Principes de la lecture critique de la littérature médicale: Illustration urologique

There has been an enormous expansion in scientific literature, especially in the area of health and medicine. At the same time the complexity of the research has increased. Through the reading of medical literature of his field of interest, the physician is in search of useful information. However, reading medical papers is very time consuming and most physicians, for their usual literature review, content themselves with the titles and the abstracts. Moreover, quality and relevancy of the publications vary greatly and the reader must be able to “separate the wheat from the chaff”. Thus the reading of literature needs selection and evaluation. As a result, physicians require critical appraisal skills. The principle of appraisal of medical literature is to assess the value of publications which will influence the medical practice of the reader. The reader has a double objective: to assess the credibility of the publications, and to define the applicability of the publication information. By following eight steps the reader is able to quickly rule out from his reading what is not valid and have an objective look at the quality of the results which are proposed to him. These eight steps comprise the assessment of the study objectives, the study design, the study factor(s), the outcome factor(s), the study population and sample, the confounding factor(s) and bias, the results with their statistical and clinical significance and the power of the study, and, lastly, the synthesis of the reader's judgment. The last word belongs to the clinician facing his patient.     

Influence comparée de l'(±)-acide abscissique,de la coumarine,de l'acide p-coumarique et de certains de leurs dérivés sur la croissance de la première feuille de blé

Summary The activities of (±)-abscisic acid and a number of compounds derived from p-coumaric acid and coumarin and their interaction with gibberellic acid in the control of the elongation of the first wheat leaf are examined. (±)-Abscisic acid strongly inhibits leaf growth in the presence as well as in the absence of gibberellic acid, but the inhibition is greater in the presence of gibberellic acid (3 g/l already have an observable effect). Among other compounds, only ferulic acid and coumarin significantly reduce leaf elongation, and they are effective only at high concentrations (1.44 · 10^-4 M/l).     

Apports de la géologie et de la géomorphologie à l’étude du mégalithisme : identifier,interpréter,dater

The contribution of geology and geomorphology to architectural and technological study of the Atlantic coast of France megaliths is important and can be grouped into three main axes: to identify, interpret and dating. Identification refers to the sourcing of the megalithic materiel from 0 to 7 km, sometimes around 10 km, or even exceptionally around 30 km. It is never the entire supply that is affected by such long distances but only a few blocks, some of them are remarkably well staged in the megalithic architecture. Another contribution lies in a fresh look at the management of stone recognized through the modes of acquisition, transformation and use of the raw material. More particularly, the geomorphology associated with technological reading offers tools for recognizing ancient standing stones. In the context of the interpretation of funerary chambers, the two sciences open a large window on the modalities of the internal structuring of monuments. From the entrance to the end of the chamber, the organization and use of the space is documented, sometimes a symbolic coding emerges from the mineral walls. This symbolic coding is based on particular petrography, on surface conditions operating a subdivision of space, on granulometries and homogeneities of differentiated surfaces. The internal organization can also be marked with natural “patterns”, which refer to a completely new aspect of Neolithic thought. Finally, the last axis concerns relative dating, by recognizing forms of postmegalithic fossil erosion, geomorphology makes it possible to identify reused stelae. A very important tool in a current research context where an important episode of reuse of standing stones at the end of the middle Neolithic is anticipated in the construction of dolmens in the south of France.     

Étude de la cohorte nord-finlandaise de 1966: facteurs prédictifs et conséquences de la schizophrénie

Subtle motor, emotional, cognitive and behavioural abnormalities are often present in apparently healthy children and adolescents who later develop schizophrenia. This suggests that some aspects of causation are established long before psychosis becomes manifest. We aim to assess the factors contributing to the development of schizophrenia focusing mainly on genetic factors, pregnancy and delivery complications, early development and scholastic performance, as well as later educational, social and health consequences. This is done by reviewing the Northern Finland 1966 Birth Cohort, its scientific activities, publications and work in progress.     

Alcaloïdes de Zanthoxylum decaryi: la decarine,nouvel alcaloide dérivé de la benzophénanthridine

Four alkaloids have been isolated from the stem bark of Zatithoxylum decaryi. Three are known, dictamnine skimmianine, 4-methoxy-1- methyl-2-quinolone. The fourth decarine is new; its structure has been established as 9-methoxy-10-hydroxy-2,3-methylenedioxybenzophenanthridine.¹     

Joseph-Pierre Pétrequin (1809–1876): chirurgien, anatomiste, historien de la médecine, fondateur de la Faculté médicale lyonnaise et son procédé chirurgical original pour la cure de la gangrène de la verge

Pétrequin was an outstanding anatomist, surgeon, medical historian, and founder of the Lyon School of Medicine. This article describes his scientific contribution with particular emphasis on his original surgical procedure for the treatment of penile gangrene.     

