Gold as a modifier of metal nanoparticles: effect on structure and catalysis.

Bimetallic gold based catalysts have been prepared using a sol immobilisation technique. Despite a very similar metal dispersion, different structures are revealed depending on the second metal, with alloyed systems being preferred in the case of Pd, Pt and Cu, and core-shell in the case of Ru. A positive synergistic effect between the metals has been revealed only in the cases of Pd and Cu in the oxidation of benzyl alcohol. AuPd/C has been also studied in the hydrogenation of benzaldehyde where the bimetallic catalyst revealed a different selectivity compared to the monometallic counterpart.

Stage IV breast cancer: a population-based study about prognostic factors according to HER2 and HR status.

We aim to describe trends in net survival (NS) and to assess the prognostic factors among women with de novo metastatic breast cancer (MBC) according to human epidermal growth factor receptor 2 (HER2) and hormone receptor (HR) status. Data on women suffering from de novo MBC and diagnosed from 1998 to 2009 were provided by the Côte-d'Or breast cancer registry. NS was described using the Pohar Perme estimator and prognostic factors were investigated in a generalised linear model. We identified 232 patients (mean age = 64.7). Median NS was 29.2 months, 1- and 5-year NS were 76% and 26% respectively. The survival trend in patients with HER2-positive tumours who did not receive trastuzumab was similar to that in women with triple-negative tumours. A higher relative excess risk of death by cancer was observed for high-grade tumours [RER, relative excess rates = 1.76 (95% CI, confidence intervals: 1.17-2.62) for Scarff Bloom Richardson grade 3 vs. 1 + 2], while a lower risk was observed for luminal tumours [RER = 0.49 (95% CI: 0.27-0.89)] and HER2-positive tumours treated with trastuzumab [RER = 0.28 (95% CI: 0.14-0.59)], both compared with triple-negative tumours. Surgery of the primary tumour was associated with better survival [RER = 0.43 (95% CI: 0.28-0.68)]. With half of the women dead before 29 months, stage IV breast cancer still has a bleak outlook. Progress should continue with new target therapies for both HR and HER2 receptors.

[Hemolytic anemia due to naphthalene poisoning]. / Anémie hémolytique par intoxication à la naphtaline.

INTRODUCTION: Naphthalene ingestion is a rare cause of hemolysis. CASE REPORT: We report a 33-year-old woman, originating from the Comoros, hospitalized for intense fatigue associated with delirium, fever and jaundice, three days after ritual ingestion of naphthalene. Biochemical parameters showed marked hemolysis. Outcome was favorable after red cells transfusion and hydratation with intravenous fluids. CONCLUSION: Diagnostic work-up of unexplained hemolysis should include the search for toxic exposition. Naphthalene poisoning can present with diagnostic challenge for physicians.

[Neoadjuvant chemotherapy FEC-HD in locally advanced breast cancer]. / Chimiothérapie néoadjuvant FEC-HD dans le cancer du sein localement évolué.

The tolerance and the clinical and histological efficacy of a neoadjuvant chemotherapy FEC-HD including hematopoietic growth factors have been studied in 40 patients with stade II or III breast cancer between February 1991 and February 1997. Four courses were given, every 21 days, with 5-fluorouracil (750 mg/m2/day D1 to D4 by continuous infusion), epirubicin (35 mg/m2/day D2 to D4) and cyclophosphamide (400 mg/m2/day D2 to D4) with G-CSF (5 mug/kg/day D6 to D15). The surgery was performed 3 or 4 weeks after the end of the chemotherapy. All patients had radiotherapy. The neoadjuvant chemotherapy induced 37.5% CR, 45% PR, and 15% SD. In 40% of the patients, the surgery was conservative. An histological CR was obtained in 15% with no axillary involvement one time out of two. There was intraductal carcinoma without invasive carcinoma in 7.5%. There was no differences between the response of inflammatory and non inflammatory tumors. One hundred and fifty-eight courses have been delivered. A grade 3 or 4 leuconeutropenia, anemia and thrombopenia have been observed in respectively 34.6%, 6.3% and 8.8% of the courses. A grade 3 or 4 mucositis has been noticed in 2.5% of the courses. A febrile granulocytopenia has occurred in 3.8% of the courses. The median survival without metastatic progression was 48 months and the median overall survival was not achieved. In stade II and III breast cancer, neoadjuvant chemotherapy with FEC-HD obtains an important histological response with an acceptable toxicity. The role of the dose-intensity increase on survival remains to be determined.

[Epidemiologic aspects of polyarterial pathology]. / Aspects épidémiologiques de la pathologie polyartérielle.

