[Granulomatous skin disease in an immunocompromised child]. / Granulomatose cutanée chez un enfant immunodéficient.

BACKGROUND: The development of systemic and/or cutaneous granulomas associated with immunodeficiency is well established, particularly with common variable immunodeficiency (CVID). We report the case of an immunocompromised child presenting with cutaneous granulomas, predominantly on the face. PATIENTS AND METHODS: A boy aged 6 years and 9 months presenting complex and incompletely defined immunodeficiency presented with gradually worsening cutaneous lesions of granulomatous aspect on his face and right foot. Extensive laboratory tests showed no infectious or neoplastic processes. Biopsies of the lesions confirmed the presence of granulomas. Systemic corticosteroids produced no satisfying improvement and were changed to anti-TNFα. The lesions had completely disappeared after 6 months. Treatment was continued for 6 months, with no relapse 6 months after discontinuation. CONCLUSION: The originality of our case lies in the presentation of cutaneous granulomas, appearing in the context of an undefined immunodeficiency other than CVID, as well as in the therapeutic aspect, with the successful use of biotherapies in such a clinical setting.

Microcomputers and phylogenetic analysis.

The programs discussed above show how microcomputers have added to the arsenal of systematic biologists. This is a rapidly developing field, and there are no doubt major changes on the horizon. Swofford is working on a new version of PAUP that will have some of the interactive features of MacClade (and will not require a math coprocessor) and there are efforts under way to make PAUP available on Macintosh. PHYLIP has undergone a steady evolution since its release, and Felsenstein has plans to continue that policy. A microcomputer descendant of the large mainframe program PHYSYS, authored by James S. Farris, is supposed to be forthcoming before the end of the year. Just as this review was being completed, J. Rohlf and R. Sokal of the State University of New York at Stony Brook unveiled a beta-test microcomputer version of their phenetic program package, NT-SYS. Inasmuch as it was not in release form and does not include algorithms specifically designed to do phylogenetic analysis, it has not been included here (although some phenetic techniques, such as UPGMA, produce results similar to parsimony trees under certain assumptions).

[Management of cutaneous toxicities induced by epidermal growth factor receptor inhibitors: a review]. / Prise en charge des toxicités cutanées des thérapies dirigées contre les récepteurs du facteur de croissance epidermique: revue de la littérature.

The epidermal growth factor receptor (EGFR) is overexpressed in many solid tumors. Its inactivation has an inhibitory effect on the growth and spread of the tumoral cells. It therefore represents an attractive target to treat different cancers. Several molecules have already been registered while others are still under evaluation. One of the common side effects of these therapies is the development of cutaneous toxicities, more precisely a cutaneous rash, sometimes major and distressing. The physiopathology of these cutaneous side effects is poorly understood. Moreover a correlation between the severity of the rash and the tumoral response has been demonstrated in some studies. If this link is confirmed, the rash could be used as a marker for the anti-tumoral activity. This review will summarize the clinical presentations and the current recommendations for the management of cutaneous toxicities induced by EGFR inhibitors.

Training adaptations in skeletal muscle of juvenile diabetics.

Skeletal muscles from 12 male, juvenile-onset diabetics (JD) and 13 nondiabetics (ND) were studied to determine the effects of endurance training on mitochondrial enzyme activities, lipoprotein lipase (LPL) activity, and the oxidation of lipids (14C-palmityl CoA) in vitro. Ten weeks of endurance running (30 min/day, 5 days/wk) resulted in 11.0 and 12.9% gains in aerobic capacity for the JD and ND groups (P greater than 0.05), respectively. Both groups showed significant (P less than 0.05) increases in muscle LPL, carnitine palmityl transferase, succinate dehydrogenase, and hexokinase activities with training. Though the pretraining capacities for 14C-palmityl CoA oxidation were similar for both ND and JD groups, the diabetics showed a 41% greater improvement in the measurement of muscle lipid oxidation after training than did the ND group. The principal finding of this research was that skeletal muscle of juvenile diabetics who are in moderate insulin balance shows adaptations to endurance training that are similar to those of nondiabetic men.

