Intra-operative fluorescence angiography is reproducible and reduces the rate of anastomotic leak after colorectal resection for cancer: a prospective case-matched study.

AIM: Intra-operative fluorescence angiography (IOFA) with indocyanine green provides information on tissue perfusion that may help prevent an anastomotic leak (AL). The aim of this study was to assess the impact of IOFA on outcomes after left-sided colonic or low anterior resection with anastomosis for colorectal cancer. METHODS: All patients with left-sided colonic or rectal cancer, operated between June 2017 and December 2018, were prospectively included. IOFA has been routinely implemented since May 2018. Reproducibility of IOFA, after a 1:1 matching for relevant clinical risk factors of AL, was studied in patients with IOFA (IOFA+) and without IOFA (IOFA-). Outcomes were compared in terms of postoperative events such as clinically relevant AL as the primary end-point. RESULTS: In the IOFA+ group, changing of the initially planned colon transection due to inadequate perfusion occurred in five out of 46 patients (10.9%). Agreement between intra-operative assessment and postoperative blind review of IOFA was deemed strong (Cohen's kappa index 0.893, 95% CI 0.788-0.998, P < 0.001). Among 111 patients, 42 matched patients were included in each group. There was significantly more clinically relevant AL in the IOFA- group compared to the IOFA+ group (16.7% vs 2.4%, P = 0.026) involving significantly more anastomotic dehiscence which required re-intervention (19% vs 2.4%, P = 0.014). Additionally, more descending colon ischaemia/necrosis was observed in the IOFA- group compared with the IOFA+ group (9.5% vs 0%, P = 0.040). CONCLUSION: In this prospective case-matched study, IOFA decreased the occurrence of clinically relevant AL due to necrosis of the descending colon or anastomosis. Upon blind review, perfusion assessment using IOFA was reproducible.

Feasibility of encouraging participation in colorectal cancer screening campaigns by motivating people through the social network, Facebook.

AIM: To describe the results of a feasibility phase and the expected results of a new approach to increase the participation rate in a Colorectal Cancer Organized Screening Program (CRCSP) through Facebook awareness messages. METHOD: This approach targets people aged 50-74 years, who reside in an urban deprived area and regularly connect to Facebook. The feasibility phase ran over 2 months (December 2018 and January 2019) in six municipalities (Seine-Saint-Denis, France). The full provisional campaign will run over a year. The approach consists of sending electronic awareness messages on the importance of screening for colorectal cancer using a specific Facebook module. Subjects who consent to screening complete a test-kit application form. The eligibility of each subject to participate in screening is determined by a doctor before the kit is sent out. RESULTS: A total of 39 900 people were reached by the feasibility phase campaign, and 9200 were able to watch at least one Facebook message/video. Of those, 4450 people logged to learn more about the CRCSP, 298 applied for a test kit, 160 test kit applicants were eligible to participate and the test completion rate was 41.9%. According to these feasibility results, 366 120 targeted people would connect regularly in the tested area, 141 541 of whom would be interested in a specific promotional message posted on Facebook. Requests could be made for 9770 kits, with 5246 people being eligible to participate in screening. The expected test-completion rate is estimated at 42%-89%. This would represent 5%-11% of the tests carried out in the area during the same period by 'classical' CRCSP. CONCLUSION: Implementation of the Facebook strategy would significantly improve the rate of participation in the CRCSP by mobilizing people with no previous participation, including younger subjects.

Alteration of Swallowing and Ventilation Coordination in Respiratory Diseases in Small Mammals.

