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Biomedical subjects

H Blain

Publications and source records attributed to H Blain.

At least 19 recordsLinked to original sources
PubMed2006

Lean mass plays a gender-specific role in familial resemblance for femoral neck bone mineral density in adult subjects.

INTRODUCTION: Whether the femoral neck bone mineral density (FN BMD) of children may be better predicted from that of their parents when taking into account the anthropometry of the children was assessed in a healthy adult sample consisting of 86 mother-daughter, 32 mother-son, 32 father-daughter, and 23 father-son pairs from 128 families. Heritability for FN BMD, which is considered to be a measurement of general resemblance, was defined as the regression coefficient of the mean of the parents' BMD. Among the anthropometric factors, lean mass was the most strongly associated with FN BMD following the adjustment for age in women (r=0.52, p<0.0001) and men (r=0.25, p=0.02). After adjustment for age, calcium intake, physical activity, and menopause and hormonal replacement therapy if relevant, heritability estimates (h2) for FN BMD were 0.68+/-0.23 [95% credible interval (CI): 0.15-0.99] in father-daughter pairs, 0.40+/-0.17 (95% CI: 0.08-0.74) in mother-daughter pairs, and 0.19+/-0.15 (95% CI: 0.01-0.57) in father-son pairs. Adjustment for lean mass of children increased the h2 for FN BMD in mother-son pairs [from 0.24+/-0.17 (95% CI: 0.01-0.57) to 0.66+/-0.18 (95% CI: 0.26-0.95)]. The present results show that FN BMD is heritable in adult father-daughter pairs (7.2% of a daughter's FN BMD variance was explained by the father's FN BMD) and that taking into account the lean mass of sons might improve the prediction of their FN BMD based on that of their mother's (reduction of sons' FN BMD residual variance by 5.1%). Taking the lean mass of children into account might improve the prediction of their FN BMD by 9.1% in daughters and by 18.1% in sons, irrespective of their parent's FN BMD. These results, obtained using a Bayesian regression model, have to be confirmed in further studies involving a greater number of adult parent-offspring pairs of both genders before extrapolation to clinical practice.

Absorptiometry, Photon↗
PubMed2005

[Diagnostic value of the clinical probability score of deep venous thrombosis in the elderly].

SUBJECT: There is a lack of scientific data concerning the incidence, clinical signs, risk factors and diagnostic management of deep vein thrombosis (DVT) in the elderly. METHODS: We carried out a prospective case-control study in a geriatric setting. We included one in-patient without clinical signs of deep vein thrombosis for each hospitalised patient with clinically suspected DVT. Clinical signs, risk factors of DVT and a compression ultrasonography of the proximal and distal leg veins were performed in all patients at admission. Also, the clinical probability was assessed by means of the clinical score model described by Wells. RESULTS: There were 102 patients aged over 85 included during the 5 months period of the study. Fifty-one patients have had a clinical suspicion of DVT and 51 patients were clinically asymptomatic. There were 43% symptomatic DVT and 12% asymptomatic DVT. Clinical signs and symptoms of DVT were neither sensitive nor specific. Risk factors associated most frequently with DVT were: immobilisation (prevalence 64%), paralysis of the legs (22%), varicose veins (25%), deshydratation (28,5%), infections (18%). A significant relationship between a risk factor and DVT was found only for immobilisation (P<0,05) and deshydratation (P<0,02). The prevalence of DVT increased with the clinical probability score: 11.4% for the low score, 27.6% for the moderate score and 55% for the high score. CONCLUSION: Incidence of DVT is high among hospitalised elderly patients, especially for the asymptomatic ones. Clinical signs alone do not reliably predict DVT. Clinical probability score could be useful to improve diagnostic management of DVT in this population.

Aged↗
PubMed2004

Body weight change since menopause and percentage body fat mass are predictors of subsequent bone mineral density change of the proximal femur in women aged 75 years and older: results of a 5 year prospective study.

