Rare express saccades in elderly fallers

Q Yang1, T T Lê1, E Debay1, C Orssaud2, G Magnier3, Z Kapoula11Groupe IRIS Vision and Motricité Binoculaire, CNRS, Service d’Ophtalmologie-ORL-Stomatologie; 2Service d’Ophtalmologie, Hôpital Européen Georges Pompidou, Paris, France; 3Hôpital de gériatrie Henry Dunant, Paris, FranceObjective: To examine horizontal saccades in elderly subjects with falling history; prior extensive screening was done to recruit subjects with falling history in the absence of pathology.Methods: Twelve elderly with falling history were tested. Two testing conditions were used: the gap (fixation target extinguishes prior to target onset) and the overlap (fixation stays on after target onset) paradigms. Each condition was run at three viewing distances −20 cm, 40 cm, and 150 cm, corresponding to convergence angle at 17.1°, 8.6°, and 2.3°, respectively. Eye movements were recorded with the photoelectric IRIS (Skalar medical).Results: (i) like in healthy elderly subjects, elderly with falling history produce shorter latencies in the gap paradigm than in the overlap paradigm; (ii) their latencies are shorter at near distances (20 and 40 cm) relative to 150 cm for both paradigms; (iii) the novel result is that they fail to produce express latencies even in the conditions (near viewing distance and the gap task) known to promote high rates of express in adults (25%) or in healthy elderly (20%). Seven from the 10 healthy elderly produced express saccades at rates >12%, while 9 of the 12 older subjects with falling history showed no express saccades at all; the remaining 3 subjects showed low rates <12%.Conclusion: The quasi paucity of express saccades could be due to the disequilibrium of complex cortical/subcortical networks needed for making express saccades. The results support models suggesting specific network for express saccades; missing of such optomotor reflex may go along with missing other reflexes as well increasing the chances of falling.Keywords: elderly, falling, saccades, gap/overlap, express saccad

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ABSTRACT The associations between androgens and cardiovascular risk factors in men are controversial. A nested case-control study was used to compare the levels of cardiovascular risk factors in two groups (n ϭ 25 each) of healthy men contrasted by their plasma total testosterone (PTT) concentration, matched by age and ethnic origin. Compared to the men with normal PTT (mean Ϯ SEM, 19.8 Ϯ 0.7 nmol/L), the men with low PTT (10.1 Ϯ 0.3 nmol/L) had a significantly higher body mass index (P Ͻ 0.01), waist/hip ratio (P Ͻ 0.001), systolic blood pressure (P Ͻ 0.05), fasting and 2-h plasma glucose (P Ͻ 0.04 and P Ͻ 0.02 respectively), serum triglycerides (P Ͻ 0.001), total cholesterol (P Ͻ 0.04), low density lipoprotein cholesterol (P Ͻ 0.01), apolipoprotein B (P Ͻ 0.01), fasting and 2-h plasma insulin (both P Ͻ 0.0001), and lower values of serum high density lipoprotein cholesterol (P Ͻ 0.01) and apolipoprotein A1 (P Ͻ 0.05). After adjustment for both body mass index and waist/ hip ratio, fasting and 2-h plasma insulin and triglyceride levels remained significantly different between the two groups (P Ͻ 0.04, P Ͻ 0.001, and P Ͻ 0.03 respectively). Plasma sex hormone-binding globulin was markedly decreased in the low PTT group (P Ͻ 0.0001), whereas bioavailable testosterone was not significantly different. This case-control study provides further and stronger evidence of a negative association between PTT and plasma insulin in men, as suggested by cross-sectional studies. Because these are observational data, neither causality nor the direction of the associations among PTT, sex hormone-binding globulin, and insulin sensitivity can be determined. Intervention studies are needed to better assess the metabolic and cardiovascular benefits of androgen treatment that have been suggested by preliminary clinical trials. (J Clin Endocrinol Metab 82: 682-685, 1997) F OR A LONG time, androgens have been considered to decrease glucose tolerance, induce hyperinsulinemia, and increase cardiovascular risk in women (1) as well as in men (2). Recently, these effects have been questioned in men. Indeed, from recent cross-sectional studies in healthy men, lower plasma total testosterone (PTT) levels seem to be associated with hyperinsulinemia, decreased glucose tolerance, and a higher level of cardiovascular risk factors (3-5). To investigate the role of endogenous testosterone and sex hormone-binding globulin (SHBG) in the association between sex hormones and cardiovascular risk factors in healthy males, in 1992-1993 we selected from the large male occupation-based population examined in the Telecom Study in 1985-1987 (3, 6), two groups of men contrasted by their PTT concentrations to compare their levels of cardiovascular risk factors, plasma SHBG, and plasma bioavailable testosterone. Materials and Methods Study design This study used a nested case-control design. The levels of plasma SHBG, plasma bioavailable testosterone, and cardiovascular risk factors were compared between males with low and normal PTT. As age and ethnicity influence cardiovascular risk factors (7-9), the subjects were matched on these covariates (Ϯ1 yr for age). Selection of subjects For the low PTT group, we selected healthy men not treated for diabetes, dyslipidemia, or hypertension from the lower percentiles of the PTT distribution of the 1718 adult men who participated in the crosssectional study of 1985-1987 (3, 6). We recruited all healthy men with PTT levels of 11.8 nmol/L or less in 1985-1987 who could be traced and who agreed to be reexamined in 1992-1993. The fifth percentile of the PTT distribution in the background population was 11.8 nmol/L When a case with a confirmed low PTT level had been included, we then recruited a matched control subject, with PTT levels between 17. 3-24.3 nmol/L in 1985-1987 and 13.9 -28.4 nmol/L in 1992-1993. When several controls were available for a given case, we systematically chose the control who had been examined at the date closest to that of the case in [1985][1986][1987]. To obtain the a priori calculated sample size of 25 men by group (see Statistical methods), we contacted 147 subjects (65 with low PTT in 198

