The combination of deep breathing and mental imagery promotes cardiovascular recovery in firefighters.

Firefighters' rescue operations involve intense physical activity associated with a high level of cardiovascular stress. To sustain such intense physical performance whilst maintaining a healthy heart, it is crucial that they benefit from rapid recovery between each intervention. This study aimed at investigating the impacts of a recovery protocol combining deep breathing and mental imagery. Forty firefighters were divided into two experimental groups which undertook two maximum fitness tests separated by either the control recovery protocol (30 min reading time; n = 20) or the experimental recovery protocol (30 min of deep breathing and mental imagery; n = 20). When compared to the pre-tests, the percentage evolution ratios in the post-tests for the Cooper performance, the heart rate recovery and the parasympathetic reactivation were promoted by the experimental protocol, compared to simple reading. In light of these results, we propose the use of practices of deep-breathing combined with mental imagery to improve firefighters' recovery. Practitioner summary: Firefighters' activities involve intense physical activities associated with a high level of psychological stress. Enhancing their recovery after each rescue intervention appears crucial. The results of this study showed that a recovery protocol combining deep breathing and mental imagery promotes heart rate recovery and better maintenance of physical fitness.

[Use of methoxyflurane on acute pain during burn dressing in adult consultation]. / Utilisation du méthoxyflurane sur la douleur aiguë lors du pansement en consultation des brûlés adultes.

INTRODUCTION: The objective was to compare the short-term efficacy of methoxyflurane vs. MEOPA on acute pain during burn dressing in consultation, the secondary outcome was to assess the patient's comfort and the quality of the dressing performed. MATERIALS AND METHODS: Monocentric, prospective study from April 2018 to January 2019. Men and women>18 years presenting acute burn on<10% SCT were included. A pain≥4 on the numerical scale (from 0 to 10) at the beginning of the treatment established the indication of methoxyflurane or MEOPA, with randomization done by a nurse. The following data were collected: burn description, performed debridement, pain assessment by numerical scale: on arrival, at the beginning of care, after 6 to 10 inhalations for methoxyflurane or 3 to 4minutes of inhalation for MEOPA and at the end of care. RESULTS: Sixty patients were included, 30 in each group. There was a decrease of -2.47 points of numerical scale when initiating methoxyflurane against -1.53 points for MEOPA (P=0.08). Patients were significantly less painful when stopping treatment in the methoxyflurane group -4 points vs -2 points (P=0.001). Methoxyflurane significantly improved the debridement of the burn (P=0.018). CONCLUSION: Methoxyflurane is more effective than MEOPA in acute pain in burn dressing, improved patient comfort, and improved dressing quality.

Distinct Profiles of Consumers of Psychoactive Substances in People Attending French Sexual Transmitted Infections Centers.

The objective of this cross-sectional survey was to assess the prevalence of psychoactive substance use (PSU) in people attending 11 French Sexual Transmitted Infection Centers, and to specify their profiles (PSU and link with risky sexual behaviors) using the ascending hierarchical clustering method. Among the 5220 individuals who completed the survey, 55.6% were men and the median age was 24 years [IQR: 20-31]. Among the participants, 2751 (52.7%) reported PSU at least once in their life. Ascending hierarchical clustering identified seven distinct profiles of participants based on their PSU. This study shows a high prevalence of PSU and alcohol consumption in this young population. Moreover, subgroup analysis allowed identifying groups of psychoactive substance users who presented specific risks or vulnerabilities and who should be priority targets for interventions, particularly sexual minority groups.

Developmental determinants in non-communicable chronic diseases and ageing.

Prenatal and peri-natal events play a fundamental role in health, development of diseases and ageing (Developmental Origins of Health and Disease (DOHaD)). Research on the determinants of active and healthy ageing is a priority to: (i) inform strategies for reducing societal and individual costs of an ageing population and (ii) develop effective novel prevention strategies. It is important to compare the trajectories of respiratory diseases with those of other chronic diseases.

Coagulation factor X mediates adenovirus type 5 liver gene transfer in non-human primates (Microcebus murinus).

