Study of Patients Self-Training Influence on Peripheral Neuropathies Diseases Diagnosis through D.I.T.A Device.

In our daily life, the sight and the sense of touch play a fundamental role in objects recognitions. This process is helped by the experience: if a subject has already seen or already touched an object in the past, he will recognize it more easily in the future. Following this assumption, the authors of this paper wanted to investigate if the experience can influence the results of a clinical examination where the subject has an active role. The attention was focused on the peripheral neuropathies diagnosis since they require an accurate assessment of several parameters including the tactile sensitivity trend. In other words, if the tests encompass an active role of the subjects, one of the main uncertainties is the self-training that influences the subject responses. This work focuses on the study of this self-training using the D.I.T.A device (Dynamic Investigation Test-rig on hAptics). Results clearly show a fundamental role of priming during "haptic modality": expert subjects, previously experienced with the tests, demonstrated better recognition of the encountered stimuli, compared to novices. Moreover, the results show that the maximum difference between the two groups of subjects is in the first part of the test. An ANOVA analysis was carried out to demonstrate that also the errors between the pins-arrays are affected by the priming.

Canine visceral leishmaniasis in boyer ahmad district, kohgiluyeh & boyer ahmad province, southwest of iran.

BACKGROUND: Mediterranean type of visceral leishmaniasis (VL) is present in different parts of Iran. Several studies have identified dogs as the main reservoirs of the VL caused by Leishmania infantum in Iran and other Mediterranean regions. This study aimed to determine the seroprevalence of canine visceral leishmaniasis as animal reservoir host for human visceral leishmaniasis in Boyer Ahmad district in southwest of Iran. METHODS: A seroepidemiological study was carried out to determine the seroprevalence of canine visceral leishmaniasis (CVL) among ownership dogs by using direct agglutination test (DAT) in 23 of 182 villages of Boyer Ahmad district, during August 2009 to August 2010. One hundred and seventy serum samples from ownership dogs were selected by multi-stage cluster sampling in villages of Boyer Ahmad district. All samples were tested by DAT and anti-Leishmania antibodies titers at ≥ 1:320 was considered as positive. RESULTS: Of the 170 serum samples, 10% were positive by DAT at titers of 1:320 and higher. No statistical significant difference was found between male (10.7%) and female (8.3%) seroprevalence. The highest seroprevalence rate (15.1%) was observed among the ownership dogs of four to seven years age. Altogether, seventeen (25.4%) of the seropositive dogs had clinical signs and symptoms. CONCLUSION: It seems that Boyer Ahmad district is an endemic area for canine visceral leishmaniasis in Iran.

Tracking of adult adiposity in early, average and late maturing children: a thirty year longitudinal growth study.

AIM: To investigate if predictability of adult adiposity is related to maturation status in youth. METHODS: Data of the longitudinal ''LEGS''-study (N = 550) from 6 to 18 years were used. At 35 years, 59 men and 60 women participated again. Early (EM), average (AM) and late (LM) maturity groups were established, using tertiles of age at peak height velocity (JPA-method). Pearson correlations between the childhood and the adult measurements were calculated. RESULTS: Female sum of 4 skinfolds (Sigma4SF) correlations increase from very low/moderate (6-9 years) to high at 11 years (EM), 15 years (AM) and 17 years (LM). The highest predictability was 65.6% for the Sigma4SF at 14 years in EM. At this age, predictability is 30.3% in AM and 0.8% in LM (P < 0.05). In EM, BMI correlations are moderate/high until 14 yrs (r2 = 0.64 at 13 years), but low until 15 years in LM. Male Sigma4SF correlations are very low/moderate in the three maturity groups. Significant correlation was found in the LM at 16 yrs. Moderate Body Mass index (BMI) correlations are reached at 9 years (LM) and 11 years (EM). At 16 years predictability = 4.9% for BMI in LM males. CONCLUSION: Predictability of adiposity at 35 years is generally better in girls than in boys. A dose-response effect of maturity on adult adiposity is found in girls but not in boys. Interventions to prevent adult obesity might be more effective in females than in males, particularly in EM females.

[Superficial fungal infections. Epidemiologic, clinical and mycologic study over a three year period]. / Les mycoses superficielles. Etude épidémio-clinique et mycologique sur trois ans.

The object of our study is to release the epidemiological, clinical and mycological characteristics of superficial fugal infections. A retrospective study was carried out during three years (1996-1998). Direct microscopy was positive in 86% cases, the culture in 62% cases. Trichophyton rubrum accounts for 85% of the dermatophytic flora. The superficial fugal infections account for 15% of the reasons for consultation in our service. They would touch according to data's of literature 2 to 13% of the general population. Trichophyton rubrum in accordance with the various series published, is the fungi most frequently insulated with variable rates between 46 and 82% of the superficial fungal infections. Any time, Candida albicans is prevalent on the level of the hands.

