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Les FAHFAs, des acides gras esterifiés par des acides gras hydroxylés, sont une famille de lipides endogènes bioactifs. À ce jour, la plupart des FAHFAs ramifiés étudiés sont des régioisomères du PAHSA qui auraient une activité antidiabétique et anti-inflammatoire chez l'Homme et les rongeurs. Récemment, nous avons démontré que la prise de 9-PAHPA ou de 9-OAHPA augmentait le métabolisme basal et la sensibilité à l'insuline chez des souris C57BL/6 nourries avec un régime contrôle, mais qu'elle provoquait des lésions hépatiques chez certaines souris. Cette étude vise à déterminer si un apport à long terme de 9-PAHPA ou de 9-OAHPA a les mêmes effets chez les souris nourries avec un régime obésogène. Des souris C57BL/6 ont été nourries pendant douze semaines soit avec un régime témoin soit avec un régime riche en graisse et en sucre (HFHS) et supplémenté ou non en 9-PAHPA ou 9-OAHPA. Le métabolisme basal a été exploré. Le métabolisme du glucose et des lipides ainsi que l'activité mitochondriale et le stress oxydant ont été analysés. La consommation du régime HFHS a induit une obésité, une résistance à l'insuline et une hyperglycémie à jeun, sans effets majeurs sur les paramètres hépatiques. Le 9-PAHPA ou le 9-OAHPA a modulé le métabolisme basal et a amélioré la sensibilité à l'insuline. Contrairement à ce que nous avons observé précédemment chez des souris saines, aucun effet délétère de ces FAHFAs n'a été observé sur le foie des souris obèses. Ce travail indique que le 9-PAHPA et le 9-OAHPA peuvent tous deux avoir des effets intéressants de sensibilisation à l'insuline chez les souris obèses et résistantes à l'insuline. [ABSTRACT FROM AUTHOR]

Summary: Congenital glucose-galactose malabsorption (CGGM) is a rare autosomal recessive disorder, which presents as a protracted diarrhea in early neonatal life. We describe the clinical history, diagnostic evaluation, and management of 7 children with CGGM in western France. There were 4 girls and 3 boys from 5 families, born between 1984 and 2010. The principal complaint was a neonatal onset of watery and acidic severe diarrhea complicated by hypertonic dehydration. The diarrhea stopped with fasting. In 2 cases, the family history supported the diagnosis. In the other cases, elimination of glucose and galactose (lactose) from the diet resulted in the complete resolution of diarrhea symptoms. In 2 cases, the H2 breath tests were positive. In 2 cases, the HGPO or oral glucose tolerance test (OGTT) demonstrated an abnormal curve with glucose and a normal curve with fructose. DNA sequencing was not used. When glucose and galactose were eliminated from the diet, the infants had normal growth and development. In conclusion, CGGM is a rare etiology of neonatal diarrhea; however, the diagnosis is easy to make and the prognosis is excellent. [ABSTRACT FROM AUTHOR]

Summary: Context: Exercise hypoglycaemia (EH) is a very common yet little studied condition. It occurs in subjects with high values of insulin sensitivity (SI) and glucose effectiveness (SG), and is mainly triggered by dietary errors, over-training, or special circumstances (exposure to unusual temperatures, altitude, disruption of circadian rhythms). Methods and results: We showed that SI and SG can be calculated from test meals by mathematical modelling (oral minimal model), whereas in athletes “surrogates” of SI (HOMA, QUICKI, etc.) are misleading (not applicable in this area of high insulin sensitivity). These meals can also provide a comprehensive picture of the components of insulin secretion, which makes this exploration more informative. We studied the results obtained by this method in 19 athletes complaining of EH compared to 58 matched athletes not complaining from this problem. We observed higher values of SI (P <0.05) and SG (P <0.03), but overall, insulin secretion Φoral was similar. However, one of the components of insulin secretion, β-cell glucose sensitivity, is higher on the average (P <0.04) because in 30% of cases it remains above the normal range for athletes, while remaining in the range for a normal population. Therefore, overall tolerance to carbohydrates (product Φoral ×SI) is higher (+58% P <0.04). Conclusion: Thus, these subjects have a powerful carbohydrate disposal, which is incompletely compensated by the expected homeostatic decrease in insulin secretion, especially with regard to β-cell glucose sensitivity. [ABSTRACT FROM AUTHOR]

