[Propositions for the standardized expression of HbA 1c results]. / Propositions pour l'expression standardisée des résultats d'HbA 1c.

The 2007 international consensus about the standardization of HbA(1c) determination and expression of results is progressively implemented in most countries. In France, a common working group of the Société française de biologie clinique (SFBC) and the Société francophone de diabétologie (SFD) has expressed the following recommendations. HbA(1c) results are expressed in percentage of total hemoglobin and in mmol HbA(1c)/mol Hb, but are not converted into estimated average glucose. A table indicating the correspondence between HbA(1c) and estimated average glucose may be given with the results, subject to precautions of interpretation at the individual level.

Episodic neonatal hypoxia evokes executive dysfunction and regionally specific alterations in markers of dopamine signaling.

Perinatal ischemic-anoxic and prolonged anoxic insults lead to impaired dopaminergic signaling and are hypothesized to contribute, at least in part, to the pathogenesis of disorders of minimal brain dysfunction such as attention-deficit hyperactivity disorder. We hypothesized that subtle intermittent hypoxic insults, occurring during a period of critical brain development, are also pathogenic to dopaminergic signaling, thereby contributing to behavioral and executive dysfunction. Between postnatal days 7 and 11, rat pups were exposed to either 20-s bursts of isocapnic hypoxic gas, compressed air, or were left undisturbed with the dam. On postnatal days 23 pups were instrumented with electroencephalographic/electromyographic electrodes and sleep-wake architecture was characterized. Locomotor activity was assessed between postnatal days 35 and 38, learning, and working memory evaluated between postnatal days 53 and 64. Rats were killed on postnatal day 80 and tyrosine hydroxylase, vesicular monoamine transporter, dopamine transporter, and dopamine D1 receptors were quantified in the prefrontal cortex, primary sensorimotor cortex, and precommissural striatum by Western blot analyses. Post-hypoxic pups spent less time awake and more time in rapid-eye-movement sleep during the lights-on phase of the circadian cycle, were hyperlocomotive, and expressed impaired working memory. Striatal expression of vesicular monoamine transporter and D1 receptor proteins were increased in post-hypoxic rats, consistent with depressed dopaminergic signaling. These observations lead to the intriguing hypothesis that intermittent hypoxia occurring during a period of critical brain development evokes behavioral and neurochemical alterations that are long lasting, and consistent with disorders of minimal brain dysfunction.

The beta G156C substitution in the F1-ATPase from the thermophilic Bacillus PS3 affects catalytic site cooperativity by destabilizing the closed conformation of the catalytic site.

Fluorescence titrations of the alpha(3)(betaG(156)C/Y(345)W)(3)gamma, alpha(3)(betaE(199)V/Y(345)W)(3)gamma, and alpha(3)(betaY(345)W)(3)gamma subcomplexes of TF(1) with nucleotides show that the betaG(156)C substitution substantially lowers the affinity of catalytic sites for ATP and ADP with or without Mg(2+), whereas the betaE(199)V substitution increases the affinity of catalytic sites for nucleotides. Whereas the alpha(3)(betaG(156)C)(3)gamma and alpha(3)(betaE(199)V)(3)gamma subcomplexes hydrolyze 2 mM ATP at 2% and 0.7%, respectively, of the rate exhibited by the wild-type enzyme, the alpha(3)(betaG(156)C/E(199)V)(3)gamma hydrolyzes 2 mM ATP at 9% the rate exhibited by the wild-type enzyme. The alpha(3)(betaG(156)C)(3)gamma, alpha(3)(betaG(156)C/E(199)V)(3)gamma, and alpha(3)(betaG(156)C/E(199)V/Y(345)W)(3)gamma subcomplexes resist entrapment of inhibitory MgADP in a catalytic site during turnover. Product [(3)H]ADP remains tightly bound to a single catalytic site when the wild-type, betaE(199)V, betaY(345)W, and betaE(199)V/Y(345)W subcomplexes hydrolyze substoichiometric [(3)H]ATP, whereas it is not retained by the betaG(156)C and betaG(156)C/Y(345)W subcomplexes. Less firmly bound, product [(3)H]ADP is retained when the betaG(156)C/E(199)V and betaG(156)C/E(199)V/Y(345)W mutants hydrolyze substoichiometric [(3)H]ATP. The Lineweaver-Burk plot obtained with the betaG(156)C mutant is curved downward in a manner indicating that its catalytic sites act independently during ATP hydrolysis. In contrast, the betaG(156)C/E(199)V and betaG(156)C/E(199)V/Y(345)W mutants hydrolyze ATP with linear Lineweaver-Burk plots, indicating cooperative trisite catalysis. It appears that the betaG(156)C substitution destabilizes the closed conformation of a catalytic site hydrolyzing MgATP in a manner that allows release of products in the absence of catalytic site cooperativity. Insertion of the betaE(199)V substitution into the betaG(156)C mutant restores cooperativity by restricting opening of the catalytic site hydrolyzing MgATP for product release until an open catalytic site binds MgATP.

