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The use of new lightweight meshes in pelvic organ prolapse (POP) surgery may reduce complications related to mesh retraction (chronic pain, dyspareunia, and mesh exposure). The aim of this study was to investigate changes in the area and position of Uphold Lite™ mesh 6 weeks and 12 months after anterior and/or apical prolapse repair. This observational prospective multicenter study included patients who had undergone transvaginal surgery for symptomatic POP-Q stage ≥ II anterior and/or apical compartment prolapse with placement of Uphold Lite mesh. The dimensions and position of the mesh were evaluated at 6 weeks and 12 months by ultrasonography. Correlations between ultrasonographic mesh characteristics and POP recurrence were analyzed. Fifty evaluable women with an average age of 66.8 years were included. No statistically significant difference in mesh area was found between week 6 and month 12 postoperatively, either at rest (1746.92 vs. 1574.48 mm2; p = 0.15) or on Valsalva (1568.81 vs. 1542.98 mm2; p = 0.65). The ROC-AUC of the distance between the mesh and the bladder neck (M-BN) at 6 weeks for predicting cystocele recurrence at 12 months was 0.764 (95% CI 0.573–0.955) at rest and 0.724 (95% CI 0.533–0.916) on Valsalva. An M-BN distance > 12.5 mm could predict cystocele recurrence at month 12 with a sensitivity of 80% and a specificity of 69%. Ultrasonographic measurements of the Uphold Lite™ mesh appear to remain stable between 6 weeks and 12 months postoperatively. M-BN distance correlates with cystocele recurrence. These results appear to confirm the value of ultrasound in mesh evaluation.

Objective To assess the incidence of serious complications and reoperations for recurrence after surgery for pelvic organ prolapse (POP) and compare the three most common types of repair. Design Prospective cohort study using a registry. Setting Nineteen French surgical centres. Population A total of 2309 women participated between 2017 and 2019. Methods A multivariate analysis including an inverse probability of treatment weighting approach was used to obtain three comparable groups. Main outcome measures Serious complications and subsequent reoperations for POP recurrence. Results The median follow-up time was 17.6 months. Surgeries were native tissue vaginal repairs (n = 504), transvaginal mesh placements (n = 692) and laparoscopic sacropexies with mesh (n = 1113). Serious complications occurred among 52 women (2.3%), and reoperation for POP recurrence was required for 32 women (1.4%). At 1 year the cumulative weighted incidence of serious complications was 1.8% for native tissue vaginal repair, 3.9% for transvaginal mesh and 2.2% for sacropexy, and the rates for reoperation for recurrence of POP were 1.5, 0.7 and 1.1%, respectively. Compared with native tissue vaginal repair, the risk of serious complications was higher in the transvaginal mesh group (weighted hazard ratio, wHR 3.84, 95% CI 2.43-6.08) and the sacropexy group (wHR 2.48, 95% CI 1.45-4.23), whereas the risk of reoperation for prolapse recurrence was lower in both the transvaginal mesh (wHR 0.22, 95% CI 0.13-0.39) and sacropexy (wHR 0.29, 95% CI 0.18-0.47) groups. Conclusions Our results suggest that native tissue vaginal repairs have the lowest risk of serious complications but the highest risk of reoperation for recurrence. These results are useful for informing women and for shared decision making. Tweetable abstract Laparoscopic sacropexy had fewer serious complications than transvaginal mesh and fewer reoperations for recurrence than vaginal repair.

Obstetric anal sphincter injury (OASI) is strongly associated with a major negative impact on women's health. Due to the consequences of an undiagnosed and therefore unrepaired OASI, it is essential to prevent or at least diagnose OASI at childbirth. We need to promote training of professionals to improve OASI screening at childbirth. High-risk situations such as operative delivery must be identified and preventive strategies such as the choice of a less traumatic instrument (vacuum) and mediolateral episiotomy should be considered. For a woman with OASI and/or symptoms, postnatal consultation with a specialist on pelvic floor disorders is essential to correctly orient her toward an adequate care pathway and to eventually identify occult or underestimated OASI. More data are required on therapeutic approaches for symptomatic women, primarily including physical therapy, sacral neuromodulation, delayed sphincter repair and palliative devices.

International audience; Objectifs : la chirurgie de l’incontinence urinaire d’effort (IUE) par bandelettes sous-urétrales (BSU) fait l’objet d’essais cliniques limités en taille, rapportant peu les complications rares et la qualité de vie (QdV). Les registres permettent de rapporter ces complications rares dans la pratique courante et de mesurer la QdV globale, du point du vue des troubles urinaires et pelviens.Méthodes : l’objectif du registre VIGI-MESH est de spécifier l’incidence de ces complications rares et graves en fonction des différents types de BSU (rétropubiennes, transobturatrices, à incision unique/mini-bandelettes) ainsi que de mesurer cette QdV après la pose de BSU. Entre février 2017 et novembre 2019, chaque chirurgie initiale ou de reprise de BSU dans un des 18 centres participants était colligée sur un formulaire par le chirurgien. Un contrôle était effectué à partir des pharmacies délivrant les dispositifs médicaux implantés et des actes codés par les centres participants. Un questionnaire recherchant une complication était envoyé à toutes les patientes à un an. Il comportait également des questions validées en français sur le bien-être ressenti et l’amélioration des symptômes (WHO, European Quality of life Questionnaire 5 Dimensions [EQ5D], Patient Global Impression of Improvement [PGI-I]) Les complications ont été gradées selon la classification de Clavien–Dindo : arrêt de l’intervention sans pose de matériel (grade III), intervention chirurgicale ultérieure secondaire à une complication (grade III), complication menaçant la vie (grade IV), décès de la patiente (grade V).Résultats : quatre-vingt-deux patientes ont eu des complications de grade ≥ III : 5,7 % (53/923) voie rétropubienne, 4,0 % (21/521) voie transobturatrice et 2,2 % (8/370) mini-bandelette. Dix complications peropératoires ont empêché la pose de BSU. La BSU a été desserrée dans les 48 h dans 6 cas. Le risque de complication était 3 fois plus faible avec une mini-bandellette par rapport à une BSU rétropubienne (RR = 0,36 [0,170,75]), le risque n’était pas significativement différent entre les approches transobturatrice et rétropubienne (RR = 0,67 [0,40–1,11]). Vingt-sept femmes (1,5 %) ont eu une reprise chirurgicale pour échec ou récidive, 15 après BSU rétropubienne (1,6 %), 7 après bandelette transobturatrice (1,4 %) et 5 après mini-bandelette (1,4 % ; p = 0,95) (Fig. 1). La procédure a consisté à retendre la BSU (9 cas), injection de Bulkamid® (2 cas) et mise en place d’une seconde BSU (16 cas). Parmi les 1167 patientes contactées par courrier, 692 réponses (59,3 %) ont été retournées à un an ou plus après la chirurgie. À la question « Que pensez-vous de votre état de santé actuel par rapport à ce qu’il était avant votre chirurgie pour incontinence ou prolapsus ? » 91,4 % (608/665) se sentaient mieux (beaucoup mieux, mieux ou un peu mieux) (PGI-I). L’amélioration ressentie était meilleure en l’absence de complications graves ≥ III (p = 0,008). Parmi les patientes, 96,2 % (630/655) ont évalué leur état de santé général comme étant bon (très bon, bon ou assez bon). L’état de santé général ressenti était similaire qu’elles aient eu ou non des complications. Par rapport à la population française du même âge, les patientes opérées d’une BSU ont déclaré avoir un meilleur état de la santé.Conclusion : les premiers résultats du registre VIGI-MESH montrent que les mini-bandelettes sont une option thérapeutique avec une efficacité à moyen terme similaire aux voies rétropubiennes et transobturatrices avec moins de complications. Ils montrent également que plus de 90 % des patientes rapportent avoir été améliorées par la mise en place d’une BSU pour IUE. Le ressenti de l’état de santé global des patientes opérées était meilleur que celui de la population française féminine du même âge. Néanmoins, une analyse à plus long terme est nécessaire pour confirmer ces premiers résultats.

