Neuropsychological outcome after extra-temporal epilepsy surgery.

BACKGROUND: The neuropsychological results of temporal lobe epilepsy surgery are well reported in the literature. The aim of this study was to analyse the neuropsychological outcome in a consecutive series of patients with extra-temporal epilepsy. METHODS: We retrospectively analysed the data of patients operated between 1996 and 2008 for extra-temporal epilepsy. Standard neuropsychological tests were applied. We assessed the neuropsychological outcome after surgery and the correlation of the neuropsychological outcome with (1) side and localisation of surgery, (2) Engel scale for seizure outcome and (3) timing of surgery. FINDINGS: Patients had a better neuropsychological outcome when undergoing non-frontal resection [χ2 (2) =6.66, p = 0.036]. Subjects who had undergone left or right resection showed no difference in outcome [χ2 (2) =0.533, p = 0.766]. The correlation between the Engel scale for seizure re-occurence and the neuropsychological scores showed only a tendency for better outcome (Spearman ρ = -0.437; p = 0.069). The global measure of change did not correlate significantly with delay of surgery (Spearman ρ = -0.163; p = 0.518). CONCLUSIONS: Resective epilepsy surgery improves neuropsychological status outcome in patients with extra-temporal epilepsy even if the patient did not become seizure free. The outcome is better for non-frontal localisation.

Elevated serum uric acid is associated with high circulating inflammatory cytokines in the population-based Colaus study.

BACKGROUND: The relation of serum uric acid (SUA) with systemic inflammation has been little explored in humans and results have been inconsistent. We analyzed the association between SUA and circulating levels of interleukin-6 (IL-6), interleukin-1beta (IL-1beta), tumor necrosis factor- alpha (TNF-alpha) and C-reactive protein (CRP). METHODS AND FINDINGS: This cross-sectional population-based study conducted in Lausanne, Switzerland, included 6085 participants aged 35 to 75 years. SUA was measured using uricase-PAP method. Plasma TNF-alpha, IL-1beta and IL-6 were measured by a multiplexed particle-based flow cytometric assay and hs-CRP by an immunometric assay. The median levels of SUA, IL-6, TNF-alpha, CRP and IL-1beta were 355 micromol/L, 1.46 pg/mL, 3.04 pg/mL, 1.2 mg/L and 0.34 pg/mL in men and 262 micromol/L, 1.21 pg/mL, 2.74 pg/mL, 1.3 mg/L and 0.45 pg/mL in women, respectively. SUA correlated positively with IL-6, TNF-alpha and CRP and negatively with IL-1beta (Spearman r: 0.04, 0.07, 0.20 and 0.05 in men, and 0.09, 0.13, 0.30 and 0.07 in women, respectively, P<0.05). In multivariable analyses, SUA was associated positively with CRP (beta coefficient +/- SE = 0.35+/-0.02, P<0.001), TNF-alpha (0.08+/-0.02, P<0.001) and IL-6 (0.10+/-0.03, P<0.001), and negatively with IL-1beta (-0.07+/-0.03, P = 0.027). Upon further adjustment for body mass index, these associations were substantially attenuated. CONCLUSIONS: SUA was associated positively with IL-6, CRP and TNF-alpha and negatively with IL-1beta, particularly in women. These results suggest that uric acid contributes to systemic inflammation in humans and are in line with experimental data showing that uric acid triggers sterile inflammation.

Weight status, body image and bullying among adolescents in the Seychelles.

We investigated the relationship between being bullied and measured body weight and perceived body weight among adolescents of a middle-income sub Saharan African country. Our data originated from the Global School-based Health Survey, which targets adolescents aged 13-15 years. Student weights and heights were measured before administrating the questionnaire which included questions about personal data, health behaviors and being bullied. Standard criteria were used to assess thinness, overweight and obesity. Among 1,006 participants who had complete data, 16.5% (95%CI 13.3-20.2) reported being bullied ≥ 3 days during the past 30 days; 13.4% were thin, 16.8% were overweight and 7.6% were obese. Categories of actual weight and of perceived weight correlated only moderately (Spearman correlation coefficient 0.37 for boys and 0.57 for girls; p < 0.001). In univariate analysis, both actual obesity (OR 1.76; p = 0.051) and perception of high weight (OR 1.63 for "slightly overweight"; OR 2.74 for "very overweight", both p < 0.05) were associated with being bullied. In multivariate analysis, ORs for categories of perceived overweight were virtually unchanged while ORs for actual overweight and obesity were substantially attenuated, suggesting a substantial role of perceived weight in the association with being bullied. Actual underweight and perceived thinness also tended to be associated with being bullied, although not significantly. Our findings suggest that more research attention be given to disentangling the significant association between body image, overweight and bullying among adolescents. Further studies in diverse populations are warranted.