Abstract: Since the publication of the first Leuven study highlighting the association between tight glycemic control and reduced mortality in surgical intensive care patients, many protocols have been developed and used in clinical practice. Recent multicentrer studies that did not find the positive results of the landmark study lead us to question the methods used to achieve tight glycemic control. New computerized protocols must take in account the nurse workload, the risk for severe hypoglycaemia and the unnecessary variation in clinical care. There are two opposite approaches: the “closed-loop” approach coming from research in diabetes but necessitating reliable near-continuous glucose sensors and involving legal and regulatory concerns and the “human in the loop” approach easier to implement in clinical practice. Whatever the approach, a standardized multifactorial evaluation in order to select the most efficient computer protocols is required. [Copyright &y& Elsevier]

Summary: GLUT-1 protein is the principal glucose transporter across the blood-brain barrier. GLUT-1 deficiciency results in a syndrome of infantile seizures refractory to anticonvulsive drugs, developmental delay, acquired microcephaly and neurologic manifestations including spasticity, hypotonia, and ataxia. A low cerebrospinal fluid glucose concentration in the absence of hypoglycaemia is pathognomonic of glucose transporter deficiency syndrome. Ketogenic diet is an effective treatment of epileptic manifestations but it has less effect on the cognitive symptoms. We report on a child who presented with paroxistical events often occurring prior to meals, developmental delay, microcephaly and spasticity. CSF and serum glucose levels measured simultaneously showed a CSF/serum glucose ratio of 0.39. Molecular analysis identified a heterozygous novel mutation. [Copyright &y& Elsevier]

Abstract: Incretins are peptidic hormones which enhance the effect of glucose on insulin release. They are released by endocrine cells of the intestinal epithelium during the passage of nutrients. There are two types, the insulinotropic glucose-dependent peptide (GIP) is secreted by duodenal K cells K, and the glucagon-like peptide 1 (GLP-1) is produced by ileum L cells. Their actions pass by their connection to specific receptors, but also depend on indirect mechanisms implying the nervous system. The GIP and the GLP-1 are very quickly degraded to inactive metabolites by dipeptidyl-peptidase-IV (DPP-IV). Besides its effect on insulin release, dependent on the glycaemia, the GLP-1 stimulates the synthesis of insulin, inhibits the secretion of glucagon, slows down the gastric emptying and acid secretion, and reduces oral intakes. It also showed trophic capacities on the pancreas cellular mass, in experimental conditions. In type-2 diabetes, the activity of GLP-1 is preserved, the therapeutic properties of this peptide were studied. Several pharmacological strategies are investigated, and molecules in clinical development are (1) GLP-1 analogues resistant to DPP-IV, an IV product and, (2) DPP-IV inhibitors administered by mouth. The data confirm the promising character of these two therapeutic classes, alone or associated with conventional diabetes treatments, with a substantial advantage of analogues on the weight control. [Copyright &y& Elsevier]

Summary: Glucose monitoring and management of hypoglycaemia in preterm infants remain controversial. However, recent animal studies have shown that hypoglycaemia is associated to increased generation of reactive oxygen and nitrogen species, to inhibition of cellular maturation and to apoptosis in brain. Despite potential consequences of hypoglycaemia on brain development in preterm infants, only few studies are available on this topic. Available clinical studies on neurological development of hypoglycaemic preterm infants are not conclusive but suggest detrimental effect of repeated mild hypoglycaemia on brain development. Both experimental and clinical arguments are sufficient to mind to this problem with great awareness. Therefore, routine repeated measurements of blood glucose concentration are necessary and active intervention is proposed if glucose plasma level decreases below 2.5mmol/l. [Copyright &y& Elsevier]

