A Systematic Review of the Quality of Perpetrator Programs' Outcome Studies: Toward A New Model of Outcome Measurement.

This systematic review assessed whether studies on the outcomes of perpetrator programs comply with the model recommendations for outcome evaluation. Three databases (PsycINFO, Medline, and Scopus) were used to identify perpetrator program outcome studies from 1988 to 2021. The inclusion criteria were as follows: empirical studies with no time restriction; published in English or Spanish; evaluated interventions aimed at male perpetrators of any type of abuse toward women; evaluated the effectiveness of the intervention in a follow-up post-intervention; and provided an indicator of recidivism. The search and selection process resulted in 46 original studies. The results showed that studies did not include a thorough description of the study sample. Many approaches to psychological intervention are used, with cognitive behavioral therapy being the most widely used. Most studies did not describe the program content. Dropout rates varied greatly from one study to another (from 0% to 64%) and only eight studies provided dropout rates specified by each type of perpetrator. The follow-up period ranged from 3 months to 9 years. The recidivism rates (ranging from 5% to 72.5%), and their assessments were also very different. Only 12 of the 46 studies (26.1%) used more than one source to obtain recidivism rates. In terms of outcomes, few studies considered (ex-) partner accounts. Some studies had other measures of outcome, whereas a few included a pretest-posttest. In summary, these studies do not follow the recommendations of the model.

Maternal dietary methionine restriction alters hepatic expression of one-carbon metabolism and epigenetic mechanism genes in the ducklings.

BACKGROUND: Embryonic and fetal development is very susceptible to the availability of nutrients that can interfere with the setting of epigenomes, thus modifying the main metabolic pathways and impacting the health and phenotypes of the future individual. We have previously reported that a 38% reduction of the methyl donor methionine in the diet of 30 female ducks reduced the body weight of their 180 mule ducklings compared to that of 190 ducklings from 30 control females. The maternal methionine-restricted diet also altered plasmatic parameters in 30 of their ducklings when compared to that of 30 ducklings from the control group. Thus, their plasma glucose and triglyceride concentrations were higher while their free fatty acid level and alanine transaminase activity were decreased. Moreover, the hepatic transcript level of 16 genes involved in pathways related to energy metabolism was significantly different between the two groups of ducklings. In the present work, we continued studying the liver of these newly hatched ducklings to explore the impact of the maternal dietary methionine restriction on the hepatic transcript level of 70 genes mostly involved in one-carbon metabolism and epigenetic mechanisms. RESULTS: Among the 12 genes (SHMT1, GART, ATIC, FTCD, MSRA, CBS, CTH, AHCYL1, HSBP1, DNMT3, HDAC9 and EZH2) identified as differentially expressed between the two maternal diet groups (p-value < 0.05), 3 of them were involved in epigenetic mechanisms. Ten other studied genes (MTR, GLRX, MTHFR, AHCY, ADK, PRDM2, EEF1A1, ESR1, PLAGL1, and WNT11) tended to be differently expressed (0.05 < p-value < 0.10). Moreover, the maternal dietary methionine restriction altered the number and nature of correlations between expression levels of differential genes for one-carbon metabolism and epigenetic mechanisms, expression levels of differential genes for energy metabolism, and phenotypic traits of ducklings. CONCLUSION: This avian model showed that the maternal dietary methionine restriction impacted both the mRNA abundance of 22 genes involved in one-carbon metabolism or epigenetic mechanisms and the mRNA abundance of 16 genes involved in energy metabolism in the liver of the newly hatched offspring, in line with the previously observed changes in their phenotypic traits.

Interest of individual breast cancer screening by mammography in women aged over 75 years / Intérêt du dépistage individuel du cancer du sein par mammographie chez la femme âgée de plus de 75 ans