IntroductionAlthough aircraft noise is known to impact human health, the biological pathway is still unclear. One of the possible pathway is that aircraft noise exposure may induce a modification o...

Resume Introduction Les recommandations internationales pour l’administration de la vitamine D (25-OH) chez les prematures sont divergentes (800–1000 UI/jour en Europe, 200 UI/kg sans depasser 400 UI/j aux Etats-Unis). Les nouveau-nes prematures de faible poids de naissance sont a risque de carence, mais egalement de surdosage en 25-OH. Methode Entre 2013 et 2015, 16 anciens prematures ( Resultats L’âge gestationnel etait de 27 (24–35) SA pour un poids de 810 (560–2120) grammes. Le signe d’appel du surdosage en 25-OH avait ete une nephrocalcinose (37 %), une hypercalcemie (44 %) ou une hypercalciurie (19 %). L’âge le jour du signe d’appel etait de 36,6 (27,6–47,6) SA. Un dosage de 25-OH avait ete realise 13 (0–281) jours apres le signe d’appel ; la concentration en 25-OH etait alors de 210 (119–350) nmol/L et celle en 1-25(OH), lorsqu’elle avait ete mesuree (n = 10), de 370 (245–718) pmol/L. Apres arret de la supplementation, la 25-OH s’etait normalisee chez 10 patients dans un delai de 10 (3–32) mois. Conclusion Le diagnostic de surdosage en 25-OH chez les anciens prematures doit etre envisage devant l’existence d’une nephrocalcinose, d’une hypercalcemie ou d’une hypercalciurie. Il justifie la realisation d’un dosage de la 25-OH. La supplementation en vitamine D est essentielle pour une formation osseuse optimale mais les objectifs cibles superieurs ne devraient probablement pas exceder 120 nmol/L.

Latinoamérica ha mostrado una reducción importante de la mortalidad infantil en los últimos años. El objetivo del estudio buscó analizar los datos oficiales correspondientes a niños menores de cinco años en Colombia, haciendo énfasis en las causas externas de muerte, que han sido menos estudiadas. Pacientes y Método: Diseño descriptivo y transversal que utilizó información secundaria proveniente de los registros de defunción reportados por el Departamento Administrativo Nacional de Estadística (DANE) y las tablas dinámicas de información de estadísticas vitales del sistema oficial de información del Ministerio de Salud y Protección Social (SISPRO), entre los años 2005 y 2013. La información se organizó en tablas para el análisis descriptivo de variables como edad, sexo, y causa específica de muerte, por departamentos del país. Resultados: En este período fallecieron 106.339 niños menores de 5 años; 85.897 de ellos (81%) en el primer año de vida. De 14.266 niños fallecidos en 2005, se pasó a 9.499 en 2013. Entre las causas externas de muerte, la primera es ahogamiento, responsable de 1.749 fallecimientos, seguida de accidentes de transporte, con 1.282. Los homicidios fueron responsables de 692 muertes. En todas las causas analizadas hubo un descenso durante el decenio. Discusión: Colombia va cumpliendo el cuarto objetivo del milenio, “reducir la mortalidad de los niños menores de 5 años”. Se ha avanzado en muertes de causa externa, pero todavía hay camino por recorrer.

International audience; Objectifs : le prolapsus des organes pelviens (POP) de la femme est une situation fréquente qui mène dans 19 % des cas à un traitement chirurgical. Le registre VIGI-MESH a permis de collecter les interventions chirurgicales de POP dans 19 centres et à surveiller les complications et les révisions chirurgicales. Nous présentons ici les premiers résultats à moyen terme de notre registre.Méthodes : l’analyse comprend 2 341 patientes dont la chirurgie prévue était une promontofixation par laparoscopie avec prothèse (n = 1 143), une chirurgie transvaginale avec prothèse (n = 694) ou sans prothèse (n = 504). La promontofixation a été converti dix fois (0,9 %) : 5 par laparotomie, 2 fixations latérales par laparoscopie, 3 voies transvaginale dont 2 avec prothèse. Les patientes étaient plus jeunes, avec moins de comorbidités dans le groupe promontofixation, et avec plus d’antécédents chirurgicaux chez les patients opérés par voie vaginale. Il y a une majorité de chirurgie avec prothèse en cas de prolapsus antérieur ou apical.Résultats : avec 15 mois de suivi médian, nous avons observé des complications Clavien–Dindo grade III ou plus chez 48 patientes (2,05 %). L’incidence de complications graves à 12 mois est significativement supérieure pour la réparation vaginale prothétique soit 3,71 % [2,28–5,13] versus 1,27 pour la réparation vaginale non prothétique [0,25–2,29] et 1,44 pour la promontofixation [0,71–2,167] avec p = 0,005 (Fig. 1). Il y a 29 réinterventions (1,24 %) en raison d’échec ou de récidive du prolapsus : 11 après promontofixation (0,96 %), 6 après prothèse vaginale (0,86 %) et 12 après réparation vaginale autologue (2,38 %). La réparation vaginale native comporte un risque de reprise chirurgicale pour prolapsus récidivé trois fois plus élevé qu’en cas de promontofixation (RR 0,34 [0,15–0,77]) ou de prothèse vaginale (RR = 0,29 [0,11–0,76]) .Conclusion : dans notre registre, la promontofixation présente le meilleur ratio bénéfice/risque par rapport à la réparation vaginale. Cette dernière expose à un faible risque de complications en cas de réparation autologue mais avec un risque de récidive 3 fois plus élevé et à l’inverse à un faible risque de récidive en cas de chirurgie prothétique mais avec un risque de complication grave 3 fois plus élevé.

