Identification of factors associated with sarcopenic obesity development: Literature review and expert panel voting.

Sarcopenic obesity (SO) is defined as the combination of excess fat mass (obesity) and low skeletal muscle mass and function (sarcopenia). The identification and classification of factors related to SO would favor better prevention and diagnosis. The present article aimed to (i) define a list of factors related with SO based on literature analysis, (ii) identify clinical conditions linked with SO development from literature search and (iii) evaluate their relevance and the potential research gaps by consulting an expert panel. From 4746 articles screened, 240 articles were selected for extraction of the factors associated with SO. Factors were classified according to their frequency in the literature. Clinical conditions were also recorded. Then, they were evaluated by a panel of expert for evaluation of their relevance in SO development. Experts also suggested additional factors. Thirty-nine unique factors were extracted from the papers and additional eleven factors suggested by a panel of experts in the SO field. The frequency in the literature showed insulin resistance, dyslipidemia, lack of exercise training, inflammation and hypertension as the most frequent factors associated with SO whereas experts ranked low spontaneous physical activity, protein and energy intakes, low exercise training and aging as the most important. Although literature and expert panel presented some differences, this first list of associated factors could help to identify patients at risk of SO. Further work is needed to confirm the contribution of factors associated with SO among the population overtime or in randomized controlled trials to demonstrate causality.

Risk of Gluten Cross-Contamination Due to Food Handling Practices: A Mini-Review.

Celiac disease (CD) is an autoimmune disease triggered by the ingestion of gluten in genetically predisposed individuals, affecting 1.4% of the world population. CD induces an inflammatory reaction that compromises small intestine villi, leading to nutrient malabsorption, and gastro and extraintestinal manifestations. Although other treatment approaches are being studied, adherence to a gluten-free diet (GFD) is the only effective intervention to date. Despite this, about 50% of patients experience persistent inflammation, often associated with unintentional gluten ingestion through contaminated food. There are regulations for labeling gluten-free foods which specify a limit of 20 mg/kg (20 ppm). The risks of gluten cross-contamination above that level are present throughout the whole food production chain, emphasizing the need for caution. This review explores studies that tested different procedures regarding the shared production of gluten-containing and gluten-free food, including the use of shared equipment and utensils. A literature review covering PubMed, Scielo, Web of Science, VHL and Scopus identified five relevant studies. The results indicate that shared environments and equipment may not significantly increase gluten cross-contamination if appropriate protocols are followed. Simultaneous cooking of gluten-containing and gluten-free pizzas in shared ovens has demonstrated a low risk of contamination. In general, shared kitchen utensils and equipment (spoon, ladle, colander, knife, fryer, toaster) in controlled experiments did not lead to significant contamination of samples. On the other hand, cooking gluten-free and gluten-containing pasta in shared water resulted in gluten levels above the established limit of 20 ppm. However, rinsing the pasta under running water for a few seconds was enough to reduce the gluten content of the samples to less than 20 ppm.

Upper motor neuron assessment in amyotrophic lateral sclerosis using the patellar tendon reflex and motor-evoked potentials to the lower limbs.

Amyotrophic lateral sclerosis (ALS) diagnosis relies on signs of progressive damage to both lower motoneuron (LMN), given by clinical examination and electromyography (EMG), and upper motoneuron (UMN), given by clinical examination only. Recognition of UMN involvement, however, is still difficult, so that diagnostic delay often remains too long. Shortening the time to clinical and genetic diagnosis is essential in order to provide accurate information to patients and families, avoid time-consuming investigations and for appropriate care management. This study investigates whether combined patellar tendon reflex recording with motor-evoked potentials to the lower limbs (T-MEP-LL) is relevant to assess corticospinal function in ALS, so that it might serve as a tool improving diagnosis. T-MEP-LL were recorded in 135 patients with suspected motor neuron disease (MND) from February 2010 to March 2021. The sensitivity, specificity, and ability to improve diagnosis when added to Awaji and Gold Coast criteria were determined. The main finding of the study is that T-MEP-LL can detect UMN dysfunction with a 70% sensitivity and 63% specificity when UMN clinical signs are lacking. The sensitivity reaches 82% when considering all MND patients. Moreover, at first evaluation, using T-MEP-LL to quantify reflex briskness and to measure central conduction time, can improve the diagnostic accuracy. T-MEP-LL is easy to perform and does not need any electrical stimulation, making the test rapid, and painless. By the simultaneous quantification of both UMN and LMN system, it could also help to identify different phenotype with more accuracy than clinical examination in this broad-spectrum pathology. The question whether T-MEP-LL could further be a real biomarker need further prospective studies.

