including 28 already reported and 20 new patients were analyzed. Over a mean of 3.1 years, 11 patients died (22.9%) and 18 (37.5%) relapsed. CAA-ri patients were more frequently institutionalized than non-inflammatory CAA patients (30% vs 8.3%, p < 0.001); mortality rates remained similar. MMSE and modified Rankin scale scores showed greater severity in CAA-ri at last follow-up. MRI showed a higher number of CMB at baseline and last follow-up in CAA-ri (p < 0.001 and p = 0.004, respectively). CSF showed lower baseline levels of Aß42 in CAA-ri than non-inflammatory CAA (373.3 pg/ml vs 490.8 pg/ml, p = 0.05). CAA-ri patients more likely carried at least one APOE ε4 allele (76% vs 37.5%, adjusted p = 0.05) particularly as homozygous status (56% vs 6.2%, p < 0.001).

INTERPRETATION

CAA-ri appears to be more severe than non-inflammatory CAA with a significant loss of autonomy and global higher amyloid burden, shown by more CMB and a distinct CSF profile. This burden may be partially promoted by ε4 allele.

Endovascular treatment for acute ischemic stroke at a primary stroke center: First results of the Perpignan center

INTRODUCTION

Converting a high-volume primary stroke center (PSC) into a stroke center that can perform emergency endovascular treatment (EVT) could reduce the time to thrombectomy. We report the first results of a newly established EVT facility at the Perpignan PSC and their comparison with the targets defined by the established guidelines.

PATIENTS AND METHOD

For this comprehensive observational study, data of patients with acute ischemic stroke (AIS) due to proximal large vessel occlusion (LVO) and treated by EVT at the Perpignan PSC from December 5, 2019 to September 15, 2020 were extracted from an ongoing prospective database.

RESULTS

During the study period, 37 patients underwent EVT at the Perpignan PSC. The median (range) symptom-onset to recanalization time was 262min (100-485min). The median (range) intra-hospital times were: 20min (2-58min) for door-to-imaging, 57min (30-155min) for imaging-to-puncture, 55min (15-180min) for puncture-to-recanalization, and 137min (59-319min) for door-to-recanalization. At 3 months post-AIS, the favorable outcome (modified Ranking Score: 0-2) rate was 50% and the mortality rate was 19.4%. These results are comparable to those of previous clinical trials, and meet the targets defined by the current consensus statements for EVT.

DISCUSSION AND CONCLUSION

Our results show the feasibility and safety of EVT in a PSC for patients with AIS due to LVO. The implementation of this strategy may be important for shortening the time to thrombectomy.

Tissue-specific bioaccumulation of a wide range of legacy and emerging persistent organic contaminants in swordfish (Xiphias gladius) from Seychelles, Western Indian Ocean

Swordfish (Xiphias gladius) is a major marine resource of high economic value to industrial and artisanal fisheries. As a top predator with a long lifespan, it is prone to accumulate high levels of contaminants. The bioaccumulation of a wide range of both legacy and emerging persistent organic contaminants was investigated in the muscle, liver and gonads of swordfish collected from the Seychelles, western Indian Ocean. The detection of all target contaminants, some at frequencies above 80%, highlights their widespread occurrence, albeit at low levels. Mean concentrations in muscle were 5637, 491 and 331 pg g^-1 ww for organochlorine pesticides (OCPs), polychlorinated biphenyls (PCBs) and perfluoroalkyl substances (PFASs), respectively. ∑BFR mean concentrations were far below, i.e. 47 pg g^-1 ww. The data are among the first obtained for such a high diversity of contaminants in an oceanic top predator worldwide and constitute a benchmark of the contamination of Indian Ocean ecosystems.