In human and animal, swallowing and ventilation are coordinated to avoid laryngeal penetration or tracheal aspiration, and respiration is interrupted during swallowing and resumes in the expiratory phase. Some respiratory diseases may alter this coordination due to impaired lung function. The aim of this study was to evaluate swallowing-ventilation coordination in unrestrained rats with pulmonary emphysema or with pulmonary fibrosis. Two protocols were performed in 38 male Sprague-Dawley rats (2-3 months, 250-300 g): pulmonary emphysema and pulmonary fibrosis. Ventilation during swallowing and swallowing-ventilation coordination were recorded using a whole-body plethysmography and video recordings. The rats were free to take water after 24 h without drinking. Compared to control groups, swallowing frequency was significantly higher in rats with pulmonary emphysema and there was a decrease of swallows during expiration in rats with pulmonary emphysema and in rats with pulmonary fibrosis. In this study, we show that respiratory diseases are associated with changes in swallowing-ventilation coordination and hypothesize that they increase the risk of aspiration.

Balance during walking on an inclined instrumented pathway following incomplete spinal cord injury.

OBJECTIVES: To study the postural adaptations of subjects with incomplete spinal cord injury (iSCI) and non-injured subjects during overground walking on level and inclined surfaces. METHODS: Six subjects with iSCI and seven non-injured subjects walked on an inclined surface (slope: 15%) and a level surface at their natural gait speed and at a slow gait speed (non-injured subjects only). Maximal stabilizing and minimal destabilizing forces were calculated to quantify dynamic balance during walking. Correlational analysis identified the variables that influence these stabilizing and destabilizing forces. RESULTS: Subjects with iSCI and good sensorimotor recovery were similar to non-injured subjects with respect to maximal stabilizing and minimal destabilizing forces when they walked at the same speed. The MaxSF was mainly explained by the center of pressure speed and step length, whereas the minimal destabilizing force was moderately correlated with body mass and height. CONCLUSION: The influence of gait speed on balance should be considered with a group comparison. With regard to dynamic balance, highly functioning subjects with iSCI do not seem to be sufficiently challenged while walking at their preferred gait speed. Asking individuals with subtle impairments to walk faster following an iSCI may reveal postural adaptations and have an effect on balance abilities.

Physiological Interpretation of the Slope during an Isokinetic Fatigue Test.

To assess the relationship between selected measures (the slope and average performance) obtained during a high intensity isokinetic fatigue test of the knee (FAT) and relevant measures of anaerobic and aerobic capacities. 20 well-trained cyclists performed 3 randomly ordered sessions involving a FAT consisting in 30 reciprocal maximal concentric contractions of knee flexors and extensors at 180°.s(-1), a maximal continuous graded exercise test (GXT), and a Wingate anaerobic test (WAnT). The slope calculated from peak torque (PT) and total work (TW) of knee extensors was highly associated to maximal PT (r=-0.86) and maximal TW (r=-0.87) measured during FAT, and moderately associated to peak power output measured during the WAnT (r=-0.64 to -0.71). Average PT and average TW were highly associated to maximal PT (r=0.93) and maximal TW (r=0.96), to mean power output measured during WAnT (r=0.83-0.90) and moderately associated to maximal oxygen uptake (0.58-0.67). In conclusion, the slope is mainly determined by maximal anaerobic power, while average performance is a composite measure depending on both aerobic and anaerobic energy systems according to proportions that are determined by the duration of the test.

Sleep and wake disturbances following traumatic brain injury.

Traumatic brain injury (TBI) is a major health concern in industrialised countries. Sleep and wake disturbances are among the most persistent and disabling sequelae after TBI. Yet, despite the widespread complaints of post-TBI sleep and wake disturbances, studies on their etiology, pathophysiology, and treatments remain inconclusive. This narrative review aims to summarise the current state of knowledge regarding the nature of sleep and wake disturbances following TBI, both subjective and objective, spanning all levels of severity and phases post-injury. A second goal is to outline the various causes of post-TBI sleep-wake disturbances. Globally, although sleep-wake complaints are reported in all studies and across all levels of severity, consensus regarding the objective nature of these disturbances is not unanimous and varies widely across studies. In order to optimise recovery in TBI survivors, further studies are required to shed light on the complexity and heterogeneity of post-TBI sleep and wake disturbances, and to fully grasp the best timing and approach for intervention.

