The place of new antibiotics for Gram-negative bacterial infections in intensive care: report of a consensus conference.

INTRODUCTION: New beta-lactams, associated or not with beta-lactamase inhibitors (NBs/BIs), can respond to the spread of carbapenemase-producing enterobacteriales and nonfermenting carbapenem-resistant bacteria. The risk of emergence of resistance to these NBs/BIs makes guidelines necessary. The SRLF organized a consensus conference in December 2022. METHODS: An ad hoc committee without any conflict of interest (CoI) with the subject identified the molecules (ceftolozane-tazobactam, ceftazidime-avibactam, imipenem-cilastatin-relebactam, meropenem-vaborbactam and cefiderocol); defined 6 generic questions; drew up a list of subquestions according to the population, intervention, comparison and outcomes (PICO) model; and reviewed the literature using predefined keywords. The quality of the data was assessed using the GRADE methodology. Seven experts in the field proposed their own answers to the questions in a public session and answered questions from the jury (a panel of 10 critical-care physicians without any CoI) and the public. The jury then met alone for 48 h to write its recommendations. Due to the frequent lack of powerful studies that have used clinically important criteria of judgment, the recommendations were formulated as expert opinions as often as necessary. RESULTS: The jury provided 17 statements answering 6 questions: (1) Is there a place in the ICU for the probabilistic use of new NBs/IBs active against Gram-negative bacteria? (2) In the context of documented infections with sensitivity to several of these molecules, are there pharmacokinetic, pharmacodynamic, ecological or medico-economic elements for prioritization? (3) What are the possible combinations with these molecules and in what context? (4) Should we integrate these new molecules into a carbapenem-sparing strategy? (5) What pharmacokinetic and pharmacodynamic data are available to optimize their mode of administration in critically ill patients? (6) What are the dosage adaptations in cases of renal insufficiency, hepatocellular insufficiency or obesity? CONCLUSION: These recommendations should optimize the use of NBs/BIs in ICU patients.

Hydrocortisone in Severe Community-Acquired Pneumonia.

BACKGROUND: Whether the antiinflammatory and immunomodulatory effects of glucocorticoids may decrease mortality among patients with severe community-acquired pneumonia is unclear. METHODS: In this phase 3, multicenter, double-blind, randomized, controlled trial, we assigned adults who had been admitted to the intensive care unit (ICU) for severe community-acquired pneumonia to receive intravenous hydrocortisone (200 mg daily for either 4 or 7 days as determined by clinical improvement, followed by tapering for a total of 8 or 14 days) or to receive placebo. All the patients received standard therapy, including antibiotics and supportive care. The primary outcome was death at 28 days. RESULTS: A total of 800 patients had undergone randomization when the trial was stopped after the second planned interim analysis. Data from 795 patients were analyzed. By day 28, death had occurred in 25 of 400 patients (6.2%; 95% confidence interval [CI], 3.9 to 8.6) in the hydrocortisone group and in 47 of 395 patients (11.9%; 95% CI, 8.7 to 15.1) in the placebo group (absolute difference, -5.6 percentage points; 95% CI, -9.6 to -1.7; P = 0.006). Among the patients who were not undergoing mechanical ventilation at baseline, endotracheal intubation was performed in 40 of 222 (18.0%) in the hydrocortisone group and in 65 of 220 (29.5%) in the placebo group (hazard ratio, 0.59; 95% CI, 0.40 to 0.86). Among the patients who were not receiving vasopressors at baseline, such therapy was initiated by day 28 in 55 of 359 (15.3%) of the hydrocortisone group and in 86 of 344 (25.0%) in the placebo group (hazard ratio, 0.59; 95% CI, 0.43 to 0.82). The frequencies of hospital-acquired infections and gastrointestinal bleeding were similar in the two groups; patients in the hydrocortisone group received higher daily doses of insulin during the first week of treatment. CONCLUSIONS: Among patients with severe community-acquired pneumonia being treated in the ICU, those who received hydrocortisone had a lower risk of death by day 28 than those who received placebo. (Funded by the French Ministry of Health; CAPE COD ClinicalTrials.gov number, NCT02517489.).