Legacy and emerging organic contaminants: Levels and profiles in top predator fish from the western Indian Ocean in relation to their trophic ecology

Tuna and billfish are large pelagic fish of ecological importance in open oceans. As top predators with a long lifespan, they are prone to exposure to various contaminants such as persistent organic pollutants (POPs) and contaminants of emerging concern. In this study, three pollutant families were investigated, including polychlorinated biphenyls (PCBs), organochlorinated pesticides (OCPs) and perfluoroalkyl substances (PFASs), including perfluorooctane sulfonate (PFOS) and perfluorocarboxylic acids (PFCAs). Contamination was investigated in individuals from three tropical tuna species, namely bigeye (Thunnus obesus), skipjack (Katsuwonus pelamis) and yellowfin (Thunnusalbacares) tunas and the billfish swordfish (Xiphias gladius), collected from various areas of the western Indian Ocean (WIO) in 2013-2014. Contamination levels and profiles were examined in fish muscle, together with biological parameters (fish length / age, sex, lipid content) and ecological tracers (carbon and nitrogen stable isotopes). POP levels were low in all species in comparison to other locations worldwide, revealing a low impact of anthropogenic organic contaminants in the WIO. A predominance of OCPs (especially DDTs) versus PCBs was highlighted in all species; PFASs were predominant over chlorinated POPs in tunas. Among the studied PFASs, long-chain PFCAs were found to prevail over PFOS in all species. Organic contaminant profiles differed across species according to their foraging habitat; swordfish and bigeye tuna, which both feed in deep oceanic layers, showed similarities in their contaminant profiles. Geographically, the distinct DDT profiles of fish from the Mozambique Channel suggested an exposure to different DDT sources, in line with regional use of this insecticide and coupled with an extended residence time of fish in the Channel. To our knowledge, the data presented here are among the first obtained for legacy and emerging organic contaminants in various species of large pelagic predators from the WIO.

IMA Genome-F 8: Draft genome of Cercospora zeina, Fusarium pininemorale, Hawksworthiomyces lignivorus, Huntiella decipiens and Ophiostoma ips

The genomes of Cercospora zeina, Fusarium pininemorale, Hawksworthiomyces lignivorus, Huntiella decipiens, and Ophiostoma ips are presented in this genome announcement. Three of these genomes are from plant pathogens and otherwise economically important fungal species. Fusarium pininemorale and H. decipiens are not known to cause significant disease but are closely related to species of economic importance. The genome sizes range from 25.99 Mb in the case of O. ips to 4.82 Mb for H. lignivorus. These genomes include the first reports of a genome from the genus Hawksworthiomyces. The availability of these genome data will allow the resolution of longstanding questions regarding the taxonomy of these species. In addition these genome sequences through comparative studies with closely related organisms will increase our understanding of how these species or close relatives cause disease.

Tissue-specific distribution and maternal transfer of polybrominated diphenyl ethers (PBDEs) and their metabolites in adult common sole (Solea solea L.) over an entire reproduction cycle

Tissue-specific accumulation and distribution of polybrominated diphenyl ethers (PBDEs) and their debrominated metabolites were studied in common sole (Solea solea) over an entire reproduction cycle. The fish were dietary-exposed to selected PBDEs in laboratory-controlled conditions for one year. Fish of both sexes were sampled throughout the reproduction cycle and their muscle, liver, viscera, carcass, skin and gonads (female) were analysed for total lipid content, PBDEs and their debrominated metabolites. On a wet weight basis, the concentrations of most spiked congeners showed an increase at the end of the exposure time in the whole body of fish of both sexes. Conversely, BDE-99 and BDE-209 - the two most highly metabolized congeners - did not show a similar increase, while their debrominated metabolites exhibited a linear increase over time. Biomagnification factors (BMFs) calculated in whole body were > 1 for all PBDEs except BDE-99 (0.89 ± 0.22) and BDE-209 (0.013 ± 0.006). BMFs were strongly correlated to apparent assimilation efficiencies, which ranged from 1.6% ± 0.7% (BDE-209) to 88% ± 11% (BDE-100). Fish carcass was the most predominant storage compartment for all PBDEs except BDE-209 in both male and female fish, followed by skin, muscle, female gonads, liver and visceral tissue. BDE-209 showed a different distribution and was stored more predominantly in the liver, viscera and female gonads than other congeners, probably due to its transport with lipoproteins. All PBDEs except BDE-209 showed equilibrium partitioning between the liver and other studied compartments, while BDE-209 showed a higher affinity with blood-enriched tissues, leading to higher liver / carcass, skin and muscle concentration ratios. Visceral tissue and liver exhibited the most pronounced differences in terms of concentration variations between sexes and over time. In females, both tissues showed a significant decrease in most PBDE concentrations (ww) and TLC in March during the spawning season, with low inter-individual variability, reflecting the striking utilisation of lipids by females for reproduction at this time. In males, no differences were found in concentrations in these compartments over time and a high inter-individual variability was observed. Maternal transfer of PBDEs from gonad to eggs was constant, regardless of spawn rank in the spawning season. Egg / gonad PBDE concentration ratios (in lw) were 1.3 ± 0.7 for all congeners and 2.6 ± 0.3 for BDE-209, suggesting a higher transfer of this congener from gonads to eggs.

