Chestnut Wood Tannins in Broiler Diets: Pharmacokinetics, Serum Levels during Rearing, and Intestinal Absorption Pattern of Gallic Acid

Studies on the bioavailability, serum levels, and absorption of hydrolyzable tannin compounds are lacking. In this study, we performed a pharmacokinetic trial, measured the serum levels of compounds in broilers that were reared with different feed added or not with tannins, and tested the digestibility of tannins throughout the intestinal tract. Only gallic acid and 4-O-methyl gallic acid were found in the serum. Moreover, gallic acid showed a 41.8% absolute oral bioavailability and a 72.3% relative bioavailability of gallic acid from chestnut extract compared to the standard. The rapid metabolization caused alternating serum levels during the day and night. These patterns were not affected by the feed type or the previous addition of tannins in the feed. The absorption and metabolization in the intestines occurred gradually throughout the intestinal tract. The latter was true for gallic acid as well as ellagic acid, which was not found in the serum. We can conclude that components from chestnut tannins are absorbed throughout all components of the intestinal tract and are eliminated quickly with little interaction from the feed and previous addition of tannins. Moreover, ellagic acid seems to be absorbed but would remain accumulated in the intestinal tissue or be metabolized by the microbiome.

Decreasing hospitalizations through geriatric hotlines: a prospective French multicenter study of people aged 75 and above

BACKGROUND

The Emergency unit of the hospital (Department) (ED) is the fastest and most common way for most French general practitioners (GPs) to respond to the complexity of managing older adults patients with multiple chronic diseases. In 2013, French regional health authorities proposed to set up telephone hotlines to promote interactions between GP clinics and hospitals. The main objective of our study was to analyze whether the hotlines and solutions proposed by the responding geriatrician reduced the number of hospital admissions, and more specifically the number of emergency room admissions.

METHODS

We conducted a multicenter observational study from April 2018 to April 2020 at seven French investigative sites. A questionnaire was completed by all hotline physicians after each call.

RESULTS

The study population consisted of 4,137 individuals who met the inclusion and exclusion criteria. Of the 4,137 phone calls received by the participants, 64.2% (n = 2 657) were requests for advice, and 35.8% (n = 1,480) were requests for emergency hospitalization. Of the 1,480 phone calls for emergency hospitalization, 285 calls resulted in hospital admission in the emergency room (19.3%), and 658 calls in the geriatric short stay (44.5%). Of the 2,657 calls for advice/consultation/delayed hospitalization, 9.7% were also duplicated by emergency hospital admission.

CONCLUSION

This study revealed the value of hotlines in guiding the care of older adults. The results showed the potential effectiveness of hotlines in preventing unnecessary hospital admissions or in identifying cases requiring hospital admission in the emergency room. Hotlines can help improve the care pathway for older adults and pave the way for future progress.

TRIAL REGISTRATION

Registered under Clinical Trial Number NCT03959475. This study was approved and peer-reviewed by the Ethics Committee for the Protection of Persons of Sud Est V of Grenoble University Hospital Center (registered under 18-CETA-01 No.ID RCB 2018-A00609-46).

Radiotherapy Capabilities, Population, Average Income, and Health Insurance Status as Predictors of Cancer Mortality at the County Level in the United States

PURPOSE/OBJECTIVE(S)

Sufficient radiotherapy capacity at the country level is commonly seen in high income countries and is an essential factor in access to high quality cancer care. However, universal access is not always possible due to other factors beyond the commonly used parameter of machines per million population. This study aims to assess the barriers cancer patients in a high-income country face in accessing radiotherapy, and how this impacts cancer mortality.

MATERIALS/METHODS

This cross-sectional study utilized United States county level oncologic and demographic data obtained from Centers for Disease Control and Prevention and the International Atomic Energy Agency Directory of Radiotherapy Centers. Radiotherapy facilities in the United States were mapped using Geographic Information Systems software. Univariate analysis was used to identify whether distance to a radiotherapy center or various socioeconomic factors were predictive of all-cancer mortality-to-incidence ratios. Variables that were deemed to be significant (p ≤ 0.05) on univariate analysis were then included in a step-wise backwards elimination method of multiple regression analysis.

