[Impact of a psychoeducational program on stress of caregivers of Alzheimer disease patients].
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Aged↗
Biomedical subjects
A Richard
Publications and source records attributed to A Richard.
[Percutaneous angioplasty of native coarctation of the aorta. Results in children and young adults].
The authors report the experience of one centre in the treatment of native coarctation of the aorta by percutaneous angioplasty. Between 1999 and August 2005, 22 patients (7 girls, 15 boys) underwent dilatation of their coarctation by a balloon catheter at an average age of 11.8 +/- 5 years and body weight of 44 +/- 21 kg. In 20 patients, balloon angioplasty alone was performed and, in the other two, the angioplasty was associated with the insertion of a covered CP stent. The dilatation was performed with a balloon/coarctation ratio of 2.18 +/- 0.6 (1.7 to 3.5) and a balloon/isthmus ratio of 1.0 +/- 0.23 (0.7 to 1.87). After the procedure, ascending aortic pressure decreased from 134.7 +/- 23.4 mmHg to 125 +/- 22.7 mmHg (p= 0.0003); descending aortic pressure increased from 93.4 +/- 14.9 mmHg to 104.8 +/- 21.7 mmHg (p= 0.003); transisthmic pressure gradient decreased from 41.7 +/- 14.1 mmHg to 19.8 +/- 9.5 mmHg (p< 0.0001) and the diameter of the coarctation increased from 5.9 +/- 2.6 mm to 9.3 +/- 2.6mm (p= 0.0015). The two patients treated by covered CP stents had excellent immediate results without significant residual gradients. After dilatation (sometimes repeated, N= 13), a gradient > 20 mmHg persisted in ten patients (36% of cases) but no predictive factor was found on statistical analysis. There were no cases of acute aneurysm. In one patient, the femoral pulse decreased but returned to normal with heparin therapy. No patient required emergency surgical treatment after the angioplasty. During the clinical follow-up, echocardiography and MRI showed no signs of aneurysm and one patient had mild irregularity of the isthmic region. Three patients underwent surgery by resection suture for persistent coarctation (one combined with a Ross procedure); another patient was treated by a CP stent. In conclusion, percutaneous angioplasty of native coarctation of the aorta gives satisfactory results with few complications in bigger children and young adults. The results can be improved by using a slightly higher balloon/coarctation ratio.
Adolescent↗
[The effect of an endothelin receptor antagonist in Eisenmenger syndrome: a single-center experience of 11 patients].
The Eisenmenger syndrome is a complication of congenital heart disease with significant left-to-right shunts, such as large ventricular septal defects, and corresponds to fixed pulmonary hypertension with shunt reversal. Bosentan, an inhibitor of endothelin A and B receptors, is a new molecule previously validated in the treatment of primary pulmonary hypertension. The authors report their monocentric experience of bosentan in 11 consecutive patients with the Eisenmenger syndrome treated for at least one year. This retrospective study comprised 7 females and 4 males with an average age of 34 years (range 17 to 51 years). The underlying lesion was ventricular septal defect (n = 4), atrial septal defect (n = 3), pulmonary atresia with septal defect (n = 4 of which 2 were treated palliatively). Before treatment, the patients were classified according to the NHYA functional class (I, II, IIIa and IIIb, IV or, respectively from 1 to 5) with a distribution in this series between Classes IIIa and IV (average 3.81 +/- 0.75) and from 3 to 10 on Borg's dyspnoea scale (average 6.54 +/- 2.29). The ambient oxygen saturation (SaO2) at rest was, on average 77 +/- 9%, the haemoglobin concentration 16.6 +/- 2.4 g/dl; hepatic transaminase levels were normal. The 6 minute walk test before treatment was 216 +/- 111 m with marked desaturation on exercise (49 +/- 18%). With Bosentan, patients were globally much better clinically with a decrease in dyspnoea, improvement in NHYA class and increased 6 minute walking perimeter. Improvement in NYHA class was observed from 3 months' treatment (3.0 +/- 0.8, p = 0.0002) and was sustained to one year (2.54 +/- 0.7, p< 0.001). An improvement of dyspnoea on Borg's scale was observed from the second month's treatment (5.56 +/- 1.65, p = 0.0201) and persisted throughout follow up to one year (3.81 +/- 1.32, p < 0.0001). Similarly, the 6 minute walking perimeter increased from the first control at 6 months (323 +/- 82 m, p < 0.0001) and at one year (322 +/- 62 m, p <0.0004). Finally, although a significant increase in SaO2 was observed at 6 months (p = 0.0032), this was hardly significant at one year (82 +/- 10 %, p = 0.0512). Transaminase levels did not rise significantly at the follow up visits (p = ns) and the haemoglobin concentration was unchanged. No patient died during the study period. This study showed a clear functional improvement in patients with Eisenmenger's syndrome treated with bosentan. The drug was well tolerated clinically with few adverse effects and a good safety margin of usage.
