Uric acid is negatively associated with cognition in the first- episode of schizophrenia.

BACKGROUND: We explored the relationship between levels of serum uric acid (UA) and cognitive impairment in people with schizophrenia to order to better protect and improve cognitive function in such patients. METHODS: A uricase method evaluated serum UA levels in 82 individuals with first-episode schizophrenia and in 39 healthy controls. The Brief Psychiatric Rating Scale (BPRS) and the event-related potential P300 were used to assess the patient's psychiatric symptoms and cognitive functioning. The link between serum UA levels, BPRS scores, and P300 was investigated. RESULTS: Prior to treatment, serum UA levels and latency N3 in the study group were significantly higher than in the control group, whereas the amplitude P3 was considerably lower. After therapy, the study group's BPRS scores, serum UA levels, latency N3, and amplitude P3 were lower than before treatment. According to correlation analysis, serum UA levels in the pre-treatment study group significantly positively correlated with BPRS score and latency N3 but not amplitude P3. After therapy, serum UA levels were no longer substantially related to the BPRS score or amplitude P3 but strongly and positively correlated with latency N3. CONCLUSIONS: First-episode schizophrenia patients have higher serum UA levels than the general population which partly reflects poor cognitive performance. Improving patients' cognitive function may be facilitated by lowering serum UA levels.

Assessment of risk factors for postoperative complications of breast reduction by superior or superomedial pedicle.

BACKGROUND: Some risk factors for breast reduction complications are well known but for others the results are contradictory in scientific literature. The choice between superior pedicle and superomedial pedicle as a risk factor has been rarely studied. We aim to better identify the risk factors for breast reduction complications, including the choice between these two pedicles, in order to better prevent their occurrence. METHODS: We performed a retrospective analysis of the medical records of patients who underwent a bilateral breast reduction from august 2020 to august 2023 in our center. Patient data were obtained and correlated with postoperative complications using statistical tests and a literature search was carried out to compare our results to the current evidence. RESULTS: We included 216 patients. The complication rate was 24.07%. The most frequent complication was wound dehiscence (17.59%), followed by partial Nipple-Areola-Complex necrosis or peroperative suffering requiring conversion to Nipple-Areola-Complex free graft (5.56%). Increased Body Mass Index, superomedial pedicle and resection weight ≥650g were associated with an increased probability of complication occurrence (P=0.048, P=0.005 and P=0.044). The superomedial pedicle and the resection weight ≥650g were associated with an increased probability of wound dehiscence (P=0.005 and P=0.037). The difference between the preoperative and the postoperative Sternal-Notch-Nipple distance was associated with an increased probability of partial Nipple-Areola-Complex necrosis or Nipple-Areola-Complex free graft (P=0.014). CONCLUSION: Correcting modifiable preoperative risk factors and mastering both techniques, enabling the surgeon to choose the one best suited to each patient's clinical situation, reduces the complication rate.

[Atypical depression as a risk factor for obstructive sleep apnea syndrome in young adults]. / La dépression majeure à caractéristique atypique comme facteur de risque du syndrome d'apnées obstructives du sommeil chez le jeune adulte.

