[Responses to the Risk of Canine and Human Rabies in the City of Sibut, Central African Republic]. / Les réponses au risque de rage canine et humaine dans la ville de Sibut, République centrafricaine.

In Sibut (CAR), the increase in bites by stray dogs and two cases of human rabies alerted health authorities in 2019. The answers were the vaccinations of humans and of dog (780 dogs). Among the 127 humans bitten and identified, 87% received a first injection of post-exposure prophylaxis. The drop-out between the first and third doses was 41%. Communication on rabies and the provision of vaccines and serums to the population are necessary, but difficult to achieve in the crisis conditions of the country.

À Sibut (RCA), la multiplication des morsures par des chiens en divagation et deux cas de rage humaine ont alerté les autorités sanitaires en 2019. Les réponses ont été la vaccination de 780 chiens. Parmi les 127 humains mordus et identifiés, 87 % ont reçu une première dose de prophylaxie postexposition. Le taux d'abandon vaccinal entre la première et la troisième dose a été de 41 %. La communication sur la rage et la mise à la disposition de la population de vaccins et sérums sont nécessaires, difficiles à réaliser dans les conditions de crise que connaît le pays.

Anticancer effect of metformin against 2-amino-1-methyl-6-phenylimidazo [4,5-b]pyridine-induced rat mammary carcinogenesis is through AMPK pathway and modulation of oxidative stress markers.

OBJECTIVES: Metformin, the type 2 anti-diabetes medication, showed antitumor activity both in vivo and in vitro. This study was carried out to investigate the mechanisms behind the metformin anticancer effect against 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine (PhIP)-induced mammary carcinogenesis in female Sprague-Dawley rats. METHODS: Rats received 10 doses of PhIP (75 mg/kg, p.o., days 1-5 and 8-12). Then, rats were treated with metformin for 26 weeks at a dose of 2 mg/ml in drinking water. KEY FINDINGS: Metformin antitumor effect was mediated by increasing the adenosine monophosphate protein kinase (AMPK) activity, liver kinase B1, and decreasing the aromatase and insulin levels compared with the PhIP-administered group. Also, this treatment resulted in a significant decrease in mammary tissue oxidative stress markers and serum lipid profile. In parallel, mammary gland tumors found in PhIP+metformin group were all histologically benign included only (hyperplasia). However, most of the mammary gland tumors found in PhIP group were histologically malignant. CONCLUSIONS: These results showed that metformin antitumor effect was mediated through AMPK pathway, reducing oxidative stress and serum lipid levels. This study supports the potential benefit of using metformin as adjuvant therapy during breast cancer treatment.

Physical Characterization and Innate Immunogenicity of Aggregated Intravenous Immunoglobulin (IGIV) in an In Vitro Cell-Based Model.

PURPOSE: To investigate in vitro the innate immune response to accelerated stress-induced aggregates of intravenous immunoglobulin (IGIV) using a well-defined human cell-line model, and to correlate the innate response to physical properties of the aggregates. METHODS: IGIV aggregates were prepared by applying various accelerated stress methods, and particle size, count and structure were characterized. Immune cell activation as tracked by inflammatory cytokines released in response to aggregates was evaluated in vitro using peripheral blood mononuclear cells (PBMC), primary monocytes and immortalized human monocyte-like cell lines. RESULTS: IGIV aggregates produced by mechanical stress induced higher cytokine release by PBMC and primary monocytes than aggregates formed by other stresses. Results with the monocytic cell line THP-1 paralleled trends in PBMC and primary monocytes. Effects were dose-dependent, enhanced by complement opsonization, and partially inhibited by blocking toll-like receptors (TLR2 and TLR4) and to a lesser extent by blocking Fc gamma receptors (FcγRs). CONCLUSIONS: Stress-induced IGIV aggregates stimulate a dose-dependent cytokine response in human monocytes and THP-1 cells, mediated in part by TLRs, FcγRs and complement opsonization. THP-1 cells resemble primary monocytes in many respects with regard to tracking the innate response to IgG aggregates. Accordingly, the measurement of inflammatory cytokines released by THP-1 cells provides a readily accessible assay system to screen for the potential innate immunogenicity of IgG aggregates. The results also highlight the role of aggregate structure in interacting with the different receptors mediating innate immunity.

