Overwhelming Underuse of Bisphosphonates in French Nursing Home Residents After Proximal Femoral Fracture.

OBJECTIVE: To evaluate the prescription of bisphosphonates in female nursing home residents aged 75 and older with a history of proximal femoral fracture. DESIGN: Observational descriptive study, led in Brest, France, between June and August 2015. SETTING: 12 nursing homes in Brest, France. PARTICIPANTS: Female nursing home residents, aged 75 and older, with a history of proximal femoral fracture were included. Exclusion criteria were contraindications to bisphosphonate treatment and residents restricted to bed and chair. MEASUREMENTS: The primary endpoint was the evaluation of prescription of bisphosphonates at the time of the study. The secondary endpoints were to evaluate vitamin D supplementation and factors associated with bisphosphonate prescription. RESULTS: 12 of the 116 included residents (10.3 %) received bisphosphonates. 66.4 % received vitamin D supplementation. CONCLUSION: Despite successive French and international recommendations, there is still a very important underuse of treatment by bisphosphonates in old institutionalized female patients with a very high risk of fracture.

Impact of the introduction of a nucleic acid amplification test for Clostridium difficile diagnosis on stool rejection policies.

BACKGROUND: The change from non-molecular to nucleic acid amplification tests (NAATs) is known to increase the detection of Clostridium difficile infection (CDI); however, the impact on stool rejection policies in clinical laboratories is unclear. The current guidelines have reinforced the importance of respecting strict conditions for performing tests on stool samples for CDI diagnosis. The purpose of this study was to estimate whether the implementation of molecular tests has resulted in changes in stool rejection policies between clinical laboratories that introduced NAATs and those that did not. RESULTS: A survey was conducted to evaluate the change in the number of stool samples rejected and the rejection criteria among 12 hospital laboratories in southwestern France before and after the switch from non-molecular tests to NAATs using retrospective data from June 1 till September 30, 2013 and the same period 2014. Four laboratories introduced NAATs as a second or third step in the process. A total of 1378 and 1297 stools samples were collected in 2013 and 2014, respectively. The mean number of rejected stool samples significantly increased (p < 0.001, Chi square test), with a total of 99 (7.1%) and 147 (11.3%) specimens rejected in 2013 and 2014, respectively. Notably, these laboratories had more stringent criteria and were no longer testing the stool samples of patients with CDI-positive results within 7 days. In contrast, there was a significant decrease in the rate of rejected stool samples (p < 0.001, Chi square test) in the five laboratories that did not adopt NAATs and a less stringent stool rejection policy. CONCLUSION: Nucleic acid amplification test implementation improved compliance with recommended stool rejection policies. Laboratories should follow the recommended laboratory algorithm for the CDI diagnosis combined with the correct stool rejection policy.

Di- and tetranuclear palladium complexes incorporating phospha- and diphosphaferrocenes as ligands.

Monophosphaferrocenes and 4 react with [Pd(COD)Cl2] (COD = cyclooctadiene) to afford cis- [Pd(1 or 4)2Cl2] complexes that slowly decompose in solution to give dimeric complexes 3 and 6 of general formula [[Pd(1 or 4)Cl]2]. In these dimers, which incorporate a Pd-Pd bond, phosphaferrocenes act as four electron donors through the phosphorus-atom lone pair (mu2-bonded) and through one orbital of appropriate symmetry at iron. These dimers can also be more conventionally prepared from the reaction of cis- [Pd(1 or 4) Cl2] complexes with [Pd(dba)2] (dba = dibenzylidene acetone). The reaction of octaethyldiphosphaferrocene (7) with [Pd(COD)Cl2] yields a dinuclear complex [Pd2(7)2Cl4] (8) in which the two ligands 7 are coordinated in a trans fashion through the phosphorus-atom lone pairs. Decomposition of 8 in solution yields a dimeric dicationic complex of general formula [[Pd2(7)2Cl]2]2+[FeCl4]2- (9a) incorporating four palladium atoms. In each ligand. one phospholyl ring behaves as a two-electron donor through the phosphorus-atom lone pair whereas the second binds two palladium centers in a mu2-fashion. A plausible mechanism that explains the formation of dimers 3, 6, and 9a involves the preliminary oxidation of the mono- or diphosphaferrocene ligand. Parallel experiments aimed at confirming this hypothesis have shown that complex 9a can be synthesized from the reaction of FeCl2 with complex 8. Also presented is another synthetic approach to the synthesis of the tetranuclear complex 9b (counterion is GaCl4-) from the reaction of the palladium(0) complex [Pd(7)2] (10) with [Pd(COD)Cl2] the presence of GaCl3 as chloride abstractor.

Formation of a phosphorus-phosphorus bond by successive one-electron reductions of a two-phosphinines-containing macrocycle: crystal structures, EPR, and DFT investigations.

