Prise en charge de sujets âgés chuteurs en atelier « Équilibre et prévention des chutes ¼ en hôpital de jour gériatrique : étude observationnelle prospective.

Résumé Introduction. Cette étude évaluait l'impact d'un atelier équilibre en hôpital de jour gériatrique sur la prévention des chutes chez le sujet âgé. Méthode. Il s'agissait d'une étude prospective et monocentrique. Des tests moteurs ont été réalisés ainsi qu'un bilan psychologique à 2 mois (M2), à 6 mois (M6) et à 1 an (M12). Résultats. Soixante-cinq patients ont été inclus, d'âge moyen de 82,0 ans, dont 58 femmes. Il existait une amélioration significative des différents tests moteurs durant le suivi. La durée du Timed Up and Go (s), passait de 19,1 ± 8,2 à l'inclusion, à 15,8 ± 6,6 à M2 (P = 0,01 ), à 16,4 ± 6,9 à M6 (P = 0,04 inclusion vs M6) et à 16,3 ± 6,4 à M12 (P = 0,04 inclusion vs M12). Il existait aussi une amélioration psychologique significative. Le score à l'échelle Falls Efficacy Scale International-I passait de 11,6 ± 6,1 à l'inclusion à 8,2 ± 5,5 à M2 (P = 0,001), à 9,2 ± 6,0 à M6 (P = 0,02 inclusion vs M6) et à 9,0 ± 6,1 à M12 (P = 0,02 inclusion vs M12). CONCLUSION: Cette étude souligne l'intérêt des ateliers équilibre en soins primaires. Abstract Introduction. Falls are a major public health problem as a result of the high frequency of these events and morbidity/mortality among elderly persons. A prevention policy is a potential means to reduce the incidence of falls. This study aimed to assess the impact of a balance workshop in a geriatric day-hospital (GDH) on the prevention of falls in olderadults. METHOD: This was a prospective, single centre study conducted in the GDH of a general hospital. Motor tests and a psychological assessment were performed at 2 months (M2), 6 months (M6)and 1 year (M12). RESULTS: Sixty-five patients were included, aged 82.0 ± 7.7 years. Fifty-eight were women (89.2%). The statistical analyses showed a significant improvement in all motor tests during the follow-up at the defined intervals. The Timed Up and Go test (s) significantly decreased between inclusion, 19.1 ± 8.2, and M2, 15.8 ± 6.6 (P = 0.01 inclusion vs M2), then was stable at M6, 16.4 ± 6.9 (P = 0.04 inclusion vs M6) and at M12, 16.3 ± 6.4 (P = 0.04 inclusion vs M12). There was also significant psychological improvement throughout follow-up. The score on the Falls Efficacy Scale International-I decreased from 11.6 ± 6.1 at inclusion to 8.2 ± 5.5 at M2 (P = 0.001 inclusion vs. M2), 9.2 ± 6.0 at M6 (P = 0.02 inclusion vs. M6), and 9.0 ± 6.1 at M12 (P = 0.02 inclusion vs. M12). CONCLUSION: This study highlights the value and the need for balancing workshops in primary care.

Changes in maternal blood inflammatory markers as a predictor of chorioamnionitis: a prospective multicenter study.

PROBLEM: To evaluate the inflammatory pattern in maternal circulation from women with preterm premature rupture of membranes (PPROM) considering the occurrence of histologically confirmed chorioamnionitis (HCA). METHOD OF STUDY: A prospective study was conducted in 121 women with PPROM between 24 and 34 + 0 weeks of gestation. Association between white blood cells (WBC) count, plasma CRP, IL-6, MCP-1 and IP-10 levels, and HCA was assessed. RESULTS: The rate of HCA was 44.7% (54/121). During the 5 days preceding delivery, median CRP, WBC, and IL-6 levels were significantly higher in the HCA than in no-HCA group (P < 0.001). Variations in IL-6, IP-10 levels, during the 24-72 hr before delivery, were predictors of the occurrence of HCA, but the diagnostic accuracy was low [Receiver Operating Characterictic (ROC) curve, area under the curve (AUC) = 0.56]. CONCLUSION: An increase in IL-6, CRP, IP-10 maternal plasma levels was confirmed in PPROM women with HCA. Longitudinal follow-up of these markers did not add valuable information regarding HCA.

Postnatal overfeeding in rats leads to moderate overweight and to cardiometabolic and oxidative alterations in adulthood.

In contrast to the masses of data on obesity, few data are available concerning the cardiometabolic and oxidative consequences of moderate overweight. The model of postnatal overfeeding (OF) induces an increase in body weight at weaning that remains during adult life. Litters of Wistar rats were either maintained at 12 pups (normal-fed group, NF), or reduced to 3 pups at birth in order to induce OF. At 6 months of age, metabolic parameters, circulating oxidative stress and aortic and coronary vasoreactivity were assessed. Cardiac susceptibility to ischemia-reperfusion injury was also evaluated ex vivo as were markers of cardiac remodeling. OF led to an increase in body weight at weaning (+50%); the increase in body weight persisted throughout adult life, but was less marked (+10%). Significant increases in plasma levels of fasting glucose, insulin and leptin were found in OF rats. An increase in both plasma hydroperoxides and cardiac superoxide dismutase activity and a decrease in plasma ascorbate were found in OF rats. Vasoreactivity was not modified, but ex vivo, after 30 min of ischemia, isolated hearts from OF rats showed lower recovery of coronary flow along with a greater release of LDH. Studies on heart tissues showed an increase in collagen content and increased expression and activity of MMP-2. Our findings show that moderate overweight in adult rats, induced by postnatal overfeeding, leads to both metabolic and oxidative disturbances as well as a higher susceptibility to cardiac injury after ischemia ex vivo, which may be explained, at least in part, by ventricular remodeling.

Secreted surfactant protein A from fetal membranes induces stress fibers in cultured human myometrial cells.

In the present study, we investigated the ability of human fetal membranes (amnion and choriodecidua) to regulate human maternal uterine cell functions through the secretion of surfactant protein (SP)-A and SP-D at the end of pregnancy. We detected the expression of both SP-A (SP-A1 and SP-A2) and SP-D by quantitative reverse transcription polymerase chain reaction. Immunohistochemistry revealed that human fetal membranes expressed both SP-A and SP-D. By Western blot analysis, we demonstrated that SP-A protein expression was predominant in choriodecidua, whereas the amnion predominantly expressed SP-D. Only the secretion of SP-A was evidenced in the culture supernatants of amnion and choriodecidua explants by immunodot blot and confirmed by Western blot. Exogenous human purified SP-A induced stress fiber formation in cultured human myometrial cells via a pathway involving Rho-kinase. Conditioned medium from choriodecidua and amnion explants mimicked the SP-A effect. Treatment of myometrial cells with SP-A-depleted conditioned medium from choriodecidua or amnion explants failed to change the actin dynamic. These data indicate that SP-A released by human fetal membranes is able to exert a paracrine regulation of F-actin filament organization in myometrial cells.