Infliximab is an effective option in patients with ulcerative colitis previously exposed to full subcutaneous anti-TNF agent: Results from a real-world multicenter study.

BACKGROUND: Data on infliximab efficacy in bio-exposed patients with ulcerative colitis (UC) are limited. AIMS: To evaluate infliximab effectiveness and its predictors in UC patients with prior exposure to subcutaneous (SC) anti-TNF agent. METHODS: In this multicenter retrospective study (8 centers), we included all consecutive UC patients with prior exposure to subcutaneous anti-TNF, starting infliximab for symptomatic UC, excluding acute severe colitis. Corticosteroid-free clinical remission (CFREM) was assessed at week 14 (W14) and W52 while endoscopic improvement (CFREM + endoscopic Mayo score≤1) was evaluated at W14. RESULTS: Overall, 104 patients were included (pancolitis=54.8%, primary failure to subcutaneous anti-TNF=57.4%, concomitant immunosuppressant=53.8%, median partial Mayo score at baseline=7[5-8]). The rate of CFREM was 33.6% (35/104) at W14 and 40.4% (42/104) at W52. At W14, endoscopic improvement was achieved in 29.8%(31/104). In multivariable analysis, concomitant immunosuppressant was associated with higher rate of CFREM at W14(OR=2.83[1.06-7.54], p = 0.037) and W52(OR=2.68[1.16-6.22];p = 0.021), while primary failure to a previous subcutaneous anti-TNF agent led to lower rate of CFREM at W14 (OR=0.37[0.14-0.98], p = 0.046). After a median follow-up of 20.9 months[11.7-33.7]), 50.0%(52/104) patients had discontinued infliximab. CONCLUSION: Infliximab is an effective option in UC patients previously exposed to prior subcutaneous anti-TNF agent and should be used with concomitant immunosuppressant.

Improved walking energy efficiency might persist in presence of simulated full weight regain after multidisciplinary weight loss in adolescents with obesity: the POWELL study.

AIM: Weight loss leads to a reduction of the energy cost of walking but the respective implications of the metabolic and mechanic changes remain unknown. The present study compares the post-weight loss energy cost of walking (Cw) with and without a total reload of the induced weight reduction in adolescents with obesity. METHODS: Energy cost of walking and substrate use were evaluated during a graded walking exercise (4×6-min at 0.75, 1, 1.25, 1.5 m.s-1) before (V1) and after a 12-week intervention in 21 adolescents with obesity (11 girls; 13.8 ± 1.4 y). After weight loss, the walking exercise was randomly repeated once without weight reload (V2) and once with a loading corresponding to the total induced weight loss during the program (V2L). Body composition was assessed before and after the intervention. RESULTS: Body weight and fat mass decreased in response to the 12-week intervention (p < 0.001), while FFM did not change. The absolute gross Cw (ml.m-1) was higher on V1 compared with V2 at every speed. The absolute net Cw (ml.m-1) was higher on V1 compared to V2L at 0.75 m.s-1 (p = 0.04) and 1 m.s-1 (p = 0.02) and higher on V2L compared with V2 at 1.5 m.s-1 (p = 0.03). Net Cw (ml.m-1.kg-1) on V1 being higher than V2 (p < 0.001), and V2L higher than V2 (p = 0.006). The absolute CHO oxidation (mg.min-1) did not show any condition effect (p = 0.12) while fat utilization was higher on V1 compared to V2 and V2L (p < 0.001). Relative to body weight CHO oxidation was lower on V1 compared to V2 (p = 0.04) and V2L (p = 0.004) while relative to body weight fat oxidation was higher on V1 than V2 (p = 0.002). CONCLUSION: Adolescents with obesity might not show an entire rise back to pre-weight loss values of their metabolic cost of walking when weight gain is simulated. These new findings suggest metabolic and physiological adaptations to weight loss of the energy metabolism that remain to be clarified.