Organized breast cancer screening in France is recommended for women up to 74 years of age, while the frequency and severity of this cancer increases after 75 years. The aim of this work is to assess the potential benefits of extending organized screening. Methodology: Retrospective study of a continuous monocentric series of women over 75 having undergone surgery for breast cancer. The following variables were studied: addressing after screening or not, age at diagnosis, UICC stage and therapeutic measures (surgery by lumpectomy or mastectomy, lymph node dissection, adjuvant treatment with chemotherapy, radiotherapy or hormone therapy). Results: 185 women aged 82.8 ± 5.2 years [extreme ages 75 to 95] were included in the study. 136 (73.5%) breast cancers were discovered after palpation and 49 (26.5%) after screening mammography. The distribution by stage was: I - 38.8%, II - 39.5%, III - 15.1% and stage IV - 7%. 164 (87.7%), patients received surgical treatment: 115 lumpectomies (61.2%) and 49 mastectomies (26.5%). 51 (27.6%) patients underwent lymph node dissection. The distribution of adjuvant treatments was: chemotherapy 21.1%, radiotherapy 68.6%, or hormone therapy (79.5%), sometimes combined. Women not screened are older than women screened (84 ± 5.3 versus 79.5 ± 3.6 years; p < 0.0001). Cancers are diagnosed at a more advanced stage in non-screened patients compared to screened patients (p < 0.0001). While there is a higher proportion of stage I among screened patients (75.5%), stage II is the most frequent in women not screened (47%). Stage I and II are the majority in the latter (72%). In multivariate analysis with adjustment for age, screening made it possible to make a diagnosis at a less advanced stage (stage I-II vs II-IV: OR = 5.593; 95% CI [1.575­19.866]; p = 0.0078) and to have conservative surgery more often (lumpectomy vs mastectomy: OR = 2.645; 95% CI [1.079­6.493]; p = 0.0333) without more recourse to surgery (OR = 1.856 95% CI [0.207­16.612]; p = 0.58). After adjusting for age and stage, screening was no longer a determining factor in the choice of type of surgery (OR = 1.934; 95% CI [0.753­4.975]; p = 0.170). Conclusion: At the age when organized breast cancer screening in France stopped, there was a decrease in survival, a diagnosis at a higher stage and an increase in co-morbidities. Our study shows a change in management with heavier treatment, more complications and a greater loss of autonomy without screening. This pleads for a continuation beyond 75 years of the practice of mammography screening for breast cancer in elderly women.

Le dépistage du cancer du sein par mammographie est recommandé jusqu'à 74 ans alors que fréquence et gravité de ce cancer augmentent après 75 ans. Le but de ce travail est d'évaluer les bénéfices potentiels de l'extension du dépistage individuel par mammographie. Méthodologie: Étude rétrospective d'une série continue monocentrique de femmes de plus de 75 ans ayant consulté pour cancer du sein. Résultats: Cent-quatre-vingt-cinq femmes âgées (82,8 ± 5,2 ans [75-95]) ont été inclues. Cent-soixante-quatre (87,7 %) patientes ont bénéficié d'une chirurgie (115 tumorectomies (61,2 %), 49 mastectomies (26,5 %) et 51 curages ganglionnaires (27,6 %) avec traitement adjuvant (chimiothérapie 21,1 % ; radiothérapie 68,6 % ; ou hormonothérapie 79,5 %). Quarante-neuf cancers du sein ont été découverts après dépistage individuel par mammographie (26,5 %) chez des femmes moins âgées (79,5 ± 3,6 vs 84 ± 5,3 ans ; p < 0,0001), à un stade moins avancé (stade I-II vs III-IV : OR = 5,6 [1,5­19,8] ; p = 0,0078) avec une chirurgie plus conservatrice (tumorectomie vs mastectomie : OR = 2,6 [1,1­6,5] ; p = 0,0333). Conclusion: Le dépistage individuel du cancer du sein par mammographie permet une prise en charge moins lourde, à un stade moins avancé et devrait être poursuivi après 75 ans.

Evaluation of the impact of the COVID-19 lockdown on BMI in children and adolescents with or without obesity.

BACKGROUND: In Switzerland, from March 15th to May 11th 2020, schools and most shops were closed nationwide due to the COVID-19-related lockdown. This cessation of activities may have impacted weight gain in children and adolescents. The aims of our study were to evaluate the effects of the COVID-19 lockdown on the BMI of children and adolescents in treatment for obesity, and to compare its evolution to that of the previous year at the same time, as well as to that of normal-weight children. METHODS: This retrospective study gathered demographic and anthropometric data from subjects aged 6-18 years both with normal weight and with obesity, who attended our hospital clinics at four time points: before and after the lockdown period in 2020, and at the same times of the year in 2019. We used paired t-tests to assess weight, BMI and BMI z-score changes, linear and standard multiple regressions, independent Student's t-tests or Chi-square tests to compare groups, and Pearson correlation coefficient when appropriate. RESULTS: Forty-seven children with obesity and 18 normal-weight subjects had complete data for the 4 visits. The mean BMI increased in both groups during the lockdown (obese: + 0.96 ± 1.5 vs. control: + 0.51 ± 0.1), however the increase was significantly more important in the subjects with obesity compared to the same period in 2019 (2019: + 0.33 ± 1.0; mean difference between 2019 and 2020: + 0.63 ± 2.0 p = 0.034). CONCLUSION: The COVID-19 lockdown had a negative impact on the BMI of youth with obesity. Interestingly we observed extreme changes in this population, which was not the case in normal-weight children. Therefore, families with a child with obesity must be actively supported during these stressful and obesogenic periods of confinement.