No use for waist-for-height ratio in addition to body mass index to identify children with elevated blood pressure.

Abstract Background. In children, waist-for-height ratio (WHtR) has been proposed to identify subjects at higher risk of cardiovascular diseases. The utility of WHtR to identify children with elevated blood pressure (BP) is unclear. Design. Cross-sectional population-based study of schoolchildren. Methods. Weight, height, waist circumference and BP were measured in all sixth-grade schoolchildren of the canton de Vaud (Switzerland) in 2005/06. WHtR was computed as waist [cm]/height [cm]. Elevated BP was defined according to sex-, age- and height-specific US reference data. The area under the receiver operating characteristic curve (AUC) statistic was computed to compare the ability of body mass index (BMI) z-score and WHtR, alone or in combination, to identify children with elevated BP. Results. 5207 children participated (76% response) [2621 boys, 2586 girls; mean (± SD) age, 12.3 ± 0.5 years; range: 10.1-14.9]. The prevalence of elevated BP was 11%. Mean WHtR was 0.44 ± 0.05 (range: 0.29- 0.77) and 11% had high WHtR (> 0.5). BMI z-score and WHtR were strongly correlated (Spearman correlation coefficient r = 0.76). Both indices were positively associated with elevated BP. AUCs for elevated BP was relatively low for BMI z-score (0.62) or for WHtR (0.62), and was not substantially improved when both indices were considered together (0.63). Conclusions. The ability of BMI z-score or WHtR to identify children aged 10-14 with elevated BP was weak. Adding WHtR did not confer additional discriminative power to BMI alone. These findings do not support the measurement of WHtR in addition to BMI to identify children with elevated BP.

Avaliação espaço-temporal das armazenagens gravimétrica e volumétrica da água num Latossolo com citros

A estabilidade temporal é descrita como a persistência temporal de um padrão espacial e é avaliada pela análise de correlação de medidas em datas sucessivas. Neste trabalho, foi avaliada a armazenagem de água no solo em duas transeções de 76 m cada, contendo 20 pontos em cada uma. em um Latossolo Vermelho-Amarelo argissólico cultivado com citros com 11 anos em Piracicaba/SP. A umidade do solo para determinação da armazenagem, na camada de 0,00-1,10 m, ao longo do tempo, foi obtida com uma sonda de nêutrons, calibrada para o solo em estudo, realizando leituras semanais às profundidades de 0,20, 0,40, 0,60, 0,80, 1,0 e 1,10 m. A armazenagem de água no solo foi determinada utilizando-se o método de Simpson. Os dados da armazenagem média de água no solo nos três anos de estudo mostraram que sua distribuição, ao longo do tempo, apresentou comportamento semelhante e que os coeficientes de correlação linear e de posição de Spearman foram altos entre o ano 1 e o ano 2, o ano 2 e o ano 3 e o ano 1 e o ano 3, indicando existência de estabilidade temporal e persistência temporal significativa do padrão espacial observado. Foi verificada dependência espacial moderada de 17,10 m pelo semivariograma exponencial. Pela técnica da diferença relativa, os pontos que apresentaram comportamento estável no tempo foram o ponto 29, para os anos 1 e 2, e os pontos 16, 29 e 39, para o ano 3, que podem ser usados para estimar com segurança a armazenagem média de água no solo. O ponto 29 foi o que se apresentou estável para os três anos de estudo, sendo, portanto, o mais recomendável tanto para a armazenagem gravimétrica como para a volumétrica.

Identifying the best body mass index metric to assess adiposity change in children.

