Is a pre-anaesthetic information form really useful ?

Background: All patients should be fully informed about the risks and benefits of anaesthetic procedures before giving a written consent. Moreover, the satisfaction level may vary in proportion to the information given. We aimed to determine, in a single-blind randomized-controlled study, whether an information form given before the pre-anaesthetic consultation could improve perceived information, information gain and satisfaction level. Methods: Two hundred patients ASA 1-3 scheduled for an elective orthopaedic surgery were randomized into two groups: a group that received an information form before the pre-anaesthetic consultation (IF group) and a control group (no information form). A standardized questionnaire was submitted after the pre-anaesthetic consultation and after the operation. This 17-item questionnaire explored perceived information (five items), information gain (three items) and satisfaction level (nine items). The items of each topic were pooled and compared between groups. Results: One hundred and eighty-five patients (92.5%) completed the study. The IF group had better perceived information (IF group 73% vs. control group 63%, P=0.002), higher information gain (IF group 75% vs. control group 62%, P=0.001) and a higher satisfaction level (IF group 95% vs. control group 92%, P=0.048). Conclusions: Our study suggests that an information form given before the pre-anaesthetic consultation enhances perceived information, information gain and satisfaction level. Méthode Cette étude prospective randomisée en simple aveugle a été conduite à l'hôpital Orthopédique du Centre Hospitalier Universitaire Vaudois. Deux cents patients prévus pour une chirurgie élective orthopédique ont été recrutés entre avril et juin 2008 et repartis en deux groupes selon une table de randomisation : un groupe recevait une feuille d'information 30 minutes avant la consultation préanesthésique, et l'autre pas. Les patients des deux groupes étaient ensuite examinés à la consultation preoperatoire par un anesthésiste indépendant de l'étude, puis recevaient un questionnaire standardisé. Ce questionnaire, issu de questionnaires existants, et validé préalablement sur un échantillon de 50 patients, comportait 17 questions qui exploraient la perception- de l'information (5 questions), le gain d'information (3 questions) et le niveau de satisfaction (9 questions) Parmi ces 17 questions, 3 étaient posées 24 h après l'intervention chirurgicale lors d'une visite dans la chambre ou lors d'un contact téléphonique. Les réponses étaient analysées et comparées entre les deux groupes. Résultats Cent huitante-cinq patients ont terminé l'étude. Le groupe qui a reçu la feuille d'information avait une meilleure perception de l'information (73% vs 63% dans le groupe de contrôle, ρ = 0 002) un gain d'information plus élevé (75% vs. 62% dans le groupe de contrôle, ρ = 0.001) et un niveau de satisfaction plus élevé (95% vs. 92% dans le groupe de contrôle, ρ= 0.048). Discussion et conclusion Cette étude a permis de démontrer que la remise d'une feuille d'information explicative avant la consultation préanesthésique était un moyen simple et bon marché pour améliorer la perception de l'information et le niveau de satisfaction.

Association of smoking and nicotine dependence with pre-diabetes in young and healthy adults.

INTRODUCTION: Several studies have shown an increased risk of type 2 diabetes among smokers. Therefore, the aim of this analysis was to assess the relationship between smoking, cumulative smoking exposure and nicotine dependence with pre-diabetes. METHODS: We performed a cross-sectional analysis of healthy adults aged 25-41 in the Principality of Liechtenstein. Individuals with known diabetes, Body Mass Index (BMI) >35 kg/m² and prevalent cardiovascular disease were excluded. Smoking behaviour was assessed by self-report. Pre-diabetes was defined as glycosylated haemoglobin between 5.7% and 6.4%. Multivariable logistic regression models were done. RESULTS: Of the 2142 participants (median age 37 years), 499 (23.3%) had pre-diabetes. There were 1,168 (55%) never smokers, 503 (23%) past smokers and 471 (22%) current smokers, with a prevalence of pre-diabetes of 21.2%, 20.9% and 31.2%, respectively (p <0.0001). In multivariable regression models, current smokers had an odds ratio (OR) of pre-diabetes of 1.82 (95% confidential interval (CI) 1.39; 2.38, p <0.0001). Individuals with a smoking exposure of <5, 5-10 and >10 pack-years had an OR (95% CI) for pre-diabetes of 1.34 (0.90; 2.00), 1.80 (1.07; 3.01) and 2.51 (1.80; 3.59) (p linear trend <0.0001) compared with never smokers. A Fagerström score of 2, 3-5 and >5 among current smokers was associated with an OR (95% CI) for pre-diabetes of 1.27 (0.89; 1.82), 2.15 (1.48; 3.13) and 3.35 (1.73; 6.48) (p linear trend <0.0001). DISCUSSION: Smoking is strongly associated with pre-diabetes in young adults with a low burden of smoking exposure. Nicotine dependence could be a potential mechanism of this relationship.

