The angiopoietin/Tie-2 axis: a novel player in chronic kidney disease

The development of atherosclerosis in patients with chronic kidney disease (CKD) is severely accelerated leading to life-threatening cardiovascular (CV) events and its pathogenesis is different from that in the general population. Mainly the so-called uremic toxins are thought to count responsible for this phenomenon. Recently, the angiopoietin/Tie2 system has been identified as a potential new player in the uremia-associated pathogenesis of atherosclerosis. This review provides an overview of molecular mechanisms of angiopoietin-1/-2 and Tie2 signaling in regard to the endothelial activation status in health and disease. The first part reviews the role of angiopoietins in experimental models of inflammation. Then, we summarize the most important clinical trials showing a severely altered angiopoietin balance in favor of Ang-2. Those trials contain data on patients with CKD stage 1-4, on dialysis (CKD stage 5), arterial hypertension, and diabetes mellitus. Future experiments to prove a direct mechanism by which angiopoietins accelerate and/or aggravate atherosclerotic burden in CKD patients are highly desirable. Very recently, a clinical trial (in oncology) proved safety of a selective angiopoietin inhibitor. Those latest drugs might represent a future treatment option against CKD-associated micro-inflammation.

Cost analysis in total hip arthroplasty: experience of a teaching medical center located in Paris

BACKGROUND

Since the beginning of 2008, the implementation of a 100% activity-based payment system, has made efficiency one of the prime concern for the French health-care providing institutions. We therefore assessed the real cost of a scheduled total hip replacement (THR) ina teaching hospital and compared findings with French national data (and with the Government Healthcare Insurance System allowance).

HYPOTHESIS

The study should suggest possible means to optimize organization of management and/or clinicians' practice.

MATERIAL AND METHODS

This is a retrospective full-cost economic study. Patients were included only if fulfilling the following criteria: admitted in 2006; classified in Diagnosis-Related Group (DRG) 08C23 V or 08C23W (respectively THR without and with associated comorbidity); treated in a single department; admitted from home; and having undergone a THR (coded as NEKA020 in the french CPT) that same year. Treatment-cost was established on the basis of data collected from two main sources: the Information Systems Medicalization Program (ISMP) data-base, and the finance department data, which were taken into account in line with the French National Costs Study (NCS) structure.

RESULTS

The methodology employed here follows the 2006 National Costs Scale structure. Treatment costs (excluding the cost of implantable medical devices or IMDs) were estimated at 8,104.72 EUR for DRG 08C23W and 7,529.19 EUR for DRG 08C23 V. These figures were higher than the rates authorized in 2006 (excluding IMDs), which were 7,677.92 EUR for 08C23W and 6,358.97 EUR for 08C23 V (taking the 7% geographic coefficient into account) and than the 2005 NCS figures (excluding IMDs) of respectively 7,536.13 EUR and 6,083.59 EUR.

DISCUSSION

Clinical units and departments need to be able to assess costs for the pathologies they treat, as health-care institutions have to balance their expenditure against their income, which largely comes from their hospital-care activity. The methodology put forward here, of cost comparison according to the NCS structure, enables the total cost to be known. Comparing results (expenditure line by expenditure line) against national data, selectively highlights the areas in which efficiency can be improved. The exactitude of the obtained results remains, however, limited by the rules currently in use at each individual hospital's accounting department.

LEVEL OF EVIDENCE

Level IV, retrospective economic and decision analysis study.

