[Impact of obstetric lesions of the levator ani on anal continence]. / Impact des lésions obstétricales du levator ani sur la continence anale.

INTRODUCTION: Vaginal delivery induces avulsion type muscle lesions and minor stretching of the levator ani muscle (LAM). Sharing the same risk factors as obstetric anal sphincter injury (OASIS), they can be concomitant. OASIS are the first risk factor for anal incontinence (AI) in women. The role of levatorian lesions in the genesis of AI is controversial. OBJECTIVE: This is a systematic review without meta-analysis aimed at clarifying the impact of LA lesions on anal continence. METHOD: According to PRISMA recommendations, carrying out a bibliographic search (2000-2022) on PubMed with the keywords: "levator ani" "anal incontinence" "obstetric trauma" and on Science Direct with the keywords "levator ani", "avulsion", "anal incontinence". One hundred and eighty articles were identified, 16 were selected.. The level of evidence was determined using the Newcastle Ottawa Scale. RESULTS: According to the different authors, the prevalence of avulsion varied from 15% to 32.2% among women who gave birth vaginally, women with LA lesions presented more LOSA (29.4% to 37.5% of patients with OASIS also had an LA lesion). For AI, LA avulsions are not an independent risk factor but are, in the presence of OASIS, an aggravating factor (OR, 23.3, 95% CI, 2.0-267.6). Double lesions would be at greater risk of long-term AI (P<0.001). CONCLUSION: LA lesions are not an independent factor of AI, although their prevalence is higher in the population of anal incontinent women; they are more frequent in women with OASIS and in this population, they are an aggravating factor for AI and a risk factor for long-term AI.

Impact of microbiological samples in the hospital management of community-acquired, nursing home-acquired and hospital-acquired pneumonia in older patients.

We investigated the positivity rate, the detection rates for non-covered pathogens and the therapeutic impact of microbiological samples (MS) in community-acquired pneumonia (CAP), nursing home-acquired pneumonia (NHAP) and hospital-acquired pneumonia (HAP) in elderly hospitalised patients. Patients aged 75 years and over with pneumonia and hospitalised between 1/1/2013 and 30/6/2013 in the departments of medicine (5) and intensive care (1) of our university hospital were included. Microbiological findings, intra-hospital mortality and one-year mortality were recorded. Among the 217 patients included, there were 138 CAP, 56 NHAP and 23 HAP. MS were performed in 89.9, 91.1 and 95.6 % of CAP, NHAP and HAP, respectively. Microbiological diagnosis was made for 29, 11.8 and 27.3 % of patients for CAP, NHAP and HAP, respectively (p = 0.05). Non-covered pathogens were detected for 8 % of CAP, 2 % of NHAP and 13.6 % of HAP (p = 0.1). The antimicrobial spectrum was significantly more frequently reduced when the MS were positive (46.7 % vs. 10.8 % when MS were negative, p = 10(-7)). The MS positivity rate was significantly lower in NHAP than in CAP and HAP. MS revealed non-covered pathogens in only 2 % of NHAP. These results show the poor efficiency and weak clinical impact of MS in the management of pneumonia in hospitalised older patients and suggest that their use should be rationalised.

[The seasonal flu vaccination among caregivers in geriatric units: Up-to-date]. / La couverture vaccinale contre la grippe saisonnière du personnel soignant en gériatrie : mise au point.

BACKGROUND: Flu vaccinations for healthcare professionals seems to be one of the most effective preventive actions in the face of a disease that carries a high risk of a potentially serious nosocomial epidemic in a geriatric environment. The aim of this study was to take stock of the flu vaccination status among caregivers in the geriatric units and to understand the reasons for their reluctance to be vaccinated, in order to put forward proposals to improve vaccination coverage. METHOD: A literature search of articles published since 2000 in the area of geriatrics, infectious diseases or pneumology was mainly conducted on PubMed using the keywords "caregivers", "elderly", "flu", "influenza", "nosocomial" and "vaccination". After reading all abstracts in English or French and ruling out irrelevant articles, only 64 relevant articles have been listed in bibliography section. RESULTS: Despite official recommendations, the literature reveals insufficient vaccination coverage of healthcare personnel at both the national and international level. Vaccination coverage seems to be lower among younger female non-medical staff. The factors that determine the likelihood of vaccination are the wish to protect one's self, one's family and patients/residents, as well as the experience of earlier bouts of flu. Factors that oppose vaccination are complex and related to the fear of side effects, the use of other preventive measures, the feeling that vaccination is ineffective, poor understanding of the disease and the vaccine, forgetfulness and problems of organization. Campaigns to promote vaccination that target healthcare professionals must be multidimensional and very incentive. The pedagogical message must be centered on the benefits to the individual and adjusted to socio-professional categories. Mobile strategies in the different departments to encourage staff are a pragmatic solution to this challenge. The referring doctor has an essential role to play, as does the occupational doctor in association with the hospital hygiene services. CONCLUSION: Flu vaccinations must be included in the education and training of caregivers.