Long-term effectiveness and acceptability of switching from intravenous to subcutaneous infliximab in patients with inflammatory bowel disease treated with intensified doses: The REMSWITCH-LT study.

BACKGROUND: The long-term risk of relapse after switching from intravenous (IV) to subcutaneous (SC) infliximab remains unknown in inflammatory bowel disease (IBD). AIMS: To assess the long-term effectiveness and acceptability of switching from IV to SC infliximab in patients with IBD treated with or without an intensified IV regimen. METHODS: We extended the follow-up of the REMSWITCH study including patients with IBD in clinical remission who were switched from IV to SC infliximab (120 mg/2 weeks). Relapse was defined as clinical relapse or faecal calprotectin increase ≥150 µg/g compared to baseline. RESULTS: After median follow-up of 18 [15-20] months, among 128 patients, rates of relapse were 13.8% (8/58), 18.4% (7/38), 35.3% (6/17) and 86.7% (13/15) at last follow-up (p < 0.001), in those receiving 5 mg/kg/8 weeks, 10 mg/kg/8 weeks, 10 mg/kg/6 weeks and 10 mg/kg/4 weeks at baseline, respectively. Among relapsing patients, dose escalation led to clinical remission in 82.1% (23/28). In multivariable analyses, factors associated with higher risk of relapse were IV infliximab 10 mg/kg/4 weeks (OR = 61.0 [6.1-607.0], p < 0.001) or 10 mg/kg/6 weeks (OR = 4.7 [1.1-20.2], p = 0.017), and decreased (OR = 5.6 [1.5-20.3], p = 0.004) or stable (OR = 5.0 [1.6-15.0], p = 0.009) serum levels of infliximab between baseline and first post-switch visit. Acceptability was improved at 6 months and did not decrease over time (6.9 ± 1.6 before the switch vs. 8.8 ± 1.3 at 6 months and 8.8 ± 1.3 at last follow-up; p < 0.001). No severe adverse events were reported. CONCLUSIONS: Switching from IV to SC infliximab 120 mg every other week is safe and well accepted leading to low long-term risk of relapse. Tight monitoring and dose escalation should be recommended for patients receiving 10 mg/kg/6 weeks and 4 weeks, respectively.

Potential breeding containers of Aedes aegypti (Linnaeus, 1762) and Aedes albopictus (Skuse, 1894) at strategic points in a city in the eastern region of Maranhão.

Potential breeding containers for Aedes aegypti and Aedes albopictus mosquitoes are found in different environments, these places are considered by the National Dengue Control Program in Brazil as strategic points (SP), which have favorable conditions for the development of those insects. The aim of this study is to identify potential breeding containers for A. aegypti and A. albopictus at strategic points in the city of Codó, Maranhão. This study was conducted in five districts, one in each administrative area of the city. A survey of the types and quantity of existing strategic points in each neighborhood was carried out, and surveys of these properties were carried out to inspect the potential breeding containers, with the collection of the vectors' number of immatures found at them. 125 properties were inspected of which 76.91% and 81.25% were vacant lots in the dry and rainy seasons, respectively. There was a difference between the median of the different strategic points (H = 21.96; p < 0.0001), For A. aegypti, there was no difference between the medians of number of immatures regarding the strategic points (H = 3.71; p = 0.28). The total number of immature A. albopictus was higher in vacant lots than in workshops (H = 9.41; p = 0.02, p < 0.05). 4,356 and 4,911 potential breeding containers were found in the dry and rainy seasons, respectively. Regarding the potential breeding containers, 7 (0.16%) and 47 (0.96%) were found with immature vectors, in the dry and rainy seasons, respectively. There were more positive containers in the rainy season for which there was a difference between the median of the number of mosquitoes per positive container (H = 15.66; p = 0.01), the number of immatures for the tires group was greater than Vases and Fixed groups (p < 0.05); the same result was observed in the analyses of the species in the separate form. The impressive number of potential breeding containers found in the SP in both seasons highlights the importance of developing control strategies for these vectors, with emphasis on places such as vacant lots, workshops, tire shops and junkyards, which are serving as dispersal urban sites of vectors.

