Chronic administration of minoxidil protects elastic fibers and stimulates their neosynthesis with improvement of the aorta mechanics in mice.

Arterial wall elastic fibers, made of 90% elastin, are arranged into elastic lamellae which are responsible for the resilience and elastic properties of the large arteries (aorta and its proximal branches). Elastin is synthesized only in early life and adolescence mainly by the vascular smooth muscles cells (VSMC) through the cross-linking of its soluble precursor, tropoelastin. In normal aging, the elastic fibers become fragmented and the mechanical load is transferred to collagen fibers, which are 100-1000 times stiffer than elastic fibers. Minoxidil, an ATP-dependent K+ channel opener, has been shown to stimulate elastin expression in vitro, and in vivo in the aorta of male aged mice and young adult hypertensive rats. Here, we have studied the effect of a 3-month chronic oral treatment with minoxidil (120 mg/L in drinking water) on the abdominal aorta structure and function in adult (6-month-old) and aged (24-month-old) male and female mice. Our results show that minoxidil treatment preserves elastic lamellae integrity at both ages, which is accompanied by the formation of newly synthesized elastic fibers in aged mice. This leads to a generally decreased pulse pressure and a significant improvement of the arterial biomechanical properties in female mice, which present an increased distensibility and a decreased rigidity of the aorta. Our studies show that minoxidil treatment reversed some of the major adverse effects of arterial aging in mice and could be an interesting anti-arterial aging agent, also potentially usable for female-targeted therapies.

NIRS prediction of the feed value of temperate forages: efficacy of four calibration strategies.

Near infrared reflectance spectroscopy (NIRS) of 924 fresh temperate forages were used to develop calibration models for chemical composition - crude ash (CA) and crude protein (CP) - organic matter digestibility (OMD) and voluntary intake (VI). We used 110 samples to assess the models. Four calibration strategies for determining forage quality were compared: (i) species-specific calibration, (ii) family-specific calibration, (iii) a global procedure and (iv) a local approach. Forage calibration data sets displayed CA values ranging from 52 to 205 g/kg of dry matter (DM), CP values from 50 to 280 g/kg DM, OMD values from 0.48 to 0.85 g/g and VI values from 22.5 to 115.2 g DM/kg metabolic body weight (BW0.75). The calibration models performed well for all the variables except for VI. For CA, local procedure showed lower standard error of prediction (SEP) than species-specific, family-specific or global models. For CP, the calibration models all showed similar SEP values (11.13, 11.08, 11.38 and 11.34 g/kg DM for species-specific, family-specific, global and local approaches). For OMD, the local procedure gave a similar SEP (0.024 g/g) to specific species and global procedures (0.027 g/g) and a lower SEP than the family-specific approach (0.028 g/g). For VI, the local approach and species-specific calibration showed lower SEP (7.08 and 7.16 g/kg BW0.75) than the broad-based calibrations (8.09 and 8.34 g/kg BW0.75 for family-specific model and global procedure, respectively). Local calibration may thus offer a practical way to develop robust universal equations for animal response determinations.

[Psychosocial distress and communication about cancer in ill partners and their spouses]. / Détresse psychosociale et communication à propos du cancer chez le partenaire malade et son conjoint.

INTRODUCTION: Each cancer can have a psychological impact not only on the patient himself/herself, but also on his/her spouse. OBJECTIVE: Our study concerned 30 couples encompassing a member treated for a cancer, non related to gender. It was aimed at determining the links between the levels of psychosocial distress measured in both members of each couple, patients' sociodemographic and clinical characteristics, as well as communication skills about cancer in both members of the couples. METHODS: Psychosocial distress and communication about cancer were measured by the general health questionnaire (GHQ-28) and the openness to discuss cancer in the nuclear family (ODCF), with an additional version adapted for the spouse on the occasion of this study. RESULTS: A positive correlation was found between the respective scores of the two members of the couples, for the GHQ-28 (r=0.53; p=0.005) as well as for the ODCF (r=0.44; p=0.024). GHQ-28 scores were not associated with the sociodemographic characteristics of the patients, nor with the stage of cancer, the number of months elapsed since the diagnosis of cancer, or the ODCF personal or spouse's score. On the other hand, when the communication within each couple was classified into concordant (insufficient or, on the contrary, open for both members) or discordant (insufficient for one of the two members and open for the other), and after controlling for gender, higher levels of psychosocial distress were found in patients (p=0.038) as well in spouses (p=0.052) belonging to discordant compared with concordant couples. CONCLUSION: These results suggest an effect of contamination or a mutual reinforcement of the distress of each member of such couples, as well as the presence of relatively similar styles of communication in the two partners of each couple. They also underline the possible adaptive function of a restricted style of communication about cancer, if such a restriction is shared by both the members of the couple, and incites particular attention to be paid to couples where one of the partners, but not the other, adopt an open style of communication about cancer.