[Implications of choice of products and impression technique on the thickness of the dento-prosthetic interface of the CAD-CAM crowns]. / Incidences du choix des produits et de la technique d'empreinte sur l'épaisseur de l'interface dento-prothétique des couronnes CAD/CAM.

The purpose of this study is to find out what type of impression material is able to achieve a CAD-CAM (Procera) crown with minimal thickness at the dental-prosthetic interface, taking into account the effect of the oversize replica and dimensional variations of the impression materials over time. The accuracy of the marginal adaptation will therefore depend on the oversize replica of clinical preparation controlled by the constant K. Three different types of impression materials: medium viscosity polyether (Impregum 3M-ESPE, Germany), silicones polyvinyl siloxane A (Putty + Very Light) and (Heavy + Light) (Express 3M-ESPE, Germany), were used for making impressions of fifteen initial prototype maxillary teeth made of nickel chrome. The cast of the impressions were poured with plaster type IV (Zhermack, Italy), on which thirty Procera crowns were fabricated. The thickness of the dental-prosthetic interface was then studied at three levels: 0, 1 and 2 mm. The results show that the impression material has a statistically significant impact on the thickness of the dental-prosthetic interface at all three levels. The most compressive impression technique, Putty + Very Light gave the best results at the three levels pre-cited. The results analyzed under optical microscopy show a statistically significant difference between the three impression material products (p-value < 0.05). The calibration constant K, according to each clinical situation, can therefore lead to optimal dental-prosthetic inter-face.

In vivo efficacy of microbiota-sensitive coatings for colon targeting: a promising tool for IBD therapy.

The first proof of concept in vivo for a new type of microbiota-sensitive film coatings allowing for colon targeting is presented. The efficacy of these polysaccharide barriers to optimize drug release for the treatment of inflammation is demonstrated in an experimental colitis model with Wister rats. 5-Aminosalicylic acid (5-ASA) pellets were prepared by extrusion-spheronization and coated with Nutriose:ethylcellulose (EC) 1:4 or peas starch:ethylcellulose 1:2 blends. The pellets were mixed with standard chow, and the daily drug dose was 150mg/kg. For reasons of comparison, also commercially available Pentasa pellets and placebo pellets were studied. At day 3 after the beginning of the treatment, colitis was induced by intrarectal administration of trinitrobenzene sulfonic acid (TNBS). Animals were sacrificed on day 6. Macroscopic and histological evaluations of colitis were performed blindly. In addition, inflammatory markers were evaluated using ELISA and real-time PCR. Rats receiving TNBS and placebo pellets developed a severe colitis in the distal half of the colon. 5-ASA administered in the form of Pentasa pellets reduced macroscopic inflammation by only 5%. In contrast, the colon lesions were much less severe upon treatment with Nutriose:EC- and peas starch:EC-coated pellets: The macroscopic score was reduced by 25 and 24%, respectively. Decreases of 37 and 38% of the histological lesions confirmed the efficacy of these new colon targeting systems. Also, inflammatory markers (MPO, IL-1ß mRNA, TNF mRNA) were significantly decreased in rats receiving Nutriose:EC- and peas starch:EC-coated pellets compared to Pentasa pellets. Furthermore, real-time PCR analysis indicated increased activation of the target receptor PPAR-γ and the HMGCS2 gene in rats upon administration of 5-ASA loaded Nutriose:EC- and peas starch:EC pellets compared to the commercial product. Also, HPLC-MS/MS analysis of plasma samples demonstrated that the level of the main metabolite of the drug (N-acetyl-5-ASA) was much lower upon administration of Nutriose:EC or peas starch:EC coated pellets compared to Pentasa pellets, indicating that undesired premature drug release in the upper gastrointestinal tract was more effectively hindered. In addition to the rat study, in vivo imaging of transgenic mice expressing the luciferase gene evidenced much more pronounced PPAR-γ activation upon 5-ASA administration in the form of Nutriose:EC-coated pellets versus Pentasa pellets. All these results clearly demonstrate the superiority of these microbiota-sensitive polysaccharide-based film coatings for colon targeting in vivo.

