Severe pelvic pain is associated with sexual abuse experienced during childhood and/or adolescence irrespective of the presence of endometriosis.

STUDY QUESTION: Is endometriosis associated with childhood and/or adolescent sexual abuse? SUMMARY ANSWER: Endometriosis is not associated with a history of sexual abuse, unlike the presence of severe pelvic pain. WHAT IS KNOWN ALREADY: Several studies have highlighted a link between pelvic pain and sexual abuse during childhood/adolescence. Moreover, an inflammatory state has been described in patients with a history of childhood maltreatment. Given that inflammation and pelvic pain are two entities often encountered with endometriosis, several teams have investigated whether endometriosis is associated with abuse during childhood/adolescence. However, the results are conflicting, and the link between sexual abuse and the presence of endometriosis and/or pain is hard to disentangle. STUDY DESIGN, SIZE, DURATION: A survey nested in a cohort study of women surgically explored for benign gynecological indications at our institution between January 2013 and January 2017. For each patient, a standardized questionnaire was completed during a face-to-face interview with the surgeon in the month preceding the surgery. Pelvic pain symptoms (dysmenorrhea, deep dyspareunia, non-cyclic chronic pelvic pain, and gastrointestinal or lower urinary tract symptoms) and their intensities were assessed with a 10 cm visual analog scale (VAS). Pain was considered to be severe when the VAS score was ≥7. PARTICIPANTS/MATERIALS, SETTING, METHODS: A 52-question survey was sent in September of 2017 to evaluate abuses, especially sexual abuse during childhood and/or adolescence, and the psychological state during childhood and adolescence. The survey was structured to cover the following sections: (i) abuses and other life events during childhood and adolescence; (ii) puberty and body changes; (iii) onset of sexuality; and (iv) family relationships during childhood and adolescence. The patients were divided into groups according to whether or not they exhibited histologically proven endometriosis. Statistical analyses were conducted using univariate and multivariate logistic regression models. MAIN RESULTS AND THE ROLE OF CHANCE: Two hundred and seventy-one patients answered all the questions of the survey: 168 with (endometriosis group) and 103 without endometriosis (control group). The mean ± SD overall population age was 32.2 ± 5.1 years. There were 136 (80.9%) and 48 (46.6%) women who experienced at least one severe pelvic pain symptom in the endometriosis and the control groups, respectively (P < 0.001). No differences were found between the two study groups regarding the following characteristics: (i) a history of sexual, physical, or emotional abuse; (ii) a history of abandonment or bereavement; (iii) the psychological state regarding puberty; and (iv) the family relationships. After multivariable analysis, we found no significant association between endometriosis and a history of sexual abuse during childhood and/or adolescence (P = 0.550). However, the presence of at least one severe pelvic pain symptom was independently associated with a history of sexual abuse (odds ratio = 3.6, 95% CI (1.2-10.4)). LIMITATIONS, REASONS FOR CAUTION: Evaluation of the psychological state during childhood and/or adolescence can be subject to recall bias. In addition, selection bias is also a possibility given that some of the patients surveyed did not return the questionnaire. WIDER IMPLICATIONS OF THE FINDINGS: Severe gynecological painful symptoms in women with or without histologically proven endometriosis may be linked to sexual abuse experienced during childhood and/or adolescence. Patient questioning about painful symptoms and abuses is important to provide comprehensive care to the patients, from a psychological to a somatic point of view. STUDY FUNDING/COMPETING INTEREST(S): No funding or competing interests. TRIAL REGISTRATION NUMBER: N/A.

False-Positive Ethanol Level in Urine and Plasma Samples of a Resuscitated Infant.

