Predictive factors and screening strategy for obstructive sleep apnea in patients with advanced multiple sclerosis.

BACKGROUND: Obstructive sleep apnea (OSA) screening questionnaires have been evaluated in Multiple Sclerosis (MS) but not yet validated in patients with advanced disease. The aim of this study is to identify OSA predictive factors in advanced MS and to discuss screening strategies. METHODS: Oximetry data from 125 patients were retrospectively derived from polysomnographic reports. Univariate and multivariate analysis were used to determine predictive factors for OSA. A two-level screening model was assessed combining the oxygen desaturation index (ODI) and a method of visual analysis. RESULTS: multivariate analysis showed that among the clinical factors only age and snoring were associated with OSA. Usual predictive factors such as sleepiness, Body mass index (BMI) or sex were not significantly associated with increased Apnea Hypopnea Index (AHI). The ODI was highly predictive (p < 0.0001) and correctly identified 84.1 % of patients with moderate OSA and 93.8 % with severe OSA. The visual analysis model combined with the ODI did not outperform the properties of ODI used alone. CONCLUSION: As the usual clinical predictors are not associated with OSA in patients with advanced MS, questionnaires developed for the general population are not appropriate in these patients. Nocturnal oximetry seems a pertinent, ambulatory and accessible method for OSA screening in this population.

Strengthening cancer biology research, prevention, and control while reducing cancer disparities: student perceptions of a collaborative master's degree program in cancer biology, preventions, and control.

This article provides the findings of a survey of previous and current students in the UDC/GU-LCCC master's degree program. This master's degree program, Cancer Biology, Prevention, and Control is administered and taught jointly by faculty of a Minority Serving Institution, the University of the District of Columbia, and the Lombardi Comprehensive Cancer Center to incorporate the strengths of a community-based school with a research intensive medical center. The program was initiated in 2008 through agreements with both University administrations and funding from the National Cancer Institute. The master's degree program is 36 credits with a focus on coursework in biostatistics, epidemiology, tumor biology, cancer prevention, medical ethics, and cancer outreach program design. For two semesters during the second year, students work full-time with a faculty person on a laboratory or outreach project that is a requirement for graduation. Students are supported and encouraged to transition to a doctoral degree after they obtain the master's and many of them are currently in doctorate programs. Since the inception of the program, 45 students have initiated the course of study, 28 have completed the program, and 13 are currently enrolled in the program. The survey was designed to track the students in their current activities, as well as determine which courses, program enhancements, and research experiences were the least and most useful, and to discern students' perceptions of knowledge acquired on various aspects of Cancer Biology Prevention, and Control Master's Program. Thirty of the 35 individuals to whom email requests were sent responded to the survey, for a response rate of 85.7%. The results of this study will inform the strengthening of the Cancer Biology program by the Education Advisory Committee. They can also be used in the development of comparable collaborative master's degree programs designed to address the significant disparities in prevalence of cancer, low screening awareness, and access to and outcomes of cancer prevention and treatment services. This, in turn, will contribute to the elimination of the dearth of underrepresented minority scientists who address these disparities. By far, the students were satisfied with the program and believe that it has had significant impact on their ability to contribute to cancer prevention and control. They provided both general and specific recommendations to strengthen the program.

[Could speech rate of Wilson's disease dysarthric patient be improved in dual task condition?]. / Le débit de parole du patient wilsonien dysarthrique peut-il être amélioré en condition de double tâche?

