Depression with atypical features and increase in obesity, body mass index, waist circumference, and fat mass: a prospective, population-based study.

IMPORTANCE: Depression and obesity are 2 prevalent disorders that have been repeatedly shown to be associated. However, the mechanisms and temporal sequence underlying this association are poorly understood. OBJECTIVE: To determine whether the subtypes of major depressive disorder (MDD; melancholic, atypical, combined, or unspecified) are predictive of adiposity in terms of the incidence of obesity and changes in body mass index (calculated as weight in kilograms divided by height in meters squared), waist circumference, and fat mass. DESIGN, SETTING, AND PARTICIPANTS: This prospective population-based cohort study, CoLaus (Cohorte Lausannoise)/PsyCoLaus (Psychiatric arm of the CoLaus Study), with 5.5 years of follow-up included 3054 randomly selected residents (mean age, 49.7 years; 53.1% were women) of the city of Lausanne, Switzerland (according to the civil register), aged 35 to 66 years in 2003, who accepted the physical and psychiatric baseline and physical follow-up evaluations. EXPOSURES: Depression subtypes according to the DSM-IV. Diagnostic criteria at baseline and follow-up, as well as sociodemographic characteristics, lifestyle (alcohol and tobacco use and physical activity), and medication, were elicited using the semistructured Diagnostic Interview for Genetic Studies. MAIN OUTCOMES AND MEASURES: Changes in body mass index, waist circumference, and fat mass during the follow-up period, in percentage of the baseline value, and the incidence of obesity during the follow-up period among nonobese participants at baseline. Weight, height, waist circumference, and body fat (bioimpedance) were measured at baseline and follow-up by trained field interviewers. RESULTS: Only participants with the atypical subtype of MDD at baseline revealed a higher increase in adiposity during follow-up than participants without MDD. The associations between this MDD subtype and body mass index (β = 3.19; 95% CI, 1.50-4.88), incidence of obesity (odds ratio, 3.75; 95% CI, 1.24-11.35), waist circumference in both sexes (β = 2.44; 95% CI, 0.21-4.66), and fat mass in men (β = 16.36; 95% CI, 4.81-27.92) remained significant after adjustments for a wide range of possible cofounding. CONCLUSIONS AND RELEVANCE: The atypical subtype of MDD is a strong predictor of obesity. This emphasizes the need to identify individuals with this subtype of MDD in both clinical and research settings. Therapeutic measures to diminish the consequences of increased appetite during depressive episodes with atypical features are advocated.

Segmental body composition assessed by bioelectrical impedance analysis and DEXA in humans.

The present study assessed the relative contribution of each body segment to whole body fat-free mass (FFM) and impedance and explored the use of segmental bioelectrical impedance analysis to estimate segmental tissue composition. Multiple frequencies of whole body and segmental impedances were measured in 51 normal and overweight women. Segmental tissue composition was independently assessed by dual-energy X-ray absorptiometry. The sum of the segmental impedance values corresponded to the whole body value (100.5 +/- 1.9% at 50 kHz). The arms and legs contributed to 47.6 and 43.0%, respectively, of whole body impedance at 50 kHz, whereas they represented only 10.6 and 34.8% of total FFM, as determined by dual-energy X-ray absorptiometry. The trunk averaged 10.0% of total impedance but represented 48.2% of FFM. For each segment, there was an excellent correlation between the specific impedance index (length2/impedance) and FFM (r = 0.55, 0.62, and 0.64 for arm, trunk, and leg, respectively). The specific resistivity was in a similar range for the limbs (159 +/- 23 cm for the arm and 193 +/- 39 cm for the leg at 50 kHz) but was higher for the trunk (457 +/- 71 cm). This study shows the potential interest of segmental body composition by bioelectrical impedance analysis and provides specific segmental body composition equations for use in normal and overweight women.

