Worldwide population prevalence and impact of sub-diagnostic gastrointestinal symptoms

BACKGROUND

The Rome Foundation Global Epidemiology Study (RFGES) found that 40.3% of adults in 26 internet-surveyed countries met Rome IV criteria for disorders of gut-brain interaction (DGBI). However, additional people not meeting DGBI criteria may also be burdened by frequent gastrointestinal symptoms.

AIMS

To explore the prevalence and demographic distribution of sub-diagnostic gastrointestinal symptoms, and the hypothesised associated effects on quality of life (QoL), life functioning and healthcare needs.

METHODS

We analysed data from the RFGES survey, which included the Rome IV diagnostic questionnaire and QoL, psychological, work productivity and healthcare questions.

RESULTS

Of the 50,033 people without a history of organic gastrointestinal disorders, 25.3% classified in the sub-diagnostic group (no DGBI but one or more frequent gastrointestinal symptoms), 41.4% had DGBI and 33.4% had no frequent gastrointestinal symptoms (non-GI group). Sub-diagnostic prevalence in different world regions ranged from 22.2% (North America) to 30.5% (Middle East), was slightly higher among males than females and decreased with age. The sub-diagnostic group was intermediate between the non-GI and DGBI groups, and significantly different from both of them on QoL, anxiety, depression, somatisation, healthcare utilisation and life and work impairment.

CONCLUSIONS

One in four adults without organic gastrointestinal disorders or DGBI report frequent gastrointestinal symptoms. This sub-diagnostic group has reduced QoL, greater psychological and non-GI bodily symptoms, impaired work productivity and life activities and greater healthcare use compared to non-GI individuals. This suggests that many in this sub-diagnostic group might benefit from healthcare services or symptom self-management advice.

A poor diet quality is associated with more gas-related symptoms and a decreased quality of life in French adults

This study evaluated the association between dietary patterns, Gas-Related Symptoms (GRS) and their impact on quality of life (QoL) in a representative sample (n=936) of the French adult population. During the 2018-2019 "Comportements et Consommations Alimentaires en France" (CCAF) survey (Behaviors and Food Consumption in France), online evaluation of GRS in adult participants was performed using the validated Intestinal Gas Questionnaire (IGQ), which captures the perception of GRS and their impact on QoL via 6 symptom dimensions scores (range 0-100; 100=worse) and a global score (mean of the sum of the 6 symptom dimensions scores). Socio-demographics, lifestyle parameters and dietary habits (7-day e-food diary) were also collected online. Quality of diet was determined using the NRF9.3 score (range 0-900; 900=best). Univariate and multivariate linear regression models were applied to identify factors associated with IGQ global score. K-means was used to identify clusters of subjects based on their dietary records. Data from 936 adults who completed both the IGQ and the food diary showed a mean (SD) IGQ global score of 11.9 (11.2). Younger age and female gender were associated with a higher IGQ global score. Only 7% of subjects reported no symptom at all and nearly 30% of study participants reported a high impact of GRS on their QoL. Two dietary clusters were identified: cluster1, characterized by a higher consumption of fruits and vegetables, lower sugars intake and higher NRF9.3 score and cluster 2, characterized by higher intake of sugars, lower intake in dietary fibers and lower NRF9.3 score. The IGQ global score was lower in cluster1 and higher in cluster2 vs. the total sample average (p<0.001). Prevalence of GRS in the French adult population is high and is associated with impaired QoL and dietary patterns. A change in food habits towards healthier patterns could help reducing the burden of GRS.

Attitudes and Expectations of Clinical Research Participants Toward Digital Health and Mobile Dietary Assessment Tools: Cross-Sectional Survey Study

Background

The adoption of health technologies is key to empower research participants and collect quality data. However, the acceptance of health technologies is usually evaluated in patients or healthcare practitioners, but not in clinical research participants.

Methods

A 27-item online questionnaire was provided to the 11,695 members of a nutrition clinical research participant database from the Nantes area (France), to assess (1) participants' social and demography parameters, (2) equipment and usage of health apps and devices, (3) expectations in research setting and (4) opinion about the future of clinical research. Each item was described using frequency and percentage overall and by age classes. A global proportion comparison was performed using chi-square or Fisher-exact tests.

