Impact of an ambulatory physical activity program on balance and motor abilities of retirees: a prospective study.

BACKGROUND: Given the public health problem generated by posture and gait disorders, a preventive approach is essential. OBJECTIVE: We investigated the impact of an ambulatory physical activity program (APAP) on the motor skills of retirees. METHOD: Retirees ≥60 years were recruited in this prospective study. The APAP was supported by a French regional health insurance plan. Between inclusion (T0) and 12 weeks (T1), subjects participated in an APAP (1 h/wk) that included strengthening muscular exercises, balance work, joint flexibility exercises, one-leg-balance test (OLB), stimulation of the foot arch and rise-from-the-floor (RFF). Timed-up-and-go test (TUG) duration, gait speed (GS), OLB duration and RFF success were compared between T1 and T0. RESULTS: Two hundred subjects (86% women) were enrolled; mean age was 73.8 years (45.5% ≥75 years). TUG durations (s) were lower at T1 than at T0 (8.98 and 9.64; P < .0001). The GS (m/s) and OLB durations (s) were higher at T1 than at T0 (1.26 vs 1.12 for GS, 16.16 vs 13.02 for OLB; P < .0001). The rate of participants who successfully completed RFF was higher at T1 (94%) than at T0 (76%) (P < .0001). After the APAP, TUG duration was reduced in 64.5% of cases, the GS improved in 73% of cases, OLB duration increased in 50% of cases and RFF became possible in 18.5% of cases (all P < .0001). CONCLUSION: Physical activity programs are effective for improving motor performance, even in older adults. Retirees must be encouraged to do regular physical activity to prevent or slow the functional decline associated with ageing, and to improve their overall quality of life.

The prescription of direct oral anticoagulants in the elderly: An observational study of 19 798 Ambulatory subjects.

OBJECTIVE: Direct oral anticoagulants (DOACs) are increasingly prescribed to elderly people, but the epidemiologic data for this population remains scarce. We compared the elderly population taking DOACs and those not taking DOACs (noDOAC). METHOD: We included individuals over 75 years old, affiliated to Mutualité Sociale Agricole of Burgundy (a French regional health insurance agency), who had been refunded for a prescribed DOAC between 1st and 30th September 2017. The DAOC group (DAOCG) and noDOAC group (noDOACG) were compared in terms of demographic conditions, registered chronic diseases (RCD), and number and types of prescribed drugs. In the DOACG, we compared the type of prescribing physician and laboratory monitoring for novel prescriptions (initial) and prescription refills (≥ 3 months). RESULTS: Of the 19 798 included patients, 1518 (7.7%) were prescribed DAOCs and 18 280 (92.3%) were not. Mean and median age was 85 years in the 2 groups (DOACG and noDOACG). In the DOACG, there were more men (50% vs 40.2%), more RCD (88.9% vs 68.7%) and more drugs per prescription (6 ± 2.8 vs 5 ± 2.9) (All P < .01). The DOACG also took more antihypertensive drugs. The most commonly prescribed DOACs were apixaban (42.9%) followed by rivaroxaban (38.4%) and dabigatran (18.6%). Complete blood count, serum creatinine and coagulation function tests were requested for 69.4%, 75% and 22.2%, respectively, of patients prescribed DAOCs. CONCLUSIONS: The DOACG had more RCD and drugs per prescription than the noDOACG; routine laboratory monitoring was insufficient. What's known Platelet aggregation inhibitors (low-dose) are recommended for secondary prevention of cardiovascular events in patients suffering from symptomatic atherosclerosis. The main risk of this treatment is bleeding. What's new A prescription for platelet aggregation inhibitors was found in 34% of geriatric inpatients in this prospective study. Compliance to guidelines was better for symptomatic peripheral artery disease than for primary prevention in accordance with recent publications. Geriatric comorbidities had no impact on the prescription of platelet aggregation inhibitors. Underuse of platelet aggregation inhibitors was observed in 11.3% of cases and overuse in 13.7% of cases.

Outcomes of Transcatheter Arterial Embolization with a Modified N-Butyl Cyanoacrylate Glue for Spontaneous Iliopsoas and Rectus Sheath Hematomas in Anticoagulated Patients.