Results of a 1-year quality-improvement process to reduce door-to-needle time in acute ischemic stroke with MRI screening

OBJECTIVE

To determine the effects of a 1-year quality-improvement (QI) process to reduce door-to-needle (DTN) time in a secondary general hospital in which multimodal MRI screening is used before tissue plasminogen activator (tPA) administration in patients with acute ischemic stroke (AIS).

METHODS

The QI process was initiated in January 2015. Patients who received intravenous (iv) tPA<4.5h after AIS onset between 26 February 2015 to 25 February 2016 (during implementation of the QI process; the "2015 cohort") were identified (n=130), and their demographic and clinical characteristics and timing metrics compared with those of patients treated by iv tPA in 2014 (the "2014 cohort", n=135).

RESULTS

Of the 130 patients in the 2015 cohort, 120 (92.3%) of them were screened by MRI. The median DTN time was significantly reduced by 30% (from 84min in 2014 to 59min; P<0.003), while the proportion of treated patients with a DTN time≤60min increased from 21% to 52% (P<0.0001). Demographic and baseline characteristics did not significantly differ between cohorts, and the improvement in DTN time was associated with better outcomes after discharge (patients with a 0-2 score on the modified rankin scale: 59% in the 2015 cohort vs 42.4% in the 2014 cohort; P<0.01). During the 1-year QI process, the median DTN time decreased by 15% (from 65min in the first trimester to 55min in the last trimester; P≤0.04) with a non-significant 1.5-fold increase in the proportion of treated patients with a DTN time≤60min (from 41% to 62%; P=0.09).

CONCLUSION

It is feasible to deliver tPA to patients with AIS within 60min in a general hospital, using MRI as the routine screening modality, making this QI process to reduce DTN time widely applicable to other secondary general hospitals.

A diagenetic control on the Early Triassic Smithian-Spathian carbon isotopic excursions recorded in the marine settings of the Thaynes Group (Utah, USA)

In the aftermath of the end-Permian mass extinction, Early Triassic sediments record some of the largest Phanerozoic carbon isotopic excursions. Among them, a global Smithian-negative carbonate carbon isotope excursion has been identified, followed by an abrupt increase across the Smithian-Spathian boundary (SSB; ~250.8 Myr ago). This chemostratigraphic evolution is associated with palaeontological evidence that indicate a major collapse of terrestrial and marine ecosystems during the Late Smithian. It is commonly assumed that Smithian and Spathian isotopic variations are intimately linked to major perturbations in the exogenic carbon reservoir. We present paired carbon isotopes measurements from the Thaynes Group (Utah, USA) to evaluate the extent to which the Early Triassic isotopic perturbations reflect changes in the exogenic carbon cycle. The δ(13) Ccarb variations obtained here reproduce the known Smithian δ(13) Ccarb -negative excursion. However, the δ(13) C signal of the bulk organic matter is invariant across the SSB and variations in the δ(34) S signal of sedimentary sulphides are interpreted here to reflect the intensity of sediment remobilization. We argue that Middle to Late Smithian δ(13) Ccarb signal in the shallow marine environments of the Thaynes Group does not reflect secular evolution of the exogenic carbon cycle but rather physicochemical conditions at the sediment-water interface leading to authigenic carbonate formation during early diagenetic processes.