OBJECTIVE: Although dual-energy X-ray absorptiometry (DEXA) is the preferred method to estimate adiposity, body mass index (BMI) is often used as a proxy. However, the ability of BMI to measure adiposity change among youth is poorly evidenced. This study explored which metrics of BMI change have the highest correlations with different metrics of DEXA change. METHODS: Data were from the Quebec Adipose and Lifestyle Investigation in Youth cohort, a prospective cohort of children (8-10 years at recruitment) from Québec, Canada (n=557). Height and weight were measured by trained nurses at baseline (2008) and follow-up (2010). Metrics of BMI change were raw (ΔBMIkg/m(2) ), adjusted for median BMI (ΔBMIpercentage) and age-sex-adjusted with the Centers for Disease Control and Prevention growth curves expressed as centiles (ΔBMIcentile) or z-scores (ΔBMIz-score). Metrics of DEXA change were raw (total fat mass; ΔFMkg), per cent (ΔFMpercentage), height-adjusted (fat mass index; ΔFMI) and age-sex-adjusted z-scores (ΔFMz-score). Spearman's rank correlations were derived. RESULTS: Correlations ranged from modest (0.60) to strong (0.86). ΔFMkg correlated most highly with ΔBMIkg/m(2) (r = 0.86), ΔFMI with ΔBMIkg/m(2) and ΔBMIpercentage (r = 0.83-0.84), ΔFMz-score with ΔBMIz-score (r = 0.78), and ΔFMpercentage with ΔBMIpercentage (r = 0.68). Correlations with ΔBMIcentile were consistently among the lowest. CONCLUSIONS: In 8-10-year-old children, absolute or per cent change in BMI is a good proxy for change in fat mass or FMI, and BMI z-score change is a good proxy for FM z-score change. However change in BMI centile and change in per cent fat mass perform less well and are not recommended.

Atributos de solo e cultura espacialmente distribuídos relacionados ao rendimento do milho

A agricultura de precisão pode aumentar a eficiência e a sustentabilidade da agricultura brasileira de grãos, principalmente auxiliando no manejo do solo e das culturas. O objetivo deste estudo foi avaliar a importância de atributos de solo e da cultura com variação espacial do rendimento de grãos de milho e o uso dessa informação para aprimorar as decisões sobre o manejo da cultura. Foram utilizados dados da safra 2005/6 de uma gleba comercial de milho de 18 ha, na região de Guarapuava, Paraná, em um solo Latossolo Bruno de textura argilosa. Atributos de solo (0-0,10 m) e cultura foram coletados em quadrículas georreferenciadas com densidade amostral de 2 ha-1. O rendimento de grãos espacializado foi avaliado com sensor de produtividade na colhedora. Esse rendimento apresentou variabilidade espacial (média de 12,4 Mg ha-1, com amplitude entre 11,1 e 14,0 Mg ha-1) relacionada aos atributos do solo: P-Mehlich-1, Mg2+, soma de bases e relações Ca:Mg, Mg:K e Mg:CTC, mas não da cultura, conforme uma matriz de correlação de Spearman. A análise por árvore de regressão identificou a saturação por Mg (Mg:CTC), com valor crítico de 0,10, e a relação Mg:K, com valor crítico de 2,30, como atributos de solo com efeito mais significativo, pois valores inferiores ao crítico estão relacionados aos menores rendimentos de grão. A análise de cluster confirmou os resultados obtidos com as duas análises estatísticas anteriores, e sua interpretação conjunta suporta a conclusão de que os elementos P e Mg eram os mais críticos em termos de necessidade de manejo localizado. Comparativamente, o manejo localizado com agricultura de precisão demandaria, na gleba, maior consumo de calcário (incremento de 6,6 Mg, sendo 3,4 Mg de calcário calcítico e 3,2 Mg do tipo dolomítico), menor consumo de P2O5 (- 235 kg) e maior consumo de K2O (+ 135 kg) em relação ao manejo uniforme (tradicional). Contudo, o manejo localizado permite que esses insumos sejam aplicados nas dosagens adequadas em partes específicas da gleba, e não uniformemente em toda a gleba, alterando positivamente a produtividade dessas partes. Quando as tomadas de decisão sobre o manejo são auxiliadas por ferramentas estatísticas apropriadas, a agricultura de precisão é viável tecnicamente para o manejo de atributos químicos do solo, proporcionando assim a otimização no uso de insumos e, potencialmente, contribuindo para o rendimento economicamente ideal.

