Comparison between radiometry and spectrophotometry for the determination of angiotensin-converting enzyme activity in cerebrospinal fluid

Determination of angiotensin-converting enzyme (ACE) activity in cerebrospinal fluid (CSF) can help for establishing the diagnosis of neurosarcoidosis. We investigated the performance characteristics of two assays for ACE determination in 57 CSF, radiometry with [glycine-1-14C] benzoyl-L-histidyl-L-leucine and spectrophotometry with furylacryloyl-phenylalanyl-L-glycyl-L-glycine (FAPGG) as substrates. We compared both kinetic assays to an ELISA specific for human ACE. Within run and between run imprecisions were 14-17% for radiometry, 6-19% for spectrophotometry and 5-8% for ELISA. The limit of detection was 0.04 U/L for radiometry, 1.0 U/L for spectrophotometry and 0.156 μg/L for ELISA. The limit of quantification was 0.06 U/L for radiometry, 1.5 U/L for spectrophotometry, but not known for ELISA. The domain for quantification was 0.06-4.0 U/L for radiometry, 1.5-24 U/L for spectrophotometry and 0.156-10 μg/L for ELISA. Deming regression and Bland-Altman plots show good correlations between the three assays, but with high slopes, because both kinetic assays use different substrates and ELISA measures ACE molecule but not activity. Radiometry was more sensitive than spectrophotometry, which has a limit of detection above most pathological levels. ELISA could be an alternative to radiometry but only after complete evaluation, determination of normal values and assessment of its clinical value. We claim for standardization of ACE determination as well as in serum as in other biological fluids, in particular CSF.

3β-Hydroxysteroid Dehydrogenase Type 2 (3βHSD2) Deficiency due to a Novel Compound Heterozygosity of a Missense Mutation (p.Thr259Met) and Frameshift Deletion (p.Lys273ArgFs*7) in an Undervirilized Infant Male with Salt Wasting

Deficiency of 3β-hydroxysteroid dehydrogenase type 2 (3βHSD2) is a rare type of congenital adrenal hyperplasia (CAH), causing impaired steroid hormone production in both adrenals and gonads. Phenotype ranges, according to the genetic defect, from the salt-wasting form in both sexes to undervirilization in males and virilization in females. We present a 13-month-old male infant who was admitted to the hospital with signs of adrenocortical insufficiency and genital ambiguity. Clinical presentation, hormonal profile, laboratory evaluation, and karyotype were suggestive of the salt-wasting form of CAH due to 3βHSD2 deficiency. Mutational analysis revealed a missense mutation c.776C>T (p.Thr259Met), inherited by the mother, and a frameshift deletion c.818-819delAA (p.Lys273ArgFs*7), inherited by the father. Both mutations are considered pathogenic. To our knowledge this is the first case of an undervirilized male infant with salt wasting bearing this pathogenic frameshift deletion p.Lys273ArgFs*7 in compound heterozygosity with the missense mutation p.Thr259Met.

Cord blood procalcitonin level and early-onset sepsis in extremely preterm infants

Early-onset neonatal sepsis (EOS) is observed in 1.7% of extremely preterm infants, with high morbidity and mortality rate. Cord blood procalcitonin (PCT) is a sensitive marker of EOS in full-term newborns, but it has been rarely studied in premature infants. The diagnostic value of cord blood PCT by immunofluorescence has been assessed as an early marker of EOS in a prospective cohort of extremely preterm infants, with a threshold at 0.5 μg/L. EOS was defined by a positive bacterial culture or by the association of postnatal biological/clinical signs of EOS and antibiotic treatment for more than 72 h. Correlation between PCT serum concentrations and postnatal morbidities was also analyzed. Among a total of 186 infants, 45 (24%) were classified as EOS. Blood PCT concentration was ≤ 0.5 μg/L in 114 infants, including 11 EOS (9.6%) and PCT was > 0.5 μg/L in 72 babies including 34 EOS (47.2%). PCT concentration > 0.5 μg/L was associated with higher risk of EOS (OR 2.18; CI95% 1.58-3.02; p < 0.0001). The receiver operating characteristic curve determined a cutoff of 0.7 μg/L as the best compromise, with an area under the curve of 0.75 (sensitivity 69%, specificity 70%). In multivariate analysis, clinical chorioamnionitis was associated with PCT concentration > 0.5 μg/L (OR 2.58; CI95% 1.35-4.94; p = 0.004). Cord blood PCT is a marker significantly associated with EOS in extremely preterm infants, but its sensitivity remains low. Its added value in combination with other early marker of EOS needs to be further investigated in this high-risk population.