Coagulation factor X (FX)-binding ablated adenovirus type 5 (Ad5) vectors have been genetically engineered to ablate the interaction with FX, resulting in substantially reduced hepatocyte transduction following intravenous administration in rodents. Here, we quantify viral genomes and gene transfer mediated by Ad5 and FX-binding-ablated Ad5 vectors in non-human primates. Ad5 vectors accumulated in and mediated gene transfer predominantly to the liver, whereas FX-binding-ablated vectors primarily targeted the spleen but showed negligible liver gene transfer. In addition, we show that Ad5 binding to hepatocytes may be due to the presence of heparan sulfate proteoglycans (HSPGs) on the cell membrane. Therefore, the Ad5-FX-HSPG pathway mediating liver gene transfer in rodents is also the mechanism underlying Ad5 hepatocyte transduction in Microcebus murinus.

Reverse Lip Lift For Deep Face Burn Sequelae With Bilateral Nostril Stenosis And Lip Contracture: An Original Technique. A Case And Literature Review.

Bilateral nostril stenosis resulting from deep facial burn that occurred on an oxygen-requiring patient with tobacco use is life threatening with obstruction of the airway and impossibility of oxygen supplementation use. We report the case of a deep burn involving the nose and the upper lip during oxygen and tobacco use with a severe bilateral nostril stenosis and upper lip retraction. We did a reverse bullhorn lip lift with bilateral alar base transposition realized in a one-stage surgery with nasal conformer for 4 months. Surgery allowed a significant opening of the nostril stenosis with a 9mm and 11mm major axis on the right and left side respectively. It brought restoration of the ability to nose breath and use an oxygen device, and was considered satisfactory by the patient and the operators. There was no recurrence at 18-month follow-up. Literature provides few examples of management of severe bilateral nostril stenosis following facial deep burn. Nasal conformers with progressive diameter augmentation, rhinoplasty procedure, local plasties, dermal flap, skin and composite grafts can treat this situation but there is no gold standard procedure. Reverse bullhorn lip lift with bilateral alar base transposition makes it possible to correct this severe deep burn sequela. With this clinical case, we show the possibility to treat it in a one-stage procedure through an aesthetic procedure inspiration, with an acceptable scar on the donor site.

La survenue d'une sténose narinaire bilatérale après une brûlure profonde de la face, chez un patient oxygénodépendant et fumeur, impacte le pronostic vital, par obstruction des voies aériennes supérieures et impossibilité d'utiliser l'oxygénothérapie. Nous rapportons le cas d'une brûlure profonde du nez et de la lèvre supérieure survenue en fumant pendant l'oxygénothérapie, entraînant une importante sténose narinaire bilatérale et une rétraction de la lèvre supérieure. Nous avons réalisé un lifting labial en corne de buffle inversé avec transposition bilatérale des ailes narinaires en un seul temps opératoire. Un conformateur narinaire a été porté pendant quatre mois. Cette chirurgie a permis une ouverture significative des sténoses narinaires, avec 9 mm et 11 mm de grand axe transversal respectivement à droite et à gauche. Cela a permis de restaurer la fonction respiratoire nasale et de permettre le port du masque à oxygène. Le résultat a été jugé satisfaisant par le patient et par les opérateurs. Nous n'avons pas noté de récidive à 18 mois de la chirurgie. La littérature rapporte peu de cas de sténose narinaire bilatérale après brûlure profonde de la face. Des conformateurs narinaires de diamètre progressivement croissant, des techniques type rhinoplastie, des plasties locales, des lambeaux cutanés, des greffes cutanées ou composites ont été décrites mais il n'y a pas de consensus. La technique de lifting labial en corne de buffle inversé associée à une transposition des ailes narinaires nous a permis de traiter ces séquelles de brûlure profonde. À travers ce cas cliniques, nous montrons la possibilité de traitement en un temps par une technique inspirée des techniques de chirurgie esthétique et avec un résultat cicatriciel acceptable.

Prevalence of meticillin-resistant Staphylococcus aureus amongst professional meat handlers in the Netherlands, March-July 2008.

