Sympathetic overactivity increases the risk of ventricular arrhythmias. Previous studies showed that alteration of QT dynamicity, reflecting abnormal sympathetic modulation of ventricular repolarisation, is independently predictive of sudden cardiac death among patients with chronic heart failure. The aim of this study was to determine whether impaired adaptation of the QT interval to changes in heart rate also predicts death at one month in patients with acute heart failure. In this study, we prospectively included 99 patients (mean age 71+/-13 years) with acute heart failure (EF = 35,2±13,4 %, BNP = 1045±83 pg/ml). Heart rate variability and QT dynamicity was evaluated by analyzing 24-h Holter recordings. The linear regression slope of QT interval measured to the apex and to the end of T wave plotted against RR intervals was calculated using dedicated Holter algorithm. Clinical, biological and morphological data were collected. Follow-up was performed by direct examination or. After a follow up of one month 21 patients died. Non survivors were older (76+/8 vs. 69±15 years, p<0,05), had signifi cantly decreased ejection fraction (28,8±12,7 % vs. 36,9±13,1 %, p<0,05), lower hemoglobin levels (11,4±1,7 g/dl vs. 12,5±2,3 g/dl, p < 0,05) and red blood cells (3650±458 1000/μl vs. 4287±771 1000/μl, p < 0,05). Among parameters issued from 24-h Holter-EKG analysis only day QTe slope was signifi cantly decreased in non survivors (0,33±0,23 vs 0,56±0,64, p<0,05). These results suggest that clinical, biological and electrical parameters issued from 24 hours Holter-ECG recording are able to predict short term mortality in patients with acute heart failure. These preliminary results need to be confirmed by a more extensive statistical approach currently ongoing. These predictive parameters are simple to use and their clinical or pharmacological interest need to be confirmed.

Adjustment Disorders With Anxiety (ADWA) account for almost 10% of psychologically motivated consultations in primary care. The aim of this double‐blind randomised parallel group study was to compare (non‐inferiority test) the efficacies of etifoxine, a non‐benzodiazepine anxiolytic drug, and lorazepam, a benzodiazepine, for ADWA outpatients followed by general practitioners. 191 outpatients (mean age: 43, female: 66%) were assigned to receive etifoxine (50 mg tid) or lorazepam (0.5‐0.5‐1 mg /day) for 28 days. Efficacy was evaluated on days 7 and 28 of the treatment. The main efficacy assessment criterion was the Hamilton Rating Scale for Anxiety score (HAM‐A) on Day 28 adjusted to Day 0. The anxiolytic effect of etifoxine was found not inferior to that of lorazepam (HAM‐A score decrease: 54.6% vs 52.3%, respectively, p = 0.0006). The two drugs were equivalent on Day 28. However, more etifoxine recipients responded to the treatment (HAM‐A score decreased by ≥50%, p = 0.03). Clinical improvement (based on Clinical Global Impression scale CGI, Social Adjustment Scale Self‐Report SAS‐SR, and Sheehan scores) was observed in both treatment arms, but more etifoxine patients improved markedly (p = 0.03) and had a marked therapeutic effect without side effects as assessed by CGI, p = 0.04. Moreover, 1 week after stopping treatment, fewer patients taking etifoxine experienced a rebound of anxiety, compared to lorazepam (1 and 8, respectively, p = 0.034). Copyright © 2006 John Wiley & Sons, Ltd.