[Hemoglobin A1C determination and hemoglobinopathies: problems and strategies]. / Dosage de l'hémoglobine A(1c) et hémoglobinopathies: problèmes posés et conduite à tenir.

The semiological value of hemoglobin A1c (HbA1c) as a retrospective and cumulative marker of glycemic balance in diabetic patients is greatly weakened in case of hemoglobinopathy. The presence of an abnormal hemoglobin raises methodological problems due to the interferences generated in most assay methods, but also alters the normal process of HbA glycation to HbA1c, and often induces a certain level of hemolysis, very variable and impossible to quantify. This paper reviews methodological and semiological problems related to the presence of abnormal hemoglobin species, and proposes a standardized strategy in case of hemoglobinopathies.

[Considerations on delocalized HbA1c assays]. / Réflexions sur les dosages délocalisés d'hémoglobine A1C.

Availability and knowledge of HbA(1c) value during consultation is an important feature for diabetologists, that permits a better adaptation of therapy and a better motivation of patients. This expectation explains the request for delocalized assays of HbA(1c), even though life prognosis is not affected, like in the other cases of point of care testing. One of the most frequent solutions is the use of immunological delocalized HbA(1c) assays. Technically, these methods have to meet the same criteria as those used in laboratories. They have to be standardized, and controlled according to the "Guide de Bonne Exécution des Analyses de Biologie Médicale" (GBEA) rules. Solutions chosen for delocalization must respect specific skills of clinicians and biologists and cope with cost limitations. This paper reviews rationales for delocalized HbA(1c) assays, steps of their implementation, and their use in practical routine, with a special emphasis given on the necessary complementarity between clinicians and biologists.

HBA1c: clinical and biological agreement for standardization of assay methods. Report by the experts of ALFEDIAM (Association de Langue Française pour lEtude du Diabète et des Maladies Métabolique) and SFBC (Société Française de Biologie Clinique). / HbA1c: concertation clinico-biologique pour la standardisation des méthodes de dosage. Rapport des experts de l'ALFEDIAM et de la SFBC.

Glycohaemoglobin, and particularly haemoglobin A1c(HbA1c), assays have been used for many years to retrospectively evaluate the glycaemic control of diabetic patients. Cut-off values have been established for deciding treatment modifications. The techniques used in the laboratories however exhibit varying quality, and all of them are not yet standardized. The consequence is an under-utilization of this test, especially in non-hospital practice. In this context, working groups of Société Française de Biologie Clinique (SFBC), Association de Langue Française pour l'Etude du Diabète et des Maladies Métaboliques (ALFEDIAM) and Société Française d'Endocrinologie (SFE) have met together, in order to analyze the national status, and to propose practical recommendations for implementing a standardization process on the basis of international experiences. It is recommended to exclusively express results as HbA1c percentage, using methods standardized and certified by comparison to reference methods such as those using Diabetes Control and Complications Trial (DCCT) values. Simultaneously, contacts have been established with manufacturers, and the realisation of periodic quality control surveys was encouraged.

[Assay of cardiac troponin T on Elecsys 2010: comparison with cardiac troponin I]. / Dosage de la troponine T cardiaque sur l'automate Elecsys 2010: comparison avec la troponine I cardiaque.

