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International audience; BACKGROUND:Mild primary hyperparathyroidism (serum calcium ≤ 2.85 mmol/L) is the most representative form of pHPT nowadays. The aim of this study was to evaluate its subtypes and the multiglandular disease (MGD) rate as it may lower the sensitivity of preoperative parathyroid scintigraphy and the surgical cure rate.METHODS:We retrospectively included patients with mild pHPT who underwent parathyroid dual-tracer scintigraphy with 99mTc-MIBI SPECT/CT and surgery between January 2013 and December 2015. Cure was defined as normalization of serum calcium (or PTH in the normocalcemic form) at 6 months. MGD was defined by either two abnormal resected glands or persistent disease after resection of at least one abnormal gland.RESULTS:We included 121 patients. Median preoperative serum calcium was 2.68 mmol/L and median PTH was 83.4 pg/mL. A total of 141 glands were resected (95 adenomas, 33 hyperplasias). The subtypes were 57% classic, 32.2% normohormonal, and 10.7% normocalcemic. MGD occurred in 23.5% of patients divided as 13%, 30%, and 64% respectively (p = 0.0011). The surgical cure rate was 85.2%. The normocalcemic form had lower cure rate than the normohormonal (45% vs 84%, p = 0.018) and classic forms (45% vs 93%, p = 0.0006). MIBI scintigraphy identified at least one abnormal lesion, later confirmed by the pathologist in 90/98 patients, making the sensitivity per patient 91.8% (95% CI 84.1-96.2%).CONCLUSIONS:MGD is strongly associated with mild pHPT, especially the normocalcemic form where it accounts for 64% of cases. Bilateral neck exploration should be performed in this population to improve the cure rate, even if the scintigraphy shows a single focus.

International audience; Interval aerobic training programs (IATP) improve cardiorespiratory and endurance parameters. They are, however, unsuitable to seniors as frequently associated with occurrence of exhaustion and muscle pain. The purpose of this study was to measure the benefits of an IATP designed with recovery bouts (IATP-R) in terms of cardiorespiratory and endurance parameters and its acceptability among seniors (≥70 years). Sedentary healthy volunteers were randomly assigned either to IATP-R or sedentary lifestyle. All participants performed an incremental cycle exercise and 6-minute walk test (6-MWT) at baseline and 9.5 weeks later. The first ventilatory threshold (VT1 ); maximal tolerated power (MTP); peak of oxygen uptake (VO2peak ); maximal heart rate (HRmax ); and distance walked at 6-MWT were thus measured. IATP-R consisted of 19 sessions of 30-minute (6 × 4-min at VT1 + 1-minute at 40% of VT1 ) cycling exercise over 9.5 weeks. With an adherence rate of 94.7% without any significant adverse events, 9.5 weeks of IATP-R, compared to controls, enhanced endurance (VT1 : +18.3 vs -4.6%; HR at baseline VT1 : -5.9 vs +0.2%) and cardiorespiratory parameters (VO2peak : +14.1 vs -2.7%; HRmax : +1.6 vs -1.7%; MTP: +19.2 vs -2.3%). The walk distance at the 6-MWT was also significantly lengthened (+11.6 vs. -3.1%). While these findings resulted from an interim analysis planned when 30 volunteers were enrolled in both groups, IATP-R appeared as effective, safe, and applicable among sedentary healthy seniors. These characteristics are decisive for exercise training prescription and adherence.