Conséquences de la chimiothérapie anticancéreuse sur la fertilité de la femme

Sterility is a potential toxic effect of chemotherapy. This risk is well established for alkylating agents, but is less clearly defined for anthracyclines, methotrexate and fluorouracil and poorly defined for alkaloids, platinum, etoposide and taxanes. The main predictive factors for ovarian toxicity are the additive effect of cytotoxic drugs, the cumulative dose of each drug and the patient’s age. This effect of chemotherapy is evaluated on menstrual cycles, hormonal assays and the number of pregnancies observed in patient cohorts. Chemotherapy induces destruction of oocytes and granulosa cells. In mice, it has been shown that adriamycin may induce oocyte apoptosis, which can be prevented by modulation of cycle cell signalling (dysregulation of Bax gene or, on the contrary, expression of its antagonist gene Bcl-2 or inhibition of apoptosis with sphingosine-1-phosphate or caspase inhibitors). Clinical data in the literature are usually based on retrospective studies and are somewhat confused: global fertility after MOPP chemotherapy for Hodgkin’s disease is about 20%, adjuvant chemotherapy with CMF, F(A)C or TAC for breast cancer induces amenorrhea in 50% to 70% of cases, PVB or BEP chemotherapy for ovarian germ cell tumors has little effect on fertility when the uterus and one ovary can be preserved, and the majority of women treated with methotrexate, actinomycin D or various combinations for persistent trophoblastic disease remain fertile. Preservation of fertility is a major goal for cancer patients receiving chemotherapy: in vitro fertilization could preserve the couple’s fertility, but is usually not feasible as it would delay initiation of chemotherapy until after stimulation of ovulation; oocyte or ovarian tissue cryopreservation is at the stage of research; oral contraceptives have not been demonstrated to be effective to preserve ovarian function; gonadotropin releasing hormone (GnRH) agonists prevent cyclophosphamide toxicity in rat and monkey ovaries, and a few pilot clinical studies suggest that chemotherapy-induced amenorrhea could be prevented by administration of GnRH analogues simultaneously to chemotherapy, but randomised studies are necessary.     

Cancer de la prostate : la maladie localisée

Localized prostate cancer is characterized by a tumor confined to the prostate gland at clinical evaluation. Since the onset of PSA screening, the detection of localized prostate cancer has increased. Prognosis factors are clinical stadification, PSA value, PSA doubling time, tumor volume related to needle biopsy pathologic findings (Gleason score, percentage biopsies involved). Treatment depends on tumor prognosis, symptoms and performance status of the patient. Localized prostate cancer can be treated by surgery (radical prostatectomy, high intensity focused ultrasound) or radiotherapy (conformational radiation therapy, brachytherapy). Active follow-up can be proposed to very low risk patients.     

Variations de quelques aclivités enzymatiques (peroxydase, catalase, AIA-oxydase) et de la teneur en polyphénols au cours de la germination de I'Orge. Influence de la kinétine

Peroxidase catalase, IAA-oxidase and polyphenol content of growing barley coleoptile. Effect of kinetin. - Kinetin strongly inhibits root and coleoptile growth of germinating barley in the dark. Treated coleoptiles become senescent before the untreated ones. Soluble proteins content, peroxidase, catalase and IAA-oxidase activity were greatly increased in treated coleoptiles while the level of polyphenols was reduced. These biochemical effects joined with the other property of kinetin to diminish α-amylase synthesis in the endosperm are discussed in relation to growth and in connection with the classic view of a cytokinin retarded senescence.     

Effets de la température sur la croissance de deux algues vertes du fleuve St-Laurent,secteur de Gentilly,Québec

Two abundant phytoplankters from the St-Lawrence river: Scenedesmus spinosus Chodat 1913 and Pediastrum boryanum (Turp.) Menegh (Chlorophyta, Chlorococca) were sampled, isolated and cultured in monospecific culture. Growth responses were measured after acclimation to different temperatures and after thermal shock treatments.Post-acclimation specific growth rates followed similar patterns with optimal temperatures at about 24°C (S. spinosus) and 26°C (P. boryanum). Final densities were much less influenced by temperature in S. spinosus than in P. boryanum. Post-treatment responses depended on the temperature level maintained after treatment rather than on treatment conditions. No treatment seemed to delay the exponential growth phase. The time needed to reach final densities corresponding to stationary growth phase was not influenced by any thermal treatment. In situ thermal effects at Gentilly nuclear site could be more severe, due to differences in time-temperature history experienced by the algae.

