Studying the impact of a medication use evaluation for polymedicated older patients by the community pharmacist (SIMENON): study protocol.

BACKGROUND: Aged polymedicated patients are particularly vulnerable for drug-related problems. A medication review aims to optimize the medication use of patients and improve health outcomes. In this study, the effect of a pharmacist-led medication use review is investigated for polymedicated ambulatory older patients with the aim of implementing this pharmaceutical care intervention across Belgium. METHODS: This article describes the study protocol of the SIMENON study and reports the results of the feasibility study, which aimed to test and optimize this study protocol. In the SIMENON intervention study, 75 Belgian community pharmacies each recruit 12 patients for a medication use review. For each patient, the identified drug-related problems and subsequent interventions are registered using the PharmDISC classification. In a subset of Dutch speaking patients, a pretest-posttest single group design is used to measure the impact of this review on patient related outcomes using questionnaires. The main outcome of the study is the type and number of drug-related problems and related interventions. A second outcome is the impact of the medication use review on adherence, objectively measured with dispensing data. Evolution in medication related quality of life is another outcome, measured with the Living with Medicines Questionnaire version 3. Other patient reported outcomes include adherence, self-management, patient satisfaction, fall incidents and use of emergency healthcare services. DISCUSSION: The findings of this study can provide data on the effectiveness of a medication use review in the Belgian primary care setting. Furthermore, it will provide insights in which patients benefit most of this intervention and therefore facilitate the implementation of medication review in Belgium. TRIAL REGISTRATION: ClinicalTrials.gov NCT03179722 . Retrospectively registered 7 June 2017.

Sleep misperception, EEG characteristics and autonomic nervous system activity in primary insomnia: a retrospective study on polysomnographic data.

Misperception of Sleep Onset Latency, often found in Primary Insomnia, has been cited to be influenced by hyperarousal, reflected in EEG- and ECG-related indices. The aim of this retrospective study was to examine the association between Central Nervous System (i.e. EEG) and Autonomic Nervous System activity in the Sleep Onset Period and the first NREM sleep cycle in Primary Insomnia (n=17) and healthy controls (n=11). Furthermore, the study examined the influence of elevated EEG and Autonomic Nervous System activity on Stage2 sleep-protective mechanisms (K-complexes and sleep spindles). Confirming previous findings, the Primary Insomnia-group overestimated Sleep Onset Latency and this overestimation was correlated with elevated EEG activity. A higher amount of beta EEG activity during the Sleep Onset Period was correlated with the appearance of K-complexes immediately followed by a sleep spindle in the Primary Insomnia-group. This can be interpreted as an extra attempt to protect sleep continuity or as a failure of the sleep-protective role of the K-complex by fast EEG frequencies following within one second. The strong association found between K-alpha (K-complex within one second followed by 8-12 Hz EEG activity) in Stage2 sleep and a lower parasympathetic Autonomic Nervous System dominance (less high frequency HR) in Slow-wave sleep, further assumes a state of hyperarousal continuing through sleep in Primary Insomnia.

Peripheral neuropathy caused by joint-related cysts: a review of 17 cases.

BACKGROUND: Clinical compression neuropathy caused by para-articular cysts is rare. Only recently, the unifying articular theory was proposed to clarify its true etiologic nature. The authors attribute 17 cases to this theory in order to illustrate the shift in the diagnostic and treatment protocol, and the possible impact on patient outcome. METHODS: Eight intraneural and nine extraneural cysts were included. The proposed diagnostic protocol includes electromyography and ultrasound, followed by magnetic resonance imaging to characterize the cyst. The proposed treatment protocol consists of (1) ligation of the pedicle connecting the cyst with the afflicted joint, (2) decompression of the nerve and, when needed and (3) disarticulation of the superior tibiofibular joint (in case of peroneal nerve involvement). RESULTS: Outcome was good to excellent in all patients, with recovery of sensory and motor function. Cyst recurrence was observed in three intraneural cases (18 %). Analysis of our own diagnostic protocol showed that atypical compression neuropathies should follow a strict diagnostic protocol to exclude missing the presence of a cyst. Ultrasound needs to play a crucial role, with MRI for cyst characterization and pedicle identification. CONCLUSIONS: Retrospective proof in favor of the articular theory was found in all cases. An explanation for the cyst recurrences was formed based on the articular theory. In addition, a diagnostic and therapeutic protocol is proposed for all atypical peripheral compression neuropathies with the ultimate goal to achieve optimal patient outcome.

Biomechanics-based active control of bedding support properties and its influence on sleep.