Maternal dietary methionine restriction alters the expression of energy metabolism genes in the duckling liver.

BACKGROUND: In mammals, the nutritional status experienced during embryonic development shapes key metabolic pathways and influences the health and phenotype of the future individual, a phenomenon known as nutritional programming. In farmed birds as well, the quantity and quality of feed offered to the dam can impact the phenotype of the offspring. We have previously reported that a 38% reduction in the intake of the methyl donor methionine in the diet of 30 female ducks during the growing and laying periods - from 10 to 51 weeks of age - reduced the body weight of their 180 mule ducklings compared to that of 190 ducklings from 30 control females. The maternal dietary methionine restriction also altered the hepatic energy metabolism studied in 30 of their ducklings. Thus, their plasma glucose and triglyceride concentrations were higher while their plasma free fatty acid level was lower than those measured in the plasma of 30 ducklings from the control group. The objective of this new study was to better understand how maternal dietary methionine restriction affected the livers of their newly hatched male and female ducklings by investigating the hepatic expression levels of 100 genes primarily targeting energy metabolism, amino acid transport, oxidative stress, apoptotic activity and susceptibility to liver injury. RESULTS: Sixteen of the genes studied were differentially expressed between the ducklings from the two groups. Maternal dietary methionine restriction affected the mRNA levels of genes involved in different pathways related to energy metabolism such as glycolysis, lipogenesis or electron transport. Moreover, the mRNA levels of the nuclear receptors PPARGC1B, PPARG and RXRA were also affected. CONCLUSIONS: Our results show that the 38% reduction in methionine intake in the diet of female ducks during the growing and egg-laying periods impacted the liver transcriptome of their offspring, which may explain the previously observed differences in their liver energy metabolism. These changes in mRNA levels, together with the observed phenotypic data, suggest an early modulation in the establishment of metabolic pathways.

Stress and coping in times of pandemic: Longitudinal follow-up of a group of medical patients / Estrés y afrontamiento en tiempos de pandemia: Seguimiento longitudinal de un grupo de pacientes médico

The Covid-19 pandemic has impacted the mental health and medical care of patients with pre-existing conditions. We longitudinally evaluated perceived stress, psychological distress, and coping strategies in 50 patients with medical diseases, finding that, 6 months after baseline evaluation, perceived stress and psychological distress were increased, and that less use was made of active coping strategies. Age (younger patients), previous psychological problems, and altered medical treatments emerge as risk factors. Proactive detection of psychopathological suffering is essential to prevent a parallel mental health pandemic from unfolding. Covid-19 has had an impact on patients with medical diseases, expressed in increased psychological vulnerability that may interfere in their disease course. While telematic monitoring is an important factor in reducing impact, early detection of psychopathological symptoms is crucial to ensuring adherence to treatments and to developing effective biopsychosocial approaches.

La pandemia de Covid-19 ha afectado la salud mental y la atención médica de pacientes con afecciones preexistentes. Se evaluó longitudinalmente la percepción de estrés, malestar psicológico y estrategias de afrontamiento en 50 pacientes con patologías médicas, encontrándose que, 6 meses después de la evaluación inicial, el estrés percibido y el malestar psicológico se incrementaron, mientras que se redujo el uso de estrategias de afrontamiento activas. La edad (pacientes más jóvenes), los problemas psicológicos previos y la alteración del tratamiento médico emergen como factores de riesgo. La detección proactiva del sufrimiento psicopatológico es esencial para evitar que se desarrolle una pandemia paralela de salud mental. La Covid-19 ha tenido un impacto en pacientes con enfermedades médicas, expresado en una mayor vulnerabilidad psicológica que puede interferir en el curso de su enfermedad. Si bien el monitoreo telemático es un factor importante para reducir el impacto, la detección temprana de los síntomas psicopatológicos es crucial para garantizar la adherencia a los tratamientos y para desarrollar enfoques biopsicosociales efectivos.

Sentinel node involvement with or without completion axillary lymph node dissection: treatment and pathologic results of randomized SERC trial.

