Using intercostal muscle EMG to quantify maternal expulsive efforts during vaginal delivery: a pilot study

AIMS: The expulsive forces of childbirth can be included among the many potential risk factors implicated in the subsequent development of stress urinary incontinence (SUI) in women. The objective of this study was to devise a non-invasive way to measure abdominal pushing that would accurately represent the expulsive forces during childbirth. METHODS: By means of intravesical and intrauterine manometry, and electromyography (EMG) of intercostal muscles, we quantified these forces in 21 women during vaginal delivery. RESULTS: A mathematical analysis of variance (ANOVA) model showed the integral of intravesical pressure to be significantly associated (P < 0.001) with the integral of intercostal muscle electrical activity during the first six uterine contractions during the phase of fetal expulsion. CONCLUSIONS: EMG is a non-invasive measurement that can replace intravesical determinations to quantify these forces as it reflects the real intra-abdominal pressure.     

Electrophoretic characterization of the human sperm-specific enolase at different stages of maturation

The presence of a sperm-specific enolase isoform (ENO-S) in human ejaculated spermatozoa was previously demonstrated. The objective of this study was to characterize this ENO-S in spermatozoa at different steps of maturation. Sperm ENO-S was characterized in testicular, epididymal, and ejaculated spermatozoa to determine whether any change occurred in the isoform patterns of this enzyme during epididymal maturation. In testicular sperm, ENO-S was present under 2 main bands named S1 and S3. In epididymal sperm, S1 and S3 bands and a prominent additional S2 band, with the same electrophoretic properties as the S isoform of ejaculated sperm, were visualized. In the testicular extracts obtained from testes in which no spermatozoa were visualized by histologic analysis, none of the 3 ENO-S bands was found. ENO-S exists as different isoforms (electrophoretic variants) in the different stages of sperm maturation. Passage through the epididymis seems to play a major role in the maturational process of this sperm-specific enolase.     

Prognostic value of inducible myocardial ischemia in predicting cardiovascular events after renal transplantation

BACKGROUND: The aims of the present study were to determine the prevalence of inducible myocardial ischemia (IMI) in renal transplant recipients (RTR) more than 50 years old, to identify predictors of IMI, and to search for its prognostic value. METHODS: Among the 377 renal transplantations performed between 1989 and 1998 in a single institution, 120 were done in patients > or =50 years old, and 97 were recruited for the study. During the last quarter of 1998, all of them underwent an exercise test (EST), an exercise-thallium 201 single photon emission computed tomography coupled with dipyridamole (SPECT), and 81% of them had a dobutamine stress echocardiography (DSE). Patients with IMI subsequently underwent coronary angiography to detect coronary stenosis. RESULTS: IMI was present in 12 of the 97 patients (10%). The diagnosis was evidenced by EST in four cases, by SPECT in 11 cases, and DSE in three cases. Five of these 12 patients (42%) had significant coronary artery stenosis (> or =50%). Multivariate analysis of several pre- and post-transplant variables evidenced acute rejection and left ventricular hypertrophy as significant correlates of IMI (both P < 0.03). Patients were prospectively followed-up for 48 months for the occurrence of major cardiovascular events. Kaplan-Meier analysis revealed a significant increase in cardiovascular events in the IMI group (P < 0.0001). In addition, the Cox proportional hazards model revealed that IMI and diabetes mellitus had an independent significant effect on the occurrence of major cardiovascular events. CONCLUSION: IMI was present in 10% of RTR aged > or =50 years, and was predicted by acute rejection and left ventricular hypertrophy. IMI had a strong effect on major cardiovascular events in this population.     

Lack of contribution of dihydrofluorouracil and alpha-fluoro-beta-alanine to the cytotoxicity of 5'-deoxy-5-fluorouridine on human keratinocytes

Capecitabine (Xeloda) is a very active oral fluoropyrimidine (colon and breast cancers) whose clinical use is complicated by the presence of hand-foot syndrome (HFS). This cutaneous toxicity is less frequently encountered with other oral fluoropyrimidines containing a dihydropyrimidine dehydrogenase (DPD) inhibitor. The HFS is thus attributed to the presence of the main 5-fluorouracil (5-FU) metabolites, dihydrofluorouracil (5-FUH2) and alpha-fluoro-beta-alanine (FBAL), but without strong pharmacological arguments. The aim of the present study was to closely examine this latter hypothesis. Capecitabine generates 5'-deoxyflourouridine (5'-DFUR) which is transformed into 5-FU at the cellular target site through the intermediary of thymidine phosphorylase (TP). The cytotoxic effects (MTT test, 4-day exposure) of 5'-DFUR, 5-FU, 5-FUH2 and FBAL were tested against the spontaneously immortalized human keratinocyte cell line (HaCaT) and the human cancer colon cell line WiDr as a control. Mean IC50s on HaCaT and WiDr were, respectively, 1.3 and 10 microM for 5'-DFUR, 0.2 and 3.3 microM for 5-FU, 13.4 and 560 microM for 5-FUH2, and greater than 650 and 6500 microM for FBAL. The respective 5'-DFUR IC50s values were not different when cells were exposed to 5'-DFUR alone or in combination with 5-FU, 5-FUH2 and FBAL in both cell lines, the relative proportion of each drug reflecting known pharmacokinetic data for capecitabine (5'-DFUR 12.4%, 5-FUH2 6.4%, 5-FU 1.2% and FBAL 80%). This latter finding demonstrates the relative lack of significant cytotoxic activity of 5-FUH2 and FBAL on human keratinocytes. TP activity was particularly high in HaCaT cells and DPD activity was very low in both cell lines. These data strongly suggest that the presence of 5-FU metabolites does not play a major role in the HFS generated by capecitabine and that it can probably be attributed to particularly high TP activity in keratinocytes. This observation may have important clinical consequences such as a possible local pharmacological inhibition of TP for controlling HFS.     

Fundic endocrine tumors and atrophic gastritis: the value of antrectomy

We report two cases of fundic endocrine tumors associated with fundic atrophic gastritis-related hypergastrinemia and treated by antrectomy. About twenty infracentimetric tumors were observed in each patient and restrictively involved fundic mucosa. Antrectomy induced normalization of gastrinemia and the disappearance of fundic tumors, as soon as the 4(th) and 7(th) month. No recurrence was observed during the 5-year and 18-month follow-up time, respectively. We therefore consider that antrectomy may be regarded as a useful alternative treatment in the management of atrophic gastritis-related fundic endocrine tumors.     

Autobiographical memory in major depression: a comparison between first-episode and recurrent patients

Autobiographical memory in depression is characterized by an increase in general memory evocation. The aim of this study is to compare autobiographical memory in patients with a first depressive episode and in recurrent patients before and after recovery, using Williams' and Scott's autobiographical memory test. Our results show an increase of the number of general memories only with positive cue words in both groups of patients during the depressive episode. After clinical improvement, this specificity remains in recurrent patients who, in addition, recall more general memories for negative words. By contrast, patients with a first depressive episode are no longer different from controls. These results show both an overgeneralization and a deficit in positive memory access during the depressive episode, whatever the number of previous episodes. Moreover, recurrence chronically modifies access to emotional memories.