Metabolically defined body size and body shape phenotypes and risk of postmenopausal breast cancer in the European Prospective Investigation into Cancer and Nutrition.

BACKGROUND: Excess body fatness and hyperinsulinemia are both associated with an increased risk of postmenopausal breast cancer. However, whether women with high body fatness but normal insulin levels or those with normal body fatness and high levels of insulin are at elevated risk of breast cancer is not known. We investigated the associations of metabolically defined body size and shape phenotypes with the risk of postmenopausal breast cancer in a nested case-control study within the European Prospective Investigation into Cancer and Nutrition. METHODS: Concentrations of C-peptide-a marker for insulin secretion-were measured at inclusion prior to cancer diagnosis in serum from 610 incident postmenopausal breast cancer cases and 1130 matched controls. C-peptide concentrations among the control participants were used to define metabolically healthy (MH; in first tertile) and metabolically unhealthy (MU; >1st tertile) status. We created four metabolic health/body size phenotype categories by combining the metabolic health definitions with normal weight (NW; BMI < 25 kg/m2 , or WC < 80 cm, or WHR < 0.8) and overweight or obese (OW/OB; BMI ≥ 25 kg/m2 , or WC ≥ 80 cm, or WHR ≥ 0.8) status for each of the three anthropometric measures separately: (1) MHNW, (2) MHOW/OB, (3) MUNW, and (4) MUOW/OB. Conditional logistic regression was used to compute odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: Women classified as MUOW/OB were at higher risk of postmenopausal breast cancer compared to MHNW women considering BMI (OR = 1.58, 95% CI = 1.14-2.19) and WC (OR = 1.51, 95% CI = 1.09-2.08) cut points and there was also a suggestive increased risk for the WHR (OR = 1.29, 95% CI = 0.94-1.77) definition. Conversely, women with the MHOW/OB and MUNW were not at statistically significant elevated risk of postmenopausal breast cancer risk compared to MHNW women. CONCLUSION: These findings suggest that being overweight or obese and metabolically unhealthy raises risk of postmenopausal breast cancer while overweight or obese women with normal insulin levels are not at higher risk. Additional research should consider the combined utility of anthropometric measures with metabolic parameters in predicting breast cancer risk.

Nitrogen-related intermediate band in P-rich GaNxPyAs1-x-y alloys.

The electronic band structure of phosphorus-rich GaNxPyAs1-x-y alloys (x ~ 0.025 and y ≥ 0.6) is studied experimentally using optical absorption, photomodulated transmission, contactless electroreflectance, and photoluminescence. It is shown that incorporation of a few percent of N atoms has a drastic effect on the electronic structure of the alloys. The change of the electronic band structure is very well described by the band anticrossing (BAC) model in which localized nitrogen states interact with the extended states of the conduction band of GaAsP host. The BAC interaction results in the formation of a narrow intermediate band (E- band in BAC model) with the minimum at the Γ point of the Brillouin zone resulting in a change of the nature of the fundamental band gap from indirect to direct. The splitting of the conduction band by the BAC interaction is further confirmed by a direct observation of the optical transitions to the E+ band using contactless electroreflectance spectroscopy.

Antiphase domain tailoring for combination of modal and 4¯ -quasi-phase matching in gallium phosphide microdisks.

We propose a novel phase-matching scheme in GaP whispering-gallery-mode microdisks grown on Si substrate combining modal and 4¯ -quasi-phase-matching for second-harmonic-generation. The technique consists in unlocking parity-forbidden processes by tailoring the antiphase domain distribution in the GaP layer. Our proposal can be used to overcome the limitations of form birefringence phase-matching and 4¯ -quasi-phase-matching using high order whispering-gallery-modes. The high frequency conversion efficiency of this new scheme demonstrates the competitiveness of nonlinear photonic devices monolithically integrated on silicon.