Based on results of clinical trials, completion ALND (cALND) is frequently not performed for patients with breast conservation therapy and one or two involved sentinel nodes (SN) by micro- or macro-metastases. However, there were limitations despite a conclusion of non-inferiority for cALND omission. No trial had included patients with SN macro-metastases and total mastectomy or with >2 SN macro-metastases. The aim of the study was too analyze treatment delivered and pathologic results of patients included in SERC trial. SERC trial is a multicenter randomized non-inferiority phase-3 trial comparing no cALND with cALND in cT0-1-2, cN0 patients with SN ITC (isolated tumor cells) or micro-metastases or macro-metastases, mastectomy or breast conservative surgery. We randomized 1855 patients, 929 to receive cALND and 926 SLNB alone. No significant differences in patient's and tumor characteristics, type of surgery, and adjuvant chemotherapy (AC) were observed between the two arms. Rates of involved SN nodes by ITC, micro-metastases, and macro-metastases were 5.91%, 28.12%, and 65.97%, respectively, without significant difference between two arms for all criteria. In multivariate analysis, two factors were associated with higher positive non-SN rate: no AC versus AC administered after ALND (OR = 3.32, p < 0.0001) and >2 involved SN versus ≤2 (OR = 3.45, p = 0.0258). Crude rates of positive NSN were 17.62% (74/420) and 26.45% (73/276) for patient's eligible and non-eligible to ACOSOG-Z0011 trial. No significant differences in patient's and tumor characteristics and treatment delivered were observed between the two arms. Higher positive-NSN rate was observed for patients with AC performed after ALND (17.65% for SN micro-metastases, 35.22% for SN macro-metastases) in comparison with AC administered before ALND.

Psychological Distress in Erectile Dysfunction: The Moderating Role of Attachment.

INTRODUCTION: In clinical consultations, men with erectile dysfunction do not always express personal, sexual, and interpersonal concerns. AIM: We explore whether the attenuated impact of erectile dysfunction may be explained by a regulation of negative affect that causes activation of the attachment system. METHODS: The study sample consisted of 69 men diagnosed with erectile dysfunction, mean (SD) age 56 (10.83) years. Participants completed self-reported questionnaires to assess erectile dysfunction severity, attachment style, sexual satisfaction, relationship satisfaction, and psychological symptoms. MAIN OUTCOME MEASURE: The moderating role of attachment between erectile dysfunction and sexual satisfaction, relationship satisfaction, and psychological distress was evaluated using multiple linear regression and moderation analysis. RESULTS: All men in the sample had high attachment avoidance, distributed between the dismissive-avoidant (69.6%) and fearful-avoidant (30.4%) substyles, but low levels of psychological symptoms. Despite their erectile dysfunction, 27 patients (39.1%) rated their sexual life as satisfactory, and 46 (66.7%) rated their relationship with their partner as satisfactory. Men with fearful-avoidant attachment reported feeling more sexual desire and less sexual satisfaction than men with dismissive-avoidant attachment. Multiple linear regression analysis showed that sexual satisfaction variance was explained by erectile dysfunction severity, attachment anxiety, and relationship satisfaction scores. Moderation analysis showed that attachment anxiety, but not relationship satisfaction, moderated the impact of erectile dysfunction on sexual satisfaction. CONCLUSION: The avoidance dimension of attachment, which tends to be high in patients with erectile dysfunction, involves deactivation of the sexual system in an effort to minimize the emotional distress associated with erectile dysfunction, which damages sexual and relationship intimacy and delays the decision to obtain professional help. The presence of high attachment avoidance and the moderating value of attachment anxiety allow us to propose specific treatments for these men. Maestre-Lorén F, Castillo-Garayoa JA, López-i-Martín X, et al. Psychological Distress in Erectile Dysfunction: The Moderating Role of Attachment. Sex Med 2021;9:100436.

Matrix of Architectural Solutions for the Conflict between Transport Infrastructures, Landscape and Urban Habitat along the Mediterranean Coastline: The Case of the Maresme Region in Barcelona, Spain.

Maresme is a littoral region of Barcelona (Spain) in which the railway and an important road run along the coastline with a high landscape impact. Over time, several facilities connected to these transport infrastructures have appeared, such as industries, malls, marinas or train stations. These activities profit from the easy connection but create a barrier between the inhabitants and the sea. This research follows three aspects identified in a large variety of locations along the Mediterranean coast: longitudinal mobility, transversal accessibility and landscape discontinuities. The first territorial analysis defines a series of urban problematics classified by category. Then, the most representative case studies are developed by means of urban and architectural projects. The comparative analysis of these proposals provides a catalogue of design strategies which can be combined as criteria for solving multiple conflicts detected in the region. The result of this project is a methodology based on a matrix of general guidelines to ease the solving of local conflicts in a homogeneous way for the whole territory. The final aim is to re-establish order and continuity in the Mediterranean littoral skyline, fostering sustainable mobility and recovering public space for inhabitants.

