Porites' coral calcifying fluid chemistry regulation under normal- and low-pH seawater conditions in Palau Archipelago: Impacts on growth properties

Ongoing ocean acidification is known to be a major threat to tropical coral reefs. To date, only few studies have evaluated the impacts of natural long-term exposure to low-pH seawater on the chemical regulation and growth of reef-building corals. This work investigated the different responses of the massive Porites coral living at normal (pHsw ~ 8.03) and naturally low-pH (pHsw ~ 7.85) seawater conditions at Palau over the last decades. Our results show that both Porites colonies maintained similar carbonate properties (pHcf, [CO32-]cf, DICcf, and Ωcf) within their calcifying fluid since 1972. However, the Porites skeleton of the more acidified conditions revealed a significantly lower density (~ 1.21 ± 0.09 g·cm-3) than the skeleton from the open-ocean site (~ 1.41 ± 0.07 g·cm-3). Overall, both Porites colonies exerted a strong biological control to maintain stable calcifying fluid carbonate chemistry that favored the calcification process, especially under low-pH conditions. However, the decline in skeletal density observed at low pH provides critical insights into Porites vulnerability to future global change.

Differences in carbonate chemistry up-regulation of long-lived reef-building corals

With climate projections questioning the future survival of stony corals and their dominance as tropical reef builders, it is critical to understand the adaptive capacity of corals to ongoing climate change. Biological mediation of the carbonate chemistry of the coral calcifying fluid is a fundamental component for assessing the response of corals to global threats. The Tara Pacific expedition (2016-2018) provided an opportunity to investigate calcification patterns in extant corals throughout the Pacific Ocean. Cores from colonies of the massive Porites and Diploastrea genera were collected from different environments to assess calcification parameters of long-lived reef-building corals. At the basin scale of the Pacific Ocean, we show that both genera systematically up-regulate their calcifying fluid pH and dissolved inorganic carbon to achieve efficient skeletal precipitation. However, while Porites corals increase the aragonite saturation state of the calcifying fluid (Ω_cf) at higher temperatures to enhance their calcification capacity, Diploastrea show a steady homeostatic Ω_cf across the Pacific temperature gradient. Thus, the extent to which Diploastrea responds to ocean warming and/or acidification is unclear, and it deserves further attention whether this is beneficial or detrimental to future survival of this coral genus.

Determining the geochemical fingerprint of the lead fallout from the Notre-Dame de Paris fire: Lessons for a better discrimination of chemical signatures

On 2019, the fire of Notre-Dame de Paris cathedral ("NDdP") spread an unknown amount of lead (Pb) dust from the roof of the cathedral over Paris. No data describing the geochemical fingerprint of the roof lead, as well as no particle collected during the fire, were available: a post-hoc sampling was performed. To discriminate the potential environmental impact of the fire from multiple Pb sources in Paris, it was mandatory to define unequivocally the fire dust geochemical signature. A dedicated and in hindsight geochemistry-based strategy was developed to eliminate any source of potential contamination due to sampling substrates or previously deposited dust. Radiogenic Pb isotopic signatures (²⁰⁶Pb/²⁰⁷Pb and ²⁰⁸Pb/²⁰⁶Pb ratios) and elemental ratios were determined in 23 Pb-rich samples collected inside NDdP. We determined that the dust collected on wood substrates on the first floor was most representative of fire emissions. These samples were the analyzed for the 4 Pb isotopes (204, 206, 207, 208) and the fire dust signature is characterized by ratio values of ²⁰⁶Pb/²⁰⁷Pb: 1.1669-1.1685, ²⁰⁸Pb/²⁰⁶Pb: 2.0981-2.1095, ²⁰⁸Pb/²⁰⁴Pb: 38.307-38.342, ²⁰⁷Pb/²⁰⁴Pb: 15.633-15.639 and ²⁰⁶Pb/²⁰⁴Pb: 18.242-18.275. In addition, the fire dust presents typical element-to-Pb ratio. This fingerprint was compared to the signatures of the known local Pb sources. The geochemical fingerprint of the fire is significantly different from that of the dominant urban Pb source. This will allow future evaluation of the contribution of the fire to Paris Pb pollution and of the real extent of the area affected by the Pb-containing dust plume. Moreover, the geographical origin of Pb used for the roof restauration and the spire building was identified. These findings open new ways to study the Pb sources in historical monuments for environmental impacts evaluation, as well as for historical perspectives.

Fate of antimony contamination generated by road traffic - A focus on Sb geochemistry and speciation in stormwater ponds

Although antimony (Sb) contamination has been documented in urban areas, knowledge gaps remain concerning the contributions of the different sources to the Sb urban biogeochemical cycle, including non-exhaust road traffic emissions, urban materials leaching/erosion and waste incineration. Additionally, details are lacking about Sb chemical forms involved in urban soils, sediments and water bodies. Here, with the aim to document the fate of metallic contaminants emitted through non-exhaust traffic emissions in urban aquatic systems, we studied trace element contamination, with a particular focus on Sb geochemistry, in three highway stormwater pond systems, standing as models of surface environments receiving road-water runoff. In all systems, differentiated on the basis of lead isotopic signatures, Sb shows the higher enrichment factor with respect to the geochemical background, up to 130, compared to other traffic-related inorganic contaminants (Co, Cr, Ni, Cu, Zn, Cd, Pb). Measurements of Sb isotopic composition (δ¹²³Sb) performed on solid samples, including air-exposed dusts and underwater sediments, show an average signature of 0.07 ± 0.05‰ (n = 25, all sites), close to the δ¹²³Sb value measured previously in certified reference material of road dust (BCR 723, δ¹²³Sb = 0.03 ± 0.05‰). Moreover, a fractionation of Sb isotopes is observed between solid and dissolved phases in one sample, which might result from Sb (bio)reduction and/or adsorption processes. SEM-EDXS investigations show the presence of discrete submicrometric particles concentrating Sb in all the systems, interpreted as friction residues of Sb-containing brake pads. Sb solid speciation determined by linear combination fitting of X-Ray Absorption Near Edge Structure (XANES) spectra at the Sb K-edge shows an important spatial variability in the ponds, with Sb chemical forms likely driven by local redox conditions: "dry" samples exposed to air exhibited contributions from Sb(V)-O (52% to 100%) and Sb(III)-O (<10% to 48%) species whereas only underwater samples, representative of suboxic/anoxic conditions, showed an additional contribution from Sb(III)-S (41% to 80%) species. Altogether, these results confirm the traffic emission as a specific source of Sb emission in surface environments. The spatial variations of Sb speciation observed along the road-to-pond continuum likely reflect a high geochemical reactivity, which could have important implications on Sb transfer properties in (sub)surface hydrosystems.

