[Crozet protocol: does a lipid-rich meal interfere with cryoglobulinemia assay?]. / Protocole Crozet : le dosage des cryoglobulinémies est-il perturbé par un repas riche en lipides ?

Cryoglobulins are serum immunoglobulins that precipitate reversibly at low temperature. It is important to determine their presence, because they can be responsible for severe complications. They can also reveal underlying conditions, in particular hepatitis C and haematological diseases. Laboratory investigations of cryoglobulins are problematic and require adherence to strict preanalytical conditions. We decided to determine wether a patient really needs to be in a fasting state when a blood sample is taken. In practice, this requirement is difficult for us to meet, because of our large patient population (consultations in a teaching Hospital). We therefore devised a protocol, called the Crozet protocol based on the assay of cryoglobulinemia in healthy volunteers, before and after a meal rich in lipids. Ten patients were tested. Cryoglobulinemia assays were performed according to the technique of Hartree. Lipid profiles were measured on Modular P (Roche Diagnostics). Cryoglobulinemia assay does not seem to be unduly affected by a meal rich in lipids, in particular in triglycerides. Hence the patient does not necessarily have to be on an empty stomach at blood sampling. This study allowed us to modify our threshold of significance (from 15 to 30 microg/mL), which confirmed our view of the physiological character of a low cryoglobulinemia level. Studies involving a greater number of healthy subjects are needed to accurately establish a new threshold and to confirm our findings.

Food restriction, performance, biochemical, psychological, and endocrine changes in judo athletes.

In order to test the hypothesis that dietary restriction may have a negative influence on physiological and psychological adaptation to a judo competition, we examined the effects of weight loss induced by restricting energy and fluid intake on the physiology, psychology, and physical performance of judo athletes. Twenty male judoka were randomly assigned to one of two groups (Group A: called diet, n = 10; height 174.8 +/- 1.9 cm, body weight 75.9 +/- 3.1 kg; they were asked to lose approximately 5 % of their body weight through self-determined means during the week before the competition; Group B: called control, n = 10; height 176.4 +/- 1.1 cm, body weight 73.3 +/- 6.3 kg maintained their body weight during the week before the competition). A battery of tests was performed during a baseline period (T1), on the morning of a simulated competition (T2) and 10 min after the end of the competition (T3). The test battery included assessment for body composition, performance tests, evaluation of mood, determination of metabolic and hormonal responses. Dietary data were collected using a 7-day diet record. The nutrient analysis indicated that all the athletes followed a low carbohydrate diet whatever the period of the investigation. For the Group A, the food restriction (- 4 MJ per day) resulted in significant decreases of the body weight and altered the mood by increasing Fatigue, Tension and decreasing Vigour. Dietary restriction had also a significant influence on metabolic and endocrine parameters and was associated with poor performance. After the competition, significant decreases of the levels in testosterone, T/C ratio, alkali reserve, and free fatty acid were observed in both groups, whereas the plasma concentrations in insulin, ammonia, urea, and uric acid were increased. In conclusion, our results suggest that the combination of energy restriction and intense exercise training, which causes weight reduction before a competition, adversely affects the physiology and psychology of judo athletes and impairs physical performance before the competition. Our data are the first to demonstrate that a competition including five 5-min bouts induced the same changes of physiological and psychological variables and performance whatever the dietary intake (dietary restriction or not) during the seven days before the competition.

Effects of 16 weeks of training prior to a major competition on hormonal and biochemical parameters in young elite gymnasts.

The aim of this study was to investigate the response to 16 weeks of training on selected hormonal and biological parameters in seven international competition level female artistic gymnasts (14.5 +/- 1.2 years). Data were collected at the beginning of the first training week (W1) and in the 16th week (W16). Assessments also included anthropometric measurements, dietary intake for 7 days and Tanner staging. No gymnast had reached menarche and the puberty stages corresponded to Tanner's pubertal stage 2. The gymnasts were smaller than average for their age group, with a height:weight ratio above the 50th percentile. Energy intake was about 31% lower than recommendations. Significant decreases in IGF-I, IGFBP3, IGF-I:C ratio and triglyceride values and increases in uric acid and creatinine levels were noted. Cortisol values were high regardless of the period. This training provided evidence for alterations in resting somatotropic and adrenocorticotropic parameters.

