[Mental health educational programs in schools: Experiences, needs and expectations expressed by students in France]. / L'éducation à la santé mentale à l'école : vécu, besoins et attentes exprimés par les étudiants en France.

AIMS: This study explores the experiences and expectations of young adults concerning mental health educational programs in schools. The scarcity of these programs leads us to deepen students' perspective in order to boost the establishment of such sessions. Indeed, this type of prevention plan can improve the access to care and reduce the impact of such disorders. METHODOLOGY: We have developed a standardized questionnaire to be filled online by students between the ages of 18 and 25 years, reached using Facebook pages of student associations of universities from different regions of France. RESULTS: From the 3rd to the 20th of July 2017, 1852 students filled in the questionnaire. In total, 1672 (90%) of the young adults had not experienced mental health educational programs in their school career. However, 1652 (90%) requested that these programs be a part of their academic career. The majority of the young adults (n=590, 56%) would have chosen a psychologist as leader for these programs, preferably (>80%) in a discussion around a difficult imaginary situation, using role-playing or a board game. Furthermore, 1067 (57%) young adults reported having felt the need to talk to someone about mental health during their school career. CONCLUSION: This exploratory study highlights the lack of mental health educational programs in schools and the need expressed by students themselves. It suggests directions to think about how to develop these mental health preventive programs, evoking their limits and advantages.

Validation of the Sexual Activity Questionnaire in women with endometriosis.

STUDY QUESTION: Is the Sexual Activity Questionnaire (SAQ) a valid tool for patients treated for symptomatic endometriosis? SUMMARY ANSWER: For women having surgical treatment for endometriosis, we determined that the SAQ is a valid and responsive tool. WHAT IS KNOWN ALREADY: Endometriosis adversely affects sexual quality of life. Suitable validated sexual quality of life instruments for endometriosis are lacking both in clinical practice and for research. STUDY, DESIGN, SIZE, DURATION: A total of 367 women with proven endometriosis undergoing medical or surgical treatment were included in an observational study conducted between 1 January 2012 and 31 December 2014 in two French tertiary care centers. Both hospitals are reference centers for endometriosis treatment. Of these 367 women, 267 were sexually active and constituted the baseline population. PARTICPANTS/MATERIALS, SETTINGS, METHODS: Women >18 years old with histological or radiological proven endometriosis, consulting for painful symptoms of at least 3 months duration, infertility, or other symptoms (bleeding, cysts) were invited to complete self-administered questionnaires before (T0) and 12 months after treatment (T1). Tests of data quality included descriptive statistics of the data, missing data levels, floor and ceiling effects, structural validity and internal consistency.The construct validity was obtained by testing presupposed relationships between previously established SAQ scores and prespecified characteristics of the patients by comparing different subgroups of patients at T0. Sensitivity to change was subsequently calculated by comparing the SAQ score between T1 and T0 overall and for different subgroups of treatment. Effect sizes (to T1) were calculated according to Cohen's method. The minimally important difference was estimated by a step-wise triangulation approach (including anchor-based method). MAIN RESULTS AND THE ROLE OF CHANCE: In total, 267 sexually active patients (204 surgical and 63 medical treatment) completed the SAQ at T0 and 136 (50.9%) at T1. The SAQ score ranged from 2.0 to 28.0 (mean ± SD: 16.8 ± 5.7).The SAQ score was one-dimensional according to the scree plot with good internal consistency (Cronbach alpha = 0.78, 95% CI 0.74-0.81) and had good discriminative ability according to pain descriptors and quality of life in endometriosis. The SAQ was responsive in patients treated by surgery but the effect size was low (0.3, 95% CI (0.0-0.6), P = 0.01). The minimally important difference was determined at 2.2. LIMITATIONS, REASONS FOR CAUTION: The effect size for medical treatment was non-significant. Other effect sizes were low but statistically significant. This could be explained by lower libido due to progestin intake, which was used for both surgically and medically treated patients. WIDER IMPLICATIONS OF THE FINDINGS: The SAQ is easy to use, valid and effective in assessing sexual quality of life in patients with endometriosis. This patient-reported score could be used as a primary outcome for future clinical studies. The minimally important difference estimation will be useful for future research. We recommend using 2.2 for the minimally important difference of the SAQ. STUDY FUNDING/COMPETING INTEREST(S): This work was funded by the 'Direction à la Recherche Clinique et à l'Innovation' of Versailles, France and the 'Institut de Recherche en Santé de la Femme' (IRSF). The authors have no conflicts of interest to declare.