Spatiotemporal reorganization of growth rates in the evolution of ontogeny.

Heterochrony, evolutionary changes in rate or timing of development producing parallelism between ontogeny and phylogeny, is viewed as the most common type of evolutionary change in development. Alternative hypotheses such as heterotopy, evolutionary change in the spatial patterning of development, are rarely entertained. We examine the evidence for heterochrony and heterotopy in the evolution of body shape in two clades of piranhas. One of these is the sole case of heterochrony previously reported in the group; the others were previously interpreted as cases of heterotopy. To compare ontogenies of shape, we computed ontogenetic trajectories of shape by multivariate regression of geometric shape variables (i.e., partial warp scores and shape coordinates) on centroid size. Rates of development relative to developmental age and angles between the trajectories were compared statistically. We found a significant difference in developmental rate between species of Serrasalmus, suggesting that heterochrony is a partial explanation for the evolution of body shape, but we also found a significant difference between their ontogenetic transformations; the direction of the difference between them suggests that heterotopy also plays a role in this group. In Pygocentrus we found no difference in developmental rate among species, but we did find a difference in the ontogenies, suggesting that heterotopy, but not heterochrony, is the developmental basis for shape diversification in this group. The prevalence of heterotopy as a source of evolutionary novelty remains largely unexplored and will not become clear until the search for developmental explanations looks beyond heterochrony.

Dietary potassium and heavy exercise: effects on muscle water and electrolytes.

Eight men were studied during two 4-day exercise-dietary regimens, once under a control diet (80 mEq K+/day) and again with a diet low in K+ (25 mEq/day). Muscle K+ increased 5 to 6% as a result of the two exercise-dietary regimens, while no change was observed for muscle Na+ or Mg++. Plasma volume increased throughout the 4 days of each exercise-diet sequence, with the low K+ regimen resulting in the largest plasma volume gain (+15%) and a marked reduction in urinary K+ excretion. Despite the losses of K+ in sweat and the low K+ intake, there was a relatively small decrease in total body K+ content (less than 2% of body content). Based on these measurements of extracellular (plasma) and tissue (muscle) water and electrolytes, we have concluded that in combination with 4 days of heavy exercise and sweating, a low K+ diet will not significantly diminish the total body K+ content.

The role of dietary carbohydrates in muscle glycogen resynthesis after strenuous running.

This study examined the effect of the type, amount, and the frequency of feeding of carbohydrates on muscle glycogen resynthesis after running. Trained male runners performed a 16.1 km run at 80% VO2 max to decrease gastrocnemius glycogen levels. A complex or simple carbohydrate diet (approximately 3000 kcal) resulted in similar muscle glycogen levels 24 h after exercise. Forty-eight hours after exercise the complex carbohydrate diet resulted in significantly higher (p less than 0.05) muscle glycogen levels. Consuming increasing amounts of carbohydrate, between 88 to 648 g carbohydrate/day, resulted in increasingly larger amounts of muscle glycogen resynthesis (24 h) after exercise. Frequent feedings of a high carbohydrate diet did not enhance muscle glycogen synthesis when compared to equal amounts of carbohydrates in two meals. It appears that muscle glycogen can be normalized between daily strenuous running activity.

Human vitamin B-6 pools estimated through muscle biopsies.

Previous estimates of total vitamin B-6 pools in humans based on extrapolations from tracer studies yielded values of 107-190 mumol when the tracer was administered orally and 345-725 mumol when the tracer was administered intravenously. To obtain a more direct estimate of vitamin B-6 pools, muscle biopsies from five female and seven male adults were analyzed by cation-exchange chromatography. Total muscle mass was estimated from creatinine excretion and the assumption that muscle is 40% of the body weight. The total muscle vitamin B-6 pool was estimated to be 917 +/- 319 mumol in the females and 850 +/- 216 mumol in the males. Because muscle accounts for approximately 80% of the vitamin B-6 in the body, the total body pool of vitamin B-6 in adult humans is probably approximately 1000 mumol.