Formal guidelines: management of acute respiratory distress syndrome.

Fifteen recommendations and a therapeutic algorithm regarding the management of acute respiratory distress syndrome (ARDS) at the early phase in adults are proposed. The Grade of Recommendation Assessment, Development and Evaluation (GRADE) methodology has been followed. Four recommendations (low tidal volume, plateau pressure limitation, no oscillatory ventilation, and prone position) had a high level of proof (GRADE 1 + or 1 -); four (high positive end-expiratory pressure [PEEP] in moderate and severe ARDS, muscle relaxants, recruitment maneuvers, and venovenous extracorporeal membrane oxygenation [ECMO]) a low level of proof (GRADE 2 + or 2 -); seven (surveillance, tidal volume for non ARDS mechanically ventilated patients, tidal volume limitation in the presence of low plateau pressure, PEEP > 5 cmH2O, high PEEP in the absence of deleterious effect, pressure mode allowing spontaneous ventilation after the acute phase, and nitric oxide) corresponded to a level of proof that did not allow use of the GRADE classification and were expert opinions. Lastly, for three aspects of ARDS management (driving pressure, early spontaneous ventilation, and extracorporeal carbon dioxide removal), the experts concluded that no sound recommendation was possible given current knowledge. The recommendations and the therapeutic algorithm were approved by the experts with strong agreement.

Effect of selenium pre-treatment on plasma antioxidant vitamins A (retinol) and E (α-tocopherol) in static magnetic field-exposed rats.

In the present study, we evaluate the effect of the co-exposure to static magnetic field (SMF) and selenium (Se) on the antioxidant vitamins A and E levels and some other parameters of oxidative stress in rat. Sub-acute exposure of male adult rats to a uniform SMF (128 mT, 1 h/day during 5 consecutive days) increased plasma activity of glutathione peroxidase (+35%) but decreased α-tocopherol (-67%) and retinol levels (-41%). SMF exposure failed to alter the plasmatic thiobarbituric acid-reactive species (TBARs), total thiol groups and selenium concentrations. Sub-chronic administration of Se (Na(2)SeO(3), 0.2 mg/L, for 30 consecutive days, per os) ameliorated the antioxidant capacities in SMF-treated rats. Our investigation demonstrated that sub-acute exposure to SMF induced oxidative stress, which may be prevented by a pretreatment with selenium.

Effects of long-term antioxidant supplementation and association of serum antioxidant concentrations with risk of metabolic syndrome in adults.

BACKGROUND: Limited observational evidence suggests lower antioxidant concentrations in individuals with the metabolic syndrome (MetS); few randomized controlled trials have addressed the effect of multiple antioxidants on the risk of MetS. OBJECTIVE: The objective was to examine the effect of antioxidant supplementation for 7.5 y on the incidence of MetS and the epidemiologic association between baseline serum antioxidant concentrations and the prospective risk of MetS. DESIGN: Adults (n = 5220) participating in the SUpplementation en VItamines et Minéraux AntioXydants (SU.VI.MAX) primary prevention trial were randomly assigned to receive a supplement containing a combination of antioxidants (vitamins C and E, beta-carotene, zinc, and selenium) at nutritional doses or a placebo. Subjects were free of MetS at baseline and were followed for 7.5 y. RESULTS: Antioxidant supplementation for 7.5 y did not affect the risk of MetS. Baseline serum antioxidant concentrations of beta-carotene and vitamin C, however, were negatively associated with the risk of MetS; the adjusted odds ratios (and 95% CIs) for the highest compared with the lowest tertile were 0.34 (0.21, 0.53; P for trend = 0.0002) and 0.53 (0.35, 0.80; P for trend = 0.01), respectively. Baseline serum zinc concentrations were positively associated with the risk of developing MetS; the adjusted odds ratio (and 95% CI) for the highest compared with the lowest tertile was 1.81 (1.20, 2.72; P for trend = 0.01). CONCLUSIONS: The experimental finding of no beneficial effects of antioxidant supplementation in a generally well-nourished population is consistent with recent reports of a lack of efficacy of antioxidant supplements. However, the relations observed between the risk of MetS and baseline serum antioxidant concentrations, which probably reflect associations with overall dietary patterns, do support the current recommendations to consume antioxidant-rich foods. This trial was registered at clinicaltrials.gov as NCT00272428.