Results

A total of 1529 respondents (81.0% women, 19.0% men) completed the survey. Main uses of health apps included physical activity tracking (54.7%, age-related group difference, p < 0.001) and food quality assessment (45.7%, unrelated to age groups). Overall, 20.4% of respondents declared owning a connected wristband or watch. Most participants (93.8%) expected the use of connected devices in research. However, protection of personal data (37.5%), reliability (35.5%) and skilled use of devices (28.5%) were perceived as the main barriers. Most participants (93.3%) would agree to track their food intake using a mobile app, and 80.5% would complete it for at least a week while taking part in a clinical study. Only 13.2% would devote more than 10 min per meal to such record. A majority (60.4%) of respondents would accept to share their social media posts in an anonymous way and most (82.2%) of them would accept to interact with a chatbot for research purposes.

Conclusions

Our cross-sectional study suggests that clinical study participants are enthusiastic about all forms of digital health technologies and participant-centered studies but remain concerned about the use of personal data. Repeated assessments are suggested to evaluate the research participant's interest in technologies following the increase in use and demand for innovative health services during the pandemic of COVID-19.

A Randomised, Controlled Trial: Effect of a Multi-Strain Fermented Milk on the Gut Microbiota Recovery after Helicobacter pylori Therapy

Helicobacter pylori (Hp) eradication therapy alters gut microbiota, provoking gastrointestinal (GI) symptoms that could be improved by probiotics. The study aim was to assess the effect in Hp patients of a Test fermented milk containing yogurt and Lacticaseibacillus (L. paracasei CNCM I-1518 and I-3689, L. rhamnosus CNCM I-3690) strains on antibiotic associated diarrhea (AAD) (primary aim), GI-symptoms, gut microbiota, and metabolites. A randomised, double-blind, controlled trial was performed on 136 adults under 14-day Hp treatment, receiving the Test or Control product for 28 days. AAD and GI-symptoms were reported and feces analysed for relative and quantitative gut microbiome composition, short chain fatty acids (SCFA), and calprotectin concentrations, and viability of ingested strains. No effect of Test product was observed on AAD or GI-symptoms. Hp treatment induced a significant alteration in bacterial and fungal composition, a decrease of bacterial count and alpha-diversity, an increase of Candida and calprotectin, and a decrease of SCFA concentrations. Following Hp treatment, in the Test as compared to Control group, intra-subject beta-diversity distance from baseline was lower (p_adj = 0.02), some Enterobacteriaceae, including Escherichia-Shigella (p_adj = 0.0082) and Klebsiella (p_adj = 0.013), were less abundant, and concentrations of major SCFA (p = 0.035) and valerate (p = 0.045) were higher. Viable Lacticaseibacillus strains were detected during product consumption in feces. Results suggest that, in patients under Hp treatment, the consumption of a multi-strain fermented milk can induce a modest but significant faster recovery of the microbiota composition (beta-diversity) and of SCFA production and limit the increase of potentially pathogenic bacteria.

Differential Responses of Blood Essential Amino Acid Levels Following Ingestion of High-Quality Plant-Based Protein Blends Compared to Whey Protein-A Double-Blind Randomized, Cross-Over, Clinical Trial

This study assessed the bio-equivalence of high-quality, plant-based protein blends versus Whey Protein Isolate (WPI) in healthy, resistance-trained men. The primary endpoint was incremental area under the curve (iAUC) of blood essential Amino Acids (eAAs) 4 hours after consumption of each product. Maximum concentration (Cmax) and time to maximum concentration (Tmax) of blood leucine were secondary outcomes. Subjects (n = 18) consumed three plant-based protein blends and WPI (control). An analysis of Variance model was used to assess for bio-equivalence of total sum of blood eAA concentrations. The total blood eAA iAUC ratios of the three blends were [90% CI]: #1: 0.66 [0.58-0.76]; #2: 0.71 [0.62-0.82]; #3: 0.60 [0.52-0.69], not completely within the pre-defined equivalence range [0.80-1.25], indicative of 30-40% lower iAUC versus WPI. Leucine Cmax of the three blends was not equivalent to WPI, #1: 0.70 [0.67-0.73]; #2: 0.72 [0.68-0.75]; #3: 0.65 [0.62-0.68], indicative of a 28-35% lower response. Leucine Tmax for two blends were similar to WPI (#1: 0.94 [0.73-1.18]; #2: 1.56 [1.28-1.92]; #3: 1.19 [0.95-1.48]). The plant-based protein blends were not bio-equivalent. However, blood leucine kinetic data across the blends approximately doubled from fasting concentrations, whereas blood Tmax data across two blends were similar to WPI. This suggests evidence of rapid hyperleucinemia, which correlates with a protein's anabolic potential.

