Criterion values for urine-specific gravity and urine color representing adequate water intake in healthy adults.

Growing evidence suggests a distinction between water intake necessary for maintaining a euhydrated state, and water intake considered to be adequate from a perspective of long-term health. Previously, we have proposed that maintaining a 24-h urine osmolality (UOsm) of ⩽500 mOsm/kg is a desirable target for urine concentration to ensure sufficient urinary output to reduce renal health risk and circulating vasopressin. In clinical practice and field monitoring, the measurement of UOsm is not practical. In this analysis, we calculate criterion values for urine-specific gravity (USG) and urine color (UCol), two measures which have broad applicability in clinical and field settings. A receiver operating characteristic curve analysis performed on 817 urine samples demonstrates that a USG ⩾1.013 detects UOsm>500 mOsm/kg with very high accuracy (AUC 0.984), whereas a subject-assessed UCol⩾4 offers high sensitivity and moderate specificity (AUC 0.831) for detecting UOsm >500 m Osm/kg.

Equivalence of afternoon spot and 24-h urinary hydration biomarkers in free-living healthy adults.

BACKGROUND/OBJECTIVES: Urinary biomarkers of hydration (urine osmolality, UOsm; urine specific gravity, USG) follow circadian variations. For individuals, researchers and health-care professionals, there is value in identifying time frames during which spot values of UOsm and USG are representative of 24-h values in healthy young adults. SUBJECTS/METHODS: Eighty-two free-living adults (22.3±2.9 years, 22.2±1.5 kg/m(2)) collected individual urine voids over a 24-h period. UOsm and USG were measured on each void and on the pooled 24-h sample. To determine the time of day when a spot sample was likely to be equivalent to the 24-h value, daytime voids were binned by time and equivalence was tested for each 2-h window. Equivalence was a priori defined as being within 100 mOsm/kg (UOsm) and within 0.003 units (USG) of 24-h values. RESULTS: For both UOsm and USG, voids between 1400 and 2000 hours produced values that were equivalent to the 24-h sample, whereas earlier voids tended to overestimate 24-h UOsm and USG. For windows 1401-1600 hours, 1601-1800 hours and 1801-2000 hours, the mean difference (95% confidence interval) between spot and 24-h UOsm (mOsm/kg) was -25 (-72; 22), 28 (-35; 92) and 12 (-41; 66), respectively, whereas for USG the difference was 0.0014 (-0.0028; -0.0001), 0.0001 (-0.0017; 0.0019) and 0.0005 (-0.0018; 0.0009), respectively. CONCLUSIONS: In free-living healthy French adults, 24-h urine concentration can be approximated from a mid- to late-afternoon spot urine sample. This finding suggests that an afternoon sample may be an accurate and practical tool for hydration monitoring, useful to individuals and health-care practitioners.

[Venous thromboembolic risk during repatriation for medical reasons]. / Risque veineux thromboembolique et sa prévention lors d'un rapatriement sanitaire.

In France, approximately 3000 people are repatriated every year, either in a civil situation by insurers. Repatriation also concerns French army soldiers. The literature is scarce on the topic of venous thromboembolic risk and its prevention during repatriation for medical reasons, a common situation. Most studies have focused on the association between venous thrombosis and travel, a relationship recognized more than 60 years ago but still subject to debate. Examining the degree of venous thromboembolic risk during repatriation for medical reasons must take into account several parameters, related to the patient, to comorbid conditions and to repatriation modalities. Appropriate prevention must be determined on an individual basis.

Relation between urinary hydration biomarkers and total fluid intake in healthy adults.

