Remote Design of a Smartphone and Wearable Detected Atrial Arrhythmia in Older Adults Case Finding Study: Smart in OAC - AFNET 9.

Introduction: Screening for atrial fibrillation and timely initiation of oral anticoagulation, rhythm management, and treatment of concomitant cardiovascular conditions can improve outcomes in high-risk populations. Whether wearables can facilitate screening in older adults is not known. Methods and Analyses: The multicenter, international, investigator-initiated, single-arm case-finding Smartphone and wearable detected atrial arrhythmia in older adults case finding study (Smart in OAC - AFNET 9) evaluates the diagnostic yield of a validated, cloud-based analysis algorithm detecting atrial arrhythmias via a signal acquired by a smartphone-coupled wristband monitoring system in older adults. Unselected participants aged ≥65 years without known atrial fibrillation and not receiving oral anticoagulation are enrolled in three European countries. Participants undergo continuous pulse monitoring using a wristband with a photo plethysmography (PPG) sensor and a telecare analytic service. Participants with PPG-detected atrial arrhythmias will be offered ECG loop monitoring. The study has a virtual design with digital consent and teleconsultations, whilst including hybrid solutions. Primary outcome is the proportion of older adults with newly detected atrial arrhythmias (NCT04579159). Discussion: Smart in OAC - AFNET 9 will provide information on wearable-based screening for PPG-detected atrial arrhythmias in Europe and provide an estimate of the prevalence of atrial arrhythmias in an unselected population of older adults.

Smartphone and wearable detected atrial arrhythmias in Older Adults: Results of a fully digital European Case finding study.

Aims: Simplified detection of atrial arrhythmias via consumer-electronics would enable earlier therapy in at-risk populations. Whether this is feasible and effective in older populations is not known. Methods and results: The fully remote, investigator-initiated Smartphone and wearable detected atrial arrhythmia in Older Adults Case finding study (Smart in OAC-AFNET 9) digitally enrolled participants ≥65 years without known atrial fibrillation, not receiving oral anticoagulation in Germany, Poland, and Spain for 8 weeks. Participants were invited by media communications and direct contacts. Study procedures adhered to European data protection. Consenting participants received a wristband with a photoplethysmography sensor to be coupled to their smartphone. The primary outcome was the detection of atrial arrhythmias lasting 6 min or longer in the first 4 weeks of monitoring. Eight hundred and eighty-two older persons (age 71 ± 5 years, range 65-90, 500 (57%) women, 414 (47%) hypertension, and 97 (11%) diabetes) recorded signals. Most participants (72%) responded to adverts or word of mouth, leaflets (11%) or general practitioners (9%). Participation was completely remote in 469/882 persons (53%). During the first 4 weeks, participants transmitted PPG signals for 533/696 h (77% of the maximum possible time). Atrial arrhythmias were detected in 44 participants (5%) within 28 days, and in 53 (6%) within 8 weeks. Detection was highest in the first monitoring week [incidence rates: 1st week: 3.4% (95% confidence interval 2.4-4.9); 2nd-4th week: 0.55% (0.33-0.93)]. Conclusion: Remote, digitally supported consumer-electronics-based screening is feasible in older European adults and identifies atrial arrhythmias in 5% of participants within 4 weeks of monitoring (NCT04579159).

[Spinal infections: typical and atypical imaging features]. / Infections rachidiennes: aspects typiques et atypiques.

While the imaging features of established spondylodiscitis are well known, other presentations may be misleading. The purpose of this article is to review the typical imaging features of spondylodiscitis as well as some more atypical and unusual imaging features (early spondylodiscitis, sceptic spondylitis, septic arthritis of facet joints, primary epidural abscess, unusual germs, neonate).

[Enterococcal bacteremia at Nîmes university hospital]. / Bactériémies à Enterococcus spp.: étude prospective au CHU de Nîmes.

