Sensor-Based Frailty Assessment in Survivors of Childhood Cancer: A Pilot Study.

BACKGROUND: Survivors of childhood cancer (CCS) are at risk for early aging and frailty. Frailty in CCS has been assessed with established clinical criteria, a time-intensive approach requiring specialized training. There is an unmet need for cost-effective, rapid methods for assessing frailty in at-risk adolescent and young adult (AYA) CCS, which are scalable to large populations. OBJECTIVES: To validate a sensor-based frailty assessment tool in AYA CCS, compare frailty status between CCS and controls, and assess the correlation between frailty and number of CCS comorbidities. DESIGN, SETTING, AND PARTICIPANTS: Mean frailty index (MFI) was assessed by a frailty wrist sensor in 32 AYA CCS who were ≥1 year off therapy and in remission. Results were compared with 32 AYA controls without cancer or chronic disease. MEASUREMENTS: Frailty assessments with and without a simultaneous cognitive task were performed to obtain MFI. Results were compared between cases and controls using a Student t test, and the number of pre-frail/frail subjects by Chi Square test. The contribution of radiation therapy (RT) exposure to MFI was assessed in a sub-analysis, and the correlation between the number of comorbidities and MFI was measured using the Pearson method. RESULTS: MFI was strongly correlated with gait speed in AYA CCS. CCS were more likely to be pre-frail than controls without cancer history (p=0.032), and CCS treated with RT were more likely to be pre-frail than CCS not treated with RT (p<0.001). The number of comorbidities was strongly correlated with MFI (ρ=0.65), with a 0.028 increase in MFI for each added condition (p<0.001). CONCLUSIONS: Results from this study support higher risk for frailty among CCS, especially those with multiple comorbidities or who were treated with RT. A wrist-worn sensor-based method is feasible for application in AYA CCS, and provides an opportunity for cost-effective, rapid screening of at-risk AYA CCS who may benefit from early interventions.

Origin of relationship between ferromagnetic response and damage in stretched systems.

This article presents a study whose purpose is to elucidate the damage effects in thin films on their magnetic response. Co40Fe40B20 and Ni80Fe20 films of different nanometric thicknesses were stretched by more than 10% and in situ probed by atomic force microscopy measurements to determine their irreversible mechanical behavior (multi-cracking, buckling). Once these phenomena have been well identified, magnetic behavior of these stretched systems has been studied by ferromagnetic resonance to measure resulting magnetic anisotropy and damping evolutions. All of these experimental studies show that the magnetic properties are mainly affected by the stresses generated during the damage but not by the local discontinuities induced by the numerous cracks and buckles. This is in particular confirmed by the almost zero sensitivity to the damage of the magnetic properties of Ni80Fe20 alloy which is known for its vanishing magnetostriction.

Controlled co-deposition of FePt nanoparticles embedded in MgO: a detailed investigation of structure and electronic and magnetic properties.

Films of FePt nanoparticles (NPs) embedded in MgO were obtained by controlled co-deposition of FePt NPs pre-formed by a gas aggregation source and of Mg evaporated in an oxygen atmosphere. Assemblies of core-shell FePt@MgO NPs and films of FePt NPs embedded in MgO matrix could be obtained by varying FePt and Mg deposition rates. Transmission electron microscopy (TEM) and high resolution-TEM revealed the core-shell structure of the NPs, with an FePt core (of average diameter (d) = 4.75 nm) presenting a multitwinned icosahedral structure, and MgO partially in crystalline form. The functional effect of the MgO shell in shielding the FePt core from external oxidation was shown with XPS. Upon controlled annealing, a transition from A1 to L10 ordering could be obtained, with structural and morphological re-arrangement. The magnetic hysteresis loops obtained from alternating gradient field magnetometry at room temperature show a 'wasp-waist' shape, with small values of coercive field (Hc = 300-1400 Oe), decreasing at increasing amounts of co-deposited MgO.

Financial impact of radiological reports on medical-legal evaluation of compensation for meniscal lesions.

