[Assessing post-hospitalization therapeutic ranges in elderly patients treated for atrial fibrillation with vitamin k antagonists]. / Évaluation de l'équilibre des AVK après hospitalisation, chez des sujets âgés, traités pour une fibrillation atriale.

BACKGROUND: In France, anticoagulants are among the most recommended treatments for serious accidents, particularly among the elderly. OBJECTIVES: The purpose of this study was to evaluate the impact of practical and validated tools designed to reduce the negative effects of vitamin K antagonist (VKA) treatments by assessing patients before and after the tools were implemented. METHODS: An exhaustive before and after multi-centric cohort study was performed in the Agen territory. The follow-up period corresponded to the six-month period post-hospitalization. The principal criterion was the time in the therapeutic range (TTR) at values of 2 to 3 according to the Rosendaal method. RESULTS: The overall time spent in the follow-up period before and after the implementation of the tools in 65- and 74-year-old patients was 58% and 64%, respectively (P=0.584). After the treatments, the TTR in the 85- to 90-year-old patients was 71.1%. An increase was observed in the number of subjects with a TTR≥70% after the implementation of the tools according to age, particularly in the 85- to 90-year-old patients (8 vs. 41; [P=0.01]). Prescription help software revealed a tendency of improvement in TTR values from 61% to 68% (P=0.472). In addition, longer therapeutic periods corresponded to longer patient lifespans (r=0.86). CONCLUSION: This study demonstrates the feasibility and advantages of implementing tools to improve the efficacy of VKA treatment in primary care, particularly for patients from 85 to 90 years old. The results should promote the implementation of this type of treatment method at the national level.

Purified deoxynivalenol or feed restriction reduces mortality in rainbow trout, Oncorhynchus mykiss (Walbaum), with experimental bacterial coldwater disease but biologically relevant concentrations of deoxynivalenol do not impair the growth of Flavobacterium psychrophilum.

Diets containing deoxynivalenol (DON) were fed to rainbow trout Oncorhynchus mykiss (Walbaum) for 4 weeks followed by experimental infection (intraperitoneal) with Flavobacterium psychrophilum (4.1 × 10(6) colony-forming units [CFU] mL(-1) ). Mortality of rainbow trout fed either 6.4 mg kg(-1) DON or trout pair-fed the control diet was significantly reduced (P < 0.05) in comparison with trout fed the control diet to apparent satiation (<0.1 mg kg(-1) DON). In a second experiment, trout were fed one of three experimental diets; a control diet, a diet produced with corn naturally contaminated with DON (3.3 mg kg(-1) DON) or a diet containing purified DON (3.8 mg kg(-1) ); however, these fish were not experimentally infected. The presence of DON resulted in significant reduction (P < 0.0001) in feed intake as well as weight gain after 4 weeks. Respiratory burst of head-kidney leucocytes isolated from rainbow trout fed diets containing purified DON (3.8 mg kg(-1) ) was significantly higher (P < 0.05) at 35 day post-exposure compared with controls. The antimicrobial activity of DON was examined by subjecting F. psychrophilum in vitro to serial dilutions of the chemical. Complete inhibition occurred at a concentration of 75 mg L(-1) DON, but no effect was observed below this concentration (0-30 mg L(-1) ).

The effect of diet on ontogenic development of the digestive tract in juvenile reared long snout seahorse Hippocampus guttulatus.

Ontogenetic development of the digestive tract and associated organs in long snout seahorse Hippocampus guttulatus juveniles was morphologically and histologically examined from the time of release from the male's pouch until 72 h after the first meal. When released from the male's pouch, juvenile seahorses are small adult replicates. This means that unlike other teleost fish larvae, the first developmental phase has already taken place, and juveniles are morphologically prepared and able to feed on live prey immediately following parturition. At this stage, the buccopharynx, oesophagus, and intestine already appear to be fully developed. The intestine is divided into the midgut and hindgut by an intestinal valve, and intestinal villi are visible in the midgut. When fed with DHA-Selco(®) enriched Artemia, H. guttulatus juveniles developed a severe condition of overinflation of the gas bladder. The continuous overinflation of the gas bladder forced air into the gut (48 h after the first meal), resulting in overinflation of both the gut and the gas bladder (72 h after the first meal), and death occurred within 120 h after the first meal. When fed natural copepods, H. guttulatus juveniles continued a normal feeding activity with no signs of intestinal disorders, and the gas bladder and intestine maintained their normal shape. This is the first study to positively associate gas bladder overinflation of juvenile seahorses with nutritionally unbalanced diets, and not to gas supersaturation alone. It is therefore necessary to develop more adequate feed and/or enrichment products to improve the survival of juvenile seahorses in captivity.

