Body-composition predictors of mortality in women aged ≥ 75 y: data from a large population-based cohort study with a 17-y follow-up.

BACKGROUND: The role of body composition as a risk factor for death remains controversial in older persons. OBJECTIVE: We determined the role of body-composition variables in mortality in older women. DESIGN: Longitudinal analyses were performed in a prospective cohort study of older women. Participants were 4574 community-dwelling women aged ≥ 75 y at the baseline visit (between January 1992 and April 1994). Several body-composition variables were assessed by using anthropometric measures and dual-energy X-ray absorptiometry at the baseline visit. The main outcome was overall mortality. Body-composition variables were body mass index (BMI; in kg/m(2)), hip circumference, waist circumference, waist-to-hip ratio, fat mass/height(2), lean mass/height(2), percentage of fat mass, percentage of lean mass, and the lean mass:fat mass ratio. RESULTS: The mean (± SD) age at baseline was 80.2 ± 3.8 y. During the 17.7 y (IQR: 17.2-18.1 y) of follow-up, 2876 women died. U-shaped in crude analyses and reversed J-shaped relations in adjusted analyses between BMI, hip and waist circumferences, fat mass/height(2), and risk of death were shown. Adjusted risk of death was significantly higher in participants with BMI ≤ 24.6 and fat mass/height(2) ≤ 8.2 kg/m(2). There was a negative linear association between fat mass (%) and risk of death: a 10% increase in fat mass was associated with a 12% reduction of mortality risk (adjusted HR: 0.88; 95% CI: 0.84, 0.92; P < 0.001). Linear and statistically significant relations were shown between lean mass/height(2) and risk of death in crude but not adjusted analyses. CONCLUSIONS: Risk of mortality was consistently higher in older women with low adiposity. No lean mass indicator was associated with risk of death. Clinicians should be alerted by low adiposity in older women.

Instrumental rotation for persistent fetal occiput posterior position: a way to decrease maternal and neonatal injury?

OBJECTIVE: To evaluate immediate perineal and neonatal morbidity associated with instrumental rotations performed with Thierry's spatulas for the management of persistent posterior occiput (OP) positions. METHODS: Retrospective study including all persistent occiput posterior positions with vaginal OP delivery, from August 2006 to September 2007. Occiput anterior deliveries following successful instrumental rotation were included as well. We compared maternal and neonatal immediate outcomes between spontaneous deliveries, rotational and non rotational assisted deliveries, using χ(2) and Anova tests. RESULTS: 157 patients were enrolled, comprising 46 OP spontaneous deliveries, 58 assisted OP deliveries and 53 deliveries after rotational procedure. Instrumental rotation failed in 9 cases. Mean age and parity were significantly higher in the spontaneous delivery group, while labor duration was shorter. There were no significant differences in the rate of severe perineal tears and neonatal adverse outcomes between the 3 groups. CONCLUSION: Instrumental rotation using Thierry's spatulas was not associated with a reduced risk of maternal and neonatal morbidity for persistent OP deliveries. Further studies are required to define the true interest of such procedure in modern obstetrics.

A higher risk of acute rejection of human kidney allografts can be predicted from the level of CD45RC expressed by the recipients' CD8 T cells.

Although transplantation is the common treatment for end-stage renal failure, allograft rejection and marked morbidity from the use of immunosuppressive drugs remain important limitations. A major challenge in the field is to identify easy, reliable and noninvasive biomarkers allowing the prediction of deleterious alloreactive immune responses and the tailoring of immunosuppressive therapy in individuals according to the rejection risk. In this study, we first established that the expression of the RC isoform of the CD45 molecule (CD45RC) on CD4 and CD8 T cells from healthy individuals identifies functionally distinct alloreactive T cell subsets that behave differently in terms of proliferation and cytokine secretion. We then investigated whether the frequency of the recipients CD45RC T cell subsets before transplantation would predict acute graft rejection in a cohort of 89 patients who had undergone their first kidney transplantation. We showed that patients exhibiting more than 54.7% of CD8 CD45RC(high) T cells before transplantation had a 6 fold increased risk of acute kidney graft rejection. In contrast, the proportions of CD4 CD45RC T cells were not predictive. Thus, a higher risk of acute rejection of human kidney allografts can be predicted from the level of CD45RC expressed by the recipients' CD8 T cells.