RESULTS

Among the United States counties studied, 31.3% of counties have at least one radiotherapy facility and 8.3% have five or more radiotherapy facilities. Median linear distance from a county's centroid to the nearest radiotherapy center was 36 Km and the median county all-cancer mortality to incidence ratio (MIR) was 0.37. The ratio of radiotherapy centers, linear accelerators and brachy therapy units per 1 million people were significantly associated with all-cancer MIR (p<0.05). Greater distance to radiotherapy facilities, lower county population, lower average income per county, and higher proportion of patients without health insurance were statistically significant predictors of increased all-cancer MIR (R-squared: 0.2113, F = 94.22, p<0.001).

CONCLUSION

This analysis used unique high-quality datasets to identify significant barriers to radiotherapy access that correspond to higher cancer mortality at the county level. Geographic access, personal income, and insurance status all contribute to these concerning disparities. Efforts and novel strategies to address and minimize these barriers are needed to ensure access to care and improve oncologic outcomes.

Proximity to Radiotherapy Center, Population, Average Income, and Health Insurance Status as Predictors of Cancer Mortality at the County Level in the United States

PURPOSE

Sufficient radiotherapy (RT) capacity is essential to delivery of high-quality cancer care. However, despite sufficient capacity, universal access is not always possible in high-income countries because of factors beyond the commonly used parameter of machines per million people. This study assesses the barriers to RT in a high-income country and how these affect cancer mortality.

METHODS

This cross-sectional study used US county-level data obtained from Center for Disease Control and Prevention and the International Atomic Energy Agency Directory of Radiotherapy Centres. RT facilities in the United States were mapped using Geographic Information Systems software. Univariate analysis was used to identify whether distance to a RT center or various socioeconomic factors were predictive of all-cancer mortality-to-incidence ratio (MIR). Significant variables (P ≤ .05) on univariate analysis were included in a step-wise backward elimination method of multiple regression analysis.

RESULTS

Thirty-one percent of US counties have at least one RT facility and 8.3% have five or more. The median linear distance from a county's centroid to the nearest RT center was 36 km, and the median county all-cancer MIR was 0.37. The amount of RT centers, linear accelerators, and brachytherapy units per 1 million people were associated with all-cancer MIR (P < .05). Greater distance to RT facilities, lower county population, lower average income per county, and higher proportion of patients without health insurance were associated with increased all-cancer MIR (R-squared, 0.2113; F, 94.22; P < .001).

CONCLUSION

This analysis used unique high-quality data sets to identify significant barriers to RT access that correspond to higher cancer mortality at the county level. Geographic access, personal income, and insurance status all contribute to these concerning disparities. Efforts to address these barriers are needed.

HPLC-DAD optimization of quantification of vescalagin, gallic and ellagic acid in chestnut tannins

The quantification of hydrolysable polyphenols such as gallic, ellagic acid and vescalagin by HPLC-DAD is classically run after methanol extraction as a reference solvent. Water extraction is usually discarded because of a lower obtention of total polyphenol content compared to methanol extraction. In our study, methanol was compared to water extraction in both the total polyphenol content method and the HPLC-DAD analysis. Total polyphenol content in water extraction was lower than in methanol extraction, but water extraction gave better results on HPLC-DAD. In conclusion, total polyphenol content cannot be used as reference to choose the solvent of extraction to quantify some polyphenols by HPLC-DAD because of the specific properties of each polyphenol. Indeed, recovery results obtained on hydrolysable polyphenols with water extraction were better and with a lower variability than following methanol extraction.

Chestnut tannins in broiler diets: Affecting intestinal development in different feeding phases