Impacto de la realización de resonancia magnética multiparamétrica (RMmp) antes de la braquiterapia en pacientes con cáncer de próstata / Prior MRI-imaging impact of patients submitted to brachytherapy for prostate cancer

Introducción La braquiterapia es una opción terapéutica bien establecida para el cáncer de próstata. El uso de la resonancia magnética multiparamétrica (RMmp) para la estadificación y el diagnóstico del cáncer de próstata ha supuesto un cambio en el paradigma actual. En este estudio pretendemos evaluar el impacto, en términos de la recurrencia bioquímica y el tiempo hasta el nadir, de la realización de RMmp para evaluar la presencia de lesiones extracapsulares antes de la braquiterapia en pacientes con cáncer de próstata. Métodos Revisar los datos de 73 pacientes sometidos a braquiterapia. Se evaluaron los siguientes factores: edad, PSA inicial, resultados de la estadificación local por RMmp, ISUP, nadir, tiempo hasta el nadir, PSA a un año, recurrencia bioquímica y tiempo hasta la recurrencia. Resultados La mediana de edad fue de 68años (51-72) y la mediana de seguimiento, de 53meses (30-72). En cuanto a la modalidad de imagen para el diagnóstico, el 30,1% (n=22) de los pacientes se sometieron a RMmp. En el grupo de RMmp, el 90,9% (n=20) tenían al menos una lesión sospechosa en la RMmp. El tiempo hasta el nadir fue de 27meses (3-64) en los pacientes en los que no se realizó RMmp y de 23,5meses (2-48) en los pacientes sometidos a RMmp (p=0,244). La mediana del nadir fue de 0,42ng/ml (<0,001-2) en los pacientes sometidos a RMmp, frente a 0,28ng/ml (<0,001-4) en los pacientes sin RMmp (p=0,062) La recurrencia según los criterios Phoenix fue del 9% (n=2) en los pacientes con RMmp y del 9,2% (n=5) en pacientes sin RMmp (p=0,456), con una mediana de seguimiento de 43meses (12-72) para el grupo con RMmp y de 58meses (30-78) para el grupo sin RMmp. Ambos grupos fueron estadísticamente similares. Conclusión Nuestros resultados nos permiten concluir que en nuestra serie la RMmp no influyó en la recurrencia bioquímica, el tiempo hasta el nadir o el valor del nadir (AU)

Introduction Brachytherapy for the treatment of prostate cancer is a well-established option. Use of Multiparametric Magnetic Resonance Imaging (mpMRI) for staging and diagnosis of prostate cancer has come to change the current paradigm. In this study we aim to assess the impact of performing mpMRI to evaluate the presence of extracapsular lesions before brachytherapy in patients with prostate cancer concerning biochemical recurrence and time to nadir. Methods Review data from 73 patients submitted to brachytherapy. The following factors were evaluated: age, initial PSA, MRI local staging results, ISUP, nadir, time to nadir, PSA at one-year, biochemical recurrence, and time to recurrence. Results Median age was 68years (51-72) and median follow-up 53months (30-72). Concerning imaging modality 30.1% (n=22) patients performed mpMRI. In the mpMRI group, 90.9% (n=20) had at least one suspect lesion on mpMRI. Time to nadir was 27months (3-64) in patients where mpMRI was not performed and 23.5months (2-48) in patients submitted to mpMRI (P=.244). The median value of nadir was 0.42ng/mL (<0.001-2) in patients submitted to mpMRI and vs 0.28ng/mL (<0.001-4) in patients without MRI (P=.062) Recurrence utilizing Phoenix criteria was 9% (n=2) in patients with MRI and 9.2% (n=5) without mpMRI (P=.456), median follow-up of 43months (12-72) for the MRI group with 58months (30-78) for the non-mpMRI group. Both groups were statistically similar. Conclusion Our results allow us to conclude that in our series MRI did not influence biochemical recurrence, time to nadir, or nadir value (AU)

French validation of the Quality of life in Essential Tremor Questionnaire (QUEST) and the Essential Tremor Embarrassment Assessment (ETEA).