Relationships between different types of fruit and vegetable consumption and serum concentrations of antioxidant vitamins.

Increased fruit and vegetable consumption has become a health priority in many countries. Therefore, data investigating the influence of different types of fruits and vegetables on serum antioxidant levels would be useful. The objective of the study was to assess the relationship between fruit and vegetable consumption and vitamin serum antioxidant concentrations. Specific fruit and vegetable groups are evaluated. A total of 3521 subjects (1487 men and 2034 women), aged 35-60 years, participating in the SU.VI.MAX cohort were included in this study. Blood samples of participants were analysed for beta-carotene, vitamin C and alpha-tocopherol. Each subject had completed at least six dietary records during the first 2 years of the study. It was found that women had higher mean beta-carotene and vitamin C serum concentrations than men, but lower alpha-tocopherol serum concentrations. Serum beta-carotene and vitamin C concentrations were positively correlated with consumption of both fruit and vegetables, as well as with most of the fruit and vegetable groups tested. These relationships persisted after adjustment for confounding factors. Regression analysis showed a linear dose-response relationship. Root vegetables and citrus fruits were particularly associated with beta-carotene serum status as were citrus fruits for vitamin C. Fruit and vegetable consumption was either not or weakly associated with alpha-tocopherol serum concentrations. These results describe antioxidant serum concentrations according to fruit and vegetable consumption in a large sample and support the findings of previous studies involving a more limited number of subjects.

Nutritional and plasmatic antioxidant vitamins status of ultra endurance athletes.

OBJECTIVE: The "Marathon des Sables" (MDS) is a competition known to induce oxidative stress. Antioxidant vitamins prevent exercise-induced oxidative damages. The purpose of this study was to evaluate daily intake and plasma level of the main antioxidant vitamins (alpha-tocopherol, vitamin C, beta-carotene and retinol) in 19 male athletes who participated in this competition. METHODS: Data collected before the beginning of the competition included daily dietary intake using a 7-day food record and plasma biochemical measurements (alpha-tocopherol, vitamin C, beta-carotene and retinol). RESULTS: First, total energy intake was obviously lower than the energetic intake usually observed in well-trained endurance athletes. Second, antioxidant vitamins intake was also insufficient. Indeed, the intake was lower than the French Dietary Reference Intakes (DRI) for this population in 18 subjects for vitamin E and 6 subjects for vitamin C, beta-carotene and Retinol Equivalent. As a significant relationship was found between total energy intake and the intake of vitamin E (r = 0.73; p < 0.001) and vitamin C (r = 0.78; p < 0.001), the low total energy intake contributed partially to the insufficient antioxidant vitamins intake. The dietary questionnaire analysis also revealed a low intake of vegetable oils, fruits and vegetables. However, plasma concentrations of these antioxidant vitamins were similar to the literature data observed in athletes. CONCLUSION: This study evidenced obvious insufficient energy intake in ultra endurance athletes associated with a low antioxidant vitamin intake.

Effect of low dose antioxidant vitamin and trace element supplementation on the urinary concentrations of thromboxane and prostacyclin metabolites.