HIV-associated disseminated histoplasmosis in western French Guiana, 2002-2012.

Disseminated histoplasmosis (DH) is the most current revelation mode of AIDS in French Guiana. We describe the clinical and paraclinical presentation of DH, diagnostic tools, evolution and factors associated with 1-year mortality in HIV-infected patients from western French Guiana. Microbiologically proven AIDS-related DH in Saint Laurent du Maroni's hospital between May 2002 and May 2012 were retrospectively included. Among the 82 patients included, 58 (71%) were male, 44 (53%) presented concurrent histoplasmosis and HIV diagnosis and 63 (80%) had a CD4 cell count under 50 cells µL(-1). Almost all patients had weight loss (97%) and fever (95%), while 84% had digestive symptoms (63% diarrhoea), 55% lymphadenopathy, and 49% respiratory symptoms. Documented and presumed locations of H. capsulatum var capsulatum (Hcc) concerned almost all organs, with a particular affinity for the bone marrow and the digestive system. Co-infections were associated in 65%. Following treatment initiation, 10 patients (13%) died within 1 month and 17 patients (25%) died within a year. DH is a polymorphous systemic mycosis with haematological and digestive tropism. Co-infections are frequent and mortality rate is high.

Incidence and risk-factors of CHOP/R-CHOP-related cardiotoxicity in patients with aggressive non-Hodgkin's lymphoma.

WHAT IS KNOWN AND OBJECTIVE: The CHOP regimen with rituximab (R-CHOP) remains the standard for chemotherapy in patients with aggressive non-Hodgkin's lymphoma (NHL). The cardiotoxicity of doxorubicin appears to be a key problem in clinical practice. We studied the cardiotoxicity of CHOP/R-CHOP regimen in a retrospective series. The prognostic factors of congestive heart failure (CHF) were investigated, including the impact of empirical cardioprotection by dexrazoxane. METHODS: Patients with an aggressive NHL between 1994 and 2005 were included. Cardiac events were defined as either a decline in resting left ventricular ejection fraction (LVEF) <50%, a decline in LVEF of ≥20% from baseline or as clinical evidence of CHF. The risk of cardiotoxicity was explored by the Kaplan-Meier method. RESULTS: The study included 180 consecutive patients. During the second period of the survey, cardioprotective therapy by dexrazoxane was administered to 45% of patients. The 5-year cumulative risks of cardiac events (29% vs. 8%) and clinical CHF (17% vs. 1·5%) varied significantly between the two periods of study (1994-2000 vs. 2001-2005). In multivariate analysis, use of dexrazoxane (HR = 0·1 [0·01-0·75], P = 0·02) and age  < 60 years (HR = 0·4 [0·17-0·9], P = 0·03) appeared as protective factors of cardiac events. WHAT IS NEW AND CONCLUSION: Our study confirmed the weight of cardiac toxic effect of CHOP ± R regimen. Even if the use of dexrazoxane is highly debatable in curative situations, it may be an effective prevention of cardiotoxicity in aggressive NHL patients.

Waking qEEG to assess psychophysiological stress and alertness during simulated on-call conditions.

INTRODUCTION: On-call schedules are associated with stress and disrupted sleep. In a recent study, under non-sleep deprived conditions, low and high-stress on-call conditions did not significantly impact sleep quality but did impact next day performance. Our aim was to determine whether quantitative electroencephalography (qEEG) would reflect changes in cortical activity in on-call conditions, predicting that the high-stress condition would display faster qEEG frequencies compared with the control and low-stress condition. METHODS: Twenty-four healthy male participants (age: 26.5 ±â€¯4.0 yrs) spent four nights in a time-isolated sleep laboratory. The within-subjects, repeated measures experimental design assessed waking EEG, via the Karolinska Drowsiness Test (KDT) during four time-points across a control day and two experimental (on-call) days. Experimental days comprised a low-stress (LS - reading task) and high-stress (HS - speech task) condition and were counterbalanced. Mixed-models analysis was used to assess condition and time by EEG biomarkers: Alpha Attenuation Coefficient (AAC), Slowing Ratio (SR) and Scaling Exponent (SE). RESULTS: Main effects were found for all three biomarkers by condition, with pairwise analysis reported. There was a significant difference in AAC between the LS condition (M = 1.26 ±â€¯=1.24) and HS condition (M = 1.01 ±â€¯0.76 p = .02) indicating decreased alertness between LS and HS. A significant increase in SR between control (M = 7.1 ±â€¯4.3) and LS (M = 10.1 ±â€¯8.5 p = .0001), and a significant increase between the LS and HS (M = 7.8 ±â€¯6.8 p = .018) showing greatest EEG slowing in the LS condition, reflecting of a passive, sleepier brain state. The SE was significantly higher in the LS (M = 1.09, ±0.17) condition compared with control (M = 1.0, ±0.11 p = .001) indicating decreased alertness in the LS task. DISCUSSION: Using qEEG biomarkers, in contrast with our initial hypothesis, the current study found that compared with control, the LS condition resulted in greater EEG slowing. These findings have implications for on-call workers who engage in periods of passive attention and highlight a protective role task stress may play in maintaining alertness levels during on-call conditions.