Response of vitamin B-6 content of muscle to changes in vitamin B-6 intake in men.

Previous reports indicated that in growing rats the vitamin B-6 pool in muscle was relatively stable during deficiency but increased in response to increased vitamin B-6 intake. To determine whether human muscle would show a similar response 10 college-aged males received a low vitamin B-6 diet (1.76 mumol/d) for 6 wk followed by 6 wk on a self-selected diet supplemented with 0.98 mmol pyridoxine HCl/d. During depletion, excretion of pyridoxic acid rapidly adjusted to approximate the intake. Plasma pyridoxal phosphate concentrations at the end of the baseline, depletion, and supplementation periods were 81 +/- 51, 9 +/- 3, and 455 +/- 129 nmol/L, respectively, whereas muscle concentrations were 21 +/- 9, 20 +/- 4, and 25 +/- 7 nmol/g, respectively and total vitamin B-6 in muscle was 28 +/- 10, 27 +/- 4, and 35 +/- 10 nmol/g, respectively. These data provide further confirmation that the vitamin B-6 pools in skeletal muscle are resistant to depletion. They also demonstrate that in humans with constant body weight, vitamin B-6 supplementation is not associated with marked increases in vitamin B-6 in muscle.

Pyridoxic acid excretion during low vitamin B-6 intake, total fasting, and bed rest.

Vitamin B-6 metabolism in 10 volunteers during 21 d of total fasting was compared with results from 10 men consuming a diet low only in vitamin B-6 (1.76 mumol/d) and with men consuming a normal diet during bed rest. At the end of the fast mean plasma concentrations of vitamin B-6 metabolites and urinary excretion of 4-pyridoxic acid tended to be higher in the fasting subjects than in the low-vitamin B-6 group. The fasting subjects lost approximately 10% of their total vitamin B-6 pool and approximately 13% of their body weight. The low-vitamin B-6 group lost only approximately 4% of their vitamin B-6 pool. Compared with baseline, urinary excretion of pyridoxic acid was significantly increased during 17 wk of bed rest. There was no increase in pyridoxic acid excretion during a second 15-d bed rest study. These data suggest the possibility of complex interactions between diet and muscle metabolism that may influence indexes that are frequently used to assess vitamin B-6 status.

Submaximal and maximal working capacity of elite distance runners. Part II. Muscle fiber composition and enzyme activities.

The present study confirms earlier observations that the musculature of elite distance runners is characterized by a high predominance of ST fibers. Although the percent ST fibers effectively discriminates between good and elite distance runners, fiber composition alone is a poor predictor of distance running success within the group of elite runners. Muscle enzyme measurements suggest that the 11 to 20 miles (17.7 to 32.2 km) of daily training performed by the elite runners produced a significantly greater increase in muscle SDH activity than was observed in the good distance runners, who were running 7 to 11 miles (11.3 to 17.7 km) per day, Although such endurance training enhances the oxidative capacity of the muscle, it apparently has little influence on the enzymes of glycogenolysis.

Impaired muscle glycogen storage after muscle biopsy.

To assess the effects of repeated needle biopsies on the rate of muscle glycogen repletion, eight male subjects were studied immediately after and 2 days after an exhaustive cycling bout. A single biopsy was obtained from the right vastus lateralis muscle immediately after an exhaustive cycling bout. Two days later, a sample was taken 1 cm lateral or medial to sample A. In four of these subjects, additional biopsies were taken 3 cm distal and proximal. A control specimen was also taken from the left leg 2 days after the exercise. Ten days after the exercise, muscle was again sampled from each leg of these four subjects. Analysis of these samples revealed that the initial biopsy impaired glycogen storage in the muscle taken 1 cm medial or lateral to the previous site. This reduction in glycogen storage was most pronounced in the first 2 days after the exercise. Samples taken distal and proximal to the initial biopsy contained, on the average, less glycogen than the contralateral leg, but these differences were only significantly different in the distal muscle sample. Alteration in muscle glycogen storage was seen to persist for 10 days after the first biopsy, suggesting that care must be taken in selecting the site for repeated biopsies from the same muscle.