Severe infections in patients with lymphoproliferative diseases treated with new targeted drugs: A multicentric real-world study.

BACKGROUND: Lymphoid neoplasms treatment has recently been renewed to increase antitumor efficacy and conventional chemotherapies toxicities. Limited data have been published about the infection risk associated with these new drugs, therefore this study analyzes the infectious complications in patients with lymphoproliferative diseases (LPD) treated with monoclonal antibodies (obinutuzumab, ofatumumab, brentuximab, nivolumab, or pembrolizumab), BTK inhibitors (ibrutinib and acalabrutinib), PI3K inhibitors (idelalisib) and BCL2 inhibitors (venetoclax). METHODS: Multicenter retrospective study of 458 LPD patients treated with targeted therapies in real-life setting, in 18 Spanish institutions, from the time of their commercial availability to August 2020. RESULTS: Severe infections incidence was 23% during 17-month median follow-up; cumulative incidence was higher in the first 3-6 months of targeted drug treatment and then decreased. The most frequent etiology was bacterial (54%). Nine (6%) Invasive fungal infections (IFI) were observed, in its majority in chronic lymphocytic leukemia (CLL) patients treated predominantly with ibrutinib. Significant risk factors for severe infection were: severe lymphopenia (p = 0.009, OR 4.7, range 1.3-1.7), combined targeted treatment vs single agent treatment (p = 0.014 OR 2.2 range 1.1-4.2) and previous rituximab (p = 0.03 OR 1.8, range 1.05-3.3). Infection-related mortality was 6%. In 22% of patients with severe infections, definitive discontinuation of the targeted drug was observed. CONCLUSION: A high proportion of patients presented severe infections during follow-up, with non-negligible attributable mortality, but infection incidence is not superior to the one observed during the chemotherapy era. In selected cases with specific risk factors for infection, antimicrobial prophylaxis should be considered.

A haptic laparoscopic trainer based on affine velocity analysis: engineering and preliminary results.

BACKGROUND: There is a general agreement upon the importance of acquiring laparoscopic skills outside the operation room through simulation-based training. However, high-fidelity simulators are cost-prohibitive and elicit a high cognitive load, while low-fidelity simulators lack effective feedback. This paper describes a low-fidelity simulator bridging the existing gaps with affine velocity as a new assessment variable. Primary validation results are also presented. METHODS: Psycho-motor skills and engineering key features have been considered e.g. haptic feedback and complementary assessment variables. Seventy-seven participants tested the simulator (17 expert surgeons, 12 intermediates, 28 inexperienced interns, and 20 novices). The content validity was tested with a 10-point Likert scale and the discriminative power by comparing the four groups' performance over two sessions. RESULTS: Participants rated the simulator positively, from 7.25 to 7.72 out of 10 (mean, 7.57). Experts and intermediates performed faster with fewer errors (collisions) than inexperienced interns and novices. The affine velocity brought additional differentiations, especially between interns and novices. CONCLUSION: This affordable haptic simulator makes it possible to learn and train laparoscopic techniques. Self-assessment of basic skills was easily performed with slight additional cost compared to low-fidelity simulators. It could be a good trade-off among the products currently used for surgeons' training.

Tacrolimus 0.1% versus ciclopiroxolamine 1% for maintenance therapy in patients with severe facial seborrheic dermatitis: A multicenter, double-blind, randomized controlled study.

BACKGROUND: No long-term maintenance therapy has been tested in patients with seborrheic dermatitis (SD). OBJECTIVE: We sought to compare the efficacy and tolerance of tacrolimus 0.1% ointment versus ciclopiroxolamine 1% cream as maintenance therapy for severe SD. METHODS: This double-blind randomized controlled study was conducted from 2014 to 2017 in 5 Dermatology Departments and 15 dermatology practices in France. Consecutive patients with severe and chronic facial SD were included. Patients were initially treated with desonide 0.05% cream twice daily for 7 days. Patients cleared after this open phase were randomized to receive tacrolimus 0.1% or ciclopiroxolamine 1% cream 2 times a week 24 weeks. The primary endpoint was disease-free-duration, defined as the time from randomization to first relapse. RESULTS: One hundred fourteen patients were randomized (tacrolimus, n = 57; ciclopiroxolamine, n = 57). Twelve patients relapsed in the tacrolimus group after a median delay of 91.5 days (range 15-195 days) versus 23 patients in the ciclopiroxolamine group (median delay, 27 days [range 13-201 days]). Comparison of disease-free duration curves showed that patients in the tacrolimus group had a longer duration of complete remission than those in the ciclopiroxolamine group (P = .018), corresponding to a hazard ratio of relapse of 0.44 (95% confidence interval 0.22-0.89; P = .022). LIMITATIONS: The theoretical sample size was not reached. CONCLUSION: Tacrolimus 0.1% is more effective than ciclopiroxolamine 1% as maintenance therapy for patients with facial SD.