UNLABELLED: With the considerable technical progress in vascular investigations made in the last decade, evaluation of multifocal ischemic pathology (MIP) has become easier and allows better assessment of strategy for reperfusion. In vascular surgery, 50% of post-operative mortality and morbidity are related to coronary heart disease (CHD). Epidemiologic data, not biased by specific recruitment of medical and surgical departments, are needed to assessing the real incidence of MIP. Different clinical date have already shown the problem of MIP: the post-operative cardiac mortality rate in vascular surgery has been evaluated at between 0.9% and 3.5% for abdominal aortic aneurysms and 0.3% and 3.2% for peripheral vascular disease (PVD) according to recent statistics (2, 7, 10, 12, 21) (Table I). The total cardiac mortality rate is between 1% and 2% for vascular surgery and is 0.2% for general surgery (8). Thus, though early post-operative over-risk in vascular surgery is not very high, the long term-prognosis is far more impaired: 25% to 55% of patients will die within 10 years after vascular surgery (4, 10, 13, 20). Hertzer, using systematic pre-operative coronary angiograms, found significant coronary stenosis in 57% of patients referred for vascular surgery (11). POPULATION AND METHODS: This study was performed in a representative sample taken from an ongoing prospective survey of 10,446 council employees in Marseille (5,177 men (M.), 5,269 women (W.)). This sample of 1,883 M. and 1,212 W. (mean age: 42.3 +/- 9 for M., 44.9 +/- 11 for W., range 25-65 years) was submitted to a detailed questionnaire on personal and family history of CHD, risk factors and symptoms of CHD (22), and to a physical examination including height, weight and blood pressure measurements. Every subject underwent an ECG recording and a dietetic (5) and psychologic (1) interview, and a blood sample was taken for plasma glucose, total cholesterol and lipoprotein assay. According to epidemiologic data, the prevalence of MIP appears to be lower as compared to clinical data. Undoubtedly, clinical data from surgical departments overestimate the true prevalence of MIP since patients referred for surgical therapy are usually suffering from more advanced pathology. Epidemiology, mainly based on non invasive data probably underestimates the prevalence of MIP but confirms the highest prevalence of CHD as compared to prevalence of other localisations of atherosclerosis and shows CHD as being the earliest localisation of vascular ischemic lesions in most cases. When unifocal ischemic pathology (UIP) and MIP are compared, risk factors are the same, although different proportions of patients are concerned with some of them: in MIP, age is still the major risk factor, whereas smoking in M. and overweight in W. seem to be more frequent than in UIP. RESULTS: Sixty-eight cases (5%) of ischemic pathology were found in men and 47 cases (4%) in women, with 4.1% cases of unifocal ischemic pathology (UIP) in M. and 3.3% in W...

[Prevalence of arterial hypertension and its treatment in 2,595 adults]. / Prévalence de l'hypertension artérielle et de son traitement chez 2,595 adultes.

The prevalence of arterial hypertension, as defined by the W.H.O. (systolic BP greater than 160 mmHg and/or diastolic BP greater than 95 mmHg), and the prevalence of its treatment were studied in 2595 local government employees of Marseilles, aged from 20 to 65 years. The prevalence of hypertension was 17.96 p. 100 (466/2595, including 222 men and 244 women). The prevalence of normal tension was 57.50 p. 100 (1492/2595, including 802 men and 690 women). The prevalence of treated hypertension was 37.98 p. 100 (177/466) divided into 29.27 p. 100 (65/222) in men and 45.90 p. 100 (112/244) in women (p less than 0.0001). Blood pressure was controlled by treatment in 32.30 p. 100 (21/65) of treated men and in 36.61 p. 100 (41/112) of treated women (NS). 81.14 p. 100 (198/244) of hypertensive women and 57/82 p. 100 (399/690) of normotensive women were active (managers, executives). In treated men, the plasma level of apoprotein A1 was decreased and that of apoprotein B was increased. Among men, the global score at Bortner questionnaire was significantly lower in the group of 175 untreated hypertensive patients (176 +/- 46) than in the group of treated hypertensive patients (192 +/- 48, p less than 0.05) and in the group of normotensive subjects (186 +/- 41, p less than 0.05). This indicated that untreated hypertensive men have a tendency to type B pattern and suggested a line of research aimed at a better understanding of the relative failure of anti-hypertensive treatments in the prevention of coronary disease.

[Polyarterial pathology. Epidemiological aspects]. / La pathologie polyartérielle. Aspects épidémiologiques.