Chemical and electrochemical reductions of the macrocycle 1 lead to the formation of a radical monoanion anion [1](*)(-) whose structure has been studied by EPR in liquid and frozen solutions. In accord with experimental (31)P hyperfine tensors, DFT calculations indicate that, in this species, the unpaired electron is mainly localized in a bonding sigma P-P orbital. Clearly, a one-electron bond (2.763 A) was formed between two phosphorus atoms which, in the neutral molecule, were 3.256 A apart (crystal structure). A subsequent reduction of this radical anion gives rise to the dianion [1](2)(-) which could be crystallized by using, in the presence of cryptand, Na naphthalenide as a reductant agent. As shown by the crystal structure, in [1](2)(-), the two phosphinine moieties adopt a phosphacyclohexadienyl structure and are linked by a P-P bond whose length (2.305(2) A) is only slightly longer than a usual P-P bond. When the phosphinine moieties are not incorporated in a macrocycle, no formation of any one-electron P-P bond is observed: thus, one-electron reduction of 3 with Na naphthalenide leads to the EPR spectrum of the ion pair [3](*)(-) Na(+); however, at high concentration, these ion pairs dimerize, and, as shown by the crystal structure of [(3)(2)](2)(-)[(Na(THF)(2))(2)](2+) a P-P bond is formed (2.286(2) A) between two phosphinine rings which adopt a boat-type conformation, the whole edifice being stabilized by two carbon-sodium-phosphorus bridges.

Preparation and characterization of ruthenium(II) monophosphaferrocene complexes. Reactivity, dynamic solution behavior, and X-ray structure of [RuH(2)(eta(2)-H(2))(PCy(3))2(2-phenyl-3,4-dimethylphosphaferrocene)].

The bis(dihydrogen) complex RuH(2)(H(2))(2)(PCy(3))(2) (1) reacts with 2-phenyl-3,4-dimethylphosphaferrocene (L(1)) to give RuH(2)(H(2))(PCy(3))(2)(L(1)) (2). This dihydride-dihydrogen complex has been characterized by X-ray crystallography and variable-temperature (1)H and (31)P NMR spectroscopy. The exchange between the dihydrogen ligand and the two hydrides is characterized by a DeltaG() of 46.2 kJ/mol at 263 K. H/D exchange is readily observed when heating a C(7)D(8) solution of 2 (J(H-D) = 30 Hz). The H(2) ligand in 2 can be displaced by ethylene or carbon monoxide leading to the corresponding ethylene or carbonyl complexes. The reaction of 1 with 2 equiv of 3,4-dimethylphosphaferrocene (L(2)) yields the dihydride complex RuH(2)(PCy(3))(2)(L(2))(2) (5).

Gold(I) and Gold(0) Complexes of Phosphinine-Based Macrocycles.

A "CO-like matrix", showing coordination analogous to that of carbonyl groups, is provided by silacalix[4]phosphinine macrocycles. Reaction with Au(I) leads to the first gold(I) complexes of macrocycles, which can be reduced with sodium or potassium to the paramagnetic gold(0) complexes (an example is shown), as evidenced by cyclic voltammetry and EPR spectroscopy.

[Parasites, etiologic agents of diarrhea in AIDS. Significance of duodenal aspiration fluid test]. / Les parasites, agents étiologiques des diarrhées du SIDA. Intérêt de l'examen du liquide d'aspiration duodénale.

A research was made on one hundred cases of diarrhoeas in Aids-patients by stool examination including examination of duodenal aspirated liquid. Concerning the examination of duodenal fluid, we founded the parasites in almost one hundred patients of the cases. Among parasites observed, Isospora belli was the most frequent (20% of cases), followed by Cryptosporidium (15%). Strongyloides stercoralis represented 10% of the cases. The majority of other parasites was miscellaneous protozoa and some helminths.

[Serous ischial bursa]. / La bourse séreuse ischiatique.

The ischial bursa (Bursa ischiatica) lies on the posterior aspect of the tuberosity of the ischium at the level of the origin of the hamstring muscles. Its relations with the inferior fibers of the musculus gluteus maximus vary with the degree of the hip's flexion. Its role in the sitting position explains the specific bursitis when medullar lesions disturb the normal physiology of this posture.

[Biometry of the cervical spine using tomodensitometry]. / Biométrie du rachis cervical par tomodensitométrie.

Biometry was performed on the computed tomographical cross-sections of one human cervical spine. The entire spine was removed with the head and neck from a fresh cadaver of an adult man. Horizontal cross-sections were performed with a C.T. scan from the base of the skull to the thoracic level. The measurements concerned the diameters of the vertebrae, spinal canal and spinal cord: the density of the posterior and anterior walls, and of the para-vertebral muscles. Clinical and fundamental applications are underlined.

[Anatomic conditions of sitting positions]. / Les conditions anatomiques des positions assises.

Sitting positions are anatomically defined. Three types are described: sitting on a chair, on the ground, and half-sitting position. The ischial support is always predominant in durable sitting; the others are subsidiary: trochanter, thigh, trunk or forelimb. The respect of the articular mobility of the hips and knees is important. Several orthopaedical and neurological diseases disturb the anatomical conditions of normal sitting.

[The two columns of the lower end of the humerus]. / Les deux colonnes de l'extrémité inférieure de l'humérus.

The anatomical examination of the distal end of the human humerus brings new perspectives. The lower extremity of the humerus is considered as a structure with two diverging columns that prolong the diaphysis and flank the trochlear mass articulate with the ulna. Two series of dry humeruses, one of 100, and the other 20 permitted a study with measurements of the posterior width of the columns, their antero-posterior dimensions, the angle that they form with the posterior longitudinal axis of the diaphysis. Dry bones, radiographs, and direct tracing were used. The second series of bones was used for cross-sections in several planes, and for perforations of the fossae. Lastly, graded cuts of frozen elbows were done. These methods showed the two columns to be completely different. The outer column is thick, quadrangular, bulky, convex at the back, wide, almost vertical; in front it bears the condyle, while a lateral facet appears on its distal part; this column is articulated with the radius and extends itself to the thumb column. The inner column is fusiform, narrow, oval on cross-sections; it is a column which supports the trochlea and the muscles, two roles played also by the outer column.