Association between oropharyngeal dysphagia, oral functionality, and oral sensorimotor alteration.

OBJECTIVE: To evaluate whether the oral functionality and the oral sensorimotor alterations are associated with oropharyngeal dysphagia in community-dwelling older persons and long-term care older residents. METHODS: An exploratory study with 265 independent older persons of the southern state of Brazil. The diagnosis of dysphagia, as well as the condition of the oral sensorimotor system, was assessed by a speech-language therapist and the oral health status by a dentist. Poisson Regression with robust variance was used to calculate the crude and adjusted Prevalence Ratios (PR) and their respective confidence intervals of 95%. RESULTS: The mean age was 73.5 (±8.9) years, women represented 59.2% of the sample. The frequency of dysphagia in the studied population was 45.3% (n = 120), being more frequent in the long-term care older residents (62.5%; n = 75) than in the community-dwelling older persons (37.5%; n = 45). Individuals with four or more oral sensorimotor alterations (PR = 2.01; 95% CI 1.27-3.18), as well as those who presented a non-functional oral status (PR = 1.61; 95% CI 1.02-2.54) presented a higher frequency of dysphagia. Subgroup analysis indicates the same trend of results, when stratified by community-dwelling older persons and long-term older residents. CONCLUSION: A non-functional oral health status and oral sensorimotor alterations are associated with a higher prevalence of oropharyngeal dysphagia.

The "open" chimney graft technique for juxtarenal aortic aneurysms with discrepant renal arteries.

OBJECTIVES: A straightforward original Chimney Graft (CG) protocol has been developed at our institution in selected cases of juxtarenal aortic aneurysm (JRAA). The aim of this study was to present our clinical experience of consecutive series with use of uncovered self-expanding stent (SES) as "Open Chimney" (OCh) in the endovascular repair (EVAR) of JRAA. METHODS: A standard endograft with suprarenal fixation struts is delivered with its proximal covered edge just below the highest RA in JRAA presenting the ostium of the two renal arteries at a different aortic level and the distance between the highest renal artery and the beginning of the aneurysm (improved landing zone) ≥10 mm. The low-lying renal artery is maintained patent by the OCh graft (standard SES) delivered from left brachial access (6 Fr). All clinical, anatomical, and operative data were prospectively collected and retrieved for the study analysis. RESULTS: From July 2010 to November 2012, OCh EVAR was offered to 22 consecutive patients considered unfit for JRAA open repair. All procedures were technically successful with aneurysm exclusion and patent OCh graft. One small perioperative type Ia endoleak spontaneously disappeared at the 3-month CT control. One patient died because of acute decompensated heart failure. One patient presented a left hemispheric stroke. The median follow-up of 18 months (range 7-35) showed aneurysm exclusion in all patients without type I and III endoleaks, SES stenosis, and/or renal impairment. CONCLUSIONS: OCh-EVAR is a straightforward technique that can be employed in selected cases of JRAA, avoiding the more complex and expensive fenestrated EVAR.

Evolution of glomerular filtration rate in HIV-infected, HIV-HBV-coinfected and HBV-infected patients receiving tenofovir disoproxil fumarate.

We aimed to compare the evolution of estimated glomerular filtration rate (eGFR) in HIV-, HIV-HBV- and HBV-infected patients treated with tenofovir disoproxil fumarate (TDF). Three groups of patients receiving TDF > 12 months were recruited: 194 HIV-infected patients, 85 HIV-HBV-coinfected patients and 50 HBV-infected patients. eGFR was estimated using the Modification of the Diet in Renal Disease (MDRD) equation. Multivariate regression models were constructed to estimate factors associated with eGFR decrease from baseline. A total of 329 patients were studied. Median follow-up was 2.7 years. Median eGFR decrease was -4.9 (-16.6 to +7.2) mL/min/1.73 m(2) . After multivariate stepwise regression analysis, age (P = 0.0002), non-African origin (P < 0.0001), baseline eGFR (P < 0.0001) and TDF duration (P = 0.02) were associated with eGFR decrease in the whole population, while hypertension, diabetes and type of infection were not. Age (P < 0.0001), non-African origin (P = 0.0004), baseline eGFR (P < 0.0001) and TDF duration (P = 0.007) remained associated with eGFR decline in HIV and HIV-HBV-infected patients, while other variables including HIV risk factor, CDC stage, CD4 and HIV-RNA levels were not. Age (P = 0.03), non-African origin (P = 0.004), baseline eGFR (P < 0.0001) and baseline HBV-DNA > 2000 IU/mL (P = 0.04) were associated with eGFR decline in HBV and HIV-HBV-infected patients, while other variables including HBV risk factor and fibrosis stage were not. Estimated glomerular filtration rate decline under TDF therapy appears mainly associated with older age, non-African origin, higher baseline eGFR and longer TDF administration but not with the type of viral infection. Regular follow-up of renal function, especially tubular function is recommended during TDF therapy.