In the Netherlands, meticillin-resistant Staphylococcus aureus (MRSA) is detected on pork and veal farms, and hence farmers working with MRSA-positive animals are at an increased risk of being colonised. Recently retail meat products have been found positive for MRSA. Therefore, we tested the prevalence of MRSA among employees who work in the cold meat processing industry and in institutional kitchens. Nasal swabs and samples from the employees' hands as well as the handled meat were tested quantitatively and qualitatively for the presence of MRSA. Typical colonies were confirmed by PCR and typed using multi-locus sequence typing and spa­typing. All samples taken from 95 employees tested negative for MRSA, but 31 carried MSSA. From meat, five of 35 samples were positive for MRSA, containing between 0.01 and more than 10 bacteria per gram. The risk for professionals of MRSA colonisation from handling raw meat was therefore low in our setting, suggesting that the general population is at an even lower risk of being infected through meat handling.

Does the repetition over a short time of a microsurgical suture improve its reliability?

Our hypothesis was that immediate repetition of a microsurgery-suturing task will improve its execution and outcome. This was an experimental animal study. Ten surgeons were divided into two groups of five surgeons. Each performed two end-to-end carotid anastomoses on the same rat, one after the other. The anastomosis was evaluated by the surgeon and an instructor. The primary endpoint was permeability. The outcome was evaluated using an objective and subjective assessment grid yielding 1 to 3 points per item. The total scores for each of the 10 surgeons were used to compare the anastomosis of carotid 1 versus 2, using the ratings given by the surgeon and the instructor. Twenty anastomoses were performed, but 1 rat died intraoperatively, leaving 18 anastomoses for evaluation. No significant differences were found on the main endpoint of permeability, with all anastomoses being permeable. The surgeon's self-assessment was significantly better for the second carotid artery (P=0.05), but this was not confirmed by the proxy assessment (instructor). The analysis by subgroups-morning versus afternoon-found the second carotid anastomosis was significant better in the self-assessment and proxy assessment for the morning group (P<0.001, P=0.024). There was no significant difference in clamping times. The immediate repetition of a microsurgical procedure seems to favor its execution, which leads us to propose that the more difficult or important anastomosis should be done after an easier or less important one during complex surgeries. LEVEL OF EVIDENCE: 2B.

c-Jun N-terminal kinase 2 promotes enterocyte survival and goblet cell differentiation in the inflamed intestine.

c-Jun N-terminal kinases (JNKs) contribute to immune signaling but their functional role during intestinal mucosal inflammation has remained ill defined. Using genetic mouse models, we characterized the role of JNK1 and JNK2 during homeostasis and acute colitis. Epithelial apoptosis, regeneration, differentiation, and barrier function were analyzed in intestinal epithelium-specific (ΔIEC) or complete JNK1 and bone marrow chimeric or complete JNK2 deficient mice as well as double-knockout animals (JNK1ΔIECJNK2-/-) during homeostasis and acute dextran sulfate sodium (DSS)-induced colitis. Results were confirmed using human HT-29 cells and wild-type or JNK2-deficient mouse intestinal organoid cultures. We show that nonhematopoietic JNK2 but not JNK1 expression confers protection from DSS-induced intestinal inflammation reducing epithelial barrier dysfunction and enterocyte apoptosis. JNK2 additionally enhanced Atonal homolog 1 expression, goblet cell and enteroendocrine cell differentiation, and mucus production under inflammatory conditions. Our results identify a protective role of epithelial JNK2 signaling to maintain mucosal barrier function, epithelial cell integrity, and mucus layer production in the event of inflammatory tissue damage.

[What the cardiologist should know about physical training]. / Ce que le cardiologue doit savoir sur l'entraînement sportif.

Because of the cardiovascular stresses and the potential risks of physical training, cardiologists are often asked to give an opinion on aptitude for sport. It is therefore important to understand the fundamentals of physical training. This is based on specific rules; general physical preparation, progressive nature of the activity, individualisation of training programmes, specificity of sporting activity, recovery times and planning of exercise. The two main types of training (aerobics and weight training) are used preferentially according to the type of sport but good aerobic capacity is required in all specialities. The training implies a certain physical stress and the individual has his own limitations. The cardiologist may help identify an imbalance between the two without being an expert in all sporting disciplines. In this field, the physician is no substitute for the coach but can help in managing the sportsman's health.

Chronotropic competence in endurance trained heart transplant recipients: heart rate is not a limiting factor for exercise capacity.