[Insulinoma presenting as pseudo-drug-resistant focal epilepsy]. / Un insulinome se présentant comme une épilepsie focale pharmacorésistante.

INTRODUCTION: We describe a case of insulinoma presenting as a refractory frontal lobe epilepsy in a 44-year-old man with a history of severe head trauma. CASE REPORT: Despite escalating treatment, his seizure frequency worsened during the previous year. He also developed psychomotor slowing and sweating occurring early in the morning. He gained weight. Insulinoma was diagnosed based on the presence of episodes of hypoglycemia, abnormal insulin/blood glucose ratio and a tumor in the pancreas (echo-ultrasound). After partial pancreatectomy, the patient became seizure free and anti-epileptic drugs were progressively stopped, with a follow-up of five years. CONCLUSION: Insulinoma should be considered in patients with no reason for having drug-resistant epilepsy, especially when seizures occur early in the morning or when episodes of neuropsychiatric symptoms with sweating are present.

[Influence of the communication about one parent's cancer on children's suffering]. / Influence de la communication à propos du cancer d'un parent sur la souffrance des enfants.

INTRODUCTION: Factors contributing to children's distress when a parent is affected with a cancer are still insufficiently known. This study aimed at searching for associations between psychosocial distress in children living with a parent suffering from cancer, the severity of parental cancer, the levels of psychosocial distress in both parents and the openness to discuss cancer in the family. METHODS: Thirty families encompassing a parent treated for cancer and 54 children aged four to 16 were examined. Each parent's psychosocial distress was assessed by the General Health Questionnaire (GHQ-28) and the distress of the children living within the family by the Child Behavior Check List (CBCL) filled out by both parents. Each parent's communication ability about cancer was assessed by the Openness to Discuss Cancer in the nuclear Family questionnaire (ODCF). RESULTS: No association was found between children's distress and objective cancer characteristics. Higher externalized disorders scores at CBCL (aggression) were found when the ill parent was the mother (P=0.018). After controlling for cancer parent's gender, CBCL total score and internalized disorders (anxiety, depression) score were higher in families characterized by an "open" style of communication, defined on the parental couple as a whole (respectively p=0.007 and 0.024), such an effect being present only when the ill parent was the mother (interaction effect: p<0.001). CONCLUSION: These results underline the importance of family characteristics for understanding the suffering observed in children living with a parent affected with a cancer in comparison with objective cancer characteristics.

Prostate-specific antigen doubling time before onset of chemotherapy as a predictor of survival for hormone-refractory prostate cancer patients.

BACKGROUND: We evaluated the possible use of prostate-specific antigen doubling time (PSA-DT) before chemotherapy initiation as a surrogate marker of survival in hormone-refractory prostate cancer (HRPC) patients. PATIENTS AND METHODS: Data from 250 consecutive metastatic HRPC patients treated with chemotherapy between February 2000 and November 2006 were retrospectively analysed. At least three PSA assays were required within 3 months before chemotherapy. PSA-DT was calculated as ln 2 divided by the slope of the log PSA line, and the difference between two log PSA levels was divided by the time interval. The primary endpoint was overall survival (OS). Survival rates according to PSA-DT were stratified on chemotherapy regimen. Multivariate Cox regression analysis was performed to isolate the impact of PSA-DT on OS, controlling for associate prognostic covariates. RESULTS: Patients received docetaxel- (82%) or mitoxantrone-based chemotherapy. The median PSA-DT was 45 days (range 4.7-1108 days). There were 174 deaths (70%). The median survival was 16.5 months (95% confidence interval [CI] = 12.5-20.5) and 26.4 months (95% CI = 20.3-32.4) for patients with a PSA-DT < 45 and > or =45 days, respectively. In the multivariate setting, the adjusted hazard ratio (HR) was 1.39 (95% CI = 1.03-1.89; P = 0.04), stratified by chemotherapy regimen. CONCLUSION: A short PSA-DT before onset of chemotherapy in HRPC patients was associated with an increased risk of death. This could be useful as a stratification parameter in trials with new drugs in a metastatic setting.