Design of a prospective, longitudinal cohort of people living with type 1 diabetes exploring factors associated with the residual cardiovascular risk and other diabetes-related complications: The SFDT1 study

Type 1 diabetes mellitus (T1DM) is associated with a high risk of cardiovascular (CV) complications, even after controlling for traditional CV risk factors. Therefore, determinants of the residual increased CV morbidity and mortality remain to be discovered. This prospective cohort of people living with T1DM in France (SFDT1) will include adults and children aged over six years living with T1DM, recruited throughout metropolitan France and overseas French departments and territories. The primary objective is to better understand the parameters associated with CV complications in T1DM. Clinical data and biobank samples will be collected during routine visits every three years. Data from connected tools, including continuous glucose monitoring, will be available during the 10-year active follow-up. Patient-reported outcomes, psychological and socioeconomic information will also be collected either at visits or through web questionnaires accessible via the internet. Additionally, access to the national health data system (Health Data Hub) will provide information on healthcare and a passive 20-year medico-administrative follow-up. Using Health Data Hub, SFDT1 participants will be compared to non-diabetic individuals matched on age, gender, and residency area. The cohort is sponsored by the French-speaking Foundation for Diabetes Research (FFRD) and aims to include 15,000 participants.

Evolution in geriatric syndromes and association with survival over 5 years in the GERODIAB cohort of older French diabetic patients

PURPOSE

Although one in three patients with diabetes in Western countries is over 70 years-old, geriatric syndromes and their relationship with survival remain seldom studied. The present aim of the GERODIAB study was to examine the evolution of geriatric disorders and their relationship with survival in older type 2 patients with diabetes with initial sufficient autonomy.

METHODS

We performed a prospective, observational study over 5 years in patients with diabetes aged 70 years or above. A total of 987 consecutive type 2 patients with diabetes (mean age 77 years, range 70-94 years, 65.2% were 75 years and above, 52.1% women) were included from 56 French diabetic centres. Individual characteristics, diabetes parameters and geriatric parameters (autonomy, nutrition, cognitive alteration, depression, orthostatic hypotension, falls) were annually recorded. Survival was analysed using the Kaplan-Meier method and proportional hazards regression models.

RESULTS

Institutional living, impaired activity and difficulties in instrumental daily activity, cognitive disorders, malnutrition, depression, orthostatic hypotension and hypoglycaemia strongly increased during the follow-up. Institutional living, impaired activity and difficulties in instrumental daily activity, cognitive disorders and hypoglycaemia were strongly associated with reduced survival, but not falls. In hazard ratio models, living in an institution (HR = 2.39; CI = 1.77-3.24; p < 0.0001) and impaired Activity of Daily Living scale score were the most significant and independent predictors of death (HR = 1.59; CI = 1.19-2.13; p = 0.0016), associated with HbA1c ≥ 70 mmol/mol (HR = 1.62; CI = 1.12-2.36; p = 0.011).

CONCLUSION

Our findings show the considerable alteration of geriatric parameters and their relationship with decreased survival after a 5-year follow-up in type 2 patients with diabetes, independent of HbA1c and age. They, therefore, confirm the prognostic interest of using yearly geriatric markers in older diabetic patient management, especially the ADL, IADL and MMSE scales. Taking into account these prognostic parameters should contribute to target appropriate HbA1c goals.

TRIAL REGISTRATION

Registered at clinicaltrials.gov (21/01/2011): NCT01282060.

Tracing the sources of suspended sediment and particle-bound trace metal elements in an urban catchment coupling elemental and isotopic geochemistry, and fallout radionuclides

The excessive supply of contaminants from urban areas to rivers during the last centuries has led to deleterious impacts on aquatic ecosystems. The sources, the behavior, and the dynamics of these contaminants must be better understood in order to reduce this excessive anthropogenic pollution. Accordingly, the current research investigated the particle-bound trace element (TE) contamination of the 900-km2 Orge River (Seine basin, France) and the potential sources of these particles (agricultural or forest soils, channel banks, road deposited sediments), through the analysis of multiple fallout radionuclides, elemental geochemistry, and lead isotopic composition on suspended particulate matter (SPM) collected during a hydrological year at four stations following an increasing urbanization gradient (300 to 5000 inhab.km-2). Fallout radionuclide measurements showed an increasing contribution of recently eroded particles from urban areas to the SPM in downstream direction. However, this contribution varied depending on hydrological conditions. A greater contribution of particles originating from urban areas was observed during low stage periods. On the contrary, the contribution of agricultural soils and channel banks that are less enriched in contaminants and fallout radionuclides was higher during seasonal floods, which explained the dilution of radionuclide contents in sediment transiting the river during those events. Trace element contamination of SPM in Cu, Zn, Pb, and Sb increased from moderate to significant levels with urban pressure in downstream direction (with corresponding enrichment factors raising from 2 to 6). In addition, Pb isotopic ratios indicated that the main source of Pb corresponded to the "urban" signature found in road deposited sediments. The low variations in lead isotope ratios found in the SPM for contrasting hydrological conditions demonstrated the occurrence of a single source of Pb contamination. These results demonstrate the need to better manage urban runoff during both flood and low precipitation events to prevent the supply of diffuse particle-bound contamination to rivers draining urban areas.

