[Alcohol and atrial fibrillation]. / Alcool et fibrillation auriculaire.

Atrial fibrillation (AF) is the most common heart rhythm disorder, with an increasing prevalence, currently estimated at 3 % of the world population. It has long been well known, as the holiday heart syndrome, that acute alcohol consumption (binge drinking) may trigger an episode of AF, most often benign, during or immediately after consumption. Meta-analyses of observational studies have clearly shown a significant association between a high level of alcohol consumption and the risk of AF. According to the studies included in meta-analyses, the conclusions may differ regarding the association between low and moderate levels of alcohol consumption and the risk of AF. The association probably only exists from a level of consumption of at least one drink per day. Heavy alcohol consumption appears to increase the risk of complications in patients with AF, while light or moderate alcohol consumption does not. The causal nature of the relationship between alcohol consumption and AF cannot currently be confirmed or denied, given the contradictory results of Mendelian randomization studies published to date. However, in patients diagnosed with AF, the recommendation to abstain from alcohol, resulting in a strong reduction in consumption, made it possible to significantly reduce the recurrence of AF episodes.

: La fibrillation auriculaire (FA) est le trouble du rythme cardiaque le plus fréquent, avec une prévalence croissante, actuellement estimée à 3 % de la population mondiale. La consommation aiguë d'alcool («binge drinking¼) est susceptible de déclencher un épisode de FA, le plus souvent bénin, au cours ou au décours immédiat de la consommation. Les méta-analyses d'études observationnelles ont clairement montré une association significative entre un niveau élevé de consommation d'alcool et le risque de FA. Selon les études incluses dans les méta-analyses, les conclusions peuvent différer concernant l'association entre les niveaux faibles et modérés de consommation d'alcool et le risque de FA. L'association n'existe vraisemblablement qu'à partir d'un niveau de consommation d'au moins 1 verre par jour. Une forte consommation d'alcool semble augmenter le risque de complications chez les patients atteints de FA, contrairement à une consommation faible ou modérée. La nature causale de la relation entre la consommation d'alcool et la FA ne peut actuellement être ni confirmée ni infirmée, compte-tenu des résultats contradictoires des études de randomisation mendélienne publiées à ce jour. En revanche, chez des patients diagnostiqués avec une FA, la recommandation de s'abstenir d'alcool, résultant en une forte réduction de la consommation, a permis de réduire significativement les récurrences de FA.

[Motivational interviewing : a useful technique for both smoking cessation and periodontal interventions]. / L'entretien motivationnel : une technique commune au service de l'aide au sevrage tabagique et à la thérapeutique parodontale.

Tobacco is a risk factor for many chronic diseases and is the leading cause of preventable death. In the same way, periodontal diseases are one of the main chronic inflammatory diseases. The significant positive association between smoking and a higher risk of periodontitis is not any more to show and it appears that if smoking would be eliminated in this population, the risk of periodontitis would be reduced by approximately 14 %. Thus, the management of smoking cessation as well as periodontal treatment have become a public health issue. Motivational interviewing is a method of communication to support the change of health behaviour. The periodontist is then in the first position to set up a motivational interview in conjunction with smoking cessation and periodontal therapy. The taking into account of the risk factors among which tobacco is a stake for the restoration and the maintenance of periodontal health. Published evidence suggests that smoking cessation interventions are effective, highlighting the need for behavioural support in periodontal care. Motivational interviewing becomes an important part of both periodontal and smoking treatment.