Introduction Le brentuximab vedotin (BV) est un conjugue anticorps monoclonal anti-CD30–medicament, liberant un poison du fuseau de facon selective dans les cellules CD30+. Son utilisation dans certains lymphomes T cutanes (LTC) exprimant le CD30 est validee par l’etude de phase III ALCANZA. Nous rapportons 2 observations exceptionnelles de LTC CD30+ a grandes cellules anaplasiques (LTCGCA) monomeliques, a tres forte masse tumorale, traites avec succes par BV. Observations Cas 1 : un homme de 84 ans etait hospitalise pour d’innombrables nodules et tumeurs ulcerees d’apparition rapide sur la jambe droite. L’examen histologique montrait un infiltrat dermique massif de grandes cellules CD4+/CD30+/ALK−/CD3−/CD20−/Ki67 a 100 %. Le bilan d’extension etait negatif. Le diagnostic de LTCGCA monomelique de stade T2cN0M0 etait retenu. Devant cette cinetique et un etat pulmonaire precaire, le BV 1,8 mg/kg/21 jours etait administre en 1ere ligne, permettant une remission complete (RC) des la 4e cure. L’apparition au TEP scanner d’un ganglion iliaque moderement hypermetabolique justifiait d’une radiotherapie a ce niveau, le BV etant arrete pour des paresthesies. La reponse clinique se maintenait a 6 mois. Cas 2 : une femme de 76 ans etait traitee en 2e ligne par BV, dans le cadre de l’essai therapeutique ALCANZA, pour un LTCGCA monomelique du membre inferieur droit a tres forte masse tumorale et cinetique rapide, de stade T2cN0M0. Une RC etait obtenue apres 3 cures. Le BV etait arrete apres 12 cures en raison d’une neuropathie peripherique (NP) de grade III, regressive en 8 mois. La RC se maintenait sans traitement avec 5 ans de recul. Discussion Ces 2 observations sont exceptionnelles par : 1) Cette presentation monomelique tres extensive et agressive tres rarement decrite au cours des LTCGCA et faisant craindre une dissemination rapide. 2) La reponse spectaculaire au BV. La litterature rapporte une observation analogue, chez un patient bulgare dont le LTCGCA monomelique progressait apres radiotherapie et methotrexate. Une regression tumorale > 80 % etait obtenue apres 4 cures. La duree optimale du traitement chez les patients repondeurs au BV pour une LTCGCA n’a pas ete evaluee. La limite principale de son utilisation prolongee est l’apparition de NP chez environ deux tiers des patients, regressive apres arret dans 82 % des cas. L’absence de recidive a tres long terme dans notre second cas suggere qu’un traitement de quelques mois pourrait suffire a assurer une reponse complete et durable. Conclusion Les formes monomeliques agressives de LTCGCA peuvent simuler cliniquement un lymphome B de type jambe. Leur agressivite contraste avec le resultat remarquable du BV chez ces 3 patients, faisant discuter sa place en 1ere ligne dans ces formes rares.

Objectifs Lors d’une chirurgie pour incontinence urinaire d’effort et/ou prolapsus genital des dispositifs medicaux non-resorbables sont souvent utilises. Les complications dependent de l’experience du chirurgien, des caracteristiques des patientes, de la voie d’abord, de la technique de pose, et des materiaux utilises. L’observatoire VIGIMESH permet depuis 2017 un recueil prospectif de l’utilisation de ces dispositifs et de leurs complications (exposition, complications fonctionnelles [douleur, obstruction, consequences sexuelles]). Methodes A partir de fevrier 2017, dans les 13 centres participants toutes les patientes operees d’une incontinence urinaire d’effort (IUE) et/ou un prolapsus genital ou rectal pouvaient participer au suivi. Seuls les patientes ayant une bandelette sous-uretrale (BSU) ou une colposuspension, une reparation vaginale avec ou sans meche par voie vaginale ou abdominale ou une reparation endo-anale ont ete incluses. Les patientes ayant une pose de sphincter urinaire artificiel, de ballons peri-uretraux ou des injections de produits de comblements n’ont pas ete incluses. Chaque chirurgien declarait leurs interventions et complications. Celles-ci etaient verifiees avec les informations du departement d’information medicale et par des questionnaires de suivi. Resultats Au total, 1873 patientes ont ete incluses et analysees. Les chirurgies index ont ete reparties en 5 groupes ( Tableau 1 ). Les patientes operees d’une IUE isolee par BSU ont beneficie dans la moitie des cas d’une procedure retropubienne (338 cas soit 51,4 %). Quinze patientes ont eu un colpocleisis dans le groupe reparation vaginale sans materiel. Soixante-trois plaies peroperatoires (3,36 %) ont ete rapportes (34 de vessie, 2 de l’uretre, 2 du rectum et 19 du vagin). Seulement dans 8 cas ces plaies ont amene a l’arret de l’intervention et/ou de la mise en place de materiel. Cinquante-deux patientes (2,78 %) ont eu des complications graves durant la chirurgie ou dans les premiers mois postoperatoires (grade III ou plus) ( Tableau 2 et Fig. 1 ). Sept patientes ont necessite de multiples interventions pour traiter la complication. Conclusion L’observatoire est un outil qui permet de rapporter, de facon organisee, les complications des chirurgies du plancher pelvien et permettra sur le plus long terme de comparer les differents materiaux utilises et techniques d’implantation. Il permettra egalement a terme de proposer des recommandations sur la prevention et la prise en charge des complications de ces chirurgies et de leurs sequelles.

Resume Objectifs Evaluer l’efficacite et les effets secondaires associes a l’administration d’acide tranexamique dans le cadre de la prevention et/ou le traitement de l’hemorragie du post-partum. Type d’etude Revue systematique de la litterature avec meta-analyse. Materiel et methodes Revue systematique afin d’identifier les etudes prospectives, randomisees, controlees ayant evalue l’effet de l’acide tranexamique sur la reduction du saignement et la diminution de l’exposition aux produits sanguins dans trois situations cliniques : a) la prevention de l’hemorragie du post-partum lors de cesariennes programmees ; b) la prevention de l’hemorragie du post-partum lors d’accouchements par voie basse ; c) le traitement de l’hemorragie du post-partum. Resultats L’administration preventive d’acide tranexamique avant une cesarienne programmee permettait la reduction des pertes sanguines essentiellement en post-partum (difference moyenne–pertes sanguines peroperatoires : −177,9 mL, IC 95 % : −189,51 a −166,35, les pertes totales : −183,94, IC 95 % : −198,29 a −169,60). L’incidence d’hemorragie du post-partum etait egalement reduite quel que soit le contexte (OR : 0,49, IC 95 % : 0,33 a 0,74). Une seule etude a evalue et mis en evidence l’efficacite de l’acide tranexamique dans le traitement de l’hemorragie active du post-partum. Une reduction des pertes sanguines etait observee 30 minutes (p = 0,03) apres randomisation et etait confirmee a la 6e heure post-randomisation (mediane : 170 mL (58–323) vs 221 mL (110–543), p = 0,04). Conclusion Bien que l’acide tranexamique semble reduire de maniere significative les pertes sanguines et l’incidence des hemorragies severes du post-partum, d’autres etudes prospectives randomisees sont attendues afin de confirmer sa place dans la prise en charge de l’hemorragie du post-partum. De plus, ces etudes devront tenir compte de la pharmacocinetique de ce produit afin de pouvoir evaluer la balance benefice-risque.

Latin America has shown a significant reduction in infant mortality in recent years. The objective of this study was to analyze official data for children under five years of age in Colombia, emphasizing external causes of death, which have been less studied.Descriptive cross-sectional design using secondary information from death records reported by the National Administrative Department of Statistics (DANE) and information dynamic tables of vital statistics, taken from the official information system of the Ministry of Health and Social Protection (SISPRO), between 2005 and 2013 were reviewed. The information was organized in tables for descriptive analysis of variables such as age, sex, and specific cause of death, by departments.In this period 106,339 children under 5 years died; 85,897 of them (81%) in the first year of life. The number of deaths decreased from 14.266 in 2005, to 9.499 in 2013. The main external cause of death was drowning, responsible for 1749 deaths, followed by traffic accidents, 1.282. Homicides were responsible for 692 deaths. In all the causes of death analyzed there was a decline over the decade.Colombia is accomplishing the fourth millennium goal, “reduce the mortality of children under 5 years.” Progress has been made in deaths from external causes, but there is still some way to go.

