Retrospective comparison of a weight-based dose every 2 weeks with a fixed dose every month: a real-life analysis of nivolumab in the treatment of advanced melanoma

Nivolumab was first authorized at a weight-based dose (WBD) of 3 mg/kg every two weeks (Q2W). Since 2017, a fixed dose (FD) regimen [first 240 mg Q2W and then 480 mg per month (Q4W)] was allowed. The objective of the study was to compare a WBD regimen and an FD regimen with regard to effectiveness and safety. We conducted a single-center, retrospective, real-life study of consecutive adult patients who had received a WBD of nivolumab or an FD of 480 mg Q4W. The primary endpoint was the occurrence of grade ≥3 immune-related adverse events (irAEs). The secondary endpoints were overall survival and cost of the treatment. In all, 342 patients were included: 71 in the WBD cohort and 271 in the FD cohort. Of these patients, 201 patients (59.6%) experienced an irAE, and 24 of these events were graded as ≥3. At 12 months, there was no significant difference in irAE occurrence between the two cohorts [hazard ratio (95% confidence interval): 0.54 (0.21-1.36), P  = 0.19]. The 12-month overall survival rate was significantly lower in the WBD cohort ( P  < 0.001). Switching from a fortnightly weight dose to a fixed monthly dose halves the cost of hospitalization. Our results did not show a significant difference between WBD and FD cohort in the occurrence of severe irAEs. However overall survival appeared to be significantly higher in FD group. Some clinical trials are investigating a hybrid dosing regimen in which a WBD is capped by an FD. The present results need to be confirmed in prospective studies.

Impact of the 2nd, 3rd and 4th waves of the COVID-19 pandemic on wait times in head and neck cancer: A retrospective study in a French expert center

BACKGROUND

Treatment delay in head and neck cancer is a major problem, with impact on survival. The COVID-19 (coronavirus disease 2019) pandemic, evolving in waves around the world, caused diagnostic and therapeutic delays in certain cancers. The main objective of the present study was to analyze whether there was a change in wait times during three successive waves in our center.

METHOD

This was a single-center retrospective study of patients with a first diagnosis of head and neck cancer. Three groups, corresponding to waves 2, 3 and 4, were compared to a control group corresponding to a pre-pandemic period. Study data comprised median times between first consultation and tumor board meeting (C1-TB) and between tumor board meeting and treatment (TB-T). The significance threshold was set at P<0.005.

RESULTS

Ninety-six patients were included in the control group, and 154 in the "waves 2-3-4" group. There was no increase in C1-TB interval (respectively 35 and 26days, P=0.046) or TB-T interval (respectively 27 and 28days, P=0.723).

CONCLUSION

Intervals between first consultation and tumor board meeting and between tumor board meeting and treatment did not increase during the 2nd, 3rd and 4th waves of COVID-19 in our center.

Pyrocarbon interposition implant after lunate resection in Kienböck's disease: A case series

In advanced stages of Kienböck's disease, the lunate is no longer conservable. One of the surgical options is to resect the lunate and replace it with a prosthesis. The procedure consisted in lunate resection and interposition of a free APSI® or Pi2® pyrocarbon implant through a dorsal approach. Follow-up was clinical and radiological on QuickDASH and PRWE scores. At a median follow-up of 3 years, 12 patients were reviewed, with a median age of 56 years. Flexion significantly decreased from 42° to 28° (p < 0.01). Extension and pronation-supination were conserved. Strength was 94% compared to the opposite side, with no significant difference from the preoperative measurement. Median QuickDASH and PRWE scores were 15.9 and 23.5 respectively and had significantly improved. One patient underwent scaphocapitate fusion because she was still in pain; the other patients were pain-free. No patients had to change jobs because of their wrist. Radiographically, there was no carpal collapse and carpal height was conserved. Radioscaphoid angle and ulnar translation were stable. There was 1 case of asymptomatic implant dislocation. Interposition of a pyrocarbon implant after lunate resection in advanced Kienböck's disease is a motion-conserving procedure that provides pain relief and functional recovery in the short and medium term. LEVEL OF EVIDENCE: IV.

Arthroplasty for destroyed proximal interphalangeal joint in hand trauma surgery: Silicone hinged NeuFlex® or gliding Tactys®?

The treatment of proximal interphalangeal joints (PIP) after a traumatic injury has produced disappointing outcomes. The objective of this study was to evaluate the functional results of emergency hinged or gliding arthroplasty for destroyed PIP joints. A two-center retrospective study was carried out in 24 patients with open and closed trauma of the PIP joint of the fingers from 2007 to 2019. Fifteen hinged silicone implants (NeuFlex®) and nine gliding implants (Tactys®) were used. Pain on a visual analog scale (VAS), stability and total active motion (TAM), grip and pinch strength (Jamar®), QuickDASH and PRWE and satisfaction were assessed, and X-rays were performed. With a mean follow-up of 48 months, 24 patients aged 58 years on average were reviewed. Pain on VAS was 0.2/10, the TAM was 72% of the contralateral side, the QuickDASH was 15.6/100 and the PRWE was 24.5/100. PIP flexion was ≥50% of the contralateral side in 75% of patients. PIP and DIP extensor lag of 9° was significantly larger with the Tactys® than with the NeuFlex®, with no significant difference in the TAM. Three clinodactylies in fingers with the NeuFlex® and three reducible swanneck deformities in fingers with the Tactys® were noted. Three-quarters of patients were very satisfied or satisfied with the outcome. Emergency PIP arthroplasty with Tactys® seems to provide functional results that are as good as with NeuFlex®. Clinodactyly was found with NeuFlex® use. A significant PIP and IPD extensor lag of 9° and swan-neck deformities were found with Tactys® without significant functional impairment.

