Participation in faecal occult blood screening for colorectal cancer in a well defined French population: results of five screening rounds from 1988 to 1996

OBJECTIVE

To evaluate the influence on compliance of demographic variables and of the way of proposing a faecal occult blood test in a colorectal cancer mass screening programme.

SETTING

Well defined population in Burgundy (France).

METHODS

From 1988 to 1996 five screening rounds were conducted in people aged 45 to 74 on entering the study. The screening test was provided free of charge by primary care physicians over a four month period, then mailed to non-consultants, followed by a potential reminder letter. The whole population was invited to participate in each screening campaign.

RESULTS

During the five successive rounds, compliance was 52.8%, 54.0%, 57.3%, 58.3%, and 56.2%. It was higher in women than in men, in those initially aged 50 to 69 than in the extreme age groups, and in urban than in rural areas. Overall, 68.7% of the invited population completed at least one screening test and 37.2% completed the five rounds. Among those who participated once in a screening campaign, between 79.6% and 87.6% participated in the succeeding ones. Compliance was higher when the test was proposed by GPs (varying between 85.2% and 94.0% according to the screening campaign) than when it was sent by post (varying between 26.0% and 33.7%).

CONCLUSION

In France, a participation rate of over 50% can be achieved in colorectal cancer screening by means of a faecal occult blood test. To achieve this, primary care physicians have to play an active part in the programme and the test must be mailed to non-consultants.

[Risk and severity factors in cerebrovascular accidents in west african Blacks of Burkina Faso]

This report presents the findings of a retrospective review of 193 cases of cerebrovascular attacks (CVA) diagnosed on the basis of clinical data over a 3-year period at the Bobo Dioulasso Hospital in Burkina Faso. CVA accounted for 15.1% of admissions for cardiovascular disorders. Mean patient age was 58.4 +/- 14 years and the male to female ratio was 2:1. From a socioeconomic standpoint 72% of patients had low incomes and 22% were laborers. Risk factors were poorly controlled hypertension (83.9%), obesity (44.2%), hyperlipidemia (20.6%), thromboembolism (16.6%), smoking (12.4%), hypercholesterolemia (8.1%) and diabetes (7.3%). Further study is needed to confirm risk related to red blood cell abnormalities. The event was transient ischemic attack in 22 cases (11.7%) and stroke in 171 cases (88.3%). Hospital mortality was high (31.6%) with a significantly higher death rate in elderly (p < 0.05) and female (p < 0.001) patients. Recurrent CVA within a mean delay of 9 to 12 months following the initial event was observed in 11.4% of survivors and was fatal in 80%. The authors emphasize the need for improvement in the management of arterial hypertension by district physicians and for prevention of thromboembolic complications in high-risk patients.

Gene expression of a protein, JB70, related to rat alpha1-acid glycoprotein in Euglena gracilis

Antibodies directed against rat alpha1-acid glycoprotein (AGP) recognize a 70 kDa antigen, designated JB70, present in extracts of achlorophyllous Euglena gracilis cells as well as in their culture medium. By using 2-dimensional electrophoresis, JB70 appears to be composed of two acidic polypeptides. Additionally, Northern blot analysis reveals the presence in E. gracilis cells of a 2.3 kb mRNA hybridizing with a cDNA probe specific for rat AGP mRNA. Moreover, elevated mRNA levels are detected in dexamethasone-treated E. gracilis cells, indicating a response to this inducer similar to that observed for hepatic AGP. These results strongly suggest that polypeptides closely related to hepatic rat AGP are expressed in E. gracilis cells. They also indicate that, like other gene families implicated in natural defense processes such as heat-shock protein and metallothionein genes, the AGP gene appears to be conserved down to this early diverging eucaryote.

