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We sought to describe the reasons for intensive care unit (ICU) admission and outcomes of patients with pancreatic cancer requiring unplanned medical ICU admission. Retrospective cohort study in five ICUs from 2009 to 2020. All patients with pancreatic cancer admitted to the ICU were included. Patients having undergone recent surgery were excluded (< 4 weeks). 269 patients were included. Tumors were mainly adenocarcinoma (90%). Main reason for admission was sepsis/septic shock (32%) with a biliary tract infection in 44 (51%) patients. Second reason for admission was gastrointestinal bleeding (28%). ICU and 3-month mortality rates were 26% and 59% respectively. Performance status 3–4 (odds ratio OR 3.58), disease status (responsive/stable -ref-, newly diagnosed OR 3.25, progressive OR 5.99), mechanical ventilation (OR 8.03), vasopressors (OR 4.19), SAPS 2 (OR 1.69) and pH (OR 0.02) were independently associated with ICU mortality. Performance status 3–4 (Hazard ratio HR 1.96) and disease status (responsive/stable -ref-, newly diagnosed HR 2.67, progressive HR 4.14) were associated with 3-month mortality. Reasons for ICU admissions of pancreatic cancer patients differ from those observed in other solid cancer. Short- and medium-term mortality are strongly influenced by performance status and disease status at ICU admission. [ABSTRACT FROM AUTHOR]

Summary Aims of the study To evaluate a dual-task named the “Stroop Walking Task”, which is similar to the task of making a decision of whether to cross a street based on a pedestrian traffic light. Patients and methods Fifty-one subjects (15 young adults, 21 subjectively healthy old subjects and 15 old subjects with mild cognitive impairment) had to respond to a visual signal (pictogram) with an appropriate motor response (walk or stop). We used an electronic walkway system to record the gait parameters and performed a cluster analysis on the obtained data. Results This dual-task enables the early detection of executive function impairment with 89% sensitivity and 87% specificity. Conclusion The use of a dual-task that is inspired by an everyday event as an evaluation tool seems to facilitate the detection of ageing subjects’ cognitive impairment, which is not detectable with traditional psychometric tests. [ABSTRACT FROM AUTHOR]

Summary: Aim of the study: The objective of this preliminary study was to evaluate the effectiveness, in terms of fall reduction, of an in-home strategy that we have developed for elderly fallers. We also aimed at finding links between the expected changes in the data obtained in static posturography and in clinical balance tests through our program. Patients and methods: Twelve elderly patients living at home who were diagnosed as fallers (5 males and 7 females; 77.9±4.1 years) participated in the study. Our multimodal intervention lasted 6 months. Before this period, and one year later, an evaluation was conducted using cognitive (MMSE), clinical balance tests (i.e. Berg Balance Scale, Balance One leg, Timed Up and Go, and Functional Reach tests) and static posturography (where the area of body sway, velocity and medio–lateral and antero–posterior amplitudes were recorded twice, first with eyes open and then with eyes closed). Results: Among the 12 patients who were diagnosed as fallers, eight became non-fallers. When comparing data obtained after the intervention with those obtained beforehand, we found significant changes in all of the clinical balance tests and in the posturographic-derived variables indicating improvements in the balance control in our group of subjects. We also found significant correlations between the changes in the Berg Balance Scale scores and the changes in the area of body sway data, in antero–posterior amplitude both with eyes open and with eyes closed, and also in the medio–lateral amplitude in the eyes closed condition. Conclusions: We prospectively demonstrated the relevance of our anti-falling intervention at home and of the use of posturography for clinical follow-up. [ABSTRACT FROM AUTHOR]