Summary: Glucose homeostasis during fetal life depends entirely on continuous placental glucose transfer. Fetal endocrine milieu is characterized by high insulin which has mainly anabolic action. During third trimester, insulin promotes energetic stores as glycogen and fat deposition. At birth, constant maternal supply is interrupted and this is accompanied by a surge in glucagon and catecholamine levels and a decrease in insulin level. These hormonal changes induce hepatic glucose production provided by glycogenolysis during the first hours of life and then by gluconeogenesis. They also promote lipolysis which generates glycerol, a gluconeogenic substrate and free fatty acids. Free fatty acids provide gluconeogenesis activating factors and ketone bodies which represent alternative fuels for brain metabolism. Equilibrium between tissue consumption of glucose, hepatic glucose production and exogenous glucose supply maintains blood glucose level. If one of these mechanisms fails, hypoglycaemia may occur. Hypoglycaemia is predictable in three situations: depletion of energetic stores (prematurity and intra-uterine growth restriction), increase tissue energetic consumption and fetal hyperinsulinism. Blood glucose levels at which clinical interventions should be considered depend on operational thresholds. Therapeutic goal in case of hypoglycaemia is to increase blood glucose enhancing gluconeogenesis and providing continuous brain supply with glucose and ketone bodies. Paradoxically, many preterm infants less than 30 gestational weeks develop hyperglycaemia. There is evidence that processing of proinsulin in β-cells is deficient and that preterm infants are partially resistant to insulin. Exogenous insulin infusion is efficient and may be used with caution. [Copyright &y& Elsevier]

Abstract: Different washing and homogénéisation solutions are hereby analysed by comparing the evolution of fonctional indicators during the preservation of washed aphaeresis platelet concentrate: physiological pH 4.5 and 6 solutions, battered physiological pH 6.8 glucose solution, and two physiological pH 7 citrate solutions with acetate. Prior acidification of platelet concentrates proved to be essential. Two whashings with manual or automated technique, guarantee residual proteins at a level of less than 0.5 g. Solutions T-Sol Baxter or SSP Macopharma allow us to obtain a product that meet the PSL spécifications. Routine since June 2004, washings are down with a physiological pH 6 solution, then homogeneised with T-Sol solution. Platelet recovery, swirling phenomenon, lack of agrgegates, pH maintenance, low increase in the platelet average volume and maintenance of intra-cell potassium level, suggest that platelet entirety is preserved beyond the product''s expiry date. The platelet transfusion yield of these products is satisfactory. [Copyright &y& Elsevier]

Abstract: The infusion of vasoactive drugs in preterm babies using syringe pumps can be complicated by important variations in the infusion rate. Aims of the study. – 1) to assess the time between pump start and the actual presence of a substance in the circulation, when using slow rates; 2) to evaluate the effects of changes in the main infusion rate on substance rates infused on the same line. Methods. – We used 10% glucose to mimic vasoactive drugs. The main infusion consisted of saline, and both were infused on the same line using syringe pumps. Glucose concentration was measured at the end of the line. Results. – The time between pump start and the actual infusion of glucose depended on syringe volume and on the adjustment of the syringe in the pump. There was a transient increase in glucose rate when the main rate increased, and a transient decrease when the main rate decreased. Conclusion. – To minimize the time before a substance is actually infused, one should use low volume syringes and correctly adjust the syringe in the pump. Moreover, when a steady infusion rate is necessary, one should avoid variations in the main infusion rate. [Copyright &y& Elsevier]