PURPOSE: To assess the efficacy and safety of n-butyl cyanoacrylate methacryloxy sulfolane (NBCA-MS) transcatheter arterial embolization for anticoagulation-related soft-tissue bleeding and to evaluate predictive factors of clinical success and 30-day mortality. MATERIALS AND METHODS: A retrospective review of 50 anticoagulated patients (25 male; mean age, 71.7 y ± 14.2; range, 19-87 y) who underwent emergent Glubran 2 NBCA-MS embolization for iliopsoas hematomas (IPHs; n = 38), rectus sheath hematomas (n = 11), or both (n = 1) between 2011 and 2016 was performed. Inclusion criteria were active bleeding on computed tomography (CT) and anticoagulation. The mean number of red blood cell (RBC) units transfused was 4.8 ± 3.2 (range, 0-14), median hemoglobin level before embolization was 9.7 g/dL (range, 6.2-18 g/dL), and median "mean blood pressure" (MBP) was 62.5 mm Hg (range, 58.3-75 mm Hg). Mean International Normalized Ratio before intervention was 2.5 ± 1.5 (range, 1.0-6.9). Angiograms revealed extravasation in 44 of 50 patients (88%). Mean hematoma volume was 1,119.2 cm3 ± 863.5 (range, 134.0-3,589.0 cm3). RESULTS: Technical success was achieved in 100% of patients, and 30-day clinical success was achieved in 66% of patients. Recurrent bleeding and mortality rates within 30 days of embolization were 34% and 44%, respectively. No complications related to the embolization procedure occurred. Lower MBP (P = .003), greater number of RBC units transfused (P = .003), greater volume of hematoma (P = .04), and IPH location (P = .02) were associated with decreased clinical success. Clinical failure (P = .00002), lower MBP (P = .004), greater number of RBC units transfused (P = .002), and IPH location (P = .01) were significantly associated with higher 30-day mortality rates. CONCLUSIONS: Transcatheter arterial embolization with NBCA-MS is safe and effective in treating refractory soft-tissue bleeding in anticoagulated patients despite the high mortality rates associated with this patient population.

The prescription of antiplatelet medication in a very elderly population: An observational study in 15 141 ambulatory subjects.

OBJECTIVE: Despite the frequent use of antiplatelet medication (AM) in the elderly patients, very few studies have investigated its prescription. We describe AM prescription through retrospective study in ambulatory elderly patients. METHOD: All subjects aged over 80 years with a medical prescription delivered in March 2015 and affiliated to the Mutualité Sociale Agricole de Bourgogne. Subjects with prescriptions for AM were compared with those without. RESULTS: A total of 15 141 ambulatory elderly patients (83-89 years, 61.3% of women) were included and 4412 (29.14%) had a prescription for AM. The latter were more frequently men than those without AM (43% vs 36.93%, P < .0001) and more frequently had chronic comorbidities (77.24% vs 64.65%, P < .0001). Compared with ambulatory subjects without AM, those with AM more frequently had coronary heart disease (35.15% vs 14.49%), severe hypertension (30% vs 25.65%), diabetes (27.42% vs 20.64%), peripheral arterial diseases (16.28% vs 5.96%) and disabling stroke (9% vs 5.56% (all P < .0001). In addition, they had more prescriptions of beta-blockers (45.24% vs 36.90%), angiotensin conversion enzyme inhibitor (31.35% vs 25.44%), calcium channel blockers (33.34% vs 27.90%), nitrate derivatives (10.6% vs 6.03%) or hypolipidemic agents (HA; 49.81% vs 29.72%) (all P < .0001) than those without AM. CONCLUSION: In this study, which is very interested for its size and the advanced age of the subjects, long-course AM was prescribed in one third of ambulatory elderly patients. Coronary heart disease, severe hypertension and diabetes were more frequent in AM subjects. However, the low percentage of declared strokes was surprising. We provide additional data to doctors following subjects with AM.

Potentially inappropriate use of furosemide in a very elderly population: An observational study.