Evaluation of muscle oxygenation by near infrared spectroscopy in patients with facioscapulohumeral muscular dystrophy

The purpose of the study was to determine muscle metabolism adaptation to exercise in facioscapulohumeral muscular dystrophy patients (FSHD) and to study the correlation with clinical functional status (6-min walk test). 8 FSHD patients and 15 age-matched healthy controls (Controls) performed two isokinetic constant-load knee extension exercises: (1) at 20% of their maximal extensors' peak torque (i.e., the same relative workload) and (2) at (20N⋅m) (the same absolute workload) for up to 4 min. All exercises consisted of rhythmic, voluntary, isokinetic, concentric contractions of the quadriceps femoris at 90°/s, whereas the flexion was performed passively at the same speed. Muscle oxygenation in the vastus lateralis was evaluated using near-infrared spectroscopy (NIRS). The FSHD patients displayed a lower maximal peak torque than controls (-41%, p < 0.05). During the two-exercise modalities, deoxygenated haemoglobin (HHb) and total haemoglobin volume (tHb) were lower in the FSHD patients (p < 0.05). The initial muscle deoxygenation time delay was shorter in the control group (FSHD: 15.1 ± 4.1 s vs.

CONTROLS

10.4 ± 2.1 s, p < 0.05). Mean response time and maximal peak torque were both correlated with functional impairment (walking endurance). The results suggest that FSHD patients present an impairment in their capacity to deliver or to use oxygen.

Occurrence of legacy and emerging halogenated organic contaminants in marine shellfish along French coasts

Current contamination levels of selected legacy, currently-used and emerging halogenated contaminants were monitored in marine shellfish along French coastlines. The studied contaminants included polybrominated diphenyl ethers (PBDEs), hexabromocyclododecanes (HBCDDs), 1,2-bis(2,4,6-tribromophenoxy)ethane (BTBPE), decabromodiphenylethane (DBDPE), hexabromobenzene (HBB), 2,2′,4,4′,5,5′-hexabromobiphenyl (BB-153) and perfluorinated compounds (PFCs).BDE-47, BDE-209, BTBPE, HBB and α-HBCDD were detected in 100% of the analyzed samples, whereas BB-153, DBDPE and PFOS were detected at frequencies of 97%, 90% and 55%, respectively. Concentrations were in the pg g−1 ww range and varied as follows: PFOS > BDE-47 ∼ α-HBCDD > BDE-209 > BTBPE ∼ DBDPE > HBB ∼ BB-153. Overall, non-PBDE Brominated Flame Retardants (BFRs) revealed concentrations between 3 and 59 times lower than those of PBDEs.PBDE pattern was dominated by BDE-47, followed by BDE-99 > BDE-100 > BDE-49 > BDE-209 > BDE-154; these 6 congeners represented 94% of the summed ten PBDEs. PFC pattern determination revealed PFOS as the predominant PFC in samples from the English Channel and Atlantic, whereas perfluorocarboxylic acids (PFCAs) prevailed in Mediterranean samples. Temporal trend investigations on archived samples from the Mediterranean coast collected between 1981 and 2012 showed a prevalence of PFOS until 1998; PFCAs subsequently increased and became more abundant than PFOS. High levels of PFCAs were observed until 2008, followed by a decrease and stabilization in 2010–2012. Amongst PFCAs, perfluorotridecanoic acid (PFTrDA) and perfluoroundecanoic acid (PFUnA) were predominant and exhibited similar time trends, suggesting similar sources at the investigated site, home to major industrial activity.