Modifying the n-3 fatty acid content of the maternal diet to determine the requirements of the fetal and suckling rat

During perinatal development, docosahexaenoic acid (22:6n-3) accumulates extensively in membrane phospholipids of the nervous system. To evaluate the n-3 fatty acid requirements of fetal and suckling rats, we investigated the accumulation of 22:6n-3 in the brain and liver of pup rats from birth to day 14 postpartum when their dams received increasing amounts of dietary 18:3n-3 (from 5 to 800 mg/100 g diet) during the pregnancy-lactation period. The fatty acid composition of brain and liver phospholipids of pups, as well as that of dam's milk, was determined. At birth, 22:6n-3 increased regularly to reach the highest level when the maternal diet contained 800 mg 18:3n-3/100 g. On days 7 and 14 postpartum, brain 22:6n-3 plateaued at a maternal dietary supply of 200 mg/100 g. Docosapentaenoic acid (22:5n-6) had the opposite temporal pattern. The unusually high concentration of eicosapentaenoic acid (20:5n-3) in liver and dam's milk observed at the highest 18:3n-3 intake suggests an excessive dietary supply of this fatty acid. All these data suggest that the n-3 fatty acid requirements of the pregnant rat are around 400 mg 18:3n-3 and those of the lactating rat at 200 mg (i.e., 0.9 and 0.45% of dietary energy, respectively). The values of 18:3n-3 and 22:6n-3 milk content which allowed brain 22:6n-3 to reach a plateau value in suckling pups were 1% of total fatty acids and 0.9% (colostrum) to 0.2% (mature milk), respectively. These levels are similar to those recommended for infant formulas.

Lipid-depleted diet perturbs membrane composition and intracellular transport in lactating mammary cells

When rats were fed a control or a lipid-depleted diet for five generations, reproduction was not disturbed but pup growth was affected. The membrane organization and the secretory activity of mammary epithelial cells from these lactating rats were investigated. This diet induced a large decrease in the level of polyunsaturated fatty acids of membrane phospholipids (26.6% versus 44.0%). The level of 20:4 (n-6) was strongly decreased, mainly in phosphatidylethanolamine. Annexin VI, which interacts preferentially with this phospholipid, accumulated at the periphery of the cell and was largely associated to the hydrophobic region of the bilayer as compared to control membranes. Casein synthesis and casein secretion measured in incubated explants, after pulse-chase metabolic labeling, were both reduced by about 60% in lipid-deprived cells. The secretory ratio (radioactive secreted caseins in %) was not modified, suggesting that the mechanism of basal secretion was not mainly affected. On the contrary, the secretagogue effect of prolactin disappeared. The intracellular transport of the hormone was considerably slowed down by the diet and prolactin did not reach the lumen of the acini after 1 h of chase, in contrast to what occurred in control cells. Addition of 20:4 (n-6), in vitro, to mammary fragments from lipid-deprived rats restored the localization of annexin VI, increased synthesis and secretion of caseins as well as intracellular transport of PRI. Together, these data underline the importance of the level of 20:4 (n-6) in membrane phospholipids for exocytic and endocytic transport in lactating mammary epithelial cells.

Age-related changes in phospholipid fatty acid composition and monoaminergic neurotransmission in the hippocampus of rats fed a balanced or an n-3 polyunsaturated fatty acid-deficient diet

The influence of aging (2, 6, 12, and 24 months) on hippocampal lipid composition and neurochemical markers (endogenous noradrenaline, serotonin levels, monoamine oxidase (MOA) activities) was studied in rats fed a control or an n-3 polyunsaturated fatty acid (PUFA)-deficient diet. The n-3 PUFA deficiency reduced the 22:6 (n-3) level, compensated by the increase in 22:5 (n-6). However, the difference in 22:6 (n-3) content between control and deficient rats was less between 2 and 12 months and then became stable. There was an overall age-induced decrease in the major phospholipid classes phosphatidylethanolamine (PE), and phosphatidylcholine (PC) whereas the minor classes, phosphatidylinositol (PI), phosphatidylserine (PS), and sphingomyelin (SM), were greatly increased, regardless of diet. The n-3 PUFA deficiency induced a reduction in the PS level, concomitant with a higher level in MAO-B activity as compared to control rats at the age of 24 months. The age-related evolution of the MAO-B activity was parallel with that of noradrenaline levels in both dietary groups. The noradrenaline and serotonin levels were modified according to age but without effect of the n-3 PUFA deficiency. Results showed that the hippocampus sustained specific age-induced modifications in lipid composition and neurotransmission factors, often with a transition period between 6 and 12 months.