The French PROMIS-29. Psychometric validation and population reference values.

BACKGROUND: PROMIS-29 is a new generic standardized questionnaire measuring self-reported health status. It was developed as part of the Patient Reported Outcome Measurement Information System (PROMIS) in the United States. The objective of this study was to carry out the psychometric validation of a French-language version of PROMIS-29 and to establish general population reference values for France. METHODS: Quota sampling was conducted by an independent polling company (Ipsos) to obtain a general population sample (n=1,501) representative with regards to: gender, age, occupation, region, and population density of the place of residence. Data collected included the results of the questionnaires PROMIS-29 and Short Form Health Survey (SF-36), the presence of selected chronic diseases, and socio-demographic information. RESULTS: The French PROMIS-29 demonstrated excellent factorial validity, confirming the 7-factor model of the original PROMIS-29. The use of modern measurement methods indicated that the PROMIS-29 scales satisfy the important characteristics of unidimensionality and, for five of the seven composite scales, invariance across age, educational level and gender. Gender and age specific (10-year intervals) reference values were generated for PROMIS-29 use in France. CONCLUSION: The French version of PROMIS-29 is a valid and reliable measure of self-reported health status in the French population. The instrument's sensitivity to change needs to be evaluated before its use in longitudinal studies can be recommended.

Acute pain Factors predictive of post-operative pain and opioid requirement in multimodal analgesia following knee replacement.

BACKGROUND: Despite the development of multimodal analgesia for postoperative pain management, opioids are still required for effective pain relief after knee arthroplasty. We aimed to identify the determinants of post-operative pain intensity and post-operative opioid requirement in this context. METHODS: In this observational prospective study, we recorded patient characteristics, pre-operative pain intensity, anxiety and depression levels, sensitivity and pain thresholds in response to an electrical stimulus, and mu-opioid receptor (OPRM1) and catechol-O-methyltransferase (COMT) single-nucleotide polymorphisms. Multivariate linear regression models were used to identify predictors of post-operative pain at rest and opioid requirement. RESULTS: We included 109 patients. Pre-operative pain at rest (p = 0.047), anxiety level (p = 0.001) and neuropathic pain symptoms (p = 0.030) were independently and positively associated with mean post-operative pain intensity adjusted for mean post-operative morphine equivalent dose (MED). Mean post-operative pain intensity at rest was lower (p = 0.006) in patients receiving celecoxib and pregabalin in the post-operative period, with all other variables constant. Mean post-operative MED over 5 days was low, but highly variable (78.2 ± 32.1 mg, from 9.9 to 170 mg). Following adjustment for mean post-operative pain intensity, it was independently negatively correlated with age (p = 0.004), and positively correlated with associated paracetamol treatment (p = 0.031). No genetic effect was detected in our sample. CONCLUSIONS: Our findings suggest that clinicians could use the pre-operative pain profile, in terms of anxiety levels, neuropathic pain symptoms, and chronic pre-operative pain intensity, to improve the efficacy of pain management after knee surgery.

Flow cytometric detection of dyserythropoiesis: a sensitive and powerful diagnostic tool for myelodysplastic syndromes.

Several groups have published flow cytometry scores useful for the diagnosis or prognosis of myelodysplastic syndromes (MDS), mainly based on the detection of immunophenotypic abnormalities in the maturation of granulocytic/monocytic and lymphoid lineages. As anemia is the most frequent symptom of early MDS, the aim of this study was to identify markers of dyserythropoiesis relevant for the diagnosis of MDS analyzed by selecting erythroblasts in a whole no-lysis bone marrow strategy by using a nuclear dye. This prospective study included 163 patients, including 126 with cytopenias leading to MDS suspicion and 46 controls without MDS. In a learning cohort of 53 unequivocal MDS with specific markers, there was a significant difference between the coefficients of variation of mean fluorescence intensities of CD71 and CD36 in MDS patients compared with controls. These two parameters and the hemoglobin level were used to build a RED-score strongly suggestive of MDS if ≥ 3. Using the RED-score in the whole cohort, 80% of MDS or non-MDS patients were correctly classified. When combined with the flow score described by Ogata et al., this strategy allowed to reach a very high sensitivity of 88% of patients correctly classified.