Adult female football players have higher lumbar spine and hip bone mineral density than age- and body weight-matched controls.

AIM: The aim of this study was to compare lumbar spine, total hip, femoral neck, total forearm and 1/3 Radius bone mineral density (BMD) in young female football players and age- and body weight- matched female controls (aged 18 to 30 years). METHODS: This study included 18 female football players and 22 age- and body weight- matched sedentary females (aged 18 to 30 years). Weight and height were measured, and body mass index (BMI) was calculated. Daily calcium intake, daily protein intake and sleep duration were evaluated using validated questionnaires. BMD of the lumbar spine (L2-L4), the total hip (TH), the femoral neck (FN), the total forearm (TF) and the 1/3 Radius was assessed by dual-energy X-ray absorptiometry (DXA). RESULTS: Height and BMI were not different between the two groups (football players and controls). L2-L4 BMD, TH BMD and femoral neck BMD were significantly higher in football players compared to controls (P<0.05). There were no significant differences between the two groups concerning total forearm BMD and 1/3 Radius BMD. CONCLUSION: This study suggests that, in young adult females, football practice is associated with an increased BMD at the lumbar spine and the total hip but not at the total forearm.

The effect of methylmercury exposure on early central nervous system development in the zebrafish (Danio rerio) embryo.

Much attention is focused on environmental contamination by heavy metals. The heavy metal mercury is found worldwide and is ranked number 3 on the Comprehensive Environmental Response, Compensation and Liability Act substance list. We examined the effect of low-level methylmercury exposure on central nervous system development of wild-type zebrafish embryos (ZFEs) of the AB strain because methylmercury is the most common form of mercury to which humans are exposed in the environment. ZFEs were exposed to nine different concentrations of methylmercury [0 (negative control), 5, 10, 50, 80, 100, 200, 500 and 1000 parts per billion (µg l(-1) )] starting at 6 h post-fertilization, which is the time the neural tube is first beginning to form. ZFEs were exposed to 2% ethanol as positive controls (100% embryonic death). ZFEs were assessed at 30, 54, 72 and 96 h post-fertilization for changes in embryonic development, mortality, time of hatching and morphological deformities. No abnormalities were observed in ZFEs exposed to 5 µg l(-1) methylmercury. The time of hatching from the chorion was delayed in ZFEs exposed to methylmercury concentrations of 50 µg l(-1) or higher. Significantly more ZFEs exposed to 0, 5 or 10 µg l(-1) methylmercury successfully completed hatching compared with ZFEs exposed to 50 µg l(-1) or higher methylmercury. ZFEs exposed to more than 200 µg l(-1) methylmercury exhibited 100% embryonic mortality. The rate of cell proliferation within the neural tube was significantly decreased in embryos exposed to 10, 50 and 80 µg l(-1) methylmercury and there were no differences between these doses.

Prenatal development of the adrenal gland in the one-humped camel (Camelus dromedarius).