To evaluate any discrepancy between radiological reports for clinical purposes and for medicolegal purposes and to quantify its economic impact on repayments made by private insurance companies for meniscal injuries of the knee. The medical records obtained pertaining to 108 knee injury patients (mean age 43.3 years) assessed over a period of 12 months were analysed. Clinical medical reports, aimed at assessing the lesion, and medicolegal reports, drawn up with a view to quantifying compensation, were compared. Unlike reports for clinical purposes in reports for medicolegal purposes, in the evaluation of meniscal lesions, in addition to morphological features of lesions, chronological, topographical, severity and exclusion criteria were applied. To estimate the economic impact resulting from the biological damage, we consulted an actuarial table based on the 9-point minor incapacity classification system. Meniscal lesions not compatible with a traumatic event and therefore not eligible for an insurance payout were found in 56 patients. Of these, 37 failed exclusion criteria, while 19 failed to meet chronological criteria. This difference resulted in a reduction in compensation made by private insurance companies with savings estimated with a saving between euro 203,715.41 and euro 622,315.39. The use of a clinical report for medicolegal purposes can be a source of valuation error, as chronological and/or dynamic information regarding the trauma mechanism may be lacking. Therefore, the use of a full radiological appraisal allows a better damage's assessment and an adequate compensation for injuries.

Follow up in a developing country of patients with complete atrio-ventricular block.

AIM: The purpose of the study was to assess the incidence and survival rate of patients with complete atrio-ventricular block in the cardiac centre of St Elizabeth Catholic General Hospital, Kumbo, Cameroon. METHODS: Between 2009 and 2011, 26 patients with complete atrio-ventricular block were diagnosed at our institution. Complete atrio-ventricular block was defined as complete heart block, diagnosed by echocardiographic or electrocardiographic documentation of the dissociation between electrical activity of the atria and ventricles. Hospital charts, electrocardiograms (ECG), echocardiography and chest radiography were reviewed. RESULTS: The triad of symptoms that pointed to the diagnosis of complete atrio-ventricular block was mainly fatigue, shortness of breath on mild physical exertion, and dizziness. The median age at diagnosis was 65 ± 15 years. The escape rhythm showed a narrow QRS complex in 35.2% of patients, whereas wide QRS complexes were seen in 64.8%. In only 15 patients were pacemakers implanted: dual-chamber in 10 and single-chamber in five cases, depending on the availability of the pacemakers. During the observational period, five non-implanted patients died, giving a mortality rate of 45%. We recorded no deaths in patients with pacemakers. CONCLUSION: In developing countries, natural selection is observed in patients with complete atrio-ventricular block. Lack of infrastructure and early detection, and financial limitations are the main problems faced in the follow up of these patients. Re-organisation of the public health system, new programmes for the prevention of cardiovascular diseases, and government subsidisation are needed in our milieu.

[Arrhythmias in adult patients with congenital heart disease]. / Le aritmie nei pazienti adulti con cardiopatia congenita.

Arrhythmias are the main cause of morbidity and mortality in adult patients with congenital heart disease. Arrhythmias can be due to the primary anatomical defect or they can be a consequence of the long term effects of haemodynamical defects and surgical repairs. Atrial arrhythmias are the most frequent form and their prevalence varies between 10-60% in different congenital defects. Ventricular tachycardia are less common but they have potentially a dramatic impact on survival. When correcting the haemodynamic defect is not effective in avoiding arrhythmias complications, it is necessary to apply specific therapy. Antiarrhythmic drugs must be used very carefully, there is an increasing application for transcatheter or surgical ablation and device implantation.

The presence of capsule in Cryptococcus neoformans influences the gene expression profile in dendritic cells during interaction with the fungus.