Contamination of soils by metals and organic micropollutants: case study of the Parisian conurbation

Soils are playing a central role in the transfer and accumulation of anthropogenic pollutants in urbanized regions. Hence, this study aimed at examining the contamination levels of selected soils collected within and around the Paris conurbation (France). This also evaluated factors controlling contamination. Twenty-three trace and major elements as well as 82 organic micropollutants including polycyclic aromatic hydrocarbons (PAHs), polychlorinated biphenyls (PCBs), phthalates (PAEs), polybrominated diphenyl ethers (PBDEs), alkylphenols (APs), and perfluoroalkylated substances (PFASs) were analyzed. Results reinforced the concern raised by the occurrence and levels of metals such as Zn, Pb, Cu, and Hg, identified as metallic markers of anthropogenic activities, but also pointed out the ubiquitous contamination of soils by organic micropollutants in the 0.2-55,000-μg/kg dw range. For well-documented compounds like PAHs, PCBs, and to a lesser extent PBDEs, contents were in the range of background levels worldwide. The pollutant stock in tested soil was compared to the annual atmospheric input. For PAHs; Pb; and to a lesser extent Zn, Cu, Cd, Hg, Sb, PAEs, and APs, a significant stock was observed, far more important than the recent annual atmospheric fluxes. This resulted from both (i) the persistence of a fraction of pollutants in surface soils and (ii) the cumulative atmospheric inputs over several decades. Regarding PBDEs and PFASs, stronger atmospheric input contributions were observed, thereby highlighting their recent dispersal into the environment.

Metal exposure in cows grazing pasture contaminated by iron industry: Insights from magnetic particles used as tracers

Magnetic particles (MP) emitted by an iron smelter were used to investigate the exposure of cows grazing on a grassland polluted by these MP and by large amounts of potentially toxic elements (PTE). The morphology as well as the chemical composition of the MP separated from cow dung were studied. Large amounts of typical MP were found (1.1 g kg(-1) dry weight) in the cow dung sampled from the exposed site, whereas these particles were absent from the reference unpolluted site. The ingested MP were mainly technogenic magnetic particles (TMP) emitted by the smelter. Considering the MP concentration in the grazed grass on the exposed site, it was concluded that cows absorb the MP not only from the grass but also from the soil surface. The results of a mild acidic leaching of the MP suggested that the particles were possibly submitted to a superficial dissolution in the abomasum, pointing at a potential route of transfer of the PTE originating from the TMP and leading into food chains. TMP were only a small part of the anthropogenic contamination having affected the soil and the dung. However, due to their unequivocal signature, TMP are a powerful tracer of the distribution of PTE in the different compartments constituting the food chains and the ecosystems. Furthermore, the measurement of the particle sizes gave evidence that a noticeable proportion of the MP could enter the respiratory tract.

Three centuries of heavy metal pollution in Paris (France) recorded by urban speleothems

The first record of urban speleothems used to reconstruct the history of heavy metal pollution of shallow groundwaters is presented. Two speleothems grew during the last 300 years in an underground aqueduct in the north-eastern part of Paris. They display high Pb, Mn V, Cu, Cd and Al concentrations since 1900 due to the urbanization of the site which triggered anthropogenic contamination of the water feeding the speleothems. Surprisingly, these heavy metal concentrations are also high in the oldest part. This early pollution could come from the use of Parisian waste as fertilizers in the orchards and vineyards cultivated above the aqueduct before urbanization. Lead isotopes were measured in these carbonates as well as in lead artifacts from the 17th-18th centuries ((206)Pb/(207)Pb=1.180+/-0.003). The mean (206)Pb/(207)Pb ratio, for one of the speleothems is 1.181+/-0.003 unvarying with time. These lead signatures are close to those of coal and old lead from northern European mines, lower than the natural background signature. It confirms that the high metal concentrations found come from anthropogenic pollution. Conversely, the lead isotopic composition of the second speleothem presents two temporal trends: for the oldest levels, the mean value (1.183+/-0.003) is similar to the first speleothem. For the youngest part, a lower value (1.172+/-0.005) is recorded, evidencing the contribution of a new lead source at the beginning of the industrial revolution. Pb isotopes were also measured in recent samples from a nearby superficial site. The first sample is a recent (AD 1975+/-15 years) deposit ((206)Pb/(207)Pb=1.148+/-0.003), and the second, a thin subactual layer ((206)Pb/(207)Pb=1.181+/-0.002). These data are compatible with the adding of anthropogenic sources (leaded gasoline and industrial lead from Rio Tinto ore).

Update on cognitive decline and dementia in elderly patients with diabetes

AIM

This article is an update of the relationship between type 2 diabetes (T2D), cognitive dysfunction and dementia in older people.

METHODS AND RESULTS

The number of older patients consulting for diabetes who also exhibit cognitive difficulties is consistently growing because of the increased longevity of the population as a whole and, according to a number of studies, the increased risk of cognitive impairment and dementia in older diabetic patients. Many studies have demonstrated a link between poor glucose control and deteriorated cognitive function in diabetic patients. A history of severe hypoglycaemic episodes has also been associated with a greater risk of late-in-life cognitive deficits and dementia in patients with T2D. Several processes are thought to promote cognitive decline and dementia in diabetics. Based on both clinical and non-clinical findings, the factors most likely to alter brain function and structure are cerebrovascular complications of diabetes, alterations in glucose and insulin, and recurrent hypoglycaemia. Together with other diabetes complications, cognitive deficits contribute to functional impairment, increased frequency of depression-related symptoms, greater incidence of recurrent hypoglycaemia, poorer adherence to treatment and, finally, poorer prognosis, as evidenced by recent longitudinal studies.

CONCLUSION

Clinical guidelines have recently been devised for older diabetic patients, particularly those with cognitive deficits and a reduced capacity to self-manage. In the most vulnerable patients, specific treatment strategies have been proposed for glycaemic control to limit metabolic decompensation and avoid the risk of hypoglycaemia. Educational measures, provided mainly to maintain patient autonomy and avoid hospital admission, have also been adapted according to patients' cognitive and functional status.

Isolation of technogenic magnetic particles

Technogenic magnetic particles (TMPs) emitted by various industrial sources, such as smelting plants, end up after atmospheric transfer on the soil surface. In the present study, we characterised the origin and composition of such particles emitted by a large iron smelting plant and deposited on particular substrates, namely tombstones, which act as a very interesting and appropriate matrix when compared to soil, tree bark, lichens or attic dust. The isolation and subsequent description of TMPs require a critical step of separation between different components of the sample and the magnetic particles; here, we described an efficient protocol that fulfils such a requirement: it resorts to water suspension, sonication, repeated magnetic extraction, sedimentation, sieving and organic matter destruction at 550 °C in some instances. The isolated TMPs displayed a noticeable crystalline shape with variable compositions: a) pure iron oxides, b) iron+Cr, Ni or Zn, and c) a complex structure containing Ca, Si, Mg, and Mn. Using Scanning Electron Microscope Energy Dispersive X-ray (SEM-EDX), we obtained profiles of various and distinct magnetic particles, which allowed us to identify the source of the TMPs.

