Prognosis of an abnormal one-leg balance in community-dwelling patients with Alzheimer's disease: a 2-year prospective study in 686 patients of the REAL.FR study

ObjectivesThe aim of this study was to explore the predictive value of an abnormal one-leg balance (OLB) test for functional decline, nursing home admission, and mortality in community-dwelling patients affected with Alzheimer’s disease (AD).DesignA 2-year prospective, observational cohort study.SettingNineteen memory centers across France.ParticipantsA total of 686 community-dwelling patients with AD.MeasurementsMini-mental state examination, Activity of Daily Living scale, and balance (ability to stand unassisted for 5 seconds on 1 leg) were reported every 6 months. Functional decline was defined as a loss of 0.5 or more points at a 5-point Activity of Daily Living score (bathing, dressing, toileting, continence, and feeding). Nursing home admission and mortality were recorded. Neuropsychiatric symptoms, medication, and caregiver’s burden were assessed every 6 months. Time-to-event analyses were used.ResultsAt baseline, 632 patients with AD had a balance measurement (mean age = 77.8 years, SD = 6.9; 72.2% were women) and 15.2% had an abnormal OLB test: these patients were older, had lower mini-mental state examination and Activity of Daily Living scores, and more neuropsychiatric symptoms, osteoarthritis, comorbidities and medications (all P < .05). After adjustment for age and sex, the risk of functional decline (hazard ratio [HR]: 1.69; 95% confidence interval [CI], 1.26–2.26), nursing home admission (HR: 2.51; 95% CI, 1.69–3.73), and death (HR: 2.42; 95% CI, 1.43–4.11) was higher in patients with an abnormal OLB. After adjustment for other potential confounders, the presence of an abnormal OLB was significantly associated only with nursing home admission (HR: 1.73, 95% CI, 1.09–2.75).ConclusionIn the present study, an abnormal OLB predicts nursing home admission in patients with AD. Although statistically significant when solely adjusted for age and sex, an abnormal OLB test failed to predict functional decline and mortality when adjusted for multiple confounders.     

Macrolide-resistant Bordetella pertussis infection in newborn girl, France

A macrolide antimicrobial drug was administered to a newborn with cough. On day 23 of hospitalization, macrolide-resistant Bordetella pertussis was isolated from nasopharyngeal aspirates. DNA sequencing and PCR-restriction fragment length polymorphism showed a 2047 A-to-G mutation in the 3 copies of the 23S rRNA gene. Monitoring for macrolide resistance is essential in infants <6 months of age.     

Three-dimensional prediction of free-flap volume in autologous breast reconstruction by CT angiography imaging

Purpose

   The diagnostic use of computer tomography angiography (CTA) to identify perforating blood vessels for abdominal free-flap breast reconstruction was extended to estimate the three-dimensional (3D) preoperative flap volume and to compare it with the real intraoperative flap weights in order to (1) evaluate the accuracy of CTA-based 3D flap volume prediction, and (2) to analyze abdominal tissue estimation for required breast volume reconstruction.

Methods

   Preoperative CTA was performed in 54 patients undergoing unilateral breast reconstruction with a free, deep, inferior epigastric artery perforator flap. 3D flap volumes ( \(\hbox {cm}^{3}\) ) based on CTA data were calculated and compared with the actual intraoperative flap weight (g). In addition, a breast volume to flap volume ratio was calculated to analyze whether the estimated 3D abdominal flap volume would match that of the breast to be removed.

Results

   40 CTA data sets (74.1 %) fulfilled the technical requirements for a reliable determination of flap volume. 3D CTA flap volume prediction showed no relevant differences to the actual flap weight (p = 0.44) and high correlations (r = 0.998, \(p < 0.001\) ), allowing a prediction accuracy within 0.29 \(\pm \) 3.0 % (range: from \(-\) 8.77 to 5.67 %) of the real flap weight. Significantly larger flap volumes were harvested compared with the actually required breast volumes ( \(p < 0.001\) ), leading to an average of 21 % of the remnant flap tissue potentially being discarded.