OBJECTIVE: This trial evaluated the effect of antioxidant supplementation on the urinary excretion of 11-dehydro TXB(2)/2,3 dinor 6 keto PGF(1alpha) ratio, a marker of the pathogenesis of thrombosis and arteriosclerosis. METHODS: This study was a randomised, double-blind, placebo-controlled trial involving 186 presumably healthy volunteers. One hundred received a multi-antioxidant supplementation and 86 a placebo for two years. Blood zinc, selenium, beta-carotene, vitamin C and E and urinary excretion of 11-dehydro TXB(2) and 2,3 dinor 6 keto PGF(1alpha) were measured. RESULTS: Baseline subject characteristics did not differ between the two groups. Blood zinc, selenium, and beta-carotene concentrations significantly increased between baseline and two years in the multi-antioxidant supplementation group supporting subject compliance (p < 0.05). At two years, the median urinary 11-dehydro TXB(2)/2,3 dinor 6 keto PGF(1alpha) ratio was significantly lower in the multi-antioxidant supplementation group (3.4 versus 2.78, p = 0.015). Serum selenium concentration was the only antioxidant studied that was significantly related to the urinary 11-dehydro TXB(2)/2,3 dinor 6 keto PGF(1alpha) ratio. CONCLUSIONS: These results support the hypothesis that a low-dose multi-antioxidant supplementation may contributes to a reduction in platelet activation which is beneficial for cardiovascular function.

Multivitamin-mineral supplementation prevents lipid peroxidation during "the Marathon des Sables".

OBJECTIVE: We investigated the effect of a moderate mutivitamin and mineral supplementation containing mainly vitamin C (150.0 mg.day(-1)), vitamin E (24.0 mg.day(-1)) and beta-carotene (4.8 mg.day(-1)) prior to and during an extreme running competition -the Marathon des Sables (MDS)- that consisted of six long races in the desert. METHODS: Seventeen athletes participated in our double blind, placebo-controlled study. Blood samples were collected prior to the supplementation i.e. three weeks before the competition (D-21), two days prior to the MDS (D-2), after the third race (D3) and at the end of the competition (D7). Erythrocyte antioxidant enzyme activity (glutathione peroxidase (GPx), superoxide dismutase (SOD)), erythrocyte glutathione level (GSH), plasma non-enzymatic antioxidant status (uric acid, vitamin C, alpha-tocopherol, retinol, beta-carotene), markers of plasma lipid peroxidation (thiobarbituric reactive substances (TBARS)), reactive carbonyl derivatives (RCD) and membrane damage (creatine kinase and lactate dehydrogenase activities) were measured. RESULTS: In both groups, GSH levels, uric acid levels and membrane damage significantly increased during the competition while SOD activity significantly decreased. In Supplemented group, plasma alpha-tocopherol, beta-carotene and retinol levels significantly increased after three weeks of supplementing. In contrast to Placebo group, alpha-tocopherol, vitamin C and retinol levels were significantly affected by the competition in Supplemented group. Moreover, no increase in TBARS was observed in Supplemented group during the competition, whereas TBARS significantly increased at D3 in the placebo group. CONCLUSION: The moderate multivitamin-mineral supplementation prevented the transient increase in TBARS levels during this extreme competition.

Safety of trivalent chromium complexes: no evidence for DNA damage in human HaCaT keratinocytes.

Several studies have demonstrated beneficial effects of supplemental trivalent Cr in subjects with reduced insulin sensitivity with no documented signs of toxicity. However, recent studies have questioned the safety of supplemental trivalent Cr complexes. The objective of this study was to evaluate the cytotoxic and genotoxic potential of the Cr(III) complexes (histidinate, picolinate, and chloride) used as nutrient supplements compared with Cr(VI) dichromate. The cytotoxic and genotoxic effects of the Cr complexes were assessed in human HaCaT keratinocytes. The concentrations of Cr required to decrease cell viability were assessed by determining the ability of a keratinocyte cell line (HaCaT) to reduce tetrazolium dye, 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide. DNA damage using the Comet assay and the production of 8-hydroxy-2'-deoxyguanosine were also determined with and without hydrogen peroxide-induced stress. The LC50 for human cultured HaCaT keratinocytes was 50 microM for hexavalent sodium dichromate and more than 120-fold higher for Cr chloride (6 mM) and Cr histidinate (10 mM). For Cr picolinate at saturating concentration (120 microM) the LC50 was not attained. High Cr(III) concentrations, 250 microM Cr as Cr chloride and Cr histidinate and 120 microM Cr picolinate (highest amount soluble in the system), not only did not result in oxidative DNA damage but exhibited protective antioxidant effects when cells were exposed to hydrogen peroxide-induced oxidative stress. These data further support the low toxicity of trivalent Cr complexes used in nutrient supplements.

