Preoperative Acetaminophen For Microsuspension Laryngoscopy Reduces Postoperative Opioid Use.

OBJECTIVES: The opioid crisis has prompted consideration of analgesic prescriptions. This study explored the value of preoperative acetaminophen for pain control following microsuspension laryngoscopy (MSL) and compared the results with a previous study of pain and opioid use following MSL (Tsang et al.). METHODS: A prospective open-label clinical trial was conducted in patients undergoing MSL. All patients were administered preoperative acetaminophen. Short-form McGill Pain Questionnaire (SF-MPQ), pain visual analogue scale (VAS), and present pain intensity (PPI) scores were collected preoperatively and on postoperative days (PODs) 1, 3, 7, and 14. Statistical analysis identified variables associated with opioid use or increased pain scores, and compared outcomes with Tsang et al. RESULTS: Eighty-nine patients were included (mean age 52.8 ± 17.3 years, 40 males). All patients received preoperative 1 g acetaminophen (77 (86.5%) orally) with no adverse effects. On POD1, opioid usage was 10%. Median [IQR] pain scores were 5 [2-11], 21 [12.3-56.8], and 3 [2-3.3] on SF-MPQ, VAS, and PPI, respectively. Post-Anesthesia Care Unit (PACU) opioid requirements significantly correlated with POD1 opioid consumption (τb = 0.214; p ≤ 0.05), and significant associations with PACU opioid administration were found for total anesthesia time (OR (95%CI) = 1.271 (1.043-1.548), p = 0.017) and total laryngoscope suspension time (OR (95%CI) = 0.791 (0.651-0.962, p = 0.019)). This cohort demonstrated reduced opioid usage on POD1 compared with Tsang et al (23%). CONCLUSIONS: Preoperative acetaminophen is a safe intervention, resulting in decreased postoperative opioid use following MSL. Anesthesia time correlated with need for postoperative opioids. LEVEL OF EVIDENCE: Level 4 Laryngoscope, 2024.

Prediction of Early Neurological Deterioration in Individuals With Minor Stroke and Large Vessel Occlusion Intended for Intravenous Thrombolysis Alone.

Importance: The best reperfusion strategy in patients with acute minor stroke and large vessel occlusion (LVO) is unknown. Accurately predicting early neurological deterioration of presumed ischemic origin (ENDi) following intravenous thrombolysis (IVT) in this population may help to select candidates for immediate transfer for additional thrombectomy. Objective: To develop and validate an easily applicable predictive score of ENDi following IVT in patients with minor stroke and LVO. Design, Setting, and Participants: This multicentric retrospective cohort included 729 consecutive patients with minor stroke (National Institutes of Health Stroke Scale [NIHSS] score of 5 or less) and LVO (basilar artery, internal carotid artery, first [M1] or second [M2] segment of middle cerebral artery) intended for IVT alone in 45 French stroke centers, ie, including those who eventually received rescue thrombectomy because of ENDi. For external validation, another cohort of 347 patients with similar inclusion criteria was collected from 9 additional centers. Data were collected from January 2018 to September 2019. Main Outcomes and Measures: ENDi, defined as 4 or more points' deterioration on NIHSS score within the first 24 hours without parenchymal hemorrhage on follow-up imaging or another identified cause. Results: Of the 729 patients in the derivation cohort, 335 (46.0%) were male, and the mean (SD) age was 70 (15) years; of the 347 patients in the validation cohort, 190 (54.8%) were male, and the mean (SD) age was 69 (15) years. In the derivation cohort, the median (interquartile range) NIHSS score was 3 (1-4), and the occlusion site was the internal carotid artery in 97 patients (13.3%), M1 in 207 (28.4%), M2 in 395 (54.2%), and basilar artery in 30 (4.1%). ENDi occurred in 88 patients (12.1%; 95% CI, 9.7-14.4) and was strongly associated with poorer 3-month outcomes, even in patients who underwent rescue thrombectomy. In multivariable analysis, a more proximal occlusion site and a longer thrombus were independently associated with ENDi. A 4-point score derived from these variables-1 point for thrombus length and 3 points for occlusion site-showed good discriminative power for ENDi (C statistic = 0.76; 95% CI, 0.70-0.82) and was successfully validated in the validation cohort (ENDi rate, 11.0% [38 of 347]; C statistic = 0.78; 95% CI, 0.70-0.86). In both cohorts, ENDi probability was approximately 3%, 7%, 20%, and 35% for scores of 0, 1, 2 and 3 to 4, respectively. Conclusions and Relevance: The substantial ENDi rates observed in these cohorts highlights the current debate regarding whether to directly transfer patients with IVT-treated minor stroke and LVO for additional thrombectomy. Based on the strong associations observed, an easily applicable score for ENDi risk prediction that may assist decision-making was derived and externally validated.

