Les troubles bipolaires sont déterminés par un ensemble de facteurs, à la fois psychologiques, génétiques et environnementaux bien connus. Les perturbations des relations familiales et sociales ...constituent également des facteurs de fragilisation. Les thymorégulateurs ont considérablement amélioré le pronostic de ces troubles, en limitant le nombre de récidives. Néanmoins, un pourcentage important de patients continuent à présenter des fluctuations thymiques du fait d’une mauvaise observance thérapeutique, de la persistance de facteurs déclenchants, précipitants ou d’entretien du trouble ou encore du fait de l’insuffisance d’efficacité des thymorégulateurs. D’autres mesures thérapeutiques ont été proposées afin d’optimiser les traitements pharmacologiques et d’agir en amont sur les éléments déclenchants ou précipitants. Les mesures psychoéducatives, dont l’efficacité a longtemps été sous-évaluée, sont aujourd’hui les traitements psychologiques les mieux documentées et pour lesquels il existe un niveau de preuve élevé. Ils figurent en première ligne dans la plupart des guidelines anglo-saxons. Les bénéfices de cette approche complémentaires se situent à différents niveaux : reconnaissance précoce des symptômes qui annoncent une récidive, optimisation de l’observance, acceptation du trouble, amélioration de la qualité de vie, meilleure gestion de la vie sociale, professionnelle et affective, consolidation de l’alliance thérapeutique, contrôle des facteurs déclenchants et précipitants. Les études publiées rapportent une diminution du nombre de récidives et de rechutes, une réduction de la durée d’hospitalisation, un meilleur équilibre de la vie familiale, une amélioration de l’observance et une amélioration de la qualité de vie. L’expert de cette session, qui anime depuis 2000 des séances de psychoéducation, vient d’écrire un manuel conçu pour proposer aux patients un accompagnement personnalisé visant à renforcer le suivi thérapeutique et à stabiliser la maladie. Il présentera aussi l’expérience innovante de la création du Clubhouse France.
Obstructive sleep apnoea (OSA) is often undiagnosed before elective surgery and may predispose patients to perioperative complications.
A literature search of PubMed-Medline, Web of Science, Scopus, ...EMBASE, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials up to November 2010 was conducted. Our search was restricted to cohort or case–control studies in adults diagnosed with OSA by screening questionnaire, oximetry, or polysomnography. Studies without controls, involving upper airway surgery, and with OSA diagnosed by ICD-9 codes alone were excluded. The primary postoperative outcomes were desaturation, acute respiratory failure (ARF), reintubation, myocardial infarction/ischaemia, arrhythmias, cardiac arrest, intensive care unit (ICU) transfer, and length of stay.
Thirteen studies were included in the final analysis (n=3942). OSA was associated with significantly higher odds of any postoperative cardiac events 45/1195 (3.76%) vs 24/1420 (1.69%); odds ratio (OR) 2.07; 95% confidence interval (CI) 1.23–3.50, P=0.007 and ARF 33/1680 (1.96%) vs 24/3421 (0.70%); OR 2.43, 95% CI 1.34–4.39, P=0.003. Effects were not heterogeneous for these outcomes (I2=0–15%, P>0.3). OSA was also significantly associated with higher odds of desaturation 189/1764 (10.71%) vs 105/1881 (5.58%); OR 2.27, 95% CI 1.20–4.26, P=0.01 and ICU transfer 105/2062 (5.09%) vs 58/3681 (1.57%), respectively; OR 2.81, 95% CI 1.46–5.43, P=0.002. Both outcomes showed a significant degree of heterogeneity of the effect among studies (I2=57–68%, P<0.02). Subgroup analyses had similar conclusions as main analyses.
The incidence of postoperative desaturation, respiratory failure, postoperative cardiac events, and ICU transfers was higher in patients with OSA.
Abstract Objectives Highlight the role of patient education about physical activity and exercise in the treatment of hip and knee osteoarthritis (OA). Methods Systematic literature review from the ...Cochrane Library, PubMed and Wiley Online Library databases. A total of 125 items were identified, including 11 recommendations from learned societies interested in OA and 45 randomized controlled trials addressing treatment education and activity/exercise for the treatment of hip and knee osteoarthritis. Results In the end, 13 randomized controlled trials and 8 recommendations were reviewed (1b level of evidence). Based on the analysis, it was clear that education, exercise and weight loss are the pillars of non-pharmacological treatments. These treatments have proven to be effective but require changes in patient behaviour that are difficult to obtain. Exercise and weight loss improve function and reduce pain. Education potentiates compliance to exercise and weight loss programs, thereby improving their long-term benefits. Cost efficiency studies have found a reduction in medical visits and healthcare costs after 12 months because of self-management programs. Conclusion Among non-surgical treatment options for hip and knee osteoarthritis, the most recent guidelines focus on non-pharmacological treatment. Self-management for general physical activity and exercise has a critical role. Programs must be personalized and adjusted to the patient's phenotype. This development should help every healthcare professional adapt the care they propose to each patient. Registration number for the systematic review: CRD42015032346.