Virtual reality simulation to enhance laparoscopic salpingectomy skills.

BACKGROUND: To assess skill enhancement and maintenance by virtual-reality simulation of laparoscopic salpingectomy in gynecologic surgery fellows. Skill acquisition by virtual-reality surgical simulation is an active field of research and technological development. Salpingectomy is one of the first gynecologic surgery techniques taught to fellows that requires accompanied learning. METHODS: A single-center prospective study was performed in the University of Lyon, France, including 26 junior fellows (≤ 3 semesters' internship) performing laparoscopic salpingectomy exercises on a LapSim® virtual reality simulator. Salpingectomy was performed and timed on 3 trials in session 1 and 3 trials in session 2, at a 3-month interval. Analysis was based on students' subjective assessments and a senior surgeon's objective assessment of skill. Progress between the 2 sessions was assessed on McNemar test and Wilcoxon test for matched series. RESULTS: 26 junior specialist trainees performed all trials. Most performed anterograde salpingectomy, both in session 1 (69 %) and session 2 (86 %). Mean procedure time was significantly shorter in session 2: 6.10min versus 7.82min (p=0.0003). There was a significant decrease in blood loss between the first trial in session 1 and the last trial in session 2: 167ml versus 70.3ml (p=0.02). Subjective assessment showed a significant decrease in anxiety and significant increase in perceived efficacy, eye-hand coordination and ergonomics. Efficacy, performance quality and speed of execution as assessed by the senior surgeon all improved significantly from trial to trial, while hesitation significantly decreased. CONCLUSIONS: The study showed that junior trainees improved their surgical skills on a short laparoscopic exercise using a virtual reality simulator. Virtual reality simulation is useful in the early learning curve, accelerating the acquisition of reflexes. Maintaining skill requires simulation sessions at shorter intervals.

Effectiveness of individual and group programmes to treat obesity and reduce cardiovascular disease risk factors in pre-pubertal children.

Childhood obesity results in premature atherosclerosis and requires early intervention. Compare the effectiveness of 6-month lifestyle interventions (with choice of either individual or group therapy) with standard care on body mass index (BMI) z-score and cardiovascular disease (CVD) risks factors in children with obesity. This 6-month randomized controlled trial with a 6-month follow-up included 74 pre-pubertal children with obesity (7.5-11.9 years) assigned randomly (2:1) to intervention or control. Families in the intervention arm choose between an individually delivered treatment (3 hours paediatrician + 4 hours dietician) or group treatment (35 hours with a multidisciplinary team). Children participated also to a weekly physical activity programme. We measured BMI, BMI z-score; waist circumference (WC); total and abdominal fat; blood pressure; common carotid artery intima-media thickness and incremental elastic modulus (Einc); endothelium-dependent and independent dilation (nitroglycerin-mediated dilation [NTGMD]) of the brachial artery; fasting plasma glucose, insulin, lipids; and high-sensitivity C-reactive protein (hs-CRP). Compared to controls, at 6 months, abdominal fat and hs-CRP were reduced in both interventions. The group intervention was also effective in reducing BMI (-0.55 kg/m2 ; 95% confidence interval -1.16 to 0.06) and BMI z-score (-0.08; -0.15 to 0.00) at 6 months and BMI, BMI z-score, WC, NTGMD, total and abdominal fat at 12 months. Abdominal fat and low-grade inflammation were significantly decreased in both interventions. High-intensity group treatment improved early signs of atherosclerosis in children with obesity. These findings are important for the promotion of cardiometabolic health in this population.

Recovery of Bone Mineral Mass After Upper Limb Fractures in Children and Teenagers.