Two scales have been developed and validated in English to evaluate the impact of tremor on daily life, namely Quality of life in Essential Tremor Questionnaire (QUEST) and Essential Tremor Embarrassment Assessment (ETEA). The psychometric properties of the French version of these two scales were assessed for 117 patients with head tremor. Both scales showed excellent acceptability, very good internal consistency (Cronbach's alpha coefficient>0.8) and reproducibility (Lin concordance coefficient>0.8), satisfactory external validity and satisfactory sensitivity to change. In conclusion, the French versions of QUEST and ETEA are comprehensive, valid and reliable instruments for assessing patients with head tremor.

Strength of a Zirconia- Reinforced Glass-Ceramic After Diamond Bur Adjustment.

INTRODUCTION: Adjustments with diamond burs on the ceramic surface can affect its roughness and decrease flexural strength. This study evaluated the effect of polishing or glazing on the surface roughness and biaxial flexural strength of a zirconia-reinforced lithium silicate glass-ceramic upon adjustment with diamond burs. METHODS: Seventy disks were prepared according to ISO 6872 and divided into seven groups (n = 10) according to different adjustments and finishing processes. Surface roughness was measured prior to biaxial flexural strength testing. The topography was analyzed using an atomic force microscope , fracture markings were identified using a stereomicroscope and representative specimens were analyzed using scanning electron microscopy. RESULTS: The use of diamond burs significantly increased the surface roughness and decreased the strength of the evaluated ceramic (p⟨0.05). Polishing reduced the ceramic's roughness but resulted in flexural strength similar to that of the groups with wear (p⟩0.05). The glaze-treated specimens showed flexural strength statistically similar to the control group (p>0.05) but higher roughness, similar to those with wear. CONCLUSIONS: Polishing reduced the surface roughness but did not affect the biaxial flexural strength of the ZLS ceramic. At the same time, the application of glaze after wear increased the strength.

Vaccination coverage reinforced by an infectious disease consultation during pretransplant check-up in patients awaiting kidney transplantation: A randomized study.

BACKGROUND: Vaccine coverage (VC) in patients awaiting kidney transplantation is insufficient. METHODS: We performed a prospective, single-center, interventional, randomized, open-label study comparing a reinforced group (infectious disease consultation proposed) and a standard group (letter stating vaccine recommendations sent to the nephrologist) of patients in our institution awaiting renal transplantation. FINDINGS: Out of the 58 eligible patients, 19 declined to participate. Twenty patients were randomized to the standard group and 19 to the reinforced group. Essential VC increased from. 10% to 20% in the standard group and from 15.8% to 52.6% in the reinforced group (p < 0.034). The main obstacles identified were lack of vaccination traceability, refusal of an additional consultation and the journey time between home and hospital. CONCLUSION: While introduction of an infectious disease consultation during the pre-transplant check-up significantly improved VC in patients, it is time-consuming and failed to achieve a satisfactory rate of VC.

Is the duration of dual antiplatelet therapy (DAPT) excessive in post-angioplasty in chronic coronary syndrome? Data from the France-PCI registry (2014-2019).

