Introduction
Surgical treatment of AIS aims to correct the coronal and sagittal alignment of the spine. The global alignment of the spine may be normalized through reciprocal changes between the ...fused spine and adjacent segments. We propose a new classification system describing the specific sagittal patterns induced by AIS to define reproducible guidelines for the surgical strategy.
Methods
We analyzed 100 consecutive AIS patients aged between 12 and 18 years candidate for spinal fusion. The following parameters were measured and compared for each pattern: spino-pelvic parameters, magnitude and length of the lumbar sagittal angle, magnitude and length of the thoracic sagittal angles (T1T12 and T4T12 angles, TKmax), T10 L2 angle, C7 slope and C2C7 angle.
Results
Three parameters strongly differentiated the four patterns: thoracic sagittal angles (T1T12 and T4T12 angles, TKmax), T10 L2 angle and C7 slope. Less than half of the patients (44%) had a normal sagittal shape. Within, Type 2 characterized by thoracic hypokyphosis, Type 2a (thoracic hypokyphosis) were mostly Lenke type 1 or 2 curves, and type 2b (thoracic hypokyphosis with TL kyphosis) occurred specifically in double major or TL/L curves. Type 3 were two-curve sagittal shape with cervicothoracic kyphosis and TL lordosis (9%), mainly in Lenke 1 curves.
Discussion
This new classification summarizes all the pathological scenarios of the sagittal alignment of AIS into four patterns. A specific surgical planning can be extrapolated for each pattern. In type 1, the objective is to preserve the sagittal shape. In type 2, the objective is to restore thoracic kyphosis. In type 2b, TL junction should be straightened. In type 3, the objective is to reshape the lower arc of thoracic sagittal angle and straighten the TL junction.
Graphical abstract
These slides can be retrieved under Electronic Supplementary Material.
Introduction and hypothesis
Prolapse is a common condition seen in women and its therapeutical management consists first and foremost of surgery. Postoperative pain is one of the most common side ...effects seen after surgery. The objective of this study was to identify risk factors for postoperative pain after cystocele repair with mesh.
Methods
This is a secondary analysis of the multicenter randomized trial PROSPERE, which compared cystocele repair with mesh according to the vaginal or laparoscopic approach. The presence of postoperative pain was assessed by a pain-specific self-reported questionnaire (Questionnaire de Baudelocque). The statistical analysis is based on the Wilcoxon, Chi-squared, and Fisher’s tests.
Results
The prevalence of postoperative pain (pain persisting more than 6 months) was 39% (80 out of 205, 95% CI 32.4–46.1), with 6.3% (13 out of 205) of chronic pain reports. Preoperative pain was the only statistically significant risk factor OR = 2.32 (
p
= 0,007; 95% CI 1.24–4.36).
Conclusions
Surgeons must be careful with preoperative painful prolapse and should inform their patient of the risk of developing postoperative chronic pain.
Objective
To compare the effectiveness and safety of laparoscopic sacropexy (LS) and transvaginal mesh (TVM) at 4 years.
Design
Extended follow up of a randomised trial.
Setting
Eleven centres.
...Population
Women with cystocele stage ≥2 (pelvic organ prolapse quantification POP‐Q, aged 45–75 years without previous prolapse surgery.
Methods
Synthetic non‐absorbable mesh placed in the vesicovaginal space and sutured to the promontory (LS) or maintained by arms through pelvic ligaments and/or muscles (TVM).
Main outcome measures
Functional outcomes (pelvic floor distress inventory PFDI‐20 as primary outcome); anatomical assessment (POP‐Q), composite outcome of success; re‐interventions for complications.
Results
A total of 220 out of 262 randomised patients have been followed at 4 years. PFDI‐20 significantly improved in both groups and was better (but below the minimal clinically important difference) after LS (mean difference −7.2 points; 95% CI −14.0 to −0.05; P = 0.029). The improvement in quality of life and the success rate (LS 70%, 61–81% versus TVM 71%, 62–81%; hazard ratio 0.92, 95% CI 0.55–1.54; P = 0.75) were similar. POP‐Q measurements did not differ, except for point C (LS −57 mm versus TVM −48 mm, P = 0.0093). The grade III or higher complication rate was lower after LS (2%, 0–4.7%) than after TVM (8.7%, 3.4–13.7%; hazard ratio 4.6, 95% CI 1.007–21.0, P = 0.049)).