Le tabac est un facteur de risque commun à nombreuses maladies chroniques; c'est la première cause de mortalité évitable. Les maladies parodontales sont l'une des principales maladies inflammatoires chroniques. L'association du tabagisme à une augmentation du risque de parodontite est bien démontrée; on estime que si le tabagisme était éliminé dans cette population, le risque de parodontite serait réduit d'environ 14 %. La prise en charge du sevrage tabagique, comme du traitement parodontal, est devenue un enjeu de santé publique. L'entretien motivationnel est une approche psychologique visant à engager les personnes dans le changement de comportement en matière de santé. Le parodontiste a une position idéale pour mettre en place un entretien motivationnel visant conjointement le sevrage tabagique et la thérapeutique parodontale. La prise en compte des facteurs de risque, dont le tabac, est un enjeu pour la restauration et le maintien de la santé parodontale. Les données publiées suggèrent que les interventions pour la cessation du tabagisme sont efficaces, soulignant ainsi la nécessité d'un soutien comportemental dans les soins parodontaux. L'entretien motivationnel devient une part importante du traitement, à la fois parodontal et tabagique.

[Intravenous leiomyomatosis]. / Die intravenöse Leiomyomatose.

Intravenous leiomyomatosis (IVLM) is an unusual neoplasm derived from uterine smooth muscle cells seen in patients with uterine leiomyomas. The typical histological features of IVLM consist of benign smooth muscle cells present within venous vascular spaces of the uterine wall. Increasing intravascular and intracardial spread of IVLM may lead to life-threatening clinical complications. Thorough pathological study of routine hysterectomy specimens may lead to the diagnosis of IVLM. Most affected patients will be cardiologically asymptomatic at the time of diagnosis. Herein, the relatively unknown clinical and morphological aspects of IVLM are presented and discussed.

Validation of a new patient-reported outcome instrument of health-related quality of life specific to patients with alcohol use disorder: the Alcohol Quality of Life Scale (AQoLS).

PURPOSE: The Alcohol Quality of Life Scale (AQoLS) is a new patient-reported outcome 34-item questionnaire measuring health-related quality of life (HRQOL), specific to patients with an alcohol use disorder, developed from the patients' perspective. This is the first report establishing evidence in support of measurement reliability and validity of the AQoLS. METHODS: A total of 285 randomly selected patients receiving interventions for alcohol use disorder in addiction specialised care settings in France were included in the study (response rate 80.1 %). Exploratory factor analysis was conducted to evaluate the hypothesised-during-development-stage dimensional structure of the AQoLS. Internal consistency of the total score and the dimensions subscores were assessed through Cronbach's alpha coefficients. Construct validity was tested through correlations with the Short-Form 36 Health Survey (SF-36) and EuroQol 5 dimensions (EQ-5D). RESULTS: Exploratory analysis indicated seven observed dimensions which differed slightly from the 7 dimensions defined a priori in the framework hypothesised during the scale development: activities, relationships, living conditions, negative emotions, self-esteem, control and sleep. A major common factor allows the summing of the 34 items to obtain a total score. All the 34 items were acceptable. Cronbach's alpha for the AQoLS total score was 0.96 and ranged from 0.8 to 0.9 for the dimensions subscores. Negative correlations between AQoLS and all dimensions of the SF-36, but general health and positive correlations between AQoLS and all items of the EQ-5D were shown. As expected, the correlations were mostly moderate in magnitude, low with scores referring to physical areas and the highest with the SF-36 MSC. CONCLUSION: This study provides evidence of the measure's psychometric properties in terms of construct validity and internal consistency. The "control" and "self-esteem" dimensions are of particular interest as these concepts are not captured in existing HRQOL. Further longitudinal validation of the scale is necessary to assess sensitivity to change.

Development of the Alcohol Quality of Life Scale (AQoLS): a new patient-reported outcome measure to assess health-related quality of life in alcohol use disorder.

