Development of ELIP to Assess Physical Literacy for Emerging Adults: A Methodological and Epistemological Challenge.

Purpose: Following increased interest in physical literacy (PL), development of appropriate tools for assessment has become an important next step for its operationalization. To forward the development of such tools, the objective of this study was to build the foundations of the Évaluation de la Littératie Physique (ELIP), designed to help reduce existing tensions in approaches to PL assessment that may be resulting in a low uptake into applied settings. Methods: We followed two steps: (1) the development of the first version of ELIP by deploying a Delphi method (n = 30); and (2) the modification of items through cognitive interviews with emerging adults (n = 32). Results: The expert consensus highlighted four dimensions of PL to be assessed-physical; affective; cognitive; and social-with new perspectives, including a preference for broad motor tests over fitness. Conclusion: Results offer new insights into the assessment of emerging adults' PL, but ELIP still requires further work concerning validity, reliability, and sensitivity.

The course of primary progressive aphasia diagnosis: a cross-sectional study.

BACKGROUND: The primary progressive aphasia (PPA) diagnosis trajectory is debated, as several changes in diagnosis occur during PPA course, due to phenotype evolution from isolated language alterations to global cognitive impairment. The goal of the present study, based on a French cohort, was to describe the demographics and the evolution of subjects with (PPA) in comparison with Alzheimer's disease (AD) on a period of 7 years. METHODS: We conducted a repeated cross-sectional study. The study population comprised individuals with PPA and AD diagnosis (N=167,191) from 2010 to 2016 in the French National data Bank (BNA). Demographic variables, MMSE scores, diagnosis status at each visit and prescribed treatments were considered. RESULTS: From 2010 to 2016, 5186 patients were initially diagnosed with PPA, 162,005 with AD. Compared to AD subjects, significant differences were found concerning age (younger at first diagnosis for PPA), gender (more balanced in PPA), education level (higher in PPA) and MMSE score (higher of 1 point in PPA). Percentage of pending diagnosis, delay between first consultation and first diagnosis and the number of different diagnoses before the diagnosis of interest were significantly higher in PPA group compared to AD group. Pharmacological and non-pharmacological treatments were significatively more recommended following PPA than AD diagnosis. CONCLUSION: This study improves the knowledge of PPA epidemiology and has the potential to help adopting appropriate public health service policies. It supports the hypothesis that PPA is diagnosed later than AD. The PPA diagnosis increases the prescription of non-pharmacological treatments, especially speech and language therapy (SLT) that is the main treatment available and most effective when at the initial stage. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT03687112.

[Physical activity and chronic diseases : how can motivational principles contribute to physically active behaviour ?] / Activité physique et maladies chroniques. Principes motivationnels pour contribuer à un comportement physiquement actif.

Although physical activity is perceived as an effective therapeutic agent in the management of chronic diseases, the literature reports a low participation rate in adapted physical activity programmes and a high drop-out rate during participation. There is room for improvement in supporting the engagement of chronically ill patients in an active lifestyle, especially in optimising the process from medical management to integration into a local adapted sports structure. Based on the motivational principles of the self-determination theory, we propose courses of action to optimise the support of the chronically ill patient in the process of behavioural change. This article emphasises the importance of placing the individual at the centre of his or her physical care and the importance of taking into account individual characteristics in order to act on intrinsic motivation.

Bien que l'activité physique soit perçue comme un agent thérapeutique efficace dans la prise en charge des maladies chroniques, la littérature rapporte un faible taux de participation aux programmes d'activité physique adaptée ainsi qu'un taux élevé d'abandon lors de leur participation. Le soutien à l'engagement des malades chroniques vers un style de vie actif semble perfectible, notamment en optimisant le processus allant de la prise en charge médicale vers l'intégration au sein d'une structure sportive locale adaptée. En regard des principes motivationnels liés à la théorie de l'auto-détermination, nous proposons des pistes d'action permettant d'optimiser l'accompagnement du malade chronique lors de son processus de changement de comportement. Cet article met l'accent sur l'intérêt de placer l'individu au centre de sa prise en charge physique ainsi que sur l'importance de prendre en compte les caractéristiques individuelles afin d'agir sur sa motivation intrinsèque.

Inflammatory cardiac fibroblast phenotype underlies chronic alcohol-induced cardiac atrophy and dysfunction.