It is known that high doses of various tannins could impair broiler growth, and this seems to be linked to a lowered protein availability. However, effects on protein digestion under the influence of hydrolysable tannins were minimal in previous research and literature. Other possible proposed reasons to explain reduced growth are scarce. In this experiment we studied the effect of hydrolysable tannins on body allometry by using different feeding schemes throughout the rearing period. In total 112 individually reared male Ross 308 broilers received a 3-phase basal diet with chestnut wood extract (+: 2,000 mg/kg) or not (–: 0 mg/kg) (Tanno-SAN^®, Sanluc International NV, Belgium). This resulted in 2 groups during the starter period (S+, S–), 4 groups in the grower period (G++, G+−, G–+, G–) and 8 groups in the finisher period (F+++, F++−, F+−+, F+−−, F−++, F−+−, F−−+, F——). Similar to previous studies, growth reduction was also observed in this study. Effects were the largest in broilers that were given the tannins during the grower phase. At the end of each phase 8 broilers per group were euthanized and sampled. Liver, pancreas, pectoralis muscle, intestinal weights and intestinal length were recorded. The largest effects were seen on the intestine. Broilers that received tannins during the grower phase, had longer intestines at the end of the finisher period. Furthermore, histological differences between treatment groups were observed at the end of the grower period. Addition of tannins in the grower phase (G–+, G++) resulted in longer villi, whereas addition of tannins in the starter (G+−, G++) caused deeper crypts at the end of the grower phase, with the group (G–+) having the highest villi-to-crypt ratio. These results tentatively prove that tannins influence intestinal growth, both macroscopically as well as histologically. We hypothesize that the observed growth reduction with tannins could be the result of a changed energy and nutrient partitioning, i.e., more nutrients are directed to intestinal growth than for muscle growth.

Chestnut tannins in broiler diets: performance, nutrient digestibility, and meat quality

In 2 broiler trials, the effects of chestnut tannins on performance and meat quality (trial 1), and digestion (trial 2) were evaluated. In both trials, Ross 308 broilers received one of 2 basal diets: one basal diet contained corn and soy as main feed ingredients, while the challenge basal diet contained wheat, palm oil, and rapeseed meal. The composition of the basal diets was chosen to assess the interaction between chestnut tannins and diet composition. To both basal diets, chestnut tannins were added at 3 doses: 0 mg/kg (T-), 500 mg/kg (T+), or 2,000 mg/kg (T++), resulting in a total of 6 treatments. In trial 1, both basal diets containing 2,000 mg/kg chestnut tannins lowered broiler performance in grower and finisher phases. A tannin dose of 500 mg/kg had no effect on performance in either basal diet. Corn-based diets resulted in lower meat pH compared to wheat diets. Further, addition of chestnut tannins resulted in increased meat pH, and caused proportionally a lower meat drip loss and shear force for both basal diets. During the digestibility study (trial 2), blood was also collected. None of the treatments affected digestibility or blood parameters (glucose, non-esterified fatty acids, and triacylglycerols). Malondialdehyde (MDA) was measured in plasma to assess antioxidative properties of chestnut tannins. In wheat diets, chestnut tannins significantly lowered plasma MDA demonstrating its antioxidative nature. Regarding gut health, crypt depth decreased proportionally with the dosage of chestnut tannins in both basal diets with significantly shallower crypts for the wheat diets compared to the corn diets. Relative intestinal growth was stimulated in the wheat diets proportionally to the tannin dose based on the larger relative gut length. In conclusion, chestnut tannins did not influence digestive metabolism, yet they lowered performance at higher doses regardless of feed ingredients used in the diet. Tannins positively affected meat quality and when added to wheat diets, intestinal growth was stimulated and the antioxidative status of the broilers improved.

Social Marketing Intervention to Engage Older Adults in Balance Workshops for Fall Prevention: A Multicenter Quasi-Experimental Protocol Study

Background: Falls affects one of three people after 65 years old, and it can lead to serious consequences. Scientific evidence point out that physical exercise is the most efficient way to prevent falls among older adults.

Objective: The main objective of this study is to determine if a social marketing program can increase the attendance rate of people aged 60 and over at group balance workshops.

Methods: This quasi-experimental multicenter study is being conducted in three French Regions (Loire, Haute-Loire and Rhône) over a period of 18 months. The Social Marketing Campaign will be done in three ways. Firstly, a Communication Campaign will take place in the two Test Areas but not in the Control Area. Secondly, flyers have been designed to be distributed by local partners. Finally, conferences for older people will be organized in the areas of intervention in order to reach the target audience for the program. The study will include people aged 60 and older who want to participate in the Balance Program.

Results: The Crédit Agricole Loire/Haute-Loire Foundation funded the study and the Jean Monnet University of Saint-Etienne reviewed it. The Ethics Committee of the University Teaching Hospital of Saint-Etienne approved and peer-reviewed it on September 6, 2019, under Reference Number IRBN622019/CHUSTE.

