[Cystocele repair by a light tension-free vaginal mesh: results after 6 years of follow-up]. / Cure de cystocèle par prothèse vaginale libre de faible grammage : résultats à 6 ans.

INTRODUCTION: The objective of this study was to evaluate the long-term anatomical and functional efficacy, but also the safety of tension-free vaginal mesh in cystocele repair. METHODS: This retrospective and monocentric study included 90 women who underwent a prolapse repair between June 2006 and November 2008. A light-weight polypropylene vaginal mesh (22g/m2, Novasilk COLOPLAST®) was used without any fixation. Females were followed at 1 month, 1 year, 3 years and 6 years. Only long-term results are presented in this study. The anatomical result was assessed by the POP-Q classification and the functional results by standardized symptoms (PFDI-20), sexuality (PISQ-12) and quality of life (PFIQ-7) questionnaires. RESULTS: 6 years after surgery, the follow-up rate was 74%. Anatomically, the prolapse recurrence rate (Ba≥0) was 17% (n=8). Functionally, the overall patient satisfaction rate was 89%. Quality of life and symptoms scores (4,11±8.45 vs. 17.5±14.4 and 35.8±15.9 vs 94±23.4 respectively) were significantly improved (p<0.001). Concerning the prevalence of the complication, the retraction and exposition rate was 1.7% (n=1) and a re-intervention rate was 6.7% (n=4). The rate of de novo dyspareunia was 1.7% (n=1). CONCLUSION: In this short retrospective series of vaginal mesh interposition for cystocele repair, the prevalence of medium-term patient satisfaction was high.

Benzodiazepine dependence: focus on withdrawal syndrome.

Benzodiazepines are potentially addictive drugs: psychological and physical dependence can develop within a few weeks or years of regular or repeated use. The socioeconomic costs of the present high level of long-term benzodiazepine use are considerable. These consequences could be minimised if prescriptions for long-term benzodiazepines were decreased. However, many physicians continue to prescribe benzodiazepines and patients wishing to withdraw receive little advice or support. Particular care should be taken in prescribing benzodiazepines for vulnerable patients such as elderly persons, pregnant women, children, alcohol- or drug-dependent patients and patients with comorbid psychiatric disorders. The following update gives recent research results on the withdrawal pathophysiology and practical information in order to treat or prevent benzodiazepine withdrawal syndrome.

Impact of energy and casein or whey protein intake on bone status in a rat model of age-related bone loss.

In the elderly, nutritional deficiencies, such as low energy and protein intake, are suggested to increase the risk of osteoporotic fractures. Modulation of the amount and quality of protein intake under energy deficient conditions represents an interesting strategy to prevent aged-related bone loss. We investigated the effect of a 5-month dietary restriction on bone status in 16-month-old male rats. Rats were randomised into six groups (n 10 per group). Control animals were fed a normal diet containing either casein (N-C) or whey protein (N-WP). The other groups received a 40 % protein and energy-restricted diet with casein or whey protein (PER-C and PER-WP) or a normal protein and energy-restricted diet (ER-C and ER-WP). Both restrictions (PER and ER) induced a decrease in femoral bone mineral density (BMD), consistent with impaired biomechanical properties and a reduced cortical area at the diaphysis. Plasma osteocalcin and urinary deoxypyridinoline levels suggested a decrease in bone turnover in the PER and ER groups. Interestingly, circulating insulin-like growth factor 1 (IGF-1) levels were also lowered. Overall, normal protein intake did not elicit any bone sparing effect in energy-deficient rats. Regarding protein quality, neither casein nor WP appeared to significantly prevent the BMD decrease. This study confirms that nutritional deficiencies may contribute to osteopenia through decreased IGF-1 levels. Moreover, it seems that impaired bone status could not be significantly prevented by modulating the amount and quality of dietary proteins.

Centrifugation-based isolation of myosin for measurement of its synthesis rate in small muscle samples.

Myosin is involved in muscle mobility which is particularly affected in many pathophysiological situations. It is composed of heavy (MHC) and light (MLC) chains and measurements of its specific fractional synthesis rate (FSR) are scarce, mostly because of difficulties in isolating this protein. Our aim was to isolate pure myosin from small rat gastrocnemius skeletal muscle samples by setting up a procedure compatible with determination of stable isotope incorporation into myosin using mass spectrometry detection, allowing calculation of its FSR. A centrifugation method was compared to a validated but time-consuming elution gel electrophoresis method. Statistical analysis by the Bland and Altman test revealed a tight relationship between both methods (r2 >0.97, p <0.0001). The purity of the myosin fractions using the two procedures was verified by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. In addition, the centrifugation procedure allowed simultaneous purification of MLC and MHC, whereas the elution gel electrophoresis technique resulted only in MHC isolation. Finally, the FSRs of myosin and MHC were found to be 0.114+/-0.026 and 0.140+/-0.029%/h, respectively (p not significant). In conclusion, the centrifugation method is a useful and reproducible procedure that results in sufficient amounts of pure myosin for reliable determinations of its own synthesis rate in vivo.