BACKGROUND/OBJECTIVES: In sedentary adults, hydration is mostly influenced by total fluid intake and not by sweat losses; moreover, low daily fluid intake is associated with adverse health outcomes. This study aimed to model the relation between total fluid intake and urinary hydration biomarkers. SUBJECTS/METHODS: During 4 consecutive weekdays, 82 adults (age, 31.6±4.3 years; body mass index, 23.2±2.7 kg/m(2); 52% female) recorded food and fluid consumed, collected one first morning urine (FMU) void and three 24-h (24hU) samples. The strength of linear association between urinary hydration biomarkers and fluid intake volume was evaluated using simple linear regression and Pearson's correlation. Multivariate partial least squares (PLS) modeled the association between fluid intake and 24hU hydration biomarkers. RESULTS: Strong associations (|r| ≥ 0.6; P<0.001) were found between total fluid intake volume and 24hU osmolality, color, specific gravity (USG), volume and solute concentrations. Many 24hU biomarkers were collinear (osmolality versus color: r=0.49-0.76; USG versus color: r=0.46-0.78; osmolality versus USG: 0.86-0.97; P<0.001). Measures in FMU were not strongly correlated to intake. Multivariate PLS and simple linear regression using urine volume explained >50% of the variance in fluid intake volume (r(2)=0.59 and 0.52, respectively); however the error in both models was high and the limits of agreement very large. CONCLUSIONS: Hydration biomarkers in 24hU are strongly correlated with daily total fluid intake volume in sedentary adults in free-living conditions; however, the margin of error in the present models limits the applicability of estimating fluid intake from urinary biomarkers.

Economic benefit of the PHLAME wellness programme on firefighter injury.

BACKGROUND: Work-related injuries and illness are prevalent and costly. Firefighting is especially hazardous and many firefighters sustain work-related injuries. Workplace health promotion programmes have shown positive return on investment (ROI). Little is known about how similar programmes would impact injury and cost among firefighters. AIMS: To evaluate the impact of a workplace health promotion intervention on workers' compensation (WC) claims and medical costs among Oregon fire departments participating in the PHLAME (Promoting Healthy Lifestyles: Alternative Models' Effects) health promotion programme compared with Oregon fire departments not participating in PHLAME. METHODS: Data from firefighters from four large urban fire departments in Oregon were evaluated using a retrospective quasi-experimental study design. Outcomes were (i) total annual firefighter WC claims, (ii) total annual incurred medical costs prior to and after implementation of the PHLAME firefighter worksite health promotion programme (iii) and an ROI analysis. RESULTS: Data were obtained from 1369 firefighters (mean age of 42 years, 91% white, 93% male). WC claims (P < 0.001) and medical costs (P < 0.01) were significantly lower among PHLAME fire departments compared with Oregon fire departments not participating in the programme. Fire departments participating in the PHLAME TEAM programme demonstrated a positive ROI of 4.61-1.00 (TEAM is used to indicate the 12-session peer-led health promotion programme). CONCLUSIONS: Fire department WC claims and medical costs were reduced after implementation of the PHLAME workplace health promotion programme. This is a low cost, team-based, peer-led, wellness programme that may provide a feasible, cost-effective means to reduce firefighter injury and illness rates.

Total thyroidectomy for amiodarone-associated thyrotoxicosis: should surgery always be delayed for pre-operative medical preparation?

OBJECTIVE: Amiodarone can induce severe hyperthyroidism that justifies its withdrawal and the introduction of antithyroid drugs. Continuing amiodarone use, failure to control hyperthyroidism and poor clinical progress may require thyroidectomy. This study aimed to evaluate patients' post-operative development and mid-term outcome after thyroidectomy for amiodarone-associated thyrotoxicosis. STUDY DESIGN: Prospective case series. SETTING: Tertiary care centre. SUBJECTS AND METHODS: We prospectively collected cases of amiodarone-associated thyrotoxicosis requiring thyroidectomy due to failure of antithyroid treatment, despite amiodarone discontinuation. Post-thyroidectomy complications were compared immediately, 30 days and one year post-operatively, and also for scheduled versus emergency surgery cases. RESULTS: Of 11 total cases, nine scheduled thyroidectomy cases had no morbidity after elective surgery. Two cases required emergency surgery for multiple organ failure and cardiac problems. Immediate post-operative complications (mostly haemodynamic) occurred in both cases (emergency vs routine surgery, p = 0.018). CONCLUSION: In such cases, pre-operative medical treatment is vital to limit peri- and post-operative complications, but surgery should not be delayed if the haemodynamic status deteriorates. Surgery, with careful anaesthesia, is the cornerstone of the treatment.