Sequential study of serum glycoprotein fucosylation in acute hepatitis

BACKGROUND

alpha-Fetoprotein is a useful diagnostic marker in hepatocellular carcinoma, during which its serum level increases and its glycan structure is hyperfucosylated. Normally-expressed glycoproteins (alpha 1-antitrypsin and transferrin) are also hyperfucosylated in hepatocellular carcinoma. alpha-fetoprotein serum levels are also increased in conditions associated with hepatic regeneration, such as acute hepatitis. We conducted a longitudinal study of the alpha 1-6 fucosylation pattern of serum alpha-fetoprotein in ten patients with acute hepatitis and compared it to that of transferrin and alpha 1-antitrypsin.

METHODS

Protein levels were measured by using immunochemical assays. Crossed affinoimmunoelectrophoresis in the presence of Lens culinaris agglutinin was performed for each protein, and the fucosylation index, corresponding to the agglutinin reactive fraction, was determined. The results were compared to those in 25 healthy donors and five newborns.

RESULTS

alpha-Fetoprotein was hyperfucosylated and remained stable throughout the course of the disease. In contrast, serum transferrin and alpha 1-antitrypsin gradually became hyperfucosylated during the course of acute hepatitis. The transferrin and alpha 1-antitrypsin fucosylation indexes correlated with each other, but not with the alpha-fetoprotein fucosylation index. No correlation was found between alpha-fetoprotein, alpha 1-antitrypsin and transferrin fucosylation indexes and the corresponding glycoprotein serum levels.

CONCLUSIONS

Hyperfucosylation of alpha-fetoprotein is not specific to hepatocellular carcinoma. Increased alpha 1-6 fucosylation should not be considered solely as a tumour marker, but might also reflect cell proliferation. The study of alpha 1-6 hyperfucosylation process of normally-expressed glycoproteins awaits further investigation, to test its usefulness as a new marker of liver regeneration during the follow-up of acute hepatitis.

High frequency of a deletion polymorphism of the angiotensin-converting enzyme gene in asthma

BACKGROUND

An insertion-deletion polymorphism of the angiotensin-converting enzyme (ACE) gene has been shown to be associated with levels of ACE. Because ACE is heavily expressed in the lungs and plays a key role in the metabolism of angiotensin II and bradykinin, which are potentially involved in the pathogenesis of asthma, we tested the hypothesis of an association between the polymorphism of the ACE gene and asthma.

METHODS

Seventy-nine patients with asthma, 54 healthy subjects, and 33 patients with nonasthmatic lung disease were studied. Pulmonary function tests were performed in patients with asthma, and the ACE genotypes were determined in all subjects by the polymerase chain reaction.

RESULTS

The ACE genotype distribution was similar in healthy subjects and in patients without asthma. By contrast, the population of patients with asthma was characterized by a higher prevalence of the DD genotype of ACE (odds ratio, 2.09; 95% confidence interval, 1.05 to 4.16; p = 0.023). No difference in pulmonary function test results was detected in asthmatic patients according to the distribution of ACE genotypes.

CONCLUSION

This study reports an association between the DD genotype of ACE and asthma, which is not related to the degree of airway obstruction. These results need to be confirmed by a larger case-control study.

[Diagnostic percutaneous thoracic punctures. Assessment through a critical study of a compliation of 2406 cases]

The aim of this retrospective study of 2,406 diagnostic percutaneous thoracic needle aspirations under computer tomographic control was to assess the diagnostic value of this method, the technical problems and the complications and finally, to refine the indications. Percutaneous needle aspiration had been carried out after negative fibreoptic bronchoscopy. The authors review their technique and show the value of biopsy material which is only slightly traumatised. Computerised tomography and fine needle aspiration reduce the risk of pneumothorax and haemorrhage in a significant fashion. Personalized collaboration between the radiologist, physician and cytologist is a vital pre-requisite. The indications are discussed notably in cases of solitary pulmonary nodules and of mediastinal masses.