PURPOSE OF THE STUDY: The aim of this study was the description of enterococcal bacteremia and the evaluation of their resistance evolution to antibiotics and the virulence profile of these isolates. PATIENTS AND METHODS: We have studied all the bacteremia caused by Enterococcus spp. from the 1st of July 2003 until the 30th of June 2004 at Nîmes university hospital. For each isolate, population, clinical and microbiological data were collected. Multiplex PCR allowed for the identification of glycoprotein resistant phenotypes and furthermore, to identify the main virulence genes found in the enterococci. RESULTS: Thirty-three strains were identified from 33 patients (60.6% male) with a median age of 68 years (median: 3-96). The vital prognostic was calculated in 63.6% of the cases (MacCabe > or =1); seven patients died during their hospitalization (21.2%). The infections were nosocomial in 60.6% of the cases. No epidemic was observed. The principal comorbidities were cardiovascular and digestive pathologies. In addition, 54.5% of patients had had a surgical intervention. Enterococcus faecalis (87.9%) was the cause of infection in the majority of cases followed by Enterococcus faecium. Most of the infections were monomicrobial (75.8%). E. faecalis was sensitive to amoxicillin and to glycopeptides but was resistant to norfloxacin, erythromycin and pristinamycin. The same observations were made for the E. faecium with the exception of amoxicillin. E. faecalis had the maximum number of virulence genes and E. faecium the least. CONCLUSION: The enterococcal bacteremia had mainly a nosocomial origin. The isolates came from digestive tract flora but also from catheters. The mortality rate was 21.2%. A developing sensitivity to erythromycin and pristinamycin was observed in comparison to the data of the ONERBA (2002-2003). Only one isolate was resistant to glycopeptide. This was the first European E. faecium containing the vanD allele. This isolate proved fatal to the patient. The dark evolution of enterococcal bacteremia and their frequent nosocomial origin induce to promote studies intended for better knowing the risk factors of such infections.

Lumbar hernia: anatomical route assessed by computed tomography.

Lumbar hernia is classically described as arising from the superior (Grynfeltt's) lumbar triangle or the inferior (Jean-Louis Petit's) lumbar triangle. The present anatomical study based on a computed tomography examination performed in a patient with lumbar hernia, has led to the suggestion that lumbar hernias cross the lumbar wall through a musculoaponeurotic tunnel, whose deep and superficial openings are the superior and inferior lumbar triangles, respectively.

Effect of 10%, 30%, and 60% body weight traction on the straight leg raise test of symptomatic patients with low back pain.

STUDY DESIGN: Single group test-retest repeated measures. OBJECTIVES: To determine the effects of lumbar traction with 3 different amounts of force (10%, 30% and 60% body weight) on pain-free mobility of the lower extremity as measured by the straight leg raise (SLR) test. BACKGROUND: There are several recommendations on how lumbar traction should be performed, but the duration, frequency, force, and type of technique to be applied differ among the sources. METHODS AND MEASURES: Ten subjects with subjective complaints of low back pain or radicular symptoms with a positive unilateral SLR test below 45 degrees participated in this study. The pain-free mobility of the lower extremity in the SLR test position was measured prior to and immediately following 5 minutes of static traction in the supine position. Random assignment in the order of the amount of applied traction was implemented. RESULTS: The straight leg raise measurements were found to be significantly greater immediately following 30% and 60% of body weight traction as compared to pretraction and 10% of body weight traction. The mean (SD) SLR measurements were pretraction (24.1 degrees +/- 13.0), 10% of body weight traction (27.4 degrees +/- 14.5), 30% of body weight traction (34.0 degrees +/- 14.3), 60% of body weight traction (36.5 degrees +/- 15.8). CONCLUSIONS: The results of this study indicate that traction in this group of patients improved the mobility of the lower extremity during the SLR test. Both 30% and 60% of body weight tractions were shown to be effective for increasing motion beyond pretraction levels.

Validation of the insulin sensitivity index (ISI(0,120)): comparison with other measures.

The purpose of this study was to explore possible calculations using oral glucose tolerance test (OGTT) values in order to develop a simple measure of insulin sensitivity. We devised a formula for an insulin sensitivity index, ISI(0,120), that uses the fasting (0 min) and 120 min post-oral glucose (OGTT) insulin and glucose concentrations. It appears to be generalizable across a spectrum of glucose tolerance and obesity. Most importantly, our data show that ISI(0,120) correlates well, when applied prospectively in comparative studies, with the insulin sensitivity index obtained from the euglycemic hyperinsulinemic clamp (r = 0.63, P < 0.001). This correlation was demonstrably superior to other indices of insulin sensitivity such as the HOMA formula presented by Matthews, and performed comparably to the computerized HOMA index. Measurement of insulin sensitivity has traditionally been possible only in research settings because of the invasiveness and expense of the methods used. Clinical investigators have therefore sought more practical methods to obtain an index of insulin sensitivity. Such an index should approximate insulin sensitivity as measured by the euglycemic hyperinsulinemic clamp (M). We present ISI(0,120), a simple yet sensitive measure of insulin sensitivity which is adaptable for use in clinical settings as well as large epidemiologic studies.

