Socioeconomic inequalities in weight, height and body mass index from birth to 5 years.

BACKGROUND/OBJECTIVES: Studies in high-income countries show that despite the positive association of weight with socioeconomic position at birth, an inverse socioeconomic gradient in overweight (OW) appears later in childhood. The objectives were to understand the natural history of socioeconomic inequalities in weight, height and body mass index (BMI), by investigating their associations with maternal educational level between birth and 5 years, separately in boys and girls. SUBJECTS/METHODS: A published work of growth modelling between birth and 5 years allowed us to calculate predicted weight, height and BMI at 1 month, 6 months, 1, 3 and 5 years for 1735 children from the French EDEN mother-child cohort. Associations between maternal education and predicted measures of body size were analysed with marginal linear and logistic models, stratified by sex. RESULTS: In girls, despite a positive association between maternal education and birthweight, an inverse socioeconomic gradient was observed as early as 1 month for BMI. Girls whose mothers had low education levels were shorter on the whole than their counterparts with better-educated mothers, despite their similar weights. In boys, no socioeconomic gradient in BMI was observed at any age, including birth, but positive associations were found as early as 1 month for both weight and height. CONCLUSIONS: The emergence of an inverse socioeconomic gradient in BMI and OW apparently results from a complex pattern of socioeconomic inequalities in weight and height from 1 month onwards. The very start of life thus appears to be an important window of opportunity for addressing socioeconomic inequalities in growth.

Intrapartum group B Streptococcus screening in the labor ward by Xpert® GBS real-time PCR.

Group B Streptococcus (GBS) is the leading cause of neonatal infections in industrialized countries. Intrapartum antibiotic prophylaxis (IAP) given to colonized parturients is a key step for the prevention of neonatal early-onset infection. We compared the performances of Xpert® GBS polymerase chain reaction (PCR) (Cepheid, Sunnyvale, CA, USA) as a point-of-care system in labor wards to standard culture for intrapartum GBS detection. Pregnant women with a GBS-positive antenatal screening were prospectively included. A vaginal double swab was collected at the time of delivery for point-of-care Xpert® GBS PCR and GBS culture. A total of 565 pregnant women were included. Valid Xpert® GBS results were obtained for 488 (86.4%) women on the first attempt. Repeat testing improved the PCR success to 516 (91.3%) women. Among the 305 women positive for GBS by culture at delivery, only 238 (78.0%) were positive by Xpert® GBS PCR, cycle thresholds being correlated to culture quantification. Among 260 women negative for GBS culture, 56 (21.5%) were positive by Xpert® GBS PCR, including 50 where IAP was initiated before vaginal sampling. Overall, among the 565 women with GBS antenatal positive culture, only 335 (59.3%) were still positive at delivery whatever the technique used, resulting in unnecessary IAP for 40% of them. This large cohort study comparing intrapartum to antepartum GBS detection provides evidence that (i) Xpert® GBS PCR might be a valuable solution for intrapartum GBS detection compared to culture-based strategies and (ii) laboratory training of non-specialized staff is mandatory to reach the performances required for point-of-care tests.

The role of urinary aldosterone for the diagnosis of primary aldosteronism.

When diagnosing primary aldosteronism, the measurement of urinary aldosterone after oral sodium loading is one of the currently recommended confirmatory tests. The aim of the study was to assess the repeatability and interpretation of urinary aldosterone in patients examined for suspected primary aldosteronism. Sixty-four hypertensive patients with suspected primary aldosteronism were prospectively enrolled and examined according to the study protocol. After antihypertensive medications interfering with renin-angiotensin-aldosterone system were withdrawn for at least 2 weeks, the confirmatory testing was performed: oral sodium loading preceded the collection of 24-h urine sample and subsequent saline infusion test. The identical procedures were repeated after 2 weeks. The concordant results of both saline infusion tests served for confirmation/exclusion of primary aldosteronism. Forty-nine patients were included in data analysis. Primary aldosteronism was excluded in 16, and confirmed in 33 individuals. The repeatability of urinary aldosterone was evaluated in 44 patients: the difference of urinary aldosterone levels ranged between 1 and 88% (median 31%). Ninety-three urine samples from 49 patients were used to validate the interpretation of urinary aldosterone in respect to the diagnosis of primary aldosteronism made by saline infusion testing; 96% sensitivity was characterized by urinary aldosterone ≥19 nmol/day, and 96% specificity was associated with urinary aldosterone ≥92 nmol/day. In 22 (45%) patients, urinary aldosterone remained in the "gray" zone between 19 and 92 nmol/day in all provided samples. The estimation of urinary aldosterone excretion after oral sodium loading is associated with marked intraindividual variability, and significant number of inconclusive results.

Osteocalcin is not a strong determinant of serum testosterone and sperm count in men from infertile couples.