Proper body support plays an import role in the recuperation of our body during sleep. Therefore, this study uses an automatically adapting bedding system that optimises spinal alignment throughout the night by altering the stiffness of eight comfort zones. The aim is to investigate the influence of such a dynamic sleep environment on objective and subjective sleep parameters. The bedding system contains 165 sensors that measure mattress indentation. It also includes eight actuators that control the comfort zones. Based on the measured mattress indentation, body movements and posture changes are detected. Control of spinal alignment is established by fitting personalized human models in the measured indentation. A total of 11 normal sleepers participated in this study. Sleep experiments were performed in a sleep laboratory where subjects slept three nights: a first night for adaptation, a reference night and an active support night (in counterbalanced order). Polysomnographic measurements were recorded during the nights, combined with questionnaires aiming at assessing subjective information. Subjective information on sleep quality, daytime quality and perceived number of awakenings shows significant improvements during the active support (ACS) night. Objective results showed a trend towards increased slow wave sleep. On the other hand, it was noticed that % N1-sleep was significantly increased during ACS night, while % N2-sleep was significantly decreased. No prolonged N1 periods were found during or immediately after steering.

The genome of Laccaria bicolor provides insights into mycorrhizal symbiosis.

Mycorrhizal symbioses--the union of roots and soil fungi--are universal in terrestrial ecosystems and may have been fundamental to land colonization by plants. Boreal, temperate and montane forests all depend on ectomycorrhizae. Identification of the primary factors that regulate symbiotic development and metabolic activity will therefore open the door to understanding the role of ectomycorrhizae in plant development and physiology, allowing the full ecological significance of this symbiosis to be explored. Here we report the genome sequence of the ectomycorrhizal basidiomycete Laccaria bicolor (Fig. 1) and highlight gene sets involved in rhizosphere colonization and symbiosis. This 65-megabase genome assembly contains approximately 20,000 predicted protein-encoding genes and a very large number of transposons and repeated sequences. We detected unexpected genomic features, most notably a battery of effector-type small secreted proteins (SSPs) with unknown function, several of which are only expressed in symbiotic tissues. The most highly expressed SSP accumulates in the proliferating hyphae colonizing the host root. The ectomycorrhizae-specific SSPs probably have a decisive role in the establishment of the symbiosis. The unexpected observation that the genome of L. bicolor lacks carbohydrate-active enzymes involved in degradation of plant cell walls, but maintains the ability to degrade non-plant cell wall polysaccharides, reveals the dual saprotrophic and biotrophic lifestyle of the mycorrhizal fungus that enables it to grow within both soil and living plant roots. The predicted gene inventory of the L. bicolor genome, therefore, points to previously unknown mechanisms of symbiosis operating in biotrophic mycorrhizal fungi. The availability of this genome provides an unparalleled opportunity to develop a deeper understanding of the processes by which symbionts interact with plants within their ecosystem to perform vital functions in the carbon and nitrogen cycles that are fundamental to sustainable plant productivity.

Functional magnetic resonance imaging for preoperative localisation of eloquent brain areas relative to brain tumours: clinical implementation in a regional hospital.

The purpose of this study was to evaluate the implementation of functional magnetic resonance imaging (fMRI) for clinical use in patients with a brain tumour in the setting of a regional hospital. Twenty-three patients underwent a fMRI examination as preoperative evaluation for a tumour adjacent to a eloquent brain area. The location and distance of the tumour relative to the fMRI activation area for this eloquent brain area was determined. Presence of postoperative neurological deficits was compared to the result of the fMRI examination. The fMRI examination was not interpretable in four of the twenty-three patients. In nine patients the eloquent brain area was located more than two centimetres from the tumour: seven showed no neurological deficit postoperatively, one patient experienced a temporary deficit, and one patient has not been operated yet. In the remaining ten patients the eloquent brain area was located less than two centimetres from the tumour: after (partial) resection of the tumour often using intra-operative cortical stimulation, six patients showed no neurological deficits, and three patients had temporary or permanent deficits. One patient was not operated. The clinical implementation of fMRI was successful in the preoperative evaluation of patients with a brain tumour and useful to plan the surgical intervention and to minimize postoperative neurological deficits.

The European Large Subunit Ribosomal RNA Database.

The European Large Subunit Ribosomal RNA Database compiles all complete or nearly complete large subunit ribosomal RNA sequences available from public sequence databases. These are provided in aligned format and the secondary structure, as derived by comparative sequence analysis, is included. Additional information about the sequences such as literature references and taxonomic information is also included. The database is available from our WWW server at http://rrna.uia.ac.be/lsu/.

