[Prediction of successful induction of labor: a comparison between fetal fibronectin assay and the Bishop score]. / Prédiction de la réussite du déclenchement du travail. Comparaison entre le score de Bishop et le dosage de la fibronectine foetale.

OBJECTIVE: The aim of our study is to determine whether the fetal fibronectin is a better predictor of successful induction of labor than the Bishop score. MATERIAL AND METHODS: A prospective observational non-randomized study was conducted in our unit including 234 patients scheduled for induction of labor from October 2000 to June 2004. Fetal fibronectin was assayed by taking sample from the endocervix and the cervical status was evaluated using the Bishop score. Data were analysed by Chi-square test of Mantel-Haenzel and Cox stepwise multiple regression using SPSS version 12 software. RESULTS: The likelihood ratios for predicting that vaginal delivery would occur within 24h of induction for positive fetal fibronectine were 1.34 (95% CI 1.04-1.73, p=0.027) all patients included and 1.51(95% CI 1.00-2.33, p=0.048) for the nulliparas and 1.92 (95% CI 1.51-2.42, p=0.0001) for the Bishop score. On multiple regressions, the only variables independently associated with a successful induction were the Bishop score, the parity and the age of the patient. No significant association was found between the presence of cervical fibronectin and the caesarean section rate: 21.84% for positive fibronectin versus 21.78% for negative fibronectin. CONCLUSION: The fetal fibronectine is probably useless in this context, given the additional cost and no improvement compared with the simple Bishop score.

[Evaluation of treatment relating to gestational trophoblastic tumor registered to the French Trophoblastic Disease Reference Center (TDRC) in Lyon from 1999 to 2005]. / Evaluation de la prise en charge des tumeurs trophoblastiques gestationnelles enregistrées au Centre de référence des maladies trophoblastiques de Lyon de 1999 à 2005.

OBJECTIVES: The aim of this study was both to analyse if gestational trophoblastic neoplasia (GTN) registered to the French Trophoblastic Disease Reference Center (TDRC) in Lyon (France) were managed according to the FIGO criteria for diagnosis of GTN and if chemotherapy was adapted to the 2000 FIGO prognostic scoring system. PATIENTS AND METHODS: Retrospective, descriptive analysis of 167 GTN registered to GTC of Lyon between 1999 and 2005. RESULTS: On the one hand, 66% of women (104/158) had a diagnosis of GTN according to FIGO criteria. One third (n=54) of the patients therefore had a premature or erroneous diagnosis of a tumor, when the treatment started. No supporting element of this premature diagnosis has been found out for 26 patients. The identification of lung and vaginal metastasis and histological diagnosis of invasive mole appeared as the most mentioned inappropriate criteria for diagnosis. On the other hand, chemotherapy was adapted to 2000 FIGO scoring in 91, 5% of cases. Twelve low risk GTN were treated with polychemotherapy and two high risk GTN were treated with monochemotherapy. Moreover 29% of the patients received a non adequate treatment due to deviations from the recommended protocol. DISCUSSION AND CONCLUSION: Non respect of FIGO criteria for the diagnosis of GTN can lead to erroneous diagnosis of tumors. Identification of lung or vaginal metastasis or diagnosis of invasive mole should not automatically justify the diagnosis of gestational trophoblastic neoplasia if the decrease in HCG occurs properly. Respect of FIGO criteria for the diagnosis of GTN and adaptation of chemotherapy to 2000 FIGO scoring are necessary to avoid inadequate treatment of gestational trophoblastic neoplasia.

Comparison of progesterone concentration determination by 12 non-isotopic immunoassays and gas chromatography/mass spectrometry in 99 human serum samples.

A single serum progesterone determination may be highly predictive for early pregnancy and in vitro fertilisation and embryo-transfer outcomes. We therefore compared 12 direct non-isotopic progesterone immunoassays with gas-chromatography/mass spectrometry (GC/MS). For each assay, data from the analysis of 99 individual sera were compared with data obtained by GC/MS, using regression and bias plot analyses and the ratio method. We observed a larger difference in concentration between high and low values and a broader distribution of results for immunoassays than for GC/MS. All immunoassays displayed bias in the calibration process and a lack of specificity and/or sensitivity, to various degrees. We tried to identify the parameters of the assay procedure that might contribute to these discrepancies. None of the criteria investigated (antibodies, control and preparation of calibrators, blocking agents and choice of tracer) had a significant effect when studied alone.

Determination of plasma methoxyamines.