Energy demands during a judo match and recovery.

OBJECTIVE: To assess energy demand during a judo match and the kinetics of recovery by measuring the metabolites of the oxypurine cascade, lipolytic activity, and glycolytic pathway. METHODS: Venous blood samples were taken from 16 national judoists (mean (SEM) age 18.4 (1.6) years), before (T(1)) and three minutes (T(2)), one hour (T(3)), and 24 hours (T(4)) after a match. A seven day diet record was used to evaluate nutrient intake. RESULTS: Nutrient analysis indicated that these athletes followed a low carbohydrate diet. Plasma lactate concentration had increased to 12.3 (1.8) mmol/l at the end of the match. An increase in the levels of extracellular markers of muscle adenine nucleotide catabolism, urea, and creatinine was observed at T(2), while uric acid levels remained unchanged. High concentrations of urea persisted for 24 hours during the recovery period. Ammonia, hypoxanthine, xanthine, and creatinine returned to control levels within the 24 hour recovery period. Uric acid concentrations rose from T(3) and had not returned to baseline 24 hours after the match. The levels of triglycerides, glycerol, and free fatty acids had increased significantly (p<0.05) after the match (T(2)) but returned to baseline values within 24 hours. Concentrations of high density lipoprotein cholesterol and total cholesterol were significantly increased after the match. CONCLUSIONS: These results show that a judo match induces both protein and lipid metabolism. Carbohydrate availability, training adaptation, and metabolic stress may explain the requirement for these types of metabolism.

Effect of endurance training and/or fish oil supplemented diet on cytoplasmic fatty acid binding protein in rat skeletal muscles and heart.

Endurance training and/or a fish oil supplemented diet affect cytoplasmic fatty acid binding protein (FABP(c)) content in rat skeletal muscles and heart. After 8 weeks of swimming, trained rats exhibited higher FABP(c) content in the extensor digitorum longus (EDL) and in the gastrocnemius than did control rats (30%). The FABP(c) increase was associated with an increase of citrate synthase activity (85% and 93%, respectively, in the two muscles), whereas lactate dehydrogenase activity decreased significantly. In contrast, in the soleus and in the heart we did not observe any effect of exercise either on FABP(c) or on the metabolic profile. Therefore, increasing oxidative capacities of muscle by exercise resulted in a concomitant increase of the FABP(c) content. Giving a polyunsaturated fatty acid (omega-3) supplemented diet for eight weeks induced a large rise of the FABP(c) in EDL (300%), gastrocnemius (250%), soleus (50%) and heart (15%) without a concurrent accumulation of intramuscular triglycerides or modification of the citrate synthase activity, suggesting that polyunsaturated fatty acids may increase FABP(c) content by up-regulating fatty acid metabolism genes via peroxisome proliferator-activated receptor alpha activation. Endurance trained rats fed with an omega-3 diet had similar FABP(c) content in the gastrocnemius muscle when compared to sedentary omega-3 fed rats, whereas an additive effect of exercise and diet was observed in the EDL. The FABP(c) in the soleus and in the heart of rats fed with omega-3 supplements remained constant whether rats performed exercise or not. As a result, both exercise and omega-3-enriched diet influenced FABP(c) content in muscle. These two physiological treatments presumably acted on FABP(c) content by increasing fatty acid flux within the cell.

Food restriction, performance, psychological state and lipid values in judo athletes.

