L'oxygénothérapie hyperbare dans le traitement de la paralysie cérébrale : arnaque ou traitement approprié?

L'oxygénothérapie hyperbare (OTH) consiste à soumettre un patient à des taux de pression plus élevés que la pression atmosphérique normale et de lui faire respirer 100 % d'oxygène. Cette approche a été mise à l'essai pour le traitement de nombreuses conditions médicales avec succès dans certains cas alors pour d'autres sa validité reste encore à démontrer. Dans le cas de la paralysie cérébrale son utilisation a soulevé de nombreuses controverses et les études conduites jusqu'alors n'ont pas encore convaincu tous les membres de la communauté scientifique et ce, malgré certains effets positifs mis en évidence. Une récente étude qui a montré des améliorations notables chez des enfants atteints de paralysie cérébrale (PC) traités avec de l'air légèrement pressurisé, de même que chez ceux traités avec un protocole standard pour l'oxygénothérapie hyperbare (l'OTH), est invoquée pour nier l'efficacité de l'OTH. Des considérations politiques et économiques, plutôt que purement scientifiques, jouent un rôle important dans cette controverse. Des recherches systématiques supplémentaires sont requises, mais entre-temps, comme les effets thérapeutiques de cette approche semblent plus importants que ceux des thérapies actuellement acceptées dans le traitement de la paralysie cérébrale, les enfants atteints de cette condition ne devraient pas se faire refuser l'accès à l'OTH.Hyperbaric oxygen therapy (HBO) consist of subjecting a patient to elevated atmospheric pressure while the patient breathes 100% oxygen. This approach is considered the accepted treatment of choice for a number of medical conditions with success. In certain other conditions, the efficacy is still yet to demonstrated. In the case of cerebral palsy, the utilization of HBO has raised a number of controversial issues in the studies conducted. It has yet to convince the members of the scientific community at large. This unfortunately has been interpreted as negative despite the positive reproducible evidence. Until now, the Canadian government has had reservations concerning the efficacy of this treatment for cerebral palsy. Elsewhere, in the United States and in Quebec there is a certain interest. Specific events in the eyes of some, lead us to believe that the reticence to recognize Hyperbaric oxygen therapy as an effective treatment of cerebral palsy is more based on politics and economics rather than on the science that is available to support its use

Are Improvements Maintained After In-home Pulmonary Telerehabilitation for Patients with Chronic Obstructive Pulmonary Disease?

This study investigated if improvements can be maintained over 24 weeks when in-home pulmonary telerehabilitation is combined with asynchronous self-management education for Chronic Obstructive Pulmonary Disease (COPD). Twenty-three community-living elders with moderate to very severe COPD participated in a pre/post-intervention study. Over 8 weeks, they had access to self-learning capsules on self-management, received 15 in-home teletreatment sessions and were encouraged to gradually engage in unsupervised sessions. Participants were assessed before the intervention (T1), immediately after the intervention (T2), and 6 months later (T3). Outcome measures were 1) exercise tolerance (6-minute walk test [6MWT]), Cycle Endurance Test [CET]), and 2) quality of life (Chronic Respiratory Questionnaire [CRQ]). Although there were significant improvements after 8 weeks of pulmonary telerehabilitation on the 6MWT, CET and three of four CRQ domains, none of these improvements were maintained after 6 months and scores returned to their baseline values (all p values > 0.05 when comparing T3 with T1).  While pulmonary telerehabilitation is possible and has a positive impact on patients with moderate to very severe COPD, improvements were not maintained in the long-term even when physical therapy was accompanied by self-management education.

First Observations of an Eastern Screech-Owl, Megascops asio, Population in an Apple-Producing Region of Southern Quebec

Baseline information was collected on a local Eastern Screech-Owl population found in the apple-producing region of Saint-Hilaire and Rougemont, Quebec, as part of a larger study on pesticide exposure conducted between 2000 and 2003. Screech-Owls visited or occupied 41 of 89 nest boxes installed in 12 orchards and 2 control locations. The mean height of occupied nest boxes was 3.83 m (2.00 – 5.80 m). Squirrels, Sciurus and Tamiasciurius sp., and chipmunks, Tamias striatus, Northern Flickers, Colaptes auratus, and wasps were the owls’ primary competitors for the boxes. Intact Screech-Owl pellets retrieved from nest boxes (n = 82) had a mean length and width of 3.57 and 1.44 cm, respectively, and weighed a mean of 1.77 g. Screech-Owls in the study area consumed a variety of small mammal, avian, insect and aquatic prey. Of these, Meadow Voles, Microtus pennsylvanicus, were the predominant prey item identified in pellets, and Mourning Doves, Zenaida macroura, were the primary avian prey found in nest boxes. In Canada, the owl’s trend status remains largely unknown. The species is currently listed as “Not at Risk”, based on an assessment conducted for COSEWIC in 1986. Given that a limited amount of information exists on the natural history and ecology of the species in Quebec, we also generated a map of the owl’s distribution in the province, using data from ornithological databases and rehabilitation facilities. Potential risks to the species within the province, particularly pesticide exposure and habitat loss, are briefly addressed and follow-up studies are discussed