Decreased Immune Response in Alexithymic Women: A One-Year Longitudinal Study.

Although previous cross-sectional studies suggested significantly dysregulated immune response in alexithymia, there is a lack of longitudinal studies. We sought to determine the reliability of the reported relationship between alexithymia and decreased immune response in a longitudinal study. Thirty-eight healthy women who had participated in a cross-sectional study were recontacted 1-year later. Of this sample, 26 were finally included: 13 females who had been found to be alexithymic, and 13 females who were classified as non-alexithymic under the 20-item Toronto Alexithymia Scale during the first phase of the study. A year later, they were still healthy women without any psychiatric disorders, their ages now ranging from 19 to 28 years old. Lymphocyte subset counts (CD4, CD8), in vitro production of interleukin 1ß (IL-1ß), IL-2, IL-4, and IL-10 by phytohemagglutinin stimulated peripheral blood lymphocytes, as well as serum cortisol levels, were compared between women with and without alexithymia. One-year later, alexithymic women still had significantly lowered in vitro production of IL-2 and IL-4, with lowered IL-2/IL-10 ratio and a reduced percentage of CD4. This is the first ever published study assessing cytokine production during a follow-up of alexithymics. Although our results should be interpreted with caution due the small sample size, they suggest a sustained reduction in both major type 1 and type 2 cytokines while the former seems to be more affected. The potential long-term health impact, if any, is still to be determined.

Bridging Therapy or IV Thrombolysis in Minor Stroke with Large Vessel Occlusion.

OBJECTIVE: Whether bridging therapy (intravenous thrombolysis [IVT] followed by endovascular treatment) is superior to IVT alone in minor stroke with large vessel occlusion (LVO) is unknown. METHODS: Multicentric retrospective observational study including, in intention-to-treat, consecutive IVT-treated minor strokes (National Institutes of Health Stroke Scale [NIHSS] ≤ 5) with LVO, with or without additional mechanical thrombectomy. Propensity-score (inverse probability of treatment weighting) was used to reduce baseline between-groups differences. The primary outcome was excellent outcome, that is, modified Rankin score 0 to 1 at 3 months follow-up. RESULTS: Overall, 598 patients were included (214 and 384 in the bridging therapy and IVT groups, respectively). Following propensity-score weighting, the distribution of baseline clinical and radiological variables was similar across the two patient groups. Compared with IVT alone, bridging therapy was not associated with excellent outcome (odds ratio [OR] = 0.96; 95% confidence interval [CI] = 0.75-1.24; p = 0.76), but was associated with symptomatic intracranial hemorrhage (OR = 3.01; 95% CI = 1.77-5.11; p < 0.0001). Occlusion site was a strong modifier of the effect of bridging therapy on outcome (pinteraction < 0.0001), with bridging therapy associated with higher odds of excellent outcome in proximal M1 (OR = 3.26; 95% CI = 1.67-6.35; p = 0.0006) and distal M1 (OR = 1.69; 95% CI = 1.01-2.82; p = 0.04) occlusions, but with lower odds of excellent outcome for M2 (OR = 0.53; 95% CI = 0.38-0.75; p = 0.0003) occlusions. Bridging therapy was associated with higher rates of symptomatic intracranial hemorrhage in M2 occlusions only (OR = 4.40; 95% CI = 2.20-8.83; p < 0.0001). INTERPRETATION: Although overall outcomes were similar in intended bridging therapy as compared to intended IVT alone in minor strokes with LVO, our results suggest that intended bridging therapy may be beneficial in M1 occlusions, whereas the benefit-risk profile may favor IVT alone in M2 occlusions. ANN NEUROL 2020 ANN NEUROL 2020;88:160-169.

New Bioactive Peptides Identified from a Tilapia Byproduct Hydrolysate Exerting Effects on DPP-IV Activity and Intestinal Hormones Regulation after Canine Gastrointestinal Simulated Digestion.