Radiological and functional correlation following "SLIC" scapholunate-intercarpal ligamentoplasty at minimum 12 months' follow-up

We report outcomes for scapholunate-intercarpal ligamentoplasty ("SLIC procedure"), performed in 22 patients (mean age at surgery, 39.7 years), for reducible static scapholunate (SL) instability without repairable stump. Patients were evaluated for pain and active wrist range of motion, grip strength, functional scores (QuickDASH and PRWE) and radiological appearance (SL gap, SL angle, radiolunate angle, capitolunate angle), preoperatively and at a mean 28.3 months' follow-up (range 12-65). A CT scan without injection was performed at follow-up to measure the posterior radioscaphoid angle (PRSA). The objective was to assess radiological-functional correlations after SLIC ligamentoplasty and to analyze postoperative PRSA correction. The hypothesis was that correcting the PRSA improves clinical and functional outcomes. Pain on a visual analog scale improved significantly, from 2.7 to 0.7 at rest and from 7 to 3.2 during hand use. Mean wrist flexion was 46.4° and extension 59.1°. Grip strength reached 82.8% of the contralateral value. Functional scores improved significantly. Mean SL angle decreased significantly from 81.1° to 73.5°, and static scapholunate gap from 4.7 mm to 3.6 mm. Scaphoid subluxation was fully corrected in 15 cases (68%). PRSA angle was significantly corrected, from a mean 112.7° to 104.2°. Patients in whom PRSA was corrected showed a tendency for better clinical and subjective outcomes. There was 1 case of scaphoid necrosis, 7 of recurrent static instability, including 3 early at 4 months, 3 of scaphocapitate osteoarthritis, and 5 of carpal collapse with SLAC wrist. There were no significant correlations between clinical and radiological results in the medium term after SL ligamentoplasty by the SLIC procedure. The results were quite good in the medium term and pointed to the importance of correcting rotatory subluxation of the scaphoid, revealed by the PRSA, more than correcting the scapholunate gap.

Étude MUMI-19 (mothers undergoing mental impact of COVID-19 pandemic) : évaluation de l’impact de l’isolement maternel dans le post-partum immédiat sur le taux de dépression du post-partum en période de pandémie COVID-19

Introduction

La pandémie de COVID-19 a bouleversé le monde en imposant des mesures sanitaires inédites, notamment en suites de couches. Cette étude a pour but d’évaluer l’impact de l’isolement maternel dans le post-partum immédiat sur le taux de dépression du post-partum (DPP) dans une maternité de type 3.

Méthodes

Nous avons mené une étude de cohorte prospective de type exposés–non exposés, entre le 22 avril et le 29 octobre 2020, en utilisant des questionnaires anonymes sur 265 parturientes (129 pendant le confinement et 135 en dehors). L’échelle postnatale d’Edimbourg (EPDS) a été utilisée. Nous avons utilisé un modèle de régression logistique univariée pour l’association entre les facteurs de risques et la DPP.

Résultats

Il n’y avait pas de différence entre les deux groupes concernant la DPP évaluée par un score > 10,5 à l’EPDS à j30 et/ou j60 (23,1 % vs 29,3 %, p = 0,661). En revanche, dans le groupe « confiné », le score à j3 était plus élevé (31 % vs 17,8 %, p = 0,015) et les conjoints davantage impactés sur le plan psychologique (48,3 % vs 10,5 %, p < 0,001). La parité ?1 était un facteur protecteur de DPP (OR = 0,2, IC95 % [0,1–0,6], p = 0,003). Les antécédents de violence psychologiques (OR = 6,4, IC95 % [1,1–37,6], p = 0,04), la présence d’un stress durant la grossesse (OR = 4,5, IC95 % [1,6–12,6], p = 0,004) et le vécu traumatique de l’accouchement (OR = 5,1, IC95 % [1,4–17,8], p = 0,012) étaient associés à un sur-risque de DPP.

Conclusion

L’isolement maternel dans le post-partum immédiat est associé à un sur-risque de symptômes sévères de blues du post-partum.

Amikacin in emergency surgery: How to dose it optimally?

