[Factors associated with loss to follow-up in HIV-infected patients, Ségou, Mali]. / Facteurs associes aux perdus de vue chez les patients infectes par le VIH, Segou, Mali.

OBJECTIVE: to study the factors associatedlost to follow-up in People Living with HIV on antiretroviral therapy (ART) at the Ambulatory Treatment Center (ATC). METHODS: This is a retrospective case-control study of two years. It concerned all HIV-infected patients aged 15 and over who were started on ART for at least 4 months. Each case was matched with two controls by sex and age ± 5 years. RESULTS: The proportionlost to follow-up was 21%.The median age lost to follow-up was 36 years (IQR: 30-42 years), sex ratio was 1.4 in favor of women. The median initial CD4 cell count was 151 cells / mm3 (IQR: 51-245) versus 207 (IQR: 67-482) for controls and the median lost to follow-up was 6 months (IQR: 4-9 months): 5-16) for controls. In multivariate analysis, the factors associated lost to follow-up were: unmarried (adjusted OR = 3.84, P = 0.0346); the initial CD4 <200 cells / mm3 (adjusted OR = 3.88, P = 0.0393) and the duration of ARV <= 6 months (adjusted OR = 6.59, P = 0.0047). The protective factors against lost to follow-up were: Body Mass Index of the last visited > = 18.5 kg / m2 (adjusted OR = 0.07, P = 0.0069); (OR adjusted = 0.06, P = 0.0197) and initiation to ART in the rainy season (adjusted OR = 0.21, P = 0.0220). CONCLUSION: These results can be supplemented by quantitative and qualitative studies.

LE BUT: de ce travail était de d'étudier les facteurs associés aux perdues de vue chez les personnes vivant avec le VIH sous traitement antirétroviral (ARV) au Centre de Traitement Ambulatoire. MÉTHODES: Il s'agissaitune étude rétrospective cas-témoins de deux ans. Elle a concerné tous les patients infectés par le VIH âgés de 15 ans et plus initiés au traitement antirétroviral depuis 4 mois. RÉSULTATS: La proportionde perdue de vue était de 21% (31/151). L'âge médian des PDV était de 36 ans (IQR:30-42ans), le sexe ratio était 1.4 en faveur des femmes. Le CD4 initial médian était 151 cellules /mm3 (IQR: 51-245) contre 207 (IQR:67-482) pour les témoins et la durée médiane PDV était de 6 mois (IQR :4-9 mois) contre 9 mois (IQR:5-16) pour les témoins. A l'analyse multivariée, les facteurs associés au PDV étaient : les non mariés (OR ajusté= 3,84, P=0.0346) ; le taux de CD4 initial < 200 cellules /mm3 (OR ajusté= 3.88, P=0.0393) et la durée sous ARV ≤ 6 mois (OR ajusté= 6.59, P=0.0047). Les facteurs associés à une diminution du risque de PDV étaient : IMC de la dernière visitée ≥ 18,5 kg/m2 (OR ajusté=0.07, P=0.0069) ; les activités associatives (OR ajusté = 0.06, P=0.0197) et l'initiation aux ARV en saison de pluie (OR ajusté=0.21, P=0.0220). CONCLUSION: D'autres études quantitatives et qualitatives représentatives de la région de Ségou sont nécessaires afin de mieux comprendre ce phénomène PDV.

Factors associated with acquisition of glycopeptide-resistant enterococci during a single-strain outbreak.

The aim of our study was to describe and to investigate the factors associated with glycopeptide-resistant enterococci (GRE) acquisition during a single-strain outbreak which occurred in several wards of hospital from September 2013 to January 2014. We designed a case-control study. Analyses were performed using Bayesian methods. Univariate logistic regressions with informative priors from published studies were conducted. A multivariate model was build including variables with a probability of odd-ratio exceeding one (Pr) >85% or <15%. Thirteen cases and 52 controls were recruited. The description of this outbreak highlighted the importance to quickly detect patients at risk of GRE carriage in order to implement the isolation measures and to transfer to dedicated department if they are effectively carriers. Following multivariate analysis, antibiotics during hospitalisation (Pr = 0.968), number of hospitalisation days in the year (Pr = 0.964), antacids intake (Pr = 0.878) (with a risk increase), immunosuppression (Pr = 0.026) and isolation measures (Pr = 0.003) (both with protective effect) were associated with GRE acquisition. The use of Bayesian statistics was useful because of our study's small population size and prior information availability.

Modification of cerebral vascular anatomy induced by Leo stent placement depending on the site of stenting: A series of 102 cases.