AIMS: The purpose of this study was to investigate mechanisms of chronic alcohol-induced cardiac remodeling and dysfunction. We also sought to determine the role of cardiac fibroblasts, which play a dynamic role in cardiac remodeling, in mediating these effects. MAIN METHODS: Adult male Wistar rats were exposed to ethanol (EtOH) vapor inhalation for 16 weeks. Echocardiography was performed to assess terminal cardiac structure and function. Cardiac fibroblasts were isolated from the left ventricle (LV) for both ex vivo and in vitro analysis. Cultured H9C2 cells were also exposed to conditioned media from alcohol-exposed cardiac fibroblasts. Gene expression in whole LV tissue, isolated cardiac fibroblasts, or cultured H9C2 cells was determined by real-time PCR, and protein expression was determined by Western blot. KEY FINDINGS: EtOH led to LV wall thinning and impaired systolic function, and decreased contractile protein mRNA levels. EtOH increased LV inflammatory markers, JNK and Akt activation, and decreased mTOR expression. EtOH induced myofibroblast activation as assessed by flow cytometry, and increased LV collagen III expression. EtOH increased expression of several inflammatory mediators in cardiac fibroblasts both ex vivo and in vitro. Administration of conditioned media from EtOH-treated fibroblasts decreased contractile protein mRNA levels and impaired Akt and mTOR signaling in differentiated H9C2 cardiomyocytes. SIGNIFICANCE: Our results indicate that EtOH-induced cardiac atrophy and dysfunction is associated with activation of inflammatory pathways. Furthermore, EtOH may induce a pro-inflammatory cardiac fibroblast phenotype, leading to aberrant fibroblast-myocyte cross-talk. Thus, EtOH may promote cardiac muscle wasting in part by activation of pro-inflammatory fibroblasts.

Sex ratio in dementia with Lewy bodies balanced between Alzheimer's disease and Parkinson's disease dementia: a cross-sectional study.

BACKGROUND: Gender distribution varies across neurodegenerative disorders, with, traditionally, a higher female frequency reported in Alzheimer's disease (AD) and a higher male frequency in Parkinson's disease (PD). Conflicting results on gender distribution are reported concerning dementia with Lewy bodies (DLB), usually considered as an intermediate disease between AD and PD. The aim of the present study was to investigate gender differences in DLB in French specialized memory settings using data from the French national database spanning from 2010 to 2015 and to compare sex ratio in DLB with that in AD, Parkinson's disease dementia (PDD), and PD. Our hypothesis was that there is a balanced sex ratio in DLB, different from that found in AD and PD. METHODS: We conducted a repeated cross-sectional study. The study population comprised individuals with a DLB, AD, PDD, or PD diagnosis according to the International Classification of Diseases, Tenth Revision, in the French National Alzheimer Database between 2010 and 2015. Sex ratio and demographic data were compared using multinomial logistic regression and a Bayesian statistical model. RESULTS: From 2010 to 2015 in French specialized memory settings, sex ratios (female percent/male percent) were found as follows: 1.21 (54.7%/45.3%) for DLB (n = 10,309), 2.34 (70.1%/29.9%) for AD (n = 135,664), 0.76 (43.1%/56.9%) for PD (n = 8744), and 0.83 (45.4%/54.6%) for PDD (n = 3198). Significant differences were found between each group, but not between PDD and PD, which had a similar sex ratio. CONCLUSIONS: This large-sample prevalence study confirms the balanced gender distribution in the DLB population compared with AD and PD-PDD. Gender distribution and general demographic characteristics differed between DLB and PDD. This is consistent with the hypothesis that DLB is a distinct disease with characteristics intermediate between AD and PD, as well as with the hypothesis that DLB could have at least partially distinct neuropathological correlates.

Liver microbiome of Peromyscus leucopus, a key reservoir host species for emerging infectious diseases in North America.

