Françoise Pasleau

Health Outcomes of Sarcopenia: A Systematic Review and Meta-Analysis.

Objective The purpose of this study was to perform a systematic review to assess the short-, middle- and long-term consequences of sarcopenia. Methods Prospective studies assessing the consequences of sarcopenia were searched across different electronic databases (MEDLINE, EMBASE, EBM Reviews, Cochrane Database of Systematic Reviews, EBM Reviews ACP Journal Club, EBM Reviews DARE and AMED). Only studies that used the definition of the European Working Group on Sarcopenia in Older People to diagnose sarcopenia were included. Study selection and data extraction were performed by two independent reviewers. For outcomes reported by three or more studies, a meta-analysis was performed. The study results are expressed as odds ratios (OR) with 95% CI. Results Of the 772 references identified through the database search, 17 were included in this systematic review. The number of participants in the included studies ranged from 99 to 6658, and the duration of follow-up varied from 3 months to 9.8 years. Eleven out of 12 studies assessed the impact of sarcopenia on mortality. The results showed a higher rate of mortality among sarcopenic subjects (pooled OR of 3.596 (95% CI 2.96–4.37)). The effect was higher in people aged 79 years or older compared with younger subjects (p = 0.02). Sarcopenia is also associated with functional decline (pooled OR of 6 studies 3.03 (95% CI 1.80–5.12)), a higher rate of falls (2/2 studies found a significant association) and a higher incidence of hospitalizations (1/1 study). The impact of sarcopenia on the incidence of fractures and the length of hospital stay was less clear (only 1/2 studies showed an association for both outcomes). Conclusion Sarcopenia is associated with several harmful outcomes, making this geriatric syndrome a real public health burden.

Surrogate markers predicting overall survival for lung cancer: ELCWP recommendations

The present systematic review was performed under the auspices of the European Lung Cancer Working Party (ELCWP) in order to determine the role of early intermediate criteria (surrogate markers), instead of survival, in determining treatment efficacy in patients with lung cancer. Initially, the level of evidence for the use of overall survival to evaluate treatment efficacy was reviewed. Nine questions were then formulated by the ELCWP. After reviewing the literature with experts on these questions, it can be concluded that overall survival is still the best criterion for predicting treatment efficacy in lung cancer. Some intermediate criteria can be early predictors, if not surrogates, for survival, despite limitations in their potential application: these include time to progression, progression-free survival, objective response, local control after radiotherapy, downstaging in locally advanced nonsmall cell lung cancer (NSCLC), complete resection and pathological TNM in resected NSCLC, and a few circulating markers. Other criteria assessed in these recommendations are not currently adequate surrogates of survival in lung cancer.

Organising access to evidence-based medicine resources on the web

The continuing education is a challenge for health care professionals, considering the growing amount and variable quality of information in this field. In this context, we developed a method allowing clinicians to have a centralised access to the best current medical evidence supporting medical decision-making. Relevant data has been gathered according to the rules stated for Evidence-Based Medicine (EBM) and organised in a free-of-charge Web site, created by using common software applications. The general aim of our study was to encourage individual practice of EBM by providing tutorials as well as a selection of free access tools for searching medical information on the Web. In addition to the education part, we provided clinicians, through a Web interface, with up-to-date, accurate and quality data obtained from heterogeneous sources and presented in a full text format when available. The developed methodology has been applied to human prostate cancer. URL address: http://www.ebm.lib.ulg.ac.be/prostate/index.htm.

A comparison of bovine growth hormone expression directed by bGH genomic or intronless DNA in transiently transfected eukaryotic cells.

Two recombinant DNA plasmids were constructed with identical transcriptional and translational regulatory elements controlling expression of the bovine growth hormone (bGH) gene or the bGH gene lacking introns. Transient expression of these plasmids in cultured eukaryotic cells, monitored by assaying secretion of bGH into the culture medium, was employed to examine the relative importance of introns in the expression of this gene. The bGH gene lacking introns is expressed more efficiently than the bGH gene in avian and mammalian cells.

Competition between benzo[a]pyrene and various steroids for cytochrome P-450-dependent rat liver monooxygenases

Cytochrome P-450-dependent monooxygenases are able to oxidize a large variety of endogenous and exogenous substrates. This paper describes the in vitro interaction between benzopyrene and steroids at the level of two rat liver monooxygenases: steroid-16 alpha-hydroxylase and aryl hydrocarbon hydroxylase (AHH). The results obtained suggest the following conclusions: (1) Steroid-16 alpha-hydroxylase is partially supported by a specific cytochrome P-450 form which is not inhibited in vitro by exogenous substrates. Steroid-16 alpha-hydroxylase is completely independent from cytochrome P1-450 (or P-448), as it is insensitive, in vitro, to alpha-naphthoflavone; (2) AHH is supported by two cytochrome P-450 forms: a specific form which is inducible by methylcholanthrene and inhibited in vitro by alpha-naphthoflavone, but is insensitive to metyrapone and steroids; and another less specific form which is inhibited by metyrapone and steroids in vitro.

