Development and Implementation of a Registry of Patients Attending Multidisciplinary Pain Treatment Clinics: The Quebec Pain Registry.

The Quebec Pain Registry (QPR) is a large research database of patients suffering from various chronic pain (CP) syndromes who were referred to one of five tertiary care centres in the province of Quebec (Canada). Patients were monitored using common demographics, identical clinical descriptors, and uniform validated outcomes. This paper describes the development, implementation, and research potential of the QPR. Between 2008 and 2013, 6902 patients were enrolled in the QPR, and data were collected prior to their first visit at the pain clinic and six months later. More than 90% of them (mean age ± SD: 52.76 ± 4.60, females: 59.1%) consented that their QPR data be used for research purposes. The results suggest that, compared to patients with serious chronic medical disorders, CP patients referred to tertiary care clinics are more severely impaired in multiple domains including emotional and physical functioning. The QPR is also a powerful and comprehensive tool for conducting research in a "real-world" context with 27 observational studies and satellite research projects which have been completed or are underway. It contains data on the clinical evolution of thousands of patients and provides the opportunity of answering important research questions on various aspects of CP (or specific pain syndromes) and its management.

Glycolysis as the Central Core of Fermentation.

The increasing concerns of greenhouse gas emissions have increased the interest in dark fermentation as a means of productions for industrial chemicals, especially from renewable cellulosic biomass. However, the metabolism, including glycolysis, of many candidate organisms for cellulosic biomass conversion through consolidated bioprocessing is still poorly understood and the genomes have only recently been sequenced. Because a variety of industrial chemicals are produced directly from sugar metabolism, the careful understanding of glycolysis from a genomic and biochemical point of view is essential in the development of strategies for increasing product yields and therefore increasing industrial potential. The current review discusses the different pathways available for glycolysis along with unexpected variations from traditional models, especially in the utilization of alternate energy intermediates (GTP, pyrophosphate). This reinforces the need for a careful description of interactions between energy metabolites and glycolysis enzymes for understanding carbon and electron flux regulation.

Reassessment of the transhydrogenase/malate shunt pathway in Clostridium thermocellum ATCC 27405 through kinetic characterization of malic enzyme and malate dehydrogenase.

Clostridium thermocellum produces ethanol as one of its major end products from direct fermentation of cellulosic biomass. Therefore, it is viewed as an attractive model for the production of biofuels via consolidated bioprocessing. However, a better understanding of the metabolic pathways, along with their putative regulation, could lead to improved strategies for increasing the production of ethanol. In the absence of an annotated pyruvate kinase in the genome, alternate means of generating pyruvate have been sought. Previous proteomic and transcriptomic work detected high levels of a malate dehydrogenase and malic enzyme, which may be used as part of a malate shunt for the generation of pyruvate from phosphoenolpyruvate. The purification and characterization of the malate dehydrogenase and malic enzyme are described in order to elucidate their putative roles in malate shunt and their potential role in C. thermocellum metabolism. The malate dehydrogenase catalyzed the reduction of oxaloacetate to malate utilizing NADH or NADPH with a kcat of 45.8 s(-1) or 14.9 s(-1), respectively, resulting in a 12-fold increase in catalytic efficiency when using NADH over NADPH. The malic enzyme displayed reversible malate decarboxylation activity with a kcat of 520.8 s(-1). The malic enzyme used NADP(+) as a cofactor along with NH4 (+) and Mn(2+) as activators. Pyrophosphate was found to be a potent inhibitor of malic enzyme activity, with a Ki of 0.036 mM. We propose a putative regulatory mechanism of the malate shunt by pyrophosphate and NH4 (+) based on the characterization of the malate dehydrogenase and malic enzyme.

Estudio con PET-FDG en paciente con antecedentes de leiomiosarcoma uterino durante la menstruación con resultado falso positivo / PET-FDG study in a patient with history of uterine leiomyosarcoma during menstruation and a false positive result

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Patients' perceptions of cardiac anesthesia services: a pilot study.