Epac-1 activator 8-O-cAMP augments renoprotective effects of syngeneic [corrected] murine EPCs in acute ischemic kidney injury

Endothelial progenitor cells (EPCs) protect kidneys from acute ischemic damage. The aim of this study was to identify "treatment parameters" that optimize an EPC-based therapy of acute ischemic renal failure. Male C57BL/6N mice underwent unilateral nephrectomy with simultaneous contralateral renal artery clamping for 30, 35, and 40 min. Tagged murine EPCs were systemically injected at the time of reperfusion. In some experiments, EPCs were pretreated with the Epac (exchange protein directly activated by cAMP-1) activator 8-pCPT-2'-O-Me-cAMP (Epac-1 Ac) and the integrin binding antagonist cyclic Arg-Gly-Asp peptide (cRGD). Injections of 10(6) EPCs after 30 and 35 min of renal ischemia protected animals from acute renal failure. The same effect occurred with 0.5 x 10(6) EPCs after a 35-min period of ischemia. If ischemia lasted for 40 min, 0.5 x 10(6) cells mice did not prevent acute renal failure. To analyze whether EPC integrin receptor activation would modify the cells' renoprotective activity, EPCs were pretreated with Epac-1 Ac. Such animals did not develop acute renal failure, even if ischemia lasted for 40 min. This effect was negated if the cells were pretreated with both Epac-1 Ac and cRGD. In kidneys from those animals medullopapillary EPCs were significantly accumulated. In vitro Epac-1 Ac preactivation of EPCs did not increase the overall expression intensity but induced a redistribution of beta(1)-integrins toward the cell membranes. We conclude that EPC pretreatment with the integrin receptor activator 8-pCPT-2'-O-Me-cAMP augments the anti-ischemic potential of the cells.

Histological staging and Dupuytren's disease recurrence or extension after surgical treatment: a retrospective study of 124 patients

Dupuytren's disease has a high rate of recurrence after treatment. In this study we have assessed the usefulness of histological staging in the prediction of recurrence. We have also verified whether there is a correlation between histological staging and features of Dupuytren's diathesis. We studied 139 hands in 124 Caucasian patients treated between 1997 and 2004. There was a significant difference in the recurrence rate between the three histological types (P = 0.04). Histological staging was independent of features of Dupuytren's diathesis. This study confirms that histological staging is a reliable method for predicting recurrence. However, it should be used in association with clinical data to determine precisely the prognosis of patients suffering from Dupuytren's contracture.

[Cardiac damage due to scorpion envenomation: case involving atrial flutter]

The purpose of this report is to describe a case of scorpion envenomation observed in northern Chad in a 24-year-old-man with no medical history. The victim rapidly developed supraventricular arrhythmia due to catecholaminergic storm induced by the neurotoxic activity of the venom. Cardiomyopathy that can lead to fatal acute heart failure is a risk after scorpion envenomation. Heart damage is observed in 1% of scorpion envenomation cases and can result from several mechanisms, i.e., adrenergic myocarditis (as in the patient herein), toxic myocarditis or myocardial ischemia. Few articles describing supraventricular arrhythmia following scorpion envenomation have been published. It is paroxystic and regresses spontaneously in case of transient catecholaminergic storm. Occurrence of atrial flutter, even if not associated with heart failure, is an indication of severe scorpion envenomation and requires close patient monitoring and symptomatic treatment using betablocking drugs. The efficacy of specific treatment for scorpion envenomation, i.e., immunotherapy, remains controversial.

Acute anterior uveitis as the initial presentation of alkaptonuria

Alkaptonuria is a rare autosomal recessive metabolic disorder that may present with multi-system involvement such as ochronotic arthropathy, renal, urethral and prostatic calculi, cardiac valvular lesions and pigmentation of the skin, sclera, cartilage and other connective tissues. An association of the disease with uveitis has never been reported. We report the first case of alkaptonuria with ochronotic arthropathy presenting with recurrent acute anterior uveitis as the initial manifestation. The possible common link with the HLA-B27 gene is discussed.

The Tie2 receptor antagonist angiopoietin 2 facilitates vascular inflammation in systemic lupus erythematosus

OBJECTIVE

To investigate the role of the angiopoietin-tyrosine kinase with Ig-like and epidermal growth factor-like domains (Ang-Tie) system in systemic lupus erythematosus (SLE). Endothelial activation is emerging as a key event for leukocyte recruitment and accelerated atherosclerosis in SLE. Recently, the endothelial-specific Ang-Tie ligand-receptor system has been identified as a major regulator of vascular responsiveness to inflammatory stimuli.