Like their owners, dogs and cats are more and more affected by overweight and obesity-related problems and interest in functional pet foods is growing sharply. Through numerous studies, fish protein hydrolysates have proved their worth to prevent and manage obesity-related comorbidities like diabetes. In this work, a human in vitro static simulated gastrointestinal digestion model was adapted to the dog which allowed us to demonstrate the promising effects of a tilapia byproduct hydrolysate on the regulation of food intake and glucose metabolism. Promising effects on intestinal hormones secretion and dipeptidyl peptidase IV (DPP-IV) inhibitory activity were evidenced. We identify new bioactive peptides able to stimulate cholecystokinin (CCK) and glucagon-like peptide 1 (GLP-1) secretions, and to inhibit the DPP-IV activity after a transport study through a Caco-2 cell monolayer.

Forms of interdisciplinarity in four sport science research centres in Europe.

Interdisciplinarity is often presented as a significant element of sport science. We present here the results of an investigation conducted in four European Sport Science Research Centres applying interdisciplinarity. Four main dimensions, that we have called "forms", have been investigated. The "scientific", "organisational", "academic" and "societal" forms cover a wide range of activities run by these Centres. We have compared their situations using indicators. Globally they present quite similar combinations of forms, with dominant roles in the construction of interdisciplinarity played by the organisational and societal forms. The scientific form is never quite supported by an epistemological setting and the academic form, mostly characterised by the position of the university, plays an influential role when it is hostile to that kind of research. Following Klein classification, all of them remain at a multidisciplinary stage, one of them exploring interdisciplinary tracks in some research projects. The development of a common culture and a curiosity regarding disciplines other than its own is a key factor for a sustainable situation, as is the capacity to secure long-term financial resources, often linked to a high academic recognition for the director(s).

[Construction of a professionnal juridiction in Adapted Physical Activity in the medical world]. / Construction du territoire professionnel de l'enseignant en Activité Physique Adaptée dans le monde médical.

Analysis of interactions between professionals and patients with chronic diseases reveals a space invested by professional expertise in which APA teachers occupy their own distinctive position..

Nickel promotes biofilm formation by Escherichia coli K-12 strains that produce curli.

The survival of bacteria exposed to toxic compounds is a multifactorial phenomenon, involving well-known molecular mechanisms of resistance but also less-well-understood mechanisms of tolerance that need to be clarified. In particular, the contribution of biofilm formation to survival in the presence of toxic compounds, such as nickel, was investigated in this study. We found that a subinhibitory concentration of nickel leads Escherichia coli bacteria to change their lifestyle, developing biofilm structures rather than growing as free-floating cells. Interestingly, whereas nickel and magnesium both alter the global cell surface charge, only nickel promotes biofilm formation in our system. Genetic evidence indicates that biofilm formation induced by nickel is mediated by the transcriptional induction of the adhesive curli-encoding genes. Biofilm formation induced by nickel does not rely on efflux mechanisms using the RcnA pump, as these require a higher concentration of nickel to be activated. Our results demonstrate that the nickel-induced biofilm formation in E. coli is an adaptational process, occurring through a transcriptional effect on genes coding for adherence structures. The biofilm lifestyle is obviously a selective advantage in the presence of nickel, but the means by which it improves bacterial survival needs to be investigated.

Decreased immune response in alexithymic women: a cross-sectional study.

It has been reported in a few studies that alexithymia is associated with impaired immune response but results are still contradictory. The present study investigates whether alexithymia is associated with lower cell-mediated (Th-1) immune response. Fifty-one healthy 18-27-year-old women were selected from healthy subjects on the basis of high or low cut-off scores on the 20-item Toronto Alexithymia Scale (TAS-20). They were evaluated using standardized psychiatric rating scales notably the Hospital Anxiety Depressive Scale (HAD) and the Mini Neuropsychiatric Interview (MINI). None of the subjects were suffering from psychiatric disorders. Twenty-seven were classified as alexithymics and 24 as non-alexithymics according to the TAS-20. Blood was drawn for lymphocyte subset counts (CD4, CD8), in vitro production of interleukin 1 (IL-1beta), IL-2, IL-4, and IL-10 by phytohaemagglutinin stimulated peripheral lymphocytes, and cortisol. Women with alexithymia exhibited decreased interleukin 1beta, IL-2 and IL-4 production with reduced ratios of Th1/Th2 (IL-2/IL-10) and of CD4/CD8, as well as reduced CD4 percentages. IL-2 and IL-4 production remained significantly diminished in the alexithymic group, even after adjusting for between-group differences in anxiety and depression levels on the HAD. This study further demonstrates that alexithymic women have altered immune function, with a predominance of depressed cell-mediated immunity and a skewed Th1/Th2 ratio towards Th2 response.

