[Evaluation of the interest of procalcitonin in the diagnosis of chorioamnionitis in preterm premature rupture of membranes. An observational and prospective study]. / Évaluation de l'intérêt de la procalcitonine pour le diagnostic de chorioamniotite dans les ruptures prématurées des membranes. Étude prospective observationnelle.

INTRODUCTION: Diagnosis of chorioamnionitis (CA) is difficult because all clinical and biological signs are rarely concordant. According to recent literature, PCT could act as a specific marker of bacterial infection. Our main objective was to assess whether PCT could improve our management of patients with preterm premature rupture of membranes (pPROM), allowing earlier and more specific diagnosis for CA. METHODS: Patients with pPROM from 24 and 34weeks of amenorrhea were included, from November 2013 to October 2014. PCT was collected twice a week, from pPROM until delivery. Obstetricians were blinded from PCT results, in order not to influence the management of the patients. PCT values were then compared to clinical and other biological diagnostic markers (CRP and white blood cells count [WBC]). RESULTS: Thirty patients were included, with 11 cases of histological CA and 5 early-onset neonatal sepsis. With a cut-off value of 0.05ng/mL, the sensitivity of PCT to detect histological CA was 54%, the specificity was 79% and the positive and negative predictive value were respectively 60% and 75%. The positive likelihood ratio was 2.57 and the negative likelihood ratio was 0.58. Using PCT values, our medical decision of foetal extraction would have change in 5 cases (in a wrong way in 3 of them). CONCLUSION: PCT in the diagnostic of CA is not useful in the management of patients.

How to manage recurrent falls in clinical practice: guidelines of the French Society of Geriatrics and Gerontology.

BACKGROUND: Health care professionals need a simple and pragmatic clinical approach for the management of recurrent fallers in clinical routine. OBJECTIVE: To develop clinical practice recommendations with the aim to assist health care professionals, especially in primary care in the management of recurrent falls. METHODS: A systematic English and French review was conducted using Medline, Embase, Pascal and Cochrane literature. Search included systematic reviews, meta-analyses, controlled trials, cohort studies, case-control studies and transversal studies published until July 31, 2008. The following Medical Subject Heading (MeSH) terms were used: "aged OR aged, 80 and over", "frail elderly", "Accidental Fall", "Mental Recall", and "Recurrent falls". The guidelines were elaborated according the Haute Autorite de Sante methods by a multidisciplinary working group comprising experts and practitioners. RESULTS: A fall is an event that results in a person coming to rest inadvertently on the ground or floor or other lower level and should be considered as a recurrent event as soon as a subject reported at least two falls in a 12-month period. Recurrent falls impose a prompt and appropriate management with the first aim to systematically evaluate the severity of falls. The evaluation of fall severity should be based on a standardized questionnaire and physical examination. It is recommended not to perform cerebral imaging in the absence of specific indication based on the clinical examination and to reevaluate the subject within a week after the fall. Prior to any intervention and after an evaluation of signs of severity, it is recommended to systematically assess the risk factors for falls. This evaluation should be based on the use of validated and standardized tests. The education of recurrent fallers and their care givers is required in order to implement appropriate intervention. In the event of a gait and/or balance disorders, it is recommended to prescribe physiotherapy. A regular physical activity should be performed with low to moderate intensity exercise. It is recommended to perform rehabilitation exercises with a professional, between therapy sessions and after each session, in order to extend rehabilitation benefits to the daily life. CONCLUSION: The clinical guidelines focused on management (i.e., diagnosis, assessment and treatment) of recurrent falls in clinical routine. They provide answers to the following clinical questions: 1) How to define recurrent falls? 2) How to identify severe falls? 3) How to assess recurrent falls? and 4) How to treat recurrent falls?

Disorder effects in pnictides: a tunneling spectroscopy study.