Homeostasis, homeorhesis, and the “logic of life”: Envisaging plasticity and stability in molecular research on trauma and its effects

How does a trait develop, and what makes it persist? This question is at the heart of studies of 21st-century neurosciences that attempt to identify how people develop specific personality traits and how these may become permanently anchored in their neurobiological profiles and temperaments. Such studies have documented the neuromolecular effects of early life adversity and have contributed to an understanding of subsequent life trajectories as being disproportionately affected by early negative experiences. This view has arisen despite little evidence of the stability of the presumably early-developed molecular traits and their potential effects on phenotypes Moreover, the overall understanding of these trajectories raises questions as to the origin of the potential stability of molecular traits: namely, whether they simply persist or whether they are actively maintained, and potentially augmented by, ongoing life adversity. These two perspectives have potentially significant implications for the understanding of the malleability of life trajectories and commitments to support people in shaping their trajectories. Through an analysis of historical and contemporary scientific literature and ethnographic research with neuroscientists, we consider how trauma came to be associated with specific psychological and neurobiological effects grounded in understandings of homeostasis and homeorhesis (trajectories). We then consider the ways in which neuroscientific researchers conceptualize the relationships between early adversity and elevated suicide risk later in life. We conclude with a consideration of the conceptual, ontological, and ethical implications of framing persistent life traits as the result of the persistence of long-embodied biological traits, persistent life environments, or both

Benefits of low-dose inhaled fluticasone on airway response and inflammation in mild asthma

SummaryRationaleCurrent guidelines suggest that asthma should be controlled with the lowest dose of maintenance medication required.ObjectivesTo evaluate the effects of a low dose of inhaled corticosteroid compared to a placebo, on airway inflammation and responsiveness in patients with mild symptomatic asthma.MethodsIn this randomized double-blind, placebo-controlled, parallel group study, we looked at the influence of inhaled fluticasone propionate 250μg/day for 3 months followed by 100μg/day for 9 months on airway inflammation and methacholine responsiveness in non-smoking subjects with mild allergic asthma. Subjects were evaluated at baseline and 3, 6, 9 and 12 months after treatments; a 2-week evaluation of respiratory symptoms and peak expiratory flow measurements was done before each visit.ResultsFifty-seven subjects completed the 3-month study period. Airway responsiveness, expressed as the PC20 methacholine, increased by 0.27 and 1.14 doubling concentrations, respectively, in placebo-treated (n=33) and in fluticasone-treated (n=24) asthmatic subjects (p=0.03). An additional improvement in PC20 up to 2.16 doubling concentrations was observed in the fluticasone-treated group during the 9-month lower-dose treatment (p=0.0004, end of low-dose period compared with placebo). Sputum eosinophil counts decreased after 3 months of fluticasone 250μg/day compared with placebo (p<0.0001) and remained in the normal range during the 9-month lower-dose treatment. Respiratory symptoms and peak expiratory flows did not change significantly throughout the study in both groups.ConclusionIn mild asthma, keeping a regular minimal dose of ICS after asthma control has been achieved, may lead to a further reduction in airway responsiveness and keep sputum eosinophil count within the normal range

Homeorhesis: Envisaging the logic of life trajectories in molecular research on trauma and its effects

What sets someone on a life trajectory? This question is at the heart of studies of 21-st century neurosciences that build on scientific models developed over the last 150 years that attempt to link psychopathology risk and human development. Historically, this research has documented persistent effects of singular, negative life experiences of people’s subsequent development. More recently, studies have documented neuromolecular effects of early life adversity on subsequent life trajectories, resulting in models that frame lives as disproportionately affected by early negative experiences. This view is dominant despite little evidence of the stability of the presumably early developed molecular traits and their potential effects on phenotypes. We argue that in the context of gaps in knowledge and the need for scientists to reason across molecular and phenotypic scales, as well as time spans that can extend beyond an individual’s life, specific interpretative frameworks shape the ways in which individual scientific findings are assessed. In the process, scientific reasoning slides between understandings of cellular homeostasis and organisms’ homeorhesis, or life trajectory. Biologist and historian François Jacob described this framework as the “attitude” that researchers bring to bear on their “objects” of study. Through an analysis of, first, historical and contemporary scientific literature and then ethnographic research with neuroscientists, we consider how early life trauma came to be associated with specific psychological and neurobiological effects grounded in understandings of life trajectories. We conclude with a consideration of the conceptual, ontological, and ethical implications of interpreting life trajectories as the result of the persistence of long-embodied biological traits, persistent life environments, or both