INTRODUCTION: Dysarthria is one of the first sign of neurological Wilson's disease and is often characterized by a decreased speech rate. The aim of this study is to determine the abilities of Wilson's disease dysarthric patients to control their speech rate. We examined the impact of dual-tasking on the speech rate of patients as compared to healthy control speakers and in relation with their ability to accelerate speech rate when instructed to do so. METHODS: Twenty-six patients and twenty-six age- and sex-matched healthy controls repeated a sentence during 20 seconds at a comfortable speech rate used as reference. They were then asked to perform the same repetition task but in dual task conditions, in which sentence repetition was done while performing three types of executive grapho-motor tasks. Finally, the ability to control speech rate was tested by asking the speakers to perform the sentence repetition task alone but at a fast rate of speech. RESULTS: A significantly slower speech rate was observed for all patients as compared to controls. In the dual-task conditions, while the speech rate of healthy speakers accelerated significantly, two behaviors are found for the patients. Forty-two percent of the patients reproduced the control pattern with a significant increased in speech rate, while the other group significantly decreased their speech rate. Comparison of the ability of the two groups to intentionally modulate speech rate, when instructed to accelerate, shows that significantly better acceleration was achieved by speakers in the former group compared with the latter. CONCLUSIONS: This study supports the finding that patients with Wilson's disease exhibit an impaired speech rate and also impaired control of speech rate. Indirect assessment of speech rate modulation with the help of a dual-task paradigm has proven to be useful to distinguish patient behaviors. This paradigm could also be envisioned as a tool for rehabilitation.

MICI-MINOTS: Linguistic and metric validation of a pediatric questionnaire on knowledge about inflammatory bowel disease.

BACKGROUND: Therapeutic education is an essential part of the treatment of chronic diseases, such as inflammatory bowel disease (IBD). The IBD-KID, developed in Canada in English, assesses children's and adolescents' acquired knowledge about their condition and has been validated in Canadian and Australian populations. However, there is no pediatric questionnaire in French to assess patients' knowledge about IBD. OBJECTIVE: To report the linguistic validation process and metric validity of the MICI-MINOTS, the French version of the IBD-KID. METHOD: The translation process consisted of three consecutive steps: forward-backward translation, acceptability testing, and cognitive interviews. The IBD-KID consists of 23 questions, but a 24th question about immunomodulatory therapy was added in the MICI-MINOTS. Psychometric testing was conducted with five groups: children with IBD, their parents, children in a control group, their parents, and health workers recruited from the Timone Pediatric Hospital and the Saint-Sébastien Maternal and Child Protection Center, Marseille, France. A total of 15 individuals completed the tool twice, with a 15-day interval. Internal consistency, reliability, external validity, reproducibility, and sensitivity to change were tested. RESULTS: A total of 38 children with IBD (sex: 20 boys, 18 girls; age: 13.90 [±2.88] years; 25 with Crohn's disease), 20 children in the control group, 58 parents (every child was included with one parent), and 62 health workers were included in the analysis. Intraclass correlation was 0.94 (95% confidence interval 0.83-0.98) for test-retest assessment. Readability using the Scolarius score corresponded to elementary school level. Among the children with IBD, 89.5% answered all 24 questions. For 23 questions, the mean score of children with IBD was higher than among children in the control group: 9.58 (±3.01) versus 5.47 (±3.56), respectively (P<0.01). Parents of children with IBD scored higher than parents of children in the control group: 10.63 (±3.16) versus 8.4 (±3.07), respectively (P=0.012). In the health workers' group, pediatric residents (17.82±3.46) scored higher than nurses 11.75 (±3.4) and ward clerks (8.67±2.40; P<0.01). Patients' knowledge score was significantly related to their parents' knowledge score (r=0.402, P=0.012) for 23 questions. CONCLUSION: The French version of the IBD-KID showed satisfactory psychometric properties to assess knowledge about the disease in French-speaking children.

Occupational exposure to noise in maxillofacial operating theatres: an initial prospective study.

Exposure to excessive noise could impair surgical performance and communication, and lead to long-term hearing loss, but it is only recently that studies on occupational exposure to noise in operating theatres have been published. The aim of this prospective study was to assess mean and peak levels of noise during maxillofacial operations. We found that both were comparable to those in other surgical specialties such as orthopaedics in which power tools are used.

Susceptibility of Snails to Infection with Schistosomes is influenced by Temperature and Expression of Heat Shock Proteins.