BACKGROUND: Loss of bone mineral mass and muscle atrophy are predictable consequences of cast-mediated immobilization following wrist and forearm fractures. This study aimed to prospectively determine whether previously reported lower bone mineral mass following immobilization for wrist and forearm fractures in children and teenagers had recovered at 6- and 18-month follow-up. METHODS: We recruited 50 children and teenagers who underwent a cast-mediated immobilization for a forearm or wrist fracture. Dual-energy x-ray absorptiometry scans of different skeletal sites were performed at the time of fracture, at cast removal, at 6 and at 18-month follow-up. Injured patients were paired with healthy controls according to sex and age. Dual-energy x-ray absorptiometry values were compared between groups and the injured and uninjured forearms of the patients. RESULTS: At the time of fracture, injured and healthy subjects showed no differences between their bone mineral density (BMD) and bone mineral content (BMC) z-scores at the lumbar spine, or between their BMDs at the peripheral wrist. At cast removal, upper limb bone mineral variables were significantly lower in the injured group (except for the ultradistal radius) than in the uninjured group, with differences ranging from 3.8% to 10.2%. No residual decrease in bone mineral variables was observed at any upper limb site at 6- and 18-month follow-up (28 injured patients). Significant residual increases in the BMDs and BMCs were observed for the injured group's ultradistal radius and whole wrists (+4.8% to +5.2%). CONCLUSIONS: A rapid bone mass reversal occurs by resumption of mobilization, with full bone recovery 6 months after a forearm or wrist fracture. Finally, healing bone callus could introduce a bias into the interpretation of BMD and BMC data at the fracture site, not only at cast removal but also 18 months after the fracture.

What is the real impact of upper limb cast immobilisation on activity-related energy expenditure in children?

BACKGROUND: Upper limb fractures and subsequent cast immobilisation constitute a potential cause of reduction in childhood levels of physical activity (PA), with subsequent decrease of energy consumption. The main objective of this study was thus to quantify the decrease of activity-related energy expenditure (AEE) due to upper limb cast immobilisation. METHODS: We conducted a longitudinal matched case-control study that included 35 children and teenagers with a first episode of upper limb fracture and 35 healthy cases. PA was assessed during cast immobilisation by accelerometer. AEE was the calculated using an equation based on the total counts per day measured by accelerometers. RESULTS: AEE in children and teenagers with upper limb fractures was estimated to be 7.4 % lower than healthy controls. The mean difference corresponded to 1.35 kcal/kg per mean valid recorded time (750 min), that is, the waking hours. When converted in kcal per mean subjects' weight, the difference in AEE amounted 63.5 kcal/day, which corresponds approximately to 26 min of walking at a speed of 4 km/hours. In comparison with the mean AEE in healthy controls (18.2 kcal/kg), the noted decrease (1.35 kcal/kg) represents only 7.4 % of AEE. CONCLUSION: Reduction of AEE in children and teenagers with upper limb fractures may lead to a slight positive energy balance, as there is usually no compensatory reduction of energy intake. An increase of light PA has to be counselled in this situation or patients should be advised to reduce their energy intake during the immobilisation period. LEVEL OF EVIDENCE: Level I: high-quality prospective study (all patients were enrolled at the same point in their disease with ≥80 % follow-up of enrolled patients).

Implementing Cognitive Training Into a Surgical Skill Course: A Pilot Study on Laparoscopic Suturing and Knot Tying.

Mini-invasive surgery-for example, laparoscopy-has challenged surgeons' skills by extending their usual haptic space and displaying indirect visual feedback through a screen. This may require new mental abilities, including spatial orientation and mental representation. This study aimed to test the effect of cognitive training based on motor imagery (MI) and action observation (AO) on surgical skills. A total of 28 postgraduate residents in surgery took part in our study and were randomly distributed into 1 of the 3 following groups: (1) the basic surgical skill, which is a short 2-day laparoscopic course + MI + AO group; (2) the basic surgical skill group; and (3) the control group. The MI + AO group underwent additional cognitive training, whereas the basic surgical skill group performed neutral activity during the same time. The laparoscopic suturing and knot tying performance as well as spatial ability and mental workload were assessed before and after the training period. We did not observe an effect of cognitive training on the laparoscopic performance. However, the basic surgical skill group significantly improved spatial orientation performance and rated lower mental workload, whereas the 2 others exhibited lower performance in a mental rotation test. Thus, actual and cognitive training pooled together during a short training period elicited too high a strain, thus limiting potential improvements. Because MI and AO already showed positive outcomes on surgical skills, this issue may, thus, be mitigated according to our specific learning conditions. Distributed learning may possibly better divide and share the strain associated with new surgical skills learning.

High-fidelity simulation self-training enables novice bronchoscopists to acquire basic bronchoscopy skills comparable to their moderately and highly experienced counterparts.

