[Therapeutic education in primary cardiovascular prevention]. / Éducation thérapeutique en prévention primaire cardiovasculaire.

BACKGROUND: As primary prevention against cardiovascular diseases, Patient Therapeutic Education helps to develop a protective lifestyle within a socioeconomic context where risk factors abound. PATIENTS AND METHODS: Patient Therapeutic Education offers those eager to protect their cardiovascular health a program of six workshops. Upon enrolment, a Program aide conducts an educational diagnosis with the patient, specific to each workshop theme, so that he might understand the clinical, socio-professional, cognitive and psycho-affective dimensions. An evaluation of each workshop is requested from participants in the form of open and closed questions. RESULTS: The study comprised 2225people, majority women (79%), relatively old (age 63.9for women, 66.3for men), most often retired (65%). An analysis of the educational diagnosis notes a great frequency of classic risk factors; a good knowledge of the factors favoring them contrasting with the weak means implemented in everyday life to reduce their impact; the great majority of participants (68%) believe they have a well balanced diet; patients are greatly involved in their own health, with a slight external locus involving the general practitioner, the immediate entourage and society. The notes of the evaluation are usually maximum. CONCLUSION: Patient Therapeutic Education arouses strong interest in the public, allows a personalized approach that optimizes learning, increases knowledge and facilitates the use of new protective practices.

Immune growth hormone (GH): localization of GH and GH mRNA in the bursa of Fabricius.

Expression of growth hormone (GH) and GH receptor (GHR) genes in the bursa of Fabricius of chickens suggests that it is an autocrine/paracrine site of GH production and action. The cellular localization of GH and GH mRNA within the bursa was the focus of this study. GH mRNA was expressed mainly in the cortex, comprised of lymphocyte progenitor cells, but was lacking in the medulla where lymphocytes mature. In contrast, more GH immunoreactivity (GH-IR) was present in the medulla than in the cortex. In non-stromal tissues, GH-IR and GH mRNA were primarily in lymphocytes, and also in macrophage-like cells and secretory dendritic cells. In stromal tissues, GH mRNA, GH and GHR were expressed in cells near the connective tissue (CT) between follicles and below the outer serosa. In contrast, GH (but not GH mRNA or GHR), was present in cells of the interfollicular epithelium (IFE), the follicle-associated epithelium (FAE) and the interstitial corticoepithelium. This mismatch may reflect dynamic temporal changes in GH translation. Co-expression of GHR-IR, GH-IR, GH mRNA and IgG was found in immature lymphoid cells near the cortex and in IgG-IR CT cells, suggesting an autocrine/paracrine role for bursal GH in B-cell differentiation.

[Therapeutic education in primary cardiovascular prevention: 4 years sustained interest]. / Éducation thérapeutique en prévention primaire cardiovasculaire : intérêt prolongé à 4 ans.

BACKGROUND: Our patient therapeutic education program yields improvements in health after one year. But what can we see after 4 years, when the patient alone is responsible for following the program? PATIENTS AND METHODS: Two hundred and ninety-one patients participated in the first part of our study and were followed during one year. Four years into the ongoing study, we reviewed the progress of the first 200 patients. We compared the already published Risk Factors and Eating Habits scores between the beginning of the study (T0), one year later (T1) and after 4 years (T4). RESULTS: The Risk Factor score at T0 is 9.5±7.8, moving to 7±7.5 at T1, and then to 6.8±7.8 at T4 (P<0.001 between T0 and T1 and T0 and T4). Endurance physical activities saw the greatest improvement: 0.79±5 at T0, -1.07±4.5 at T1 and -1.61±4.5 at T4 (P<0.001 between T0 and T1 and T0 and T4). The Eating Habits score went from -18.2±7.3 to -22.2±6.4 and then to -23.5±6.4 (P<0.001 between T0 and T1 and T0 and T4). The best results were obtained through increased consumption of whole grains, green vegetables and fish. CONCLUSION: The positive results of the progress of risk factors and eating habits, noted after one year, are even greater four years after the end of the therapeutic education program.

Expression, translation, and localization of a novel, small growth hormone variant.

