Determinants of Resting Energy Expenditure in Very Old Nursing Home Residents.

OBJECTIVES: This study aimed to measure resting energy expenditure (REE) in institutionalized old persons and to determine factors possibly related to change in REE as a basis for estimating energy requirements. DESIGN AND SETTINGS: A monocentric cross-sectional study was conducted. Statistical approaches were conducted to determine independent factors associated with REE. Various published predictive equations of REE were compared to our population. PARTICIPANTS: 72 residents of a nursing home, mostly women (80.5%) aged 87.4±6.6 years were included. MEASUREMENTS: REE (indirect calorimetry), body composition (bio-impedance analysis), biological and anthropometric data were collected. RESULTS: Mean REE was 1006±181 kcal/d and was higher in men than in (1227±195 vs. 953±131 kcal/d, p<0.05). According to criteria adapted from the Global Leadership Initiative on Malnutrition consensus, 65.3 % of the institutionalized population were malnourished. In multivariate analysis adjusted on gender and age, REE was positively associated with calorie intake, fat-free mass (FFM), functional abilities (French Autonomie Gérontologie Groupe Iso Ressources scale), and elevated CRP level (> 25 mg/l). Significant differences (p<0.05) appeared between measured REE and predicted REE by using various published equations. CONCLUSION: REE of very old nursing home residents is influenced by FFM, calorie intake, functional abilities, and CRP levels and is poorly predicted by classical equations based on age, gender, height, and weight. This suggests a metabolic adaptation to caloric restriction and inflammation and prompts to consider the level of physical activity and muscle loss when assessing caloric requirements in this population.

Depression Severity as a Risk Factor of Sarcopenic Obesity in Morbidly Obese Patients.

SETTING: Etiopathogenic factors of physical disability in obesity are numerous, underestimated and not sought in the non-geriatric population. Amongst these factors, depression may favor the development of sarcopenic obesity by reducing strength and physical performance even in the absence of overt muscle loss. Objectives and participants: To study the link between depression status and muscle functional disorders (dynapenia) in a population of adult subjects with severe and morbid obesity. MEASUREMENTS: Patients were assessed for body composition, grip strength, the Short Physical Performances Battery test (SPPB), for depression according to the Beck II score as well as for metabolic parameters through biological tests. RESULTS: In 373 obese subjects (mean age 44 ± 13y and BMI 43 ± 6 kg/m²), the prevalence of depression was 53% with 18% having mild depression, 18% moderate depression and 16% severe depression. Depression was significantly related to dynapenia: 62% of dynapenic (D) patients suffered from depression compared to 50% of non-dynapenic (ND) patients (p = 0.036). The Beck questionnaire score for D patients was 20 ± 13 and 15 ± 10 for ND patients (p = 0.001). The depression intensity was significantly correlated with dynapenia with D patients having a higher severe depression degree than ND patients (30% versus 11%; p < 0.0001). Fat-free to fat mass ratio was also significantly correlated with dynapenia (p = 0.01). In multivariate analysis, the presence of depression was twice as likely to be associated with dynapenia. CONCLUSIONS: Depression is associated with a reduction of muscle function in severe obesity in relation to its severity and to changes in fat to fat-free mass, suggesting that screening and prevention of sarcopenic obesity should be considered in adult obese patients with depression.

Maternal Nutritional Deficiencies and Small-for-Gestational-Age Neonates at Birth of Women Who Have Undergone Bariatric Surgery.

The aim is to compare the prevalence of maternal deficiencies in micronutrients, the obstetrical and neonatal complications after bariatric surgery according to surgical techniques, the time between surgery and conception, and BMI at the onset of pregnancy. A retrospective cohort study concerned 57 singleton pregnancies between 2011 and 2016 of 48 adult women who have undergone bariatric surgery. Small-for-gestational-age neonates were identified in 36.0% of pregnancies. With supplements intake (periconceptional period: 56.8%, trimester 1 (T1): 77.8%, T2: 96.3%, and T3: 100.0%), nutritional deficiencies involved vitamins A (T1: 36.4%, T2: 21.1%, and T3: 40.0%), D (T1: 33.3%, T2: 26.3%, and T3: 8.3%), C (T1: 66.7%, T2: 41.2%, and T3: 83.3%), B1 (T1: 45.5%, T2: 15.4%, and T3: 20.0%), and B9 (T1: 14.3%, T2: 0%, and T3: 9.1%) and selenium (T1: 77.8%, T2: 22.2%, and T3: 50.0%). There was no significant difference in the prevalence of nutritional deficiencies and complications according to surgery procedures and in the prevalence of pregnancy issues according to BMI at the beginning of the pregnancy and time between surgery and pregnancy. Prevalence of micronutritional deficiencies and small-for-gestational-age neonates is high in pregnant women following bariatric surgery. Specific nutritional programmes should be recommended for these women.