Plasma carotenoid levels and cognitive performance in an elderly population: results of the EVA Study.

BACKGROUND: The hypothesis of carotenoids having a preventive role in cognitive impairment is suggested by their antioxidant properties. METHODS: We examined, in a cross-sectional analysis, the relationship between cognitive performance (assessed by the Mini-Mental State Examination, Trail Making Test Part B, Digit Symbol Substitution, Finger Tapping Test, and Word Fluency Test) and different plasma carotenoids (lutein, zeaxanthin, beta-cryptoxanthin, lycopene, alpha-carotene, and trans-beta-carotene and cis-beta-carotene) in a healthy elderly population (the EVA,"Etude du Vieillissement Artériel," study; n = 589, age = 73.5 +/- 3 years). RESULTS: Logistic regression showed that participants with the lowest cognitive functioning (<25th percentile) had a higher probability of having low levels of specific plasma carotenoids (<1st quartile): lycopene and zeaxanthin. For zeaxanthin, odds ratios (ORs) were as follows: OR(DSS) = 1.97 (95% confidence interval [CI] = 1.21-3.20), OR(FTT) = 1.70 (CI = 1.05-2.74), and OR(WFT) = 1.82 (CI = 1.08-3.07); for lycopene, OR(DSS) = 1.93 (CI = 1.20-3.12) and OR(TMTB) = 1.64 (CI = 1.04-2.59). CONCLUSION: Even if it is not possible to affirm if these low levels of carotenoids precede or are the consequence of cognitive impairment, our results suggest that low carotenoid levels could play a role in cognitive impairment. The biological significance of our findings needs further research.

Kinetic changes of oxidative stress and selenium status in plasma and tissues following burn injury in selenium-deficient and selenium-supplemented rats.

BACKGROUND: This study investigates the relationship between the burn-induced oxidative stress and the selenium status. METHODS: The rats were fed with a selenium-adequate diet or a selenium-depleted diet for 5 weeks, before a third-degree thermal injury was applied to the animals. One group of selenium-depleted animals received injections of sodium selenite after the injury. The selenium status and the oxidative stress parameters were measured for 5 days. RESULTS: The selenium-deficient diet leads to oxidative stress with a high stimulation of the superoxide dismutase activity. After the burn injury, the oxidative stress appears important because the initial selenium status is already impaired and, in all animals, the selenium levels and the antioxidant seleno-dependent glutathione peroxidase (GPx) activity decrease in the plasma and the tissues. A treatment with daily selenium injections is efficient in normalizing selenium levels and restores the GPx activity, but fails to counteract the initial oxidative damages induced by the selenium-deficient diet. CONCLUSIONS: The selenium status before the burn injury is a modulating factor of the burn-induced oxidative stress. A single selenium supplement is not sufficient to counteract these oxidative damages and henceforth combined antioxidant supplementations should be investigated to improve the early treatment of the burn patients.

Physical activity alters antioxidant status in exercising elderly subjects.

