Diet, cancer, and the lipidome.

International audienceThe potential for dietary fat to interfere with the development of breast cancer by delaying its occurrence makes the identification of defined molecules a mandatory step in cancer prevention. In order to circumvent the limitations and/or bias of dietary exposure assessment tools, biomarkers of past lipid intake such as the fatty acid composition of white adipose tissue have been used. When considered separately, candidate fatty acids identified as favorable on the basis of their association with breast cancer risk have usually led to inconsistent results in animal intervention studies. This inconsistency indicates that any approach based on a single fatty acid should be abandoned for an integrated view over the complex lipid interactions which finally determines the lipidome, the lipid profile that is found in individuals. This article presents a reappraisal of the role of the lipid profile through a comprehensive reanalysis of adipose tissue fatty acid composition obtained in patients with benign or malignant breast tumors as well as in experimental animals during dietary interventions. Rather than a single fatty acid, a composite indicator combining elevated monounsaturates and low omega6/omega3 fatty acid ratio was associated with breast cancer protection. This lipidome may become the template for identifying breast cancer risk related to diet, and for designing proper dietary modifications to delay the occurrence of breast cancer, although the universality of the findings cannot be assessed from a single study

Propensity score to detect baseline imbalance in cluster randomized trials: the role of the c-statistic.

BACKGROUND: Despite randomization, baseline imbalance and confounding bias may occur in cluster randomized trials (CRTs). Covariate imbalance may jeopardize the validity of statistical inferences if they occur on prognostic factors. Thus, the diagnosis of a such imbalance is essential to adjust statistical analysis if required. METHODS: We developed a tool based on the c-statistic of the propensity score (PS) model to detect global baseline covariate imbalance in CRTs and assess the risk of confounding bias. We performed a simulation study to assess the performance of the proposed tool and applied this method to analyze the data from 2 published CRTs. RESULTS: The proposed method had good performance for large sample sizes (n =500 per arm) and when the number of unbalanced covariates was not too small as compared with the total number of baseline covariates (≥40% of unbalanced covariates). We also provide a strategy for pre selection of the covariates needed to be included in the PS model to enhance imbalance detection. CONCLUSION: The proposed tool could be useful in deciding whether covariate adjustment is required before performing statistical analyses of CRTs

Effectiveness of a specific care plan in patients with Alzheimer’s disease: cluster randomised trial (PLASA study)

Objective To test the effectiveness of a comprehensive specific care plan in decreasing the rate of functional decline in patients with mild to moderate Alzheimer’s disease compared with usual care in memory clinics

Peer Review of Grant Applications: A Simple Method to Identify Proposals with Discordant Reviews

Grant proposals submitted for funding are usually selected by a peer-review rating process. Some proposals may result in discordant peer-review ratings and therefore require discussion by the selection committee members. The issue is which peer-review ratings are considered as discordant. We propose a simple method to identify such proposals. Our approach is based on the intraclass correlation coefficient, which is usually used in assessing agreement in studies with continuous ratings

The importance of decision intent within descriptions of pragmatic trials

ACKNOWLEGEMENTS This work is supported by the Canadian Institutes of Health Research through the Project Grant competition (competitive, peer-reviewed), award number PJT-153045. CRediT authorship contribution statement Stuart G. Nicholls: Writing - review & editing. Merrick Zwarenstein: Writing - review & editing. Spencer Phillips Hey: Writing - review & editing. Bruno Giraudeau: Writing - review & editing. Marion K. Campbell: Writing - review & editing. Monica Taljaard: Writing - review & editing.Peer reviewedPostprin

The genotype 3-specific hepatitis C virus core protein residue phenylalanine 164 increases steatosis in an in vitro cellular model.: HCV genotype 3-specific steatosis

International audienceBackground and aims: The prevalence and severity of liver steatosis are higher in patients infected with genotype 3 hepatitis C virus (HCV) than in patients infected with other genotypes. HCV core protein is known to affect lipid metabolism, inducing lipid droplet accumulation both in vitro and in vivo. We used an in vitro cellular model to investigate whether an HCV core protein with residues specific to genotype 3 increased this phenomenon. Methods: Sequence comparisons for HCV core protein domain II, which is known to interact with lipid droplets, identified the phenylalanine (F) residue at position 164 as the only residue specific to genotype 3. We compared the area covered by lipid droplets in sections of cells producing a wild-type genotype 1a HCV core protein with that in cells producing a Y164F mutant protein. Results: Cumulative lipid droplet area was significantly greater in sections of cells producing the Y164F mutant HCV core protein than in cells producing the wild-type protein (p<0.001). The frequency of cell sections containing more than 3 μm2 of lipid droplets, in particular, was higher for the mutant than for the wild-type protein. Conclusion: Our data provide a molecular explanation for HCV genotype 3-specific lipid accumulation. This difference between genotypes may be due to phenylalanine having a higher affinity for lipids than tyrosine (Y). These observations provide useful information for further studies of the mechanisms involved in HCV-induced steatosis

A multicentre case-control study of nonsteroidal anti-inflammatory drugs as a risk factor for severe sepsis and septic shock