Coupling of photocatalysis and catalysis using an optical fiber textile for room temperature depollution.

Herein, we investigate the interplay between a photocatalyst (TiO2) and a catalyst (Pt/TiO2 and Pt/CeO2) for the oxidation of formaldehyde and toluene at room temperature. A luminous textile is used as support and as light source for the photocatalyst. Our results indicate that the presence of the catalyst and the photocatalyst increases the catalytic performance for the oxidation of formaldehyde, while the photocatalytic performance for toluene oxidation decreases. The overall performance (toluene and formaldehyde degradation) of the system can be optimized with respect to the choice of support for the catalyst (e.g. TiO2 or CeO2), the quantity of Pt used, and the ratio between the catalyst and photocatalyst. In addition, different configurations of the photocatalyst and the catalyst on the textile are studied: under leaching and flow-through gas streams, catalyst and photocatalyst deposition on the same and opposite site of the textile are tested. The performance of the system can be optimized by adapting a configuration where the gas stream goes through the textile, while the deposition side of the catalyst and/or photocatalyst with respect to the gas stream is of minor importance.

Sexually transmitted HCV infection and reinfection in HIV-infected homosexual men.

Multiple, concomitant or successive hepatitis C virus (HCV) infections have been described in injection drug users and following organ transplantation and blood transfusion. However, data on sexual HCV reinfection is scarce. We report sexual HCV reinfection following viral eradication of a first HCV infection in two homosexual HIV-infected men. The first patient acquired HCV genotype 4 infection after resolution of an initial acute HCV genotype 1a infection. The second patient was infected with genotype 1a HCV following remission of an initial acute HCV genotype 4c/d infection. The two subjects were successfully treated with peginterferon alpha-2a and ribavirin for their first and second infection and achieved a sustained virological response on both occasions. Unprotected anal intercourse with multiple partners known to be HIV-positive (serosorting) was the only risk factor for HCV transmission reported by both patients. Therefore, sexual HCV reinfection can occur in homosexual men having unprotected sex and "serosorting" should be considered a risk factor for the sexual transmission of HCV.

On the conceptual difficulties in rooting the tree of life.

Rooting the 'tree of life' represents a major challenge for evolutionists. Without such a root, many of the first steps in biological evolution cannot be reconstructed. However, the nature of the last common ancestor of all living beings remains elusive, proof of the difficulty in shedding light on such an ancient event. Here, we highlight the practical difficulties and conceptual reasons that hinder the placement of a universal root. We discuss how, when addressing the question of the root of the tree of life, scientists unconsciously risk using the reasoning pattern of ancient skeptics, unfortunately known only to lead to further uncertainty. Hence, we argue that the root of the tree of life will not be established unless radically new approaches are considered. We propose a hypothetical means to overcome several of the conceptual difficulties pointed out, and suggest that a so-called 'transition analysis' of the structural evolution of the cytoplasmic membrane might be helpful, especially if evolutionary steps involving the rooting issue are polarized accounting more for physicochemical knowledge rather than hypothetical and controversial selective advantages.

Variability of human immunodeficiency virus-1 in the female genital reservoir during genital reactivation of herpes simplex virus type 2.

Clinical and subclinical genital herpes simplex virus type 2 (HSV-2) reactivations have been associated with increases in human immunodeficiency virus (HIV)-1 genital shedding. Whether HSV-2 shedding contributes to the selection of specific genital HIV-1 variants remains unknown. We evaluated the genetic diversity of genital and blood HIV-1 RNA and DNA in 14 HIV-1/HSV-2-co-infected women, including seven with HSV-2 genital reactivation, and seven without as controls. HIV-1 DNA and HIV-1 RNA env V1-V3 sequences in paired blood and genital samples were compared. The HSV-2 selection pressure on HIV was estimated according to the number of synonymous substitutions (dS), the number of non-synonymous substitutions (dN) and the dS/dN ratio within HIV quasi-species. HIV-1 RNA levels in cervicovaginal secretions were higher in women with HSV-2 replication than in controls (p0.02). Plasma HIV-1 RNA and genital HIV-1 RNA and DNA were genetically compartmentalized. No differences in dS, dN and the dS/dN ratio were observed between the study groups for either genital HIV-1 RNA or plasma HIV-1 RNA. In contrast, dS and dN in genital HIV-1 DNA were significantly higher in patients with HSV-2 genital reactivation (p <0.01 and p <0.05, respectively). The mean of the dS/dN ratio in genital HIV-1 DNA was slightly higher in patients with HSV-2 genital replication, indicating a trend for purifying selection (p 0.056). HSV-2 increased the genetic diversity of genital HIV-1 DNA. These observations confirm molecular interactions between HSV-2 and HIV-1 at the genital tract level.

Factors associated with pandemic influenza A/H1N1 vaccine coverage in a French cohort of HIV-infected patients.