Although Adjustment Disorder (AD) is considered a marginal diagnostic category by many clinicians and researchers, all the rare studies undertaken in the last decades indicate that the prevalence of this disorder is high in psychiatric settings, but has never been investigated in general practice. The purpose of this study was to evaluate the current prevalence of Adjustment Disorders With Anxiety (ADWA) in primary care settings and to describe the characteristics of the population, nature of the stressors and management of the disorder by General Practitioners (GPs). This French study involved 78 random liberal GPs, in 7 distinct regions (Paris, Lille, Bordeaux, Rouen, Dijon, Castres and Compiègne). GPs had to register all the consecutive attenders over 18 years old. For each physician, the registration period was over when 200 patients were registered, or 10 days of consultation were completed, or when 5 MINI had been performed. The average study period was 10 days per physician. At the first stage, they selected all the patients with psychological complaints, which were eventually associated to physical complaints. At the second stage, only the patients whose complaints were linked to a psychosocial stressor and without A1 and/or A2 DSM IV criteria for a Major Depressive Episode (MDE) were proposed the Mini International Neuropsychiatric Interview (MINI). The MINI is a brief structured clinical diagnostic interview that identifies the main axis-I DSM IV diagnoses in about 15 minutes. Before starting the study, all of the GPs participated in an intensive course on AD criteria recognition and were trained to use the MINI. The GPs registered a total of 7,759 consecutive patients. Twenty-two per cent (n = 1,719) of the patients reported psychological complaints, associated or not to physical complaints. Among them, 49% (n = 844) linked their complaints to identifiable psychosocial stressors. About half of the latter (n = 450) coded positive to A1 and/or A2 criteria for MDE. At the end, a total of 314 patients agreed to complete the MINI. Among the 1,719 patients with psychological complaints, the prevalence of ADWA eventually associated to other psychiatric disorders was 9.2%. The prevalence of "pure" ADWA was 4.5%. When considering the whole population of consecutive patients in primary care settings, the prevalence of pure ADWA was 1.0%. Patients suffering from pure ADWA were mostly women (66.7%), young patients (mean age: 42 years), with a professional activity. Patients had a psychiatric disorder history in 53.8% of the cases (mostly anxiety disorder). The main life events cited as being responsible for the disorder were work-associated problems (23.1%), followed by family illness (9.0%) and serious personal illness or accident (7.7%). The average duration of the disorder was 2.32 months. In 91% of the cases, GPs estimated that the patient required a pharmacological or psychological treatment. In most cases, they treated the patients with drug therapy (74.0%) associated with psychological support (counselling or psychotherapy, 76%). Anxiolytic agents were usually prescribed (64.9%), followed by antidepressants (10.8%) and hypnotics (8.1%). In conclusion, this first prevalence study of ADWA in general practice demonstrates that this disorder is frequent in primary care. It seems to be more present in patients who are of working age, especially women. ADWA would thus seem to preferentially affect active subjects. In most cases, GPs treat their patients with both psychological support and drug therapy. Anxiolytic is the elicited treatment of this disorder.

This paper describes the psychomotor and amnesic effects of single oral doses of etifoxine (50 and 100 mg) and lorazepam (2 mg) in healthy subjects.Forty‐eight healthy subjects were included in this randomized double blind, placebo controlled parallel group study. The effects of drugs were assessed by using a battery of subjective and objective tests that explored mood and vigilance (Visual Analog Scale), attention (Barrage test), psychomotor performance (Choice Reaction Time) and memory (digit span, immediate and delayed free recall of a word list).Whereas vigilance, psychomotor performance and free recall were significantly impaired by lorazepam, neither dosage of etifoxine (50 and 100 mg) produced such effects.These results suggest that 50 and 100 mg single dose of etifoxine do not induce amnesia and sedation as compared to lorazepam.

Although Adjustment Disorder (AD) is considered a marginal diagnostic category by many clinicians and researchers, all the rare studies undertaken in the last decades indicate that the prevalence of this disorder is high in psychiatric settings, but has never been investigated in general practice. The purpose of this study was to evaluate the current prevalence of Adjustment Disorders With Anxiety (ADWA) in primary care settings and to describe the characteristics of the population, nature of the stressors and management of the disorder by General Practitioners (GPs). This French study involved 78 random liberal GPs, in 7 distinct regions (Paris, Lille, Bordeaux, Rouen, Dijon, Castres and Compiegne). GPs had to register all the consecutive attenders over 18 years old. For each physician, the registration period was over when 200 patients were registered, or 10 days of consultation were completed, or when 5 MINI had been performed. The average study period was 10 days per physician. At the first stage, they selected all the patients with psychological complaints, which were eventually associated to physical complaints. At the second stage, only the patients whose complaints were linked to a psychosocial stressor and without A1 and/or A2 DSM IV criteria for a Major Depressive Episode (MDE) were proposed the Mini International Neuropsychiatric Interview (MINI). The MINI is a brief structured clinical diagnostic interview that identifies the main axis-I DSM IV diagnoses in about 15 minutes. Before starting the study, all of the GPs participated in an intensive course on AD criteria recognition and were trained to use the MINI, The GPs registered a total of 7 759 consecutive patients. Twenty-two percent (n = 1 719) of the patients reported psychological complaints, associated or not to physical complaints. Among them, 49 % (n = 844) linked their complaints to identifiable psychosocial stressors. About half of the latter (n = 450) coded positive to A1 and/or A2 criteria for MDE At the end, a total of 314 patients agreed to complete the MINI, Among the 1 719 patients with psychological complaints, the prevalence of ADWA eventually associated to other psychiatric disorders was 9.2 %. The prevalence of << pure >> ADWA was 4.5 %. When considering the whole population of consecutive patients in primary care settings, the prevalence of pure ADWA was 1.0 %. Patients suffering from pure ADWA were mostly women (66.7 %), young patients (mean age: 42 years), with a professional activity. Patients had a psychiatric disorder history in 53.8 % of the cases (mostly anxiety disorder). The main life events cited as being responsible for the disorder were work-associated problems (23.1 %), followed by family illness (9.0 %) and serious personal illness or accident (7.7 %). The average duration of the disorder was 2.32 months. In 91 % of the cases, GPs estimated that the patient required a pharmacological or psychological treatment. In most cases, they treated the patients with drug therapy (74.0 %) associated with psychological support (counselling or psychotherapy, 76 %). Anxiolytic agents were usually prescribed (64.9 %), followed by antidepressants (10.8 %) and hypnotics (8.1 %). In conclusion, this first prevalence study of ADWA in general practice demonstrates that this disorder is frequent in primary care. It seems to be more present in patients who are of working age, especially women. ADWA would thus seem to preferentially affect active subjects. In most cases GPs treat their patients with both psychological support and drug therapy. Anxiolytic is the elicited treatment of this disorder.

