Polyamines in human breast milk for preterm and term infants.

Maternal milk is the first source of exogenous polyamines for the newborn. Polyamines modulate gut maturation in neonates, but no studies are available on polyamine concentration in human milk of preterm babies, even though they could be important for their immature gut. The present study aimed to determine polyamine concentration in human breast milk of mothers with preterm or term infants during the first month of lactation. Human milk samples were obtained during the first month of lactation from twenty-seven mothers with preterm babies and twelve mothers with babies born at term. The polyamine concentration in human milk was quantified by HPLC. During the first month of lactation, the total polyamine concentration was significantly higher in preterm milk than in term milk samples (7590 (SD 4990) v. 4660 (SD 4830) nmol/l, respectively (P » 0·034)), as well as individual polyamine concentrations. Polyamine concentration in mature milk for preterm babies was significantly higher than that in mature milk for babies at term, and a similar trend was observed in colostrum and transition human milk. The spermidine/spermine ratio was higher in transition milk in preterm v. term samples, while in mature milk, the ratio was significantly lower in preterm than in term babies. In conclusion, the polyamine concentration was significantly higher in human milk for preterm than for term infants. This and the different spermidine/spermine ratios could influence the gut development of premature babies.

Canine Leishmaniasis Progression is Associated with Vitamin D Deficiency.

The relationship between vitamin D deficiency and the risk of suffering from a plethora of health disorders, ranging from autoimmune processes to infectious diseases has been widely described. Nonetheless, the potential role of vitamin D in visceral leishmaniasis remains uncharacterized. In the Mediterranean basin, where the dog is leishmania's main peri-domestic reservoir, control measures against the canine disease have shown beneficial effects on the incidence of human leishmaniasis. In this study, we measured the vitamin D levels in serum samples from a cohort of 68 healthy and disease dogs from a highly endemic area and we have also studied the relationship of these levels with parasitological and immunological parameters. The sick dogs presented significantly lower (P < 0.001) vitamin D levels (19.6 ng/mL) than their non-infected (31.8 ng/mL) and the asymptomatic counterparts (29.6 ng/mL). In addition, vitamin D deficiency correlated with several parameters linked to leishmaniasis progression. However, there was no correlation between vitamin D levels and the Leishmania-specific cellular immune response. Moreover, both the leishmanin skin test and the IFN-γ levels displayed negative correlations with serological, parasitological and clinical signs. Further studies to determine the functional role of vitamin D on the progression and control of canine leishmaniasis are needed.

[Metastatic cancer of the breast treated by polychemotherapy: a new prognostic approach]. / Cancer métastasé du sein traité par polychimiothérapie: une nouvelle approche du pronostic.

The series consisted of 759 patients with metastatic breast cancer entered into randomized clinical trials at the Curie Institute. Twenty factors were found to be significant by univariate analysis. The current report gives a detailed analysis of prognostic factors using a new method of multivariate analysis for survival data, the recursive partition. This method was based on the construction of a regression scheme consisting of eight variables and four prognostic groups. A test sample procedure was used to validate our results and a regression scheme with three variables was constructed (LDH, adjuvant chemotherapy and the Karnofsky scale). The results were compared to the stepwise Cox regression.

[Gastric adenocarcinoma surgically treated. A multivariate analysis of prognostic factors]. / Adénocarcinomes gastriques réséqués curativement. Analyse multifactorielle des facteurs pronostiques.

One hundred and twelve curatively resected gastric adenocarcinomas were studied retrospectively to appreciate the survival factors. Twenty different criteria (clinic, histologic and therapeutic parameters) were assessed using univariate and then multivariate analysis (semi parametric regression (COX's) model). Only three criteria were very important according to the multivariate analysis: 1) invasion of neighboring organs (p less than 0.006) with a relative risk score (RRS) of 4.26; 2) intravascular or intralymphatic tumor embols outside the tumor (p less than 0.004; RRS = 2.11); 3) invaded distal nodes (located at the origin of the vessels (p less than 0.04; RRS = 1.88). A prognosis index was described according to these results. A repartition of the patients in three prognostic groups according to these 3 criteria was proposed. Future, trials should consider these three different prognostic groups.