Amikacin is still a recommended option in emergency surgery. Current guidelines have suggested an amikacin dose of 15-20 mg/kg/24 h for intra-abdominal infections (IAI). Our objectives were to analyse amikacin pharmacokinetics (PK) and dosage requirements in patients who underwent emergency surgery, and to identify an optimal dosing approach. We performed a retrospective data analysis of patients who received amikacin for emergency surgery over 2.5 years, with measurement of both peak (C_max) and trough (C_min) concentration after the first dose. The BestDose software was used to analyse amikacin concentrations and simulate various alternative dosage regimens in each patient. We compared concentration estimates with target values: C_max > 64 mg/L and C_min < 2.5 mg/L at 24 h. Classification and regression tree analysis was used to identify determinants of C_max target attainment (TA) and optimal dose. Data from 84 patients, including 62 with IAI, were analysed. Despite a median initial dose of 25 mg/kg, 32% of patients did not achieve the C_max target. An amikacin dose ≤ 21.5 mg/kg was the primary predictor of failure to achieve the target. A dose of 30 mg kg of total or corrected body weight, as well as a fixed dose of 2500 mg would result in the highest TA. The primary determinants of the optimal dose were ideal body weight, age, and renal function. To conclude, recommended dosages of amikacin in emergency surgery are not optimal. A fixed initial dose of 2500 mg could simplify and optimise dosing in this setting.

Examples and processes from national dashboards: Belgium and Kosovo

The official national COVID-19 dashboard of Belgium was first put online on 31 Dec 2020. 1 year later, it was composed of 12 pages, 35 indicators, 73 charts and 15 tables. Lots of decisions were taken to arrive there: the definition of the indicators, the charts, the pages, the hierarchical order of the information, the colors, the footnotes & annotations... How were all of these decided? Who influenced the decisions and what was the dynamic with the decision makers and the general public? And how did it change over time? What are the particularities of the Belgian dashboard? What makes it different from the dashboard of Kosovo? What are the lessons learned and how would it be different if started from scratch?

Inhibitory control in poker: Do experienced non-pathological poker gamblers exhibit better performance than healthy controls on motor, verbal and emotional expression inhibition?

BACKGROUND AND AIMS

Strategic games, such as poker, require gamblers to develop several skills to perform better than others and to expect a potential gain. Players must remain as unpredictable and unreadable as possible by inhibiting the expression of their emotions in response to both good and bad poker events. The aim of the present study was to compare several aspects of the inhibition process in experienced poker gamblers and controls to better understand how inhibitory control is involved in poker performance.

METHODS

Thirty experienced non-pathological poker gamblers (EG) and thirty healthy controls with no or limited poker experience (HC) completed 3 cognitive tasks. Each task measured a specific type of inhibition: motor inhibition [Go/No-Go task], verbal inhibition [Hayling Sentence Completion Task] and expressive inhibition [expressive suppression task, which combines subjective, expressive (facial EMG) and physiological (skin conductance, heart interbeat interval, cardiovascular and respiratory activation) measures of emotional experience]. Linear mixed models with random effects were performed.

RESULTS

Inhibitory control skills were similar between the two groups, regardless of the form of inhibition tested. The only difference observed in EG was a higher ability to partially suppress the physiological expression of emotion. However, this difference was only present for negative and positive emotional induction and was not maintained for emotional induction related to poker situations.

DISCUSSION AND CONCLUSIONS

The development of specific inhibition skills in experienced poker gamblers was not supported and raises questions about the transferability of poker skills previously discussed in the literature.

[Remarkable medical advances in rheumatology : may be…]

The development of new drugs is a significant activity in a university hospital that favors access to therapeutic novelties to patients. Rheumatology, whose drug armamentarium was poor in the 1980s, has benefited from the huge progresses of immunology in the 1980-1990s, allowing a therapeutic revolution in whom the academic hospital of Liège (CHU Liège) has been strongly implicated. First protocols with anti-TNF-? monoclonal antibodies have been applied in 1997. Sixty-one protocols have been initiated in rheumatoid arthritis, 12 in ankylosing spondylitis, 10 in psoriatic arthritis, 9 in systemic erythematosus lupus, 3 in giant cell arteritis, 1 in polymyalgia rheumatica, 5 in osteoarthritis and 4 in osteoporosis. Potential and pitfalls will be discussed disease by disease and also by drug categories. The balance remains globally positive, but remission is far from be reached.

Using infrared and Raman microspectroscopies to compare ex vivo involved psoriatic skin with normal human skin

Psoriasis is a chronic dermatosis that affects around 3% of the world's population. The etiology of this autoimmune pathology is not completely understood. The barrier function of psoriatic skin is known to be strongly altered, but the structural modifications at the origin of this dysfunction are not clear. To develop strategies to reduce symptoms of psoriasis or adequate substitutes for modeling, a deep understanding of the organization of psoriatic skin at a molecular level is required. Infrared and Raman microspectroscopies have been used to obtain direct molecular-level information on psoriatic and healthy human skin biopsies. From the intensities and positions of specific vibrational bands, the lipid and protein distribution and the lipid order have been mapped in the different layers of the skin. Results showed a similar distribution of lipids and collagen for normal and psoriatic human skin. However, psoriatic skin is characterized by heterogeneity in lipid/protein composition at the micrometer scale, a reduction in the definition of skin layer boundaries and a decrease in lipid chain order in the stratum corneum as compared to normal skin. A global decrease of the structural organization is exhibited in psoriatic skin that is compatible with an alteration of its barrier properties.

