Changes in Physical Activity and Television Viewing From Pre-pregnancy Through Postpartum Among a Socioeconomically Disadvantaged Perinatal Adolescent Population.

STUDY OBJECTIVE: Adolescent pregnancy contributes to accelerated trajectories of adiposity and cardiometabolic diseases. Two potentially low-cost prevention strategies include promoting physical activity (PA) and limiting television (TV) viewing. Few studies have explored these behavior patterns in perinatal adolescents. This study sought to characterize PA and TV viewing in a socioeconomically disadvantaged perinatal adolescent population. DESIGN, SETTING, PARTICIPANTS, AND INTERVENTIONS: A cross-sectional, retrospective, 10-item survey was used to explore behavior patterns in 79 predominantly Black (86%) postpartum adolescents. MAIN OUTCOME MEASURES: Outcomes included self-reported changes in PA from pre-pregnancy through pregnancy, and 7-day recall of PA and TV viewing in postpartum. RESULTS: The majority of adolescents (66%) reported being active on ≥3 days/week in pre-pregnancy; however, many reported low PA (≤2 days/wk) in their first (59%), second (66%), and third (54%) trimesters. Adolescents who reported being active on ≥5 days/wk in pre-pregnancy (19%) experienced first trimester PA decline, which subsequently plateaued. This group remained the most active throughout pregnancy. In postpartum, over half (54%) of all adolescents reported low PA and irrespective of PA, spent considerable time watching TV (median = 1680.0 minutes, inerquartile range = 2940). CONCLUSION: Interventions promoting PA coupled with reducing TV viewing during pregnancy and in postpartum may benefit perinatal adolescents. The findings from this study suggest that PA history is a predictor of gestational PA, and low PA and high TV viewing in postpartum underscore the need for behavioral intervention. Conducting a brief assessment of PA history in early gestation may offer important insight.

Seasonal variation in dysplastic naevi.

There is a relationship between sunlight and the development of melanocytic neoplasms. Because the incidence and excision of melanocytic neoplasms varies according to season, we sought to determine if dysplasia and/or intraepidermal melanocytic expression differed in a cohort of dysplastic naevi (DN) removed in January compared with a similar cohort removed in August. The DN were graded based on the degree of dysplasia, and the number of intraepidermal melanocytes were counted after immunohistochemical staining with HMB-45 and Melan-A. There was no seasonal difference in the grading of the dysplastic naevi in either season (P = 0.08). Comparing 85 cases from August and 86 from January, there was a larger number of Melan-A-positive melanocytes in the August samples (P < 0.02), and a larger number of HMB-45-positive melanocytes in January (P < 0.01). This difference may be related to seasonal variations such as exposure to ultraviolet light exposure; however, there was no difference between the two groups in the degree of atypia seen.

Multiparameter scoring system for the prognosis of differentiated thyroid cancer.

UNLABELLED: The AIM of the study was to develop a scoring system consisting of multiple parameters that are significant for prognosis of thyroid cancer. The score was designed to permit a risk stratification with all available information at any time of presentation. PATIENTS, METHODS: A score using 25 parameters was used for 171 patients with differentiated thyroid cancer, who were included in follow up over a mean of 9 (+/- 5) years. The significance of each parameter as well as of a summation outcome score was determined. The result of this scoring system was compared to other scores reported in the literature applied to the same patients' group. Thirty-two out of the 171 patients presented with recurrence during follow up. RESULTS: The summation score was highly significant for prognosis of differentiated thyroid cancer. Out of 25 parameters, 18 showed a significant association with outcome also as individual parameters. In comparison to the scores commonly used, this new system showed the highest significance (p < 0.0001, chi square 90, df 1) to estimate recurrence free survival. At a cutoff of -5.95 the sensitivity and specificity for the distinction between high and low risk patients were 87.5 and 77.0%, respectively. CONCLUSION: With our multiparameter scoring system a reliable prognosis with respect to recurrence free survival is possible in patients suffering from differentiated thyroid cancer. A summation score of all parameters gives the best results. Scoring is also possible, if several important parameters are missing.

