Preoperative oral practices and incidence of postoperative complications in hospital medical-surgical procedures: A meta-analysis.

BACKGROUND:  Oral decay prior to a hospital medical-surgical procedure is a risk factor for the development of postoperative complications. However, perioperative oral practices as a protective factor have not been studied. This review aims to evaluate the effectiveness of perioperative oral practices in the reduction of risk of developing postoperative complications in in-hospital medical surgical procedures. MATERIAL AND METHODS: This review and meta-analysis was conducted according to Cochrane guidelines. Medline, Scopus, Scielo, and Cochrane were consulted. Articles of the previous 10 years concerning adult patients undergoing perioperative oral practices prior to hospital medical-surgical procedures, were included. Data of the type of perioperative oral practice, type of postoperative complication and measures of effect on the development of complications were extracted. RESULTS: Of a pool of 1470 articles, 13 were included for systematic review and 10 for meta-analysis. The most common perioperative oral procedures were focalized approach (FA), referred to only the elimination of infectious foci in the oral cavity and comprehensive approach (CA), referred to a integral approach of the patient's oral health, both of which were mainly performed in oncologic surgeries, both were effective in the reduction of postoperative complications (RR=0.48, [95% CI 0.36 - 0.63]). The most reported postoperative complication was postoperative pneumonia. CONCLUSIONS: Perioperative oral management proved to be a protective factor against the development of postoperative complications.

Long-term outcomes of primary cystocele repair by transvaginal mesh surgery versus laparoscopic mesh sacropexy: extended follow up of the PROSPERE multicentre randomised trial.

OBJECTIVE: To compare the effectiveness and safety of laparoscopic sacropexy (LS) and transvaginal mesh (TVM) at 4 years. DESIGN: Extended follow up of a randomised trial. SETTING: Eleven centres. POPULATION: Women with cystocele stage ≥2 (pelvic organ prolapse quantification [POP-Q], aged 45-75 years without previous prolapse surgery. METHODS: Synthetic non-absorbable mesh placed in the vesicovaginal space and sutured to the promontory (LS) or maintained by arms through pelvic ligaments and/or muscles (TVM). MAIN OUTCOME MEASURES: Functional outcomes (pelvic floor distress inventory [PFDI-20] as primary outcome); anatomical assessment (POP-Q), composite outcome of success; re-interventions for complications. RESULTS: A total of 220 out of 262 randomised patients have been followed at 4 years. PFDI-20 significantly improved in both groups and was better (but below the minimal clinically important difference) after LS (mean difference -7.2 points; 95% CI -14.0 to -0.05; P = 0.029). The improvement in quality of life and the success rate (LS 70%, 61-81% versus TVM 71%, 62-81%; hazard ratio 0.92, 95% CI 0.55-1.54; P = 0.75) were similar. POP-Q measurements did not differ, except for point C (LS -57 mm versus TVM -48 mm, P = 0.0093). The grade III or higher complication rate was lower after LS (2%, 0-4.7%) than after TVM (8.7%, 3.4-13.7%; hazard ratio 4.6, 95% CI 1.007-21.0, P = 0.049)). CONCLUSIONS: Both techniques provided improvement and similar success rates. LS had a better benefit-harm balance with fewer re-interventions due to complications. TVM remains an option when LS is not feasible. TWEETABLE ABSTRACT: At 4 years, Laparoscopic Sacropexy (LS) had a better benefit-harm balance with fewer re-interventions due to complications than Trans-Vaginal Mesh (TVM).

Oral Human Papillomavirus: a multisite infection.

BACKGROUND: The Human Papillomavirus (HPV) has different strategies for persist in the cells. This characteristic has led us to consider the presence of the virus in tissues of the oral cavity that had no clinical signs of infection. The aim of this study was to detect the presence of DNA-HPV at multiple sites of the oral cavity. MATERIAL AND METHODS: A case-control study was designed: Oral Squamous Carcinoma Group (OSCG), healthy n=72 and Control Group (CG), n=72, healthy volunteers paired by sex and age with OSCG. Four samples were taken from OSCG: saliva, biopsy, brush scraping of lesion and contralateral healthy side. In CG a saliva sample and a scratch of the posterior border of tongue were collected. HPV was detected by PCR using Bioneer Accuprep genomic DNA Extraction kit, and consensus primers MY09 and MY11. Chi square test was applied. RESULTS: 432 samples were obtained from 144 individuals. DNA-HPV was detected in 30 (42%) of OSCG subjects and 3(4%) of CG. Two or more positive samples were obtained in 67% of the OSCG, 67% in saliva and 60% in biopsy; in CG 100% of the individuals were positive in the two samples. CONCLUSIONS: HPV is frequently present in oral cavity as a multifocal infection, even without the presence of clinical lesions.

