Tolérance et interactions médicamenteuses des traitements anti-VIH et anti-VHC

Treating Hepatitis C among HIV patients under antiretroviral drug therapy requires a high degree of vigilance and continuous monitoring because of frequent problems with intolerance and/or drug interactions. Recent studies, including three therapeutic trials, on Ribavic, APRICOT, and ACTG A5671, have given some insights on following these patients up. The adverse effects are relatively similar in HCV-HIV-co-infected patients and patients infected by HCV only. Their frequency is, on the other hand, higher among HCV-HIV-Co-infected patients. The adverse-effects are consistent, in a non-exhaustive way, with pseudo influenza-like symptoms, fever, myalgia, cephalgia, with psychiatric disorders (irritability, depression, etc.); endocrine disorders (thyroid dysfunction, diabetes...); and with hematological anomalies especially anemia and leucopenia. But the percentage of lymphocyte T CD4 is not modified, therefore there is no risk of opportunistic infection. Pharmacokinetic interactions between antiretroviral drugs and treatment for HCV infection including ribavirin plus interferon alpha (IFN-alpha) or pegylated IFN are described. They are almost exclusively due to the combination of ribavirin and of nucleoside analogue reverse transcriptase inhibitors. One of the principal consequences is the emergence of mitochondrial toxicity defined by the occurrence of hyperlactatemia, or acute pancreatitis). Thus, some combinations should be avoided such as ddI+ribavirin and ddI+d4T+ribavirin. The d4T+ribavirin combination must also be used with caution.

[Is bone infection of endogenous or exogenous origin? A pathophysiological approach]

Osteomyelitis is a bacterial implant in bone matrix. Infection occurs as a result of a bacteremia, an inoculation during aseptic or orthopedic surgery, or a contiguous infectious focus. Persistent and relapsing infection may be due to three situations: underlying conditions such as diabetes mellitus or rheumatoid arthritis, presence of foreign surgical implant, and a causative bacterial strain. The pathogenesis of osteomyelitis has been explored through various experimental models, involving mostly Staphylococcus (S. aureus, S. epidermidis) and has given new insights. Bacterial adherence to implanted devices or bone matrix via surface proteins is critical for bacterial survival. Further bacterial growth depends on various mechanisms: the capacity to exhibit matrix-embedded lifestyle known as biofilm and the ability for bacterial subpopulations to switch to a dormant metabolic state known as small colony variants. In addition to bacterial factors, the presence of foreign material induces a defect in local inflammatory response partly responsible for the high susceptibility to infection.

High dose vancomycin for osteomyelitis: continuous vs. intermittent infusion

OBJECTIVES

To compare the efficacy, ease of use and safety of intermittent vancomycin infusion (IVI) and continuous vancomycin infusion (CVI) in high-dose therapy of osteomyelitis.

METHODS

Forty-four patients with an osteomyelitis requiring vancomycin for more than 4 weeks were prospectively included, 21 receiving IVI and 23, CVI. The target serum concentration of vancomycin was 20-25 mg/L. Pharmacokinetics, adverse effects, and clinical efficacy were recorded.

RESULTS

The mean daily vancomycin dosing was the same in the two groups, but the serum vancomycin concentrations (trough or plateau) were lower in the IVI group than the CVI group (21.7 +/- 9.3 and 26.0 +/- 6.1 mg/L, respectively; P < 0.0001). The target concentrations were achieved quicker with CVI, and daily dosing was changed more frequently in the IVI group. After reaching the target, variability of vancomycin serum concentration (trough or plateau concentrations) was higher in the IVI group than in CVI group (standard deviation 7.9 mg/L vs. 5.6 mg/L, respectively; P = 0.001). CVI did not show clinical superiority, but adverse drug effects were more frequent in the IVI group as compared with the CVI group, 9 (42.9%) and 2 (8.7%), respectively (P = 0.03). Survival multiple regression using Cox's proportional hazard model showed that IVI (RR = 5.9, P = 0.03) and osteomyelitis of the foot (RR = 5.2, P = 0.01) were the only factors associated with adverse drug reactions leading to treatment termination.

CONCLUSIONS

CVI is practical and effective, and may be a good alternative for patients requiring prolonged treatment with high vancomycin serum levels.

Clinical and familial correlates of tardive dyskinesia in India and Israel

BACKGROUND

Antipsychotic drugs are widely used for the treatment of psychosis, especially schizophrenia. Their long-term use can result at times in serious side-effects such as Tardive Dyskinesia (TD). Since over 80% of schizophrenia sufferers (lifetime prevalence 1%) receive long-term antipsychotic drug treatment, the extent of the problem is potentially large. Increasing age is the most consistently demonstrated risk factor for TD.

AIMS

To assess effect of different clinical factors and demographic variables in India and Israel and sib pair concordance of Tardive Dyskinesia (TD) in India.

SETTINGS AND DESIGN

The study was conducted simultaneously among Indian and Israeli subjects: ascertainment was family-based in India and hospital-based in Israel.

METHODS AND MATERIAL

In India the instruments used were: Diagnostic Interview for Genetic Studies (DIGS), Positive and Negative Syndrome Scale (PANSS), Abnormal Involuntary Movement Scale (AIMS), and Simpson Angus Scale (SAS). The last three instruments were also used in Israel.

STATISTICAL ANALYSIS

Regression analysis and Pearson's correlation.

RESULTS AND CONCLUSIONS

TD symptoms were present in 40.4% of 151 Israeli subjects and 28.7% of 334 Indian subjects. While age at onset and total scores on PANSS were significant predictors of TD in both the samples, lower scores on the Global Assessment of Functioning Scale (GAF), diagnostic sub-group and male gender were significant predictors among Indians. There was no concordance of TD symptoms among 33 affected sib-pairs from India.