[Why screening for a renal artery stenosis?]. / Pourquoi dépister une sténose artérielle rénale?

Diagnosis of renal artery stenosis (RAS) should be discussed in numerous clinical situations including refractory high blood pressure (HBP), HBP in a polyvascular patient, degradation of renal function following renin angiotensin inhibitor or flash pulmonary edema. Ultrasound-doppler coupled with gadolinium-enhanced MR or CT angiography has proven adequate for most patients with RAS. Digital subtraction angiography should be limited to revascularisation procedures. Functional testing are not sensitive or specific enough because the degree of renin activation differs widely among patients with RAS. Renal percutaneous angioplasty induces a light to moderate decrease in blood pressure, has no effect on renal function but allows to reduce the number of anti-hypertensive drugs. Stenting completed angioplasty is worthwhile in most patients with atherosclerotic RAS. ACE inhibitors decrease mortality and increase renal function in patients with RAS.

[Clinical assessment of drug safety]. / Sécurité d'emploi des médicaments: évaluation clinique.

The environment of drug safety is changing. In addition to the current system of pharmacovigilance based on spontaneous report of adverse events, clinical data observed in a given patient with a given symptom is taken into consideration and compared with information coming from pharmacovigilance data bases, which is then analyzed for causality by the experts of both the promotor and the public network. Such information is integrated into a risk management strategy, defined together by the French drug agency (Afssaps) and the marketing authorization holder. This strategy includes a pharmacovigilance plan and, if possible, a risk minimisation plan.

[Non-surgical treatment of critical limb ischemia]. / Traitement de l'ischémie critique chronique des membres inférieurs en dehors de la revascularisation.

In critical limb ischemia, the aim of the treatment is to increase the arterial blood flow in the affected limb in order to relieve pain, heal trophic lesions, and avoid amputation. In patients in whom revascularization is not possible, medical treatment can occasionally be considered although it may not prevent limb loss in many patients. Medical strategies include the use of antalgics frequently opioids, antiplatet agents and prevention of venous thromboembolism. Selected patients may benefit from intravenous prostanoids, although their efficacy is unconstant. Maintenance of the bed in a dependant position may increase blood perfusion in the affected limbs. Gene and cell therapies, although promissing strategies, are currently evaluated in large clinical trials.

High and low volume resistance training and vascular function.

The aim was to examine the influence of high and low volume whole-body circuit weight training on forearm reactive hyperemic blood flow, venous capacitance and outflow in young individuals. Thirty-five individuals (age: 22 +/- 1.89 years) participated in an 8 station circuit performed 3 days/week for 5 weeks. The high volume group (n = 15) was encouraged to complete 3 sets/station, whereas the low volume group (n = 20) performed 1 set/station. Before and after training, muscle strength (hand grip, knee extension and bench press) and vascular function (reactive hyperemia, venous capacitance and outflow) were measured. Before training, there were no significant group differences. Training resulted in significant but similar strength gains in both groups (hand grip: 3.89 +/- 4.57 kg (+ 15.59 %), knee extension: 30.62+/- 12.52 kg (+ 35.31 %), bench press: 12.4 +/- 8.81 kg (+ 21.03 %); p < 0.05). Group averages for vascular function did not change following the circuit training. However, individuals with the lowest pretraining vascular measures did have significant increases in reactive hyperemic blood flow (17 %, p = 0.006) and venous outflow (18 %, p = 0.013), independent of group assignment. In conclusion, high and low volume circuit weight training results in significant and similar strength gains. Individuals with evidence of lower pretraining vascular function appear to respond favorably to short-term circuit weight training.

[Nuclear medicine techniques in the diagnosis of orthopaedic diseases]. / Nuklearmedizinische Diagnostik bei orthopädischen Erkrankungen.