Blood Essential Amino Acid Levels After Ingestion of High Quality Plant-Based Protein Blends Compared to Whey Protein: A Double Blind, Randomized, Cross-Over, Clinical Trial (P08-057-19)

Objectives

This study assessed the blood essential amino acid (eAA) response after consumption of high quality (PDCAAS = 1.0) plant-based protein blends versus whey protein (WPI, control) in healthy, resistance-trained adult men. Secondary Objectives assessed the blood leucine response (Cmax and Tmax).

Methods

The study was an acute, randomized, double-blind cross-over study. Participants consumed one of four study products: Blend 1 (34 grams of pea and pumpkin protein); Blend 2 (33 grams of pea, pumpkin, sunflower and coconut protein); Blend 3 (hydrolyzed version of Blend 1). Leucine was matched at 2.6 grams across test beverages equal to WPI (24 grams protein). Total eAA content was 12 grams across beverages. Fasting blood was collected and samples at 15 min, 30 min, 1 h, 2 h, 3 h and 4 h post consumption. Blood eAA were measured by UPLC. Repeated measures ANOVA assessed for equivalence of the total sum of blood eAA concentration. Primary endpoint was iAUC over 4 hours after consumption of the study blends. Cmax and Tmax of blood leucine response were secondary outcomes.

Results

Eighteen men (25.4 ± 4.64 y) with a BMI of 24.4 ±3.35 kg.m−2 completed the study. The eAA iAUC over 4 hours of plant-based protein blends were not equivalent to WPI, the three ratios [90% CI]: Blend #1: 0.66 [0.58–0.76]; Blend #2: 0.71 [0.62–0.82], Blend #3: 0.60 [0.52–0.69] fell below the pre-defined equivalence threshold [0.80–1.25], indicative of a 30 to 40% decrease compared to WPI. Leucine Cmax over 4-hours of plant-based protein blends were not equivalent to WPI Blend #1: 0.70 [0.67–0.73]; Blend #2: 0.72 [0.68–0.75], Blend #3: 0.65 [0.62–0.68], indicative of a 28 to 35% decrease compared to WPI. Leucine Tmax for Blend #1 and Blend #3 were close to WPI (Blend #1: 0.94 [0.73–1.18]; Blend #2: 1.56 [1.28–1.92]; Blend #3: 1.19 [0.95–1.48]).

Conclusions

This study represents the first human investigation in which blood eAA responses to high-quality, plant protein blends were compared to WPI. Although the eAA iAUC were not equivalent between plant protein blends and whey control, the leucine kinetic data across our plant protein blends showed an ∼2-fold increase from fasting. Further, similar Tmax data across two plant protein blends suggest a rapid hyperleucinemia. Future studies should assess the impact of high-quality plant proteins on muscle protein synthesis.

Funding Sources

Sequel Naturals, Danone Research.

Consumption of a Fermented Milk Product Containing Bifidobacterium lactis CNCM I-2494 in Women Complaining of Minor Digestive Symptoms: Rapid Response Which Is Independent of Dietary Fibre Intake or Physical Activity

Background. Minor digestive symptoms are common and dietary approaches such as probiotic administration or fibre and fermentable carbohydrate intake adjustments are often recommended. A Fermented Milk Product (FMP) containing Bifidobacterium animalis subsp. lactis CNCM I-2494 and lactic acid bacteria has been shown to improve digestive symptoms after 4 weeks of consumption, but the speed of onset of this effect and its dependence on fibre intake or physical activity is unknown. To answer these questions, data from two previously published trials on FMP for minor digestive symptoms were combined. Methods. In total, 538 participants provided weekly assessments of bloating, abdominal pain/discomfort, flatulence, borborygmi/rumbling stomach from which a composite score was calculated. At baseline in one study (n = 336), dietary fibre consumption was recorded and physical activity classified as high, moderate or low. The speed of the FMP's effect was assessed by a repeated measure analysis of variance measuring the change from baseline for the composite score of digestive symptoms. Results. FMP consumption resulted in a significant decrease in the composite score of symptoms after only 2 weeks in both studies and the pooled data at week 1 (-0.35 [-0.69, 0.00]; p = 0.05), week 2 (-0.66 [-1.04, -0.27]; p < 0.001), week 3 (-0.49 [-0.89, -0.10]; p = 0.01) and week 4 (-0.46 [-0.88, -0.04]; p = 0.03). The interactions fibre intake-by-product group, physical activity-by-product group and time-by-product group were not statistically significant. Conclusion. FMP consumption leads to a rapid improvement in symptoms which is likely to encourage adherence to this dietary intervention. This effect is independent of dietary fibre and physical activity.