The DNA sequence quality machine at IFOM: a simple Web-based tool for quantitative assessment of sequencing reactions

DNA sequence quality is a factor of paramount importance in the world of modern genetic and genomics. Both the sequencing of Human Genome in the "post-draft" era [NHGRI Standard for quality of Human Genomic Sequences, Rev. 7 July (2002) where http://www.nhgri.nih.gov/Grant_info/Funding/ Statements/RFA/quality_standard.html is the HTTP address] and recent "high-throughput" approaches to genetic investigation such as SAGE [Velculescu, V.E., Zhang, L., Vogelstein, B. et al. (1995) "Serial analysis of gene expression", Science 270, 484-487] need a reliable, standardized measure of the quality of a sequencing reaction. The increasing importance of SNP studies also requires a stronger quality control on sequencing reactions by the final user. We propose here a simple, web-based tool for integrated sequence quality evaluation, high quality region quantitative value calculation and chromatogram display. This software is aimed at the small to medium DNA sequence laboratory or to the single researcher, interested in getting a quantitative measure of the sequence quality, browsing the chromatogram and checking the quality values base by base. The program is freely available from the IFOM bioinformatics web Server at http://bio.ifom-firc.it/Phred20/index.html.

Serotonin syndrome after concomitant treatment with linezolid and citalopram

Linezolid, a new synthetic antimicrobial, is an important weapon against methicillin-resistant Staphylococcus aureus (MRSA). Although there are reports of serotonin syndrome developing after concomitant use of linezolid and the selective serotonin reuptake inhibitor paroxitene, this report concerns a patient receiving citalopram who developed thrombocytopenia, serotonin syndrome, and lactic acidosis and died following long-term linezolid therapy.

Bartonella henselae infection mimicking a splenic lymphoma

We report a Bartonella henselae infection in a 40-y-old patient who presented with fever, weight loss, night sweats, elevated lactate dehydrogenase and multinodular splenomegaly with multiple abdominal lymphadenopathies. Splenic cat-scratch disease is an exceptional diagnosis in adults and can easily be mistaken for a splenic lymphoma, thereby leading to an unnecessary splenectomy.

Effect of the methodology on peptide amino acid concentrations in blood and plasma of sheep

Different methodologies for the measurement of peptide amino acid (PAA) in blood and plasma were compared in sheep. Preparation of blood and plasma samples consisted of a deproteinization, either chemical with sulfosalicylic acid (0.04 g for 1 ml of sample) or physical by ultrafiltration (10,000-MW cut-off filters), with or without a subsequent ultrafiltration through a 3,000-MW cut-off filter. Peptide concentrations were determined by quantification of amino acid concentrations before and after acid hydrolysis of samples. Free amino acid concentrations were similar by all the method used (about 2.5 and 2.7 mM, for blood and plasma respectively). Peptide concentrations were higher with chemical deproteinization (10.6 and 4.2 mM, for blood and plasma respectively) than with physical deproteinization (5.7 and 3.3 mM, for blood and plasma respectively). When the deproteinized samples were further treated to remove material of molecular weight above than 3 kDa, peptide concentrations were significantly reduced, which indicates inefficiencies in the ability of the deproteinizing procedures in removing all the proteinaceous materials. Concentration of small PAA (< 3 kDa) in blood was about 1.5-fold that in plasma, mainly due to peptide Gly and Glu derived from the hydrolysis of the erythrocyte glutathione. The choice of a methodology for quantifying circulating peptides is discussed.

Effect of the methodology on circulating peptides determination and consequences on net flux measurements across the gastrointestinal tract of sheep

Two methodologies for the measurement of peptide amino acids (PAA) in blood were compared to evaluate their effects on the measurement of the net flux of peptides across the gastrointestinal tract of sheep. These methods consisted of a chemical deproteinization of blood samples with sulfosalicylic acid (1.6 M, 0.1 ml for 1 ml of sample) or perchloric acid (1 M, 1 ml for 1 ml of sample) followed by ultrafiltration through a 3,000-Da cut-off filter (SSA + UF3 kD) or gel filtration through a Sephadex G-15 column (1,500-Da cut-off filter; PCA + G-15), respectively, prior to PAA analysis. Peptide concentrations as determined by amino acid concentrations before and after hydrolysis of samples were slightly greater with the SSA + UF3 kD (991 microM) than with the PCA + G-15 (605 microM) methodology. However, both methodologies gave similar net portal-drained viscera flux data in sheep fed on alfalfa pellets with histidine as the only significant uptake of peptide amino acid.

The value of suction drainage fluid culture during aseptic and septic orthopedic surgery: a prospective study of 901 patients

There are no guidelines on the value of suction drainage fluid culture (SDC), and it is difficult to determine whether the organisms cultured from suction drainage fluid samples are pathogenic or simply contaminants. We performed 2989 cultures of suction drainage fluid samples obtained, during a 1-year period, from 901 patients who underwent aseptic or septic orthopedic surgery (946 operations). The culture results were analyzed to evaluate their ability to detect postoperative infection after aseptic operations or to detect either a persistent or new episode of sepsis in patients known to have infection. For aseptic operations, the sensitivity of SDC was 25%, the specificity was 99%, the positive predictive value was 25%, and the negative predictive value was 99%. For septic operations, the sensitivity of SDC was 81%, the specificity was 96%, the positive predictive value was 87%, and the negative predictive value was 94%. We conclude that, for aseptic orthopedic surgery, SDC is not useful in detecting postoperative infection. However, for septic orthopedic surgery, it is of clinical importance.

Characterization of the caprine stearoyl-CoA desaturase gene and its mRNA showing an unusually long 3'-UTR sequence arising from a single exon

A 5-kb long transcript encoding the stearoyl-CoA desaturase (SCD) was identified by Northern-blot analysis of poly(A)+ mRNA from caprine lactating mammary gland. Complete sequencing of the SCD cDNA (5123 bp) revealed that the coding region (1080 nt) is followed by an unusually long (3.8 kb) 3'-UTR sequence, deriving from a single exon, in which a polymorphism, due to the deletion of a nucleotide triplet, was detected. The complete structural organization of the relevant gene has been determined. The transcription unit was shown to span a 15-kb region and to consist in six exons varying in size from 131 (3rd exon) to 4047 bp (6th exon), and five introns varying in size from 600 to 3700 bp. Using the fluorescence in situ hybridization technique, the SCD gene was localized to bovine and caprine chromosomes 26q21, and ovine chromosome 22q21.