Diagnostic value of Western blotting in carbohydrate-deficient glycoprotein syndrome

Carbohydrate-deficient glycoprotein syndrome (CDGS) is a newly recognized family of diseases characterized by the absence from the transferrin molecule of at least one glycan chain (type I) or an antenna of the glycan chain (type II). CDGS is currently diagnosed by studies of serum transferrin sialylation. We have developed an alternative Western blot-based method to detect serum transferrin species with reduced molecular masses due to altered glycosylation. Two additional bands are observed in type I CDGS, while a single lower band is observed in type II CDGS, relative to healthy subjects. N-glycanase treatment of serum from type I CDGS patients and normal subjects yields a single band of the same mass in the two cases, confirming that the glycan is the only moiety involved in the differential Western blot pattern. Similar results were found with serum alpha 1-acid glycoprotein, haptoglobin and alpha 1-antitrypsin. Western-blot analysis of one or more serum glycoproteins permits the differential diagnosis of CDGS.

[Unusual spinal and pulmonary metastases]

We present the clinical and imaging findings of a 72 year old man with lytic dorsal bone lesions and a pulmonary spread of nodules (miliary) that were mistakenly attributed to a cancerous disease.

Dietary (n-3) polyunsaturated fatty acids improve adipocyte insulin action and glucose metabolism in insulin-resistant rats: relation to membrane fatty acids

To study the effects of dietary fish oil on insulin-stimulated glucose metabolism in adipocytes of insulin-resistant rats (rats fed 50% sucrose and 30% fat), eighteen 5-wk-old Sprague-Dawley rats were fed, for 6 wk, a diet containing 30% fat as either fish oil (FO) or a mixture of vegetable and animal oils [control oils (CO)]. A third reference group was fed a standard diet (62% corn starch and 13% fat). At the end of the 6-wk period, the two experimental groups had comparable plasma glucose concentrations that were higher than that found in the reference group. FO feeding corrected the hyperinsulinemia of the experimental rats (P < 0.05) to reach values in the reference group. Plasma triacylglycerol (P < 0.01) and cholesterol (P < 0.001) concentrations were also lower in rats fed FO than in those fed CO. The body weights of FO-fed rats were similar to that of CO-fed rats, but epididymal adipose tissue weight was lower (P < 0.01). Adipocytes of FO-fed rats, compared with those of CO-fed rats, had high insulin-stimulated glucose transport (P < 0.05), oxidation (P < 0.001) and incorporation into total lipids (P < 0.05). The incorporation of (n-3) polyunsaturated fatty acids in adipocyte membrane phospholipids was higher in FO-fed rats than in those fed CO (P < 0.0001). Insulin action was positively correlated with the fatty acid unsaturation index in membrane phospholipids. Thus dietary fish oil has beneficial effects on insulinemia, plasma lipids and insulin-stimulated glucose metabolism in insulin-resistant slightly diabetic rats.

Does an increase in dietary linoleic acid modify tissue concentrations of cervonic acid and consequently alter alpha-linolenic requirements? Minimal requirement of linoleic acid in adult rats

