060 Plasma aldosterone levels predict long-term clinical outcome after percutaneous coronary revascularization

The renin-angiotensin-aldosterone system is a major therapeutic target in coronary artery disease (CAD). Recent data suggest that plasma aldosterone has a high prognostic value in acute coronary syndrome (ACS). We tested whether plasma aldosterone could predict clinical outcome in patients undergoing scheduled percutaneous coronary revascularization (PCR).MethodsFrom June 2001 to September 2002, we included all consecutive patients referred to Lille's University Hospital for scheduled PCR. Blood samples were taken during the PCR. The primary endpoint was cardiac death throughout at least 12 months of follow-up.Results807 patients were included, with a mean age of 61 years. Most were men (78%), smokers (71%). 32% were diabetics, mean LVEF was 58±15% and 93% received stents. 50% had stable angina. The mean plasma aldosterone level was 25(13-45)pg/mL. BMI (p=0.003), NYHA class>1 (p=0.0001) and elevated baseline troponine (p=0.01) were associated with increased aldosterone level. Old age (p=0.0001), normal GFR (p=0.01) and betablockers (p=0.01) were associated with decreased aldosterone level. The mean follow-up was 14.9 months and there were 40 cardiac deaths during this period. In multivariate analysis, old age (HR=1.42, p=0.04), low LVEF (HR=1.58, p=0.001), diabetes mellitus (HR=2.2, p=0.04), a recent history of ACS (HR=3.23, p=0.02), high usCRP (HR=2.59, p=0.004) and high plasma aldosterone (HR=3.48, p=0.004) were independent predictors of cardiac mortality.ConclusionPlasma aldosterone level seems to have an independent prognostic value in patients referred for PCR and could be useful in determining the individual cardiovascular risk. Whether this is the result of direct deleterious effects (promotion of endothelial dysfunction, pro-fibrotic, pro-inflammatory and pro-thrombotic effects) or the marker of a global activation of the neuroendocrine system remains to be determined. However plasma aldosterone appears to be an attractive risk marker in CAD

Large expert-curated database for benchmarking document similarity detection in biomedical literature search

Document recommendation systems for locating relevant literature have mostly relied on methods developed a decade ago. This is largely due to the lack of a large offline gold-standard benchmark of relevant documents that cover a variety of research fields such that newly developed literature search techniques can be compared, improved and translated into practice. To overcome this bottleneck, we have established the RElevant LIterature SearcH consortium consisting of more than 1500 scientists from 84 countries, who have collectively annotated the relevance of over 180 000 PubMed-listed articles with regard to their respective seed (input) article/s. The majority of annotations were contributed by highly experienced, original authors of the seed articles. The collected data cover 76% of all unique PubMed Medical Subject Headings descriptors. No systematic biases were observed across different experience levels, research fields or time spent on annotations. More importantly, annotations of the same document pairs contributed by different scientists were highly concordant. We further show that the three representative baseline methods used to generate recommended articles for evaluation (Okapi Best Matching 25, Term Frequency-Inverse Document Frequency and PubMed Related Articles) had similar overall performances. Additionally, we found that these methods each tend to produce distinct collections of recommended articles, suggesting that a hybrid method may be required to completely capture all relevant articles. The established database server located at https://relishdb.ict.griffith.edu.au is freely available for the downloading of annotation data and the blind testing of new methods. We expect that this benchmark will be useful for stimulating the development of new powerful techniques for title and title/abstract-based search engines for relevant articles in biomedical research.Peer reviewe

Familial SDHC mutation associated with prolactin/gh-secreting pituitary adenoma and paraganglioma

Introduction: SDH genes mutations are associated with hereditary phaeochromocytoma and paraganglioma syndromes. We describe the case of a patient with SDHC related familial paraganglioma and pituitary adenoma. Case: A 65-year old man consulted for an incidentally discovered 7 cm abdominal mass on CT-scan, lateral to the right kidney, invading inferior vena cava, associated to a retroperitoneal adenomegaly and a lesion on the body of L2 vertebra with spinal MRI aspect of metastasis. All these lesions showed hypermetabolism on 18F-FDG PET. Continuous blood pressure monitoring, plasma catecholamines and their methoxylated metabolites were normal. Chromogranine A was four times normal (Normal range<100 μg/l). Total right adrenalectomy, lumbo-aortic lymphadenectomy and nephrectomy were performed. Vertebral metastasis was treated by radiofrequency. Histopathology of the primary tumor confirmed the diagnosis of paraganglioma with 2% mitotic index. During follow-up, erectile dysfunction developed. Endocrine evaluation revealed partial hypogonadotropic hypogonadism (testosterone 214 ng/dl Normal: (280–820), LH 2.2 mUI/ml, FSH 2.5 mUI/ml) with hyperprolactinaemia (470 ng/ml, normal value <19 ng/ml) and elevated IGF1 level (214 ng/ml, normal: 41–196 ng/ml). OGTT confirmed GH hypersecretion. MRI showed a T2 hyperintense pituitary adenoma of 15×17 mm with left cavernous sinus extension without optic compression. We retained the diagnosis of PRL/GH-secreting pituitary adenoma and started dopamine agonist plus somatostatin analogue treatment. Genetic analysis revealed an new mutation on SDHC gene on exon 4 c239-242dupGTGC. The same mutation was found in his siblings (son, daughter and the grandson). His son had a non-secreting pituitary microadenoma, without pituitary abnormalities in the daughter. Work-up for paraganglioma was negative in siblings. Conclusion: This case suggests that SDHC gene mutations could be related to pituitary adenomas occurrence in association with paraganglioma syndromes, but more studies should be conducted to define the pathogenic pathways of this relationship