Long-term red blood cell exchange in children with sickle cell disease: manual or automatic?

Little information is available on erythrocytapheresis in children with sickle cell disease, and no comparison has ever been made with manual exchanges in a long-term blood exchange program. We matched a historical cohort of five patients who received 60 erythrocytapheresis procedures with five who received 124 manual exchanges. Long-term erythrocytapheresis was feasible and well-tolerated even in children of low weight. In a long-term approach, automated exchanges were more efficient in maintaining a low HbS level, and exchanges could be spaced out. This approach appears especially useful in the cases where the HbS level must be maintained below 30%.

Appropriateness of Antibiotic Prescription During Teleconsultation.

Teleconsultation has become a new means of using care which has taken off significantly since the COVID crisis, The pooling of the technological environment within the TC makes it possible to set up practice reviews by reusing the data collected. Our aim was to evaluate the relevance of antibiotic therapy during teleconsultations carried out on the national teleconsultation platform "Qare" in 4 common infections. 143,428 TCs with structured prescriptions were analyzed, with an appropriate prescription in more than 82% of cases, higher than in the literature. The use of data makes it possible to quickly assess practices and inform doctors to improve their practices.

Pragmatic Considerations on Clinical Decision Support from the 2019 Literature.

OBJECTIVES: To summarize significant research contributions published in 2019 in the field of computerized clinical decision support and select the best papers for the Decision Support section of the International Medical Informatics Association (IMIA) Yearbook. METHODS: Two bibliographic databases were searched for papers referring to clinical decision support systems (CDSSs) and computerized provider order entry (CPOE) systems. From search results, section editors established a list of candidate best papers, which were then peer-reviewed by external reviewers. The IMIA Yearbook editorial committee finally selected the best papers on the basis of all reviews including the section editors' evaluation. RESULTS: A total of 1,378 articles were retrieved. Fifteen best paper candidates were selected, the reviews of which resulted in the selection of three best papers. One paper reports on a guideline modeling approach based on clinical decision trees, both clinically interpretable and suitable for implementation in CDSSs. In another paper, authors promote the use of extended Timed Transition Diagrams in CDSSs to formalize consistently recurrent medical processes for chronic diseases management. The third paper proposes a conceptual framework and a grid for assessing the performance of predictive tools based on the critical appraisal of published evidence. CONCLUSIONS: As showed by the number and the variety of works related to decision support, research in the field is very active. This year's selection highlighted pragmatic works that promote transparency and trust required by decision support tools.

The Regenerative Effect of Trans-spinal Magnetic Stimulation After Spinal Cord Injury: Mechanisms and Pathways Underlying the Effect.

Spinal cord injury (SCI) leads to a loss of sensitive and motor functions. Currently, there is no therapeutic intervention offering a complete recovery. Here, we report that repetitive trans-spinal magnetic stimulation (rTSMS) can be a noninvasive SCI treatment that enhances tissue repair and functional recovery. Several techniques including immunohistochemical, behavioral, cells cultures, and proteomics have been performed. Moreover, different lesion paradigms, such as acute and chronic phase following SCI in wild-type and transgenic animals at different ages (juvenile, adult, and aged), have been used. We demonstrate that rTSMS modulates the lesion scar by decreasing fibrosis and inflammation and increases proliferation of spinal cord stem cells. Our results demonstrate also that rTSMS decreases demyelination, which contributes to axonal regrowth, neuronal survival, and locomotor recovery after SCI. This research provides evidence that rTSMS induces therapeutic effects in a preclinical rodent model and suggests possible translation to clinical application in humans.

Destabilizing and stabilizing forces to assess equilibrium during everyday activities.