[Winter surveillance of cold exposure effects on health among the homeless population in the Paris area: data from the Coordinated Health Surveillance of Emergency Department network (Organisation de la surveillance coordonnée des urgences [Oscour(®)])]. / Surveillance hivernale des effets du froid sur la santé des populations sans-domicile en région Île-de-France : utilisation des données du réseau d'Organisation de la surveillance coordonnée des urgences (Oscour(®)).

BACKGROUND: A program for helping homeless individuals in winter is implemented from November 1(st) to March 31(st) each year in France. Its aim is to prevent morbidity and mortality in this population during cold spells and periods of severe cold. A health surveillance system of the homeless population in the Paris area has been proposed to evaluate the effectiveness of the program and to alert decision-makers if an unusual increase in cold-weather effects is observed. The goal of this study was the creation of an indicator for the proposed surveillance system based on emergency department activity in the Paris area (Oscour(®) Network - Organisation de la surveillance coordonnée des urgences). METHODS: The winter 2007-2008 computer medical files of 11 emergency departments in the Paris area were examined to confirm diagnosis and ascertain patient-homelessness for each patient visit which was selected from the Oscour(®) database by the patient chief-complaint or diagnosis code referring to hypothermia or frostbites. The proposed indicator is based on the maximization of three criteria: the positive predictive value, the proportion of people identified as being homeless and the number of emergency department visits. A Shewhart control chart was applied to the indicator for the four winters between 2005 and 2009 in the Paris area. Values beyond the statistical threshold would indicate a need for an adjustment to the program strategy. RESULTS: Two hundred and sixteen medical files were analyzed. An indicator was created, "number of emergency department visits of 15 to 69-years-old persons with chief-complaint or diagnosis code referring to hypothermia". It had a positive predictive value estimated near 85 % and identified 61.7 % people as being homeless. In the winter of 2008-2009, the statistical threshold was reached in December during the first cold spell, and again at the beginning of January during a period of severe cold. CONCLUSION: Our results support the use of this health indicator, alongside social indicators, for optimizing the strategy for helping the homeless population during winter.

[Body composition analysis in patients with cystic fibrosis. Comparison of 3 methods: dual energy x-ray absorptiometry, bioelectrical impedance analysis, and skinfold measurements]. / Composition corporelle des patients mucoviscidosiques - comparaison de 3 techniques de mesure : anthropométrie, absorptiométrie biphotonique et impédancemétrie.

Nutritional status must be closely monitored in cystic fibrosis (CF) patients. This study compared three methods of measuring body composition in CF patients and then examined the relationships between two simple anthropometric markers of nutritional status - tricipital skinfold thickness (TSK) and arm muscular circumference (AMC) - and the results given by each method. Fifty-five patients with CF, 27 females and 28 males, participated in this study. The mean age at the time of the study was 14 ± 5 years, ranging from 4 to 29 years. The four skinfolds (SK) and arm circumference were measured in all patients and fat mass (FM) and AMC were calculated. Fifty patients underwent dual energy x-ray absorptiometry (DEXA) and 38 underwent bioelectrical impedance analysis (BIA). The values for FM as calculated by the three methods were highly correlated, as were the values for lean body mass (LM) (p<0.001). The LM assessed by anthropometry was overestimated by 8 ± 4% compared with DEXA and by 6 ± 7% compared with BIA. BIA overestimated LM by 4 ± 6% compared with DEXA (p<0.001). The LM values measured by SK, DEXA, and BIA were highly correlated with AMC (p<0.001) and FM calculated using these three techniques were highly correlated with TSK (p<0.001). The measurement of TSK and AMC are simple and rapid ways to evaluate body composition. The excellent correlation between the three methods used to measure body composition suggests that they are valid for use in patients with CF, but the results were not identical. The measurement from each technique must be interpreted according to its own norms and comparisons can only be made if the same technique is used in the same patient.

Clinical significance of anti-Ro52 (TRIM21) antibodies non-associated with anti-SSA 60kDa antibodies: results of a multicentric study.