Summary: Introduction: Posturographic measurements are often performed in hospital in the context of assessing fall risks in elderly subjects. These hospital visits may generate different kinds of stimuli that could influence test outcomes. Study aim: The aim was to investigate whether posturographic measurements performed both at home and in hospital in a randomized order provide similar data. Methods: Thirty-five healthy elderly subjects (average age 72.5±3.7 years) were assigned to two postural evaluations performed in a random order: one at home and one at the hospital. Before the first evaluation, subject''s levels of anxiety, depression and stress were assessed. Then, the area of body sway, velocity and medial-lateral and antero-posterior amplitudes were recorded twice, first with the subject''s eyes opened and then with eyes closed. Results and discussion: The posturographic data obtained in hospital and at home were quite similar. However, when the group that was first evaluated in hospital was compared with the group first evaluated at home, the medio-lateral amplitude was observed to significantly decrease in the second evaluation compared with the data obtained in the first trial (P <0.05), and this decrease was significantly higher in the first group (P <0.05). For the eyes-opened condition, we found significant correlations between anxiety and the area of body sway, stress and the area of body sway, and anxiety and the medial-lateral amplitude. Conclusions: Psychological factors may influence some posturographic data, and carrying out posturographic evaluations at home for elderly subjects could be a reasonable strategy. [Copyright &y& Elsevier]

Summary: Context: To show that emotional and cognitive information acts upon the postural balance system in a way comparable to that of the other known inputs (vision, vestibular, proprioception). Method: Controlled case study on 90 subjects. One group was composed of 45 subjects suffering from obsessive-compulsive disorder (OCD) in accordance with the Yale-Brown scale, while the other was the control group. All of the subjects underwent recording of their orthostatic posture on a force platform with eyes open and eyes closed. Results: As regards to the postural findings, the two groups appear to be quite different. The OCD patients present a considerably reduced area and velocity of sway regardless of whether their eyes are open or closed. Conclusion: These results are coherent with regard to those of other studies establishing the link between postural balance and psychological status. Recent morphological studies likewise tend to confirm the existence of neuronal networks common to postural regulation and cognitive and emotional functioning. When interpreting symptoms, these interactions should be taken into account. [Copyright &y& Elsevier]

Abstract: Objective: We aimed to assess the isokinetic profile of the flexor and extensor muscles of the knee within a population of rugby players. Methods and Population: This was a descriptive study. The rugby players underwent bilateral isokinetic assessment of knee flexion and extension on a CON-TREX MJ isokinetic dynamometer functioning at four angular frequencies — 90, 120, 180 and 240°/s — in a concentric manner. The isokinetic parameters were peak torque, mean power, and mean work in relation to weight and femoral bicep: quadriceps ratio. The population included 16 “Federal 1” (semi-professional) rugby players with mean age 25 years (range 20–33 years). The players were divided into two groups: “forward” players (props, hookers, second line, third line) and “back” players (scrum, inside, center, wing, tail). Results: The values of the isokinetic parameters did not reveal use of a preferred limb. Consequently, peak torque and mean power were higher in forward players than back players, whereas back players showed a higher relative power throughout the isokinetic test. Conclusion: Among rugby players, forward and back players showed differences in several isokinetic parameters. Accurate knowledge of the equilibrium between the knee''s effector muscles is important for stability of the joint, to not only minimize articular accidents but also pinpoint force imbalances, thereby preventing muscular lesions during the sports season. [Copyright &y& Elsevier]

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Abstract: Objectives. – To determine the main clinical and posturographic factors correlated with falls in elderly individuals and to specify the role of static posturography in this appraisal. Materials and methods. – The study involved 38 people living in an residential center who were autonomously ambulatory and had a Mini Mental Test score≥24. Fallers (N =15) had fallen within 1 month, and nonfallers (N =23) had not fallen for at least a year. Assessment consisted of a series of questions, a complete clinical appraisal, specific independently validated tests, and static posturographic analysis different parameters of the stabilogram with the eyes first open and then closed, all carried out in the center. Results. – From the clinical standpoint, spinal pathologic features and the scores on the Functional Reach Test were significantly different between the fallers and nonfallers. In static posturography, fallers'' equilibrium was more precarious than that of nonfallers with eyes are closed: significant differences were observed in surface, X length and overall fast Fourier transform score. The comparison between results with open and closed eyes showed that the fallers had a pronounced tendency to retropulsion in the absence of visual participation: a significant difference as regards overall length, Y length, minimum Y and FFT Y (0.5–2 Hz). Conclusions. – To complement a satisfactorily conducted clinical examination, static posturography allows for rapid assessment of equilibrium and posture in elderly patients who fall? Performed at the place where an individual resides, this appraisal constitutes an original and pragmatic element. As an evaluation strategy, it can reveal nonnegligible information within the framework of an appraisal of such, and thereby allows for adjustment of the rehabilitation or compensatory strategy. [Copyright &y& Elsevier]