Postural stability is essential to functional activities. This paper presents a new model of dynamic stability which takes into account both the equilibrium associated with the body position over the base of support (destabilizing force) and the effort the subject needs to produce to keep his/her centre of mass inside the base of support (stabilizing force). The ratio between these two forces (destabilizing over stabilizing) is calculated to provide an overall index of stability for an individual. Preliminary results from data collected during walking at preferred and maximal safe speed in four older adults (aged from 64 to 84yr) showed that both forces are lower for subjects with reduced maximal gait speed. In addition, the stabilizing force increases by 2-3 times from preferred to maximal speed, while the destabilizing force barely changes with gait speed. Overall, the model through the index of stability attributes lower dynamic stability to subjects with lower maximal gait speed. These preliminary results call for larger-scale studies to pursue the development and validation of the model and its application to different functional tasks.

Electrical stimulation and muscle strengthening.

OBJECTIVES: To identify the effects of application methods and indications of direct muscle electrostimulation on strength gain. METHODS: Literature review and analysis of articles from Medline database with the following entries: muscular or neuromuscular, electromyostimulation, electrical stimulation, strengthening, strength training, immobilization, muscle dystrophy, bed-rest, bed-bound, knee or hip surgery, postoperative phase, cachexia, sarcopenia, and their French equivalent. RESULTS: Because of its specific muscle recruitment order, different from that of voluntary contraction, direct muscle electrostimulation is theoretically a complementary tool for muscle strengthening. It can be used in healthy subjects and in several affections associated with muscle function loss. Its interest seems well-established for post-traumatic or postsurgery lower-limb immobilizations but too few controlled studies have clearly shown the overall benefits of its application in other indications. Whatever the indication, superimposed or combined electrostimulation techniques are generally more efficient than electrostimulation alone. CONCLUSION: Even though widely used, the level of evidence for the efficiency of electromyostimulation is still low. For strength gains, it yielded no higher benefits than traditional strengthening methods. Its interest should be tested in medical affections leading to major muscle deconditioning or in sarcopenia.

Evidence that immunoglobulin VH-DJ recombination does not require germ line transcription of the recombining variable gene segment.

The importance of V(D)J recombination for generating diversity in the immune system is well established, but the mechanisms which regulate V(D)J recombination are still poorly understood. Although transcription of unrearranged (germ line) immunoglobulin and T-cell receptor gene segments often precedes V(D)J recombination and has been implicated in its control, the actual role of germ line transcripts in V(D)J recombination is not known. We used a sensitive reverse transcription-PCR assay to study immunoglobulin VH germ line transcripts in proB lines from RAG-deficient mice. All 10 VH families analyzed were germ line transcribed, and germ line transcription was found in all of the cell lines examined, indicating that active chromatin was present in the VH region. However, not all VH families were germ line transcribed in every cell line, and there was a surprising lack of uniformity in the number and family distribution of germ line VH transcripts in individual lines. When V(D)J recombination was activated by restoration of RAG activity, recombinational activity of endogenous VH genes for which germ line transcription was observed could be compared with those of genes for which it was not observed. This analysis revealed multiple examples of endogenous VH gene segments which were rearranged in cells where their germ line transcription was not detectable prior to RAG expression. Thus, our data provide strong support for the idea that V-(D)J recombination does not require germ line transcription of the recombining variable gene segment.

Transcriptional repression by blimp-1 (PRDI-BF1) involves recruitment of histone deacetylase.