The freshwater snail, Biomphalaria glabrata is the obligate intermediate host for the transmission of the parasitic trematode, Schistosoma mansoni the causative agent of the chronic debilitating neglected tropical disease, schistosomiasis. We showed previously that in juvenile snails, early and significant induction of stress manifested by the expression of stress proteins, Hsp 70, Hsp 90 and reverse transcriptase (RT) of the non- LTR retrotransposon, nimbus, is a characteristic feature of juvenile susceptible NMRI but not resistant BS-90 snails. These latter, however, could be rendered susceptible after mild heat shock at 32°C, revealing that resistance in the BS-90 resistant snail to schistosomes is a temperature dependent trait. Here we tested the hypothesis that maintenance of BS-90 resistant snails at the permissive temperature for several generations affects the resistance phenotype displayed at the non-permissive temperature of 25°C. The progeny of BS-90 snails bred and maintained through several generations (F1 to F4) at 32°C were susceptible to the schistosome infection when returned to room temperature, shedding cercariae at four weeks post-infection. Moreover, the study of expression levels of the heat shock protein (Hsp) 70 protein by ELISA and western blot analysis, showed that this protein is also differentially expressed between susceptible and resistant snails, with susceptible snails expressing more protein than their resistant counterparts after early exposure to wild-type but not to radiation-attenuated miracidia. These data suggested that in the face of global warming, the ability to sustain a reduction in schistosomiasis by using refractory snails as a strategy to block transmission of the disease might prove challenging since non-lethal elevation in temperature, affects snail susceptibility to S. mansoni.

Negative effect of a cis-acting pBR322 element on adenovirus E1a gene expression.

A sequence element within plasmid pBR322 has a cis-acting negative effect on the expression of a cloned Ad gene in transient expression assays. The negative element is located between the PvuII and Tth111I restriction sites on pBR322 (nt 2068-2223). This element was also shown to be responsible for the decrease in focus number, when plasmids carrying Ad2 E1 genes were used to transform baby rat kidney cells. In a similar manner, this element diminished the number of G418-resistant cell foci, when plasmids containing the neo marker gene under the control of E1a promoter were used. Plasmid stability in transfected cells was not modified by deletion of this cis-acting negative element.

Susceptibility to natural killer cells and down regulation of MHC class I expression in adenovirus 12 transformed cells are regulated by different E1A domains.

All human adenoviruses transform rodent cells in vitro, but only cells transformed by serotypes belonging to subgroups A (Ad12) and B (Ad3) are tumorigenic for immunocompetent animals. In these cells, the expression of MHC-class I antigens is repressed and might allow them to escape from recognition by cytotoxic T lymphocytes (CTL) and to develop in tumor. Furthermore, these cell lines appear resistant to lysis by natural killer (NK) cells. To determine the E1A domain(s) responsible for these properties several cell lines were created by transforming baby rat kidney (BRK) cells with a set of plasmids expressing different Ad2/Ad12 hybrid E1A gene products. The MHC class 1 gene expression was inhibited in cells expressing the Ad12 13S mRNA product and in cells transformed with Ad2/Ad12 hybrid E1A gene product harboring the C-terminal part of the conserved region (CR) 3 of Ad12. Susceptibility of these transformed cell lines to NK cells was determined by cytolytic assays. The results obtained suggest that two Ad12 E1A domains are required to induce resistance of the cell lines to NK cells.

Serum and erythrocyte magnesium in critically ill patients.