We report the case of an 11-month-old male infant with a complex congenital heart disease who was admitted in the intensive care unit following cardiorespiratory arrest at home. Toxicological urine screening reported an ethanol concentration of 0.65 g/L using an enzymatic assay, without suspicion of alcohol intake; a significant amount of ethanol concentration was found in two plasma samples using the same enzymatic assay. Plasma and urine ethanol concentrations were below the limit of quantification (LOQ) when tested using a gas chromatography method. Urine ethanol level was also below the LOQ when tested by enzymatic assay after an initial urine ultrafiltration. These results confirmed our suspicion of matrix interference due to elevated lactate and lactate dehydrogenase levels interfering in the enzymatic assay. This analytical interference, well-known in postmortem samples, extensively studied in vitro, has been rarely reported in vivo, especially in children. To the best of our knowledge, this case is only the sixth one reported in an infant's plasma and the first initially discovered from urine. Indeed, as for ethanol, this last matrix has not been studied in the context of this artifact that may induce false-positive ethanol results while seeking a diagnosis in life-threatening or fatal situations that are potentially subject to forensic scrutiny. In parallel to a synthetic literature review, we propose a simple, informative decision tree, in order to help health professionals suspecting a false-positive result when performing an ethanol assay.

[Developing of an integration and training course for sterilization agents]. / Mise en place d'un parcours d'intégration et de formation pour les agents de stérilisation.

Until September 2018, there was no formal training or evaluation for sterilization agents at Nancy's hospital (CHRU). The goal was to create a formalized training path, to record the training and the evaluation of an agent using a written support. All the training resources available in the service have been identified and the missing tools have been created. A typical induction period has been created. It is divided into large parts: a welcome week followed by several weeks of training. The welcome week consists of observing all the activities of the service. The following training is divided into two parts. It begins with a theoretical training followed by 12weeks of practical training. The next 12weeks are dedicated to develop their knowledge. Follow-up is ensured through theoretical and practical evaluations, a grid of activities to be mastered completed as and when learning and a monitoring sheet on which are formalized weekly interviews with the pharmaceutical team. Finally, a logbook has been created and brings together all the useful documents for an agent throughout his career as a sterilization agent. The aim of the training path is to guide and involve the new agents, from their arrival in sterilization service to their continuous training, and to standardize the professional practices. It remains to be seen whether the tools put in place improve the knowledge and skills of the staff.

[Cognitive decline in geriatric oncology: Trends, evaluation and treatment]. / Cancer de la personne âgée : rechercher, évaluer et prendre en charge le déclin cognitif.

Cancer prevalence increases with aging. Prevalent or incident neurocognitive disorders are frequent in geriatric oncology. Cognitive decline associated with cancer increases the risk of under or over-cancer treatment and makes therapeutic decisions complex. In this context, we present tools to optimize cognitive impairment screening, identification of underlying mechanisms and specific treatments. Geriatric specialists intervention can help global care, social services utilization and patient's orientation when ambulatory cares become difficult.

[The Confusion Assessment Method: Transcultural adaptation of a French version]. / Adaptation transculturelle francophone de la Confusion Assessment Method.

INTRODUCTION: The Confusion Assessment Method (CAM) is a validated key tool in clinical practice and research programs to diagnose delirium and assess its severity. There is no validated French version of the CAM training manual and coding guide (Inouye SK). The aim of this study was to establish a consensual French version of the CAM and its manual. METHODS: Cross-cultural adaptation to achieve equivalence between the original version and a French adapted version of the CAM manual. RESULTS: A rigorous process was conducted including control of cultural adequacy of the tool's components, double forward and back translations, reconciliation, expert committee review (including bilingual translators with different nationalities, a linguist, highly qualified clinicians, methodologists) and pretesting. A consensual French version of the CAM was achieved. CONCLUSION: Implementation of the CAM French version in daily clinical practice will enable optimal diagnosis of delirium diagnosis and enhance communication between health professionals in French speaking countries. Validity and psychometric properties are being tested in a French multicenter cohort, opening up new perspectives for improved quality of care and research programs in French speaking countries.

[A woman with increasing pain after cholecystectomy]. / Een vrouw met toenemende buikpijn na cholecystectomie.