OBJECTIVE: Little is known about furosemide prescription modalities in elderly people. We describe furosemide prescription in ambulatory elderly patients. METHODS: All patients aged over 80 years, affiliated to Mutualité Sociale Agricole de Bourgogne, a French regional health insurance plan, with a medical prescription delivered in March 2015, were retrospectively included. RESULTS: Among 15 141 patients with a median age of 86 years, comprising 61.3% of women, 3937 patients (26%) had a prescription for furosemide. Severe heart failure was the most common chronic comorbidity (27.7%). Furosemide was considered a long-term therapy for almost all patients (98.7% with prescriptions for 3 months or more). Recommended indications for long-term furosemide therapy included severe heart failure (50.9%), chronic nephropathy (3%) and cirrhosis (0.1%). The furosemide prescription rate increased with age (81-85: 20.4%, 86-90: 28.5%, 91-95: 35.6%, >95: 42.7%, P<.001), and the increase was associated with a decrease in recommended heart failure therapeutics (beta-blockers, angiotensin-conversion-enzyme-inhibitors or angiotensin-receptor-blockers). Prescribers were mostly general practitioners (81.3%). Plasma electrolytes were controlled in less than a half of the patients with furosemide. CONCLUSIONS: In this large study, long-course furosemide was prescribed in a quarter of ambulatory patients. Half of those taking furosemide suffered from severe heart failure. Age was associated with a linear increase in furosemide use and a decrease in recommended heart failure therapeutic prescriptions. A large part of these prescriptions do not seem to be in accordance with recommendations.

The anticholinergic impregnation scale: Towards the elaboration of a scale adapted to prescriptions in French psychiatric settings.

PURPOSE: Some drugs have anticholinergic activity and can cause peripheral or central side effects. Several scales exist to evaluate the potential anticholinergic effect of prescribed drugs but: (i) they are validated in the elderly and mainly assess the cognitive side effect of treatments; (ii) they do not concern some of the drugs frequently used in clinical psychiatry in France. The aim of our study is to develop a new scale, the anticholinergic impregnation scale (AIS), with drugs used in France and based on an assessment of the drugs used against peripheral anticholinergic adverse effects. METHODS: We assigned a score, ranging from 1 to 3, to a list of 128 drugs with a consensus approach obtained via literature data and expert opinions. We collected data from 7278 prescriptions in 34 French psychiatric facilities: age, sex, atropinic drugs, laxatives and treatments of xerophthalmia and xerostomia, in order to evaluate the association between AIS score and the prescription of drugs aiming to reduce peripheral anticholinergic side effects. RESULTS: The most frequently prescribed drugs were cyamemazine (n=1429; 20%) and tropatepine (n=1403; 19%), two drugs marketed almost exclusively in France and with a score of 3. The frequency of patients with a high AIS score, greater than 5, was significantly higher in patients who received laxatives and treatments of xerostomia. AIS score represents the first validated solution to evaluate anticholinergic load in psychiatry settings in France. CONCLUSION: The anticholinergic problem remains underevaluated in mental health settings. In order to rule out the confounding factor of mental disease, assessment of peripheral side effects can be considered more objective than the evaluation of cognitive function in psychiatric patients. Building scales appropriate for each state also appear essential to obtain an useful and effective tool in clinical practice.

[Evaluation of the prescription of proton pump inhibitors in persons aged 75years and older in a geriatric acute-care unit]. / Évaluation de la prescription des inhibiteurs de la pompe à protons chez la personne âgée de 75 ans et plus dans un service de gériatrie aiguë.

INTRODUCTION AND OBJECTIVES: Proton pump inhibitors (PPI) are widely prescribed in France and could be responsible for adverse drug reactions especially in elderly persons (EP). In order to reduce the misuse of PPI and the excess cost to the Social Security Agency, the French health authorities (Haute Autorité de santé [HAS]) have published strict guidelines for their prescription. We conducted a study in EP to determine the proportion of PPI prescriptions outside HAS guidelines. METHOD: This was a prospective, single-centre observational study in persons aged≥75 years admitted to a geriatric acute-care unit over a period of 6months. The prevalence of prescriptions for PPI and the proportion of prescriptions outside the guidelines were calculated. The sociodemographic and medical characteristics of EP treated with PPI were studied as were the reasons for the prescription of PPI. RESULTS: Among the 818 patients hospitalized during the study period, 270 were taking PPI on admission (33%). Among these prescriptions, 60% were outside the HAS guidelines. Gastro-oesophageal reflux was the leading indication for PPI (30%), followed by dyspepsia (19%). CONCLUSION: This study confirms the high prevalence of prescriptions for PPI and their misuse. As these drugs are apparently well tolerated, prescriptions are often renewed with no medical re-evaluation.