A novel transcript of the GH gene has been identified in ocular tissues of chick embryos. It is, however, unknown whether this transcript (small chicken GH, scGH) is translated. This possibility was therefore assessed. The expression of scGH mRNA was confirmed by RT-PCR, using primers that amplified a 426-bp cDNA of its coding sequence. This cDNA was inserted into an expression plasmid to transfect HEK 293 cells, and its translation was shown by specific scGH immunoreactivity in extracts of these cells. This immunoreactivity was directed against the unique N terminus of scGH and was associated with a protein of 16 kDa, comparable with its predicted size. Most of the immunoreactivity detected was, however, associated with a 31-kDa moiety, suggesting scGH is normally dimerized. Neither protein was, however, present in media of the transfected HEK cells, consistent with scGH's lack of a signal sequence. Similar moieties of 16 and 31 kDa were also found in proteins extracted from ocular tissues (neural retina, pigmented epithelium, lens, cornea, choroid) of embryos, although they were not consistently present in vitreous humor. Specific scGH immunoreactivity was also detected in these tissues by immunocytochemistry but not in axons in the optic fiber layer or the optic nerve head, which were immunoreactive for full-length GH. In summary, we have established that scGH expression and translation occurs in ocular tissues of chick embryos, in which its localization in the neural retina and the optic nerve head is distinct from that of the full-length protein.

Growth hormone and its receptor in projection neurons of the chick visual system: retinofugal and tectobulbar tracts.

Recent studies have shown the presence of growth hormone (GH) in the retinal ganglion cells (RGCs) of the neural retina in chick embryos at the end of the first trimester [embryonic day (E) 7] of the 21 day incubation period. In this study the presence of GH in fascicles of the optic fiber layer (OFL), formed by axons derived from the underlying RGCs, is shown. Immunoreactivity for GH is also traced through the optic nerve head, at the back of the eye, into the optic nerve, through the optic chiasm, into the optic tract and into the stratum opticum and the retinorecipient layer of the optic tectum, where the RGC axons synapse. The presence of GH immunoreactivity in the tectum occurs prior to synaptogenesis with RGC axons and thus reflects the local expression of the GH gene, especially as GH mRNA is also distributed within this tissue. The distribution of GH-immunoreactivity in the visual system of the E7 embryo is consistent with the distribution of the GH receptor (GHR), which is also expressed in the neural retina and tectum. The presence of a GH-responsive gene (GHRG-1) in these tissues also suggests that the visual system is not just a site of GH production but a site of GH action. These results support the possibility that GH acts as a local growth factor during early embryonic development of the visual system.

Inflammation versus mechanical stretch biomarkers over time in acutely decompensated heart failure with reduced ejection fraction.

Heart failure can be associated with inflammation but it is unclear if inflammation is directly related to hemodynamic worsening or is an independent pathway. Our aim was to investigate inflammation and mechanical stress using serial measurements of biomarkers in acute and chronic heart failure with reduced ejection fraction (AHF and CHF). METHOD: The following biomarkers were measured on admission, at discharge and one month after discharge: B-type natriuretic peptide (BNP), high-sensitivity C-Reactive protein (hsCRP), Tumour Necrosis Factor alpha (TNFα), interleukin 6 (IL6), myeloperoxidase (MPO), suppression of tumorigenicity 2 (ST2), mid-regional pro-adrenomedullin (MR-proADM), galectin 3 (Gal3), Growth differentiating factor 15 (GDF15) and procalcitonin (PCT). RESULTS: In control CHF group (n=20, 69±11y, NYHA 1-2), most biomarker levels were low and stable over time. In AHF (n=55, 71±14y), BNP, ST2 and GDF15 levels were highly increased on admission and then decreased rapidly with clinical improvement; BNP, ST2 and GDF15 levels were statistically correlated (r=0.64, 0.46 and 0.39; p<0.001 for both). Both hsCRP, MPO, TNFα and Gal3 levels were increased in most AHF patients (70, 56, 83 and 98% respectively) with poor change over time. HsCRP, MPO and TNFα levels were correlated. IL6, MR-proADM and PCT levels were slightly increased, without change over time. Highest quartiles of BNP and ST2 were associated with death or readmission at one year (HR 2.33 [95CI 1.13-4.80] and 2.42 [1.27-4.60]). CONCLUSION: AHF is associated with systemic inflammation. This inflammatory response continued up to one month after discharge despite normalisation of mechanical stress-related markers.

