Modified cued recall test in the French population with Down syndrome: A retrospective medical records analysis.

BACKGROUND: Adults with Down syndrome (DS) are at increased risk of developing Alzheimer's disease (AD) due to genetic predisposition. Identification of patients with AD is difficult since intellectual disabilities (ID) may confound diagnosis. The objective of this study was to evaluate the ability of the French version of the modified cued recall test (mCRT) to distinguish between subjects with and without AD in the adult DS population. METHODS: This was a retrospective, single-centre, medical records study including data between March 2014 and July 2020. Adults aged ≥30 years with DS who had at least one mCRT record available were eligible. Age, sex and ID level were extracted, and subjects were attributed to three groups: patients with AD, patients with co-occurring conditions that may impact cognitive function and subjects without AD. mCRT scores, adjusted by sex, age and ID level, were compared between groups. The optimal cut-off value to distinguish between patients with and without AD was determined using the receiver operating characteristic curve. The impact of age and ID level on mCRT scores was assessed. RESULTS: Overall, 194 patients with DS were included: 12 patients with AD, 94 patients with co-occurring conditions and 88 healthy subjects. Total recall scores were significantly lower (P < 0.0001) in patients with AD compared with healthy subjects. The optimal cut-off value to discriminate between patients with AD and healthy subjects was 22, which compares well with the cut-off value of 23 originally reported for the English version of the mCRT. Patients aged 30-44 years had higher mCRT total recall scores compared with patients aged ≥45 years (P = 0.0221). Similarly, patients with mild ID had higher mCRT scores compared with patients with severe ID (P < 0.0001). INTERPRETATION: The mCRT is a sensitive tool that may help in the clinical diagnosis of AD in subjects with DS. Early recognition of AD is paramount to deliver appropriate interventions to this vulnerable population.

Propensity-based study of aminoglycoside nephrotoxicity in patients with severe sepsis or septic shock.

To assess the risk of acute kidney injury (AKI) attributable to aminoglycosides (AGs) in patients with severe sepsis or septic shock, we performed a retrospective cohort study in one medical intensive care unit (ICU) in France. Patients admitted for severe sepsis/septic shock between November 2008 and January 2010 were eligible. A propensity score for AG administration was built using day 1 demographic and clinical characteristics. Patients still on the ICU on day 3 were included. Patients with renal failure before day 3 or endocarditis were excluded. The time window for assessment of renal risk was day 3 to day 15, defined according to the RIFLE (risk, injury, failure, loss, and end-stage renal disease) classification. The AKI risk was assessed by means of a propensity-adjusted Cox proportional hazards regression analysis. Of 317 consecutive patients, 198 received AGs. The SAPS II (simplified acute physiology score II) score and nosocomial origin of infection favored the use of AGs, whereas a preexisting renal insufficiency and the neurological site of infection decreased the propensity for AG treatment. One hundred three patients with renal failure before day 3 were excluded. AGs were given once daily over 2.6 ± 1.1 days. AKI occurred in 16.3% of patients in a median time of 6 (interquartile range, 5 to 10) days. After adjustment to the clinical course and exposure to other nephrotoxic agents between day 1 and day 3, a propensity-adjusted Cox proportional hazards regression analysis showed no increased risk of AKI in patients receiving AGs (adjusted relative risk = 0.75 [0.32 to 1.76]). In conclusion, in critically septic patients presenting without early renal failure, aminoglycoside therapy for less than 3 days was not associated with an increased risk of AKI.

Effect of treatment gaps in elderly patients with dementia treated with cholinesterase inhibitors.

OBJECTIVE: To determine the effect of treatment gaps on the risk of institutionalization or death among community-dwelling elderly patients treated with cholinesterase inhibitors (ChIs). METHODS: A survival analysis was conducted among a cohort of community-dwelling elderly patients (age 66+) newly treated with ChIs identified in the Quebec drug claims databases (Régie de l'Assurance Maladie du Québec [RAMQ]) between January 1, 2000, and December 31, 2007. Treatment nonpersistence during the year following ChI initiation was defined as treatment discontinuation or gaps of at least 6 weeks. To account for reverse causality, Cox proportional hazard modeling was conducted only among patients who did not discontinue treatment, in order to assess the association between treatment nonpersistence and institutionalization or death. RESULTS: Among the 24,394 elderly ChI users, 4,108 (16.8) experienced a treatment gap during the year following ChI treatment initiation while 596 (2.4%) discontinued their treatment within the first 3 months (early stoppers) and 4,038 (16.6%) after 3 months of treatment (late stoppers). Of all treated patients, 4,409 (18.1%) were institutionalized or died during follow-up. In patients who did not stop their treatment, the risk of institutionalization or death appeared lower in patients who experienced a treatment gap (hazard ratio 0.91; 95% confidence interval 0.86-0.96). CONCLUSIONS: Our results suggest that, contrary to what was previously reported in clinical trials, treatment gaps do not compromise the outcome of patients treated with ChIs in a real-life setting.

Cardiovascular and gastrointestinal safety of NSAIDs: a systematic review of meta-analyses of randomized clinical trials.