Nuclear medicine techniques show metabolic processes, allowing the diagnoses of many bone and joint disorders. For most orthopaedic indications three-phase bone scintigraphy is used, showing inflammatory bone and joint diseases, traumatic and post-operative disorders as well as necrotic or malignant changes. In addition to bone scintigraphy, there are radiopharmaceuticals to depict inflammatory processes. Finally, positron emission tomography is a modern imaging technique used mainly for tumor diagnostics, but also for detection of inflammation.

Hypereosinophilia-induced digital necrosis in a smoking patient.

Raynaud's phenomenon and digital necrosis of the fingers are rare complications of hypereosinophilia. We report a case of a smoking male who developed Raynaud's phenomenon and digital necrosis of the fingers associated with idiopathic hypereosinophilia with angiographically documented occlusion of small and medium arteries of the extremities. The eosinophils may play a thrombotic role in vascular pathology and eosinophil blood count should be checked when investigating patients with digital gangrene.

Monitoring statistical magnetic fluctuations on the nanometer scale.

Statistical fluctuations of the magnetization are measured on the nanometer scale. As the experimental monitor we use the characteristic photoluminescence signal of a single electron-hole pair confined in one magnetic semiconductor quantum dot, which sensitively depends on the alignment of the magnetic ion spins. Quantitative access to statistical magnetic fluctuations is obtained by analyzing the linewidth broadening of the single dot emission. Our all-optical technique allows us to address a magnetic moment of only approximately equal 100 micro(B) and to resolve statistical changes on the order of a few micro(B).

Concurrent cardiovascular and resistance training in healthy older adults.

PURPOSE: The recommendations for exercise training and physical activity for older adults include cardiovascular and resistance training components (CVT and RT, respectively). The purpose of the present investigation was to compare the fitness benefits of concurrent CVT and RT with those attained through an equivalent duration of CVT or RT alone. METHODS: Thirty-six participants (ages 60-84) were assigned to a control group or to one of three exercise treatment groups. The treatment groups exercised three times per week for 12 wk using RT (N = 11), CVT (N = 10), or CVT and RT (BOTH, N = 9). Pre- and post-training, participants performed a submaximal exercise test (GXT), five repetition-maximum strength tests (5RM), and the AAHPERD functional fitness test for older adults. RESULTS: All exercise treatment groups revealed lower resting heart rate and rate-pressure product; lower exercise diastolic blood pressure and rating of perceived exertion; increased GXT duration; increased leg, back, and shoulder 5RM scores; and improved AAHPERD flexibility, coordination, and cardiovascular endurance scores. The exercise treatment groups responded differently on the following: RT and BOTH enhanced arm and chest strength more than CVT; and BOTH enhanced AAHPERD strength and agility scores more than CVT or RT. CONCLUSIONS: Concurrent CVT and RT is as effective in eliciting improvements in cardiovascular fitness and 5RM performance as CVT or RT, respectively. Moreover, incorporating both CVT and RT in exercise programs for older adults may be more effective in optimizing aspects of functional fitness than programs that involve only one component.

Modification of forearm vascular function following short-term handgrip exercise training.

This study examined the effect of low (25% of maximum voluntary contraction) and high (75% of maximum voluntary contraction) intensity short-term handgrip exercise training on localized vascular function. Forearm blood flow was evaluated in twenty-eight healthy men (age: 23 +/- 4.3) pre- and post-training in both forearms at rest, following forearm occlusion and following forearm occlusion combined with handgrip exercise using strain gauge plethysmography. The 4-week program consisted of non-dominant handgrip exercise performed 5 d/wk for 20 min at either low or high intensity. Following training a significant increase in forearm blood flow was noted for the nondominant arm in both groups after forearm occlusion (low intensity group: 16.51%; high intensity group: 20.72%; p = 0.001) and forearm occlusion combined with handgrip exercise (low intensity group: 17.71%; high intensity group: 29.27%; p = 0.001). No significant group by test interaction (p = 0.632) was found. These data show improved unilateral vasodilatory responsiveness after short-term handgrip training. In addition, the degree of change is most notable following the greatest vasodilatory stimulus. Lastly, a lack of group by treatment interaction suggests the change may be independent of training stimulus.