[Interest of evaluation of professional practice for the improvement of the management of postoperative pain with patient controlled analgesia (PCA)]. / Intérêt de l'EPP pour l'amélioration de la prise en charge de la douleur postopératoire par analgésie contrôlée par le patient (ACP).

OBJECTIVES: To evaluate the daily practice of postoperative PCA in Nancy University Hospital, in continuity with a quality program of postoperative pain (POP) care conducted in 2003. TYPE OF STUDY: A retrospective audit of patient medical records. MATERIAL AND METHODS: A review of all the medical records of consecutive surgical patients managed by PCA over a 5-week period in six surgical services. Criteria studied: Evaluation of hospital means (eight criteria) and of medical and nursing staff practice (16 criteria). A second audit was conducted 6 months after the implementation of quality improvement measures. RESULTS: Assessment of the hospital means: temperature chart including pain scores and PCA drug consumption, patient information leaflet, PCA protocol, postoperative pre-filled prescription form (PFPF) for post-anaesthesia care including PCA, and optional training of nurses in postoperative pain management. EVALUATION OF PRACTICES: One hundred and fifty-nine files of a total of 176 patients were analyzed (88%). Improvements noted after 6 months: trace of POP evaluation progressed from 73 to 87%, advance prescription of PCA adjustment increased from 56 to 68% and of the treatment of adverse effects from 54 to 68%, trace of PCA adaptation by attending nurse from 15 to 43%, trace of the administration of the treatment of adverse effects by attending nurse from 24% to 64%, as did the use of PFPF from 59 to 70%. CONCLUSIONS: The usefulness of a pre-filled prescription form for post-anaesthesia care including PCA prescription is demonstrated. Quality improvement measures include: poster information and pocket guides on PCA for nurses, training of 3 nurses per service to act as "PCA advisers" who will in turn train their ward colleagues in PCA management and the use of equipment until an acute pain team is established.

Impact Des Filières De Soins En Phase Aigue Dans L/'amélioration Fonctionnelle Des Avc A Nouakchott

Introduction. Les accidents vasculaires cerebraux (AVC) sont sources d'invalidites fonctionnelles par fois tres lourdes pour les patients et de contraintes pour leurs entourages. La prise en charge initiale est determinante dans l'amelioration du deficit moteur et partant du pronostic fonctionnel de ces patients. En Mauritanie cette prise en charge initiale se fait a travers differentes filieres de soins.Objectif. Ce travail avait pour objectif de determiner si la filiere initiale de soins en phase aigue avait un impact sur l'amelioration fonctionnelle des patients victimes d'un AVC a Nouakchott. Methodologie. Une etude prospective evaluative portant sur une cohorte de 82 personnes dont 42 au service de Neurologie du CNP; 40 en Medecine Interne et Cardiologie du CHN; s'etait deroulee du 1er mars au 30 novembre 2006. Les patients victimes d'AVC etaient recus aux urgences du CHN avant d'etre orientes en fonction de la periode du mois : en Neurologie (du 1er au 15); en Medecine Interne (du 16 au 23) ou en Cardiologie (du 24 a la fin du mois). Si les malades repondaient a tous les criteres d'inclusion et apres un consentement eclaire; ils etaient evalues sur le plan du deficit et de la capacite fonctionnelle par deux echelles validees : l'Indice de Barthel et la Mesure de l'independance fonctionnelle (MIF). Ces evaluations etaient effectuees a l'inclusion (J0); a J30; J60 et J90. La qualite de vie etait appreciee a J90 par l'echelle de la qualite de vie (EUROQOL). Les patients admis en Neurologie etaient compares a ceux qui etaient hospitalises dans les 2 autres services. Les comparaisons portaient sur les proportions des patients ayant connus une amelioration au cours du suivi et egalement sur les moyennes de l'Indice de Barthel de la MIF recuperes par les patients.Resultats. Soixante Six pour cent (66) des 42 patients inclus en Neurologie ont ete evalues a terme; ce taux est de 30pour la Cardiologie et 10pour la Medecine Interne (p : 0;0005). La comparaison des caracteres socioprofessionnelles; cliniques et radiologiques ne montrait aucune differencestatistiquement signifi-cative entre la Neurologie et les autres Services. Le delai moyen entre l'installation du deficit et le debut de la reeducation etait de 9 jours en Neurologie et 19 jours en Cardiologie; cette difference etait significative (p : 0;0002). La comparaison des proportions de patients ayant recupere aussi bien au niveau du deficit moteur que de l'independance fonctionnelle montrait une difference en faveur des patients qui etaient suivis en Neurologie. La comparaison des moyennes des echelles recuperees ne montrait aucune difference entre les filieres de soins.Conclusion. L'absence de difference entre les differents services au niveau des aspects socioprofessionnels; cliniques et radiologiques temoignait de la qualite de la randomisation. Il y avait plus de patients qui s'ameliorait en Neurologie que dans les 2 autres Services; ceci semblait etre bien correle avec une prise en charge precoce par la kinesitherapie et avec le suivi regulier des patients. Cependant les patients ne recuperaient pas mieux dans une filiere plus que dans une autre