UNLABELLED: With 14 figures and 3 tables SUMMARY: Each adrenal gland consisted of cortex and medulla that developed from different embryological origins and presented different cellular organization. One hundred male or female camel embryos or fetuses with crown vertebral rump lengths (CVRL) that ranged from 0.8 to 117 cm were examined. The adrenal cortex, which is derived from intermediate mesoderm, was first observed in the 0.8-cm CVRL camel embryo. The adrenal cortex initially was combined with the gonad as a thickened region of proliferating cells derived from splanchnic intermediate mesoderm. Adrenocortical tissue was first separated from the gonadal tissue in the 2-cm CVRL camel fetus and was observed as a separate dorso-medial mass of cells. At 2.5-cm CVRL, the adrenocortical tissue was surrounded by a capsule of undifferentiated mesenchymal cells, except at its proximal pole, where an invagination was located through which chromaffinoblast cells entered the cortex. The chromaffinoblast cells migrated from the neural crest to form the medulla of the developing adrenal gland. In the 3.5-cm CVRL camel fetus, the adrenocortical cells differentiated into two layers: the inner fetal cortex and the outer definitive cortex. As development proceeded, the fetal cortex degenerated and the definitive cortex formed the zona glomerulosa and zona fasciculata. The zona reticularis did not form until the end of gestation. During prenatal life, the adrenal medulla was much thicker than the cortex.

Obesity and catecholamine responses to maximal exercise in adolescent girls.

The aim of this study was to investigate plasma catecholamine [adrenaline (A) and noradrenaline (NA)] concentrations at rest and in response to maximal exercise in three different groups of adolescent girls. According to their body mass index, 34 adolescent girls aged 15-16 years were divided into three groups: a normal weight group (NO) (n = 11), an overweight group (OW) (n = 11) and an obese group (OB) (n = 12). Plasma A and NA concentrations were measured at rest during fasting conditions (A(0) and NA(0)), after a standardized breakfast (A(rest) and NA(rest)) and immediately after an incremental exhaustive exercise (A(EX) and NA(EX)). A (0) and NA(0) were not significantly different among the three groups. However, the A(0)/NA(0) was statistically lower in OB compared to OW and NO. A(EX) and NA(EX) were significantly higher than resting values in the three groups. However, in response to exercise, no significant differences were reported between OB (A(EX) = 2.20 +/- 0.13 nmol/l, NA(EX) = 12.28 +/- 0.64 nmol/l), OW (A(EX) = 2.39 +/- 0.23 nmol/l, NA(EX) = 12.94 +/- 0.93 nmol/l) and NO (A(EX) = 2.52 +/- 0.24 nmol/l, NA(EX) = 12.60 +/- 0.63 nmol/l). In conclusion, our results showed that at rest, in adolescent girls, the responsiveness of the adrenal medulla to the sympathetic nervous activity is lower in OB subjects compared to OW and NO ones. However, in response to maximal exercise, plasma catecholamines are not affected by obesity.

Evaluation of a wheelchair prototype with non-conventional, manual propulsion.

OBJECTIVE: To evaluate the results of a user satisfaction questionnaire on a new type of lever-propelled wheelchair designed to avoid the discomfort and potential repetitive strain injuries related to conventional hand-rim propulsion. METHODS: Seventeen participants filled out a questionnaire to rate their conventional wheelchair and the prototype (after 2 days' use) in terms of comfort, adjustability, steering/ride, manoeuvrability, stability when crossing obstacles, safety, weight, size, portability and appearance. Overall satisfaction was also scored. RESULTS: According to the user questionnaire results, the lever-propelled prototype chair was rated as significantly superior than conventional wheelchairs in terms of comfort, safety and overall satisfaction. The prototype was rated significantly inferior in terms of size, adaptability, appearance and crossing obstacles. CONCLUSION: We conclude that the prototype wheelchair is highly acceptable and comfortable and can be recommended to disabled sportspersons. The prototype's weak points are mainly related to ergonomic aspects, which could be improved in future models.

Exercise-induced oxidative stress in overweight adolescent girls: roles of basal insulin resistance and inflammation and oxygen overconsumption.

