The development and validation of the LIMPRINT methodology

[Paper two of the LIMPRINT supplement. Lymphatic Research and Biology Supplement. June 2017

Effect of sugar and acid composition, aroma release and assessment conditions on aroma enhancement by taste in model wines

Context: When congruent taste and retronasal aroma are perceived simultaneously, aroma can be enhanced by taste. Different explanations have been proposed: (i) physico-chemical interactions between tastants and aroma compounds, inducing a change of the aroma stimulus before it reaches the receptors, (ii) a contextual bias during sensory tests (dumping), when at least one relevant attribute is not proposed to the panelists to assess a product, (iii) a misunderstanding of the conceptual difference between aroma and taste, or (iv) a perceptual incapability of panelists to distinguish between two congruent percepts. This study was undertaken to better understand aroma enhancement by taste in model wines containing different sugar and acid concentrations but the same volatile composition. Method: We used a twofold approach: model wine retronasal aroma intensity was assessed twice by trained panelists. During the first session, panelists only assessed aroma intensity. During the second session, taste intensity was assessed before aroma intensity, to reduce dumping effects. In-mouth release of volatile compounds was measured by nosespace analysis with the same panelists. Results: Acid concentration influenced aroma compounds release, but it did not impact perceived aroma intensity. Increasing sugar concentration delayed ethyl octanoate (EO) release after swallowing. When taste was not assessed, perceived aroma intensity was not explained by aroma compounds release, but it increased with sugar concentration, probably because of a dumping effect. When taste was assessed, aroma intensity also depended on sugar concentration, but it was significantly correlated to the time of release of EO. Our hypothesis is that when taste declined, late aroma was more easily individualized, and thus assessed with a higher intensity. This entails that panelists focused on aroma to individualize it from taste. We concluded that trained panelists understand the conceptual difference between taste and aroma, but are not completely able to distinguish congruent and simultaneous taste and aroma percepts

Prevalence and risk factors for chronic edema in U.K. community nursing services

Background and study design: Chronic edema (CO) is believed to be a major clinical problem within community nursing services in the UK. This study was undertaken as part of the LIMPRINT international study to determine the number of people with chronic oedema and its impact on health services. Methods and Results: Three urban based community nursing services participated in the UK with prospective evaluation over 4 weeks of all patients receiving nursing care using a questionnaire-based interview and clinical assessment using the LIMPRINT tools. Of the total 2,541 assessed 1,440 (56.7%) were considered to have CO, comprising Leicester City (768/ 1298 (59.2%), Nottingham West (124/ 181 (68.5%)) and Nottingham City (548/1062 (51.6%)). The mean age for women with CO was 78.6 (SD 12.8) years and for men 72.9 (SD14.5). More patients with CO suffered from diabetes (32.1% versus 27.9%, p=0.027), heart failure/ ischaemic heart disease (27.3% versus 14.0%, p<0.001) and peripheral arterial occlusive disease (5.5% versus 1.9%, p<0.001). By far the greatest association was with the presence of a wound (73.6% versus 37.9%, p<0.001). Cellulitis affected 628 (24.7%) and 688 (47.8%) had a concurrent leg ulcer. Rates of reduced mobility (71.6% versus 61.9%) and obesity were higher in those with CO. Six independent factors associated with chronic oedema were service location, age, ethnicity, obesity, heart failure and the presence of a wound. Conclusion: Chronic oedema is a major and growing health care problem within primary care that has been previously unrecognised and requires effective service provision

LIMPRINT: the UK experience - subjective control of swelling in patients attending specialist lymphedema services

Background and study design: This study was undertaken as part of the UK LIMPRINT international study to determine the number of people with chronic oedema and its impact on health services. Overall 7436 with chronic oedema (CO) were recruited in the main UK study from a range of health settings. Methods and results: Subjective control of arm and leg chronic oedema (CO) was defined for patients attending three Lymphoedema services in the UK. Of the total available in the UK dataset 5165 (69.4%)/ 7436(100%) of participants were included. Reasons for exclusions included the following: lack of information (1669), having both arm and leg swelling (272), lack of description of control (5) and professional inability to decide whether CO was controlled (325). Arm swelling occurred in 953 (18.5%), with leg CO in 4212 (81.5%). Poor control was found in 1430 (27.7%) and good control in 3735 (72.3%). Control of arm swelling was worse in men and control increased overall in those aged over 45 years. In contrast control of CO worsened in those with leg CO with increasing age and multiple co-morbidities. Obesity and cellulitis, particularly an episode in the last year were associated with poor control. Independent risk factors for arm CO were obesity, neurological disease and cellulitis in the last year and for leg CO: obesity, poor mobility, heart disease, presence of a wound, cellulitis in the last year and duration of swelling. Conclusion: Control of CO within specialised centres is complex due to sociodemographic and clinical comorbidities

Thromboembolic Disease in Patients With Cancer and COVID-19: Risk Factors, Prevention and Practical Thromboprophylaxis Recommendations–State-of-the-Art.