Conclusions
Both techniques provided improvement and similar success rates. LS had a better benefit–harm balance with fewer re‐interventions due to complications. TVM remains an option when LS is not feasible.
Tweetable
At 4 years, Laparoscopic Sacropexy (LS) had a better benefit–harm balance with fewer re‐interventions due to complications than Trans‐Vaginal Mesh (TVM).
Tweetable
At 4 years LS had a better benefit–harm balance with fewer re‐interventions due to complications than TVM.
Background/Objectives
To date, data are lacking on the proportion of residents, and employees who have actually been exposed to SARS-Cov-2 in nursing homes and geriatric healthcare institutions, as ...well as the evolution of their serological status and the recurrence of Covid-19. The primary objective was to determine the prevalence of COVID-19 using NG Biotech rapid serological tests among caregivers and residents. The secondary objectives were to determine: prevalence according to RT PCR tests or clinical diagnosis; the risk factors (autonomy, arterial hypertension, diabetes mellitus) and clinical presentation (e.g. respiratory, abdominal or cutaneous symptoms, asthenia, fever) among residents; the risk factors (age, sex, profession, family situation) among caregivers; the evolution of the serological status at 1, 3 and 6 months using NG Biotech rapid serological tests; the symptomatic recurrence of Covid 19 at 1, 3 and 6 months.
Design
Multicentric prospective observational.
Setting
Study location: 27 nursing homes and 3 multilevel geriatric hospitals belonging to the UNIVI Group in France.
Participants
1334 professionals: 692 among multilevel geriatric hospitals (mean age: 43.6+/−11.8; 441 (82.4%) female) and 642 among nursing homes (mean age: 43.5+/−12.4; 685 (85.9%) female), and 1145 residents (mean age: 89+/−7.5; 898 (78.7%) female).
Measurements
Prevalence using NG Biotech rapid serological tests, medical diagnosis, RT-PCR tests. Risk factors among residents using the medical file and among caregivers using questionnaires. Clinical presentation in residents using the medical file.
Results
The prevalence using NG Biotech rapid serological test in residents was 14.4 % (168 of 1142 available diagnostics), the global prevalence (positive RT-PCR or positive serological test) was 22.7% (203 of 895 available diagnostics). The prevalence using NG Biotech rapid serological test in professionals was 12.8% (164 of 1315 available diagnostics), the global prevalence (positive RT-PCR test or positive serological test) was 23.8% (222 of 933 available diagnostics). The risk factors among residents were: living in an Alzheimer unit, and being a contact case. Being independent for activities of daily living was protective. The risk factor among caregivers was being a contact case. Another risk factor was the job; nurse assistants, nurses, and physicians were the most exposed. Residents had atypical clinical presentations including frequent geriatric syndromes (falls, delirium). 68.3% (71 of 104) of the initially positive residents still had a positive rapid serological test at 1 month follow up and 74 % (54 of 73) at 3 months follow up. 77.9% (88 of 113) of the initially positive employees still had a positive rapid serological test at 1 month follow up. Symptomatic reinfection was exceptional in caregivers or in residents during follow up.
Conclusion
COVID 19 prevalence among caregivers and residents in nursing homes and geriatric health Institutions is underestimated when using only one method for diagnosis. Geriatric syndromes such as falls and delirium in residents should trigger further investigations on a COVID-19 cause. Immunity was persistent in ¾ of caregivers and residents during the 3 months follow up. The high prevalence of COVID 19 in geriatric institutions pleads in favor of the French vaccination policy, initially targeting as a priority the most vulnerable and dependent people, followed by staff members in healthcare institutions and nursing homes. More studies on the persistence of immunity and the perspective of Covid 19 mutations will help determine the long-term vaccine booster policy.
