Abstract-Aortic pulse wave velocity (PWV) is a significant and independent predictor of cardiovascular mortality in subjects with essential hypertension and in patients with end-stage renal disease. Its contribution to cardiovascular risk in subjects 70 to 100 years old has never been tested. A cohort of 141 subjects (meanϮSD age, 87.1Ϯ6.6 years) was studied in 3 geriatrics departments in a Paris suburb. Together with sphygmomanometric blood pressure measurements, aortic PWV was measured with a validated automatic device. During the 30-month follow-up, 56 patients died (27 from cardiovascular events). Logistic regressions indicated that age (Pϭ0.005) and a loss of autonomy (Pϭ0.01) were the best predictors of overall mortality. For cardiovascular mortality, aortic PWV was the major risk predictor (Pϭ0.016). The odds ratio was 1.19 (95% confidence interval, 1.03 to 1.37). Antihypertensive drug treatment and blood pressure, including systolic and pulse pressure, had no additive role. In subjects 70 to 100 years old, aortic PWV is a strong, independent predictor of cardiovascular death, whereas systolic or pulse pressure was not. This prospective result will need to be confirmed in an intervention trial. Key Words: very old (Ͼ70 years) subjects Ⅲ aortic pulse wave velocity Ⅲ cardiovascular mortality Ⅲ drug treatment of hypertension Ⅲ pulse pressure W ith increasing age, there is a gradual shift from diastolic blood pressure (DBP) to systolic blood pressure (SBP) and then to pulse pressure (PP) as predictors of cardiovascular (CV) risk, mainly from coronary heart disease. In patients Ͻ50 years of age, DBP is the strongest CV predictor. The age range of 50 to 59 years is a transition period when all 3 BP indexes are comparable predictors, and, from 60 years of age, PP becomes superior to both SBP and DBP to predict myocardial infarction. 1-3 In addition, because for a given ventricular ejection aortic stiffness is the major determinant of PP, increased aortic pulse wave velocity (PWV), a classic marker of arterial rigidity, has also been identified as an independent predictor of CV risk in subjects with hypertension, whether in the presence of end-stage renal disease or with preserved renal function. 4 -6 However, these epidemiological findings are limited to cohorts between 50 and 75 years of age.BP increases with age. However, this influence of age differs markedly for SBP and DBP. 7,8 Whereas SBP increases substantially with age, particularly in women after menopause, the increase of DBP with age is less pronounced. Indeed, DBP even tends to fall after 55 years of age. In the elderly, the hemodynamic pattern associating an increase in SBP and a low DBP is a characteristic feature, usually attributed to an age-related increase of arterial stiffness. 7 In elderly populations, SBP and PP are usually considered the major markers of CV risk. 1 However, there is no study in subjects Ͼ70 years old that would indicate whether an increase in PWV could be, in place of SBP and PP, the best independent predictor of CV mortal...

BackgroundLarge anatomical variations occur during the course of intensity-modulated radiation therapy (IMRT) for locally advanced head and neck cancer (LAHNC). The risks are therefore a parotid glands (PG) overdose and a xerostomia increase.The purposes of the study were to estimate:- the PG overdose and the xerostomia risk increase during a “standard” IMRT (IMRTstd);- the benefits of an adaptive IMRT (ART) with weekly replanning to spare the PGs and limit the risk of xerostomia.Material and methodsFifteen patients received radical IMRT (70 Gy) for LAHNC. Weekly CTs were used to estimate the dose distributions delivered during the treatment, corresponding either to the initial planning (IMRTstd) or to weekly replanning (ART). PGs dose were recalculated at the fraction, from the weekly CTs. PG cumulated doses were then estimated using deformable image registration. The following PG doses were compared: pre-treatment planned dose, per-treatment IMRTstd and ART. The corresponding estimated risks of xerostomia were also compared. Correlations between anatomical markers and dose differences were searched.ResultsCompared to the initial planning, a PG overdose was observed during IMRTstd for 59% of the PGs, with an average increase of 3.7 Gy (10.0 Gy maximum) for the mean dose, and of 8.2% (23.9% maximum) for the risk of xerostomia. Compared to the initial planning, weekly replanning reduced the PG mean dose for all the patients (p < 0.05). In the overirradiated PG group, weekly replanning reduced the mean dose by 5.1 Gy (12.2 Gy maximum) and the absolute risk of xerostomia by 11% (p < 0.01) (30% maximum). The PG overdose and the dosimetric benefit of replanning increased with the tumor shrinkage and the neck thickness reduction (p < 0.001).ConclusionDuring the course of LAHNC IMRT, around 60% of the PGs are overdosed of 4 Gy. Weekly replanning decreased the PG mean dose by 5 Gy, and therefore by 11% the xerostomia risk.