Physical inactivity and platelet function in humans and brown bears: A comparative study.

Physical inactivity increases the risk of thromboembolism. However, good standardized human models on inactivity are in short supply and experimental models are few. Our objective was to investigate how standardized bed rest affects platelet aggregation in humans and to investigate if aggregation is altered in a translational model system - the hibernating brown bear (Ursus arctos). We collected blood from (1) healthy male volunteers participating in a 21-day bed rest study in head-down tilt position (-6°) 24 h a day; (2) free-ranging brown bears captured during winter hibernation and again during active state in summer. We analyzed platelet function using multiple electrode platelet aggregometry. In total, 9 healthy male volunteers (age 31.0 ± 6.4 years) and 13 brown bears (7 females and 6 males, age 2.8 ± 0.6 years) were included. In hibernating bears adenosine diphosphate, arachidonic acid, thrombin receptor activating peptide, and collagen impedance aggregometry tests were all halved compared to summer active state. In human volunteers no statistically significant changes were found between baseline and the end of bed rest. In human male volunteers 3 weeks of bed rest did not affect platelet function. In hibernating brown bears platelet aggregation was halved compared to summer and we hypothesize that this is a protective measure to avoid formation of thrombi under periods of low blood flow.

Prior automatic posture and activity identification improves physical activity energy expenditure prediction from hip-worn triaxial accelerometry.

Accelerometry is increasingly used to quantify physical activity (PA) and related energy expenditure (EE). Linear regression models designed to derive PAEE from accelerometry-counts have shown their limits, mostly due to the lack of consideration of the nature of activities performed. Here we tested whether a model coupling an automatic activity/posture recognition (AAR) algorithm with an activity-specific count-based model, developed in 61 subjects in laboratory conditions, improved PAEE and total EE (TEE) predictions from a hip-worn triaxial-accelerometer (ActigraphGT3X+) in free-living conditions. Data from two independent subject groups of varying body mass index and age were considered: 20 subjects engaged in a 3-h urban-circuit, with activity-by-activity reference PAEE from combined heart-rate and accelerometry monitoring (Actiheart); and 56 subjects involved in a 14-day trial, with PAEE and TEE measured using the doubly-labeled water method. PAEE was estimated from accelerometry using the activity-specific model coupled to the AAR algorithm (AAR model), a simple linear model (SLM), and equations provided by the companion-software of used activity-devices (Freedson and Actiheart models). AAR-model predictions were in closer agreement with selected references than those from other count-based models, both for PAEE during the urban-circuit (RMSE = 6.19 vs 7.90 for SLM and 9.62 kJ/min for Freedson) and for EE over the 14-day trial, reaching Actiheart performances in the latter (PAEE: RMSE = 0.93 vs. 1.53 for SLM, 1.43 for Freedson, 0.91 MJ/day for Actiheart; TEE: RMSE = 1.05 vs. 1.57 for SLM, 1.70 for Freedson, 0.95 MJ/day for Actiheart). Overall, the AAR model resulted in a 43% increase of daily PAEE variance explained by accelerometry predictions. NEW & NOTEWORTHY Although triaxial accelerometry is widely used in free-living conditions to assess the impact of physical activity energy expenditure (PAEE) on health, its precision and accuracy are often debated. Here we developed and validated an activity-specific model which, coupled with an automatic activity-recognition algorithm, improved the variance explained by the predictions from accelerometry counts by 43% of daily PAEE compared with models relying on a simple relationship between accelerometry counts and EE.

Pain and Vertebral Dysfunction in Dry Immersion: A Model of Microgravity Simulation Different from Bed Rest Studies.

