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5-Fluorouracil (5-FU)-induced hyperammonaemic encephalopathy is a rare but serious 5-FU adverse drug reaction (ADR). Given the growing number of cancers treated with 5-FU and the paucity of data regarding this ADR, we performed a retrospective national survey to better characterise 5-FU-induced hyperammonaemic encephalopathy. Since inception of the French pharmacovigilance database, we identified all patients who experienced 5-FU-induced hyperammonaemic encephalopathy. Variables regarding demographics, characteristics, management and outcome of patients were collected. From 1986 to 2018, 30 patients were included. 5-FU-induced hyperammonaemic encephalopathy started 2 [1–4] days after 5-FU infusion onset. Most common neurological disorders were consciousness impairment, seizures and confusion. hyperammonaemia tended to be higher in patients with the lowest Glasgow score and admitted in intensive care unit (ICU) compared to non-ICU patients (250 [133–522] versus 139 [68–220] μmol/L respectively, p = NS). Dihydropyrimidine dehydrogenase deficiency was found in 27% of tested patients (n = 3/11). Encephalopathy-induced mortality was 17%, 57% of patients were admitted in ICU and 70% had a complete neurological recovery within 5 [2–10] days. A 5-FU rechallenge was considered in 14 (67%) patients with neurological recovery and a relapse was observed in 57% of them. No 5-FU-induced hyperammonaemic encephalopathy relapse was observed as long as 5-FU rechallenge was performed with decreased 5-FU dosage. We report the largest cohort of 5-FU-induced hyperammonaemic encephalopathy cases so far. This ADR should be suspected and ammonaemia measured in all patients experiencing neurological disorders after 5-FU administration. In patients with complete neurological recovery, a 5-FU rechallenge could be cautiously considered. • Hyperammonaemic encephalopathy is a rare but serious adverse drug reaction of 5-FU. • It should be evoked in all patients with neurological disorders after 5-FU infusion. • Hyperammonaemia may result from Krebs cycle inhibition and/or urea cycle deficiency. • A complete neurological recovery is expected in properly managed patients. • A 5-FU rechallenge can be carefully considered in patients with neurological recovery. [ABSTRACT FROM AUTHOR]

The aim of this study was to characterize different possible profiles of emotional experiences of victims of traffic accident based on verbatim accounts collected one year after the accident, and to relate these profiles to various socio-demographic and health data. A hierarchical cluster analysis of the emotional lexicon was made by categorizing and quantifying the EMOTAIX© lexicon using Tropes© text analysis software. Out of the 751 selected subjects, 328 expressed one or more emotional experiences. A link appeared between quality of life (QoL), post-traumatic stress disorder (PTSD) and the valence of expressed emotions. Injury severity and history distinguished two sets expressing negative-valence emotional experience. Paradoxically, a group also emerged with a large proportion of severely injured persons, associated with the expression of positive-valence emotional experiences and with domains of QoL and PTSD. The analysis of subjective data sheds light on the experience of traffic accident victims and shows a way forward for research and clinical intervention. [ABSTRACT FROM AUTHOR]

Objectives: To investigate whether age at disease onset determines clinical, radiographic or functional outcomes in a cohort of early RA.Methods: The ESPOIR cohort is a multicenter cohort of patients with early arthritis. We selected patients fulfilling the 2010 ACR/EULAR criteria for RA during the first 3years of follow-up. Patients were pooled into 3 groups by age at RA onset: <45years (young-onset RA [YORA]), 45 to 60years (intermediate-onset RA [IORA]) and>60years (late-onset RA [LORA]). The following outcomes were compared at baseline and during the first 3years of follow-up: Simple Disease Activity Index (SDAI) remission rate, one additional erosion, Health Assessment Questionnaire Disability Index (HAQ-DI)<0.5 and first disease-modifying anti-rheumatic drug (DMARD) continuation rate.Results: We included 698 patients (median [interquartile range] age 50.3 [39.8-57.2]years), 266 YORA, 314 IORA, and 118 LORA. At 1year, SDAI remission was greater for YORA than IORA and LORA (P<0.0001). Having at least one additional erosion was greater for LORA and IORA than YORA after 1year (P=0.009) and 3years (P=0.017). The proportion of patients with HAQ score<0.5 was greater for YORA than IORA and LORA at 1 (P=0.007), 2 and 3years. First DMARD continuation rate was lower for YORA than other groups during the 3years (P=0.005).Conclusions: In a cohort of early RA, young age at disease onset is associated with high rate of remission at 1year, no radiographic progression at 3years and low functional score during 3-year follow-up. [ABSTRACT FROM AUTHOR]