Le lichen scléro-atrophique est une pathologie qui touche environ 1,7 % de la population féminine. Elle concerne principalement les femmes ménopausées et est à l’origine de symptômes pouvant être ...invalidants, comme des dyspareunies, des douleurs à type de brûlure et un prurit pouvant être intense, dégradant ainsi considérablement la qualité de vie des patientes. Le traitement de référence de cette pathologie est les dermocorticoïdes dont l’application régulière demande une bonne compliance des patientes. Le laser CO2 fractionné est un traitement en cours d’évaluation dans la prise en charge du lichen scléro-atrophique vulvaire et sa place reste à définir.
Il s’agit d’une étude descriptive sur une cohorte de 33 patientes prises en charge à l’Hôpital Nord Franche-Comté par laser CO2 fractionné dans le cadre de leur lichen scléro-atrophique vulvaire. Les objectifs de cette étude ont été l’évaluation de l’amélioration clinique à 3 mois et à 1 an des séances de laser et l’évaluation de la poursuite ou non du traitement par dermocorticoïdes. Nous avons également recensé les effets indésirables pouvant être en lien avec les séances de laser.
Une nette amélioration clinique est retrouvée chez 61 % des patientes à la fin de leurs séances de laser et une amélioration avec gène résiduelle est retrouvée pour 27 % des patientes, soit un total de 88 % des patientes satisfaites partiellement ou totalement à l’issue immédiate du traitement. À un an de la première séance de laser, 50 % des patientes encore suivies retrouvaient une amélioration totale et 50 % des patientes avaient pu être sevrées de la corticothérapie. Aucun effet indésirable n’a été retrouvé à 1 an du suivi.
Le traitement du lichen scléro-atrophique par laser CO2 fractionné permet une amélioration des symptômes rapportés par les patientes chez une grande majorité d’entre-elles. La moitié des patientes a pu être totalement sevrée des dermocorticoïdes ce qui représente un bénéfice majeur dans le cadre de cette maladie chronique. Il semblerait que le traitement par laser CO2 fractionné dans le cadre du lichen scléro-atrophique vulvaire soit un bon traitement qui pourrait être une alternative aux dermocorticoïdes avec une perspective de sevrage et de rémission complète. Des études complémentaires sur l’adaptation du nombre de séances, leur espacement et l’instauration de séances d’entretien sont nécessaires afin de préciser la place du laser CO2 pulsé dans la prise en charge du lichen scléro-atrophique vulvaire.
The reliability of general circulation models (GCMs) is commonly associated with their ability to reproduce relevant aspects of observed climate, and thus the evaluation of GCM performance has become ...a standard practice for climate change studies. As such, there is an ever-growing literature that focuses on developing and evaluating metrics to assess GCM performance. In this paper it is shown that some commonly applied metrics provide little information for discriminating GCMs based on their performance, once uncertainty is included. A new methodology is proposed that differs from common approaches in that it focuses on evaluating GCMs’ abilities to reproduce the observed response of surface temperature to changes in external radiative forcing (RF), while controlling for observed and simulated variability. It uses formal statistical tests to evaluate two aspects of the warming trend that are central for climate change studies: 1) if the response to RF produced by a particular GCM is compatible with observations and 2) if the magnitudes of the observed and simulated rates of warming are statistically similar. We illustrate the proposed methodology by evaluating the ability of 21 GCMs to reproduce the observed warming trend at the global scale and for eight subcontinental land domains. Results show that most of the GCMs provide an adequate representation of the observed warming trend for the global scale and for domains located in the Southern Hemisphere. However, GCMs tend to overestimate the warming rate for domains in the Northern Hemisphere, particularly since the mid-1990s.
Structured
Authors – Gay IC, Chen S, MacDougall M
Backround – Periodontal ligament (PDL) repair is thought to involve mesenchymal progenitor cells capable of forming fibroblasts, osteoblasts and ...cementoblasts. However, full characterization of PDL stem cell (SC) populations has not been achieved.
Objective – To isolate and characterize PDLSC and assess their capability to differentiate into bone, cartilage and adipose tissue.
Methods – Human PDL cells were stained for STRO‐1, FACS sorted and expanded in culture. Human bone marrow SC (BMSC) served as a positive control. PDLSC and BMSC were cultured using standard conditions conducive for osteogenic, chondrogenic and adipogenic differentiation. Osteogenic induction was assayed using alizarine red S staining and expression of alkaline phosphatase (ALP) and bone sialoprotein (BSP). Adipogenic induction was assayed using Oil Red O staining and the expression of PPARγ 2 (early) and LPL (late) adipogenic markers. Chondrogenic induction was assayed by collagen type II expression and toluidine blue staining.