The aim of this investigation was to study the effect of polysaccharide capsule on the gene expression in dendritic cells (DC) during their interaction with Cryptococcus neoformans. To this end, we used an encapsulated virulent strain of C. neoformans and a cap59 gene-disrupted acapsular avirulent strain derived from the same genetic background. DC were exposed to encapsulated and acapsular C. neoformans strains for 4 h and 18 h, and their transcriptional profiles were analyzed using the Affymetrix mouse gene chip U74Av2. A large number of DC genes were up-regulated after treatment with the acapsular strain. In particular, we observed the up-regulation of the genes involved in DC maturation, such as cell surface receptors, cytokines, and chemokines (interleukin-12 [IL-12], IL-2, IL-1alpha, IL-1beta, IL-6, IL-10, tumor necrosis factor alpha, CCR7, CCL17, CCL22, CCL3, CCL4, CCL7, and CXCL10), membrane proteins, and the genes involved in antigen processing and presentation as well as cell cycle or apoptosis. The chemokine gene expression data were confirmed by real-time reverse transcription-PCR, while the expression of cytokine genes was correlated with their secretion. A completely different pattern of gene expression was observed for DC treated with an encapsulated strain of C. neoformans. In particular, no significant induction was observed in the expression of the genes mentioned above. Moreover, a number of genes, such as those coding for chemokines, were down-regulated. These results suggest that the polysaccharide capsule shrouding the cell wall of C. neoformans plays a fundamental role in inducing DC response, highlighting the molecular basis of the true nature of immune silencing exerted by capsular material.

Morphological MRI and 3D Myelocisternography MRI in Spontaneous Intracranial Hypotension. A Report of Four Cases.

Spontaneous intracranial hypotension (SIH) is a polyhedric syndrome whose common denominator is postural headache. We describe four cases of spontaneous intracranial hypotension, their clinical-iconographic aspects, and emphasize the use of morphological MRI in the diagnosis and follow-up of this condition. In addition, we propose 3D myelocisternography MRI as a further contribution in cerebrospinal fluid losses causing postural headache.

Importance of subtle amnestic and nonamnestic deficits in mild cognitive impairment: prognosis and conversion to dementia.

BACKGROUND/AIMS: To evaluate baseline characteristics and conversion to dementia in mild cognitive impairment (MCI) subtypes. METHODS: We prospectively evaluated conversion to dementia in 106 patients with amnestic MCI (A-MCI) as defined by Petersen's operationalized criteria on a paragraph recall task, amnestic-subthreshold MCI (AS-MCI) as defined by impairment on the ADAS-cog delayed word list recall with normal paragraph recall, nonamnestic MCI (NA-MCI) defined by a nonmemory domain, and in 27 patients with subjective memory loss who had no deficit on formal neuropsychological testing. RESULTS: For all MCI subtypes, the 4-year conversion to dementia was 56% (14% annually) and to AD was 46% (11% annually). Conversion to AD in the A-MCI (56%) was similar to the rate in AS-MCI (50%). Conversion to AD in the A-MCI and AS-MCI combined was 56% (14% annually). Conversion to dementia in the NA-MCI was 52% (13% annually) and the majority converted to AD (62%). CONCLUSIONS: All MCI subtypes are at risk of converting to AD if the groups are carefully defined by an abnormal psychometric domain. All subtypes except subjective memory loss converted to AD at higher than expected rates. Both the A-MCI and AS-MCI subtypes had a similarly high rate of conversion to AD. The deficit on a word list recall task may develop before an abnormality on delayed paragraph recall is evident, at least in some subjects.

Dynamic breast magnetic resonance imaging without complications in a patient with dual-chamber demand pacemaker.

Mammography and ultrasound indicated a cancer of the right breast in a 77-year-old woman with a dual-chamber demand pacemaker. The patient was not pacemaker-dependent. She underwent breast 1.5T magnetic resonance imaging (MRI) (dynamic gradient echo sequence with Gd-DOTA 0.1 mmol/kg). Before the patient entered the MR room, the configuration of the device was changed (the response to magnet was switched from asynchronous to off and the rate-responsive algorithm was disabled). No relevant modifications of heart rhythm or rate were observed during the MR examination. No symptom was reported. Immediately after the examination, the pacemaker interrogation showed neither program changes nor alert warnings. MRI detected a bifocal cancer in the right breast which allowed tailored breast-conserving treatment to be initiated. Histopathology confirmed a bifocal invasive ductal carcinoma.