Two approaches to discovering and developing new drugs for Chagas disease

This review will focus on two general approaches carried out at the Sandler Center, University of California, San Francisco, to address the challenge of developing new drugs for the treatment of Chagas disease. The first approach is target-based drug discovery, and two specific targets, cytochrome P450 CYP51 and cruzain (aka cruzipain), are discussed. A "proof of concept" molecule, the vinyl sulfone inhibitor K777, is now a clinical candidate. The preclinical assessment compliance for filing as an Investigational New Drug with the United States Food and Drug Administration (FDA) is presented, and an outline of potential clinical trials is given. The second approach to identifying new drug leads is parasite phenotypic screens in culture. The development of an assay allowing high throughput screening of Trypanosoma cruzi amastigotes in skeletal muscle cells is presented. This screen has the advantage of not requiring specific strains of parasites, so it could be used with field isolates, drug resistant strains or laboratory strains. It is optimized for robotic liquid handling and has been validated through a screen of a library of FDA-approved drugs identifying 65 hits.

Y-90 Ibritumomab Tiuxetan (Zevalin (R)) Consolidation of First Remission In Advanced Stage Follicular Non Hodgkin's Lymphoma Updated Results After a Median Follow up of 662 Months From the International, Randomized, Phase III First Line Indolent Trial (FIT) In 414 Patients

The FIT trial was conducted to evaluate the safety and efficacy of 90Y-ibritumomab tiuxetan (0.4 mCi/kg; maximum dose 32 mCi) when used as consolidation of first complete or partial remission in patients with previously untreated, advanced-stage follicular lymphoma (FL). Patients were randomly assigned to either 90Y-ibritumomab treatment (n = 207) or observation (n = 202) within 3 months (mo) of completing initial induction therapy (chemotherapy only: 86%; rituximab in combination with chemotherapy: 14%). Response status prior to randomization did not differ between the groups: 52% complete response (CR)/CR unconfirmed (CRu) to induction therapy and 48% partial response (PR) in the 90Y-ibritumomab arm vs 53% CR/CRu and 44% PR in the control arm. The primary endpoint was progression-free survival (PFS) of the intent-to-treat (ITT) population. Results from the first extended follow-up after a median of 3.5 years revealed a significant improvement in PFS from the time of randomization with 90Y-ibritumomab consolidation compared with control (36.5 vs 13.3 mo, respectively; P < 0.0001; Morschhauser et al. JCO. 2008; 26:5156-5164). Here we report a median follow-up of 66.2 mo (5.5 years). Five-year PFS was 47% in the 90Y-ibritumomab group and 29% in the control group (hazard ratio (HR) = 0.51, 95% CI 0.39-0.65; P < 0.0001). Median PFS in the 90Y-ibritumomab group was 49 mo vs 14 mo in the control group. In patients achieving a CR/CRu after induction, 5-year PFS was 57% in the 90Y-ibritumomab group, and the median had not yet been reached at 92 months, compared with a 43% 5-year PFS in the control group and a median of 31 mo (HR = 0.61, 95% CI 0.42-0.89). For patients in PR after induction, the 5-year PFS was 38% in the 90Y-ibritumomab group with a median PFS of 30 mo vs 14% in the control group with a median PFS of 6 mo (HR = 0.38, 95% CI 0.27-0.53). Patients who had received rituximab as part of induction treatment had a 5-year PFS of 64% in the 90Y-ibritumomab group and 48% in the control group (HR = 0.66, 95% CI 0.30-1.47). For all patients, time to next treatment (as calculated from the date of randomization) differed significantly between both groups; median not reached at 99 mo in the 90Y-ibritumomab group vs 35 mo in the control group (P < 0.0001). The majority of patients received rituximab-containing regimens when treated after progression (63/82 [77%] in the 90Y-ibritumomab group and 102/122 [84%] in the control group). Overall response rate to second-line treatment was 79% in the 90Y-ibritumomab group (57% CR/CRu and 22% PR) vs 78% in the control arm (59% CR/CRu, 19% PR). Five-year overall survival was not significantly different between the groups; 93% and 89% in the 90Y-ibritumomab and control groups, respectively (P = 0.561). To date, 40 patients have died; 18 in the 90Y-ibritumomab group and 22 in the control group. Secondary malignancies were diagnosed in 16 patients in the 90Y-ibritumomab arm vs 9 patients in the control arm (P = 0.19). There were 6 (3%) cases of myelodysplastic syndrome (MDS)/acute myelogenous leukemia (AML) in the 90Y-ibritumomab arm vs 1 MDS in the control arm (P = 0.063). In conclusion, this extended follow-up of the FIT trial confirms the benefit of 90Y-ibritumomab consolidation with a nearly 3 year advantage in median PFS. A significant 5-year PFS improvement was confirmed for patients with a CR/CRu or a PR after induction. Effective rescue treatment with rituximab-containing regimens may explain the observed no difference in overall survival between both patient groups who were - for the greater part - rituximab-naïve.