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BACKGROUND: Interval aerobic training programme with active recovery bouts (IATP-R) has shown to improve tolerance to IATP among seniors. However, data concerning its benefits for seniors' health are still limited. PURPOSE: The purpose of this study was to examine the effects of IATP-R on seniors' health status. METHODS: Sedentary volunteers (n = 60, aged ≥70 years) were randomly assigned to either IATP-R or maintained sedentary lifestyle for 9.5 weeks. IATP-R consisted of 30-minute cycling (6 × 4 minutes at first ventilatory threshold (VT1 ) intensity + 1 minute at 40% of VT1 ) twice a week. Cognitive and functional performances were assessed with the Trail Making Test (TMT-A; TMT-B); Paced Auditory Serial Addition Test (PASAT); Timed Up and Go (TUG) test; 6-Minute Walk Test (6-MWT); one-leg balance test; and the Short Physical Performance Battery (SPPB) tests, respectively. QoL and anxiety/depression status were measured by the Short Form-12 and the Goldberg's Scale, respectively. All participants were assessed at baseline and 9.5 weeks later. RESULTS: Compared to controls, IATP-R improved cognitive functions (TMT-A: +1.5% vs -21.5%; TMT-B: +0.9% vs -13.3%; PASAT: +1.4% vs -14.6%; semantic fluency: -1.1% vs +11.7%), functional performance (TUG: +5.4% vs -16.5%; 6-MWT: -3.2% vs +11.5%; SPPB: -3.2% vs +14.6%; One-leg balance: -16.3% vs +25.0%); QoL (physical health: -13.3% vs +23.1%; mental health: -7.1% vs +8.2%); and depressive symptoms (+26.3% vs -42.8%). Significant impacts were measured neither on letter modality of fluency tasks nor on anxiety score. CONCLUSION: These data showed that IATP-R is an effective training programme to improve functional and cognitive performances, mental health and well-being in sedentary seniors. Trial registration ClinicalTrials.gov NCT02263573. Registered October 1, 2014.

International audience; Chez les patients avec insuffisance cardiaque aiguë (ICA), les facteurs pronostiques de mortalité bien connus sont cliniques. La Haute Autorité de santé (HAS) met aussi l’accent sur les facteurs organisationnels modifiables, qui pourraient être d’autres facteurs pronostiques. Notre objectif est d’évaluer le lien entre les facteurs organisationnels lors d’une hospitalisation pour ICA et le risque de réhospitalisation.Méthodes : cette étude rétrospective sur dossiers et sur PMSI a inclus les patients âgés de plus de 65 ans, hospitalisés pour ICA à Lariboisière en 2013. Les variables de parcours étaient : unités fréquentées, durée de séjour, modes d’entrée et de sortie, réalisation de procédures diagnostiques, traitement de sortie. Des groupes homogènes de parcours ont été construits, et le lien avec le taux de réhospitalisations à un mois et à un an, pour ICA ou toutes causes, a été modélisé par un modèle binomial négatif avec offset, incluant le groupe et les variables cliniques classiques (ACFA, BPCO, diabète, HTA, insuffisance rénale, présentation clinique de l’ICA, sexe, tabac, FEVG, âge).Résultats : le parcours a pu être analysé chez 207 patients, parmi les 223 initialement inclus. Cinq groupes ont été retrouvés : trois groupes classiques des filières USIC, cardiologie, et médecine/gériatrie, un groupe avec un parcours dit chaotique, et un groupe de patients décédés. Le groupe est prédictif du nombre de réhospitalisations pour ICA à un an (p = 0,0015) : le groupe chaotique augmente le risque (p = 0,0054), le groupe cardiologie a une tendance à la réduction du risque (p = 0,0675). Le groupe n’est pas associé aux autres critères de jugement.Discussion/conclusion : le parcours intrahospitalier est lié au risque de réhospitalisation, indépendamment des variables cliniques. Ce résultat devrait être confirmé, puis suivi d’une recherche des mécanismes en cause dans la génération de ces parcours chaotiques et de leurs conséquences.

International audience; AIMS/HYPOTHESIS: Infection of diabetic foot ulcers is common; at early stages it is difficult to differentiate between non-infected ulcers (or those colonised with normal flora) and ulcers infected with virulent bacteria that lead to deterioration. This pilot study aimed to assess the diagnostic accuracy of inflammatory markers as an aid to making this distinction. METHODS: We included 93 diabetic patients who had an episode of foot ulcer and had not received antibiotics during the 6 months preceding the study. Ulcers were classified as infected or uninfected, according to the Infectious Diseases Society of America-International Working Group on the Diabetic Foot classification. Diabetic patients without ulcers (n = 102) served as controls. C-reactive protein (CRP), orosomucoid, haptoglobin and procalcitonin were measured together with white blood cell and neutrophil counts. The diagnostic performance of each marker, in combination (using logistic regression) or alone, was assessed. RESULTS: As a single marker, CRP was the most informative for differentiating grade 1 from grade 2 ulcers (sensitivity 0.727, specificity 1.000, positive predictive value 1.000, negative predictive value 0.793) with an optimal cut-off value of 17 mg/l. In contrast, white blood cell and neutrophil counts were not predictive. The most relevant combination derived from the logistic regression was the association of CRP and procalcitonin (AUC 0.947), which resulted in a significantly more effective determination of ulcer grades, as shown by comparing receiver operating characteristic curves. CONCLUSIONS/INTERPRETATION: Measurement of only two inflammatory markers, CRP and procalcitonin, might be of value for distinguishing between infected and non-infected foot ulcers in subgroups of diabetic patients, to help ensure the appropriate allocation of antibiotic treatment. Nevertheless, external validation of the diagnostic value of procalcitonin and CRP in diabetic foot ulcers is needed before routine use can be recommended.