Outpatient parenteral antimicrobial therapy (OPAT) for the treatment of osteomyelitis: evaluation of efficacy, tolerance and cost

OBJECTIVES

To evaluate the feasibility, efficacy, and cost of outpatient parenteral antimicrobial therapy (OPAT) in the treatment of osteomyelitis.

SUBJECTS

39 patients with an osteomyelitis requiring parenterally administered antibiotics for more than 4 weeks, and able to receive antibiotics at home.

METHODS

All patients had a totally implanted catheter. Antibiotics were administered by continuous infusion using a portable elastomeric infusion system, which was changed every day by the patient or by the home-care nurse. Laboratory monitoring and surveillance were performed weekly. Clinical efficacy, adverse effects and quality of life were recorded.

RESULTS

The most commonly used antibiotics were vancomycin (51%) and beta-lactam (44%) antibiotics. Thirty patients were available for follow-up for a minimum of 12 months after completion of therapy. Twenty-eight (93%) were considered cured of their infection with a mean of 24 +/- 4 months after completion of antibiotic therapy. Adverse effects among the study patients were rare. The 39 patients in our OPAT programme resulted in a potential saving of US $1 873 885 relative to conventional therapy.

CONCLUSION

OPAT is practicable and effective and may be the best alternative treatment for patients suffering from osteomyelitis requiring intravenous therapy.

Cost-Effectiveness of tolterodine for patients with urge incontinence who discontinue initial therapy with oxybutynin: a Canadian perspective

BACKGROUND

Tolterodine is a novel muscarinic receptor antagonist for the treatment of overactive bladder.

OBJECTIVE

The purpose of this study was to examine the cost-effectiveness of tolterodine for patients with urge incontinence (UI) who discontinue initial therapy with oxybutynin in a Canadian setting.

METHODS

We compared 2 treatment strategies for the management of adult patients with UI: (1) generic oxybutynin with no further treatment for patients who discontinue and (2) generic oxybutynin with switch to tolterodine (2 mg BID) for patients who discontinue. We developed a 1-year Markov model (4-week cycle length) with transitions between disease states of normal, mild, moderate, and severe. Transition probabilities over 12 weeks were obtained from randomized trial data, and drug discontinuation rates were obtained from Quebec prescription claims data. Outcome measures were time in "normal" health state and quality-adjusted life-years (QALYs) using EuroQol-5D utility scores from a survey of Swedish patients with overactive bladder. Costs to the health care payer and patient out-of-pocket costs (in Canadian dollars) were included.

RESULTS

For patients who discontinue oxybutynin, the use of tolterodine is associated with approximately 6 months per year in a normal health or mild disease state, compared with approximately 3 months for those who do not receive further drug therapy after discontinuation. Tolterodine use resulted in an annual additional cost per patient of Can $163. The incremental cost per QALY was Can $9,982 and appeared to be robust to alternative model parameter assumptions.

CONCLUSION

Use of tolterodine in patients with UI who discontinue initial therapy with generic oxybutynin lies within currently accepted benchmarks for cost-effectiveness.

A longitudinal insufficiency fracture of the tibia in association with a healed chronic osteomyelitis

Longitudinal stress fracture of the tibia often present with an atypical clinical presentation which can be mistaken for osseous tumor or osteomyelitis. We present a case of longitudinal stress fracture of the tibia which occurred in a patient with healed chronic osteomyelitis of the tibia. Magnetic resonance imaging failed to make the correct diagnosis. Accurate diagnosis was only obtained by helical CT which showed the longitudinal fracture line. Magnetic resonance imaging showed only non-specific signs of bone marrow edema, suggesting recurrence of osteomyelitis. Magnetic resonance imaging can be misleading in the absence of direct visualization of the fracture line.

A prospective comparison of octyl cyanoacrylate tissue adhesive (dermabond) and suture for the closure of excisional wounds in children and adolescents

BACKGROUND

Recent studies suggest that the use of octyl cyanoacrylate tissue adhesive for closure of both traumatic lacerations and incisional surgical wounds results in a cosmetic outcome comparable to that achieved with conventional sutures. To date, no studies have looked at the use of tissue adhesive for higher-tension wounds, such as those created during cutaneous excisional procedures.

OBJECTIVE

To compare the tissue adhesive octyl cyanoacrylate with standard suture for the closure of excisional wounds in children and adolescents.

DESIGN

A prospective comparison with blinded assessment of cosmetic outcome. Twenty-eight wounds were closed with monofilament suture and 24 were closed with tissue adhesive. At approximately 2 months, photographs of the incisions were evaluated by 2 dermatologists blinded to the method of skin closure.

SUBJECTS

Forty-two consecutive patients undergoing excisional dermatologic procedures at Children's Hospital, San Diego, Calif. These 42 patients had a total of 52 wounds that were evaluated.

MAIN OUTCOME MEASURES

The cosmetic appearance of the wounds at 2 months, based on 2 validated wound scales: the Hollander Wound Evaluation Scale and a visual analog scale.

RESULTS

There were no differences in early complications between the groups. The suture group scored higher on the visual analog scale (63.3 mm for suture vs 47.8 mm for tissue adhesive), and this difference was statistically significant (P =.02). The suture group also had a higher median score on the Hollander Wound Evaluation Scale, but this difference was not statistically significant (P =.09).

CONCLUSION

The cosmetic outcome of cutaneous excisional surgery wounds closed with standard suturing was found to be superior to that of wounds closed with octyl cyanoacrylate.