Semi-online neural-Q_leaming for real-time robot learning

Reinforcement learning (RL) is a very suitable technique for robot learning, as it can learn in unknown environments and in real-time computation. The main difficulties in adapting classic RL algorithms to robotic systems are the generalization problem and the correct observation of the Markovian state. This paper attempts to solve the generalization problem by proposing the semi-online neural-Q_learning algorithm (SONQL). The algorithm uses the classic Q_learning technique with two modifications. First, a neural network (NN) approximates the Q_function allowing the use of continuous states and actions. Second, a database of the most representative learning samples accelerates and stabilizes the convergence. The term semi-online is referred to the fact that the algorithm uses the current but also past learning samples. However, the algorithm is able to learn in real-time while the robot is interacting with the environment. The paper shows simulated results with the "mountain-car" benchmark and, also, real results with an underwater robot in a target following behavior

A system to evaluate the accuracy of a visual mosaicking methodology

When underwater vehicles navigate close to the ocean floor, computer vision techniques can be applied to obtain motion estimates. A complete system to create visual mosaics of the seabed is described in this paper. Unfortunately, the accuracy of the constructed mosaic is difficult to evaluate. The use of a laboratory setup to obtain an accurate error measurement is proposed. The system consists on a robot arm carrying a downward looking camera. A pattern formed by a white background and a matrix of black dots uniformly distributed along the surveyed scene is used to find the exact image registration parameters. When the robot executes a trajectory (simulating the motion of a submersible), an image sequence is acquired by the camera. The estimated motion computed from the encoders of the robot is refined by detecting, to subpixel accuracy, the black dots of the image sequence, and computing the 2D projective transform which relates two consecutive images. The pattern is then substituted by a poster of the sea floor and the trajectory is executed again, acquiring the image sequence used to test the accuracy of the mosaicking system

A meta-analysis of the association of fracture risk and body mass index in women.

Several recent studies suggest that obesity may be a risk factor for fracture. The aim of this study was to investigate the association between body mass index (BMI) and future fracture risk at different skeletal sites. In prospective cohorts from more than 25 countries, baseline data on BMI were available in 398,610 women with an average age of 63 (range, 20-105) years and follow up of 2.2 million person-years during which 30,280 osteoporotic fractures (6457 hip fractures) occurred. Femoral neck BMD was measured in 108,267 of these women. Obesity (BMI ≥ 30 kg/m(2) ) was present in 22%. A majority of osteoporotic fractures (81%) and hip fractures (87%) arose in non-obese women. Compared to a BMI of 25 kg/m(2) , the hazard ratio (HR) for osteoporotic fracture at a BMI of 35 kg/m(2) was 0.87 (95% confidence interval [CI], 0.85-0.90). When adjusted for bone mineral density (BMD), however, the same comparison showed that the HR for osteoporotic fracture was increased (HR, 1.16; 95% CI, 1.09-1.23). Low BMI is a risk factor for hip and all osteoporotic fracture, but is a protective factor for lower leg fracture, whereas high BMI is a risk factor for upper arm (humerus and elbow) fracture. When adjusted for BMD, low BMI remained a risk factor for hip fracture but was protective for osteoporotic fracture, tibia and fibula fracture, distal forearm fracture, and upper arm fracture. When adjusted for BMD, high BMI remained a risk factor for upper arm fracture but was also a risk factor for all osteoporotic fractures. The association between BMI and fracture risk is complex, differs across skeletal sites, and is modified by the interaction between BMI and BMD. At a population level, high BMI remains a protective factor for most sites of fragility fracture. The contribution of increasing population rates of obesity to apparent decreases in fracture rates should be explored. © 2014 American Society for Bone and Mineral Research.

