[Follow-up and evaluation of plans developed during pulmonary rehabilitation]. / Suivi et évaluation sur une année de projets élaborés en réhabilitation respiratoire.

BACKGROUND: Pulmonary rehabilitation inevitably contains two essential components: therapeutic education and exercise training. The principal aim of this study was to evaluate the evolution over a year of the realization of plans determined during a pulmonary rehabilitation program (PRP). METHODS: At the end of a PRP the patient made plans in accordance with his health condition. A telephone enquiry was undertaken at 3, 7 and 12 months to evaluate the progress of the plans, the motivation to perform them, dyspnoea and quality of life. RESULTS: The data of 65 patients were analyzed (87 inclusions). Fifty-seven percent of the plans continued for one year. Walking had an adherence rating of 71%. Loss of motivation appeared to be the main cause for stopping (20%). Quality of life remained stable (p=0.39) and an increase in dyspnoea, though statistically significant (p<0.01), was of no clinical relevance. CONCLUSION: The majority of plans were maintained but without clinical effect on the quality of life or the level of dyspnoea. Decreased motivation was the major limitation to realization or continuation of the plans. New studies will have to be implemented to analyze the factors which lead to this decrease.

[Reproducibility of strength and endurance measurements of the quadriceps in patients with COPD]. / Reproductibilité de la mesure de la force et de l'endurance du quadriceps dans la BPCO.

INTRODUCTION: Patients with COPD frequently have lower strength and endurance in their lower limbs compared to healthy subjects and evaluation of their quadriceps strength is recommended in practice. The handheld dynamometer has been validated and is easy to use for this measurement but its reproducibility has never been studied for endurance evaluation and only poorly for strength. The objective of this study was to estimate the inter and intra-operator reproducibility of maximal voluntary strength and endurance measurements of the quadriceps with a handheld dynamometer in patients with COPD. METHODS: The measurements of maximal voluntary strength and endurance were performed with a single handheld dynamometer using isometric contraction. Three measurement sessions were undertaken, separated by 24hours. The intra- and interoperator reproducibility were estimated by calculation of the intraclass correlation coefficient. RESULTS: Overall, 21 patients were included in the study. The intraclass correlation coefficient calculated for the maximal voluntary strength for intra and interoperator reliability ranged between 0.95 and 0.99. For endurance, the coefficient for intra-operator reliability was 0.81 and the two for interoperator reliability were 0.69 and 0.77. CONCLUSION: The handheld dynamometer allows an excellent inter and intra-operator reproducibility for the measurement of quadricipital maximal voluntary strength and a correct to excellent reproducibility for the measurement of quadricipital endurance. This tool may be used for the evaluation of quadriceps strength in clinical practice in COPD patients, particularly during rehabilitation.

Inspiratory muscle training during pulmonary rehabilitation in chronic obstructive pulmonary disease: A randomized trial.

Although recommended by international guidelines, the benefit of inspiratory muscle training (IMT) in addition to rehabilitation remains uncertain. The objective was to demonstrate the effectiveness of IMT on dyspnea using Borg scale and multidimensional dyspnea profile questionnaire at the end of a 6-minute walk test (6MWT) in patients with chronic obstructive pulmonary disease (COPD) with preserved average maximum inspiratory pressure (PImax) of 85 cm H2O (95% of predicted (pred.) value) and admitted for a rehabilitation program in a dedicated center. In a randomized trial, comparing IMT versus no IMT in 32 COPD patients without inspiratory muscle weakness (PImax >60 cm H2O) who were admitted for pulmonary rehabilitation (PR) for 3 weeks, we evaluated the effect of IMT on dyspnea, using both Borg scale and multidimensional dyspnea profile (MDP) at the end of the 6MWT, and on functional parameters included inspiratory muscle function (PImax) and 6MWT. All testings were performed at the start and the end of PR. In unadjusted analysis, IMT was not found to be associated with an improvement of either dyspnea or PImax. After adjustment on confounders (initial Borg score) and variables of interaction (forced expiratory volume in 1 second (FEV1)), we found a trend toward an improvement of "dyspnea sensory intensity", items from MDP and a significant improvement on the variation in the 2 items of MDP ("tight or constricted" and "breathing a lot"). In the subgroup of patients with FEV1 < 50% pred., 5 items of MDP were significantly improved, whereas no benefit was observed in patients with FEV1 > 50% pred. IMT did not significantly improve dyspnea or functional parameter in COPD patients with PImax > 60 cm H2O. However, in the subgroup of patients with FEV1 < 50% pred., MDP was significantly improved.

[The effects of a pulmonary rehabilitation program in relation to the severity of COPD]. / Effets d'un programme de réhabilitation respiratoire selon la sévérité de la BPCO.