Diagnostic accuracy of the Coopscore© to predict liver fibrosis in human immunodeficiency virus/hepatitis B virus co-infection

Background Non-invasive methods for assessing liver fibrosis are increasingly used as an alternative to liver biopsy. Recently, a score-based biochemical blood test (Coopscore^©) was developed in a cohort of patients chronically infected with hepatitis C virus, showing higher diagnostic performances than Fibrometer®, Fibrotest®, Hepascore® and Fibroscan™. Here, we assess its performance in patients co-infected with the human immunodeficiency virus and hepatitis B virus. Methods Ninety-seven human immunodeficiency virus/hepatitis B virus co-infected patients with liver biopsies were included from a previously described cohort. Histological fibrosis staging using METAVIR criteria was used as the reference. Coopscore^©, Fibrotest®, Fibrometer®, Hepascore® and Zeng score were computed and compared with the Coopscore© using the Obuchowski index and area under the receiving operator characteristic curves. Results The distribution of liver fibrosis levels was as follows: F0-F1 ( n = 42), F2 ( n = 25), F3 ( n = 15) and F4 ( n = 15). The Obuchowski index was higher for Coopscore^© (0.774) than Fibrometer® (0.668), Hepascore® (0.690) and Zeng scores (0.704) ( P < 0.05), reflecting a better ability to discriminate between fibrosis stages. Similarly, when predicting significant fibrosis (≥F2), the AUROC was significantly greater for the Coopscore^© (0.836) than the Hepascore® (0.727) and Zeng scores (0.746), but not for the Fibrotest® (0.778, P = 0.14) or Fibrometer® (0.790, P = 0.19). The Coopscore^© did not show a higher capacity than other scores to predict advanced fibrosis (≥F3) or cirrhosis (F4). Conclusions This study supports the diagnostic value of the Coospcore^© in fibrosis staging among human immunodeficiency virus/hepatitis B virus co-infected patients, especially to predict significant fibrosis.

Including osteoprotegerin and collagen IV in a score-based blood test for liver fibrosis increases diagnostic accuracy

BACKGROUND

Noninvasive methods for liver fibrosis evaluation in chronic liver diseases have been recently developed, i.e. transient elastography (Fibroscan™) and blood tests (Fibrometer®, Fibrotest®, and Hepascore®). In this study, we aimed to design a new score in chronic hepatitis C (CHC) by selecting blood markers in a large panel and we compared its diagnostic performance with those of other noninvasive methods.

METHODS

Sixteen blood tests were performed in 306 untreated CHC patients included in a multicenter prospective study (ANRS HC EP 23 Fibrostar) using METAVIR histological fibrosis stage as reference. The new score was constructed by non linear regression using the most accurate biomarkers.

RESULTS

Five markers (alpha-2-macroglobulin, apolipoprotein-A1, AST, collagen IV and osteoprotegerin) were included in the new function called Coopscore©. Using the Obuchowski Index, Coopscore© shows higher diagnostic performances than for Fibrometer®, Fibrotest®, Hepascore® and Fibroscan™ in CHC. Association between Fibroscan™ and Coopscore© might avoid 68% of liver biopsies for the diagnosis of significant fibrosis.

CONCLUSION

Coopscore© provides higher accuracy than other noninvasive methods for the diagnosis of liver fibrosis in CHC. The association of Coopscore© with Fibroscan™ increases its predictive value.