A 25-year-old female presented with abdominal pain and collapse 3 days after a laparoscopic cholecystectomy. The MRCP images suggested a leakage from the stump of the cystic duct. However, an ERCP showed a leakage of a subvesical bile duct arriving from the left hepatic duct. Diagnostic and treatment modalities are discussed.

Ultra high performance liquid chromatography-quadrupole-time of flight analysis for the identification and the determination of resveratrol and its metabolites in mouse plasma.

Resveratrol is a polyphenol that has numerous interesting biological properties, but, per os, it is quickly metabolized. Some of its metabolites are more concentrated than resveratrol, may have greater biological activities, and may act as a kind of store for resveratrol. Thus, to understand the biological impact of resveratrol on a physiological system, it is crucial to simultaneously analyze resveratrol and its metabolites in plasma. This study presents an analytical method based on UHPLC-Q-TOF mass spectrometry for the quantification of resveratrol and of its most common hydrophilic metabolites. The use of (13)C- and D-labeled standards specific to each molecule led to a linear calibration curve on a larger concentration range than described previously. The use of high resolution mass spectrometry in the full scan mode enabled simultaneous identification and quantification of some hydrophilic metabolites not previously described in mice. In addition, UHPLC separation, allowing run times lower than 10 min, can be used in studies that requiring analysis of many samples.

Catalase rs769214 SNP in elderly malnutrition and during renutrition: is glucagon to blame?

Impaired glucose tolerance is common during aging. The transcription factor PAX6 is involved in glucose homeostasis. Computational promoter sequence analysis of the catalase gene highlighted a putative PAX6 binding site on the rs769214 polymorphism A allele. Creation of this binding site has been suggested to explain renutrition inefficiency in malnourished elderly patients. Our aim was to evaluate the link between the rs769214 polymorphism of the catalase gene and glucose homeostasis in malnourished elderly patients at inclusion and during renutrition. Thirty-three malnourished elderly Caucasian inpatients were recruited. Nutritional and inflammatory statuses were assessed and a multiplex adipokine analysis was conducted at inclusion and discharge from the Geriatric Nutritional Care Unit at Charles-Foix Hospital (Ivry-sur-Seine, France). Serum glucagon, PAI-1, and TNF-α levels were significantly lower in the A-allele carriers at inclusion. During renutrition, A-allele carriers exhibited increased serum glucagon, PAI-1, and TNF-α variation. After renutrition, levels of these parameters were similar for A-allele carriers and G-allele carriers. A logistic ordinal multivariate regression analysis linked only variation of glucagon to rs769214 SNP. These results support a role for catalase SNP in the efficiency of renutrition in malnourished elderly patients via the modulation of glucagon secretion, probably involving PAX6.

Cost-effectiveness of a short stay admission programme for breast cancer surgery.

BACKGROUND: Short stay (admission, surgery, and discharge the same day or within 24 hours) following breast cancer surgery is part of an established care protocol but as yet not well implemented in Europe. Alongside a before-after multi-centre implementation study, an economic evaluation was performed exploring the cost-effectiveness of a short stay programme (SSP) versus care as usual (CAU). MATERIAL AND METHODS: In the implementation study, 324 patients were included. In the economic evaluation a societal perspective was applied with a six week time horizon. Cost data were obtained from Case Record Forms and cost diaries. Effectiveness was assessed by calculating Quality Adjusted Life Years (QALYs), using the EuroQol-5D. Cost-effectiveness was expressed as the incremental costs per QALY. RESULTS: Mean societal costs decreased by euro955,- (95% CI euro - 2104,- to euro157,-) for patients in SSP (n=127) compared with CAU (n=135). Mean healthcare costs differed euro883,- (95% CI euro - 1560,- to euro870,-) in favour of SSP. The incremental cost-effectiveness ratio could not be calculated due to similar effectiveness for both groups, i.e. the difference in QALYs was zero. The cost-effectiveness acceptability curves showed that the probability that SSP was more cost-effective than CAU was over 90% in the base-case analysis. DISCUSSION: A short stay programme as implemented is cost-effective compared with care as usual. In achieving good and more efficient quality of care, larger scale implementation is warranted.