Is steroid-16α-hydroxylase supported by more than one monooxygenase?

Abstract Steroid-16α-hydroxylase activities have been measured in normal and induced rat livers using four different substrates. The male/female activity ratio as well as the induction factor vary with the substrate indicating that steroid-16α-hydroxylase activity is a heterogenous enzyme. Experiments using specific inhibitors led to the conclusion that steroid-16α-hydroxylase is supported by at least two cytochrome P-450 forms, different from the cytochrome P-448.

Sex differences in the activity of different cytochrome p450 dependent steroid 16α-hydroxylases in rat liver

Abstract Four different 16-tritiated substrates have been used to study the biochemical properties of steroid-16α-hydroxylase activity: pregnenolone, dehydroepiandrosterone (DHEA), progesterone and testosterone. From the competition between the different substrates, it appears that 16α-hydroxylase is supported by at least two different cytochrome P-450 forms. One form has a high affinity for testosterone, a low affinity for pregnenolone, and is predominant in female rat liver. Another form has a high affinity for pregnenolone but also oxidizes the three other substrates; it is the main form in male rat liver.

Are blind injections of gleno-humeral joint (GHJ) really less accurate imaging-guided injections? A narrative systematic review considering multiple anatomical approaches.

AimTo perform a systematic review to establish whether blind injections of the gleno-humeral (GHJ) joint may be an accurate alternative to injections performed imaging guidance, considering multiple anatomical approaches.Materials and methodsOur search strategy yielded 478 articles for Scopus, 815 articles for MEDLINE, 128 articles for Cochrane Central Register of Controlled Trials and 555 articles for Embase until May 2016. One hundred and sixty-seven abstracts were retrieved after duplicates removal. Two readers independently reviewed all the 1067 abstracts. They selected for the full-text analysis only the abstracts in which the accuracy of intra-articular position of the needle was confirmed on imaging (humans) or by a surgical dissection (cadavers). Thirty-eight studies were eventually selected for the full-text reading and data extraction. The selected studies included a total of 2309 patients (2690 shoulders) and 195 cadavers (299 shoulders). To objectively assess the methodological quality of the present systematic review, “Assessment of Multiple Systematic Review” (AMSTAR) tool was used.ResultsThe overall accuracy of the intra-articular injection in GHJ varied from 42 to 100% in the 38 selected studies. Imaging guidance was used in 65% of articles and the overall accuracy of guided GHJ injections was higher than blind injection. However, five articles in which blind injection the GHJ was used (159 shoulders) reported accuracy as high as 100%.ConclusionA comprehensive review of the literature confirms that guided injections of the GHJ have overall accuracy higher compared to blind injection. Nevertheless, in some studies, including a relatively large number of shoulders, blind injections have been proven to be 100% accurate. Hence, blind injections of GHJ could be proposed a cost-effective alternative to imaging-guided injection. A large prospective randomized study is needed to gauge this hypothesis and compare the cost-effectiveness of these two techniques for the most common anatomical approaches.

Des Principes De La Méta-Analyse Non Statistique Pour UNE Revue Critique De La Recherche Biomédicale

In most circumstances, considerable time lags before results from biomedical research are integrated in general medical practice are inevitable. Several economic, technical factors and educational orientation are responsible for this gap. Effective information management at the institutional level could provide clinicians the means to adopt new perspectives. At present, the link between basic research and clinical application relies upon the motivation of individuals to develop new skills in literature retrieval and analysis and yet their occupational responsabilities inhibit this endeavour. Academic librarians, educated and trained in information and biomedical sciences, have a role in providing physicians with current and readily applicable knowledge from the critical analysis of the literature.

Use of CD-ROM in the Medical Library: 8 Year Follow-Up

Besides Medline, the local library network contains different databases chosen to enlarge the coverage of specific fields: Biology (LSC: Compact Cambridge Life Sciences), Oncology (PDQ: Physician Data Query), Pediatrics (Base d’Information Robert Debre) and Pharmacy (IPA: International Pharmaceutical Abstracts). Current Contents-Life Sciences (CC) provides a day to day follow-up.