Dietary lipid quality and mitochondrial membrane composition in trout: responses of membrane enzymes and oxidative capacities.

To examine whether membrane fatty acid (FA) composition has a greater impact upon specific components of oxidative phosphorylation or on overall properties of muscle mitochondria, rainbow trout (Oncorhynchus mykiss) were fed two diets differing only in FA composition. Diet 1 was enriched in 18:1n-9 and 18:2n-6 while Diet 2 was enriched in 22:6n-3. The FA composition of mitochondrial phospholipids was strongly affected by diet. 22:6n-3 levels were twice as high (49%) in mitochondrial phospholipids of fish fed Diet 2 than in those fed Diet 1. 18:2n-6 content of the phospholipids also followed the diets, whereas 18:1n-9 changed little. All n-6 FA, most notably 22:5n-6, were significantly higher in fish fed Diet 1. Nonetheless, total saturated FA, total monounsaturated FA and total polyunsaturated FA in mitochondrial phospholipids varied little. Despite a marked impact of diet on specific FA levels in mitochondrial phospholipids, only non-phosphorylating (state 4) rates were higher in fish fed Diet 2. Phosphorylating rates (state 3), oxygen consumption due to flux through the electron transport chain complexes as well as the corresponding spectrophotometric activities did not differ with diet. Body mass affected state 4 rates and cytochrome c oxidase and F 0 F 1 ATPase activities while complex I showed a diet-specific effect of body mass. Only the minor FA that were affected by body mass were correlated with functional properties. The regulated incorporation of dietary FA into phospholipids seems to allow fish to maintain critical membrane functions even when the lipid quality of their diets varies considerably, as is likely in their natural environment.

Organically bound tritium (OBT) formation in rainbow trout (Oncorhynchus mykiss): HTO and OBT-spiked food exposure experiments.

In order to determine the rate of organically bound tritium (OBT) formation, rainbow trout (Oncorhynchus mykiss) were exposed to tritiated water (HTO) or OBT-spiked food. The HTO (in water) exposure study was conducted using a tritium activity concentration of approximately 7000 Bq/L and the OBT (in food) exposure study was conducted using a tritium activity concentration of approximately 30,000 Bq/L. Fish in both studies were expected to be exposed to similar tritium levels assuming 25% incorporation of the tritiated amino acids found in the food. Four different sampling campaigns of HTO exposure (Day 10, 30, 70, 140) and five different sampling campaigns of OBT-spiked food exposure (Day 9, 30, 70, 100, 140) were conducted to measure HTO and OBT activity concentrations in fish tissues. OBT depuration was also evaluated over a period of 30 days following the 140 d exposure studies. The results suggested that the OBT formation rate was slower when the fish were exposed to HTO compared to when the fish were ingesting OBT. In addition, the results indicated that OBT can bioaccumulate in fish tissues following OBT-spiked food exposure.

Dietary fatty acid composition changes mitochondrial phospholipids and oxidative capacities in rainbow trout red muscle.