Conclusion: The results of this first study will demonstrate whether or not social marketing for promoting group balance workshops in the elderly will increase their attendanceship in adapted physical activity sessions, especially those that prevent falls.

Clinical Trial Registration:https://clinicaltrials.gov/ct2/show/NCT04136938, identifier NCT04136938.

[The geriatric hotline improves practice, survey of general practitioners in the Saint-Etienne area]

Faced with an aging French population, the demand for unscheduled care is growing. In order to avoid referring elderly patients to emergency departments, which are unsuitable for them, the Regional Health Agencies have created telephone hot lines dedicated to geriatrics. They are exclusively accessible to general practitioners in order to obtain advice or a place in a geriatric hospital. General practitioners are rarely asked about the value of this tool in their practice.

COVID-19 and Quarantine, a Catalyst for Ageism

In February 2021, France had more than 76,000 deaths due to COVID-19 and older adults were heavily affected. Most measures taken to reduce the impact of COVID-19 (quarantine, visit ban in nursing home, etc.) significantly influenced the lives of older adults. Yet they were rarely consulted about their implementation. Exclusion of and discrimination against older adults has been accentuated during the COVID-19 pandemic. While many articles discussing COVID-19 also mention ageism, few actually incorporate the perspectives and opinions of older adults. Our research aims to assess the ageism experienced by older adults during the COVID-19 pandemic. We conducted interviews with older adults (63–92 years, mean age = 76 years) in an urban area of France. Participants reported experiencing more ageism during the COVID-19 pandemic, including hostile and benevolent ageism from older adults' families. Despite reports of experiencing ageist attitudes and behaviors from others, however, older adults also identified positive signs of intergenerational solidarity during this COVID-19 crisis.

Domestic Activities Associated With a Decreased Risk of Cognitive Disorders: Results of the "Fréle" Cohort

Background: Previous cohorts studied the association of various types of physical activities with the incidence of cognitive disorders. The objective of this work was to analyze the association of leisure, domestic and professional physical activities with mild and moderate cognitive disorders in older people living in the community. Methods: We used retrospective data from the "FRéLE" (FRagilité: étude Longitudinale de ses Expressions) a longitudinal and observational study. Data collected included socio-demographic variables, lifestyle and health status. Cognitive disorders were assessed using the Montreal Cognitive Assessment (MoCA). Two cut-offs of MoCA were used to analyze mild and moderate cognitive disorders. Physical activity was assessed by the Physical Activity Scale for the Elderly (PASE) structured in three sections: leisure, household, and professional activities. Spline and logistic regression models were used to estimate the risk of cognitive disorders. Results: At baseline, 428 participants (for study of mild disorders) and 1,271 participants (for study of moderate disorders) without cognitive disorders were included in the analysis. The mean ages were 74 and 78 years, respectively. After a 2-year follow-up, we found mild cognitive disorders in 154 participants (36%) and 71 cases of moderate cognitive disorders (5.6%). In multi-adjusted logistic models, domestic activities were associated with cognitive disorders, but not leisure and professional activities. Conclusion: We found an inverse relation between domestic sub-score and cognitive disorders defined by MoCA < 18. With a specific questionnaire and quantitative information on the type of activities, this study contributed to the debate on the beneficial effects of physical activity on cognition.

Surveillance of Cardiovascular Risk Factors in the Fifth Military Sector Health Center, Ngaoundéré, Cameroon: Observational Study

BACKGROUND

Noncommunicable diseases (NCDs) are the leading causes of death worldwide. They were responsible for 40 million of the 57 million deaths recorded worldwide in 2016. In Cameroon, epidemiological studies have been devoted to NCDs and their risk factors. However, none provides specific information on their extent or the distribution of their risk factors within the Cameroonian defense forces.

OBJECTIVE

The objective of our study was to assess the cardiovascular risk of a Cameroonian military population compared with that of its neighboring civilian population.

METHODS

We conducted a cross-sectional study that involved subjects aged 18 to 58 years, recruited from October 2017 to November 2018 at the Fifth Military Sector Health Center in Ngaoundéré, Cameroon. Data collection and assessment were done according to the World Health Organization (WHO)'s STEPS manual for surveillance of risk factors for chronic NCDs and the Alcohol Use Disorders Identification Test. Five cardiovascular risk factors were assessed: smoking, harmful alcohol consumption, obesity/overweight, hypertension, and diabetes. The risk was considered high in subjects with 3 or more of the factors. Univariate analysis and multivariate logistic regression were carried out according to their indications.

