Approches cognitivo-comportementales dans la gestion de l'insomnie secondaire à la douleur chronique

Les plaintes de sommeil font partie intégrante du tableau clinique chez une proportion considérable de patients aux prises avec de la douleur chronique. Ces dernieers rapportent des difficultés à initier et à maintenir, le sommeil ainsi que des plaintes de sommeil non réparateur. L'évaluation polysomnographique confirme la présence de perturbations dans la continuité et l'architecture du sommeil. La relation entre douleur et insomnie est souvent bidirectionnelle: I'intensité de la douleur semble prédire la sévérité des difficultés de sommeil, et les difficultés de sommeil peuvent intensifier la perception de la sévérité de la douleur. Même si la douleur est souvent la source principale de l'insomnie, plusieurs facteurs comportementaux et psychologiques peuvent contribuer à exacerber et maintenir les difficultés de sommeil. Le traitement cognitivo-comportemental de l'insomnie vise à modifier ou éliminer ces facteurs. Les méthodes utilisées sont le contr?le par le stimulus, la restriction du sommeil, la relaxation, la restructuration cognitive et l'hygiène du sommeil. L'efficacité de ces traitements est bien établie pour l'insomnie primaire. Même si les données disponibles relatives à l'insomnie secondaire à la douleur chronique sont peu nombreuses, elles indiquent que l'approche cognitivo-comportementale représente une option thérapeutique très utile chez les patients aux prises avec de telles difficultés.     

Serotonergic modulation of the respiratory rhythm generator at birth: an in vitro study in the rat.

In order to investigate the mechanisms through which serotonin (5-HT) modulates the activity of the respiratory rhythm generator, respiratory activity was recorded from cervical ventral roots of the superfused isolated brainstem-spinal cord preparation of the newborn rat. Replacing the normal bathing medium by a medium containing 5-HT (30 microM) increased the respiratory frequency by 70% of the control value. Intact pontomedullary structures are necessary for this effect to take place, however, since the 5-HT-induced increases in respiratory frequency were no longer observed after elimination (section and electrolytic lesion) of the caudal ventro-lateral pons containing the A5 areas. Local applications of 5-HT (dual bath, microdialysis and microinjection experiments) revealed, however, that 5-HT acts at the medullary level and that its effects are not due to a diffuse action on all the neurons of the medullary respiratory centers but to a specific action focusing on structures located in the rostral ventro-lateral medulla.     

Evidence for Transovarial Transmission of Tomato Yellow Leaf Curl Virus by Its Vector, the WhiteflyBemisia tabaci

The whiteflyBemisia tabaciis the only vector of the tomato yellow leaf curl geminivirus (TYLCV). The insect transmits the virus in a persistent-circulative manner. TYLCV DNA was detected by polymerase chain reaction and by Southern blot hybridization in progeny (eggs, first and second instars, adults) of single viruliferous whiteflies that developed on eggplant or on cotton (two TYLCV nonhost plants). Furthermore, TYLCV DNA was present in the progeny of insects that had acquired the virus through the egg. The adult progeny of the viruliferous insects and their own progeny were able to infect tomato test plants, producing typical disease symptoms. Ovaries and maturing eggs of viruliferous insects contained viral DNA, as did eggs laid by viruliferous insects maintained on an artificial diet. Eggs laid by nonviruliferous whiteflies on cotton plants previously caged with viruliferous insects did not acquire viral DNA from the plant. Hence, TYLCV can be transmitted through the egg for at least two generations. In the absence of an available plant host, the whitefly may serve as a reservoir of the virus between growing seasons.     

Anterior Focal Adenomyosis and Bladder Deep Infiltrating Endometriosis: Is There a Link?

Study Objective

To evaluate the association between bladder deep infiltrating endometriosis (DIE) and anterior focal adenomyosis of the outer myometrium (aFAOM) diagnosed by preoperative magnetic resonance imaging (MRI).

Sleepiness and fatigue following traumatic brain injury

ObjectivesTo compare individuals with traumatic brain injury (TBI) to healthy controls (CTLs) on measures of sleepiness, fatigue, and sleep, and explore correlates of sleepiness and fatigue separately for each group.MethodsParticipants were 22 adults with moderate/severe TBI (time since injury ?1 year; mean = 53.0 ± 37.1 months) and 22 matched healthy CTLs. They underwent one night of polysomnographic (PSG) recording of their sleep followed the next day by the Maintenance of Wakefulness Test (MWT). They also completed a 14-day sleep diary, the Epworth Sleepiness Scale (ESS), the Functional Outcomes of Sleep Questionnaire (FOSQ), and the Multidimensional Fatigue Inventory (MFI).ResultsThere were no significant group differences on measures of objective (MWT) or subjective (ESS) sleepiness, both groups being quite alert. However, TBI participants reported greater consequences of sleepiness on their general productivity (FOSQ), spent more time in bed at night, and napped more frequently and for a longer time during the day. Subjective fatigue was significantly higher in TBI participants on the general, physical, and mental fatigue MFI subscales. There were no between-group differences on any sleep parameters derived either from PSG or sleep diary.ConclusionsFatigue appeared to be a more prominent symptom than sleepiness when assessed between 1 and 11 years after TBI. Participants with TBI used compensatory strategies such as increasing time spent in bed and daytime napping in this sample. Future research should document the time course of sleepiness and fatigue after TBI and investigate treatment options.     

Prevalence and types of aggressive behaviour among adults with intellectual disabilities

Background Aggressive behaviours represent major obstacles to the integration into society of individuals with intellectual disability (ID) and pose significant management issues for carers. Methods The present study assessed the prevalence and severity of five types of aggressive behaviours in 3165 adult men and women with ID receiving services from three rehabilitation agencies in Québec by surveying their carers using the Modified Overt Aggressive Scale. Results The 12‐month prevalence of aggressive behaviour was 51.8%: 24% property damage, 37.6% verbal, 24.4% self‐oriented and 24.4% physical aggression, and 9.8% sexually aggressive behaviour, most of which being mild in severity. Only 4.9% of individuals displayed aggressive behaviour leading to injury of the victim. Few gender differences were observed. Conclusions The capacity to document and assess the types as well as the severity of aggressive behaviour is thus critical, not only to better understand the correlates of various types of behaviours but also to orient intervention programmes whether they be prevention, assessment, monitoring or management of aggressive behaviour.     

Running from Paris to Beijing: biomechanical and physiological consequences

The purpose of this study was to examine the physiological and biomechanical changes occurring in a subject after running 8,500 km in 161 days (i.e. 52.8 km daily). Three weeks before, 3 weeks after (POST) and 5 months after (POST+5) running from Paris to Beijing, energy cost of running (Cr), knee flexor and extensor isokinetic strength and biomechanical parameters (using a treadmill dynamometer) at different velocities were assessed in an experienced ultra-runner. At POST, there was a tendency toward a ‘smoother’ running pattern, as shown by (a) a higher stride frequency and duty factor, and a reduced aerial time without a change in contact time, (b) a lower maximal vertical force and loading rate at impact and (c) a decrease in both potential and kinetic energy changes at each step. This was associated with a detrimental effect on Cr (+6.2%) and a loss of strength at all angular velocities for both knee flexors and extensors. At POST+5, the subject returned to his original running patterns at low but not at high speeds and maximal strength remained reduced at low angular velocities (i.e. at high levels of force). It is suggested that the running pattern changes observed in the present study were a strategy adopted by the subject to reduce the deleterious effects of long distance running. However, the running pattern changes could partly be linked to the decrease in maximal strength.