Skeletal muscle characteristics among distance runners: a 20-yr follow-up study.

The purpose of this investigation was to examine the histochemical and enzymatic characteristics of skeletal muscle after 20 yr of distance running training. Twenty-eight men were first studied between 1966 and 1974 when they were all highly trained distance runners. On the basis of their training regimens in the interim between testing, subjects were described as highly trained (HI; n = 11), fitness trained (FIT; n = 10), or untrained (UT; n = 7). Gastrocnemius muscle biopsy samples revealed a mean increase (P < 0.05) in the proportion of type I fibers of the FIT and UT groups, whereas the HI group, which was initially characterized by a high percentage (> 70%) of type I fibers, was unchanged. Although the mean fiber type change of the HI group was similar between evaluations, 6 of the 11 subjects did elicit an increase in the percentage of type I fibers. A subgroup of elite distance runners who had continued to train for competition experienced an approximately 25% reduction (P > 0.05) in muscle succinate dehydrogenase activity and decreases (P > 0.05) in types I and II muscle fiber areas. On the average, in 1993 the HI group had higher (P < 0.05) succinate dehydrogenase and citrate synthase activities than the FIT and UT groups, whereas phosphorylase activity did not differ among the three groups. These data suggest that the middle-aged men in this study had a significantly greater proportion of type I muscle fibers than when they were 20 yr younger.(ABSTRACT TRUNCATED AT 250 WORDS)

Glucose feeding and exercise in trained rats: mechanisms for glycogen sparing.

This investigation studied the effect of an oral glucose feeding on glycogen sparing during exercise in non-glycogen-depleted and glycogen-depleted endurance-trained rats. The non-glycogen-depleted rats received via a stomach tube 2 ml of a 20% glucose solution labeled with [U-14C]glucose just prior to exercise (1 h at 25 m/min). Another group of rats ran for 40 min at higher intensity to deplete glycogen stores, after which they received the same glucose feeding and continued running for 1 h at 25 m/min. The initial 40-min run depleted glycogen in heart, skeletal muscle, and liver. In the non-glycogen-depleted rats the glucose feeding spared glycogen in the liver, primarily from the oxidation of blood-borne glucose in muscle. In the glycogen-depleted rats, muscle glycogen was repleted after the feeding, but sources other than the administered glucose also contributed to glycogen synthesis. The results suggest that glycogen depletion rather than the glucose feeding per se stimulates glycogen resynthesis in muscle during exercise in endurance-trained rats.

Threshold for muscle lactate accumulation during progressive exercise.

The purpose of this study was to investigate the relationship between muscle and blood lactate concentrations during progressive exercise. Seven endurance-trained male college students performed three incremental bicycle ergometer exercise tests. The first two tests (tests I and II) were identical and consisted of 3-min stage durations with 2-min rest intervals and increased by 50-W increments until exhaustion. During these tests, blood was sampled from a hyperemized earlobe for lactate and pH measurement (and from an antecubital vein during test I), and the exercise intensities corresponding to the lactate threshold (LT), individual anaerobic threshold (IAT), and onset of blood lactate accumulation (OBLA) were determined. The test III was performed at predetermined work loads (50 W below OBLA, at OBLA, and 50 W above OBLA), with the same stage and rest interval durations of tests I and II. Muscle biopsies for lactate and pH determination were taken at rest and immediately after the completion of the three exercise intensities. Blood samples were drawn simultaneously with each biopsy. Muscle lactate concentrations increased abruptly at exercise intensities greater than the "below-OBLA" stage [50.5% maximal O2 uptake (VO2 max)] and resembled a threshold. An increase in blood lactate and [H+] also occurred at the below-OBLA stage; however, no significant change in muscle [H+] was observed. Muscle lactate concentrations were highly correlated to blood lactate (r = 0.91), and muscle-to-blood lactate ratios at below-OBLA, at-OBLA, and above-OBLA stages were 0.74, 0.63, 0.96, and 0.95, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Muscle metabolism during exercise in the heat in unacclimatized and acclimatized humans.