BACKGROUND: We sought to determine whether a self-training program on a high-fidelity flexible bronchoscopy (FB) simulator would allow residents who were novices in bronchoscopy to acquire competencies similar to those of experienced bronchoscopists as concerns the visualization of the bronchial tree and the identification of its anatomical elements. METHODS: We performed a prospective cohort study, categorizing bronchoscopists into three groups according to their experience level: novice (Group A, no FBs performed, n = 8), moderate (Group B, 30 ≤ FBs performed ≤200, n = 17) or high (Group C, > 200 FBs performed, n = 9). All were initially evaluated on their ability to perform on a high-fidelity FB simulator a complete visualization/identification of the bronchial tree in the least amount of time possible. The residents in Group A then completed a simulation-based self-training program and underwent a final evaluation thereafter. RESULTS: The median total procedure time for Group A fell from 561 s (IQR = 134) in the initial evaluation to 216 s (IQR = 257) in the final evaluation (P = 0.002). The visualization and identification scores for Group A also improved significantly in the final evaluation. Resultantly, the overall performance score for Group A climbed from 5.9% (IQR = 5.1) before self-training to 25.5% (IQR = 26.3) after (P = 0.002), thus becoming comparable to the overall performance scores of Group B (25.3%, IQR = 13.8) and Group C (22.2%, IQR = 5.5). CONCLUSIONS: Novice bronchoscopists who self-train on a high-fidelity simulator acquire basic competencies similar to those of moderately or even highly experienced bronchoscopists. High-fidelity simulation should be rapidly integrated within the learning curriculum and replace traditional, in-patient learning methods.

The Shift From Sentinel Lymph Node Biopsy Performed Either Before or After Neoadjuvant Systemic Therapy in the Clinical Negative Nodes of Breast Cancer Patients. Results, and the Advantages and Disadvantages of Both Procedures.

BACKGROUND: In patients with breast cancer who are candidates for neoadjuvant therapy (NAT), the timing of when to perform sentinel lymph node biopsy (SLNB) remains under discussion. The aim of this study was to compare the advantages and disadvantages of SLNB performed before and after NAT. PATIENTS AND METHODS: One hundred seventy-two patients, T1c to T3 and N0 (clinically and according to ultrasound) candidates for NAT were included. We compared the outcomes of 2 groups: (1) 122 patients of whom SLNB was performed before NAT (pre-NAT) from December 2006 to April 2014; and (2) 50 patients with SLNB performed after NAT (post-NAT) from May 2014 to July 2016. RESULTS: Both groups were homogeneous in baseline patient characteristics. The SLNB was positive in 50 patients [41.7%] (33 macrometastases [66%] and 17 micrometastases [34%]) versus 6 patients [12%] (5 macrometastases [83.3%] and 1 micrometastases [16.7%]) in pre- and post-NAT groups, respectively. The lymphadenectomy was performed in 34 patients [28.3%] versus 4 patients [8%], with an odds ratio of 3.48 (95% confidence interval, 1.3-9.3). The recurrences in the pre-NAT group after a median follow-up of 62 months were 12 systemic, 2 local and systemic, and none axillary. In the post-NAT group were no recurrences after a median follow-up of 16 months. Finally, SLNB after NAT reduces the delay in starting NAT from 24 to 14 days (medians; P < .001) and the identification of the SLNB was in 122 patients [100%] versus 49 patients [98%]. CONCLUSION: SLNB performed after NAT significantly reduces the rate of lymphadenectomies without any increase in recurrences at early follow-up. Furthermore, it allows systemic treatment to be started earlier without interfering in the SLNB identification rate.

Long-term kidney transplant survival in patients with continent urinary diversion.

OBJECTIVES: To report the long-term survival of transplanted kidneys in patients with a continent urinary diversion. METHODS: Between January 1987 and July 2015, 16 patients with a median age of 37 years (range 21-63 years) underwent kidney transplantation on a continent urinary diversion. A total of 14 patients presented irreversible dysfunction of the lower urinary tract, and two patients had required radical cystectomy because of bladder cancer. All continent urinary diversions were carried out before the transplantation. There were nine Kock pouches, five Mainz pouches, one Mainz neobladder and one Hautmann neobladder. A total of 11 patients had a previous non-continent urinary diversion. Of the transplants, 14 came from brain-dead donors and two from related living donors. RESULTS: The median post-transplantation follow up was 171 months (range 30-298 months). Two patients died, while six patients lost their transplant and resumed hemodialysis. Nine patients (56.2%) were alive with a functional transplant at the end of follow up. The most common allograft complication was acute pyelonephritis, but no graft was lost as a result of urinary diversion complications. The kidney transplant survival rate was 73.3% after 10 years, and 66.6% after 15 years. Among patients who still had a functional transplant at the time of the study, creatinine clearance was >30 mL/min for seven patients and <30 mL/min for two patients. CONCLUSIONS: The present study is the longest series to date of renal transplantation on continent urinary diversions. The long-term outcome shows that the presence of a continent urinary diversion does not reduce transplant survival.