The determination of plasma methoxyamines is the most informative parameter for the diagnosis of pheochromocytoma. Very good sensitivity and specificity are necessary for this. The measurement of deconjugated (free plus sulfate-conjugated) metanephrines is more useful. Concentrations are 10-fold higher than free metanephrine concentrations. The methodology generally uses a column purification and high performance liquid chromatography with electrochemical detection. We have tested six commercial columns used for the purification step. We chose a rapid and reliable method with a mixture of strong cation-exchange and strong anion-exchange groups bonded onto a silica column. This protocol has been validated with samples of plasma from normal subjects, healthy elderly people, renal failure patients and patients with pheochromocytoma.

[Validity of immunochemical methods for bloody progesterone: a study performed in 1998]. / Validité des dosages immunochimiques de la progestérone dans le sang: étude réalisée en 1998.

The aim of this study was to compare, with manufacturer's agreement, twelve direct and non-isotopic commercial assays of progesterone. We have evaluated the analytical performances: low limit detection, imprecision, accuracy (recovery and dilution tests) and we have tested some patient samples. Results were compared to a reference method using isotope dilution Gas Chromatography and Mass Spectrometry combination (GC-MS). For each assay, analytical qualities and defaults are established. Large differences are found between progesterone concentration measured on the same sample with the different methods essentially for the low concentrations. Comparison with GC-MS raised questions about the accuracy of the different assays. This work will be aid laboratories to their choice and/or validation.

Influence of acute and chronic exercise on insulin-like growth factor-I in healthy active elderly men and women.

We examined the influence of physical activity (PA) and acute resistance exercise on insulin-like growth factor I (IGF-I) in 39 healthy, independent, community-dwelling elderly volunteers (14 men and 25 women) aged from 66 to 84. In a longitudinal non-interventional study, we compared the fluctuations in IGF-I levels and changes in habitual PA over a 6-month period. PA was evaluated by a questionnaire QAPSE (Questionnaire d'Activité Physique Saint-Etienne), and expressed by two activity indices: mean habitual daily energy expenditure (MHDEE), and daily energy expenditure corresponding to leisure time sports activities (sports activity index). In an experimental design we compared IGF-I levels before, at 1 and 15 minutes after short quadriceps muscle exertion (10 consecutive repetitions) carried out with optimal muscle power development. Changes in IGF-I levels over a 6-month period were positively related to changes in MHDEE (r = 0.41; p<0.01), and sports activity (r = 0.40; p<0.02). When analyzed by gender, these correlations were still statistically significant in women (r = 0.39; p = 0.05 and r = 0.41; p<0.05), but not in men (r = 0.36; p = 0.21 and r = 0.20; p = 0.50). No changes (p = 0.17) were observed in serum IGF-I concentrations after the acute exercise protocol. These findings indicate that IGF-I levels are positively related to fluctuations in habitual PA, at least in women. Further research is needed to establish the best intensity and duration of exercise training to induce these changes.

Physical activity and dehydroepiandrosterone sulphate, insulin-like growth factor I and testosterone in healthy active elderly people.

OBJECTIVE: to examine the association of physical activity and cardio-respiratory fitness with dehydroepiandrosterone sulphate (DHEAS), insulin-like growth factor I (IGF-I) and testosterone in healthy elderly people. DESIGN: cross-sectional study. SETTING: university research department and department of geriatric medicine. PARTICIPANTS: 60 independent, community-dwelling elderly subjects (26 men and 34 women) aged 66-84 who volunteered to participate. MEASUREMENTS: physical activity was evaluated by the Questionnaire d'Activité Physique Saint-Etienne and expressed by three indices: mean habitual daily energy expenditure (MHDEE), daily energy expenditure (DEE) [comprising activities with intensities corresponding to at least three metabolic equivalents (MET; 3.5 ml.kg1 x min1 of oxygen consumption)] and sport activity. Cardio-respiratory fitness was expressed by maximal oxygen consumption (VO2max). RESULTS: In women, DHEAS correlated with VO2max (partial correlation: r=0.33; P=0.05), MHDEE (r=0.50; P=0.002), DEE > 3 METs (r=0.49; P=0.003) and sport activity (r=0.35; P=0.04) whereas IGF-I correlated with MHDEE (r=0.48; P=0.004). DHEAS was correlated with IGF-I (r=0.43; P < 0.02) and with testosterone (r=0.41; P < 0.02). No such correlation was found in men. CONCLUSION: lower habitual physical activity is related to lower levels of circulating DHEAS and IGF-I independently of age and anthropometric measures. Lower maximal aerobic capacity is associated with lower DHEAS concentrations, in healthy elderly women.

[Validity of immunochemical assays for blood estradiol. Study conducted in 1994]. / Validité des dosages immunochimiques de l'estradiol sanguin. Etude réalisée en 1994.