Initial evidence for the role of CACNA1C on subcortical brain morphology in patients with bipolar disorder.

BACKGROUND: The polymorphism rs1006737 within the CACNA1C gene is associated with increased risk for bipolar disorder (BD) and variations in brain morphology and function of subcortical regions. Here we sought to investigate the influence of CACNA1C polymorphism on key subcortical brain structures implicated in the pathophysiology of BD. METHODS: Structural magnetic resonance imaging scans were acquired from 41 euthymic patients with BD and 40 healthy controls, who were also genotyped for the CACNA1C rs1006737 polymorphism. The effect of diagnosis, genotype and their interaction was examined in predefined volumes of interest in the basal ganglia, hypothalamus and amygdala extracted using SPM5. RESULTS: Carriers of the CACNA1C rs1006737 risk allele showed increased grey matter density in the right amygdala and right hypothalamus irrespective of diagnosis. An interaction between genotype and diagnosis was observed in the left putamen which was smaller in BD patients carrying the risk allele than in healthy controls. CONCLUSIONS: The CACNA1C rs1006737 polymorphism influences anatomical variation within subcortical regions involved in emotional processing.

In vitro and in vivo efficacy of sulfo-carrabiose, a sugar-based cosmetic ingredient with anti-cellulite properties.

Most of adult women exhibit cellulite on the hips, buttock and thighs. Although extracellular matrix and lymphatic system disorders can increase its appearance, cellulite basically results from an excessive fat storage in the adipose tissue which exerts considerable pressure on the surrounding skin tissue and creates a dimpled irregular appearance. Caffeine, the most widely used anti-cellulite ingredient, favours fat break-down by inhibiting the phosphodiesterase enzyme and encouraging a high intracellular level of cAMP. A series of studies has shown that spermine and spermidine, two ubiquitous polyamines, encouraged fat storage and slowed fat break-down in the adipose tissue. Besides, it was shown that heparan sulfate glycosaminoglycans had a strong affinity for polyamines. To design a new cosmetic ingredient with anti-cellulite properties, we used molecular modelling to screen several ingredients with a structure similar to that of heparan sulfate glycosaminoglycans. This way, we identified sulfo-carrabiose as a potent molecule for trapping spermine and spermidine. These virtual results were first confirmed in tubo where sulfo-carrabiose was shown to dose-dependently inactivate spermine and spermidine. In vitro, adipocytes cultured with sulfo-carrabiose exhibited a significant reduction of lipogenesis and a significant increase of lipolysis. When sulfo-carrabiose was incorporated in a cosmetic formula, significant improvements were observed in thigh circumference, with better results than those obtained with caffeine after 28 days of use. Furthermore, a combination of caffeine and sulfo-carrabiose led to results significantly better than those obtained with caffeine alone. As measured by fringe projection, thigh volume was also significantly reduced after sulfo-carrabiose treatment. Finally, the appearance of cellulite assessed by clinical evaluation was also significantly reduced within 28 days.

[Treatment specifics for spontaneous pneumothorax in flight personnel]. / Spécificités de la prise en charge du pneumothorax spontané chez le personnel navigant.

Spontaneous pneumothorax is one cause of aeronautical unfitness in flight personnel, because of the risk of recurrence in flight, making it an issue of flight safety. Specific treatment is required for fighter pilots, pilots flying single-pilot and pilots in professional training: surgical synthesis via video-thoracoscopy is obligatory from the first episode. Considering the exposure to an accumulation of aeronautical factors that are likely to encourage pneumothorax recurrence in flight, it is apical pleurectomy together with abrasion of the remaining pleura and resection of bullae/blebs that is required for fighter pilots to allow them to recover aeronautical fitness unrestrictedly. For all other categories of flight personnel, treatment is no different from that of the common patient. Knowledge of these treatment specifics is essential, to avoid unnecessary systematic surgical indication for all flight personnel, or jeopardise professional fitness in some of them due to inappropriate treatment.

Chondrogenic potential of bone marrow- and adipose tissue-derived adult human mesenchymal stem cells.

