Dopaminergic drugs and the risk of hip or femur fracture: a population-based case–control study

SUMMARY: The effect of dopaminergic medication on the risk of hip/femur fractures is not clear. Our results showed a nearly twofold increased risk of hip/femur fractures in current dopaminergic drug users. Concomitant use of antidepressants further increased this risk. Fracture risk assessment may be warranted in elderly users of dopaminergic drugs. INTRODUCTION: Dopaminergic drugs, often used in the treatment of Parkinson's disease, have several pharmacological effects that may increase or decrease the risk of falling and fractures. Thus, the effect of dopaminergic medication on the risk of hip/femur fractures is not clear. The objective of the study was to examine the effect of dopaminergic medication and concomitant use of psychotropics on the risk of hip/femur fractures taking into account the timing of dopaminergic drug use. METHODS: A population-based case-control study in the PHARMO database was conducted for the period 1991 to 2002. Cases were patients aged 18 years and older with a first hip or femur fracture and matched to four control patients by year of birth, sex and geographical region. RESULTS: The study population included 6,763 cases and 26,341 controls. Current use of dopaminergic drugs (1-30 days before the index date) was associated with an increased risk of hip/femur fractures compared to never use (OR(adj) 1.76, 95% CI = 1.39-2.22), but this excess risk rapidly dropped to baseline levels when treatment had been discontinued >1 year ago. Concomitant use of antidepressants among current dopaminergic drug users further increased the risk of hip/femur fractures (OR(adj) 3.51, 95% CI = 2.10-5.87) while there was no additional risk with concomitant use of other psychotropics. CONCLUSIONS: Although the observed association between dopaminergic drugs and fracture risk may not be entirely causal, due to absence of information on the (severity of the) underlying disease, fracture risk assessment may be warranted in elderly users of dopaminergic drugs

Hyper-IgG4 disease: report and characterisation of a new disease

BACKGROUND: We highlight a chronic inflammatory disease we call 'hyper-IgG4 disease', which has many synonyms depending on the organ involved, the country of origin and the year of the report. It is characterized histologically by a lymphoplasmacytic inflammation with IgG4-positive cells and exuberant fibrosis, which leaves dense fibrosis on resolution. A typical example is idiopathic retroperitoneal fibrosis, but the initial report in 2001 was of sclerosing pancreatitis. METHODS: We report an index case with fever and severe systemic disease. We have also reviewed the histology of 11 further patients with idiopathic retroperitoneal fibrosis for evidence of IgG4-expressing plasma cells, and examined a wide range of other inflammatory conditions and fibrotic diseases as organ-specific controls. We have reviewed the published literature for disease associations with idiopathic, systemic fibrosing conditions and the synonyms: pseudotumour, myofibroblastic tumour, plasma cell granuloma, systemic fibrosis, xanthofibrogranulomatosis, and multifocal fibrosclerosis. RESULTS: Histology from all 12 patients showed, to varying degrees, fibrosis, intense inflammatory cell infiltration with lymphocytes, plasma cells, scattered neutrophils, and sometimes eosinophilic aggregates, with venulitis and obliterative arteritis. The majority of lymphocytes were T cells that expressed CD8 and CD4, with scattered B-cell-rich small lymphoid follicles. In all cases, there was a significant increase in IgG4-positive plasma cells compared with controls. In two cases, biopsies before and after steroid treatment were available, and only scattered plasma cells were seen after treatment, none of them expressing IgG4. Review of the literature shows that although pathology commonly appears confined to one organ, patients can have systemic symptoms and fever. In the active period, there is an acute phase response with a high serum concentration of IgG, and during this phase, there is a rapid clinical response to glucocorticoid steroid treatment. CONCLUSION: We believe that hyper-IgG4 disease is an important condition to recognise, as the diagnosis can be readily verified and the outcome with treatment is very good

Frequency dependence of TDDB & PBTI with OTF monitoring methodology in high-k/metal gate stacks

session posterInternational audienceThis paper deals with AC/DC effect on nMOS TDDB (Time Dependent Dielectric Breakdown) and PBTI (Positive Bias Temperature Instability) using suitable OTF (on the Fly) monitoring methodologies. First, an adapted unipolar AC stress without stress interruption is used to study TDDB dependences on frequency and duty cycle. For frequencies above 100Hz, Time to Breakdown is shown to depend significantly on these two parameters. On the other hand, in order to evidence a possible effect of trapping on TDDB, PBTI dependences on frequency and duty cycle are also studied using fast BTI measurement. Finally, trapping/detrapping mechanisms fail to explain TDDB observations

