Is disease activity prior to fingolimod initiation predictive of response? Fingolimod as a "common" first line treatment.

BACKGROUND: In countries where fingolimod is available as first-line therapy without restrictions, we have an opportunity to observe long-term efficacy profile of this drug in treatment-naive patients according to their initial disease activity. METHODS: We retrospectively analysed the data of RRMS patients treated with FTY, focusing on 2 groups: 17 highly active patients (HA) defined as follows: ≥2 relapses in the year before treatment initiation and either≥1 Gd-enhancing T1 lesion or a significant increase in T2 lesion load from a baseline MRI; and 37 "not highly active" (NHA). We reviewed treatment efficacy (defined as NEDA-3), reasons for discontinuation and treatment tolerance in both groups. RESULTS: Mean follow-up duration was 48.2 months, SD 18.4. Fingolimod efficiently reduced relapses (NHA 90.3% reduction, P<0.001, HA 84.9%, P<0.001), and new Gd enhancing lesions (NHA 85.4% reduction, P=0.019, HA 92.3%, P=0.043). The proportion of patients reaching NEDA-3 status was higher in the NHA group (NHA: 80% at 2 years and 66% at 4 years, HA: 58% at 2 years and 38% at 4 years, P=0.042). Fingolimod was discontinued in 20 cases, mainly because of lack of efficacy (n=15). CONCLUSIONS: FTY is efficient in reducing relapses and new Gd enhancing lesions in both HA and NHA patients although the probability of achieving NEDA-3 over time is higher in early-treated treatment-naive NHA patients.

First-ever treatment in multiple sclerosis.

BACKGROUND: The current treated MS population is very different from that of patients in randomized clinical trials. OBJECTIVES: To study the long-term efficacy and tolerance of fingolimod (FTY) and dimethyl fumarate (DMF), both available as first-line treatment in early-treated treatment-naïve MS patients. METHODS: Retrospective analysis of 75 patients from our prospective MS registry fulfilling the inclusion criteria: FTY or DMF as first-line treatment, treatment initiation within 36months of disease onset and treatment duration>12months. RESULTS: Demographics and MRI characteristics at baseline were similar in both groups (FTY 55 patients, DMF 20), but patients on FTY had higher pretreatment clinical activity (P=0.008). Twenty-two percent of patients in the FTY group and 15% in the DMF group had highly active disease. At last follow-up (mean: 44.2, SD: 17.3months), the majority of the patients were still on treatment while 54.5% of FTY and 65% of DMF patients reached NEDA 3 status (P=0.444). Both treatments significantly decreased relapses and occurrence of new T1 Gd-enhancing lesions (P<0.001). The main reason for discontinuation was disease activity without severe side effects on either treatment. CONCLUSIONS: Our findings support efficacy and tolerance of both drugs in early-treated treatment-naive MS patients, arguing in favour of efficient early immunomodulation in MS patients. Both drugs significantly reduced the incidence of new relapses and Gd-enhancing lesions on treatment with FTY being more frequently prescribed than DMF, especially in patients with evidence of higher clinical disease activity.

Molecular data reveal a cryptic species within the Culex pipiens mosquito complex.

The Culex pipiens mosquito complex is a group of evolutionarily closely related species including C. pipiens and Culex quinquefasciatus, both infected by the cytoplasmically inherited Wolbachia symbiont. A Wolbachia-uninfected population of C. pipiens was however described in South Africa and was recently proposed to represent a cryptic species. In this study, we reconsidered the existence of this species by undertaking an extensive screening for the presence of Wolbachia-uninfected C. pipiens specimens and by characterizing their genetic relatedness with known members of the complex. We first report on the presence of Wolbachia-uninfected specimens in several breeding sites. We next confirm that these uninfected specimens unambiguously belong to the C. pipiens complex. Remarkably, all uninfected specimens harbour mitochondrial haplotypes that are either novel or identical to those previously found in South Africa. In all cases, these mitochondrial haplotypes are closely related, but different, to those found in other C. pipiens complex members known to be infected by Wolbachia. Altogether, these results corroborate the presence of a widespread cryptic species within the C. pipiens species complex. The potential role of this cryptic C. pipiens species in the transmission of pathogens remains however to be determined. The designation 'Culex juppi nov. sp.' is proposed for this mosquito species.