Zenker's diverticulum associated with multilevel cervical osteomyelitis

STUDY DESIGN

A case report of cervical osteomyelitis possibly associated with a Zenker's diverticulum perforation.

OBJECTIVES

To present clinical, radiologic, and surgical findings of a cervical osteomyelitis due to a Zenker's diverticulum perforation.

SUMMARY OF BACKGROUND DATA

A 56-year-old patient was in an intensive care unit for a severe head injury. He was fed via a nasogastric tube. Four months later he developed a pyogenic cervical vertebral infection.

METHODS

Plain films and magnetic resonance imaging showed a diffuse cervical osteomyelitis. Investigation of his dysphagia revealed a Zenker's diverticulum.

RESULTS

After administration of antibiotics and surgical treatment of the diverticulum, the cervical infection resolved. Plain films and magnetic resonance imaging showed healing with vertebral fusion.

CONCLUSIONS

Cervical osteomyelitis is uncommon. Only one case of direct contamination leading to cervical vertebral osteomyelitis after esophageal perforation has been previously described. Direct contamination of the prevertebral soft tissues by bacteria traveling through the fistula may have occurred. The development of vertebral osteomyelitis in this case is consistent with the hypothesis of direct contamination. Management relies on appropriate antimicrobial therapy and surgical management of the diverticulum. The association of Zenker's diverticulum with vertebral osteomyelitis and discitis is a unique, previously undescribed situation.

[Indinavir-ritonavir combination: pharmacologic results and tolerance in patients infected by HIV]

OBJECTIVES

Ritonavir (RTV) is a powerful inhibitor of P450 3A4 cytochorme. When given in combination with indinavir (IDV) it increases the IDV trough concentrations (Cmin) allowing a lower IDV dosage in a twice a day regimen, independently of meals. We report tolerance data and IDV Cmin levels observed in plasma and cerebrospinal fluid (CSF) in a cohort of HIV-infected patients treated with the IDV-RTV combination at different dosages of IDV and RTV.

PATIENTS AND METHODS

IDV Cmin was assayed 56 times in 40 patients (few patients had received different dosages of the IDV-RTV combination). Tolerance was recorded.

RESULTS

For patients given the IDV-RTV combination at the doses of 800/100 mg b.i.d., 800/200 mg b.i.d. or 400/400 mg b.i.d., the IDV Cmin was 12 times the median IDV IC95. If the Cmin/IC95 ratio was greater than 10 with the 800/100 mg b.i.d. regimen and virological success was achieved, the IDV dosage was reduced to 400 mg b.i.d. For these patients, the 400/100 mg b.i.d. IDV-RTV regimen always gave a Cmin above the IDV IC95. Median Cmin for IDV in CSF was 146 ng/ml (range 71-881 ng/ml), above the IDV IC95. It was possible to control most of the adverse effects by reducing dosage after obtaining the IDV pharmacological levels. Definitive interruption of treatment was required in only 2 cases at mean follow-up of 7.9 months.

DISCUSSION

The IDV-RTV combination should be used to improve observance of antiretroviral treatments and reduce the risk of virological failure related to low plasma levels. The IDV-RTV combination at 800/100 mg b.i.d. is a useful protocol when IDV efficacy alone is the goal. The 400/400 mg b.i.d. IDV-RTV regimen is an interesting alternative when efficacy of both inhibitors is the goal. Drug assays should be systematic to adapt individual dosages and limit the risk of adverse effects.

A new approach to determine the genetic diversity of viable and active bacteria in aquatic ecosystems

BACKGROUND

Discrimination among viable, active, and inactive cells in aquatic ecosystems is of great importance to understand which species participate in microbial processes. In this study, a new approach combining flow cytometry (FCM), cell sorting, and molecular analyses was developed to compare the diversity of viable cells determined by different methods with the diversity of total cells and active cells.

METHODS

Total bacteria were determined by SYBR-II staining. Viable bacteria were determined in water samples from different sites by plate count techniques and by the direct viable count (DVC) method. Substrate-responsive cells (i.e., DVC(+) cells) were distinguished from nonresponsive cells (i.e., DVC(-) cells) by FCM and sorted. The genetic diversity of the sorted cell fraction was compared with the diversity of the total microbial community and with that of the culturable cell fraction by denaturing gradient gel electrophoresis (DGGE) of polymerase chain reaction (PCR)-amplified 16S rDNA fragments. The same approach was applied to a seawater sample enriched with nutrients. In this case, actively respiring cells (CTC+) were also enumerated by FCM, sorted, and analyzed by DGGE.

RESULTS

The diversity of viable cells varied depending on the methods (traditional culture or DVC) used for viability assessment. Some phylotypes detected in the fraction of viable cells were not detectable at the community level (from total DNA). Similar results were found for actively respiring cells. Inversely, some phylotypes found at the community level were not found in viable and active cell-sorted fractions. It suggests that diversity determined at the community level includes nonactive and nonviable cells.

CONCLUSION

This new approach allows investigation of the genetic diversity of viable and active cells in aquatic ecosystems. The diversity determined from sorted cells provides relevant ecological information and uncultured organisms can also be detected. New investigations in the field of microbial ecology such as the identification of species able to maintain cellular activity under environmental changes or in the presence of toxic compounds are now possible.

[Anti-infection prophylaxis after sexual assault. Experience of the Raymond Poincaré-Garches Hospital]

OBJECTIVE

The August 1997 Directive of the Direction of General Health in France extended indications for antiretroviral treatment to risk of HIV exposure by sexual intercourse or syringe sharing. In November 1997, in collaboration with the Hauts-de-Seine MedicoJudiciary center, the Infectious Disease unit of the Raymond Poincaré Garches Hospital established a health care and anti-HIV prophylaxis clinic for victims of sexual assault. We report here the experience in 1998 and 1999.

PATIENTS AND METHODS

Between January 1998 and December 1999, 109 victims of sexual assault, 105 women and 4 men, mean age 24.7 +/- 10.6 years attended the clinic.