The pandemic caused by SARS-COV-2 infection spread rapidly during the "first wave" through France between March and May 2020. It was responsible for high mortality in subjects with comorbidities and ...the elderly who lived in nursing homes. In May 2020, 75% of the deaths occurred in people over 75 years old in nursing homes. It is difficult to estimate accurately the prevalence of COVID-19 infection during this period because only 50% of the diagnoses in nursing homes were made by RT-PCR. During this period, the diagnosis was mainly based on the clinical symptoms.
We carried out a prospective study among residents of the 27 EHPADs in the UNIVI group (SEROCOVID study) between August 31 and October 16, 2020 using rapid ELISA serotests carried out by pricking the fingertip. We looked for the seroprevalence by the use of rapid serotests as well as the overall prevalence by cumulating the positive results of the RT-PCR when done and of the rapid serotest. The secondary objectives were the study of risk factors for infection by multivariate analysis as well as the description of the symptoms that led to the diagnosis.
In total, 1145 residents were included aged on average 89±7.5 years old (female 78.7%). The time between the COVID-19 disease and the rapid inclusion serotest was on average 5±1.7 months. The prevalence estimated by the three diagnostic evaluation methods (medical diagnosis, RT-PCR or by rapid serotest ELISA) is about 14%, underestimated compared to the overall prevalence at 22.7%. The study of risk factors in multivariate analysis shows that the most dependent residents, living in a protected unit due to behavioral disorders or whose close contact with a person with COVID-19 had significantly higher rates of infection. Finally, the symptoms most frequently observed in residents differed from those in younger subjects with geriatric characteristics, such as the higher frequency of digestive symptoms and geriatric syndromes. Fever has only been observed in one third of cases in the elderly. Smell and taste disorders were seldom described.
Our study provides an estimate of the overall prevalence as well as the mean seroprevalence of COVID-19 in EHPAD residents five months after the diagnosis of COVID-19 disease. The difference between the two estimates is probably explained by the frailty and decreased immunity of the nursing home residents. Therefore, it would need to be reactivated by vaccination of all residents, even those already infected with SARS-COV-2. These elements corroborate the governmental strategy of vaccination deployed in all residents of EHPAD regardless of their previous contact with the virus.
No specific biomarkers for prognostication or evaluation of tumour load in melanoma have been reported to our knowledge. MicroRNAs (miRNAs) are strongly implicated in oncogenesis and tumour ...progression, and their circulating forms have been studied as potential biomarkers in oncology. The aim of this prospective study was to identify a melanoma-specific profile of plasma miRNAs. A screening phase, using RNA microarray, was conducted on plasma from 14 patients with metastatic melanoma and 5 healthy subjects. Selected miRNAs were analysed by RTqPCR in 2 independent training and validation cohorts including, respectively, 29 and 31 patients and 16 and 43 control subjects. A profile of 2 miRNAs (miR-1246 and miR-185) significantly associated with metastatic melanoma with a sensitivity of 90.5% and a specificity of 89.1% was identified. This plasma miRNA profile may become an accurate non-invasive biomarker for melanoma.
► PLS discriminant analysis is used to analyze conventional sensory profiling data. ► Its outcomes are compared to those of alternative methods. ► Thereafter, VIP indices are used to select a subset ...of relevant variables.
Several methods have been proposed in the literature to analyze conventional sensory profiling data. We focus on factor analytical methods which have been extensively used due to their ability to produce graphical displays which are both useful and easy to interpret. Available factor analytical methods include principal components analysis on averaged assessors data or on the data matrix obtained by stacking the assessors’ datasets one on top of the others, and canonical variates analysis; each method has advantages and drawbacks. As an alternative it is advocated the use of
PLS discriminant analysis, which is at the intersection of the methods mentioned above. This method of analysis takes account of the within and between product variations while minimizing the impact of multicolinearity. It provides statistical tools to assess on the one hand the agreement among assessors and the discrimination among products by means of the between to total variance ratio, and on the other hand the relative importance of variables by means of
VIP (variable importance in the projection) indices. The
VIP indices may also be useful to guide the selection of a subset of relevant attributes from the complete set of attributes. In this paper,
PLS discriminant analysis is compared with other methods, and results are illustrated through a case study. In particular, the stability of the various methods is investigated using assessors’ re-sampling (bootstrap) and confidence ellipses.