Adolescent↗
Single molecule study of perylene orange photobleaching in thin sol-gel films.
The paper reports on photobleaching mechanisms of perylene orange embedded in thin sol-gel films, derived from single molecule studies. The experimental configuration uses wide-field illumination and one photon excitation of the molecules. Measurements have been performed both at ambient conditions and under vacuum in order to get information on the influence of oxygen on photobleaching in such porous samples. We have also recorded the evolution of photobleaching with respect to the excitation intensity. The results demonstrate that photobleaching from excited states higher than the first singlet and triplet states has a nonnegligible contribution as soon as the excitation energy exceeds a few hundred W/cm2 and that this process is favored in the presence of air. The study also demonstrates that perylene orange in sol-gel films is not a very efficient emitter but that photobleaching can be slow, which explains the interest for perylene orange as a good candidate to produce long lifetime solid-state lasers when embedded in monoliths of sol-gel.
Journal Article↗
Omega- and Omega+ production in central Pb + Pb collisions at 40 and 158A GeV.
Results are presented on Omega production in central Pb+Pb collisions at 40 and 158A GeV beam energy. For the first time in heavy ion reactions, rapidity distributions and total yields were measured for the sum Omega(-) + Omega(+) at 40A GeV and for Omega(-) and Omega(+) separately at 158A GeV. The yields are strongly underpredicted by the string-hadronic UrQMD model but agree better with predictions from hadron gas models.
Journal Article↗
System-size dependence of strangeness production in nucleus-nucleus collisions at squareroot[sNN]=17.3 GeV.
Emission of pi+/-, K+/-, phi, and Lambda was measured in near-central C+C and Si+Si collisions at 158 AGeV beam energy. Together with earlier data for p+p, S+S, and Pb+Pb, the system-size dependence of relative strangeness production in nucleus-nucleus collisions is obtained. Its fast rise and the saturation observed at about 60 participating nucleons can be understood as the onset of the formation of coherent systems of increasing size.
Journal Article↗
[Factors altering low-flow drug delivery using syringe pumps: Consequences on vasoactive drug infusion in preterm infant].
UNLABELLED: The infusion of vasoactive drugs in preterm babies using syringe pumps can be complicated by important variations in the infusion rate. AIMS OF THE STUDY: 1) to assess the time between pump start and the actual presence of a substance in the circulation, when using slow rates; 2) to evaluate the effects of changes in the main infusion rate on substance rates infused on the same line. METHODS: We used 10% glucose to mimic vasoactive drugs. The main infusion consisted of saline, and both were infused on the same line using syringe pumps. Glucose concentration was measured at the end of the line. RESULTS: The time between pump start and the actual infusion of glucose depended on syringe volume and on the adjustment of the syringe in the pump. There was a transient increase in glucose rate when the main rate increased, and a transient decrease when the main rate decreased. CONCLUSION: To minimize the time before a substance is actually infused, one should use low volume syringes and correctly adjust the syringe in the pump. Moreover, when a steady infusion rate is necessary, one should avoid variations in the main infusion rate.
Equipment Design↗
[Desmoplastic fibroma or bone desmoid tumor: two cases].
Desmoplastic fibroma or desmoid bone tumor is a rare tumor described for the first time by Jaffe in 1958. It accounts for 0.1 to 0.3% of all benign bone tumors. To date, about 150 cases involving the locomotor system have been reported. Histology is required for certain diagnosis of desmoplastic fibroma. The tumor is composed of sparse fibroblasts in a rich background of collagen fibers, a histological presentation exactly the same as soft tissue desmoid fibroma. We report two new cases of desmoplastic fibroma of the locomotor system. The observations illustrate the radiological diagnosis. MRI was used to search for local extension in bone or soft tissues. Biopsy is necessary to confirm the diagnosis. The histological presentation may be difficult to recognized and distinguish from low grade fibrosarcoma. After treatment, the rate of local recurrence is high in the event of partial resection. Surgery is the optimal treatment, with tumor resection as wide as possible depending on the localization.
Adult↗
[Resection of a retroperitoneal schwannoma by a combined approach].
