Distortion of the anterior part of the interhemispheric fissure: significance and implications for prenatal diagnosis.

In order to illustrate the significance of a new anatomical finding, distortion of the interhemispheric fissure (DIHF) associated with impacted medial borders of the frontal lobes, we report a retrospective observational study of 13 fetuses in which DIHF was identified on prenatal imaging. In 10 cases there were associated anatomical anomalies, including mainly midline anomalies (syntelencephaly (n=2), lobar holoprosencephaly (n=1), Aicardi syndrome (n=2)), but also schizencephaly (n=1), cortical dysplasia (n=1) and more complex cerebral malformations (n=3), including neural tube defect in two cases. Chromosomal anomaly was identified in two cases, including 6p deletion in a case without associated central nervous system anomalies and a complex mosaicism in one of the cases with syntelencephaly. In two cases, the finding was apparently isolated on both pre- and postnatal imaging, and the children were doing well at follow-up, aged 4 and 5 years. The presence of DIHF on prenatal imaging may help in the diagnosis of cerebral anomalies, especially those involving the midline. If DIHF is apparently isolated on prenatal ultrasound, magnetic resonance imaging is recommended for careful analysis of gyration and midline, especially optic and olfactory structures. Karyotyping is also recommended.

[Grief, evolution of new definitions]. / Deuil, évolution conceptuelle et nouvelles définitions.

The concept of pathological grief is a controversial issue. Bereavement is a universal experience, and its association with excess morbidity and mortality is well established. Complicated grief is a process that by its length or intensity is considered pathological but not considered as a distinct mental disorder in the present international classifications: ICD-10 and DSM-IV-TR. For some individuals, if intense grief persists, is distressing and disabling, and may meet criteria as a distinct mental disorder. This definition evolved with the implementation of a proposed criteria for a persistent complex bereavement disorder in the section of "condition of further study"s of the new DSM-5 after the debate raised by the proposition of several authors to include a distinct mental disorder. We tried to illustrate that complex question with a non exhaustive review and with a case report of a clinical situation of a female that was treated in a crisis center in Geneva, following the sudden death of her husband.

A new electric method for non-invasive continuous monitoring of stroke volume and ventricular volume-time curves.

BACKGROUND: In this paper a new non-invasive, operator-free, continuous ventricular stroke volume monitoring device (Hemodynamic Cardiac Profiler, HCP) is presented, that measures the average stroke volume (SV) for each period of 20 seconds, as well as ventricular volume-time curves for each cardiac cycle, using a new electric method (Ventricular Field Recognition) with six independent electrode pairs distributed over the frontal thoracic skin. In contrast to existing non-invasive electric methods, our method does not use the algorithms of impedance or bioreactance cardiography. Instead, our method is based on specific 2D spatial patterns on the thoracic skin, representing the distribution, over the thorax, of changes in the applied current field caused by cardiac volume changes during the cardiac cycle. Since total heart volume variation during the cardiac cycle is a poor indicator for ventricular stroke volume, our HCP separates atrial filling effects from ventricular filling effects, and retrieves the volume changes of only the ventricles. METHODS: ex-vivo experiments on a post-mortem human heart have been performed to measure the effects of increasing the blood volume inside the ventricles in isolation, leaving the atrial volume invariant (which can not be done in-vivo). These effects have been measured as a specific 2D pattern of voltage changes on the thoracic skin. Furthermore, a working prototype of the HCP has been developed that uses these ex-vivo results in an algorithm to decompose voltage changes, that were measured in-vivo by the HCP on the thoracic skin of a human volunteer, into an atrial component and a ventricular component, in almost real-time (with a delay of maximally 39 seconds). The HCP prototype has been tested in-vivo on 7 human volunteers, using G-suit inflation and deflation to provoke stroke volume changes, and LVot Doppler as a reference technique. RESULTS: The ex-vivo measurements showed that ventricular filling caused a pattern over the thorax quite distinct from that of atrial filling. The in-vivo tests of the HCP with LVot Doppler resulted in a Pearson's correlation of R = 0.892, and Bland-Altman plotting of SV yielded a mean bias of -1.6 ml and 2SD =14.8 ml. CONCLUSIONS: The results indicate that the HCP was able to track the changes in ventricular stroke volume reliably. Furthermore, the HCP produced ventricular volume-time curves that were consistent with the literature, and may be a diagnostic tool as well.