PURPOSE: The development of patient-centred approaches and of reduction in consumption strategies in alcohol use disorder requires giving a larger place to qualitative assessments that are closer to patients' concerns and more clinically relevant than drinking outcomes and generic health-related quality of life instrument. Our purpose was to develop from patients input the Alcohol Quality of Life Scale (AQoLS), a disease-specific measure for alcohol use disorder (AUD). METHODS: Concept elicitation focus groups were conducted with AUD patients in the UK and France. Thematic analysis was used to identify key areas of impact of AUD, and draft items were developed to capture these issues. The draft items underwent expert review to ensure clinical and cross-cultural applicability. Two iterative rounds of cognitive debriefing interviews were conducted with AUD patients in both countries, to assess face and content validity. RESULTS: From focus groups conducted with 38 AUD patients, seven areas of impact emerged, forming the basis for the AQoLS: relationships, activities, looking after self, emotional impact, control, living conditions, and sleep. An initial pool of 90 items was reduced to 50 following the review process. In cognitive interviews, the measure took less than 10 min to complete, and patients reported that items were relevant to their experience. Following Round 1 interviews (n = 16), 14 items were removed because patients felt they were unclear or uneasy to respond to, 2 were combined, 7 were revised, and 4 new items were added. The recall period of 2 weeks was changed to 4 weeks, based on patient comments. Following Round 2 interviews (n = 15), 5 items were removed and 3 were modified to produce the 34-item AQoLS. CONCLUSION: As the only de novo measure of health-related quality of life developed specifically for AUD, the AQoLS offers the potential of increased sensitivity to show the effectiveness of therapeutic interventions from the patient's perspective.

Metal oxide resistive switching: evolution of the density of states across the metal-insulator transition.

We report the study of gold-SrTiO3 (STO)-gold memristors where the doping concentration in STO can be fine-tuned through electric field migration of oxygen vacancies. In this tunnel junction device, the evolution of the density of states (DOS) can be followed continuously across the metal-insulator transition (MIT). At very low dopant concentration, the junction displays characteristic signatures of discrete dopant levels. As the dopant concentration increases, the semiconductor band gap fills in but a soft Coulomb gap remains. At even higher doping, a transition to a metallic state occurs where the DOS at the Fermi level becomes finite and Altshuler-Aronov corrections to the DOS are observed. At the critical point of the MIT, the DOS scales linearly with energy N(ϵ)∼ϵ, the possible signature of multifractality.

[Mitral regurgitation in heart failure. Surgical therapy]. / Mitralinsuffizienz bei Herzinsuffizienz. Chirurgische Therapie.

The optimal treatment of mitral regurgitation concomitant to heart failure remains controversial. A lack of consensus between cardiologists and cardiac surgeons, because of limited studies and heterogeneous data, has led to vaguely defined guidelines and different handling in the clinical routine in the past. However, progress in the operative management with excellent results of individual experienced centers suggests that a variety of patients might benefit from surgical therapy. Each patient should be evaluated individually regarding the benefits of surgical therapy which requires an interdisciplinary approach ("heart team") due to the complex pathophysiology and demanding diagnostics.

[Maintaining opioid abstinence long after inpatient treatment with opioid substitution in an addictology hospital unit]. / Maintien de l'abstinence aux opioides à distance d'un sevrage de traitement de substitution aux opiacés réalisé en unité hospitalière d'addictologie.

OBJECTIVES: Assess the effectiveness of hospital detoxification of opiate substitution treatment (OST) in patients who failed to withdraw as outpatients. METHODS: Retrospective study, conducted among patients admitted for withdrawal of OST in an addiction unit between 2005 and 2011. Referent physicians were interviewed about outcomes at M2, M3, M6 and M12. RESULTS: 47 patients were hospitalized for OST withdrawal. The opioid abstinence rates at 2, 6 and 12 months were 60, 28 and 21 %. No death occurred within 12 months after withdrawal. The only variables significantly associated with the M3 opioids abstinence were : age at admission and among the patients admitted for buprenorphine withdrawal, a low dose of buprenorphine at admission. CONCLUSION: OST withdrawal in a specialized inpatient unit among patients with failure of outpatient withdrawal appears as an option, with an efficacy at least comparable to other methods of detoxification. It allows a comprehensive care and to prevent the risk of overdose.