Macrophage activation syndrome with acute hepatitis E during tocilizumab treatment for rheumatoid arthritis

Tocilizumab is a humanized antibody against the membrane and soluble receptors for interleukin-6. Tocilizumab is among the disease-modifying antirheumatic drugs (DMARDs) used to treat moderate-to-severe active rheumatoid arthritis (RA) refractory to conventional DMARDs. We report a case of macrophage activation syndrome that complicated acute hepatitis E and started within 24hours after the fourth tocilizumab infusion in a patient with RA.

Improving verb anomia in the semantic variant of primary progressive aphasia: the effectiveness of a semantic-phonological cueing treatment

The semantic variant of primary progressive aphasia (svPPA) is known to affect the comprehension and production of all content words, including verbs. However, studies of the treatment of anomia in this disorder focused on relearning object names only. This study reports treatment of verb anomia in an individual with svPPA. The semantic-phonological cueing therapy resulted in significant improvement in naming abilities, for treated verbs only. This case study demonstrates that improvement in verb-naming abilities may be possible in svPPA. The almost complete maintenance of the treatment's effects in the patient 4 weeks after the end of the therapy also suggests improvements may be durable, at least in the short term, for some individuals with svPPA.

A comparative study between human skin substitutes and normal human skin using Raman microspectroscopy

Research in the field of bioengineered skin substitutes is motivated by the need to find new dressings for people affected by skin injuries (burns, diabetic ulcers), and to develop adequate skin models to test new formulations developed in vitro. Thanks to advances in tissue engineering, it is now possible to produce human skin substitutes without any exogenous material, using the self-assembly method developed by the Laboratoire d'Organogénèse Expérimentale. These human skin substitutes consist of a dermis and a stratified epidermis (stratum corneum and living epidermis). Raman microspectroscopy has been used to characterize and compare the molecular organization of skin substitutes with normal human skin. Our results confirm that the stratum corneum is a layer rich in lipids which are well ordered (trans conformers) in both substitutes and normal human skin. The amount of lipids decreases and more gauche conformers appear in the living epidermis in both cases. However, the results also show that there are fewer lipids in the substitutes and that the lipids are more organized in the normal human skin. Concerning the secondary structure of proteins and protein content, the data show that they are similar in the substitutes and in the normal human skin. In fact, the epidermis is rich in α-keratin, whereas the dermis contains mainly type I collagen.

Cognitive rehabilitation in multiple sclerosis

Cognitive impairments are frequent in multiple sclerosis (MS). However, most studies about efficacy of cognitive rehabilitation interventions have been criticized in terms of methods and/or design. The aim of this study is to evaluate the efficacy of cognitive rehabilitation in MS patients with a cognitive intervention (ProCogSEP* program), compared to a control intervention (discussion program). Twenty MS patients have completed this simple blind study: 10 patients followed 13 sessions (2 hours) of the ProCog-SEP(1) program. Ten other patients followed 13 sessions (2 hours) of a discussion program (Control Group). All patients underwent neuropsychological assessment, before and after their program, in order to evaluate cognitive functions. Two neuropsychologists respectively assessed the patients and conducted the group sessions. Compared to its own baseline, ProCog-SEP Group show improvements in verbal memory [free recall (p = .02), learning (p = .002)], in visual memory [free (p = .05) and delayed recall (p = .007)], in working-memory (p = .03), in verbal fluency (p = .05) and in language (p = .01). Inter group analysis show a benefit of cognitive program mainly in verbal and visual memory, and in verbal fluencies. These results support the interest of a cognitive therapeutic management of MS patients.

Characterization of a psoriatic skin model produced with involved or uninvolved cells

Current knowledge suggests that uninvolved psoriatic skin could demonstrate characteristics associated with both normal and involved psoriatic skins. However, the triggering factor allowing the conversion of uninvolved skin into a psoriatic plaque is not fully understood. To counter this lack of information, we decided to develop pathological skin substitutes produced with uninvolved psoriatic cells, in order to better characterize the uninvolved psoriatic skin. Substitutes were produced using the self-assembly approach. Macroscopic, immunohistochemical, permeability and physicochemical results showed that involved substitutes had a thicker epidermis, higher cell proliferation, abnormal cell differentiation and a more permeable and disorganized stratum corneum compared with normal substitutes. Various results were observed using uninvolved cells, leading to two proposed profiles: profile 1 was suggested for uninvolved skin substitutes mimicking the results obtained with normal skin substitutes; and profile 2 was dedicated to those mimicking involved skin substitutes in all aspects that were analysed. In summary, uninvolved substitutes of profile 1 had a thin, well-organized epidermis with normal cell proliferation and differentiation, such as observed with normal substitutes, while uninvolved substitutes of profile 2 showed an inverse trend, i.e. a thicker epidermis, higher cell proliferation, abnormal cell differentiation and a more disorganized and more permeable stratum corneum, such as seen with involved substitutes. The results suggest that uninvolved substitutes could demonstrate characteristics associated with both normal or involved psoriatic skins.