The problem of over-medicalisation: How AOD disease models perpetuate inequity for young people with multiple disadvantage.

Young people who experience multiple disadvantage have been identified as some of the most marginalised and under-serviced people in the alcohol and other drug (AOD) system. In this paper, we draw on a range of research evidence to argue that one of the challenges in responding appropriately to the needs of these young people are models of care which seek to ameliorate 'illness' rather than promote wellness. While disease approaches have some important benefits, overly-medicalised AOD treatment responses also have negative impacts. We argue that disease models rest on understandings of substance use as an individual enterprise and thereby pay insufficient attention to the material disadvantage that shape young people's substance use, creating feelings of shame, failure and a reluctance to return to care if they continue to use. Additionally we draw on literature that shows how disease models construe young people's substance use as compulsive, perpetuating deficit views of them as irrational and failing to account for the specific meanings that young people themselves give to their substance use. By focusing on clinical solutions rather than material and relational ones, medicalised treatment responses perpetuate inequity: they benefit young people whose resources and normative values align with the treatments offered by disease models, but are much less helpful to those who are under-resourced,. We suggest that alternative approaches can be found in First Nations models of care and youth programs that attend to social, cultural, and material wellbeing, making living well the focus of treatment rather than illness amelioration.

Magnetic resonance imaging in the prenatal diagnosis of congenital diarrhea.

OBJECTIVE: Congenital diarrhea is very rare, and postnatal diagnosis is often made once the condition has caused potentially lethal fluid loss and electrolyte disorders. Prenatal detection is important to improve the immediate neonatal prognosis. We aimed to describe the prenatal ultrasound and magnetic resonance (MRI) imaging findings in fetuses with congenital diarrhea. METHODS: The study reports the pre- and postnatal findings in four fetuses that presented with generalized bowel dilatation and polyhydramnios. We analyzed the fetal ultrasound and MRI examinations jointly, then compared our provisional diagnosis with the amniotic fluid biochemistry and subsequently with the neonatal stool characteristics. RESULTS: In each of the four cases an ultrasound examination between 22 and 30 weeks' gestation showed moderate generalized bowel dilatation and polyhydramnios suggesting intestinal obstruction. MRI examinations performed between 24 and 32 weeks' gestation confirmed that the dilatation was of gastrointestinal (GI) origin, with a signal indicating intraluminal water visible throughout the small bowel and colon. The expected hypersignal on T1-weighted sequences characteristic of physiological meconium was absent in the colon and rectum. This suggested that the meconium had been completely diluted and flushed out by the water content of the bowel. The constellation of MRI findings enabled a prenatal diagnosis of congenital diarrhea. The perinatal lab test findings revealed two cases of chloride diarrhea and two of sodium diarrhea. CONCLUSION: Congenital diarrhea may be misdiagnosed as intestinal obstruction on prenatal ultrasound but has characteristic findings on prenatal MRI enabling accurate diagnosis; this is important for optimal neonatal management.

Pediatric outcome of children with the prenatal diagnosis of isolated septal agenesis.

BACKGROUND: Isolated Septal Agenesis (SA) is a rare disease with clinical outcomes (especially neurological outcomes) that are unknown. The purpose of this study was to evaluate the clinical outcome of these children. METHODS: We conducted a retrospective multicenter study of 17 children with an isolated SA or SA combined with a moderate ventricular dilatation (VD) that was diagnosed antenatally and confirmed by a magnetic resonance imaging (MRI) performed in the antenatal period. RESULTS: Of the 17 children, 14 had normal neurological examinations, 2 had language development delay and visuo-spatial dyspraxia, and 3 of the 17 children had behavioral problems. Eight children had neuropsychological evaluations, and the results were normal in six cases. There were 3 cases of septo-optic dysplasia (SOD) diagnosed postnatally, which highlighted the difficulties in assessing the optic tract and hypothalamic-pituitary region in antenatal imaging. Language delay and behavioral disorders were the main abnormalities at follow-up. CONCLUSION: The discovery of an isolated SA reveals the difficulties of prenatal diagnosis to correlate the neurological and functional prognosis to morphological findings. The prognosis seemed to be good. It appears necessary to improve the diagnostic performance of fetal brain imaging and to follow-up these children prospectively to assess their long-term cognitive-behavioral outcomes.