Nutritional adequacy and physical activity are two aspects of a health-promoting lifestyle. Not much is known about antioxidant nutrient requirements for exercising elderly (EE) subjects. The question of whether exercise training alters the status of antioxidant vitamins as well as trace elements in elderly subjects and fails to balance the age-related increase in oxidative stress is addressed in this study. There were 18 EE (68.1+/-3.1 years), 7 sedentary elderly (SE; 70.4+/-5.0 years), 17 exercising young (EY; 31.2+/-7.1 years) and 8 sedentary young (SY; 27.1+/-5.8 years) subjects who completed 7-day food and activity records. Each subject's blood was sampled on Day 8. A similar selenium (Se) status but a higher erythrocyte glutathione peroxidase (GSH-Px) activity were found in EE subjects as compared with EY and SE subjects. Blood oxidized glutathione was higher and plasma total thiol was lower in EE subjects as compared with EY subjects. Mean vitamin C (167 vs. 106 mg/day), vitamin E (11.7 vs. 8.3 mg/day) and beta-carotene (4 vs. 2.4 mg/day) intakes were higher in EE subjects as compared with EY subjects. However, EE subjects exhibited the lowest plasma carotenoid concentrations, especially in beta-carotene, which was not related to intakes. Despite high intakes of antioxidant micronutrients, no adaptive mechanism able to counteract the increased oxidative stress in aging was found in EE subjects. Results on GSH-Px activity illustrate that the nature of the regulation of this biomarker of Se status is different in response to training and aging. These data also strongly suggest specific antioxidant requirements for athletes with advancing age, with a special attention to carotenoids.

Optimization of selenium status by a single intraperitoneal injection of Se in Se-deficient rat: possible application to burned patient treatment.

In order to investigate the efficiency of a single selenium (Se) administration in restoring selenium status, Se and antioxidant enzymes were studied in an animal model of Se depletion. In Se-depleted animals receiving or not a single parenteral administration of Se, plasma, red blood cell (RBC), and tissue Se levels were measured concurrently with glutathione peroxidase (GPx) and superoxide dismutase (SOD) activities. The oxidative stress was assessed by thiobarbituric acid-reactive species (TBARs), total thiol groups, glutathione, and tocopherol measurements. Our study showed that Se depletion with alterations in the antioxidant defense system (Se and GPx activity decreases) led to an increase of lipid peroxidation, a decrease of the plasma vitamin E level, and SOD activation. Sodium selenite injection resulted after 24 h in an optimal plasma Se level and a reactivation of GPx activity. In liver, brain, and kidney, Se levels in injected animals were higher than those in reference animals. However, this single administration of Se failed to decrease free radical damage induced by Se depletion. Therefore, in burned patients who exhibit an altered Se status despite a daily usually restricted Se supplementation, the early administration of a consistent Se amount to improve the GPx activity should be of great interest in preventing the impairment of the antioxidant status.

Antioxidant status and risk of cancer in the SU.VI.MAX study: is the effect of supplementation dependent on baseline levels?

The SUpplementation en VItamines et Mineraux AntioXydants (SU.VI.MAX) study, a randomised double-blind, primary-prevention trial showed that after 7.5 years, low-dose antioxidant supplementation lowered the total cancer incidence in men, but not in women. To explain this difference in the impact of antioxidant supplementation in men and women, we hypothesised that the effect of supplementation is dependent on initial antioxidant status; 12 741 French adults (7713 females aged 35--60 years; 5028 males aged 45--60 years) received daily antioxidant supplementation (120 mg vitamin C, 30 mg vitamin E, 6 mg beta-carotene, 100 microg Se, 20 mg Zn daily) or a matching placebo. Cut-off limits for baseline serum concentrations of the different antioxidant vitamins and minerals were defined as follows for both men and women: 0.3 micromol/l for beta-carotene, 11.4 micromol/l for vitamin C, 15 micromol/l for vitamin E, 0.75 micromol/l for Se and 10.7 micromol/l for Zn. The percentage of men with serum concentrations under cut-off limits was higher for vitamins C and E and beta-carotene in those who developed a cancer than in those who did not. The risk of cancer was higher in men with baseline concentrations of serum vitamin C or vitamin E under cut-off limits, but not in women. The effect of supplementation was greater in men with baseline serum concentrations of vitamin C, vitamin E and beta-carotene below the cut-off limits compared with those above it. This effect was maintained only for vitamin E after adjustment for age, tobacco, and alcohol consumption and BMI. No effect of supplementation could be seen in women. Baseline antioxidant status is related to the risk of cancer in men but not in women and therefore does not entirely explain the differences observed in the effect of antioxidant supplementation on cancer risk between sexes in the SU.VI.MAX study.