Fluorescent probe for high-throughput screening of membrane protein expression

Screening of protein variants requires specific detection methods to assay protein levels and stability in crude mixtures. Many strategies apply fluorescence-detection size-exclusion chromatography (FSEC) using green fluorescent protein (GFP) fusion proteins to qualitatively monitor expression, stability, and monodispersity. However, GFP fusion proteins have several important disadvantages; including false-positives, protein aggregation after proteolytic removal of GFP, and reductions in protein yields without the GFP fusion. Here we describe a FSEC screening strategy based on a fluorescent multivalent NTA probe that interacts with polyhistidine-tags on target proteins. This method overcomes the limitations of GFP fusion proteins, and can be used to rank protein production based on qualitative and quantitative parameters. Domain boundaries of the human G-protein coupled adenosine A2a receptor were readily identified from crude detergent-extracts of a library of construct variants transiently produced in suspension-adapted HEK293-6E cells. Well expressing clones of MraY, an important bacterial infection target, could be identified from a library of 24 orthologs. This probe provides a highly sensitive tool to detect target proteins to expression levels down to 0.02 mg/L in crude lysate, and requires minimal amounts of cell culture.

Ultracompact electro-optic phase modulator based on III-V-on-silicon microdisk resonator

A novel ultracompact electro-optic phase modulator based on a single 9 μm-diameter III-V microdisk resonator heterogeneously integrated on and coupled to a nanophotonic waveguide is presented. Modulation is enabled by effective index modification through carrier injection. Proof-of-concept implementation involving binary phase shift keying modulation format is assembled. A power imbalance of ∼0.6  dB between both symbols and a modulation rate up to 1.8 Gbps are demonstrated without using any special driving technique.

Evaluation of muscle oxygenation by near-infrared spectroscopy in patients with Becker muscular dystrophy

Several authors have reported alterations in vasodilation during effort in patients with dystrophinopathies, in which a lack of neuronal NO synthase is thought to lead to functional muscle ischemia. In order to determine changes in muscle oxygenation during effort in patients with Becker muscular dystrophy (BMD) and assess the parameters' links with disease severity and functional status, 10 BMD patients and 10 age-matched controls performed isokinetic, constant-load knee extension exercises at (i) 20% of their extensors' peak torque (i.e. the same relative load) and (ii) the same absolute load (20 Nm). Muscle oxygenation was evaluated noninvasively using near-infrared spectroscopy (NIRS), with the time course of deoxygenation as the main criterion. As expected, BMD patients displayed a lower peak torque than controls (-62%). During both types of exercise, initial muscle deoxygenation was faster (by 27-41%) in BMD patients than in controls. Greater disease severity (according to the Motor Function Measure) and functional impairment (walking endurance) were associated with a faster second deoxygenation phase (τ). The validity and relevance of muscle deoxygenation parameters and the alteration of vasodilatation by nNOS deficiency in dystrophinopathies should be assessed by further studies.

Electrically driven hybrid Si/III-V Fabry-Pérot lasers based on adiabatic mode transformers

We report the first demonstration of an electrically driven hybrid silicon/III-V laser based on adiabatic mode transformers. The hybrid structure is formed by two vertically superimposed waveguides separated by a 100-nm-thick SiO2 layer. The top waveguide, fabricated in an InP/InGaAsP-based heterostructure, serves to provide optical gain. The bottom Si-waveguides system, which supports all optical functions, is constituted by two tapered rib-waveguides (mode transformers), two distributed Bragg reflectors (DBRs) and a surface-grating coupler. The supermodes of this hybrid structure are controlled by an appropriate design of the tapers located at the edges of the gain region. In the middle part of the device almost all the field resides in the III-V waveguide so that the optical mode experiences maximal gain, while in regions near the III-V facets, mode transformers ensure an efficient transfer of the power flow towards Si-waveguides. The investigated device operates under quasi-continuous wave regime. The room temperature threshold current is 100 mA, the side-mode suppression ratio is as high as 20 dB, and the fiber-coupled output power is ~7 mW.