Dietary conditioning of juvenile trout changed the acyl chain composition of mitochondrial phospholipids and the oxidative capacities of muscle mitochondria. Trout were fed three diets differing only in fatty acid (FA) composition. The highly unsaturated 22:6 n-3 (DHA) accounted for 0.4, 14, and 30% of fatty acids in Diets 1, 2 and 3. After 10 weeks of growth, the dietary groups differed markedly in FA composition of mitochondrial phospholipids, with significant dietary effects for virtually all FA. Mean mitochondrial DHA levels were 19, 40 and 33% in trout fed Diets 1, 2 and 3. Mitochondrial oxidative capacities changed with diet, while mitochondrial concentrations of cytochromes and of the adenylate nucleotide translocase (nmol mg(1) protein) did not. Mitochondria from fish fed Diet 1 had higher non-phosphorylating (state 4) rates at 5 degrees C than those fed other diets. When phosphorylating (state 3) rates differed between dietary groups, rates at 5 and 15 degrees C were higher for fish fed the more unsaturated diets. Stepwise multiple regressions indicated that FA composition could explain much (42-70%) of the variability of state 4 rates, particularly at 5 degrees C. At 15 degrees C, FA composition explained 16-42% of the variability of states 3 and 4 rates. Similar conclusions were obtained for the complete data set (trout fed diets 1, 2 and 3) and for the data from trout achieving similar growth rates (e.g. those fed Diets 1 and 2). Neither general characteristics of membrane FA, such as % saturates, unsaturation index, n-3, n-6 or n-3/n-6 nor levels of abundant unsaturated FA such as DHA or 18:1(n-9 + n-7), were systematically correlated with mitochondrial capacities even though they differed considerably between trout fed the different diets. Relatively minor FA (20:5n-3, 20:0, 18:2n-6, 18:3n-3, 18:0 and 15:0) showed better correlations with mitochondrial oxidative capacities. This supports the concept that acyl chain composition modulates mitochondrial capacities via interactions between membrane proteins and specific FA of particular phospholipid classes in their microenvironment.

Effect of DHA supplementation on digestible starch utilization by rainbow trout.

Rainbow trout has a limited ability to utilize digestible carbohydrates efficiently. Trout feeds generally contain high levels of DHA, a fatty acid known to inhibit a number of glycolytic and lipogenic enzymes in animals. A study was conducted to determine whether carbohydrate utilization by rainbow trout might be affected by dietary DHA level. Two low-carbohydrate (<4 % digestible carbohydrate) basal diets were formulated to contain 1 (adequate) or 4 (excess) g/100 g DHA diet respectively. The two basal diets were diluted with increasing levels of digestible starch (0 %, 10 %, 20 % and 30 %, respectively) to produce eight diets. These diets were fed to fish for 12 weeks at 15 degrees C according to a pair-fed protocol that consisted of feeding the same amount of basal diet but different amounts of starch. Live weight, N and lipid gains, hepatic glycogen and plasma glucose values significantly increased, whereas feed efficiency (gain:feed) significantly decreased, with increasing starch intake (P<0.05). The retention efficiency of N (N gain/digestible N intake) improved with starch supplementation but was not affected by DHA level (P>0.05). Starch increased the activity of glucokinase, pyruvate kinase, glucose 6-phosphate dehydrogenase and fatty acid synthase (P<0.05) but did not affect hexokinase and malic enzyme activity. DHA had no effect on growth but increased plasma glucose and reduced carcass lipid and liver glycogen contents (P<0.05). Glycolytic and lipogenic enzymes were not affected by DHA level, except for pyruvate kinase, which was reduced by increasing DHA level. These results suggest only a marginal effect of dietary DHA on the ability of fish to utilize carbohydrate.

Comparing efficiency of metabolizable energy utilization by rainbow trout (Oncorhynchus mykiss) and Atlantic salmon (Salmo salar) using factorial and multivariate approaches.

A study was conducted to compare utilization of ME for growth vs. maintenance in rainbow trout and Atlantic salmon. Fish were hand-fed to satiation one of four isoenergetic diets (DE = 20 MJ/kg, as-fed basis) with different digestible protein (DP) to DE ratios (24, 22, 20, and 18 g/MJ). Intake of ME (kJ/d), energy deposited as protein (PD, kJ/d), and energy deposited as lipid (LD, kJ/d) were determined by a comparative slaughter technique. Data were analyzed by a factorial approach or by multivariate analysis of PD and LD on ME. Maintenance energy requirements (ME(m)) and efficiency of ME utilization for PD (k(p)) and LD (k(f)) were estimated with both approaches. For the multivariate analysis, an additional parameter, the fraction of ME intake above maintenance used for PD (X) was defined as linear function of BW, with slope (d) and intercept (c) estimated simultaneously with the above parameters. Estimates were highly dependent on the approach and assumptions used. The ME(m) and k(p) values were higher and less accurate with the factorial approach than with multivariate analysis. The factorial approach estimated unrealistic k(f) values (k(f) > 1). With the multivariate analysis, ME(m) did not differ between species (20 kJ x d(-1) x kg(-0.8)). On the other hand, k(p) was significantly higher (e.g., 0.52 +/- 0.06 vs. 0.43 +/- 0.06; P < 0.05) for salmon than for trout and independent of diet, but k(f) was 0.81 (+/-0.13) regardless of species or diet. The ME intake above ME(m) used for PD (c) was higher in salmon than trout (57 vs. 55%; P < 0.05). The change in partitioning of ME for PD due to the change in BW was negative for trout (d = -0.18), but positive for salmon (d = 0.16). The d values agreed well with the increase of LD:PD ratio with BW for trout and the decrease of LD:PD with BW for salmon, which may have been related to the maturation status of this fish and the associated loss of body lipid observed by maturing salmon. In conclusion, ME(m) and cost of LD were similar for rainbow trout and Atlantic salmon, but the cost of PD was lower for salmon than for trout.