Padrão espaço-temporal da umidade volumétrica do solo em uma bacia hidrográfica com predominância de latossolos

A umidade volumétrica do solo possui alta variabilidade espacial e temporal devido à influência de vários fatores ambientais e de uso do solo. Desse modo, seu entendimento assume papel fundamental na modelagem dos processos que envolvem o escoamento superficial, a erosão do solo e o transporte de sedimentos. Nesse contexto, objetivou-se neste estudo avaliar o padrão espacial e temporal da umidade volumétrica na camada superficial do solo, nas diferentes estações do ano, em uma bacia hidrográfica experimental, com predominância de latossolos, localizada na região Sul de Minas Gerais. Para isso, utilizou-se o conceito de estabilidade temporal e escalonamento de semivariogramas, o qual possibilitou a comparação da estrutura espacial dos modelos de semivariogramas ajustados. Foi possível detectar forte dependência espacial da umidade do solo na bacia hidrográfica, com grau de dependência sempre acima de 80 %, e os semivariogramas escalonados mostraram semelhanças no padrão espacial no verão e no outono e diferenças em relação ao inverno e à primavera. Dessa forma, constatou-se que houve diferença no padrão espacial da umidade do solo ao longo do ano, contudo maior homogeneidade no período chuvoso (verão). Ocorreu variação no padrão temporal de umidade do solo de acordo com as estações do ano, sendo verificada tendência nos dados de inverno e primavera, demonstrada pelo teste de Spearman. Devido às diferenças verificadas no padrão espaçotemporal da umidade do solo ao longo das estações do ano, quatro pontos distintos foram identificados, um em cada estação, para implantação de monitoramento permanente desse atributo do solo na bacia hidrográfica.

Pedotransfer functions to estimate retention and availability of water in soils of the state of Santa Catarina, Brazil

Studies on water retention and availability are scarce for subtropical or humid temperate climate regions of the southern hemisphere. The aims of this study were to evaluate the relations of the soil physical, chemical, and mineralogical properties with water retention and availability for the generation and validation of continuous point pedotransfer functions (PTFs) for soils of the State of Santa Catarina (SC) in the South of Brazil. Horizons of 44 profiles were sampled in areas under different cover crops and regions of SC, to determine: field capacity (FC, 10 kPa), permanent wilting point (PWP, 1,500 kPa), available water content (AW, by difference), saturated hydraulic conductivity, bulk density, aggregate stability, particle size distribution (seven classes), organic matter content, and particle density. Chemical and mineralogical properties were obtained from the literature. Spearman's rank correlation analysis and path analysis were used in the statistical analyses. The point PTFs for estimation of FC, PWP and AW were generated for the soil surface and subsurface through multiple regression analysis, followed by robust regression analysis, using two sets of predictive variables. Soils with finer texture and/or greater organic matter content retain more moisture, and organic matter is the property that mainly controls the water availability to plants in soil surface horizons. Path analysis was useful in understanding the relationships between soil properties for FC, PWP and AW. The predictive power of the generated PTFs to estimate FC and PWP was good for all horizons, while AW was best estimated by more complex models with better prediction for the surface horizons of soils in Santa Catarina.

Partição de substâncias húmicas em solos brasileiros

As substâncias húmicas (SH) representam o principal reservatório de carbono orgânico total do solo (COT) e sua partição entre diferentes frações de solubilidade em meio alcalino ou ácido pode guardar relação com o tipo de solo e manejo adotado. O objetivo deste trabalho foi comparar a partição das SHs, de acordo com profundidade, tipo de solo, bioma e uso do solo no Brasil. Revisou-se a literatura, incluindo teses, dissertações, artigos e resumos em anais de eventos, em busca de dados sobre o teor de COT, sua porcentagem como ácidos húmicos (AH), ácidos fúlvicos (AF) e humina (HU) e a razão AH/AF. Os dados foram estratificados por intervalos comparáveis de profundidades (0-5, 5-10, 0-20, 20-50, 50-100 e >100 cm), biomas (Mata Atlântica, Cerrado, Amazônia, Pampa e Caatinga), ordem de solo (Argissolo, Latossolo, Cambissolo, Planossolo, Neossolo, Gleissolo e Organossolo) e principais usos do solo (florestas nativas, pastagem natural, pastagem plantada, eucalipto, culturas perenes e anuais). Os dados foram analisados por estatística descritiva, correlações de Spearman e análise de componentes principais (ACP). Nos Argissolos, Latossolos e Organossolos, a fração HU contribuiu com metade do COT, tendendo a diminuir em profundidade. Para Latossolos e Organossolos, a fração AF tendeu a aumentar em profundidade. Em Neossolos, a fração AH aumentou em profundidade, embora tenha diminuído em Gleissolos e Planossolos. A razão AH/AF geralmente diminui em profundidade. Pela ACP, não foi possível identificar um padrão de agrupamento das amostras em razão do tipo de bioma e uso do solo, sugerindo que a partição das SHs tem baixo potencial como indicador de efeitos do manejo ou condições ambientais, embora seja útil para discriminar processos de humificação em algumas ordens de solo.