Preterm neonates are particularly at risk of vitamin D (25-D) deficiency. To prevent rickets and osteopenia in this population, international guidelines vary between 800 and 1000IU per day of vitamin D in Europe and recommend 400IU per day in the USA. Target levels of circulating 25-D are not well identified, with the lower target level 50-75nmol/L and the upper target level probably 120nmol/L.Between 2013 and 2015, 16 premature infants (born35WG) were referred to pediatric nephrology clinics because of symptoms secondary to 25-D overdose during the neonatal period. Clinical and biological data were retrospectively reviewed to better define this population. The results are presented as the median (range).Gestational age was 27 (24-35)WG with a birth weight of 810 (560-2120)g. Nephrocalcinosis was the initial symptom in 37% of cases, hypercalcemia in 44%, and hypercalciuria in 19%. Daily vitamin D doses were 333 (35-676)IU. Age and body weight at initial symptom were 36.6 (27.6-47.6)WG and 2300 (640-3760)g, respectively. The 25-D level at the time of the first dosage was 210 (119-350)nmol/L and the 1-25 vitamin D level was 370 (245-718)pmol/L (local normal values for age240). During follow-up, 12 patients displayed nephrocalcinosis, ten hypercalciuria, and three hypercalcemia. The 25-D level normalized in ten patients within 10 (3-32)months after vitamin D withdrawal. Nephrocalcinosis improved in ten of 12 patients, within 12 (3-30)months. Vitamin D could be readministered in ten patients. When searched (n=3), no CYP24A1 mutation was identified in two patients, but was identified in the heterozygous state in one.A 25-D overdose should be systematically ruled out in the presence of nephrocalcinosis, hypercalcemia, and/or hypercalciuria during infancy in children born preterm. Studies are required to assess the exact frequency of 25-D deficiency and overdose in this population, as well as to evaluate the potential deleterious effects of this imbalance on bone, kidney, and brain development.

Resume Introduction Les benzodiazepines sont largement utilisees en geriatrie, mais exposent a des evenements iatrogenes graves comme des chutes. L’analyse de leurs consommations s’avere complexe (nombreuses specialites, dosages). Notre objectif est de construire un outil d’analyse des consommations de benzodiazepines, et d’evaluer le lien entre cette information et les chutes des patients de trois etablissements geriatriques. Methodes Des coefficients de conversion retrouves dans la litterature nous ont permis de rapporter l’action des benzodiazepines a un comparateur unique : le diazepam. Les consommations de benzodiazepines observees sur 20 mois consecutifs ont ete collectees et ponderees par l’activite des etablissements. Une correlation entre ces consommations et le nombre de chutes signalees durant la meme periode a ete recherchee. Resultats Les consommations de benzodiazepines exprimees en nombre de milligrammes d’equivalent diazepam par jour d’hospitalisation sont significativement liees au nombre de chutes signalees sur la meme periode (R = 0,63 ; p Discussion et conclusions Ces resultats sont concordants avec la litterature : les chutes sont statistiquement liees a la consommation de benzodiazepines, mais la reduction de cette consommation est de faible valeur pronostique (caractere multifactoriel des chutes). Cet indicateur permet d’analyser la consommation de benzodiazepines aussi bien en termes d’exposition globale que de repartition par molecule. Son lien avec les evenements iatrogenes majeurs que constituent les chutes en fait un outil de suivi interessant pour les cliniciens et les pharmaciens.

Osteocalcin is a hormone secreted by osteoblasts, which regulates energy metabolism by increasing β-cell proliferation, insulin secretion, insulin sensitivity, and energy expenditure. This has been demonstrated in mice, but to date, the evidence implicating osteocalcin in the regulation of energy metabolism in humans are indirect. To address this question more directly, we asked whether a benign osteoblastic tumor, such as osteoma osteoid in young adults, may secrete osteocalcin. The study was designed to assess the effect of surgical resection of osteoid osteoma on osteocalcin and blood glucose levels in comparison with patients undergoing knee surgery and healthy volunteers. Blood collections were performed the day of surgery and the following morning after overnight fasting. Patients and controls were recruited in the orthopedic surgery department of New York Presbiterian Hospital, NY-USA and Hospices Civils de Lyon, France. Seven young males were included in the study: two had osteoid osteoma, two underwent knee surgery, and three were healthy volunteers. After resection of the osteoid osteomas, we observed a decrease of osteocalcin by 62% and 30% from the initial levels. Simultaneously, blood glucose increased respectively by 32% and 15%. Bone turnover markers were not affected. This case study shows for the first time that osteocalcin in humans affects blood glucose level. This study also suggests that ostoid osteoma may be considered, at least in part, as an osteocalcinoma.

Resume Les tests ELISA et d'inhibition de l'hemagglutination ont ete compares pour la recherche des anticorps Newcastle lors de vaccination par goutte oculaire au moyen de virus type La Sota. Les deux tests sont positifs des le 6eme jour, moment ou seules des IgM specifiques sont observees. Les IgG specifiques apparaissent entre le 7eme et le 8eme jour. On ne trouve pas d'IgA specifiques dans le serum des volailles vaccinees. Une fixation non specifique des IgM sur l'antigene s'observe en methode ELISA. Le test d'inhibition de l'hemagglutination est aussi sensible et plus specifique que le test ELISA pour la recherche des anticorps Newcastle. Zusammenfassung Serologische Diagnostik der Newcastle Disease durch Hamagglutinationshemmungstests und ELISA Kinetik der verschiedenen vakzinalen Antikorperklassen Die ELISA- und Hamagglutinationshemmungstests wurden, um die Newcastle-Antikorper bei der Vakzinierung durch Augentropfen mittels Virus des Types La Sota zu untersuchen, verglichen. Die beiden Tests sind ab dem 6. Tag, wenn nur die spezifischen IgM beobachtet werden, positiv. Die spezifischen IgG erscheinen zwischen dem 7. und 8. Tag. Es gibt keine spezifischen IgA im Serum des vakzinierten Geflugels. Eine unspezifische Verbindung der IgM am Antigen wird mit dem ELISA beobachtet. Um die Newcastle-Antikorper zu untersuchen, ist der Hamagglutinationshemmungstest gleich sensible und spezifischer als der ELISA-Test. Summary Serological diagnosis of Newcastle Disease by haemagglutination inhibition and ELISA tests Kinetics of different classes of vaccinal antibodies The ELISA and HI tests were compared in investigating the antibody response following eyedrop vaccination with La Sota types of Newcastle Disease virus. Both were positive from day 6, when only specific IgM was detected. Specific IgG in the serum of vaccinated fowls appeared between days 7 and 8. No specific IgA was detected in the serum of vaccinated birds. A non-specific binding of IgM to the antigen was revealed by the ELISA test. For the study of ND antibodies the HI test is just as sensitive and more specific than the ELISA test. Resumen El diagnostico de la enfermedad de Newcastle por las pruebas de inhibicion de la hemaglutinacion y ELISA Se compararon las pruebas ELISA y de inhibicion de la hemaglutinacion para examinar los anticuerpos Newcastle en la vacunacion por gota ocular mediante virus tipo La Sota. Ambas pruebas son positivas a partir del dia 6°, si solo se tienen en cuenta las IgM especificas. Las IgG especificas aparecen entre el dia 7° y 8°. No hay ninguna IgA especifica en el suero sanguineo de las aves vacunadas. Se observa con la ELISA una fijacion inespecifica de las IgM als antigeno. Para estudiar los anticuerpos Newcastle, la prueba de inhibicion de la hemaglutinacion es mas sensible y especifica que la prueba ELISA.