BACKGROUND: Astronauts frequently experience back pain during and after spaceflight. The aim of this study was to utilize clinical methods to identify potential vertebral somatic dysfunction (VD) in subjects exposed to dry immersion (DI), a model of microgravity simulation. METHOD: The experiment was performed in a space research clinic, respecting all the ethical rules, with subjects completing three days of dry immersion (n = 11). Assessments of VD, spine height, and back pain were made before and after simulated microgravity. RESULTS: Back pain was present in DI with great global discomfort during the entire protocol. A low positive correlation was found (Pearson r = 0.44; P < 0.001) between VD before DI and pain developed in the DI experiment. CONCLUSIONS: There is a specific location of pain in both models of simulation. Our analysis leads to relativizing constraints on musculoskeletal system in function of simulation models. This study was the first to examine manual palpation of the spine in a space experience. Additionally, osteopathic view may be used to select those individuals who have less risk of developing back pain.

Exercise training improves fat metabolism independent of total energy expenditure in sedentary overweight men, but does not restore lean metabolic phenotype.

BACKGROUND: Obesity is a dietary fat storage disease. Although exercise prevents weight gain, effects of chronic training on dietary fat oxidation remains understudied in overweight adults. OBJECTIVE: We tested whether 2 months of training at current guidelines increase dietary fat oxidation in sedentary overweight adults like in sedentary lean adults. DESIGN: Sedentary lean (n=10) and overweight (n=9) men trained on a cycle ergometer at 50% VO2peak, 1 h day-1, four times per week, for 2 months while energy balance was clamped. Metabolic fate of [d31]palmitate and [1-13C]oleate mixed in standard meals, total substrate use, total energy expenditure (TEE), activity energy expenditure (AEE) and key muscle proteins/enzymes were measured before and at the end of the intervention. RESULTS: Conversely to lean subjects, TEE and AEE did not increase in overweight participants due to a spontaneous decrease in non-training AEE. Despite this compensatory behavior, aerobic fitness, insulin sensitivity and fat oxidation were improved by exercise training. The latter was not explained by changes in dietary fat trafficking but more likely by a coordinated response at the muscle level enhancing fat uptake, acylation and oxidation (FABPpm, CD36, FATP1, ACSL1, CPT1, mtGPAT). ACSL1 fold change positively correlated with total fasting (R2=0.59, P<0.0001) and post-prandial (R2=0.49, P=0.0006) fat oxidation whereas mtGPAT fold change negatively correlated with dietary palmitate oxidation (R2=0.40, P=0.009), suggesting modified fat trafficking between oxidation and storage within the muscle. However, for most of the measured parameters the post-training values observed in overweight adults remained lower than the pre-training values observed in the lean subjects. CONCLUSION: Independent of energy balance and TEE, exercise training at current recommendations improved fitness and fat oxidation in overweight adults. However the improved metabolic phenotype of overweight adults was not as healthy as the one of their lean counterparts before the 2-month training, likely due to the spontaneous reduction in non-training AEE.

Drivers of hibernation in the brown bear.

BACKGROUND: Hibernation has been a key area of research for several decades, essentially in small mammals in the laboratory, yet we know very little about what triggers or ends it in the wild. Do climatic factors, an internal biological clock, or physiological processes dominate? Using state-of-the-art tracking and monitoring technology on fourteen free-ranging brown bears over three winters, we recorded movement, heart rate (HR), heart rate variability (HRV), body temperature (Tb), physical activity, ambient temperature (TA), and snow depth to identify the drivers of the start and end of hibernation. We used behavioral change point analyses to estimate the start and end of hibernation and convergent cross mapping to identify the causal interactions between the ecological and physiological variables over time. RESULTS: To our knowledge, we have built the first chronology of both ecological and physiological events from before the start to the end of hibernation in the field. Activity, HR, and Tb started to drop slowly several weeks before den entry. Bears entered the den when snow arrived and when ambient temperature reached 0 °C. HRV, taken as a proxy of sympathetic nervous system activity, dropped dramatically once the bear entered the den. This indirectly suggests that denning is tightly coupled to metabolic suppression. During arousal, the unexpected early rise in Tb (two months before den exit) was driven by TA, but was independent of HRV. The difference between Tb and TA decreased gradually suggesting that bears were not thermoconforming. HRV increased only three weeks before exit, indicating that late activation of the sympathetic nervous system likely finalized restoration of euthermic metabolism. Interestingly, it was not until TA reached the presumed lower critical temperature, likely indicating that the bears were seeking thermoneutrality, that they exited the den. CONCLUSIONS: We conclude that brown bear hibernation was initiated primarily by environmental cues, but terminated by physiological cues.