Objective: To use a posture analysis to show the evolution of postural pattern connected with falls.Material and Method: It is a prospective study on two groups of 16 persons of more than 60 years. A group concerns 16 small disability off drug parkinsonian patients, a group concerns 16 healthy witnesses. All the persons benefited from a posture recording by means of a force platform and were followed during 1 year.Results: Data analysis underlines three groups of persons corresponding to three postural patterns, independently of the presence of Parkinson disease. A group (n = 18) did not contain fallers, the second (n = 10 ) contained 20% of fallers, the third (n = 4) contained 100% of fallers. Differences between the groups were identified on 16 posturographic parameters.Discussion: A group has a good functional value and one does not record any fall. Its characteristics, which correspond to a category of persons who compensate well for the phenomena of ageing, are found in the literature. A group has an intermediate functional value and regrets 20% of fallers. Kinetic profile reveals a tendency to the stiffness of the posture. This group is going to operate rather ankle strategies. A group has an inferior functional value and regrets 100% of fallers. Kinetic profile seems disrupted and not to be able to adapt itself in a satisfactory way to the situation otherwise than by stereotypical reactions. This group is going to operate systematically much less stabilizing hip strategies.Conclusion: A close determinism between physiological neuromotor ageing and Parkinson disease does exist. We showed with a prospective follow-up, the arisen of fall and showed the evolution of postural patterns related to fall. It appears as well that evolution mainly follows three stages leading from a small risk of fall gait pattern to a major risk of fall gait pattern. [Copyright &y& Elsevier]

Objectives. – The aim of this paper was to present the first results of a study about lower limbs’ soft tissues (fat and muscle) evolution using magnetic resonance images.Material and methods. – Magnetic resonance images method (MRI) was chosen instead of X-ray scanner for its non-invasive and non-radiating properties. Three hemiplegics volunteers were followed during the first 6 months of their therapy. Lower limbs’ MRI captures were made at the beginning and in the end of this period. Computerized processing of the data allows automatic recognition of the main lower limb’s tissues. Volumes were determined from images and classified in 4 categories (i.e. muscle, fat, spongy bone, cortical bone).Results. – Data analysing showed a different evolution of soft tissues in healthy lower limb compared to pathological lower limb.Discussion–Conclusion. – This results should lead us to a better understanding of therapeutic efficiency. [Copyright &y& Elsevier]

Objectives Study relevance a priori of a mobile service robot dedicated to seniors living in institution. The robot have three functionality: moving support for the fragile person, orientation help of the cognitively vulnerable person and assistance to carry the personal objects. Method Beforehand, a slide show was presented suggesting the potential functionality of the robot. Then residents answered semi-structured interview and questionnaire about issues related to five areas: safety, operability, functionality, and mutual support, design. Results Sixty-two residents were interviewed. 82,3% of residents think that robot acts as an ordinary tele-alarm. The favourite robot's control mode was the voice (82.6%). The robot was rarely viewed as a companion, but it offered for anyone the image of a servant device to support the resident when moving, guidance as well as carrying objects. Fifty percent of the residents appreciated the three robot's functions especially in case of loss of autonomy. Residents preferred basin height for the robot, while standing. Whatever, the robot presented through a simulation was still subject of surprise and interrogation for 42% of the residents. Finally, the residents attached more importance to the functionalities compared to the design. Discussion and conclusion This study shows that the accession of the elderly to the robot in an institution is very nuanced. The assessment is potentially biased by the difficulty of the very old person to project into the possible use of such a device. The function of security or reinsurance dominates the expectations to compensate for the delay of intervention of caregivers particularly at night and/or the discomfort to produce the call. However, this type of investigation can offer designers all the negative and/or positive representations aroused by such a device and warns about the need to offer immediately a simple but very functional prototype to convince users and financers. [ABSTRACT FROM AUTHOR]