Background: while the duration of dual antiplatelet therapy (DAPT) following coronary angioplasty for chronic coronary syndrome (CCS) recommended by the European Society of Cardiology has decreased over the last decade, little is known about the adherence to those guidelines in clinical practice in France. Aim: To analyze the real duration of DAPT post coronary angioplasty in CCS, as well as the factors affecting this duration. Methods: Between 2014 and 2019, 8.836 percutaneous coronary interventions for CCS from the France-PCI registry were evaluated, with 1 year follow up, after exclusion of patients receiving oral anticoagulants, procedures performed within one year of an acute coronary syndrome, and repeat angioplasty. Results: Post-percutaneous coronary intervention (PCI) DAPT duration was > 12 months for 53.1% of patients treated for CCS; 30.5% had a DAPT between 7 and 12 months, and 16.4% a DAPT ≤ 6 months. Patients with L-DAPT (>12 months) were at higher ischemic risk [25.0% of DAPT score ≥2 vs. 18.8% DAPT score ≥2 in S&I-DAPT group (≤12 months)]. The most commonly used P2Y12 inhibitor was clopidogrel (82.2%). The prescription of ticagrelor increased over the period. Conclusions: post-PCI DAPT duration in CCS was higher than international recommendations in the France PCI registry between 2014 and 2019. More than half of the angioplasty performed for CCS are followed by a DAPT > 12 months. Ischemic risk assessment influences the duration of DAPT. This risk is probably overestimated nowadays, leading to a prolongation of DAPT beyond the recommended durations, thus increasing the bleeding risk.

Prior MRI-imaging impact of patients submitted to brachytherapy for prostate cancer.

INTRODUCTION: Brachytherapy for the treatment of prostate cancer is a well-established option. Use of Multiparametric Magnetic Resonance Imaging (mpMRI) for staging and diagnosis of prostate cancer has come to change the current paradigm. In this study we aim to assess the impact of performing mpMRI to evaluate the presence of extracapsular lesions before brachytherapy in patients with prostate cancer concerning biochemical recurrence and time to nadir. METHODS: Review data from 73 patients submitted to brachytherapy. The following factors were evaluated: age, initial PSA, MRI local staging results, ISUP, nadir, time to nadir, PSA at one-year, biochemical recurrence, and time to recurrence. RESULTS: Median age was 68 years (51-72) and median follow-up 53 months (30-72). Concerning imaging modality 30,1% (n = 22) patients performed mpMRI. In the mpMRI group, 90.9% (n = 20) had at least one suspect lesion on mpMRI. Time to nadir was 27 months (3-64) in patients where mpMRI was not performed and 23.5 months (2-48) in patients submitted to mpMRI (P = .244). The median value of nadir was 0.42 ng/mL (<0.001-2) in patients submitted to mpMRI and vs 0.28 ng/mL (<0.001-4) in patients without MRI (P = .062) Recurrence utilizing Phoenix criteria was 9% (n = 2) in patients with MRI and 9.2% (n = 5) without mpMRI (P = .456), median follow-up of 43 months (12-72) for the MRI group with 58 months (30-78) for the non-mpMRI group. Both groups were statistically similar. CONCLUSION: Our results allow us to conclude that in our series MRI did not influence biochemical recurrence, time to nadir, or nadir value.

Development, sensitivity and reliability of a French version of the Leeds food preference questionnaire (LFPQ-fr) for the evaluation of food preferences and reward.

BACKGROUND: There is a growing global interest in the evaluation of food reward, necessitating the adaptation of culturally appropriate instruments for use in empirical studies. This work presents the development and validation of a culturally adapted French version of the Leeds Food Preference Questionnaire (LFPQ-fr). METHODS: The LFPQ-fr was developed and validated in healthy-weight adults using the following systematic approach: i) selection and validation of appropriate food pictures; ii) linguistic translation of liking and wanting constructs in the target population (n = 430; 81% female; 42.2 ± 12.7 years); iii) validation of the sensitivity and reliability of the task performed in a fasted state and in response to a standardized test meal (n = 50; 50% female; 30.0 ± 8.4 years). RESULTS: During the first and second phases, the nutritional and perceptual validation of culturally appropriate food pictures and pertinent reward constructs, respectively, was demonstrated in a healthy-weight French sample. Findings from the third phase indicated that all food reward components were sensitive to the test meal and showed moderate to high agreement in both fasted (Lin's CCC =0.72-0.94) and fed (Lin's CCC = 0.53-0.80) appetitive states between visit 1 (V1) and visit (V2). Except for explicit liking fat bias, all primary outcomes were statistically consistent in fasted and fed states between V1 and V2. Changes in fat and taste biases in response to a standardized meal for all primary outcomes were also consistent between V1 and V2 except for explicit liking fat bias (Lin's CCC = 0.49- 0.72). CONCLUSION: The LFPQ-fr developed and tested in this study is a reproducible and reliable method to assess food reward in both the fasted and fed states in a healthy-weight French population.