Objective: The Recovery Assessment Scale (RAS) is one of the most widely used measurements of recovery in mental health research. To date, no data have been available concerning the psychometric characteristics of the RAS in homeless people with severe mental illness. The aim of this study was to provide new data regarding the psychometric properties of the RAS in homeless people with schizophrenia and bipolar disorder.Methods: This multi-center study was conducted in 4 French cities. In addition to the RAS, data on sociodemographic information, disease severity using the Modified Colorado Symptom Index - MCSI, and the number of mental health comorbidities, care characteristics and quality of life (S-QoL-18) were collected. The RAS was tested for construct validity, reliability, external validity, sensitivity to change and acceptability.Results: Six hundred fifty-eight homeless patients participated in this study. The five-factor structure was confirmed by confirmatory factor analysis (RMSEA = 0.043, CFI = 0.95, NFI = 0.94 and SRMR = 0.063). The internal item consistency (from 0.40 to 0.80) and reliability (Cronbach's alpha from 0.79 to 0.87) were satisfactory for all dimensions. External validity testing revealed that the dimension scores were correlated significantly with the MCSI and S-QoL 18 scores. Significant associations with age, disease severity, psychiatric comorbidities and care characteristics showed good discriminant validity. The percentage of missing data (< 14.4%) and sensitivity to change were satisfactory.Conclusions: Our study demonstrated the satisfactory acceptability and psychometric properties of the RAS, supporting its use as a mean of recovery measurement for homeless patients. [ABSTRACT FROM AUTHOR]

Abstract: The centralization phenomenon is the migration of low back and/or radiating pain to the spinal midline in response to specific positions or movements, for instance during a McKenzie mechanical assessment. However, differences in the definition of the centralization phenomenon occur across studies, most notably regarding the smallest required change in pain location and the time to centralization. Standardized criteria would be useful. Available data fail to establish that centralization is sufficiently specific of diskogenic pain as to obviate the need for investigations, particularly in patients considered for surgical treatment (e.g., fusion or implant). Although centralization correlates strongly with a positive diskography, the value of this last finding as a sign of diskogenic pain or an indicator that surgery is needed remains highly controversial. Nevertheless, centralization may indicate a high likelihood of diskogenic pain and may provide therapeutic guidance. Because centralization is associated with better outcomes after nonsurgical treatment, even in patients with nerve root pain, its presence may constitute an argument against surgical treatment. Finally, the McKenzie assessment may induce pain relief, albeit to a modest extent and for no longer than 3months. [Copyright &y& Elsevier]

• Techniques for late spontaneous recovery from stuttering clustered into six strategies. • The strategies reflect components of established treatments and naïve explanations. • Causal attributions of recovery clustered into three implicit theories about recovery. • Knowledge about strategies and implicit theories may help to improve treatment. (1) To survey the employed techniques and the reasons/occasions which adults who had recovered from stuttering after age 11 without previous treatment reported as causal to overcome stuttering, (2) to investigate whether the techniques and causal attributions can be reduced to coherent (inherently consistent) dimensions, and (3) whether these dimensions reflect common therapy components. 124 recovered persons from 8 countries responded by SurveyMonkey or paper-and-pencil to rating scale questions about 49 possible techniques and 15 causal attributions. A Principal Component Analysis of 110 questionnaires identified 6 components (dimensions) for self-assisted techniques (Speech Restructuring; Relaxed/Monitored Speech; Elocution; Stage Performance; Sought Speech Demands; Reassurance; 63.7% variance explained), and 3 components of perceived causal attributions of recovery (Life Change, Attitude Change, Social Support; 58.0% variance explained). Two components for self-assisted techniques (Speech Restructuring; Elocution) reflect treatment methods. Another component (Relaxed/Monitored Speech) consists mainly of items that reflect a common, non-professional understanding of effective management of stuttering. The components of the various perceived reasons for recovery reflect differing implicit theories of causes for recovery from stuttering. These theories are considered susceptible to various biases. This identification of components of reported techniques and of causal attributions is novel compared to previous studies who just list techniques and attributions. The identified dimensions of self-assisted techniques and causal attributions to reduce stuttering as extracted from self-reports of a large, international sample of recovered formerly stuttering adults may guide the application of behavioral stuttering therapies. [ABSTRACT FROM AUTHOR]