[Improvement of the prognosis of the acute coronary syndromes in Landes by lifestyle modifications]. / Amélioration du pronostic des syndromes coronaires aigus dans les Landes par la modification de l'hygiène de vie.

The global coverage of the patients having had an acute coronary syndrome requires the modification of their life hygiene. Six hundred and sixty-seven consecutive victims of this syndrome benefited from clinics by a nurse, aiming at decreasing their risk factors and to modify their food customs. The initial interrogation allows the collection of these items and every answer is transformed into a digital score. The patients being seen again every 6 months in consultation, progress was observed, not only for the control of the risk factors (the score passes from 6.4 to 5.1 P < 0.001) but also for that of the food customs (the score passes from 1.5 to 6, P < 0.001). The evolution of the patients was compared as they are (group 1, N = 216) or not (group 2, N = 448) followed regularly in consultation, on the basis of a voluntary service, with a follow-up of 20, 8 months. Three patients were lost sight. The patients of the group 1 have fewer cardiovascular events (17 patients with event vs 82, P < 0.02), in particular a cardiac insufficiency (2 vs 28, P < 0.01) or the other events bound to the atherosclerosis (13 vs 55, P < 0.02), They are less often hospitalised (14 vs 70, P < 0.001). The deaths are less frequent in group 1 (Curve of Kaplan-Meyer: P < 0.01; RR = 0.23; IC = 0.09-0.58. The bad hygiene of life, which led to the arisen of an acute coronary syndrome, can be corrected and this is translated by an improved prognosis.

Influence of the fatty acid composition of high-density lipoprotein phospholipids on the cholesterol efflux from cultured fibroblasts.

The purpose of this work was to determine whether the changes induced by dietary manipulations in the chemical composition of high-density lipoproteins (HDL) (particularly phospholipid fatty acid composition) modified their capacity to promote [3H]cholesterol efflux from cultured fibroblasts. Plasma HDL were obtained from subjects fed for six successive long periods on diets consisting of one predominant fat: peanut oil, corn oil, olive oil, soybean oil, low erucic acid rapeseed oil or milk fats. The [3H]cholesterol efflux from cells in the presence of plasma HDL was studied by means of normal adult human fibroblasts in culture. The [3H]cholesterol efflux from fibroblasts appeared to be independent of the overall composition of HDL and of the degree of saturation of the HDL phospholipid fatty acids, but it was correlated with the phospholipid fatty acid chain length. The [3H]cholesterol efflux from fibroblasts is highly and positively correlated with the sum of the HDL phospholipid C20, C22, C24 fatty acids, and negatively correlated with the sum of the HDL phospholipid C18 fatty acids.

Effects of dietary fats on the fluidity of human high-density lipoprotein: influence of the overall composition and phospholipid fatty acids.

The present study was undertaken to analyze whether the changes induced by dietary manipulations in the chemical composition of HDL, particularly in total phospholipids, phosphatidylcholine and sphingomyelin fatty acid composition, modified their fluidity. 12 healthy women, aged 26-49 years were studied. They consumed, over periods of 5 weeks, various isocaloric diets, each containing 30% of the calories as fat. 15.6% of the total calories were provided successively by olive oil, soybean oil, corn oil, and milk fats. The HDL fluorescence anisotropy was measured with 1,6-diphenyl-1,3,5-hexatriene (DPH) by fluorescence polarization. The HDL from the monounsaturated diet, olive oil, were the most fluid particles. The HDL fluorescence anisotropy was positively correlated with their free cholesterol percentage and negatively correlated with their triacylglycerol content and their triacylglycerol/phospholipid ratio. Moreover, the HDL fluorescence anisotropy was negatively correlated with the percentage of oleic acid in their total phospholipids and particularly in the phosphatidylcholine. These results suggest that the percentages of triacylglycerol and oleic acid in phospholipids of HDL have a fluidifying effect on these lipoproteins.