Active normal faulting in the upper Rhine graben and paleoseismic identification of the 1356 Basel earthquake.

We have identified an active normal fault in the epicentral area of the Basel (Switzerland) earthquake of 18 October 1356, the largest historical seismic event in central Europe. The event of 1356 and two prehistoric events have been characterized on the fault with geomorphological analysis, geophysical prospecting, and trenching. Carbon-14 dating indicates that the youngest event occurred in the interval 610 to 1475 A.D. and may correspond to the 1356 Basel earthquake. The occurrence of the three earthquakes induced a total of 1.8 meters of vertical displacement in the past 8500 years for a mean uplift rate of 0.21 millimeters per year. These successive ruptures on the normal fault indicate the potential for strong ground movements in the Basel region and should be taken into account to refine the seismic hazard estimates along the Rhine graben.

Irradiation of atactic polystyrene: linear energy transfer effects.

Atactic glassy polystyrene (PS) has been irradiated in anoxic conditions by electron and ion beams. The induced modifications were followed, in situ, by Fourier transform infrared spectroscopy (FTIR). In-film modifications and hydrocarbon gas release were followed. In-situ measurements allowed one to avoid any spurious oxidation of the films after irradiation and also permitted studying in detail the evolution with dose of the FTIR spectra. The data were quantitatively analyzed, and we present a complete analysis of the effects of the Linear Energy Transfer (LET) on the radiation chemical yields of several radiation-induced modifications (alkynes, allenes, alkenes, benzene, and disubstituted benzenes). For a better understanding of the LET effects, the in-film modifications are compared to H2 release data from the literature and to our measurements of hydrocarbon gaseous molecule yields obtained by us. The overall destruction yield becomes very significant at high LET, and the radiation sensitivity of this aromatic polymer merges with typical values of aliphatic polymers: the radiation resistance conferred at low LET to polystyrene by the phenyl side groups is lost at high LET. This loss of radiation resistance equally affects the aromatic and aliphatic moieties. Monosubstituted alkynes are created above a LET threshold, whereas the other radiation-induced modifications are observed in the whole LET range. Several observations indicate that the phenyl ring is broken at high LET. Comparison of the alkyne yield in PS, polyethylene, and polycarbonate as well as the formation of nitrile bonds in poly(vinylpyridine- co-styrene) are consistent with a cleavage of the phenyl ring as the prominent source of alkynes. As the competing damage mechanisms do not have the same LET evolution, the relative importance of a specific modification on the global damage depends on LET. Some (benzene and disubstituted benzenes) dominate at low LET, while others (in-film alkyne and acetylene release) dominate at high LET.

IANA task force on nutrition and cognitive decline with aging.

Cognitive impairment can be influenced by a number of factors. The potential effect of nutrition has become a topic of increasing scientific and public interest. In particular, there are arguments that nutrients (food and/or supplements) such as vitamins, trace minerals, lipids, can affect the risk of cognitive decline and dementia, especially in frail elderly people at risk of deficiencies. Our objective in this paper is to review data relating diet to risk of cognitive decline and dementia, especially Alzheimer's disease (AD). We chose to focus our statements on homocysteine-related vitamins (B-vitamins), antioxidant nutrients (vitamins E and C, carotenoids, flavonoids, enzymatic cofactors) and dietary lipids. Results of epidemiological studies may sometimes appeared conflicting; however, certain associations are frequently found. High intake of saturated and trans-unsaturated (hydrogenated) fats were positively associated with increased risk of AD, whereas intake of polyunsaturated and monounsaturated fats were protective against cognitive decline in the elderly in prospective studies. Fish consumption has been associated with lower risk of AD in longitudinal cohort studies. Moreover, epidemiologic data suggest a protective role of the B-vitamins, especially vitamins B9 and B12, on cognitive decline and dementia. Finally, the results on antioxidant nutrients may suggest the importance of having a balanced combination of several antioxidant nutrients to exert a significant effect on the prevention of cognitive decline and dementia, while taking into account the potential adverse effects of these nutrients. There is no lack of attractive hypotheses to support research on the relationships between nutrition and cognitive decline. It is important to stress the need to develop further prospective studies of sufficiently long duration, including subjects whose diet is monitored at a sufficiently early stage or at least before disease or cognitive decline exist. Meta analyses should be developed, and on the basis of their results the most appropriate interventional studies can be planned. These studies must control for the greatest number of known confounding factors and take into account the impact of the standard social determinants of food habits, such as the regional cultures, social status, and educational level.