Faecal incontinence after first instrumental vaginal delivery using Thierry's spatulas.

OBJECTIVE: The purpose of this study is to estimate the prevalence of faecal incontinence after first vaginal delivery and to assess the impact of Thierry's spatulas-assisted delivery. METHODS: A prospective observational study of primiparas who underwent a vaginal delivery at term was conducted. Faecal incontinence was assessed at 2 and 6 months postpartum by a questionnaire (Wexner score >or=5 was considered significant). Univariate and multivariate analyses were performed. RESULTS: Five hundred thirty-eight women were recruited with undergoing 176 spatulas-assisted deliveries and 362 spontaneous vaginal deliveries. The response rate was 85.9% (2 months) and 80.5% (6 months). The prevalence of faecal incontinence was similar between the two groups at 2 months (14.3% and 9.7%). Episiotomy (odds ratio [OR] = 5.0) and maternal age over 35 years (OR = 4.1) were independently associated with faecal incontinence after adjustment. CONCLUSIONS: Anal symptoms are common after the first vaginal delivery. Thierry's spatulas do not increase the prevalence of faecal incontinence after delivery given that an episiotomy is performed.

Seasonal variations in frontoethmoidal meningoencephalocele births in Cambodia.

OBJECT: Frontoethmoidal meningoencephalocele (fMEC) is relatively common in many Southeast Asian countries, with devastating aesthetic and social consequences for affected children. No cause has been detected to date. Among other factors, the authors of this paper attempt to identify a statistically significant difference in the spread of fMEC births throughout the year compared with other births. This seasonal variation in the incidence of fMEC births may provide clues to the causes of this condition. METHODS: From a group of 175 children with fMEC who underwent surgery at the authors' humanitarian institution (Children's Surgical Centre) in Phnom Penh between 2004 and 2008, 86 children were studied. These children were born at full term and had an accurately recorded date of birth. The birth dates of this fMEC group were compared with a group of > 15,000 other live births at one of the main maternity units in Phnom Penh in 2005 and 2006. RESULTS: Seasonal variation in incidence of fMEC by month of birth was highly statistically significant (p < 0.001), with the peak of births occurring in the dry season (between March and May). This is in contrast to the control group, in which there was an equal distribution of births throughout the year. More than 85% of the parents of children with fMEC who the authors treated were farmers, but this figure reflects the composition of the Cambodian population. CONCLUSIONS: Uneven spread in the incidence of fMEC births throughout the year suggests that a seasonal factor during the wet season may be suspected in the pathogenesis of fMEC in Cambodia.

Difficulties with physical function associated with obesity, sarcopenia, and sarcopenic-obesity in community-dwelling elderly women: the EPIDOS (EPIDemiologie de l'OSteoporose) Study.