Ro52 antigen has recently been identified as TRIM21 protein, but the clinical significance of anti-Ro52/TRIM21 antibodies remains controversial. The aim of this multicentric study was to investigate the significance of anti-Ro52 antibodies without anti-SSA/Ro60 antibodies in various connective diseases. Sera were selected by each laboratory using its own method (ELISA, immunodot or Luminex technology), and then performed with ANA Screen BioPlex™ reagent (BIO-RAD). Among the 247 screened sera, 155/247 (63%) were confirmed as anti-Ro52 positive and anti-SSA/Ro60 negative. These sera were analyzed for the detection of other antibodies in relation with clinical settings. Isolated anti-Ro52 antibodies were detected in 89/155 (57%) sera. For the remaining sera (66/155), the main antibodies associations were Sm/SmRNP or Chromatin (n=38; 57%), Jo1 (n=17; 26%) and CenpB (n=9; 14%). Clinical data from the 155 patients showed high prevalence in autoimmune diseases (73%) including myositis or dermatomyositis (n=30), lupus (n=23); Sjögren and/or sicca syndrome (n=27); CREST or Systemic sclerosis (n=11) and autoimmune hepatitis (n=11). We found that pulmonary manifestations were often associated with the presence of anti-Ro52 antibodies (n=34, 22%), in addition with anti-tRNA synthetases, anti-SRP or anti-Ku antibodies (18/34) or isolated in half of cases (16/34). Separate detection of anti-Ro52 antibodies might be useful in related antisynthetase syndrome diagnosis. The presence of anti-Ro52 antibodies should probably precede development of autoimmune disease and must induce sequential follow-up of positive patients, particularly in interstitial lung disease progression.

[Impact of exhaled CO measurement. A randomised study among 578 smoking patients in general practice]. / Evaluation de l'impact de la mesure du monoxyde de carbone (CO) dans l'air expiré. Etude randomisée effectuée auprès de 578 fumeurs consultant en médecine générale.

UNLABELLED: Nicotine addiction (NA) is a serious public health problem and helping patients to stop consumption is a major concern for general practitioners (GP). The positive effects of "brief advice" are well known. The aim of our paper is to evaluate the effectiveness of adding exhaled carbon monoxide (CO) measurement using a CO analyser to a normal smoking cessation practice in a GP's office. METHODS: This was a descriptive study, using a questionnaire, among randomised smoking patients; one group receiving brief advice and the other brief advice plus exhaled CO analysis in their GP's office. RESULTS: Five hundred and seventy-eight questionnaires were analysed: 60% of smoking patients wished to stop smoking and 72% within the next 6 months, without significant difference between the two groups. In the group "minimal advice plus CO analyser" (282), 60% of the smokers reported that they had been influenced by the results of the level of CO in the exhaled air and were more motivated to quit because of this. CONCLUSION: Measuring the level of exhaled CO in smokers helps to inform them of the dangers of their addiction and helps to motivate them to quit.

[Teenagers' views and needs on sexual and emotional education. Survey among 15- to 16-year-old boys and girls]. / Connaissances, besoins et attentes des adolescents en éducation sexuelle et affective. Etude réalisée auprès d'adolescents de classes de troisième.

AIMS: Teenagers have very particular needs and their healthcare must be adapted to these needs. Despite all the modern means of communication and education, problems related to sex and sexuality have an effect on their well-being. Sex education has improved in the last 40 years, but what is today's situation? METHODOLOGY: In the Maine-et-Loire region of France, approximately 100 15- to 16-year-olds responded to a questionnaire, giving their views on the nature and quality of the sexual and emotional education they received. RESULTS: It appears that it falls very short of the legal requirements and that it is often inappropriate to the needs of young people. To improve sexual prevention, it is necessary to start early to provide sexual and emotional education and to increase the opportunities and the diversity of speakers presenting themes of importance to young people. The speaker should preferably be young and use lively means of communication and role-plays to normalize sex education. CONCLUSION: The most important aspects are respecting this young population as well as opening and maintaining communication with them, which will help them make better choices toward a better future. Promoting sex education is part of a global approach to healthy lifestyles and requires a national strategy, cooperation between the interested parties, and an adequate budget.

[Pregnant women and smoking: descriptive study and prognostic factors to stop smoking during pregnancy]. / Le tabagisme gravidique. Etude descriptive et facteurs pronostiques d'arrêt du tabac pendant la grossesse.