IANA (International Academy on Nutrition and Aging) Expert Group: weight loss and Alzheimer's disease.

Weight loss, together with psychological and behavioural symptoms and problems of mobility, is one of the principal manifestations of Alzheimer's disease (AD). Weight loss may be associated with protein and energy malnutrition leading to severe complications (alteration of the immune system, muscular atrophy, loss of independence). Various explanations have been proposed such as atrophy of the mesial temporal cortex, biological disturbances, or feeding behaviours; however, none has been proven. Prevention of weight loss in AD is a major issue. It requires regular follow-up and must be an integral part of the care plan. The aim of this article is to review the present state of scientific knowledge on weight loss associated with AD. We will consider four points: the natural history of weight loss, its known etiological factors, its consequences and the various management options.

Examining the elemental contribution towards the biodegradation of Mg-Zn-Ca ternary metallic glasses.

The Mg-Zn-Ca metallic glass system has been the focus of recent studies as a prospective material for biodegradable implants. To date, the influence each alloying element has on the degradation behaviour of this class of alloy is still not well understood. This study employs electrochemical polarisation and in situ impedance spectroscopy coupled with H2 gas collection in simulated body fluid at 37 °C to elucidate the mechanisms by which a series of custom produced Mg-Zn-Ca metallic glasses degrade compared with high purity Mg. The results show that Mg-Zn-Ca metallic glasses provide significantly more noble corrosion potentials and suppressed hydrogen gas evolution relative to high purity Mg. Furthermore, the role each element has in degradation was investigated systematically by varying the concentration of each alloying element. Testing revealed that the complex nature of dissolution in metallic glasses requires testing beyond solely polarisation and hydrogen gas collection to elucidate degradation behaviour in vitro. Practical limits to which the composition may be adjusted in this ternary alloy system, so as to maintain minimal degradation, have been achieved.

Consumption of Dairy Products and Cognitive Functioning: Findings from the SU.VI.MAX 2 Study.

OBJECTIVES: Research concerning the link between dairy product intake and cognition is scant while experimental studies suggest links through various biological mechanisms. This study's objective was to examine the cross-time associations of total and specific dairy product consumption with cognitive performance in aging adults. We also explored compliance with dairy intake recommendations in France. DESIGN: The study was based on the «Supplémentation en Vitamines et Minéraux Antioxydants¼ randomized trial (SU.VI.MAX, 1994-2002) and the SU.VI.MAX 2 observational follow-up study (2007-2009). SETTING: A general-population cohort in France. PARTICIPANTS: N=3,076 participants included in both the SU.VI.MAX and SU.VI.MAX 2 studies. MEASUREMENTS: Dairy product consumption was estimated using repeated 24h records (1994-1996; mean=10 records, SD=3). Cognitive performance was assessed by neuropsychologists after an average of 13 years post-baseline via a battery of six validated tests. Mean age at the time of the cognitive function evaluation was 65.5 (SD=4.6) years. Principal component analysis revealed factors for verbal memory and working memory. Associations of energy-adjusted dairy product consumption and compliance with the respective dietary guidelines with subsequent cognitive impairment were examined using ANCOVA, providing mean differences (95% confidence intervals, CI) according to tertiles (T), adjusted for confounders including overall dietary patterns. RESULTS: Total dairy product consumption was not associated with cognitive function. However, milk intake was negatively associated with verbal memory performance: mean difference T3 versus T1= -0.99 (-1.83, -0.15). Among women, consuming more than the recommended amount of dairy was negatively associated with working memory performance: excess versus adequate = -1.52 (-2.93, -0.11). CONCLUSION: Our results indicate that dairy products consumption and especially compliance with dietary guidelines regarding dairy product intake are differentially associated with performance in specific cognitive domains after a comprehensive adjustment for lifestyle factors, health status markers and dietary patterns. Further longitudinal research is needed given the limited data available.