OBJECTIVES: In the literature, several studies have investigated the particular relationship between major depression and obstructive sleep apnoea syndrome (OSAS). However, most of these studies have focused primarily on middle-aged to elderly individuals (≥40 years) which means that this problem has been little studied in young adults (<30 years). Nevertheless, in young adults the prevalence of major depression (particularly its atypical subtype) is not negligible, which seems to justify carrying out additional investigations in order to allow a better understanding of the potential role played by major depression in the pathophysiology of OSAS in this particular subpopulation. The aim of this study was therefore to empirically investigate the prevalence of OSAS in young adults and to study the risk of OSAS associated with major depression in this particular subpopulation. METHODS: Polysomnographic and demographic data from 264 young adults were collected from the Erasme Hospital Sleep Laboratory (Brussels, Belgium) database to enable our analyses. During their two-night stay (including a first night of habituation and a night of polysomnography) at the Sleep Laboratory, these individuals underwent a complete somatic assessment (including blood test, electrocardiogram, daytime electroencephalogram and urinalysis), a systematic psychiatric assessment by a unit psychiatrist and an assessment of their complaints related to sleep. These different steps made it possible to systematically diagnose all somatic pathologies, psychiatric disorders according to the diagnostic criteria of the DSM-IV-TR and sleep pathologies according to the diagnostic criteria of the AASM. This allowed the selection of young adults included in our study based on our inclusion and exclusion criteria. Polysomnographic recordings from our Sleep Laboratory were visually scored according to AASM criteria. An obstructive sleep apnoea-hypopnoea index ≥5/hour was used for the diagnosis of OSAS. At the statistical level, in order to allow our analyses, we subdivided our sample of young adults into two groups: a control group without OSAS (n=215) and a patient group with OSAS (n=49). After checking the normal distribution of our data, normally distributed data were analysed with t-tests whereas asymmetrically or dichotomously distributed data were analysed with Wilcoxon tests or Chi2 tests. Univariate regression models were used to study the risk of OSAS associated with major depression (categorized: absent, typical, atypical) in young adults and potential confounding factors. In multivariate regression models, the risk of OSAS associated with major depression (categorized: absent, typical, atypical) in young adults was adjusted only for confounding factors significantly associated with OSAS during univariate analysis. These confounding factors were introduced in a hierarchical manner in the various multivariate regression models constructed. RESULTS: The prevalence of OSAS in our population of young adults was 18.6 %. During univariate analyses, atypical depression [OR 2.51 (95% CI 1.18-5.32), p-value=0.014], male gender [OR 4.53 (95% CI 2.20-9.34), P-value <0.001], presence of snoring [OR 2.51 (95% CI 1.33-4.75), P-value=0.005], presence of at least one cardio-metabolic alteration [OR 2.26 (95% CI 1.19-4.28), P-value=0.012], body mass index>30 kg/m2 [OR 4.55 (95% CI 2.07-10.03), P-value <0.001] and ferritin ≥150 µg/L [OR 3.28 (95% CI 1.69-6.36), P-value<0.001] were associated with increased risk of OSAS in our population of young adults. After adjusting for these major confounding factors associated with OSAS (gender, body mass index, cardio-metabolic alterations, ferritin level, and snoring) in the four models studied, multivariate regression analyses confirmed that unlike typical depression, atypical depression [OR 3.09 (95% CI 1.26-7.54), P-value=0.019] was a risk factor for OSAS in young adults. CONCLUSIONS: In our study, we demonstrated that the prevalence of OSAS was 18.6 % in young adults referred to the Erasme Hospital Sleep Laboratory. In addition, we have shown that unlike typical depression, atypical depression was associated with an increased risk of OSAS in young adults, which seems to justify more systematic research of this pathology in young adults suffering from atypical depression in order to allow the establishment of adapted therapeutic strategies and avoid the negative consequences associated with the co-occurrence of these two pathologies.

[Elder fallers: A group at risk of readmission?] / Les patients âgés chuteurs : un groupe à risque de réhospitalisation ?

OBJECTIVES: To describe older patients hospitalized for falls, at risk of readmission and priority for interventions to reduce this risk. METHODS: We conducted an observational, monocentric, prospective study (from April to June 2019). The inclusion criteria were: patients aged 75 and over, admitted to the Emergency Department for falls, consenting to the study. For patients subsequently hospitalized, the geriatric scores were determined (risk of readmission [ISAR score], state of frailty, degree of autonomy [Katz score]), and when appropriate, medication treatments were listed and compliance of patients was assessed (Girerd score). RESULTS: In three months, 154 patients were included (median age 86 years [min 75-max 103], sex ratio 0.44), of which 73 patients were hospitalized. Among these patients, 63% presented a high risk of readmission; 45.2% are likely to become frail; 72.6% were dependent. Finally, 53 of the 73 patients (72.6%) had a treatment in primary care and presented a 71.7% non-compliance or low-compliance rate. Fifty height patients (79.5%) had at least 1 drug associated with fall [min 1-max 7]. CONCLUSIONS: Older patients presenting at hospital with a fall were numerous, often likely to become frail and dependent for the majority of them. As the readmission risk is also very high in this population, future studies aiming at reducing the risk of hospital readmission are needed.