[Stress and smoking in treatment-seeking smokers]. / Stress et tabagisme des consultants en tabacologie.

Fear of not controlling stress is the most frequently reported obstacle to smoking cessation. We report a retrospective study involving 70 smokers whose files were randomly selected from a smoking cessation clinic's recruitment. Stress management as a motive to smoke (SMMS) was systematically explored at the first visit, before quit date. SMMS mean score was 7.36 (+/- 2.4) on a 10 point scale. The score was higher in females than in males (p = 0,048). A multivariate logistic regression showed that SMMS was explained by two variables: physical dependence as measured with the FTND score (OR = 1.7, 95% CI = 1.18-2.46), and anxiety as measured with the HAD scale (OR = 1.27, 95% CI = 1.03-1.56). In conclusion, the high frequency and impact of perceived stress on smoking behavior call for a systematic clinical evaluation of perceived stress when engaging a treatment for smoking dependence. Our work has confirmed the importance for the smokers of perceived stress on their smoking behavior, particularly in females. Perceived stress showed a strong relationship with nicotine dependence and anxiety. Further investigation is warranted for a better understanding of the relationship between perceived stress and anxiety in smokers.

[Religion and brain functioning (part 2): does religion have a positive impact on mental health?]. / Religion et fonctionnement du cerveau (partie 2): les religions jouent-elles un rôle favorable sur la santé mentale?

Religion's impact on mental health has been largely studied, but results are often difficult to interpret due to methodological concerns: definition of religion and of spirituality ; measuring issues ; identification of specific components such as social dimension, cognitive schemas influencing world perception and meditating behaviors such as prayers. Furthermore, correlations between religious dimensions and mental health variables are too often considered as evidence of causality. Despite all those methodological problems, it appears that religiosity, defined as a global concept encompassing all aspects of religious life, might be a protective factor against several mental health problems, namely substance abuse, depression, suicide and anxiety disorders. This protective property isn't likely due to religions per se, but to associated components: risky behaviors' prevention due to shared moral standards, social support, sense of meaning, purposefulness and control, and meditation habits, exercising an inhibiting influence on chronic stress.

Electron cotunneling transport in gold nanocrystal arrays.

We describe current-voltage (I-V) characteristics of alkyl-ligated gold nanocrystals ~5 nm arrays in a long screening length limit. Arrays with different alkyl ligand lengths have been prepared to tune the electronic tunnel coupling between the nanocrystals. For long ligands, electronic diffusion occurs through sequential tunneling and follows activated laws, as a function of temperature σ∝e(-T(0)/T) and as a function of electric field I∝e(-E(0)/E). For better conducting arrays, i.e., with small ligands, the transport properties cross over to the cotunneling regime and follow Efros-Shklovskii laws as a function of temperature σ∝e(-(T(ES)/T)(1/2) and as a function of electric field I∝e(-(E)(ES)/E)(1/2). The data show that electronic transport in nanocrystal arrays can be tuned from the sequential tunneling to the cotunneling regime by increasing the tunnel barrier transparency.

Is controlled drinking an acceptable goal in the treatment of alcohol dependence? A survey of French alcohol specialists.

AIM: Assessing acceptance of controlled drinking (CD) among French alcohol specialists. METHODS: On-line survey of 547 French alcohol specialists. We searched factors associated with acceptance of CD, and factors that affected the specialists' selection of treatment goal. Criteria for success used by specialists in clinical practice were compared with criteria expected to be used in clinical trials. RESULTS: CD was accepted as a treatment goal by 48.6% of alcohol specialists (n = 105, n = 216), and 61.9% practiced CD for their own patients (n = 130, n = 210). Factors in selecting outcome goals were: patient's choice, perceived self-efficacy, relapse history and severity of dependence. Age, profession and basis of specialists' opinion on CD were associated with acceptance of CD. CONCLUSION: Half of French alcohol specialists accept CD as a goal. Acceptance was associated with specialists' personal and professional characteristics. The criteria for success specialists use in their clinical practice differ from those they expect to be used in clinical trials.