Dietary exposure of juvenile common sole (Solea solea L.) to polybrominated diphenyl ethers (PBDEs): Part 1. Bioaccumulation and elimination kinetics of individual congeners and their debrominated metabolites

The uptake and elimination of six PBDE congeners (BDE-28, -47, -99, -100, -153, -209) were studied in juvenile common sole (Solea solea L.) exposed to spiked contaminated food over a three-month period, then depurated over a five-month period. The results show that all of the studied PBDEs accumulate in fish tissues, including the higher brominated congener BDE-209. Several additional PBDE congeners were identified in the tissues of exposed fish, revealing PBDE transformation, mainly via debromination. The identified congeners originating from PBDE debromination include BDE-49 and BDE-202 and a series of unidentified tetra-, penta-, and hepta- BDEs. Contaminant assimilation efficiencies (AEs) were related to their hydrophobicity (log Kow) and influenced by PBDE biotransformation. Metabolism via debromination appears to be a major degradation route of PBDEs in juvenile sole in comparison to biotransformation into hydroxylated metabolites.

Monitoring aortic stiffness in the presence of measurement artifact based on an arterial tube model

Pulse wave velocity (PWV) determined through the foot-to-foot time delay between carotid and femoral artery waveforms is an index of aortic stiffness with proven clinical value. However, handheld transducers, which are often used to non-invasively measure the waveforms, are prone to motion artifact that may limit the full potential of this index. Here, we conceived an artifact robust technique to estimate PWV based on an arterial tube model. We applied the technique to high fidelity canine arterial pressure waveforms before and after contamination with known amounts of noise. Our results showed that, as the signal-to-noise ratio decreased, the PWV estimates of the technique predicted diastolic and mean arterial pressure with increasingly greater accuracy than the PWV estimates of the conventional foot-to-foot detection technique.

Monitoring cardiac output and left atrial pressure by analysis of the right ventricular pressure waveform based on missing output identification

A proven implantable device is now available for long-term ambulatory monitoring of the right ventricular pressure (RVP) waveform of congestive heart failure patients. However, cardiac output (CO) and left atrial pressure (LAP) are far more useful for assessing cardiac function and managing volume status. We developed a new technique to monitor both CO and LAP by analysis of the RVP waveform based on missing output identification. We initially evaluated the technique against gold standard reference CO and LAP measurements from two dogs during common hemodynamic interventions. We report overall CO and LAP errors of 13.3% and 1.9 mmHg, respectively. With further successful testing, the technique may potentially be employed with an established implantable device for chronic monitoring of vital hemodynamic variables.

[One-leg cycling aerobic training with the healthy leg in amateur soccer players after anterior cruciate ligament reconstruction]

OBJECTIVE

To examine cardiorespiratory fitness changes in subjects having undergone knee surgery and to assess the benefits of one-leg cycling aerobic training program during the rehabilitation period.

METHOD

Two groups of 12 patients took part in this study. The control group profited from a five weeks conventional rehabilitation in day hospital without cardiorespiratory training. The second group profited in supplement from a one-leg cycling aerobic training program with the valid leg. The subjects were trained for 21 min, by alternating 3 min at 70% and 3 min at 85% of VO(2 peak). They totaled 15 sessions spread over five weeks. The initial evaluation (T1) is carried out the first day of rehabilitation and the final evaluation (T2) at a distance within 35 days. The evaluation consisted in realizing a maximal graded tests starting from the valid leg.

RESULTS

After five weeks of conventional rehabilitation, we record a reduction of peak power output (W(peak)), peak oxygen uptake (VO(2 peak)) and peak minute ventilation (VE(peak)), respectively of 11, 12 and 13% for the control group. On the other hand, in T2, the training group has on average identical maximum values and some of them increased (W(peak): +14%; VE(peak): +15%). The first and second ventilatory thresholds appear with higher intensities of exercises.

CONCLUSION

After knee surgery, conventional rehabilitation does not limit cardiorespiratory deconditioning. One leg cycling appears to be an adapted method to stop the effects of hypoactivity.

[Does exercise therapy for chronic lower-back pain require daily isokinetic reinforcement of the trunk muscles?]