RESULTS

Mean delay from assault to antiretroviral tritherapy (AZT, 3TC, indinavir) was 18.35 +/- 17.39 hours. Mean duration of antiretroviral treatment was 17.4 +/- 11.8 days. HIV screening in perpetrators enabled early interruption of the antiretroviral treatment in 23 cases (21.1%). Sixty-two victims (62%) were still in follow-up at W4/W7. Excellent compliance to tritherapy was observed in these subjects. Clinical intolerance was observed in 46.6% with nausea-vomiting in 91.4% of the cases. Adverse effects led to interruption of indinavir in 5 cases. Initial HIV serology was negative in all cases and no case of HIV seroconversion was observed. Among the 23 known perpetrators, one was HIV-positive with an HIV-RNA at 88,000 copies. Sixty-one victims (55.9%) had been previously vaccinated against the hepatitis B virus; 16 victims were vaccinated after the assault. There were no cases of hepatitis B virus seroconversion. Search for chlamydiae in vaginal secretions was positive in 3 cases and chlamydia serology demonstrated a seroconversion in 1 case. There was no case of syphylitic seroconversion and no case of gonococcal or trichomonas infection.

CONCLUSION

The low rate of attendance for follow-up in regards to the gravity of the potential risk of HIV and/or hepatitis B virus transmission and the burden and cost of the antiretroviral treatment highlight the need for better medico-psycho-social support for rape victims. For the victims who attended the clinic, antiretroviral treatment was generally well accepted and well tolerated.

Human immunodeficiency virus (HIV) protease inhibitors have no effect on hepatitis C virus (HCV) serum levels of HIV-HCV co-infected patients

Ten severely immunocompromised HIV-HCV co-infected patients were enrolled in a quantifiable HCV-RNA assay. Serum alanine aminotransferase, HCV-RNA levels and HIV viral loads were determined at baseline, at month three and at month six after initiation of a highly active antiretroviral therapy including an HIV protease inhibitor. HCV genotypes were determined using a line probe assay kit. Our results suggested that this therapy did not result in lower HCV viraemia, whatever the HCV genotypes, and probably had no effect on the outcome of chronic viral hepatitis C. As our patients were severely immunocompromised and their mean increase of CD4 cell counts was less than 50/mm(3), we cannot reach any conclusions about the impact of the improvement of immune status on the HCV-RNA load.

Microbial community dynamics in Mediterranean nutrient-enriched seawater mesocosms: changes in the genetic diversity of bacterial populations

A mesocosm experiment was performed to study the influence of nutrients on activity and diversity of bacterial assemblages from the Mediterranean Sea. Changes in the diversity of the predominant bacterial populations were monitored by DGGE fingerprinting of PCR products derived from 16S rRNA encoding genes. Fluctuations in the diversity of the most active populations was inferred by performing the DGGE fingerprinting on the basis of the cellular rRNA after reverse transcription and PCR amplification. DNA-derived DGGE patterns obtained from duplicate control and nutrient-enriched mesocosms showed differences in the development of the bacterial communities between control and nutrient-enriched experimental mesocosms. Multidimensional scaling analysis of the DNA-derived DGGE fingerprints indicated that duplicate treatments were reproducible. DNA- and RNA-derived DGGE fingerprints of bacterial assemblages changed over time, showing that the composition of the bacterial assemblages, as well as the most active bacterial populations changed during different phases of the incubation. Sequences of predominant DGGE bands in RNA-derived patterns were similar to 16S rRNA gene sequences of members of the alpha-, gamma- and delta-Proteobacteria and of the Cytophaga-Flavobacterium-Bacteroides phylum (CFB). Bands corresponding to Ruegeria-like bacteria and members of the CFB became especially dominant during the course of incubation, suggesting that these populations were important contributors to bacterial production and activity in the post-grazing phase of the experiment.

Microbial community dynamics in Mediterranean nutrient-enriched seawater mesocosms: changes in abundances, activity and composition

Quantitative and qualitative changes in bacterial communities from the Mediterranean Sea were compared in duplicate batch mesocosms with or without addition of inorganic nutrients. Methods including traditional microbial ecology techniques, molecular biology and flow cytometry were combined to determine abundances, production, cell size, activity, culturability and taxonomic diversity of bacterial cells. Addition of nutrients and confinement resulted in an increase of bacterial densities which were rapidly controlled by protozoan grazing. Changes in bacterial activity and morphology were observed during the growth phase of bacteria and under grazing pressure. The proportion of medium-size and culturable cells increased during the growth phase. These cells were preferentially consumed by grazers resulting in a strong limitation of bacterial production. As a consequence of the grazing pressure, large cells were produced and contributed to the remaining bacterial productivity after grazing. Grazing had an effect on the taxonomic composition of bacterial communities by preferentially eliminating gamma-Proteobacteria, alpha-Proteobacteria were preserved. It seems that some species from the genera Ruegeria and Cytophaga may have developed defence strategies to escape predation.

Cloning and functional analysis of SEL1L promoter region, a pancreas-specific gene

We examined the promoter activity of SEL1L, the human ortholog of the C. elegans gene sel-1, a negative regulator of LIN-12/NOTCH receptor proteins. To understand the relation in SEL1L transcription pattern observed in different epithelial cells, we determined the transcription start site and sequenced the 5' flanking region. Sequence analysis revealed the presence of consensus promoter elements--GC boxes and a CAAT box--but the absence of a TATA motif. Potential binding sites for transcription factors that are involved in tissue-specific gene expression were identified, including: activator protein-2 (AP-2), hepatocyte nuclear factor-3 (HNF3 beta), homeobox Nkx2-5 and GATA-1. Transcription activity of the TATA-less SEL1L promoter was analyzed by transient transfection using luciferase reporter gene constructs. A core basal promoter of 302 bp was sufficient for constitutive promoter activity in all the cell types studied. This genomic fragment contains a CAAT and several GC boxes. The activity of the SEL1L promoter was considerably higher in mouse pancreatic beta cells (beta TC3) than in several human pancreatic neoplastic cell lines; an even greater reduction of its activity was observed in cells of nonpancreatic origin. These results suggest that SEL1L promoter may be a useful tool in gene therapy applications for pancreatic pathologies.

