Epitope load identifies kidney transplant recipients at risk of allosensitization following minimization of immunosuppression

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Patterns of health-compromising behaviors among Minnesota adolescents: sociodemographic variations.

OBJECTIVES: This study compared prevalence rates of health-compromising behaviors among boys and girls from different ethnic backgrounds in early, middle, and late adolescence and compared co-occurrences of such behaviors across gender and ethnic groups. METHODS: The study population included 123 132 adolescents in grades 6, 9, and 12. Adolescents completed a classroom-administered statewide survey focusing on high-risk behaviors, including unhealthy weight loss, substance abuse, suicide risk, delinquency, and sexual activity. RESULTS: Prevalence rates of most health-compromising behaviors differed by gender, increased with age, and tended to be highest among American Indian youth and lowest among Asian Americans. Strong associations were found between substance abuse and delinquency across all ethnic groups. Substance abuse and delinquency were associated with suicide risk across most ethnic groups. Covariations with sexual activity and unhealthy weight loss behaviors showed more ethnic variation. CONCLUSIONS: Prevention interventions should take into account the tendency for health-compromising behaviors to co-occur and should be sensitive to demographic and socioeconomic differences in behavior patterns.     

Factors associated with liver biopsy performance in HCV-HIV coinfected injecting drug users with HCV viremia: Results from a five-year longitudinal assessment

The last international consensus conference about hepatitis C virus (HCV) treatment emphasized the importance of treatment for persons coinfected with HCV and human immunodeficiency virus (HIV). As liver biopsy precedes treatment, we aimed to identify factors associated with the performance of liver biopsy among HIV-HCV coinfected drug users during a 5-year follow-up to study their access to HCV treatment. Of the 296 patients followed in the HIV hospital departments of Nice and Marseilles and with retrievable records about HCV diagnosis and care, 166 were eligible for analysis having had detectable HCV RNA at least once during the study period. Overall, 45.2% of patients underwent liver biopsy during follow-up. Using proportional hazard models, predictors of having had a liver biopsy were high social support, complete abstinence from drug injection, and lack of immunosuppression as well as male gender, no history of multiple incarcerations, more recent onset of drug use, and an increase of liver enzyme levels. These results suggest that specific efforts should be devoted to HIV-HCV coinfected drug users to assist with stabilizing these patients to optimize their access to HCV care whenever possible. The MANIF 2000 study group includes C. Boirot, A. D. Bouhnik, M. P. Carrieri, J. P. Cassuto, M. Chesney, P. Dellamonica, P. Dujardin, S. Duran, J. G. Fuzibet, H. Gallais, J. A. Gastaut, G. Lepeu, D. A. Loundou, C. Marimoutou, D. Mechali, J. P. Moatti, J. Moreau, M. Nègre, Y. Obadia, I. Poizot-Martin, C. Pradier, D. Rey, C. Rouzioux, A. Sobel, B. Spire, F. Trémolières, and D. Vlahov.     

recA protein promotes homologous-pairing and strand-exchange reactions between duplex DNA molecules.

Purified recA protein, product of the recA+ gene, promotes homologous pairing between intact covalent circular duplex DNA and circular single-stranded DNA carrying a short hybridized fragment [West, S. C., Cassuto, E. & Howard-Flanders, P. (1981) Nature (London) 290, 29-33.]. In this paper we investigate the interaction of duplex fragments with circular single-stranded DNA carrying the hybridized fragment and find that recA protein promotes an efficient strand-exchange reaction between interacting DNA molecules. The exchange is dependent upon linear duplex DNA fragments that are homologous to, but extend beyond, the short fragment present on the hybridized DNA substrate. The reactions require stoichiometric amounts of recA protein and the presence of ATP.     

Peroxisome proliferator activating receptor alpha and gamma polymorphisms and metabolic abnormalities in HIV-infected patients receiving highly active antiretroviral therapy: the ANRS CO8 APROCO-COPILOTE study

Highly active antiretroviral therapy (HAART) is associated with fat redistribution and metabolic disorders. The present study was undertaken to evaluate the association between peroxisome proliferator activated receptor (PPAR)α and PPARγ polymorphisms, two genes involved in lipid metabolism and adipocyte differentiation, and elements of the metabolic syndrome, lipodystrophy, or carbohydrate metabolism abnormalities in patients receiving HAART. The frequency distribution of rare alleles for PPARα (L162V) and PPARγ (P12A and H449H) was compared using the chi square test in 363 HIV-1-infected patients classified according to the presence or absence of the metabolic syndrome after 48 months of follow-up on their first PI-containing regimen. The P12A rare g allele was present in 12% patients with normal glucose metabolism, 11% patients with impaired glucose tolerance or impaired fasting glucose, and 35% patients with diabetes (p=0.014). The rare g allele for L162V was present in 14% of patients free of hypertriglyceridemia and in 7% patients with hypertriglyceridemia (p=0.04). The rare g allele for L162V was found in 15% of patients free of any sign of lipodystrophy and 8% with at least one sign of lipodystrophy (p=0.04) and the rare t allele for H449H was found in 14% of patients free of any sign of lipodystrophy and 23% of patients with at least one sign of lipodystrophy (p=0.05). There was no convincing association between any polymorphism of PPARα and PPARγ and each individual component of the metabolic syndrome, except for the relationship of the P12A polymorphism with diabetes. Confirmatory studies on a larger number of individuals are needed.     