A dendritic cell-based vaccine for treating HIV infection: background and preliminary results.

Antibody response against human immunodeficiency virus-1 (HIV) is ineffective and cellular immune response is not strong enough to achieve the complete suppression or at least a strong control of viral replication in HIV- infected patients. In 2001, we showed in vitro that dendritic cells (DCs) of HIV-infected patients loaded with autologous HIV chemically inactivated by aldrithiol-2 were capable of raising an HIV-specific cellular immune response powerful enough to allow the destruction of autologous HIV- infected CD4 T cells. In 2003, we showed that simian immunodeficiency virus (SIV)-infected macaques vaccinated with inactivated SIV-loaded autologous DCs raised a strong SIV-specific cellular response. Ten months after vaccination, plasma viral load of 7 out of the 10 vaccinated monkeys remained 1000-fold lower than initially. In December 2004, we published results observed in 18 untreated HIV-infected patients vaccinated with autologous monocyte-derived DCs loaded with autologous inactivated HIV. A year following vaccination, 8 patients had a plasma viral load decrease >90%; among them, 4 had viral load <1000 copies mL(-1). Moreover, by one year, the viral load decline of the 18 patients was significantly correlated with their percentage of HIV-1-gag-specific CD8(+) T cells expressing perforin and that of HIV-1-specific CD4(+) T(H)1 cells. This is the first demonstration of the capacity of a therapeutic vaccine to induce an effective HIV-specific T cell response associated with sustained viral suppression in untreated viremic patients. The manipulation of antigen presenting cells to elicit virus-specific cellular responses is a promising tool to control persistant viral infections.

Experimental study of the impact of annealing on ice structure and mass transfer parameters during freeze-drying of a pharmaceutical formulation.

The principal aim of this study is to evaluate the influence of annealing on structural properties and mass transfer parameters of a model formulation used for freeze-drying of pharmaceutical proteins. Characterization runs on ice morphology of the frozen material were performed in a cold chamber by direct optical microscopy using episcopic coaxial lighting. Consequently, it was possible to quantify the influence of annealing (temperature, duration) on ice morphology. Then, the pressure rise analysis method was used during primary drying to identify as a function of time both the dried layer mass transfer resistance values, R(p), and the sublimation front temperature, T(i), with or without annealing. Annealing turned out to accelerate sublimation rates by increasing ice crystal sizes of the frozen matrix, thus leading to lower values of R(p). Finally, secondary drying kinetics were studied by measuring the values of the desorption constant by a simple gravimetric method. In this study, annealing turned out to decrease desorption kinetics by a factor of two.

Potyvirus terminal protein VPg, effector of host eukaryotic initiation factor eIF4E.

Potyvirus RNA contains at the 5' end a covalently linked virus-encoded protein VPg, which is required for virus infectivity. This role has been attributed to VPg interaction with the eukaryotic translation initiation factor eIF4E, a cap-binding protein. We characterized the dissociation constants for the interaction of the potato virus Y VPg with different plant eIF4Es and its isoforms and mapped the eIF(iso)4E attachment region on VPg. VPg/eIF4E interaction results in the inhibition of cell-free protein synthesis, and we show that it stems from the liberation of the cap moiety from the complex with eIF4E. Since VPg does not attach the cap, it appears that VPg induces changes in the eIF4E structure, diminishing its affinity to the cap. We show here that the initiation complex scaffold protein eIF(iso)4G increases VPg interaction with eIF(iso)4E. These data together suggest similar cap and VPg interactions with eIF4E and characterize VPg as a novel eIF4E-binding protein, which inhibits host protein synthesis at a very early stage of the initiation complex formation through the inhibition of cap attachment to the initiation factor eIF4E.