Few studies have evaluated risk factors for bone loss in elderly women. We examined risk factors associated with a 5-year longitudinal change in bone mineral density (BMD) at the hip in healthy women aged 75 years and older. The BMD of 276 women from the French EPIDOS (Epidémiologie des Osteoporoses) study was assessed in Montpellier from 1992 to 1993 and again from 1997 to 1998. BMD was measured at the femoral neck, trochanter, and Ward's area using the same Lunar densitometer. We examined the relationship between clinical and behavioral factors at baseline and their variations during follow-up, with percentage BMD change adjusted for baseline BMD. Depending on the femur subregion studied, a significant decrease in BMD (exceeding the least significant difference, i.e., > 2.8 CV) was observed in 36.2% to 51.1% of women. Multivariate analysis showed that both postmenopausal weight change before baseline and baseline percentage of fat mass were positively correlated with BMD change at the Ward's triangle and the trochanter. Yearly absolute and relative weight changes over the follow-up period were significantly associated with change of trochanter and femoral neck BMD. Our results show that maintenance of body weight throughout the postmenopause period and body fat mass play protective roles against bone loss at the proximal femur in women aged 75 years and older and suggest the value in including assessment of weight change throughout postmenopause and percentage body fat mass in screening programs for elderly women who are at higher risk of accelerated bone loss.

Absorptiometry, Photon↗
PubMed2004

[Osteoporosis in men: epidemiology, physiopathology, diagnosis, prevention and treatment].

PURPOSE: This article reviews the most current information about epidemiology, risk factors, diagnosis, prevention and management of male osteoporosis. MAIN POINTS: Although osteoporosis is often regarded as a disease of women, 30% of osteoporotic fractures occur in men. Risk factors for osteoporosis or fractures in men include previous fragility fractures, maternal history of fragility fracture, hypogonadism, low body mass index, smoking, high alcohol consumption, low calcium intake, corticoid therapy, physical inactivity, and the presence of conditions such as hyperthyroidism, hyperparathyroidism, hypercalciuria or chronic inflammatory diseases. Treatment of osteoporosis is recommended in men aged > 65 years with low bone mass (T-score < -2.5), in men aged 50 to 65 years with low bone mass and at least one risk factor for osteoporosis or fracture, in men aged < 50 years with Z-score < -2 with at least one risk factor for osteoporosis or fracture and in men with at least two fragility fractures. FUTURE ASPECTS: Further studies are needed to better estimate the benefit of of bisphophonates in the prevention of glucocorticoid-induced osteoporosis and the prevention of androgen-deprivation therapy (treatment of prostate cancer) in men at high-risk for osteoporosis, of parathyroid hormone (1-34) in male primary osteoporosis, and of androgen therapy in men with symptoms (including low bone mineral density) and biological signs (with low blood free testosterone levels) of hypogonadism.

Age Factors↗
PubMed2001

[Determination by flow cytometry of reference values of erythrocyte parameters in aged subjects].

OBJECTIVES: Normal values for hemoglobin and hematocrit have been established for healthy young adults, but it is unknown whether age-related decline in hematological values occurs in the elderly. We compared normal values of hematological parameters in healthy adults and healthy persons aged 65 years and over using flow cytometry. SUBJECTS AND METHODS: Erythrocyte and reticulocyte parameters were determined in 585 subjects (294 men and 206 women aged 26 to 64 years, and 37 men and 48 women aged 65 years and over), living independently and without medication, symptom and disease, using Technicon H1 (Bayer) and R2000 (Roche) analyzers. Serum erythropoietin levels, red cell folate and creatinine clearance were determined in subjects aged 65 years and over. RESULTS: Irrespective of subject age, hemoglobin (Hb), hematocrit (Hct), red blood cell count (RBC), mean cell volume (MCV), mean corpuscular hemoglobin (MCH) and mean corpuscular hemoglobin concentration (MCHC) were higher in males than in females, but sex-related differences tended to decrease with aging. In males, there was a trend toward lower Hb and Hct with aging, due to an increase in RBC, MCV and MCH. In females, Hb and Hct (p < 0.05) increased with aging, due to a trend toward higher values of RBC, MCV and MCH. Red blood cell distribution width and hemoglobin distribution width were not modified by aging. Despite these age-related changes in erythrocyte parameters, values for anemia defined in adults appear appropriate for geriatric subjects (Hb < 130 g/l in males and Hb < 120 g/l in females). Reticulocyte count and creatinine clearance decreased in men and women aged 65 years and over (p < 0.05), whereas erythropoietin levels and red cell folate were not influenced by aging. CONCLUSION: Normal erythrocyte values defined in adults are appropriate for evaluating hematological test results in older individuals. The decrease in reticulocyte count observed in men and women aged 65 years and over does not appear to be linked to a decrease in erythropoietin production with aging.

Adult↗
PubMed2000

[The preventive effects of physical activity in the elderly].