Regarding cartilage repair, tissue engineering is currently focusing on the use of adult mesenchymal stem cells (MSC) as an alternative to autologous chondrocytes. The potential of stem cells from various tissues to differentiate towards the chondrogenic phenotype has been investigated and it appears that the most common and studied sources are bone marrow (BM) and adipose tissue (AT) for historical and easy access reasons. In addition to three dimensional environment, the presence of member(s) of the transforming growth factor (TGF-ß family and low oxygen tension have been reported to promote the in vitro differentiation of MSCs. Our work aimed at characterizing and comparing the degree of chondrogenic differentiation of MSCs isolated from BM and AT cultured in the same conditions. We also further aimed at and at determining whether hypoxia (2% oxygen) could affect the chondrogenic potential of AT-MSCs. Cells were first expanded in the presence of FGF-2, then harvested and centrifuged to allow formation of cell pellets, which were cultured in the presence of TGF-ß3 and/or Bone Morphogenetic Protein-2 (BMP-2) and with 2 or 20% oxygen tension, for 24 days. Markers of the chondrocyte (COL2A1, AGC1, Sox9) and hypertrophic chondrocyte (COL10A1, MMP-13) were monitored by real-time PCR and/or by immunohistological staining. Our data show that BMP-2/TGF-ß3 combination is the best culture condition to induce the chondrocyte phenotype in pellet cultures of BM and AT-MSCs. Particularly, a switch in the expression of the pre-chondrogenic type IIA form to the cartilage-specific type IIB form of COL2A1 was observed. A parallel increase in gene expression of COL10A1 and MMP-13 was also recorded. However when AT-MSCs were cultured in hypoxia, the expression of markers of hypertrophic chondrocytes decreased when BMP-2/TGF-ß3 were present in the medium. Thus it seems that hypoxia participates to the control of AT-MSCs chondrogenesis. Altogether, these cellular model systems will help us to investigate further the potential of different adult stem cells for cartilage engineering.

A Hibiscus Abelmoschus seed extract as a protective active ingredient to favour FGF-2 activity in skin.

In the skin, heparin, heparan sulphate and heparan sulphate proteoglycans control the storage and release of growth factors and protect them from early degradation. We developed a cosmetic active ingredient containing Hibiscus Abelmoschus seed extract (trade name Linefactor) that can maintain the FGF-2 content in the skin by mimicking the protective effect of heparan sulphate proteoglycans. By preventing the natural degradation of FGF-2, Hibiscus Abelmoschus seed extract maintains the bioavailability of this growth factor for its target cells, i.e. skin fibroblasts. Our in vitro evaluations showed that this ingredient exhibited heparan sulphate-like properties and dose-dependently protected FGF-2 from thermal degradation. We could also show that, in turn, the protected FGF-2 could stimulate the synthesis of sulphated GAGs, the natural protective molecules for FGF-2, thus providing a double protection. Finally, the in vitro results were confirmed in vivo thanks to a clinical study in which skin biomechanical properties and reduction in wrinkles were assessed.

Mechanistic model of fuel selection in the muscle.

Fuel selection in human muscle is key to explaining insulin resistance. In obesity and type 2 diabetes mellitus, there is an increased content of lipid within and around muscle fibers. Changes in muscle fuel partitioning of lipid, between oxidation and storage of fat, contribute to the accumulation of intramuscular triglycerides and to the pathogenesis of both obesity and type 2 diabetes mellitus. A mathematical model of the aggregated metabolism in skeletal muscle was developed and the effects of fuel selection for lean and obese individuals under fasting conditions, insulin-stimulated conditions, and oscillating insulin conditions were examined. Model results were complementary to prior observations that elevated lipid oxidation during insulin-stimulated conditions is correlated with insulin resistance. The model also adequately simulated metabolic inflexibility between fat and glucose oxidation in the obese individual. A novel sensitivity analysis indicated the strong interaction effects of parameters of glucose and lipid oxidation pathways on the variables of each pathway.

Release of antimicrobial actives from microcapsules by the action of axillary bacteria.