Cytochrome P450s from the fall armyworm (Spodoptera frugiperda): responses to plant allelochemicals and pesticides.

Spodoptera frugiperda is a polyphagous lepidopteran pest that encounters a wide range of toxic plant metabolites in its diet. The ability of this insect to adapt to its chemical environment might be explained by the action of major detoxification enzymes such as cytochrome P450s (or CYP). Forty-two sequences coding for P450s were identified and most of the transcripts were found to be expressed in the midgut, Malpighian tubules and fat body of S. frugiperda larvae. Relatively few P450s were expressed in the established cell line Sf9. In order to gain information on how these genes respond to different chemical compounds, larvae and Sf9 cells were exposed to plant secondary metabolites (indole, indole-3-carbinol, quercetin, 2-tridecanone and xanthotoxin), insecticides (deltamethrin, fipronil, methoprene, methoxyfenozide) or model inducers (clofibrate and phenobarbital). Several genes were induced by plant chemicals such as P450s from the 6B, 321A and 9A subfamilies. Only a few genes responded to insecticides, belonging principally to the CYP9A family. There was little overlap between the response in vivo measured in the midgut and the response in vitro in Sf9 cells. In addition, regulatory elements were detected in the promoter region of these genes. In conclusion, several P450s were identified that could potentially be involved in the adaptation of S. frugiperda to its chemical environment.

High-resolution, high-sensitivity NMR of nanolitre anisotropic samples by coil spinning.

Nuclear magnetic resonance (NMR) can probe the local structure and dynamic properties of liquids and solids, making it one of the most powerful and versatile analytical methods available today. However, its intrinsically low sensitivity precludes NMR analysis of very small samples-as frequently used when studying isotopically labelled biological molecules or advanced materials, or as preferred when conducting high-throughput screening of biological samples or 'lab-on-a-chip' studies. The sensitivity of NMR has been improved by using static micro-coils, alternative detection schemes and pre-polarization approaches. But these strategies cannot be easily used in NMR experiments involving the fast sample spinning essential for obtaining well-resolved spectra from non-liquid samples. Here we demonstrate that inductive coupling allows wireless transmission of radio-frequency pulses and the reception of NMR signals under fast spinning of both detector coil and sample. This enables NMR measurements characterized by an optimal filling factor, very high radio-frequency field amplitudes and enhanced sensitivity that increases with decreasing sample volume. Signals obtained for nanolitre-sized samples of organic powders and biological tissue increase by almost one order of magnitude (or, equivalently, are acquired two orders of magnitude faster), compared to standard NMR measurements. Our approach also offers optimal sensitivity when studying samples that need to be confined inside multiple safety barriers, such as radioactive materials. In principle, the co-rotation of a micrometre-sized detector coil with the sample and the use of inductive coupling (techniques that are at the heart of our method) should enable highly sensitive NMR measurements on any mass-limited sample that requires fast mechanical rotation to obtain well-resolved spectra. The method is easy to implement on a commercial NMR set-up and exhibits improved performance with miniaturization, and we accordingly expect that it will facilitate the development of novel solid-state NMR methodologies and find wide use in high-throughput chemical and biomedical analysis.

Multiplexed immunoassay for the rapid detection of anti-tumor-associated antigens antibodies.

TAAs (tumor-associated antigens) microarrays were designed to detect auto-antibodies directly in patient sera. Twelve different probes were chosen according to their described occurrence in cancer pathologies (Cyclin B1, Cyclin D1, Complement factor H, c-myc, IMP1, p53, p62, survivin, Her2/neu, Koc, NY-ESO-1 and PSA). Microarrays of these 12 proteins were immobilized within the nitrocellulose/cellulose acetate membrane of a 96-well filtering microtiter plate bottom. The captured auto-antibodies were detected using a staining approach based on alkaline phosphatase labeling. Thus, the presence of specific auto-antibodies in samples was visualized through the positive staining of the corresponding TAA spots. The TAA HiFi microarrays were shown to be able to capture specific purified anti-TAA antibodies. In real samples, 9 proteins from the 12 TAAs panel were shown to generate specific signal and 5 antigens (p53, NY-ESO-1, IMP1, cyclin B1 and c-myc) were shown to have interaction with more than 10% of the positive sera from cancer patients. This protein subpanel was proven to be able to detect 72.2% of the cancer patients tested (within a 34 panel of 18 patients and 16 healthy donors).