Results – Human PDL tissue contains about 27% STRO‐1 positive cells with 3% strongly positive. In osteogenic cultures ALP was observed by day‐7 in BMSC and day‐14 in PDLSC. BSP expression was detectable by day‐7; with more intense staining in PDLSC cultures. In adipogenic cultures both cell populations showed positive Oil Red O staining by day‐25 with PPARγ 2 and LPL expression. By day‐21, both BMSC and PDLSC chondrogenic induced cultures expressed collagen type II and glycosaminoglycans.
Conclusions – The PDL contains SC that have the potential to differentiate into osteoblasts, chondrocytes and adipocytes, comparable with previously characterized BMSC. This adult PDLSC population can be utilized for potential therapeutic procedures related to PDL regeneration.
Human milk provides the infant with the essential nutritive and non-nutritive factors required for health, growth and development. The human milk lipidome is complex, but comprises predominantly ...triacylglycerides. Historically, the fatty acid profile of the entire human milk lipidome has been investigated, and many relationships have been identified between infant health and fatty acids. Most of these fatty acids are, however, delivered to the infant as triacylglycerides. Using liquid chromatography-ion mobility-mass spectrometry, the objective of this study was to characterise the triacylglyceride profile of human milk and elucidate relationships between the triacylglyceride profile and infant outcomes in a cohort of 10 exclusively breastfeeding woman-infant dyads. 205 triacylglycerides were identified, including 98 previously not reported in human milk. The dose of specific triacylglycerides differed in relation to infant health, such as lauric acid containing TAGs, which were delivered in significantly higher dose to healthy infants compared to unwell infants.
Patients with obstructive sleep apnea are at risk for perioperative morbidity. The authors used a screening prediction model for obstructive sleep apnea to generate a sleep apnea clinical score ...(SACS) that identified patients at high or low risk for obstructive sleep apnea. This was combined with postanesthesia care unit (PACU) monitoring with the aim of identifying patients at high risk of postoperative oxygen desaturation and respiratory complications.
In this prospective cohort study, surgical patients with a hospital stay longer than 48 h who consented were enrolled. The SACS (high or low risk) was calculated; all patients were monitored in the PACU for recurrent episodes of bradypnea, apnea, desaturations, and pain-sedation mismatch. All patients underwent pulse oximetry postoperatively; complications were documented. Chi-square, two-sample t test, and logistic regression were used for analysis. The oxygen desaturation index (number of desaturations per hour) was calculated. Oxygen desaturation index and incidence of postoperative cardiorespiratory complications were primary endpoints.
Six hundred ninety-three patients were enrolled. From multivariable logistic regression analysis, the likelihood of a postoperative oxygen desaturation index greater than 10 was increased with a high SACS (odds ratio = 1.9, P < 0.001) and recurrent PACU events (odds ratio = 1.5, P = 0.036). Postoperative respiratory events were also associated with a high SACS (odds ratio = 3.5, P < 0.001) and recurrent PACU events (odds ratio = 21.0, P < 0.001).
Combination of an obstructive sleep apnea screening tool preoperatively (SACS) and recurrent PACU respiratory events was associated with a higher oxygen desaturation index and postoperative respiratory complications. A two-phase process to identify patients at higher risk for perioperative respiratory desaturations and complications may be useful to stratify and manage surgical patients postoperatively.
Biotic stresses, including diseases, severely affect rice production, compromising producers' ability to meet increasing global consumption. Understanding quantitative responses for resistance to ...diverse pathogens can guide development of reliable molecular markers, which, combined with advanced backcross populations, can accelerate the production of more resistant varieties. A candidate gene (CG) approach was used to accumulate different disease QTL from Moroberekan, a blast-resistant rice variety, into Vandana, a drought-tolerant variety. The advanced backcross progeny were evaluated for resistance to blast and tolerance to drought at five sites in India and the Philippines. Gene-based markers were designed to determine introgression of Moroberekan alleles for 11 CGs into the progeny. Six CGs, coding for chitinase, HSP90, oxalate oxidase, germin-like proteins, peroxidase and thaumatin-like protein, and 21 SSR markers were significantly associated with resistance to blast across screening sites. Multiple lines with different combinations, classes and numbers of CGs were associated with significant levels of race non-specific resistance to rice blast and sheath blight. Overall, the level of resistance effective in multiple locations was proportional to the number of CG alleles accumulated in advanced breeding lines. These disease resistant lines maintained tolerance to drought stress at the reproductive stage under blast disease pressure.
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