INTRODUCTION: The aim of this study is to assess the effects of in-patient pulmonary rehabilitation in relation to the stages of COPD according to GOLD and the BODE index. METHOD: A prospective cohort study over 4 weeks. The 6-minute walk test, the relationship dyspnoea (EVA)/walking distance, dyspnoea (MRC scale), the Saint-George's respiratory questionnaire and the BODE index were estimated at the beginning and end of a pulmonary rehabilitation programme. RESULTS: Fifty patients with COPD were included, distributed according to GOLD (II: 30%; III: 32%; IV: 38%) and BODE (quartile 1: 22%; quartile 2: 36%; quartile 3: 26%; quartile 4: 16%). All the patients benefited from the programme. For the GOLD classification, there was no significant difference between stages. For the BODE classification, a significant difference existed between quartiles concerning the evolution of dyspnoea (P=0,025), the relationship dyspnoea/walking distance (P<0,001) and BODE index (P<0,001), to the advantage of patients in quartiles 3 and 4. CONCLUSION: All patients benefit from rehabilitation in hospital; the most severe benefit the most. The BODE index seems to predict those who make the greatest improvement.

A comparative study of the preventative effects exerted by three probiotics, Bifidobacterium lactis, Lactobacillus casei and Lactobacillus acidophilus, in the TNBS model of rat colitis.

AIMS: The intestinal anti-inflammatory effects of three probiotics with immunomodulatory properties, Lactobacillus casei, Lactobacillus acidophilus and Bifidobacterium lactis, were evaluated and compared in the trinitrobenzenesulphonic acid (TNBS) model of rat colitis. METHODS AND RESULTS: Colitis was induced in rats by intracolonic administration of 10 mg of TNBS dissolved in 0.25 ml of 50% ethanol. Each probiotic was administered orally (5x10(8) CFU suspended in 0.5 ml of skimmed milk) for 3 weeks, starting 2 weeks before the administration of TNBS. Colonic damage was evaluated histologically and biochemically 1 week after TNBS instillation. The results obtained revealed that all probiotics assayed showed intestinal anti-inflammatory effects, macroscopically evidenced by a significant reduction in the colonic weight/length ratio. Only B. lactis showed a lower incidence of diarrhoea in comparison with untreated rats. Biochemically, all probiotics restored colonic glutathione levels, depleted as a consequence of the oxidative stress of the inflammatory process. Bifidobacterium lactis treatment reduced colonic tumour necrosis factor (TNF)-alpha production, and inducible nitric oxide synthase (iNOS) and cyclo-oxygenase-2 (COX-2) expression; L. acidophilus administration reduced colonic leukotriene B4 production and iNOS expression and L. casei intake was associated with a decrease in colonic COX-2 expression. CONCLUSION: The three probiotics assayed have shown intestinal anti-inflammatory activity in the TNBS model of rat colitis, although each probiotic shows its own anti-inflammatory profile. SIGNIFICANCE AND IMPACT OF THE STUDY: These probiotics could be considered as potential adjuvants in the treatment of inflammatory bowel disease, although more studies are required in order to demonstrate their efficacy in humans.

Estadios de Tanner y niveles de sulfato de dehidroepiandrosterona (DHEA-S) en niños sanos de la provincia de Granada / Tanner´s staging and dehydroepiandrosterone sulphate (DHEA-S) levels in healthy children from Granada province

En el curso del crecimiento del individuo existen cambiosque implican el desarrollo sexual hasta el cuerpo adulto. Duranteeste desarrollo la maduración de la corteza suprarrenal conla consiguiente producción de DHEA (adrenarquia), precede a lapubertad. Durante la gonadarquia, cuyo inicio está mediado porhormonas hipotalámicas, es cuando tiene lugar la adquisiciónde la fertilidad y la capacidad reproductiva; para esto el DHEA,una vez sulfatado a nivel gonadal, es usado como sustrato en laproducción de andrógenos y estrógenos principales responsablesde la maduración sexual. La adrenarquia y la gonadarquiason dos acontecimientos de inicio y regulación independientepero que guardan una relación temporal directa. En este trabajohemos comparado los niveles séricos de DHEA-S de 215niños sanos de la provincia de Granada con la edad fisiológica yel desarrollo de sus caracteres sexuales. En el estudio se concluyela existencia de una dependencia entre las concentracionesséricas de DHEA-S y las edades fisiológica y ósea y el gradode madurez sexual según los estadios de Tanner, mientrasque no la hay con el sexo; además se obtienen los limites dereferencia de DHEA-S para distintos grupos de edades fisiológicay ósea y para los estadios de Tanner