[Hypocholesterolemia in hospitalized elderly: relations with inflammatory and nutritional status]. / Hypocholestérolémie du sujet âgé: influence de l'inflammation et de la dénutrition.

PURPOSE: Hypocholesterolemia is a common finding in hospitalized elderly people and is associated with increased mortality. Changes in plasma lipid levels are well known in the acute phase response. It has also been suggested that malnutrition is a cause of hypocholesterolemia. However, malnutrition is the reflect of general condition, and the respective roles of malnutrition and inflammation have not yet been clearly established. This research project was undertaken to examine the impact of nutritional and inflammatory status on the hypocholesterolemia. METHODS: In a prospective study, 597 elderly patients (83 +/- 7 years) consecutively admitted in a geriatric acute care unit were included. Clinical and anthropometric data: Body Mass Index (BMI), Tricipital Skinfold Thickness (TSF), Sub-Scapular Skinfold Thickness (SSF), Mid Arm Circumference (MAC) have been collected. The blood samples were obtained within the 72 hours following the admission. Nutritional proteins (albumin, prealbumin, transferrin, retinol binding protein); inflammatory proteins (CRP, alpha-1 acid glycoprotein), and blood lipids (cholesterol, LDL, HDL cholesterol, triglycerides, apoproteins A1 and B) were dosed. RESULTS: The anthropometric and biologic parameters have been compared on the two sexes, significant differences were observed only for blood lipids. The analyses are thus realized and presented by sex separately. Four groups of patients are generated according to the quartile of total cholesterol. Means and standard deviation for all factors are calculated within each group. Both, the trend of means and analyses of correlation show associations with cholesterol in the two sexes. The analysis of variance showed that the cholesterolemia is associated with 1/ decrease in the values of the anthropometrics, and nutritional proteins and 2/ upward trends of the inflammatory parameters. Significant correlations were observed for all transport proteins and CRP with total cholesterol in men and women. The multiple linear regression of the total cholesterol retained albumin, APO A1, APO B and RBP as predictor factors of cholesterolemia for women and APO A1, APO B and tryglicerid for men. When patients with infectious diseases were compared to the others, significant differences have been observed for total cholesterol and all blood lipids, as well as for nutritional and inflammatory proteins. CONCLUSION: The results confirm an association between nutritional status and hypocholesterolemia, and suggest also the responsability of inflammation as a cause of hypocholesterolemia.

Malnourished elderly people and lipid status.

UNLABELLED: Protein-energy malnutrition is common in the elderly. The relationship between protein-energy malnutrition and lipid status remains uncertain and few studies are available. The aim of this study was to evaluate the lipid status of malnourished elderly subjects recently hospitalized in a geriatric medical care unit. Classical parameters such as total cholesterol, HDL cholesterol, apoproteins A1 et B, vitamins A and E were measured. Particular attention was given to other parameters such as fatty acids. The studied population included 86 elderly subjects. They were divided into two groups, according to serum albumin (alb) and Body Mass Index (BMI). Fifty patients aged 81.5 7.3 years were considered to be well-nourished (WN) with albumin 35 g/l and BMI 21 kg/m2. Thirty six patients aged 84.1 6.6 years were considered to be malnourished (MN) with albumin < 35 g/l and BMI < 21 kg/m2. Our main findings shown significant decrease in all classical lipid parameters : total cholesterol (p< 0.001), HDL cholesterol (p< 0.005), apoproteins A1 (p< 0.001) and B (p< 0.001) in the malnourished group. We found an increase in the rate of v9 fatty acids (p< 0.001 for the oleic acid; p< 0.05 for the eicosatrienoic acid) and also an increase in the triene/tetraene ratio (p< 0.05) as a result of malnutrition. CONCLUSION: Protein-energy malnutrition is accompanied by lipid status alterations.

Emergency hospitalization in the elderly in a French university hospital: medical and social conditions and crisis factors precipitating admissions and outcome at discharge.