[Discovery of a focus of intestinal bilharziasis in te Republic of Djibouti]. / Découverte d'un foyer de bilharziose intestinale en République de Djibouti.

An unprecedented pocket of intestinal schistosomiasis was discovered in the Republic of Djibouti in 1997. The first cases were diagnosed in French and Djiboutian tourists who presented initial symptoms of bilharzian infection after bathing in the fresh-water basin under Hassan Gari Bira Falls, near Randa. Seventeen cases were subsequently confirmed by detection of anti-schistosome antibodies using indirect hemagglutination (IH) and indirect immunofluorescence (IIF) and/or detection of Schistosoma mansoni eggs in the stool. Further testing was performed in 35 village inhabitants, mostly children, who had been exposed by bathing in the basin. The IH reaction was positive in 28 patients (80 p. 100) including 17 (49 p. 100) with levels greater than 1/64. In 92 p. 100 of cases, IH findings were confirmed by IIF which indicated that association with hypereosinophilia was common. Schistosoma mansoni eggs were found in stools from 7 patients (19 p. 100) who generally displayed mild hypereosinophilia. Information concerning the zone of risk was distributed and control measures were undertaken as widely as possible in Djibouti and abroad.

Spontaneous intracranial hypotension: report of four cases and review of the literature.

Spontaneous intracranial hypotension is an unusual syndrome of postural headache and low cerebrospinal fluid pressure without an established cause. We present four cases, analyze those previously reported in the literature, examine the MRI, CT, angiographic and cisternographic finding and discuss the clinical picture, proposed pathophysiologic mechanisms and potential treatment.

Absence of the supraclinoid internal carotid artery in association with intracranial aneurysms.

We report a case of absence of the supraclinoid segment of the left internal carotid artery associated with hypoplasia of the ipsilateral internal carotid artery and anterior communicating artery aneurysm formation. We discuss the embryology probably responsible for this anatomical variant and show the imaging findings.

Health-damaging personality traits and verbal-autonomic dissociation: the role of self-control and environmental control.

This study tested predictions derived from D.C. Glass's (1977) uncontrollability model regarding the link between control-related personality attributes and the dissociation of affective and autonomic responses to stress. Pressured drive, measured by the Jenkins Activity Survey (D. S. Krantz, D. C. Glass, & M. L. Snyder, 1974), and emotional defensiveness, measured by the Marlowe-Crowne Social Desirability Scale (D. P. Crowne & D. Marlowe, 1964), were examined in relation to cardiovascular and affective responses to mental arithmetic in 31 male and 26 female college students. Pressured drive was positively associated with cardiovascular reactivity but unrelated to affect ratings. In contrast, emotional defensiveness was unrelated to cardiovascular reactivity, but high scores were associated with smaller increases in self-reported negative affect. The findings suggest that these potentially health-damaging personality attributes may influence stress response measures through independent mechanisms for maintaining environmental control and self-control.

MR of spinal meningeal melanocytoma.

We report an unusual case of meningeal melanocytoma, a rare pigmented lesion of the leptomeninges, that occurred within the leptomeninges of the thoracic spinal canal. The lesion showed increased signal intensity on T1-weighted MR images relative to gray matter, was isointense with gray matter on T2-weighted images, and enhanced mildly but homogeneously after administration of contrast material.

Cystic papillary adenocarcinoma of the submandibular gland in a child.

A 12-year-old boy reported that a mass in his left jaw had been growing slowly for 8 months. Axial and coronal contrast-enhanced spiral CT showed a 5-cm cystic mass within an enhancing, mildly enlarged submandibular gland. Excisional biopsy revealed a cystic papillary adenocarcinoma of the left submandibular gland, very rare in children.

MR demonstration of Wegener granulomatosis of the infundibulum, a cause of diabetes insipidus.

We report a case of Wegener granulomatosis causing hyperprolactinemia followed by central diabetes insipidus. The initial T1-weighted MR image showed an isointense heterogeneous sellar mass. After the onset of diabetes insipidus, repeat sagittal and postcontrast T1-weighted images showed marked infundibular thickening, enlargement of the sellar mass, and enhancement of both the infundibulum and hypothalamus. Follow-up MR after marked clinical response to corticosteroids showed nearly complete resolution of the aforementioned abnormalities.