PHYSICAL ACTIVITY AND AGING: Physical activity prevents some age-related impairment. Physical activity reduces the decline of physical capacity which remains limited by maximal heart rate, and reduces the incidence of cardiovascular diseases by decreasing and preventing associated risk factors. Physical activity reduces age-related bone loss, its effect being potentialized by hormonal replacement therapy, and improves balance function, leading to a lower incidence of falls and fractures in older subjects. Physical activity helps to preserve nutritional balance and lean mass/fat mass ratio and reduces age-related insulin resistance. Moreover, physical activity has a beneficial influence on psychological function by improving cognitive performances and decreasing incidence of depression. Lastly, physical activity seems to reduce the incidence of several cancers, colic and mammary cancers particularly. PHYSICAL ACTIVITY, QUANTITY AND QUALITY OF LIFE: These multiple actions explain that physical activity, if it's adapted to subject's specificities increases longevity, delay entry in dependence and improves quality of life in older subjects. WHAT ARE THE RECOMMENDED ACTIVITIES: There is a superiority of individualized programs giving greater place to warm-up and associated endurance and resistive exercises intended to improve simultaneously cardiovascular and muscular functions. SPECIAL INTERESTS OF PHYSICAL ACTIVITY IN FRAIL AND VERY OLD SUBJECTS: Throughout its beneficial effects on aerobic capacity, muscular function, social integration, cognitive function and autonomy, physical activity may have a particular interest in frail subjects, when programs are adapted to physical capacities of these subjects and associated with nutritional supplements.

Accidental Falls↗
PubMed2000

[The role of drugs in falls in the elderly. Epidemiologic aspects].

FALLS AND POST-FALL SYNDROME: Falls are a major health problem among the elderly because of the resulting psychological sequelae (sometimes termed "post-fall syndrome") and in a few cases serious injury, particularly hip fractures. DRUGS AND FALLS: The scientific literature on the link between medications and falls and fractures suggests that psychotropic drugs used in about 50% of residents of nursing homes and in 20% in the community cause around 30% of falls in nursing homes and 20% of falls in the community. PSYCHOTROPS: The relative effect of selective serotonin reuptake inhibitors and tricyclic antidepressors and the relative effect of short/long acting or sedative/hypnotic benzodiazepines are not well established. CARDIOVASCULAR DRUGS: Appropriate use of cardiovascular medications and analgesics does not increase the risk of falls. PREVENTION: These data reinforce the concept that reducing the use of psychotrops, especially benzodiazepines, is probably one of the most effective means of reducing serious falls in older people.

Accidental Falls↗
PubMed2000

[Non-steroidal anti-inflammatory drugs with selectivity for cyclooxygenase-2 in Alzheimer's disease. Rationale and perspectives].

POSSIBLE INFLAMMATORY MECHANISMS: Alzheimer's disease (AD) is a degenerative disease of the brain including possibly inflammatory mechanisms, as illustrated by the presence of activated microglial cells in the periphery of senile plaques and neurofibrillary tangles and the subsequent release of proinflammatory mediators with neurotoxic potency. RATIONALE FOR NSAID USE: Although not firmly demonstrated, the rationale for the prescription of non steroidal anti-inflammatory drugs (NSAIDS) as neuroprotective agents in AD lies on epidemiological data having shown a reduced risk of developing AD in patients on long-term therapy with NSAIDs (non selective cyclo-oxygenase [COX] inhibitors). RATIONALE FOR THE USE OF SELECTIVE COX-2 INHIBITORS: The rationale for the prescription of selective COX-2 inhibitors as neuroprotective drugs in AD lies on: Epidemiological data having shown a reduced risk of developing AD in patients treated with anti-inflammatory doses of classical NSAIDs (inhibition of COX-1 and COX-2) but not with antithrombotic doses of aspirin (selective inhibition of COX-1), Cellular experiments, Demonstration of a better gastro-intestinal (GI) safety profile with selective COX-2 inhibitors than with classical NSAIDs in short-term studies, allowing a possible long-term use in AD. BEFORE PRESCRIBING: COX-2 may have an ambivalent functionality in the brain since the basal production of prostaglandins through COX-2 may participate in neuronal homeostasis whereas the expression of COX-2 is associated with brain development. Classical NSAIDs are ineffective in reducing the formation of senile plaque and neurofibrillary tangles in AD, which is consistent with an ability to reduce inflammation associated with activation of microglia but illustrates their failure to suppress the degenerative process. Prophylactic use of selective COX-2 NSAIDs can be considered on the basis of their good GI safety after 6 months of marketing in United States but need to be confirmed for a longer time. CURRENT TRIALS: Clinical studies focusing on both the prevention and the slowing down of early AD are under way with two recently launched selective COX-2 inhibitors, celecoxib and rofecoxib.