OBJECTIVES: To evaluate the prevalence of serum and erythrocyte magnesium (Mg) abnormalities in patients on admission to the intensive care unit (ICU) and to test the hypothesis that low levels of Mg are associated with a higher mortality. DESIGN: Prospective study. SETTING: 14-bed ICU in a 1000-bed teaching hospital. PATIENTS: 179 consecutive patients admitted over a 4-month period. MEASUREMENTS: Total serum Mg (Mgs) and erythrocyte Mg (Mge) were determined on admission by atomic absorption spectrophotometry. Severity of illness was assessed by Acute Physiology and Chronic Health Evaluation (APACHE) II and the number of organ system failures (OSF) during the first 24 h. The patients were followed up until discharge from hospital. MAIN RESULTS: On admission, 79 patients (44%) were hypomagnesemic and 10 (6%) were hypermagnesemic. A low level of Mge was observed in 119 patients (66%). In patients with similar APACHE II scores and OSF numbers, more of those with hyperMgs died during their ICU stay. However, the Mge value on admission did not correlate with patient outcome. CONCLUSIONS: We confirm the high prevalence of Mgs abnormalities as well as Mg deficiency on admission to a medical ICU. Low levels of Mgs and Mge are not associated with higher fatality. HyperMgs was associated with patient death.

Cryopreservation of schistosomules of Schistosoma mansoni in quantity.

Large quantities of Schistosoma mansoni schistosomules were cryopreserved in 35% ethanediol, and attempts were made to improve their morphology and infectivity after thawing. Several variables affected the appearance of the thawed organisms. These included: 1) the particular in vitro method used to transform cercariae to schistosomules; 2) addition of serotonin to the thawing medium; 3) changing the thawing temperature; and 4) culturing schistosomules for extended post-thaw times before assessing their condition. Varying either the postemergence age of the cercariae before transformation or the concentration of organisms in the freezing suspension had no effect on their survival. Although damage to many of the thawed schistosomules became apparent only upon extended in vitro cultivation, the addition of fetal calf serum to the thawing medium usually retarded this deterioration. When injected into mice, approximately 5% of cryopreserved schistosomules matured to adult worms, representing 71% of the value for maturation of unfrozen schistosomules. These studies define conditions of importance for the successful preservation of very large quantities of schistosomules (up to 500,000 in 1 ml volume) in liquid nitrogen.

Watershed cerebral infarcts: retrospective study of 24 cases.

Twenty-four patients presenting an acute stroke with watershed cerebral infarct on CT scan or MRI were included in this retrospective study. Age was 63 +/- 14 years (mean +/- SD), and sex ratio was 2 men for 1 woman. Main clinical features were: in anterior location, lower limb weakness and frontal syndrome with transcortical motor aphasia in left lesions or spatial dyscalculia in right ones; in posterior location, brachiofacial weakness with constant quadranopsia and hypoesthesia, and Gerstmann syndrome in left lesion. There was no distinctive feature for subcortical and multiple infarcts. In bilateral infarcts, there were one pseudobulbar syndrome, and 2 pseudo brainstem syndromes with neuropsychological signs. Aetiologies were severe carotid artery disease in 14 cases, severe cardiopathy in 6, isolated cerebral angiitis in 1, essential thrombocythemia in 1, protein C deficiency with sickle cell disease in 1, and cholesterol emboli in 1 anatomical case. CBF performed in carotid artery occlusions or tight stenoses showed evidence of haemodynamic changes. Microembolic process can be proposed in the case with cholesterol emboli. Preventive treatment is discussed.

Cyton II: a subtegumental cell type in the cercaria of Schistosoma mansoni.

In Schistosoma mansoni cercaria, an aggregate of subtegumental cells is found in a small, dorsoanterior area of the body (middivision). These cells are nestled between two laterally positioned flame cells and the muscle that delimits the anterior end of the body, and the anterior end of the central ganglion. This highly amorphous cell type, designated as cyton II, has a heterochromatic nucleus and a cytoplasm that is elaborated into coarse, tortuous processes. Its cytoplasm contains ribosomes, mitochondria, sparse amounts of endoplasmic reticulum, and two types of circular-to-oval concentric membranous bodies. One type has an electron-dense core and measures 200-250 nm on the short axis, and the other is completely membranous and measures 100-125 nm on the short axis. The cell body of cyton II communicates with the tegument that covers a small, dorsoposterior area of the anterior organ (oral sucker); however, we could not confirm a tegumental connection with the body division. When cercariae transform into schistosomules, the concentric membranous bodies of cyton II migrate into the anterior organ's tegument via cytoplasmic processes of the cell. The major function of previously described cells that have similar membranous bodies is to supply additional membranes to the outer tegument during development into an adult worm. A multilaminated outer membrane is an adaptation to the survival of the schistosomule and adult worm in the bloodstream of the vertebrate host (Hockley amd McLaren ['73]). The presence of membranous bodies from cyton II in the tegument does not confirm that this cell type participates in the formation of multilaminated membranes. Its precise function remains to be determined.