PRIM an Open Mobile Robot Platform. Motivation, Present and Future Trends

This paper is focused on the robot mobile platform PRIM (platform robot information multimedia). This robot has been made in order to cover two main needs of our group, on one hand the need for a full open mobile robotic platform that is very useful in fulfilling the teaching and research activity of our school community, and on the other hand with the idea of introducing an ethical product which would be useful as mobile multimedia information point as a service tool. This paper introduces exactly how the system is made up and explains just what the philosophy is behind this work. The navigation strategies and sensor fusion, where machine vision system is the most important one, are oriented towards goal achievement and are the key to the behaviour of the robot

Plane-to-plane positioning from image-based visual servoing and structured light

In this paper we face the problem of positioning a camera attached to the end-effector of a robotic manipulator so that it gets parallel to a planar object. Such problem has been treated for a long time in visual servoing. Our approach is based on linking to the camera several laser pointers so that its configuration is aimed to produce a suitable set of visual features. The aim of using structured light is not only for easing the image processing and to allow low-textured objects to be treated, but also for producing a control scheme with nice properties like decoupling, stability, well conditioning and good camera trajectory

Misdeployment of Edwards Sapien Valve in Transfemoral Aortic Valve Implantation Due to Iatrogenic Endarterectomy

Transcatheter aortic valve implantation is an expanding procedure thus far restricted to a target population of old and high-comorbidity patients with symptomatic aortic stenosis. The need for bulky devices (up to 24F) combined with the high prevalence of peripheral vascular disease in these patients explains the increased risk of vascular complications in transfemoral Edwards Sapien (Edwards Lifesciences, Irvine, Calif) transcatheter aortic valve implantation procedures, with a rate of 20% for the transfemoral arm of either the Placement of AoRTic traNscathetER valves in the European Union (PARTNER EU) trial or the SOURCE Registry.1,2

Environnement et capacités cognitives chez le rat : compétition entre les facteurs qui influencent les stratégies spatiales