Natural vertical transmission of dengue viruses by Aedes aegypti in Bolivia.

The natural transmission of dengue virus from an infected female mosquito to its progeny, namely the vertical transmission, was researched in wild caught Aedes aegypti during an important outbreak in the town of Santa Cruz de la Sierra, Bolivia. Mosquitoes were collected at the preimaginal stages (eggs, larvae and pupae) then reared up to adult stage for viral detection using molecular methods. Dengue virus serotypes 1 and 3 were found to be co-circulating with significant higher prevalence in male than in female mosquitoes. Of the 97 pools of Ae. aegypti (n = 635 male and 748 female specimens) screened, 14 pools, collected in February-May in 2007, were found positive for dengue virus infection: five DEN-1 and nine DEN-3. The average true infection rate (TIR) and minimum infection rate (MIR) were respectively 1.08% and 1.01%. These observations suggest that vertical transmission of dengue virus may be detected in vectors at the peak of an outbreak as well as several months before an epidemic occurs in human population.

[Mosquitoes, Distribution and Specific Richness in Eight Countries of Africa: Cape Verde, Mauritania, Senegal, Gambia, Mali, Burkina Faso, Niger and Chad]. / Moustiques, Distribution et Richesse Spécifique dans Huit Pays D'afrique: Cap-Vert, Mauritanie, Sénégal, Gambie, Mali, Burkina Faso, Niger et Tchad.

Mosquitoes (Diptera, Culicidae) form a family of insects of considerable public health importance. Mention of their presence/absence was tackled in the literature and by specialized websites for eight African countries: Cape Verde, Mauritania, Senegal, Gambia, Mali, Burkina Faso, Niger and Chad. In total, 216 species have been recorded belonging to 13 genera: Anopheles (48 species), Aedeomyia (2), Aedes (62), Coquillettidia (6), Culex (54), Culiseta (1), Eretmapodites (7), Ficalbia (3), Lutzia (1), Mansonia (2), Mimomyia (7), Toxorhynchites (4) and Uranotaenia (19). The presence of these species in the study area is certain except for three species whose presence is doubtful. This specific richness represents 6% of the world's richness. The countries with the highest specific richness are Burkina Faso (162 species), Senegal (143) and Mali (110); the country with the lowest richness is Cape Verde (11). This richness is lower in the north in hyper-arid climate and higher in the south in sub-humid climate. Chad is the least well inventoried country. All species are considered native, with the exception of Ae. (Stegomyia ) albopictus (the Asian tiger mosquito) introduced in 2016 into Mali and possibly Ae. (Ochlerotatus ) caspius into Mauritania and Ae. (Stg. ) aegypti introduced into Nouakchott, Mauritania. This synthesis of the knowledge may be useful for vector control, public health, and future research.

[Updated inventory of mosquitoes (Dipbra: Culkidae) from the French islets of Europa, Juan-de-Nova and Grande-Glorieuse (Mozambique channel, Indian Ocean)]. / Inventaire actualisé des moustiques (Diptera: Culicidae) des îlots Francais de Europa, Juan-de-Nova et Grande-Glorieuse (Canal du Mozambique, Océan Indien).

The islets of Europa, Juan-de-Nova and Grande-Glorieuse are French territories isolated in the Mozambique Channel (Indian Ocean) which have remained relatively preserved from anthropization all along their history These three islets have been classified entire nature reserves from 1975 and are today inhabited only by a permanent military detachment of about fifteen men even if they occasionally greet technical and scientific staff. Sanitary and environmental issues brought about assessment of the present culicid fauna. The authors propose a synthesis of the culicid knowledge from the islets and make an inventory of new species. The role played by humans in importation of culicids is discussed as well as sanitary consequences of their adaptation to environment

Microarray analysis of cytochrome P450 mediated insecticide resistance in Drosophila.