International audience; There is no consensus on a diagnostic strategy for osteomyelitis underlying pressure ulcers. We conducted a prospective study to assess the accuracy of multiple bone biopsies and imaging to diagnose pelvic osteomyelitis. Patients with clinically suspected osteomyelitis beneath pelvic pressure ulcers were enrolled. Bone magnetic resonance imaging (MRI) and surgical bone biopsies (three or more for microbiology and one for histology per ulcer) were performed. Bacterial osteomyelitis diagnosis relied upon the association of positive histology and microbiology (at least one positive culture for non-commensal microorganisms or three or more for commensal microorganisms of the skin). From 2011 to 2014, 34 patients with 44 pressure ulcers were included. Bacterial osteomyelitis was diagnosed for 28 (82.3%) patients and 35 (79.5%) ulcers according to the composite criterion. Discrepancy was observed between histology and microbiology for 5 (11.4%) ulcers. Most common isolates were Staphylococcus aureus (77.1%), Peptostreptococcus (48.6%) and Bacteroides (40%), cultured in three or more samples in 42.9% of ulcers for S. aureus and ≥20% for anaerobes. Only 2.8% of ulcers had three or more positive specimens with coagulase-negative staphylococci, group B Streptococcus, and nil with enterococci and Pseudomonas aeruginosa. Staphylococcus aureus, Proteus and group milleri Streptococcus were recovered from one sample in 22.8%, 11.4% and 11.4% of ulcers, respectively. Agreement was poor between biopsies and MRI (κ 0.2). Sensitivity of MRI was 94.3% and specificity was 22.2%. The diagnosis of pelvic osteomyelitis relies on multiple surgical bone biopsies with microbiological and histological analyses. At least three bone samples allows the detection of pathogens and exclusion of contaminants. MRI is not routinely useful for diagnosis.

Background— The mineralocorticoid pathway is involved in cardiac arrhythmias associated with heart failure through mechanisms that are incompletely understood. Defective regulation of the cardiac ryanodine receptor (RyR) is an important cause of the initiation of arrhythmias. Here, we examined whether the aldosterone pathway might modulate RyR function. Methods and Results— Using the whole-cell patch clamp method, we observed an increase in the occurrence of delayed afterdepolarizations during action potential recordings in isolated adult rat ventricular myocytes exposed for 48 hours to aldosterone 100 nmol/L, in freshly isolated myocytes from transgenic mice with human mineralocorticoid receptor expression in the heart, and in wild-type littermates treated with aldosterone. Sarcoplasmic reticulum Ca 2+ load and RyR expression were not altered; however, RyR activity, visualized in situ by confocal microscopy, was increased in all cells, as evidenced by an increased occurrence and redistribution to long-lasting and broader populations of spontaneous Ca 2+ sparks. These changes were associated with downregulation of FK506-binding proteins (FKBP12 and 12.6), regulatory proteins of the RyR macromolecular complex. Conclusions— We suggest that in addition to modulation of Ca 2+ influx, overstimulation of the cardiac mineralocorticoid pathway in the heart might be a major upstream factor for aberrant Ca 2+ release during diastole, which contributes to cardiac arrhythmia in heart failure.