RESULTS

Our study sample of 566 participants included 295 soldiers and 271 civilians of the same age group (median age 32 years versus 33 years, respectively; P=.57). The military sample consisted of 31 officers and 264 noncommissioned officers (NCOs). Soldiers were more exposed to behavioral risk factors than civilians, with a prevalence of smoking of 13.9% versus 4.4% (P<.001) and excessive alcohol consumption of 61.7% versus 14.8% (P<.001). They also presented with a higher cardiovascular risk than civilians (odds ratio 2.7, 95% CI 1.50-4.81; P<.001), and among the military participants, the cardiovascular risk was higher for officers than for NCOs (51.6% versus 14.0%, respectively; P<.001).

CONCLUSIONS

Cameroonian soldiers are particularly exposed to cardiovascular behavioral risk factors and consequently are at higher risk of NCDs.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04315441; https://clinicaltrials.gov/ct2/show/NCT04315441.

Feasibility and acceptability in health centers of screening for chlamydia in deprived population

Issue

The French Health Insurance (FHI) is in charge of the governance of 100 Health Examination Centers (HEC). HEC provide evidence-based interventions in prevention, focused on deprived population. In France, Chlamydia trachomatis (Ct) infection is the most sexually transmitted infection, especially among young women.

Description of the problem

To assess the feasibility of systematic screening Ct infection, in HEC, among 18-25 years women and 18-30 years men, with a focus on self-sampling. Pragmatics questions were: how the youth accept the screening of Ct infection (especially the self-taken vaginal swabs)? Was the feasibility and Ct positivity similar between deprived and non-deprived population (according to the EPICES score)? A cross-sectional multicenter survey was performed in 13 HEC in January 2018.

Results

Screening was proposed to 1702 eligible young people (sexually active and no recent Ct treatment). 90.3% [88.8-91.6] accepted and participated: 44% women, 54% deprived people. Among women, 76.8% [73.4-79.9] used self-taken vaginal swabs, others urinary tests. Rates did not differ according to deprivation (p = 0.96). Screening was performed in 1487 people (96.7% for deprived vs 97.7% for non-deprived population, p = 0.258). Ct detection rate was 4.7% [3.7%-5.9%], significantly higher for deprived population (6.5% vs 2.5%, p &lt; 0.001).

Lessons

The results demonstrated the feasibility of Ct screening in HEC with a good acceptance among youth even among young deprived. The performance rate of the test was similar according to deprivation. However, deprivation was associated with having a positive Ct result. This feasibility led to the implementation of Ct screening in all HEC.

Key messages

Chlamydia trachomatis screening can be easily implemented even in deprived populations that accept and perform it as well as non-deprived populations. Promoting access to Chlamydia trachomatis screening to deprived populations might contribute to reduce social inequalities in health.

Social marketing interventions to promote physical activity among 60 years and older: a systematic review of the literature

BACKGROUND

Falls are a significant source of morbidity in people aged 65 and over, affecting one in three people in this age group. The scientific evidence indicates that physical activity is the most effective method for preventing falls among seniors. Although public health professionals often use social marketing to design and plan successful interventions, its use to promote physical activity and prevent falls among older people remains low. This article aims to provide a new systematic literature review of social marketing interventions promoting physical activity and targeting people aged 60 and over.

METHODS

Following CRD's guidance and PRISMA guidelines, we searched between January 2008 and July 2019 for relevant articles in five primary databases using predefined search and inclusion criteria. Two independent reviewers analysed the selected articles to identify evidence of the seven social marketing benchmark criteria, defined by experts in the field as the common elements that contribute to social marketing success.

RESULTS

The final review included nine studies. Of the studies selected, three specifically targeted over 60-year-olds, whereas the others segmented the population into several age-based subcategories, including over 60-year-olds. Eight studies highlighted positive results for the participants with an increase in participation or an increase in physical activity level. None of the nine studies selected for this systematic review implemented the entire social marketing approach.