Hémorragie du post-partum immédiat : technique de méchage

Le Méchage intra-utérin (MIU) est une technique d'étape importante pour stopper l'Hémorragie du post-partum (HPP); il est pratiqué après l'inefficacité des moyens médicaux et avant l'étape chirurgicale. Les préalables pour une PEC efficace sont évoqués puis une description détaillée de la technique de méchage est faite, terminée par une étude portant sur 265 cas d'HPP sur 7 ans dont 119 cas de méchage. Avec 93,3% de taux de succès et un coût très faible, le MIU est très efficace dans la PEC de l'HPP. Aucune complication à court ou long terme n'est constatée dans la cohorte présentée. 58 cas de grossesses spontanées sont constatés par la suite

Analytical aspects of measuring (2)H/(1)H and (18)O/(16)O ratios in urine from doubly labelled water studies by high-temperature conversion elemental analyser-isotope-ratio mass spectrometry.

RATIONALE: Total Body Water (TBW) and Total Energy Expenditure (TEE) are routinely measured in free-living conditions by the (2)H2(18)O method. Isotope eliminations can be measured from spot urine samples by HTC-EA IRMS, but only after cumbersome cryogenic distillation to extract water. Distillation may, however, be replaced by charcoal treatment and filtration. This study tested (1) the effect of sample treatments (filtration versus distillation) on the isotope ratios, (2) the effect of different ways of normalization that respect or not the principle of identical treatment of the sample and references, and (3) the impact on the biological outcomes. METHODS: Two filters (PES membrane; 10 kDa) accepting volumes of urine samples (V500: 0.5 mL versus V6: 3.0 mL) were tested. In-house water standards and in-house urine standards were prepared and normalized against the international scale to calibrate the urine samples. The δ(2)H and δ(18)O values from water in the urine were measured by HTC-EA IRMS. RESULTS: Filtered urine normalized with water standards showed a bias in the δ(2)H values that was corrected when calibration was performed with urine standards. At a δ(2)H value of 1101.4‰, the accuracy increased from -11.9 to -0.2 δ‰ (V500) and from -3.8 to 0.4 δ‰ (V6). The TBW errors were greatest with V500 and water calibration (1.20%) and lowest with V6 and urine calibration (0.34%; preparation-by-calibration interaction p = 0.027). For the δ(18)O values the accuracy of enrichments and TBW were not affected whatever preparations and normalization were used. The average TEE was not affected but the variability increased from 0.6 to 2.7% versus cryogenic distillation. CONCLUSIONS: Cryogenic distillation remains the gold standard for small sample size experiments where small changes in TEE are to be detected. Filtration offers an alternative for large-scale experiments. When the body composition is derived from (2)H2O dilution, it is strongly recommended that urine standards should be used to eliminate the effect of filtration.

Improved recovery of Listeria monocytogenes from stainless steel and polytetrafluoroethylene surfaces using air/water ablation.

AIMS: To develop a gentle ablation technique to recover Listeria monocytogenes biofilms from stainless steel (SS) and polytetrafluoroethylene (PTFE) surfaces by using compressed air and water injection. METHODS AND RESULTS: Biofilms were grown for 4, 24 and 48 h or 7 days and a compressed air and water flow at 2, 3 and 4 bars was applied for cell removal. Collected cells were quantified for total/dead by staining with SYTO 9/PI double staining and cultivable populations were determined by plating onto brain heart infusion (BHI) agar, while coupon surfaces also were stained with DAPI to quantify in situ the remaining cells. The recovery efficiency was compared to that of conventional swabbing. Results showed that the air/water ablation is able to collect up to 98·6% of cells from SS surfaces while swabbing only recovered 11·2% of biofilm. Moreover, air/water ablation recovered 99·9% of cells from PTFE surfaces. CONCLUSIONS: The high recovery rate achieved by this technique, along with the fact that cells were able to retain membrane integrity and cultivability, indicate that this device is suitable for the gentle recovery of viable L. monocytogenes biofilm cells. SIGNIFICANCE AND IMPACT OF THE STUDY: This work presents a highly efficient technique to remove, collect and quantify L. monocytogenes from surfaces commonly used in the food industry, which can thus serve as an important aid in verifying cleaning and sanitation as well as in reducing the likelihood of cross-contamination events.

[Acute cough in infants: impact of national guidelines on medical practices in a French department]. / Recommandations de l'Agence nationale de sécurité du médicament concernant le traitement de la toux aiguë du nourrisson : évaluation des pratiques médicales dans les Alpes-Maritimes.