Microbiome studies generally focus on the gut microbiome, which is composed of a large proportion of commensal bacteria. Here we propose a first analysis of the liver microbiome using next generation sequencing as a tool to detect potentially pathogenic strains. We used Peromyscus leucopus, the main reservoir host species of Lyme disease in eastern North America, as a model and sequenced V5-V6 regions of the 16S gene from 18 populations in southern Quebec (Canada). The Lactobacillus genus was found to dominate the liver microbiome. We also detected a large proportion of individuals infected by Bartonella vinsonii arupensis, a human pathogenic bacteria responsible for endocarditis, as well as Borrelia burgdorferi, the pathogen responsible for Lyme disease in North America. We then compared the microbiomes among two P. leucopus genetic clusters occurring on either side of the St. Lawrence River, and did not detect any effect of the host genotype on their liver microbiome assemblage. Finally, we report, for the first time, the presence of B. burgdorferi in a small mammal host from the northern side of the St. Lawrence River, in support of models that have predicted the northern spread of Lyme disease in Canada.

Relationship between ambulatory physical activity assessed by activity trackers and physical frailty among nursing home residents.

BACKGROUNDS: The aim of this study was to assess the relationship between the level of ambulatory physical activity, measured by physical activity tracker, and the clinical components of physical frailty, among nursing home residents. METHODS: We proceeded in 3 steps: (1) Validation of the physical activity tracker (i.e. the Pebble): 24 volunteer adults walked on a treadmill. The number of steps recorded by the Pebble worn by the subjects was compared with the number of steps counted by the investigators, by means of the Intra-class correlation coefficients (ICC). (2) Measurement of ambulatory physical activity, using the Pebble trackers, over a 7-day period. (3) Relationship between the results obtained with the Pebble trackers (step 2) and subjects' clinical characteristics, linked to physical frailty. RESULTS: ICC data, showed that the reliability of the Pebble was better when it was worn at the foot level (ICC ranged from 0.60 to 0.93 depending on the tested speed). Gait speed is also an important determinant of the reliability, which is better for low gait speed. On average, the 27 nursing home residents included in the second step of this study walked 1678.4±1621 (median=1300) steps per day. Most physical components of frailty measured in this study were significantly different between subjects who walked less than 1300 steps per day and those who were more active. CONCLUSION: This study showed that nursing home residents have a poor ambulatory physical activity, assessed using a physical activity tracker, which is associated with poorer physical performances and higher disability.

Patient's satisfaction after outpatient forefoot surgery: Study of 619 cases.

INTRODUCTION: The number of outpatient surgical procedures performed in France on the forefoot has grown rapidly in recent years. OBJECTIVES: The goal of this study was to evaluate experience and satisfaction of patients undergoing outpatient foot surgery using a telephone questionnaire developed for this purpose. MATERIAL AND METHODS: In 2012 and 2013, every patient who was admitted to the day surgery unit at our hospital for an open procedure on their forefoot was called the morning after the procedure. A nurse went through the 14-item questionnaire with the patient. The same perioperative protocol, written instructions and treatment were used for all patients. RESULTS: Six hundred nineteen patients were included. The questionnaire response rate was 89% (n=540). Isolated hallux valgus surgery was performed on 319 patients (61%); 107 patients (20%) underwent hallux valgus surgery with lateral metatarsal osteotomy; 57 patients (10.5%) underwent first metatarsophalangeal fusion and 47 patients (8.5%) underwent a procedure on the lateral rays only. In the postoperative phase, 65% reported having satisfactory sleep quality, 32% had experienced nausea, 16% had experienced vomiting and 17% had experienced bleeding. Eighty percent of patients experienced pain (VAS ≥ 1); 80% of these patients had their pain relieved by the prescribed treatment and 4% had not taken it. Nearly all the patients (99%) were satisfied with the outpatient care; the overall satisfaction score was 9.4 out of 10. There was a significant relationship between the type of procedure and vomiting, pain, bleeding and fever. DISCUSSION: Outpatient care is becoming more common in response to economic challenges. The development of outpatient foot surgery appears to have satisfied the vast majority of operated patients. However, adjustments should be made to improve their tolerance to the pain management protocol. Although the logistics of performing follow-up call can be complicated, the patients appreciate receiving this call the next day. The call also seems to reassure both the patients and care providers.

Physical medicine and rehabilitation multidisciplinary approach in a case of posterior cortical atrophy.