[125I]-S36057: a new and highly potent radioligand for the melanin-concentrating hormone receptor.

Shortened, more stable and weakly hydrophobic analogues of melanin-concentrating hormone (MCH) were searched as candidates for radioiodination. Starting from the dodecapeptide MCH(6 - 17), we found that: (1) substitution of Tyr(13) by a Phe residue; (2) addition of a 3-iodo-Tyr residue at the N-terminus; and (3) addition of a hydrophilic spacer 8-amino-3,6-dioxyoctanoyl between the 3-iodo-Tyr and MCH(6 - 17) (compound S36057), led to an agonist more potent than MCH itself in stimulating [35S]-GTPgammaS binding at membranes from HEK293 cells stably expressing the human MCH receptor. Specific binding of [125I]-S36057 was found in HEK293 and CHO cell lines stably expressing the human MCH receptor. This radioligand recognized a similar number of binding sites (ca. 800 fmol mg(-1)) than [125I]-[3-iodo Tyr(13)]-MCH. However, the K(D) for [125I]-S36057 obtained from saturation studies (0.037 nM) or from binding kinetics (0.046 nM) was at least 10 fold higher to that of [125I]-[3-iodo Tyr(13)]-MCH (0.46 nM). Affinities determined for a series of MCH analogues were similar with both radioligands, S36057 being the most potent compound tested (K(i)=0.053 nM). Finally, [125I]-S36057 also potently labelled the MCH receptor in membranes from whole rat brain (K(D) 0.044 nM, B(max)=11 fmol mg(-1)). In conclusion, [125I]-S36057 is a more potent and more stable radioligand than [125I]-[3-iodo Tyr(13)]-MCH that will represent a reliable tool for binding assays in the search of novel MCH ligands. It should also provide great help for autoradiographic studies of the MCH receptor distribution in the central nervous system.

Structure-activity relationship studies of melanin-concentrating hormone (MCH)-related peptide ligands at SLC-1, the human MCH receptor.

Melanin-concentrating hormone (MCH) is a cyclic nonadecapeptide involved in the regulation of feeding behavior, which acts through a G protein-coupled receptor (SLC-1) inhibiting adenylcyclase activity. In this study, 57 analogues of MCH were investigated on the recently cloned human MCH receptor stably expressed in HEK293 cells, on both the inhibition of forskolin-stimulated cAMP production and guanosine-5'-O-(3-[(35)S]thiotriphosphate ([(35)S]- GTPgammaS) binding. The dodecapeptide MCH-(6-17) (MCH ring between Cys(7) and Cys(16), with a single extra amino acid at the N terminus (Arg(6)) and at the C terminus (Trp(17))) was found to be the minimal sequence required for a full and potent agonistic response on cAMP formation and [(35)S]- GTPgammaS binding. We Ala-scanned this dodecapeptide and found that only 3 of 8 amino acids of the ring, namely Met(8), Arg(11), and Tyr(13), were essential to elicit full and potent responses in both tests. Deletions inside the ring led either to inactivity or to poor antagonists with potencies in the micromolar range. Cys(7) and Cys(16) were substituted by Asp and Lys or one of their analogues, in an attempt to replace the disulfide bridge by an amide bond. However, those modifications were deleterious for agonistic activity. In [(35)S]- GTPgammaS binding, these compounds behaved as weak antagonists (K(B) 1-4 microm). Finally, substitution in MCH-(6-17) of 6 out of 12 amino acids by non-natural residues and concomitant replacement of the disulfide bond by an amide bond led to three compounds with potent antagonistic properties (K(B) = 0.1-0.2 microm). Exploitation of these structure-activity relationships should open the way to the design of short and stable MCH peptide antagonists.

Screening of ligand binding on melatonin receptor using non-peptide combinatorial libraries.