[Virologic evolution in HIV-infected subjects with an undetectable viral load in the first trimester of 1997]. / Evolution virologique des personnes infectées par le VIH à charge virale indétectable au 1er trimestre 1997.

OBJECTIVES: Assess the evolution of viral load in HIV-infected patients whose viral load was < 500 copies/ml during the first three months of 1997. PATIENTS AND METHODS: The viral load during the first three months of 1998 was recorded for comparison. Data were collected from the DM12 database implanted in the CISIH and concerned 2113 patients. RESULTS: Virological failure was observed in one-third of the patients in the study cohort whose viral load was undetectable in 1997 (< 500 copies/ml) as their load was > 500 copies/ml one year later in 1998. The percentage of patients in a situation of virological failure in 1998 who were taking tritherapy in 1997 (38%) was lower than that in those who were not (47%). The clinical and immunological characteristics were however similar. The difference in the therapeutic regimen would probably explain the difference. CONCLUSION: These findings demonstrate that virological failure is an important problem. Other analyses should be conducted in other cohorts to determine the influence of non compliance or resistance to antiretroviral treatments. Future therapeutic strategies should take into account the results of such studies.

[Initial antiretroviral prescriptions in patients with HIV. Second semester 1994-second semester 1996]. / Les primoprescriptions d'antirétroviraux chez les patients atteints par le VIH. Second semestre 1994-second semestre 1996.

OBJECTIVES: The nature of antiretroviral therapy has radically changed these last years. A study has been conducted on data obtained from the DMI2 information system to evaluate changes on treatments, immunity and transmission profile of the patient naive to antiretroviral therapy when initiating a therapy. METHODS: DMI2 is a national, multicentered database which contains medical, epidemiological and economic information on hospital care for HIV patients. This study, on 18,510 patients followed up in one of the fifty hospitals belonging to the Centers for Information and Care of Human immune Deficiency, was conducted from the second half of 1994 to the second half of 1996. RESULTS: The therapeutic changes seen on the whole seropositive population are also observed on these patients: the proportion of regimen with only one nucleoside analogue have decreased from 90.2% in 1994 to 7.5% in 1996. The proportion of treatment with two nucleoside analogues increased from 7.9% to 67.6%. The proportion of two nucleoside analogues with one protease inhibitor regimen increased from 1.9% in 1994 to 24.6% at the end of 1996. A study focused on the second semester of 1996 shows that the proportion of homo-bisexual patients initiating an antiretroviral treatment with a three antiretroviral agents combination (29.7%) is greater than the one in the IVDU group (20.4%) or in the heterosexual group (20.8%). CONCLUSION: These results show that a higher number of patient naive to the antiretroviral therapy initiate therapy earlier, with a two or three agents combination preferentially and at a better stage of immunity.

[Prescription of antiretroviral and prophylactic drugs in HIV diseases: reality of medical practices]. / Les prescriptions des antirétroviraux et des médicaments prophylactiques dans la pathologie VIH: la réalité des pratiques médicales.

Antiretroviral and prophylactic therapy given to HIV-infected patients attending hospital (DMI 2 data base) was analyzed according to TCD4+ cell count; 19,020 patients were included in the study. Under 200 TCD4+/mm3, more than 80% of the patients received antiviral therapy, most often AZT (45.3%) or ddI (27.2%). Combined treatment was quite low, less than 8%. Although above 500 TCD4+/mm3, 11.6% of patients received AZT, this study showed that antiretroviral therapy followed French recommendations. This was not the case for prophylaxis: a large proportion of patients under 200 TCD4+/mm3 did not received pentamidine aerosol, or cotrimoxazole, or dapsone.