BACKGROUND AND PURPOSE: We report a remarkable case of retroperitoneal schwannoma with significant spinal growth illustrating the effectiveness of a combined surgical approach. METHODS: A 41-year-old man presented with a long history of back pain and unexplained weight loss. An abdominal mass was found in the right upper quadrant. The CT-scan revealed a partially cystic lesion located in the right psoas muscle. Spinal extension was noticed through the L1-L2 neural foramen. MRI better showed the wide rostro-caudal extension in the spinal canal. RESULTS: Bilateral L1 and L2 laminectomy was performed to remove the spinal portion of the tumor. It was extradural but attached to the dura. The roots were not infiltrated. The retroperitoneal mass was removed by an anterior transperitoneal approach. The histological examination did not reveal criteria of malignancy. CONCLUSIONS: Retroperitoneal schwannomas are rare and their preoperative diagnosis remains difficult. In case of significant spinal growth, a combined surgical exposure should be preferred to allow total removal of the lesion and control of the neurological structures.
Adult↗
[Revision total knee arthroplasty after unicompartmental femorotibial prosthesis: 54 cases].
PURPOSE OF THE STUDY: We analyzed technical difficulties encountered when performing revision total knee arthroplasty in patients with unicompartmental femorotibial prostheses. MATERIAL AND METHODS: This multicentric retrospective study included 54 revisions of unicompartmental femorotibial prosthesis with implantation of a total knee prosthesis. The series included 45 medial and nine lateral compartment prostheses. A gliding total knee prosthesis was implanted in 53 cases (98%) (39 standard, 14 revision). Mean time to failure of the unicompartmental prosthesis was four years. IKS scores were established at review. The radiological work-up included AP and lateral views in single leg stance and goniometry for 22 medial compartment revisions. Twenty-seven patients were seen for physical examination and x-rays and eight were lost to follow-up; data were recorded from medical files for 19 patients. RESULTS: The revision procedure was considered easy in 82% of the cases. Mean follow-up after revision was four years (range 2 - 12 years). Subjective outcome was very satisfactory for 56% of the patients, satisfactory for 36% and unsatisfactory for 8%. The mean function score was 62 points, the mean knee score 85 points, and the mean flexion was 113 degrees. No laxity was found for 90% of the knees. The femorotibial angle was 180 +/- 2 degrees in 46% of the patients. The mechanical femoral angle was 90 degrees in 54% of the patients with 2-4 degrees varus in 42%. The mechanical tibial angle was 90 degrees in 46% of the patients with 2-8 degrees valgus in 37%. Complications included pulmonary embolism (n=2), mobilization under general anesthesia (n=3), arthrolysis (n=1), lateral vertical patellectomy (n=1), and secondary infection (n=1). There were five failures requiring changing the total knee prosthesis. DISCUSSION: Loss of bone stock raises specific problems during revision of unicompartmental knee prostheses. Loss of tibial bone is more frequent but it is more difficult to correct for loss of femoral bone. A gliding knee prosthesis is generally preferred for first intention revision. We recommend a long stem when the bone defect is important or involves loss of cortical bone. We have had good mid-term results with revision total knee prostheses after unicompartmental prostheses. Longer follow-up is needed. Poor results were obtained when revision was performed for persistent pain without a clearly defined cause. The presence or not of significant bone loss did not appear to affect outcome. The observation of medial laxity in case of failed lateral unicompartmental prostheses suggests a more constrained total knee prosthesis might be indicated. Compared with earlier series, our results with total knee prostheses after unicompartmental prostheses appear to be better than after tibial valgus osteotomy and also better than after total knee arthroplasty. Conversely, they would be less satisfactory than for primary total knee arthroplasty. The surgical procedure for revision total knee arthroplasty after unicompartmental prosthesis requires precision and skill but is not technically difficult.
Aged↗
Specific Raman signatures of a dimetallofullerene peapod.
We report on the Raman spectroscopy of a dimetallofullerene peapod, (La(2)@C(80))(m)@SWNT. Drastic changes are observed with respect to pristine nanotubes. A sharp intense line at 142 cm(-1) is interpreted as a signature of polymerization of the encapsulated metallofullerenes. Additional strong signatures appear at about 400, 520, and 640 cm(-1), respectively. Their intensity suggests the existence of an enhancement effect. The stiffening and the up-shift of the G-band modes appear to imply that a charge transfer process between the nanotube and the peas occurs.