[Testosterone assays using non recommended methods lead to misdiagnosis in women]

French and US endocrine societies recommend using GC-MS or RIA after purification (extraction + chromatography) to assess blood levels of testosterone in women. However, most of laboratories use automatized methods that have to be reserved to measure testosterone levels in men. The aim of this study was to show the consequences of analytical discrepancies of some immunological methods on the diagnostics values of testosterone levels assayed in women. Compared to GC-MS the correlations of the assayed levels varied (Spearman's rank correlation coefficients: 0.935; 0.793; 0.841; 0.852 respectively for RIA Immunotech™ with extraction and chromatographic purification; Testosterone Access-DxI800®; Testosterone Immulite 2000®; Testosterone II Cobas E601®). The testosterone levels allowed an accurate conclusion in 95.2 %; 75.8 %; 77.4 %; 89.8 % of patients, respectively. The agreement with GC-MS results was very good for RIA method (κ=0,840), moderate for DxI800® method (κ=0,414), moderate for Immulite® method (κ=0,467), good for Cobas® method (κ=0,667). Most of discordances are false hypertestosteronemia. The use of non recommended methods may leads to nosological errors (misclassification rates of 10 to 25% with automatized methods) that causes loss of chance in part of female patients.

How the FSH/LH ratio and dose numbers in the p-FSH administration treatment regimen, and insemination schedule affect superovulatory response in ewes

We wished to evaluate the effects of FSH/LH ratio and number of doses of p-FSH during a superovulatory treatment on ovulation rate and embryo production (Experiment I). In Experiment II, we studied the efficacy of fertilization after various insemination schedules in superovulated donors. In Experiment I estrus was synchronized in 40 ewes (FGA, for 9 days plus PGF2alpha on Day 7) and the ewes were randomly assigned to four treatment groups as follows (n = 10 ewes each): Group A: four p-FSH doses with the FSH/LH ratio held constant (1.6); Group B: four p-FSH doses with the FSH/LH ratio decreasing (FSH/LH 1.6-1.0-0.6-0.3); Group C: eight p-FSH doses with the FSH/LH ratio held constant (1.6); Group D: eight p-FSH doses and FSH/LH ratio decreasing (1.6-1.6, 1.0-1.0, 0.6-0.6, 0.3-0.3). p-FSH administrations were performed twice daily 12 h apart. The ewes were mated at the onset of estrus and again after 12 and 24 h; then, one ram per four ewes was maintained with the ewes for two additional days. Ovarian response and embryo production were assessed on Day 7 after estrus. Experiment II. Three groups (n = 10 each) of superovulated ewes were inseminated as follows: Group M: mated at onset of estrus; Group AI: artificial insemination 30 h after onset of estrus; M + AI) mating at onset of estrus and intrauterine AI performed 30 h from estrus with fresh semen. Results of Experiment I showed that treatment (D) improved (P < 0.05) ovulatory response in comparison to Groups (C) and (A). The fertilization rate was lower (P < 0.01) in Group D) than Group (A). Also the proportion of transferable embryos was lower in Group (D) in comparison to all the other treatments (P < 0.01). Group A gave the best production of embryos (7.3/ewe; 89.0% transferable). In Experiment II, combined mating plus AI improved fertilization rate (80.3%) compared to both mating (P < 0.01) and AI (P < 0.02) alone.

Effects of Somatic Cell Count and Stage of Lactation on the Plasmin Activity and Cheese-Making Properties of Ewe Milk

The experiment was conducted from March to July 2002 using 5 intensively managed flocks of Southern Italy. In each flock, 2 groups of 50 ewes were created. The groups were designated LSCC (low somatic cell count [SCC]) when their milk SCC was lower than 500,000/mL and HSCC (high SCC) when their milk SCC was higher than 1,000,000/mL. Bulk milk and whey samples were analyzed for fat, total protein, lactose, casein, and whey protein contents. Renneting properties of milk were also determined. Moisture, NaCl, and nitrogen fractions were determined in fresh cheese curds. In addition, plasmin (PL) and plasminogen (PG) activities in milk and cheese were monitored. The proteolytic activity of plasmin by urea-polyacrylamide gel electrophoresis and the white blood cell (WBC) differentials were determined. The HSCC resulted in higher pH values in milk and in higher moisture and lower fat contents in fresh cheese curds. Moreover, a lower recovery of fat and whey proteins was obtained from the HSCC than from the LSCC raw milk. The crude protein and casein contents were higher in the HSCC than in the LSCC curds during early and midlactation; an opposite trend was observed in late lactation. Plasmin and PG activities underwent more marked fluctuations in the LSCC than in the HSCC curds through lactation. The results of this experiment demonstrate that the PL activity in ewe milk is markedly influenced by the SCC, although SCC is not the only parameter for predicting PL and PG evolution in ewe milk. The LSCC milk resulted in a higher proteolytic potential of Canestrato pugliese cheese curds.