OBJECTIVE

The goal of this study was to determine the benefits of a functional retraining programme (with or without daily isokinetic reinforcement of the trunk muscles) in patients with lower-back pain.

METHOD

Two groups of 30 patients took part in the study. The control group (CG) underwent a four-week reconditioning program in a day hospital, whereas a second interventional group (IG) additionally performed daily isokinetic training of the trunk muscles. Three evaluations were carried out: before hospitalization (T1), immediately after hospitalization (T2) and three months postrehabilitation (T3).

RESULTS

We observed an improvement in each parameter after rehabilitation, regardless of the group. A decrease in the DALLAS scores revealed a reduced impact of lower-back pain on the patients' lives. Pain experienced fell by 24%, analgesic treatment was significantly decreased (CG: -53%; IG: -56%), muscle endurance was improved (quadriceps: +30%, abdominal muscles: +20%, paraspinal muscles: +23%, quadratus lumborum: +33%) and the patients were more supple, as revealed by a decrease in the finger-to-ground distance (at T1, CG: 12.9+/-6.1cm; IG: 13.6+/-5.5 cm at T1; CG: 2.2+/-5.4 cm; IG: 2.8+/-5.1cm at T2). The sole difference for CG and IG at T2 resulted from an improvement in the performance of the trunk extensor muscles, which was significantly greater in the IG (CG: +14%; IG: +20%). Three months after rehabilitation, the benefits were still present for the two groups and, indeed, were even greater for certain parameters.

CONCLUSION

Regardless of the protocol, the patients improved in both physical and psychological terms and these improvements were maintained over a short period, at least. Our results confirmed that one functional recovery programme is not superior to another for patients with lower-back pain.

Estimation of the aortic pressure waveform from a peripheral artery pressure waveform via an adaptive transfer function

We developed a new technique to estimate the aortic pressure (AP) waveform from a single peripheral artery pressure (PAP) waveform. The technique 1) employs a parallel tube model of the arterial tree to establish a transfer function relating PAP to AP with unknown parameters; 2) estimates the parameters from the measured PAP waveform, along with a single non-invasive measurement of the wave transmission delay from the aorta to the peripheral artery measurement site, by exploiting the fact that aortic flow is zero during diastole; and 3) applies the transfer function to the PAP waveform to predict the unmeasured AP waveform. In this way, in contrast to the conventional generalized transfer function paradigm, the transfer function is able to adapt to the inter-subject and temporal variability of the arterial tree. We applied this adaptive transfer function technique to PAP waveforms measured from five dogs instrumented with reference AP catheters during various hemodynamic interventions. Our results showed that the technique was able to reliably estimate the AP waveform with an overall error of 4.2 mmHg. For comparison, the corresponding errors of two previously proposed generalized transfer functions trained on a subset of the same canine data were, on average, 19% larger.

Intérêts des évaluations isocinétiques du genou avant et après reconstruction du ligament croisé antérieur chez le footballeur

AIM

The aim of this study was to analyse the evolution of the isokinetic performance of the knee flexor and extensor muscles in soccer players before and after intra-articular anterior cruciate ligament reconstruction (Kennet-Jones).

METHODS

Two isokinetic evaluations were carried out before surgery and after rehabilitation (i.e. 4 months later) in 18 soccer players.

RESULTS

The initial evaluation showed that the stabilizing muscles of the knee were affected differently after lesion of the external anterior crossed ligament. At the opposite of the flexor muscles, the performance of the knee extensor muscles of the injured leg was significantly reduced as compared with that of the healthy leg (peak torque at 90 degrees /s, -16%; power at 180 degrees /s, -14%; total work at 240 degrees /s, -11%). Even if 4 months after surgery, this deficit was accentuated (peak torque at 90 degrees /s, -26%; power at 180 degrees /s, -23%; total work at 240 degrees /s, -19%), the preoperative results of the knee extensor muscle do not condition the postoperative performance.