International audience; We found for the first time that in maintenance hemodialysis patients, higher sclerostin serum level was associated with severe abdominal aortic calcification (AAC). In addition, cortical bone microarchitecture (density and thickness) assessed by high-resolution peripheral quantitative computed tomography (HR-pQCT) at tibia was also independently associated with severe AAC. These results suggest that sclerostin may be involved in the association of mineral and bone disorder with vascular calcification in hemodialysis patients. INTRODUCTION: Severe abdominal aortic calcifications are predictive of high cardiovascular mortality in maintenance hemodialysis (MHD) patients. In patients with end-stage renal disease, a high aortic calcification score was associated with lower bone turnover on bone biopsies. Thus, we hypothesized that sclerostin, a Wnt pathway inhibitor mainly secreted by osteocytes and acting on osteoblasts to reduce bone formation, may be associated with vascular calcifications in MHD patients. METHODS: Fifty-three MHD patients, aged 53 years [35-63] (median [Q1-Q3]) were included. Serum was sampled before the MHD session to assay sclerostin. Framingham score was computed and the abdominal aortic calcification (AAC) score was assessed according to Kauppila method on lateral spine imaging using DEXA. Tibia bone status was evaluated by high-resolution peripheral quantitative computed tomography (HR-pQCT). Patients were distributed into two groups according to their AAC score: patients with mild or without AAC (score below 6) versus patients with severe AAC (score of 6 and above). RESULTS: In multivariate analysis, after adjustment on age, dialysis duration and diabetes, serum sclerostin and cortical thickness were independently associated with severe AAC (odds ratio (OR) = 1.43 for each 0.1 ng/mL increase [95 % confidence interval (CI) 1.10-1.83]; p = 0.006 and 0.16 for 1 SD increase [0.03-0.73]; p = 0.018, respectively). A second cardiovascular model adjusted on Framingham score and the above mentioned confounders showed similar results. CONCLUSIONS: Elevated sclerostin serum level and poorer tibia cortical bone structure by HR-pQCT were positively and independently associated with higher odds of severe AAC in MHD patients. Serum sclerostin may become a biomarker of mineral and bone disorder and vascular risk in MHD patients.

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 35 - N° 8 - p. 822-825

Assess the efficacy and safety of tranexamic acid administration for the prevention and/or the treatment of postpartum haemorrhage.Systematic review with meta-analysis.Systematic review of the literature with the aim of identifying prospective, randomised, controlled trials that assessed the effect of tranexamic acid on peripartum blood loss and transfusion requirement in three clinical contexts: (i) prevention of post-partum haemorrhage in case of elective caesarean section, (ii) prevention of post-partum haemorrhage in case of vaginal delivery, (iii) treatment of post-partum haemorrhage.Prophylactic administration of tranexamic acid reduced blood loss (mean difference for intraoperative blood loss: -177.9mL, IC 95%: -189.51 to -166.35, total blood loss: -183.94, IC 95%: -198.29 to -169.60), and the incidence of severe post-partum haemorrhage (OR: 0.49, IC 95%: 0.33 to 0.74). None of the published trials assessed the effect of tranexamic acid on blood products administration or transfusion requirement. Only one study assessed and reported the efficacy of tranexamic acid when administered as a treatment for postpartum haemorrhage. A significant reduction in blood loss was reported within 30 minutes after randomisation (P=0.03) and confirmed after 6 hours (median: 170mL (58-323) vs 221mL (110-543), P=0.04). None of the included studies adequately studied the incidence of side effects after tranexamic acid administration.Although tranexamic acid administration seemed to significantly reduce blood loss and the incidence of severe post-partum haemorrhage, further prospective trials are needed to confirm the efficacy and safety of tranexamic administration in the treatment of postpartum haemorrhage. Those studies should assess the pharmacokinetic profile and the safety of this drug in pregnant women.

The most misunderstood essay in literary theory must be Roland Barthes's 'The Death of the Author' (originally 'La mort de l'auteur', 1968). Repeatedly critics and commentators have taken this satiric jeu d'esprit literally, and have credulously assumed that it is advocating the very position that it is condemning.

cited By 30; International audience; A reliable and rapid speciation method for the determination of both butyl- and phenyltin compounds in environmental samples has been developed. Organotins are extracted from solid matrices by acid leaching. The analytical procedure is based on the one-step simultaneous ethylation/extraction using the reaction with sodium tetraethylborate in aqueous phase in the presence of isooctane. Direct analysis of the organic layer is performed using gas chromatography interfaced to Flame Photometric Detection (GC-FPD). Absolute detection limits of a few pg tin are reached. The technique has been validated by its application to different polluted environmental samples: wastewaters, sediments and biological tissues from marine and freshwater environments and intercomparisons on freshwater sediment and a mussel sample. © 1997 Taylor & Francis Group, LLC.

Adrenal insufficiency is a rare but life-threatening disease. Replacement therapy sometimes fails to prevent an acute adrenal crisis and most often does not lead to restoration of well-being. We report here the 1-year outcome of the first simultaneous kidney-adrenal gland-pancreas transplantation in a 33-year-old patient with type 1 diabetes and concomitant autoimmune adrenal insufficiency. En bloc left adrenal gland and kidney grafts were anastomosed on the left iliac vessels in normal vascular conditions and the pancreas graft was anastomosed on the right iliac vessels. The immunosuppressive regimen was not modified by the addition of the adrenal gland. We observed no additional morbidity due to the adrenal gland transplantation, as there were no surgical complications. One-year kidney and pancreas graft functions were satisfactory (estimated glomerular filtration rate: 55 mL/min/1.73 m(2) and HbA1c: 4.8%). The adrenal graft functioned well at 12 months with a normalization of cortisol and aldosterone baseline levels. Functional imaging at 3 months showed good uptake of [(123) I]-metaiodobenzylguanidine by the adrenal graft. Transplantation of the adrenal gland en bloc with the left kidney appears to be a good therapeutic option in patients with adrenal insufficiency awaiting kidney or kidney-pancreas transplantation.