B-lymphocyte-induced maturation protein (Blimp-1) is a transcriptional repressor that is considered to be a master regulator of terminal B-cell development because it is sufficient to trigger differentiation in the BCL(1)-cell model. Transcription of the c-myc gene is repressed by Blimp-1 during B-cell differentiation. In this study, we have explored the mechanism by which Blimp-1 represses transcription by using Gal4-fusion protein assays and assays in which Blimp-1 represses the natural c-myc promoter. The results show that Blimp-1 represses the c-myc promoter by an active mechanism that is independent of the adjacently bound activator YY1. Blimp-1 contains two regions that independently associate with histone deacetylase (HDAC) and endogenous Blimp-1 in nuclear extracts binds in vitro to the c-myc Blimp-1 site in a complex containing HDAC. The functional importance of recruiting HDAC for Blimp-1-dependent repression of c-myc transcription is supported by two experiments. First, the HDAC inhibitor tricostatin A inhibits Blimp-1-dependent repression in cotransfection assays. Second, a chromatin immunoprecipitation assay shows that expression of Blimp-1 causes deacetylation of histone H3 associated with the c-myc promoter, and this deacetylation depends on the Blimp-1 binding site in the c-myc promoter.

Vibration-induced post-effects: a means to improve postural asymmetry in lower leg amputees?

Muscle vibration has been shown to induce long-lasting and oriented alteration of standing posture in healthy individuals. The postural alterations can last several minutes following the end of vibration and are called post-effects. The goal of this study was to determine whether persons with lower leg amputation that show persistent postural asymmetry after usual rehabilitation experience these postural post-effects and if this could improve their weight bearing on the prosthesis. Centre of pressure (CP) position during stance was recorded prior to and up to 13 min after a 30s unilateral vibration applied during sitting to lateral neck (trapezius) or hip (gluteus medius) muscles in 14 individuals with unilateral lower leg amputation and 18 controls. The amputees' postural asymmetry was confirmed prior to the vibration intervention. A CP displacement, without an increase in CP velocity, was observed in both groups of participants over the 13 min post-vibration. For both the neck or hip vibration sites, the CP shifts were directed in the medio-lateral plane and were oriented either towards the vibrated side or the opposite side across subjects. This led to a decrease of postural asymmetry in half of the group of amputees. Within subject, the orientation of the post-effect was constant and changed to the opposite direction with vibration of the opposite body side. It is suggested that the post-effects are produced by a change of the postural reference consequent to the sustained proprioceptive message induced during the muscle vibration period. The orientation of the post-effects is discussed in relation to the notion of reference frame preference. All in all, because post-effect orientation is constant within subject and adaptive, future studies should investigate if individuals with lower leg amputation could benefit from postural post-effects induced by muscle vibration to improve function.

Effect of liquid properties on swallowing and ventilation coordination in rats.

BACKGROUND: One aspect of rehabilitation in swallowing disorders is to change liquid properties. The objective of our study was to test how liquid properties could improve oropharyngeal dysphagia and swallowing and ventilation coordination in an animal model. METHODS: Forty-two healthy male rats were distributed in six groups, including a control group. Rats were deprived of water for 24 h and then each group was administered liquid with different properties: tap water, sugar water, sparkling water, salt water, cold water, and acidic water. Rats were studied without and with oropharyngeal dysphagia achieved by unilateral section of the hypoglossal nerve. Swallowing and ventilation were analyzed by barometric plethysmograph. KEY RESULTS: In healthy rats, swallowing occurred during expiratory time for all liquid properties. Most deglutitions were during expiratory time for all liquid properties (88±12%) and were not modified. There was an increase in VT/TI during swallowing with sparkling water and cold water (P<.05). In the operated groups, rats had significantly fewer swallows with tap water (P<.05) and significantly more swallows with sparkling water (P<.001), sugar water (P<.001) and cold water (P<.001) during expiratory time. The mean inspiratory volume (VT/TI) increased with sparkling water (P<.05). CONCLUSION AND INFERENCES: Sparkling water seemed to improve swallowing and ventilation coordination in an animal model, to be confirmed in a study including patients with oropharyngeal dysphagia.

Human herpes virus 8 (Kaposi's sarcoma herpes virus) and malignant lymphoproliferations in France: a molecular study of 250 cases including two AIDS-associated body cavity based lymphomas.