Plasmatic presepsin (sCD14-ST) concentrations in acute pyelonephritis in adult patients

INTRODUCTION

Presepsin (sCD14-ST) is an emerging biomarker for infection. We hypothesized that presepsin could specifically increase during acute pyelonephritis and correlate with severity.

METHODS

We compared presepsin values in patients with acute pyelonephritis and controls, and we assessed its capacity to predict bacteraemia and admission in patients.

RESULTS

In 312 patients with acute pyelonephritis (median age 33years), presepsin concentrations were higher than in controls (476 vs 200ng/L, p<0.001). ROC curve indicated an AUC at 0.90 [for presepsin (vs. 0.99 and 0.98 for CRP and PCT, respectively; p<0.05) and an optimal threshold at 340ng/L (74% sensitivity, 94% specificity). Presepsin concentrations increased in acute pyelonephritis patients with bacteraemia (614 vs. 461ng/L, p,=0.001) and in those requiring admission (614ng/L vs. 320ng/L, p<0.001). Performance of presepsin to predict bacteraemia [AUC=0.63, 95%CI: 0.55-0.72] was similar to CRP (AUC=0.64, p=0.87) and less accurate than PCT (AUC=0.78, p<0.001). AUC for presepsin to detect the need for admission was 0.67, and comparable to CRP (p=0.26) and PCT (p=0.18).

CONCLUSION

Presepsin is a valuable biomarker to detect patients with acute pyelonephritis. However, it presents mild performance to predict bacteraemia and the need for admission, and offers no advantage as compared to CRP and PCT.

Tumor necrosis factor-α blockade in recurrent and disabling chronic sciatica associated with post-operative peridural lumbar fibrosis: results of a double-blind, placebo randomized controlled study

INTRODUCTION

The aim of this study was to assess the efficacy and safety of tumor necrosis factor (TNF)-α inhibition with infliximab (IFX) in treating recurrent and disabling chronic sciatica pain associated with post-operative peridural lumbar fibrosis.

METHOD

A double-blind, placebo-controlled study randomized 35 patients presenting with sciatica pain associated with post-operative peridural lumbar fibrosis to two groups: IFX (n = 18), a single intravenous injection of 3 mg/kg IFX; and placebo (n = 17), a single saline serum injection. The primary outcome was a 50 % reduction in sciatica pain on a visual analog scale (VAS) at day 10. Secondary outcomes were radicular and lumbar VAS pain at day 0 and radicular and lumbar VAS pain, Québec disability score, drug-sparing effect and tolerance at days 10, 30, 90, and 180.

RESULTS

At day 10, the placebo and IFX groups did not differ in the primary outcome (50 % reduction in sciatica pain observed in three (17.6 %) versus five (27.8 %) patients; p = 0.69). The number of patients reaching the patient acceptable symptom state for radicular pain was significantly higher in the placebo than IFX group after injection (12 (70.6 %) versus five (27.8 %) patients; p = 0.01). The two groups were comparable for all other secondary outcomes.

CONCLUSION

Treatment with a single 3 mg/kg IFX injection for post-operative peridural lumbar fibrosis-associated sciatica pain does not significantly reduce radicular symptoms at day 10 after injection.

TRIAL REGISTRATION

ClinicalTrials.gov NCT00385086 ; registered 4 October 2006 (last updated 15 October 2015).

Ketoconazole in Cushing's disease: is it worth a try?

BACKGROUND

The use of ketoconazole has been recently questioned after warnings from the European Medicine Agencies and the Food and Drug Administration due to potential hepatotoxicity. However, ketoconazole is frequently used as a drug to lower circulating cortisol levels. Several pharmacological agents have recently been approved for the treatment of Cushing's disease (CD) despite limited efficacy or significant side effects. Ketoconazole has been used worldwide for more than 30 years in CD, but in the absence of a large-scale study, its efficacy and tolerance are still under debate.

PATIENTS AND METHODS

We conducted a French retrospective multicenter study reviewing data from patients treated by ketoconazole as a single agent for CD, with the aim of clarifying efficacy and tolerance to better determine the benefit/risk balance.