Copyright of IBS, Immuno-analyse & Biologie Specialisee is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The brain and particularly the hypothalamus, is involved in the regulation of metabolism by controlling either the secretory activity or the metabolic pathways of different tissues or organs. Numerous hypothalamic areas are informed in turn of the metabolic status of the individual. Various molecules (metabolites, hormones, neuropeptides) have been involved as signal, among which glucose. Thus, it has repeatedly been shown that the electrical activity of some neurones depends on glucose concentration. New insights into the cellular and molecular mechanism that support the fact that the electrical activity of some neurones depends on the glucose and/or insulin concentration, have been gained recently. Making the analogy with the beta cell of the islet of Langerhans, it has been proposed that proteins such as glucose transporter 2, glucokinase and the ATP–dependent potassium channel, could assure this sensing. Furthermore, it has been proposed that mitochondria, especially via production of reactive oxygen species during glucose oxidation, plays a role of metabolic sensor in various cells. Such glucose sensing systems have been also described outside the brain like in the portal vein. Alterations in glucodetection could participate in some extend to deregulations observed in metabolic pathologies such as obesity and diabetes. [Copyright &y& Elsevier]

Copyright of IBS, Immuno-analyse & Biologie Specialisee is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction. – Type 1 diabetes in children in France is frequently diagnosed at the stage of ketoacidosis (DKA).Patients and methods. – A prospective study was performed in a group of 72 children (mean age = 9.4 years) at onset of diabetes, in order to determine which factors were associated to DKA and to the severity of DKA (pH < 7.10) at diagnosis.Results. – Younger age was related to DKA (p = 0.03), but not to its severity. A lesser frequency of DKA was found in children with a family history of insulin-treated diabetes ( p = 0.04). Misdiagnosis was more frequently observed in children with DKA than in children without DKA (p = 0.02) and in case of severe DKA at admission by comparison with non severe cases (76 vs 23%; p = 0.002). Children in low economic intake families exhibited more frequently a severe DKA (77 vs 23%; p = 0.002) and were more frequently misdiagnosed before admission (48% vs 10%; p < 0.01). Urine strips for glucose and ketone determinations were underused for diagnosis before admission (15% only).Conclusion. – Those results underline the need to both inform physicians and ameliorate the access to health care for low social class families, in order to take up the challenge of reducing the incidence of DKA at diagnosis in diabetic children in our country. [Copyright &y& Elsevier]

Purpose. – We report three cases of Horton’s disease, in which F18-Fluorine-2-Deoxy-D-Glucose (18FDG) positron emission tomography (PET) demonstrated a clinically unsuspected extra-cranial vessels hypermetabolism.Methods. – Fully corrected whole-body PET was performed in three patients (two women, one man) for exploring a marked inflammatory syndrome. Scanning was acquired 60 min after i.v. injection of 222 MBq of 18FDG in average.Results. – In two patients with histologically proven Horton’s disease, PET alone showed increased glucose metabolism involving the carotid and sub-clavian arteries as well as the ascending aorta, aortic arch, thoracic and abdominal aorta, and the iliac and femoral arteries. In the third patient, by detecting cervical, thoracic and abdominal vessel hypermetabolism, PET non-invasively contributed to the diagnosis of giant cell arteritis. All patients had complete clinical and biological response to corticoids. PET controls performed 3- to 6-months post-treatment, confirmed the disappearance of the metabolic stigma.Conclusion. – 18FDG PET may show an increased glucose metabolism in asymptomatic extra-cranial vessels locations of Horton’s arteritis. If these observations are confirmed on controlled trials, PET could be particularly useful for non-invasive diagnosing, staging and monitoring atypical clinical forms of Horton’s disease. The metabolic imaging could also contribute to a better understanding of the pathogenesis of GCA. [ABSTRACT FROM AUTHOR]

Copyright of IRBM is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Introduction. – The impact of low intensity light neuromuscular electrostimulation (14 Hz, 30 mA) of the vastus lateralis was assessed through interstitial microdialysis measurement of free Insulin-Like Growth Factor-I, glucose and lactate during the stimulation (45 minutes) and recovery (40 minutes) periods in 3 healthy subjects. Results. – Muscular uptake of glucose was immediate, while delayed decrease of lactate production was observed. Free Insulin-Like Growth Factor-I was decreased during recovery. Conclusion. – These data suggest that a low intensity of neuromuscular electrostimulation determines a metabolic activation of the muscle. That activation spreads to the recovery period. [Copyright &y& Elsevier]

