Combining balneotherapy and health promotion to promote active and healthy ageing: the Balaruc-MACVIA-LR® approach.

Scaling up and replication of successful innovative integrated care models for chronic diseases is one of the targets of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA). MACVIA-LR® (MAladies Chroniques pour un VIeillissement Actif en Languedoc-Roussillon) is a Reference Site of the EIP on AHA. The main objective of MACVIA-LR® is to develop innovative solutions in order to (1) improve the care of patients affected by chronic diseases, (2) reduce avoidable hospitalization and (3) scale up the innovation to regions of Europe. The MACVIA-LR® project also aims to assess all possible aspects of medicine-including non-pharmacologic approaches-in order to maintain health and prevent chronic diseases. These approaches include hydrotherapy and balneotherapy which can be of great importance if health promotion strategies are considered. Balneotherapy at Balaruc-les-Bains focusses on musculoskeletal diseases and chronic venous insufficiency of the lower limbs. Each year, over 46,000 people attend an 18-day course related to a new falls prevention initiative combining balneotherapy and education. On arrival, each person receives a flyer providing information on the risk of fall and, depending on this risk, a course is proposed combining education and physical activity. A pilot study assesses the impact of the course 6 and 12 months later. This health promotion strategy for active and healthy ageing follows the FEMTEC (World Federation of Hydrotherapy and Climatotherapy) concept.

A comprehensive rehabilitation program improves disease severity in patients with obstructive sleep apnea syndrome: a pilot randomized controlled study.

BACKGROUND: Exercise training may improve components of metabolic syndrome and obstructive sleep apnea syndrome (OSAS). The objective of our pilot randomized controlled study was to determine the benefits of a short intensive inpatient individualized exercise training (IET) program in sedentary untreated OSAS patients. METHODS: Twenty-two sedentary patients with moderate to severe OSAS were randomly assigned either to one-month education activity sessions (n=11; control group) or to inpatient rehabilitation program (n=11), including IET, education activities sessions, and dietary management. Full polysomnography (PSG), OSLER (Oxford Sleep Resistance test), body composition, anthropometric measurements, metabolic syndrome components, and questionnaires were performed at baseline and at study end point. RESULTS: No changes occurred in the control group in all variables. Compared to controls, participants randomized to the IET group presented a significant decrease in apnea-hypopnea index (AHI) (40.6±19.4 vs. 28.0±19.3; P<0.001), oxygen desaturation index (ODI), and arousal index, which occurred in conjunction with significant decrease in body mass index (BMI), neck circumference, fat mass, fasting glucose, and diastolic blood pressure. Increased sleep latency was found in participants in the IET group with altered values at baseline. CONCLUSIONS: IET reduced OSAS severity with improvement of metabolic syndrome components with concomitant loss in body fat in sedentary adults. If confirmed on a larger scale, a comprehensive rehabilitation program could constitute an additional or alternative treatment for moderate to severe OSAS patients.

Effect of a high dose of simvastatin on muscle mitochondrial metabolism and calcium signaling in healthy volunteers.

Statin use may be limited by muscle side effects. Although incompletely understood to date, their pathophysiology may involve oxidative stress and impairments of mitochondrial function and of muscle Ca(2+) homeostasis. In order to simultaneously assess these mechanisms, 24 male healthy volunteers were randomized to receive either simvastatin for 80 mg daily or placebo for 8 weeks. Blood and urine samples and a stress test were performed at baseline and at follow-up, and mitochondrial respiration and Ca(2+) spark properties were evaluated on a muscle biopsy 4 days before the second stress test. Simvastatin-treated subjects were separated according to their median creatine kinase (CK) increase. Simvastatin treatment induced a significant elevation of aspartate amino transferase (3.38±5.68 vs -1.15±4.32 UI/L, P<0.001) and CK (-24.3±99.1±189.3 vs 48.3 UI/L, P=0.01) and a trend to an elevation of isoprostanes (193±408 vs 12±53 pmol/mmol creatinine, P=0.09) with no global change in mitochondrial respiration, lactate/pyruvate ratio or Ca(2+) sparks. However, among statin-treated subjects, those with the highest CK increase displayed a significantly lower Vmax rotenone succinate and an increase in Ca(2+) spark amplitude vs both subjects with the lowest CK increase and placebo-treated subjects. Moreover, Ca(2+) spark amplitude was positively correlated with treatment-induced CK increase in the whole group (r=0.71, P=0.0045). In conclusion, this study further supports that statin induced muscular toxicity may be related to alterations in mitochondrial respiration and muscle calcium homeostasis independently of underlying disease or concomitant medication.

Higher plasma n-3 fatty acid status in the moderately healthy elderly in southern Québec: higher fish intake or aging-related change in n-3 fatty acid metabolism?

The elderly reportedly have a significantly higher % of eicosapentaenoic (EPA) and docosahexaenoic (DHA) acids in plasma and red cell lipids. However, these observations are from a few small studies and the health status of the elderly in these studies is for the most part unclear. Since the elderly are susceptible to cardiovascular and neurological illnesses that seem to be related in part to lower intake of n-3 fatty acids it seems paradoxical that their blood levels of EPA and DHA would be higher than in young adults. We report here plasma fatty acid profiles and their response to supplementation with two types of fish oils from several of our recent studies in the moderately healthy elderly. We define the moderately healthy elderly as those who were in good physical condition, had no cognitive decline and, if present, in whom hypothyroidism, hyperlipidemia and/or hypertension were well-controlled. As shown previously, we confirm the higher % EPA and % total n-3 fatty acids (but not DHA) in fasting plasma and extend these findings to include higher plasma concentrations (mg/L) of n-3 fatty acids as well. The EPA-predominant supplement raised DHA only in the young, whereas the DHA-predominant supplement raised EPA more in the young than in the elderly. The moderately healthy elderly clearly have higher plasma n-3 fatty acids but whether this reflects differences in intake versus aging-related changes in n-3 fatty acid metabolism remains to be elucidated.