BACKGROUND: In elders, decreased muscle mass (sarcopenia) and increased fat mass (obesity) may contribute to difficulties with physical function. OBJECTIVE: The objective was to examine the association of obesity, sarcopenia, and their combination (sarcopenic-obesity) with self-reported difficulties performing physical function in a cohort of community-dwelling elderly women. DESIGN: We assessed muscle and fat mass by dual-energy X-ray absorptiometry and self-reported difficulties with physical function in 1308 healthy women aged > or =75 y. Sarcopenia was defined as an appendicular skeletal muscle mass < or =2 SD below the mean in a young female reference group. Obesity was defined as a percentage body fat above the 60th percentile. Thirty-six sarcopenic-obese, 90 purely sarcopenic, 435 purely obese, and 747 women with a healthy body composition were studied. Anthropometric measures, health status, lifestyle habits, and self-reported difficulties with 6 different physical functions were obtained. RESULTS: Compared with women with a healthy body composition and after adjustment for confounders, purely sarcopenic women had no increased odds of having difficulties for all of the physical functions assessed, purely obese women had a 44-79% higher odds of having difficulties with most of the physical functions assessed (P < 0.05), and sarcopenic-obese women had a 2.60 higher odds of having difficulty climbing stairs and a 2.35 higher odds of having difficulty going down stairs (all P < 0.05). CONCLUSIONS: Sarcopenia is not associated with physical difficulties in the absence of obesity. However, in the presence of obesity, sarcopenia tends to add difficulty for some physical functions.

Factors associated with overweight in preschool-age children in southwestern France.

BACKGROUND: Pediatric overweight and obesity are becoming an epidemic worldwide, which indicates the need for formulating preventive programs and policies during a child's early years. OBJECTIVE: We identified factors associated with overweight in young children in southwestern France. DESIGN: Children [n = 1780; x (+/-SD) age: 3.9 +/- 0.4 y] were recruited in kindergarten. Medical information on the parents, grandparents, and child as well as the child's 3-d dietary intake, participation in organized sports, and television-viewing habits were ascertained, and anthropometric measurements of the child were taken. RESULTS: The prevalence of overweight was 9.1% when using body mass index >or= 90th percentile of French reference curves as a cutoff. In a multivariate logistic regression, overweight at 4 y was associated with female sex, having an overweight mother, and having >or=1 diabetic grandparent; odds ratios (ORs; 95% CIs) for these variables were 1.9 (1.2, 3.0), 2.2 (1.0, 4.7), and 2.6 (1.6, 4.1), respectively. Being small or large for gestational age was not associated with the risk of overweight at 4 y, whereas this risk was increased for children who were overweight at 9 or 24 mo: ORs (95% CIs) were 4.0 (2.4, 6.9) and 11.7 (6.1, 22.2), respectively. Nutrient intakes did not differ significantly with weight status in girls; however, overweight boys had significantly greater energy and lipid intakes than did their nonoverweight counterparts. Overweight was positively associated with television viewing (>1 h/d) in both sexes and with participation in organized sports in girls only. CONCLUSIONS: A family history of overweight or diabetes, overweight in the first 2 y of life, and television viewing are associated with overweight at 4 y. These factors should be considered in developing programs for the prevention of overweight in early childhood.

Disability in obese elderly women: Lower limb strength and recreational physical activity.

CONTEXT: Disability in the obese may be a consequence of low muscle strength and inactivity. OBJECTIVE: We compared isometric knee extensor strength (KES) between obese (body mass index, BMI >29 kg/m(2)), normal (BMI [24-29]) and lean (BMI < 24) elderly and its association with disability. Then, we investigated the risk of disability in obese, normal, and lean participants according to their physical activity. METHODS: 215 obese (80.0 ± 3.5 y, BMI 31.9 ± 2.6), 630 normal (80.2 ± 3.7 y, BMI 26.3 ± 1.4) and 598 lean (80.7 ± 4.1 y, BMI 21.6 ± 1.8) women with good functional ability were studied. A cross-sectional design was used. Anthropometric measures, KES (statometers), health status, self-reported difficulties for physical function, disability (Instrumental and Basic Activity of Daily Living), and recreational physical activities (RPA; walking, gymnastics, cycling, swimming, and gardening) were obtained. RESULTS: KES was negatively and significantly associated with disability and functional difficulties. When KES was adjusted for age, RPA, pain, depression, visual impairment, steroid treatment, comorbidity, osteoporosis and, weight, an interaction effect between the BMI groups and RPA (p = 0.01) was found. KES significantly decreased in the sedentary women with increasing BMI but was not significantly different in active (≥1 h/week in ≥1 RPA for ≥1 month) women. Association between KES and self-reported difficulties for physical function was significantly lower in the active compared to the sedentary women and was not significantly higher in the active obese women. CONCLUSIONS: Low KES is associated with disability and difficulties for physical function in elderly women. The higher level of KES in participants engaged in RPA may prevent disability related to obesity.