RESULTS

Data from 200 patients were included in this study. At the last follow-up, 49.3% of patients had normal urinary free cortisol (UFC) levels, 25.6% had at least a 50% decrease, and 25.4% had unchanged UFC levels. The median final dose of ketoconazole was 600 mg/d. Forty patients (20%) received ketoconazole as a presurgical treatment; 40% to 50% of these patients showed improvement of hypertension, hypokalemia, and diabetes, and 48.7% had normal UFC before surgery. Overall, 41 patients (20.5%) stopped the treatment due to poor tolerance. Mild (<5N, inferior to 5-fold normal values) and major (>5N, superior to 5-fold normal values) increases in liver enzymes were observed in 13.5% and 2.5% of patients, respectively. No fatal hepatitis was observed.

CONCLUSIONS

Ketoconazole is an effective drug with acceptable side effects. It should be used under close liver enzyme monitoring. Hepatotoxicity is usually mild and resolves after drug withdrawal.

Smoking and health-related quality of life in the general population. Independent relationships and large differences according to patterns and quantity of smoking and to gender

Background

Relationships between smoking and health-related quality of life (HRQoL) in the general population remain unclear.

Objectives

To quantify the independent associations between smoking patterns and HRQoL and to identify any threshold or non-linear tendencies in these associations.

Methods

A national representative, cross-sectional household survey of the French general non institutionalized population included 7525 men and 8486 women, aged 25–64 year in 2003. Scores on the eight subscales of the Medical Outcomes Study 36-item Short Form were the primary outcomes. Linear regression analyses were used to evaluate the associations between HRQoL and smoking history, quantity of smoking and smoking cessation while controlling for various socio-economic variables, depression, alcohol dependence and pathological conditions. Analyses were conducted in 2013.

Results

Independent associations between smoking and HRQoL were found, including small positive associations for occasional or light smoking (up to 5 cigarettes per day), and larger and diffuse negative associations above this threshold. Much weaker associations and higher thresholds for negative HRQoL were found for women than for men. For ex-smokers of both genders, HRQoL was found to be better between 2 and 5 years after quitting.

Conclusions

Smoking was independently related to HRQoL, with large differences according to the pattern and quantity of smoking, and to gender. These results may have considerable relevance both for public health action and care of smokers.

Treatment of oxaliplatin-induced peripheral neuropathy by intravenous mangafodipir

BACKGROUND

The majority of patients receiving the platinum-based chemotherapy drug oxaliplatin develop peripheral neurotoxicity. Because this neurotoxicity involves ROS production, we investigated the efficacy of mangafodipir, a molecule that has antioxidant properties and is approved for use as an MRI contrast enhancer.

METHODS

The effects of mangafodipir were examined in mice following treatment with oxaliplatin. Neurotoxicity, axon myelination, and advanced oxidized protein products (AOPPs) were monitored. In addition, we enrolled 23 cancer patients with grade ≥ 2 oxaliplatin-induced neuropathy in a phase II study, with 22 patients receiving i.v. mangafodipir following oxaliplatin. Neuropathic effects were monitored for up to 8 cycles of oxaliplatin and mangafodipir.

RESULTS

Mangafodipir prevented motor and sensory dysfunction and demyelinating lesion formation. In mice, serum AOPPs decreased after 4 weeks of mangafodipir treatment. In 77% of patients treated with oxaliplatin and mangafodipir, neuropathy improved or stabilized after 4 cycles. After 8 cycles, neurotoxicity was downgraded to grade ≥ 2 in 6 of 7 patients. Prior to enrollment, patients received an average of 880 ± 239 mg/m2 oxaliplatin. Patients treated with mangafodipir tolerated an additional dose of 458 ± 207 mg/m2 oxaliplatin despite preexisting neuropathy. Mangafodipir responders managed a cumulative dose of 1,426 ± 204 mg/m2 oxaliplatin. Serum AOPPs were lower in responders compared with those in nonresponders.

CONCLUSION

Our study suggests that mangafodipir can prevent and/or relieve oxaliplatin-induced neuropathy in cancer patients. Trial registration. Clinicaltrials.gov NCT00727922. Funding. Université Paris Descartes, Ministère de la Recherche et de l'Enseignement Supérieur, and Assistance Publique-Hôpitaux de Paris.