Ventilation Effects on Air Quality and on the Yield and Quality of Ewe Milk in Winter

The effects of ventilation on air quality, and on the welfare and production performance of dairy ewes were assessed in a 6-wk trial conducted during the winter of 2002. Thirty-six midlactation Comisana ewes were divided into three groups of 12, which were randomly balanced for parity, time of lambing, and number of lambs suckled. Treatments were low (LOV), moderate (MOV), and programmed ventilation regimen (PROV). In LOV and MOV rooms, fans provided 10 ventilation cycles of 40 min each at a fan speed of 1 and 2 m/s, respectively. In the PROV room, the fan was programmed to maintain a 70% relative humidity. Mean ventilation rates were 23, 47, and 73 m3/h per ewe in LOV, MOV, and PROV rooms, respectively. Air concentrations of microorganisms and dust, and of gaseous pollutants were measured twice weekly. Cell-mediated immune response to phytohemagglutinin at d 1, 21 and 42, and humoral response to chicken egg albumin at d 11, 21, 30, and 40 were determined. At d 39, ewes were injected with 2 IU of porcine adreno-corticotropic-hormone/kg body weight(0.75), and subjected to blood sampling for evaluation of cortisol concentrations immediately before and 1, 2, and 4 h after adreno-corticotrophic-hormone injection. Milk yield was recorded daily. Individual milk samples were analyzed weekly for composition, renneting parameters, and somatic cell count. The LOV treatment resulted in higher air concentrations of NH3 and CO2 than the MOV and PROV treatments. Greater amounts of total and respirable dust were found in the PROV room than in the LOV and the MOV rooms. The LOV ewes had lower milk yield than the PROV ewes, lower milk casein content, and higher rate of clot formation than the MOV and PROV ewes. The ventilation regimen did not affect the immune and endocrine responses of the ewes. Results suggest that an intermittent ventilation regimen, providing a mean ventilation rate of 47 m3/h per ewe at a fan speed of 2 m/s, is required to sustain the yield and cheese-making ability of ewe milk during the winter season.

Effects of ventilation regimen on the welfare and performance of lactating ewes in summer