Análise espaço-temporal de componentes do balanço hídrico em um Latossolo

O monitoramento das variáveis que constituem a equação do balanço hídrico do solo em campo cultivado é necessário para avaliar com confiabilidade os períodos de déficits hídricos durante o ciclo das culturas, manejar a irrigação e quantificar perdas de nutrientes por lixiviação. Os componentes da equação do balanço hídrico podem variar no espaço e no tempo, e o estudo da estabilidade temporal da variabilidade espacial desses componentes é essencial para determinar quais são os pontos de observação no campo (locais) para monitorar a água do solo com precisão e esforço amostral reduzido. Assim, os objetivos deste trabalho foram avaliar os componentes do balanço da água (especificamente a variação de armazenamento de água do solo, drenagem interna e evapotranspiração real) de plantas de milho em um Latossolo Vermelho-Amarelo e analisar a variabilidade espacial e temporal, por meio da técnica de estabilidade temporal. O estudo foi realizado em uma área do Campus da ESALQ/USP, município de Piracicaba, Estado de São Paulo, Brasil. O relevo da área experimental, que tem 1.500 m², é plano. Nessa área foram instalados 60 tubos de alumínio para acesso de uma sonda de nêutrons e 120 tensiômetros com manômetro de mercúrio (60 na profundidade de 0,75 m e 60 na profundidade de 0,85 m). Isso permitiu estimar a densidade de fluxo de água do solo na profundidade de 0,80 m por meio da equação de Darcy-Buckingham e o armazenamento de água na camada de 0,0-0,80 m, ao longo do ciclo da cultura. A precipitação pluvial foi medida por meio de um pluviômetro instalado no centro da área experimental, e a evaporação real foi considerada como desconhecida da equação do balanço hídrico. A pesquisa foi realizada dividindo o ciclo de cultivo em 13 períodos (P1 a P13). O uso da estatística descritiva foi feito para evidenciar a variação do comportamento dos dados após a remoção dos pontos discrepantes, que representaram entre 0,0 e 3,9 % dos pontos amostrais por período. O uso da estatística descritiva foi útil por ter apresentado a mudança no comportamento dos dados, após a retirada de valores discrepantes e extremos em alguns períodos. A técnica da estabilidade temporal é viável para avaliação do balanço hídrico no espaço e no tempo. Os coeficientes de correlação de Spearman entre os períodos indicaram estabilidade temporal para a armazenagem da água independentemente do teor de umidade do solo, mas não expressaram confiabilidade para a avaliação da drenagem interna e a evapotranspiração real da cultura. A evapotranspiração oscilou ao longo do ciclo da cultura mantendo-se praticamente constante nos períodos P5 a P9, em que houve maior desenvolvimento vegetativo das plantas.

Impact of a smoking ban in hospitality venues on second hand smoke exposure: a comparison of exposure assessment methods

BACKGROUND: In May 2010, Switzerland introduced a heterogeneous smoking ban in the hospitality sector. While the law leaves room for exceptions in some cantons, it is comprehensive in others. This longitudinal study uses different measurement methods to examine airborne nicotine levels in hospitality venues and the level of personal exposure of non-smoking hospitality workers before and after implementation of the law. METHODS: Personal exposure to second hand smoke (SHS) was measured by three different methods. We compared a passive sampler called MoNIC (Monitor of NICotine) badge, to salivary cotinine and nicotine concentration as well as questionnaire data. Badges allowed the number of passively smoked cigarettes to be estimated. They were placed at the venues as well as distributed to the participants for personal measurements. To assess personal exposure at work, a time-weighted average of the workplace badge measurements was calculated. RESULTS: Prior to the ban, smoke-exposed hospitality venues yielded a mean badge value of 4.48 (95%-CI: 3.7 to 5.25; n = 214) cigarette equivalents/day. At follow-up, measurements in venues that had implemented a smoking ban significantly declined to an average of 0.31 (0.17 to 0.45; n = 37) (p = 0.001). Personal badge measurements also significantly decreased from an average of 2.18 (1.31-3.05 n = 53) to 0.25 (0.13-0.36; n = 41) (p = 0.001). Spearman rank correlations between badge exposure measures and salivary measures were small to moderate (0.3 at maximum). CONCLUSIONS: Nicotine levels significantly decreased in all types of hospitality venues after implementation of the smoking ban. In-depth analyses demonstrated that a time-weighted average of the workplace badge measurements represented typical personal SHS exposure at work more reliably than personal exposure measures such as salivary cotinine and nicotine.