The human body undergoes various changes during itsgrowth and development into sexual adolescence. In this processthe maturation of the suprarenal complex and the productionof DHEA (adrenarche) precedes the puberty. During thegonadarche, which is initiated and regulated by the hypothalamichormones, the human body reaches its fertility and reproductiveability. This involves sulfation of DHEA at gonadal leveland its use as a substrate for the production of androgenes andestrogenes, the main substances responsible for the sexualmaturation. Adrenarche and gonadarche are two independentmajor events in terms of their initiation and regulation, however,they have a temporary direct relation. In this work we haveanalysed the serum levels of DHEA-S in 215 healthy childrenresiding in the Granada province in association with their ageand signs of sexual maturation. In this study we found a correlationbetween the serum concentration of DHEA-S and thephysiological and bone age, and the stage of sexual maturationaccording to Tanner´s. However, there is no correlation with thesex. In addition, we have established limits of reference ofDHEA-S for different groups of physiologic and bone ages, aswell as for stages according to Tanner´s

Relación de parámetros bioquímicos de estrés con índices de masa ósea / Relationship between biochemical factors associated to stress and bone mass indexes. AEBM reference 2003 award

Objetivos. Pretendemos observar si algunos de los parámetros bioquímicos asociados al estrés (cortisol plasmático y metanefrinas urinarias), se relacionan directamente con la aparición de osteoporosis en mujeres postmenopaúsicas, y por lo tanto, con una disregulación inmune, objetivable por alteraciones en factores bioquímicos como las citoquinas osteoclastogénicas (IL-1 e IL-6). Material y Métodos. En una cohorte de 173 mujeres, medimos cortisol, IL-1, IL-6, fosfatasa ácida tartrato-resistente (FATR) y metanefrinas urinarias, así como su densidad mineral ósea (BMD), en columna lumbar (L2-L4) y en cuello de fémur. Resultados. Obtuvimos una relación estadísticamente significativa (p<0.05), para las siguientes asociaciones: BMD en columna lumbar (L2-L4) y en cuello de fémur, respecto a metanefrinas urinarias (p=0.0319 y p=0.0234, respectivamente); IL-1-cortisol (p=0.0198); FATR-cortisol (p=0.015) e IL-6-FATR (p=0.016). Conclusiones. Existe una relación directa entre BMD disminuida y una elevación en un parámetro de estrés (metanefrinas urinarias), así como entre IL-1 y FATR con respecto a cortisol plasmático (índice bioquímico de estrés) (AU)

Studies on an isolated West Indies population. VI. Immunoglobulin (Gm and Km) allotypes.

A random sample of 221 individuals taken from 2000 inhabitants of a small Caribbean island of French origin were typed for Gm and Km allotypes. Gm haplotype frequencies were found to be significantly different from France. Km(1) frequency was found to be lower than in the French population. These differences suggest a small degree of admixture with the Black population, and genetic drift.

Further contribution of common Gm*-Am* haplotypes and Km* alleles in the characterization of the Tunisian population.

The Gm, Am and Km allotypes have been investigated in 405 sera from unrelated students and blood donors coming from the different areas of Tunisia. Thirty Gm and fourty-seven Gm-A2m common phenotypes have been observed. Eleven Gm* and seventeen Gm*-A2m* common haplotypes have been deduced from these phenotypes. The Tunisian population appears as mainly Caucasoid (combined frequency of Caucasoid Gm*-Am* haplotypes in the order of 0.81-0.82) with a relatively important Black contribution in the gene pool (combined frequency of Negroid Gm*-Am* haplotypes of 0.17-0.18) and a very low Oriental participation (0.01-0.02). Our results are compared to those previously reported for two other samples of the Tunisian population, the first from the regions of Mahdia and Sfax and the second from several villages of Berbers, the first inhabitants of Tunisia. Likewise, other comparisons are made with populations from Africa, Europe and Asia, since Tunisians are a mixture of Berbers, invaders and immigrants from different origins.

IgG (Gm) allotypes and multiple sclerosis in a French population: phenotype distribution and quantitative abnormalities in CSF with respect to sex, disease severity, and presence of intrathecal antibodies.

The association of a given Gm allotype or phenotype with MS susceptibility, as previously described in some Caucasian populations, was not observed in a large French MS group, whether or not considering the possible influence of sex or disease severity. This result could be related to variations in geographical distribution of Gm alleles and MS susceptibility gene(s) or suggests the simultaneous involvement of Gm and other genetic system(s). In contrast, the corresponding CSFs exhibited already known MS-associated abnormalities of IgG1 (G1m) allotype contents, which therefore did not merely result from a Gm-associated MS susceptibility. These quantitative abnormalities were not sex dependent, but may fluctuate with MS severity. The G1m allotype levels in each CSF were not correlated with titers of various intrathecal antibodies but with the number of antibody specificities detected, a picture arguing for a polyclonal, non-antigen-specific activation of G1m allotype-producing B cells present in MS brain.