Contribution of serum anti-Müllerian hormone in the management of azoospermia and the prediction of testicular sperm retrieval outcomes: a study of 155 adult men

Résumé Introduction L’extraction chirurgicale de spermatozoïdes testiculaires (ECST) est la méthode qui permet d’offrir aux hommes ayant une azoospermie des chances de paternité via l’assistance médicale à la procréation. Cependant, le manque de biomarqueurs fiables rend impossible de prédire les résultats de l’ECST. À ce jour, peu d’attention a été accordée aux valeurs sériques d’hormone anti-müllérienne (AMH) chez les hommes adultes ayant une spermatogenèse altérée. Dans cette étude, nous avons cherché à déterminer si les concentrations sériques d’AMH et le rapport AMH sur testostérone totale (AMH/T) pouvaient être des facteurs prédictifs des résultats de l’ECST dans une cohorte de 155 hommes adultes caucasiens ayant une azoospermie. Résultats Les concentrations sériques d’AMH étaient significativement plus faibles dans l’azoospermie non-obstructive (ANO) non inexpliquée, ANO associée à un antécédent de cryptorchidie, ANO d’origine cytotoxique et génétique (médianes [pmol/l] = 30,1; 21,8; 26,7; 7,3; et p = 0,02; 0,001; 0,04; <0,0001, respectivement) comparativement au groupe contrôle d’azoospermie obstructive (AO) (médiane = 44,8 pmol/l). Les plus faibles valeurs ont été observées dans le groupe d’ANO d’origine génétique (p = 0,0001, par rapport à l’ANO non inexpliquée) et particulièrement chez les individus avec un syndrome de Klinefelter (médiane = 2,3 pmol/l, p <0,0001). Seules les concentrations sériques d’AMH différaient significativement entre les individus avec résultats positifs et négatifs d’extraction de spermatozoïdes chez les hommes atteints d’un syndrome de Klinefelter non mosaïque. Un seuil optimal du taux sérique d’AMH a été fixé à 2,5 pmol/l. La sensibilité, la spécificité, la valeur prédictive positive, la valeur prédictive négative et l’exactitude de ce seuil pour prédire un résultat négatif étaient de 100 %, 76,9 %, 66,6 %, 100 % et 84,2 %, respectivement. Conclusions Seules les concentrations sérique d’AMH, et non pas le rapport AMH/T, sont un bon marqueur du dysfonctionnement des cellules de Sertoli ainsi que des cellules germinales chez les hommes adultes caucasiens atteints du syndrome de Klinefelter non mosaïque. Elles peuvent prédire un résultat négatif du prélèvement de spermatozoïdes lors de l’ECST avec une sensibilité de 100 % lorsque les niveaux sériques sont inférieurs à 2,5 pmol/l

Bibliographie critique

Eisemann Pierre Michel, Ascensio Hervé, Boisson de Chazournes Laurence, Bore Valérie, Buzzi Alessandro, Bannelier-Christakis Karine, Combacau Jean, Coussirat-Coustère Vincent, Daudet Yves, Decaux Emmanuel, Ecalle Adeline, Gérard Caroline, Geslin Albane, Hustache Marie, Jouannet Emmanuelle, Kastranta Sofia, Laugier-Deslandes Sophie, Legendre Mathilde, Maljean-Dubois Sandrine, Morosoli Anthony, Moulier Isabelle, Perez Nicolas, Peyro Llopis Ana, Pigny Philippe, Poulain Michèle, Tardieu Aurélie, Tavernier Paul, Tigroudja Hélène. Bibliographie critique. In: Annuaire français de droit international, volume 47, 2001. pp. 641-706

Bibliographie critique

Eisemann Pierre Michel, Ascensio Hervé, Boisson de Chazournes Laurence, Bore Valérie, Buzzi Alessandro, Bannelier-Christakis Karine, Combacau Jean, Coussirat-Coustère Vincent, Daudet Yves, Decaux Emmanuel, Ecalle Adeline, Gérard Caroline, Geslin Albane, Hustache Marie, Jouannet Emmanuelle, Kastranta Sofia, Laugier-Deslandes Sophie, Legendre Mathilde, Maljean-Dubois Sandrine, Morosoli Anthony, Moulier Isabelle, Perez Nicolas, Peyro Llopis Ana, Pigny Philippe, Poulain Michèle, Tardieu Aurélie, Tavernier Paul, Tigroudja Hélène. Bibliographie critique. In: Annuaire français de droit international, volume 47, 2001. pp. 641-706