Effect of underfeeding on metabolism of portal-drained viscera in ewes

We investigated whether short-term underfeeding could induce adaptative mechanisms in portal-drained viscera (PDV) that would allow nutrients to be spared for vital functions in adult ewes. Six ewes (three of them fitted with catheters in the mesenteric artery and portal and mesenteric veins) were fed, in a double Latin square design (2 weeks per experimental period), a regrowth of natural grassland hay at 143 (high; H), 88 (medium; M) and 51 (low; L) % of their energy maintenance requirements. The digestibility of the diet was measured in all six ewes and the net portal fluxes of nutrients in the three catheterized ewes. The organic matter content and N digestibility of the diet were not affected by underfeeding. Urinary and faecal N losses and N balance were linearly related to feed intake. Arterial concentration of acetate was linearly related to feed intake. Arterial concentrations of the other volatile fatty acids, 3-hydroxybutyrate, lactate, glucose, NH3, urea and total amino acids were not affected by underfeeding. Arterial concentration of non-esterified fatty acids (NEFA) increased with underfeeding. The portal net release of all volatile fatty acids, 3-hydroxybutyrate and NH3 were linearly related to intake. The portal net flux of both essential and non-essential amino acids, and thus total amino acids, remained unchanged between levels H and M, and decreased between levels M and L. A significant net uptake for glycine and total non-essential amino acids occurred at level L. The portal net uptake of glucose, urea, glutamate and glutamine, and the portal net release of lactate and NEFA were not affected by underfeeding. Summation of portal energy fluxes indicated that 51% of the metabolizable energy intake was recovered in the portal blood with the three levels of intake. In conclusion, no quantitative adaptation to spare energy, in terms of percentage of intake, occurred in PDV of short-term underfed ruminants, but the pattern of absorption of energetic nutrients was modified.

Depression-related variables and breast self-examination in single older african-american women

PURPOSE: Depression-related symptoms, such as despair and loneliness, may prevent women from using preventive screening for diseases. This study aimed to assess if depression-related variables affect the likelihood of implementation of breast self-examination (BSE) in single African-American women aged 65 and older.METHODS: Subjects for this study included 325 African-American women, aged 65 and older, who were widowed, divorced, separated, or never-married, and lived in ten public housing tenements in Nashville, Tennessee. In-person interviews were conducted to collect information on breast screening behavior, knowledge and attitudes, social networks and activities, medical care use and depression. Depression variables included 19 factors, such as feeling guilty, feeling sad or blue, and feeling worthless.RESULTS: Using logistic regression with adjustment for potential confounders, we found that, compared with women who did not perform BSE, those who performed BSE were less likely to have felt guilty in the preceding year (p < 0.05, odds ratio (OR) = 0.3, confidence interval (CI) = 0.13-0.71). However, the other depression-related variables were not associated with BSE. For example, women who performed BSE and those who did not perform BSE reported feeling sad or blue in equal frequencies (OR = 0.93, CI 0.49-1.7).CONCLUSIONS: In general, this study suggests that there is no overall association between depression-related symptoms and breast self-examination in single African-American women aged 65 and older.

Specific combinations of zein genes and genetic backgrounds influence the transcription of the heavy-chain zein genes in maize opaque-2 endosperms

The transcript levels of heavy-chain zein genes (zH1 and zH2) and the occurrence of the zH polypeptides in different opaque-2 (o2) lines were investigated by RNA-blot analyses and by sodium dodecylsulfate-polyacrylamide gel electrophoresis or two-dimensional gel electrophoresis protein fractionations. Four mutant alleles o2R, o2T, o2It, and o2-676 introgressed into different genetic backgrounds (GBs) were considered. The mono-dimensional gel electrophoresis zein pattern can be either conserved or different among the various GBs carrying the same o2 allele. Likewise, in the identical GB carrying different o2 alleles, the zein pattern can be either conserved or differentially affected by the different mutant allele. Zein protein analysis of reciprocal crosses between lines with different o2 alleles or the same o2 showed in some case a more than additive zH pattern in respect to the o2 parent lines. Electrophoretic mobility shift assay approaches, with O2-binding oligonucleotide and endosperm extracts from the above o2 lines, failed to reveal o2-specific retarded band in any of the o2 extracts. The results suggest that the promoter of some zH1 and zH2 contains motif(s) that can respond to factors other than O2.

Relationships among Bacterial Cell Size, Productivity, and Genetic Diversity in Aquatic Environments using Cell Sorting and Flow Cytometry

The study of relationships between cell size and productivity is of key importance in microbial ecology to understand which members of natural aquatic communities are responsible for the overall activity and/or productivity. Flow sorting of microorganisms from different environmental samples was used to analyze the activity of bacterial cells depending on their biovolume. Bacterial cells from five different natural samples taken along the Mediterranean coast including fresh- and seawaters were incubated with tritiated leucine, then stained with SYTO 13 and sorted by flow cytometry according to their average side-angle-scattered (SSC) light. In all samples, a bell-shaped relationship was found between cell biovolume and activity, whereas activity of a given cell-size class varied between samples. In contrast, an inverse relationship was found between biovolumes and abundances. These results suggest that medium-sized cells with highest growth rates are probably submitted to intense grazing. For one sample, bacteria within five different size classes were sorted and the genetic diversity of cells within each sorted size class and that of the whole community were analyzed by the denaturing gradient gel electrophoresis (DGGE) method. The genetic diversity, as determined at the community level was highly represented into the pool of small cells, whereas only few species were present into larger cell subpopulations. The results suggest that only a few genotypes may be dominant within the largest and most productive cells. Furthermore, cell size polymorphism as well as heterogeneous cellular activities were found within some species.