Fishing has always been an essential component of the Polynesians- life. Fishhooks, mostly in pearl shell, found during archaeological excavations are the artifacts related to this activity the most numerous. Thanks to them, we try to reconstruct the ancient techniques of resources exploitation, inside the lagoons and offshore. They can also be used as chronological and cultural indicators. The shapes and dimensions of these artifacts allow comparisons and classifications used in both functional approach and chrono-cultural perspective. Hence it is very important for the ethno-archaeologists to dispose of reliable methods and standardized measurement of these artifacts. Such a reliable objective and standardized method have been previously proposed. But this method cannot be envisaged manually because of the very important time required to measure each fishhook manually and the quantity of fishhooks to measure (many hundreds). We propose in this paper a detailed acquisition protocol of fishhooks and an automation of every step of this method. We also provide some experimental results obtained on the fishhooks coming from three archaeological excavations sites., {"references":["C. Carlier and E. Conte. \"Proposition de nouvelles approches dans\nl-étude des hame├ºons océaniens\". Journal de la Société des Océanistes\nvol.128, 2009, pp.133-145.","E. Conte. \"La p├¬che pré-européenne et ses survivances. L-exploitation\ntraditionnelle des ressources marines ├á Napuka (Tuamotu - Polynésie\nfran├ºaise)\". PhD Thesis Paris I University, 1988.","E. Conte. \"L-archéologie en Polynésie fran├ºaise. Esquisse d-un bilan\ncritique\". Tahiti : Editions Au Vent des Iles, 302 p, 2000.","K.P. Emory, W. Bonk and Y. Sinoto. \"Fishhooks. Honolulu: Hawaiian\nArchaeology\", Bernice P. Bishop Museum Special Publication 47, 1959.","R.C Suggs. \"The Archaeology of Nuku Hiva, Marquseas Isalnds\",\nFrench Polynesia, Anthropological Papers of The American Museum of\nNatural History, Vol. 49, part 1, New York, 1961.","J. Garanger. \"Hame├ºons océaniens, éléments de typologie\". Journal de\nla Société des Océanistes vol.21, 1965, pp.128-136.","M. Allen. \"Style and function in East Polynesian fish-hooks\". Antiquity\nvol.70, 1996, pp.96-116.","P. Ottino. \"Anapua : Abri sous-roche de pêcheurs. Etude des hameçons\n(1ère partie)\". Journal de la Société des Océanistes vol.94, 1992, pp.57-\n79.","C. Carlier. \"Etude typologique de la collection d-hame├ºons du site de\nManihina (Ua Huka, ├«les Marquises)\". Mémoire de Ma├«trise, Université\nParis I Panthéon-Sorbonne, 2002.\n[10] G. Molle. \"Ua Huka, une ├«le dans l-Histoire. Histoire pré- et posteuropéenne\nd-une société marquisienne\". PhD Thesis, University of\nFrench Polynesia, 2 vols., 465 p, 2011.\n[11] G. Molle and E. Conte. \"New Perspectives on the Occupation of\nHatuana Dune Site, Ua Huka, Marquesas Islands\". Journal of Pacific\nArchaeology vol.2(2) , 2011, pp.1.3-108.\n[12] M. Piccardi, \"Background subtraction techniques: a review\", in Proc. of\nIEEE SMC 2004 International Conference on Systems, Man and\nCybernetics, The Hague, The Netherlands, October 2004.\n[13] J. Bezdeck. Pattern Recognition with Fuzzy Objective Function\nAlgorithms. Plenum Press, 1981.\n[14] R. Krishnapuram et J. Keller. \"The Possibilistic C-Means Algorithm:\nInsights and Recommendations\". IEEE transactions on Fuzzy Systems,\n1996, 4 : 385-393.\n[15] S. P. Lloyd, ÔÇÿÔÇÿLeast squares quantization in PCM,-- Institute of\nMathematical Statistics Meeting, Atlantic City, NJ, September 1957;\nIEEE Transactions on Information Theory, March 1982, pp. 129-136.\n[16] A. Z. Chitade and S.K. Katiyar, \"Colour Based image segmentation\nusing k-means clustering\". International Journal of Engineering Science\nand Technology, Vol. 2(10), 2010, pp. 5319-5325.\n[17] C. Harris and M.J. Stephens. \"A Combined Corner and Edge Detector\".\nIn: Proceedings of the 4th Alvey Vision Conference, 1988, pp. 147-152."]}

The concept "inborn error of metabolism" (IEM) arose from the observations of Sir A. Garrod at the beginning of the XXth century. The exponential development, during the last decades, of our knowledge in cellular biology and molecular genetics, and the availability of increasingly more precise diagnostic tools, allow the identification of a still growing number of inborn errors of metabolism. Their physiopathology is better understood. Treatments have considerably improved: more specific diets, new medical treatments, enzyme replacement therapy, organ transplantation, hepatocyte or stem cell transplantation... New techniques are under development, including various strategies of gene therapy. Improved therapeutic efficacy combined with earlier diagnosis have dramatically changed the prognosis of many disorders. As a consequence, new challenging questions have to be answered. Today, patients with an IEM, because of the extreme complexity of their management, need to be looked after by a multidisciplinary team of physicians (pediatricians and internists), dieticians, social workers, psychologists... It is essential, in this complex and rapidly expanding field, that experiences should be shared at national and international level, in order to provide the most adequate care for patients.

Benzodiazepines are widely used in the elderly, but may induce potentially severe iatrogenic events like falls. The analysis of their use is difficult because of the numerous molecules and dosages available. The aim of the present study is to build a tool to monitor their consumption and to evaluate the relation between this consumption and patient's falls reported in three geriatric institutions.Conversion coefficients found in the literature allowed the expression of benzodiazepine action with a unique comparator: diazepam. Benzodiazepine consumption observed during 20 consecutive months was collected and weighted by hospital activity. A correlation between benzodiazepine consumption and the number of falls reported during the same period was researched.Benzodiazepine consumption expressed in milligrams of diazepam-equivalent per hospitalization day is significantly linked to the number of falls expressed during the same period (R=0.63; p0.01). However, no statistical bound was found between monthly falls variations and monthly benzodiazepine consumption variations. These results corroborate others published studies: benzodiazepine consumptions are statistically linked to falls, but the reduction of this consumption is of poor predictive value, maybe because of the multifactorial nature of falls.The expression of benzodiazepine consumption in diazepam-equivalent enables one to estimate the general exposition of patients and to compare the use of each molecule. The statistical link between this indicator and a major iatrogenic event like falls makes it a tool worth interest for both clinicians and pharmacists.

This is a case report, for the first time in the literature, of a third trimester pregnant woman with acute abdominal pain for which the diagnosis of varicose veins rupture was achieved by MRI.

Administration of large oral doses of retinyl palmitate has become the most widely practised vitamin A deficiency prevention strategy in developing countries. We conducted a follow-up study among 220 Senegalese children aged 2–7 years suffering from moderate undernutrition to determine the efficacy of vitamin A treatment on their vitamin A status assessed by biochemical and cytological (impression cytology with transfer) methods. The first examination (T= 0 m[onth]) was carried out during April 1989, before the mango (Mangifera indicaL,) harvest. The second examination (T= 2 m) was carried out 2 months after vitamin A treatment during June 1989 when ripe mangoes become widely available. Conjunctival cells of the eyes of the children with or without ocular inflammation were responsive to vitamin A administration (P< 0.01). There was a significant increase (P< 0.001) in mean serum retinol and β-carotene levels betweenT= 0 m andT= 2 m. Mean serum retinol-binding protein (RBP) and transthyretin (TTR) levels did not differ significantly (P> 0.05) atT= 0 m andT= 2 m. Despite the intake of vitamin A, 54% of the children who had abnormal cytology atT= 0 m remained abnormal atT= 2 m. This was due to inadequate levels of TTR and RBP, presumably due to the cereal diet eaten by the Senegalese population. Children with abnormal eye cytology had lower serum retinol levels than those with normal eyes atT= 0 m, and β-carotene values did not correlate with eye cytological abnormalities atT= 0 m. Children with normal cytology had higher serum retinol and also β-carotene levels than those with abnormal cytology after massive oral doses of vitamin A and consumption of mangoes atT= 2 m. Retinyl palmitate may, therefore, only lead to partial cytological improvement due to a lack of retinol-carrier proteins but dietary β-carotene may also be involved

The evaluation of the prevalence of ophthal- mological diseases and vitamin A deficiency in Senegalese pre- school-aged children enabled us to confirm the method of impression cytology with transfer (ICT) and to assess the impact of ophthalmological diseases on the cytological appearance of conjunctival cells. A simplification ofthe ICT method consisted of transferring cells present on a strip of paper to a glass slide by finger pressure. Harris-Schorr staining of the sample papers confirmed the results obtained by the transfer. Inflammatory trachoma influenced the results of the test. This simple method will prove very helpful for detection of vitamin A deficiency in children in underdeveloped areas. Am J Clin Nutr 1991; 53:66-9.