[Mindfulness based interventions for addictive disorders: a review]. / Interventions basées sur la pleine conscience en addictologie.

INTRODUCTION: In substance use disorders, the lack of empirically supported treatments and the minimal utilization of available programs indicate that innovative approaches are needed. Mindfulness based therapies have been used in addictive disorders for the last 10years. Mindfulness can be defined as the ability to focus open, non-judgmental attention to the full experience of internal and external phenomena, moment by moment. Several therapies based on mindfulness have been developed. The aim of this study is to review the existing data on the use of these programs in addictive disorders. METHODS: We have reviewed the literature published from January 1980 to January 2009, using the following keywords: mindfulness, mindfulness based stress reduction program, dialectical behavior therapy, acceptance and commitment therapy, mindfulness based cognitive therapy, addiction, substance use, alcohol and smoking. RESULTS: Results of six clinical trials evaluating four different programs were found. Five studies were controlled and four were randomized. Drop-out rates were relatively high (from 28 to 55%). In five cases out of six, the program significantly reduced substance use. In four comparative trials out of five, interventions based on mindfulness proved more effective than control conditions. The effectiveness of interventions based on mindfulness and the differential improvement across conditions became greater and was maintained during follow-up when it was long enough. Participants in mindfulness programs were less likely to endorse the importance of reducing emotions associated with smoking and reported significant decreases in avoidance of thoughts which partially mediated alcohol use reduction. Psychiatric symptoms and the level of perceived stress were also significantly reduced. DISCUSSION: Mindfulness may help substance abusers to accept unusual physical sensations that might be confused with withdrawal symptoms, decentre from a strong urge and not act impulsively. It may reduce an individual's susceptibility to act in response to a drug cue. Practice of mindfulness may develop the ability to maintain perspective in response to strong emotional states and mood fluctuations and increase the saliency of natural reinforcers. Mindfulness based programs require an intensive participation, and should therefore be proposed to highly motivated patients. In smoking cessation, they should be used in patients who were unable to quit with less intensive interventions. Some programs are specifically designed for patients with co-occurring psychiatric disorders. CONCLUSION: The first clinical studies testing mindfulness based interventions in substance use disorders have shown promising results. They must be confirmed by larger controlled randomized clinical trials. By developing a better acceptance of unusual physical sensations, thoughts about drugs and distressing emotions, mindfulness may help in reducing the risk of relapse.

Disorder-Promoted Splitting in Quasiparticle Interference at Nesting Vectors.

Inelastic interactions of quantum systems with the environment usually wash coherent effects out. In the case of Friedel oscillations, the presence of disorder leads to a fast decay of the oscillation amplitude. Here we show both experimentally and theoretically that in three-dimensional topological insulator Bi2Te3 there is a nesting-induced splitting of coherent scattering vectors which follows a peculiar evolution in energy. The effect becomes experimentally observable when the lifetime of quasiparticles shortens due to disorder. The amplitude of the splitting allows an evaluation of the lifetime of the electrons. A similar phenomenon should be observed in any system with a well-defined scattering vector regardless of its topological properties.

[Exposure of vapers to formaldehyde and acrolein: A systematic review]. / Exposition des vapoteurs au formaldéhyde et à l'acroléine : revue systématique.

Although recognized as less dangerous than conventional cigarettes, the toxicity of the electronic cigarette vapor's toxicity remains to be fully assessed. This review explores vapers' exposition to formaldehyde and acrolein. METHOD: Systematic PubMed search for reports regarding formaldehyde or acrolein or their metabolites in electronic cigarette vapor, in vapers, or in ambient air. RESULTS: Fifty-two publications were selected. Found in almost all studies on vaper, formaldehyde is 8 times out of 11 - and acrolein constantly - in lower amounts than those found in conventional cigarettes. Acrolein's metabolite is found in all studies in vapers. The concentrations of formaldehyde and/or acrolein generated during vapor production may be affected by the characteristics of the E-liquid, voltage, vaping topography, and by the flavor additives. CONCLUSION: In the current state of knowledge, we must continue to support and help smokers to quit smoking, and for those who are engaged in a harm reduction approach, to minimize the duration of their electronic cigarette use.