Abstract Objectives High-risk prescribing can have deleterious effects on the health of older people. This study aimed to assess the role of inappropriate prescribing on changes in frailty status over 3 years of follow-up. Design, setting This is a prospective observational study nested in the GAZEL cohort. Participants The study sample included 12,405 community-dwelling people aged 58 to 73 in 2012, and followed for 3 years. Measurement Polypharmacy and potentially inappropriate medications (PIMs) were assessed from reimbursement data by the French National Health Insurance. Frailty was evaluated each year with the Strawbridge questionnaire. PIMs were defined according to the Laroche list plus additional criteria dealing with inappropriate prolonged use of medications. The relationship between PIMs and changes in frailty status (incident frailty and recovery) was analyzed with Markov multistate modeling. Results The prevalence of frailty increased from 14% in 2012 to 17% in 2014, whereas the frequency of PIMs was 29% in 2012 and 23% in 2014. Polypharmacy (5-9 drugs: aHR 1.31, 95% CI 1.14-1.50; and 10 drugs or more: aHR 1.57, 95% CI 1.28-1.92) and potentially inappropriate use of nonsteroidal anti-inflammatory drugs (aHR 1.33, 95% CI 1.04-1.71) were significantly associated with incident frailty, when the presence of at least 1 PIM presented a small association with the risk of becoming frail (aHR 1.15, 95% CI 1.01-1.32). Conclusions/Implications This study brings new elements to our knowledge regarding the association between inappropriate prescribing and frailty in older adults, which support research development to alert on inappropriate prescribing and to improve drug prescribing among old people, especially with polypharmacy. [ABSTRACT FROM AUTHOR]

The aim of this study was to report the epidemiological characteristics and the experience of 5 departments of trauma, in France, in the management of fractures of the proximal ulna. 163 patients with fractures of the proximal ulna with a mean age of 49.9 years (range 16-97) were managed. The most common mode of injury was a motor vehicle collision (48%). 18% sustained associated injuries to the ipsilateral limb. Open fractures were present in 42 patients (25%). A total of 109 patients had a fracture of the olecranon, with the Mayo 2A and B types most frequently seen (66%). The patients were invited for clinical examination at a mean duration of 16 months, retrospectively. Validated patient-oriented assessment scores involving the Mayo Elbow Performance Index (MEPI) and the Broberg and Morrey score were evaluated. All patients had follow-up radiographs. The mean arc of elbow motion was 130° (70-150°). The mean MEPI was 91 (20-100) with good results in 23% and excellent results in 52% of the patients. The mean Broberg and Morrey score was 90 after isolated olecranon fracture, and decreased with the complexity of the lesion. 117 fractures (72%) healed with ulnohumeral congruity. 9 fracture non-unions occurred (6%). Although the fracture of the proximal ulna can be described in several classifications, none of them accommodate it satisfactorily, because of the complexity of the lesion. The coronoid process is the keystone for the stability of the elbow. It forms the anterior buttress with the radial head. Tension band wire fixation is by far the commonest technique of internal fixation used for the treatment of non-comminuted olecranon fractures. Dorsal plate fixation is a useful option by providing improved fixation of complex comminuted fractures and fracture-dislocations. The radiocapitellar joint has to be restored appropriately, preserving the radial head when possible and replacing it with a prosthesis otherwise. The lateral collateral ligament complex is commonly disrupted and usually can be reattached to its origin from the lateral epicondyle. In addition, a brief period of hinged external fixation should be considered. [ABSTRACT FROM AUTHOR]