CONTEXT AND AIM: Guidelines have been published regularly since 2010 by the ANSM (the Health Products Safety Agency) advising against antitussive drugs for infants because of their inefficacy and their side effects (convulsions, respiratory congestion). Antihistamines, mucolytics, and terpene-based suppositories have theoretically disappeared from infant pharmacopoeia. We assessed the degree of compliance with these guidelines on the part of health professionals. MATERIALS AND METHODS: From June 2012 to August 2012, 198 general practitioners and 44 pediatricians were assessed in the Alpes-Maritimes department of France by means of questionnaires. At the same time, an analysis of medical prescriptions was sought from the Regional Directorate of Medical Services (RDMS) of the PACA-Corse region Health Insurance. RESULTS: The rate of noncompliance with the contraindications was 14.9% (17.7% general practitioners and 2.3% pediatricians). The RDMS study showed a slight decrease in prescriptions for antitussives not recommended from 2011 to 2012: -21% for pediatricians, -15.5% for generalist physicians. CONCLUSION: Continued educational and informative campaigns are therefore needed to stop medical prescriptions of cough medicines for infants, which should also involve parents.

[Acute cough in infants: impact on families and pharmacists of contraindications of the Agence nationale de sécurité du médicament et des produits de santé (ANSM)]. / Recommandations de l'Agence nationale de sécurité du médicament et des produits de santé (ANSM) concernant la prise en charge de la toux aiguë du nourrisson : impact sur les familles et les pharmacies.

CONTEXT AND OBJECTIVE: Although commonplace and usually not serious, acute cough in the context of upper respiratory tract infection is a frequent reason for consultation and generates significant parental anxiety. Parents often request active drug intervention. Following the contraindications in infants of mucolytics, Hélicidine(®), antihistamines, and terpene-based suppositories, issued between 2010 and 2011 by the Agence nationale de sécurité du médicament et des produits de santé (ANSM), we wished to assess whether these contraindications were known by parents and applied in pharmacies. MATERIALS AND METHODS: An assessment of compliance with these contraindications was made by a double declarative prospective observational study in Nice, first with 29 pharmacists and pharmacy technicians (4-25 August 2012) and then with 289 parents of infants (December 2011 to April 2012). RESULTS: The rate of noncompliance with contraindications was 23.8 % for parents and 34.5 % of pharmacists and pharmacy technicians. Consumption of cough medicines was inversely correlated to the ability to perform a correct nasal wash (OR=2.3). Only 21 % of parents used nasal wash properly. Full-time work was a risk factor for noncompliance with contraindications (OR=1.91). CONCLUSION: ANSM contraindications still have a limited impact on pharmacists and families. Therefore, efforts must be pursued to stop delivering cough medicines for infants. The information and educational campaigns should also involve parents and help to improve nasal wash use.

A socio-ecological approach promoting physical activity and limiting sedentary behavior in adolescence showed weight benefits maintained 2.5 years after intervention cessation.

BACKGROUND: Obesity in youth remains a major public health issue. Yet no effective long-term preventive strategy exists. We previously showed that a school-based socio-ecological approach targeting behavior and social/environmental influences on physical activity (PA) prevented 4-year excessive weight gain in 12-year olds. In this study, we investigated if this efficacy persists 30 months after intervention cessation. METHODS AND FINDINGS: The program targeted students, family, school and the living environment to promote/support PA and prevent sedentary behavior (SB). A total of 732 students from eight randomized middle schools completed the 4-year trial. At the 30-month post-trial follow-up, body mass index (BMI), fat mass index (FMI), leisure PA (LPA), home/school/workplace active commuting, TV/video time (TVT), and attitudes toward PA were measured in 531 adolescents. The beneficial effects of the intervention on the excess BMI increase (+0.01 vs +0.34 kg m(-2) in the intervention and control groups, respectively) and on the overweight incidence in initially non-overweight students (4.3% vs 8.6%; odds ratio=0.48 (95% confidence interval: 0.23-1.01)) were maintained at the post-trial follow-up. LPA was not maintained at the level achieved during the trial. However, we still observed a prevention of the age-related decrease of the adolescents' percentage reporting regular LPA (-14.4% vs -26.5%) and a higher intention to exercise in the intervention group. The intervention promoted lower TVT (-14.0 vs +13.6 min per day) and higher active commuting changes (+11.7% vs -4.8%). Trends in higher BMI reduction in students with high initial TVT and in the least wealthy group were noted. TVT changes throughout the follow-up predicted excess BMI and FMI changes. CONCLUSIONS: Long-term multilevel approach targeting PA and SB prevents excessive weight gain up to 30 months after intervention cessation. The efficacy may be higher in the most sedentary and least wealthy adolescents. Healthy PA-related behavior inducing long-lasting weight effects can be promoted in youth providing that an ecological approach is introduced in the prevention strategy.