[Suicide, a separate entity in psychiatry]. / Le suicide, une entité à part en psychiatrie.

Since ancient times, the subject of suicide has been recurrently discussed in societies. Whether it is a selfish or altruistic act, the ethical debate has always been intense. Today, the suicidal act is at the center of the public debate with the subject of euthanasia and assisted suicide. Philosophers, theologians, sociologists, doctors and jurists share their thoughts on this subject, which is still considered "taboo". Between suicide, suicidal ideas or suicidal crisis, the stakeholders are involved in the field of prevention and are mobilizing to propose innovative treatments.

[Suicide prevention in the agricultural sector]. / La prévention du suicide en milieu agricole.

The French agricultural sector is strongly affected by suicide. Various studies show that there is an excess mortality rate among people working in this sector. Although specific risk factors have been identified, the Ministry of Agriculture and Food has identified prevention as a national priority. In this context, the 'sentinel' training of peers in the world of agriculture is an essential lever which, over the years, is beginning to bear fruit.

["It's the people who are invested and motivated who fall apart"]. / « Ce sont les personnes investies et motivées qui s'effondrent ¼.

Isabelle Roskam is a psychological sciences doctor and a developmental psychology professor at the Université Catholique de Louvain. A specialist in parental burn-out, she provides an overview of the current situation, enabling a better understanding of this disorder and its manifestations.

["I almost died of parental exhaustion"]. / « J'ai failli mourir d'épuisement parental ¼.

Lucie is the mother of Georges, 5, and Camille, 3. Two years ago, she collapsed following parental exhaustion. She talks about her descent into hell, the reasons for it and the way she has been treating herself since then. She is accompanied to find a role as a mother that suits her better and allows her to have a calmer relationship with her children.

The prevalence, diagnosis and surgical risk factors of spinal tuberculosis in children.

OBJECTIVE: To date, the burden of childhood spinal TB in China has not been estimated, and current treatment is hindered by a lack of evidence. This study aimed to review our experience of childhood spinal TB. METHODS: We reviewed the medical records of paediatric patients (≤15 years) admitted for spinal TB (confirmed or possible) at Shandong Provincial Chest Hospital from January 2006 to December 2019. Demographic, clinical, laboratory and radiological data were collected from medical records and analysed retrospectively. RESULTS: Seventy-two patients were diagnosed with spinal TB. 45 were male (62.5%), and 27 female (37.5%), with a mean age of 8.42 ± 4.47 (SD) years. During this 14-year period, the overall prevalence of spinal TB among childhood TB was 4.5%. T-SPOT.TB, AFB smear, mycobacterial culture, TB RT-PCR and biopsies were positive in 29.6%, 14.3%, 23.3%, 43.8% and 88.5% of assayed patients, respectively. The overall surgical rate of the studied patients was 40.3%. The requirement of surgery in childhood spinal TB was associated with pulmonary TB (OR = 4.000, 95% CI: 1.197, 13.367). CONCLUSION: Spinal TB in children cannot be neglected. It remains a severe problem to public health, and more attention should be paid to initiating treatment early.

OBJECTIF: A ce jour, la charge de la tuberculose (TB) vertébrale infantile en Chine n'a pas été estimée et le traitement actuel est entravé par un manque de données. Cette étude visait à passer en revue notre expérience de la TB vertébrale infantile. MÉTHODES: Nous avons examiné les dossiers médicaux des patients pédiatriques (≤15 ans) admis pour une TB vertébrale (confirmés ou possibles) au Shandong Provincial Chest Hospital de janvier 2006 à décembre 2019. Les données démographiques, cliniques, de laboratoire et radiologiques ont été recueillies à partir des dossiers médicaux et analysées rétrospectivement. RÉSULTATS: Soixante-douze patients ont reçu un diagnostic de TB vertébrale. 45 étaient de sexe masculin (62,5%) et 27 de sexe féminin (37,5%), avec un âge moyen de 8,42 ± 4,47 (DS) ans. Au cours de cette période de 14 ans, la prévalence globale de la TB vertébrale dans la TB infantile était de 4,5%. T-SPOT.TB, frottis de BAR, culture mycobactérienne, RT-PCR, TB et biopsies étaient positifs chez 29,6%, 14,3%, 23,3%, 43,8% et 88,5% des patients testés, respectivement. Le taux chirurgical global chez les patients étudiés était de 40,3%. La nécessité d'une intervention chirurgicale dans la TB vertébrale infantile était associée à la TB pulmonaire (OR: 4,000, IC95%: 1,197 - 13,367). CONCLUSION: La TB vertébrale chez l'enfant ne peut pas être négligée. Elle demeure un grave problème de santé publique et il faudrait accorder plus d'attention à l'initiation précoce du traitement.