Thermophysical properties of aqueous and frozen states of BSA/water/Tris systems.

In the modelling and the optimization of pharmaceutical protein freeze-drying processes, thermophysical properties values of the formulation in frozen or in liquid states are necessary in order to determine the optimal operating conditions (temperature, pressure) of the two steps (sublimation, desorption) drying diagramme and the optimal storage conditions of the final freeze-dried product. The most important thermophysical properties of BSA/water/Tris system buffered with Tris-HCl (5%, w/w) at pH 7, a standard formulation largely used in industrial freeze-drying process of pharmaceutical proteins, are reported in this paper. The state diagram of this formulation was determined by modulated temperature differential scanning calorimetry (MTDSC) and, then the vitreous transition temperatures were interpreted as a function of water content by the Gordon-Taylor equation. The same technique was used to experimentally determine the heat capacity of the BSA/water frozen system. Moreover, the transient hot wire probe method was used to measure the thermal conductivity of the frozen system as a function of temperature. It proved that the thermal conductivity and the apparent heat capacity values for this dilute formulation were reasonably close to the values for the pure water/ice system. Sorption isotherms data were also measured by two different methods-the equilibrium with saturated salts solutions and also the controlled humidity oven. Water vapour sorption data were finally correlated by the three parameters Guggenheim, Anderson, De Boer (GAB) equation.

NUP98 rearrangements in hematopoietic malignancies: a study of the Groupe Francophone de Cytogénétique Hématologique.

The NUP98 gene is fused with 19 different partner genes in various human hematopoietic malignancies. In order to gain additional clinico-hematological data and to identify new partners of NUP98, the Groupe Francophone de Cytogénétique Hématologique (GFCH) collected cases of hematological malignancies where a 11p15 rearrangement was detected. Fluorescence in situ hybridization (FISH) analysis showed that 35% of these patients (23/66) carried a rearrangement of the NUP98 locus. Genes of the HOXA cluster and the nuclear-receptor set domain (NSD) genes were frequently fused to NUP98, mainly in de novo myeloid malignancies whereas the DDX10 and TOP1 genes were equally rearranged in de novo and in therapy-related myeloid proliferations. Involvement of ADD3 and C6ORF80 genes were detected, respectively, in myeloid disorders and in T-cell acute lymphoblastic leukemia (T-ALL), whereas the RAP1GDS1 gene was fused to NUP98 in T-ALL. Three new chromosomal breakpoints: 3q22.1, 7p15 (in a localization distinct from the HOXA locus) and Xq28 were detected in rearrangements with the NUP98 gene locus. The present study as well as a review of the 73 cases previously reported in the literature allowed us to delineate some chromosomal, clinical and molecular features of patients carrying a NUP98 gene rearrangements.

Optimization of the freeze-drying cycle: adaptation of the pressure rise analysis model to non-instantaneous isolation valves.

The principal aim of this study is to extend to a pilot freeze-dryer equipped with a non-instantaneous isolation valve the previously presented pressure rise analysis (PRA) model for monitoring the product temperature and the resistance to mass transfer of the dried layer during primary drying. This method, derived from the original MTM method previously published, consists of interrupting rapidly (a few seconds) the water vapour flow from the sublimation chamber to the condenser and analysing the resulting dynamics of the total chamber pressure increase. The valve effect on the pressure rise profile observed during the isolation valve closing period was corrected by introducing in the initial PRA model a valve characteristic function factor which turned out to be independent of the operating conditions. This new extended PRA model was validated by implementing successively the two types of valves and by analysing the pressure rise kinetics data with the corresponding PRA models in the same operating conditions. The coherence and consistency shown on the identified parameter values (sublimation front temperature, dried layer mass transfer resistance) allowed validation of this extended PRA model with a non-instantaneous isolation valve. These results confirm that the PRA method, with or without an instantaneous isolation valve, is appropriate for on-line monitoring of product characteristics during freeze-drying. The advantages of PRA are that the method is rapid, non-invasive, and global. Consequently, PRA might become a powerful and promising tool not only for the control of pilot freeze-dryers but also for industrial freeze-dryers equipped with external condensers.