CONCLUSION

Few published interventions use the seven social marketing criteria. Further research is required to encourage uptake and inclusion in successful social marketing interventions to increase program effectiveness in this target population.

Recurrence or Relapse of COVID-19 in Older Patients: A Description of Three Cases

BACKGROUND

COVID-19 has infected millions of people worldwide, particularly in older adults. The first cases of possible reinfection by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were reported in April 2020 among older adults.

DESIGN/SETTING

In this brief report, we present three geriatric cases with two episodes of SARS-CoV-2 infection separated by a symptom-free interval.

PARTICIPANTS

The participants of this brief report are three cases of hospitalized geriatric women.

MEASUREMENTS/RESULTS

We note clinical and biological worsening during the second episode of COVID-19 for all three patients. Also, there is a radiological aggravation. The second episode of COVID-19 was fatal in all three cases.

CONCLUSION

This series of three geriatric cases with COVID-19 diagnosed two times apart for several weeks questions the possibility of reinfection with SARS-CoV-2. It raises questions in clinical practice about the value of testing for SARS-CoV-2 infection again in the event of symptomatic reoccurrence. J Am Geriatr Soc 68:2179-2183, 2020.

Impact of Home Quarantine on Physical Activity Among Older Adults Living at Home During the COVID-19 Pandemic: Qualitative Interview Study

Background

Older adults and those with pre-existing medical conditions are at risk of death from severe acute respiratory syndrome coronavirus 2 (SARS CoV-2). In this period of quarantine, one of the reasons for going out is physical activity. This issue is important, as the impact of a sedentary lifestyle might be lower for children and young adults, but is far more severe for older adults. Although older adults need to stay at home because they have a higher risk of coronavirus disease (COVID-19), they need to avoid a sedentary lifestyle. Physical activity is important for older adults, especially to maintain their level of independence, mental health, and well-being. Maintaining mobility in old age is necessary, as it may predict loss of independence in older adults.

Objective

Our first objective was to evaluate the impact of this quarantine period on physical activity programs and on the physical and mental health of older adults. Our second objective was to discuss alternatives to physical activity programs that could be suggested for this population to avoid a sedentary lifestyle.

Methods

We conducted a qualitative survey using semistructured interviews with professionals (managers in charge of physical activity programs for older adults and sports trainers who run these physical activity programs) from the French Federation of Physical Education and Voluntary Gymnastics (FFPEVG) and older adults participating in a physical activity program of the FFPEVG. We followed a common interview guide. For analysis, we carried out a thematic analysis of the interviews.

Results

This study suggests that the COVID-19 epidemic has affected, before quarantine measures, the number of seniors attending group physical activity programs in the two study territories. In addition, despite the decline in their participation in group physical activities before the quarantine, older adults expressed the need to perform physical activity at home. There is a need to help older adults integrate simple and safe ways to stay physically active in a limited space. A national policy to support older adults for physical activity at home appears essential in this context.

Conclusions

Given the results of our study, it seems necessary to globally communicate how important it is for older adults to maintain physical activity at home. We are concerned about the level of independence and mental health state of older adults after the end of quarantine if there is no appropriate campaign to promote physical activity among them at home.

Impact of Geriatric Hotlines on Health Care Pathways and Health Status in Patients Aged 75 Years and Older: Protocol for a French Multicenter Observational Study

Background

In France, emergency departments (EDs) are the fastest and most common means for general practitioners (GPs) to cope with the complex issues presented by elderly patients with multiple conditions. EDs are overburdened, and studies show that being treated in EDs can have a damaging effect on the health of elderly patients. Outpatient care or planned hospitalizations are possible solutions if appropriate geriatric medical advice is provided. In 2013, France’s regional health authorities proposed creating direct telephone helplines, “geriatric hotlines,” staffed by geriatric specialists to encourage interactions between GP clinics and hospitals. These hotlines are designed to improve health care pathways and the health status of the elderly.

Objective

This study aims to describe the health care pathways and health status of patients aged 75 years and older hospitalized in short-stay geriatric wards following referral from a geriatric hotline.