Complication risk factors related to central venous catheter in pediatric.

BACKGROUND: A prospective epidemiological study was carried out in the pediatric intensive care unit (ICU), at the Mayotte Hospital Center (MHC). The purpose of the study was to identify and to evaluate complications risk factors related to central venous catheterization. Improving side effects prevention and patients care was the second goal. METHOD: Data collection took place over a period of 10 months. The central approaches followed in the study were femoral, jugular and subclavian. Since the database is composed of qualitative and quantitative variables, the Chi2 test has been used to measure the association between two variables. RESULTS: The study was carried out on 101 patients. Five infectious risk factors on the 10 variables evaluated have been significantly highlighted: the number of punctures, the number of repair of the dressing, the duration of the catheterization, the exposure time and the parenteral nutrition administration. CONCLUSIONS: Evaluation of practices through audits, an appropriate training for the staff, the update and the standardization of procedures, development of standardized assembly of the devices should lower the incidence of complications related to the venous approach.

[COVID-19, state of medical knowledge]. / Covid-19, état des connaissances médicales.

Coronavirus disease 2019 caused one of the largest health crises ever known. It is primarily defined as a viral respiratory infection, and the symptomatology can take various forms, particularly among the elderly population, who are most at risk of severe disease. Despite rapid scientific advances, therapeutics unfortunately are still very limited, especially for this category of patients. The priority is therefore to adopt and comply with preventive measures as far as possible, while awaiting possible progress.

High incidence of drug-resistant Mycobacterium tuberculosis in Hainan Island, China.

OBJECTIVES: To assess the proportion of drug-resistant tuberculosis (TB) cases and to identify independent risk factors associated with drug-resistant TB in Hainan. METHODS: Descriptive analysis of demographic and clinical data of culture-positive TB patients to assess the trends in drug-resistant TB at the Provincial Clinical Center on Tuberculosis of Hainan between 2014 and 2017. RESULTS: 994 patients were recruited into the study. Overall, the proportion of patients resistant to at least one TB drug tested was 36.1% (359/994). The most frequent resistance was to isoniazid (INH, 29.8%), followed by rifampin (RIF, 29.3%), streptomycin (19.3%), ofloxacin (OFX, 17.4%), ethambutol (9.5%) and kanamycin (KAN, 3.2%). Of 291 RIF-resistant isolates, 228 (78.4%) were also resistant to INH, while the remaining 63 (21.6%) were susceptible to INH. Among those with multidrug-resistant tuberculosis (MDR-TB), 41.2% had additional resistance to OFX and 3.9% to KAN. 8.8% of MDR-TB patients were affected by extensively drug-resistant (XDR-TB). Females were more likely to infected with MDR-TB than males, and young people (<20 years old) were more likely to have MDR-TB; patients exhibited decreasing MDR-TB risk with increasing age. CONCLUSIONS: Our data provide the first primary understanding of the drug-resistant TB epidemic in Hainan. The high incidence of drug resistance, especially RIF and FQ resistance, highlight the importance of interventions for preventing epidemics of drug-resistant TB. Younger age is an independent predictor of MDR-TB, reflecting the potential transmission in this population.