[Cognitive rehabilitation in multiple sclerosis: a review of the literature]

INTRODUCTION

Cognitive impairment is now well-known in multiple sclerosis (MS). However, few rehabilitation interventions are proposed or really efficient.

OBJECTIVES

To present a review of cognitive rehabilitation intervention research conducted in people with multiple sclerosis (MS), regarding different findings about episodic memory, working memory, attention and executive function disorders in MS.

DATA SOURCES

A search of Medline (yield 20 papers) and of PsychInfo (yield 1 article), using combinations of the following terms: cognitive rehabilitation, multiple sclerosis, cognitive therapy, neuropsychological rehabilitation, in the title or in the abstract, from 1960 to March 2010, excluding animal studies.

RESULTS

Episodic memory rehabilitation studies appear to be promising. Programs on working memory, attention and executive functions are in the very early phases.

CONCLUSIONS

Results are encouraging and allow specific recommendations for future research about: (1) inclusion criteria, often not defined, (2) a specific baseline adapted to the program of rehabilitation, (3) a control measure regarding program efficiency and (4) a role for the psychologist (presence and advice during the program).

Prise en charge de l’infécondité dans les troubles de l’éjaculation: avis conjoints de l’andrologue, du biologiste et du gynécologue

Quatre-vingts pour cent des hommes qui présentent des troubles de l’éjaculation sont en âge de procréer, mais seul 5 à 10 % en sont spontanément capables. Du sperme antérograde et/ou rétrograde peut être recueilli par éjaculation assistée en association à des traitements pharmacologiques (chlorhydrate de minodrine-vibroéjaculation). En cas d’échecs de recueil de sperme et d’azoospermie, l’extraction chirurgicale des spermatozoïdes épididymaires ou testiculaires permet d’obtenir des spermatozoïdes, en quantité généralement moins importante que les techniques d’éjaculation assistée, mais non infectés et dépourvus de plasma séminal (souvent délétère dans les troubles de l’éjaculation). Même en cas d’éjaculation antérograde, il est impératif de recueillir les urines systématiquement à la recherche d’une éjaculation rétrograde, fréquente dans les troubles de l’éjaculation. Au laboratoire, l’analyse du sperme et de l’urine s’effectue par les méthodes de routine standardisées. La plupart des hommes présentant des troubles de l’éjaculation ont un sperme de mauvaise qualité (asthénospermie, nécrospermie, leucospermie). Les étiologies de la dégradation des paramètres du sperme sont multifactorielles, d’origine centrale et périphérique (testiculaire et extratesticulaire). Optimiser la qualité du sperme et des spermatozoïdes reste un challenge d’actualité dans les troubles de l’éjaculation. Si la cryopréservation doit être systématique, l’utilisation du sperme frais optimisé a généralement la préférence. Réussir à obtenir du sperme offre au couple une chance de grossesse naturelle (rarement) grâce à une éjaculation coïtale, par auto-insémination, par insémination intra-utérine, par fécondation in vitro conventionnelle (FIVc) ou injection intracytoplasmique de spermatozoïdes (ICSI) dans l’ovocyte. Dans les troubles de l’éjaculation, la prise en charge de la fécondité de l’homme doit être la plus rapide possible. Elle s’effectue conjointement à celle de la femme par une équipe coordonnant l’andrologue, le biologiste et le gynécologue.

Modulating mouse innate immunity to RNA viruses by expressing the Bos taurus Mx system

Mx proteins are interferon-induced members of the dynamin superfamily of large guanosine triphosphatases. These proteins have attracted much attention because some display antiviral activity against pathogenic RNA viruses, such as members of the orthomyxoviridae, bunyaviridae, and rhabdoviridae families. Among the diverse mammalian Mx proteins examined so far, we have recently demonstrated in vitro that the Bos taurus isoform 1 (boMx1) is endowed with exceptional anti-rabies-virus activity. This finding has prompted us to seek an appropriate in vivo model for confirming and evaluating gene therapy strategies. Using a BAC transgene, we have generated transgenic mouse lines expressing the antiviral boMx1 protein and boMx2 proteins under the control of their natural promoter and short- and long-range regulatory elements. Expressed boMx1 and boMx2 are correctly assembled, as deduced from mRNA sequencing and western blotting. Poly-I/C-subordinated expression of boMx1 was detected in various organs by immunohistochemistry, and transgenic lines were readily classified as high- or low-expression lines on the basis of tissue boMx1 concentrations measured by ELISA. Poly-I/C-induced Madin-Darby bovine kidney cells, bovine turbinate cells, and cultured cells from high-expression line of transgenic mice were found to contain about the same concentration of boMx1, suggesting that this protein is produced at near-physiological levels. Furthermore, insertion of the bovine Mx system rendered transgenic mice resistant to vesicular-stomatitis-virus-associated morbidity and mortality, and embryonic fibroblasts derived from high-expression transgenic mice were far less permissive to the virus. These results demonstrate that the Bos taurus Mx system is a powerful anti-VSV agent in vivo and suggest that the transgenic mouse lines generated here constitute a good model for studying in vivo the various antiviral functions-known and yet to be discovered-exerted by bovine Mx proteins, with priority emphasis on the antirabic function of boMx1.