Abstract-Isolated systolic hypertension is predominantly observed in the elderly because of increased arterial stiffness.Aggressive treatment leads to excessive lowering of diastolic blood pressure and favors the presence of a J-shaped curve association with mortality. We investigated whether, in the elderly, this pattern of association is a simple epiphenomenon of increased arterial stiffness and impaired cardiac function. In a cohort of 331 hospitalized subjects Ͼ70 years old (mean ageϮSD: 85Ϯ7 years), aortic pulse wave velocity and pressure wave reflections, by pulse wave analysis, and cardiac function, by ultrasound, were assessed. During a 2-year follow-up period, 110 subjects died. No association of prognosis with systolic pressure, pulse pressure, or pulse wave velocity was observed. A J-shaped association between diastolic pressure and overall and cardiovascular mortality was observed. Unadjusted Cox regression analysis showed that patients in the first tertile of diastolic pressure (Յ60 mm Hg) had higher mortality.In Cox regression analysis, diastolic pressure Յ60 mm Hg was a predictor of mortality independently from cardiac-vascular properties, cardiovascular risk factors, and drug treatment. Multivariate regression analysis showed that increased age and low total peripheral resistance, but not left ventricular function, were the cardinal determinants of low diastolic pressure. An "optimal" diastolic pressure of 70 mm Hg in subjects with isolated systolic hypertension was found. We showed that, in the frail elderly, a value of diastolic blood pressure Յ60 mm Hg is associated with reduced survival, independent from large artery stiffness and left ventricular function, suggesting that more rational antihypertensive therapy, not only based on systolic pressure level, is needed. Key Words: diastolic blood pressure Ⅲ mortality Ⅲ elderly Ⅲ arterial stiffness Ⅲ pressure wave reflections Ⅲ total peripheral resistance T he goal of antihypertensive treatment is to prevent cardiovascular (CV) complications through the reduction of systolic (SBP) and diastolic blood pressure (DBP). However, since the primary work of Cruickshank et al, 1 several reports, but not all, have shown that, in hypertensive subjects treated with drugs, low DBP is frequently associated with increased mortality (reviewed in Reference 2 ). This finding was constantly difficult to evaluate. First, it is difficult in epidemiological studies to assess a J-or U-shaped association with mortality, and it is often easier, using a semilogarithmic scale, to show a linear relation between DBP and mortality. Second, in humans, the decrease of DBP is the consequence of both the aging process 3 and the result of drug treatment, making the net drug effect quite difficult to define. Finally it should be noted that isolated systolic hypertension is difficult to treat and, therefore, aggressive treatment may lead to excessive lowering of diastolic blood pressure and that, in the oldest old, treating high SBP is not always related to reduced overall mortality....

This study described the diet of the orange-rumped agouti Dasyprocta leporina in French Guiana. Five food types were identified in stomach contents: seeds, pulp, fibre, leaves and animal matter. D. leporina ate mainly fruit parts, pulp and seeds, although the ingestion of animals, leaves and fibre was not negligible. Food intake differed from one season to another. D. leporina was a pulp-eater (64.8% pulp in March) when fleshy fruit was plentiful and available on the ground (February–May). The level of pulp ingestion was globally in accordance with fruit production. When food resources were low (June–September), D. leporina consumed seeds and cotyledons (73.0% seeds in August) as well as animal (16.4% in July) and to a lesser level, plant parts. By focusing on other food categories, and particularly seeds, it gets nutritious food thus avoiding starvation between June–September. Large proportions of seeds appeared in stomach contents and correlations between seed quantities and ground production were negative and significant; D. leporina seemed to react to environmental factors such as rainfall and fruit production.