Portal vein embolization with ethylene-vinyl alcohol copolymer for contralateral lobe hypertrophy before liver resection: safety, feasibility and initial experience.

BACKGROUND: To report our preliminary experience with preoperative portal vein embolization (PVE) using liquid ethylene vinyl alcohol (EVOH) copolymer. METHODS: Retrospectively review of patients with primary or secondary liver malignancies scheduled for extensive hepatectomy after the induction of future liver remnant (FLR) hypertrophy by right or left PVE with EVOH as the only embolic agent between 2014 and 2018 at two academic centers. Cross-sectional imaging liver volumetry data obtained before and 3-6 weeks after PVE were used to assess the FLR volume (FLRV) increase, degree of FLR hypertrophy and the FLR kinetic growth rate (KGR). RESULTS: Twenty-six patients (17 males; mean age, 58.7±11 years; range, 32-79 years) were included. The technical and clinical success rate was 100%. PVE produced adequate FLR hypertrophy in all patients. Embolization occurred in all targeted portal branches and in no non-target vessels. The %FLRV increased by 52.9%±32.5% and the degree of FLR hypertrophy was 16.7%±6.8%. The KGR was 4.4%±2.0% per week. Four patients experience minor complications after PVE which resolved with symptomatic treatment. The resection rate was 84.5%. One patient died during surgery for reasons unrelated to PVE. CONCLUSIONS: Preoperative PVE with EVOH copolymer is feasible, safe, and effective in inducing FLR hypertrophy.

Age-period-cohort analysis of stroke incidence in Dijon from 1985 to 2005.

BACKGROUND AND PURPOSE: Variations in stroke incidence could be explained by changes in vascular and environmental factors that affect the risk of stroke and changes in risk factors that are present in early life. The aim of this study was to identify and measure the effects of 3 interrelated factors, age, calendar period of stroke onset, and birth year cohort, on the incidence rates of stroke from 1985 through 2005. METHODS: Age-period-cohort models were used to analyze stroke incidence in Dijon from 1985 to 2005 from a population-based registry that collects data on all stroke patients whatever the type of management, in the public hospital, private hospitals, or at home, in the population of Dijon (150,000 inhabitants). RESULTS: For ischemic stroke, the incidence rose with time in men depending not only on age, but also on the period and cohort effects (P = 0.017). For women, the incidence only depended on age (P < 0.001; incidence rate ratio, 1.085; 95% CI, 1.081 to 1.089). For hemorrhagic stroke, the rise in the incidence with time depended only on age in men, whereas in women, it depended on age, period, and cohort effects (P = 0.019). CONCLUSIONS: Age, birth cohort, and calendar period contain relevant information to define and explain trends in stroke incidence rates over a long period.

C-reactive protein is an early predictor of septic complications after elective colorectal surgery.

BACKGROUND: Nowadays, most patients who undergo colorectal surgery are discharged early. An early predictor of septic complications could avoid readmissions and decrease morbidity. CRP could be a good predictor allowing a safe discharge. METHODS: A prospective, observational study was conducted from November 2007 to October 2008. All patients who underwent elective colorectal surgery were included. Clinical (temperature, pulse, abdominal tenderness, bowel movements) and laboratory data (C-reactive protein, leukocyte count) were recorded and evaluated as early predictors of septic complications (namely, anastomotic leaks). All detected leaks were considered fistulas, independently of their clinical significance. Clinical and inflammatory parameters were analyzed with univariate and multivariate techniques; logistic regression was performed and areas under the receiver operating characteristic curve were compared. RESULTS: A total of 133 patients were included. The overall incidence of anastomotic leaks was 15.5% and mortality was 4.5%. C-reactive protein at postoperative days 2 and 4 was a good predictor of anastomotic leak (areas under the curve were 0.715 and 0.845, respectively) and other postoperative septic complications (areas under the curve were 0.804 and 0.787), showing the highest accuracy among clinical and laboratory data. A cutoff of 125 mg/l in the level of C-reactive protein at postoperative day 4 yielded a sensitivity of 81.8% and a negative predictive value of 95.8% for the detection of anastomotic leakage. CONCLUSIONS: C-reactive protein is a simple way to ensure a safe discharge from hospital after elective colorectal surgery. Patients with CRP values >125 mg/l on the fourth postoperative day should not be discharged.