Insecticide resistance in laboratory selected Drosophila strains has been associated with upregulation of a range of different cytochrome P450s, however in recent field isolates of D. melanogaster resistance to DDT and other compounds is conferred by one P450 gene, Cyp6g1. Using microarray analysis of all Drosophila P450 genes, here we show that different P450 genes such as Cyp12d1 and Cyp6a8 can also be selected using DDT in the laboratory. We also show, however, that a homolog of Cyp6g1 is over-expressed in a field resistant strain of D. simulans. In order to determine why Cyp6g1 is so widely selected in the field we examine the pattern of cross-resistance of both resistant strains and transgenic flies over-expressing Cyp6g1 alone. We show that all three DDT selected P450s can confer resistance to the neonicotinoid imidacloprid but that Cyp6a8 confers no cross-resistance to malathion. Transgenic flies over-expressing Cyp6g1 also show cross-resistance to other neonicotinoids such as acetamiprid and nitenpyram. We suggest that the broad level of cross-resistance shown by Cyp6g1 may have facilitated its selection as a resistance gene in natural Drosophila populations.

Detection of falciparum malarial forms in naturally infected anophelines in Cameroon using a fluorescent anti-25-kD monoclonal antibody.

Anopheles gambiae s.s. and An. funestus were sampled in houses located in a Plasmodium falciparum-holoendemic site in southern Cameroon. The midguts of female mosquitoes in half-gravid or gravid stages of blood digestion were incubated with a fluorescent monoclonal antibody directed against the P. falciparum zygote/ookinete surface protein Pfs25 and examined using a fluorescent light microscope. Malarial forms were detected in 11.6% of the half-gravid mosquitoes and in 0.0% of the gravid ones (P = 0.012). No difference in infections or the occurrence of malarial forms between An. gambiae and An. funestus was observed. Overall, 127 malarial forms were counted and distributed among round forms, retorts, and ookinetes in 77.2%, 9.5%, and 13.4%, respectively. Round forms include macrogametes, activating microgametocytes, and zygotes. The mean number of malarial forms per infected midgut was 2.16 and the maximum number observed was 13. In four anophelines, round forms, retorts, and ookinetes were simultaneously observed. Sporozoite rates were 5.7% for An. gambiae and 3.8% for An. funestus. In the human population, the gametocyte index for P. falciparum was 38% with a mean density of 1.11 gametocytes per microliter of blood. Differences concerning malarial forms in mosquito midguts were observed between houses (range percentage = 4.7--21.3%; mean range of forms per positive anopheline = 1.1--3.1). In each house, relationships existed between infected vectors and the gametocyte reservoir of their inhabitants. The role in transmission of people with very low gametocytemia, approximately one per microliter, as a reservoir of falciparum malaria in highly endemic areas, is emphasized.

The sibling species Drosophila melanogaster and Drosophila simulans differ in the expression profile of glutathione S-transferases.

Two major forms of glutathione S-transferase are known in Drosophila melanogaster: GST D and GST 2. In the present paper we report the existence of a third major form of glutathione S-transferase in Drosophila simulans. Induction with phenobarbital revealed a different regulation of GST between these species. Despite the fact that these two species are closely related, there was a difference in the expression profile of the enzyme implicated in the detoxification system, suggesting variations in capacity to suit their environment.

Global left ventricular function and regional wall motion in pure mitral stenosis.

Global left ventricular function (LVF) and segmental wall motion of the left ventricle are registered in 113 patients presenting a pure mitral stenosis (MS) and in a control group of 50 individuals. The segmental wall motion is measured on the end-diastolic-end-systolic frames of the left ventricle, obtained from right anterior oblique (RAO) monoplane cineangiography. Measurement of the segmental wall shortening is performed using the Stanford method. Group 1 includes 68 patients (60% of the total number of patients studied). These patients show no pathological contraction abnormality. In this group, the global LVF is not different from the control group. Group 2 includes 45 patients (40% of the total) for whom contraction abnormalities are present: anterior hypokinesis in 20% of the cases (anterior area mean shortening (AAS) = 18 +/- 8%; p less than 0.001 vs. group 1 and control group), and posterior hypokinesis in 20% of the cases (posterior area mean shortening (PAS) = 9.8 +/- 5.8%, p less than 0.001 vs. group 1 and control group). In this group, global LVF is impaired; ejection fraction (EF) = 0.57 +/- 0.1% (p less than 0.001 vs. group 1); velocity of circumferential fiber shortening (VCF) = 1 +/- 0.3 circ/s (p less than 0.001 vs. group 1); enddiastolic pressure (EDP) = 11 +/- 5 mmHg (p less than 0.01 vs. group 1). Segmental contraction abnormalities appear to be the main factor involved in the global LVF impairment. Segmental wall motion abnormalities could be related to subvalvular fibrosis, or LV filling difficulties, or principally, to a possible interplay between the right and the left ventricles.