METHODS

Ang1 (by immunoradiometric sandwich assay (IRMA)) and Ang2 (by ELISA) were measured in sera of 43 patients with SLE and 30 healthy controls. Expression of Ang2 was studied by immunohistochemistry in biopsies of human lupus nephritis.

RESULTS

Circulating Ang2 concentrations were increased and concentrations of Ang1 decreased in patients with active SLE compared to healthy controls. This tendency was still present in inactive SLE, although less pronounced. Individual Ang2 concentrations correlated well with SLE Disease Activity Index (SLEDAI) score, proteinuria, double-stranded DNA (dsDNA) titre and soluble vascular cell adhesion molecule 1 (sVCAM-1). In a multivariate regression analysis, renal involvement was the only independent predictor for elevated Ang2. Serum Ang2 was identified as a strong predictor for disease activity by receiver operating characteristic (ROC) procedures and regression tree models. Protein expression of Ang2 was upregulated in glomeruli of patients with lupus nephritis.

CONCLUSIONS

These data indicate that Ang2-mediated disruption of protective Ang1/Tie2 signalling is operational in SLE. Ang2 might facilitate endothelial inflammation, permeability and contribute to premature atherosclerosis. Furthermore, circulating Ang2 may be a valuable new biomarker for disease activity in SLE. Strategies to control the deleterious effects of Ang2 may open new perspectives to prevent endothelial inflammation in SLE.

Quality factor of Si-based photonic crystal L3 nanocavities probed with an internal source

We have investigated the quality factors of silicon-based photonic crystal nanocavities using the photoluminescence of a single layer of Ge/Si self-assembled islands as an internal source. We focus on membrane-type L3 elongated cavities with or without their lateral edge air holes shifted in position. The photoluminescence measurements are performed at room temperature. We show that the quality factor of the fundamental mode observed at a normalized frequency u = a/lambda~_ 0.25 is strongly dependent on the incident pump power. This dependence is associated with the free-carrier absorption of the photogenerated carriers. The slope of the quality factor vs. incident pump power gives access to the carrier recombination dynamics in these Si-based nanocavities. The measurements indicate that the carrier dynamics is controlled by nonradiative recombination associated with surface recombinations. A surface recombination velocity of 4.8 x 10(4) cm/s is deduced from the experiments. The spectral red-shift of the cavity modes as a function of incident pump power is correlated to the temperature rise due to thermo-optic effects. The measured temperature rise, which can reach 190 K, is correlated to the value estimated by a thermal analysis.

Devastating femoral osteomyelitis after anterior cruciate ligament reconstruction

Osteomyelitis following arthroscopic assisted anterior cruciate ligament (ACL) reconstruction has not been reported in literature. We describe an aggressive progression of septic arthritis and osteomyelitis leading to the complete destruction of the condylar region in a young non-immunosuppressed patient after reconstruction of the ACL. In addition we discuss the steps in diagnostics and our salvage procedures.

[Safety surveillance in the National Vaccination Programme; fewer adverse events with the DTP-IPV-Hib vaccine after the transition to an acellular pertussis component in 2005]

OBJECTIVE

To determine the adverse reactions to the combined vaccine against diptheria, acellular pertussis, tetanus, poliomyelitis and Haemophilus Infuenzae type B (DTP-IPV-Hib) before and after the introduction of an acellular pertussis component.

DESIGN

Descriptive.

METHOD

Safety surveillance of the Dutch National Vaccination Programme is performed by the National Institute for Public Health and Environment (RIVM). It is based on an enhanced passive reporting system and complemented by targeted survey-based studies. The data obtained were analysed.

RESULTS

The passive surveillance system showed a large increase in reports in 2004, probably linked to increased media attention on the efficacy and safety of the whole-cell DTP-IPV-Hib vaccine. The Health Council recommended transitioning to the use of a DTP-IPV-Hib vaccine with an acellular pertussis component, which was implemented in January 2005. The number of reports dropped sharply in 2005 to a level below that of 2002-2003. Results of a survey study on adverse events following DTP-IPV-Hib vaccination that began in late 2003 and continued in 2005 confirmed the wide coverage ofthe enhanced passive surveillance system and revealed low rates of underreporting of rare adverse events, such as collapse and convulsions.