Early Variscan I-type pluton in the pre-Alpine basement of the Western Alps: The ca. 360 Ma Cogne diorite (NW-Italy)

Located at the internal border of the Grand-Saint-Bernard Zone, the diorite and its aureole lie on top of intensively studied Alpine eclogitic units but this pluton, poorly studied yet, has kept locally almost undeformed. The pluton intruded, at similar to 360 Ma, country-rocks mostly composed of dark shales with Na2O > K2O and minor mafic intercalations of tholeiitic basalt affinity. This association is characteristic of the Vanoise (France) basement series, where available age determinations suggest an Early Paleozoic age. Parts of the pluton, and of its hornfels aureole that is evidenced here for the first time, in the Punta Bioula section of Valsavaranche valley (NW-Italy), have been well-preserved from the Alpine deformation. Syn-emplacement hardening, dehydration-induced, probably prevented strain-enhanced Alpine recrystallization. Magmatic rock-types range continuously from subordinate mafic types at SiO2 similar to 48%, of hornblendite with cumulative or appinite affinities, to the main body of quartz diorite to quartz monzonite (SiO2 up to 62%). P-T estimates for the pluton emplacement, based on the abundance of garnet in the hornfelses, using also zircon and apatite saturation thermometry and Al-in-hornblende barometry, suggest T similar to 800-950 degrees C and minimum P in the 0.2-0.5 GPa range, with records of higher pressure conditions (up to 1-2 GPa?) in hornblendite phlogopite-cored amphibole. The high-K, Na > K, calcalkaline geochemistry is in line with a destructive plate-margin setting. Based on major element data and radiogenic isotope signature (epsilon Nd-360 Ma from -1.2 to + 0.9, Sr-87/Sr-86(360 MA) from 0.7054 to 0.7063), the parental magmas are interpreted in terms of deep-seated metabasaltic partial melts with limited contamination from shallower sources, the low radiogenic Nd-content excluding a major contribution from Vanoise tholeiites. There is no other preserved evidence for Variscan magmatism of similar age and composition in the Western Alps, but probable analogs are known in the western and northern parts of French Massif Central. Regarding the Alpine tectonics, not only the age of the pluton and its host-rocks (instead of the Permo-Carboniferous age previously believed), but also its upper mylonitic contact, suggest revisions of the Alpine nappe model. The Cogne diorite allegedly constituted the axial part of the E-verging ``pli en retour [backfold] du Valsavaranche'', a cornerstone of popular Alpine structural models: in fact, the alleged fold limbs, as attested here by field and geochemical data, do not belong to the same unit, and the backfold hypothesis is unfounded. (C) 2012 Elsevier B.V. All rights reserved.

Lack of tumor recognition by hTERT peptide 540-548-specific CD8(+) T cells from melanoma patients reveals inefficient antigen processing.

Telomerase is a ribonucleoprotein complex responsible for the maintenance of the length of the telomeres during cell division, which is active in germ-line cells as well as in the vast majority of tumors but not in most normal tissues. The wide expression of the human telomerase catalytic subunit (hTERT) in tumors makes it an interesting candidate vaccine for cancer. hTERT-derived peptide 540-548 (hTERT(540)) has been recently shown to be recognized in an HLA-A*0201-restricted fashion by T cell lines derived from peptide-stimulated peripheral blood mononuclear cells (PBMC) from healthy donors. As a first step to the inclusion of this peptide in immunotherapy clinical trials, it is crucial to assess hTERT(540)-specific T cell reactivity in cancer patients as well as the ability of hTERT-specific CD8(+) T lymphocytes to recognize and lyse hTERT-expressing target cells. Here, we have analyzed the CD8(+) T cell response to peptide hTERT(540) in HLA-A*0201 melanoma patients by using fluorescent HLA-A*0201/hTERT(540) peptide tetramers. HLA-A*0201/hTERT(540) tetramer(+) CD8(+) T cells were readily detected in peptide-stimulated PBMC from a significant proportion of patients and could be isolated by tetramer-guided cell sorting. hTERT(540)-specific CD8(+) T cells were able to specifically recognize HLA-A*0201 cells either pulsed with peptide or transiently transfected with a minigene encoding the minimal epitope. In contrast, they failed to recognize hTERT-expressing HLA-A*0201(+) target cells. Furthermore, in vitro proteasome digestion studies revealed inadequate hTERT processing. Altogether, these results raise questions on the use of hTERT(540) peptide for cancer immunotherapy.