The effect of heat acclimatization on aerobic exercise tolerance in the heat and on subsequent sprint exercise performance was investigated. Before (UN) and after (ACC) 8 days of heat acclimatization, 10 male subjects performed a heat-exercise test (HET) consisting of 6 h of intermittent submaximal [50% of the maximal O2 uptake] exercise in the heat (39.7 degrees C dB, 31.0% relative humidity). A 45-s maximal cycle ride was performed before (sprint 1) and after (sprint 2) each HET. Mean muscle glycogen use during the HET was lower following acclimatization [ACC = 28.6 +/- 6.4 (SE) and UN = 57.4 +/- 5.1 mmol/kg; P less than 0.05]. No differences were noted between the UN and ACC trials with respect to blood glucose, lactate (LA), or respiratory exchange ratio. During the UN trial only, total work output during sprint 2 was reduced compared with sprint 1 (24.01 +/- 0.80 vs. 21.56 +/- 1.18 kJ; P less than 0.05). This reduction in sprint performance was associated with an attenuated fall in muscle pH following sprint 2 (6.86 vs. 6.67, P less than 0.05) and a reduced accumulation of LA in the blood. These data indicate that heat acclimatization produced a shift in fuel selection during submaximal exercise in the heat. The observed sparing of muscle glycogen may be associated with the enhanced ability to perform highly intense exercise following prolonged exertion in the heat.

Effect of fat emulsion infusion and fat feeding on muscle glycogen utilization during cycle exercise.

Elevated plasma fatty acids have been shown to spare muscle glycogen during exercise. However, on the basis of recent findings, the saturation of fatty acids may influence this response. The purpose of this study was to determine whether saturated or unsaturated fatty acids affected muscle glycogenolysis to varying degrees during cycle exercise. Five healthy men completed three 60-min cycle ergometer trials (EX) at approximately 70% maximal O2 uptake (VO2max). Triglyceride levels were elevated by a fat feeding (FF) composed of 90% saturated fatty acids (heavy whipping cream, 90 g) or by the infusion of Intralipid (IL; Clintec Nutrition; 45 ml/h of 20% IL, 9.0 g), which was 85% unsaturated. A control trial (CON) consisted of a light breakfast (43 g carbohydrate and 1 g fat). Heparin (2,000 U) was administered 15 min before EX in FF and IL trials, resulting in one- and threefold increases in free fatty acid (FFA) levels in IL and FF, respectively. Pre-EX muscle glycogen did not differ. The utilization of muscle glycogen during 60 min of EX was less (P < 0.05) during the FF (60.0 +/- 5.2 mmol/kg wet wt) and IL (58.6 +/- 6.2 mmol/kg wet wt) compared with CON (81.8 +/- 7.5 mmol/kg wet wt). There was no difference between FF and IL in the amount of glycogen utilized. Serum triglyceride levels were greater (P < 0.05) at preheparin in FF (1.58 +/- 0.37 mmol/l) and IL (0.98 +/- 0.13 mmol/l) compared with CON (0.47 +/- 0.14 mmol/l).(ABSTRACT TRUNCATED AT 250 WORDS)

Muscle glycogenolysis during differing intensities of weight-resistance exercise.