Determination of mass and heat transfer parameters during freeze-drying cycles of pharmaceutical products.

The principal aim of this study was to evaluate the water vapour mass transfer resistance of the dried layer and the vial heat transfer coefficient values of a pharmaceutical product during the primary drying period. First, overall vial heat transfer coefficient values, Kv, were determined by a gravimetric method based on pure ice sublimation experiments. Thus, it was possible to set up a map of the total heat flux received by each vial throughout the plate surface of our pilot scale freeze-dryer. Important heterogeneities were observed for the vials placed at the plate edges and for the vials placed at the center of the plate. As well, the same gravimetric method was also used to precisely determine the influence of main lyophilization operating parameters (shelf temperature and gas total pressure) or the vial types and sizes on these overall heat transfer coefficient values. A semi-empirical relationship as a function of total gas pressure was proposed. The transient method by pressure rise analysis (PRA method) after interrupting the water vapour flow between the sublimation chamber and the condenser, previously set up and validated in our laboratory, was then extensively used with an amorphous BSA-based formulation to identify the dried layer mass transfer resistance values, Rp, the ice front temperature, and the total heat transfer coefficient values, Kv, with or without annealing treatment. It was proved that this method gave accurate and coherent data only during the first half of the sublimation period when the totality of the vials of the set was still sublimating. Thus, this rapid method allowed estimation of, on line and in situ, the sublimation front temperature and the characterization of the morphology and structure of the freeze-dried layer, all along the first part of the sublimation period. The estimated sublimation temperatures shown by the PRA model were about 2 degrees C lower than the experimental values obtained using thermocouples inserted inside the vial, in accordance with previous data given by this method for similar freeze-drying conditions. As well, by using this method we could confirm the homogenization of the dried layer porous structure by annealing treatment after the freezing step. Furthermore, frozen matrix structure analysis (mean pore diameter) using optical microscopy and mass transfer modelling of water vapour by molecular diffusion (Knudsen regime) allowed, in some cases, to predict the experimental values of this overall mass transfer resistance directly related to the freeze-dried cake permeability.

[Therapeutic strategies in somatotroph adenomas with extrasellar extension: role of the medical approach, a consensus study of the French Acromegaly Registry]. / Stratégies thérapeutiques dans les adénomes somatotropes avec extension extrasellaire. Place du traitement médical. Etude consensus du Répetoire français de l'Acromégalie.

UNLABELLED: From the first 198 patient files included into the French Acromegaly Registry, we analyzed 68 patients harboring a somatotroph adenoma with extrasellar extension, after exclusion of those treated by stereotactic or conventional radiotherapy. In these patients (including 37 women), aged 21-77 yr. (45.7 +/- 13.3), GH concentrations ranged from 2-260 microg/L (38.6 +/- 44.3), and IGF I from 86-967% of age-matched upper limit of normal (303 +/- 164). Maximal diameter of the adenoma at MRI was 11-36.5 mm (20.4 +/- 6.5), with cavernous sinus involvement in 68% of cases. Three subgroups were defined: 20 patients treated by long-acting somatostatin analogs only (group M), for a mean duration of 3 yr. (extremes 1-7 yr.), 48 patients initially treated by transsphenoidal surgery (group C), of whom 21 were secondarily treated by long-acting somatostatin analogs (group CM) for a mean duration of 1.2 yr. (extremes 0.2-2 yr.). All 3 groups were not statistically different in terms of tumor mass and initial levels of GH and IGF-1. Patients from group M were significantly older than those of the other groups (p<0.05). RESULTS: 46% of patients from group C after surgery vs. 45% of patients from group M had a mean GH below 2.5 microg/L. Biochemical remission (GH<2.5 microg/L and normal IGF1 normal) was obtained in 31% of cases in group C, vs. 25% in group M. In this group, a decrease of the largest tumor diameter was observed in 10 patients (71.5%), ranging from 10-25% in 7 (50%) and exceeded 50% in 3 (21.5%). In group CM, the biochemical remission rate (42%) and final GH or IGF1 values were not significantly different from group M. In conclusion, these data suggest that surgery or long-acting somatostatin analogs have a comparable efficacy in terms of remission rates in somatotroph macroadenomas with extrasellar extensions.