International audienceINTRODUCTION: We aimed to establish whether the use of nonsteroidal anti-inflammatory drugs (NSAIDs) during evolving bacterial community-acquired infection in adults is associated with severe sepsis or septic shock. METHODS: We conducted a multicentre case-control study in eight intensive care units. Cases were all adult patients admitted for severe sepsis or septic shock due to a bacterial community-acquired infection. Control individuals were patients hospitalized with a mild community-acquired infection. Each case was matched to one control for age, presence of diabetes and site of infection. RESULTS: The main outcome measures were the proportions of cases and controls exposed to NSAIDs or aspirin during the period of observation. In all, 152 matched pairs were analyzed. The use of NSAIDs or aspirin during the observation period did not differ between cases and controls (27% versus 28; odds ratio = 0.93, 95% confidence interval [CI] = 0.52 to 1.64). If aspirin was not considered or if a distinction was made between acute and chronic drug treatment, there remained no difference between groups. However, the median time to prescription of effective antibiotic therapy was longer for NSAID users (6 days, 95% CI = 3 to 7 days) than for nonusers (3 days, 95% CI = 2 to 3 days; P = 0.02). CONCLUSIONS: In this study, the use of NSAIDs or aspirin during evolving bacterial infection was frequent and occurred in one-quarter of the patients with such infection. Although the use of NSAIDs by patients with severe sepsis or septic shock did not differ from their use by those with mild infection at the same infected site, we observed a longer median time to prescription of effective antibiotic therapy in NSAID users

Impacts of Mayan land use on Laguna Tusp an watershed (Pet en, Guatemala) as seen through clay and ostracode analysis

International audienceMost of the cities built by the Mayas in the Pet en area, in the Central Yucat an Peninsula, were abandoned 1200 to 1000 years ago. The phenomenon is sometimes un-appropriately called " the collapse of the Maya civilization ". Its main causes are still debated, ranging from climatic according to the occurrence of severe or modest droughts, to societal in the form of environmental mismanagement of the environment. In both processes, it is inferred that stress triggered the formation in many Pet en lake sediments of erosional clay deposits, known as 'Maya clays'. This work presents a high resolution, multi-proxy study of 'Maya clays' in lacustrine sediments from Laguna Tusp an, near the archaeological site of La Joyanca. Micropaleontological (ostracodes), mineral-ogical (clay minerals) and geochemical (bulk elemental composition and stable isotopes in organic carbon) records reveal three different phases of soil erosion throughout the last 5300 years. The oldest phase from 5281 to 2998 cal yr BP (i.e. 3331 e 1048 BC) is characterized by successive natural and moderate soil erosion deposits which follow climatic variations recorded in the American tropical belt. The time interval between 2998 and 1281 cal yr BP (i.e. 1048 BC and AD 661) contains four distinct erosional layers which, according to clay mineralogy, are indicative of both increased erosion of the regolith and strong soil loss. The most recent, also the most massive, deposit of Maya clay ends around 1281 cal yr BP (AD 661), that is some 200 years before the so-called 'Maya collapse' in the Pet en area. Recent archeological fieldwork studies indicate that a population mobility took place into the city of La Joyanca from its hinterland by the early Late Classic Period (ca. AD 600), that is, at the end or just after this erosion episode, and well before the occurrence of the Terminal Classic-Postclassic (AD 800e1250) drastic climatic changes. Shifts in environmental management by the local society and timing of urbanization may explain environmental changes better than droughts per se

Viral sequence variation in chronic carriers of hepatitis C virus has a low impact on liver steatosis.: HCV variability and steatosis

International audienceMost clinical studies suggest that the prevalence and severity of liver steatosis are higher in patients infected with hepatitis C virus (HCV) genotype 3 than in patients infected with other genotypes. This may reflect the diversity and specific intrinsic properties of genotype 3 virus proteins. We analyzed the possible association of particular residues of the HCV core and NS5A proteins known to dysregulate lipid metabolism with steatosis severity in the livers of patients chronically infected with HCV. We used transmission electron microscopy to quantify liver steatosis precisely in a group of 27 patients, 12 of whom were infected with a genotype 3 virus, the other 15 being infected with viruses of other genotypes. We determined the area covered by lipid droplets in liver tissues and analyzed the diversity of the core and NS5A regions encoded by the viral variants circulating in these patients. The area covered by lipid droplets did not differ significantly between patients infected with genotype 3 viruses and those infected with other genotypes. The core and NS5A protein sequences of the viral variants circulating in patients with mild or severe steatosis were evenly distributed throughout the phylogenic trees established from all the collected sequences. Thus, individual host factors seem to play a much greater role than viral factors in the development of severe steatosis in patients chronically infected with HCV, including those infected with genotype 3 viruses

Design effect in multicenter studies: gain or loss of power?

<p>Abstract</p> <p>Background</p> <p>In a multicenter trial, responses for subjects belonging to a common center are correlated. Such a clustering is usually assessed through the design effect, defined as a ratio of two variances. The aim of this work was to describe and understand situations where the design effect involves a gain or a loss of power.</p> <p>Methods</p> <p>We developed a design effect formula for a multicenter study aimed at testing the effect of a binary factor (which thus defines two groups) on a continuous outcome, and explored this design effect for several designs (from individually stratified randomized trials to cluster randomized trials, and for other designs such as matched pair designs or observational multicenter studies).</p> <p>Results</p> <p>The design effect depends on the intraclass correlation coefficient (ICC) (which assesses the correlation between data for two subjects from the same center) but also on a statistic <it>S</it>, which quantifies the heterogeneity of the group distributions among centers (thus the level of association between the binary factor and the center) and on the degree of global imbalance (the number of subjects are then different) between the two groups. This design effect may induce either a loss or a gain in power, depending on whether the <it>S </it>statistic is respectively higher or lower than 1.</p> <p>Conclusion</p> <p>We provided a global design effect formula applying for any multicenter study and allowing identifying factors – the ICC and the distribution of the group proportions among centers – that are associated with a gain or a loss of power in such studies.</p