Posterior cortical atrophy (PCA) is a degenerative syndrome heralded by progressive visual and spatial disorders, while the memory and execution capacities remain preserved for a long time. We report the clinical case of a female patient who received a global Physical and Rehabilitation Medicine (PRM) therapy. Our objective is to highlight the interest of a multidisciplinary approach in PCA. A female patient, LO, 60 years old, presented with visual and spatial difficulties of progressive worsening, while global cognitive efficiency was preserved, signing PCA, with a loss of autonomy in daily life. A six-month multidisciplinary approach (speech therapy, occupational therapy, and physiotherapy) centered on her visual disturbances and associated to the reinforcement of her preserved abilities, as well as a rehabilitation program, was proposed. At the end of this period, LO was again able to read, find efficient exploratory strategies, use the underground, visit museums, have leisure activities, and carry out everyday life activities, which she had ended up abandoning. The specific therapeutic management allowed reaching functional objectives. Our hypothesis is that the absence of other cognitive disorders allowed this type of rehabilitation "contract". The neurodegenerative pathologies responsible for specific instrumental disabilities without global cognitive alteration, and particularly PCA, should be able to benefit from a specific, or even multidisciplinary PMR therapy approach.

Primary aseptic revision of the femoral component of a cemented total hip arthroplasty using a cemented technique without bone graft.

BACKGROUND: Primary revisions using cement without bone graft reconstruction are less frequently used because of their supposed higher failure rate. The results, in fact, depend on multiple parameters: number of prior revisions, cementing technique quality, and residual bone stock; these intricate factors are rarely taken together into account when analyzing this treatment method. HYPOTHESIS: Femoral component fixation with cement can be a valid option in total hip arthroplasty primary revision. OBJECTIVES: The objective of this investigation was to study the long-term results of cemented femoral stems in total hip arthroplasty primary revisions in terms of the quality of the cementing technique and the residual bone stock. PATIENTS AND METHODS: This is a retrospective study of a series of 80-cemented primary femoral stems revised for aseptic loosening using a new-cemented femoral stem without bone graft. Seventy implants were analyzed at the longest follow-up. The Postel Merle D'Aubigné and the Harris Hip Scores were used for clinical assessment. The French Academy SOFCOT 99 bone loss grading system was used to classify preoperative bone compromise severity. The Barrack classification assessed the quality of the postoperative cementation. The radiographic study at the last follow-up sought signs of femoral implant loosening classified according to Harris. RESULTS: The mean follow-up was 10 years and 10 months. The functional evaluation of the hip showed a significant overall gain (p<0.0001) after surgical revision. In our series, the existence of severe grade III or IV bone loss on the SOFCOT 99 classification exposed the patient to a significant risk of intraoperative complications (p=0.03). The grade III and IV femurs had a significantly higher risk (p=0.0001) of having type C or D cementation according to the Barrack classification. Type D cementation was a risk factor for significant iterative radiographic loosening (p=0.005) compared to A, B or C cementations. The 10-year survival rate of the femoral implant was 90% (95% confidence interval [95% CI]: 79.2-94.9%). This survival rate was significantly better (p=0.0016) for revisions with type A or B cementations on the Barrack scale (96% survival; 95% CI: 85.1-99%) than for type C or D (70% survival; 95% CI: 41.4-86.1%). CONCLUSION: This study shows that revised cemented femoral stems without bone graft added are a valid therapeutic option in primary cemented total hip arthroplasty revisions provided that a good-quality cement technique can be achieved. Sufficient bone stock (SOFCOT 99 grade 0, I or II) was indispensable for good cementation. LEVEL OF EVIDENCE: IV: therapeutic retrospective study.

[Urethral cancer: report of three cases and review of the literature]. / Cancer de l'urètre féminin, à propos de trois cas et revue de la littérature.

OBJECTIVE: To review the various clinical forms of female urethral cancer in the light of three clinical cases with a review of the corresponding treatment guidelines. METHOD: The authors report three cases of female urethral cancer. Case 1 consisted of squamous cell carcinoma in a 56-year-old woman with no particular history. Case 2 was a urothelial tumour arising in a urethral diverticulum in a 60-year-old smoker. Case 3 was a 69-year-old woman patient with invasive urothelial carcinoma. RESULTS: Case 1 was treated by segmental urethrectomy with no adjuvant therapy and a favourable course. Case 2 was treated by anterior pelvic exenteration with no adjuvant therapy. This patient relapsed in the form of peritoneal carcinomatosis two years later and died. Case 3 was initially treated by anterior pelvic exenteration followed by a chemoradiotherapy combination after local recurrence with a favourable course. CONCLUSION: There are many clinical presentations and histological forms of female urethral cancer. Localized distal lesions can be treated by simple circumferential resection. The treatment of other lesions comprises anterior pelvic exenteration and platinum- or M-VAC-based chemoradiotherapy. The main prognostic factors for these tumours are their size, histological type, site and the presence of pelvic lymph node extension.