Impact of Age, Multimorbidity and Frailty on the Prescription of Preventive Antiplatelet Therapy in Older Population.

Platelet aggregation inhibitors (PAI) have widely proven their efficiency for the prevention of ischemic cardiovascular events. We aimed to describe PAI prescription in an elderly multimorbid population and to determine the factors that influence their prescription, including the impact of age, comorbidities and frailty, evaluated through a comprehensive geriatric assessment. This cross-sectional study included all patients admitted to the acute geriatric department of a university hospital from November 2016 to January 2017. We included 304 consecutive hospitalized patients aged 88.7 ± 5.5 years. One third of the population was treated with PAI. A total of 133 (43.8%) patients had a history of cardiovascular disease, 77 of whom were on PAI. For 16 patients, no indication was identified. The prescription or the absence of PAI were consistent with medical history in 61.8% of patients. In the multivariate analysis, among the 187 patients with an indication for PAI, neither age (odds ratio (OR) = 1.00; 95% confidence interval (CI): [0.91-1.08], per year of age), nor comorbidities (OR = 0.97; 95% CI: [0.75-1.26], per point of Charlson comorbidity index), nor cognitive disorders (OR = 0.98; 95% CI [0.91-1.06] per point of Mini Mental State Examination), nor malnutrition (OR = 1.07; 95% CI [0.96-1.18], per g/L of albumin) were significantly associated with the therapeutic decision. PAI were less prescribed in primary prevention situations, in patients taking anticoagulants and in patients with a history of bleeding. In conclusion, a third of our older comorbid population of inpatients was taking PAI. PAI prescription was consistent with medical history for 61.8% of patients. Age, multimorbidity and frailty do not appear to have a significant influence on therapeutic decision-making. Further research is needed to confirm such a persistence of cardiovascular preventive strategies in frail older patients from other settings and to assess whether these strategies are associated with a clinical benefit in this specific population.

The Prescription of Vitamin K Antagonists in a Very Old Population: A Cross-Sectional Study of 8696 Ambulatory Subjects Aged Over 85 Years.

We compared very elderly people taking vitamin K antagonists (VKA) and those not taking VKA (noVKA). Individuals were included in the noVKA group if there was no VKA on their reimbursed prescriptions during the study period. We also compared three subgroups, constituted by VKA type (fluindione, warfarin, or acenocoumarol). We included individuals aged over 85 years, affiliated to Mutualité Sociale Agricole of Burgundy, who were refunded for prescribed VKA in September 2017. The VKA and noVKA groups were compared in terms of demographic conditions, registered chronic diseases (RCD), number of drugs per prescription and cardiovascular medications. The three VKA subgroups were compared for the same items plus laboratory monitoring, novel and refill VKA prescriptions, and prescriber specialty. Of the 8696 included individuals, 1157 (13.30%) were prescribed VKA. Mean age was 90 years. The noVKA group had fewer women (53.67 vs 66.08%), more RCD (93.43 vs. 71.96%) and more drugs per prescription (6.65 vs. 5.18) than the VKA group (all p < 0.01). Except for direct oral anticoagulants and platelet aggregation inhibitors, the VKA group took significantly more cardiovascular medications. The most commonly prescribed VKA was fluindione (59.46%). Mean age was higher in the warfarin (90.42) than in the acenocoumarol (89.83) or fluindione (89.71) subgroups (p < 0.01). No differences were observed for sex (women were predominant) or RCD. 13% of subjects in this population had a VKA prescription. Fluindione was the most commonly prescribed VKA.

Arterial embolotherapy for endoscopically unmanageable acute gastroduodenal hemorrhage: predictors of early rebleeding.