Sensitization and elicitation of an allergic reaction to wheat gliadins in mice

We developed a mouse model of allergy to wheat flour gliadins, a protein fraction containing major wheat allergens. We compared the antibody responses (i.e., specific IgE and IgG1) and the profiles of cytokines secreted by reactivated splenocytes induced after intraperitoneal injections of gliadins in three strains of mice, namely, Balb/cJ, B10.A, and C3H/HeJ. The intensities of the allergic reactions elicited by intranasal challenge were also compared. Both the sensitization and elicitation were the highest in Balb/cJ mice, whereas weak or no reaction was observed in the others strains. Interestingly, the specificity of the mouse IgE against the different gliadins (i.e., alpha-, beta-, gamma-, omega 1,2-, and omega 5-gliadin) was similar to that observed in children allergic to wheat flour. Balb/cJ mice may thus provide a relevant model for the study of sensitization and elicitation by wheat gliadins and for improving our understanding of the specific role and mechanisms of action of the different classes of gliadins.

Muscle strength and body composition in adult women with Marfan syndrome

OBJECTIVE

The purpose of this study was to assess skeletal muscle function and body composition in a group of women with Marfan syndrome compared with matched controls.

METHODS

The 21 women who were receiving follow-up for Marfan syndrome at our institution, were free of major cardiovascular disease, and consented to the study performed isokinetic and isometric knee extension and flexion maximal strength tests and had their body composition evaluated using dual-energy X-ray absorptiometry (DEXA). The same assessments were done in 19 matched controls.

RESULTS

A significant decrease in lean leg mass with no change in total soft-tissue leg mass was noted in the patients compared with the controls. Peak torque values for the quadriceps and hamstring muscle groups were decreased in the patients, but only quadriceps strength was significantly reduced after normalization for lean leg mass.

CONCLUSION

The muscle strength reduction in Marfan patients was not fully explained by a decrease in lean leg mass, suggesting qualitative skeletal-muscle alterations related to abnormal fibrillin expression in muscle connective tissue.

Differential Anti-Influenza Activity among Allelic Variants at TheSus Scrofa Mx1Locus

A promising way to oppose infectious challenges would be to improve the resistance of the target species through genetic selection. Theoretically, a candidate gene is available against influenza viruses since a resistance trait was fortuitously discovered in the A2G mouse strain. This trait was demonstrated to be correlated with the expression of a specific isoform of the type I interferon (IFN)-dependent protein MX, an isoform coded by a specific allele at the mouse Mx1 locus. Two allelic polymorphisms were described recently in the Sus scrofa homologous gene. In this study, the frequencies and distribution of both alleles were evaluated among European domestic pig and wild boar populations by PCR-RFLP, and the anti-influenza activity conferred by both MX1 isoforms was evaluated in vitro using transfection of Vero cells followed by flow cytometric determination of the fraction of influenza virus-infected cells among MX-producing and MX-nonproducing cell populations. A significant difference in the anti-influenza activity brought by the two MX1 isoforms was demonstrated, which suggests that a significant improvement of innate resistance of pigs by genetic selection might be feasible provided the differences found here in vitro are epidemiologically relevant in vivo.

[Compliance with and acceptability of a new electronic peak flow meter, the PiKo-1]

BACKGROUND

Monitoring airflow obstruction is an essential component of asthma management. We examined home recording of PEFR using a new electronic peak flow meter in terms of compliance and acceptability in a group of children with asthma.

METHODS

Twenty three children (3 with intermittent asthma and 20 with persistent asthma) (average age 10.9 +/- 3.8 [5-18] yrs) were asked to assess their PEFR every day during a period of 5.8 +/- 1.2 [4-8] weeks and record it in a diary card. Patients were not aware that their data was also being stored on the PiKo-1. At the end of the study, the written data were compared to the stored data. A multiple choice questionnaire was given to each subjectto check the acceptability of the PiKo-1.

RESULTS

2 patients were lost to follow up. The compliance (expressed as a percent of the number of recordings that should have been made) was more that 80% for 14/21(67%) patients and less than 45% for 3/21 (14%). Compliance decreased during the study (96% in the first week, 68% during the fifth). 12% of the values were falsified. The PiKo-1 was considered to be small, attractive and useful. Some children found the mouthpiece too small.

CONCLUSION

The good results for compliance that we observed might have been due to the short duration of the study. PiKo-1 was well accepted by the subjects. It will be possible to monitor PEFR and forced expiratory volume in the first second of expiration at home using this new device.