Journal Article↗
Summary version of the Standards, Options and Recommendations for the use of analgesia for the treatment of nociceptive pain in adults with cancer (update 2002).
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Adult↗
[Evolution of medical practice in the care of anemia amd the use of erythropoietin in chronic renal insufficiency hemodialysis in the past six years].
In order to analyze changes in anemia management in the hemodialysis patients, a retrospective survey was performed in 1999 on a representative French sample of patients in hemodialysis treated by EPO since 1992, 1994, 1996, and 1998 respectively. 368 patients were enrolled in 97 centres. At treatment initiation, some patients characteristics have significantly changed: the percentage of type 2 diabetic patients has increased marquedly from 4.5% in 1992 to 22.1% in 1998. The mean time lag between dialysis and EPO treatment initiation has decreased from 3.3 years to 0.9 on the 6-year period. Lastly, the mean hemoglobin level has increased from 73.7 to 78.5 g/l. No significant evolution in the EPO protocol was observed at the initiation as well as in the maintenance phase. An average percentage of 33.7% of patients were treated in i.v. route at initiation with a mean posology of 105.2 IU/kg (respectively 91.4 in s.c.). In the first year of follow-up, the overall mean posology was 84 IU/kg. In conclusion, this survey suggests that anemia management has been optimized over the last 6 years follow-up, including an earlier initiation of EPO treatment and a higher target of hemoglobin while EPO needs were reduced in the same time.
Anemia↗
Subregional variations of dietary consumption and incidences of cancers in southern France.
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Adult↗
[Quality of life of lumbago patients cared for in a pain center].
OBJECTIVE: To evaluate the quality of life of patients treated in a pain center. METHOD: Sixty eight patients were assessed during their first consultation, then 6, 12 and 18 months later, using a quality of life questionnaire "SQVP or Subjective Quality of Life Profile" validated in French populations and a panel of questionnaires for the monitoring of chronic pain, recommended by the ANAES (French Agency for Health Assessment). RESULTS: Results showed that: the patients' quality of life was clearly deteriorated (lowest quality in the data base--14,000 patients--with regard to the SQVP); the profile obtained (severe handicap) suggests that the lumbagos are part of a psychiatric context; the patients' quality of life clearly improves after 6 months' treatment, but the pain only stabilizes later.
Adult↗
Mechanisms of uptake and resistance to troxacitabine, a novel deoxycytidine nucleoside analogue, in human leukemic and solid tumor cell lines.
Troxacitabine (Troxatyl; BCH-4556; (-)-2'-deoxy-3'-oxacytidine), a deoxycytidine analogue with an unusual dioxolane structure and nonnatural L-configuration, has potent antitumor activity in animal models and is in clinical trials against human malignancies. The current work was undertaken to identify potential biochemical mechanisms of resistance to troxacitabine and to determine whether there are differences in resistance mechanisms between troxacitabine, gemcitabine, and cytarabine in human leukemic and solid tumor cell lines. The CCRF-CEM leukemia cell line was highly sensitive to the antiproliferative effects of troxacitabine, gemcitabine, and cytarabine with inhibition of proliferation by 50% observed at 160, 20, and 10 nM, respectively, whereas a deoxycytidine kinase (dCK)-deficient variant (CEM/dCK(-)) was resistant to all three drugs. In contrast, a nucleoside transport-deficient variant (CEM/ARAC8C) exhibited high levels of resistance to cytarabine (1150-fold) and gemcitabine (432-fold) but only minimal resistance to troxacitabine (7-fold). Analysis of troxacitabine transportability by the five molecularly characterized human nucleoside transporters [human equilibrative nucleoside transporters 1 and 2, human concentrative nucleoside transporter (hCNT) 1, hCNT2, and hCNT3] revealed that short- and long-term uptake of 10-30 microM [(3)H]troxacitabine was low and unaffected by the presence of either nucleoside transport inhibitors or high concentrations of nonradioactive troxacitabine. These results, which suggested that the major route of cellular uptake of troxacitabine was passive diffusion, demonstrated that deficiencies in nucleoside transport were unlikely to impart resistance to troxacitabine. A troxacitabine-resistant prostate cancer subline (DU145(R); 6300-fold) that exhibited reduced uptake of troxacitabine was cross-resistant to both gemcitabine (350-fold) and cytarabine (300-fold). dCK activity toward deoxycytidine in DU145(R) cell lysates was <20% of that in DU145 cell lysates, and no activity was detected toward troxacitabine. Sequence analysis of cDNAs encoding dCK revealed a mutation of a highly conserved amino acid (Trp(92)-->Leu) in DU145(R) dCK, providing a possible explanation for the reduced phosphorylation of troxacitabine in DU145(R) lysates. Reduced deamination of deoxycytidine was also observed in DU145(R) relative to DU145 cells, and this may have contributed to the overall resistance phenotype. These results, which demonstrated a different resistance profile for troxacitabine, gemcitabine, and cytarabine, suggest that troxacitabine may have an advantage over gemcitabine and cytarabine in human malignancies that lack or have low nucleoside transport activities.