Polyarterial arteriosclerosis is a problem facing more and more clinicians because of the technical advances in exploration and revascularization methods. Epidemiologic data are rare in this field except for Framingham's study. We are reporting here the results of a French epidemiologic study regarding a representative sample of a group of 11,000 active men and women, with age ranging between 25 and 65 years. Methodologic difficulties cannot be avoided, but a minimal estimation may be expressed: polyarterial pathology represents approximately 15 p. cent of the pathology in each case. Polyarterial pathology is as prevalent as monoarterial pathology with a 10 years delay between the two sexes. Coronary diseases are the most frequent and represent the initial location in two-thirds of the cases. The same risk factors are found, but their chronology is different: more than ever, age is an essential factor since there is a ten years difference. Hyperglycaemia in men, overweight in women are major factors as important as tobacco abuse in men, arterial hypertension and dyslipidemia in both sexes. Finally the type A behavior seems to occupy an even larger role in polyarterial patients of both sexes.

[Ischemic cardiopathies, environment and personality. Role of type A behavior]. / Cardiopathies ischémiques, environnement et personnalité. Place du comportement de type A.

Type A represents a type of behavior manifested by an almost constant pressure of time, a deep desire of social success and a considerable underlying hostility which is largely repressed. A critical study is presented in light of the results of two prospective epidemiological surveys. The evaluation methods (interview, questionnaires) are described and seem to offer a satisfactory concordance ratio. Type A is as widespread among the french populations studied (42.2%) as among the north-american populations. It is closely related to environmental pressures. Prospective surveys have shown that this type of behavior is strongly correlated with an incidence of ischemic cardiopathies and that its predictive value is independent, and equivalent, to that of major risk factors (tobacco, arterial hypertension, dyslipidemia). This predictive value seems definite, but with more magnitude for myocardial infarction than for angina. Major implications in the prevention and the treatment of ischemic cardiopathies and the direction of research programs may be considered.

[Resistant ventricular tachycardia caused by right ventricular dysplasia. A case of surgical recovery reported 6 years after intervention]. / Tachycardie ventriculaire rebelle par dysplasie ventriculaire droite. Un cas de guérison chirurgicale rapporté à 6 ans de l'intervention.

A 52 year old patient with no previous medical history had an attack of ventricular tachycardia, the configuration of which showed left sided delay. Electrical reduction was followed by multiple recurrences. There were ST-T wave changes over the right precordium on the basal ECG. The hydro-electrolytic equilibrium was normal. Coronary angiography and selective left ventricular cineangiography were also normal. Right angiocardiography showed an aneurysmal deformation of the pulmonary infundibulum. The recurrence of attacks over a two year period led to several hospital admissions, demonstrating the failure of antiarrhytmic therapy. The attacks became so frequent in the last three months that surgery was undertaken. Epicardial mapping showed delayed potentials over the pulmonary infundibulum and surgery consisted in resection of the abnormal infundibular zone. The macro- and microscopic pathological findings were of wall thinning and muscular degeneration with fibrosis and fatty infiltration. The authors discuss the relationship between right ventricular dysplasia and a localised form of Uhl's anomaly. Six years after surgery the patient has had no recurrence of the arrhythmia or shown signs of cardiac failure in the absence of any drug therapy.

[Duration of electric systole in the acute phase of myocardial infarct. Methodology, natural history, semiological value, therapeutic consequences]. / Durée de la systole électrique à la phase aiguë de l'infarctus du myocarde. Méthodologie, histoire naturelle, valeur séméiologique et conséquences thérapeutiques.

Extension of the duration of electric systol in the acute phase of coronary thrombosis can be analysed in satisfying conditions whatever the physiological frequencies by the measurement (formula; see text) represents the average QT measurement of three non-consecutive complexes in five derivations (DI, DIII, aVF, VI and V6). This extension is of prognostic value when the QTc is greater than 44 c/s. Out of 1 255 acute phase thrombosis patients, 18 Out of 20 cases of ventricular fibrillation revealed a QTc greater than 44 c/s in the 24 hours preceding sudden death. Therapeutic intervention with anti-andrenergic drugs such as bretylium tosylate or beta-blocking agents appears to reduce the QTc of these patients and thus prevent sudden death.

Comparative study of electrophysiological and Holter monitoring data in estimating sinoatrial function. Significance of intrinsic heart rate in disclosing autonomic sinus node dysfunction.