[Postoperative pain management on surgical wards in one university hospital: short- and medium-term effects of a quality assurance program]. / Evaluation à court et à moyen terme d'une démarche qualité pour la prise en charge de la douleur postopératoire dans un CHU.

OBJECTIVES: Evaluation of the short- and medium-term impact of a postoperative pain management quality assurance programme in a university hospital. STUDY DESIGN: Prospective study. MATERIALS AND METHODS: In 1998: chart review and survey of patients and professionals. Principal corrective actions: support for evaluation and tracking of potentially painful surgical procedures, prescription form including an emergency treatment plan, distribution of a set of guidelines. Evaluation was identical during the quality assurance programme and three years later, in 2003. RESULTS: In 2003, information regarding postoperative analgesia was received by 70% of patients and understood by 99% (50% in 1998, p<0.001). Sixty-two percent of patients were totally satisfied with their doctors in 2003 vs 75% in 1998 (NS). Pain was documented in 63.1% of charts in 2003, vs 10% in 1998 (p<0.001). Hundred percent of doctors were aware of the analgesic protocols in 2003 vs 69% in 1998 (p<0.02). In 2003, the treatment of analgesic side effects was known by 86% of doctors vs 29% in 1998 and these effects were looked for by 57% of caregivers in 2003 vs 11% in 1998 (p<0.001). CONCLUSION: Management of postoperative pain has progress significantly and the quality indicators used for evaluation have improved. Patients are better informed, which raises standards. The programme will be extended to all other surgical departments of the hospital, under the authority of CLUDS (Committee for Pain Control and Palliative Care).

Study to determine the efficacy of topical morphine on painful chronic skin ulcers.

OBJECTIVE: To assess the efficacy of the topical application of morphine on painful chronic skin ulcers. METHOD: A prospective bi-centric controlled double-blind randomised study was conducted involving 24 patients with painful chronic skin ulcers using topically applied morphine versus placebo. Ten milligrams of morphine hydrochloride with Intrasite Gel or Intrasite Gel with placebo were applied daily for five days. All patients were treated with a level II analgesic treatment. A numeric pain scale lower than 4/10 and no need for a 'rescue' treatment (morphine sulphate) indicated that the treatment was successful. Local and systemic tolerance of the treatments was analysed daily. RESULTS: Twenty-four patients were included in the study, but only 18 started the protocol. Only 2/11 patients were completely relieved in the morphine group compared with 1/7 in the placebo group. Local and general tolerance of morphine was good. The peripheral efficacy of morphine is under discussion. CONCLUSION: The results suggest that topical morphine cannot be an alternative to morphine administered by other routes (subcutaneously or orally) in painful chronic skin ulcers. Stimulation of peripheral morphine receptors by systemic morphine could explain the difference between these results and those of previous studies.