OBJECTIFS: Evaluer la proportion de cas de tuberculose (TB) résistante aux médicaments et identifier les facteurs de risque indépendants associés à la TB résistante à Hainan. MÉTHODES: Analyse descriptive des données démographiques et cliniques de patients TB à culture positive pour évaluer les tendances de la TB résistante au Centre Clinique Provincial de la TB de Hainan entre 2014 et 2017. RÉSULTATS: 994 patients ont été recrutés dans l'étude. Au total, la proportion de patients résistant à au moins un antituberculeux testé était de 36,1% (359/994). La résistance la plus fréquente était à l'isoniazide (INH, 29,8%), suivi par la rifampine (RIF, 29,3%), la streptomycine (19,3%), l'ofloxacine (OFX, 17,4%), l'éthambutol (9,5%) et la kanamycine (KAN, 3,2%). Sur les 291 isolats résistants au RIF, 228 (78,4%) étaient également résistants à l'INH, tandis que les 63 restants (21,6%) étaient sensibles à l'INH. Parmi ceux avec la multirésistance (TB-MDR), 41,2% présentaient une résistance supplémentaire à l'OFX et 3,9% à la KAN. 8,8% des patients atteints de TB-MDR étaient atteints d'une TB ultrarésistante (TB-XDR). Les femmes étaient plus susceptibles d'être infectées par la TB-MDR que les hommes et les jeunes (<20 ans) étaient plus susceptibles d'être atteints de TB-MDR; les patients présentaient un risque décroissant de TB-MDR avec l'âge. CONCLUSIONS: Nos données fournissent la première compréhension importante de l'épidémie de TB résistante à Hainan. L'incidence élevée de la résistance aux médicaments, en particulier des résistances RIF et FQ, souligne l'importance des interventions pour prévenir les épidémies de TB résistante. L'âge plus jeune est un facteur indépendant de prédiction de la TB-MDR, reflétant le potentiel de transmission dans cette population.

Characteristics of bacterial isolates in Swiss farmed and ornamental fish from a retrospective study from 2000 to 2017.

INTRODUCTION: Aquaculture is a rapidly growing field of food production of high economic importance. Bacterial infections are an important threat to aquaculture growth and also a common problem in ornamental fish. Some pathogenic agents and aquaculture production types are reported to be associated with increased disease. However, a detailed description of bacterial pathogens causing disease in Swiss aquaculture and ornamental pet fish is still missing. In this study we describe 1448 bacterial isolations originating from 1134 diagnostic laboratory submissions from farmed and ornamental fish in Switzerland for the period from 2000 to 2017. A strong seasonality was observed with submissions peaking in spring and summer. Bacterial isolations in fish submitted from organic farms were approximately six times more frequent than in conventional fish farms. Flavobacteriaceae, aeromonads and Yersinia ruckeri were the most common isolates from aquaculture, and motile aeromonads and Vibrio spp. were most often isolated from ornamental fish. The results of this study provide some interesting hypotheses, but further research is needed to better characterize risk factors for bacterial diseases in both aquaculture and aquarium fish in Switzerland.

INTRODUCTION: L'aquaculture est un secteur de la production alimentaire en pleine croissance et d'une grande importance économique. Les infections bactériennes constituent une menace importante pour la croissance de l'aquaculture mais également un problème courant chez les poissons d'ornement. Certains agents pathogènes et types de production aquacole seraient associés à une plus forte incidence de certaines maladies. Une description complète des agents pathogènes bactériens responsables de maladies chez les poissons d'élevage et d'ornement en Suisse fait cependant défaut. Nous décrivons dans cette étude 1448 isolats bactériens provenant de 1134 soumissions de poissons d'élevage et de poissons d'ornement en Suisse à un laboratoire de diagnostic entre 2000 et 2017. Une forte saisonnalité a été observée au printemps et en été. Les infections bactériennes chez les poissons de fermes biologiques étaient environ six fois plus fréquentes que dans les exploitations conventionnelles. Flavobacteriaceae, Aeromonas spp. et Yersinia ruckeri sont les isolats qui ont été les plus communément isolés des soumissions des piscicultures. Vibrio spp. ainsi que les espèces motiles d'Aeromonas spp. ont été les principaux isolats mis en évidence chez les poissons d'ornement. Les résultats de cette étude fournissent des hypothèses intéressantes, mais des recherches supplémentaires sont nécessaires pour mieux caractériser les facteurs de risque des maladies bactériennes chez les poissons d'aquaculture et d'aquarium en Suisse.