Lateralization of olfactory processing: Differential impact of right and left temporal lobe epilepsies.

Olfactory processes were reported to be lateralized. The purpose of this study was to further explore this phenomenon and investigate the effect of the hemispheric localization of epileptogenic foci on olfactory deficits in patients with temporal lobe epilepsy (TLE). Olfactory functioning was assessed in 61 patients and 60 healthy control (HC) subjects. The patients and HC subjects were asked to rate the intensity, pleasantness, familiarity, and edibility of 12 common odorants and then identify them. Stimulations were delivered monorhinally in the nostril ipsilateral to the epileptogenic focus in TLE and arbitrarily in either the left or the right nostril in the HC subjects. The results demonstrated that regardless of the side of stimulation, patients with TLE had reduced performance in all olfactory tasks compared with the HC subjects. With regard to the side of the epileptogenic focus, patients with left TLE judged odors as less pleasant and had more difficulty with identification than patients with right TLE, underlining a privileged role of the left hemisphere in the emotional and semantic processing of odors. Finally, irrespective of group, a tendency towards a right-nostril advantage for judging odor familiarity was found in agreement with a prominent role of the right hemisphere in odor memory processing.

Comparisons of preoperative three-dimensional planning and surgical reconstruction in primary cementless total hip arthroplasty.

Reconstruction of important parameters such as femoral offset and torsion is inaccurate, when templating is based on plain x-rays. We evaluate intraoperative reproducibility of pre-operative CT-based 3D-templating in a consecutive series of 50 patients undergoing primary cementless THA through an anterior approach. Pre-operative planning was compared to a postoperative CT scan by image fusion. The implant size was correctly predicted in 100% of the stems, 94% of the cups and 88% of the heads (length). The difference between the planned and the postoperative leg length was 0.3 + 2.3 mm. Values for overall offset, femoral anteversion, cup inclination and anteversion were 1.4 mm ± 3.1, 0.6° ± 3.3°, -0.4° ± 5° and 6.9° ± 11.4°, respectively. This planning allows accurate implant size prediction. Stem position and cup inclination are accurately reproducible.

Teaching motivational interviewing to medical students : a pre-post test pilot study

Objective: To test the efficacy of teaching motivational interviewing (MI) to medical students. Methods: Thirteen 4th year medical students volunteered to participate. Seven days before and 7 days after an 8-hour interactive training MI workshop, each student performed a videorecorded interview with two standardized patients: a 60 year old alcohol dependent woman and a 50 year old cigarette smoking man. Students' counseling skills were coded by two blinded clinicians using the Motivational Interviewing Treatment Integrity 3.0 (MITI). Inter-rater reliability was calculated for all interviews and a test-retest was completed in a sub-sample of 10 consecutive interviews three days apart. Difference between MITI scores before and after training were calculated and tested using non-parametric tests. Effect size was approximated by calculating the probability that posttest scores are greater than pretest scores (P*=P(Pre<Post)+1/2P(Pre=Post)), P*>1/2 indicating greater scores in posttest, P*=1/2 no effect, and P*<1/2 smaller scores in posttest. Results: Median differences between MITI scores before and after MI training indicated a general progression in MI skills: MI spirit global score (median difference=1.5, Inter quartile range=1.5, p<0.001, P*=0.90); Empathy global score (med diff=1, IQR=0.5, p<0.001, P*=0.85); Percentage of MI adherent skills (med diff=36.6, IQR=50.5, p<0.001, P*=0.85); Percentage of open questions (med diff=18.6, IQR=21.6, p<0.001, P*=0.96); reflections/ questions ratio (med diff=0.2, IQR=0.4, p<0.001, P*=0.81). Only Direction global score and the percentage of complex reflections were not significantly improved (med diff=0, IQR=1, p=0.53, P*=0.44, and med diff=4.3, IQR=24.8, p=0.48, P*=0.62, respectively). Inter-rater reliability indicated weighted kappa ranged between 0.14 for Direction to 0.51 for Collaboration and ICC ranged between 0.28 for Simple reflection to 0.95 for Closed question. Test-retests indicated weighted kappa ranged between 0.27 for Direction to 0.80 for Empathy and ICC ranged between 0.87 for Complex reflection to 0.98 for Closed question. Conclusion: This pilot study indicated that an 8-hour training in MI for voluntary 4th year medical students resulted in significant improvement of MI skills. Larger sample of unselected medical students should be studied to generalize the benefit of MI training to medical students. Interrater reliability and test-retests suggested that coders' training should be intensified.

Role of the superior parietal lobules in letter-identity processing within strings: FMRI evidence from skilled and dyslexic readers.