Common SNPs of AmelogeninX (AMELX) and dental caries susceptibility

Genetic approaches have shown that several genes could modify caries susceptibility; AmelogeninX (AMELX) has been repeatedly designated. Here, we hypothesized that AMELX mutations resulting in discrete changes of enamel microstructure may be found in children with a severe caries phenotype. In parallel, possible AMELX mutations that could explain resistance to caries may be found in caries-free patients. In this study, coding exons of AMELX and exon-intron boundaries were sequenced in 399 individuals with extensive caries (250) or caries-free (149) individuals from nine French hospital groups. No mutation responsible for a direct change of amelogenin function was identified. Seven single-nucleotide polymorphisms (SNPs) were found, 3 presenting a high allele frequency, and 1 being detected for the first time. Three SNPs were located in coding regions, 2 of them being non-synonymous. Both evolutionary and statistical analyses showed that none of these SNPs was associated with caries susceptibility, suggesting that AMELX is not a gene candidate in our studied population.

Non response, incomplete and inconsistent responses to self-administered health-related quality of life measures in the general population: patterns, determinants and impact on the validity of estimates - a population-based study in France using the MOS SF-36

BACKGROUND

Health-related quality of life (HRQoL) measures are increasingly used in the general population. However, little is known about patterns and determinants of unanswered or unusable questionnaires and their consequences on estimates of HRQoL.

METHODS

The 2003 Decennial Health Survey collected socio-demographic and health information, including HRQoL, for 30,782 adults representative of the French population. The pattern, determinants and impact on estimate validity of non, incomplete and inconsistent responses to the SF-36 questionnaire were determined. For this, phi coefficients, polytomous logistic regression models and multiple imputation methods were used.

RESULTS

Only 48% of the subjects eligible for the HRQoL measurement provided a complete and consistent SF-36 questionnaire. Three patterns of non-response and five of partial (incomplete or inconsistent) response were identified, sharing largely similar socio-demographic profiles (higher age, lower educational level and economic status, foreign background, and isolated). The consequences of non and partial responses on HRQoL estimates were large in several groups of subjects although these biases ran in opposite directions and partially neutralized each other.

CONCLUSIONS

When measuring HRQoL in the general population, missing and inconsistent data are frequent, especially in elderly, educationally and socio-economically deprived, foreign and isolated groups. Methods for handling missing data are required to correct for potentially the associated and serious selection and non-differential information biases in studies targeting or investigating these groups.

Insulin-like growth factor-I and insulin-like growth factor binding protein-3 in Alzheimer's disease

CONTEXT

Few large studies have been conducted to assess the relationship between circulating IGF and late-life cognition.

OBJECTIVE

The aim of the study was to assess the relationship between IGF-I and IGF binding protein-3 (IGFBP-3) serum levels and cognitive impairment, including Alzheimer's disease (AD).

METHODS

In this multicentric cross-sectional study, 694 elderly subjects (218 men, 476 women; 78.6 ± 6.7 yr old) were included; 481 had memory complaints and were diagnosed, after comprehensive cognitive assessment, with AD (n = 224) or mild cognitive impairment (MCI) (n = 257). The control group was comprised of 213 subjects without memory complaint and with normal cognition (recruited among patients' caregivers). IGF-I and IGFBP-3 serum levels were determined by ELISA.

RESULTS

IGF-I and IGFBP-3 serum levels were significantly associated with cognitive status in men (IGF-I, 137 ± 69 ng/ml for AD vs. 178 ± 88 ng/ml for MCI and 172 ± 91 ng/ml for controls, P = 0.01; IGFBP-3, 3675 ± 1542 ng/ml for AD vs. 4143 ± 1828 ng/ml for MCI and 4488 ± 1893 ng/ml for controls, P = 0.04). In women, IGFBP-3 was significantly associated with cognitive status (3781 ± 1351 ng/ml for AD vs. 4190 ± 1408 ng/ml for MCI and 4390 ± 1552 ng/ml for controls; P < 0.001), but no significant differences between groups for IGF-I occurred. After adjustment for confounding variables (age, educational level, body mass index, diabetes, apolipoprotein E ε4 status), logistic regression indicated that IGF-I [odds ratio (95% confidence interval) = 0.48 (0.26-0.88)] and IGFBP-3 [odds ratio (95% confidence interval) = 0.71 (0.52-0.97)] serum levels were independently associated with AD in men, but not in women.