Eosinophils in COPD exacerbations are associated with increased eeadmissions

Abstract: Background. A subset of patients with COPD demonstrates eosinophilic inflammation either in their sputum or blood. Previous studies regarding the association between increased blood eosinophil levels and poor readmission outcomes are conflicting. The goal of this study was to investigate outcomes following severe COPD exacerbations in patients with higher blood eosinophil levels. Methods. With an observational study design, data on hospitalizations for severe COPD exacerbation were retrospectively gathered. Patient health data previous to and up to 1 year following the index hospitalization were included. Patients were stratified into the eosinophilic group if the blood eosinophil level on admission was ≥ 200 cells/μL and/or ≥ 2% of the total WBC count. Clinical outcomes were 12-month COPD-related readmission, 12-month all-cause readmission, length of stay, and time to COPD-related readmission. These outcomes were analyzed by using logistic, negative binomial, and Cox regression models. Results. A total of 167 patients were included; 55 had eosinophilia. Eosinophilia was associated with an increased risk of 12-month COPD-related readmission (OR, 3.59 [95% CI, 1.65-7.82]; P = .0013), an increased risk of 12-month all-cause readmission (2.32 [95% CI, 1.10-4.92]; P = .0277), and a shorter time to first COPD-related readmission (hazard ratio, 2.74 [1.56-4.83]; P = .0005). The length of stay was not statistically different between eosinophilic and noneosinophilic patients. Sensitivity analyses using different eosinophilia definitions revealed a proportional increase in effect size with increasing eosinophil cell count definitions for predicting 12-month readmissions. Conclusions. Blood eosinophil levels can be used as a biomarker in severe COPD exacerbations for predicting higher readmission rates

Compréhension des relations interpersonnelles et comportements agressifs chez de jeunes garçons à l'école primaire

Whether disruptive elementary school boys displayed a developmental lag in their level of interpersonal understanding was investigated. The social-cognitive level of individuals and of friendship understanding, as outlined in the Selman (1980) theory, were compared across two groups of boys contrasted on their level of stable disruptiveness according to teachers. As expected, level of interpersonal understanding moved forward for the two groups within the two years period between the two assessments. Predictions regarding a social-cognitive developmental lag on the part of stable disruptive boys are only partly confirmed. Results are discussed in the larger context of the relationships between social-cognitive development and the development of social competence.L'objectif de la présente étude est de vérifier, chez des garçons du niveau de l'école primaire, s'il y a des différences dans le niveau de compréhension des relations interpersonnelles entre un groupe de sujets agressifs et un groupe de non agressifs. Les conduites sociales des enfants ont été évaluées à trois reprises par leurs enseignants sur une période de six ans. L'appartenance aux différents groupes a été déterminée par les évaluations des enseignants selon que les sujets manifestaient des comportements stables d'agressivité ou non. Les garçons ont été interviewés à 9 et 11 ans pour évaluer leur niveau de compréhension des relations inter personnelles selon le modèle développemental de Selman (1980). L'ensemble des sujets évoluent dans le sens anticipé par le modèle développemental, mais l'hypothèse d'un décalage entre le groupe des sujets agressifs et les autres n'est que partiellement confirmée. Ces résultats sont discutés dans le contexte plus général des relations entre développement sociocognitif et développement de la compétence sociale.Gagnon Claude, Charlebois Pierre, Larivée Serge, Tremblay Richard E. Compréhension des relations interpersonnelles et comportements agressifs chez de jeunes garçons à l'école primaire. In: Enfance, tome 45, n°3, 1991. pp. 221-239

Safety and Efficacy of HFA-134a Beclomethasone Dipropionate Extra-Fine Aerosol over Six Months

OBJECTIVE: To compare the systemic safety and efficacy of hydrofluoroalkane beclomethasone dipropionate (HFA-BDP) extra-fine aerosol 800 µg/day with chlorofluorocarbon (CFC)-BDP 1500 µg/day