PURPOSE: To develop an instrument to measure patients' perceptions of the services provided by anesthesiologists, an important indicator of quality for which little information is available. METHODS: The scale of patients' perceptions of cardiac anesthesia services (SOPPCAS) is composed of 17 Likert-type and sociodemographic questions. Data collection was conducted on T-1 (fourth postoperative day) and T-2 (15 days postoperatively). In addition, we employed the Marlow-Crowne scale and a short form of the Psychological Symptoms Index to verify the influence of social desirability and psychological distress respectively. Data analysis included a principal component analysis (PCA). RESULTS: One hundred seventy patients answered the questionnaires at T-1 and 133 patients at T-2. Cronbach alpha of the SOPPCAS was 0.58. PCA revealed four perioperative factors: patient/anesthesiologist interactions, preoccupations related to anesthesia, experience with anesthesia and pain management. Global mean satisfaction was 4.45 +/- 0.64 (maximum score 6.0). Main items related to satisfaction were: satisfaction with premedication, empathy from anesthesiologists, pain management. Main items related to dissatisfaction were: lack of information on blood transfusion and recall of endotracheal intubation. A score of 14/20 was obtained for social desirability. Social desirability did not influence the construct of the SOPPCAS. CONCLUSION: We developed, using rigorous methods, an instrument to measure patients' perceptions of the quality of cardiac anesthesia services. Global mean satisfaction with anesthesia services was moderately high contrary to previous studies where it was high. Finally, the SOPPCAS should allow anesthesiologists to improve the quality of the care they provide.

Psychometric properties of the Center for Epidemiologic Studies-Depression scale in multiple sclerosis.

The factorial structure of the Center for Epidemiologic Studies-Depression (CES-D) scale has been examined on a large sample of multiple sclerosis (MS) subjects (n = 696), general practice patients (n = 1,308) and healthy workers (n = 342). The aim of this study was to verify if the CES-D is a valid and reliable scale to assess depressive symptomatology in MS. As previously reported in the literature, we found four factors that measure depressed affect, positive affect, somatic complaints or retarded activity and interpersonal relationships. The percent of total variance explained by the four factors was greater than 50% in each group. Cronbach's alpha coefficients were 0.90 in the MS sample and 0.93 in the general practice sample, indicative of high reliability in both samples. From these results, we conclude that the CES-D can be used to screen for depression in epidemiological studies of this psychiatric disorder among MS patients.

Patient satisfaction with anesthesia services.

PURPOSE: The evaluation of services by patients is an essential component of continuous quality improvement in anesthesiology. Little is known, however, about how to achieve this objective. Our goal was to conduct a systematic review of all available studies on patient satisfaction with anesthesia services, thereby ascertaining the present level of knowledge in this field and suggesting ways of improving current measurement methodologies. SOURCE: We reviewed relevant major data banks--Medline, Dissertation Abstract, Psyclit and Cochrane--between 1980 and 2000 and bibliographies from primary sources. We used the following keywords for our search: quality improvement, anesthesia, quality, patient perceptions, consumer satisfaction, continuous quality improvement, outcome measures. PRINCIPAL FINDINGS: The review yielded 14 pertinent studies. Studies were divided into two groups (A & B), according to the quality of the psychometric evaluation (tests performed to verify the reliability and validity of an instrument). While all studies reported high levels of patient satisfaction with anesthesia services, many used methods of questionable value. None of the 14 studies controlled for any confounding variables, such as social desirability. Four studies had seriously biased their data collection and the majority of the studies lacked rigour in the development of the instrument used to measure patient satisfaction. Only one study presented a definition of the concept measured, and none provided a conceptual model of patients' satisfaction with anesthesia services. CONCLUSION: The currently available studies of patient satisfaction are of questionable value. Only rigorous methods and reliable instruments will yield valid and clinically relevant findings of this important issue in anesthesiology.

Low blood pressure and risk of depression in the elderly. A prospective community-based study.

BACKGROUND: The relationship between depression and low blood pressure in unclear. AIMS: To examine the temporal relation between low blood pressure and depression in a two-year follow-up. METHOD: The study group consisted of 1389 subjects aged 59-71 years; 1272 (92%) were examined after two years. Subjects completed the Center for Epidemiological Studies-Depression (CES-D) and the Spielberger inventory scales to assess depressive and anxiety symptoms respectively. Data were collected on socio-demographic characteristics, smoking and drinking habits, medical history, drug use and blood pressure measures. RESULTS: Among 1112 subjects who were considered as non-depressed at baseline, logistic regression models showed that low diastolic blood pressure (DBP) and decrease of blood pressure were predictors of high depressive symptomatology at follow-up. Baseline high CES-D scores did not predict low blood pressure two years after. CONCLUSIONS: In our study, low blood pressure was a risk factor for, but not a consequence of, high depressive symptomatology.