The screening of combinatorial libraries requires a deconvolution procedure to obtain, in fine, the most active compound of the starting library. The standard screening assays used in regular molecular pharmacology, have been poorly assessed when transposed to combinatorial chemistry-related experiments, particularly those involving large numbers of chemicals in a single assay. One key issue is the effect of the inactive analogs on the identification of the active ligand in mixtures. We chose melatonin receptors to measure the apparent affinity of a single ligand when tested alone or in mixtures of non-peptide low molecular weight compounds. Using ligands with IC50 from the micro- to the picomolar range, mixed with increasingly complex mixtures of 5 to 20 or 25 inactive compounds, we analyzed the displacements from the mt1 and MT2 melatonin receptor subtypes of the radioligand 2-iodomelatonin (KD= 25 pmol/l and 200 pmol/l, respectively) . The behavior of equimolar mixtures in displacement curves led to the conclusion that the observed binding affinity reflects the dilution effect of mixing the active component with inactive compounds but does not reveal noticeable interactions which would interfere with the binding process. From the practical point of view, the concentrations of the active species in the binding assay should be large enough to displace significantly the radioligand, a requirement which may be limited by the solubility of the ligand mixtures. In contrast, previous observations with peptide libraries report that the dilution effect is often compensated by additive or synergic action of structurally related analogs, thus making possible the deconvolution of very large (typically up to 10(7) compounds) peptide libraries.

Characterization of 2-[125I]iodomelatonin binding sites in Syrian hamster peripheral organs.

The neurohormone melatonin is a key agent in synchronizing the circadian rhythms. At least three types of binding sites have been described for melatonin: the G-coupled, seven-transmembrane domain receptors mt1 and MT2 and a putative binding site called MT3. The latter has been described in hamster brain membranes, and its binding capacity is optimum at 4 degrees C. We further characterized this binding site on other peripheral hamster tissues, including intestine, liver, kidney, lung, muscle, and heart. We found a high level of binding sites (>30 fmol/mg of protein) in intestine and kidney. Furthermore, we completed the existing pharmacological profile of this site, which can now be described as 2-iodomelatonin > 6-chloromelatonin > methy-isobutyl-amiloride > acridine orange > 5-methylcarbonylamino-N-acetyltryptamine > prazosin > N-acetylserotonin > melatonin. This profile was found in all the hamster organs tested that had a large number of binding sites, namely, brain, intestine, kidney and liver. Furthermore, when comparisons were possible, the MT3 pharmacological characteristics were similar to those described in the literature for hamster brain and testis. This profile was compared to the pharmacology obtained on human cloned mt1 and MT2 receptors and proved to be completely different, as expected. We provide new evidence for an alternate melatonin binding site not only in hamster brain but also in some peripheral organs.

[Ultrasound-guided needle biopsy in non-palpable breast lesions. Technic, evaluation, management--72 cases]. / La cytoponction échoguidée dans les lésions mammaires impalpables. Technique, évaluation, conduite à tenir--72 observations.

Non-palpable breast lesions set histological problems. The authors with a series of 72 ultrasound guided cytology aspirations, describe the technique, its limits, its difficulties and its advantages. A biopsy was carried out on 51 lesions. The results were evaluated as follows: sensibility 86%, specificity 100%, positive predictive value 100%, false predictive value 97.5%. The diagnostic value of the method has been compared with other diagnostic tests (mammography, ultrasound and cytological puncture in palpable lesions). The procedure to be adopted has been suggested.

[Acute idiopathic dilatation of the right colon or Ogilvie's syndrome. Apropos of a case encountered after cesarean section]. / La dilatation aiguë idiopathique du côlon droit ou syndrome d'Ogilvie. A propos d'un cas rencontré après une césarienne.

The syndrome of acute colectasia of the right colon following a caesarean section is a rare disease observed and described for the first time by Ogilvie in 1948. Many etiopathological hypotheses have been formulated but recent studies demonstrate the role of the neuro-vegetative nervous system, causing the functional obstacle responsible for the idiopathic right colon dilatation. The clinical picture of low obstruction is seldom typical, as in our case; however, the abdominal X-Ray easily confirms the diagnosis, since the caecal distention may exceed 10 cm in diameter. Most of the time, the prognosis is favorable after aspiration via colonoscopy; caecal perforation is always the spontaneous outcome, due to the "vicious cycle" perpetuating the functional obstruction.