We present the synthesis and the tunneling spectroscopy study of superconducting FeSe(0.5)Te(0.5) (T(c) = 14 K), SmFeAsO(0.85) (T(c) = 54 K) and SmFeAsO(0.9)F(0.1) (T(c) = 45 K). The samples were characterized by Rietveld refinement of x-ray diffraction patterns and transport as well as temperature-dependent magnetic measurements. Tunneling experiments on FeSe(0.5)Te(0.5) revealed a single superconducting gap ∼ 1 meV in BCS-like tunneling conductance spectra. In SmFeAsO(0.85) and SmFeAsO(0.9)F(0.1), however, more complex spectra were observed, characterized by two gap-like structures at ∼ 4 and ∼ 10 meV. These spectra are qualitatively understood assuming a two-band superconductor with a 's ±' order parameter. We show that, depending on the sign relation between the pairing amplitudes in the two bands, the interband quasiparticle scattering has a crucial effect on the shape of the tunneling spectra. On the other hand, single-gap spectra found in FeSe(0.5)Te(0.5) are more compatible with a disorder-induced 's '-wave gap, due to the Se-Te substitution.

Stops walking when talking: a predictor of falls in older adults?

The objective of this study was to systematically review all published articles examining the relationship between the occurrence of falls and changes in gait and attention-demanding task performance whilst dual tasking amongst older adults. An English and French Medline and Cochrane library search ranging from 1997 to 2008 indexed under 'accidental falls', 'aged OR aged, 80 and over', 'dual task', 'dual tasking', 'gait', 'walking', 'fall' and 'falling' was performed. Of 121 selected studies, fifteen met the selection criteria and were included in the final analysis. The fall rate ranged from 11.1% to 50.0% in retrospective studies and from 21.3% to 42.3% in prospective ones. Amongst the three retrospective and eight prospective studies, two and six studies, respectively, showed a significant relationship between changes in gait performance under dual task and history of falls. The predictive value for falling was particularly efficient amongst frail older adults compared with healthy subjects. Two prospective studies challenged the usefulness of the dual-task paradigm as a significant predictor compared to single task performance and three studies even reported that gait changes whilst dual tasking did not predict falls. The pooled odds ratio for falling was 5.3 (95% CI, 3.1-9.1) when subjects had changes in gait or attention-demanding task performance whilst dual tasking. Despite conflicting early reports, changes in performance whilst dual tasking were significantly associated with an increased risk for falling amongst older adults and frail older adults in particular. Description of health status, standardization of test methodology, increase of sample size and longer follow-up intervals will certainly improve the predictive value of dual-task-based fall risk assessment tests.

Scanning tunneling spectroscopy on the novel superconductor CaC6.

We present scanning tunneling microscopy and spectroscopy of the newly discovered superconductor CaC6. The tunneling conductance spectra, measured between 3 and 15 K, show a clear superconducting gap in the quasiparticle density of states. The gap function extracted from the spectra is in good agreement with the conventional BCS theory with Delta0=1.6+/-0.2 meV. The possibility of gap anisotropy and two-gap superconductivity is also discussed. In a magnetic field, direct imaging of the vortices allows us to deduce a coherence length in the ab plane xiab approximately 33 nm.

Dual-task-related gait changes in the elderly: does the type of cognitive task matter?

Dual-task-related gait changes among older adults while they perform spoken verbal tasks have been reported frequently. The authors examined whether the type of walking-associated spoken verbal task matters for dual-task-related gait changes in 16 older adults classified as transitionally frail. Mean stride time increased significantly when they walked and performed an arithmetic or a verbal fluency task compared with when they only walked (p < .001), whereas the coefficients of variation increased significantly only when they walked and performed the arithmetic task (p = .005) but not the verbal fluency task (p = .134). Those findings suggest that stride time variability under a dual-task condition depends on the type of walking-associated spoken verbal task.

Similar planning strategies for whole-body and arm movements performed in the sagittal plane.

The present paper looks for kinematic similarities between whole-body and arm movements executed in the sagittal plane. Eight subjects performed sit-to-stand (STS) and back-to-sit (BTS) movements at their preferred speed in the sagittal plane. Kinematics analysis focused on shoulder motion revealed that STS was composed of a straight, forward displacement followed by a curved, upward displacement while BTS was characterized by a curved, downward and straight, backward displacement. Curvature of the upward displacement was significantly greater than the downward one. Analysis of shoulder-velocity profiles showed that movement duration was significantly longer for BTS compared with STS and that the shape of the velocity profiles changed when subjects performed an STS compared with a BTS movement. Velocity profiles of the upward and downward displacements also differed; the relative acceleration duration (acceleration duration divided by movement duration during the vertical motion) was smaller for the upward compared with the downward displacement. The present results are in accordance with previous findings concerning the execution of vertical arm movements and suggest that the CNS uses similar motor plans for the performance of arm and whole-body movements in the sagittal plane.