Relationship between paramacular thinning, cerebral vasculopathy, and hematological risk factors in sickle cell disease

PurposeTo identify risk factors for sickle cell maculopathy due to hematological parameters (especially anemia and hemolysis) or cerebral vasculopathy.MethodsThis retrospective study was conducted at a Referral Center. The follow-up included optical coherent tomography/optical coherent tomography angiography, neuro-radiological imaging, and a hematological assessment (hemoglobin, hemoglobin S level, reticulocytes, mean corpuscular volume, bilirubin, and lactate dehydrogenase).ResultsHundred and thirty-two sickle cell patients were included. Maculopathy was observed in 127 eyes of SS patients and 10 eyes of SC patients (p < 0.001), unrelated to peripheral retinopathy. Cerebral vasculopathy was more frequent in SS patients (p < 0.001) and was also associated with the presence of maculopathy (p = 0.049), and it was related to peripheral retinopathy (p < 0.001). All biological parameters significantly differed according to the genotype (p < 0.001) but not according to the presence of cerebral vasculopathy or maculopathy. In the multivariate analysis, reticulocytes and bilirubin were associated with the presence of cerebral vasculopathy and maculopathy.ConclusionThe data obtained were consistent with the role of anemia or hemolysis markers in cerebral vasculopathy and macular involvement. As a trend of hemolysis appears to be a risk factor for these complications, this validates the use of preventive plasmapheresis in these patients

Central Crosstalk for Somatic Tinnitus: Abnormal Vergence Eye Movements

Frequent oulomotricity problems with orthoptic testing were reported in patients with tinnitus. This study examines with objective recordings vergence eye movements in patients with somatic tinnitus patients with ability to modify their subjective tinnitus percept by various movements, such as jaw, neck, eye movements or skin pressure.Vergence eye movements were recorded with the Eyelink II video system in 15 (23–63 years) control adults and 19 (36–62 years) subjects with somatic tinnitus.1) Accuracy of divergence but not of convergence was lower in subjects with somatic tinnitus than in control subjects. 2) Vergence duration was longer and peak velocity was lower in subjects with somatic tinnitus than in control subjects. 3) The number of embedded saccades and the amplitude of saccades coinciding with the peak velocity of vergence were higher for tinnitus subjects. Yet, saccades did not increase peak velocity of vergence for tinnitus subjects, but they did so for controls. 4) In contrast, there was no significant difference of vergence latency between these two groups.The results suggest dysfunction of vergence areas involving cortical-brainstem-cerebellar circuits. We hypothesize that central auditory dysfunction related to tinnitus percept could trigger mild cerebellar-brainstem dysfunction or that tinnitus and vergence dysfunction could both be manifestations of mild cortical-brainstem-cerebellar syndrome reflecting abnormal cross-modality interactions between vergence eye movements and auditory signals