Hypoglycaemia and dementia in diabetic patients

Diabetes and dementia, which have a complex relationship between them, are undergoing extensive growth in their fields. The occurrence of hypoglycaemia, the potential severity of which has just been pointed out in some recent studies, must be included in these relationships. In fact, diabetes is the cause of decline in cognitive functions and most certainly is involved in the occurrence of vascular dementia. The brain, which is highly dependent on glucose for its metabolism, is particularly vulnerable to hypoglycaemia in children and the elderly. Animal studies and pathoanatomical observations confirm the clinical impression of the reality of genuine post-hypoglycaemic encephalopathy. The impact of mild hypoglycaemia however is being debated. Lastly, the existence of dementia promotes the occurrence of hypoglycaemia due to disorders related to eating habits or poor treatment management. This hypoglycaemic risk however must not constitute a pretext for exaggerated laxity in achieving the blood glucose objectives.

Diabetes and inflammation: fundamental aspects and clinical implications

AIM

The aim of this paper is to provide the fundamental background of the inflammation theory associated with type 2 diabetes, to discuss the clinical consequences of low-grade inflammation, particularly in terms of cardiovascular risk, and to infer some clinical therapeutic strategies deriving from drugs that already exist or are in development.

METHODS

This non-exhaustive work is the result of a Pubmed(®) research, based on requests including the following keywords: diabetes, inflammation, innate immunity, obesity, reticulum endoplasmic stress, cytokines, endothelial dysfunction.

RESULTS

Obesity and type 2 diabetes are linked with a low-grade inflammation state that reflects the activation of innate immunity where metabolic, environmental and genetic factors are implicated. The role of endoplasmic reticulum stress and unfold protein response is underlined. Inflammation markers are predictive for the risk to develop diabetes, and are associated with an increased cardiovascular risk. While lifestyle modifications are followed by an improvement in inflammation markers, treatments inferred from the inflammation theory are of great interest, although quite moderate effects on glycaemic control have been observed with some of them.

CONCLUSION

The development of molecules targeting different inflammatory mechanisms could lead in diabetic patients to improvement of both glycaemia and cardiovascular prognosis.

[Thyroid metastasis of kidney cancer]

Thyroid metastasis of solid tumors is rare and often asymptomatic. Differential diagnosis with malignant thyroid tumor is difficult. We report a 65-year-old man who presented with a solitary intrathoracic thyroid nodule of the left lobe, inaccessible to fine needle biopsy. His past medical history was remarkable for a nephrectomy for a kidney clear cell carcinoma one year before. The PET-scan did not show any abnormal fixation. A left lobo-isthmectomy was performed. Histologic examination revealed an intrathyroid metastasis of kidney carcinoma.

[Hyperparathyroidism during pregnancy: dangerous association for the mother and her infant]

Hypercalcaemia during pregnancy is rare but requires a systematic approach for its diagnosis and its treatment. We report a 32-year-old pregnant female at 32 weeks of gestation who presented a severe hypercalcaemia, due to primary hyperparathyroidism. The delivery allowed the birth of a healthy child who had a serum calcium level in the normal range. Eight days later, the mother was operated from a parathyroid adenoma allowing normalisation of calcaemia. Hyperparathyroidism during pregnancy is rarely reported; it can lead to severe complications for both the mother and the infant. The newborn can present tetania due to hypocalcaemia and hypoparathyroidism can be definitive. Surgery should be discussed when serum calcium level of the mother is markedly elevated.

[Type 2 diabetes mellitus associated with pancreatic and renal malformations]

A 55-year-old woman presented with a recent diabetes mellitus associated with pancreatic and renal malformations. This atypical diabetes raised the possibility of maturity onset diabetes of the young (MODY) and a genetic research was performed. These malformations led to MODY5 diagnosis that was confirmed by the presence of HNF1beta gene mutation.

[Ofloxacin is contraindicated in case of G6PD deficiency: is it evidenced based?]

G6PD deficiency is very frequent with almost 400 millions of patients worldwide in Asia, Africa and Mediterranean. G6PD deficiency is involved in mild or severe haemolysis and the precipitating factor is usually a drug. More than 100 drugs have been implicated and fluoroquinolones are one of the more classic. However, the literature review shows that only a few observations have been clearly documented.

Prise en charge du syndrome de Nelson: données actuelles

PURPOSE

Nelson's syndrome is a severe complication of bilateral adrenalectomy performed in the treatment of some Cushing's diseases, and its management remains difficult. Trough the observation of a patient suffering from a severe form of Nelson's syndrome for more than 10 years, the authors review the literature and discuss the main current therapeutic possibilities.

CURRENT KNOWLEDGE AND KEY POINTS

Many molecules have been used with variable results. In our observation cabergoline at 2 mg per week seems to be efficient after a 3 and a half years follow-up, in accordance with some recent publications. More than bromocriptine, this dopamine agonist provides interesting prospects for this disease's management. Moreover, if the conventional treatments as valproic acid or cyproheptadine are not very efficient, somatostatin analogs seem to be of some therapeutic interest.

FUTURE PROSPECTS AND PROJECTS

New molecules are currently evaluated, but studies are difficult to conduct because of the low disease prevalence. Tumour receptors analysis undoubtedly constitutes an attractive way to find new therapeutic targets.

[Role of nocturnal blood pressure in the onset of diabetic nephropathy]

The aim of this study was to assess the responsibility of night-time blood pressure in the onset of nephropathy in diabetic patients.

PATIENTS AND METHODS

This study included 98 diabetic patients (mean age: 54 +/- 15 years, diabetes duration: 15 +/- 10 years). An evaluation of diabetes and a 24-h ambulatory blood pressure were performed at the initial evaluation (Y0) and about five years later (Y5). At Y0, all patients had normal urinary albumin excretion (UAE) (<30 mg/24h). They were separated into two groups according to urinary albumin excretion at Y5: group (N +): UAE>30 mg/24h and group (N-): UAE<30 mg/24h. Twenty four hours ambulatory blood pressure, clinical and biological parameters recorded at Y0 were compared in both.