[Clinical significance of antiribosomal antibodies. Study Group on Autoimmunity (GEAI)]. / Signification clinique des anticorps antiribosomes. Groupe d'étude auto-immunité (GEAI).

PURPOSE: Autoantibodies directed against the ribosomal P proteins, P0, P1 and P2 (anti-P), have been related to lupus-related psychosis and/or depression. The diagnostic value of antibodies directed against other ribosomal proteins or 28S RNA (anti-no-P) remains unknown. A multicenter study including ten centers belonging to the study group for autoimmune diseases (GEAI) was conducted in order to determine the diagnostic value of anti-P and anti-no-P antibodies in a large population of patients. METHODS: The patients were selected on the basis of the presence of serum anti-ribosomal antibodies detected by indirect immunofluorescence (IF) on rat liver/kidney/stomach/pancreas sections and human HEp2 cells. The clinical course of all patients was studied using a predetermined survey. The specificity of anti-P antibodies were determined by Western blot. RESULTS: Anti-ribosomal antibodies were found in 82 patients. Fifty-five of them had systemic lupus erythematosus and 27 had another disease. Only 54% of the anti-ribosomal antibodies detected by IF were anti-P and were found in 69% of the patients with systemic lupus erythematosus. Anti-no-P antibodies (46%) were preferably detected in patients who suffered from another disease (78%). In patients with systemic lupus erythematosus, neurological and psychiatric disorders were more frequent in the no-P group (47% vs. 16%, P < 0.01) than arthritis, which was found more frequently in the P group (78% vs. 53%, P < 0.05). CONCLUSION: Anti P antibodies do not constitute a specific diagnostic marker of systemic lupus erythematosus, and lupus-related neuropsychiatric disorders would be preferably associated with the presence of anti no-P antibodies.

[Familial multiple sclerosis: study of 357 consecutive patients]. / Sclérose en plaques familiale: étude de 357 patients consécutifs.

The empiric recurrence risk of multiple sclerosis (MS) of relatives of French MS patients is not known. Using a standardized interview, we collected the family histones of 357 consecutive patients followed at our MS clinic; adequate information was obtained on 4784 relatives up to the third degree. Thirty-five patients (9.8%) had a relative with MS. The risk-curve for relatives was the same as in other studies conducted with a similar methodology in Canada. England and Flanders. but the crude overall MS recurrence risk for relatives was lower in France. The genetic burden of MS may be lower in France than in areas of higher MS prevalence.

Clinimetric scale to measure surgeons' satisfaction with anesthesia services.

PURPOSE: Continuous quality improvement is of increasing interest to anesthesiologists. Since surgeons are coworkers and important clients of anesthesiologists, the level of satisfaction of surgeons with anesthesia services should be explored to optimize quality. The purpose of this study was, first, to introduce the concept of surgeons as clients of anesthesiologists and second, to develop and test an instrument to measure surgeons' satisfaction, the Surgeon Satisfaction with Anesthesia Services (SSAS) scale. METHODS: A conceptual model of surgeon satisfaction with anesthesia services was created before the development of the SSAS scale. The scale, composed of socio-demographic, Likert-type and open-ended questions was sent to a sample of 250 surgeons selected randomly by the Collège des Médecins du Québec. Exploratory factorial analysis were performed on the results. RESULTS: A Cronbach's alpha of 0.84 was obtained for internal consistency. Exploratory factorial analysis yielded two subscale factors: a) clinical expertise and b) attitudes and behaviour Global mean of surgeons'satisfaction was moderately high (3.11/4.0). Satisfaction was not related to sociodemographic variables. Very high scores were obtained for items related to clinical expertise. Items related to attitudes and behaviour obtained lower scores. A significant difference was obtained between both factors (t = -5.732, P = 0.0001). CONCLUSION: The SSAS scale is a new instrument to evaluate surgeon satisfaction. Overall, surgeons seem satisfied with anesthesia services, but many areas of dissatisfaction persist. Further discussions with surgeons should be encouraged, in view of improving the perceptions of the quality of anesthesia services and interprofessional relationships.

[The first episode of central nervous system demyelinization and hepatitis B virus vaccination]. / Premier épisode de démyélinisation du système nerveux central et vaccination contre l'hépatite B.