[Diagnostic value of the determination of serum beta human chorionic gonadotropin in extra-uterine pregnancy]. / Valeur diagnostique du dosage de la beta hCG plasmatique lors de la grossesse extra-utérine.

The methods of immunological diagnosis of pregnancy are described, and their reliability is evaluated according to the results of 35 case files of extrauterine pregnancy clinics. In all these case the beta-hCG results were negative, and there was no extrauterine pregnancy. The analysis of positive cases allows it to be stated that on each occasion in which the reaction is positive there is a pregnancy, but the location of this pregnancy is uncertain, and recourse to a complementary technique is justified.

Optimal laser parameters for port wine stain therapy: a theoretical approach.

The optimal parameters for laser therapy of port wine stains (PWS) have been deduced from temperature calculations on two models: (i) the four-layer model; and (ii) the tube model in which two plane parallel layers, representing the epidermis and dermis, and a dermal rectangular blood vessel are considered. The calculations were performed with a vessel of average cross section 0.06 mm X 0.08 mm located in the centre of the laser beam. The numerical calculations were performed by an alternate direction-implicit finite difference method. The optimal parameters were: wavelengths lambda = 415, 577 and 540 nm; pulse time, 1 ms less than t1 less than or equal to 10 ms; and beam radius W1 greater than 0.1 mm. The energy densities E1 (for t1 = 1 ms) required to coagulate blood vessels down to a depth of 0.65 mm in order to establish bleaching of the PWS were 0.5, 1.6 and 2 J cm-2 for the different lambda respectively. The value for the argon laser (lambda = 488 and 514.5 nm) was E1 = 6.5 J cm-2 (t1 = 1 ms). Because, for this pulse time, heat summation effects at the boundary of the laser beam cause no drastic increase in local temperature at optimal wavelengths, the stripe technique was again considered and compared with the separated spot technique. The Nd-YAG and CO2 lasers prove even less selective than the argon laser. The influence of cooling the skin with water shows that only for lambda = 577 nm and t1 = 0.1 s is there an increase in E1 from 2.5 to 6 J cm-2 for which dermal damage occurs.

The effect of phenylbutazone on acute hemorrhagic pancreatitis in the rat.

The effect of phenylbutazone on acute experimental pancreatitis was investigated in the rat. Severe necrotico-hemorrhagic pancreatitis was produced by intraductal injection of trypsin. Pretreatment by phenylbutazone did not alter the mortality rate but reduced the severity of pancreatitis as was demonstrated by histological quantification (total score 13.35 +/- 0.80 in treated rats versus 17.67 +/- 0.69 in the control group; P less than 0.01). The protective effect of phenylbutazone seems to be related to the specific anti-inflammatory properties of the drug and not to inhibition of prostaglandin synthesis.

Clinical and histological evaluation of portwine stain treatment with a microsecond-pulsed dye-laser at 577 NM.

Test treatment of portwine stains (PWS) was performed with a microsecond-pulsed dye laser at 577 nm using a 2-mm spot diameter. Although selective coagulation of the erythrocytes occurred, this did not result in bleaching of the treated area. Massive destruction of the dilated capillaries is suggested to be a prerequisite for PWS-bleaching, very probably requiring msec (instead of microseconds) laser pulses.

Renin and arterial pressure in perfused dog kidneys.

20 isolated dog kidneys were perfused in vitro at 37 degrees C during 6h in a closed circuit system with a Roller pump maintaining a pulsatile flow with a constant output. The perfusate electrolyte concentrations were kept constant. In 12 experiments where a hemodiluted standardized perfusion fluid was used, a significant (0.01 greater than p greater than 0.001) correlation (r = 0.798) was found in the beginning of the experiments between the mean arterial pressure expressed in mm Hg (y) and the renin level, expressed in log U/1 (x): y = 57.0+76.8x. In 4 other experiments, phenoxybenzamine added to the perfusion fluid decreased the arterial pressure but did not prevent the rise of the renin level. In 4 other experiments where the perfusion fluid did not contain blood, renin level and arterial pressure increased, whereas in the experiments using a circuit without a kidney, the renin level did not rise. The possible role of the renin-angiotensin system in causing increased renal vascular resistance during in vitro kidney perfusions is discussed.