BACKGROUND & AIMS: Severe bleeding from gastrointestinal ulcers is a life-threatening event that is difficult to manage when endoscopic treatment fails. Transcatheter embolization has been proposed but factors that influence the angiographic outcome are not well documented. We aimed to identify predictors of recurrent bleeding within 30 days after transcatheter embolization for refractory hemorrhage from gastroduodenal ulcers. METHODS: This retrospective single-center study of 60 consecutive emergency embolization procedures included hemodynamically unstable patients (41 men, 19 women; mean age, 69.4 +/- 15 y), referred from 1999 to 2008 for selective angiography after failed endoscopic treatment. Predictors of early rebleeding were tested with univariate analysis and a multivariate logistic regression model. RESULTS: The procedural success rate was 95%, the primary clinical success rate was 71.9% (41 of 57), and secondary clinical success was achieved in 3 patients (77.2%) after repeat embolization. No major catheterization-related complications occurred. Periprocedural mortality was 26.7% (16 of 60). Early bleeding recurrence was associated with coagulation disorders (P = .007), longer time to angiography (P = .0005), greater preprocedural blood transfusion volume (P = .0009), 2 or more comorbidities (P = .005), and use of only coils (P = .003). Two factors were independent predictors of embolization failure: coagulation disorders (odds ratio, 6.18; P = .027) and the use of coils as the only embolic agent (odds ratio, 6.24; P = .022). The median follow-up time was 7 months (range, 1 day to 103 months). CONCLUSIONS: Angiographic embolization should be performed early in the course of bleeding, and not with coils alone, in critically ill patients. It is important to correct coagulation disorders throughout the embolization procedure.

Prognostic factors in stage D heart failure in the very elderly.

BACKGROUND: The clinical characteristics of frail older patients with advanced heart failure have scarcely been studied. OBJECTIVE: To describe this population and to identify some prognostic factors of mortality. METHODS: 104 patients aged 75 years and older hospitalized with refractory heart failure were enrolled in a prospective multicentric study. RESULTS: Mean age was 87.2 +/- 5.3 years. Dyspnea (79.8%), crepitant rales (76.9%) and peripheral edema (73.1%) were particularly frequent. Signs of low cardiac output such as renal insufficiency (46.9%), cutaneous low flow (40.4%), and systolic hypotension (< or =100 mm Hg) (24.3%) were observed less often. Signs of cognitive impairment including anxiety (55.4%), sleep disorders (43.7%) and delirium (35.5%) were frequent. Asthenia and chronic pain were noted in 92.3 and 37.5% of cases, respectively. Mortality rates were 32.7, 59.6 and 71.2% during hospitalization, at 6 months and at 12 months, respectively. According to the multivariate Cox model, six significant factors suggesting a poor prognosis were observed: chronic renal insufficiency, past neuropsychological pathology, long-term treatment with nitrates, presence of edema, low cutaneous flow, and pain. The ability to sit on a chair was the only significant factor associated with a good prognosis. CONCLUSION: Our study identified some clinical and prognostic factors which had been observed in very old patients with refractory heart failure. Pain management has to be a priority in these patients in order to improve their quality of life.

Covalent modifications of antitetanus F(ab')2 fragments with natural and synthetic polyamines and their effects on the antibody endocytosis in cultured HL60 cells.

For antibody therapeutics to succeed when intracellular target molecules are involved, a strategy must be applied to increase the delivery of antibodies into cells to reach their targets. Antibody cationization by chemical conjugation of a polyamine could be one such strategy. Both natural polyamines with increasing net charge valencies (putrescine, PUT; spermidine, SPD; and spermine, SPM) and a synthetic polyamine (hexamethylenediamine, HMD) can be used to cationize antibodies, but no comparison of the respective effects of these polyamines on intracellular delivery of antibodies has been performed yet. This study describes the covalent modification of antitetanus F(ab') 2 with these four polyamines using different reaction conditions, and compares the effects of these modifications on antibody interaction with cultured HL60 cells. The cationized antibodies retained > or =80% of the binding activity of the unmodified F(ab') 2 with regard to tetanus toxin, as measured by an antigen-binding capture enzyme immunoassay. This same method was used to quantify the amount of cell-associated F(ab') 2 following incubation with HL60 cells. Cationization was shown to enhance cell interaction of the F(ab') 2 : the higher the number of coupled polyamine molecules, the greater the amount of antibody associated with the cells. Moreover, coupling the F(ab') 2 to the SPD and SPM polyamines had greater effect on cell interaction than coupling the F(ab') 2 to the PUT and HMD diamines. Internalization of the cationized antibodies by the HL60 cells was demonstrated by confocal microscopy. This technique also showed that SPD and SPM were more effective than PUT and HMD in terms of intracellular delivery of the F(ab') 2 . It follows from all these results that electrostatic interaction involving charge density plays a predominant role in the endocytic transport mechanism of the F(ab') 2 modified with these polyamines. However, coupling the F(ab') 2 to SPM and SPD yielded the same maximum effects in terms of cell interaction, although coupling SPM was expected to increase the antibody net charge valency more than coupling SPD. This finding suggests that the effective global charge for the cell interaction and uptake of polyamine-modified antibodies does not simply correspond to the addition of the ionizable amine functions on the coupled polyamines, and that other factors may come into play.