Rats were fed a control diet containing both linoleic and alpha-linolenic acid. When 60-days-old they were divided into 8 groups, each receiving the same amount of alpha-linolenic acid, but varying amounts of linoleic acid. When the (n-6)/(n-3) ratio in the diet varied from 2 to 32 (with a constant amount of 150 mg alpha-linolenic acid per 100 g diet), tissue levels of the (n-3) series fatty acids were not significantly modified, except in the liver, heart and testes. In all organs studied, the saturated and monounsaturated fatty acids were practically unchanged. For the (n-6) series fatty acids, arachidonic acid was not significantly affected, in muscle, kidney, brain, myelin, nerve-endings or sciatic nerve, whatever the quantity of linoleic acid in the diet. In liver, arachidonic acid plateaued at 2400 mg linoleic acid/100 g diet and at 400 mg/100 g diet in heart. Results for 22:5(n-6) showed a marked increase in heart, a moderate increase in liver and kidney, and no effect in muscle, testes, brain, myelin, nerve-endings or sciatic nerve. This experiment defined the minimum amount of linoleic acid required in the diet to maintain fatty acids of the linoleic family in the young adult rat. For the first time it was demonstrated that 1200 mg/100 g diet are sufficient for the liver, as evidenced by maintenance of the arachidonic acid concentration. For the other organs, there is either a very marked preservation of this acid, or the dietary level is less than 300 mg/100 g diet. For the essential fatty acid precursors (i.e. linoleic and alpha-linolenic acids), the optimal (n-6)/(n-3) ratio required in the diet is about 8.

Neuroprotective effects of RPR 104632, a novel antagonist at the glycine site of the NMDA receptor, in vitro

The NMDA antagonist and neuroprotective effects of RPR 104632 (2H-1,2,4-benzothiadiazine-1-dioxide-3-carboxylic acid), a new benzothiadiazine derivative, with affinity for the glycine site of the NMDA receptor-channel complex are described. RPR 104632 antagonized the binding of [3H]5,7-dichlorokynurenic acid to the rat cerebral cortex, with a Ki of 4.9 nM. This effect was stereospecific, since the (-)-isomer was 500-fold more potent than the (+)-isomer. The potent affinity of RPR 104632 for the glycine site was confirmed by the observation that RPR 104632 inhibited [3H]N-[1-(2-thienyl)cyclohexyl]-3,4-piperidine ([3H]TCP) binding in the presence of N-methyl-D-aspartate (NMDA) (IC50 = 55 nM), whereas it had no effect on the competitive NMDA site or on the dissociative anaesthetic site. RPR 104632 inhibited the NMDA-evoked increase in guanosine 3',5'-cyclic monophosphate (cGMP) levels of neonatal rat cerebellar slices (IC50 = 890 nM) in a non-competitive manner and markedly reduced NMDA-induced neurotoxicity in rat hippocampal slices and in cortical primary cell cultures. These results suggest that RPR 104632 is a high-affinity specific antagonist of the glycine site coupled to the NMDA receptor channel with potent neuroprotective properties in vitro.

alpha-Linolenic acid dietary deficiency alters age-related changes of dopaminergic and serotoninergic neurotransmission in the rat frontal cortex

The effects of alpha-linolenic acid diet deficiency on rat dopaminergic and serotoninergic neurotransmission systems were investigated in the frontal cortex, striatum, and cerebellum of male rats 2,6,12, and 24 months of age. The diet deficiency induced severe decrease in the 22:6n-3 fatty acid levels in all regions and a compensatory increase in n-6 fatty acid levels. A recovery in the levels of 22:6n-3 was observed in deficient rats between 2 and 12 months of age; however, this recovery was lower in frontal cortex than in striatum and cerebellum. In the striatum and cerebellum, dopaminergic and serotoninergic receptor densities and endogenous dopamine and serotonin levels were affected by aging regardless of the diet. In contrast, a 40-75% lower level of endogenous dopamine in the frontal cortex occurred in deficient rats according to age. The deficiency also induced an 18-46% increase in serotonin 5-HT2 receptor density in the frontal cortex during aging, without variation in endogenous serotonin level, and a 10% reduction in density of dopaminergic D2 receptors. Monoamine oxidase-A and -B activities showed specific age-related variations but regardless of the diet. Our results suggest that a chronically alpha-linolenic-deficient diet specifically affects the monoaminergic systems in the frontal cortex.