Thigh abscess as a complication of continuous popliteal sciatic nerve block.

We present a case report of severe localized infection after continuous popliteal sciatic nerve block. The report highlights the importance of meticulous asepsis and possibly limiting the duration of catheter use.

[Evaluation of continuous nerve block for postoperative pain management in orthopaedic surgery]. / Evaluation de la mise en place d'un protocole d'analgésie postopératoire par cathéter périnerveux.

OBJECTIVE: After orthopaedic surgery, continuous nerve block analgesia provides effective postoperative pain relief. The practical use of these techniques may present problems. The purpose of this study was to assess the development of continuous block procedure for postoperative pain based on quality standard management and the effectiveness of initial training as an adjunct for introduction of these techniques. MATERIALS AND METHODS: A staff committee of anaesthesiologists established a specific practical working protocol. The medical and paramedical teaching sessions were immediately evaluated using a questionnaire. RESULTS: 214 consecutive patients were included. The incidence of side effects and complications were higher in the beginning of protocol. Constant improvement of these results was observed throughout the study. The rate patients with pain were 10%. The analysis of medical evaluation should permit to determine an acceptable level of quality. Most patients were satisfied with their management. CONCLUSION: Pain management quality assurance program provided an improvement in efficacy of postoperative pain management in our protocol. Further, evaluation may be required to assess the complete benefits of this new protocol as regards postoperative pain.

[Impact of 2 strategies of analgesia on postoperative pain after emergency hand surgery performed on an ambulatory basis]. / Impact des modalités de prescriptions d'antalgiques sur la douleur postopératoire après chirurgie de la main réalisée en urgence en hospitalisation de jour.

OBJECTIVES: The assessment of the impact of various analgesic regimens on postoperative pain at home, following emergency and ambulatory hand surgery. STUDY DESIGN: Prospective comparative study of "before" and "after" groups by phone questionnaire on the first postoperative day. PATIENTS: All emergency and ambulatory surgery patients undergoing hand surgery in a specialist university hospital unit. METHODS: a) "Before" group (120 patients): analysis of current analgesic practice in the service (prescriptions by surgeon on duty), assessment of the incidence of pain scores with an intensity >/= 4 on a numerical score of 0 to 10, and identification of the most painful surgical interventions; b) formulation for these surgical interventions of multimodal analgesic protocols drown up by the anaesthetists; c) "After" group (51 patients): assessment of the efficacy of these analgesic protocols through comparison with the "before" group. RESULTS: a) "Before" group: the total incidence of pain scores with an intensity >/= 4 was 42% and in the case of conditions involving a joint or sepsis, 88%. Dextropropoxyfen-paracetamol alone was prescribed in 66% of cases and was associated with a 48% analgesic failure rate. Non-steroidal anti-inflammatory drugs were prescribed in 14% of cases, tramadol in 7% and a combination of drugs in 15%; b) "After" group: the incidence of pain scores with an intensity >/= 4 decreased to 21% in surgical interventions involving joints or sepsis (p < 0.001). CONCLUSION: Multimodal analgesic regimens are more effective than free prescriptions. This study underlines the need to further educate surgeons in this area. Despite these written protocols, there remains a 21% incidence of pain at home on day one.

Acute postoperative pain management at home after ambulatory surgery: a French pilot survey of general practitioners' views.

IMPLICATIONS: We assessed the views of French general practitioners concerning pain relief at home after ambulatory surgery in a cross-sectional prospective survey. The results revealed that there is need for improvement, mainly in prescribing more suitable analgesic protocols and optimizing postdischarge relationships between physicians.

[Quality assurance for the assessment of postoperative pain: proposal of procedures and questionnaires]. / Démarche assurance-qualité pour la prise en charge des douleurs postopératoires: proposition d'un outil de réalisation d'enquêtes.