OBJECTIVES: The purpose of this study was to show that the chronotropic potential of the well trained heart transplant recipient (HTR) does not limit exercise capacity. BACKGROUND: Chronotropic incompetence is considered to be the main limiting factor of the functional capacity of heart transplant recipients. However, no systematic study had been published on patients who had spontaneously undergone heavy endurance training for several years. METHODS: Heart rate (HR) and respiratory gas exchanges (VO2, VCO2, VE) were measured in 14 trained HTRs (T-HTRs) during exercise tests on a bicycle, on a treadmill and by Holter electrocardiography during a race. RESULTS: Peak values observed in T-HTRs during the treadmill test were higher than those reached during the bicycle test (VO2peak: 39.8+/-6.9 vs. 32.5+/-7.8 ml x kg(-1) x min(-1), p < 0.001; HRpeak: 169+/-14 vs. 159+/-16 bpm, p < 0.01). During treadmill exercise VO2peak and HRpeak values observed were very close to the mean predicted VO2pmax and HRpmax. The maximum heart rate during the race (HRrace) was greater than HRpeak values during the treadmill test (179+/-14 vs 169+/-14 bpm, p < 0.01) and slightly above the mean predicted values (HRrace/HRpmax X 100 = 101+/-10%). The treadmill exercise test yields more reliable data than does the bicycle test. CONCLUSIONS: Extensive endurance training enables heart transplant recipients to reach physical fitness levels similar to those of normal sedentary subjects; heart rate does not limit their exercise capacity.

Carcinogen-induced mutation spectrum in wild-type, uvrA and umuC strains of Escherichia coli. Strain specificity and mutation-prone sequences.

Forward mutations induced by the ultimate carcinogen N-acetoxy-N-2-acetylaminofluorene (N-Aco-AAF) in the tetracycline resistance gene carried on plasmid pBR322 are shown to be dependent upon the induction of the host SOS functions in wild-type and umuC Escherichia coli cells. The mutation frequency in the umuC strain is equal to about 40% of the mutation frequency observed in the umu+ background. In the excision-repair-deficient uvrA mutant strain the mutagenic response is the same as in SOS-induced wild-type cells whether or not the uvrA bacteria are SOS-induced. Equal mutation frequencies are obtained in both the wild-type and the uvrA strains for equal modification levels although the survival of AAF-modified plasmid DNA is greatly reduced in the uvrA strain as compared to the wild-type strain. Sequence analysis of the mutations reveals that more than 90% of the N-Aco-AAF-induced mutations are frameshift mutations. Two types of mutational hotspots are observed occurring either at repetitive sequences or at non-repetitive sequences. Both types of mutants appear at similar locations and frequencies in both the wild-type and the uvrA strains. On the other hand, only the non-repetitive sequence mutants are obtained in the umuC background. These non-repetitive sequence mutants preferentially occur within the sequence 5' G-G-C-G-C-C 3' (the NarI restriction enzyme recognition sequence). The analysis of the -AAF binding spectrum to the same DNA fragment shows that there is no direct correlation between the modification spectrum and the mutation spectrum. We suggest that certain sequences are "mutation-prone" in the sense that only these sequences can be efficiently mutated as the result of an active processing mediated by specific proteins. When a sequence is said to be mutation-prone it probably corresponds to a particular structure that is induced within this sequence as a result of the binding to the DNA of the mutagen. This sequence-specific conformational change is the substrate for the protein(s) that fixes the mutation. The mutagenic processing pathway(s) is part of the cellular response to DNA-damaging agents (the so-called SOS response). Two pathways for frameshift mutagenesis are suggested by the data: an umuC-dependent pathway, which is involved in the mutagenic processing of lesions within repetitive sequences; an umuC-independent pathway responsible for the fixation of mutations within specific non-repetitive sequences.

Lithostathine and pancreatitis-associated protein are involved in the very early stages of Alzheimer's disease.