La flore bactérienne dans les blépharites

National audienceBlepharitis has multiple, poorly defined origins. The goal of this study was to investigate the bacterial flora present in patients affected with blepharitis in comparison with healthy subjects, so as to understand the role of bacterial etiologies in blepharitis. Fifty-four patients with blepharitis and 50 healthy controls participated in this study. Swabs were obtained and analyzed qualitatively and quantitatively for bacteria. A subgroup of 16 people (9 with blepharitis and 7 controls) also were investigated for Demodex. The percentages of the positive cultures and the number of colonies/case were clearly higher for patients with blepharitis in comparison with healthy controls. Bacteria were isolated for 81% of cases versus 38% for controls, with a mean of 39 colonies versus 4.4 colonies for controls. Corynebacterium sp. were the most common microorganisms isolated from patients with blepharitis (53.7% for cases versus 18% for controls, P<0.01), and the bacterial load was 15 times higher (37.4 col/case versus 2.6 col/case). C. macginleyi was the most common Corynebacteria (33% versus 6%, P<0.01). S. epidermidis: 35.1% versus 16% (P=0.02) with 11.3 col/case versus 1.6 col/case. S. aureus: 13% versus 0% (P=0.01) with 24.7 col/case versus 0. We did not find a significant difference for Propionibacterium acnes: 14.8% versus 14% with 4.7 col/case versus 5.1 col/case, or for Demodex, with 22.2% versus 28.6%. Corynebacterium sp. and especially C. macginleyi seem to participate actively in the physiopathology of blepharitis. S. epidermidis and S. aureus also remain associated with this pathology.Introduction Les blépharites ont des origines mal définies et multiples. L’objectif de cette étude a été d’étudier la flore bactérienne présente chez les patients atteints de blépharite par rapport à des sujets sains dans la perspective d’apprécier la place des étiologies bactériennes dans les blépharites. Matériel et méthodes Cinquante-quatre patients ayant une blépharite et 50 témoins ont participé à cette étude. Ils ont bénéficié d’un prélèvement à l’écouvillon. Les prélèvements ont bénéficié d’une analyse bactériologique qualitative et quantitative. Un sous-groupe de 16 personnes (9 blépharites et 7 témoins) a bénéficié en même temps d’une recherche du Demodex. Résultats Les patients atteints de blépharite présentaient significativement plus de prélèvements bactériens positifs et la quantité de bactéries chez ces patients, exprimée en nombre de colonies bactériennes, était supérieure par rapport aux témoins ; les prélèvements sont revenus positifs chez 81,5 % des cas versus 38 % des témoins avec en moyenne 39 colonies versus 4,4 colonies pour les témoins. Les corynébactéries sont les espèces les plus souvent isolées : 53,7 % des cas versus 18 % des témoins (p<0,01) avec 37,4 versus 2,6 col/cas (C. macginleyi : 33 % versus 6 % (p<0,01) avec 40,4 col/cas versus 1,6 col/cas). S. epidermidis : 35,1 % versus 16 % (p=0,02) avec 11,3 col/cas versus 1,6 col/cas. S. aureus : 13 % versus 0 % (p=0,01) avec 24,7 col/cas versus 0. Nous n’avons pas trouvé de différence significative pour Propionibacterium acnes : 14,8 % versus 14 % avec 4,7 col/cas versus 5,1 col/cas et pour Demodex avec 22,2 % versus 28,6 %. Conclusion Les corynébactéries et surtout C. macginleyi semblent participer activement dans la physiopathologie des blépharites. S. epidermidis et S. aureus restent également associés à cette pathologie

Physical understanding of low frequency degradation of NMOS TDDB in High-k metal gate stack-based technology. Implication on lifetime assessment

session 5A: Gate dielectrics reliabilityInternational audienceThis paper deals with oxide breakdown (BD) under positive gate voltage in nMOS Devices. First, a stress interruption effect is evidenced on TBD and shown to depend significantly on fabrication process. Then, based on experiments done both with the OTF monitoring methodology and the Fast measurement using Agilent B1530A, the interruption signature on MOS parameters are analyzed. Finally, Maxwell-Wagner instability followed by dielectric relaxation mechanism is found to be responsible for the stress interruption effect on TDDB nMOS