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To assess the safety and efficacy of tocilizumab (TCZ) in elderly (≥65 years) rheumatoid arthritis (RA) patients treated in daily practice.We conducted a retrospective study of TCZ use in RA patients in five French university hospitals between 2009 and 2012. We considered two age groups, under 65 years (65) and over 65 years (≥65). TCZ efficacy was evaluated at 24 weeks by the European League Against Rheumatism (EULAR) response and remission score. We also evaluated drug maintenance and safety, relative to adverse events discontinuation. A multivariate cumulative logit model for ordinal categories was performed to assess the relationship between age class and EULAR response (none, moderate and good) adjusted on possible confounders. TCZ retention (drug survival) over time was estimated with the Kaplan-Meier method. Treatment retention curves were compared according to age group with the log-rank test.Among 222 RA patients treated with TCZ, 61 (27.5%) were≥65 years at the initiation of treatment. After 6 months, this elderly patient group less often reached remission (27.8% versus 45.6%; P=0.02) or good EULAR response (40.7% versus 61.0%; P0.01) compared to the younger patient group (65). Multivariate analysis adjusted on baseline C-reactive protein and disease duration confirmed that elderly patients were more likely to have a lower EULAR response (none vs moderate-good or none-moderate vs good) (OR: 3.63; 95% CI [1.86-7.06], P0.001) compared to younger patients. Drug maintenance for TCZ and adverse events discontinuation rates were similar between the two age groups.In daily practice, TCZ seems to be well tolerated in RA patients but is less efficient in elderly patients. A broader field of analysis to include an international register will be required to confirm these results.

In eighty-eight cases of myocardial infarction, clinically identified, of which the electrocardiographic features were pathognomonic in the standard limb leads, the unipolar limb leads and the six Wilson's unipolar precordial leads, the evolution of two-thirds of which was followed, additional thoracic and abdominal unipolar leads have been studied. These may be divided into three groups: (1) Lead V E from the ensiform cartilage; (2) two leads on the median abdominal line, one at the level of the umbilicus (V O ), the other at the center of a line joining V E and V O , which may be called V EO ; and (3) the lateroposterior leads V 7 , V 8 , and V 9 . Every lead has been recorded in thirty-three normal subjects. The cases of infarction studied may be divided according to their location into: anterior less or more extensive, 20; anteroseptal, 7; anterolateral, 12; plain posterior, 33; posterolateral, 7; posteroseptal, 3; that is, 39 infarctions of the anterior group and 43 of the posterior group; lastly, 4 infarcts both anterior and posterior and 2 subendocardial infarcts. From this survey, the following conclusions may be drawn: 1.1. Lead V E shows direct infarction patterns in nearly all anterior infarcts studied, whatever their location and extension, and in the anteroseptal and posteroseptal infarcts studied. This lead is, on the contrary, silent in the case of anterolateral and posterior infarcts. However, it may show direct patterns when the infarcts are or become posterolateral. 2.2. The high abdominal Leads V EO and V O usually show direct patterns of infarction, not only in the plain posterior infarcts, Lead V E remaining silent, but also in cases of infarcts which are or become posterolateral. In the latter, the features in V EO and V O are more characteristic and complete than in V E . Leads V EO and V O are often silent in the cases of anterior, anteroseptal, or anterolateral infarction. 3.3. Lead V 7 may be useful for measuring the extent of a large anterior infarct, the features of which may spread exceptionally to V 8 . The same conditions are true in the case of anterolateral infarcts that may show infarction patterns up to V 9 . Leads V 7 , V 8 , and V 9 often show direct infarction patterns in the cases of plain posterior infarction and of posterolateral infarction. By leading from V E , V EO and V O , it is possible to know whether a posterior infarct involves chiefly the inferior wall of the heart (V EO and V O ) or spreads to its anterior wall (V E ) and, reciprocally, it would be possible to know if an anterior infarct (V E ) spreads over the inferior wall (V EO and V O ). The unipolar dorsal Leads V 7 , V 8 , and V 9 give information on the lateral and posterior location and extension of the infarcts. Lead V E seems to belong to the group of leads that explore the anterior wall of the left ventricle and the septum. Usually, it does not furnish information about the lesions of the posterior or inferior wall which give rise to characteristic changes at lower lead points at the level of the abdominal wall. Leads V 7 , V 8 , and V 9 are useful for exploring the posterior wall, and more especially the posterolateral wall, of the left ventricle.