[Effectiveness of falls prevention strategies for elderly subjects who live in the community with performance assessment of physical activities (before-after)]. / Impact d'un programme de prévention multidisciplinaire de la chute chez le sujet âgé autonome vivant à domicile, avec analyse avant-après des performances physiques.

OBJECTIVES: The development of falls prevention strategies is an essential health concern in elderly people. However, a global consensus does not exist for elderly subjects who live independently in the community. The aim of the study was to evaluate the benefit of an exercises program. MATERIALS AND METHODS: A control group (153 subjects) and an "Intervention" group (150 subjects) were tested before and after a 1-year prospective study. The "Intervention" group performed ten training sessions of physical activity, based on balance, muscular activity and coordination. We compared the incidence of falls, and the performances in several tests between the two groups. RESULTS: The clinical features were similar between the two groups: mean age 71 years, 83% of females, subjects who were independent for activities of daily living. However, all subjects presented risk for factors for falls: 38% were not able to maintain the unipodal position more than five seconds, 29% had already fallen during the previous year. For the "Intervention" group, the comparison of the performances before and after the physical activity program showed significant increases (p < 0.001) for all the tests, and specifically for the unipodal position and for the exercises performed with eyes closed. After one year follow-up, the incidence rate of falls was lower in the "Intervention" group compared with the control group, but the difference was not significant (p = 0.32). However, falls occurred significantly latter in the "Intervention" group (p = 0.02). CONCLUSION: Ten training sessions of physical activity allowed to improve the performance of elderly people in several tests. This result suggests that a fall prevention program based on collective and regular exercises, may be efficient for elderly subjects who still have an active and independent way of live.

[Influence of a specific cognitive task on spatial-temporal walking parameters in elderly frail individuals]. / Etude de l'influence d'une tâche cognitive explicite sur les paramètres spatio-temporels de la marche du sujet âgé fragile.

OBJECTIVE: Walking is a complex voluntary rhythmic motor behaviour. Its implicit nature suggests that reduced attention resources are required for its execution. The aim of this study was to demonstrate that, to perform a mental calculation while walking, might modify the spatial-temporal parameters of walking in fragile elderly patients. METHODS: We compared the walking, in a straight line over a distance of 10 meters, of 30 fragile elderly subjects (mean age 82.6 +/- 7.1 years) with that of 30 healthy controls (mean age 37.5 +/- 11.5 years). Two walking conditions were studied: with and without a counting task. The time, number of steps, lateral deviations and stops were recorded on a video camera. RESULTS: The condition of a double-task provoked three types of effects on walking: an increase in time and the number of steps in both groups, but significantly greater in the elderly patients than in the control group of patients (6.4 s and 4.6 steps in the elderly versus 0.5 s and 0.4 steps in the controls); a reduction in the cadence and length of the step, only significant in the elderly patients, and a significant increase in the number of lateral deviations and stops in the double-task condition in the elderly patients. CONCLUSION: Globally, these results indicate that walking requires more attention resources in the elderly than in the middle-aged. The loss of the implicit character of walking to the benefit of cognitive attention resources may partly explain the high risk of falling in fragile elderly subjects.

[Development of a clinical test of gait in frail elderly by a cognitive approach of locomotion]. / Elaboration d'un test clinique de marche du sujet âgé fragile à partir d'une approche cognitive de la locomotion.

OBJECTIVE: From a cognitive approach of locomotion, we studied the feasibility and the reproducibility of a clinical test of gait which is devoted to predict fall. METHODOLOGY: With a cross-sectional design, we studied the gait of 30 old subjects (average age 82.6+/-7.1 years). The gait course consisted of a 10m length in a well light room, with regular walking shoes. Two conditions were examined: walking with and without explicit cognitive task (mental arithmetic and verbal flow task). Time (seconds) and number of steps were collected by two operators Deviations and stops were video-taped. Number of figures was recorded with a tape recorder. The difficulty to perform gait conditions was estimated by each subject with a quotation ranging from 0 (easy gait) to 10 (difficult gait). RESULTS: Increases of time, steps, deviations and stops were observed when gait was associated to a cognitive task (6.4 seconds and 4.6 steps with mental arithmetic; 10.5 seconds and 6.7 steps with verbal flow task). All subjects managed this test. These results were reproducible across tests and operators. Walking with mental arithmetic was the most easy gait condition for subjects. CONCLUSIONS: The simplicity and the reproducibility of this test make it as adequate instrument of gait evaluation in geriatrics. Walking with mental arithmetic is the condition that must to be used. Validation of its predictive value for fall in frail elderly subjects remains to be shown.