Methods

The study will be conducted over 24 months in seven French university hospital centers. It will include all patients aged 75 and older, living in their own homes or nursing homes, who are admitted to short-stay geriatric wards following hotline consultation. Two questionnaires will be filled out by medical staff at specific time points: (1) after conducting the telephone consultation and (2) on admitting the patient to a short-stay geriatric medical care. The primary endpoint will be mean hospitalization duration. The secondary endpoints will be intrahospital mortality rate, the characteristics of patients admitted via the hotline, and the types of questions asked and responses given via the hotline.

Results

The study was funded by the National School for Social Security Loire department (École Nationale Supérieure de Sécurité Sociale) and the Conference for funders of prevention of autonomy loss for the elderly of the Loire department in November 2017. Institutional review board approval was obtained in April 2018. Data collection started in May 2018; the planned end date for data collection is May 2020. Data analysis will take place in the summer of 2020, and the first results are expected to be published in late 2020.

Conclusions

The results will reveal whether geriatric hotlines provide the most effective management of elderly patients, as indicated by shorter mean hospitalization durations. Shorter hospital durations could lead to a reduced risk of complications—geriatric syndromes—and the domino chain of geriatric conditions that follow. We will also describe different geriatric hotlines from different cities and compare how they function to improve the health care of the elderly and pave the way toward new advances, especially in the organization of the care path.

Trial Registration

ClinicalTrials.gov NCT03959475; https://clinicaltrials.gov/ct2/show/NCT03959475

International Registered Report Identifier (IRRID)

DERR1-10.2196/15423

Serial comprehensive geriatric assessment in elderly head and neck cancer patients undergoing curative radiotherapy identifies evolution of multidimensional health problems and is indicative of quality of life

Head and neck (H&N) cancer is mainly a cancer of the elderly; however, the implementation of comprehensive geriatric assessment (CGA) to quantify functional age in these patients has not yet been studied. We evaluated the diagnostic performance of screening tools [Vulnerable Elders Survey-13 (VES-13), G8 and the Combined Screening Tool 'VES-13 + (17-G8)' or CST], the feasibility of serial CGA, and correlations with health-related quality of life evolution [HRQOL; European Organisation for Research and Treatment of Cancer Quality of Life Questionnaires (EORTC QLQ)-C30 and -HN35] during therapy in hundred patients, aged ≥65 years, with primary H&N cancer undergoing curative radio(chemo)therapy. Respectively 36.8%, 69.0%, 62.1% and 71.3% were defined vulnerable according to VES-13, G8, CST and CGA at week 0, mostly due to presence of severe grade co-morbidities, difficulties in community functioning and nutritional problems. At week 4, significantly more patients were identified vulnerable due to nutritional, functional and emotional deterioration. The CST did not achieve the predefined proportion necessary for validation. Vulnerable patients reported lower function and higher symptom HRQOL scores as compared with fit patients. A comparable deterioration in HRQOL was observed in both groups through therapy. In conclusion, G8 remains the screening tool of choice. Serial CGA identifies the evolution of multidimensional health problems and HRQOL conditions during therapy with potential to guide individualised supportive care.

A new approach to the validation of tissue microarrays

Although tissue microarrays (TMA) have been widely used for a number of years, it is still not clear how many core biopsies should be taken to determine a reliable value for percentage positivity or how much heterogeneity in marker expression influences this number. The first aim of this study was to validate the human visual semi-quantitative scoring system for positive staining of tumour tissue with the exact values determined from computer-generated images. The second aim was to determine the minimum number of core biopsies needed to estimate percentage positivity reliably when the immunohistochemical staining pattern is heterogeneous and scored in a non-binary way. Tissue sections from ten colorectal cancer specimens were stained for carbonic anhydrase IX (CA IX). The staining patterns were digitized and 400 artificial computer-generated images were generated to test the accuracy of the human scoring system. To determine the minimal number of core biopsies needed to account for tumour heterogeneity, 50 (artificial) core biopsies per section were taken from the tumoural region of the ten digitally recorded full tissue sections. Based on the semi-quantitative scores from the 50 core biopsies per section, 2500 x n (n = 1-10 core biopsies) experimental core biopsies were then generated and scores recorded. After comparison with field-by-field analysis from the tumoural region of the whole tissue section, the number of core biopsies that need to be taken to minimize the influence of heterogeneity could be determined. In conclusion, visual scoring accurately estimated the percentage positivity and the percentage tumour present in a section, as judged by comparison with the artificial images. The exact number of core biopsies that has to be examined to determine tumour marker positivity using TMAs is affected by the degree of heterogeneity in the expression pattern of the protein, but for most purposes at least four is recommended.