CONCLUSION

This study confirms the data from the passive surveillance system, which show that the newly introduced acellular DTP-IPV-Hib vaccine is associated with fewer adverse events than the whole-cell vaccine that was used previously.

Mental health and physical health of family caregivers for persons with dementia: a comparison of African American and white caregivers

This investigation analyzed the differences between African American and white caregivers in the effects of family caregiving for a person with dementia on mental health and physical health variables (including subjective health, reported diseases and cardiovascular measures). A population-based sample of 102 caregivers is compared with 102 non-caregivers matched on ethnicity, gender and age. There were no significant group differences for mental health effects. Most significant physical health effects were attributable to main effects of ethnicity rather than caregiving status. However, African American caregivers had higher diastolic blood pressure than all other groups, a finding consistent with group-specific risk for circulatory system disorders.

Hypermethylation of the nel-like 1 gene is a common and early event and is associated with poor prognosis in early-stage esophageal adenocarcinoma

The nel-like1 (NELL1) gene maps to chromosome 11p15, which frequently undergoes loss of heterozygosity in esophageal adenocarcinoma (EAC). NELL1 promoter hypermethylation was examined by real-time methylation-specific polymerase chain reaction in 259 human esophageal tissues. Hypermethylation of this promoter showed highly discriminative receiver-operator characteristic curve profiles, clearly distinguishing esophageal squamous cell carcinoma (ESCC) and EAC from normal esophagus (NE) (P<0.001). NELL1 normalized methylation values were significantly higher in Barrett's metaplasia (BE), dysplastic Barrett's (D) and EAC than in NE (P<0.0000001). NELL1 hypermethylation frequency was zero in NE but increased early during neoplastic progression, to 41.7% in BE from patients with Barrett's alone, 52.5% in D and 47.8% in EAC. There was a significant correlation between NELL1 hypermethylation and BE segment length. Three (11.5%) of 26 ESCCs exhibited NELL1 hypermethylation. Survival correlated inversely with NELL1 hypermethylation in patients with stages I-II (P=0.0264) but not in stages III-IV (P=0.68) EAC. Treatment of KYSE220 ESCC and BIC EAC cells with 5-aza-2'-deoxycytidine reduced NELL1 methylation and increased NELL1 mRNA expression. NELL1 mRNA levels in EACs with an unmethylated NELL1 promoter were significantly higher than those in EACs with a methylated promoter (P=0.02). Promoter hypermethylation of NELL1 is a common, tissue-specific event in human EAC, occurs early during Barrett's-associated esophageal neoplastic progression, and is a potential biomarker of poor prognosis in early-stage EAC.

Adult stem cells: the real root into the embryo?

During embryonic development, a pool of cells may become a reserve of undifferentiated cells, the embryo-stolen adult stem cells (ESASC). ESASC may be responsible for adult tissue homeostasis, as well as disease development. Transdifferentiation is a sort of reprogramming of ESASC from one germ layer-derived tissue towards another. Transdifferentiation has been described to take place from mesoderm to ectodermal- or endodermal-derived tissues and viceversa but not from ectodermal- to endodermal-derived tissues. We hypothesise that two different populations of ESASC could exist, the first ecto/mesoblast-committed and the second endo/mesoblast-committed. If confirmed, this hypothesis could lead to new studies on the molecular mechanisms of cell differentiation and to a better understanding of the pathogenesis of a number of diseases.