[MRI imaging of the neural pituitary]. / Imagerie par résonance magnétique nucléaire de la neurohypohyse.

The main illness of the neural pituitary is diabetes insipidus (DI). MRI is essential if DI occurs during childhood, in order to highlight malignant germinoma prognosis of which remains excellent if the diagnosis is made as early as possible. In adults, primary intracranial tumours causing DI include craniopharyngioma, or pineal tumours. Infiltrative histiocytosis is another frequent aetiology. One third of previously considered idiopathic DI is in fact auto-immune. Early MRI findings advocate for such a diagnosis. Finally, meticulous analysis of the neural pituitary imaging may avoid several pitfalls and help the analysis of adenopituitary abnormalities.

Introduction of a breast cancer care programme including ultra short hospital stay in 4 early adopter centres: framework for an implementation study.

BACKGROUND: Whereas ultra-short stay (day care or 24 hour hospitalisation) following breast cancer surgery was introduced in the US and Canada in the 1990s, it is not yet common practice in Europe. This paper describes the design of the MaDO study, which involves the implementation of ultra short stay admission for patients after breast cancer surgery, and evaluates whether the targets of the implementation strategy are reached. The ultra short stay programme and the applied implementation strategy will be evaluated from the economic perspective. METHODS/DESIGN: The MaDO study is a pre-post-controlled multi-centre study, that is performed in four hospitals in the Netherlands. It includes a pre and post measuring period of six months each with six months of implementation in between in at least 40 patients per hospital per measurement period. Primary outcome measure is the percentage of patients treated in ultra short stay. Secondary endpoints are the percentage of patients treated according to protocol, degree of involvement of home care nursing, quality of care from the patient's perspective, cost-effectiveness of the ultra short stay programme and cost-effectiveness of the implementation strategy. Quality of care will be measured by the QUOTE-breast cancer instrument, cost-effectiveness of the ultra short stay programme will be measured by means of the EuroQol (administered at four time-points) and a cost book for patients. Cost-effectiveness analysis will be performed from a societal perspective. Cost-effectiveness of the implementation strategy will be measured by determination of the costs of implementation activities. DISCUSSION: This study will reveal barriers and facilitators for implementation of the ultra short stay programme. Moreover, the results of the study will provide information about the cost-effectiveness of the ultra short stay programme and the implementation strategy. TRIAL REGISTRATION: Current Controlled Trials ISRCTN77253391.

The patient's perspective of the quality of breast cancer care. The development of an instrument to measure quality of care through focus groups and concept mapping with breast cancer patients.

Quality of care is often described by professionals. However, in this study breast cancer patients participated in developing an instrument that reflects quality of care from the patient's perspective. Through focus groups and concept mapping patients' ideas on determinants of good quality of care were generated and categorised according to similarity and importance. Information from eight focus group interviews with a total of 72 participants yielded 221 quality of care aspects. Following reduction, 81 aspects were used for categorisation during six concept mapping sessions with 67 participants. After analysis, 55 aspects remained grouped into six clusters. This study was conducted with a large number of breast cancer patients, undergoing the full range of treatment modalities, in different hospitals, in different areas in the Netherlands. Therefore, this set of quality of care indicators can be considered valid and suitable for the evaluation of breast cancer care as experienced by patients.

Leptin a new biological marker for evaluating malnutrition in elderly patients.