RESULTS

At Y5, there was 18 patients in group (N +) and 78 in group (N-). Patients of group (N +) were older than those of group (N-): 62.9 +/- 9.5 vs. 52.6 +/- 15.7 years, p<0.01, and their BMI was higher (28 +/- 5 vs. 25 +/- 4 kg/m2, p<0.03). Diabetes duration and Hb A1c levels did not differ from significant manner in both. At Y0, UAE was significantly higher in group (N +) than in group (N-): 13 +/- 7 vs. 8 +/- 6 mg/24h, p<0.01. At the initial evaluation, daytime systolic and diastolic blood pressures did not differ from significant manner in both. Systolic and diastolic BP night-time were higher in diabetic patients who developed microalbuminuria (SBP: 122 +/- 19 vs. 113 +/- 13 mmHg, p<0.05 and DBP: 70 +/- 6 vs. 65 +/- 10 mmHg, p<0.03). UAE collected at Y5 was correlated to night-time BP recorded at Y0 (SBP: r=0.381, p=0.001 and PAD: r=0.294, p=0.004) and night-time systolic BP explained 12.3% of the UAE variance. Progression of UAE between the two evaluations was found to be correlated to the night-time systolic BP recorded at Y0 (r=0.335, p=0.0008) and night-time systolic BP explained 11.7% of the progression variance. There was a negative correlation between UAE at A5 and the difference between daytime and night-time BP recorded during the same evaluation (r=- 0.230, p=0.024 with SBP and r=- 0.243, p=0.017 with DBP).

CONCLUSION

The results underlign the resposability of night-time blood pressure, and more especially of nighttime systolic blood pressure, for the onset of nephropathy in diabetic patients.

[Hypertension and acromegaly in the elderly: French Registry Data]

Multi centre registries such as the French Acromegaly Registry created in 1999 provide data on rare disorders that are otherwise difficult to obtain. This study focuses on the characteristics of high blood pressure in people aged of over 70 years old.

PATIENTS AND METHODS

The data were obtained from the thirty centres where patients had been recorded on the Acromegaly Registry since 1999.

RESULTS

The Register listed a total of 644 patients with acromegaly at January 1st 2005, of whom 68 (22 men and 46 women) were aged over 70 years old (10.6%). Their mean age was 76.8 +/- 5 years (range 70 - 95) and they had been presenting acromegaly for 11 +/- 6 years (compared to 7 years in those aged less than 70). Their BMI were 27.9 +/- 4 kg/m2 for men, 27.7 +/- 4 for women (respectively 28.4 +/- 4.3 and 26.7 +/- 4.4 in those aged less than 70 years). Hypertension was particularly frequent in this population, reaching 80% vs. 27% under 70 years (p=0.0001). Prevalence was then higher than in general population (referring to FLAHS study). Mean blood pressure was 143 +/- 12 / 84 +/- 15 mmHg for men and 141 +/- 17 / 79 +/- 9 for women. 46% of men and 30% of women treated or not, had blood pressure over 140 / 90 mmHg. Data showed 12% of arrhythmic cardiopathy, 8% of cardiac insufficiency, 12% of ischemic cardiopathy and 12% of patients suffering from arteritis or stroke. Although various therapeutic strategies had been applied for young and elderly patients, 51% in each group were in remission one year after inclusion.

DISCUSSION

More than 10% of patients are aged over 70 years in the French Acromegaly Registry and hypertension is very frequently observed in this population. The increasing life expectancy due to currently available treatments justifies a strict management of patients in order to reduce cardiovascular risks, which stay the main cause of morbidity and mortality.

[Recommendations of the French National Health Authority for management of high blood pressure in clinical practice]

The new recommendations of the French national authority for health (or Haute Autorité de Santé: HAS) concerning management of high blood pressure (HBP) deserve to be compared with real clinical practices in a large population.

MATERIAL AND METHODS

[corrected] EPIMIL is a prospective epidemiological study designed to assess the prevalence of the metabolic syndrome and the risk factors in a 2045 French male military personnel coming from Paris area. The different recommendations of the HAS have been applied to these subjects, and the aim of this work is to compare these theoretical objectives to what is done in real practice.

RESULTS

Among these 2045 subjects aged of mean 38,6 +/- 8,8 years, 78 (4%) are known and treated for HPB. Although half of them present more than two associated risk factors, the means of systolic blood pressure and diastolic blood pressure stay at high levels. The blood pressure (BP) targets established at 140/90 mmHg are only reached by 33 patients (42%). Among the 1967 subjects considered to have normal BP, the BP considered as optimal (120/80 mmHg) is only found in 695 subjects (35.3%) and 428 (21.7%) do present ignored or neglected HBP, in spite of the presence of important associated risk factors. Then, the cardiovascular risk stratification into levels, as recommended by the HAS, shows that for these subjects considered to have normal BP, risk is finally low for 6%, moderate for 12%, and high for 3.5%.

COMMENTS

In a selected and in theory regularly followed population, the recommendations of the HAS are insufficiently applied, as well for detection or treatment of HBP. Then, information of both medical personnel and also the interested parties should be necessary, in order to see these recommendations applied in real practice.

[Modifications of 24-h blood pressure profile associated with reduction of the heart rate variability in type 1 diabetic patients]

The purpose of this study was to assess the blood pressure modifications in type 1 diabetic patients who present reduction of heart rate variability.

PATIENTS AND METHODS

This study included 70 type 1 diabetic patients (mean age: 42 +/- 13 years, diabetes duration: 13.2 +/- 9 years. They were free for complications and did not receive other treatment than insulin. Heart rate variability was evaluated using 24-h continuous ECG record spectral analysis. Patients were divided into two groups according to whether log high frequency power was lower (group 1, N=36) or higher (group 2, N=3 4) than 70 patients'mean. Clinical and biological features and 24-h ambulatory blood pressure measurement were compared in both groups.