Emergency admissions of elderly patients constitute a major management issue due to the complexity of their problems. The aim of this retrospective observational study was to identify medical and social characteristics and crisis factors for emergency department (ED) hospitalization in elderly patients, and to evaluate the influence of these factors on the length of stay and outcome at discharge. During a 4-month period, 396 patients aged 70 years and older were referred to the ED of a University Hospital (Hjpital Edouard Herriot) in Lyon, France. A questionnaire specifically designed for the study was completed for each patient using the information in the patients' files previously filled in by the "Rapid Geriatric Assessment Team" of the ED. We described civil and marital status, living conditions, reason for admission to ED and other associated pathologies according to the ICM-9, crisis factors, length of stay (LOS) and outcome at discharge. The mean age was 81.9 years (SD 6.5); two thirds (66.7%) of the study subjects were female, and 46.7% were widowed; the majority (68.7%) lived in their own homes. The main reasons for admission were cardiopulmonary diseases in 31.6% of cases, followed by neuropsychiatric disorders in 28.2%, and falls in 8.3%; a final category (31.8%) included subjects admitted for general, non-specific symptoms. Among the crisis factors observed, 49.4% presented an acute episode of a chronic illness, 33.6% lived alone, and 20.9% had been hospitalized during the 6-month period preceding the study. The average LOS was 3.15 days. The multivariate model showed that falls increase LOS by 74%, dementia by 65%, and depression by 21%. Upon discharge, 13% returned to their residence before hospitalization, 55% were transferred to a medical speciality ward, and 4% to other facilities, whereas only 19% were transferred to a geriatric ward, and 9% died during their stay in the ED. The multinomial model showed that outcome at discharge was influenced by functional dependency, dementia, depression, and acute episodes of a chronic illness. For many elderly, the ED remains a critical point of access to more complete managed care. This elderly population is comprised of polypathological, frail persons whose morbid state requires multidisciplinary management in geriatric units. The findings of this study suggest that interventions of multidisciplinary networks, such as home health care programs aimed at detecting crisis factors and establishing early prevention of crisis states, may improve unfavorable medical and social conditions and reduce hospitalization in geriatric patients.

Early detection of viral resistance by determination of hepatitis B virus polymerase mutations in patients treated by lamivudine for chronic hepatitis B.

We have analyzed the molecular dynamics of emergence of drug-resistant strains in patients receiving lamivudine therapy for chronic hepatitis B. Twenty consecutive patients with lamivudine resistance were studied (13 hepatitis B e antigen [HBeAg]-positive patients and 7 HBe antibody [anti-HBe]-positive patients). Determination of viral genotype, precore mutants, and polymerase gene mutants (L528M, M552V, M552I) was performed using the research version of Lipa-HBV. Quantitative analysis of HBV DNA was performed using both branched DNA (bDNA) and polymerase chain reaction (PCR) assays. Polymerase mutants (genotypic resistance) were found in 16 of 20 patients. Genotypic resistance was detected earlier than the phenotypic resistance (P =.004). Quantitative PCR allowed detection of viral DNA throughout the entire study period in 16 of 20 patients. Analysis of pretreatment variables showed that high alanine transaminase (ALT) levels (>3 x the upper limit of normal [ULN]) was associated with a more rapid selection of drug-resistant mutants (P =.027) and a high hepatitis B virus (HBV) DNA level (>1,497 Meq/mL, bDNA) with a more rapid occurrence of phenotypic resistance (P =.04). At the time of viral breakthrough, the mean serum HBV-DNA values were not different from the pretreatment values (P =.37). ALT levels were higher in anti-HBe-positive patients compared with pretreatment values and to HBeAg-positive patients (P =.01). In 8 patients, antiviral therapy was modified after viral breakthrough, with the introduction of famciclovir and/or interferon alfa. Viral DNA became undetectable by bDNA in 3 patients who received interferon. Our results suggest that genotypic assays for polymerase mutant detection and quantitative determination of viremia with highly sensitive assay are warranted for an optimal monitoring of antiviral therapy of chronic hepatitis B.

Patellar instability: assessment on MR images by measuring the lateral trochlear inclination-initial experience.

Lateral trochlear inclination (LTI) of the knee was compared on magnetic resonance (MR) images obtained in 30 patients with patellar instability (PI) and 30 patients with nonspecific internal knee derangement. Differences in LTI values between the two populations were significant (P <.001). Reproducibility of the measurement was judged excellent with an intraclass correlation superior to 0.98. Below a threshold value fixed at 11 degrees, LTI appears to be an excellent diagnostic test of PI with a sensitivity of 0.93 (28/30), a specificity of 0.87 (26/30), and an accuracy of 0.90 (54/60).

Knee instability after injury to the anterior cruciate ligament. Quantification of the Lachman test.

