[Ortho-geriatric rehabilitation: challenges and impact]. / Réadaptation ortho-gériatrique : enjeux et impact.

The risk of developing functional dependence rises with age. Following an acute event, a rehabilitation stay is often needed to restore functional capacities and consider home discharge. The geriatric rehabilitation process usually involves standardized multidisciplinary management, setting and frequent reviewing of the goals, and a discharge plan. In a retrospective observational study conducted in orthogeriatric rehabilitation conducted in Geneva, comorbidities, functional status at admission, and length of stay appear to have a significant impact on recovery potential and destination at discharge, whereas the intensity of the rehabilitation program (number of therapies per week) does not influence patient outcome.

Le risque de développer une dépendance fonctionnelle augmente avec l'âge. À la suite d'un événement aigu, un séjour en réadaptation est souvent nécessaire pour restaurer les capacités fonctionnelles et permettre un retour à domicile. Le processus de réadaptation gériatrique comporte une prise en charge standardisée pluridisciplinaire, la fixation et la révision régulière d'objectifs et la planification de la sortie. Dans une étude observationnelle rétrospective en réadaptation ortho-gériatrique menée à Genève, les comorbidités, l'état fonctionnel à l'admission et la durée de séjour prédisent les chances de récupération fonctionnelle et le retour à domicile, tandis que l'intensité du programme (nombre de thérapies par semaine) n'influence pas le devenir du patient.

Endoscopic Versus Open Repair for Craniosynostosis in Infants Using Propensity Score Matching to Compare Outcomes: A Multicenter Study from the Pediatric Craniofacial Collaborative Group.

BACKGROUND: The North American Pediatric Craniofacial Collaborative Group (PCCG) established the Pediatric Craniofacial Surgery Perioperative Registry to evaluate outcomes in infants and children undergoing craniosynostosis repair. The goal of this multicenter study was to utilize this registry to assess differences in blood utilization, intensive care unit (ICU) utilization, duration of hospitalization, and perioperative complications between endoscopic-assisted (ESC) and open repair in infants with craniosynostosis. We hypothesized that advantages of ESC from single-center studies would be validated based on combined data from a large multicenter registry. METHODS: Thirty-one institutions contributed data from June 2012 to September 2015. We analyzed 1382 infants younger than 12 months undergoing open (anterior and/or posterior cranial vault reconstruction, modified-Pi procedure, or strip craniectomy) or endoscopic craniectomy. The primary outcomes included transfusion data, ICU utilization, hospital length of stay, and perioperative complications; secondary outcomes included anesthesia and surgical duration. Comparison of unmatched groups (ESC: N = 311, open repair: N = 1071) and propensity score 2:1 matched groups (ESC: N = 311, open repair: N = 622) were performed by conditional logistic regression analysis. RESULTS: Imbalances in baseline age and weight are inherent due to surgical selection criteria for ESC. Quality of propensity score matching in balancing age and weight between ESC and open groups was assessed by quintiles of the propensity scores. Analysis of matched groups confirmed significantly reduced utilization of blood (26% vs 81%, P < .001) and coagulation (3% vs 16%, P < .001) products in the ESC group compared to the open group. Median blood donor exposure (0 vs 1), anesthesia (168 vs 248 minutes) and surgical duration (70 vs 130 minutes), days in ICU (0 vs 2), and hospital length of stay (2 vs 4) were all significantly lower in the ESC group (all P < .001). Median volume of red blood cell administered was significantly lower in ESC (19.6 vs 26.9 mL/kg, P = .035), with a difference of approximately 7 mL/kg less for the ESC (95% confidence interval for the difference, 3-12 mL/kg), whereas the median volume of coagulation products was not significantly different between the 2 groups (21.2 vs 24.6 mL/kg, P = .73). Incidence of complications including hypotension requiring treatment with vasoactive agents (3% vs 4%), venous air embolism (1%), and hypothermia, defined as <35°C (22% vs 26%), was similar between the 2 groups, whereas postoperative intubation was significantly higher in the open group (2% vs 10%, P < .001). CONCLUSIONS: This multicenter study of ESC versus open craniosynostosis repair represents the largest comparison to date. It demonstrates striking advantages of ESC for young infants that may result in improved clinical outcomes, as well as increased safety.

Differential effects and rates of normal aging in cerebellum and hippocampus.

Cognitive functions show many alternative outcomes and great individual variation during normal aging. We examined learning over the adult life span in CBA mice, along with morphological and electrophysiological substrates. Our aim was to compare cerebellum-dependent delay eyeblink classical conditioning and hippocampus-dependent contextual fear conditioning in the same animals using the same conditioned and unconditioned stimuli for eyeblink and fear conditioning. In a subset of the behaviorally tested mice, we used unbiased stereology to estimate the total number of Purkinje neurons in cerebellar cortex and pyramidal neurons in the hippocampus. Several forms of synaptic plasticity were assessed at different ages in CBA mice: long-term depression (LTD) in both cerebellum and hippocampus and NMDA-mediated long-term potentiation (LTP) and voltage-dependent calcium channel LTP in hippocampus. Forty-four CBA mice tested at one of five ages (4, 8, 12, 18, or 24 months) demonstrated statistically significant age differences in cerebellum-dependent delay eyeblink conditioning, with 24-month mice showing impairment in comparison with younger mice. These same CBA mice showed no significant differences in contextual or cued fear conditioning. Stereology indicated significant loss of Purkinje neurons in the 18- and 24-month groups, whereas pyramidal neuron numbers were stable across age. Slice electrophysiology recorded from an additional 48 CBA mice indicated significant deficits in LTD appearing in cerebellum between 4 and 8 months, whereas 4- to 12-month mice demonstrated similar hippocampal LTD and LTP values. Our results demonstrate that processes of aging impact brain structures and associated behaviors differentially, with cerebellum showing earlier senescence than hippocampus.

Source and release mechanism of arsenic in aquifers of the Mekong Delta, Vietnam.

In order to elucidate the arsenic source and its release mechanism into groundwater in the Mekong Delta, Vietnam, groundwater samples were collected from wells at different depths (20 to 440 m) and core samples (from 20 to 265 m depth) were analyzed. Based on the analytical results for groundwater and core samples, the As source in groundwater is considered to be pyrite (FeS(2)) in acid sulfate soil (ASS) under oxidizing conditions and hydrous ferric oxide (Fe(OH)(3)) under reducing conditions. Geochemical modeling demonstrated that As(III) is the dominant species and the presence of As-bearing sulfides, Fe-bearing sulfides and oxides phases may locally act as potential sinks for As. From variation between Fe and As concentrations in groundwater samples, the release mechanism of As is: dissolution of Fe(OH)(3) containing As under reducing conditions and oxidative decomposition of FeS(2) containing As under oxidizing conditions.