Effects of aquatic exercise on appetitive responses in adolescents with obesity: An exploratory study.

Aquatic exercise has been suggested as a beneficial modality to improve weight loss, cardiorespiratory fitness and quality of life in adolescents with obesity; however, its impact on appetite control in youth remains unknown. The aim of this preliminary study was to examine the effect of an acute aquatic exercise session on energy intake (EI), appetite feelings and food reward in adolescents with obesity. Twelve adolescents with obesity (12-16 years, Tanner stage 3-5, 9 males) randomly completed two conditions: i) control (CON); ii) aquatic exercise session (AQUA). One hour before lunch, the adolescents stayed at rest outside the water in a quiet room for 45 min on CON while they performed a 45-min aquatic exercise session on AQUA. Ad libitum EI and macronutrients were assessed at lunch and dinner, subjective appetite feelings taken at regular intervals, and food reward measured before and after lunch. Paired T-test showed that EI was not different between CON and AQUA at lunch (1333 ± 484 kcal vs 1409 ± 593 kcal; p = 0.162) and dinner (528 ± 218 kcal vs 513 ± 204 kcal; p = 0.206). Total daily ad libitum EI was significantly higher on AQUA (1922 ± 649 kcal) compared with CON (1861 ± 685 kcal; p = 0.044) but accounting for the exercise-induced energy expenditure, relative energy intake did not differ (2263 ± 732 kcal vs 2117 ± 744 kcal, p = 0.304). None of the appetite feelings (hunger, fullness, prospective food consumption and desire to eat) and food reward dimensions were significantly different between conditions. These preliminary and exploratory results suggest that an acute aquatic-exercise session might not induce energy compensatory responses in adolescents with obesity.

A proof of principle study using radiopharmaceuticals to quantify and localize container-content interactions in medical syringes.

The sorption of drugs onto their contents is a known phenomenon that is difficult to analyse precisely. The purpose of this study was to present a non-invasive method for locating and quantifying sorption phenomena using radiopharmaceuticals. Radiopharmaceutical are medicines armed with a radionuclide enabling quantification and imaging using dedicated scanners. The sorption of nine different radiopharmaceuticals on 2- and 3-part syringes was investigated. These syringes were filled with the studied radiopharmaceutical solutions and stored immobile for 3 h. At different times ranging from 0 to 180 min, 10 µL were taken from the syringes and the radioactivity of these samples was determined by a gamma counter. 5 radiopharmaceuticals exhibited no significant sorption at any time point in both 2 and 3-parts syringes, but 4 radiopharmaceuticals exhibited sorption losses varying from 20 to 33% after 3 h contact with 3-part-syringes, but no sorption on 2-part syringes at any time point. [99mTc]Tc-tetrofosmine Single Photon Emission Computed Tomography/Computed Tomography imaging indicated clearly that the interactions were located on the rubber plunger of the 3-part-syringes. The specific nature of radiopharmaceuticals allowed their use as an innovative method to quantify and localize drug sorption phenomena.

Efficacy of self-management program associated with a spa therapy for knee osteoarthritis patients (GETT 2): a research protocol for a randomized trial.