UNLABELLED: Nicotine addiction (NA) is a serious public health problem. Today, smoking effects on the foetus and the mother are well known; however, studies into smoker's behaviour are lacking. The aim of our paper was to identify factors which influence either NA stopping or continuation during pregnancy. METHODS: It's a descriptive study, using a questionnaire, among pregnant women during prenatal consultation in a university hospital, at home with freelance mid-wives or in mother and infant welfare services (PMI). RESULTS: Two hundred and forty-one questionnaires were analysed. Smoker's behaviour, psycho-environmental factors, co-addictions, were described and compared. One out of four women was smoking during pregnancy and one out of ten was smoking more than 10cigarettes per day. One out of three women who were smokers before pregnancy, stated that they had stopped NA during the year. Only 58/241 readings of exhaled carbon monoxide were performed, which reflects hesitation of medical staff to employ this device. Forty seven women indicated the number of alcohol glasses consumed during pregnancy. The study showed that partner's attitude towards smoking, good or bad mood during pregnancy, number of cigarettes smoked before pregnancy and medical information would appear to be significant factors that influence NA stopping during pregnancy. CONCLUSION: The identification of prognostic factors for NA stopping is of primordial importance, especially among heavy smokers, in order to target the actions necessary to help NA stopping.

Evaluation of the LIAISON ANA screen assay for antinuclear antibody testing in autoimmune diseases.

Antinuclear antibodies (ANA) are widely detected by immunofluorescence on HEp-2 cells in patients with connective tissue diseases and other pathological conditions. We evaluated the first-automated chemiluminescence immunoassay for the detection of ANA (LIAISON ANA screen, DiaSorin). This study was carried out simultaneously in two laboratories by testing 327 patient samples with clinically defined connective diseases, 273 routine samples for ANA screening, and 300 blood donors. A total of 268 out of 337 IIF-positive sera were positive with LIAISON ANA screen (79.5% of agreement) and 240 out of 263 IIF-negative sera were negative with LIAISON ANA screen (91.2% of agreement). After resolution of discrepant results, the concordance reached, respectively, 94.9% and 98.8%. The specificity was 99.3% and the sensitivity was 94%. Unlike results obtained by other ANA screening assays, we observed acceptable sensitivity and specificity. Despite the presence of HEp-2 cell extract, we failed to detect some antibodies as antinucleolar, antinuclear envelope, and antiproliferating cell nuclear antigen. This automated assay allows quick process to results and exhibits satisfactory sensitivity for the detection of the main ANA specificities of connective tissue diseases.

Detection of antibodies to dsDNA: an overview of laboratory assays.

This brief review is focused on different methodologies available for detection of anti-dsDNA antibodies with respect to the best adequacy between biological results of laboratory and clinical significance. A large array of assays has been developed for the measurement of anti-dsDNA. New assays continually introduced have reflected not only technical innovations to avoid difficulties of some assays, but even more with hope to correlate better with systemic lupus erythematosus (SLE), particularly with its clinical course and exacerbations. Finally, with the development of micro arrays technology new insights into the pathophysiology of autoimmune disease processes should be revealed.

[Chronic urticaria, thyroiditis and autologous serum test]. / Urticaire chronique, thyroïdite auto-immune et test au sérum autologue.

INTRODUCTION: The autoimmune nature of certain forms of chronic urticaria remains debatable. Aim of the study. To find a correlation in terms of autoimmune pattern between chronic urticaria and thyroiditis using the autologous serum test and the search for anti-thyroid antibodies. PATIENTS AND METHODS: Study in a single center of 59 patients having consulted for urticaria that had progressed for more than six weeks and without precise etiology. An autologous serum test was conducted and anti-thyroid autoantibodies were searched for in the serum stored after the test. RESULTS: Out of 59 patients, 51 had an interpretable autologous serum test and 57 underwent research for anti-thyroid antibodies. Twelve patients out 57 (21 p.cent) exhibited one or more types of positive (n=10) or borderline (n=2) anti-thyroid antibodies, and eight out of 12 (66.6 p.cent) had a known thyroid disease before the onset of urticaria. The systematic blood test permitted the discovery of 4 cases of unknown anti-thyroid antibodies. The symptoms regressed in two of these patients without any specific treatment, one patient was treated with L thyroxin for hyperthyroidism without any improvement in the symptoms and one other patient had normal thyroid function. Among these 12 patients, 11 underwent autologous serum tests, but only 3 of them exhibited clearly positive results and one was doubtful. CONCLUSIONS: Within the limits of this study, we found a 21 p.cent rate of patients with chronic urticaria exhibiting one or more anti-thyroid antibodies. The positivity of the autologous serum test does not appear to be related with autoimmune thyroid disorders.