[Psychometric properties of the French version of Karasek's "Job Content Questionnaire" and its scales measuring psychological pressures, decisional latitude and social support: the results of the SUMER]

Psychosocial factors at work have been found to be associated with having potential risk for adverse health effects. The main instrument used to measure these factors and their impact is the Job Content Questionnaire (JCQ) by Karasek. The objective of this study was to evaluate the psychometric properties of the French version of the JCQ, and in particular to assess its internal coherence and consistency, as well as the factorial and convergent validity of psychological demands, decisional latitude and social support at work based upon the SUMER survey, which was the first French national survey of its kind to include the JCQ. The study was based on a sample of 24, 486 workers who answered the JCQ in 2003 (96.5% response rate). Internal consistency was satisfactory, as Cronbach's alpha coefficients were observed as being higher than 0.65. Confirmatory factor analysis showed that the best model was composed of 5 latent variables: demands and pressures, the two dimensions of latitude (utilization of skills and autonomous decision-making), and the two dimensions of support (from supervisors and from colleagues). Convergent validity tests confirmed the expected association with key variables, which were: age, work status, sector of activity, occupation, job satisfaction, perception of job stress, and intent to change job. This study demonstrated satisfactory psychometric properties of Karasek's JCQ scales for the French working population.

Research of cardiomyocyte precursors in adult rat heart

Recent reports supported the existence of stem cells in adult hearts. However, phenotype and localization of these cells have not been completely described and it is unknown if cardiac regenerative potential differs from one subject to another. The aims of our work were to identify different populations of cardiac stem cells by the analysis of specific markers and to evaluate the expression variability of these markers in 12 adult rat hearts. The expression of CD9, taube nuss and nanog suggests the presence of stem cells from the earliest stages of embryogenesis in adult myocardium. Their different expression could be associated to the degree of stem cell differentiation. CD34 and c-Kit antibodies were used to detect stem cells committed to one or more specific tissue lineages and we found a strong immunoreactivity for CD34 exclusively in the endothelial cells and a low positivity for c-Kit in the interstitium and next to the vessels. Moreover, as c-Kit expression highly differed within all examined hearts, we suggest that cardiomyogenic potential is different among the various subjects. Undifferentiated cells with myogenic-committed phenotype expressing GATA-4 and nestin were found, respectively, in the interstitial and myocardial cells and in few interstitial cells. Therefore, the physiologic turn over of cardiomyocytes may occur in adult hearts as it has been shown in many others organs. The study of myogenic potential could be important to identify markers specific of stem cells in in vivo adult myocardium that may be used to purify these cells and evaluate their regenerative ability.

Financement des traitements endovasculaires des anévrysmes cérébraux

METHOD

We have calculated all hospital expenses related to treated intracerebral aneurysms for 2005. Catheters, microcatheters, and guidewires as well as coils were included. We have compared these expenses to the payment by activity and fee per service collected for providing these services.

RESULTS

Payments received covered only a third of the expenses for the supplies used. Three types of expenses are not reimbursed: the guiding material, the coils used but not released, and the latest generation of coils not yet added to the national list of covered devices. These expenses are also not covered by the payment received for the hospital admission.

DISCUSSION

Endovascular management of intracranial aneurysms has become the treatment of choice over the recent years. This treatment is virtually only available in university hospitals. With the current mode of reimbursement, such treatment generates losses to the hospital.

CONCLUSION

This example raises the question of financial support for innovative treatments and procedures.

[Infradiaphragmatic extralobar pulmonary sequestration]

PURPOSE

To demonstrate characteristic imaging findings in infradiaphragmatic extralobar pulmonary sequestration (IEPS) with special emphasis on ultrasound (US).

MATERIALS AND METHODS

The imaging material (pre- and postnatal US in all cases, magnetic resonance imaging (MRI) in 2 cases) for 4 infants (3 girls, 1 boy) was reviewed. 2 patients underwent surgery (after birth and at 4 months of age, respectively) and the diagnosis of IEPS was confirmed. The other 2 patients were monitored conservatively using US for up to 15 months.