BACKGROUND AND PURPOSE: Recent studies demonstrated the capacity of stents to modify cerebral vascular anatomy. This study evaluates arterial anatomy deformation after Leo stent placement according to the stenting site and the impact on the immediate postoperative and six-month degree of aneurysmal occlusion. MATERIALS AND METHODS: A total of 102 stents were placed against the neck of aneurysms situated in the anterior cerebral circulation. Aneurysms were classified into two groups: The first was called the distal group (n = 62) and comprised aneurysms situated in the middle cerebral and anterior communicating arteries and the second was called the proximal group (n = 40) and comprised aneurysms in other sites. The stented arterial segment was classified as deformed or non-deformed by blinded review and superimposition of anonymised films before and after stenting. The degree of occlusion was determined immediately postoperatively and at six months. RESULTS: Significantly, anatomical deformity was observed in the distal group compared to the proximal group (85% vs 28%). No significant difference was observed between the two groups in terms of postoperative degree of occlusion. At six months, a significant difference was observed between the two groups: three recurrences in the distal group vs 10 recurrences in the proximal group. Two (3%) recurrences were observed in the deformed group vs 11 (31%) recurrences in the non-deformed group. CONCLUSIONS: Arterial deformity induced by stenting is even more marked for distal aneurysms. The recurrence rate is smaller when the stent placement results in an arterial anatomical change. The percentage of recurrence is lower when anatomy was amended by stent implantation.

Tropheryma whipplei associated with diarrhoea in young children.

Tropheryma whipplei was detected in preliminary studies in faeces of young children with diarrhoea and also in faeces of asymptomatic persons, not only in Europe but also in Africa. In this study, the link between this bacterium and the presence of acute diarrhoea was evaluated in a large group of children. From December 2009 to January 2013, rectal swabs collected from 3796 children in the emergency departments of university hospitals in Marseille, France, were analysed: 555 children (245 female and 310 male, from 6 days to 6 years old) with acute diarrhoea defined as at least three loose stools per day for <1 week and 3241 children (1444 female and 1797 male, from 22 days to 6 years old) without diarrhoea. Specific quantitative real-time PCR was performed to detect the presence of T. whipplei and of two enteric pathogens Clostridium difficile and Giardia duodenalis. Tropheryma whipplei was significantly more common in children with diarrhoea (22/555, 4%) than without (56/3241, 1.7%; p 0.001). Neither C. difficile nor G. duodenalis showed this association. For C. difficile, 39 of 531 (7.3%) children with diarrhoea were positive versus 184 of 3119 (5.9%) of children without diarrhoea (p 0.25). For G. duodenalis, 2 of 529 (0.37%) children with diarrhoea were positive versus 5 of 3119 (0.16%) children without diarrhoea (p 0.26). Tropheryma whipplei was found more commonly in autumn. Tropheryma whipplei is significantly associated with diarrhoea in children, suggesting that the bacterium may be a cause of acute diarrhoea.

[Study of reports to the departmental home of disabled children placed in social assistance to children in the Bouches-du-Rhône]. / Étude des notifications à la Maison départementale des personnes handicapées chez les enfants placés à l'Aide sociale à l'enfance dans les Bouches-du-Rhône.

INTRODUCTION: By the end of 2011, 275,000 children in France were included in the Aide sociale à l'enfance (ASE, Child Welfare System). Half of these children were entrusted to public care. There is limited data on these children. The MDPH (Maison départementale des personnes handicapées) is an administrative body assisting in the care of disabled children, through material, financial, and human means. Analyzing MDPH medical records can provide medical information about these children. The aim of this study was to describe the characteristics of children left to the ASE with a record at MDPH in Bouches-du-Rhône. METHODS: We extracted administrative data from two registers, the ASE register and the MDPH register. The MDPH medical files of each patient were analyzed and their medical information was coded: gestational age, deficiencies, and pathologies. RESULTS: In Bouches-du-Rhône, 2965 children were entrusted, 506 (17%) of whom were known by the MDPH: 30.6% of the entrusted children known by MDPH were taken into foster care and 48% were in residential group homes. Half of the MDPH notifications concerned a referral to a school or medico-social institution. By analyzing the medical data, we observed an average of 2.1 deficiencies per child. The types of deficiencies were distributed as follows: 35.9% were psychological deficiencies, 26.4% were speech deficiencies, and 21.6% were intellectual cognitive deficiencies. The most common pathology was mental and behavioral disorder (71% of diagnoses). DISCUSSION: The MDPH notification rate in children entrusted to public care was seven times higher than in the general population. Overall, explaining the relation between child abuse and neglect and disability is difficult. The psychopathology of these children is complex. These results show the importance of specific medical monitoring for these children.

Landscape and climatic characteristics associated with human alveolar echinococcosis in France, 1982 to 2007.