Active epidemiological surveillance of musculoskeletal disorders in a shoe factory.

AIMS: (1) To evaluate an active method of surveillance of musculoskeletal disorders (MSDs). (2) To compare different criteria for deciding whether or not a work situation could be considered at high risk of MSDs in a large, modern shoe factory. METHODS: A total of 253 blue collar workers were interviewed and examined by the same physician in 1996; 191 of them were re-examined in 1997. Risk factors of MSDs were assessed for each worker by standardised job site work analysis. Prevalence and incidence rates of carpal tunnel syndrome, rotator cuff syndrome, and tension neck syndrome were calculated for each of the nine main types of work situation. Different criteria used to assess situations with high risk of MSDs were compared. RESULTS: On the basis of prevalence data, three types of work situation were detected to be at high risk of MSDs: cutting, sewing, and assembly preparation. The three types of work situations identified on the basis of incidence data (sewing preparation, mechanised assembling, and finishing) were different from those identified by prevalence data. At least one recognised risk factor for MSDs was identified for all groups of work situations. The ergonomic risk could be considered as serious for the four types of work situation having the highest ergonomic scores (sewing, assembly preparation, pasting, and cutting). CONCLUSION: The results of the health surveillance method depend largely on the definition of the criteria used to define the risk of MSDs. The criteria based on incidence data are more valid than those based on prevalence data. Health and risk factor surveillance must be combined to predict the risk of MSDs in the company. However, exposure assessment plays a greater role in determining the priorities for ergonomic intervention.

Occupational and personal risk factors for carpal tunnel syndrome in industrial workers.

OBJECTIVES: The purpose of the study was to evaluate both nonoccupational and occupational factors associated with carpal tunnel syndrome (CTS) in industrial workers. METHODS: Sixty-five workers with CTS were compared with 65 referents matched for gender, age, and plant. The medical history and household activities of the workers and the ergonomic and organizational characteristics of the job were analyzed. RESULTS: Exertion of force over 1 kg was associated with CTS [odds ratio (OR) 9.0]. Two risk factors were related to motion repetitiveness: length of the shortest elementary operation of < or = 10 s (OR 8.8) and lack of change in tasks or lack of breaks for at least 15% of the daily worktime (OR 6.0). No posture of the upper limb was associated with CTS. Workstation design involving the manual supply of the workers (OR 5.0) and the lack of job rotation (OR 6.3) were associated with CTS. The only personal factor associated with CTS was a parity of at least 3 (OR 3.2). There was a continuous increase in the odds ratio against the number of risk factors accumulated by the workers; the odds ratio thus ranged from 5.6 when 3 of the 6 risk factors were present to > or = 90 when 4, 5, or 6 risk factors were accumulated. CONCLUSIONS: The results were in agreement with a model for CTS which included 1 personal and 5 occupational risk factors. The number of risk factors cumulated by the workers seems to be a major determinant of CTS.

[Socioeconomic stakes of menopause: evaluation of the cost-effectiveness studies]. / Enjeux socio-économiques de la ménopause: bilan des études coûts-efficacité.

The extension of hormonal replacement therapy to all women after their menopause as a preventive action is becoming a major public health issue. Cost-effectiveness analysis represents an appropriate tool to address the economical aspects of this issue. Out of the 3 studies reported in the past recent years on this topic, the Oxford Hormone Therapy Group study is the only one to take into account all possible outcomes of the hormonal replacement therapy. Its conclusions, however, cannot be extended directly to other countries, as the hormonal replacement therapy may differ in many aspects, like: 1) the chemical nature, metabolism and mode of administration of the hormones used, both as regard the oestrogen component and the progestative one; 2) the acceptability of the therapy in relation to its side effects; 3) the age-specific morbi-mortality data in relation to hip fractures, breast cancer and cardiovascular diseases.