Plasma lipoprotein-associated phospholipase A2 activity in Alzheimer's disease, amnestic mild cognitive impairment, and cognitively healthy elderly subjects: a cross-sectional study.

ABSTRACT: INTRODUCTION: Lipoprotein-associated phospholipase A2 (Lp-PLA2) is a circulating enzyme with pro-inflammatory and oxidative activities associated with cardiovascular disease and ischemic stroke. While high plasma Lp-PLA2 activity was reported as a risk factor for dementia in the Rotterdam study, no association between Lp-PLA2 mass and dementia or Alzheimer's disease (AD) was detected in the Framingham study. The objectives of the current study were to explore the relationship of plasma Lp-PLA2 activity with cognitive diagnoses (AD, amnestic mild cognitive impairment (aMCI), and cognitively healthy subjects), cardiovascular markers, cerebrospinal fluid (CSF) markers of AD, and apolipoprotein E (APOE) genotype. METHODS: Subjects with mild AD (n = 78) and aMCI (n = 59) were recruited from the Memory Clinic, University Hospital, Basel, Switzerland; cognitively healthy subjects (n = 66) were recruited from the community. Subjects underwent standardised medical, neurological, neuropsychological, imaging, genetic, blood and CSF evaluation. Differences in Lp-PLA2 activity between the cognitive diagnosis groups were tested with ANOVA and in multiple linear regression models with adjustment for covariates. Associations between Lp-PLA2 and markers of cardiovascular disease and AD were explored with Spearman's correlation coefficients. RESULTS: There was no significant difference in plasma Lp-PLA2 activity between AD (197.1 (standard deviation, SD 38.4) nmol/min/ml) and controls (195.4 (SD 41.9)). Gender, statin use and low-density lipoprotein cholesterol (LDL) were independently associated with Lp-PLA2 activity in multiple regression models. Lp-PLA2 activity was correlated with LDL and inversely correlated with high-density lipoprotein (HDL). AD subjects with APOE-ε4 had higher Lp-PLA2 activity (207.9 (SD 41.2)) than AD subjects lacking APOE-ε4 (181.6 (SD 26.0), P = 0.003) although this was attenuated by adjustment for LDL (P = 0.09). No strong correlations were detected for Lp-PLA2 activity and CSF markers of AD. CONCLUSION: Plasma Lp-PLA2 was not associated with a diagnosis of AD or aMCI in this cross-sectional study. The main clinical correlates of Lp-PLA2 activity in AD, aMCI and cognitively healthy subjects were variables associated with lipid metabolism.

Pericardial fat volume correlates with coronary vasomotion

Purpose: Recent studies showed that pericardial fat was independently correlated with the development of coronary artery disease (CAD). The mechanism remains unclear. We aimed at assessing a possible relationship between pericardial fat volume and endothelium-dependent coronary vasomotion, a surrogate of future cardiovascular events.Methods: Fifty healthy volunteers without known CAD or cardiovascular risk factors (CRF) were enrolled. They all underwent a dynamic Rb- 82 cardiac PET/CT to quantify myocardial blood flow (MBF) at rest, during MBF response to cold pressure test (CPT-MBF) and adenosine stress. Pericardial fat volume (PFV) was measured using a 3D volumetric CT method and common biological CRF (glucose and insulin levels, HOMA-IR, cholesterol, triglyceride, hs-CRP). Relationships between MBF response to CPT, PFV and other CRF were assessed using non-parametric Spearman correlation and multivariate regression analysis of variables with significant correlation on univariate analysis (Stata 11.0).Results: All of the 50 participants had normal MBF response to adenosine (2.7±0.6 mL/min/g; 95%CI: 2.6−2.9) and myocardial flow reserve (2.8±0.8; 95%CI: 2.6−3.0) excluding underlying CAD. Simple regression analysis revealed a significant correlation between absolute CPTMBF and triglyceride level (rho = −0.32, p = 0.024) fasting blood insulin (rho = −0.43, p = 0.0024), HOMA-IR (rho = −0.39, p = 0.007) and PFV (rho = −0.52, p = 0.0001). MBF response to adenosine was only correlated with PFV (rho = −0.32, p = 0.026). On multivariate regression analysis PFV emerged as the only significant predictor of MBF response to CPT (p = 0.002).Conclusion: PFV is significantly correlated with endothelium-dependent coronary vasomotion. High PF burden might negatively influence MBF response to CPT, as well as to adenosine stress, even in persons with normal hyperemic myocardial perfusion imaging, suggesting a link between PF and future cardiovascular events. While outside-to-inside adipokines secretion through the arterial wall has been described, our results might suggest an effect upon NO-dependent and -independent vasodilatation. Further studies are needed to elucidate this mechanism.