To study the diagnostic possibilities and mechanisms involved in sinus node dysfunction (SND), 26 patients with sick sinus syndrome were evaluated by basic electrophysiological tests before and after autonomic blockade, and by Holter monitoring. Based on intrinsic heart rate (IHR), two groups, a normal and a pathologic one, were separated. With Holter recordings, significant differences were manifested in minimal heart rate during sleeping and also in sinus cycles averaged for 24 h between the two groups. In patients with pathological IHR (n = 9) abnormal intrinsic rhythmicity were verified by electrophysiological means, while we found positive ECGs referring to sinoatrial dysfunction during the first 24 h of rhythm recording. The group of normal IHR (n = 17) covers patients with intrinsic SND (intrinsic SA block, 3/17 patients) and patients (14/17) where the electrophysiologic properties of the pacemaker cells were normal: normal intrinsic recovery time, gradual return to the stable intrinsic sinus cycle length in the postpacing secondary cycles, biphasic postextrasystolic patterns with a well-estimated intrinsic sinoatrial conduction time. Repeated Holter recording (total 26 X 24 h) revealed severe bradycardia (2 cases), SA block (4 cases), SA arrest (2 cases), tachybradyarrhythmia (1 case). Electrophysiological studies have a low diagnostic value in autonomic SND; repeated rhythm monitoring is obviously the best complementary method for appreciating the role and significance of autonomic tone in sick sinus syndrome.

[Screening for blood glucose abnormalities and coronary heart disease through routine annual examination (author's transl)]. / Détection de la glycémie et des maladies coronariennes a partir d'une examen annuel systématique.

The authors address the two following questions: 1) Is detection of glycoregulation disorders possible from data yielded by routine annual examination (7,923 subjects)? 2) Do further investigations, carried out in a subdivision of subjects selected according to the risk of cardiovascular disease (n = 1,232), show a difference in the distribution of risk factors and risk indicators between patients and "healthy" individuals? Analysis of the results of this transversal study demonstrates a fact that is well-known concerning diabetes: even mild hyperglycemia (greater than or equal to 6 Mmol/l) is significantly correlated to age, excess weight and high systolic blood pressure. In both male and female subjects, there is a strong correlation between mean blood glucose concentration and the other biologic parameters that were studied (blood pressure, serum cholesterol, LDL/HDL cholesterol). Conversely, no correlation was found with smoking habits or with the intake of various dietary components. These results indicate that age, excess weight and increased blood pressure are simple data which are suggestive of abnormal glycoregulation. Comparison of risk factors and risk indicators in patients and "healthy" subjects showed significant differences for age, smoking habits and systolic blood pressure only. Glycemia, cholesterolemia and obesity were similar in both groups. These findings are evidence of the high risk in the subjects considered as "healthy", in whom the degree of atherosclerosis cannot be ascertained. Atherosclerosis in "healthy" individuals can certainly not be overlooked: in subjects with normal blood pressure, fundus examination showed a similar proportion of abnormalities in patients and "healthy" individuals.

Holter monitoring in the complex analysis of sinus node dysfunction.

To study the diagnostic possibility and the mechanisms involved in sinus node dysfunction, 23 patients with sick sinus syndrome were evaluated by the basic electrophysiological method (recovery times, secondary postpacing phases, sinoatrial conduction times) before and after pharmacologic autonomic blockade with i.v. propranolol 0.2 mg/kg and atropine 0.04 mg/kg, and by continuous rhythm monitoring. Patient groups of normal (I) and pathological (II) intrinsic heart rate (IHR) were compared. In group I (no. 15) prolonged recovery time (2/15), postpacing sinoatrial-block (1/15) and chaotic postextrasystolic patterns (5/15) ceased after autonomic blockade; we obtained normal intrinsic recovery time, gradual return to the stable intrinsic sinus cycle length in the secondary phase, and a normal intrinsic sinoatrial conduction time. In group II (no. 8) during the control study only 50% of patients had pathological electrophysiological parameters before, and 100% after the drug test (no gradual postpacing return to the intrinsic heart rate, abnormal recovery times, abnormal sinoatrial conduction times or chaotic postextrasystolic patterns). Holter monitoring revealed significant differences between the minimal heart rate during sleeping (group I: 48 +/- 10 bpm, mean +/- SD group II: 32 +/- 4 bpm, probability less than 0.001) as well as in the average sinus cycle length for 24 hours (group I: 848 +/- 88 ms, group II: 1254 +/- 136 ms, P less than 0.001) with a very characteristic histogram. In the patients with pharmacologically and electrophysiologically documented abnormal intrinsic rhythmicity (group II), the first 24 hour Holter monitoring revealed positive ECGs for sinus node dysfunction. In patients with normal intrinsic electrophysiological sinus node properties (group I) repeated continuous rhythm recordings revealed severe sinus bradycardia (1 patient), sinoatrial-block (1 patient), tachybrady syndrome (1 patient) and sinus-arrest (2 patients, up to 29 120 ms in waking period). These findings suggest that 1) IHR is the best and simplest diagnostic method of intrinsic sinus node dysfunction (in patients of abnormal low IHR we found positive electrophysiological and Holter parameters), and 2) in autonomic sinus node dysfunction electrophysiological parameters are essentially negative showing normal intrinsic sinus node function; in these patients systematically repeated Holter monitoring is the most valuable diagnostic method.