A 6-wk trial was performed with thirty-six lactating Comisana ewes during the summer of 2001. The animals were divided into three groups of 12, which were designated low (LVR), moderate (MVR), and programmed (PROGR) ventilation regimens. In LVR and MVR rooms, fans provided 10 ventilation cycles of 12.5 and 25 min/h, respectively, whereas in the PROGR room, the fan was programmed to operate at 30 degrees C air temperature and 70% relative humidity. Mean ventilation rates were 33, 66, and 173 m3/h per ewe in LVR, MVR, and PROGR rooms. Air concentrations of microorganisms and dust and of gaseous pollutants were measured twice weekly. Respiration rate and rectal temperature were monitored throughout the trial at 1430. Behavioral traits of ewes were recorded once per week from 0930 to 1230. Cell-mediated immune response to phytohemagglutinin at d 3, 20, and 40 and humoral response to chicken egg albumin at d 11, 21, 30, and 40 were determined. At d 37, ewes were injected with 2 IU porcine ACTH/kg body weight(0.75) and subjected to blood sampling for evaluation of cortisol concentrations immediately before and 1, 2, and 4 h after ACTH injection. Milk yield was recorded daily. Individual milk samples were analyzed weekly for composition and renneting parameters and fortnightly for bacteriological characteristics. Averages of temperature-humidity index values were 78.9, 76.8, and 74.5 in LVR, MVR, and PROGR rooms, respectively. The LVR and MVR treatments resulted in higher NH3 and CO2 air concentrations than PROGR treatment (P < 0.05). The LVR and MVR ewes had higher rectal temperatures than PROGR ewes (P = 0.001). LVR animals also exhibited higher idling compared to PROGR (P < 0.01) and lower feeding times than MVR (P < 0.05) and PROGR animals (P < 0.01). Ewes under the LVR treatment displayed significant lower averages of antibody titers and higher plasma cortisol levels than PROGR (P < 0.01) and MVR ewes (P < 0.05) 60 min after ACTH injection. The LVR treatment resulted in lower yields of milk (P < 0.01) and reduced feed efficiency (P < 0.01) than PROGR treatment. Results suggest that a fan-ventilated system, providing ventilation cycles during the warmest hours of the day and the night at a mean ventilation rate of 66 m3/ewe per hour, may sustain the performance and welfare in lactating ewes raised in warm climates during summer. A ventilation regimen, programmed to operate over upper critical air temperature and relative humidity, may be economically unattractive under these conditions.

Airspace effects on the yield and quality of ewe milk

Three groups of 12 midlactating Comisana ewes were housed in separate rooms of the same building and assigned to treatments of low (LV, 4.1 m3), medium (MV, 5.6 m3), or high (HV, 7.3 m3) airspace/animal. The concentrations of airborne microorganisms in the experimental rooms were measured twice weekly at 0930 and 1630. Ewe milk yield was recorded daily. Individual milk samples were analyzed weekly for milk composition, coagulating properties, somatic cell concentration (SCC), and polymorphonuclear neutrophil leukocyte count (PMNLC), and fortnightly for bacteriological characteristics; samples with more than 10(6) somatic cells/ml were cultured for mastitis-related pathogens. The LV and MV treatments resulted in higher relative humidity and air concentrations of staphylococci than the HV treatment. Greater amounts of air mesophilic bacteria were also found in the LV than in the HV room. Ewes in the HV group gave greater yields of milk than those in the LV and MV groups. LV milk also had a lower casein content than HV milk. Significant interactions of treatment x time were found for milk protein and fat content as well as for clotting time and clot firmness, with LV milk having the poorest composition and deteriorated renneting ability during the last 3 wk of the trial. The HV ewes had lower SCC and PMNLC and psychrotroph counts in their milk than LV and MV ewes and smaller amounts of mesophilic bacteria and fecal coliforms than LV animals. Subclinical mastitis occurred in two ewes of the LV and one of the MV groups, while no cases were recorded in the HV group. Results suggest that airspace is a critical factor in dairy sheep housing and indicate that a volume allocation of less than 7 m3/animal may adversely affect the performance and health of the lactating ewe.

Behavioral, adrenal, immune, and productive responses of lactating ewes to regrouping and relocation