RESULTS

Patients of group 1 were older than group 2 (47.8 +/- 11.2 vs. 35.7 +/- 12.2 years, p<0.0001) and diabetes duration was higher (16.9 +/- 8.4 vs. 9.4 +/- 8 years, p<0.001). BMI and Hb A1c did not differ from significant in both. Night-time blood pressure was upper in group 1 (SBP: 112 +/- 13 vs. 103 +/- 11 mmHg, p<0.01 and DBP: 66 +/- 8 vs. 60 +/- 7 mmHg, p<0.001). The difference between blood pressures during day and night (DeltaBP) were lower in group 1 than in group 2 (DeltaSBP: 10 +/- 9 vs. 15 +/- 7 mmHg, p<0.02 and DeltaDeltaBP: 9 +/- 7 vs. 12 +/- 5 mmHg, p<0.04). DSBP and DDBP were found to be correlated with log HF power (r=0.356, p<0.003), which could explain 11.8% and 12% of their variance. Urinary albumin excretion rate was higher in group 1 (8 +/- 4 vs. 5 +/- 3 mg/24h, p<0.01).

CONCLUSION

In type 1 diabetic patients free for complications, reduction in heart rate variability linked to age and diabetes duration is associated with a reduction in nighttime BP fall. These two parameters of autonomic neuropathy could have a pathogenic role in the development of incipient nephropathy.

Should we have more definitions of metabolic syndrome or simply take waist measurement?

The disorder now known as metabolic syndrome has been recognized for 50 years, but its multiple definitions have led to some confusion and even doubt about its very nature. Metabolic syndrome is directly linked to the presence of android obesity, which indicates insulin resistance and lies at the root of all risk factors and early indications of type 2 diabetes. It is diagnosed by systematic measurements of waist size and its direct interpretation taking ethnic origin into account. This pragmatic approach avoids the uncertainties generated by differing definitions and is subtler than the presence or absence of metabolic syndrome in a given patient. Drug-free treatment of an android obese patient is inexpensive and effective, but this apparently simple approach masks difficulties of application. However, these are sociological problems.

[Silent thyroiditis in a patient under lithium therapy]

While hypothyroidism secondary to treatments by lithium are well known, cases of hyperthyroidism are less common. A 48 years old patient under lithium carbonate from about 10 years ago presents hyperthyroidism without any auto-immunity biological markers, associated with a very low thyroid tracer uptake on scintigraphy. Treatments by anti thyroid agents will be necessary during months in order to normalize the hormone level, whereas lithium is maintained. Only few tens of cases of hyperthyroidism related to lithium have been reported in the literature. This observation shows the importance of the thyroid hormonal follow up for patients under lithium, in order to treat them before the outbreak of a thyroid dysfunction. The causal toxic mechanism is still unclear, and may be related with a direct damage of lithium to follicular cells.

[Influence of blood pressure level on urinary albumin excretion rate and erythropoietin production in diabetic patients]

The purpose of this study was to investigate blood pressure variations during diabetic incipient nephropathy and to evaluate theirs consequences for erythropoietin (EPO) production.

PATIENTS AND METHODS

This study included 94 diabetic patients (mean age: 59.9 +/- 15.3 years, diabetes duration: 13.8 +/- 15.3 years). Patients were divided in two groups according to urinary albumin excretion rate (UAE): group 1: UAE <30 mg/24 hrs, N=64 and group 2: 30<UAE <300 mg/24 hrs; N=30 EPO levels and 24 hrs ABPM where compared between these two groups.

RESULTS

patients' age and BMI, diabetes duration and Hb A1c levels, blood pressure and creatinine clairance did not differ from significant manner between the two groups. 24 hrs BP and daytime BP did not differ according to UAE rate. Night-time BP was significantly higher in group 2 than in group 1 (SBP: 126 +/- 17 vs. 118 +/- 15 mmHg, p<0.04 and DBP: 71 +/- 10 vs. 67 +/- 8 mmHg, p < 0.02). UAE was positively correlated nigh-time BP (r = 0.263, p = 0.01 for SBP and r = 0.273, p = 0.008 for DBP) and negatively with the difference between daytime and night-time SBP (delta SBP) (r = -0.205, p < 0.05). Hemoglobin levels did not differ significantly between the two groups. EPO levels of group 2 were significantly lower than those of group 1 (15.1 +/- 5.6 vs. 17.7 +/- 6.2 mU/ml, p < 0.05). A negative correlation between UAE and EPO was found (r = -0.266, p < 0.01). UAE and delta SBP explained 12.2% of EPO variance.

CONCLUSION

in diabetic patients, elevation of night-time BP and reduction in nightime BP fall participate to the installation of incipient nephropathy. A significant decrease in EPO production is noted in the same time.

[Pasteurella dagmatis spondylodiscitis in a diabetic patient]

INTRODUCTION

Healthy pets contact are able to induce unusual and severe diseases.

CLINICAL CASE

This case reports the medical history of a dorsal spondylodiscitis in a diabetic patient admitted for a chronic wound of his toes. He had a long-standing history of regular consumption of alcohol and tobacco. Blood bottles and biopsy of intervertebral disc infected discovered Pasteurella dagmatis, commonly colonizing the oropharynx of healthy dogs and cats. In this case, licking of his injured toe by his dog was the likely source of entry of the organism.

DISCUSSION

We found no identical cases in the medical literature. Diabetes mellitus and other immunocompromised disorders justify to change behaviours toward domestic animals.

Diagnostic d’un syndrome de Klinefelter trois ans après chirurgie d’exérèse d’un tératome médiastinal

INTRODUCTION

The association between some types of tumor and Klinefelter's syndrome (KS) is often missed and diagnosis of the latter delayed, as in this case report.

CASE

We present the case of a 20 year-old patient for whom KS was not diagnosed until three years after thoracic surgery for a mediastinal teratoma.

DISCUSSION

The association between KS and mediastinal germ-cell tumors is not coincidental; it illustrates the relation between aneuploidy and oncogenesis. In a young adult male, palpation of the scrotum to look for microorchidism is justified when these tumors are diagnosed because 25% occur in patients with KS.

Epidemiology of the metabolic syndrome in 2045 French military personnel (EPIMIL study)

CONTEXT

The Metabolic syndrome is considered to be an important public health problem, but few epidemiological studies have defined the present situation in France. EPIMIL is a prospective epidemiological study that began on February 1, 2003.

SUBJECTS AND METHODS

This study was designed to identify the clinical and laboratory parameters of metabolic syndrome and cardiovascular risk factors in a population of 2045 male military personnel based in the Paris region. The initial 1-year cross-sectional study will be followed by a 10-year follow-up and patient care.