Expression of the interferon-alpha/beta-inducible bovine Mx1 dynamin interferes with replication of rabies virus

Rabies is a fatal anthropozoonotic viral infection of the central nervous system that remains a serious public health problem in many countries. As several animal cases of spontaneous survival to infection were reported and because type 1 interferons were shown to protect against the virus, it was suggested that innate resistance mechanisms exist. Among the antiviral proteins that are synthesized in response to interferon-alpha/beta stimulation, Mx proteins from several species are long known to block the replication of vesicular stomatitis virus (VSV). As both VSV and rabies virus belongs to the Rhabdoviridae family, this study was started with the aim to establish whether the anti-VSV activity of a mammalian Mx protein could be extended to rabies virus. This question was addressed by inoculating the virus onto a bovine Mx1 or human MxA-expressing Vero cell clone. Plaque formation was unambiguously blocked, and viral yields were reduced 100- to 1000-fold by bovine Mx1 expression for both SAG2 and SADB19 viral strains. In opposition, only SAG2 strain could be inhibited by the expression of human MxA protein. The effect of both proteins expression was then evaluated at the viral protein expression level. Again, boMx1 was able to repress protein expression in both strain, whereas only SAG2 proteins were inhibited in human MxA-expressing cells. These results suggest that protection conferred by interferon-alpha/beta against rabies could be, at least partially, attributable to the Mx pathway. Alternatively, bovine Mx1 could be unique in its ability to repress rabies virus which, if confirmed in vivo, would open an avenue for the development of new antirabies therapeutic strategies.

Degradation of organolead species in aqueous solutions by electron beam irradiation

Electron beam irradiation of aqueous solutions containing different lead compounds (Pb(2+), (CH(3))(3)Pb(+), (C(2)H(5))(3)Pb(+)) was carried out. Formate and hydrogen peroxide were used as radical scavengers to elucidate the influence of the different species generated by water radiolysis. The precipitation of Pb(2+), only observed in the presence of formate, was attributed to COO(*-) but the nature of the precipitate is still unclear. Organolead compounds were shown to be efficiently degraded, probably converted into Pb(2+), using doses around 4 kGy. In the absence of scavengers, the degradation occurred according to the alkyl group stability. Both trialkyllead compounds were shown to be degraded by HO(*). On the contrary, the contribution of hydrogen atoms (H(*)) was shown to be highly dependent on the nature of the alkyl group, i.e. negligible for (C(2)H(5))(3)Pb(+) and more important for (CH(3))(3)Pb(+).

Hypercapnia during transperitoneal and retroperitoneal endoscopic spinal surgery: a prospective study

STUDY OBJECTIVE

To evaluate the effect of carbon dioxide (CO(2)) pneumoperitoneum and retropneumoperitoneum insufflation on CO(2) excretion.

DESIGN

Prospective study.

SETTING

Operating room and recovery room in a teaching hospital.

PATIENTS

29 patients scheduled for orthopedic spine fusion surgery.

INTERVENTIONS

Patients received either transperitoneal insufflation (n = 12) or retroperitoneal insufflation (n = 17).

MEASUREMENTS AND MAIN RESULTS

Increases in the partial pressure of end-tidal CO(2) (PetCO(2)) and arterial CO(2) tension (PaCO(2)) during retropneumoperitoneum exceeded those obtained during pneumoperitoneum. Furthermore, PetCO(2) increased faster during retroperitoneum and did not reach a plateau. Finally, 76% of the patients in this group required ventilatory adjustment due to high PetCO(2) levels.

CONCLUSIONS

This study may focus attention on the need for continuous ventilatory adjustments during transperitoneal endoscopic surgery.

[Contribution of ovarian and uterine color Doppler in medically assisted reproduction techniques (ART)]

Along the menstrual cycle and during pregnancy, small blood vessels proliferate within the uterus and the ovulating ovary. Angiogenic factors such as VEGF are involved in this phenomenon. In the ovulating ovary, neo-angiogenesis spreads progressively inside the dominant follicle wall and plays a role in the maintenance of the corpus luteum, under the influence of LH (or HCG during pregnancy). In ART, the measure of the blood flow is interesting since it correlates to the number and quality of harvested oocytes. Follicle hypoxia may impair chromosomal organization and separation within the oocyte. This neo-angiogenesis is also important in endometrium, in particular for embryo implantation. Ultrasounds with Doppler allow to estimate the endometrial receptivity, especially in IVF cycles. It is assumed that chance for ongoing pregnancy is almost zero if: endometrial thickness is < 8 mm; uterine pulsatility index (PI) is > 3. Doppler ultrasounds are a useful and even mandatory complement to standard vaginal ultrasonoghraphy in ART. It can be viewed as an indicator of the endometrial and follicular "well-being".