We have measured anterior and posterior displacement in 563 normal knees and 487 knees with chronic deficiency of the anterior cruciate ligament (ACL). We performed stress radiography using a simple apparatus which maintained the knee at 20 degrees of flexion while a 9 kg load was applied. There was no significant difference in posterior translation dependent on the condition of the ACL. Measurement of anterior translation in the medial compartment proved to be more reliable than in the lateral compartment for the diagnosis of rupture of the ACL, with better specificity, sensitivity and predictive values. We have classified anterior laxity based on the differential anterior translation of the medial compartment and identified four grades in each of which we can further distinguish four subgrades for laxity of the lateral compartment. Within each of these subgroups, either internal or external rotation may dominate and sometimes there is a major translation of both compartments. Radiological evaluation of displacement of the knee in 20 degrees of flexion provides conclusive evidence of rupture of the ACL. A detailed study of pathological displacement is the basis for a classification of laxity. It is then possible to decide for each type of laxity, the surgical treatment which is specifically adapted to the lesion, and to define a reference value for judging outcome.

Electronic evaluation of the value of double gloving.

BACKGROUND: Breakdown of the surgeon-patient barrier represents a risk for transmission of infectious disease. Such breakdowns are frequently not recognized by the surgical team. The protection afforded by double gloving under normal operating conditions was evaluated. METHODS: An electronic device detected breakdown of the surgeon-patient barrier in a series of 80 surgical procedures, randomly assigned to either double or single gloving. Fluid contact due to glove perforation, porosity or gown wetting was recorded during 151 individual surgeon episodes covering 238 operator-hours. Surgical procedures were called superficial for incisions of less than 10 cm. RESULTS: Double gloving reduced the number of perforation and porosity alarms twofold in both superficial and deep surgical procedures. Deep procedures carried a sevenfold increased risk of barrier breakdown compared with superficial procedures, the risk being greatest for the principal operator. CONCLUSION: Without electronic detection, a large majority of barrier breakdowns would remain undetected by the surgical team and lead to prolonged contact with potentially contaminating body fluids. The use of double gloving provides real protection against such contamination risks.

Lipid peroxidation and antioxidant defenses in cystic fibrosis patients.

Lipid peroxidation biomarkers and antioxidant status were measured in 76 cystic fibrosis (CF) patients and compared to 40 control subjects. Univariate and multivariate statistics were performed in this study. Results showed that indicators of lipid peroxidation were higher in CF patients than in controls; thiobarbituric acid reactants and autoantibodies against oxidized low-density lipoproteins were significantly increased in CF patients. Red blood cells and whole blood glutathione peroxidase activities were lower in CF patients than in controls. No difference in red blood cell superoxide dismutase activity was observed. Measured concentration of glutathione peroxidase in plasma showed a higher mean value of this protein in CF patients than in controls. Retinol, alpha-tocopherol and beta-carotene concentrations were all reduced in CF patients as compared to controls; this was particularly pronounced for beta-carotene. The decreased alpha-tocopherol concentration was associated with higher percent hemolysis in CF patients. The results of this study indicate that both lipid peroxidation biomarkers and antioxidant status were disturbed in CF patients, despite medical assistance. Measures of oxidative stress parameters, such as thiobarbituric acid reactants, glutathione peroxidase, and beta-carotene concentrations can be considered as significant indicators to discriminate CF patients and control subjects.

Ultrasmall superparamagnetic iron oxide particles (AMI 227) as a blood pool contrast agent for MR angiography: experimental study in rabbits.

The purpose of this study was to evaluate the contribution of an ultrasmall superparamagnetic iron oxide particles (USPIOs) based contrast agent (AMI 227), in a transverse three-dimensional time-of-flight TONE MR angiography sequence of abdominal aorta in rabbits. The main goal was to assess improvement in the visualization of small arteries such as renal arteries, when using such a sequence. Imaging experiments were performed on a 1.5 T magnet, using a transverse 3D time-of-flight (TOF) tilted optimized nonsaturating excitation (TONE) sequence with magnetization transfer suppression. The contrast media used were composed of a USPIO core surrounded by a dextran-surfactant (AMI 227). Different concentrations of AMI 227 were evaluated in 12 rabbits. Concentrations varied within the range 8.5-34 micromol Fe/kg - bw: 8.5 micromol Fe/kg (three rabbits); 17 micromol Fe/kg (three rabbits); 25.5 micromol Fe/kg (three rabbits); 34 micromol Fe/kg (three rabbits). A visual analysis based on the improvement of visualization of small arteries (renal arteries) on MIP images and a quantitative analysis based on the percentage of contrast enhancement of the aorta plotted against distance in the slab from the top edge of the acquisition volume were obtained. A signal-to-noise ratio enhancement of the distal part of the aorta and only improvement in the delineation of the renal arteries were noted when using low concentrations of the contrast media. A loss of signal-to-noise ratio of the aorta and a decrease in arterial visualization were respectively noted with higher concentration of contrast media. In this experimental study, using a transverse three-dimensional TOF TONE MR angiography sequence of renal arteries, in which sequence the saturation effect is minimized, the use of AMI 227 allows only improvement in the delineation of small arteries when using low concentrations of contrast media.