HYPOTHESIS: Basal insulin resistance (IR) and inflammation exacerbate post-exercise oxidative stress (OS) in overweight adolescent girls. DESIGN: Cross-sectional study, effect of incremental ergocycle exercise until exhaustion on OS markers. PARTICIPANTS: Normal-weight (control) (n=17, body mass index (BMI): 20-24.2 kg/m(2)) and overweight adolescent girls (n=29, BMI: 24.1-36.6 kg/m(2)). MEASUREMENTS: Dietary measurement, physical activity assessment (validated questionnaires), fat distribution parameters (by dual-energy X-ray absorptiometry and anthropometry) and maximal oxygen consumption (VO2peak). Blood assays include the following: (1) at fasting state: blood cell count, lipid profile, and IR parameters (leptin/adiponectin ratio (L/A), homeostasis model assessment of IR, insulin/glucose ratio; (2) before exercise: inflammation and OS markers (interleukin-6 (IL-6), C-reactive protein (CRP), myeloperoxidase (MPO), reduced glutathione/oxidized glutathione ratio (GSH/GSSG), 15 F(2)alpha-isoprostanes (F(2)-Isop), lipid hydroperoxides (ROOH), oxidized low-density lipoprotein (ox-LDL)) and antioxidant status (superoxide dismutase (SOD), glutathione peroxidase (GPX), vitamin C, alpha-tocopherol and beta-carotene); and (3) after exercise: inflammation and OS markers. RESULTS: At rest, overweight girls had a deteriorated lipid profile and significantly higher values of IR parameters and inflammation markers, compared with the control girls. These alterations were associated with a moderate rest OS state (lower GSH/GSSG ratio, alpha-tocopherol/total cholesterol (TC) ratio and GPX activity). In absolute values, overweight girls exhibited higher peak power output and oxygen consumption (VO2peak), compared with the control girls. Exercise exacerbated OS only in the overweight group (significant increase in F(2)-Isop, ROOH and MPO). As hypothesized, basal IR and inflammation state were correlated with the post-exercise OS. However, the adjustment of F(2)-Isop, ROOH and MPO variation per exercise VO(2) variation canceled the intergroup differences. CONCLUSION: In overweight adolescent girls, the main factors of OS, after incremental exhaustive exercise, are not the basal IR and inflammation states, but oxygen overconsumption.

Mammary gland secretory concretions contain non-collagenous bone matrix proteins.

Secretory concretions in mammary gland alveoli are commonly of microscopical size. However, some concretions reach clinically palpable dimensions and may occlude teat canals and obstruct milk flow. We studied secretory concretions in sheep, goat and cow mammary glands, using routine histological staining methods, conventional histochemistry and electron microscopy. As concretions frequently mineralize, immunostaining for keratan sulphate and calcium-binding non-collagenous bone matrix proteins (bone sialoprotein, osteocalcin, osteonectin and osteopontin) was performed. Concretions consisted of organic matrix (condensed secretions) with calcium precipitates. Mineralized deposits mostly show concentric organization, bound haematoxylin, and were readily identified in H&E-stained sections. Mineral components of concretions reacted for calcium carbonate and phosphate, organic matrix was found to contain sialoglycan material. Immunohistochemistry revealed bone sialoprotein, osteonectin and keratan sulphate in cow and goat concretions. Osteocalcin was detected in sheep, cow and goat concretions, whilst osteopontin was not identified in any of the specimens studied. Our results indicate the presence of non-collagenous bone matrix proteins (except osteopontin) in mammary gland concretions. These glycoproteins are commonly thought to govern mineralization of organic matrix and are assumed also to promote mineral deposition in mammary gland secretory concretions. Besides caseins, these particular glycoproteins have to be considered as calcium-binding milk proteins.

D-dimer levels, constitutional thrombophilia, and venous thrombosis prediction: clinical aspects and implications.

The negative predictive value of D-dimers in the diagnosis of a recent venous thromboembolism (VTE) episode is well established. The plasma level of D-dimer is usually increased in hypercoagulable states. The measurement of D-dimer could be of clinical interest in patients with constitutional thrombophilia as there is no close relationship between the clinical expression and the genotype indicating the existence of a hypercoagulable state. Moreover, the predictive value of D-dimer testing in patients with thrombophilia has been questioned. The review of the literature and results of a recent study of our group are presented. Decreased levels of D-dimer are observed in patients receiving an oral anticoagulant treatment versus untreated patients. In contrast, no significant difference was observed between those with and those without thrombophilia among treated or untreated patients. Patients with constitutional thrombophilia are supposed to have an increased risk of postoperative VTE. The review of the existing literature could not confirm this opinion but this could be due to the fact that most patients receive a prophylactic treatment. Thus, there is an indirect evidence of its efficacy in these patients.