RESULTS

The 2045 subjects included 185 (9%) presented at least 3 of the 5 NCEP ATP III criteria defining metabolic syndrome. They were significantly older (42.2 +/- 8.5 yrs) than the other subjects (37.3 +/- 8.7 yrs, P<0.001), had a higher BMI (29.5 +/- 3.4 vs 24.8 +/- 2.9 kg/m2, P<0.001) and a greater body weight at age 20 (75.4 +/- 11 vs 70.4 +/- 8.5 kg, P<0.01). Smoking, little physical activity and family histories of diabetes and arterial hypertension were more frequent in these men. While levels of the cholesterol and CRP us were higher, Lp(a) and homocysteine concentrations were normal. Plasma insulin and BMI (r = 0.456 P<0.0001) and plasma insulin and waist circumference (r = 0.446 P<0.0001) were well correlated. Lastly, plasma insulin, free fatty acids and cardiovascular risk increased steadily with the increase in the number of metabolic syndrome criteria.

CONCLUSIONS

These results in a large and particularly uniform population of men show the prevalence of metabolic syndrome in adult men, and demonstrate its link with insulin resistance. Men with several risk factors require specific care, particularly for hypertension and dyslipidemia; the effectiveness of this care will be evaluated during the follow-up period.

L'hyperhomocystéinémie est-elle un facteur de risque supplémentaire du syndrome métabolique ?

INTRODUCTION

Metabolic syndrome is a cardiovascular risk factors cluster and hyperhomocysteinemia an obvious independant risk factor.

OBJECTIVE

To ascertain if hyperhomocysteinemia is associated with the metabolic syndrome.

METHODS

"Epimil" is a prospective epidemiologic survey, which began by a cross-sectionnal study of cardiovascular risk factors in a French population, which then will be followed for ten years for supervision and intervention. Initial data collection, blood pressure measurement, ECG and blood samples (biology and DNA) have been performed. For the metabolic syndrome, we used the criterias of the third report of the national cholesterol education program expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (NCEP ATP III).

RESULTS

Out of 2045 men aged from 20 to 58 years (37.7+/-8.7 years), 185 (9%) have metabolic syndrome (at least three criterias), 587 (29%) a blood homocysteine>or=12 micromol/L and 202 (10%)>or=15 micromol/L. Homocysteinemia is 10.97+/-5.01 micromol/L for the whole population and doesn't differ with (11.4+/-6 micromol/L) or without (10.9+/-5 micromol/L) the metabolic syndrome, as does its values distribution. It's not correlate with the body mass index, waist and hip measurements, nor with glycemia, HbA1c, insulin resistance and cardiovascular risk markers (CRPus, microalbuminuria). It weakly correlates with systolic and diastolic blood pressure, creatinine clearance, tobacco use, cholesterolemia, triglycerides and free fatty acids but not with HDL and LDL fractions, nor lipoprotein (a). Among this population, it slightly contributes to the ten years vascular risk evaluated according to Framingham equations or Score system.

CONCLUSIONS

Homocysteinemia and the prevalence of hyperhomocysteinemia don't differ with or without the metabolic syndrome and doesn't correlate its main criterias.

Tumeur intracanalaire papillaire mucineuse du pancréas révélée par une pancréatite aiguë et un diabète

INTRODUCTION

Imaging of the pancreas soon after diagnosis of diabetes can help screen for tumors.

CASE

A 45 year-old man with recently diagnosed insulin-dependent diabetes and no other notable history was found to have intraductal papillary mucinous tumour of the pancreas (IPMTP), a month after an unexplained and benign acute pancreatitis.

DISCUSSION

The histology of IPMTP differs from that of the adenocarcinomas usually described in these circumstances, and they are far rarer. Because they carry the risk of malignant degeneration, early diagnosis is important. Surgery is the only curative treatment and should therefore be discussed.

Should pancreas imaging be recommanded in patients over 50 years when diabetes is discovered because of acute symptoms?

The relationship between diabetes mellitus and cancer of the pancreas is complex and incompletely understood. Nevertheless, it is generally agreed that new-onset diabetes in a patient over 50 Years old is a classical indication of pancreatic cancer. But there is no official directive in France that a scan should routinely be performed in such cases. We have studied 115 patients aged over 50 who were hospitalized for new-onset diabetes (fewer than 30 days) whose instability required insulin treatment. Routine imaging revealed abdominal disorders in 14 patients, 6 (5.2%) of whom were suffering from pancreatic adenocarcinomas. No clinical indication or laboratory test, apart from an unusually severe anorexia, suggested the discovered disorders. We therefore routinely carry out a pancreas scan, preferably by MRI, on all patients over 50 Years old presenting with new-onset diabetes, even if there are not clinical or laboratory indications of cancer. This is the only way in which small pancreatic cancers can be detected, thus providing the best hopes for successful treatment. Unfortunately, too often, this approach also detects only tumors that are already well developed. However, nowadays, it is not conceivable for a clinical team to discharge a patient from hospital with such a serious disease undiagnosed.

[Evolution of circadian blood pressure and urinary albumin excretion according to the type of diabetes over a 10-year period]

The aim of the present study was to evaluate the circadian blood pressure and rinary albumin excretion (UAE) according to the type of diabetes over a 10-year period.

PATIENTS AND METHODS

This study is based on 43 diabetic patients, 24 type 1 and 19 type 2. Ambulatory blood pressure monitoring was used to assess blood pressure at the initial evaluation (A0) and about 10 years later (A10). UAE was also checked at 10 years interval and was <30 mg/day at A0.

RESULTS

At A0, ABPM and UAE did not differ in a significant manner between type 1 and type 2 diabetics. Type 2 diabetic patients were older than type 1 (59.7 +/- 15.4 vs 42.9 +/- 12.9; p<0.0001) but the age of diabetes did not differ between the 2 groups. Between A0 and A10, there was an increase in 24 h SBP of type 1 and type 2 diabetics (type 1: 114 +/- 10 vs 124 +/- 12 mmHg; p<0.01 and type 2: 113 +/- 19 vs 135 +/- 13 mmHg; p<0.0001). 24 h DBP, as well as BP differences (day-night) did not differ between the 2 evaluations. At A10, 24 h SBP was higher in type 2 than in type 1 (135 +/- 13 vs 124 +/- 12 mmHg; p<0.001) but differences between day and night BP were not significant. In type 1 diabetes, progression of SBP was not associated with an increase in UAE rate, while this rate increased in type 2 betwwen A0 and A10 (9 +/- 7 vs 70 +/- 101 mg/24 h; p<0.01). AT A10, UAE was higher in type 2 than in type 1 diabetes (70 +/- 101 vs 14 +/- 31 mg/24 h; p<0.02). In type 2 diabetes, the progression of UAE was correlated with SBP at A10 (r=0.495; p<0.03).