Since 1989 many kits have been commercialized for measuring estradiol by non-isotopic immunoassays which largely contributed to the diffusion of this parameter. Rapidly, in quality control schemes, a wide dispersion of results has been observed. In this paper, the kits' characteristics (precision, accuracy and detection limit) have been studied and compared to a reference method (gas chromatography-mass spectrometry). In addition, estradiol determinations in patients with various pathophysiological situations have been performed to underline the difficulties of interpretation of this analyte when clinicians compare results given by the different kits. This work demonstrates that precision and accuracy varied both with the kit and the level of concentration of estradiol and gives better results for high concentrations of estradiol. In seven out of the 12 kits, the limits of detection are in good agreement with those announced by manufacturers. On the contrary, the determination on patients sera gives results with a high variability with no systematic error.

In vivo unaltered muscle protein synthesis in experimental chronic metabolic acidosis.

Chronic metabolic acidosis (CMA) is a major cause of growth defect, implying disturbances of protein metabolism. Previously, in vivo studies performed in the fasting state showed enhanced whole body protein turnover, whereas in vitro studies showed unchanged muscle protein synthesis. The present study is the first to determine the effects of CMA on muscle protein synthesis and degradation in vivo. Two studies were performed in 60 g male rats fed a 30% casein diet. In study I, one group was sham-operated (C rats), and two groups underwent subtotal nephrectomy. One of them developed acidosis (UA rats) which was corrected in the other by NaHCO3 in the diet (UNA rats). Study II compared sham-operated rats rendered acidotic by NH4Cl in the drinking water (CA rats) and normal pair-fed (CNA) rats. Fractional protein synthesis rate (FSR) was determined in gastrocnemius muscle after injection of 3H-phenylalanine. Fractional protein degradation rate (FDR) was calculated as FSR minus fractional rate of muscle growth (FGR). In study I, UA rats had lower growth and N balance (163 +/- 12 vs. 216 +/- 11 mg N/day; P < 0.001) than UNA rats, despite identical food intake (11 g/day). This was associated with identical FSR (10.4 +/- 0.5 vs. 10.9 +/- 0.5%/day), but enhanced protein degradation (6.30 +/- 0.99 vs. 5.10 +/- 0.71%/day; P < 0.05). Plasma insulin, C peptide, PTH and corticosterone did not differ in UA and UNA rats, whereas plasma IGF-I was markedly reduced (147 +/- 21 vs. 283 +/- 27 ng/ml; P < 0.01) in UA rats.(ABSTRACT TRUNCATED AT 250 WORDS)

Long-term isolation of Wistar rats alters brain monoamine turnover, blood corticosterone, and ACTH.

In this work, we investigated neurochemical parameters in the brain of male Wistar rats after isolation times (13 weeks) longer than those previously reported with this strain: a large majority of animals became muricidal under these conditions. Changes in monoamines turnover in hippocampus, cortex, and cerebellum and, in the blood, ACTH, and corticosterone were investigated. Monoamine turnover was analysed using two different approaches: first, by measuring neurotransmitter and metabolite levels and second, by measuring rate of accumulation of the precursor after decarboxylase. Both methods revealed a significant increase in catecholamine turnover in the three regions studied after the 13-week isolation; in contrast, only a modest elevation of 5-hydroxytryptophan accumulation was obtained in cortex and cerebellum of isolated rats. We also observed a decrease in corticosterone levels in blood concomitant with an increase of ACTH.

Specific assay for unconjugated dehydroepiandrosterone in human plasma by capillary gas chromatography with electron-capture detection.

A specific and sensitive method for the determination of unconjugated dehydroepiandrosterone in plasma is described. After extraction and purification of the extracts on a Celite column, the iodomethyldimethylsilyl ether derivative of dehydroepiandrosterone was isolated on an aluminium oxide column and assayed by gas chromatography with electron-capture detection. The method is sensitive: sample volumes of 0.5-1 ml are sufficient for the determination of dehydroepiandrosterone in plasma of normal male and female subjects aged 1-80 years. The assay is highly specific and has the potential to be used as a reference method for the determination of unconjugated dehydroepiandrosterone in biological samples.

Dietary regulation of intestinal glycosyl-transferase activities: relation between developmental changes and weaning in rats.