L’hypoparathyroïdie est une affection rare due à une insuffisance de sécrétion de l’hormone parathyroïdienne, hormone de régulation de la calcémie dans l’organisme. Parmi les causes de l’hypoparathyroïdie néonatale, on retrouve l’hyperparathyroïdie maternelle. Nous en rapportons un cas. Il s’agit d’un nouveau né de 15 jours, sans antécédents particuliers, hospitalisé pour convulsions ayant débuté à j11 de vie. Le bilan réalisé : une hypocalcémie profonde associée à une hyperphosphatémie, une hypomagnésémie, un taux bas de parathormone et une hyperparathyroïdie maternelle. Le nouveau né a été mis sous perfusion de glucose 5 % + gluconates de calcium 10 % : 50 mg/kg/j de calcium élément associée aux dérivés de la vitamine D (Un-Alfa) : 1 μg/j et au magnésium. L’évolution a été marquée par la disparition des convulsions et la normalisation de la calcémie après trois semaines de traitement. Les étiologies des hypoparathyroïdies néonatales sont multiples : hypoparathyroïdies familiales, hypoplasie ou agénésie congénitale des parathyroïdes. Parfois il s’agit d’une hyperparathyroïdies fonctionnelles secondaires à une dysmagnésémie ou à une hyperparathyroïdies maternelle inconnue, cas de notre patient, d’où la nécessité de demander un bilan maternel à la recherche d’une cause maternelle. [ABSTRACT FROM AUTHOR]

L’objectif de cette étude a été de comparer les effets analgésiques des administrations orales du glucosé à 30 %, du lait ou de la succion d’une tétine ainsi que l’effet analgésique synergique du glucosé à 30 %, du lait et des tétines lors des ponctions veineuses profondes chez le nouveau-né. Matériel et Méthode: Il s’agissait d’une étude prospective. Le critère de jugement principal a été l’évaluation de la douleur en utilisant l’échelle de douleur aigue du nouveau-né : DAN. Pour obtenir une puissance de 80 % et une signification de 5 % dans la détection d’une différence de 2 points dans l’échelle de DAN, chaque groupe comportait 25 nouveau-nés recevant des méthodes différentes d’analgésie non pharmacologique lors des ponctions veineuses profondes. Résultats: Cette étude a confirmé l’effet analgésique du sérum glucosé à 30 %, du lait et de la succion d’une tétine seuls ou associés lors des ponctions fémorales chez le nouveau-né. Le sérum glucosé 30 % associé à une tétine, avait au moins la même efficacité décrite dans la littérature pour le saccharose 30 % (P =0,0001 (. Conclusion: L’association du sérum glucosé 30 % à la succion non nutritive d’une tétine, procure un soulagement de la douleur des nouveau-nés au cours des ponctions veineuses profondes. [ABSTRACT FROM AUTHOR]

Abstract: Different hypertonic solutions are employed during cardiac surgery. Indications of two of them are linked with the molecule itself. It is sodium bicarbonate and glucose. The first indication of mannitol et hypertonic saline solutions is the hyper osmolarity. The solutions of 4.2 and 8.4% bicarbonate allow the correction of a metabolic acidosis when the cause does not be rapidly treated. The 30% glucose solution is used with high dose of insulin and with potassium to enhance the myocardial function. The 10 or 20% solution of mannitol is added to the prime solution of CPB circuit to increase the osmolality. Mannitol is also a scavenger of free radicals produce during CPB when heart reperfusion and hyperoxie. Originally the “small volume resuscitation”, the 7.5% hypertonic saline solution is little employed during cardiac surgery. It enhances the myocardial inotropisme and decreases the systemic vascular resistances. It acts against the hydria leak from intravascular sector to the interstitial sector with a decrease of post CPB oedema. Hypertonic saline and glucose 30% solutions proprieties are particularly evolved. [Copyright &y& Elsevier]