OBJECTIVES: This study presents a tool including survey questionnaires and a specific data-processing software for the data processing, allowing health care providers to assess the quality of postoperative pain management in surgical wards. STUDY DESIGN: Descriptive study. METHODS: A committee including anesthesiologists, nurses and epidemiologists had elaborated and tested three survey questionnaires to assess patients, nurses and medical staff satisfaction respectively. Specific data processing software was issued out of the final questionnaires. It allowed a quick analysis of items possibly, explaining inadequate postoperative pain management. After this adjustment, this tool was used in three different surgical wards, named A, B, C. RESULTS: The rate of answer (of investigated persons) being over 50%, data resulting from the survey performed in the surgical wards A and B were considered valid. The items which could explain insufficient pain relief were classified into 4 levels: patients assertion (ex: more than 50% of patients experienced persistent postoperative pain); practices evaluation (ex: 42 to 72% health care providers declared being aware of analgesic procedures); behavior's evaluation (ex: 19 to 34% of health care providers considered persistent postoperative pain to be useful for monitoring); and surgical wards potential (ex: 21 to 61% of health care providers took a specific course on pain management). Pros and cons of this tool were carefully examined and subsequent strategies defined. CONCLUSIONS: This survey's device should allow health care providers to assess the quality of postoperative pain management in surgical wards. Its validation is currently developed to improve its use, and keep the most performing indicators, showing an adequate postoperative pain management.

[Postoperative pain and surgical treatment of trapeziometacarpal osteoarthritis of the thumb after ambulatory surgery]. / Douleur postopératoire et cure chirurgicale de rhizarthrose du pouce opérée sur le mode ambulatoire.

OBJECTIVE: The course of pain and the incidence of the side effects from analgesics were evaluated for 15 days in 26 consecutive outpatients who underwent a surgical cure of trapeziometacarpal osteoarthritis of the thumb under regional block. STUDY DESIGN: Prospective study. METHODS: The analgesic regimen prescribed at discharge consisted on a regular administration of a combination of ketoprofen (50 mg.6.h-1) plus the association of acetaminophen and propoxyphene (two tablets.6.h-1). Patients were asked to evaluate their pain using a numerical rating scale graduated from 0 to 10. Data were collected during a telephone interview at day 4, 8 and 15. RESULTS: Overall, patients scrupulously followed the medical prescription. At day four, 80% of patients still needed analgesics. The mean period during which NSAID, acetaminophen and propoxyphene were maintained was 4 and 6 days respectively. Fifty percent of patients reported severe pain during postoperative day 1 and 2. Moderate pain was reported at day 3 and 4 in respectively 54% and 42% of cases. Beyond this period, most patients indicated pain of weak intensity (71% at day 8). Epigastric pain has been noticed for 27% of patients. CONCLUSION: The surgical correction of trapeziometacarpal osteoarthritis of the thumb is frequently performed according to an ambulatory setting. The fact that 50% of patients reported severe pain during the early postoperative period emphasize the inadequacy of our postoperative pain management for this surgical procedure.

Exchange of pigment-binding amino acids in light-harvesting chlorophyll a/b protein.

Four amino acids in the major light-harvesting chlorophyll (Chl) a/b complex (LHCII) that are thought to coordinate Chl molecules have been exchanged with amino acids that presumably cannot bind Chl. Amino acids H68, Q131, Q197, and H212 are positioned in helixes B, C, A, and D, respectively, and, according to the LHCII crystal structure [Kühlbrandt, W., et al. (1994) Nature 367, 614-621], coordinate the Chl molecules named a(5), b(6), a(3), and b(3). Moreover, a double mutant was analyzed carrying exchanges at positions E65 and H68, presumably affecting Chls a(4) and a(5). All mutant proteins could be reconstituted in vitro with pigments, although the thermal stability of the resulting mutant versions of recombinant LHCII varied significantly. All complexes reconstituted with the mutant proteins contained fewer chlorophyll molecules per two lutein molecules than complexes reconstituted with the wild-type protein. However, the chlorophyll-binding amino acids could not be unambiguously assigned to binding either chlorophyll a or b, as in most cases more than one chlorophyll molecule was lost due to the mutation. The changes in Chl stoichiometries suggest that in LHCII some chlorophyll positions can be filled with either Chl a or b. Only some of the point mutations in LHCII affected the ability of the apoprotein to assemble into trimeric LHCII upon insertion into isolated thylakoid membranes. Among these were exchanges of H68 with either F or L, suggesting that the stability of the LHCII trimer significantly depends on this amino acid or the Chl molecule named a(5) that is attached to it and is located close to the center of the trimeric complex. The ion pair bridge between E65 and R185 in LHCII does not appear to be essential for the proper folding of the protein.