Stem cell transplantation for patients with Fanconi anemia with low-dose cyclophosphamide and antithymocyte globulins without the use of radiation therapy.

In all, 22 patients with confirmed Fanconi anemia (FA) underwent stem cell transplantation (SCT) from HLA-matched, related donors at KFSHRC. Median age at SCT was 7.6 years (range, 2.5-14.6 years). Conditioning regimen consisted of cyclophosphamide (CY) 15 mg/kg/day intravenously (i.v.) for 4 consecutive days, in addition to equine antithymocyte globulins (ATG) given i.v. at 40 mg/kg/day for four doses pre-SCT. No radiation therapy was given. For graft-versus-host disease prophylaxis, we used cyclosporin at the standard doses; ATG was added at 20 mg/kg/dose i.v. on days 2, 4, 6, 8, 10, and 12 post-SCT (total of six doses). All patients engrafted and are alive and transfusion independent with a median follow-up time of 20.2 months (range, 3.3-59 months). One patient however developed a decrease in her WBC and platelet count. Her work-up revealed slightly hypocellular bone marrow, and a series of chimerism studies over 1 year confirmed that she has stable mixed chimerism; she remains transfusion independent. We conclude that low-dose CY without radiation therapy can be used satisfactorily in the conditioning of patients with FA undergoing related SCT.

[Hepatitis delta virus RNA detection by one-step RT-PCR]. / Détection de l'ARN du virus de l'hépatite delta par une RT-PCR rapide en une étape.

We have developed a method of detection HDV RNA where the reverse transcription and amplification are carried out in the same tube, thus reducing the handling time and the contamination risk. RNA extracted from serum or plasma on a microcolumn technique (kit QIAamp viral RNA, QIAgen) is submitted to reverse transcription and amplification by using the One-Step RT-PCR kit (QIAgen). Primers and probe were placed in the conserved ribozymic regions of the HDV genome. The sensitivity of the technique was estimated to 420 copies per reaction by using serial dilutions of a tittered sample. Its specificity was shown by the negativity of 24 samples from anti-HDV negative subjects, either healthy or coinfected by HBV, HCV or HGV. A low tittered sample was reproductively detected in different series. This One-step RT-PCR technique is specific, reproducible and allows the fast detection of active HDV RNA replication. Its adaptation to the routine diagnosis in a laboratory of medical virology is possible and will allow its evaluation on a greater number samples.

Allogeneic stem cell transplantation in patients with Fanconi's anemia and myelodysplasia or leukemia utilizing low-dose cyclophosphamide and total body irradiation.

Five patients with confirmed Fanconi's anemia (FA) and myelodysplasia and/or leukemia underwent stem cell transplantation (SCT) from related donors at KFSHRC. The median age at SCT was 12.6 year (range, 6.2-15 years). Conditioning regimen consisted of cyclophosphamide (CY) 5 mg/kg/day i.v. for 4 days, total body irradiation (TBI) 450 cGy in a single dose. Graft-versus-host disease (GVHD) prophylaxis was with cyclosporine and antithymocyte globulins (ATG). The median time to engraftment (defined as ANC>/=0.5 x 10(9)/l) was 16 days (range, 12-26 days). The median time to a self-sustaining platelet count of >/=20 x 10(9)/l was 27 days (range, 12-40 days). All patients engrafted. Two patients developed acute GVHD; one of the gut (grade 3) and the other of the skin (grade 1), and one patient developed chronic GVHD of the liver. Four are alive and well with no evidence of the disease; one patient died of bacterial sepsis after controlling her GVHD and clearing her pulmonary aspergillosis and CMV infection. We conclude that the use of low-dose CY plus TBI in patients with FA and MDS/AML undergoing SCT is adequate; the regimen is well tolerated and may be curative for such patients.