[Hashimoto's thyroiditis and silicone breast implants: 2 cases]. / Thyroïdite de hashimoto et prothèses mammaires en silicone: 2 observations.

The silicone implant controversy wavers between reassuring epidemiological studies and about 300 case reports of patients developing a definite or incomplete/atypical connective tissue disease (CTD) after receiving a silicone gel-filled breast implant (SBI). Since Hashimoto's thyroiditis (HT) is rarely reported in this context, we report here two new cases of HT associated with a history of bilateral cosmetic SBIs. The first patient was a 45-year-old white woman who had SBIs in 1976. In 1991 she developed HT, evolving to thyroid deficiency which was compensated with levothyroxine treatment. In addition, the patient complained of fatigue, arthralgia, morning stiffness and developed a sicca syndrome necessitating artificial tears. The 1995 evaluation disclosed the presence of antinuclear antibodies at a titre of 1/640, and high level anti-thyroid microsomal antibodies (1/256,000). Gamma globulins rose to 22.6%. Thyroid ultrasonography showed an enlarged thyroid gland with a diffusely hypoechogenic pattern. The implants were painful, and in 1996 they were removed. Microscope examination of the fibrous capsule surrounding the prostheses showed extremely dense connective tissue with fibrosis. The second patient was a 55-year-old white woman who had SBIs in 1984. In 1995, she developed HT with clinical pain and tenderness of the thyroid gland, with mild hyperthyroidism and positive antithyroglobulin antibodies, and was given corticosteroid treatment for 5 months. In 1996, the implants were again painful and the patient developed positive antinuclear antibodies with a titre of 1/200. Ultrasonography showed a heterogeneous thyroid gland, and implant removal was advised. Hashimoto's thyroiditis is recognized as a subset of chronic auto-immune thyroiditis, and its association with SBI is rare. In these 2 observations, an association without relation is possible, but a future survey of similar cases seems warranted.

Autoantibodies to phospholipids and to the coagulation proteins in AIDS.

In HIV-1 infection, an increased prevalence of anticardiolipin autoantibodies (aCL) and lupus anticoagulant (LA) has been described. In order to see if these antibodies are isolated or, like in autoimmune diseases, associated with hematological disorders and with antibodies to other phospholipids and to proteins of coagulation, we investigated 3 groups of patients: 1. 342 HIV-1 infected patients, 2. 145 control patients including 61 systemic lupus erythematosus (SLE) patients, 58 patients with a connective tissue disease, 15 patients with stroke, 11 patients with syphilis and 3. 100 blood donors. In HIV-1 infection antiprothrombin (aPrT) antibodies were present in 2% of patients, the prevalence of antiphosphatidylcholine antibodies (aPC) (50%) was almost as high as aCL (64%), and 39% had both antibodies. Absorption on liposomes of the latter revealed an heterogeneous mixture of aCL and aPC or cross-reacting antibodies. In contrast with SLE, anti-beta 2-glycoprotein I (4%), LA (1%), biological false positive test for syphilis (0.3%), thrombosis (p < 0.001) were uncommon. In HIV-1 infection, antiphospholipid antibodies do not associated with features linked to them in SLE or syphilis.

Advantage of using both anionic and zwitterionic phospholipid antigens for the detection of antiphospholipid antibodies.

To investigate the benefit of assaying for antiphospholipid antibodies (aPA) with different antigenic specificities, sera from 141 patients suspected of having aPA were tested by ELISA for IgG and IgM antibodies directed against the following phospholipids (PL) coated individually or together: cardiolipin, phosphatidylinositol, phosphatidylserine and phosphatidylethanolamine. Nonspecific background optical density (OD) was systematically subtracted from the test OD value. Positive reactions were defined as having an OD greater than the 97th percentile OD distribution obtained with sera from 100 healthy individuals. Although the majority of the 79 detected aPA (89% IgG and 77% IgM) were polyspecific, 11 reacted with a single PL and, moreover, belonged to only one isotype. Seven of these 11 patients presented recurrent fetal losses or thrombotic events. These results suggest that routine use of a mixture of both anionic and zwitterionic PL antigens to coat ELISA plates would better detect aPA involved in suggestive pathologies and enhance the ability to identify patients with these mono- or polyspecific antibodies directed or not against cardiolipin, the current standard.