Amino Acid Sequence↗
Topically applied vitamin C enhances the mRNA level of collagens I and III, their processing enzymes and tissue inhibitor of matrix metalloproteinase 1 in the human dermis.
Ascorbic acid (vitamin C) is a cofactor required for the function of several hydroxylases and monooxygenases. It is not synthesized in humans and some other animal species and has to be provided by diet or pharmacologic means. Its absence is responsible for scurvy, a condition related in its initial phases to a defective synthesis of collagen by the reduced function of prolylhydroxylase and production of collagen polypeptides lacking hydroxyproline, therefore, they are unable to assemble into stable triple-helical collagen molecules. In fibroblast cultures, vitamin C also stimulates collagen production by increasing the steady-state level of mRNA of collagen types I and III through enhanced transcription and prolonged half-life of the transcripts. The aim of the experimental work has been to evaluate the effect on dermal cells of a preparation of vitamin C topically applied on one side vs placebo on the other side of the dorsal face of the upper forearm of postmenopausal women. Biopsies were collected on both sides and the level of mRNA measured by non competitive reverse transcription-polymerase chain reaction made quantitative by the simultaneous transcription and amplification of synthetic RNA used as internal standards. The mRNA of collagen type I and type III were increased to a similar extent by vitamin C and that of three post-translational enzymes, the carboxy- and amino-procollagen proteinases and lysyloxidase similarly increased. The mRNA of decorin was also stimulated, but elastin, and fibrillin 1 and 2 were not modified by the vitamin. The expression of matrix metalloproteinases 1, 2, and 9 was not significantly changed, but an increased level of tissue inhibitor of matrix metalloproteinase 1 mRNA was observed without modification of tissue inhibitor of matrix metalloproteinase 2 mRNA. The stimulating activity of topical vitamin C was most conspicuous in the women with the lowest dietary intake of the vitamin and unrelated to the level of actinic damage. The results indicate that the functional activity of the dermal cells is not maximal in postmenopausal women and can be increased.
Administration, Topical↗
Genetic polymorphisms of the renin-angiotensin-aldosterone system in end-stage renal disease.
BACKGROUND: Hypertension contributes to the progression to renal failure. A genetic susceptibility to hypertension may predispose to the development of end-stage renal disease (ESRD) and promote a more rapid progression to ESRD in patients with renal diseases. Genes encoding for angiotensinogen (AGT), angiotensin-converting enzyme (ACE), and aldosterone synthase (CYP11B2) are candidates for abnormal blood pressure regulation. METHODS: Genotyping was performed in 327 control subjects and 260 ESRD patients for the M235T-AGT, the insertion/deletion (I/D)-ACE, and the -344T/C-CYP11B2 gene polymorphisms using polymerase chain reaction, gel analysis, and appropriate restriction digest when required. RESULTS: Genotype frequencies did not differ significantly between ESRD patients and controls. When ESRD diabetic subjects were compared with diabetic patients without nephropathy, the prevalence of the AGT-MM genotype was lower (28.1 vs. 52.8%, P < 0.01), while the AGT-TT genotype was higher (15.6 vs. 2.7%, P < 0.05). The AGT-TT genotype was associated with a faster progression to ESRD in patients with glomerulonephritis (P < 0.05). In the total ESRD population, progression of renal disease was faster with the ACE-DD than with the DI and II alleles (P < 0.05). This association was particularly strong when the interaction with the AGT genotype was analyzed, with a rapid progression in ACE-DD as compared with ACE-DI and II in patients with the AGT-MM genotype (P < 0.01). CONCLUSIONS: Susceptibility for ESRD and faster progression to ESRD are linked with the AGT genotype in diabetic patients. Faster progression to ESRD is associated with the ACE genotype when the total population with ESRD and with the AGT genotype when patients with glomerulonephritis are considered. Thus, genes of the renin-angiotensin-aldosterone system are candidate genes for further understanding of the interindividual differences in the development and course of ESRD.
Adult↗