RESULTS

All 4 left-side suprarenal masses exhibited the same characteristic sono-morphology, leading to the suspected diagnosis of IEPS. The masses were small (max. 10 ml), hyperechoic with cystic components and without calcifications, well demarcated and separate from the normal kidney and the suprarenal gland, and without any change in prenatal and directly postnatal size. Doppler US showed low-grade perfusion in all cases and an aberrant systemic artery originating from the abdominal aorta in 2 cases. MRI did not add any fundamental information. Despite the suspected imaging diagnosis of IEPS and negative urinalyses for neuroblastoma, 2 patients underwent surgery for histological confirmation. The lesions in the other 2 patients were monitored via US. A complete disappearance after 4 months in one patient and a continuous decrease in size over 15 months in the other patient were documented.

CONCLUSION

Based on the characteristic findings of prenatal and postnatal US, IEPS can be diagnosed reliably. With the knowledge of its benign spontaneously regressing behavior, suspected suprarenal lesions should be treated conservatively via US monitoring.

Opioid antagonists for smoking cessation

BACKGROUND

The reinforcing properties of nicotine may be mediated through release of various neurotransmitters both centrally and systemically. Smokers report positive effects such as pleasure, arousal, and relaxation as well as relief of negative affect, tension, and anxiety. Opioid (narcotic) antagonists are of particular interest to investigators as potential agents to attenuate the rewarding effects of cigarette smoking.

OBJECTIVES

To evaluate the efficacy of opioid antagonists in promoting long-term smoking cessation. The drugs include naloxone and the longer-acting opioid antagonist naltrexone.

SEARCH STRATEGY

We searched the Cochrane Tobacco Addiction Group specialized register for trials of naloxone, naltrexone and other opioid antagonists and conducted an additional search of MEDLINE using 'Narcotic antagonists' and smoking terms in March 2006. We also contacted investigators, when possible, for information on unpublished studies.

SELECTION CRITERIA

We considered randomized controlled trials comparing opioid antagonists to placebo or an alternative therapeutic control for smoking cessation. We included in the meta-analysis only those trials which reported data on abstinence for a minimum of six months. We also reviewed, for descriptive purposes, results from short-term laboratory-based studies of opioid antagonists designed to evaluate psycho-biological mediating variables associated with nicotine dependence.

DATA COLLECTION AND ANALYSIS

We extracted data in duplicate on the type of study population, the nature of the drug therapy, the outcome measures, method of randomization, and completeness of follow up. The main outcome measure was cotinine- or carbon monoxide-verified abstinence from smoking after at least six months follow up in patients smoking at baseline. Where appropriate, we performed meta-analysis using a fixed-effect model (Mantel-Haenszel odds ratios).

MAIN RESULTS

Four trials of naltrexone met inclusion criteria for meta-analyses for long-term cessation. All four trials failed to detect a significant difference in quit rates between naltrexone and placebo. In a pooled analysis there was no significant effect of naltrexone on long-term abstinence, and confidence intervals were wide (odds ratio 1.26, 95% confidence interval 0.80 to 2.01). No trials of naloxone or buprenorphine reported long-term follow up.

AUTHORS' CONCLUSIONS

Based on limited data from four trials it is not possible to confirm or refute whether naltrexone helps smokers quit. The confidence intervals are compatible with both clinically significant benefit and possible negative effects of naltrexone in promoting abstinence. Data from larger trials of naltrexone are needed to settle the question of efficacy for smoking cessation.

Proximale Humerusfraktur des Kindes und Adoleszenten

BACKGROUND

There is great uncertainty among trauma surgeons regarding the correct treatment of rare proximal humerus fractures in children and adolescents, in spite of the great potential of the proximal humeral epiphysis for self-correction, even in cases of gross malalignment.

METHODS

Over a span of 6 years, we treated 52 children and adolescents with closed proximal humerus fractures, 45 of whom had no other injuries. In only three cases did we see an indication for operative treatment at our institution. Operations on another three were performed elsewhere. Forty two patients were available for follow-up exams.

RESULTS

They all had good or very good results with regard to fracture healing (constant score) independently of age, sex, fracture morphology, and treatment.

CONCLUSIONS

We believe it is particularly important to discuss therapy concepts with parents and the involved outpatient physicians in order to avoid unnecessary and stressful operations.

