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Background & aims: Elderly subjects are at risk for undernutrition. Restrictive diets may increase this risk. The aim was to evaluate the impact of restrictive diets on undernutrition and its risk in free-living elderly. Methods: Ambulatory patients over age 75 and under a restrictive diet (low salt, low cholesterol, diabetic) were included prospectively, along with age-and gender-matched controls. Weight and height were measured, and the short-form of the Mini Nutritional Assessment was scored. Groups were compared to determine variables associated with a low MNA-SF Ò . Results: 95 patients in the diet group (62 F, 33 M, 80 AE 4 y) and 95 controls (57 F, 38 M, 82 AE 5 y) were included. Restrictive diets (low salt n ¼ 33, diabetic n ¼ 19, low cholesterol n ¼ 15, combination n ¼ 27) had been followed since 11.0 AE 5.9 years. Using the cut-off of 12 for MNA-SF Ò , 44 patients in the diet group were at risk vs. 22 among controls (P < 0.001). In multivariate analysis, a restrictive diet increased the probability of having an MNA-SF Ò < 12 (OR ¼ 3.6, 95% CI ¼ 1.8e7.2, P < .001). Conclusions: Restrictive diets in patients over 75 increase the risk of undernutrition. On an individual level, these diets may need reassessment. Society guidelines should promote specific recommendations for the elderly.

Objective: Across all stages of Alzheimer disease (AD), apathy is the most common neuropsychiatric symptom. Studies using the Neuropsychiatric Inventory (NPI) have found that apathy is present in up to 70% of individuals with Alzheimer disease. One of the main difficulties in assessing apathy and other neuropsychiatric symptoms is the absence of reliable, objective measures. Motor activity assessment using ambulatory actigraphy could provide an indirect, objective evaluation of apathy. The aim of our study was to assess the relationship between apathy and daytime motor activity in AD, using ambulatory actigraphy. Methods: One hundred seven AD outpatients wore a wrist actigraph (Motionlogger) during seven consecutive 24-hour periods to evaluate motor activity. Participants were divided into two subgroups according to their apathy subscores on the NPI: individuals with apathy (NPI-apathy subscores >4) and those without. Daytime mean motor activity scores were compared between the two subgroups. Results: Individuals with AD who had symptoms of apathy (n = 43; age = 79 ± 4.7 years; Mini-Mental State Examination = 20.9 ± 4.8) had significantly lower daytime mean motor activity than AD patients without apathy (n = 64; age = 76.3 ± 7.7; Mini-Mental State Examination = 21.5 ± 4.7), while nighttime mean motor activity did not significantly differ between the two subgroups. Conclusions: Ambulatory actigraphy could be added to currently used questionnaires as a simple, objective technique for assessing apathy in the routine assessment of AD patients. (Am J Geriatr Psychiatry 2012; 20:806-814)

Apathy is the most frequently reported neuropsychiatric symptom across all stages of Alzheimer&#39;s disease (AD). Both apathy and sleep disorders are known to have independent negative effects on the quality of life in individuals with AD. The aim of this study was to assess the relationship between apathy and sleep/wake patterns in individuals with AD using ambulatory actigraphy. One hundred and three non-institutionalized individuals with AD wore a wrist actigraph continuously over seven consecutive 24-h periods. Apathy was assessed using the Neuropsychiatric Inventory. Daytime mean motor activity (dMMA) was calculated from daytime wrist actigraphy data. Actigraphic parameters of sleep included total sleep time (TST), wake after sleep onset (WASO), time in bed (TIB), WASO normalized by TIB, sleep latency, and nighttime mean motor activity (nMMA). Among the 103 individuals with AD (aged 76.9 ± 7.2 years; MMSE = 21.4 ± 4.3), those with apathy had significantly lower dMMA, higher WA...

Since 1996, a European network has been organized from Rennes, France and holoprosencephalic files were collected for clinical and molecular study. Familial instances of typical and atypical holoprosencephaly (HPE) were found in 30% of cases. All affected children had psychomotor delay with microcephaly, often associated with endocrine, digestive, and respiratory abnormalities, and thermal dysregulation. Among 173 subjects in the molecular study, 28 heterozygous mutations were identified (16%): 15 SHH mutations, 6 ZIC2 mutations, 5 SIX3 mutations, and 2 TGIF mutations.