Free and peptide amino acid net flux across the rumen and the mesenteric- and portal-drained viscera of sheep

This experiment was conducted to determine the significance of the peptide amino acid (PAA) contribution to amino acid (AA) net flux in the portal vein and to evaluate the capacity for peptide absorption in the different segments of the gastrointestinal tract of ruminants. Four sheep (64+/-3 kg BW) were fitted with catheters and blood flow probes, allowing AA net flux measurements across the portal- (PDV) and mesenteric (MDV)-drained viscera and the rumen. Sheep were fed at maintenance a diet containing hay and extruded peas (70:30). Peptide absorption was investigated by a dose infusion of a mixture of peptides (casein hydrolysate, Pro-Phe, beta-Ala-His, Gly-Gly) into the rumen. Control and postinjection net fluxes of plasma free amino acids (FAA) and PAA were determined. The concentration of plasma PAA was determined by quantification of amino acids before and after acid hydrolysis of samples first submitted to chemical deproteinization and ultrafiltration (3-kDa cut-off filter). During the control period a significant net release (12 mmol/h) of PAA was observed across the PDV, which accounted for 35% of the sum of FAA and PAA net fluxes. This PDV flux of PAA mainly resulted from a MDV release of PAA (15 mmol/h). The net flux of total PAA across the ruminal wall was not significantly different from zero, but uptake of peptide Ile and release of peptide Gly were observed. The injection into the rumen of the peptide mixture increased the net release of peptide essential AA (EAA) across the MDV (P < .05) and the PDV (P < .10), and of peptide Pro and Phe across the non-MDV (P < .10). Peptide Ile uptake by the rumen tissues was decreased by the injection (P < .05). Significant increases in peptide Pro and Gly arterial concentrations were observed (P < .05). The 3-Ala-His and Gly-Gly arterial concentrations and net fluxes across the PDV were not affected by their injections into the rumen. This study showed that PAA may contribute significantly to AA flux across the PDV of sheep, and that part of this flux can probably be attributed to peptide absorption from the gut lumen. When high concentrations of peptides are generated in the rumen the possibility of peptide absorption before the jejunum has to be considered.

Hepatitis C virus co-infection is a negative prognostic factor for clinical evolution in human immunodeficiency virus-positive patients

A longitudinal study of human immunodeficiency virus (HIV)-infected individuals followed-up in 13 centres was performed to assess the influence of hepatitis C virus (HCV) on the clinical and immunological evolution of HIV-infected patients. Eight-hundred and twelve HIV-infected patients with known HIV acquisition date, 89 co-infected with HCV, were included in the cohort. Clinical progression was defined as: 30% decrease of Karnofsky's index; and/or 20% body weight loss; and/or acquired immune deficiency syndrome (AIDS)-defining illness; and/or death (except by accident, suicide, or overdose). Immunological progression was defined as a decrease of initial CD4 count to below 200 mm(-3). If immunological progression was not statistically different between groups (P=0.25), clinical progression was significantly faster in HCV-HIV co-infected patients in univariate (P=0.02) and multivariable survival analysis (hazard ratio=1.63, P=0.03). This argues for active management of hepatitis C chronic infection among HCV-HIV co-infected patients.

Identification of 6 new mutations in the iduronate sulfatase gene. Mutation in brief no. 233. Online

Mucopolysaccharidosis type II (Hunter syndrome) is an X-linked lysosomal storage disorder caused by a deficiency of the enzyme iduronate-2-sulfatase. We sequenced genomic DNA and RT-PCR products in the iduronate sulfatase (IDS) gene in 6 unrelated patients with Hunter syndrome to assess genotype/phenotype relationships and offer carrier testing where required. Six novel mutations were identified: four missense mutations, one four-base pair deletion (596-599delAACA) and a cryptic splice site mutation. Three of the missense mutations were significant amino acid substitutions (S143F, S491F, E341K) of which the latter two involve amino acids conserved amongst sulfatase enzymes. The patients identified with these mutations all had a severe clinical phenotype. One missense mutation with a minimal amino acid substitution (H342Y), in a non-conserved region of the gene, was associated with a mild clinical phenotype. We identified a novel cryptic splice site (IVS5+934G>A) with some normal (wild type) mRNA processing. We predict that the normal mRNA product confered some residual functional enzyme, resulting in a mild phenotype associated with the absence of overt central nervous system disease.

The effect of physical form of orchardgrass hay on the passage of particulate matter through the rumen of sheep

Four Texel wethers (60 to 64 kg) fitted with ruminal and duodenal cannulas were used to study the kinetics of particulate matter in the rumen and the series of processes involved in their selection and passage. They were fed, in eight equal meals, 1,200 g of a mixture of a chopped orchardgrass hay and ground (8-mm screen) and pelleted orchardgrass hay in 90/10, 50/50, 30/70, or 10/90 ratios, according to a 4 x 4 Latin square design. The particle size distributions in feed, chewed feed, and ruminal, reticular, and duodenal digesta were determined by a wet-sieving procedure. Indigestible lignin was used as an internal marker to trace the passage of particles through the rumen. Digesta flow measurement was performed using the double-marker technique. We used a three-pool model, which partitions particles through the large, medium, and small particle pools, to determine the passage of lignin through those pools. Particle pool sizes and rumen and pool mean retention times (MRT) of lignin and of the rumen MRT of an ideal marker introduced separately in each pool were corrected for the "filter bed" effect. Grinding and pelleting of hay decreased the MRT of the indigestible lignin pool in the rumen. Particle MRT decreased and then reached a plateau with increased proportion of ground/pelleted hay in the diet. The diet with a ratio of 50/50 of chopped and ground/pelleted hay was the most favorable for the exit of particles from the rumen because of both a higher outflow rate from the rumen of particles eligible to exit and a sufficient comminution rate of larger particles to supply particles that were able to pass. For all diets, the large-particle comminution rate was always higher than the small-particle outflow rate, indicating that comminution was not the limiting step for passage. These results were the consequence of the curvilinear and opposite evolutions of both the particulate lignin pool in, and outflow from, the rumen. Those results contribute to an improved explanation of the mechanisms involved in the outflow of particles from the rumen.