Hereditary optic neuropathies in childhood

Knowledge of the genetic mechanisms underlying hereditary optic neuropathies has increased over the past two decades. Identified genes are mainly related to forms that begin after adolescence. However, hereditary optic neuropathies can begin from early childhood and may then exhibit specific clinical features. We report a series of patients with early-onset hereditary optic neuropathies to determine their clinical and genetic characteristics

Cardiac Disorders in Patients With Leber Hereditary Optic Neuropathy

Cardiac abnormalities have been described in patients with Leber hereditary optic neuropathy (LHON). Some are life-threatening because of the risk of ventricular fibrillation and sudden death. The purpose of our study was to better characterize the cardiac abnormalities in a large patient cohort with LHON. A retrospective study of the electrocardiogram (EKG) results performed on all patients with LHON evaluated at The Reference Center for Rare Diseases in Ophthalmology, Paris, France, from January 2015 to June 2017. Our series included 73 patients with LHON (9 women/64 men) with a mean age of 30.29 ± 14.48 years. Although only 1 patient had cardiac complaints, cardiac abnormalities were detected in 17 patients (23.2%): 9 patients had an excitation syndrome, 6 had atrioventricular block, and 2 had repolarization abnormalities. All patients harbored mtDNA point mutations 11778 or 3460. Cardiac abnormalities occur frequently enough in patients with LHON that a baseline EKG is warranted. However, further studies are needed to determine the true cardiac risk associated with specific LHON mtDNA mutations

Pop argentino

On voit apparaître au cours des années 1990 en Argentine une nouvelle génération d’artistes qui font figurer dans leurs œuvres des icônes de la culture populaire : fast food et symboles patriotiques dans les photographies de Marcos López, marques de produits, telenovelas et Internet dans les romans d’Alejandro López, cumbia et langage populaire dans ceux de Cucurto. Ces artistes ont également en commun de ne pas faire référence aux dures années de la dernière dictature, mais au néolibéralisme, instauré pendant les présidences de Carlos Saúl Menem (1989-1999). En outre, tous trois questionnent l’identité des Argentins, qu’ils montrent plus proches de l’Amérique du Sud que de l’Europe.The 1990s saw the rise of a new generation of artists in Argentina who include pop culture icons in their works: fast food and patriotic symbols in Marco López’s photographs, brand names, soap operas and the Internet in Alejandro López’s novels, and cumbia and popular speech in those of Cucurto. In addition, these artists all make references to neoliberalism, established during the presidency of Carlos Saúl Menem (1989-1999), while avoiding references to the hard years of the last dictatorship. Furthermore, all three question Argentinean identity, which they show as closer to South America than to Europe.En la decada del noventa surge en Argentina una nueva generación de artistas que integran en sus obras iconos de la cultura popular : pancherías y símbolos patrióticos en las fotografías de Marcos López, marcas de productos, telenovelas e Internet en las novelas de Alejandro López, cumbia y lenguaje popular en las de Cucurto. Estos artistas comparten la falta de referencias al autodenominado proceso de reorganización, sin embargo utilizan las del neoliberalismo, instaurado durante las presidencias de Carlos Saúl Menem (1989-1999). Además, los tres cuestionan la identidad argentina, que muestran más cerca de América del Sur que de Europa

Imposible equilibrio, de Mempo Giardinelli

La province du Chaco fait l’acquisition d’un couple d’hippopotames pour freiner une invasion de plantes aquatiques. C’est à partir de cette situation comique que Mempo Giardinelli propose un état des lieux de l’Argentine des années 1990, théâtre d’une société qui n’a pas encore retrouvé son équilibre après la dernière dictature. Militants et hommes politiques véreux s’y côtoient, tandis que la crise économique de 2001 se met en place inexorablement. Dans cette lecture du roman, nous donnerons à voir les différentes dénonciations que l’auteur intègre au récit, que ce soit par le biais de l’allégorie ou de la voix de ses personnages.La provincia del Chaco adquiere una pareja de hipopótamos para frenar la invasión de unas plantas acuáticas. A partir de esta situación estrafalaria Mempo Giardinelli propone su visión de la Argentina de los años 1990, teatro de una sociedad que no volvió a encontrar su equilibrio después de la última Dictadura. En ella se mezclan militantes y políticos corruptos mientras la crisis económica del 2001 empieza a ponerse en marcha inexorablemente. En esta propuesta de lectura de la novela, mostraremos las distintas denuncias integradas por el autor a lo largo de la narración, sea por medio de la alegoría o sea por la voz de los mismos personajes