INTRODUCTION: Osteoarthritis is a chronic pathology that involves multidisciplinary management. Self-management for patients is an essential element, present in all international guidelines. During the time of the spa therapy, the patient is receptive to take the advantage of self-management workshops. The aim of this study is to assess the effects of 18 days spa therapy associated with a self-management intervention in patients with knee osteoarthritis in comparison with spa therapy alone on a priority objective, personalized and determined with the patient, chosen in the list of 5 objectives determined during the self-management initial assessment. METHODS AND ANALYSIS: Two hundred fifty participants with knee osteoarthritis will participate to this multicenter, prospective, randomized, controlled study. All patients will benefit 18 days of spa therapy and patients randomized in the intervention group will participate to 6 self-management workshops. Randomization will be centralized. The allocation ratio will be 1:1. Data analysts and assessor will be blinded. The primary outcome is the effectiveness of the educational workshops associated with spa therapy in comparison with spa therapy alone on a priority objective, measured by Goal Attainment Scaling (GAS). The secondary outcomes are disability, health-related quality of life, and pain intensity. ETHICS AND DISSEMINATION: Ethics were approved by the CPP Sud-Méditerranée II. The results will be disseminated in a peer-reviewed journal and disseminated at PRM, rheumatology, and orthopedics conferences. The results will also be disseminated to patients. TRIAL REGISTRATION: Trial registration number NCT03550547. Registered 8 June 2018. Date and version identifier of the protocol. Version N°6 of March 12, 2018.

Determinants of Resting Energy Expenditure in Very Old Nursing Home Residents.

OBJECTIVES: This study aimed to measure resting energy expenditure (REE) in institutionalized old persons and to determine factors possibly related to change in REE as a basis for estimating energy requirements. DESIGN AND SETTINGS: A monocentric cross-sectional study was conducted. Statistical approaches were conducted to determine independent factors associated with REE. Various published predictive equations of REE were compared to our population. PARTICIPANTS: 72 residents of a nursing home, mostly women (80.5%) aged 87.4±6.6 years were included. MEASUREMENTS: REE (indirect calorimetry), body composition (bio-impedance analysis), biological and anthropometric data were collected. RESULTS: Mean REE was 1006±181 kcal/d and was higher in men than in (1227±195 vs. 953±131 kcal/d, p<0.05). According to criteria adapted from the Global Leadership Initiative on Malnutrition consensus, 65.3 % of the institutionalized population were malnourished. In multivariate analysis adjusted on gender and age, REE was positively associated with calorie intake, fat-free mass (FFM), functional abilities (French Autonomie Gérontologie Groupe Iso Ressources scale), and elevated CRP level (> 25 mg/l). Significant differences (p<0.05) appeared between measured REE and predicted REE by using various published equations. CONCLUSION: REE of very old nursing home residents is influenced by FFM, calorie intake, functional abilities, and CRP levels and is poorly predicted by classical equations based on age, gender, height, and weight. This suggests a metabolic adaptation to caloric restriction and inflammation and prompts to consider the level of physical activity and muscle loss when assessing caloric requirements in this population.

Attitude of community pharmacists toward patients with a substance-related disorder (heroin, alcohol and tobacco), estimation of harmfulness and knowledge of these substances, and continuing education: A pilot cross-sectional study.

OBJECTIVES: To investigate attitude of community pharmacists toward patients with a substance-related disorder (heroin, alcohol and tobacco). MATERIAL AND METHODS: The attitudes were assessed thanks to the Attitude to Mental Illness Questionnaire (AMIQ) for heroin, alcohol and tobacco-related disorders in three independent groups of pharmacists. Estimation of substance-related harmfulness, knowledge of substance-related disorders and activities/needs for continuing education on substance-related disorders were also recorded. RESULTS: Thirty-five pharmacists were included (heroin: 11, alcohol: 10 and tobacco: 14). AMIQ scores for heroin-related disorder were negative and lower than for alcohol (P<0.01) and tobacco (P<0.001). AMIQ scores for alcohol-related disorder were lower than for tobacco (P<0.05). The estimation of heroin-related harmfulness was higher than for alcohol and tobacco (P<0.001). The estimations of knowledge of substance-related disorders were lower for opioid and alcohol than for tobacco (P<0.001). AMIQ scores and the needs for continuing education on each associated addiction showed a positive relation (P<0.01). CONCLUSION: Pharmacists had a negative attitude toward heroin and alcohol-related disorders. A positive attitude toward patients with a substance-related disorder was associated with a need for continuing education. Efforts should be made to change attitudes and to promote continuing education on heroin and alcohol-related disorders.