Osteocalcin (OC) - released by osteoblasts and known as a marker of bone turnover - has been suggested to influence male fertility in murine models by enhancing testosterone production and sperm count. Results from clinical studies are scarce, however. The aim of this cross-sectional study was to investigate the proposed association of OC, undercarboxylated osteocalcin (ucOC) or carboxylated osteocalcin (cOC) with testosterone and sperm count in a cohort of 159 young male adults from infertile couples. Semen analysis was performed. Testosterone, free testosterone, LH, OC and ucOC were measured in serum samples after an overnight fast. cOC and OC correlated weakly but significantly with testosterone (OC: r = 0.165, p = 0.040, cOC: r = 0.193, p = 0.017), but not after adjusting for age and body mass index (BMI) or waist-hip ratio (WHR). %ucOC (ucOC levels expressed as percentage of total OC) correlated inversely with LH (r = -0.184, p = 0.023) and remained significant after the same adjustment. No significant correlations were observed between OC, cOC, ucOC, %ucOC and sperm count, semen volume and number of vital spermatozoa. In binary logistic regression analyses, none of the parameters of OC were predictors of oligozoospermia after adjusting for age and BMI or WHR. The weak association between %ucOC and LH has marginal clinical importance because of the lack of associations of parameters of OC with testosterone and sperm count. The current data thus cannot support the notion that OC is associated with male fertility in young men from infertile couples.

DNA cytometry as a first-line method for diagnosis of cervical precancer with respect to clinical behaviour.

BACKGROUND: The objective of this study was to estimate DNA image cytometry (DNA-ICM) as a first-line diagnostic method for diagnosis of cervical precancer with respect to its clinical behaviour. METHODS: 30 consecutive patients with Papanicolaou smears that yielded diagnoses of LSIL or HSIL and showed single cell or stem line aneuploidy were included in a prospective cohort study. Slides were classified according to the Bethesda system. DNA-ICM was performed according to the consensus reports of the European Society of Analytical Cellular Pathology. RESULTS: 24 (80%) patients with DNA aneuploid cervical epithelial cell abnormalities had cervical intraepithelial neoplasia (CIN) (CIN I: n = 5; CIN II: n = 6; CIN III n = 13). Six (20%) patients showed no evidence of CIN in subsequent biopsies. During follow-up of three years none of the six patients with negative histology developed cervical precancer or cancer. All 24 (100%) lesions confirmed as CIN by histology showed DNA aneuploidy in cytology. CONCLUSIONS: DNA-ICM should be used as an objective first-line diagnostic tool for predicting cervical precancer. Yet, due to immune response, DNA aneuploid cervical cell abnormalities do not seem to be enough to predict the definitive clinical outcome in each patient.

[Is confirmation of an adrenal adenoma in patients with primary aldosteronism sufficient for indication of adrenalectomy?]. / Je prukaz adenomu nadledviny u pacientu s primárním hyperaldosteronizmem dostatecný pro indikati adrenalektomie?

BACKGROUND: Primary aldosteronism is one of the most common forms of secondary arterial hypertension. Adrenalectomy is effective in patients with proven unilateral hypersecretion of aldosterone whereas pharmacotherapy is indicated in bilateral forms of the disease. We can meet the opinion that in patients with confirmed primary aldosteronism and finding ofsuprarenal adenoma > or = 1 cm on computed tomography (CT) scanning, adrenalectomy can be recommended without further investigation. On the other hand we can perform adrenal venous sampling (AVS) to prove unilateral overproduction of aldosterone. OBJECTIVES: To evaluate whether AVS is necessary in all patients with unilateral adenoma > or = 1 cm. METHODS: We analyzed data from patients with proven primary aldosteronism, CT finding of adenoma > or = 1 cm along with normal morphology of contralateral adrenal gland, and successfully performed AVS. RESULTS: Out of 107 patients with proven primary aldosteronism, indicated for AVS, we included 30 patients with CT finding of suprarenal adenoma > or = 1 cm along with normal morphology of contralateral adrenal gland and successful AVS. Unilateral overproduction of aldosterone was found only in 17 cases (56.7%), the results in remaining 13 patients (43.3%) did not confirm activity of adenoma. CONCLUSION: Our results support necessity of performing AVS in all patients with primary aldosteronism in whom surgical treatment is considered, CT confirmation ofan adenoma is insufficient in this indication.

[Clinicopathological confrontation. Was the skin cancer eradicated?]. / Confrontation anatomo-clinique. Le cancer cutané a-t-il été éradiqué?

Distinguishing complete removal of a skin cancer and its partial destruction is frequently requested by the clinicians and their patients. The information is awaited from the laboratory, but it is not always correctly interpreted by the information-seekers. The factors influencing this assessment include the combination of the nature of the antineoplastic therapy, the sampling modality of the area to be examined, and the quality of the dermatopathology procedure. In addition, the possibility of neoplastic regression linked to scarring or, conversely, the existence of a possible field cancerisation should be taken into consideration.