According to one of the theories formulated to explain the etiology of Alzheimer's disease (AD), amylosis may reflect a specific inflammatory response. Two inflammatory proteins, lithostathine and PAP, were evidenced by immunohistochemistry in senile plaques and neurofibrillary tangles of patients with AD. In addition, lithostathine and PAP were significantly increased in the cerebrospinal fluid of patients with AD when compared to patients with multiple sclerosis, another inflammatory disease, and to normal control subjects. However, no correlation was observed with age of occurrence. Furthermore, lithostathine and PAP were increased even at the very early stages of AD, and their level remained elevated during the course of the AD unlike TNFalpha whose level, very high at very early stages, regularly decreased. Finally, if part of lithostathine and PAP are synthesized in the brain, a large part comes from serum by passage over the blood-brain barrier. These results indicate (i) the existence of an acute phase response followed by a chronic inflammation in AD, and (ii) that lithostathine and PAP are involved even at the first pre-clinical biochemical events of AD. In addition, because lithostathine undergoes an autolytic cleavage leading to its precipitation and the formation of fibrils, we believe that it may be involved in amyloidosis and tangles by allowing heterogeneous precipitation of other proteins.

Genomic exploration of the hemiascomycetous yeasts: 2. Data generation and processing.

The generation of sequencing data for the hemiascomycetous yeast random sequence tag project was performed using the procedures established at GENOSCOPE. These procedures include a series of protocols for the sequencing reactions, using infra-red labelled primers, performed on both ends of the plasmid inserts in the same reaction tube, and their analysis on automated DNA sequencers. They also include a package of computer programs aimed at detecting potential assignation errors, selecting good quality sequences and estimating their useful length.

Association of APOE promoter but not A2M polymorphisms with risk of developing Alzheimer's disease.

The APOE4 allele is widely accepted as a major risk factor for late-onset Alzheimer's disease (AD). Recently, it has been reported that polymorphisms in the APOE promoter and in the alpha2-macroglobulin gene (A2M) are associated with AD. We have analyzed the distribution of APOE alleles, -219T/G APOE promoter polymorphism, and A2M/A2Mdel polymorphism in a large case-control study. Our results showed that APOE genotype was the only informative marker of AD risk contrary to -219T/G and A2M/A2Mdel polymorphism. In AD patients however, a strong linkage disequilibrium was observed between the T allele of -219T/G polymorphism and APOE4 allele. This result indicates that -219T/G APOE promoter polymorphism is a risk factor for AD by increasing the APOE4-associated risk.

Comparison of epidural analgesia and cryoanalgesia in thoracic surgery.

A prospective study was carried out in 120 patients undergoing elective thoracotomy for parenchymal disease. Patients were randomized into three groups: A (control group), B (epidural analgesia), C (freezing of intercostal nerves). Subjective pain relief was assessed on a linear visual analog scale. Analgesic requirements were evaluated during the 12 days following surgery, or until discharge if earlier. The vital capacity (VC) and forced expiratory volume in 1 s (FEV1) were measured on the day before operation and on the 1st, 2nd, 3rd and 7th postoperative days (POD). Subjective pain relief was significantly better in Group B in comparison with Group A (P < 0.05) or C (P < 0.05). Group C had the lowest score on the 11th and 12th POD but differences were not statistically significant. Requirements for intravenous analgesics were lower in Group B than in the control group (P < 0.05) during the first 3 POD, and in group C than in the control group the day of operation (P < 0.05). Oral analgesic requirements, when compared with controls, were lower in group B during the first 5 POD, and lower in group C on the 3rd and the 4th POD (P < 0.05). Cryoanalgesia led to a slight but not significant increase in VC and FEV1. Epidural analgesia led to a significant increase when compared with controls in FEV1 during the first 3 POD, and in FVC on the 7th POD (P < 0.05). It is concluded that epidural analgesia led to the best pain relief and restoration of pulmonary function after thoracotomy.(ABSTRACT TRUNCATED AT 250 WORDS)

[The use of acetylsalicylic acid in patients with ischemic cardiomyopathy cared for in Spanish emergency services (results of the EVICURE Study). Evaluacion del Manejo de la cardiopatia isquemica en los Servicios de Urgencias Hospitalarios of the Sociedad Espanola de Medicina de Urgencias y Emergencias (SEMES)]. / Utilizacin del cido acetilsaliclico en pacientes con cardiopata isquemica atendidos en los servicios de urgencias espaoles (resultados del estudio EVICURE).