BACKGROUND: There is no single universally accepted biochemical marker of nutritional status in the elderly. Many markers are affected by non-nutritional factors. OBJECTIVE: The purpose of this study was to determine the biological parameters best related to anthropometric markers of malnutrition in an elderly polypathological population, and determine cutoff values for these potential parameters to diagnose malnutrition. DESIGN: This prospective study enrolled 116 elderly hospitalized patients and 76 elderly outpatients. Nutritional status (albumin, transthyretin, body mass index (BMI), skinfold thickness) and biological parameters (leptin, insulin-like growth factor-1 (IGF-1), IGF binding protein-1 (IGFBP-1), IGFBP-3, C-reactive protein (CRP), orosomucoid) were assessed. We defined malnutrition according to the lowest quartile of BMI and skinfold thickness measured in a large healthy elderly French sample population. RESULTS: In this sample of elderly patients (age: 85+/-7 years old), leptin concentration was the only biological parameter significantly related to nutrition status. Independent correlations were found between leptin concentration and BMI, skinfold thickness and sex. The relationship between nutritional status and leptin concentration is significantly different in each sex: the more the patients are undernourished, the lower the leptin concentration in both sexes. The optimal leptin cutoff value for the diagnosis of malnutrition in this population was 4 microg/l in men (sensitivity 0.89, specificity 0.82) and 6.48 microg/l in women (sensitivity 0.90, specificity 0.83). CONCLUSION: Leptin concentration is highly correlated with anthropometric data whereas albumin or transthyretin are known to be also influenced by morbidity and inflammatory conditions. Serum leptin concentration could be used for nutritional assessment in elderly patients with acute diseases.

[Imaging follow-up of post-traumatic myelomalacia]. / Evolution d'une myelomalacie post-traumatique vers une syringomyelie: suivi iconographique.

The authors report a case of secondary worsening of neurological symptoms in a patient 2 months after cord injury at T5 causing paraplegia. The MRI showed myeolomalacia, which appears as cord oedema, located in the grey matter, extending increasingly from the initial lesion (eighth thoracic vertebra) to the bulb. This cord lesion known as grey matter cytotoxic oedema, evolved into a syringomyelic cavity.

[Cerebral gliomas: imaging diagnosis and follow-up]. / Imagerie cérébrale des gliomes: diagnostic et suivi conventionnels.

The management of gliomas evolves towards more aggressive strategies with a combination of surgery, radiotherapy and chemotherapy. Follow-up imaging based on morphological MRI, with simple and reproducible protocols, may be associated with functional MRI and spectroscopy. Baseline postsurgical MRI must be performed within the first three days. Follow-up examinations should be done 2 months after radiotherapy and during chemotherapy, usually after each cycle of two or three treatments. Continued follow-up after therapy is recommended to assess response and detect recurrences or therapeutic complications.

[Alzheimer's disease: cardiovascular risk factors must be assessed]. / Maladie d'Alzheimer: prendre en compte les facteurs de risque et pathologies cardiovasculaires.

BACKGROUND: Dementia is nowadays of major importance in public health. Alzheimer's disease and vascular cognitive impairments are its main aetiology in the elderly. The cause of Alzheimer's disease remains unknown. The factor initiating the physiopathology of this neurodegenerative disease is source of controversy. CURRENT KNOWLEDGE AND KEY POINTS: The theory of a neurotoxicity initiated by amyloid deposition is questioned. A growing number of data suggest a central role of cardiovascular risk factors and alteration of arterial walls, inducing chronic brain hypoperfusion, as the primary trigger in the physiopathology of the disease. These data are based on epidemiological, physiopathological, neuroimaging, neuropathological and pharmacological studies. However, the exact link between arteriosclerosis, vascular cognitive impairment and Alzheimer's disease remains controversial. FUTURE PROSPECTS AND PROJECTS: These debates point out the crucial importance of the assessment of cardiovascular risk factors, as a preventable cause, either of cognitive decline, morbidity and mortality. In this aim, major targets could be different when primary or secondary prevention are at stake. These controversies also suggest new research directions towards Alzheimer's disease physiopathology, and for pharmacological interventions aimed on the prevention of cognitive decline or the curative treatment for this disease.

[Appropriate drug prescribing in the elderly]. / Le bon usage des médicaments chez la personne âgée.