[Risk assessment in medical geriatric oncology]. / Évaluation des risques en oncogériatrie médicale.

The assessment of risks in medical geriatric oncology requires close collaboration between oncologists and geriatricians. Vulnerability, death and severe chemotoxicity during cancer treatment represent the main risks to be assessed before making a decision regarding treatment in elderly patients with cancer. A comprehensive geriatric assessment and predictive scores enable a multidimensional assessment of the elderly cancer patient to be carried out.

[Ageing, a hidden form of violence]. / Vieillir, une violence qui ne dit pas son nom.

Violence towards the elderly can occur in various forms. These include domestic or institutional abuse but other more covert forms exist. The complex conditions of their appearance, both in the elderly victim as well as in their abusers imply a pluridisciplinary repsonse. It is essential to preserve the notions of humanity, the safety of the elderly, autonomy and the respect of the wishes of our senior citizens.

[Strokes and Giant cell arteritis: imaging characteristics]. / AVC et Horton : caractéristiques de l'imagerie.

Giant cell arteritis (GCA) is associated with an increased risk of cardio- or cerebro-vascular death. The stroke rate in patients with GCA varies between 2.7 and 7.4%. The etiological diagnosis may be challenging between atherosclerotic stroke and stroke related to GCA. Case of an old woman who had ischemic stroke and concomitant diagnosis of GCA and brain imaging characteristics.

Association of HIV status with infection by multiple HPV types.

OBJECTIVES: To identify the clinical and demographic characteristics of HIV-positive and HIV-negative women infected by multiple HPV types. METHODS: 1399 women participated in the study (240 HIV-positive and 1159 HIV-negative women). Samples were provided for Pap tests and for HPV detection and typing by PCR. Data were collected on HPV infection, frequency of multiple infection, and HPV type distribution. Odds ratios were reported from logistic regression models. RESULTS: Compared with HIV-negative women, HIV-positive women had higher frequencies of cervical abnormality (30% vs. 20.8%), higher HPV prevalence (68.3% vs. 51.3%) and were more commonly infected with multiple HPV types (78.7% vs. 44.3%). HPV-16 was the most common type detected in the study population, with other types showing variable associations with HIV status. Positive associations were observed between infection by multiple HPV types and HIV status, cervical abnormality and having had more than three pregnancies. The odds of multiple infection by HPV types were higher in HIV-positive women who used an intrauterine device, who had a history of abortions and who had HIV viral loads >100 000 copies/ml, whilst the odds were lower in women with >500 CD4 cells/mm3 . CONCLUSIONS: HIV immunosuppression favours infection by multiple high-risk HPV types, mainly in women affected by low-grade squamous intraepithelial lesions. Antiretroviral therapy had no effect on infection by multiple HPV types. Risk factors related to progressive damage to the cervix were positively associated with infection by multiple HPV types in women living with HIV.

[Teacher sick leave: Prevalence, duration, reasons and covariates]. / Congés-maladie des enseignants : fréquence, durées, raisons et facteurs associés.

BACKGROUND: Absences from work have considerable social and economic impact. In the education sector, the phenomenon is particularly worrying since teacher sick leave has an impact on the overall performance of the education system. Yet, available data are scarce. METHODS: In April-June 2013, 2653 teachers responded to a population-based postal survey on their quality of life (enquête Qualité de vie des enseignants, MGEN Foundation/Ministry of education, response rate 53 %). Besides questions on work environment and health, teachers were asked to describe their eventual sick leave(s) since the beginning of the school year: duration, type and medical reasons. Self-reported information was reinforced by administrative data from ministerial databases and weighted to be extrapolated to all French teachers. Tobit models adjusted for individual factors of a private nature were used to investigate different occupational risk factors of teacher sick leave, taking into account both the estimated effect on the probability of sick leave and the length of it. RESULTS: More than one in three teachers (36 %) reported having had at least one day of sick leave since the beginning of the school year. Respiratory/ENT diseases were the leading reason for sick leave (37 %). However, and because sick leave duration depended on the underlying health problem, such diseases came in third place among justifications of sick leave days (14 %), far behind musculoskeletal problems (27 %) and neurological and psychological disorders (25 %). Tobit models suggested that some occupational factors significantly associated with the risk of sick leave may represent promising preventive targets, including high psychological demand, workplace violence and unfavorable socio-environmental context. CONCLUSION: Our study provides objective evidence about the issue of sick leave among French teachers, highlighting the usefulness of implementing actions to minimize its weight. To this end, the study findings point-out the importance of considering not only the probability of sick leave, but also its duration.