Effect of sprint duration (6 s or 30 s) on plasma glucose regulation in untrained male subjects.

AIM: We have explored in the following study the glucoregulatory responses (glycemia, insulinemia, catecholamines) at the end of 2 supramaximal tests of different durations. METHODS: Seven untrained male subjects (21.9+/-0.3 y) performed an isolated exercise of 6 s (T6) and a Wingate-test of 30 s. To determine the levels of lactate (La), plasma concentrations of glucose, insulin, adrenaline (A) and noradrenaline (NA), blood samples have been collected successively at rest, after a warm-up period of 15 min, immediately after T6 and T30, and after 5, 10, 20, and 30 min of recovery. RESULTS: Whether expressed as absolute or relative values, the peak power recorded during the 2 tests is statistically the same in T6 and T30. The maximal value of lactate (L(amax)) measured 5 min after the end of the 2 exercises is significantly greater after T30 (12.3+/-0.9 mmol x L(-1)) than after T6 (5.4+/-0.4 mmol x L(-1)) and T30 (4.2+/-0.2 mmol x L(-1)). No significant difference is observed between the plasma glucose concentrations recorded after the 2 tests until the first 10 min of recovery. However the plasma glucose values recorded after 20 and 30 min of recovery are significantly higher after T6 than after T30. Whatever the duration of the test, the insulinemia level remains unchanged at the end of the exercise and during the 30 min of recovery. On the other hand, the values of adrenaline and noradrenaline after T6 and T30 become considerably higher than those recorded at rest. However, the increase remains significantly higher after T30 (13.5+/-1.8 nmol x L(-1) for NA and 2.7+/-0.7 nmol x L(-1) for A) than after T6 (4.9+/-0.3 nmol x L(-1) for NA and 1.2+/-0.2 nmol x L(-1) for A). CONCLUSION: These results suggest that the mechanism responsible for increasing blood glucose surpass those which decrease it during supramaximal exercise. However, plasma glucose concentrations is affected by the duration of supramaximal exercise. The lower increase of plasma glucose concentration after T30 than after T6 might be explained by the resting of muscle glycogen stores which are more used during T30 than after T6, but in the absence of muscle glycogen content measurement we cannot conclude.

Potential use of D-dimer measurement in patients treated with oral anticoagulant for a venous thromboembolic episode.

AIM: We compared the level of plasma D-dimer in patients with previous venous thromboembolism (VTE), receiving or not oral anticoagulant treatment (OAT) and investigated its predictive value for the risk of VTE recurrence after OAT withdrawal. METHODS: We have studied 149 patients, 81 receiving oral anticoagulants and 68 after treatment interruption. Patients with known causes of D-dimer increase were excluded. D-dimer measurements were performed by Vidas analyzer (bioMérieux, France). RESULTS: A significantly lower D-dimer plasma level was found in patients under OAT than in untreated patients, 197+/-134 ng/ml versus 399+/-239 ng/ml, respectively (p<0.001). This decrease was similar in the different age populations and whether the patient had thrombophilia (n=84) or not. There was no correlation between INR and D-dimer levels. During a mean follow-up of 30 months, no recurrence occurred in patients under OAT versus 7 untreated patients. Among them, 3 had a D-dimer below 500 ng/ml, and 3 others had a level above 500 ng/ml. The last patient was not tested. CONCLUSION: The physician should be informed of the decrease of D-dimer under OAT, since the usual cut-off of 500 ng/ml used for deep vein thrombosis (DVT) exclusion is probably lower in such treated patients. It has been recently proposed that normal D-dimer level had a high negative predictive value for VTE recurrence when this dosage was performed 3 months after OAT interruption. The small number of recurrences observed in our study with an available result of D-dimer measured more than 3 months after OAT discontinuation does not allow a definite

[Therapeutic impact of streptococcal and enterococcal bacteremia in hematology patients]. / Impact thérapeutique des bactériémies à streptocoques et à entérocoques chez des malades d'hématologie.