Quantitative frame by frame analysis of regional contraction and lengthening on left ventricular cineangiograms: application to the study of normal left ventricles and left ventricles with mitral valve prolapse.

This work attempted to study the segmental wall motion on left ventriculograms, in terms of segmental shortening, velocity of segmental shortening, and temporal sequences of various events in systole as well as in diastole. The ability of such a method to characterize patterns of normal regional wall motion and to detect mild abnormalities such as isolated asynchronisms, was tested on two groups of patients. Group I included 25 patients presenting evidence of a normal left ventricle (LV) after left heart catheterization. Group II consisted of 21 patients suffering from an isolated pure idiopathic mitral valve prolapse (MVP), with no mitral insufficiency and with an unaffected global LV function. In all patients left ventriculography was filmed in the right anterior oblique view at a rate of 50 frames/s. For each patient a cycle was chosen, distant from any premature beat, with acceptably contrasted outlines, and a quantitative frame by frame study of the motion of 10 segments was performed using a semiautomated method derived from the Stanford method. In the control group (Group I), analysis of the segmental motion by means of this method demonstrates a mild nonuniformity of the normal wall motion. This is principally marked by a stronger and faster contraction in anterolateral segments (segments 7, 8, 9) and by a shorter duration of the contraction in this region. In contrast the MVP group (Group II), exhibited a frank asynergy of the anterolateral region occurring from end systole to early diastole.(ABSTRACT TRUNCATED AT 250 WORDS)

Long-term beneficial effects of PTCA on segmental early relaxation in disease of the left anterior descending coronary artery.

The relationship between regional left ventricular (LV) motion and global pressure relaxation of the left ventricle remains unclear. To clarify the recent concept of segmental early relaxation in coronary artery disease, the authors investigated two groups of patients. In group I, all 12 patients (mean age 47 +/- 7 years) exhibited evidence of a normal heart after an extensive investigation. In group II, 25 patients (55 +/- 7 years) presented an isolated stenosis of the left anterior descending coronary artery, and they underwent a hemodynamic investigation before and after (six to nine months) a durable successful percutaneous transluminal coronary angioplasty (PTCA). After all conventional hemodynamic measurements had been done, a quantitative frame-by-frame analysis of left ventricular wall motion was conducted. The authors' method is derived from that of Ingels, applying to LV cineangiograms filmed in 30 degrees right anterior oblique view at a 50 frames/second rate. Thus segmental wall motion is analyzed in terms of amplitudes (%), velocities of shortening and lengthening in circumferences/second (circ/sec), and times of events (%). Statistical results took into account the reproducibility of the method. Main results regarding the control state of group II consisted of an asynergic motion of the anterior region taking place from end systole to early diastole: 1. Early end of contraction in anterior segments (% of systolic time interval: 88 +/- 14% vs 96 +/- 6% in group I, p less than 0.001) 2. Asynchronism at end systole (maximal velocity of shortening - 0.4 +/- 2.3 circ/sec in anterior segments vs 0.05 +/- 1.9 in inferior segments, p less than 0.02) 3. An early but poor outward anterior wall motion (anterior lengthening at 0.04 sec after the end of ejection 2.9 +/- 10% in group II versus 5.4 +/- 7.2% in group I, p less than 0.05) These abnormalities are strongly correlated with a significant impairment of peak negative diastolic pressure/diastolic time (dP/dt) (1500 +/- 400 mmHg. sec-1 vs 1850 +/- 410 in group I, p less than 0.02). Long-term beneficial effects of PTCA in group II were characterized by an almost complete normalization, both asynergy and relaxation taking place back within the normal range. The authors conclude that in this kind of patient, peak negative dP/dt could be an index of an asynergic segmental motion, this one being correctly analyzed and quantified on LV cineangiograms with our method.

Comparative total tract digestibility of dietary energy and nutrients in growing pigs and adult sows.