Front-line high-dose therapy with autologous stem cell transplantation for high risk Hodgkin's disease: comparison with combined-modality therapy.

This retrospective study compares high-dose therapy (HDT) with autologous stem cell transplantation and combined-modality treatment (CT) as a first-line therapy for Hodgkin's disease (HD) for patients with both a clinical stage (CS) IV and/or a mediastinal mass > or =0.45 of the thoracic diameter (MM > or =0.45) at diagnosis, and an incomplete response after the first-line chemotherapy. Data on 42 grafted patients (GP) in Nantes Hospital, France and on 108 combined-modality treated patients (CTP) from two protocols of the GOELAMS group, France (POF 81 and H90) was analyzed. Both groups were comparable except for pulmonary disease in excess in the grafted group (P = 0.01). Among GP, 95% were in complete response at the end of first-line treatment and 77% among CTP. Median follow-up was 53 months (range, 7 to 128 months) for GP and 88 months (range, 25 to 181 months) for CTP. The 5-year freedom from progression (FFP) and event-free survival (EFS) rates were better for GP (87% vs 55% for FFP: P = 0.0004 and 81% vs 51% for EFS: P = 0.0004) whereas the overall survival (OS) rates did not differ significantly (85% for GP vs 71% for CTP: P = 0.06). Similar results were obtained for the groups with a response > or =50% after initial chemotherapy: 91% vs 65% for FFP, P = 0.01; 87% vs 61% for EFS, P = 0.02; and 92% vs 77% for OS, P = 0.2; and for the groups with a response <50%: 80% vs 22% for FFP, P = 0.0003; 72% vs 13% for EFS, P = 0.0001; and 76% vs 46% for OS, P = 0.04. This study shows a better control of the disease with HDT.

[Management of cleft lip and palate in university hospital of Rouen]. / Prise en charge des fentes faciales et palatines à la clinique chirurgicale du centre hospitalier universitaire de Rouen.

Cleft lips and cleft palates are managed in the department of Pediatric surgery in Rouen for the last 30 years. From the antenatal diagnosis, the parents got in touch with the surgeon who will coordinate this management. Around thirty new patients are treated every year. The chronology of the treatment is of "classic" manner. The cleft lip is repaired at about 3 weeks of age and the palatoplasty is performed after the age of 1 year. In view to maintain the intimacy of the consultation we did not institute multidisciplinary consultations. The other members of the interdisciplinary team will intervene during the follow up depending on the form of the cleft and the encountered problems. The information and the files circulate freely and are discussed together.

In vitro human immunodeficiency virus eradication by autologous CD8(+) T cells expanded with inactivated-virus-pulsed dendritic cells.

Despite significant immune recovery with potent highly active antiretroviral therapy (HAART), eradication of human immunodeficiency virus (HIV) from the bodies of infected individuals represents a challenge. We hypothesized that an inadequate or inappropriate signal in virus-specific antigen presentation might contribute to the persistent failure to mount efficient anti-HIV immunity in most HIV-infected individuals. Here, we conducted an in vitro study with untreated (n = 10) and HAART-treated (n = 20) HIV type 1 (HIV-1) patients which showed that pulsing of monocyte-derived dendritic cells (DC) with aldrithiol-2-inactivated autologous virus resulted in the expansion of virus-specific CD8(+) T cells which were capable of killing HIV-1-infected cells and eradicating the virus from cultured patient peripheral blood mononuclear cells independently of the disease stages and HAART response statuses of the patients. This in vitro anti-HIV effect was further enhanced by the HIV protease inhibitor indinavir (at a nonantiviral concentration), which has been shown previously to be able to up-regulate directly patient T-cell proliferation following immune stimulation. However, following a 2-day treatment with culture supernatant derived from immune-activated T cells (which mimics an in vivo environment of HIV-disseminated and immune-activated lymphoid tissues), DC lost their capacity to present de novo inactivated-virus-derived antigens. These findings provide important information for understanding the establishment of chronic HIV infection and indicate a perspective for clinical use of DC-based therapeutic vaccines against HIV.