PURPOSE: The frequency of chronic illness and the expenditure of medications increase with the older age. If drug-prescribing is very often beneficial for the patients, elderly subjects are particularly exposed to the side-effects of medications, and to their consequences. Although the age in itself do not generally forbid a medication, it can modify some of the objectives and the modality of the treatment. CURRENT KNOWLEDGE AND KEY POINTS: Four main factors explain the growing frequency of the iatrogenic pathology in the old age: polymedication, pharmacological modifications that occur with the ageing process, lack of coordination between different prescribers, and physical and psycho-social deficiencies which are the keys for identifying the "frail elderlies". FUTURE PROSPECTS AND PROJECTS: In regard to the frequent polypathological conditions of the oldest patients, one does not have to consider a sum of sicknesses, but a global situation, and one needs to replace a condition in a general context, and to establish priorities in the goals of the treatment. Appropriate drug-prescribing also needs to take account of the latest medical recommendations concerning numbers of medications, and a more frequent involving of elderly subjects in clinical trials.

[Concerning: aging, the beginning of dialysis, the beginning of dependence: repercussions on the psychopathology of the very old dialysis patient]. / Le point sur: vieillissement, entrée en dialyse, entrée en dépendance: répercussion sur le psychisme du patient dialysé très âgé.

The incidence of psychopathology, particularly depression, is high in dialysed elderly patients whereas their perceived level of health in the mental domain is similar to that of a non-dialysed and, even younger, population. Although the losses associated with advancing years, chronic disease and then entry into dialysis renders the psyche of elderly people frail, they do not strictly add in negative terms: their psychological reserve or resignation helps very elderly people to tolerate dialysis and its constraints. However, maintaining functional autonomy (ability to provide for one's fundamental needs and preserve leisure activities) while remaining independent to take decisions (particularly in controlling ways of receiving assistance) and preserving close relationships emerge as major determinant factors of the quality of life of very elderly dialysed patients. Added to the dependency due to dialysis, losses in these domains very often represent a turning point by changing the patient's identity, predisposing to the development of relationship problems, leading the patient to question his self-esteem or even resulting in psychological dependency, which itself adversely affects the quality of life. These mechanisms of psychopathology may not hide the possibility of an underlying dementia.

[Symptoms and quality of life of hemodialysis patients aged 75 and over]. / Symptômes et qualité de vie de patients hémodialysés de plus de 75 ans.

BACKGROUND: The population of dialysed patients includes an increasing percentage of very elderly patients. Although their life expectancy continues to increase, there are few currently available data about their quality of life. OBJECTIVES: descriptive analysis of the determinants of quality of life, perceptual level of health and quality of life, and estimation of symptomatic complaints in a population of very elderly haemodialysed patients. METHOD: Study of 35 haemodialysed patients aged 75 years old and older, who answered a questionnaire divided into 7 parts, defining: the determinants of their quality of life by open-ended questions, the prevalence of complaints amongst 35 pre-determined symptoms, Folstein MMSE performance, scores on Katz (ADL) and Lawton (IADL) independence scales, SF-36 perceptual health scale, and score subjectively allocated by the patients to their quality of life. RESULTS: Maintenance of functional autonomy, independence in the decision-making process and maintaining good relationships with friends and family were major determinants of quality of life. Asthenia, the major complaint, was well reflected the reduced physical capabilities of the patients (mean SF-36 physical score: -1.1 SD). Despite the high prevalence of incapacitating painful symptoms (42%) and psychological symptoms (23%), autonomy remained satisfactory (mean ADL score: 5.6 out of 6 and IADL: 58%). The levels of perceptual health and of quality of life remained satisfactory for the majority of patients (mean mental SF-36 score: -0.06 SD, and 84% of the patients scored their quality of life > 5 out of 10). CONCLUSION: These figures indicate the considerable resources that these patients could mobilise. It also emerges as an additional argument against the exclusion, based only on the criteria of age and multiple pathologies, of the oldest patients from the access to dialysis.