Activities of rat intestinal fucosyl-transferase (GDP-fucose: glycoprotein fucosyl-transferase; EC 2.4.1.68) and sialyl-transferase (N-acetylneuraminyl-transferase; EC 2.4.99.1) respectively exhibited a significant increase following weaning and a steady decrease between birth and weaning. The variations of the two glycosyl-transferase activities with age could not be explained by the presence of inhibitory factors in microsomes or cytosol, nor were they due to a natural modification of the milk composition at the end of lactation. The increase in fucosyl-transferase activity that followed weaning was prematurely induced by early weaning. Prolonged nursing prevented the normal increase in fucosyl-transferase activity, and late weaning delayed the increase. The sensitivity to the modification of the time of weaning indicated a major effect of dietary changes, related to the introduction of a solid carbohydrate-rich diet, on the developmental pattern of this enzyme. However, a stress response could not be excluded after early weaning since the corticosterone level of the early weaned rats was enhanced as compared to that of suckling rats. For sialyl-transferase, early weaning caused a slightly greater than normal decrease in the activity, whereas prolonged nursing only weakly diminished the normal decrease in the activity. Moreover, late weaning had no effect on the sialyl-transferase activity. The age-related variations of this enzyme likely are due to factors independent of diet. Thus, the developmental variations of the fucosyl- and sialyl-transferases appear to be differently regulated.

[Assay of sex hormone-binding globulin (SHBG) in human serum. Comparative measurements using three methods]. / Dosage de la "sex hormone binding globulin" (SHBG) dans le sérum humain. Mesures comparatives avec trois méthodes.

Determination of sex-hormone-binding-globulin was performed by three methods: binding, electroimmunodiffusion and DELFIA methods. Results of normal and pathological values correlated well with the three techniques.

Production of monoclonal antibodies to dehydroepiandrosterone-sulphate after immunization of mouse with dehydroepiandrosterone-bovine serum albumin conjugate.

Monoclonal antibodies with a much higher specificity for DHA-S than for DHA were obtained from a BALB/c mouse immunized with a non-sulphated DHA-7CMO-BSA antigen. An improved fusion technique using PEG containing 10% DMSO instead of PEG alone increased the number of positive hybridomas. One of the five monoclonal antibodies obtained, showed a high affinity for DHA-S (Ka = 10(10) M-1) and very low cross-reactions with androsterone (0.62%) and androsterone sulphate (0.83%) which made it potentially useful for direct quantitation of DHA-S in human serum.

[Specific determination of free urinary cortisol using high performance liquid chromatography]. / Dosage spécifique du cortisol libre urinaire par chromatographie liquide de haute performance.

Specific assay of free urinary cortisol is difficult. Only high pressure liquid chromatography (HPLC) is suitable for this problem but requires pretreatment of urines. Seven protocols of purification are compared and a routine method is proposed. Performance of this is evaluated and discussed in patients with corticoid therapy.

Effects of intermittent electrical stimulations on muscle catabolism in intensive care patients.

To determine whether muscular contractions obtained by electrical stimulation in immobilized patients are able to reduce muscle catabolism, we studied 10 patients (65-79 yr old) hospitalized in the intensive care unit for postoperative ventilatory failure or cerebral infarction. Artificial nutrition was the same for each patient during the 9-day study period. Two periods of 4 days were defined and randomized for each patient, separated by one day. During the muscular stimulation (MS) period, intermittent electrical stimulation of the muscles of the legs (external electrodes), were performed daily during 2 X 30 mn. During the other period, muscular stimulations were not performed. Urinary excretion of nitrogen (micro-Kjeldhal digestion and Nessler procedure), creatinine (Jaffe reaction), and 3-methyl histidine (3-MH) (gas phase chromatography) was measured every day. (table; see text) We conclude that a significant decrease in 3-MH and creatinine excretion is observed during the MS period. In intensive care unit patients, muscle protein breakdown may be influenced by intermittent muscular electrical stimulation.

[Urinary elimination of urinary tetrahydroaldosterone measured by gas-phase chromatography. Normal values in adults]. / Elimination urinaire de la tétrahydroaldostérone urinaire par chromatographie en phase gazeuse. Valeurs usuelles chez l'adulte.

The authors describe a method of titration of tetrahydroaldosterone in the urine, requiring an internal non-radioactive standard. This method uses high performance liquid chromatography as a mean of isolating tetrahydroaldosterone (THAldo) and chromatography in gaseous phase as a method of titration in the form of heptafluorobutyrate after oxidation into gamma lactone. It permits to detect 3 ng of gamma lactone of THAldo corresponding to a urinary concentration of 16 nmol/l.

Determination of urinary estradiol using an enzymatic method during the menstrual cycle. Comparison with an method using isotope dilution-mass spectrometry (ID-MS).

Results for measurements of urinary estradiol were compared with results from a method using isotope dilution-mass fragmentography. Urine samples were collected from women during the menstrual cycle. The results obtained differed in absolute values, but showed good correlation.