La chirurgie à l'hôpital de district : obstétrique, gynécologie, orthopédie, et traumatologie

Le troisième guide de la série traite des interventions chirurgicales essentielles en cas de complications majeures de grossesse et d'accouchement ainsi que des lésions traumatiques et notamment des fractures et des brûlures. Les actes gynécologiques fréquemment pratiqués dans les petits hôpitaux sont également envisagés. L'ouvrage débute par six chapitres dans lesquels sont décrites les interventions essentielles permettant de traiter les principales complications de grossesse et d'accouchement, et d'éviter les décès maternels. Les urgences engageant le pronostic vital (dystocie d'obstacle, rupture de grossesse extra-utérine etc.) sont examinées, au même titre que certains actes obstétricaux plus généraux qui s'imposent souvent pendant et après l'accouchement. Les opérations gynécologiques occupent quatre chapitres dans lesquels sont décrits les actes gynécologiques généraux, les techniques de stérilisation féminine et de pose de stérilets, ainsi que les prélèvements biopsiques et cytologiques. Les 14 autres chapitres exposent les techniques essentielles utilisées en orthopédie et en traumatologie

Identification of different classes of superoxide dismutase in carnation petals.

Isoelectric focusing and nondenaturing two-dimensional electrophoresis, followed by an enzymatic characterization involving use of specific inhibitors were applied to identify the different forms of the superoxide dismutase (SOD) extracted from petals of cut carnation. Electrophoresis was carried out either with the crude extract or with fractions obtained after ion exchange chromatography of the extract. Three forms of the SOD were identified (Cu,Zn-SOD, Fe-SOD and Mn-SOD). They have close pI's (4.7 to 4.9) and most of them are composed of several isoforms.

Efficiency of a smooth desorption procedure for the purification of barley beta-amylase using immunoaffinity chromatography.

Immunoaffinity chromatography was used for a one step purification procedure of beta-amylase from the G25 Sephadex gel filtrated fraction of whole barley protein extracts. The immunoglobulin G (IgG) fraction of an anti-barley beta-amylase immune serum was immobilized on Ultrogel. A gentle desorption procedure was used, combining distilled water elution with an interrupted elution. The quality of the purification was assayed by using cross immunoelectrophoresis with a polyspecific anti-barley protein immune serum. The extent of the damaging effect of this procedure was evaluated on the specific activity of the enzyme and on its polymorphism, as displayed by isoelectric focusing. The results underline the efficiency of the purification procedure and its low denaturing effect on the beta-amylase. This opens new possibilities for some aspects of the enzyme study and for the purification of other biologically active proteins.

Desorption following immunoaffinity chromatography; generalization of a gentle procedure for desorbing antigen.

Possibilities for generalizing the use of 2 gentle procedures for desorption of antigens in immunoaffinity chromatography were investigated. The procedures involve the use of distilled water as desorbing agent and an interruption period during the desorption procedure. Six proteins of different nature and function (albumins, globulins, enzymes, glycoproteins) and of different origins (seeds, pollen, eggs) were tested with use of the corresponding immune sera. The IgG fractions of the immune sera were immobilized on either activated CNBr-Sepharose or Ultrogel. The procedure was used successfully for all the proteins except one which was denatured on short exposure to distilled water. With the 5 other proteins maximum yield of antigen was obtained by combining the use of distilled water with an interruption period during desorption. Ease of desorption depends on the antigen-antibody system. With antibarley beta-amylase antibodies immobilized either on CNBr-Sepharose or Ultrogel, desorption proved to be easier from Ultrogel.

Immunoaffinity chromatography of proteins. A gentle and simple desorption procedure.

A gentle procedure for desorption in immunoaffinity chromatography was investigated. Barley beta-amylase absorbed on the Sepharose-immobilized IgG fraction of the anti-barley beta-amylase immune serum was used in this study. Elution with water did not desorb the antigen by using a continuous elution procedure. However, desorption with water became effective when the elution procedure involved an interruption of a few hours. Several factors of the desorption in these conditions were further investigated. At best, up to 35% of the absorbed antigen could be desorbed in one fraction. Preliminary assays carried out with another plant protein and its corresponding antibodies provided similar results.