Effects of a supplementation during exercise and recovery.

The present study was designed to investigate whether a protein hydrolysate enriched in branched chain amino acids and antioxidants, trace and mineral elements, and vitamins would affect performance and fatigue. Eighteen sportsmen underwent testing before and after 28 days supplementation with either treatment in protein hydrolysate or placebo. Testing included exhaustive aerobic and anaerobic exercises with determination of blood lactate concentration through exercise and recovery and antioxidant status, but also measurements of maximal oxidative capacity (V. (max)) and citrate synthase activity (CS) from a resting muscle biopsy. Protein hydrolysate resulted in a significant decrease in fatigue indices, without affecting performances. A significant increase in enzymatic antioxidant and a decrease in oxidative damage were observed at rest after treatment but not with a placebo. Decrease in maximal blood lactate and improvement of blood lactate removal were only observed after protein hydrolysate treatment. Furthermore, CS increased significantly, whereas no change was observed in V. (max). In conclusion, this protein hydrolysate treatment induced adaptations that may promote a decrease in fatigue during exercises, potentially explained by changes in parameters used to represent oxidative damage and antioxidant status at rest and changes in lactate metabolism.

[Dental extraction in patients with bleeding disorders. Proposal of a protocol based on the type of anesthesia used]. / Extractions dentaires chez les patients porteurs d'un trouble de l'hémostase. Proposition d'un protocole basé sur le type d'anesthésie nécessaire.

INTRODUCTION: The authors propose a protocol to avoid bleeding complications in patients with bleeding disorders. MATERIAL AND METHOD: When a general anesthesia or trunk nerve infiltration is indicated, clotting factor concentrates are to be used in patients with severe bleeding disorders. Desmopressin is to be used in patients with mild bleeding disorders but who are good responders and in patients with thrombopathy. An antifibrinolytic treatment and a fibrin glue are also used. Ninety-six patients underwent 107 extractions with this protocol. RESULTS: Only two patients had bleeding complications requiring an additional treatment. DISCUSSION: In case of bleeding disorders, the treatment depends on disease severity and type of anesthesia. A general treatment (clotting factor concentrates or desmopressin) is indicated with general anesthesia and with local anesthesia in severe bleeding disorders, but not absolutely necessary with local anesthesia in mild bleeding disorders. However, desmopressin can used in all good responders.

Role of leaf surface sugars in colonization of plants by bacterial epiphytes.

The relationship between nutrients leached onto the leaf surface and the colonization of plants by bacteria was studied by measuring both the abundance of simple sugars and the growth of Pseudomonas fluorescens on individual bean leaves. Data obtained in this study indicate that the population size of epiphytic bacteria on plants under environmentally favorable conditions is limited by the abundance of carbon sources on the leaf surface. Sugars were depleted during the course of bacterial colonization of the leaf surface. However, about 20% of readily utilizable sugar, such as glucose, present initially remained on fully colonized leaves. The amounts of sugars on a population of apparently identical individual bean leaves before and after microbial colonization exhibited a similar right-hand-skewed distribution and varied by about 25-fold from leaf to leaf. Total bacterial population sizes on inoculated leaves under conditions favorable for bacterial growth also varied by about 29-fold and exhibited a right-hand-skewed distribution. The amounts of sugars on leaves of different plant species were directly correlated with the maximum bacterial population sizes that could be attained on those species. The capacity of bacteria to deplete leaf surface sugars varied greatly among plant species. Plants capable of supporting high bacterial population sizes were proportionally more depleted of leaf surface nutrients than plants with low epiphytic populations. Even in species with a high epiphytic bacterial population, a substantial amount of sugar remained after bacterial colonization. It is hypothesized that residual sugars on colonized leaves may not be physically accessible to the bacteria due to limitations in wettability and/or diffusion of nutrients across the leaf surface.

[Evolution of breathing pattern and ventilation at maximal exercise during growth. Definition of reference values]. / Evolution du régime ventilatoire et de la ventilation à l'exercice maximal en période de croissance. Définition de valeurs de références.

The aim of the study was to define the changes of parameters of breathing pattern and ventilation (VE) as a function of age during maximal exercise in children. A multi-longitudinal survey was conducted in forty four untrained schoolboys, divided in three groups with initial age of 11.2 years for group I, 12.9 years for group II, and 14.9 for group III. These children were subsequently followed three years ago at the same period. The range age was thus 11.2 to 16.9 years. This study showed that, during growth, ventilation (VE max), tidal volume (VT max) and mean inspiratory flow (VT/TI max) increased significantly with age, that inspiratory frequency (f max) decreased, that inspiratory, expiratory and total time of the respiratory cycle (TI max, TE max, TTOT max) increased slightly and that the inspiration fraction (TI/TTOT max) was identical at 11 and 17 years. Furthermore we observed that the peak height velocity and peak tidal volume velocity took place at the same age, i.e., 14 years and that those of weight and VT/TI at the same age of 15 years. In conclusion, this study allowed us to define reference values for breathing pattern at maximal exercise in sedentary boys and to specify the relation between growth and parameters of breathing pattern in these children.