Importance of zinc in the elderly: the ZENITH study.

The elderly are at nutritional risk as a result of multiple physiological, social, psychological, and economic factors. Physiological functions naturally decline with age, which may influence absorption and metabolism. Social and economic conditions can adversely affect dietary choices and eating patterns. However, at the same time, the nutrient needs of the elderly for certain nutrient (such as vitamins, minerals, proteins) is higher than for younger adults. This article reviews the importance of zinc (Zn) in elderly people, particularly for behavioural and mental function, micronutrient status, immune and antioxidant system, and bone metabolism.

Introduction to the ZENITH study and summary of baseline results.

Zinc is known to be essential for a great number of biochemical activities and physiological and cognitive functions. The objective of Zenith study was to investigate the effects of Zn, as a nutritional supplement, on psychological and behavioural factors and on surrogate markers that are indicative of trends towards better health in order to evaluate the need for dietary recommendations specific to the studied population. We report in this paper the summary of baseline results obtained before Zn supplementation.

Cognitive function in healthy older European adults: the ZENITH study.

OBJECTIVE: Baseline data are reported from a study of the effects of zinc supplementation on cognitive function in older adults as assessed by the CANTAB computerised test battery. DESIGN: This is a multicentre prospective intervention study employing a randomised double-blind design. SETTING: European community-based study. PARTICIPANTS: There are 387 healthy adults aged 55-87 y from centres in France, Italy and Northern Ireland. INTERVENTIONS: Measures of visual memory, working memory and attention were obtained at baseline (prior to supplementation). RESULTS: Younger adults (<70 y) performed significantly better than older adults (>70 y) on all tests, with minimal differences between centres. In addition, men outperformed women on tests of spatial span, pattern recognition memory and reaction times, although these gender differences varied somewhat between centres. CONCLUSIONS: The results are generally consistent with previous age- and gender-related effects on cognitive functioning.

Zinc intake and status in middle-aged and older European subjects: the ZENITH study.

OBJECTIVE: Inadequate intakes of micronutrients in elderly negatively affect the nutritional status. Zinc is an essential micronutrient in the elderly, especially in relation to its impact on immune function, bone mass, cognitive function and oxidative stress. However, data are lacking on zinc intake and status during normal ageing. In this study, we evaluate the intake and status of zinc in late middle-aged and older free-living subjects. DESIGN: Dietary zinc intake and zinc status in 188 middle-aged subjects from Clermont-Ferrand (Fr) and Coleraine (UK), and in 199 older subjects from Grenoble (Fr) and Roma (It) were assessed at the entry in the ZENITH study. RESULTS: In relation to the zinc RDA for people older than 55 y, zinc intakes in most of the middle-aged and older subjects (more than 96%) in the present study were adequate. Older people had significantly lower (P < 0.01) energy intakes as compared to middle-aged. Zinc intake expressed per MJ was also significantly (P < 0.01) higher in older people compared to middle-aged. Erythrocyte and urinary zinc concentrations were significantly (P < 0.001) higher in middle-aged subjects compared to older ones. The prevalence of biological Zn deficiency in free-living ageing European people was low (<5%). CONCLUSION: The results of the present study showed a relatively low prevalence of zinc deficiencies in healthy free-living late middle-age and older subjects. These results should be useful for health professionals to have reference data on zinc intake and status for a healthy ageing.

Screening and recruitment procedure of late-middle aged and older subjects: the ZENITH study.