Ultrastructure of the ventral sucker of Schistosoma mansoni cercaria.

The ventral sucker of Schistosoma mansoni cercaria is a cup-shaped structure that is attached to the ventral surface of the organism by a homogeneous connective tissue that surrounds the acetabular glands. The sucker consists of an extensive complex of circular and longitudinal muscles. The longitudinal muscles extend outward in a radial pattern to form the cup of the organ. Intermingled with the muscles are nerve bundles and subtegumental cells (cytons). Dendritic nerve fibers connect to sensory papillae which are found on the surface tegument. Two types of sensory papillae are present: a commonly found unsheathed uniciliated papilla, and a previously unidentified tegumental encapsulated structure. Tegument with spines covers the ventral sucker, although the tegumental encapsulated sensory papilla lacks spines.

Operative injuries during vaginal hysterectomy.

OBJECTIVE: To evaluate incidence, characteristics and consequences of urinary and intestinal tract injuries during vaginal hysterectomy for benign conditions. STUDY DESIGN: From January 1970 to December 1996, 3076 vaginal hysterectomies with or without additional procedures, were performed for benign conditions in our department. We retrospectively analyzed operative injury cases. RESULTS: Incidence of urinary and intestinal tract injuries were 1.7 and 0.5%, respectively. Concerning urinary tract injuries, we observed only one ureteral lesion, all others being bladder lacerations (54 cases). The bladder lacerations occured during the hysterectomy step of the surgery in 61% of cases and during the additional procedures in 39%. All bladder injuries were recognized and treated during the primary operation. We observed four cases of vesico-vaginal fistula as a consequence of these injuries; all fistulas occured after bladder laceration during the hysterectomy step of the surgical procedure. Intestinal tract injuries (16 cases) were rectal lacerations occuring during the hysterectomy step of the surgery (31% of cases) and during the additional procedures (69%). All rectal injuries were recognized and repaired during the primary operation and all healed without sequellae. CONCLUSION: Operative injuries during vaginal hysterectomy are relatively rare. They are easily recognized and treated during the primary operation without important sequellae.

Prevalence and influence of Mycoplasma hominis and Ureaplasma urealyticum in 218 African pregnant women and their infants.

OBJECTIVES: To estimate the prevalence of Ureaplasma urealyticum (Uu) and Mycoplasma hominis (Mh) in the lower genital tract of pregnant women, their evolution during pregnancy, and the effect of these pathogens on the outcome of pregnancy in Equatorial Africa. STUDY DESIGN: 218 pregnant women were followed from before 20 weeks gestational age through delivery. Samples were taken from the cervix at every visit and from the newborn at delivery and tested for Uu and Mh. The data were analysed using Student's t-test, the Mann-Whitney, or the chi 2-test. RESULTS: The prevalence of cervical colonization by Ureaplasma urealyticum and Mycoplasma hominis in pregnant women was 79% and 41% respectively. Colonization with Uu and Mh increased significantly throughout pregnancy (P < 0.001). Their presence was associated with lower gestational age at delivery, lower birth weight and increased neonatal morbidity and mortality (P < 0.05). Erythromycin therapy did not have any effect on the evolution of Uu and Mh colonization during pregnancy. CONCLUSION: Uu and Mh are additional factors that might contribute to poor pregnancy outcome in a country where neonatal health is already impaired by many other microorganism.