The aim of this study was to determine the changes in carotid artery intima-media thickness as measured by B-mode ultrasound in postmenopausal women receiving hormone replacement therapy (HRT) or not. One hundred and fifty-nine healthy postmenopausal women aged 45-65 years were recruited from our menopause clinic. All the selected women were free of cardio-vascular diseases and had no cardio-vascular risk factors. None of the women were receiving lipid-lowering or antihypertensive drugs. Because carotid artery intima-media thickness was shown to be strongly and positively correlated with age in women aged 55 years and older but not before, women were divided into four groups according to age (<55 vs. > or =55 years) and use of HRT (current users vs. never users). All the treated women received non-oral 17beta-estradiol with a non-androgenic progestin and had started HRT within the first year after menopause. Scanning of the right common carotid artery was performed with a B-mode ultrasound imager and thickness of the intima-media complex as well as luminal diameter of the artery were determined using an automated computerized procedure. Within each age group (i.e. <55 or > or =55 years), women had comparable demographic characteristics and only differed by HRT use. Long-term treated women had significantly lower total cholesterol levels than untreated women (P=0.005). Triglycerides, low-density lipids (LDL)-cholesterol and high-density lipids (HDL)-cholesterol levels, systolic and diastolic blood pressure were not significantly different between users and non-users. In women <55 years, no significant difference in carotid intima-media thickness was found between current users (mean 2.5+/-1.4 years) and non users. In older women, the mean values of carotid intima-media thickness were significantly smaller in current users (mean 6.9+/-3.3 years) than in never treated women: 0.50+/-0.05 versus 0.56+/-0.07 mm, P<0.0001. Carotid artery intima-media thickness was significantly correlated to age in never users (r=0.5, P<0.0001) but not in women who were currently receiving HRT (r=0.2, ns). These findings suggest an apparent protective effect of long-term HRT on age-related thickening of the intima-media of the right common carotid artery. This may contribute to explain the apparent cardio-protective effect of HRT after the menopause.

The hydrolysis of niobium pentaethoxide was followed by X-ray absorption at the niobium K-edge. The niobium alkoxide appears to auto-associate into oligomers in which niobium atoms exhibit a six-fold coordination. Only one NbNb distance is observed by EXAFS and is typical of edge-sharing octahedra. The niobium coordination does not change significantly upon hydrolysis but a few NbNb distance appears that corresponds to corner-sharing NbO6 octahedra. The small number of Nb neighbours suggests a very open structure for the gel network.

Niobium pentoxide gels can be obtained by the two classical ways already known for silica, namely destabilisation of a sol and alkoxide's hydrolysis. Owing to the lack of reproducibility of the first route and to the high cost of niobium alkoxides, two other processes are proposed. Addition of hydrogen peroxide to the sol greatly improves the destabilisation process, while using chloroalkoxides instead of alkoxides reduces the cost of the precursors. It is thus shown that either monolithic gels or thixotropic gels can be obtained depending on the process used. Upon drying these gels lead to quite different xerogels, that can be either amorphous oxides or even mixed mineralorganic materials.