BACKGROUND: Central nervous system (CNS) demyelinating episodes have been described following numerous vaccines but there is no definite conclusion about a causal relationship. Recently, in France, in the context of an Expanded Program on Immunization, several cases of CNS demyelination have been observed following injection of recombinant hepatitis B (HB) vaccine, leading to great concern. METHODS: We performed a hospital-based case-control study of 121 patients with a first episode of CNS demyelination occuring between July 1993 and December 1995 and 121 age and sex matched controls seen in the same period. Data on vaccinations history of cases and controls were collected by a postal questionnaire and confirmed by a phone interview. RESULTS: Adjusted odds ratio (OR) obtained from conditional logistic regression between a first episode of CNS demyelination and any vaccination were equal to 1.4 (95 p. 100 CI 0. 5-4.3) for an exposure within the 60 previous days and 2.1 (95 p. 100 CI 0.7-6.0) for an exposure within the 61-180 previous days. Similar results were found for HB vaccine exposure within the 60 previous days (adjusted OR=1.7, 95 p. 100 CI 0.5-6.3) or within the 61 to 180 previous days (adjusted OR= 1.5, 95 p. 100 CI 0.5-5.3). CONCLUSION: These findings did not permit to exclude confidently an association between HB vaccine and the occurrence of a first CNS demyelinating episode.

[Bacterial contamination of platelet concentrates by Propionibacterium acnes]. / Contamination bactérienne de concentrés de plaquettes à Propionibacterium acnes.

In this study, three incidents of platelet contamination by Proprionibacterium acnes and an investigation of the transfusion process have been reported, which occurred at the Nord-Pas-de-Calais Blood Center over a period of several months. P. acnes is a bacterium that is present in the cutaneous flora; it does not produce any toxin, and is rarely considered as a pathogenic agent; its occurrence is widespread, in particular in those regions that are rich in sebum (face, back, scalp), and it is extremely apparent during adolescence. The three incidents occurred following the transfusion of a pool of leucodepleted platelet concentrates obtained from immunodeficient patients. The clinical outcome was in all cases positive. It was considered that the bacterial contamination of platelet concentrates could reflect insufficient skin disinfection at the site of the venipuncture and a minimal bacterial risk involving the blood collection procedure.

Occupational environment as risk factor for unemployment in multiple sclerosis.

INTRODUCTION: Few studies have examined the factors of occupational environment related to unemployment in multiple sclerosis (MS). MATERIAL AND METHODS: A case control-study was carried out. Cases were patients unemployed for less than five years before the study (n = 77); controls were patients currently employed (n = 94). The odds ratios of the relationship under study adjusted for sex, age, disease form and educational level, were estimated. RESULTS: Employment in the public sector, sedentary jobs and possibility of obtaining specific improvements in the work environment were found to be protective factors, while jobs needing force, rigid work schedule, manual precision, frequent moves and a daily work duration over 8 h were found as risk factors. Multivariate analyses showed that the only remaining factors were public sector jobs as protective factor (OR = 0.4), and strenuous work as risk factor (OR = 4.5). Factors were slightly different in male and female patients. CONCLUSION: This study suggests that simple and early changes in the occupational environment could maintain MS patients at work.

Validation of self-reported neurological disability in multiple sclerosis.

In all 129 unselected patients with multiple sclerosis (MS) completed a 25 item auto-questionnaire for assessment of disability. Each patient was examined on the same day by a neurologist who was blind to patients' answers and gave Expanded Disability Status Scale (EDSS) scores. From the auto-questionnaire, eight scores were obtained, one for each of the seven functional systems rated by the EDSS and the eighth relating to walking difficulties. Analysis showed that correlation between patients' self assessments and the neurologist's ratings was high (r > 0.50) for five out of the eight scores and low for three, especially for brainstem and mental functions which were excluded from subsequent analysis. Using a linear regression model, it was possible to predict the EDSS scores given by the neurologist (+/- 1 point) from patients' answers in 73% of the cases. The performance of the model was robust and was not influenced by patients' characteristics (sex, age, disease course). This study shows that most aspects of MS disability can be self-assessed by patients, and suggest a useful approach when it is not feasible to examine each MS patient as in large community-based studies. Collaborative studies for defining and validating auto-questionnaires on disability should be encouraged.