Spiral CT artifact that simulates aortic dissection: image reconstruction with use of 180 degrees and 360 degrees linear-interpolation algorithms.

PURPOSE: To evaluate a computed tomographic (CT) artifact that simulates aortic dissection. MATERIALS AND METHODS: Two groups of 65 patients underwent spiral CT of the chest for reasons other than suspected aortic dissection. In each group, two series of images (10-mm sections) were reconstructed with use of a 180 degrees or 360 degrees linear-interpolation algorithm. Series of images were read by two radiologists, and variance between interpretations was statistically measured. RESULTS: Among series of images, artifacts were seen on 21-26 (32%-40%) with use of a 180 degrees algorithm and 41 (63%) and 44 (68%) with use of a 360 degrees algorithm. Concordance between reviewers was fair (kappa = 0.58, 0.59) or good (kappa = 0.65) with use of a 180 degrees algorithm and excellent (kappa = 0.92) with use of a 360 degrees algorithm. In one group, with use of a 180 degrees algorithm, two series of reconstructed images were separated by 5 mm; artifact was observed on seven (11%) CT studies (on both series of images) and was located along the left or left anterior side of the aorta. CONCLUSION: To reduce the frequency of a spiral CT artifact that simulates aortic dissection, two series of segmented images can be reconstructed with a change of image position along the z axis of the aorta and use of a 180 degrees linear-interpolation algorithm.

Transplanted renal artery: detection of stenosis with color Doppler US.

PURPOSE: To evaluate the influence of various parameters on peak systolic velocity in the transplanted renal artery and to define the normal range of peak systolic velocity. MATERIAL AND METHODS: Color Doppler ultrasonographic (US) findings in 105 patients were reviewed. There were no clinical or biologic findings suggestive of a stenosis in the transplanted renal artery in these patients. The peak systolic velocity in the transplanted renal and external iliac arteries and the renal resistive index were measured. RESULTS: A large range of peak systolic velocities was noted in the transplanted renal artery. Peak systolic velocity in the renal artery was statistically significantly correlated with that in the external iliac artery when there was no pronounced vessel curvature. There was no relationship between peak systolic velocity and resistive index or time between transplantation and US. High peak systolic velocity was associated with a pronounced vessel curvature. CONCLUSION: The normal range of peak systolic velocity in the transplanted renal artery has considerable variability. Because of the strong correlation, the ratio of velocity in the renal artery to that in the external iliac artery may be useful in detection of stenosis.

Prothrombin time sensitivity and specificity to mild clotting factor deficiencies of the extrinsic pathway: evaluation of eight commercial thromboplastins.

Prothrombin-time (PT) sensitivity and specificity to mild clotting factor II, V, VII and X deficiencies have rarely been studied. We therefore carried out a prospective study, in 350 patients, of eight commercial thromboplastins (CTs) in their ability to detect mild clotting factor deficiencies, notably in factor VII. In each patient the factor II, V, VII and X clotting activities and PT performed with each CT were determined. For each CT, PT sensitivity and specificity in detecting factor deficiencies below 0.5 U/ml or below 0.4 U/ml were determined at various PTs, and then Receiver Operator Characteristic curves constructed. At optimum PT threshold level (sensitivity = specificity), exactitude varied from 0.64 to 0.74 (p < 0.01) and from 0.67 to 0.81 (p < 0.0001) in detecting deficiencies below 0.5 and 0.4 U/ml respectively. In conclusion, this study shows the limits of the PT test as performed with 8 CTs in patients with mild clotting factor deficiencies. The impact of such differences in sensitivity and specificity on monitoring certain patients subjects to decrease in coagulation factor, and, in particular, of those under low dose oral anticoagulant, remains to be determined.

Bayesian estimation of the parameters of a nonlinear model. An application to human height.

The estimation of the parameters of a nonlinear model by means of the maximum likelihood procedure is widely used in the study of growth phenomena. The accuracy with which these parameters are calculated is a function of the number of measures taken and particularly, of their distribution across the growth period. If the growth curve is only partially known, the inaccuracy can increase considerably. However, if we have information on the distribution of the parameters of a model in the population, the empirical Bayes method should be used. In this paper, the principle of this approach for nonlinear modeling was recalled. The method was then applied on data of human height. Four nonlinear models are used and their performances are compared. The results show the importance of information on the quality of estimates of growth parameters and consequently on the prediction of adult height.