Comparative analysis of MRI vs mammography in evaluation of size, number of lesions and nodal status of breast cancer

600

Background: Breast MRI is thought to be better in evaluating patients (pts) with BrCa. Our study was to compare MRI vs mam to predict leisons and LNS in BrCa. Methods: A retrospective study of 100 consecutive pts with pathologically proven BrCa was done. All had preoperative MRI and mam. Findings were compared to the final pathologic size, used as gold standard. MRI and was done at same center and single surgeon did all surgeries. Results: Of 100 pts,MRI reported 124 lesions. MRI reported size in 107 and mam reported size in 63 lesions. In MRI detected sizes 8% had same size as pathological size, 66% were overestimated by a mean of 0.64cm and 26% were underestimated by a mean of 0.48cm. For mam lesions, 10% had same size, 34% were overestimated by a mean of 1.10cm, 57% were underestimated by a mean of 0.78 cm. Total of 25 additional lesions were found in 23 pts in same and 6 leisons in 6 pts in contralateral breast by MRI. MRI also detected enlarged axillary and intramammary LN in 15% pts, 40% were true positives(+ve) and 60% were false +ve. One pt had metastatic LN in the contralateral axilla detected by MRI and confirmed by lymphoscintogram and pathology. 3% pts had neo-adjuvant chemotherapy Conclusion: In our study mam underestimated the breast lesion size in pts significantly more than MRI, but MRI overestimated BrCa lesion size in more number of pts. The mean difference in size on MRI when compared to the pathological size is less than 1 cm, while mam overestimated by a mean of greater than 1cm. This might be particularly important for T1 and T2 lesions, where size is the most important criterion for the T-stage classification. The identification of additional lesions and enlarged LN on MRI further validates the utility of MRI.

[Table: see text]

No significant financial relationships to disclose.

La version française du questionnaire de Leymann sur la violence psychologique au travail : le « Leymann Inventory of Psychological Terror » (LIPT)

BACKGROUND

Workplace bullying is considered as a major job stress factor and is associated with mental disorders. To date, there was no validated French version of the "Leymann Inventory of Psychological Terror" (LIPT), considered to be the instrument of reference. The objective of this study was to elaborate this French version and to explore its factorial, convergent and predictive validity.

METHODS

The present study was based on a large sample of men and women of the working population asked to participate to a cross-sectional survey by a network of 143 occupational physicians in the South-East of France. This study included 7694 subjects, 3132 men and 4562 women, who responded to the anonymous self-questionnaire including the French version of the LIPT. This version was obtained by a standard forward/backward translation procedure.

RESULTS

The LIPT allows to evaluate the 12-month prevalence of exposure to 45 forms of bullying. The analysis of an open question asking for other potentially missing forms of bullying underlined the satisfactory coverage of the LIPT. The study of the factorial validity showed a satisfactory coherence in the interpretation of the factors obtained. Leymann defined workplace bullying by the exposure to at least one form of bullying, weekly or more, and for at least six months. The convergent and predictive validity were increased when this definition was combined with the self-report of being exposed to bullying.

CONCLUSION

This study is the first one elaborating and validating the French version of the LIPT by Leymann. This step of development and validation of the French version of questionnaires seems crucial to set up future high-quality studies, and to allow comparisons at the international level. Workplace bullying seems to be a serious problem in the French working life given the prevalence observed here (around 10%). Forthcoming studies should prefer using such validated questionnaire to better understand and prevent this occupational risk factor.

Comparison of Microcapillary Cytometry Technology and Flow Cytometry for CD4+ and CD8+ T-Cell Estimation

An alternative technology for the estimation of T cells based on a microcapillary technique (Guava Technologies, Hayward, CA) was compared to FACSCount (Becton Dickinson, San Jose, CA). Samples from 51 human immunodeficiency virus-infected and 21 healthy individuals were tested. The correlation (r) of the two systems for CD4(+) T cells was 0.994, and the coefficient of variation was 6.5%, establishing equable performance between the two technologies.