Leukocyte 8-oxo-7,8-dihydro-2'-deoxyguanosine and comet assay in epirubicin-treated patients.

Epirubicin fights cancer through topoisomerase II inhibition, hence producing DNA strand breaks that finally lead to cell apoptosis. But anthracyclines produce free radicals that may explain their adverse effects. Dexrazoxane--an iron chelator--was proven to decrease free radical production and anthracycline cardiotoxicity. In this article, we report the concentrations of cellular 8-oxo-7,8-dihydro-2'-deoxyguanosine (8-oxo-dGuo) relative to 2'-deoxyguanosine (dGuo), and comet assay results from a study including 20 cancer patients treated with epirubicin. Plasma concentrations of vitamins A, E, C and carotenoids are also reported. All data were obtained before and immediately after epirubicin infusion. The ratios of 8-Oxo-dGuo to dGuo were measured in leukocyte DNA by HPLC-coulometry after NaI extraction of nucleic acids. Vitamins A and E and carotenoids were measured by HPLC-spectrophotometry. Vitamin C was measured by HPLC-spectrofluorimetry. Median 8-oxo-dGuo/dGuo ratios increased significantly from 0.34 to 0.48 lesions per 100,000 bases while per cent of tail DNA increased from 3.47 to 3.94 after chemotherapy 8-Oxo-dGuo/dGuo and per cent of tail DNA medians remained in the normal range. Only vitamin C decreased significantly from 55.4 to 50.3 microM Decreases in vitamins A, E, lutein and zeaxanthin were not significant, but concentrations were below the lower limit of the normal range both before and after chemotherapy. Only the correlation between comet assay results and vitamin C concentrations was significant (rho =-0.517, p = 0.023). This study shows that cellular DNA is damaged by epirubicin-generated free radicals which produce the mutagenic modified base 8-oxo-dGuo and are responsible for strand breaks. However, strand breaks are created not only by free radicals but also by topoisomerase II inhibition. In a previous study we did not find any significant change in urinary 8-oxo-dGuo excretion after adriamycin treatment. However, 8-oxo-dGuo may have increased at the end of urine collection as DNA repair and subsequent kidney elimination are relatively slow processes. In another study, authors used GC-MS to detect 8-oxo-dGuo in DNA and did not find any change after prolonged adriamycin infusion. Reasons for these apparent discrepancies are discussed.

Antioxidant vitamin status in high exposure to oxidative stress in competitive athletes.

We conducted a cross-sectional study in 118 well-trained athletes to investigate 'high exposure' to sub-deficient antioxidant status, and consequently to oxidative damage, in relation to estimated daily energy expenditure (EE) and dietary antioxidant intake. Subjects completed 7 d food and activity records. Blood samples were obtained on day 8. Of the athletes 81, 60 and 43% had intakes of vitamins E, C and beta-carotene below two-thirds of the French RDA respectively, which is adjusted for EE (FRDAa). The deficit in vitamin E intake was positively correlated with EE (r 0.51, P<0.0001). All the athletes had normal plasma vitamins E and C and 14% had marginal plasma beta-carotene. Plasma thiobarbituric acid-reactive substances (TBARS) did not increase with increased EE. As evidenced by ANOVA, EE-induced vitamin C intakes increased and consequently led to increased plasma ascorbic acid concentrations. In male athletes, plasma total carotenoids were negatively correlated with plasma TBARS concentrations (r -0.31, P<0.006). The relationship between vitamin C intakes and plasma concentrations was logarithmic (r 0.59, P< 0.0001). To summarize, it is not clear whether vitamin E requirements are overestimated with reference to EE in the FRDAa. Daily requirements for vitamin C do not exceed 200 mg. Our present results could be interpreted as meaning that carotenoids play a protective role as exogenous antioxidants. Carotenoid intakes in athletes must be considered carefully.

Moisture content of Hemoccult slides influences test sensitivity.