[Complications with surgical treatment of basal cell carcinomas in individuals over 75 years of age: A retrospective study of prognostic factors in 158 cases]. / Complications du traitement chirurgical des carcinomes basocellulaires après 75 ans. Étude rétrospective des facteurs pronostiques sur 158 cas.

INTRODUCTION: Basal cell carcinoma (BCC) is a pathology that evolves locally and it is common in elderly subjects whose frailty could restrict the indications for the reference treatment, which is based on surgery. The aim of this study was to investigate the morbidity and the mortality associated with surgical treatment of BCC in patients over 75 years of age, so as to identify possible prognostic factors for postoperative complications. MATERIALS AND METHODS: This was a retrospective study carried out with patients over 75 years of age who were treated surgically for one or several BCC between 2010 and 2015 in the reconstructive and cosmetic plastic surgery unit of the Saint-Louis Hospital in Paris (France). We collated the demographic characteristics, the characteristics of the treatment, as well as the rate of major postoperative complications. We performed a univariate and then a multivariate analysis of the various risk factors that were identified. RESULTS: A total of 158 patients were analyzed and they exhibited a rate of major complications of 12%. The statistical analysis identified five significant risk factors: being over 85 years of age (P=0.006), long-term use of anticoagulant treatment (P=0.02), the presence of at least one comorbidity (P=0.018), a conventional hospitalization (P=0.002), and the use of general anesthesia (P=1.2e-10). CONCLUSION: Five risk factors for major postoperative complications with the surgical treatment of BCC in patients over 75 years of age were identified. These factors may provide direction to medico-surgical teams in regard to the optimal treatment of BCC in elderly patients.

Risk factors for systemic inflammatory response syndrome after percutaneous nephrolithotomy.

OBJECTIVES: To explore the risk factors for systemic inflammatory response syndrome (SIRS) after percutaneous nephrolithotomy (PCNL). METHODS: A retrospective chart review was performed to identify 1030 patients who had undergone PCNL from January 2014 to July 2016 in the Minimally Invasive Surgery Center. Multiple data, including age, sex, body mass index (BMI), operation time, Staghorn calculi, diabetes, Serun creatinine, preoperative urine culture and the urinary sediment microscopy white blood cell (WBC) were collected. These factors and postoperative SIRS were retrospectively analyzed. RESULTS: There were 108 cases (10.49%) of SIRS among 1030 patients. The results of univariate analysis showed that sex (P=0.015), Staghorn calculi (P<0.001), preoperative urinary culture of Gram-negative bacteria (P<0.001) and preoperative urinary sediment microscopy WBC (+, ++, +++, ++++) (P<0.001, P<0.001, P=0.009, P=0.045) were correlated with postoperative SIRS (P<0.05). According to Multivariate analysis results, the likelihood of SIRS after PCNL increased with Staghorn calculi (P=0.01, OR=10.457, 95% CI=1.312-3.092), the urinary sediment microscopy WBC (+∼++++) (P<0.001, OR=2.591, 95% CI=1.661-4.042) and positive urine culture for Gram-negative bacteria (P<0.001, OR=3.550, 95% CI=2.205-5.715). CONCLUSIONS: Staghorn calculi, the urinary sediment microscopy WBC and positive urine culture for Gram-negative bacteria are independent risk factors for SIRS. Patients affected by these risk factors should receive careful anti-infectious perioperative management for prevention of postoperative SIRS. LEVEL OF INCIDENCE: 4.