Circulating Levels of Apelin, GDF-15 and Sarcopenia: Lack of Association in the MAPT Study

OBJECTIVES

Apelin and GDF-15 have been proposed as biomarkers of age-related sarcopenia but evidence in human models is scarce. This study aimed to explore the associations between blood apelin and GDF-15 with sarcopenia incidence and the evolution of sarcopenia components over two years in older adults >70 years.

DESIGN

Secondary longitudinal analysis of the Multidomain Alzheimer Preventive Trial.

PARTICIPANTS

Older adults (>70 years) attending primary care centers in France and Monaco.

SETTING

Community.

MEASUREMENTS

Serum Apelin (pg/mL) and plasma GDF-15 (pg/mL) were measured. Outcomes included sarcopenia defined by the European Working Group on Sarcopenia in Older People (EWGSOP) and its determinants (appendicular lean mass [ALM] evaluated through a Dual-energy X-ray Absorptiometry (DXA) scan, handgrip strength (HGS) and the 4-meter gait speed) measured over 2 years. Linear mixed models and logistic regression were used to explore the longitudinal associations.

RESULTS

We included 168 subjects from MAPT (median age=76y, IQR=73-79; 78% women). Serum apelin was not significantly associated with sarcopenia incidence (OR=1.001;95%CI=1.000,1.001;p-value>0.05 in full-adjusted models) nor with ALM (β=-5.8E-05;95%CI=-1.0E-04,2.12E-04;p>0.05), HGS (β=-1.1E-04;95%CI=-5.0E-04,2.8E-04;p>0.05), and GS (β=-5.1E-06;95%CI=-1.0E-05,2.0E-05;p>0.05) in fully adjusted models. Similarly, plasma GDF-15 was not associated with both the incidence of sarcopenia (OR=1.001,95%CI=1.000,1.002,p>0.05) and the evolution of its determinants ([ALM, β=2.1E-05;95%CI=-2.6E-04,3.03E-04;p>0.05], HGS [β=-5.9E-04;95%CI=-1.26E-03,8.1E-05; p>0.05] nor GS [β=-2.6E-06;95%CI=-3.0E-05, 2.3E-05;p>0.05]) in fully adjusted models.

CONCLUSIONS

Blood apelin and GDF-15 were not associated with sarcopenia incidence or with the evolution of sarcopenia components over a 2-year follow-up in community-dwelling older adults. Well-powered longitudinal studies are needed to confirm or refute our findings.

Proxy indicators to estimate the appropriateness of medications prescribed by paediatricians in infectious diseases: a cross-sectional observational study based on reimbursement data

Background

We previously developed proxy indicators (PIs) that can be used to estimate the appropriateness of medications used for infectious diseases (in particular antibiotics) in primary care, based on routine reimbursement data that do not include clinical indications.

Objectives

To: (i) select the PIs that are relevant for children and estimate current appropriateness of medications used for infectious diseases by French paediatricians and its variability while using these PIs; (ii) assess the clinimetric properties of these PIs using a large regional reimbursement database; and (iii) compare performance scores for each PI between paediatricians and GPs in the paediatric population.

Methods

For all individuals living in north-eastern France, a cross-sectional observational study was performed analysing National Health Insurance data (available at prescriber and patient levels) regarding antibiotics prescribed by their paediatricians in 2017. We measured performance scores of the PIs, and we tested their clinimetric properties, i.e. measurability, applicability and room for improvement.

Results

We included 116 paediatricians who prescribed a total of 44 146 antibiotic treatments in 2017. For all four selected PIs (seasonal variation of total antibiotic use, amoxicillin/second-line antibiotics ratio, co-prescription of anti-inflammatory drugs and antibiotics), we found large variations between paediatricians. Regarding clinimetric properties, all PIs were measurable and applicable, and showed high improvement potential. Performance scores did not differ between these 116 paediatricians and 3087 GPs.

Conclusions

This set of four proxy indicators might be used to estimate appropriateness of prescribing in children in an automated way within antibiotic stewardship programmes.

Isotropic finishing of austempered iron casting cylindrical parts by roller burnishing

Roller burnishing technique to achieve isotropic surface topography on cylindrical components made of austempered ductile iron (ADI) casting is presented in this paper. In the last years, ADI casting components are used in many mechanical applications, due to their enhanced mechanical properties. ADI castings are difficult-to-cut materials; therefore, advanced techniques to improve manufacturing productivity are necessary and under research. On the other hand, spiral roughness pattern produced by turning operation is a common source of unconformities in several applications. Turning produces a defined kinematic pattern, similar to a thread. This work presents a theoretical and experimental validation using different burnishing conditions. Roughness and surface topography and surface integrity were checked. Results show that the technique greatly improves surface roughness, and eliminates the kinematic-driven roughness pattern of turning, leading to a more isotropic finishing. A comparison between roller burnishing and ball burnishing is also presented in this paper.