Heterogeneity in hepatic transport of somatostatin analog octapeptides.

Hepatic transport of the synthetic somatostatin analog octreotide-SMS 201-995, (D)Phe-Cys-Phe-(D)Trp-Lys-Thr-Cys-Throl--and its novel derivative N-alpha-(alpha-D-glucosyl(1-4)-1-deoxy-D-fructosyl)-octreotide--SD Z CO-611, N-alpha-(alpha-D-glucosyl(1-4)-1-deoxy-D-fructosyl)-(D)Phe-Cys-Phe- (D)Trp-Lys-Thr-Cys-Throl--was studied. In rats SMS 201-995 showed a plasma elimination half-life of 1.2 +/- 0.2 hr; that of SDZ CO-611 was 1.9 +/- 0.3 hours. Within 120 min 66% of a mesenterically injected 4.4-nmol dose of SMS 201-995 was excreted in bile, but only 5.3% of SDZ CO-611 was excreted in bile. Biliary concentration of SMS 201-995 showed a maximum enrichment of 540-fold +/- 75-fold over peripheral blood concentration, indicating hepatic transport mechanisms different from simple diffusion. Comparison of plasma profiles of both peptides after mesenteric and femoral administration demonstrated the relative importance of hepatic extraction for SMS 201-995 but not for SDZ CO-611. The mode of extraction was studied by means of multiple-indicator dilution in isolated perfused rat liver, with inulin as nonpermeable marker. Ratio plots, ln([inulin]/[peptide]) vs. time, exhibited decreasing slopes for SMS 201-995, suggesting very rapid binding to hepatocyte membranes. The slope of the ratio plot of (inulin/SDZ CO-611) was almost zero even at low doses (down to 0.2 microgram), implying mainly extracellular distribution and nonhepatic elimination. Binding assays indicated the absence of somatostatin receptors in sinusoidal hepatocyte membranes. However, SMS 201-995 and SDZ CO-611 bound with high affinity to somatostatin receptors in rat cortical membranes. Multiple-indicator dilution experiments in presence of increasing cholyltaurine concentrations suggested an interaction of SMS 201-995 with sinusoidal bile salt transport. In isolated hepatocytes, uptake of SMS 201-995 was saturable and showed mutual inhibition with cholyltaurine. The results indicate that SMS 201-995 transport is different from receptor mediated endocytosis as known for peptide hormones and elimination pathways of SDZ CO-611 other than biliary excretion.

Characteristics of bile salt uptake into skate hepatocytes.

The substrate specificity for the transporter that mediates the hepatic uptake of organic anions in freshly isolated hepatocytes of the elasmobranch little skate (Raja erinacea) was determined for bile salts and bile alcohols. The Na(+)-independent transport system exhibits a substrate specificity, which is different from the specificity of Na(+)-dependent bile salt transport in mammals. Unconjugated and conjugated di- and tri-hydroxylated bile salts inhibit uptake of cholyltaurine and cholate competitively. Inhibition is significantly greater with unconjugated as opposed to glycine- or taurine-conjugated bile salts. However, the number of hydroxyl groups in the steroid moiety of the bile salts has only minor influences on the inhibition by the unconjugated bile salts. Since the transport system seems to represent an archaic organic-anion transport system, other anions, such as dicarboxylates, amino acids and sulphate, were also tested, but had no inhibitory effect on bile salt uptake. To clarify whether bile alcohols, the physiological solutes in skate bile, share this transport system, cholyltaurine transport was studied after addition of 5 beta-cholestane-3 beta,5 alpha,6 beta-triol, 5 alpha-cholestan-3 beta-ol and 5 beta-cholestane-3 alpha, 7 alpha, 12 alpha-triol. These bile alcohols inhibit cholyltaurine uptake non-competitively. In contrast, uptake of 5 beta-cholestane-3 alpha,7 alpha,12 alpha-triol, which is Na(+)-independent, is not inhibited by cholyltaurine. The findings further characterize a Na(+)-independent organic-anion transport system in skate liver cells, which is not shared by bile alcohols and has preference for unconjugated lipophilic bile salts.