Micromachined phase-shifted array-type Mirau interferometer for swept-source OCT imaging: design, microfabrication and experimental validation.

OCT instruments permit fast and non-invasive 3D optical biopsies of biological tissues. However, they are bulky and expensive, making them only affordable at the hospital and thus, not sufficiently used as an early diagnostic tool. Significant reduction of system cost and size is achieved by implementation of MOEMS technologies. We propose an active array of 4x4 Mirau microinterferometers where the reference micro-mirrors are carried by a vertical comb-drive microactuator, enabling the implementation of the phase-shifting technique that improves the sensitivity and eliminates unwanted interferometric terms. We focus on the design of the imaging system, the microfabrication and the assembly of the Mirau microinterferometer, and the swept-source OCT imaging.

A dual-electrochemical cell to study the biocorrosion of stainless steel.

The presence of microorganisms on metal surfaces can alter the local physical/chemical conditions and lead to microbiologically influenced corrosion (MIC). The goal of the present work was to study the effect of a mixed aerobic-anaerobic biofilm on the behaviour of stainless steel (316 L) in underground conditions. Rather than testing different bacteria or consortia, investigations were based on the mechanisms of MIC. Mixed biofilms were simulated by the addition of glucose oxidase to reproduce the aerobic conditions and by sulphide or sulphate-reducing bacteria (SRB) for the anaerobic conditions. A double thermostated electrochemical cell has been developed to study the coupling between aerobic and anaerobic conditions. Results suggested a transfer of electrons from the stainless steel sample of the anaerobic cell to the stainless steel sample of the aerobic one. Inorganic sulphide was replaced by SRB in the anaerobic cell revealing an increase of the galvanic current which may be explained by an effect of lactate and/or acetate on the anodic reaction or by a high sulphide concentration in the biofilm. The results of this study underline that the dual-electrochemical cell system is representative of phenomena present in natural environments and should be considered as an option when studying MIC.

Anxiety disorders in children and their families.

The first- and second-degree relatives of children with anxiety disorders were compared with relatives of children with attention deficit-hyperactivity disorder and children who had never been psychiatrically ill for lifetime rates of psychopathological conditions, particularly anxiety disorders. Results from blind, diagnostic interviews indicated an increased prevalence of anxiety disorders in the first-degree relatives of children with anxiety disorder compared with relatives of both children with attention deficit-hyperactivity disorder and never psychiatrically ill children. Relationships between specific anxiety disorders in children and their relatives revealed an increased rate of panic disorder among the first-degree relatives of children with over-anxious disorder, compared with the relatives of children with separation anxiety disorder and children with other types of anxiety disorders. There also was a trend for panic disorder to be more prevalent among relatives of children with panic disorder than among relatives of children with anxiety disorder without panic. Obsessive-compulsive disorder was the only other anxiety disorder that appeared to show a similar specific relationship between children and their relatives. In general, the findings from this study suggest that there is a familial component involved in the pathogenesis of childhood anxiety disorders. The specificity of this relationship varies among individual anxiety disorders.

Developmental regulation of elastin gene expression.

Developmental regulation of elastin gene expression appears to be exerted primarily at the transcriptional level. Although the elastin gene promoter possesses features of "housekeeping" genes, these characteristics do not preclude transcriptional regulation as shown with a number of other gene promoters of this class. Direct evidence for transcriptional regulation has been obtained by nuclear run-on analysis of nuclei isolated from developing lung and aortic tissues and indirectly through elastin promoter activity in transgenic mice and transient tissue transfections of embryonic lung and aortic tissues. Although several different modulators have been proposed to control the developmental activation of elastin gene expression, only insulin-like growth factor I has been experimentally linked to increased transcription by in vivo studies. This link is specific for aortic smooth muscle cells in which cell cycle control appears intimately associated with elastogenesis. Recent studies suggest that progress in understanding developmental activation of the elastin gene lies in transgenic models and organ transfection assays that assess the direct relevancy of the modulators and cis- and trans-acting factors involved.