Microbiología de 26 casos de peritonitis secundaria de origen no traumático / Microbiology of 26 case of secondary peritonitis of non traumatic origin

Se realizó un estudio clínico prospectivo desde julio 1995 a octubre 1996 incluyendo un total de 26 pacientes que fueron intervenidos quirúrgicamente en el Servicio de Cirugía II del Hospital Vargas de Caracas con el diagnóstico de peritonitis secundaria de origen no traumático penetrante. Se tomó muestra para cultivo de la fuente de infección, en quirófano antes de iniciar la antibioticoterapia. Las patologías que más frecuentemente originaron peritonitis fueron: ulcus péptico perforado, apendicitis aguda perforada y absceso tuboovárico roto. Se obtuvo crecimiento bacteriano en el 73 por ciento de los casos. Se aislaron un total de 30 gérmenes patógenos de las muestras intraabdominales correspondiendo el 50 por ciento de gram negativos; el 13,4 por ciento a gram positivos, el 16,6 por ciento a anaerobios y el 20 por ciento restante a hongos (candida albicans). En el 36,8 por ciento de los casos se aisló más de un gérmen. La antibioticoterapia inicial en los casos de peritonitis secundaria es empírica, utilizando agentes de amplio espectro. Se ha cuestionado la utilidad del cultivo en estos casos por su elevado costo y relativa poca utilidad en la escogencia del antibiótico

The diabetic foot with synovial cyst.

Diabetic lower extremity infections, frequently polymicrobial, are at times fascinating though frustrating for the practitioner to treat. The classical triad of neuropathy, infection, and angiopathy is the hallmark of diabetic foot pathology. One of the main forms demonstrating the severe long-term neuropathic disease is called osteoarthropathy or Charcot joint. This is usually relatively painless, always progressive, and frequently destructive. It generally attacks the midtarsal joint and eventually changes the entire architecture of the foot, causing the so-called "rocker bottom" foot type. We present a case of a severely destructive Charcot foot that caused a large synovial cyst because of its vast underlying osseous pathology. The morbidity and mortality of these infections can be minimized by understanding the unique challenges these individuals offer the practitioner.

Pedal nail pathology: biomechanical implications.

Proper treatment of pedal nail disorders requires a thorough understanding of the underlying etiology. As a class, biomechanical abnormalities constitute an important cause of pedal nail dystrophy. These biomechanical etiologies have been presented with regard to the three body planes. Treatments using biomechanical and orthopedic principles were explored, with an emphasis on counteracting abnormal dynamic and static forces. Additionally, sports that have a high correlation of nail pathologies have been discussed with prevention as the key element to treatment.

Applied biomechanics of bone: functional and clinical perspectives.

Proper locomotion depends on the presence of a strong, intact skeletal system that is able to withstand the stresses and strains of everyday life. In this article, the authors discuss the function of force on bones from a clinical and biomechanical viewpoint. As is presented, bone is a living, viable organ that responds to both external and internal stimuli.

Workers' compensation.

Workers' compensation is a system through which the injured worker is assured by law of a partial income during the period in which he or she is unable to work. Presented in this article is a general discussion of the role of workers' compensation in our industrial society and how it relates to the practice of podiatric medicine.

In vivo animal demonstration of the effect of vasoactive drugs using 195mAu and gamma camera techniques.

195mAu, an ultrashort-lived (physical half life = 30.5 s) generator-produced radionuclide, has been used in an animal model to study, by gamma camera techniques, the peripheral effects of the vasoactive drugs norepinephrine and sodium nitroprusside systemically administered or epinephrine (intraarterially) injected at various concentrations. According to the results obtained by the analysis of time activity curves generated from areas of interest drawn on the proximal and distal parts of the limbs, the well known hemodynamic changes induced by these drugs, vasoconstriction (resulting in a decrease of the distal activity recorded), or vasodilatation (shortening the time of radioactivity appearance), could be observed. It is concluded that gamma camera techniques using the ultrashort lived radionuclide 195mAu allow the in vivo study of the effects of vasoactive drugs in an animal model and potentially in clinical situations.

Antimicrobial prophylaxis.

This paper discusses when antimicrobial prophylaxis should be initiated and when it is not recommended as an effective treatment or means of prophylaxis. Various surgical procedures take complete advantage of the effectiveness of such prophylaxis against the emergence of infection and complications; however, the possibility of superinfection is always present and should not be overlooked by the attending physician.