BACKGROUND: Mass screening programmes in Europe and in the USA have shown that a 15-18% decrease in mortality rate from colo-rectal cancer can be achieved with biannual testing. In a 10 year screening programme in the Isère region (France), we have noticed that the positivity percentage of Hemoccult II changes significantly with seasons: it varies from 1.61% in summer to 2.80% in winter, while intermediate values occur in spring (1.69%) and autumn (2.50%). During transport in the mail, Hemoccult slides are stored in unheated rooms, without air-conditioning, and are thus being exposed to outdoor conditions of temperature and humidity. In this paper, we show that the moisture content of Hemoccult slides influences test sensitivity. METHODS: In an in-vitro experiment, we smeared slides from the same batch all with the same blood-spiked stool sample. Positivity rate varies from 58%, when slides contain 0.46% moisture, to 84% when they contain 10.90% moisture (P = 0.0066). Positivity rates are not different in rehydrated and in saturated Hemoccult slides. RESULTS: Data collected from the Grenoble meteorological centre were compared to positivity percentages. Regression studies show that moisture deficit in the air is strongly correlated (r = 0.794, P < 0.01) to positivity percentage and explains most of its seasonal variations. CONCLUSIONS: These results would suggest that Hemoccult slides should be allowed to equilibrate for 24 h at the same level of moisture in all seasons at least in regions where large temperature variations are observed between winter and summer, and between day and night. Indeed, positivity percentages are probably too high in winter, and too low in summer.

Physical fitness and plasma non-enzymatic antioxidant status at rest and after a wingate test.

We tested seven physical education students whether 30-s sprint anaerobic exercise (Wingate test) would result in oxidative stress (evaluated by lipid radical levels) sufficient to alter plasma non-enzymatic antioxidant status (plasma uric acid, ascorbic acid, alpha-tocopherol, beta-carotene). This study demonstrates that 1) Wingate test increases plasma uric and ascorbic acid concentrations (p <.05), and decreases plasma alpha-tocopherol and beta-carotene levels (p <.05); 2) lipid radical levels at rest and sprint performance are negatively correlated with resting plasma uric acid and alpha-tocopherol concentrations (p <.05). In conclusion, this study 1) demonstrates that a 30-s sprint anaerobic exercise is associated with acute changes in plasma non-enzymatic antioxidant status, 2) indicates that the subjects with largest leg peak power are those who exhibit the lowest plasma antioxidant status at rest (uric acid and alpha-tocopherol), 3) and suggests that antioxidant intake by maintaining plasma antioxidant concentration at rest in the normal range might protect athletes against oxidative stress induced by exercise.

No antioxidant effect of combined HRT on LDL oxidizability and oxidative stress biomarkers in treated post-menopausal women.

OBJECTIVE: To compare oxidative stress and LDL oxidizability in postmenopausal women with and without HRT. METHODS: In a cross sectional study, two groups of women, with or without combined per os HRT (1.5-2 mg estrogen associated with 10 mg dydrogesteron), were age and duration of menopause matched. Women were recruited after medical examination at LBSO (Oxidative Stress Laboratory), Joseph Fourier University, Grenoble, and Department of Gynecology, Grenoble University Hospital, France. Main outcome measures included determination of lipid profile and oxidative stress biomarkers (TBARS, LDL oxidizability, autoantibodies against oxidized-LDL). Measurement of circulating levels of vitamin C, E, beta-carotene, lycopene and total antioxidant plasma capacity. RESULTS: HRT led to decreased plasma total and LDL cholesterol (p < 0.05), but did not affect oxidizability and oxidation of LDL. Circulating levels of antioxidant vitamins (beta-carotene, vitamin C, vitamin E/triglycerides) and total antioxidant capacity of plasma and lipid peroxidation, assessed by plasma TBARs, were not different from controls in postmenopausal women receiving HRT. CONCLUSION: This study suggests that even if combined HRT modifies the blood lipid profile, it does not appear to influence oxidative status.