Cardiac troponin T (troponin Tc) of second generation has been measured on the Boehringer Elecsys 2010 analyzer. Cardiac specificity has been studied in patients presenting a rhabdomyolysis syndrome and the results compared with those obtained for cardiac troponin I (troponin Ic) measured on the Dade-Behring Stratus analyzer. The results clearly demonstrated that both troponin Tc and Ic showed similar cardiac specificity. Moreover, troponin Tc and troponin Ic can be indifferently used for the biological diagnostic of myocardial infarction or to asses reperfusion after percutaneous transluminal coronary angioplasty for acute myocardial infarction. In renal disease, troponin Tc was upper the reference limit (0.10 microgram/l) in 25% of the patients studied (20 patients). By contrast, troponin Ic was upper the reference limit (0.6 microgram/l) in only one patient.

[Determination of cardiac troponin I on Stratus analyzer: prospective evaluation in unstable angina]. / Dosage de la troponine I cardiaque sur l'automate Stratus: évaluation prospective dans I'angor instable.

Cardiac troponin I (troponin lc) has been measured on the Dade Stratus analyzer. Cardiac specificity has been studied in patients presenting a rhabdomyolysis syndrome. The obtained results clearly demonstrated that this parameter may be used as a specific marker of myocardial injury, in contrast to total creatine kinase- or mass CK-MB measurements. In unstable angina, two groups of patients may be defined: one group with elevated troponin lc (> 0.60 microgram/L; 31 patients, group I), one other with normal troponin lc (< 0.35 microgram/L; 49 patients; group II). Quantitative angiographic analysis was performed on 50 patients including 18 patients from group I. Group I showed a more severe culprit lesion than group II. All the results suggested that troponin Ic might be an indicator of severity in unstable angina.

Protein binding of digitoxin, valproate and phenytoin in sera from diabetics.

Chronic hyperglycaemia results in glycation of serum albumin and might affect the binding of drugs. The aim of the present study was to compare, using an equilibrium dialysis method, the protein binding of therapeutic concentrations digitoxin, valproate and phenytoin in sera from 70 insulin-dependent diabetics and 25 controls. Drug concentrations were measured by fluorescence immunopolarisation. Glycated albumin was measured by laser nephelometry after affinity chromatography. In sera from diabetics, protein binding of digitoxin (88.8 versus 89.9%) was unchanged; the protein binding of valproate (75.2 versus 80.7%) and phenytoin (67.9 versus 75.3%) was significantly decreased, but with no correlation with the concentration of glycated albumin. We conclude that the difference in protein binding between diabetic and control sera is due to glucose-independent modification of albumin in diabetics.

[Hereditary hyperoxaluria or oxalosis. Apropos of a case]. / L'hyperoxalurie héréditaire ou oxalose. A propos d'un cas.

We report a case of primary oxalosis in a 12-year old girl. This unusual observation exemplifies two diagnostic pitfalls, i.e. false urinary tract infections and technical difficulties in accurately measuring oxalate urinary excretion. On the basis of this case and a review of the literature, we discuss diagnostic and therapeutic methods. Early diagnosis of the disease is important in order to monitor the patient and provide genetic counseling.

[High-density lipoproteins, total cholesterol, triglycerides and serum trypsin activity. Study in chronic alcoholic and withdrawn subjects]. / Lipoprotéines de haute densité, cholestérol total, triglycérides et activité trypsique sérique. Etude chez l'homme alcoolisé chronique et sevré d'alcool.

Apolipoprotein is controlled by proteolytic processus and serum trypsin-like activity (STA) may be elevated in some chronic alcoholic subjects. STA, apoA lipoprotein, HDL-cholesterol, total cholesterol and triglycerides were tested in 44 men dealt in 4 groups (subjects with normal or elevated STA, alcoholic or withdrawn). Significantly lower apoA lipoprotein (p less than 0,02) and HDL-cholesterol (p less than 0,001) levels as well as significantly higher triglyceride levels (p less than 0,01) were evidenced in the group with elevated STA compared to the group with normal STA. In another way, a negative correlation between HDL-cholesterol and STA (p less than 0,01) and a positive correlation between triglycerides and STA (p less than 0,001) were noted. The different factors known to modify these lipidic parameters cannot account for such disturbances. The role of elevated STA is evoked.