Delayed increase of plasma selenoproteins and absence of side effect induced by infusion of pharmacological dose of sodium selenite in septic shock: Secondary analysis of a multicenter, randomized controlled trial.

BACKGROUND: In sepsis, neutrophil respiratory bursts participate in endothelium damage, the first step to multiple organ failure. In plasma two antioxidant selenoenzymes, which protect the endothelium, decrease: selenoprotein-P, and to a lesser extent glutathione peroxidase (GPX3). Sodium selenite (Na2SeO3) is a Se donor, but also an oxidant chemotherapy drug depending on its concentration. In a previous published study, Na2SeO3 continuous infusion in septic shock patients at a pharmacological dose of 4 mg1 Se/day on day-1, followed by a high nutritional dose of 1 mg Se/day during 9 days, showed no beneficial effect on weaning of catecholamine nor on survival. In this ancillary study, we report clinical and biological effects of such continuous infusion of Na2SeO3. METHODS: This was a multicenter, placebo-controlled, double-blind study on 60 patients. Na2SeO3 or placebo in continuous infusion as described above. Evolution with time of plasma Se, selenoprotein-P, GPX3, Organ dysfunction (sequential organ failure assessment SOFA scores, including PaO2/FiO2, for respiratory failure, and plasma lactate) and quality of life at 6 months (by SF36 scores) were analyzed using two-way (time, treatment) non-parametric repeated-measures analysis of variance (Friedman test). MAIN RESULTS: At baseline, plasma Se was about a quarter of reference values. From baseline to day-4 plasma Se, selenoprotein-P and GPX3 significantly increased by 3.9, 2.7 and 1.8 respectively in the Na2SeO3 group as compared with placebo and remained elevated by 2.3, 2.7 and 2.1 at day-14 respectively (p < 0.001). Na2SeO3 did not affect global and organ by organ SOFA Scores and plasma lactate concentration at day-1 and later up to day-14. The evolution of PaO2/FiO2 until day-14 was similar in the two groups. Quality of life in the surviving patients at 6 months was similar between the two groups. CONCLUSION: Continuous infusion of Na2SeO3 at 4 mg Se at day-1 seems to have neither beneficial nor toxic effect at day-1 or later and induces a late increase of selenoprotein-P at day-4. Preclinical studies are required to confirm the use of Na2SeO3 as a cytotoxic drug against neutrophils and protection of the endothelium by selenoprotein-P.

Preanalytical step of urinary protein measurement: from urine sampling to preparation for analysis of the specimen.

The preanalytical phase is a key step in urinary protein measurement. It is a complex step, which includes urine sampling, storage and transport to the laboratory and preparation for analysis of the specimen. It can lead to numerous errors, since urine sampling is made by the patient himself. According to different cases, the procedures for urine sampling are presented in appendix 1 to 4. The aim of the presented guidelines is to improve the preanalytical step. In addition to the sampling made by a well-informed patient, the laboratory has to optimize transport and sample preservation, according to the analytes. The 24-hour urine collection is divided into aliquots with commercially available systems. Urinary proteins are measured on samples stored without preservatives. When 24-hour urine collection is not possible, a mid-stream urine sample is the most appropriate sample for protein measurement.

[Necessity to define thyroid reference values for better clinical interpretation]. / De la nécessité de bien définir les valeurs de référence des hormones thyroïdiennes pour une meilleure interprétation clinique.

Discordances were observed with thyroid reference range from BCF Access 2 analyser. The purpose of this study was to establish specific reference range value for free thyroxine (FT4), free triiodothyronine (FT3) and thyrotropin (TSH) in adult Meaux Hospital population. Samples from 308 adults aged from 18 to 65 years were studied. Patients (no pregnancy and no iodine contrast media used) after informed consent, were exempted of thyroidal, cardiac, renal, multiple-organ-failure illnesses. Thyroid assays, anti-TPO and anti-TG levels were measured on the BCF Access2 immunoassay system. This work exposes difficulties to define range values in order to better use the biomarker in the clinical context.