Corneal endothelial cell changes after trabeculectomy and deep sclerectomy.

PURPOSE: To compare the effect of trabeculectomy and deep sclerectomy on the corneal endothelium. METHODS: This prospective comparative study investigated 62 eyes of 62 patients scheduled for a single trabeculectomy (n=18), a single deep sclerectomy (n=14), a combined trabeculectomy and phacoemulsification (n=11), or a combined deep sclerectomy and phacoemulsification (n=19). Exclusion criteria were history of corneal disease, ocular trauma, inflammation, or previous glaucoma or cataract surgery. Preoperative, 3-month and 1-year postoperative noncontact specular microscopies were performed on central and superior corneas. Endothelial cells were counted with a computer-assisted analyzer. RESULTS: In central cornea, a statistically significant postoperative endothelial cell loss was found after trabeculectomy and deep sclerectomy (alone and combined with cataract extraction) at 3 and 12 months. Cell loss was 7% after penetrating surgery and 2.6% after nonpenetrating surgery (noncombined surgeries). This difference in cell loss was statistically significant. Cell loss increased significantly over the course of the study at 12 months (9.6% and 4.5%, respectively). Cell loss was also significantly higher after trabeculectomy than sclerectomy in upper cornea only in noncombined surgeries. No statistically significant difference in coefficient of variation of cell size (CV) and percentage of cell hexagonality (Hex %) was noted. CONCLUSIONS: Endothelial cell loss was moderate 3 and 12 months after glaucoma surgery. However, it was greater after trabeculectomy, suggesting less corneal damage after deep sclerectomy. This observation deserves further clinical study.

Multidisciplinary management in geriatric day-hospital is beneficial for elderly fallers: a prospective study of 28 cases.

We determined whether management including medical, psychological, and physiotherapeutic approaches, over a period of 6 weeks, has a beneficial effect on motor abilities, psychological status, and independence of elderly fallers with psychomotor disadaptation syndrome (PDS). We included 28 subjects (mean age 81.4 years). They were assessed from a medical, motor, and psychological point of view at both the inclusion and the end of the multidisciplinary intervention. A follow-up was conducted with multidisciplinary assessment at 6 and 9 months after the beginning of the study in order to evaluate duration of benefits of the management. The statistical analysis concerned only subjects who took part in the total multidisciplinary program, i.e., 14 subjects. The multidisciplinary intervention had an overall positive impact on motor abilities as shown by the increase in the mini-motor test scores, the rate of success in rising from the floor and decrease of time for the dual task. This study also showed a reduction in the fear of falling and a decrease in the rate of fallers. This positive effect on motor abilities, fear of falling and rate of fallers was sustained until 9 months after the beginning of the multidisciplinary management. This study shows the importance of a multidisciplinary management of elderly fallers with PDS.

A new formula for correction of total calcium level into ionized serum calcium values in very elderly hospitalized patients.