[Adapted physical activity and patient education in the French diabetes networks]. / Activité physique adaptée et éducation du patient dans les Réseaux Diabète français.

A thorough questionnaire-based survey of French diabetes networks depicts an accurate description of the services they offer, in particular concerning physical activity. Often considered as less important than medicinal monitoring and dietetics, physical activity is at the core of a new professional dynamic. Practical sessions of adapted physical activity are presently offered in half the networks, as either one-time awareness-raising sessions or a complete series of sessions. Sports medicine educators seem to constitute an emerging professional group within a framework which aims to complement information provided to patients by skills-building through group sessions. Two distinct perspectives emerge as being linked to intervention methods: the first one aims to educate about physical activity, while the second aims to educate through physical activity.

Motives for regular physical activity in women and men: a qualitative study in French adults with type 2 diabetes, belonging to a patients' association.

Patients' associations are an integral but often overlooked component of the French healthcare system dominated by the medical profession. Very few patients' associations exist to enable patients to self-manage into physical activity programmes. The aim of this qualitative study was to examine perceived motives for regular physical activity in male and female individuals, with type 2 diabetes involved in one French patients' association, called 'Move for Health'. Twenty-three adults (14 women and 9 men) with type 2 diabetes ranging in age from 35 to 78 volunteered to participate. The participants undertook regular physical activities autonomously with some medico-sporting educators' help. Results showed that participants reported intrinsic motives such as enjoyment, interest, fun, stimulation and highlighted gender differences. Female participants were more likely than male participants to emphasise the importance of emotional support obtained from the group meetings, and the pleasure of doing something together, and male participants emphasised the knowledge acquisition and skill development for disease control. Moreover, female participants indicated the importance of the sense of well-being and the positive body image related to regular physical activity, and male participants underlined the strength of the relationship between physical activity and health-promoting behaviours. This study provides insights into how gender motives are related to the interest and usefulness of physical activities in the management of diabetes. Findings lend support to the setting up of this type of patients' association in the French healthcare system and underline its contribution to self-determination and the behaviour change process in people with diabetes.

Predicting dropout in male youth soccer using the theory of planned behavior.

This investigation prospectively predicted dropout among young soccer players, using the theory of planned behavior (TPB). First, behavioral beliefs required to develop a TPB-questionnaire were elicited from 53 male soccer players, aged 13-15 years. Second, at the beginning of the soccer season, 354 different male soccer players aged 13-15 years completed this questionnaire, thereby assessing direct dimensions (intention, attitude, subjective norm, perceived control) and indirect dimensions (attitudinal, normative and control beliefs) derived from TPB. Nine months later--upon termination of the soccer season--these players were classified into 323 perserverers and 31 dropouts, with TPB being applied prospectively to predict these two groups. For both direct and indirect dimensions, between-group comparisons revealed significant differences in favor of the perseverers. Discriminant analyses revealed five measures (intention, attitude, subjective norm, a normative belief, and a control belief), which enabled a 22.1% a priori dropout prediction when used within a suitable equation. In conclusion, TPB may have a promising application to prospectively discriminate dropouts from perseverers, providing a potential predictive a priori classification model for sport participation.

Lifestyle patterns concerning sports and physical activity, and perceptions of health.

OBJECTIVES: To explore the perceptions of health and physical activity, and the associations between these two areas from a theoretical lifestyle perspective. METHODS: Data was collected by means of a self-administered questionnaire, among 3019 adults attending centres for preventive medicine in France. Correspondence analysis examined the significance of the relationships between perceptions of health and perceptions of sports and physical activity. RESULTS: Four principal types of subjects emerged from the factor analyses expressing four different lifestyle patterns. "Non physically active lifestyle: a feeling of not being healthy", "Physically active lifestyle, pleasure/leisure-oriented", "Necessarily physically active lifestyle, regardless of health", "Physically active lifestyle aimed at stress relief". CONCLUSIONS: The sociological approach helps tackle sports and physical activity as behaviour patterns but also and especially as a health orientation connected with the socio-economical climate. This approach also gives sports practice back its meaningful cultural dimension.