The new human herpes virus 8 (HHV8) was recently detected in cases of body cavity based lymphoma (BCBL), a rare B cell lymphoma, mostly AIDS-associated. We investigated for HHV8 DNA sequences a series of 250 B or T cell lymphoproliferative malignancies, as seen in France, including 126 leukemias and 124 lymphomas (232 non-AIDS-associated and 18 AIDS-associated tumors). HHV8 sequences were detected in only three patients. The first two were homosexual males, HIV-infected since 1985 who suffered from a BCBL initially characterized in one case by a pleural lymphomatous effusion and a peritoneal one in the other case. A high level of HHV8 copies was detected in the tumoral cells of these two BCBL. In contrast, in the third positive patient who had an AIDS-associated immunoblastic lymphoma, the HHV8 sequences level was quite low. In the two BCBL patients, the HHV8-infected clonal B cells had a large immunoblastic feature with an indeterminate phenotype and were also infected by Epstein-Barr virus. In one BCBL case, a semiquantitative PCR analysis revealed that the HHV8 sequences were much more abundant in the effusion tumor cells than in the cutaneous Kaposi's biopsy while no HHV8 sequence was detectable in the peripheral blood lymphocytes. This study reports HHV8-associated BCBL in European AIDS patients and confirms that HHV8 is present at a high copy number in the tumoral B cells of this malignancy. Furthermore, HHV8 does not seem to play a pathogenic role in any of the other T or B malignant lymphoid neoplasias studied so far. This study also stresses the necessity for quantification studies in interpretation of a positive PCR analysis for HHV8 sequences, especially in patients at risk for HIV infection or Kaposi's sarcoma.

Utilization of alcohol, drug, and mental health treatment services among American Indian adolescent detainees.

OBJECTIVE: To describe the relationship between psychiatric status and the use of alcohol, drug, and mental health (ADM) services among a sample of American Indian (AI) juvenile detainees. METHOD: A structured diagnostic and service use interview was administered to 150 AI youths detained in a juvenile detention center located on a Northern Plains reservation. RESULTS: Forty percent of AI youths with a diagnosed substance use disorder and 34.1% with a diagnosed anxiety, mood, or disruptive behavior disorder reported lifetime use of services for substance use and emotional problems, respectively. While services for substance use problems were most commonly provided in residential settings, services for emotional problems were most commonly provided in outpatient settings. Traditional healers and pastoral counselors provided services to 23.7% and 29.6% of youths who received services for substance use and emotional problems, respectively. Detained youths were more likely to receive ADM services than AI adolescents living at--large in another, comparable Northern Plains reservation community. Still, the vast majority of youths in detention who suffered from psychiatric disorders did not report use of ADM services. CONCLUSIONS: Detention facilities serving AI adolescents need to screen carefully for the presence of psychiatric disorders and facilitate the use of ADM services.

Prevalence of common psychiatric disorders among American Indian adolescent detainees.

OBJECTIVES: To examine the prevalence of common psychiatric disorders among adolescents detained on a Northern Plains reservation. METHODS: Prevalence data were gathered using lay interviewers administering structured diagnostic instruments based on DSM-III-R criteria to 150 youths booked into a reservation-based juvenile detention center from July 1995 through April 1996. RESULTS: Approximately 49% of the sample had at least one alcohol, drug, or mental health disorder; 12.7% had two disorders; and 8.7% had three or more disorders. The most common diagnoses were substance abuse/dependence (38%), conduct disorder (16.7%), and major depression (10%). Females were significantly more likely than males to have major depression and/or anxiety disorders and were significantly more likely to have three or more disorders. These rates were higher in comparison with general and Indian adolescent community samples. CONCLUSIONS: These American Indian adolescent detainees had a high prevalence of psychiatric disorders. Local juvenile justice systems should be vigilant for the presence of psychiatric disorders and appropriately connected with psychiatric services to address this considerable need. Careful psychiatric assessment is necessary to ensure a more coordinated community service response to juvenile delinquency.