Since 2005, international guidelines propose a stadification for chronic renal failure based on the glomerular filtration rate (GFR) value. The performance of the creatinine-based equations allowing the estimation of GFR and the bias of the creatinine measurements is, more than ever, a crucial issue. The consequences for the clinical biologists are of importance. First, the Cockcroft-Gault formula must be replaced by the four variable-MDRD equation. Second, the biologists must chose from the "175" and the "186" versions of the MDRD equation. The first one fits the creatinine methods which are traceable to the reference method (liquid or gas chromatography coupled to mass spectrometry). The second equation must be used for creatinine methods, which are not traceable to the reference method. Today, only some enzymatic methods can prove that they are traceable to the reference method. For the colorimetric methods, future is inclear.

Aminoglycoside-resistant strains of Staphylococcus and Enterococcus, approximately 500 of each, were screened by dot blot hybridization for the presence of genes encoding aminoglycoside-modifying enzymes. The MICs of various aminoglycosides for the strains were determined, and the enzyme contents of the cells were inferred from the resistance phenotypes. The agreements (in percent) of the hybridization results with the deduced enzyme contents for Staphylococcus and Enterococcus species were, respectively, 80 and 87.6 for ANT(6) (aminoglycoside nucleotidyltransferase), 99.8 and 100 for both APH(3') (aminoglycoside phosphotransferase) and APH(2")-AAC(6') (aminoglycoside acetyltransferase), and 100 and 100 for ANT(4'). The weak correlation obtained with the probe for ANT(6) was due to the fact that gram-positive cocci can also be streptomycin resistant by synthesis of APH(3") or ANT(3")(9) and by ribosomal mutation. The remaining probes appeared to be specific: they hybridized with all the resistant clinical isolates but not with the susceptible strains. These results indicate that, except for streptomycin, nucleic acid hybridization is a valid approach for the detection and characterization of aminoglycoside resistance in gram-positive cocci.

Initial trials of web-based smoking-cessation programs have generally been promising. The active components of these programs, however, are not well understood. This study aimed to (1) identify active psychosocial and communication components of a web-based smoking-cessation intervention and (2) examine the impact of increasing the tailoring depth on smoking cessation.Randomized fractional factorial design.Two HMOs: Group Health in Washington State and Henry Ford Health System in Michigan.1866 smokers.A web-based smoking-cessation program plus nicotine patch. Five components of the intervention were randomized using a fractional factorial design: high- versus low-depth tailored success story, outcome expectation, and efficacy expectation messages; high- versus low-personalized source; and multiple versus single exposure to the intervention components.Primary outcome was 7 day point-prevalence abstinence at the 6-month follow-up.Abstinence was most influenced by high-depth tailored success stories and a high-personalized message source. The cumulative assignment of the three tailoring depth factors also resulted in increasing the rates of 6-month cessation, demonstrating an effect of tailoring depth.The study identified relevant components of smoking-cessation interventions that should be generalizable to other cessation interventions. The study also demonstrated the importance of higher-depth tailoring in smoking-cessation programs. Finally, the use of a novel fractional factorial design allowed efficient examination of the study aims. The rapidly changing interfaces, software, and capabilities of eHealth are likely to require such dynamic experimental approaches to intervention discovery.

Gayet-Wernicke syndrome is a rare neurological pathology due to a deficit in vitamin B1. It occurs in alcoholics but several reports have been published of cases in a context of intractable vomiting. The frequency is probably under-estimated because there have been many cases described at autopsy. The diagnosis is clinical with the triad (found in 60% of cases) of mental confusion, oculomotor disorders and ataxia. MRI can confirm the diagnosis by hyper signal images most frequently in a peri-acqueductal location, the thalamus and mamillary bodies. We report 3 observations of Gayet-Wernicke encephalopathy discovered in a context of hyperemesis gravidarum. These 3 cases, which occurred within the past two years in the West of France, give us the opportunity to assess 3 different outcomes for this pathology. In a second section we review the main publications in the literature. Hyperemesis gravidarum is a frequent pathology and can be the cause of serious neurological complications. Early vitamin supplementation should be instituted in case of severe vomiting in order to ensure the pregnancy can continue together with the mother's well-being.

The National Kidney Foundation/Kidney-Dialysis Outcome Quality Initiative guidelines recommend to maintain the serum intact parathyroid hormone (PTH) concentration between 150 and 300 ng/l in chronic kidney disease (CKD) stage 5 patients. As these limits were derived from studies that used the Allegro intact PTH assay, we aimed to evaluate whether they were applicable to other PTH assays. We compared the PTH concentrations measured with 15 commercial immunoassays in 47 serum pools from dialysis patients, using the Allegro intact PTH assay as the reference. We also evaluated the recovery of graded amounts of synthetic 1–84 and 7–84 PTH added separately to a serum pool. Although the assays were highly correlated, the concentrations differed from one assay to another. The median bias between the tested assays and the Allegro intact PTH assay ranged from -44.9 to 123.0%. When the PTH concentrations were 150 or 300 ng/l with the Allegro intact PTH assay, they ranged with other assays from 83 to 323 ng/l and from 160 to 638 ng/l, respectively. The tested assays recognized 7–84 PTH with various cross-reactivities, whereas a given amount of 1–84 PTH was recovered differently by these assays. We found important inter-method variability in PTH results owing to both antibody specificity and standardization reasons. The unacceptable consequence is that opposite therapeutic attitudes may be reached in a single patient depending on the PTH assay used. We propose to use assay-specific decision limits for CKD patients, or to apply a correcting factor to the PTH results obtained with a given assay.