Dietary intake, plasma lipids, lipoprotein and apolipoprotein levels, anthropometric measurements and anaerobic performance were studied in eleven judo athletes during a period of weight maintenance (T1) and after a 7d food restriction (T2). Dietary data were collected using a 7-day diet record. Nutrient analysis indicated that these athletes followed a low carbohydrate diet whatever the period of the investigation. Moreover, mean micronutrient intakes were below the French recommendations. Food restriction resulted in significant decreases in body weight. In addition, it had significant influence on triglyceride and free fatty acid, although glycerol, total cholesterol, LDL-C, HDL-C, apolipoprotein A-1 and B did not alter. Left arm strength and 30 s jumping test decreased significantly. The 7 s jumping test was not affected by the food restriction. Regardless of psychological parameters, tension, anger, fatigue and confusion were significantly elevated from T1 to T2; vigor was significantly lower. The data indicated that a 7-day food restriction adversely affects the physiology and psychology of judo athletes and impairs physical performance, possibly due to inadequate carbohydrate and micronutrients.

[Influence of alleles of apolipoprotein E on restenosis after coronary angioplasty in women]. / Influence des allèles de l'apolipoprotéine E sur la resténose après angioplastie coronaire chez la femme.

Although coronary stenting reduces the incidence of post-angioplasty restenosis, it remains a problem. The influence of lipoproteins on the development of atherosclerosis has been demonstrated but their role in restenosis is controversial. Contradictory results have been published on the subject of the influence of the APO E genotype. In an initial study, the authors showed a closer correlation between Lp (a) and coronary artery disease in women than in men. A sub-group of women who underwent angioplasty and whose lipid profile had been well established, was analysed with respect to APO E alleles. The 59 patients who underwent angioplasty included 35 single, 20 twin and 4 triple vessel diseases. Control coronary angiography was performed in 40 of these women. A telephonic interview was carried out between 12 and 22 months after dilatation on the whole population. The apolipoproteins A1, B, Lp (a) and Lp A1 were measured by immunological, turbidimetric or electroimmunological techniques. The APO E genotyping was performed with the Inno-Lipa kit. The results showed 18 angiographic restenoses (Group A), 20 coronary artery disease without restenosis (Group B), 41 without angiographic (20) or clinical (21) restenosis (Group C). In Group A, the Lp (a) was well above the threshold value of 0.30 g/l. The e4 allele was associated with the highest values of total and LDL cholesterol fractions. There was no significant difference between the APO E genotype of the different groups or with respect to the severity of lesions. The authors conclude that if the e4 is more commonly associated with high LDL-cholesterol and Lp (a), its role in the process of restenosis remains unproven. A greater number of patients is required and further studies are desirable to determine the inflammatory and/or immunological mechanisms through which APO E could influence restenosis.

Cholesterol, phospholipids and markers of the function of the accessory sex glands in the semen of men with hypercholesterolaemia.

The effect of hypercholesterolaemia on the cholesterol and phospholipid content of spermatozoa and seminal plasma was studied. Testosterone and specific markers of the accessory sex glands were also measured. Semen samples from 11 hypercholesterolaemic patients (plasma cholesterol > 6.42 mmol/l, plasma triglycerides < 2 mmol/l) were compared with those of 11 normocholesterolaemic controls (plasma cholesterol < 5.14 mmol/l, plasma triglycerides < 2 mmol/l). Cholesterol, phospholipids and the molar ratio of cholesterol: phospholipids were not significantly different between the two groups of patients either in spermatozoa or in seminal plasma. In hypercholesterolaemic patients the total amount of carnitine in the ejaculate was significantly higher, but there were no significant differences in the levels of acid phosphatase or fructose. There were no significant differences in seminal plasma levels of testosterone in the two groups of subjects. These results suggest that hypercholesterolaemia has no effect on cholesterol and phospholipid levels in spermatozoa and does not cause gross modification of the secretory function of the accessory sex glands.

[Multiple complications of monoclonal IgM]. / Multiples complications d'une IgM monoclonale.

A 64 year old woman with monoclonal IgM Kappa cryoglobulinemia had developed neurologic, vascular and bone involvements. If each features were previously reported, their association appears to be rare. The polyneuropathy was consistent with an IgM anti MAG neuropathy rather than a cryoglobulinemic neuropathy. The vascular occlusion is well known in dysglobulinemia. The diffuse osteosclerosis without medullary fibrosis or myeloproliferative disorder was as like as a Schnitzler's syndrome (chronic urticaria, osteosclerosis, monoclonal IgM Kappa gammopathy.