Calorie restriction and resveratrol supplementation prevent age-related DNA and RNA oxidative damage in a non-human primate.

Oxidative stress is a key factor in the aging process and in the development of age-related diseases. Because nutritional interventions such as caloric restriction (CR) delay the onset of age-related diseases and increase the lifespan of many species, the impact of a moderate CR was tested on male grey mouse lemur (Microcebus murinus), which have a median survival time of 5.7 years in captivity. The effects of CR on these lemurs were compared with a potential mimetic, resveratrol (RSV), a polyphenol naturally found in grapes. We hypothesized that both CR and RSV impact oxidative DNA and RNA damage compared to standard-fed control (CTL) animals. Adult (3-4 years old) male mouse lemurs were assigned to three dietary groups: a CTL group, a CR group receiving 30% fewer calories than the CTL and a RSV group receiving the CTL diet supplemented with RSV (200 mg·day(-1)·kg(-1)). Oxidative stress was estimated after 3, 9, 15 and 21 months of treatment using the measurement of oxidized nucleosides in urine samples by mass spectrometry. The resting metabolic rate, adjusted for changes in body composition, was also measured to assess the potential relationship between oxygen consumption and oxidative damage markers. This study provides evidence for oxidative stress accumulation with age in grey mouse lemur. Dietary interventions resulted in a short-term increase in oxidative stress levels followed by reduced levels with increasing age. Moreover, in this photoperiod-dependent heterotherm primate, seasonal variations in oxidative stress were observed, which was likely due to a season-dependent, cost-benefit trade-off between torpor use and oxidative stress.

[PROSPERE randomized controlled trial: laparoscopic sacropexy versus vaginal mesh for cystocele POP repair]. / Étude randomisée comparant la promontofixation cœlioscopique à la chirurgie prothétique par voie vaginale pour le traitement des cystocèles : PROSPERE (PROSthetic PElvic organ prolapse REpair).

BACKGROUND: Cystocele is a frequent and invalidating type of genital prolapse in woman. Sacropexy using synthetic mesh is considered the surgical gold standard, and the laparoscopic approach has supplanted the open abdominal route because it offers the same anatomical results with a lower morbidity. The use of mesh through the vaginal route may have many advantages: easiness to perform, shorter operative time and recovery, but may increase morbidity. In France, both laparoscopic sacropexy and vaginal mesh are commonly used to treat cystoceles. The French Haute Autorité de santé (HAS) has highlighted the lack of evaluation of safety assessment for vaginal meshes. METHOD/DESIGN: The main objective of the study is to compare the morbidity of laparoscopic sacropexy with vaginal mesh for cystocele repair. The primary endpoint will be the rate of surgical complications greater or equal to grade 2 of the Clavien-Dindo classification at 1-year follow-up. The secondary aims are to compare the functional results in the medium term (sexuality, urinary and bowel symptoms, pain), the impact on quality of life as well as anatomical results. PROSPERE is a randomized controlled trial conducted in 12 participating French hospitals. 262 patients, aged 45 to 75years old, with cystocele greater or equal to stage 2 of the POP-Q classification (isolated or not) will be included. Exclusion criterias are a previous surgical POP repair, and inability or contra-indication to one or the other technique. We have designed this study to answer the question of the choice between laparoscopic sacropexy and vaginal mesh for the treatment of cystocele. The PROSPERE trial aims to help better determine the indications for one or the other of these techniques, which are currently based on subjective choices or school attitudes. This is the reason why competent authorities have asked for such studies.

Raman-scattering measurements and theory of the energy-momentum spectrum for underdoped Bi2Sr2CaCuO(8+δ) superconductors: evidence of an s-wave structure for the pseudogap.