Effects of probucol on the composition and in vitro catabolism of LDL in type IIa hypercholesterolemia.

A possible mechanism of action of probucol on low density lipoprotein uptake was examined in 7 type IIa hypercholesterolemic subjects. Probucol administration effectively lowered plasma cholesterol. Both apo B-associated cholesterol and HDL cholesterol were decreased but a great inter-patient variability was noted. Plasma triglycerides were unchanged and phospholipids decreased. The composition of the isolated LDL was unaffected. The LDL displaceable activity of reference [125I]LDL measured by competition assays in control fibroblasts, was increased in 3 subjects, decreased in 1 subject and unchanged in the other 3. No correlation was found between the change in apo B-associated cholesterol and the change in the in vitro catabolism of LDL of treated patients. The results did not allow a simple mechanism of action to be ascribed to the drug, but questioned the origin of the hypercholesterolemia.

Ghrelin-induced GH secretion in domestic fowl in vivo and in vitro.

Although avian and mammalian species differ significantly in their regulation of GH secretion, preliminary studies have demonstrated in vivo GH responses to ghrelin in chickens, as in mammals. However, the relative potency of ghrelin as a GH-releasing hormone (GHRH) in birds is uncertain, as is its site of action. The intravenous administration of human ghrelin to immature chickens promptly increased the circulating GH concentration (within 10 min), although this was transitory and was only maintained for 20 min. This GH response was dose-related with an EC50 of approximately 3.0 microg/kg, comparable with the reported potency of human GHRH in chickens. When incubated with dispersed pituitary cells, human ghrelin induced dose-dependent GH release over a range of 10(-6) to 10(-9) M, with an EC50 of 7.0 x 10(-8) M, comparable with that induced by human GHRH (EC50 6.0 x 10(-8) M), although it was less effective at doses of 10(-6) to 10(-8) M. This was due to direct effects on pituitary somatotrophs, since human ghrelin increased GH release (determined by the reverse hemolytic plaque assay) from individual pituitary cells. The incubation of these cells with human ghrelin induced a dose-dependent increase in the numbers of somatotrophs secreting GH and in the amount of GH released by each cell. In summary, these results demonstrated that ghrelin is a dose-related GH-releasing factor in chickens with a potency comparable with that induced by human GHRH. The GH-releasing action of ghrelin is due, at least in part, to stimulatory actions on the numbers of somatotrophs induced to release GH and upon the amount of GH released from individual somatotrophs.

Extrapituitary GH in the chicken: underestimation of immunohistochemical staining by Carnoy's fixation.

GH has previously been shown to be present in peripheral extrapituitary tIssues of chick embryos, but the cellular distribution of GH immunoreactivity is still uncertain because of differing immunohistochemical findings. The possibility that this uncertainty reflects differences in fixation of the embryonic tIssues was assessed by comparing GH immunoreactivity in tIssues fixed in 4% (w/v) paraformaldehyde or Carnoy's fluid (60% ethanol (v/v); 30% chloroform (v/v); 10% acetic acid (v/v)). A widespread distribution of GH immunoreactivity was seen in paraformaldehyde-fixed tIssues, although it was particularly intense in the spinal cord, dorsal and ventral root ganglia, notochord, myotome, epidermis, crop, heart, lung and humerus. In marked contrast, GH immunoreactivity in embryonic tIssues fixed with Carnoy's was more discrete and mainly restricted to marginal and mantle layers of the spinal cord, spinal nerves, the ventral root ganglia and the extensor nerve of the anterior limb bud. Since these are neural derivatives, Carnoy's fixation appears to preferentially result in neural GH staining, whereas GH staining in neural and non-neural tIssues is seen after paraformaldehyde fixation. Carnoy's, because it is a precipitive fixative, may only fix large GH moieties, whereas GH in peripheral tIssues includes numerous molecular variants, many of which are of relatively small size. Paraformaldehyde, because it is a cross-linking fixative, preferentially fixes peptides and small proteins, and it may therefore fix more GH moieties than Carnoy's fluid. Carnoy's fixation appears to underestimate GH immunoreactivity in immunohistochemical studies on the cellular distribution of GH-like proteins in embryonic chicks.