Treatment of homozygous familial hypercholesterolemia by plasma exchange and LDL-apheresis.

Two girls with familial hypercholesterolemia were treated for 7 years by plasma exchanges (PE) or LDL-apheresis (LA). We compared different methods of treatment; PE with or without reuse of the plasma separator, LA of varying frequency, and LA with or without oral administration of simvastatin. We assessed the long-term results by measuring the blood levels of the biochemical parameters before sessions, and determined the effectiveness of each session by the percentage of decrease in the blood levels between the beginning and the end of the sessions. LA led to a more selective treatment (lowering of LDL cholesterol and maintenance of HDL cholesterol), but the blood levels of total cholesterol before sessions were the same as those obtained by PE. IgG and haemoglobin levels decreased little with LA. The rhythm of one session a week gave better results in LA. Although reuse of the plasma separator represents a financial saving it produced poorer results. The oral administration of simvastatin improved the results of LA.

[Detection and analysis of cryoglobulins: comparative study of a population of patients and one of healthy controls]. / Détection et analyse des cryoglobulines: étude comparative d'une population de malades et d'une population de témoins sains.

During an 11-month period, 270 cryoglobulins were identified in 735 sera from patients versus 34 in 82 sera from apparently healthy blood donors. Western-blot analysis of the cryoglobulins was performed and cryoglobulin protein content was determined using a colorimetric assay. Comparison of findings in the two groups suggested that a substantial proportion of cryoglobulins identified in the sera of patients are quantitatively and qualitatively indistinguishable from cryoglobulins identified in healthy controls.

Complement activation during low-density lipoprotein apheresis.

Complement system activation was investigated in two girls with familial homozygous hypercholesterolemia undergoing two monthly sessions on LA15 or LA40 (Kaneka liposorber). We determined blood levels of C3c and C3a, leukocyte counts, and plasma levels of C3c and C3a in the extracorporeal circulation device at the start of the sessions and 15 and either 60 or 120 min into them. Sequential eluates were collected from LA40 at the end of the sessions (0.5M NaCl, 1M hydroxylamine). Anaphylatoxin C3a increased throughout, especially with LA40. As previously reported, C3a was trapped in the dextran column but was noticeably present in efferent plasma. Besides many proteins, nonnative complement fragments bearing C3a and C3d antigens were detected in almost all the eluates, suggesting possible in situ complement activation. Practically, complement activation induced by the first filter is a risk; long-term side effects may arise from this extracorporeal circulation device.

[Prenatal diagnosis of X-linked adrenal hypoplasia associated with glycerol kinase deficiency]. / Diagnostic prénatal de l'hypoplasie surrénale liée a l'X (HS) associée à un déficit en glycerol kinase (GK).

We report a case of X-linked adrenal hypoplasia associated with glycerol kinase deficiency in a boy. Cytogenetic studies and X-linked probes did not demonstrate deletion at Xp21. These probes are not informative enough to be used in prenatal diagnosis. This diagnosis was achieved by glycerol concentration assay in amniotic fluid and by maternal plasma estriol assay.

Enzymatic and hormonal responses following a 24 h endurance run and a 10 h triathlon race.

Muscle cell leakage and hormonal changes were compared immediately after and during the 3 days following a 24 h endurance run (R24h) in 8 subjects, and a 10 h triathlon non-competitive race (T10h) in 6 subjects. The study showed three main differences: 1) plasma enzyme increases were considerably more significant in R24h than in T10h: compared with resting levels, creatine kinase increased x 120 after R24h but only x 2 after T10h; lactic dehydrogenase x 4, as opposed to x 1.5; and transaminases only showed an increase after R24h. The plasma myoglobin increase after R24h was double that found after T10h; 2) for the same magnitude of plasma aldosterone and cortisol after R24h and T10h (3 times the resting levels), a highly significant decrease in urinary Na+ (p less than 0.001) and an increase in urinary K+ (p less than 0.01) were found only after R24h; and 3) the plasma free noradrenaline level increased significantly after R24h (x 2.6) whereas it was unchanged after T10h. In contrast, the plasma level of conjugated dopamine increased only after T10h (x 3.7, p less than 0.05). These results suggest that long-distance running causes more muscular lesions than the triathlon, and that important factors other than aldosterone are probably involved in the regulation of urinary electrolyte excretions during T10h.