Abstract: Objectives. – To determine factors predicting falls by patients with vascular hemiplegia to establish a program aimed at preventing falls in this population. Methods. – A comparative prospective study performed over 19 months with 44 patients older than 16 years who had had a cerebral vascular accident (CVA, stroke) and were consequently admitted to the Centre Richelie. The exclusion criteria were represented by CVA history, evidence of another form of encephalic lesion, and subsequent admission to hospital after hemiplegia or for follow-up. Assessment consisted of taking note of the mechanism of the fall, possible lesions, and number of falls and analyzing follow-up after the return home. Also included for all patients was information on 20 variables that could be risk factors for fall. Results. – The patients'' average age was 60.43±13.43 years and 20 had had at least one fall (mean 2.2), which allowed us to determine a “falling” group and a control group. Statistical analysis revealed the following factors considered to predict falls: large amount of time prior to hospitalization and lengthy hospitalization, low functional independence measure for entering and leaving, the existence of sensitivity disorders, spatial neglect, failed seated and standing equilibrium, and sedative treatment. In most cases, whatever their nature, falls occurred during transfers (68% of cases). Most often, the post-fall lesions were minor. However, in one case, a femur neck fracture necessitated osteosynthesis. One-third of the patients had a fall at home (as opposed to 5% of the control group). Conclusion. – Our results confirm those in the literature. The predictive factors for falls in patients with hemiplegia are therefore well established and essentially correlate with the CVA. This consideration must lead to implementation of a prevention program including material-based as well as human measures. [Copyright &y& Elsevier]

Objective. – To assess the impact of functional restoration programs on fears, avoidance and beliefs in chronic low back pain.Methods. – Open prospective study in eight spine centers. Seventy patients enrolled in several restoration programs were evaluated before and at the end of the program. Variables recorded were pain (VAS), disability (Quebec back pain disability scale), handicap (VAS), anxiety and depression (HAD scale), and fears, avoidance and beliefs (FABQ).Results. – All variables recorded significantly improved at the end of the programs except for fears about professional activities (FABQ1) and lumbar mobility. Fears about physical activities (FABQ2) significantly decreased after these programs. Variations in FABQ1 and FABQ2 scores were not correlated with variations in scores of outcome measures assessing impairment, disability, and handicap.Conclusion. – Functional restoration programs in their current form in France do not decrease fears and beliefs about professional activities in chronic low back pain patients. Adding psychosocial intervention at the work place to the functional restoration programs may lead to a better impact on fears about work thus reducing work loss. [Copyright &y& Elsevier]

Abstract: The Dandy–Walker syndrome is a rare malformation usually diagnosed during pregnancy or early in the course of life. We report a case in an elderly hospitalised for gait disorders and recurrent falls. Cerebral MRI revealed hydrocephalus and posterior fossa cyst. The patient improved after ventriculocisternostomia. [Copyright &y& Elsevier]

Introduction Une chute peut avoir d’importantes conséquences psychologiques qui peuvent être vues sous l’angle d’un syndrome de stress post-traumatique (SSPT). La réalité virtuelle, qui a fait ses preuves dans le traitement du SSPT, pourrait être alors une solution efficace pour rééduquer les conséquences psychologiques post-chute. L’objectif était de développer un programme de rééducation en réalité virtuelle chez des sujets âgés associant un serious game et un fauteuil de stimulation de marche. Matériel et méthode Le serious game permettait au sujet de faire parcourir la plus grande distance d’un parcourt virtuel à un avatar, à l’aide d’un joystick en étant assis sur le fauteuil de stimulation de marche. Ce fauteuil, développé par « Backwell Active Balance Solution » reproduit un mouvement coordonné de bascule antéropostérieure, latérale et de rotation du bassin. Les mouvements du fauteuil étaient synchronisés au déplacement de l’avatar pour améliorer l’immersion dans l’environnement virtuel avec une approche de type « Living-Lab ». Résultats Nous avons testé chez 8 sujets âgés de plus de 80 ans trois environnements virtuels : un couloir sans fin, une ville moderne et un jardin public. Différents joysticks ont été utilisés mais aucun d’entre eux ne convenait parfaitement. Discussion–conclusion Il apparaît que l’esthétique de l’environnement virtuel était un important facteur de motivation pour les sujets âgés et que la recherche d’une manette de jeu s’était avérée complexe. Nous avons observé que les mouvements du fauteuil n’entravaient pas l’immersion dans l’environnement virtuel et pouvaient même l’améliorer pour certains participants. L’étape suivante sera de tester l’efficacité de ce programme chez des sujets âgés souffrant d’un syndrome post-chute en comparaison à une rééducation classique. [ABSTRACT FROM AUTHOR]