[Intracranial hemorrhage and oral anticoagulants of patients treated between 2011 and 2013 at the Nancy Regional University Hospital]

OBJECTIVE

To perform a descriptive analysis of intracranial hemorrhages of patients treated with an antivitamin K (fluindione, acenocoumarol or warfarin) or a direct oral anticoagulant (dabigatran, rivaroxaban or apixaban) at the Nancy Regional University Hospital.

MATERIAL AND METHOD

The study period was from January 2011 to December 2013 and the computerized data (Programme de Médicalisation des Systèmes d'Information) of our hospital was accessed to identify the patients. Clinical data were obtained from the patients' files. Regional healthcare system was queried for reimbursement data.

RESULTS

Among the 157 identified cases of intracranial hemorrhage, 153 were related to antivitamin K, primarily fluindione (n=127), and only 4 to a direct oral anticoagulant (3 dabigatran and 1 rivaroxaban). During the same period, regional data indicated that 65,345 patients had had at least one reimbursement of antivitamin K and 20,983 patients one reimbursement of an oral direct anticoagulant. In our series, the most frequent intracranial hemorrhages were subdural hematoma (chronic in 65 cases, acute in 50 cases) and intraparenchymal hemorrhage (20 cases). The global mortality rate was 20.2% but varied with the site of hemorrhage. In multivariate analysis, the two risk factors of fatal outcome were coma on admission (OR 6.2; 95%CI: 2.6-15.0) and a history of previous intracranial hemorrhage (OR 13,4; 95% CI: 1,6-114,9).

CONCLUSION

During the 2011-2013 period, antivitamin K, especially fluindione, was the most frequently involved anticoagulants in intracranial hemorrhages with hospitalization at our Regional University Hospital. Coma on admission and a history of previous intracranial hemorrhage were the two main risk factors for fatal outcome.

Designing 2-aminoimidazole alkaloids analogs with anti-biofilm activities: structure-activities relationships of polysubstituted triazoles

In order to discover novel probes that may help in the investigation and the control of bacterial biofilms, we have designed a library of triazole-based analogs of 2-aminoimidazole marine alkaloids: naamine A and isonaamine A. Twenty-two compounds were screened for their biofilm inhibitory activity against two strains of Gram-negative bacteria. Four compounds were shown to act as non-toxic inhibitors of biofilm development without effect on bacterial growth even at high concentrations (100 μM).

Acral necrosis by Stenotrophomonas maltophilia

BACKGROUND

Stenotrophomonas maltophilia (SM) has been considered a nosocomial pathogen. Nevertheless, community acquired infection may occur more frequently than usually recognized.

CASE

We describe distal necrosis of the fingers by SM in a farmer, contracted in the community and successfully treated with a combination of cotrimoxazole and ciprofloxacin. The patient was diagnosed with chronic lymphocytic leukaemia 6 months later.

CONCLUSIONS

This unusual presentation shows that infection with SM should be included in the differential diagnosis of the skin and soft tissue infection, even in apparently healthy patients.

Guess what! Porokeratosis of Mibelli

A 72-year-old man had noticed, in his early forties, the appearance of well-defined papulous hyperkeratotic lesions, with increasing growth, located on both sides of his feet. After twenty-five years he consulted a dermatologist for the first time. Physical examination showed annular papules and rose-coloured plaques with atrophic centres, some of them hypopigmented, with higher and irregular borders, separated from the surrounding skin by longitudinal and well-defined furrows. The lesions presented variable sizes and shapes, some of them punctate, involving exclusively and in a bilateral form, both sides, back and sole of the feet (Figs. 1 and 2). The patient did not report any subjective symptoms. He was immunocompetent and did not remember that any relative had the same disease, nor had he been subjected to radiation treatment.

Cultural Diversity in Florida Nursing Programs: A Survey of Deans and Directors

To determine how nursing programs in the state of Florida promote and integrate cultural diversity, a survey of deans and directors was conducted. Of 90 deans and directors surveyed, 46 (51%) responded. The ethnic composition of students and faculty in the respondents' programs was examined in comparison with that of the Florida population. Hispanics, Blacks, and Asians were found to be underrepresented in nursing faculty as compared with their proportion in the state population. The majority of deans and directors ranked the goal of promoting cultural diversity of moderate importance. The two most critical issues perceived by the respondents were the lack of cultural knowledge, sensitivity, and awareness, and the academic problems and educational deficits of minority students. In 50% of the programs surveyed, culture content was integrated throughout the curriculum. Other programs either integrated culture content in specific classes or offered a course in transcultural nursing. Although numerous approaches are currently being employed to recruit ethnically diverse faculty and students, the data suggest that more extensive and innovative efforts are needed to overcome existing barriers. As nursing faces the challenge of caring for a multicultural society in the 21st century, nursing leaders and organizations must collaborate to resolve the issues and problems revealed in this survey.