[Tangier disease. A rare thesaurismosis]. / La maladie de Tangier. Une thésaurismose rare.

The authors report the case of a 15-year old boy with Tangier disease characterized clinically by grossly enlarged tonsils, liver and spleen. Blood counts showed signs of hypersplenism, and blood lipid assays disclosed hypercholesterolaemia with moderate hypertriglyceridaemia and very low levels of high density lipoproteins. The diagnosis was confirmed by biopsies of the liver, spleen, rectal mucosa, tonsils and bone marrow, all tissues which contained foamy histiocytic cells staining like adipose cells. Following splenectomy, the child developed an unexplained, persistent (6 months) fever, then died suddenly of digestive haemorrhage. A genetic study showed a high degree of inbreeding, with 2 deaths probably due to Tangier disease. The authors contrast the surprising severity of this case with the apparent benignity of the disease as described in other publications.

[Changes in the activity of antibiotics by fatty acids in bone tissue]. / Modifications de l'activité des antibiotiques par les acides gras dans le tissu osseux.

The C14 to C18 fatty acid content of spongious bone was measured by gas-liquid chromatography. Palmitic acid (C16:0), oleic acid (C18:1) and linoleic acid (C18:2) represented 20 to 40% of the total free fatty acid concentration (30 mM/l). Linoleic acid was found to have the greatest bacteriostatic activity against Staphylococcus aureus, Escherichia coli and Pseudomonas aeruginosa strains. The effect of linoleic acid-gentamicin combination was synergistic against S. aureus. In contrast, both gentamicin and colistin activities were highly antagonized by linoleic and oleic acids against E. coli and P. aeruginosa strains. These different effects of free fatty acids on antibiotic activity could be explained, in part, by a change in permeability of bacterial cells. The clinical implications of these results in bone infections are discussed.

[Recent findings on occupational allergic alveolitis]. / Acquisitions récentes sur les alvéolites allergiques professionnelles.

Occupational allergic alveolitis may be observed in agricultural or industrial environment. The presence of serum precipitins to specific antigens remains a valuable symptom. But other immunologic tests, such as inhibition of leucocyte migration, may be performed in doubtful cases or for retrospective diagnosis. It shows the role of delayed hypersensitivity in the pathogenesis of the disease. The functional investigation confirms the alveolar involvement but also reveals in some cases (by flow/volume curves and compliance tests) evidence of small airways disease. The broncho-alveolar lavages show the high percentage of lymphocytes (mainly T lymphocytes) in in the cell population recovered and a very typical phospholipid profile in the supernatant (total absence of lecithin whereas the two other fractions phosphatidyl-inositol and phosphatidyl-ethanolamine are considerably enhanced). The tensioactive properties of the phospholipids were investigated by fluorescence polarisation technique. High values of microviscosity were found in patients. These findings provide a new diagnostic guidance and a new therapeutic approach of these diseases.

[Phospholipids in bronchoalveolar lavage fluid]. / Les phospholipides du liquide de lavage broncho-alvéolaire.

Progress in recent years in knowledge of respiratory diseases has lead the clinician and laboratory worker to assess at an early stage the disturbances in metabolism of the pulmonary or alveolar tissue. The technique of bronchoalveolar washings (BAW) provides a sample of the alveolar film and opens up the possibility of its biochemical study. The surface tension properties of pulmonary surfactant suggested by Von Neegard then confirmed by Pattle and Clements are due essentially to the presence of phospholipids (lecithins amongst others) and to their association with proteins and other lipids. Analysis of these substances in bronchoalveolar washings and measurement of their fluidifying properties are possible in various forms of pulmonary pathology.