We reveal the full energy-momentum structure of the pseudogap of underdoped high-Tc cuprate superconductors. Our combined theoretical and experimental analysis explains the spectral-weight suppression observed in the B2g Raman response at finite energies in terms of a pseudogap appearing in the single-electron excitation spectra above the Fermi level in the nodal direction of momentum space. This result suggests an s-wave pseudogap (which never closes in the energy-momentum space), distinct from the d-wave superconducting gap. Recent tunneling and photoemission experiments on underdoped cuprates also find a natural explanation within the s-wave pseudogap scenario.

Validity of combining heart rate and uniaxial acceleration to measure free-living physical activity energy expenditure in young men.

Combining accelerometry (ACC) with heart rate (HR) monitoring is thought to improve activity energy expenditure (AEE) estimations compared with ACC alone to evaluate the validity of ACC and HR used alone or combined. The purpose of this study was to estimate AEE in free-living conditions compared with doubly labeled water (DLW). Ten-day free-living AEE was measured by a DLW protocol in 35 18- to 55-yr-old men (11 lean active; 12 lean sedentary; 12 overweight sedentary) wearing an Actiheart (combining ACC and HR) and a RT3 accelerometer. AEE was estimated using group or individual calibration of the HR/AEE relationship, based on an exercise-tolerance test. In a subset (n = 21), AEE changes (ΔAEE) were measured after 1 mo of detraining (active subjects) or an 8-wk training (sedentary subjects). Actiheart-combined ACC/HR estimates were more accurate than estimates from HR or ACC alone. Accuracy of the Actiheart group-calibrated ACC/HR estimates was modest [intraclass correlation coefficient (ICC) = 0.62], with no bias but high root mean square error (RMSE) and limits of agreement (LOA). The mean bias of the estimates was reduced by one-third, like RMSE and LOA, by individual calibration (ICC = 0.81). Contrasting with group-calibrated estimates, the Actiheart individual-calibrated ACC/HR estimates explained 40% of the variance of the DLW-ΔAEE (ICC = 0.63). This study supports a good level of agreement between the Actiheart ACC/HR estimates and DLW-measured AEE in lean and overweight men with varying fitness levels. Individual calibration of the HR/AEE relationship is necessary for AEE estimations at an individual level rather than at group scale and for ΔAEE evaluation.

[Pediatric ophthalmologic and orthoptic evaluation of the dyspraxic child]. / Évaluation ophtalmo-pédiatrique et orthoptique de l'enfant dyspraxique.

Orthoptic and ophthalmologic consultation is an essential step in the diagnosis and treatment of learning disorders, particularly in children with dyspraxia. Such a specialized consultation allows identification of cognitive visual disorders, especially oculomotor or visual-spatial impairment, which disrupt the cognitive processes involved in key academic tasks such as reading or handwriting. It is therefore essential to screen and manage these disorders early in order to implement a rehabilitation plan and counsel educators so as to facilitate learning. After describing cognitive visual disorders in the context of dyspraxia, we discuss principal signs, assessment and ophthalmologic and orthoptic management as conducted in our practice. Several clinical cases illustrate our approach.

[Brain tuberculoma in a 10-year-old child: the diagnosis is in the belly]. / Tuberculome cérébral chez une enfant de 10 ans diagnostiqué par biopsie d'une adénopathie abdominale.

We report the case of a 10-year-old child from Reunion Island who was hospitalized because of headaches and partial convulsive fits. The brain MRI showed several conglomerated right frontal lesions suggestive of a tumor process. This girl, vaccinated with BCG, had familial risk factors for tuberculosis and a 20-mm tuberculin intradermo-reaction. Given the palpation of an abdominal mass, a thoracoabdominal scan was done, which revealed the presence of mesenteric adenopathies. Their biopsy confirmed the diagnosis of tuberculosis without having to perform neurosurgery. A 2-month quadritherapy and a 10-month dual therapy against tuberculosis led to the disappearance of brain damage and mesenteric adenopathies, with focal epilepsy the only sequela. The tuberculosis incidence in Reunion Island (8/100,000) is comparable with the French average, but the island is surrounded by high-endemic countries. Tuberculomas were responsible for one-third of expanding intracranial lesions in Europe in 1933, and their incidence remains high in developing countries. Even though extrapulmonary or disseminated tuberculosis has become rare in children in industrialized countries, this diagnosis must be kept in mind, in spite of vaccination. In accordance with international guidelines, this case report shows the importance of a systematic extensive check-up (cervical, thoracic and abdominopelvic) when brain tuberculosis is suspected in order to find more accessible tuberculosis lesions and to avoid the side effects of a brain biopsy.