OBJECTIVE: To report the rational, design, recruitment, baseline characteristics and preliminary overview of volunteers in the ZENITH study. DESIGN: A multicentre prospective intervention study employing a randomised double-blind design. SETTING: Clermont-Ferrand, Theix (France), Coleraine (Northern Ireland), Grenoble (France), Rome (Italy). PARTICIPANTS: Healthy men and women middle-aged (55-70 y) and older volunteers (70-87 y). INTERVENTIONS: At baseline (prior to zinc (Zn) supplementation), all volunteers underwent a full clinical examination, anthropometric measurements, health and lifestyle questionnaire, Mini Mental State Examination, Geriatric Depression Scale, and biochemistry profile. RESULTS: In total, 842 volunteers (378 men and 464 women) were invited to take part in the study. A total of 49% of these volunteers were excluded on the basis of inclusion/exclusion criteria. In total, 433 participants were admitted to the Zn supplementation for 6 months. During this period, about 10% of volunteers dropped out from the study. CONCLUSIONS: A total of 387 subjects (197 male and 190 female subjects) successfully completed the supplementation phase of the ZENITH study.

Health and lifestyle characteristics of older European adults: the ZENITH study.

OBJECTIVE: To describe health and lifestyle factors of participants in the ZENITH study. DESIGN: A prospective multicentre intervention study employing a randomised double-blind design. PARTICIPANTS: Community dwelling older adults (n = 387), aged 55-87 y were recruited from regions in France, Italy and the UK. INTERVENTION: A self-report questionnaire comprising socio-demographic variables, dietary habits, physical activity in the home, at work and recreation. RESULTS: Participants differed with regards dietary habits and physical activity for each region. Recreational activity was higher in France and women generally tend to perform less hours of recreational activity per week than men. CONCLUSIONS: The differences found for these regions of Europe in relation to lifestyle factors will affect health and well-being within these countries and may mediate the impact of zinc supplementation on various biological and psychological parameters.

The SOLINUT study: analysis of the interaction between nutrition and loneliness in persons aged over 70 years.

BACKGROUND: Insufficient nutritional status is a frequent problem in the elderly, correlated with aging, diseases, but also environmental factors in this growing part of the population. Loneliness should be one of these factors. OBJECTIVE AND DESIGN: the aim of the SOLINUT study was to determine the relationship between loneliness and nutritional status in persons aged over 70 years, in order to improve the detection and management of the isolated elderly at high risk of malnutrition. It was both an epidemiological and cross-sectional anthropological study, based on quantitative and qualitative nutritional and sociological investigation, carried out between March 2002 and May 2003 in 150 elderly persons (mean age 80.8 years, oldest subject 99 years) living alone at home. RESULTS: a large number of subjects had a dietary intake which was inadequate to cover their nutritional needs--42.6% less than 25 kcal/kg/day, threshold for undernutrition in the elderly--21.3% had established undernutrition, ( average in epidemiological studies in non isolated elderly populations: 3-7%)--44% were not able to carry a shopping bag weighing 5 kg and so could not buy their own food. Lastly, 32% never shared a meal with family or friends, which reveals their degree of social isolation. CONCLUSION: It has been demonstrated that greater coordination between the various service providers would prevent a large number of isolated persons from failing to obtain the various allocations and services available to them. We must stress the extreme importance of preemptive intervention, by an active screening policy which could simultaneously prevent undernutrition and encourage physical activity in isolated persons to avoid their becoming "excluded recluses".

A predictive structural model for bulk metallic glasses.

Great progress has been made in understanding the atomic structure of metallic glasses, but there is still no clear connection between atomic structure and glass-forming ability. Here we give new insights into perhaps the most important question in the field of amorphous metals: how can glass-forming ability be predicted from atomic structure? We give a new approach to modelling metallic glass atomic structures by solving three long-standing problems: we discover a new family of structural defects that discourage glass formation; we impose efficient local packing around all atoms simultaneously; and we enforce structural self-consistency. Fewer than a dozen binary structures satisfy these constraints, but extra degrees of freedom in structures with three or more different atom sizes significantly expand the number of relatively stable, 'bulk' metallic glasses. The present work gives a new approach towards achieving the long-sought goal of a predictive capability for bulk metallic glasses.