[Attitudes to counseling related to HIV infection screening in Bobo-Dioulasso, Burkina Faso]

Two approaches, a questionnaire administered to pregnant women and interviews independently with selected individuals in posts of responsibility, were used to assess (i) the perception of HIV screening among patients attending a Maternal and Child Health Clinic and (ii) the attitudes of health staff and local authorities. One hundred and thirty five pregnant women were individually interviewed in their native language at the Farakan Maternal and Child Health Clinic, Bobo Dioulasso. Ninety six percent accepted the principle of being screened for HIV, and 91% wanted to be given the result, 46% in the presence of a family member. The person most often chosen to share the announcement of the result was the regular partner. Three physicians, two midwives, a hospital director, a parish priest and a politician were interviewed. One midwife did not approve of offering screening tests in the absence of available treatment. Four of these individuals suggested that the presence of a member of the family during counselling would be valuable to promote a sense of partnership. Many reasons were given to explain the difficulties associated with announcing the results of tests. They included: the absence of treatment; the cost of the test; the lack of confidentiality; psychosocial consequences; the reaction, particularly fear, of the patient; difficulties associated with communication and with changing behavior. These observations contribute to a basis for analysis to develop a local and national consensus about HIV testing and counselling for pregnant woman.

Polyunsaturated fatty acids status in blood, heart, liver, intestine, retina and brain of newborn piglets fed either sow milk or a milk replacer diet

Docosahexaenoic (DHA) and arachidonic acids (20:4n-6) are deposited in large amounts in the developing neural tissues of the fetus and neonate. The suckling infants receive both fatty acids via the maternal milk, whereas formula-fed infants must synthesize them de novo from their respective precursors, linoleic (18:2n-6) and alpha-linolenic (18:3n-3) acids. We compared the lipid status of 14- and 21-day-old piglets fed either natural milk or infant formula, with special emphasis on the resulting DHA and 20:4n-6 levels in the neural tissues. The two diets presented similar ratios of precursors (18:2n-6/18:3n-3 = 14-16). The sow milk contained 20:4n-6 (0.6% of total fatty acids) and very low levels of DHA (< 0.1%). Formula feeding resulted in higher deposition of DHA in the brain than sow milk feeding, whereas the brain content of 20:4n-6 was not altered. The brain DHA level was negatively correlated with the 18:2n-6/18:3n-3 ratio in the red blood cells (RBC). In contrast, it was not correlated with the DHA concentration in the circulating lipids. The results indicate that the very low amount of DHA in sow milk has no effect on the accumulation of DHA in the piglet's brain, and that natural milk and formula are not equivalent with respect to precursor bio-availability and processing. This difference could be the result of a higher absorption rate and/or the metabolic sparing of formula 18:3n-3. The data support the view that the balance between the essential precursors in the circulating lipids is of vital importance for optimal deposition of DHA in the developing neural tissues.

The antidepressant metapramine is a low-affinity antagonist at N-methyl-D-aspartic acid receptors

Metapramine, a pharmacological compound with antidepressant activity in humans, was tested for possible antiglutamatergic activity, in vitro. We investigated the effects of metapramine on the N-methyl-D-aspartic acid (NMDA) receptor complex, by determining whether this compound would interfere with the binding of [3H]N-[1-(2-thienyl)cyclohexyl]-3,4-piperidine ([3H]TCP) to rat cortical membranes in the presence of either glycine NMDA, or both. Metapramine in the micromolar range inhibited the binding of [3H]TCP in the presence of both NMDA and glycine (IC50 = 1.4 +/- 0.2 microM). That very similar affinities were observed when either NMDA or glycine was present suggests that metapramine exerted a direct action at the PCP site. The affinity of metapramine for this site was about 25 and 350 times lower than that of PCP and MK-801, respectively. Metapramine inhibited the NMDA-evoked increase in guanosine 3',5'-cyclic monophosphate (cGMP) levels of neonatal rat cerebellar slices (IC50 = 13 microM). These results suggest that metapramine is a low-affinity antagonist of the NMDA receptor complex channel. This paper discusses the potential application of metapramine to the treatment of diseases linked to excessive stimulation of glutamatergic NMDA receptors.