Validation de la mesure de l'oedème postopératoire par bioimpédance chez les patients opérés d'une prothèse totale du genou : une expérience de collaboration entre physiothérapeutes et ingénieurs

Fondements : La recherche sur l'oedème postopératoire consécutif à la chirurgie prothétique du genou est peu développée, notamment en raison de l'absence d'une méthode de mesure adaptée. Une collaboration entre physiothérapeutes et ingénieurs a permis de développer et valider une méthode de mesure innovante et facilement applicable. Les physiothérapeutes ont identifié un besoin clinique, les ingénieurs ont apporté leur savoir technologique, et l'équipe a conjointement élaboré le protocole de mesure et effectué l'étude de validation. Introduction : La bioimpédance est fréquemment utilisée pour évaluer l'oedème par l'analyse d'un signal électrique passant au travers du corps, en extrapolant la résistance théorique à une fréquence égale à zéro (R0). La mesure s'avère fiable et rapide, mais n'a jamais été appliquée et validée pour l'évaluation de l'oedème en chirurgie orthopédique. Objectif : L'objectif de l'étude est de valider la mesure de l'oedème du membre inférieur par bioimpédance, chez des patients ayant bénéficié d'une prothèse totale de genou (PTG). Questionnement : Après nous être assurés de l'absence d'influence de l'implant métallique de la PTG sur la mesure, nous nous questionnions sur la validité et la fiabilité des mesures de bioimpédance dans ce contexte. Méthodes : Deux évaluateurs ont mesuré à tour de rôle et à deux reprises successives l'oedème chez 24 patients opérés d'une PTG, à trois temps différents (préopératoire, J+2, J+8). L'oedème a été évalué par bioimpédance (R0) et par conversion en volume de mesures centimétriques du membre inférieur (MI). Nous avons calculé le ratio moyen des MI pour chaque méthode. Nous avons évalué la reproductibilité intra- et inter-observateurs de la bioimpédance (coefficient de corrélation intraclasse, CCI) et la corrélation entre méthodes (Spearman). Résultats : Le ratio moyen opéré/sain du volume des MI est de 1.04 (SD ± 0.06) en préopératoire, 1.18 (SD ± 0.09) à J+2 et 1.17 (SD ± 0.10) à J+8. Le ratio sain/opéré des MI de R0 est de 1.04 (SD ± 0.07) en préopératoire, 1.51 (SD ± 0.22) à J+2 et 1.65 (SD ± 0.21) à J+8. En préopératoire, à J+2 et J+8, les CCI tous supérieurs à 0.95 pour la reproductibilité intra- et inter-observateurs de la bioimpédance. La corrélation entre méthodes est de 0.71 en préopératoire, 0.61 à J2 et 0.33 à J8. Analyse et conclusion : La variation du ratio des MI entre les temps préopératoire, J+2 et J+8 est plus marquée pour R0. La mesure de bioimpédance bénéficie d'une excellente reproductibilité intra- et inter-observateurs. L'évolution dans le temps de la corrélation entre méthodes peut être expliquée par l'influence potentielle de facteurs confondants sur R0 (modification de la composition liquidienne) et par l'influence de l'atrophie musculaire postopératoire sur la mesure de volume. La collaboration physiothérapeutes-ingénieurs a permis le développement et l'évaluation d'une nouvelle méthode de mesure.