We describe the use of unique microcapsules that may be degraded by the actions of bacteria. These microcapsules are approximately 35 mum in diameter, are composed of natural protein, and may be filled with a variety of actives. We describe the use of antimicrobial actives such as farnesol and methylparaben to demonstrate that their release by the degradative actions of axillary bacteria such as Corynebacterium minutissimum, C. urealyticum, and Staphylococcus epidermidis leads to their demise. These microcapsules may be used in consumer products such as deodorants and antiperpirants that may, under actual use conditions, control malodor.

Studies of compounds that enhance sphingolipid metabolism in human keratinocytes.

Several products are known to inhibit the biosynthesis of ceramides and glucosylceramides, but very few stimulate this process. We studied the influence of a hydrolysate of potato proteins (Lipidessence) in vitro on the sphingolipid metabolism of normal human epidermal keratinocytes. By measuring growth with the thymidine uptake assay, it was seen that Lipidessence, added in the culture medium up to an 8% concentration, did not change significantly the proliferation rate of keratinocytes, but beyond this concentration a progressive dose-dependent inhibition of growth was noticeable. Following incubation of cells with the product at 5% and 10% concentrations for 2 days, the lipids were extracted. The different lipid classes were separated by fractionation on columns of aminopropyl silica gel and analyzed by high-performance thin-layer chromatography. When keratinocytes were cultivated in the presence of Lipidessence, the biosynthesis of cholesterol, phosphatidylcholine, phosphatidylserine and gangliosides was stimulated, and a major increase was noticeable in the biosynthesis of free fatty acids, free ceramides, glucosylceramide and sphingomyelin. Radioactive [(14)C]-serine was used as a precursor of sphingoid bases to study sphingolipid biosynthesis. After migration of lipid fractions on thin-layer plates, autoradiography showed that free ceramides and glucosylceramide were labeled, thus suggesting that de novo biosynthesis was accounting for the increased cellular content in sphingolipids.

[3D cellular models: a powerful access to cutaneous physiology and to innovative developments of cosmetic active compounds]. / Les modèles cellulaires 3D: un accès puissant à la physiologie cutanée et aux développements innovants de principes actifs cosmétiques.

Two different anti-ageing cosmetic actives based respectively, on dermal compartment regeneration and on dermoepidermal reinforcement, have been developed using tissular engineering models. Conjointly use of different innovative three-dimensional models such as reconstructed dermis and skin built with human cells coming from variable aged donors allowed first, a better understanding of matrix modifications due to ageing and second, the screening of active ingredients highly targeted to reverse observed damages. The validity of such three-dimensional models has been then confirmed by in vivo studies on healthy volunteers.

[Multislice computed tomography to detect coronary stenosis among asymptomatic patients with cardiovascular risk factors and equivocal prior stress test: preliminary study]. / Apport du scanner multicoupes dans le dépistage des lésions coronaires chez des patients asymptomatiques à risque: étude préliminaire.

UNLABELLED: Multislice computed tomography (MSCT) is a non-invasive and validated technique to detect coronary stenoses. Some questions remain about its accuracy to detect coronary stenoses (CS), especially for asymptomatic patients (P) when a prior stress test isn't conclusive. METHODS: MSCT was performed among 45 asymptomatic men (mean age: 58,3 +/- 16), with a high ten year risk of fatal cardiovascular disease (SCORE 2003 data for low-risk regions of Europe), without any previous coronary history and with previous non conclusive exercise testing. When significant (> 50%) CS was suspected at MSCT, an angiocoronarography (AC) was done. RESULTS: Eighteen MSCT were normal, unsignificant CS (< 50%) were detected on 14 MSCT and significant coronary stenoses (SCS) for 13 P. Among this 13 P, 19 SCS were identified: 2 SCS of left main coronary artery (CA), 9 of the left descending CA, 6 of the right CA and 2 of the left circumflex CA. 13 CS were confirmed at AC. Finally, because of critical angiographic lesions +/- ischemia at nuclear tomoscintigraphy (NT), 9 P had coronary revascularization (7 catheter based, 2 surgical bypass), 4 P had medical treatment. DISCUSSION: Benefits of this preliminary study are obvious: 9 coronary revascularization/45 P. However, the place of MSCT for the screening of CS is uncertain, but may be usefull as a complement for the screening of coronary arterial disease.