The survival benefit of kidney transplantation in the setting of combined peripheral arterial disease and end‐stage renal failure

Given the deleterious effects of concomitant peripheral arterial disease (PAD) and severe renal disease, a role for aggressive screening and management of PAD in renal failure patients has been suggested. However, limited data exist detailing the impact of PAD on kidney waitlist survival and the potential benefit of transplantation in PAD. Multivariable COX regression and Kaplan–Meier survival models were fit using UNOS data to assess kidney waitlist and post‐transplant five‐yr survival. Compared to PAD?Dial? (no PAD or dialysis) waitlist survival, PAD+Dial? was associated with a 36%, PAD?Dial+ a 95%, and PAD+Dial+ a 190% increased risk of death. A significant survival benefit of kidney transplantation was identified in the PAD population (p < 0.001, HR = 0.440 comparing post‐transplant to waitlist survival). Time to survival benefit (equal mortality between waitlist and post‐transplant population) of kidney transplantation in PAD+ was realized 2.5 times sooner in pre‐emptive transplantation than transplant after dialysis (154 d vs. 381 d), per unadjusted Kaplan–Meier analysis. To our knowledge, this is the first study to demonstrate a survival benefit of kidney transplantation in the setting of PAD. Pre‐emptive transplantation with emphasis on living donation prior to dialysis should be advocated to improve outcomes in this high risk patient population.     

Positive HIV (human immunodeficiency virus) serology in the pregnant woman: current data on its management. Apropos of a continuous series of 56 cases

56 cases of pregnant women with a positive HIV serology were reported in 20 months at the Maternity of the Nice Hospital Center. In 10 cases, there were clinical signs of the disease (9 ARC-Syndrome, one case of AIDS). The predisposing factor was most of the time drug addiction, 53 cases (94.5%) and one case occurred after a blood transfusion. In the majority of the cases (52%) the pregnancy was pursued because of the late term or the patient's decision. A therapeutic abortion was performed in 12 instances (25%) and an interruption before 12 weeks of amenorrhea in 15 cases. 24 women delivered. The obstetrical complications were frequent with especially a fetal death in utero, five premature deliveries and fifteen hypotrophies. A severe infectious complication (septicemia, pneumopathy secondary to Pneumocystis carinii) was observed in 9 cases, a marked thrombopenia causing profuse post-partum haemorrhages in one case. Finally, one woman died 35 days after delivery. The study of the consequences on the child is incomplete because of insufficient follow-up: all children were sero-positive at birth and among thirteen children aged between 12 to 20 months, there were one death, one AIDS syndrome, 4 ARC-syndrome, 4 sero-positive and 3 sero-negative. The notion of HIV sero-positivity in a pregnant woman presents serious problems for the obstetrician. Decompensation of the disease during the pregnancy is uncertain but it is now confirmed that the child is affected, and this is a well established fact. These important consequences lead to propose, at this time a therapeutic interruption of pregnancy when possible, depending on the term, and when accepted by the patient.     

Long-term follow-up of benign lesions treated by SolcoDerm: a deleterious cosmetic effect

During the past five years, 15 patients, aged between 17 years to 35 years of age (mean 26 years), presented for cosmetic improvement of scars which were induced by treatment with SolcoDerm, either in the childhood or in their early teens. It was an homogenic group of patients who were treated at least 10 years before the present examination. Two representative cases are presented, and the literature is reviewed.     

Les polyamines : intérêt clinique, diagnostique et pronostique

Polyamines (putrescine, spermidine, spermine) are organic cations which are omnipresent in the living world and intimately involved in the phenomena of cell kinetics. Putrescine primarily reflects tissue growth while spermidine concentrations correlate with lysis. Several techniques exist for polyamine measurement in serum, urine and other biological fluids. At present, use of an automatic ion exchanger represents the most satisfactory method, with urine being the ideal physiological fluid.Neoplasias without residual disease present concentrations identical to those of the control group, whereas excessive values are specific to tumors in evolution. While high concentrations of these kinetic markers are also associated with certain benign affections, the latter are rare or easily diagnosed, and the value of these markers in oncology remains unaffected.Combined measurement of putrescine and spermidine levels allows evaluation of the tumor growth/lysis ratio at any given moment. The most important feature of this analysis of kinetics is the possibility of short term evaluation of the efficacy of a therapy program.