Traditionally, the ventral occipito-temporal (vOT) area, but not the superior parietal lobules (SPLs), is thought as belonging to the neural system of visual word recognition. However, some dyslexic children who exhibit a visual attention span disorder - i.e. poor multi-element parallel processing - further show reduced SPLs activation when engaged in visual multi-element categorization tasks. We investigated whether these parietal regions further contribute to letter-identity processing within strings. Adult skilled readers and dyslexic participants with a visual attention span disorder were administered a letter-string comparison task under fMRI. Dyslexic adults were less accurate than skilled readers to detect letter identity substitutions within strings. In skilled readers, letter identity differs related to enhanced activation of the left vOT. However, specific neural responses were further found in the superior and inferior parietal regions, including the SPLs bilaterally. Two brain regions that are specifically related to substituted letter detection, the left SPL and the left vOT, were less activated in dyslexic participants. These findings suggest that the left SPL, like the left vOT, may contribute to letter string processing.

Organization of pre-Variscan basement areas at the north-Gondwanan margin

Pre-Variscan basement elements of Central Europe appear in polymetamorphic domains juxtaposed through Variscan and/or Alpine tectonic events. Consequently, nomenclatures and zonations applied to Variscan and Alpine structures, respectively, cannot be valid for pre-Variscan structures. Comparing pre-Variscan relics hidden in the Variscan basement areas of Central Europe, the Alps included, large parallels between the evolution of basement areas of future Avalonia and its former peri-Gondwanan eastern prolongations (e.g. Cadomia, Intra-Alpine Terrane) become evident. Their plate-tectonic evolution from the Late Proterozoic to the Late Ordovician is interpreted as a continuous Gondwana-directed evolution. Cadomian basement, late Cadomian granitoids, late Proterozoic detrital sediments and active margin settings characterize the pre-Cambrian evolution of most of the Gondwana-derived microcontinental pieces. Also the Rheic ocean, separating Avalonia from Gondwana, should have had, at its early stages, a lateral continuation in the former eastern prolongation of peri-Gondwanan microcontinents (e.g. Cadomia, Intra-Alpine Terrane). Subduction of oceanic ridge (Proto-Tethys) triggered the break-off of Avalonia, whereas in the eastern prolongation, the presence of the ridge may have triggered the amalgamation of volcanic arcs and continental ribbons with Gondwana (Ordovician orogenic event). Renewed Gondwana-directed subduction led to the opening of Palaeo-Tethys.

Allostatic working memory processing in schizophrenia: Human and animal model coherence

The most evident symptoms of schizophrenia are severe impairment of cognitive functions like attention, abstract reasoning and working memory. The latter has been defined as the ability to maintain and manipulate on-line a limited amount of information. Whereas several studies show that working memory processes are impaired in schizophrenia, the specificity of this deficit is still unclear. Results obtained with a new paradigm, involving visuospatial, dynamic and static working memory processing, suggest that schizophrenic patients rely on a specific compensatory strategy. An animal model of schizophrenia with a transient deficit in glutathione during the development reveals similar substitutive processing, masking the impairment in working memory functions in specific test conditions only. Taken together, these results show coherence between working memory deficits in schizophrenic patients and in animal models. More generally, it is possible to consider that the pathological state may be interpreted as a reduced homeostatic reserve. However, this may be balanced in specific situations by efficient allostatic strategies. Thus, the pathological condition would remain latent in several situations, due to such allostatic regulations. However, to maintain a performance based on highly specific strategies requires in turn specific conditions, limitating adaptative resources in humans and in animals. In summary, we suggest that the psychological and physical load to maintain this rigid allostatic state is very high in patients and animal subjects.

Processing of tumor-associated antigen by the proteasomes of dendritic cells controls in vivo T-cell responses.

Dendritic cells are unique in their capacity to process antigens and prime naive CD8(+) T cells. Contrary to most cells, which express the standard proteasomes, dendritic cells express immunoproteasomes constitutively. The melanoma-associated protein Melan-A(MART1) contains an HLA-A2-restricted peptide that is poorly processed by melanoma cells expressing immunoproteasomes in vitro. Here, we show that the expression of Melan-A in dendritic cells fails to elicit T-cell responses in vitro and in vivo because it is not processed by the proteasomes of dendritic cells. In contrast, dendritic cells lacking immunoproteasomes induce strong anti-Melan-A T-cell responses in vitro and in vivo. These results suggest that the inefficient processing of self-antigens, such as Melan-A, by the immunoproteasomes of professional antigen-presenting cells prevents the induction of antitumor T-cell responses in vivo.