Nonorgan-specific autoantibodies and immunoglobulin allotypes in relatives of patients with monoclonal gammopathy.

Polyclonal immunoglobulin increase, rheumatoid factor, antinuclear antibodies and cold lymphocytotoxins were detected 10, 8, 7 and 8 times, respectively, in a group of these informative families (22, 17 and 29 subjects tested, respectively). Each family included at least 1 subject with a monoclonal gammopathy in addition to that of the proband. No correlation could be shown between any of these abnormalities and Gm haplotypes. Nonetheless, it is worth noting that 6 out of 41 relatives under 30 years of age had cold lymphocytotoxins.

[Interaction between HLA and Gm for susceptibility to insulin-dependent diabetes]. / Interaction entre HLA et Gm pour la susceptibilité au diabète insulino-dépendant.

It is now well established that HLA system is involved in the susceptibility to Type 1 diabetes mellitus. In this study we look for a possible effect of the Gm system. A first study (cases-controls) suggests that among individuals who had HLA-DR3 but not HLA-DR4 or HLA-DR4 without HLA-DR3, there is a possible effect of the phenotype Gm3,23,5 or Gm3,-5 in the susceptibility to IDDM. Moreover, we have tested by the sibpair method whether HLA and Gm are transmitted independently from IDDM: an unaffected sib, sharing the same HLA haplotypes than an affected individual, seems to be more often phenotypically different at the Gm loci.

Genetic study of Tunisian Berbers. I. Gm, Am and Km immunoglobulin allotypes and ABO blood groups.

The Gm, Am and Km immunoglobulin allotypes and ABO blood groups were studied in three groups of Tunisian Berbers . The results showed that the actual Berbers of Tunisia present certain heterogeneity and their ancestors were probably the first inhabitants of North Africa. Indeed, although their Gm-Am haplotypes are mainly Caucasoid, some of them are typically African. The group of Kesra village, the most Caucasoid, shows frequencies of Gm-Am haplotypes very close to those of South European populations, particularly the Spanish, who are probably of the same origin. The gene frequencies of the ABO groups in the three Berber groups were similar to those recorded in European populations with a relatively high frequency of the O genes typical of the Berbers .

Influence of IgG subclasses on automated anti-D (Rho) quantification.

Anti-D quantification by both an automated Polybrene method and an automated trypsin-albumin-dextran (TAD) method gave discrepant results in certain cases. These discrepancies, expressed as the polybrene TAD ratio of reactivity (PTR), were related to the IgG subclass of anti-D. Anti-D of the IgG3 subclass showed a higher PTR than IgG1 (0.94 vs 1.65). No difference was shown between G1m(1) and G1m(3) (0.93 and 0.95, respectively) or between G3m(11) and G3m(21) (1.40 and 1.81, respectively) allotypes. The simultaneous use of our automated Polybrene and TAD methods provides information about the anti-D subclass composition.

The incidence of Gm and Km allotypes in a group of Bretons, the Bigoudens.

Immunoglobulin allotypes were studied in a peculiar Breton community, the Bigoudens. Results showed that the incidence of the common Gm and Km phenotypes fell into the ranges quoted for Caucasian populations, except for the Gm1;..;5,10,11,13,14 and Gm1,2;..;5,10,11,13,14. The frequencies were found to be significantly different from those of non-Bigouden Breton neighbouring controls.

Deleted IgG1 and IgG2 H chains in a patient with an IgG subclass imbalance.

The serum of a female patient studied over 7 months initially showed, in addition to normal residual IgG, two abnormal IgG proteins and in the last 3 months of the disease showed only one abnormal IgG protein. Gm typing and serological subclass determinations revealed an imbalance of allelic forms within the IgG1 subclass during the disease. The IgG2 level remained markedly elevated throughout the study. The two abnormal IgG-related proteins were devoid of light chains. The abnormal gamma cathodic immunoglobulin and the abnormal beta 2-immunoglobulin were Fc-like and covalently disulphide linked, with molecular weights of 60,000 daltons (N terminal, SER) and 72,000 daltons (N terminal, GLY) respectively. The first belonged to the IgG1 subclass and the second to the IgG2 subclass. No abnormal proteolytic activity was noted and plasma cells reacted with anti-gamma-chain antisera only. We hypothesize that the molecular defect leading to the deleted chains was an early event, preceding the differentiation into plasma cells which produced the two IgG1 and IgG2 deleted H chains.