Chemo-radiotherapy versus radiotherapy alone in the pre-operative treatment of resectable rectal cancer

AIM

To determine the differences in downstaging, local control (LC), disease free survival (DFS) and overall survival (OS) between combined pre-operative chemoradiation and pre-operative radiotherapy alone in the treatment of resectable rectal cancer.

METHODS

One hundred and ten patients who underwent pre-operative radiotherapy or chemo-radiotherapy were reviewed. Fifty-seven patients were treated with radiotherapy (30 Gy/3 Gy) alone and 53 patients with chemo-radiotherapy (bolus 5FU+45 Gy/1.8 Gy). The median interval between the end of neo-adjuvant treatment and surgery was 28 and 46 days for the patients treated with radiotherapy alone and chemo-radiotherapy.

RESULTS

The groups were homogeneously distributed for all characteristics except for cN-stage with more clinically node positive patients in the combined modality treatment group (47 vs 73%). A significant downstaging for tumour and/or lymph node status was observed in both groups. More ypT0-x-is were observed after chemoradiation than after radiotherapy alone (26 vs 7%; p=0.02). The local control rate at 3 years was 94% for both groups. DFS after radiation and chemoradiation was comparable with a 3-year DFS of 83 and 88%, respectively.

CONCLUSION

Both pre-operative schemes have similar outcomes concerning DFS, OS and LC. Tumour downstaging is associated with improved survival.

Disfluency in Tourette syndrome: observational study in three cases

It is often stated that stuttering is a common speech disorder in individuals with Tourette syndrome (TS). It has also been suggested, however, that the fluency failures observed in people with TS do not completely conform to the classic pattern of stuttering. The present paper describes the results of an analysis of the speech patterns of three individuals with TS. A picture emerged that bears some resemblance to stuttering, cluttering, and palilalia but that is also different from each of these disfluency types.

Dysphagia in a patient with giant osteophytes: case presentation and review of the literature

A patient with increasing dysphagia due to external bone compression of the oesophagus is presented. Radiographic evaluation revealed the underlying condition to be a diffuse idiopathic skeletal hyperostosis with exuberant and bumpy change within the anterior longitudinal ligament.

Long-term functional results of the non-surgical treatment of common bacterial infections of joints

Thirty patients with acute bacterial infection of a peripheral joint were treated with intravenous antibiotics, daily closed needle aspiration and early mobilization therapy. Joint mobility, expressed as a percentage of normal mobility, was evaluated at the end of the reconvalescence period and again after 42 to 65 months (mean: 50 months). The functional outcome was excellent and joint mobility normal in 2/3 of the cases as revealed by the short- and long-term evaluation results. Factors that affected joint mobility were: delayed treatment, joint disorders prior to treatment, and ease of access to the joint for needle aspiration. Poor results were found in the presence of hip infections. In the long term, deterioration of joint mobility can occur in the same aggravating conditions. Treatment of septic arthritis with daily needle aspiration and early mobilization gave very good functional results.

Levamisole as basic treatment of rheumatoid arthritis: longterm evaluation

We evaluated longterm levamisole treatment of 201 rheumatoid patients. Fifty-nine patients in their 1st yr of treatment were not analyzed; of the remaining 142, 69 (49%) still took levamisole with benefit. Levamisole was stopped in 32 patients (22%) for inefficacy and for reversible adverse reactions in 37 (26%). Leukotoxic side-effects were the commonest cause of withdrawal (23 patients = 16%). Since June 1977, we administer levamisole on a 1 d/wk schedule (150 mg), with determination of white blood cells 10 h after intake to detect high-risk patients for agranulocytosis. With disease exacerbation during treatment or lack of response after 6 months, the drug is given on a 2nd non-consecutive day. Since June 1977, cases of agranulocytosis have not been observed. Allergic vasculitis did not occur with a 1 d/wk schedule. The absence of nephrotoxicity and hepatotoxicity is stressed. Only 4 patients (3%) were lost to follow-up. Comparison is made with longterm use of gold and D-penicillamine. We conclude that levamisole is a useful slow acting antirheumatic drug.