Alpha-adrenoceptor-mediated prejunctional effects of chloroethylclonidine in the canine saphenous vein

The present study was undertaken to look for the effect of chloroethylclonidine (CEC) on prejunctional alpha-2 autoreceptors of the canine saphenous vein. The effect was tested on tritium overflow evoked by electrical stimulation from tissues preloaded with 0.2 microM 3H-norepinephrine. Yohimbine (3-300 nM) and CEC (1-125 microM) increased and UK-14,304 reduced the overflow of tritium evoked by 300 pulses (1 Hz). The maximal increase of tritium overflow caused by yohimbine was much higher than that caused by CEC: 3.82 and 1.74 times, respectively. CEC (5 microM) abolished both the inhibition caused by UK-14,304 and the enhancement of tritium overflow caused by yohimbine. However, when CEC was added after yohimbine, it reduced the electrically evoked overflow of tritium, the maximal effect being a reduction of tritium overflow by 35%. Prazosin (1-100 nM) did not change either the inhibitory effect of UK-14,304 or the facilitatory effect of CEC. These results suggest that CEC acts on two different subtypes of prejunctional alpha-2 autoreceptors; on one of them it acts as an antagonist and increases the electrically evoked overflow of tritium (and inhibits both the effect of UK-14,304 and yohimbine); on the other it acts as an agonist and reduces the electrically evoked overflow of tritium. Alternatively, one can admit that CEC is able to inhibit alpha-2 autoreceptors, which causes an increase of the transmitter release, and to activate a nonadrenergic inhibitory receptor thus causing a reduction of the transmitter release.

[Prevalence of hepatitis C virus antibodies in chronic hemodialysis and kidney transplantation patients]

Hepatitis C virus antibodies were measured in 26 chronic hemodialyzed patients and 43 kidney transplant recipients, using a second generation ELISA method. Fifty four percent of hemodialyzed had a longer duration of dialysis treatment compared with patients with negative antibodies (57.6 +/- 30.5 vs 15.4 +/- 7.3 months), and did not differ in the number of transfusions. Seven patients had elevated serum transaminase values, all with positive antibodies. Thirty five percent of kidney transplant recipients had positive antibodies. In these subjects, no relation was observed between the number of transfusions or length of dialysis treatment and the presence of positive hepatitis C antibodies.

Involvement of alpha 1- and alpha 2-adrenoceptors in the responses of proximal and distal segments of the canine saphenous vein to exogenous and endogenous noradrenaline

In the present study the relationship between adrenergic nerve terminals and postjunctional alpha-adrenoceptors mediating the responses to the endogenous transmitter was compared at proximal and distal levels of the canine saphenous vein. Concentration-response curves to noradrenaline and to tyramine as well as frequency-response curves to electrical stimulation were compared at both levels of the vessel, in the absence and presence of either prazosin (100 nmol.l-1) or yohimbine (100 nmol.l-1). The influence of inhibition of neuronal uptake by cocaine (12 mumol.l-1) on the responses to noradrenaline in the presence of prazosin (56 nmol.l-1) or yohimbine (20 nmol.l-1) was compared at the proximal level. The results show that, at the proximal level, the maximal responses to electrical stimulation and tyramine reached 80.1 +/- 2.2 (n = 18) and 74.2 +/- 1.9 (n = 18)%, respectively, of the maximal responses to noradrenaline, and 70.3 +/- 0.8 (n = 15) and 53.1 +/- 1.2 (n = 14)%, respectively, at the distal level. Furthermore, the proximal strips were more sensitive to electrical stimulation than the distal ones. Prazosin had a much greater inhibitory effect on the contractile responses to noradrenaline than on those to electrical stimulation, at both levels. At proximal level, the shifts (to the right) of the concentration (frequency)-response curves (at EC50) amounted to 0.58 +/- 0.02 (n = 16) and 0.18 +/- 0.02 (n = 8) log units, respectively (P less than 0.05), but, at the distal level, to 1.12 +/- 0.03 (n = 16) and 0.28 +/- 0.08 (n = 8) log units, respectively (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)