Treatment of early postinfarction ventricular aneurysm by intra-aortic balloon pumping and surgery.

In nine patients with medically refractory left ventricular failure and/or ventricular arrhythmias, secondary to acute formation of a ventricular aneurysm, intra-aortic balloon pumping (IABP) was instituted 24 to 36 hours before diagnostic angiographic studies. Ventricular irritability was reduced and heart failure was controlled in all patients. Eight patients underwent operation, four within 3 weeks of an acute myocardial infarction and four within 3 months. All had resection of the recent infarction and two had myocardial revascularization as well. Two of the eight patients died in the early postoperative period from intractable ventricular fibrillation. All six patients who survived the operation (mean follow-up 12 months) had excellent clinical results. Ventricular irritability was suppressed and only one patient had residual heart failure. However, there was one late death 7 months after operation. The results suggest that surgical therapy may be effective in the management of medically unresponsive arrhythmias and/or congestive heart failure in the acute or intermediate postinfarction phase. IABP assistance was helpful in supporting the circulation and reducing ventricular irritability during the preoperative and postoperative periods.

Cholesterol efflux from cultured skin fibroblasts in 12 patients clinically heterozygous for familial hypercholesterolemia.

The [3H]cholesterol efflux from cultured skin fibroblasts was investigated in 12 patients, clinically heterozygous for familial hypercholesterolemia (FH). The [3H]cholesterol efflux from fibroblasts was studied in the presence of high-density lipoproteins, isolated either from control sera or from the patient's own serum. The [3H]cholesterol efflux from fibroblasts of 3 patients was increased; it was decreased for 4 patients and similar to that of control cells for 5 patients. This study indicates that in some patients with heterozygous FH, abnormalities of [3H]cholesterol efflux from fibroblasts can be detected. The heterogeneity of the results is consistent with the heterogeneity of the low-density lipoprotein receptor activity and with the variability of the clinical picture found in this disease.

Effects of three dietary fats on plasma lipids and lipoproteins in fasting and post-prandial humans after a short-term diet.

The effects of 3 dietary fats (olive oil, canbra oil and butter) on the fatty acids of blood lipids and on serum lipoproteins were compared in 6 healthy adult outpatients, after a 6-day normocaloric diet including 35% of the studied fat. Important, although incomplete, changes appeared in the fatty acid composition of the various serum lipids and in the composition and distribution of serum lipoproteins. These changes probably result from the degree of saturation of the fat ingested. Moreover, differences were observed among individual subjects. Genetic differences, which are important in clinical practice, are stressed in connection with risks of vascular diseases and hyperlipidemia and affect intestinal fat absorption and lipoprotein metabolism.

[Moderate aortic incompetence due to traumatic rupture of a cusp]. / Insuffisance aortique modérée par rupture traumatique d'une sigmoïde.

The authors recall a case of moderate aortic incompetence caused by traumatic rupture of an aortic cusp occurring in a man of 36 years of age. Anatomical lesions of the aortic valve usually lead to severe incompetence for which surgical treatment is required. In this case, the lesion was well tolerated from the clinical and haemodynamic points of view, and surgery was not required; this tolerance has extended into the mid term. The authors emphasise the importance of echocardiography in the diagnosis of disturbance of an aortic valve, and also in following up the progress of the subsequent aortic incompetence.

[Treatment of early post-infarction ventricular aneurysms by assisted circulation and surgery]. / Traitement des anévrysmes ventriculaires post-infarctus précoces par l'assistance circulatoire et la chirurgie.

Ventricular aneurysm formation in the 3 months following transmural myocardial infarction is rare but may cause serious complications. Cardiac failure and/or ventricular arrhythmias resistant to medical treatment are indications for ventricular resection. The operative mortality is high in this group of patients. 8 patients with ventricular aneurysms of average volume (124 +/- 117 ml/m2) and very impaired left ventricular function (EF : 21 +/- 10%, akinesia : 53 +/- 10%) were operated on with two early deaths and one death in the 7th post operative month. The long term clinical result was satisfactory in the surviving patients, and confirmed by haemodynamic investigation in two of them. The benefical effects of intra-aortic balloon pumping, used preoperatively in all patients, and associated myocardial revascularisation procedures performed in some of them are discussed.