Adult↗
PubMed2000

[Non-steroidal anti-inflammatory agents with selective inhibitory activity on cyclooxygenase-2. Interest and future prospects].

INTRODUCTION: Non-steroidal anti-inflammatory drugs (NSAIDs) inhibit the production of primary prostanoids by blocking the access of arachidonic acid to the active site of the cyclooxygenases (COXs). Because the prostanoids produced by COX-1 appear to play a physiological role (protection of the gastric mucosa, platelet aggregation, vascular homeostasis, maintenance of renal sodium-water balance) while those produced by COX-2 seem mainly to intervene in the inflammatory response and in certain processes associated with cell proliferation, the hypothesis has been put forward that the NSAIDs that are selective COX-2 inhibitors should theoretically be capable of maintaining NSAID therapeutic properties but also have fewer adverse side effects due to the maintenance of prostaglandin production at normal physiological levels. CURRENT KNOWLEDGE AND KEY POINTS: The hypothesis of COX isoenzyme selectivity has led to a proposed classification for COX inhibitors: 1) COX-1 selective inhibitors (low-dosage aspirin); 2) COX non-selective inhibitors (the majority of classified NSAIDs, which when administered over the long term, e.g., in cases of rheumatoid arthritis, cause duodenal ulcers in 20% of cases and gastric hemorrhage in 1-4% of cases/year); 3) COX-2 preferential inhibitors (meloxicam and nimesulide, which have fewer gastric side effects than standard NSAIDs, but which are not risk-free at high doses); 4) COX-2 selective inhibitors (celecoxib and rofecoxib). Preliminary clinical studies have shown that COX-2 selective inhibitors are as efficient as standard NSAIDs and have fewer adverse digestive side effects, thereby confirming the interest of this proposed classification. In the UK, the aforementioned studies have led to the commercialization of rofecoxib for the treatment of pain and osteoarthritis, while celecoxib has been introduced in medical practice in the USA and other countries for the treatment of rheumatoid arthritis and osteoarthritis. FUTURE PROSPECTS AND PROJECTS: Various epidemiological and laboratory studies have indicated that NSAIDs may be able to reduce the risk of cancer (colorectal cancer in particular) and Alzheimer's disease due to their inhibitory activity on COXs, especially COX-2. The therapeutic contribution of COX-2 specific inhibitors has to be more fully evaluated, particularly as these agents could delay the healing of duodenal ulcers and interfere with several COX-2-induced physiological functions. It is therefore suggested that until further information becomes available, this new class of NSAIDs should be used with caution in certain patient populations.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2000

Cryofibrinogenaemia: a study of 49 patients.

The purpose of this study was to characterize the clinical features and components of 30 patients with isolated cryofibrinogen (CF) versus those of 19 patients with combined CF and cryoglobulins (CG). Secondary forms of cryofibrinogenaemia associated with collagen disorders, infectious or malignant diseases, were significantly more frequent in patients with combined CF and CG than those with isolated CF (79 versus 47%, P = 0.02). Both groups of CF patients presented predominantly cutaneous symptoms (77% in isolated CF; 58% in combined CF + CG), and less frequently venous and/or arterial thrombosis (13% in isolated CF; 3% in combined CF + CG). Patients with idiopathic forms of CF, and particularly those without CG, suffered essentially from recurrent painful skin ulcers, mainly triggered by cold exposure. Patients with isolated CF had higher mean plasma concentrations of CF than those with combined CF + CG (1. 61 +/- 1.26 versus 0.82 +/- 1.18 g/l, respectively; P = 0.004), but there was no correlation between the CF plasma level and either the severity of symptoms or the sensitivity to cold. In patients with isolated CF, fibronectin was suggested (by precipitation analysis) to be a major component of the cryoprecipitate, whereas immunoglobulins were rarely present (in only three out of 30 patients). By contrast, in the majority of patients (78%) with combined CF and CG, the CF consisted mainly of immunoglobulins of the same class as those characterizing the associated CG. Analysis of the CG precipitate revealed the presence of fibronectin but not fibrinogen, alpha1-antitrypsin and alpha2-macroglobulin. In conclusion, isolated and combined cryofibrinogenaemia are associated with different clinical signs requiring different clinical management, but there is no evidence as yet for a causal role of the cryoprecipitates in the differences observed.

Adolescent↗