Aortic pulse wave velocity, a classic index of aortic stiffness, may be easily measured in humans using noninvasive ultrasound methods of high reproducibility. Recent epidemiologic studies have shown that, independently of confounding factors such as age, blood pressure and cardiac mass, aortic pulse wave velocity is a predictor of cardiovascular mortality in populations of hypertensive subjects, whether they have end-stage renal disease or not. Since aortic pulse wave velocity is dominantly influenced by age, this finding may be of major importance for the evaluation of cardiovascular risk in geriatric populations.

The diets of the acouchy Myoprocta exilis, agouti Dasyprocta leporina and paca Agouti paca, the three largest terrestrial rodents of French Guiana forests, were investigated from stomachs collected over several years. These species are primarily frugivores. The percentage of fruit in their diet decreased, and seasonal variation increased from the smallest species, the acouchy, to the largest, the paca (contents in dry mass: respectively, 98.5% ± 0.6%, 87.4% ± 3.5%, and 83.9% ± 7.6%). They differed from each other in the proportions of pulp and secondary foods (leaves, fibre, insects) consumed annually as well as seasonally. Dietary diversity in the acouchy was half that of the two other species. The seasonal variation in consumption of different fruit parts and of secondary foods by these species corresponded well with the fruit production in the forest, and was linked to their reproductive events. Overall, the diets of these three large rodents appeared intermediate between the small rodent species and the artiodactyls (peccaries and brocket deer) inhabiting the same areas, which also concords with their body mass and their place within the guild of terrestrial mammals.

The diets of the two Amazonian brocket deer (the red brocket Mazama americana and the grey brocket Mazama gouazoubira) were studied in French Guiana through the examination of stomach contents. The two species are mainly frugivore^granivores, even during the annual period of fruit scarcity (56% of the annual diet in red brockets and 68% in grey brockets). Both rely heavily on fruits and seeds, but overcome the fall in fruit availability by eating significant quantities of fibres, leaves and flowers, particularly the red brocket. Seasonal variation in quantity consumed was observed only for gravid females, which suggests that reproduction may be dependent on the fruiting season. Both species took a wide variety of plants (respectively a total of 79 and 107 species, and 8.4 and 8.9 species per stomach on average). They can be considered non-selective feeders, choosing fruits above all according to their abundance, their size, and perhaps their softness. Both species are seed eaters, destroying nearly all seeds ingested. The two species are potential competitors, but their diet competition may be reduced by their large difference in body size and somewhat different ecological niches. These deer are among the most generalized frugivores of the Guianan forest, thus reducing their food competition with other frugivores.

In the context of head and neck cancer (HNC) adaptive radiation therapy (ART), the two purposes of the study were to compare the performance of multiple deformable image registration (DIR) methods and to quantify their impact for dose accumulation, in healthy structures. Fifteen HNC patients had a planning computed tomography (CT0) and weekly CTs during the 7 weeks of intensity-modulated radiation therapy (IMRT). Ten DIR approaches using different registration methods (demons or B-spline free form deformation (FFD)), preprocessing, and similarity metrics were tested. Two observers identified 14 landmarks (LM) on each CT-scan to compute LM registration error. The cumulated doses estimated by each method were compared. The two most effective DIR methods were the demons and the FFD, with both the mutual information (MI) metric and the filtered CTs. The corresponding LM registration accuracy (precision) was 2.44 mm (1.30 mm) and 2.54 mm (1.33 mm), respectively. The corresponding LM estimated cumulated dose accuracy (dose precision) was 0.85 Gy (0.93 Gy) and 0.88 Gy (0.95 Gy), respectively. The mean uncertainty (difference between maximal and minimal dose considering all the 10 methods) to estimate the cumulated mean dose to the parotid gland (PG) was 4.03 Gy (SD = 2.27 Gy, range: 1.06–8.91 Gy).