[Analgesia after thoracotomy by extrapleural administration of continuous bupivacaine]. / Analgésie après thoracotomie par administration extrapleurale de bupivacaïne à débit continu.

This study was aimed to assess the efficiency and the side effects of a continuous administration of bupivacaine into the paravertebral space. Twenty patients, ranked ASA 2 or 3, with a mean age of 57.9 years, and having had a posterolateral thoracotomy for resection of lung tissue, were randomly assigned to one of two groups, B or C. At the end of the surgical procedure, a 22 gauge catheter was inserted into the paravertebral extrapleural space, at T4 levels As soon as pain occurred during recovery (T0), the patients were given two-hourly intravenous boluses of buprenorphine. The patients in group B were also given, through the paravertebral catheter, a 20 ml bolus of 0.25% bupivacaine, followed by a continuous steady rate infusion (10 ml.h-1). Group C patients were given normal saline in the same way. All patients could improve their analgesia with 0.05 ml boluses of buprenorphine given by an auto-analgesia pump (Pharmacia). The following parameters were assessed during the 72 h which followed the first injection: pain with a visual analogic scale, quality of sedation (5 grades), heart and breathing rate, systolic and diastolic blood pressure, arterial blood gases. In group B, plasma bupivacaine concentrations were measured throughout the infusion, and for an 8-hour period after its end. The statistical analysis included 15 patients only, as the catheter had moved into the chest cavity in the other 5. Analgesia was qualified to be adequate by all patients, but there was no statistically significant difference in the amounts of self-administered buprenorphine between groups B and C.(ABSTRACT TRUNCATED AT 250 WORDS)

[Clinical features of malignant hyperthermia crisis]. / Formes cliniques de la crise d'hyperthermie maligne.

Malignant hyperthermia (MH) is a pharmacogenetic disorder. It is classically described as a hypermetabolic state triggered by halogenated anaesthetics and/or depolarizing muscle relaxants. In fact, since Denborough and Lovel's case, it has been shown that MH has a great number of clinical forms. The overwhelming picture of muscular hypercatabolism with fulminating hyperthermia and generalized rigidity is becoming rare. A better knowledge of the first symptoms explains in part the better prognosis: masseter spasm after suxamethonium, an increase in expired CO2 concentration, unexplained tachycardia, ventricular arrhythmias. The use of dantrolene reduced the mortality of MH. The different types of clinical manifestations are due to genetic differences, the concentration of the anaesthetic agent, and the length of time of exposure to the drug. The severity of the episode is linked to environmental factors such as stress, physical exercise, ambient temperature, concomitant use of other drugs. Masseter spasm after suxamethonium is specific for MH, but not pathognomonic. It occurs in 1% of cases in children when using halothane with suxamethonium. However, in those patients who displayed such a spasm, more than 50% had a positive contracture test. Masseter spasm is often associated with severe rhabdomyolysis in patients with muscle dystrophy, especially Duchenne's dystrophy. In the latter case, major cardiac problems may occur at the time of anaesthetic induction. Even if there are no other signs of MH, all patients who have had a masseter spasm must be considered as open to doubt, and should be further explored. MH is often difficult to diagnose in medium severity types.(ABSTRACT TRUNCATED AT 250 WORDS)