From January 1999 to May 2000 (17 months), 21 strains of streptococci and four strains of enterococci have been isolated from 74 blood cultures in 25 infectious episodes in hematologic patients. They concerned 21 patients, of 21 to 77 years old. These patients suffered from acute leukaemia (14 cases), chronic lymphoid leukaemia (two cases), non-Hodgkin's lymphoma (two cases) or myeloma (three cases). Seventeen patients displayed a single streptococcal or enterococcal episode, two had two episodes in the course of a single stay in the hospital, two others in the course of two different stays. During 16 episodes (64%), the bacteremia occurred within 15 days after the onset of neutropenia consecutive to antimitotic chemotherapy, and in nine episodes (36%) it has occurred after a period exceeding 15 days. In six cases the patients had already received antibiotics with a large antibacterial activity (beta-lactam, fluoroquinolone and/or glycopeptide +/- aminoside) and in four cases a single antibiotic (synergistine or cotrimoxazole). Most streptococci (20/21) were oral streptococci (ten Streptococcus mitis, five S. oralis, two S. sanguis, three S. pneumoniae). A single strain of beta-hemolytic streptococci has been identified as S. dysgalactiae subsp. equisimilis. The enterococci were one strain of Enterococcus faecalis and three E. faecium. Ten streptococci were susceptible to 0.25 mg/L of penicillin G, ten were less susceptible (0.5 < or = MIC < 32 mg/L), and a strain was resistant (MIC = 32 mg/L). Eighteen strains were susceptible to amoxicillin and cefotaxime. For three strains, the MICs of amoxicillin and cefotaxime (8-16 mg/L and 8-32 mg/L, respectively) were higher. Levels of resistance of the enterococci to the beta-lactam (penicillin, amoxicillin, and piperacillin) were variable. All species were susceptible to glycopeptides. Three patients were transferred in intensive care unit for respiratory distress or shock syndrome. Their evolution has remained severe under antibiotherapy comprising beta-lactam or vancomycin associated with an aminoside. This results demonstrate the interest of species identification to adapt the antibiotic treatment and confirms the frequency of oral streptococci in severe bacteremia in neutropenic patients.

[Influence of oral anticoagulant treatment on D-dimers levels]. / Influence des traitements anticoagulants oraux sur la mesure des D-dimères.

The usefulness of D-dimers determination for the exclusion of deep vein thrombosis (DVT) has been extensively studied. The persistence of high levels of D-dimers has also been suggested as a marker of hypercoagulability in rare studies and might be used to identify patients at risk for recurrent DVT. We have studied the influence of oral anticoagulant treatment in 149 patients, 17 to 84 year-old, with a history of venous thromboembolism; 81 received oral anticoagulant treatment, 68 did not. Patients with known reasons for high level of D-dimers such as cancer were excluded. Thrombophilia was found in 84 patients. D-dimers measurements were performed by ELFA technique using Vidas (bioMérieux, France) analyzer. A significantly lower level of D-dimers was observed in patients under oral anticoagulant compared to patients without this treatment, 197 +/- 134 mug/L versus 399 +/- 239 mug/L, respectively (p < 0.001). A level upper the normal value (500 mug/L) was found in only 3 patients out of 81 receiving an oral anticoagulant treatment as compared with 21 of the 68 patients without treatment. This decrease of D-dimers in patients receiving oral anticoagulants was the same in the different age populations. There was no correlation between INR and D-dimers levels in this study. The clinician should be informed of the decrease of D-dimers in patients treated with anticoagulants. The decrease of D-dimers plasma level during oral anticoagulant treatment suggest that D-dimers concentration in plasma is an indirect marker of reduced clotting activity in vivo.