Seventy-seven diets were fed to 61-kg growing pigs at a feeding level close to their ad libitum intake and to nonlactating, nonpregnant sows slightly above their maintenance energy level (2.4 kg/d). The main objectives of this study were to compare the total tract digestibility of dietary energy or nutrients of the 77 diets in growing pigs and adult sows and to analyze the effect of diet chemical composition on total tract digestibility in both groups of pigs. Diets were formulated to represent a range of chemical compositions as large as those found in most practical situations. The DE and ME values and total tract digestible nutrient contents of diets were measured for each group of animals; each diet was measured in four to five animals per group, and collection of urine and feces lasted 10 d. The results were used to establish equations for predicting DE and ME values, total tract digestible nutrient contents, and total tract digestibility coefficients of energy from chemical characteristics for each group of animals. The results show that the total tract digestibility of energy or nutrients was higher (P < 0.01) in adult sows than in growing pigs; the total tract digestibility coefficients of energy, crude protein, ether extract, and NDF averaged 85.2, 85.1, 37.1, and 64.4%, respectively, for sows and 82.1, 80.3, 31.6, and 56.3%, respectively, for growing pigs. The ME/DE ratio was lower (P < 0.01) in sows (94.8%) than in growing pigs (96.5%), as a result of higher urinary energy losses in sows. The difference in DE values (on average, 0.6 MJ/kg of DM) between adult sows and growing pigs was not constant (P < 0.01) but increased with dietary fiber content (3.3, 8.6, and 10.1 kJ for each gram of NDF, ADF, and crude fiber increase in the diet, respectively), which suggests that the origin of the difference between the two physiological stages is mainly due to a higher rate of degradation of dietary fiber in the hindgut of sows. The DE and ME values could be accurately predicted from total tract digestible nutrients or from chemical characteristics for each physiological stage. Equations for predicting urinary energy loss from urinary N are also proposed. From a practical point of view, it is suggested to use two energy values for pig feeds: one applicable to growing-finishing pigs and one to adult sows. Equations for predicting DE in adult sows from energy values obtained in growing pigs are proposed.

[Mass and geometry of the left ventricle. Methods of angiographic determination]. / Masse et géométrie du ventricule gauche. Méthodes de détermination angiographique.

Hypertrophy is a myocardial adaptation to pathological conditions of overload and leads to a reduction of cardiac afterload. Angiocardiography (the so-called reference method) allows calculation of mass and volume after opacification of the left ventricle in two orthogonal planes, based on different mathematical models: the area-length method: the left ventricle is assumed to be ellipsoid. The short axis diameter and the volume are calculated from measurements of the area of the left ventricle in the long axis; Simpson's method: the ventricle is divided into sections along its long axis. The diameters of the sections are measured in each incidence. Left ventricular volume is calculated from the area of each section and the distance between two sections; myocardial mass: calculation of the myocardial mass requires measurement of the volumes of the left ventricle with the diameters increased by twice the wall thickness. The accuracy of these measurements depends on several factors: geometrical: true parallelism between the long axis of the ventricle and the planes of projection; influence of the contrast medium in the volume and contraction; this is negligible in the first three systoles; detection of the ventricular contours: this may be manual or automatic and requiring techniques of image digitalization. Therefore, the calculation of ventricular mass is directly related to volume determination, and hypertrophy can only really be quantified by mass/volume or wall thickness/diameter ratios.

[Enoximone, vasodilator and/or inotropic agent in congestive cardiac insufficiency? Hemodynamic and ventriculographic study of 20 cases]. / Enoximone, vasodilatateur et/ou inotrope dans l'insuffisance cardiaque congestive? Etude hémodynamique et ventriculographique à propos de 20 cas.