The hypothalamus contains integrative systems that support life, including physiological processes such as food intake, energy expenditure, and reproduction. Here, we show that anorexia nervosa (AN) ...patients, contrary to normal weight and constitutionally lean individuals, respond with a paradoxical reduction in hypothalamic levels of glutamate/glutamine (Glx) upon feeding. This reversal of the Glx response is associated with decreased wiring in the arcuate nucleus and increased connectivity in the lateral hypothalamic area, which are involved in the regulation on a variety of physiological and behavioral functions including the control of food intake and energy balance. The identification of distinct hypothalamic neurochemical dysfunctions and associated structural variations in AN paves the way for the development of new diagnostic and treatment strategies in conditions associated with abnormal body mass index and a maladaptive response to negative energy balance.
L’immunothérapie spécifique par voie orale (ITO) déjà documentée pour les allergies au lait et à l’œuf est considérée actuellement pour l’arachide. Les auteurs rapportent la mise en place de ...l’immunothérapie orale à l’arachide dans un service hospitalier selon une démarche devant assurer une sécurité maximale et fixant les paramètres biologiques nécessaires pour la décision et pour la surveillance de l’évolution. Le matériel est l’arachide grillée. Les procédures de l’immunothérapie orale spécifique reposent sur l’administration de doses croissantes à domicile. Trois protocoles de durée variable (17, 36, 60semaines) sont adaptés à la sévérité des cas. Cette revue détaille les conditions d’achat, de stockage, de préparation de la poudre, du conditionnement des doses, et de leur envoi postal, les textes explicatifs de l’allergie à l’arachide et de l’immunothérapie spécifique, les bénéfices et risques attendus, les consentements éclairés écrits pour les tests cutanés, biologiques, le test de provocation oral et l’ITO, les conditions de mise en œuvre du protocole à domicile, les adaptations en cas d’événement intercurrent, les contrôles hospitaliers reposant à intervalles de 12semaines sur les prick-tests au même matériel et le dosage des IgE et IgG4 spécifiques des trois allergènes majeurs recombinants, le choix et la quantité quotidienne des aliments industriels choisis pour la maintenance. Les tâches et responsabilités des personnels paramédicaux et des allergologues sont détaillées. La revue des questions en suspens conduit à recommander la mise en place de l’ITO à l’arachide par des services hospitaliers, mais une progression régulière des doses à domicile est possible sous condition d’évaluation régulière à intervalles de 12semaines.
Specific oral immunotherapy (OIT) has been described for allergy to milk and to egg and is now being considered as treatment for peanut allergy. The authors describe the initiation of a course of peanut-specific OIT in a hospital allergy department using a procedure designed to ensure maximum safety and which includes the laboratory assays necessary for decision-making and monitoring of the evolution of the therapy. The material used in this OIT is grilled peanut. The practice of OIT we use is based on taking increasing doses of the allergen at home. Based on the severity of the cases, three protocols of different durations (17, 36, 60weeks) are available. This review details the conditions of the purchase, the preparation and storage of the powdered allergen, packaging of the doses and of sending them through the mail; it includes texts explaining peanut allergy and OIT, the expected benefits and risks, written informed consent forms for skin and laboratory tests, for the oral provocation test and for OIT, as well as the conditions for conducting the protocol at home, changes when necessary due to intercurrent events, the 12-weekly hospital consultations for prick-tests with the same material and assays for peanut-specific IgE and IgG4 using the three major recombinant peanut allergens; and the choice and the daily quantity of the industrial foodstuffs chosen for the patient's maintenance diet. The responsibilities of the allergists and paramedical personnel are described in detail. This review of some important questions, which may need further discussion, ends by recommending that hospital-based allergy departments set up peanut-specific OIT, with regular progression of doses at home and with regular evaluation at the hospital at 12-week intervals.
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