     

Contribution à la connaissance des Desmidiées du Sud-est de la Province de Québec et de la Gaspésie

Sans résumé     

Déficit androgénique: effet de la substitution sur la composition corporelle

Male hypogonadism is responsible for an increase in fat body mass and a decrease in lean body mass. Similar changes are observed in aging men. Aging is also frequently associated with a decrease in testicular function. Androgen replacement therapy in adult men with hypogonadism has been shown to reverse these changes in body composition. Androgens stimulate protein synthesis, especially in muscles, leading to a gain of muscle mass and muscle strength. In contrast, androgen therapy inhibits tissue utilization of lipids, predominantly in visceral fat and consecutively induces a decrease in fat body mass. As the same changes in body composition are observed in aging and in hypogonadal adult men, the value of androgen replacement therapy was evaluated in aging men with an age-related decrease in androgen production. About ten studies have included human males over the age of 65. The results obtained indicate the benefit of such therapy in terms of improvement in body composition in aging men due to a rise in plasma testosterone levels up to the normal range of young adult men.     

Étude de la variabilité de la clairance hépatique de la mébrofénine-99mTc en scintigraphie hépatobiliaire

AimThe purpose of this study was to investigate some of the parameters likely to influence mebrofenin-^99mTc hepatic clearance calculation and inter-and intra-observers reproducibility.Materials and methodsHepatic clearance (%/min m²) of 30 scintigraphies was calculated from the values of hepatic, cardiac, and total activities, according to the method recommended in the literature. We studied: 1) impact of injection–acquisition delay variations; 2) acquisition type: anterior face only (FA) or geometric mean (GM); 3) clearances calculated according to four different body surface area (BSA) formulas; 4) intra-and inter-observers reproducibility for three observers (two evaluations for each observer).Results1) Clearance differences between different studied intervals were statistically significant, more important if the studied interval was far from reference interval (150–350 secondes) and even more when the interval studied was too early (110–310 secondes). 2) There was a statistically significant difference between clearance calculated using either FA or GM datasets (0.85 %/min m²). 3) There were small but statistically significant differences for four of the clearance comparisons using different BSA formulas. 4) Despite differences in size of cardiac and hepatic regions of interest (ROI), intra-observer reproducibility of hepatic clearance was excellent for each observer. Inter-observers reproducibility was also excellent (r = 0.982).ConclusionHepatic clearance of mebrofenin-^99mTc appears to be a highly reproducible method provided that acquisition and clearance calculation are standardized. It provides additionnal functional information to morphological and biological data usually performed before major hepatectomy. Thereby, the definition of a standardized protocol would enable realization of multicentric studies.     

Comprendre la dépression : apport de la psychologie évolutionniste

Darwinian medicine considers that many symptoms are the organism’s defence mechanisms and adaptations that have been inherited and shaped by natural selection. But in many cases, signs and symptoms of disease are of no benefit to human survival and are in fact deregulations of normal mechanisms. Evolutionary explanations help us understand how some human affective and emotional processes could have an adaptive value and enable us to cope with a wide spectrum of situations. But the wide range of intensity levels and different forms, ranging from low moods to major depression with psychotic features, suggest that these symptoms cannot always be explained by adaptation: where is the cut-off point? In this paper, we describe the evolutionary concepts related to adaptation as applied to the emotions, particularly focusing on low mood and depression, and discuss their possible functional and adaptive role.     

Les inhibiteurs spécifiques de la recapture de la sérotonine dans la dépression de l’enfant et de l’adolescent: revue des controverses récentes

European and US drug regulatory authorities have recently warned against the use of selective serotonin reuptake inhibitors (SSRIs) in childhood and adolescent depression. Through an extensive literature review on the use of SSRIs to treat depression in children and adolescents — including psychiatric clinical trials, pharmacology, and drug safety data — we will: i) describe the main arguments justifying various regulatory decisions; ii) present published data and subsequent meta-analyses; iii) discuss how to integrate the recommendations into daily clinical practice, freeing professionals from a Manichean approach. We reach the limits of evidence-based medicine, which provide the basis of the scientific work of the regulatory authorities.