[Left ventricular cineangiography in the convalescent phase of a 1st myocardial infarct. Influence of coronary lesions]. / Cinéangiographie ventriculaire gauche à la phase de convalescence d'un primo-infarctus myocardique. Influence des lésions coronariennes.

80 patients with a primary myocardial infarction (32 anterior and 48 posterior) underwent cardiac catheterisation and angiography (coronary arteriography and selective left ventricular cineangiography) within 12 months of infarction. Analysis of the results of catheterisation and angiography showed: -- Diffuse coronary artery narrowing to be more frequent in patients with posterior infarction. Significant stenosis of the left anterior descending artery was observed in half these cases; -- No correlation between the results of cardiac catheterisation and the distribution of the coronary artery lesions. Changes of ventricular contraction are essentially related to the infarct size and much less to the quality of the healthy myocardium as far as can be appreciated by the usual haemodynamic methods in both anterior and posterior myocardial infarction.

[Aortocoronary bypass. 2. Long-term results evaluated in 318 survivors]. / Pontages aorto-coronariens. 2. résultats à long terme appréciés chez 318 survivants.

Of the 318 patients surviving the first postoperative month 14 died secondarily, 5 were lost to follow-up, and 299 were therefore reviewed with a mean follow-up of 16.6 months (extremes of 2 and 42 months). The percentage of late infarcts was 5.9%. Complete disappearance of the angina occurred in 80.3% of patients. Persistant angina was commoner in females (p less than 0.05) and in patients with a lesion affecting all three trunks (p less than 0.05). On the other hand age, the clinical indications for bypass, the presence of an infarct preoperatively, and the development of an infarct immediately postoperatively did not affect the functional result. The cardio-thoracic ratio decreased significantly, from0.51 +/- 0.07 to 0.47 +/- 0.05 (p less than 0.001). 45 coronary arteriograms in a total of 63 grafts were analysed. 73% were patent after a follow-up period of 10.5 months. The patency rate was 88.6% when coronary arteriography was carried out systematically, and 63% (p less than 0.002) when it was indicated by persistant or recurrent angina. The actuarial survival curve in patients with 2 or 3 trunk involvement demonstrates clearly the superiority of surgical over medical treatment.

[Isolated stenosis of the anterior interventricular artery. Comparison of the effects of medical and surgical treatment (in a randomised series)]. / Sténose isolée de l'artère interventriculaire antérieure. Comparaison des effets du traitement médical et du traitement chirurgical (dans une série randomisée).

Forty-five patients presenting with unstable angina having 70 p. 100 stenosis of the left anterior descending artery judged acceptable for coronary bypass surgery were randomly allocated, using a table of random numbers, for medical (21 patients) or surgical treatment (24 patients). There were no significant differences between the two groups with regards to age (53 +/- 10 years for the medical group; 55 +/- 9 years for the surgical group), the length of follow-up (55 +/- 26 vs 61 +/- 28 months), left ventricular end diastolic volumes (87 +/- 27 vs 84 +/- 18 ml/m2) or ejection fraction (62 +/- 8 vs 59 +/- 11 p. 100). There were no deaths in the medical group; two patients developed uncomplicated myocardial infarction 19 days and 7 months after coronary angiography, respectively. 5 patients had recurrent angina and were referred for surgery. This operation of second intention did not pose any special problems. 6 of the 14 patients with stenosis of the LAD before the origin of the first septal artery had complications (infarction in 1 case, recurrent angina in 5 cases). In the surgical group, 1 patient died in the immediate postoperative period, of resistant cardiac arrhythmia; 2 patients developed uncomplicated peroperative myocardial infarction; 21 patients had no complications at all. The surgical patients were heparinised in the immediate postoperative period and anticoagulant therapy was continued with oral vitamin K antagonists for 6 months to 1 year, followed in some cases, by platelet antiaggregant therapy. 20 patients in this group underwent maximal exercise stress testing which was negative in 19 cases.(ABSTRACT TRUNCATED AT 250 WORDS)