Distribution of substitution rates and location of insertion sites in the tertiary structure of ribosomal RNA.

The relative substitution rate of each nucleotide site in bacterial small subunit rRNA, large subunit rRNA and 5S rRNA was calculated from sequence alignments for each molecule. Two-dimensional and three-dimensional variability maps of the rRNAs were obtained by plotting the substitution rates on secondary structure models and on the tertiary structure of the rRNAs available from X-ray diffraction results. This showed that the substitution rates are generally low near the centre of the ribosome, where the nucleotides essential for its function are situated, and that they increase towards the surface. An inventory was made of insertions characteristic of the Archaea, Bacteria and Eucarya domains, and for additional insertions present in specific eukaryotic taxa. All these insertions occur at the ribosome surface. The taxon-specific insertions seem to arise randomly in the eukaryotic evolutionary tree, without any phylogenetic relatedness between the taxa possessing them.

Comparative analysis of more than 3000 sequences reveals the existence of two pseudoknots in area V4 of eukaryotic small subunit ribosomal RNA.

The secondary structure of V4, the largest variable area of eukaryotic small subunit ribosomal RNA, was re-examined by comparative analysis of 3253 nucleotide sequences distributed over the animal, plant and fungal kingdoms and a diverse set of protist taxa. An extensive search for compensating base pair substitutions and for base covariation revealed that in most eukaryotes the secondary structure of the area consists of 11 helices and includes two pseudoknots. In one of the pseudoknots, exchange of base pairs between the two stems seems to occur, and covariation analysis points to the presence of a base triple. The area also contains three potential insertion points where additional hairpins or branched structures are present in a number of taxa scattered throughout the eukaryotic domain.

The European small subunit ribosomal RNA database.

The European database of the Small Subunit (SSU) Ribosomal RNA is a curated database that strives to collect all information about the primary and secondary structure of completely or nearly-completely sequenced rRNAs. Furthermore, the database compiles additional information such as literature references and taxonomic status of the organism the sequence was derived from. The database can be consulted via the WWW at URL http://rrna.uia.ac.be/ssu/. Through the WWW, sequences can be easily selected either one by one, by taxonomic group, or by a combination of both, and can be retrieved in different sequence and alignment formats.

The European large subunit ribosomal RNA database.

The European Large Subunit (LSU) Ribosomal RNA (rRNA) database is accessible via the rRNA WWW Server at URL http://rrna.uia.ac.be/lsu/. It is a curated database that compiles complete or nearly complete LSU rRNA sequences in aligned form, and also incorporates secondary structure information for each sequence. Taxonomic information, literature references and other information about the sequences are also available, and can be searched via the WWW interface.

Construction of a variability map for eukaryotic large subunit ribosomal RNA.

In this paper, we present a variability map of the eukaryotic large subunit ribosomal RNA, showing the distribution of variable and conserved sites in this molecule. The variability of each site in this map is indicated by means of a colored dot. Construction of the variability map was based on the substitution rate calibration (SRC) method, in which the substitution rate of each nucleotide site is computed by looking at the frequency with which sequence pairs differ at that site as a function of their evolutionary distance. Variability maps constructed by this method provide a much more accurate and objective description of site-to-site variability than visual inspection of sequence alignments.

[Vulvar sebaceous epithelioma]. / Epithélioma sébacé vulvaire.

A-77-years old woman had a solitary ulcerated tumor on her vulva present for one year. It proved, on histologic examination, to be a sebaceous epithelioma of 1.5 cm wide because of a peripheral area with less differentiated cells, excess of mitoses and slight invasiveness. To the authors' knowledge this is the first sebaceous epithelioma documented in this region. Previously have been described one sebaceous hyperplasia and two sebaceous carcinomas, one of them eight years after hemicolectomy for adenocarcinoma of the colon (Torre-Muir syndrome).

[A reliable orthopedic technic in the treatment of humeral diaphyseal fractures in the adult: the hanging plaster. Report of a series of 74 cases (author's transl)]. / Une technique orthopédique fiable dans le traitement des fractures diaphysaires humérales de l'adulte: le plâtre pendant. Analyse d'une série de 74 cas.

The authors treated 74 humeral shaft fractures with "hanging cast" technique. They study the benefits and difficulties of the method, compared to other orthopaedic and surgical possibilities. Stiffness of the shoulder represent the most important part of 12% bad results. There are only 3% pseudarthrosis. It is a simple and safe treatment, with appliance to most humeral shaft fractures in cooperant patients.