CONCLUSION

After a rupture of the external anterior crossed ligament, a regular program of isokinetic evaluation of the knee seems to be relevant in the follow-up of the wounded athlete. The evaluation before surgery can be used as reference, and from a psychological point of view, this evaluation can create confidence in the athlete during hospitalization. A second evaluation 4 months after surgery can be used to quantify the muscular deficit to direct the exercises of rehabilitation.

Étude préliminaire de la désadaptation cardiorespiratoire après une ligamentoplastie de genou chez le sportif

AIM

The aim of this study was to analyze changes in cardiorespiratory fitness of athletes who had surgery following a lesion of the anterior cruciate ligament of the knee.

METHODS

Two groups of 12 athletes at the regional level underwent surgical repair to rebuild the external anterior crossed ligament of the knee (central third bone patellar tendon bone autograft and doubled semitendinosus/doubled gracilis autograft techniques). All subjects were evaluated before and after surgery within 7 days: the first group underwent maximal incremental tests with the upper limbs, and the second group measurement of resting cardiac volumes.

RESULTS

Surgery followed by a few days of confinement generated a quick and significant reduction in the maximal oxygen consumption (-7%, P<0.05) and peak aerobic power (-8%, P<0.05). End diastolic volume and stroke volume were reduced, by 23% and 27% respectively (P<0.05). A significant reduction of ejection fraction was also observed (P<0.05). The mean left ventricular ejection fraction was 65% before the surgery 60% after 7 days' of hospitalization.

CONCLUSION

In sportsmen, 7 days of hospitalization due to surgery of the knee led to resting cardiac unsuitability characterized by a significant reduction in the stroke volume. These elements could involve decreased aerobic fitness and should encourage the hospital practitioner to propose a program of aerobic training in addition to conventional rehabilitation.

Orally active iron chelators

In patients with transfusion-dependent anemias, iron accumulation is fatal in the absence of chelating therapy. Extended survival, free of most complications of iron overload is observed in patients treated with early, adequate parenteral deferoxamine. Despite its success in prevention and treatment of iron toxicity, the expense and inconvenience of this therapy have stimulated a continued quest for an effective chelating agent that is orally active. Unfortunately, studies emerging over the last five years have confirmed that the most widely administered orally active agent, deferiprone (L1; 1,2-dimethyl-3-hydropyrid-4-one) may be harmfully ineffective in many patients: 18-65% of patients in six studies which obtained hepatic irons after long term deferiprone treatment had body iron exceeding the threshold for cardiac disease and premature death. The impact of deferiprone on cardiac and liver disease must be evaluated further, while the association between deferiprone and accelerated hepatic fibrosis still awaits refutation in large prospective trials. In view of the striking therapeutic successes of deferoxamine over the past 20 years, administration of deferiprone outside the setting of prospective clinical trials may need to be reconsidered. Meanwhile, an orally active iron chelator of demonstrated safety and effectiveness remains an objective for development for transfused patients.

Efficacy and safety of aerosolized triamcinolone acetonide in steroid-dependent and steroid-independent chronic asthmatic patients

Fourteen steroid-dependent and 16 steroid-independent asthmatic patients received aerosol triamcinolone acetonide for 12 weeks (two 200-micrograms inhalations four times daily). The mean daily oral steroid dose for the steroid-dependent patients was reduced from 12.5 mg at baseline to 1.34 mg after 12 weeks of aerosol therapy. In both groups of patients, FEV1.0, FVC and FEF25-75% values improved during therapy, usually at a statistically significant rate. Highly significant improvement occurred in shortness-of-breath, wheezing tightness-in-chest, and cough symptoms in all patients. However, changes in serum cortisol levels were not statistically significant. Side effects included transient hoarseness (seven patients), dry throat (one), and sore throat (one). No oral candidiasis was observed and no patient discontinued therapy because of side effects. Steroid withdrawal symptoms, which gradually abated, were experienced by half of the steroid-dependent patients. Aerosolized triamcinolone acetonide was therefore considered a safe and effective modality in the management of chronic asthma.