Cancer and COVID-19 are both well-established risk factors predisposing to thrombosis. Both disease entities are correlated with increased incidence of venous thrombotic events through multifaceted pathogenic mechanisms involving the interaction of cancer cells or SARS-CoV2 on the one hand and the coagulation system and endothelial cells on the other hand. Thromboprophylaxis is recommended for hospitalized patients with active cancer and high-risk outpatients with cancer receiving anticancer treatment. Universal thromboprophylaxis with a high prophylactic dose of low molecular weight heparins (LMWH) or therapeutic dose in select patients, is currentlyindicated for hospitalized patients with COVID-19. Also, prophylactic anticoagulation is recommended for outpatients with COVID-19 at high risk for thrombosis or disease worsening. However, whether there is an additive risk of thrombosis when a patient with cancer is infected with SARS-CoV2 remains unclear In the current review, we summarize and critically discuss the literature regarding the epidemiology of thrombotic events in patients with cancer and concomitant COVID-19, the thrombotic risk assessment, and the recommendations on thromboprophylaxis for this subgroup of patients. Current data do not support an additive thrombotic risk for patients with cancer and COVID-19. Of note, patients with cancer have less access to intensive care unit care, a setting associated with high thrombotic risk. Based on current evidence, patients with cancer and COVID-19 should be assessed with well-established risk assessment models for medically ill patients and receive thromboprophylaxis, preferentially with LMWH, according to existing recommendations. Prospective trials on well-characterized populations do not exist

Intérêt de la volumétrie par scanner laser auto-positionné et reconstruction 3D en temps réel dans le lymphoedème du membre supérieur avant et après traitement décongestif intensif

Le lymphoedème du membre supérieur est une pathologie relativement fréquente et invalidante, notamment après chirurgie du cancer du sein. Sa prise en charge initiale ainsi que son suivi passent par la quantification de l'oedème. La mesure des circonférences (périmétrie) et le calcul du volume par la formule des troncs de cône est l'une des techniques de volumétrie les plus utilisées actuellement. Cependant, elle ne permet pas de quantifier l'oedème de la main qui constitue une gêne fonctionnelle majeure pour le patient. Cette étude prospective, monocentrique, comparait une technique innovante, la volumétrie par scanner laser 3D portatif, à la méthode des troncs de cône pour la quantification du lymphoedème du membre supérieur, sur 26 membres pathologiques et 29 membres sains mesurés par deux opérateurs indépendants avant et après traitement décongestif intensif. La reproductibilité intra-observateur évaluée par le coefficient de concordance de corrélation de Lin (LCCC) était de 0.97 pour les membres pathologiques et de 1 pour les membres sains. La précision estimée selon la méthode de Bland et Altman était de 3,4%. Le LCCC évaluant la concordance entre les deux techniques était de 0.99 pour les membres pathologiques et de 0.97 pour les membres sains, avec un biais qui augmentait proportionnellement au volume du membre. La réduction moyenne de volume obtenue par le traitement était de 2,7% à la main, 7,7% à l'avant-bras, et 6,9% pour l'ensemble main + avant-bras. Notre étude a démontré que la volumétrie par laser 3D est une méthode fiable, reproductible et précise, capable de rendre compte des effets thérapeutiques. La comparaison à la volumétrie par déplacement d'eau permettrait d'analyser ses différences avec la méthode périmétriqueMONTPELLIER-BU Médecine UPM (341722108) / SudocMONTPELLIER-BU Médecine (341722104) / SudocSudocFranceF

Vitamine B6 et maladie thrombo-embolique veineuse

MONTPELLIER-BU Médecine UPM (341722108) / SudocPARIS-BIUM (751062103) / SudocMONTPELLIER-BU Médecine (341722104) / SudocSudocFranceF

Étude de la prise en charge des artériopathies oblitérantes des membres inférieurs au Centre hospitalier de Perpignan par rapport au référentiel des enseignants de médecine vasculaire

MONTPELLIER-BU Médecine UPM (341722108) / SudocPARIS-BIUM (751062103) / SudocMONTPELLIER-BU Médecine (341722104) / SudocSudocFranceF

Approche du diagnostic de l'insuffisance veineuse chronique à travers la construction d'un score d'imputabilité

MONTPELLIER-BU Médecine UPM (341722108) / SudocPARIS-BIUM (751062103) / SudocMONTPELLIER-BU Médecine (341722104) / SudocSudocFranceF

Le diagnostic d'homocystinurie à l'âge adulte (à propos de six cas extraits d'une étude de l'homocystinurie dans la population française)

MONTPELLIER-BU Médecine UPM (341722108) / SudocPARIS-BIUM (751062103) / SudocMONTPELLIER-BU Médecine (341722104) / SudocSudocFranceF