CONCLUSION

The increase in BP levels and in UAE rate differ between type 1 and type 2 diabetes and these differnces are not due to patients age, nor to modifications in BP curves. They are probably linked to a physiopathology which could be more complex in type 2 than in type 1 diabetes.

[Value of non-esterified fatty acids quantification in diabetes]

Non-esterified fatty acids (NEFA) play a complex role in glucidic homeostasis. This role led us to investigate their quantification in diabetic patients. The plasmatic NEFA concentrations, measured with the FA115 kit of Randox, showed significant differences between control patients (0.42 +/- 0.14 mmol/L, N = 50) and diabetic patients (0.68 +/- 0.35 mmol/L, p < 0.01, 443 diabetic patients (70 with type l and 373 with type 2 diabetes)). NEFA concentrations were significantly higher in type 2 diabetics (0.70 +/- 0.32 mmol/L) when compared to type 1 diabetics (0.59 +/- 0.35 mmol/L, p < 0.05). In type 2 diabetics, a significant correlation was observed between NEFA and glucose concentrations at 8 hrs a.m., and the mean glucose concentrations along the day (p < 0.001). In contrast NEFA concentrations were less correlated to levels of HbA1c. NEFA were well correlated with cholesterol and triglycerides (p < 0.05) but not with Lp(a). They were also correlated with BMI but not with age or duration of the disease. Diabetic patients on metformin associated to lipolytic treatment, presented lower concentrations of NEFA and better glucidic control. The results confirm the role of NEFA in glucidic homeostasis and suggest an interest for their routine determination.

Diabetes and Amoebiasis: a high risk encounter

Amoebiasis is the second most common parasitic disease worldwIde. It occurs mainly in developing countries. A high percentage of people in countries where it is endemic are asymptomatic carriers. It results in severe disease that can be fatal in rare cases. Diabetics are at increased risk of exposure as travel to countries where it is endemic becomes more frequent, as indicated by the present case. This patient suffered from amoebiasis that produced an amoeboma which is most rare in cases of colonic amoebiasis. The clinical picture was that of an occluding gut tumor, but it was treated only with drugs. Retrospective studies show that diabetics are at increased risk of suffering severe complications after amoebic infection. The frequency and severity of this diabetes-amoeba association requires patients to take prophylactic measures, especially when travelling in developing countries.

[Diabetes and amoebiasis: a high-risk combination]

Amoebiasis is the second most common parasitic disease in the world. It occurs mainly in developing countries. Many people in endemic countries are asymptomatic carriers. It results in severe disease that can be fatal in rare cases. The case described in this report illustrates the growing risk of exposure to amoebiasis for diabetic patients as travel to endemic countries becomes more and more frequent. In the patient described here amoebiasis led to amoeboma, a rare complication of the colonic presentation. Despite a clinical disease syndrome mimicking that of an occluding gut tumor, the patient was treated medically with drugs alone. Retrospective studies show that diabetics are at higher risk for severe complications after amoebic infection. Because of the high incidence and severity of concurrent diabetes and amoeba, prophylactic measures are necessary for diabetic patients traveling in developing countries.

Home blood pressure monitoring in diabetic population

Normalization of blood pressure is today as necessary as an optimal blood glucose control. These targets aim at reducing the negative consequences of hypertension which is particularly frequent and of poor prognosis for these patients. Nevertheless, the definition of the real blood pressure of these patients is uneasy because of the lack of precision of clinical blood pressure measurement. New methods have been developed to address this insufficiency. Home blood pressure monitoring is characterised by good compliance and accuracy, but patient education needs a special training and validated automated devices. This method has to be proposed to the diabetic population as soon as hypertension may be a problem. These patients will contribute to monitor their own blood pressure as they do it with blood glucose control.

[Extreme obesity in Prader-Willi Syndrome (PWS)]

INTRODUCTION

Prader-Willi Syndrome (PWS) belong to genetic obesities and we report a caricatural observation.

DEVELOPMENT

The early onset of (PWS) is characterised by a severe neonatal hypotonia with poor suck reflex--which may lead to tube feeding--and poor weight gain. Later appears insatiable appetite, morbid obesity associated with short stature, dysmorphic syndrome with small hands and behavioural disorders. Although diagnosis is based on clinical features, it must be confirmed by genetic test looking for the characteristic deletion of the chromosome 15q11-q13 region. PWS is the first example in humans of genetic imprinting.

CONCLUSION

Today, the challenge in PWS is it early management which may authorise Growth Hormone administration.

[Input of coronary artery calcium score assessed by computed tomography in the screening of diabetic coronaropathy]

The poor prognosis of coronary artery disease along with the inaccuracy of available testing methods have favoured the development of new screening techniques. One such innovation involves measuring the coronary artery calcium score (CAC). Through computed tomography, this test quantifies the amount of calcium deposited in coronary arteries, itself a reflection of the degree of atherosclerosis. This investigation is a prospective study of 48 diabetic subjects comparing the performance of CAC score with the gold standard testing methods. The results of our study showed that, due to its high negative predictive value, 5 invasive tests were performed needlessly as these subjects had very low CAC scores. At this time, the CAC score is not recommended for every patient but rather on a case-by-case basis. However, it may soon emerge as the next step after the ECG in the evaluation of coronary artery disease. This would alleviate the need for more invasive tests in those patients for whom such investigations are deemed unnecessary. The CAC score, when matched for age, sex and other variables, could also serve as an indication for prescribing medications such as statins, along with other therapeutic interventions. Diabetologists, cardiologists and radiologists must work together in order to gain a better understanding of these new techniques. This may facilitate the emergence of a new approach to the treatment of coronary artery disease.