RESUME Ce travail se propose de discuter des résultats comportementaux observés chez des rats obtenus dans trois paradigmes expérimentaux différents : le bassin de Morris (Morris Water Maze, Morris, 1984) ; la table à trous (Homing Board, Schenk, 1989) et le labyrinthe radial (Radial Arm Maze, Olton et Samuelson, 1976). Les deux premières tâches sont spatiales et permettent un apprentissage de place en environnements contrôlés, et la troisième est une tâche comportementale qui différencie deux habiletés particulières, celle d'élimination (basée sur la mémoire de travail) et celle de sélection (basée sur la mémoire de référence). La discussion des résultats porte sur les stratégies de navigation utilisées par les animaux pour résoudre les tâches et plus précisément sur les facteurs qui peuvent influencer le choix de ces stratégies. Le facteur environnemental (environnement contrôlé) et le facteur cognitif (vieillissement) représentent les variables étudiées ici. C'est ainsi que certaines hypothèses communément acceptées ont été malmenées par nos résultats. Or si l'espace est habituellement supposé homogène (toutes les positions spatiales présentent le même degré de difficulté lors d'un apprentissage en champ ouvert), ce travail établit qu'une position associée -sans contiguïté - à l'un des trois indices visuels situés dans la périphérie de l'environnement est plus difficile à apprendre qu'une position située entre deux des trois indices. Deuxièmement, alors qu'il est admis que l'apprentissage d'une place dans un environnement riche requiert le même type d'information. dans la bassin de Morris (tâche nagée) que sur la table à trous (tâche marchée), nous avons montré que la discrimination spatiale en bassin ne peut être assurée par les trois indices visuels périphériques et nécessite la présence d'au moins un élément supplémentaire. Enfin, l'étude du vieillissement a souvent montré que l'âge réduit les capacités cognitives nécessaires à la navigation spatiale, conduisant à un déficit général des performances d'un animal sénescent, alors que dans notre travail, nous avons trouvé les animaux âgés plus performants et plus efficaces que les adultes dans une tâche particulière de collecte de nourriture. Ces expériences s'inscrivent dans une étude générale qui met à l'épreuve le modèle théorique proposé pax Schenk et Jacobs (2003), selon lequel l'encodage de la carte cognitive (Tolman, 1948 ; O'Keefe et Nadel, 1978) se ferait dans l'hippocampe par l'activité de deux modules complémentaires :d'une part le CA3 - Gyrus Denté pour le traitement d'une trame spatiale basée sur des éléments directionnels et Jou distribués en gradient (bearing map) et d'autre part le CAl - Subiculum pour le traitement des représentations locales basées sur les positions relatives des éléments fixes de l'environnement (sketch map). SUMMARY This work proposes to talk about behavioural results observed in three different experimental paradigms with rats: the Morris Water Maze (Morris, 1984); the Homing Board (Schenk, 1989) and the Radial Arm Maze (Olton and Samuelson, 1976). The two first tasks are spatial ones and allow place learning in controlled environments. The third one is a behavioural task which contrasts two particular skills, the elimination (based on working memory) and the selection one (based on reference memory). The topic of the discussion will be the navigation strategies used by animals to solve the different tasks, and more precisely the factors which can bias this strategies' choice. The environmental (controlled) and the cognitive (aging) factors are the variables studied here. Thus, some hypotheses usually accepted were manhandled by our results. Indeed, if space is habitually homogenously considered (all spatial positions present the same degree of difficulty in an open field learning), this work establishes that an associated position -without being adjacent - to one of the three visual cues localised in the environmental periphery is more difficult to learn than a configurationnel position (situated between two of the three cues). Secondly, if it is received that place learning in a rich environment requires the same information in the Morris water maze (swimming task) that on the Homing board (walking task), we showed that spatial discrimination in the water maze can't be provided by the three peripheral cue cards and needs the presence of a supplementary cue. At last, aging studies often showed that oldness decreases cognitive skills in spatial navigation, leading to a general deficit in performances. But, in our work, we found that senescent rats were more efficient than adult ones in a special food collecting task. These experiments come within the scope of a general study which tests the theoretical model proposed by Jacobs and Schenk (2003), according to which the cognitive map's encoding (Tolman, 1948, O'Keefe and Nadel, 1978) should take place in the hippocampus by two complementary modules, first the DG-CA3 should encode directional and/or gradients references (the bearing map), and secondly the Subiculum-CAl should process locale elements (the sketch map).

Studies about the atomic capabilities concept for linear control systems in physical multi-agent environments

This paper shows the impact of the atomic capabilities concept to include control-oriented knowledge of linear control systems in the decisions making structure of physical agents. These agents operate in a real environment managing physical objects (e.g. their physical bodies) in coordinated tasks. This approach is presented using an introspective reasoning approach and control theory based on the specific tasks of passing a ball and executing the offside manoeuvre between physical agents in the robotic soccer testbed. Experimental results and conclusions are presented, emphasising the advantages of our approach that improve the multi-agent performance in cooperative systems

Long-term follow-up of follicular lymphoma (FL) patients receiving single agent rituximab at two different schedules in trial SAKK 35/98