Human immunodeficiency virus infection and levels of Dehydroepiandrosterone sulfate in plasma among Indians

The shift in cytokine profile during human immunodeficiency virus (HIV) disease progression is influenced by dehydroepiandrosterone sulfate (DHEAS) level. Radioimmunoassay was used to measure plasma DHEAS for 30 treatment-naïve HIV-infected and 30 uninfected individuals. There was a significant negative correlation of viral load with DHEAS level (P<0.05). Further studies of the use of DHEAS levels for monitoring HIV patients economically are warranted.

Perinatal care regionalization and acceptability by professionals in France

BACKGROUND

For twenty years, most of industrial countries developed recommendations on regionalization of perinatal care. Perinatal regionalization is particularly aimed at improving morbidity and mortality outcomes of low birth weight newborns by transferring pregnant women to the maternity units having a medical or neonatal environment suited to the risks incurred by mothers or babies. Perinatal regionalization cannot be effective without being well accepted by the majority of professionals. The objectives of this study were then to identify professionals'expectations and objections to perinatal regionalisation and to compare them from a professional group to another one.

METHODS

Professionals of 3 French perinatal networks were under consideration: the Rhône, the Auvergne and the Gard-Lozère networks. The study included two stages: 1) a psychosociological qualitative study, based on professionals'interviews, aimed at identifying main concerns of professionals and developing a questionnaire; then 2) an epidemiological quantitative study, using this questionnaire within French networks. In the questionnaire, 8 dimensions explored the professionals'views: constraints related to regulation aspects and to the setting up of maternity units care levels, risk of loss of professionals' competence and prestige, consequences on medical practices, on inter-professional relationship, on work organization and financial aspects, and related to the new role of 'private practice'professionals, legal consequences.

RESULTS

The response rate of the epidemiological study was 80%. The results permitted to construct 8 dimension scores describing the reasons of poor acceptability of regionalization. After taking into account the age, the sex, the network and the juridical status of the institution, the study revealed a significant poorer acceptability of regionalization by most of medical specialty groups (anesthetists, obstetricians, midwives and "private practice" professionals) compared with neonatologists, or by "private" professionals (professionals working in private clinics and "private practice" professionals) compared with professionals working in university or community hospitals. The study described also network setting up conditions related to its functioning.

CONCLUSION

By identifying clearly professionals 'objections and expectations, this study should facilitate improvement in the organization of studied perinatal networks.

[Analysis of the static pressure volume curve of the lung in experimentally induced pulmonary damage by CT-densitometry]

PURPOSE

To study quantitative changes of lung density distributions when recording in- and expiratory static pressure-volume curves by single slice computed tomography (CT).

MATERIALS AND METHODS

Static in- and expiratory pressure volume curves (0 to 1000 ml, increments of 100 ml) were obtained in random order in 10 pigs after induction of lung damage by saline lavage. Simultaneously, CT acquisitions (slice thickness 1 mm, temporal increment 2 s) were performed in a single slice (3 cm below the carina). In each CT image lung segmentation and planimetry of defined density ranges were achieved. The lung density ranges were defined as: hyperinflated (-1024 to -910 HU), normal aerated (-910 to -600 HU), poorly aerated (-600 to -300 HU), and non aerated (-300 to 200 HU) lung. Fractional areas of defined density ranges in percentage of total lung area were compared to recorded volume increments and airway pressures (atmospheric pressure, lower inflection point (LIP), LIP*0.5, LIP*1.5, peak airway pressure) of in- and expiratory pressure-volume curves.

RESULTS

Quantitative analysis of defined density ranges showed no differences between in- and expiratory pressure-volume curves. The amount of poorly aerated lung decreased and normal aerated lung increased constantly when airway pressure and volume were increased during inspiratory pressure-volume curves and vice versa during expiratory pressure-volume loops.

CONCLUSION

Recruitment and derecruitment of lung atelectasis during registration of static in- and expiratory pressure-volume loops occurred constantly, but not in a stepwise manner. CT was shown to be an appropriate method to analyse these recruitment process.