The experiment involved 40 mid-lactating Comisana ewes. The animals were housed in straw-bedded pens and assigned to a control group (n = 10) and two test groups of 15 subjects each. Control ewes were never moved from their pen and peers throughout the experiment period, whereas test animals were subjected to either regrouping (RG) or regrouping and relocation (RGRL) three times at weekly intervals (d 7, 14, and 21 of the trial). Three behavioral recordings were conducted after each social and pen exchange over a 6-h period (1000 to 1600). Animals from groups RG and RGRL were bled immediately before each regrouping and relocation and 15 and 60 min afterward. The phytohemagglutinin skin test was performed at d 9, 16, and 23. Milk yield was recorded when the ewes were mixed and moved, and before and after each mixing and moving procedure. Individual milk samples were analyzed for composition, renneting parameters, and bacteriological characteristics; samples with more than 10(6) somatic cells/mL were cultured for mastitis-related pathogens. Control ewes spent more time lying than groups RG (P < 0.001) and RGRL (P < 0.01) and less time in ambulatory activities than RGRL sheep (P < 0.05). Moved and remaining ewes showed a higher number of aggressive interactions than control subjects (P < 0.001 and P < 0.01, respectively). Control sheep showed the highest cell-mediated immune response compared with both moved and mixed ewes (P < 0.001 and P < 0.01, respectively). The RGRL ewes gave lower yields of milk than did the control ewes on the days after the first (P < 0.05) and the second (P < 0.01) change of pen and peers. The RGRL ewes also had a lower fat content (P < 0.05) than control ewes in the milk yielded on the day of the first regrouping and relocation and a lower milk protein content (P < 0.05) on the following day. The RG treatment resulted in the ewes yielding milk with a lower fat content (P < 0.01) on the day of each mixing procedure as compared with controls and in a decreased milk protein content on the days after the first (P < 0.05) and the second regrouping (P < 0.01). One case of subclinical mastitis was recorded in both the RG and RGRL groups, whereas no cases were detected in control group. These findings suggest that regrouping and relocation may cause increased aggression, altered immune responses, and short-term effects on the production performance of lactating ewes. These practices should be performed by attempting to minimize their impact on animal welfare.

Effects of solar radiation and feeding time on behavior, immune response and production of lactating ewes under high ambient temperature

A 6-wk trial was performed with 40 late-lactation Comisana ewes, which were either exposed to or protected from solar radiation and fed either in the morning (EXPM, PROM) or afternoon (EXPA, PROA) during summer in a Mediterranean climate. Behavioral traits of ewes were recorded once per week from 0800 to 2000 h. Rectal temperature (RT) and respiration rate (RR) were measured twice weekly at 1430 h. The phytohemagglutinin (PHA) skin test was performed to induce nonspecific delayed-type hypersensitivity at d 10, 20, and 32 of the experiment. Jugular blood samples were taken from ewes at the beginning and at d 21 and 42 of the experiment. Ewe milk yield was recorded daily. Individual milk samples were analyzed weekly for milk composition, coagulating properties, somatic cell count (SCC) and polymorphonuclear neutrophil leukocyte counts (PMNLC) and every 2 wk for bacteriological characteristics. Solar radiation and the interaction of solar radiation x time of feeding had significant effects on rectal temperatures. EXPM ewes had higher rectal temperatures than EXPA ewes, which in turn exhibited higher RT compared with PROM and PROA ewes. EXP groups also had significantly higher respiration rates than PRO groups. Immune response was lower in EXPM ewes at d 10 and in EXPM, EXPA, and PROM animals at d 20 compared with PROA ewes. Exposure to solar radiation resulted in decreased plasma concentrations of alanine amino-transferase, alkaline phosphatase, potassium, and magnesium, as well as in increased levels of nonesterified fatty acids and aspartate amino-transferase. Milk yield and composition were not changed by exposure to solar radiation and time of feeding, but the EXPM treatment resulted in lower yields of casein and fat and reduced clot firmness compared with the three other treatments. Milk SCC was similar across treatments, but PMNLC was higher in EXPM than in PROM and PROA milk. EXPM animals also had the greatest amounts of total and fecal coliforms and of Pseudomonadaceae as well as the highest number of mastitis related pathogens in their milk. Results suggest that provision of shaded areas can play a major role in helping lactating ewes to minimize the adverse effects of high ambient temperatures on thermal balance and energy and mineral metabolism. Changing the time of feeding to late afternoon may be beneficial to exposed ewes in lowering their heat loads during the warmest hours of the day, thereby reducing the detrimental impact of thermal stress on immune function and udder health.

R-banding pattern of the prometaphase chromosomes of the goat

R-banded prometaphase karyotypes of the goat are presented using both fluorescent and light staining techniques. A model for the standardization of the R-banded prometaphase goat karyotype is suggested.

Excision of hemivertebrae in children with congenital scoliosis

This study reports the authors' experience with excision of hemivertebrae in the treatment of congenital scoliosis. Although it is limited to 10 cases, it is significant because of the 9 years follow-up. The first patients treated have already passed the age of puberty and this is the most interesting aspect of the study.