[Cerebral infarction, a complication of paroxysmal nocturnal haemoglobinuria]. / Infarctus cérébral complication de l'hémoglobinurie paroxystique nocturne.

Paroxysmal nocturnal hemoglobinuria (Marchiafava-Micheli disease) is a rare acquired clonal disorder of the hematopoietic stem cell. Its most frequent clinical manifestations are hemolytic crisis and the most serious are venous thrombosis of the mesenteric, hepatic, portal or cerebral territories. Arterial cerebral infarctions are extremely rare. We report and comment on a case of multiple strokes occurring during an hemolytic crisis and despite effective long-term anticoagulation treatment.

Management of recurrent cervical cancer.

Treatment for cervical cancer is very successful, especially in early stages. However, most patients presenting in late stages of disease will experience recurrence. The prognosis of recurrent disease is very poor and treatment options are limited. The diagnosis of recurrence may be apparent or difficult, but determining the extent of disease is always complex. Routine follow-up of asymptomatic patients has other objectives and is not a reliable way to detect recurrences. Symptomatic patients require extensive investigation to detect the extent of the disease. For patients with central pelvic recurrences, exenteration offers the prospect of survival in more than one-third of cases. Newer developments include laterally extended endopelvic resection that may become an option for patients with more extensive pelvic recurrence. For patients with recurrences of cervical cancer, the roles of second-time radiotherapy or postradiation chemotherapy are very limited. Palliative treatment is important for all patients with untreatable disease. Pain relief forms a central part of palliative care. Caregivers also experience emotional feelings and probably function best in a system offering strong colleageal support.

PCR-RFLP using a SNP on the mitochondrial Lsu-rDNA as an easy method to differentiate Tuber melanosporum (Perigord truffle) and other truffle species in cans.

Canned truffle products labeled Tuber melanosporum, the famous Perigord truffle, may contain other less tasty and cheaper truffle species. To protect consumers from fraud, a PCR DNA-based method was used to unequivocally identify the nature of the product. Several rapid and simple cell lysis procedures, used in conjunction with a commercially available DNA purification kit, were evaluated for their effectiveness in recovering DNA from canned truffle. In parallel, a marker for T. melanosporum was tested on the mitochondrial rDNA. These two techniques were then combined to differentiate T. melanosporum from other truffle species like T. aestivum, T. brumale or T. indicum up to the legal threshold in canned products. These findings not only allow a comparison of the effectiveness of the different DNA extraction methods but also provide a preliminary indication of the specificity and sensitivity of the detection with the mitochondrial marker that might be attainable for truffle species in a quantitative PCR-based analysis method.

Salvage of immature forearm fistulas for haemodialysis by interventional radiology.

BACKGROUND: The goal of this article is to assess the value of endovascular techniques for the salvage of fistulas that fail to mature. METHODS: Over a 6-year period, 52 dysfunctional and 17 thrombosed immature forearm fistulas (mean age 10 weeks) were treated by interventional radiology. Angiography was performed by puncture of the brachial artery but dilation of underlying stenoses was performed after cannulation of the fistula itself, whenever possible, with a balloon never smaller than 5 mm. Embolization or ligation of any type of vein was never indicated and never performed. For thrombosed fistulas, significant clots were removed by manual catheter-directed aspiration. A covered stent (Passager) was used in cases of dilation-induced rupture not controlled by balloon tamponade. RESULTS: An underlying stenosis was diagnosed in 100% of cases. Half of them were located in the anastomotic area. The initial success rate of interventional radiology was 97%. Dilation-induced rupture occurred in nine cases (13%) but stents were necessary in only two cases. The rate of significant clinical complications was 2.8% (bacteraemia, pseudoaneurysm). Primary and secondary patency rates at 1 year were 39 and 79%, respectively. CONCLUSIONS: Delayed maturation of native fistulas should lead systematically to imaging as an underlying stenosis is diagnosed in all cases. Interventional radiology can treat the majority of cases and achieve a 97% success rate but early recurrence of stenoses can occur. Multidisciplinary re-evaluation of the patient must, therefore, be performed after radiological salvage of the fistula.