Background: In FL, Rituximab as a single agent delivered in the standard schedule (4 times weekly) may induce a response rate of 50−70% with an event-free survival (EFS) of 1−3 years according to patients' characteristics. Prolonged Rituximab exposure seems to improve EFS at least in responding patients and to increase the rate of longterm responders. Here we report long-term results of a clinical trial comparing single agent Rituximab delivered in the standard schedule versus prolonged exposure, with focus on the proportion of long-term responders and their characteristics. Material and Methods: Between 1998 and 2002, chemotherapy na¨ıve (n = 64) or pre-treated (n = 138) FL patients received Rituximab in the standard schedule. Those responding or with stable disease were randomized to no further treatment (observation, n = 78) or 4 additional doses of Rituximab given at 2-month intervals (prolonged exposure, n = 73). EFS was calculated from the first dose of standard schedule until progression, relapse, second tumor or death. Results: At a median follow up of 9.4 years and with all living patients having been followed for at least 5 years, the median EFS is 13 months for the observation and 24 months for the prolonged exposure arm (p = 0.0007). In the observation arm 13% had no event at 5-years and only 4% at 8 years, while in the prolonged exposure arm it was 27% at 5 years and remained 21% at 8 years. The only significant prognostic factor for EFS in a multivariate Cox regression was the prolonged Rituximab schedule (hazard ratio 0.58, CI 0.39−0.86, p = 0.007), whereas being chemotherapy na¨ıve, presenting with stage

Improved prediction of coronary heart disease with markers of atherosclerosis and of inflammation in older adults?

Background: Several markers of atherosclerosis and of inflammation have been shown to predict coronary heart disease (CHD) individually. However, the utility of markers of atherosclerosis and of inflammation on prediction of CHD over traditional risk factors has not been well established, especially in the elderly. Methods: We studied 2202 men and women, aged 70-79, without baseline cardiovascular disease over 6-year follow-up to assess the risk of incident CHD associated with baseline noninvasive measures of atherosclerosis (ankle-arm index [AAI], aortic pulse wave velocity [aPWV]) and inflammatory markers (interleukin-6 [IL-6], C-reactive protein [CRP], tumor necrosis factor-a [TNF-a]). CHD events were studied as either nonfatal myocardial infarction or coronary death ("hard" events), and "hard" events plus hospitalization for angina, or the need for coronary-revascularization procedures (total CHD events). Results: During the 6-year follow-up, 283 participants had CHD events (including 136 "hard" events). IL-6, TNF-a and AAI independently predicted CHD events above Framingham Risk Score (FRS) with hazard ratios [HR] for the highest as compared with the lowest quartile for IL-6 of 1.95 (95%CI: 1.38-2.75, p for trend <0.001), TNF-a of 1.45 (95%CI: 1.04-2.02, p for trend 0.03), of 1.66 (95%CI: 1.19-2.31) for AAI 0.9, as compared to AAI 1.01-1.30. CRP and aPWV were not independently associated with CHD events. Results were similar for "hard" CHD events. Addition of IL-6 and AAI to traditional cardiovascular risk factors yielded the greatest improvement in the prediction of CHD; C-index for "hard"/total CHD events increased from 0.62/0.62 for traditional risk factors to 0.64/0.64 for IL-6 addition, 0.65/0.63 for AAI, and 0.66/0.64 for IL-6 combined with AAI. Being in the highest quartile of IL-6 combined with an AAI 0.90 or >1.40 yielded an HR of 2.51 (1.50-4.19) and 4.55 (1.65-12.50) above FRS, respectively. With use of CHD risk categories, risk prediction at 5 years was more accurate in models that included IL-6, AAI or both, with 8.0, 8.3 and 12.1% correctly reclassified, respectively. Conclusions: Among older adults, markers of atherosclerosis and of inflammation, particularly IL-6 and AAI, are independently associated with CHD. However, these markers only modestly improve cardiovascular risk prediction beyond traditional risk factors.

Peut-on exclure l'hypothèse d'une imitation parfaite de signature?

L'expert, en présence d'une signature contestée qu'il juge authentique, peut être confronté à l'argument selon lequel il pourrait s'agir d'une imitation parfaite. Les différents facteurs pouvant avoir un impact sur cette possibilité sont inventoriés et discutés dans cet article. Il s'agit principalement d'éléments liés soit à la signature en tant que telle, par exemple sa complexité et son degré de variation, soit à l'imitateur putatif, en particulier ses compétences. Pour répondre à la question d'un magistrat sur la possibilité de se trouver face à une imitation parfaite, l'expert sera armé pour écarter la simple explication que représente l'imitation parfaite au profit d'une discussion des résultats balancée et cohérente, où l'ensemble de ces facteurs sont discutés dans un cadre d'évaluation probabiliste.