Ionized calcium (Ca(2+)) seems to be the best measure of active serum calcium but, in France, numerous laboratories do not have Ca(2+) analyzers so that numerous clinicians use Payne's formula to obtain adjusted calcium (Ca(Ad)) values. In frail very elderly patients with protein/energetic malnutrition and very low concentrations of albumin, "correction" with Payne's formula usually gives false hypercalcemic results, so that hypocalcemia may be seriously underdiagnosed. Two hundred and ninety-four patients of 80 years and older with serum albumin level < 35 g/l were included in four French hospitals for elderly people. Biological measurements were standardized in order to determine Ca(2+) and total calcium (Ca(T)) in accordance with approved guidelines. Ca(Ad) was calculated with Payne's formula whereas the dependence of Ca(2+) with serum protein, albumin and Ca(Ad) was investigated by linear regression, the goodness-of-fit of each equation with the measure of Ca(2+) being studied. Taking into account serum protein and albumin levels, multiple linear regression gave the equation: Ca(2+) (mmol/l)=0.188-0.00469 protein (g/l)+0.0110 albumin (g/l)+0.401 Ca(Ad) with r(2)=0.442. The relative difference between the measure and the value given by the equation did not depend upon the center, and the correlation between measured and computed values of Ca(2+) was better, for any group, with our formula than with Payne's formula. When Ca(2+) was expressed with Ca(T) instead of Ca(Ad), albumin term was no longer significant and the new equation was: Ca(2+) (mmol/l)=0.592-0.00449 protein (g/l)+0.410 total calcium (mmol/l) with r(2)=0.438. We propose an alternative to direct measurement of Ca(2+) with a simple formula usable in geriatric units, which are often deprived of high-performance equipment.

Success rates in smoking cessation: Psychological preparation plays a critical role and interacts with other factors such as psychoactive substances.

INTRODUCTION: The aim of this study was to identify factors associated with the results of smoking cessation attempts. METHODS: Data were collected in Clermont-Ferrand from a smoking cessation clinic between 1999 and 2009 (1,361 patients). Smoking cessation was considered a success when patients were abstinent 6 months after the beginning of cessation. Multivariate logistic regression was used to investigate the association between abstinence and different factors. RESULTS: The significant factors were a history of depression (ORadjusted = 0.57, p = 0.003), state of depression at the initial consultation (ORa = 0.64, p = 0.005), other psychoactive substances (ORa = 0.52, p<0.0001), heart, lung and Ear-Nose-Throat diseases (ORa = 0.65, p = 0.005), age (ORa = 1.04, p<0.0001), the Richmond test (p<0.0001; when the patient's motivation went from insufficient to moderate, the frequency of abstinence was twice as high) and the Prochaska algorithm (p<0.0001; when the patient went from the 'pre-contemplation' to the 'contemplation' level, the frequency of success was four times higher). A high score in the Richmond test had a greater impact on success with increasing age (significant interaction: p = 0.01). In exclusive smokers, the contemplation level in the Prochaska algorithm was enough to obtain a satisfactory abstinence rate (65.5%) whereas among consumers of other psychoactive substances, it was necessary to reach the preparation level in the Prochaska algorithm to achieve a success rate greater than 50% (significant interaction: p = 0.02). CONCLUSION: The psychological preparation of the smoker plays a critical role. The management of smoking cessation must be personalized, especially for consumers of other psychoactive substances and/or smokers with a history of depression.

Stiripentol in childhood partial epilepsy: randomized placebo-controlled trial with enrichment and withdrawal design.

Stiripentol, a new antiepileptic drug inhibiting cytochrome P450-enzymes, suggested some efficacy when combined with carbamazepine in an open trial in refractory partial epilepsy of childhood. Our objective was to test these results in a placebo-controlled trial. To limit the number of patients included, we used an enrichment and withdrawal design. Among the 67 children entered in a 4-month open add-on stiripentol study following a 1-month single-blind placebo baseline, the 32 responders were randomized for 2 months either to continue stiripentol (n = 17) or to withdraw to placebo (n = 15). If seizures increased by at least 50% after randomization compared with baseline, the patients dropped out (primary end point): there were six patients on stiripentol and eight patients on placebo (not significant). However, a decrease in seizure frequency compared with baseline (secondary end point) was greater on stiripentol (-75%) than on placebo (-22%) (P < .025). Twelve patients experienced at least one adverse event on stiripentol (71%) compared with four patients on placebo (27%); none were reported as severe. The combination of stiripentol and carbamazepine proved to reduce seizure frequency in children with refractory partial epilepsy, although it failed to show a significant impact according to the escape criteria selected as the primary end point in the present study, for ethical reasons.