Conclusions

   CTA-based 3D flap volume prediction provides accurate preoperative guidelines concerning the needed amount of abdominal tissue that can be harvested to achieve acceptable symmetry.     

Cytotoxicity and genotoxicity of nanosized and microsized titanium dioxide and iron oxide particles in Syrian hamster embryo cells

Potential differences in the toxicological properties of nanosized and non-nanosized particles have been notably pointed out for titanium dioxide (TiO(2)) particles, which are currently widely produced and used in many industrial areas. Nanoparticles of the iron oxides magnetite (Fe(3)O(4)) and hematite (Fe(2)O(3)) also have many industrial applications but their toxicological properties are less documented than those of TiO(2). In the present study, the in vitro cytotoxicity and genotoxicity of commercially available nanosized and microsized anatase TiO(2), rutile TiO(2), Fe(3)O(4), and Fe(2)O(3) particles were compared in Syrian hamster embryo (SHE) cells. Samples were characterized for chemical composition, primary particle size, crystal phase, shape, and specific surface area. In acellular assays, TiO(2) and iron oxide particles were able to generate reactive oxygen species (ROS). At the same mass dose, all nanoparticles produced higher levels of ROS than their microsized counterparts. Measurement of particle size in the SHE culture medium showed that primary nanoparticles and microparticles are present in the form of micrometric agglomerates of highly poly-dispersed size. Uptake of primary particles and agglomerates by SHE exposed for 24 h was observed for all samples. TiO(2) samples were found to be more cytotoxic than iron oxide samples. Concerning primary size effects, anatase TiO(2), rutile TiO(2), and Fe(2)O(3) nanoparticles induced higher cytotoxicity than their microsized counterparts after 72 h of exposure. Over this treatment time, anatase TiO(2) and Fe(2)O(3) nanoparticles also produced more intracellular ROS compared to the microsized particles. However, similar levels of DNA damage were observed in the comet assay after 24 h of exposure to anatase nanoparticles and microparticles. Rutile microparticles were found to induce more DNA damage than the nanosized particles. However, no significant increase in DNA damage was detected from nanosized and microsized iron oxides. None of the samples tested showed significant induction of micronuclei formation after 24 h of exposure. In agreement with previous size-comparison studies, we suggest that in vitro cytotoxicity and genotoxicity induced by metal oxide nanoparticles are not always higher than those induced by their bulk counterparts.     

Seasonality of the dietary dimension of household food security in urban Burkina Faso

Food insecurity is affecting an increasing number of urban poor in the developing world. Yet seasonal characteristics of food intakes have rarely been studied in West African cities. The objective of the present study was to assess the seasonality of the dietary dimension of household food security in Ouagadougou (Burkina Faso). In 2007, two sets of data were collected during the lean and post-harvest seasons, respectively, on a representative sample of 1056 households. At each season, two non-consecutive 24 h recalls were performed at the household level. Food prices were also recorded. Household food security was assessed by the household's mean adequacy ratio (MAR) for energy and eleven micronutrients. Changes in the MAR according to the season were analysed by mixed multivariate linear regression. Results showed that intakes of energy and of ten micronutrients were significantly lower during the lean season than during the post-harvest season, leading to a lower MAR in the lean season (49·61 v. 53·57, P < 0·0001). This was related to less frequent consumption and consumption of smaller amounts of vegetables and of foods prepared at home. Food security relied heavily on food expenses (P < 0·0001) and on the price of meat/fish (P = 0·026). Households with economically dependent adults (P = 0·021) and larger households (P < 0·0001) were the most vulnerable, whereas education (P = 0·030), social network (P = 0·054) and urban origin other than Ouagadougou (P = 0·040) played a positive role in food security. To achieve food security in Ouagadougou, access to micronutrient-dense foods needs to be ensured in all seasons.