Skeletal muscle glycogen metabolism was investigated in eight male subjects during and after six sets of 70% one repetition maximum (1 RM, I-70) and 35% 1 RM (I-35) intensity weight-resistance leg extension exercise. Total force application to the machine lever arm was determined via a strain gauge and computer interfaced system and was equated between trials. Compared with the I-70 trial, the I-35 trial was characterized by almost double the repetitions (13 +/- 1 vs. 6 +/- 0) and half the peak concentric torque for each repetition (12.4 +/- 0.5 vs. 24.2 +/- 1.0 Nm). After the sixth set, muscle glycogen degradation was similar between I-70 and I-35 trials (47.0 +/- 6.6 and 46.6 +/- 6.0 mmol/kg wet wt, respectively), as was muscle lactate accumulation (13.8 +/- 0.7 and 16.7 +/- 4.2 mmol/kg wet wt, respectively). After 2 h of passive recovery without caloric intake, muscle glycogen increased by 22.2 +/- 6.8 and 14.2 +/- 2.5 mmol/kg wet wt in the I-70 and I-35 trials, respectively. Optical absorbance measurement of periodic acid-Schiff-stained muscle sections after the 2 h of recovery revealed larger absorbance increases in fast-twitch than in slow-twitch fibers (0.119 +/- 0.024 and 0.055 +/- 0.024, P = 0.02). Data indicated that when external work was constant, the absolute amount of muscle glycogenolysis was the same regardless of the intensity of resistance exercise. Nevertheless the rate of glycogenolysis during the I-70 trial was approximately double that of the I-35 trial.

Substrate utilization in leg muscle of men after heat acclimation.

Eight men were heat acclimated (39.6 degrees C and 29.2% rh) for 8 days to examine changes in substrate utilization. A heat exercise test (HET), (cycling for 60 min; 50% maximal O2 consumption) was performed before (UN-HET) and after (ACC-HET) the acclimation period. Muscle glycogen utilization (67.0 vs. 37.6 mmol/kg wet wt), respiratory exchange ratio (0.85 +/- 0.002 vs. 0.83 +/- 0.001), and calculated rate of carbohydrate oxidation (75.15 +/- 1.38 vs. 64.80 +/- 1.52 g/h) were significantly reduced (P less than 0.05) during the ACC-HET. Significantly lower (P less than 0.05) femoral venous glucose (15, 30, and 45 min) and lactate (15 min) levels were observed during the ACC-HET. No differences were observed in plasma free fatty acid (FFA) and glycerol concentrations or glucose, lactate and glycerol arteriovenous uptake/release between tests. A small but significant increase (P less than 0.05) above resting levels in FFA uptake was observed during the ACC-HET. Leg blood flow was slightly greater (P greater than 0.05) during the ACC-HET (4.64 +/- 0.13 vs. 4.80 +/- 0.13 l/min). These findings indicate a reduced use of muscle glycogen following heat acclimation. However, the decrease is not completely explained by a shift toward greater lipid oxidation or increased blood flow.

Carbohydrate balance in competitive runners during successive days of intense training.

This study was designed to investigate the effect of intense training on muscle glycogen stores under conditions of controlled carbohydrate (CHO) intake. On two separate occasions, 10 highly trained distance runners increased their training load for 5 days (20 km/day, approximately 80% maximal O2 consumption) while eating a diet whose carbohydrate composition either equaled (EQ-CHO) or contained approximately 50% of the runner's estimated daily expenditure (LO-CHO). Total muscle glycogen levels were lower after the LO-CHO regimen. Photometric analysis of the glycogen content in individual fibers revealed that 27% type I and 17% type II fibers had optical densities less than 0.2 U after the LO-CHO regimen, whereas 7% type I and 0% type II were similarly depleted after the EQ-CHO diet. A linear relationship was observed between the histochemical and direct chemical analysis of muscle glycogen content. Treadmill O2 uptake measured at 185 and 238 m/min was higher during the LO-CHO than the EQ-CHO regimen. Ratings of perceived exertion were higher during the 238-m/min run for the LO-CHO regimen. After 3 days of rest, running economy and perception of effort returned to pretraining levels and muscle glycogen stores were approximately 85% of the pretraining values. Thus when CHO intake was only approximately 50% of the energy requirements there was a marked depletion of muscle glycogen stores, particularly in type I fibers, and a concomitant decrease in running economy and increased perception of fatigue.(ABSTRACT TRUNCATED AT 250 WORDS)