Exacerbation of sleep-apnoea related nocturnal blood-pressure fluctuations in hypertensive subjects

Obstructive sleep apnoea syndrome (OSAS) induces marked haemodynamic fluctuations during sleep that might be deleterious to the cardiovascular system. The influence of daytime blood pressure (BP) levels and aging on short-term BP variability during sleep in OSAS patients was investigated. Twenty-nine subjects with newly-diagnosed untreated OSAS were categorised into three groups: normotensive subjects aged <50 yrs (n=10); subjects aged <50 yrs with untreated hypertension (n=8); and normotensive subjects aged >50 yrs (n=11). Beat-by-beat BP was recorded with a Finapres device during polysomnography. The average values+/-SD of apnoea-related BP elevations and the values of the frequency distribution of all BP variations during sleep were assessed to estimate short-term BP variability. Apnoea-related systolic (or diastolic) BP elevations were significantly greater in hypertensives than in normotensives aged <50 yrs (50.3+/-4.88 versus 30.7+/-2.14 mmHg, p<0.001), as was the SD of systolic (or diastolic) BP variations during sleep (19.6+/-2.22 versus 11.1+/-0.73, p<0.001). Short-term BP variability was not significantly increased in normotensive elderly patients. To conclude, the results suggested that systemic hypertension is associated with a greater exacerbation of short-term variability during sleep in obstructive sleep apnoea syndrome patients.

Clinical and biological heterogeneity in pseudohypoparathyroidism syndrome. Results of a multicenter study

Pseudohypoparathyroidism (PHP) is a rare inherited syndrome frequently associated with Albright's hereditary osteodystrophy (AHO). We conducted a multicenter study including 71 PHP children and 77 relatives. Erythrocyte Gsalpha biological activity was measured in each patient (normal range 85-110%). 61 patients were classified into four subtypes based on clinical and endocrine data and Gsalpha activity: 45 PHP Ia, 8 PHP Ib, 2 PHP II, and 6 PHP Ic. PHP Ia had decreased Gsalpha (58 +/- 9%), PHP Ib patients had PTH resistance, no AHO and normal Gsalpha (96 +/- 9%), PHP Ic patients had PTH resistance, AHO and no decreased Gsalpha (97 +/- 13%). The 10 remaining patients were considered to have pseudo-pseudohypoparathyroid (Pseudo-PHP) and were divided into two subtypes. One subtype had decreased Gsalpha and the second subtype had normal Gsalpha activity. The heterogeneous expression of Pseudo-PHP and thyrotropin resistance, which preceded parathyroid hormone resistance in 24% of the children, suggested that PHP might be a gradually evolving disease. GRF resistance was found in 4 out of 9 children investigated. The pedigree analysis showed PHP Ia had a dominant mode of inheritance with increased severity through generations. Pedigree analysis did not support a genomic imprinting hypothesis. Two children out of 9 had a chromosome 2 abnormality. This study confirms that Gsalpha activity is a significant marker in the diagnosis and classification of PHP.

Arterial blood gases during exercise: validity of transcutaneous measurements

OBJECTIVE

To investigate the validity of transcutaneous measurements of blood gas tensions for the assessment of partial arterial pressure of oxygen (PaO(2)) and carbon dioxide (PaCO(2)) during treadmill exercise.

DESIGN

Experimental, self-controlled against a reference standard.

SETTING

Lung function laboratory.

PATIENTS

Eighty-one patients with various lung diseases.

INTERVENTIONS

At rest and at symptom-limited peak exercise, puncture of the radial artery with concurrent transcutaneous measures of blood gases.

MAIN OUTCOME MEASURES

Arterial blood samples were analyzed with a radiometer to measure PaO(2) and PaCO(2). A microgas apparatus was used to measure gas tensions transcutaneously. Values obtained transcutaneously (TcPO(2), TcPCO(2)) were compared with those obtained by blood sample. TcPO(2) was adjusted as close as possible to the PaO(2) obtained in the same conditions, with the correction factor of the apparatus. Values obtained transcutaneously were compared with those obtained by blood sample to establish the sensitivity and specificity of the noninvasive method.

RESULTS

Mean differences +/- standard deviation between transcutaneous and arterial tension at peak exercise were 0.4 +/- 7.0mmHg and 2.1 +/- 3.3mmHg for PaO(2) and PaCO(2), respectively. The transcutaneous device enabled us to predict a decrease in PaO(2) (>or=2mmHg) from rest to exercise with a sensitivity of 92.1% and a specificity of 90% and an increase in PaCO(2) with a sensitivity of 88% and a specificity of 58.9%.

CONCLUSIONS

Although transcutaneous measurement are sufficiently sensitive and specific to detect patients whose PaO(2) decreases during exercise, its precision is not sufficient for gas exchange calculations.

Determination of tumor markers in serum. Pitfalls and good practice

The determination of tumor markers may have consequences for the patients' treatment, which requires special attention to the analysis and to the expression of the results. In addition to the factors usually dealt with in the pre-analytical phase (identification, quality and storage of the sample) and in the analytical phase (interference, endogenous antibodies, hook effect), we must consider factors such as normal values (which depend heavily on the used techniques), threshold values defining other characteristics (sensitivity, specificity, positive and negative predictive value) and kinetics. Knowledge of the limitations of the tumor marker analysis, in particular tumor markers for non-cancerous diseases leading to possible increases (false positives), is also indispensable. All of this led to the definition of guidelines for good practice, including the design of quality control, rules for requesting, validation and interpretation of results, and the setting up of a serum library.