As part of the Safety of Non-Steroidal Anti-Inflammatory Drugs (SOS) Project, we reviewed the incidence of cardiovascular (CV) and gastrointestinal (GI) events associated with the use of this category of drugs. We collected data from published meta-analyses (MAs) of clinical trials of nonsteroidal anti-inflammatory drugs (NSAIDs). The Medline, Cochrane, ISI, and SCOPUS databases were systematically searched for MAs of NSAID clinical trials that could potentially contain data on adverse incidents such as myocardial infarction (MI), cerebrovascular events (CeVs), stroke, thromboembolic events (ThEs), heart failure (HF), gastrointestinal bleeding (GIB), and perforation, ulcer, and bleeding (PUB). From 1,733 identified references, 29 MAs were selected for the review. This allowed 109 estimations of incidence rates of CV adverse events and 26 estimations of incidence rates for GI adverse events. No data were found on hemorrhagic stroke or LGIB. Coxibs were studied in more MAs than traditional NSAIDs were (21 MAs for coxibs vs. 7 for traditional NSAIDs; one meta-analysis studied both). Many NSAIDs were not considered in any of the MAs. Our systematic review of MAs included information on the incidence of CV and GI events and identified important knowledge gaps regarding, in particular, the CV safety of traditional NSAIDs.

Microbiological composition of raw milk from selected farms in the Camembert region of Normandy.

Raw milk from 27 farms was sampled over 6 months for listerias, salmonellas, Yersinia enterocolitica and campylobacters. Total bacterial counts and somatic cell counts were measured. Lactococci, lactobacilli, dextran-producing leuconostocs, Brevibacterium linens, yeasts and moulds, Staphylococcus aureus and other Micrococcaceae, Pseudomonas, coliforms, Escherichia coli, enterococci, Clostridium perfringens and spores of anaerobic lactate-fermenting bacteria were also counted. Pseudomonas (2000 cfu ml-1), lactococci (760 cfu ml-1) and Micrococcaceae (720 cfu ml-1) were the most numerous groups. Lactic acid bacteria were detected in all samples. Coliforms were present in most samples, but 84% of samples had counts < 100 cfu ml-1. Staphylococcus aureus was detected in 62% of milks, the average count was 410 cfu ml-1. About 80% of supplies had < or = 10 E. coli cfu ml-1 and all samples had < or = 1 Cl. perfringens cfu ml-1. Two of the tested milks were positive for salmonellas (2.9%), four were positive for Listeria monocytogenes (5.8%), 25 for Yersinia enterocolitica (36%) and one for campylobacters (1.4%).

[Early management of language disorders]. / Interventions précoces dans les troubles du langage.

The audio-language consultations of the Centre d'Audiophonologie of Lyon, France, allow the diagnosis of language delay to be documented in very young children. Based on a five-year clinical study, the authors propose a method of regular follow-up for the child and the parents.

[Idiopathic congenital dilatation of the common bile duct and pregnancy. Report of one case, reflexions and comments (author's transl)]. / Dilatation idiopathique congénitale de la voie biliaire principale et grossesse. A propos d'une observation, réflexions et commentaires.

Congenital idiopathic dilatation of the common bile duct, called commonly and incorrectly congenital cyst of the common bile duct, is sometimes diagnosed during pregnancy. The latter may be the source of severe complications. The disease should thus be treated rapidly, even if the pregnancy is at a late stage. In a case of this type we carried out surgical treatment in two stages: firstly simple external drainage of the common bile duct and of the gall bladder and only after labour has been brought to term by Caesarian section, for breech presentation, was a cystojejunostomy carried out on a Y shaped jejunal loop.

[Cytological study of the hemopoietic organ in the crab: Carcinus maenas (L.) (Crustacea, Decapoda). (author's transl)]. / Ultrastructure de l'organe hématopoïétique chez le crabe Carcinus Maenas (L.) (Crustacea, Decapoda).

A cytological observation, using conventional fixing and staining, is made on the hemopoietic tissue in the crab, Carcinus maenas. The hemopoietic organ is formed by nodules grouping different cell types; nodules are surrounded by a limiting layer including collagenous filaments and material looking like basal lamina. Some fibrocytes and semi-granulous hemocytes are lining this limited layer. These hemocytes, more or less flattened, are transforming in fibrocytes. Fibroblast-like cells, with well developed intercellular junctions, are the first cell type: their dedifferentiation gives rise to isolated mitoting cells. We have named these mitoting cells "hemocytoblast". They are stem cells for hyaline hemocytes. Fibroblast-like cells can be compared with "reticular cells" in Insects. Uncertainty exists as to the formation and evolution of nodules.

[Effects of injections of ecdysterone on the molt and regeneration in the crab Carcinus maenas (L.)]. / Effets d'injections d'ecdystérone sur la mue et la régénération chez le crabe Carcinus maenas (L.)

Two successives injections of 10 microng/g of ecdysterone induce precocious ecdysis in 66% of Crabs. This induction of precocious ecdysis is always accompanied by an inhibiting effect on regeneration: tiny abnormal regenerates or none are obtained. A majority of recipients of ecdysterone underwent successful ecdysis. Experimental results are discussed; a morphological and cytological study of ecdysterone effects on regeneration is announced.

[Cytological structures similar to those of steroid-producing glands in the mandibulary and Y glands of the crab Carcinus maenas L., whether normal or without eyestalk]. / Mise en évidence des caractères cytoligiques des glandes stéroïdogènes dans les glandes mandibulaires et les glandes Y du crabe Carcinus maenas (L) normal et épédonculé

Mandibular glands and Y organs have characteristic organelles of steroid glands: a network of smooth endoplasmic reticulum and numerous mitochondria with tubular cristae. Development of S.E.R. and activation of mitochondria are stimulated in mandibular glands by eyestalk ablation.