BACKGROUND: Acetyl salicylic acid is a drug with demonstrated effectiveness in ischemic cardiomyopathy. The objective of our study was to know the use of this drug in the emergency services of Spain. PATIENTS AND METHOD: The EVICURE study analyzes the use of acetyl salicylic acid in 35 emergency services of Spanish hospitals. RESULTS: 2,168 patients were studied. Of the 473 patients with stable angina, 9.2% received acetyl salicylic acid before going to the hospital and 90,7% at the arrival to the hospital, of 1,067 with unstable angina 13% received acetyl salicylic acid before the arrival to the hospital and 56% at the arrival to the hospital. Of 600 patients affected of myocardial infarction only 17% received acetyl salicylic acid before the arrival to the hospital and 59.8% received this drug in the emergency room. CONCLUSIONS: The use of acetyl salicylic acid in patients affected of ischemic cardiopathy assisted in the emergency services of Spain is improperly low.

[Long-term treatment of Alzheimer's disease: followup of a cohort of 255 patients treated with lacrine for four years]. / Traitement de la maladie d'Alzheimer au long cours: à propos d'une cohorte de 255 patients traités quatre ans par tacrine.

We describe the follow-up of a cohort of 255 Alzheimer's disease (AD) patients (81 males, 174 females) treated by tacrine during 4 years. We performed the survey of hepatic, cholinergic and general tolérance. Drug efficacy was measured by MMS examination on weeks 0, 18, 30, 52, 104, 156 and 208. A total of 190 patients (74.5 percent) were dropped out of this study, 75 (29 percent) for adverse events. We found 85 hepatic (33 percent), 79 cholinergic (31 percent), 31 (12 percent) neuropsychiatric and 72 general (28 percent) side effects. In term of drug efficacy we observed a global decline of 2.5 MMS points during the first year and 2 MMS points between W52 and W156. Tacrine's symptomatic efficacy, defined as the number of patients improved or stabilized at W30, was present in 50 patients (46 percent) among the 109 patients reaching W30. The intensity of symptomatic efficacy was expressed by a 2.7 MMS points increase in 37 patients improved on W30. The long term effects of Tacrine, measured by the MMS score at one year, showed a positive impact as the MMS was 2.5 points above the expected score in non treated AD patients. This study raises the practical problem of optimal cholinesterase inhibitors use in AD and the theoretical question of long term action of cholinesterase inhibitors on cerebral lesions of AD.

[Anti-TNF alpha monoclonal antibodies (infliximab) and tuberculosis: apropos of 3 cases]. / Anticorps anti-TNF alpha (infliximab) et tuberculose: à propos de trois cas.

INTRODUCTION: Monoclonal TNF alpha antibodies are a new treatment of severe rheumatoid arthritis. One of the possible side effects is the appearance of opportunistic infections. We report here on three cases of disseminated tuberculosis observed in patients undergoing treatment with infliximab. EXEGESIS: A 45-year-old woman, treated with infliximab, was hospitalised after five infusions for fever and dyspnoea. The exams showed pulmonary and peritoneal tuberculosis. The second case is a 75-year-old woman whose symptoms were fever, cough and cervical adenopathy after three infliximab infusions. Diagnosis was disseminated tuberculosis. The third case is a 59-year-old man who was hospitalised for an infectious syndrome with dyspnoea, after two infliximab infusions. We discovered pulmonary tuberculosis. CONCLUSION: These three cases added to the 68 cases of tuberculosis registered with the treatment of infliximab. This confirms the risk of severe opportunist infectious side effects. TNF alpha is a cytokine which has anti-infectious properties. These tuberculoses are severe and generalized. It is recommended to search for an active or latent tuberculosis before beginning treatment with infliximab, and to check these patients frequently.

[digital angiography via intravenous route in the study of the transplanted kidney artery]. / Angiographie numérisée par voie intraveineuse dans l'étude de l'artère du rein transplanté.

Results of 351 intravenous digital subtraction angiographs (AN) of transplanted kidneys emphasized reliability of this examination for detection of renal artery stenosis. A prospective study of 219 patients (188 interpretable AN) showed significant stenosis of grafted artery in 22% of cases: 17% of the 126 patients with normal blood pressure and 34% of the 62 cases of hypertension. Digital subtraction allows, with a single injection, assessment of renal artery, nephrogram and excretory cavities, but it is not a substitute for conventional intravenous urography 1 to 2 months after grafting.