The aim of this study was to document the effects of enoximone in congestive cardiac failure. The haemodynamic data (aortic pressure, pulmonary pressures, left ventricular pressure, cardiac output, isovolumic contractility index: Vmax) and left ventricular kinetics of 20 patients with dilated cardiomyopathy (11 ischemic and 9 idiopathic in Stages III or IV of the NYHA Classification before recompensation) were recorded under basal conditions, after 30 minutes infusion of dobutamine (10 micrograms/kg/mn) and after 3 hours infusion of enoximone (total dose: 3.6 mg/kg). The two drugs had an equivalent inotropic effect: ejection fraction + 4 +/- 22% with dobutamine and + 16 +/- 39% with enoximone; Vmax increased from 1.53 +/- 0.5 c/sec to 2.49 +/- 0.8 c/sec with dobutamine and to 1.82 +/- 0.5 c/sec with enoximone. Enoximone induced a greater degree of vasodilation (systemic resistances - 14 +/- 21% with dobutamine and - 21 +/- 27% with enoximone) and a more pronounced fall in ventricular filling pressures (- 35 +/- 42% with dobutamine and - 58 +/- 24% with enoximone). Enoximone was less effective than dobutamine in increasing cardiac output (+ 46 +/- 42% with dobutamine and 16 +/- 33% with enoximone) and stroke volume (+ 23 +/- 47% with dobutamine and + 2 +/- 41% with enoximone). This difference in efficacy may be explained by the major reduction in ventricular preload which enoximone induced after that observed with dobutamine. "Responders" (12 patients) had basal cardiac outputs of less than 2.3 l/mn/m2; the peripheral vasodilatation caused by enoximone was greater. Finally, the reduction in left ventricular end diastolic pressure and the increase in Vmax were significantly less in the 11 patients with ischemic cardiomyopathy.(ABSTRACT TRUNCATED AT 250 WORDS)

[Isolated stenosis of the left anterior descending coronary artery and regional function of the left ventricle]. / Sténoses isolées de l'interventriculaire antérieure et fonction régionale du ventricule gauche.

This study compared regional and global left ventricular function of a population of patients with a stenosis of the left anterior descending (LAD) artery and a control population in a prospective 18 months protocol. The 25 patients in the LAD group, 21 men and 4 women (55 +/- 9 years), had a pure and isolated stenosis of the LAD artery (70 +/- 8%) without infarction with normal global systolic function. The 12 patients in the control group strictly no cardiovascular disease after extensive investigation. Cardiac catheterisation was carried out in the conventional manner under the same conditions in both groups, after withdrawal of all medication. Regional wall motion was studied on 30 degrees right anterior oblique selective left ventriculography by a technique derived from Ingel's method using every frame of a cycle in terms of amplitude, velocity and time of segmental shortening and lengthening. The patients in the LAD group had normal cardiac function and no hypo or akinesia. The principal characteristic was the finding of anterior wall asynergy which was significantly different from the uneven contraction common in control subjects. This asynergy is observed from the end of systole to early diastole and features: early termination of anterior wall contraction (normalised contraction time: 86 +/- 13% vs 97 +/- 4% in the control group; p less than 0.02; and 90% in the inferior zone, NS, compared with the control group and p less than 0.05 compared with the anterior wall); dephased velocities of segmental shortening at the end of ejection (positive velocities in the inferior zones 0.17 +/- 1.7 circ/sec and negative velocities in the anterior zones, -0.34 +/- 2.2.(ABSTRACT TRUNCATED AT 250 WORDS)

[Correlations between vectorcardiographic data and effect of myocardial infarction on global and regional left ventricular function]. / Corrélations entre les données vectocardiographiques et le retentissement de la nécrose myocardique sur la fonction ventriculaire gauche globale et segmentaire.

The object of this study was to identify vector-cardiographic parameters (VCG) dependant on the size of myocardial infarction and its consequences on segmental left ventricular wall motion. Forty-five patients were selected for study after a complete haemodynamic investigation including quantitative analysis of LV wall motion. They were divided into three groups: Group I, comprising 15 normal control subjects; Group II, comprising 16 patients with abnormal LV wall motion related to anterior wall infarction due to a solitary lesion of the left anterior descending artery; Group III, comprising 14 patients with abnormal LV wall motion related either to posterior wall infarction or inferior wall infarction due to a solitary lesion of the right coronary or left circumflex arteries. Segmental wall motion was analysed by a semi-automatic programme derived from the Standford method. This programme detects the number of pathological segments in a ventricle and their shortening, and also determines a coefficient of severity of the abnormal zone. The VCG was performed according to Frank's principle and exploited using the computerised Arnaud RUBEL system. The characteristics of the instantaneous vectors were determined every 10 ms up to 60 ms: X, Y and 2 coordinates, amplitude, azimuth and elevation. These coordinates were compared with the segmental wall motion in every patient. There was a close correlation between LV regional wall motion abnormalities and the deflection of the initial vectors (during the first 40 ms) in the horizontal and frontal planes. A ROC statistical analysis showed that VCG was an excellent method of detecting abnormal LV wall motion.(ABSTRACT TRUNCATED AT 250 WORDS)