Urinary aquaporin-2 excretion during early human development.

This study was undertaken to assess one of the determinants of kidney concentrating capacity, aquaporin-2 (AQP2), in order to understand the physiopathology of water balance in newborn babies. Urinary AQP2 excretion has been shown to be proportional to AQP2 level in the apical plasma membrane of the kidney collecting ducts and has been suggested as a marker of vasopressin (AVP) action. Urinary AQP2 excretion in the early postnatal period and at 3 weeks of age was measured in 123 neonates admitted during a 6-month period to the neonatal intensive care unit of the Children's Hospital of Toulouse, France. Clinical and biochemical data were collected for each child. During the first days after birth, higher urinary AQP2 was observed in boys than in girls (P=0.01) and positively correlated with urinary sodium/potassium (Na/K) ratio (r=0.33, P=0.01). When the babies had reached 3 weeks of age, urinary AQP2 was proportional to the gestational age at birth (r=0.33, P=0.0068) and daily weight gain (r=0.36, P=0.003). It did not correlate with urinary osmolality, which was overall very low in all babies. Urinary AQP2 was decreased in conditions of impaired renal function (r=-0.42, P=0.0005) and acidosis (P=0.03). Prenatal corticosteroid treatment had no significant impact on urinary AQP2 level. Our data show that urinary AQP2 correlates with the overall maturity of tubular function in human neonates. In babies at this early age, urinary AQP2 cannot serve as a direct marker of the renal action of AVP but reflects AQP2 expression level associated with different physiopathological conditions.

Risk of emergence of Pseudomonas aeruginosa resistance to beta-lactam antibiotics in intensive care units.

OBJECTIVE: The emergence of Pseudomonas aeruginosa resistance to antimicrobial drugs is frequent in intensive care units and may be correlated with the use of some specific drugs. The purpose of our study was to identify a relationship between the use of various beta-lactam antibiotics and the emergence of resistance and to characterize the mechanism of resistance involved. DESIGN: We conducted an open prospective study over a 3-yr period by including all patients in whom P. aeruginosa had been isolated from one or more specimens: bronchial aspiration, blood cultures, catheters, and urinary cultures. SETTING: General intensive care unit. PATIENTS: One hundred and thirty-two intensive care unit patients. INTERVENTIONS: The antibiotics studied were amoxiclav, piperacillin-tazobactam, cefotaxime, ceftazidime, cefepim, and imipenem. The mechanisms of resistance studied were production of penicillinase or cephalosporinase, nonenzymatic mechanisms, and loss of porin OprD2. Analysis was performed using Cox proportional-hazard regression with time-dependant variables. MEASUREMENTS AND MAIN RESULTS: Forty-two strains became resistant, 30 to one antibiotic, nine to two, and three to three, leading to the study of 57 resistant strains. Imipenem (hazard ratio 7.8; 95% confidence interval, 3.4-18.1), piperacillin-tazobactam (hazard ratio 3.9; 95% confidence interval, 1.3-11.9), and cefotaxim (hazard ratio 9.3; 95% confidence interval, 2.9-30.2) were strongly linked to the emergence of resistance. The use of imipenem (p<.0001) was associated with the loss of porin OprD2. Thirty-six strains from nine patients, assayed by pulsed-field gel electrophoresis, showed that for any one patient, all the strains were genetically related. CONCLUSIONS: Our results show that there is a high risk of the emergence of drug resistance during treatment with cefotaxime, imipenem, and piperacillin-tazobactam. This has to be taken into account in the therapeutic choice and in the patient's surveillance.