Forearm vasoreactivity in type 1diabetic subjects.

This study compared forearm vasoreactivity in 15 Type I diabetic subjects with 15 healthy controls. The groups were matched for age, exercise capacity, and the absence of other cardiovascular risk factors. Vasoreactivity was measured using strain gauge plethysmography, at rest, after arterial occlusion (OCC), and following OCC coupled with handgrip exercise (ROCC). Forearm blood flows were significantly elevated between conditions 2.58 +/- 0.37ml/100mltissue at rest to 26.80 +/- 6.56 after OCC and 32.80 +/- 8.26ml/100mltissue following ROCC in Type I diabetic subjects. There were no differences in forearm blood flow between groups for any of the conditions. These data indicate the degree of forearm blood flow is directly related to the intensity of the vasodilatory stimulus. However, our study did not reveal evidence of impaired vasodilatory capacity in Type I diabetic subjects compared to controls in the absence of other risk factors.

Influence of head-down and lateral decubitus neck flexion on heart rate variability.

The purpose of this study was to examine the response of heart rate variability (HRV), a noninvasive index of autonomic control, to head-down neck flexion (HDNF), which engages both otoliths and neck muscle afferents, and to lateral decubitus neck flexion (LNF), in which neck afferents are activated, whereas otolith afferent input is not. HRV and forearm blood flow were evaluated in participants lying prone, during HDNF, lying in the lateral decubitus position, and during LNF. Compared with the prone position, HDNF resulted in lower high-frequency (46.9 +/- 7.1 vs. 62.3 +/- 6.2) and higher low-frequency (53.1 +/- 7.1 vs. 37.7 +/- 6.2) power, expressed as normalized units, along with higher low-frequency-to-high-frequency ratio (1.65 +/- 0.3 vs. 0.78 +/- 0.2), whereas LNF resulted in no alterations in HRV indexes. Furthermore, there were no significant differences in forearm blood flow or vascular resistance among any of the positions. Our data suggest that otolith organs influence autonomic modulation of the heart, supporting previous studies reporting that HDNF elicits increased sympathetic outflow. These data further suggest that HDNF results in a parasympathetic withdrawal from the heart in addition to sympathetic activation.

Influence of age and normal plasma fibrinogen levels on flow-mediated dilation in healthy adults.

This study examined the effects of age-associated increases in fibrinogen on brachial artery flow-mediated dilation in 30 healthy nonsmokers. The findings demonstrate an inverse association between normal plasma fibrinogen levels and vascular function (r = -0.56, p = 0.001), suggesting elevated plasma fibrinogen may decrease the artery's responsiveness to certain vasodilatory signals, such as shear stress.

[Cost of hospitalizations for adverse drug effects]. / Coût des hospitalisations pour effet indésirable médicamenteux.

The French network of Regional Pharmacovigilance Centres evaluated in 1997 the prevalence of adverse effects of drugs (AED). In 1998, and again with the support of the French Drug Agency, in collaboration with the company CEMKA for economic evaluations, the incidence of AED-related hospitalizations in the medical department of French public hospitals was studied. The evaluation was performed over 14 consecutive days in 62 hospital departments, which were selected randomly. The total number of 3137 patients were hospitalized for a mean duration of 9 days and they were using a mean number of six different drugs. Taking into account the number of about 4 million patients admitted per year in the hospitals represented, it was estimated that the total number of AED-related hospitalizations amounts to about 130,000 annually (CI95%: 100,916-156,620). Using established cost calculations for hospitalized days (AP-HP, results of 1996) the mean cost for an AED-related hospitalization was estimated to be about FF16,000.