To assess inter-assay variation and accuracy of blood creatinine measurements as well as the effect of the standardization of the calibration procedures on inter-assay variation.Inter-assay variation and accuracy were assessed using 30 frozen human sera and 3 certified reference materials, which were analysed by 17 creatinine assays (colorimetric: 12, enzymatic: 4, HPLC: 1). Usual calibration procedure was compared with two common calibration procedures using either a reference material (404.1 micromol/L), or secondary sera calibrators (69, 115 et 180 micromol/L).Most of the commercially available methods display inaccuracy,10% for creatininemia150 micromol/L in most cases. For this concentration range, the mean creatininemia was statistically significantly different as a function of the assay used (p0.001). Enzymatic assays produced lower results than colorimetric ones for low creatinine levels but higher results for high creatinine levels. Assays being calibrated according to the manufacturer's recommendations, the median dispersion factor was 14% for the 20 samples between 45 and 150 micromol/L, and 8% for the 10 samples between 250 and 350 micromol/L. The calibration procedure modified inter-assay variation significantly (p0.001) but we gained little advantage from both common calibration procedures. A significant decrease of inter-assay variation occurred within each technical group (colorimetric or enzymatic) when a common calibration was performed using calibrators which concentration(s) was(were) close to the concentrations to be measured.Inter-assay variation is too high to allow prediction of glomerular filtration rate (GFR) or creatinine clearance from serum creatinine level. Our results highlight the interest of a calibration procedure using several concentrations with at least one between 90 and 150 micromol/L. The marketing of such a calibrator should be considered in order to decrease inter-assay variation in the range of creatinine levels which defines a mild chronic renal failure. Such an approach will certainly reduce inter-assay variation only within each technical group but could allow to include technical group as a co-variable in the algorithms developed for predicting GFR or creatinine clearance. A global transferability will certainly need the correlation of all types of creatinine assays versus a definitive method, whom definition remains uncertain.

For feeding the LEP (Large Electron-Positron Collider) klystrons, a series of 10 DC power converters was built according to the CERN design of a 100 kV, 4 MW pre-series unit. The power converters are fully voltage-regulated and are capable of regularly withstanding short circuits on their outputs as a normal operation mode. The prototype realization, the series production, the commissioning on the LEP site, and the first operational results of the power converters are presented. The first operational results have demonstrated the validity of the design and construction. The feeding of two klystrons by one power converter was done at a particularly reasonable cost per unit of about k$ 480. The reliability obtained gives confidence for the long-term operation. >

Biochemical markers of bone turnover have for several years been considered as valuable parameters in research clinical studies, but their use in individual patients is still debated. Recently several position papers have proposed guidelines for their use in clinical practice in patients with post menopausal osteoporosis. In the present article, we report the results of a survey which aims at comparing the actual modalities of prescription of French physicians with the above-mentioned recommendations. We contacted by phone clinical chemists from 158 different hospitals and asked them to transmit to the concerned physicians of their hospital a detailed questionnaire for assessing which bone marker(s) is (are) prescribed and for which purpose (s), and if not prescribed, the reason of non prescription. We were able to analyze 309 questionnaires from 89 hospitals including 5 specialties, rheumatology (35.9%), endocrinology (18.1%), gynecology (11.0%), internal medicine (22.0%) and geriatry (12.9%). The results showed large discrepancies between the mode of prescription of a subset of physicians and the guidelines. The most often evoked reason for non prescription was a lack of information about bone markers suggesting a need for teaching courses. This survey has also shown that many physicians do not know exactly which parameters are effectively measured in their hospital and which are addressed to specialized laboratories underlining the importance of the dialogue between clinicians and clinical chemists. We propose that in a given hospital, the present article may serve as a basis for a discussion between clinicians and biologists about the development and/or the optimization of the measurements of these markers of bone turnover.

Biochemical markers of bone turnover have been developed over the past 20 years that are more specific for bone tissue than conventional ones such as total alkaline phosphatase and urinary hydroxyproline. They have been widely used in clinical research and in clinical trials of new therapies as secondary end points of treatment efficacy. Most of the interest has been devoted to their use in postmenopausal osteoporosis, a condition characterized by subtle modifications of bone metabolism that cannot be detected readily by conventional markers of bone turnover. Although several recent studies have suggested that biochemical markers may be used for the management of the individual patient in routine clinical practice, this has not been clearly defined and is a matter of debate. Because of the crucial importance to clarify this issue, the Société Francaise de Biologie Clinique prompted an expert committee to summarize the available data and to make recommendations. The following paper includes a review on the biochemical and analytical aspects of the markers of bone formation and resorption and on the sources of variability such as sex, age, menstrual cycle, pregnancy and lactation, physical activity, seasonal variation and effects of diseases and treatments. We will also describe the effects of pre-analytical factors on the measurements of the different markers. Finally based on that review, we will make practical recommendations for the use of these markers in order to minimize the variability of the measurements and improve the clinical interpretation of the data.

BACKGROUND YKL-40 is a 40 kDa glycoprotein secreted by chondrocytes and synoviocytes. It has been suggested that it is a surrogate marker of synovial inflammation and joint destruction in rheumatoid arthritis (RA) and osteoarthritis (OA) and related to C reactive protein (CRP) serum levels in RA. OBJECTIVE To study serum levels of YKL-40 in patients with hip OA and its relation with CRP. METHODS YKL-40 and CRP were assayed in serum samples from 45 patients (24 women, 21 men, mean age 65) with symptomatic OA of the hip and 33 healthy controls. YKL-40 was assayed by immunoassay and CRP by ultrasensitive immunonephelometry. OA severity was assessed by the measurement of joint space width with a computer analysis system of digitised hip radiographs. Statistical analysis was performed to determine correlations between serum markers and radiological joint space width. RESULTS The mean (standard error) YKL-40 level was 90.3 (8.2) ng/ml in patients with hip OA and 66.9 (8.2) ng/ml in controls (p=0.03). The mean CRP level was 2.93 (3.03) mg/l in OA and 1.40 (1.61) mg/l in controls (p=0.006). The serum levels of YKL-40 and CRP increased with age and were significantly correlated (Spearman test: r s =0.42, p=0.005) in patients but not in controls. Neither YKL-40 nor CRP correlated with radiographic joint space width. CONCLUSIONS Serum YKL-40 was significantly increased in patients with hip OA. The correlation between YKL-40 and CRP suggests that YKL-40 may be a marker of joint inflammation in OA. Longitudinal studies are required to assess the usefulness of YKL-40 in the monitoring of patients with hip OA.

Shoulder dislocation is a frequent pathology with a high level of recurrences especially in young patients. One week immobilization in a Dessault dressing is sufficient if it is followed by free mobilization avoiding external rotation and abduction. A 6 weeks rehabilitation program seems to prevent recurrences.

cited By 47; International audience; A reliable and rapid speciation method for the simultaneous determination of butyl- and phenyltin species in sediment samples has been developed. Two extraction procedures are compared: methanolic hydrochloric acid (at four different concentrations) and ethanoic acid leaching. Derivatization is carried out by the one-step ethylation/extraction procedure using the sodium tetraethylborate reagent directly in aqueous phase in the presence of an isooctane layer. Analysis is performed by capillary gas chromatography hyphenated to flame photometric detection (GC-FPD). Detection limits range from 0.5 to 1.5 ng(Sn) g-1(dry weight). Analysis of environmental samples and certified reference materials demonstrate the accuracy of the analytical method.

cited By 40; International audience; A reliable and rapid speciation method for the simultaneous determination of butyl- and phenyltin species in biological samples has been developed. Three extraction procedures are compared: enzymatic hydrolysis and solubilization by ethanoic and hydrochloric acids. Derivatization is performed by the one-step ethylation/extraction procedure using the sodium tetraethylborate reagent directly in the aqueous phase in the presence of an isooctane layer. Analysis is performed using capillary gas chromatography coupled to flame photometric detection. The detection limits are in the range of a few ng(Sn)/g. Analysis of the environmental samples and the certified reference material demonstrates the accuracy of the analytical method.