Background: An assessment of the quality of health information on the Internet is an absolute necessity because peer review is often lacking in this media. Objective: To develop a simple and easy French code of ethics, which will enable medical students to judge quality of health information in teaching material available on the Internet. Design: Three medical informaticians generated ten criteria from previous codes of ethics from Europe and the USA. This instrument was tested on a sample of 30 health Internet teaching resources. Results: Chance corrected inter-observer agreement (kappa) for the quality rating ranged from k=-0.19 to k=0.33 amongst the expert panel, showing poor agreement among the raters. Conclusion: If the negative results of this study are confirmed by further research, they will affect detrimentally projects in Europe to accredit or certify Internet health resources.

infectious complications (n = 41) were septic shock (n = 3), sepsis (n = 3), Fournier gangrene (n = 1), urinary tract infection (n = 2), and fever requiring hospital admission (n = 32). Minor infectious complications were fever that did not require admission (n = 29), prostatitis (n = 6), and epididymitis (n = 2). Infectious complications occurred in 63 of 614 (10.3%) procedures without antibiotic prophylaxis and in 15 of 404 (3.7%) of those with antibiotic prophylaxis (P =.0001). Of the 41 major infectious complications, 31 (75.6%) occurred in procedures without antibiotic prophylaxis (n = 583) versus 10 (24.4%) in those with prophylaxis (n = 394; P =.0410). In conclusion, transrectal ultrasound-guided biopsy of the prostate has a statistically significant higher risk of infectious complications when performed without antibiotic prophylaxis.

The School of Medicine at the University of Rennes has moved to problem-based learning (PBL) in medical curriculum and has exploited a WWW based system for the development, delivery, and management of electronic resources for medical students. The electronic environment has provided new opportunities for educational staff to help prepare future physicians. Several services are used: virtual patient applications for training (Cardiolab is an example of such a computer system that associates basic science and clinical cases), information available on the Internet and knowledge bases for medical decision support. Emphasis is placed on acquiring lifelong learning skills. A new course for undergraduate medical students has been based on those principles

Communicated by Mireille Caustres Holoprosencephaly (HPE; 1 out of 16,000 live births; 1 out of 250 conceptuses) is a complex brain malformation resulting from incomplete cleavage of the prosencephalon, affecting both the forebrain and the face. Clinical expressivity is variable, ranging from a single cerebral ventricle and cyclopia to clinically unaffected carriers in familial dominant autosomic HPE. The disease is genetically heterogeneous, but additional environmental agents also contribute to the etiology of HPE. In our cohort of 200 patients, 34 heterozygous mutations were identified, 24 of them being novel ones: 13 out of 17 in the Sonic hedgehog gene (SHH); 4 out of 7 in ZIC2; and 7 out of 8 in SIX3. The two mutations identified in TGIF have already been reported. Novel phenotypes associated with a mutation have been described, such as abnormalities of the pituitary gland and corpus callosum, colobomatous microphthalmia, choanal aperture stenosis, and isolated cleft lip. This study confirms the great genetic heterogeneity of the disease, the important phenotypic variability in HPE families, and the difficulty to establish genotype-phenotype correlations. Hum Mutat 24:43-51, 2004.

In France, one of the aims of the current national Alzheimer&#x27;s disease plan is to collect data from all memory centers (memory units, memory resource and research centers, independent neurologists) throughout the country. Here we describe the French Alzheimer Information System and present a &#x27;snapshot&#x27; of the data collected throughout the country during the first year of operation. We analyzed all data transmitted by memory centers between January 2010 and December 2010. Each participating center is required to transmit information on patients to the French National Alzheimer dataBank (BNA). This involves completing a computer file containing 31 variables corresponding to a limited data set on AD (CIMA: Corpus minimum d&#x27;information Alzheimer). In 2010, the BNA received data from 320 memory centers relating to 199,113 consultations involving 118,776 patients. An analysis of the data shows that the initial MMSE (Mini Mental State Examination) mean score for patient...