CONCLUSIONS

We report a significant association between low IGF-I and IGFBP-3 serum levels and AD in men, but not in women.

Exponential growth combined with exponential decline explains lifetime performance evolution in individual and human species

The physiological parameters characterizing human capacities (the ability to move, reproduce or perform tasks) evolve with ageing: performance is limited at birth, increases to a maximum and then decreases back to zero at the day of death. Physical and intellectual skills follow such a pattern. Here, we investigate the development of sport and chess performances during the lifetime at two different scales: the individual athletes' careers and the world record by age class in 25 Olympic sports events and in grandmaster chess players. For all data sets, a biphasic development of growth and decline is described by a simple model that accounts for 91.7% of the variance at the individual level and 98.5% of the variance at the species one. The age of performance peak is computed at 26.1 years old for the events studied (26.0 years old for track and field, 21.0 years old for swimming and 31.4 years old for chess). The two processes (growth and decline) are exponential and start at age zero. Both were previously demonstrated to happen in other human and non-human biological functions that evolve with age. They occur at the individual and species levels with a similar pattern, suggesting a scale invariance property.

Bacteremia and MR-proANP changes in mild community-acquired pneumonia

BACKGROUND

Mid-regional pro-atrial natriuretic peptide (MR-proANP) increases with severity in community-acquired pneumonia (CAP). We investigated whether changes of MR-proANP correlated to bacteremia.

METHODS

392 adult patients with CAP visiting emergency department from a prospective observational multicenter study.

RESULTS

MR-proANP levels increased in patients with positive bacteremia (92.8 pmol/L vs. 84.3 pmol/L, p = 0.04). Performance of MR-proANP to detect bacteremia (0.60) was equivalent to CRP (0.59) but less accurate than PCT (0.69).

CONCLUSION

MR-ANP poorly predicts bacteremia in CAP patients.

Success and decline: top 10 tennis players follow a biphasic course

INTRODUCTION

The victory percentages for tennis players who entered the top 10 women and men rankings show various evolutions related to age and time since 1968.

METHODS

The study analyzed the careers of all top 10 players: 97 women (50,933 matches) and 144 men (92,450 matches). For each player, we describe a biphasic performance course. Two generations were compared: the first one (G1), including players who started their professional career before 1985, and the second one (G2), with players starting after 1985.

RESULTS

The average career length is 16.1 ± 3.8 yr for the top 10 men and 15.8 ± 4.4 yr for women. Compared with G1 players, G2 players begin earlier (women = 1.3 yr, men = 0.8 yr), but career length remains the same. An exponential model describes the time course of the victory percentage with a great similarity for both genders. Using this equation, the peak victory rate reaches 82.5% at 21.5 yr for number 1 (no. 1) women and 78.5% at 23.7 yr for no. 1 men, showing a greater precocity and earlier decline in women. Finally, the area under the curve shows a potential that is 22.8% (men) to 56.8% (women) larger for the no. 1 players as compared with all other numbers 2-10.

CONCLUSIONS

Tennis players in the top 10 show a biphasic career. Women reach their highest level earlier than men, consistent with their more precocious biological development. For the current generation, the peak performance tends toward a younger age than the first generation. We show how to precisely quantify and compare tennis performances using indicators that follow the trends of development and aging and demonstrate that precocity does not provide a larger victory potential.

Is mid-regional pro-atrial natriuretic peptide (MRproANP) an accurate marker of bacteremia in pyelonephritis?

INTRODUCTION

Mid-regional pro-atrial natriuretic peptide (MRproANP) increases during systemic infections and could possibly correlate with bacteremia.

METHODS

We determined the characteristics of MRproANP for accuracy to detect positive blood culture.

RESULTS

Bacteremia was positive in 58 (15%) of 347 patients. MRproANP levels increased in patients with bacteremia (98.4 pmol/L [interquartile range (IQR) 68.2-153.1] vs. 66.4 pmol/L [IQR 51.0-90.3], p <0.01). Performance of MRproANP to predict bacteremia [AUC = 0.69, 95%CI: 0.61-0.77] was equivalent to C-reactive protein (0.66 [95%CI: 0.59-0.74], p = 0.53) but less accurate than procalcitonin (0.78 [95%CI: 0.72-0.84], p <0.001).

CONCLUSION

Although MRproANP increased in bacteremic patients with acute pyelonephritis, results of likelihood ratios discarded its use at bedside to predict bacteremia.