Variations in subject pool as a function of earlier or later participation

Data were obtained from 113 participants in a university subject pool during a 16-wk. semester. Without knowing the purpose of the study, participants self-selected to participate earlier (Weeks 3 and 4: n = 63) or later (Weeks 15 or 16) n = 50). Variations in scores on the NEO Personality Inventory--Revised, the Crowne-Marlowe Social Desirability Scale, the General Expectancy of Success Scale, the Shipley Institute of Living Scale, self-reported SATs and GPAs, and a measure of academic self-efficacy as a function of earlier or later participation were examined. Multivariate analysis of variance indicated that early participants differed significantly from later participants but not in predicted ways. Earlier participants scored higher on NEO PI-R Neuroticism; specifically men (n = 15) and women (n = 48) scored higher on Hostility, and women scored higher on Depression and Self-consciousness. An additional significant difference occurred for self-reported SAT Verbal scores for men, which were significantly higher for later participants. These temporal variations may represent confounds in research using university subject pools.

[A case of progressive multifocal leukoencephalopathy in AIDS: neuroimaging with clinical and pathologic correlation]

We present the neuroimaging features with clinical and pathologic correlation in a case of Progressive Multifocal Leukoencephalopathy (PML) in AIDS. CT and MRI showed typical lesions of PML. At pathology examination, characteristic lesions of PML were found in association with HIV encephalitis due to CNS infection by the virus.

Use of rare earth elements as external markers for mean retention time measurements in ruminants

The present review deals with the utilisation of rare earth (RE) elements as particulate markers for ruminant nutrition studies. RE elements have similar chemical properties. They are attractive for use as a multiple marker system because they bind tightly to plant materials. RE binding of plant cell walls is cyclic throughout the RE series, which can be explained by the filling of the 4 f electron shell. RE markers may migrate from labelled feedstuffs under gastrointestinal conditions and particularly under acidic conditions, and they may decrease the digestibility of labelled feedstuffs. The various binding techniques used for labelling particulate matter with RE elements are evaluated in order to increase the stability of bound RE in different gastrointestinal conditions. The soaking procedure of plant cell walls to be labelled in an RE chelate solution, followed by washing to remove loosely bound RE, is recommended.

SEL1L, the human homolog of C. elegans sel-1: refined physical mapping, gene structure and identification of polymorphic markers

We have cloned the human full-length cDNA SEL1L, which is highly similar to the C. elegans sel-1 gene, an important negative regulator of the "notch" pathway which acts as a key regulator of the cellular proliferation and specification processes in both vertebrates and invertebrates. The SEL1L gene maps to 14q24.3-31 and here we report its fine localization by HAPPY mapping, which determines its molecular distance to microsatellite markers isolated in the region. We have found two new polymorphic (CA)n microsatellites located in the gene, and have identified the exon-intron boundaries. The gene is composed of 21 exons spanning 70 kb of genomic DNA. Human SEL1L protein exhibits a high degree of similarity compared to the mouse and nematode homologs.

Amino acid flux in ruminal and gastric veins of sheep: effects of ruminal and omasal injections of free amino acids and carnosine

The possibility of free amino acid (FAA) and peptide absorption across the ruminant stomach wall was studied in multicatheterized wethers fed every 12 h. During the last third of the feeding cycle, two intraruminal or intraomasal injections of solutions containing increasing amounts of Ser, Gly, Val, Met, Phe, Lys, and carnosine were successively performed. Before injections, a net uptake of each of these FAA was measured in the ruminal and the gastric veins. The ruminal injections produced a linear increase in ruminal FAA concentration. The highest ruminal concentrations (observed with 3 g of FAA and carnosine) ranged between 5 and 14 mM. After ruminal injections, Ser (P < .05), Gly (P < .05), Val (P < .05), Met (P < .10), and Lys (P < .10) uptake decreased and carnosine net release linearly increased (P < .05), suggesting absorption across the ruminal epithelium. Owing to the low net flux generated by high ruminal concentration, the ruminal epithelium permeability to these molecules seemed to be low. After omasal injections, net flux of injected FAA were not modified, suggesting a low permeability of the gastric epithelia to FAA. Carnosine net release linearily increased (P < .05) with increasing level of carnosine injection, indicating the possibility of dipeptide absorption at the gastric level. This study demonstrated in vivo that the stomach epithelia possess the capacity to absorb FAA and small peptides; however, the permeability of these epithelia to these molecules seemed limited.

Mycobacterium kansasii septic arthritis: French retrospective study of 5 years and review

Septic arthritis due to Mycobacterium kansasii is rare; only 40 cases have been published. A French national inquiry revealed the occurrence of 10 new cases between 1992 and 1997 (8 men and 2 women: mean age, 37 years; range, 25-54 years). Seven had an underlying condition: AIDS (n=4), chronic skin psoriasis and AIDS (n=2), or a renal transplant (n=1). Trauma to the joint, use of intra-articular corticosteroid(s) 1 month to 2 years after the event, and chronic skin psoriasis were risk factors. The mean interval between appearance of the first symptoms of arthritis and the diagnosis was 5 months. Monarthritis was localized to the knee (n=4), wrist (n=3), finger (n=1), elbow (n=1), or ankle (n=1). The main diagnostic procedure was culture of a synovial biopsy specimen. In all cases, debridement was associated with antimycobacterial treatment. Three patients died of AIDS during treatment, and another is still undergoing treatment; the other 6 patients were cured. M. kansasii infection should be considered in all cases of indolent arthritis with any of the following risk factors: local trauma, local or systemic corticosteroid therapy, chronic skin psoriasis, and immunodepression, especially that due to human immunodeficiency virus infection.