BACKGROUND: A mass influenza A/H1N1 vaccination campaign took place in France during the 2009 winter. Overall, 7.9% of the general population was vaccinated. However, vaccine coverage data are missing for at-risk groups. METHODS: A vaccination centre was implemented for HIV-infected patients followed-up in a French University Hospital. Demographical, clinical and biological characteristics were collected. Adjusted odds ratios (aOR) were calculated to identify factors associated with being vaccinated against A/H1N1 influenza. RESULTS: A/H1N1 vaccine coverage was 44.4% (635/1430) in HIV-infected patients. In univariate analysis, uptake of vaccination was significantly associated with male gender, men who have sex with men, age ≥ 50 years, ≥ 1 seasonal influenza risk factor, longer HIV disease, longer duration of antiretroviral therapy, greater number of lines of antiretroviral treatments, lower nadir CD4, recent HIV-RNA<50 copies/ml, previous pneumococcal vaccination, > 2 visits to the unit during the study period and follow-up by a physician who assessed ≥ 100 patients/year (senior physician). CDC stage, recent CD4 count, diabetes, BMI>30 and pregnancy were not associated with vaccination. After multivariate analysis, vaccination remained significantly associated with age ≥ 50 years (aOR 1.56, CI 1.16-2.09), time since HIV diagnosis (aOR per 1 year 1.02, CI 1.00-1.04), previous pneumococcal vaccination (aOR 2.56, CI 1.96-3.34), >2 visits to the unit (aOR 5.09, CI 3.87-6.68) and follow-up by a senior physician (aOR 1.73, CI 1.20-2.48). CONCLUSION: A/H1N1 vaccination was more successful in HIV-infected patients than in the French general population. Organization of the vaccination in a convenient location and implication of the physicians seem to be determining factors for A/H1N1 acceptability in this population.

Capucin: a novel striatal marker down-regulated in rodent models of Huntington disease.

In an initial study, we compared quantitative transcriptome data across mouse brain territories using the serial analysis of gene expression method. Among the novel regional markers that we discovered, we focused on a striatum-enriched transcript with no available experimental cDNA sequence. Here, we report its cloning, gene structure, and detailed distribution in mouse brain. Quantitative RT-PCR and in situ hybridization demonstrated predominant expression in dorsolateral striatum. We therefore named it capucin for caudate-and putamen-enriched sequence. Mouse capucin is a 237-amino-acid protein, without any registered ortholog in mammalian species. It contains no recognizable motif other than two predicted carboxy-terminal transmembrane domains. When expressed in fusion with a fluorescent protein, it localized to the Golgi apparatus in two mammalian cell lines. Interestingly, we observed a significant down-regulation of capucin mRNA levels in two rodent models of Huntington disease, indicating a possible contribution to the pathogenesis of this disorder.

[Pseudo-myasthenic syndromes. Clinical and electromyographic review of 4 cases, one with an unusual reaction to lidocaine (author's transl)]. / Les syndromes pseudo-myasthéniques. Rappel clinique et électromyographique à propos de quatre cas, dont un présentant une réaction thérapeutique inhabituelle à la lidocaïne.

The authors report 4 cases of pseudo-myasthenic syndrome followed with EMG for a period varying from a few months to 4 years. They go over the electrophysiological points which led to the diagnosis: small amplitude of the muscle potential evoked by simple shock and, in particular, the phenomenon of potentiation which may reach 2000 p. 100 during repetitive stimulation at high frequencies. Study of the behaviour of the muscle potential during ischaemia, which was carried out twice, showed an absence of fatigue of the potential which may be considered a sign of disturbance at the muscle level of the motor-end plate. On the other hand, EMG signs of peripheral neuropathy, which were found 3 times, rather suggests a motor neuropathy responsible for the presynaptic block. In 3 patients guanidine had a beneficial effect and no signs of paraneoplastic aetiology had occurred yet. The fourth case, with a bronchial neoplasm discovered at autopsy, was clearly improved by injectable lidocaine, for which no explanation can be supplied.

[Corticoids in respiratory pathology]. / Les corticoïdes en pathologie respiratoire

After briefly recalling the action of corticosteroids on the normal and pathological lung, the authors review the different etiologies where they can be used in respiratory pathology.

Quality of life assessment in psychiatry: the Subjective Quality of Life Profile (SQLP)--first results of a new instrument.

This article describes early results of a new instrument for measuring quality of life--the French Subjective Quality of Life Profile (SQLP) questionnaire. This 36-item, self-administered questionnaire has been previously validated in a large sample population with somatic disorders. It is characterized by its multidimensional pattern and subjective approach (i.e., the degree of satisfaction with various domains of life, the degree of change anticipated and the importance attributed to these domains). The SQLP was tested with three psychiatric patient samples: people with depression, psychosis or substance abuse. Preliminary findings indicate that the questionnaire is useful in describing psychiatric patients, their characteristics, and explaining some of their changes.