Mineral trioxyde aggregate versus calcium hydroxide in apexification of non vital immature teeth: study protocol for a randomized controlled trial

Background

Pulp necrosis is one of the main complications of dental trauma. When it happens on an immature tooth, pulp necrosis implies a lack of root maturation and apical closure. A therapy called apexification is required to induce the formation of a calcified apical barrier allowing a permanent and hermetic root filling. The aim of this prospective randomized clinical trial is to compare Mineral Trioxide Aggregate(MTA)with Calcium Hydroxide(CH)as materials used to induce root-end closure in necrotic permanent immature incisors.

Methods/Design

This study, promoted by AP-HP, was approved by the ethics committee(CPP Paris Ile de France IV). 34 children aged from 6 to 18 years and presenting a non-vital permanent incisor are selected. Prior to treatment, an appropriate written consent has to be obtained from both parents and from children. Patients are then randomly assigned to either the MTA(experimental)or CH(control)groups. Recalls are performed after 3, 6 and 12 months to determine the presence or absence of a calcified apical barrier through the use of clinical and radiographic exams. Additional criteria such as clinical symptoms, apical radiolucencies, periapical index(PAI)are also noted.

Trial registration

ClinicalTrials.gov no. NCT00472173 (First inclusion: May 10, 2007; Last inclusion: April 23, 2009; study completed: April 15, 2010)

Women and Men in Sport Performance: The Gender Gap has not Evolved since 1983

Sex is a major factor influencing best performances and world records. Here the evolution of the difference between men and women's best performances is characterized through the analysis of 82 quantifiable events since the beginning of the Olympic era. For each event in swimming, athletics, track cycling, weightlifting and speed skating the gender gap is fitted to compare male and female records. It is also studied through the best performance of the top 10 performers in each gender for swimming and athletics. A stabilization of the gender gap in world records is observed after 1983, at a mean difference of 10.0% ± 2.94 between men and women for all events. The gender gap ranges from 5.5% (800-m freestyle, swimming) to 18.8% (long jump). The mean gap is 10.7% for running performances, 17.5% for jumps, 8.9% for swimming races, 7.0% for speed skating and 8.7% in cycling. The top ten performers' analysis reveals a similar gender gap trend with a stabilization in 1982 at 11.7%, despite the large growth in participation of women from eastern and western countries, that coincided with later- published evidence of state-institutionalized or individual doping. These results suggest that women will not run, jump, swim or ride as fast as men. Key pointsSex is a major factor influencing best performances and world records.A stabilization of the gender gap in world records is observed after 1983, at a mean difference of 10.0% ± 2.94 between men and women for all events.The gender gap ranges from 5.5% (800-m freestyle, swimming) to 36.8% (weight lifting).The top ten performers' analysis reveals a similar gender gap trend with a stabilization in 1982 at 11.7%.Results suggest that women will not run, jump, swim or ride as fast as men.

Success in developing regions: world records evolution through a geopolitical prism

A previous analysis of World Records (WR) has revealed the potential limits of human physiology through athletes' personal commitment. The impact of political factors on sports has only been studied through Olympic medals and results. Here we studied 2876 WR from 63 nations in four summer disciplines. We propose three new indicators and show the impact of historical, geographical and economical factors on the regional WR evolution. The south-eastward path of weighted annual barycenter (i.e. the average of country coordinates weighting by the WR number) shows the emergence of East Africa and China in WR archives. Home WR ratio decreased from 79.9% before the second World War to 23.3% in 2008, underlining sports globalization. Annual Cumulative Proportions (ACP, i.e. the cumulative sum of the WR annual rate) highlight the regional rates of progression. For all regions, the mean slope of ACP during the Olympic era is 0.0101, with a maximum between 1950 and 1989 (0.0156). For European countries, this indicator reflects major historical events (slowdown for western countries after 1945, slowdown for eastern countries after 1990). Mean North-American ACP slope is 0.0029 over the century with an acceleration between 1950 and 1989 at 0.0046. Russia takes off in 1935 and slows down in 1988 (0.0038). For Eastern Europe, maximal progression is seen between 1970 and 1989 (0.0045). China starts in 1979 with a maximum between 1990 and 2008 (0.0021), while other regions have largely declined (mean ACP slope for all other countries  = 0.0011). A similar trend is observed for the evolution of the 10 best performers. The national analysis of WR reveals a precise and quantifiable link between the sport performances of a country, its historical or geopolitical context, and its steps of development.