Varenicline versus transdermal nicotine patch for smoking cessation: results from a randomised open-label trial.

BACKGROUND: Varenicline, a new treatment for smoking cessation, has demonstrated significantly greater efficacy over placebo and sustained release bupropion (bupropion SR). A study was undertaken to compare a 12-week standard regimen of varenicline with a 10-week standard regimen of transdermal nicotine replacement therapy (NRT) for smoking cessation. METHODS: In this 52-week, open-label, randomised, multicentre, phase 3 trial conducted in Belgium, France, The Netherlands, UK and USA, participants were randomly assigned (1:1) to receive varenicline uptitrated to 1 mg twice daily for 12 weeks or transdermal NRT (21 mg/day reducing to 7 mg/day) for 10 weeks. Non-treatment follow-up continued to week 52. The primary outcome was the biochemically confirmed (exhaled carbon monoxide < or = 10 ppm) self-reported continuous abstinence rate (CAR) for the last 4 weeks of the treatment period in participants who had taken at least one dose of treatment. Secondary outcomes included CAR from the last 4 weeks of treatment through weeks 24 and 52, and measures of craving, withdrawal and smoking satisfaction. RESULTS: A total of 376 and 370 participants assigned to varenicline and NRT, respectively, were eligible for analysis. The CAR for the last 4 weeks of treatment was significantly greater for varenicline (55.9%) than NRT (43.2%; OR 1.70, 95% CI 1.26 to 2.28, p<0.001). The week 52 CAR (NRT, weeks 8-52; varenicline, weeks 9-52) was 26.1% for varenicline and 20.3% for NRT (OR 1.40, 95% CI 0.99 to 1.99, p = 0.056). Varenicline significantly reduced craving (p<0.001), withdrawal symptoms (p<0.001) and smoking satisfaction (p<0.001) compared with NRT. The most frequent adverse event was nausea (varenicline, 37.2%; NRT, 9.7%). CONCLUSIONS: The outcomes of this trial established that abstinence from smoking was greater and craving, withdrawal symptoms and smoking satisfaction were less at the end of treatment with varenicline than with transdermal NRT. TRIAL REGISTRATION NUMBER: NCT00143325.

Sleep effects of a 24-h versus a 16-h nicotine patch: a polysomnographic study during smoking cessation.

BACKGROUND AND PURPOSE: Sleep disturbance is a common symptom of tobacco withdrawal and might contribute to early relapse vulnerability in abstinent smokers. This study was designed to compare the effects on sleep of nicotine patches applied either for 24 h (Nicopatch) or 16 h (Nicorette). PATIENTS AND METHODS: During a short smoking cessation period (48 h), this open-label, randomised, two-period crossover study compared the effects on sleep of the two nicotine patches in 20 heavy smokers (9 women, 11 men). During each period, polysomnographic recordings were performed from 12 pm to 7 am for two consecutive nights (baseline and treatment nights). Smoking cessation started from 8 pm the day of the baseline sleep recordings, and treatments were applied around 8 am the following morning. RESULTS: Compared to the 16-h nicotine patch, smokers who received the 24-h nicotine patch experienced significantly less microarousals, a greater proportion of slow wave sleep, a higher REM density and higher rapid eye movement (REM) beta activities. CONCLUSIONS: The results of this study suggest that a 24-h nicotine patch is more efficient than a 16-h nicotine patch to alleviate tobacco withdrawal-induced sleep disturbances.