International audience; This study evaluated the antibacterial efficacy of the consumption of cranberry capsules vs. placebo in the urine of healthy volunteers. A first double-blind, randomised, crossover trial involved eight volunteers who had followed three regimens, with or without cranberry, with a wash-out period of at least 6 days between each regimen. Twelve hours after consumption of cranberry or placebo hard capsules, the first urine of the morning was collected. Different Escherichia coli strains were cultured in the urine samples. Urinary antibacterial adhesion activity was measured in vitro using the human T24 epithelial cell-line, and in vivo using the Caenorhabditis elegans killing model. With the in-vitro model, 108 mg of cranberry induced a significant reduction in bacterial adherence to T24 cells as compared with placebo (p

Citrobacter spp. are aerobic, gram-negative bacilli that are frequently found in water, soil, food, and the intestines of animals and humans [1]. Even though their level of virulence is low and they rarely cause infections in humans, these pathogens have been associated with a wide spectrum of infections involving the central nervous system and the gastrointestinal, urinary, or respiratory tracts [1]. The fact that Citrobacter spp. are rather uncommon in clinical specimens explains why few studies of them appear in the medical literature [2, 3]. However, these organisms may be responsible for serious infections, especially in immunocompromised hosts. To evaluate the epidemiology of Citrobacter spp. in our 1,700-bed university hospital in southern France, we conducted a prospective study from 1 October 2003 to 30 April 2004. Hospitalized patients were screened for the presence of Citrobacter spp. and nonrepetitive clinical strains isolated consecutively from infection sites were included in the study. Antibiotic susceptibility testing was performed using the Vitek 2 GNS-F7 card (bioMerieux, Marcy l’Etoile, France) and an agar disk-diffusion assay on Mueller-Hinton agar. Strains were classified as susceptible, intermediately resistant or resistant to the other antibiotics tested according to the recommendations of the Antibiotic Susceptibility Testing Committee of the French Society for Microbiology [4]. The strains that were found to be resistant to extended-spectrum cephalosporins were additionally screened for extended-spectrum β-lactamase (ESBL) production using the double-disk synergy test. Isoelectric focusing was performed using polyacrylamide gels as described previously [5]. Macrorestriction analysis of chromosomal DNAwas performed using pulsed-field gel electrophoresis according to previously published procedures and analyzed with Gel compar computer software (Applied Math, Belgium) as described previously [5]. The qnrA, qnrB and qnrS genes were screened using PCR as described previously [5]. During the study period, information concerning patient age, sex and immune status (MacCabe score [6]), hospital ward, source of infection, mortality, comorbid diseases, antecedent of hospitalization (notably prior stay in an intensive care unit), prior antibiotic therapy, date of bacterial isolation, length of hospitalization, and the source of infection were collected to determine the risk factors for infections caused by extended-spectrum, cephalosporinresistant Citrobacter spp. Duplicate isolates from the same patient were excluded. Of the 1,531 Enterobacteriaceae we isolated, 45 strains were Citrobacter spp., i.e., 2.94% isolated from 45 patients. The characteristics of these 45 patients are presented in Table 1. The infections were of nosocomial origin in 62% of cases. Citrobacter koseri was the species isolated most frequently (57.7%), but this finding differs from previous Eur J Clin Microbiol Infect Dis (2007) 26:439–441 DOI 10.1007/s10096-007-0315-3

Skeletal muscle atrophy is a major systemic impairment in chronic diseases. Yet its determinants have been hard to identify because a clear research definition has not been agreed upon. The reduction in muscle fiber cross-sectional area (CSA) is a widely acknowledged marker of muscle atrophy, but no reference values for the muscle fiber CSA at the age of the onset of chronic disease have ever been published. Thus, we aimed to systematically review the studies providing data on fiber CSA and fiber type proportion in the vastus lateralis of the quadriceps of healthy subjects (age >40 yr) and then to pool and analyze the data from the selected studies to determine reference values for fiber CSA. We followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and identified 19 studies, including 423 subjects that matched the inclusion criteria. On the basis of fiber type and gender, the mean fiber CSA and the lower limits of normal (LLNs) were (%type I*60) + 1,743 μm2 and (%type I*60) − 718 μm2, respectively, for men; and (%type I*70) + 139 μm2 and (%type I*70) − 1,485 μm2, respectively, for women. There was no significant heterogeneity among subgroups of fiber type and gender. The pooled type I fiber proportion was 50.3% (LLN = 32.9%). In multivariate analysis, fiber CSA was significantly correlated with V̇o2 peak ( r = 190.92; P = 0.03), and type I fiber proportion was correlated with age ( r = −0.024; P = 0.005), body mass index ( r = 0.096; P = 0.005), and V̇o2 peak ( r = −0.053; P = 0.005). Our metaanalysis of a homogeneous set of studies is the first to provide valuable LLNs for fiber CSA according to fiber type and gender. This analysis will be improved by prospective assessment in well-characterized healthy subjects.