Schistosoma mansoni: changes in the albumen gland of Biomphalaria glabrata snails selected for nonsusceptibility to the parasite.

The LAC-line strain of the snail Biomphalaria glabrata has very low susceptibility to the parasite Schistosoma mansoni and a very low reproductive potential. Upon examination of the reproductive tract of these snails, light and electron microscopy revealed obvious abnormalities in the albumen gland. Secretory cells that are normally cuboidal in susceptible NMRI (F0) snails were squamous in LAC-line snails. These LAC-line cells contained small secretory granules and negligible rough endoplasmic reticulum and Golgi, compared to large granules and an extensive array of both organelles in F0 albumen gland cells. Comparative analyses of soluble protein extracts of F0 and LAC-line albumen glands showed several qualitative differences. Among the most prominent was an 18-kDa protein in F0 snails that was remarkably reduced in the soluble protein extracts of LAC-line snails. Also, metabolic incorporation of [35S]-methionine was impaired in LAC-line albumen glands. Whether these albumen gland changes are caused by decreased susceptibility to parasitism is yet to determined.

Use of RAPD-PCR to differentiate genetically defined lines of an intermediate host of Schistosoma mansoni, Biomphalaria glabrata.

The genetic differentiation among several laboratory-maintained pedigree snail lines of Biomphalaria glabrata (with different susceptibility phenotypes to Schistosoma mansoni infection) was assessed with the random amplified polymorphic DNA method. Out of the 20 primers tested, 2 (OPA-01 and OPA-06) gave reproducible markers with either individual or bulked DNA samples from resistant (BS-90, 10-R2, LAC-line) and susceptible (M-line) snails. Arbitrary primer, OPA-01, amplification of BS-90 DNA identified a 180-bp strain-specific fragment and a 400-bp marker in the susceptible M-line stock. In the 10-R2 and LAC snail lines, OPA-01 specific markers of 200 bp and 550 bp were identified. Amplification with primer OPA-06 identified several major strain-specific markers in the BS-90 (150 bp, 400 bp, 800 bp) and M-line (1,100 bp) snails. The heritability of the RAPD markers was evaluated in progeny snails derived from a cross between the BS-90 and M-line stocks. Results showed that markers were inherited in a dominant or codominant fashion. The 1,100-bp M-line marker was inherited in all susceptible progeny snails analyzed.

[Intrapericardial congenital ectasias of the left atrium]. / Les ectasies congénitales intrapéricardiques de l'auricule gauche

Congenital intrapericardial dilatation of the left atrium is an abnormality which is either very rare (16 cases reported in the literature) or one that is easily missed. The clinical features are unhelpful, and the diagnosis is suggested by the outline on X ray and confirmed by angiocardiography. The great importance of this abnormality lies in its natural history. Disorders of rythm (9 cases out of 16) and embolism (5 cases out of 16) are amongst the complications to be weighed up when deciding the treatment policy. Operative treatment, which is straightforward, seems to us to be indicated in all cases.

[Uterine rupture. A case of spontaneous rupture in a thirty week primiparous gestation ]. / Rupture utérine. A propos d'un cas de rupture spontanée à 30 SA chez une primipare.

Uterine rupture is one of the major complications of pregnancy. Most spontaneous uterine ruptures occur during labor in parturients with a scarred uterus. Spontaneous rupture where the uterus is unscarred are more rare and occur more frequently in older multiparous patients. Starting from a case of uterine rupture occurring in a 40 year-old primiparous women, we will present a review of the literature concerning cases of rupture in healthy uteri with no obvious cause.

[Periodic disease and pregnancy]. / Maladie périodique et grossesse.

The authors report a case of familial Mediterranean fever in a pregnant woman treated with Colchicine. She delivered normally at term. A review of the literature shows that colchicine does not have a teratogenic effect which it was long thought to have. All the same it is best to carry out fetal karyotype examination using early amniocentesis. Furthermore, colchicine improves fertility which is disturbed in these patients and pregnancy has a good effect on the disease.