Human alveolar echinococcosis (AE) is a severe hepatic disease caused by Echinococcus multilocularis. In France, the definitive and intermediate hosts of E. multilocularis (foxes and rodents, respectively) have a broader geographical distribution than that of human AE. In this two-part study, we describe the link between AE incidence in France between 1982 and 2007 and climatic and landscape characteristics. National-level analysis demonstrated a dramatic increase in AE risk in areas with very cold winters and high annual rainfall levels. Notably, 52% (207/401) of cases resided in French communes (smallest French administrative level) with a mountain climate. The mountain climate communes displayed a 133-fold (95% CI: 95-191) increase in AE risk compared with communes in which the majority of the population resides. A case-control study performed in the most affected areas confirmed the link between AE risk and climatic factors. This arm of the study also revealed that populations residing in forest or pasture areas were at high risk of developing AE. We therefore hypothesised that snow-covered ground may facilitate predators to track their prey, thus increasing E. multilocularis biomass in foxes. Such climatic and landscape conditions could lead to an increased risk of developing AE among humans residing in nearby areas.

Mass gathering and globalization of respiratory pathogens during the 2013 Hajj.

Every year, more than 10 million pilgrims arrive in the Kingdom of Saudi Arabia for the Hajj or Umrah. Crowding conditions lead to high rates of respiratory infections among the pilgrims, representing a significant cause of morbidity and a major cause of hospitalization. Pre- and post-Hajj nasal specimens were prospectively obtained from a paired cohort (692 pilgrims) and from nonpaired cohorts (514 arriving and 470 departing pilgrims) from 13 countries. The countries of residence included Africa (44.2%), Asia (40.2%), the United States (8.4%) and Europe (7.2%). Nasal specimens were tested for 34 respiratory pathogens using RT-PCR. A total of 80 512 PCRs were performed. The prevalence of viruses and bacteria increased, from 7.4% and 15.4% before the Hajj to 45.4% and 31.0% after the Hajj, respectively, due to the acquisition of rhinovirus, coronaviruses (229E, HKU1, OC43), influenza A H1N1, Streptococcus pneumoniae, Haemophilus influenzae and Staphylococcus aureus. We did not identify Middle East respiratory coronavirus carriage. At arrival, the prevalence of several viruses was clearly dependent on the pilgrim's country of origin. After Hajj participation, these viruses were isolated among pilgrims from all countries, with few exceptions. No significant differences were observed between paired and nonpaired cohort results. Our results strongly suggest that, given the particularly crowded conditions during the rituals, an international mass gathering such as the Hajj may contribute to the globalization of respiratory pathogens after the cross-contamination of pilgrims harbouring pathogens that easily spread among participants. Influenza and pneumococcal vaccination, face mask use and hand hygiene should be considered in the context of the Hajj.

[BCG vaccination: survey among children less than 5 years of age in an emergency department]. / Vaccination par le BCG : enquête auprès d'enfants de moins de 5 ans consultant dans un service d'urgences hospitalières.

UNLABELLED: France is a country with a low incidence of tuberculosis. However, there are important local variations: some parts of the city of Marseilles (southern France) presented a yearly incidence greater than 30/100,000 in 2010. The main goal of this study was to evaluate the BCG vaccine coverage among at-risk children younger than 5 years consulting in one of the city's pediatric emergency departments. MATERIAL AND METHODS: This descriptive study took place in February 2013 and used a semi-directive questionnaire distributed to parents. RESULTS: One hundred and thirty-five children were included, 98 (72.6 %) were considered as being at risk of tuberculosis and among them 75 (76.5 %, 95 % CI [68.0-85.1]) were vaccinated with BCG. Parents' knowledge of tuberculosis was relevant in 48 % of the respondents. Only 19 % of the parents reported that BCG protects against tuberculosis, but 73 % were in favor of this vaccination. Two criteria significantly increased vaccine coverage among at-risk children: birth in Marseilles and age more than 6 months on the consultation day. The child living in a poor family and type of medical follow-up did not significantly influence BCG vaccine coverage. CONCLUSION: BCG coverage was high in at-risk children younger than 5 years born in Marseilles. Cooperation between private physicians, maternity hospitals and mothers, and children's public health services probably facilitates this high level of protection.

Is exposure to night-time traffic noise a risk factor for purchase of anxiolytic-hypnotic medication? A cohort study.

BACKGROUND: Studies suggest that road traffic noise increases risks of sleep disturbances, anxiety and depressive symptoms, but few have focused on psychotropic drug use. We examined whether exposure to night-time road traffic noise in Marseilles (France) is associated with an increased risk of purchasing anxiolytic or hypnotic medications. METHODS: Cohort of 190,617 inhabitants of Marseilles (aged 18-64 years) covered by the National Health Insurance Fund. We used the CadnaA noise propagation prediction model to calculate a potential road noise exposure indicator at dwellings for the night-period: Ln. Association between the number of purchases of anxiolytics-hypnotics in 2008-9 and the Ln was analysed with a zero-inflated negative binomial (ZINB) model adjusted for characteristics of individuals (sociodemographic, consultations with general practitioners, presence of chronic psychiatric disorder), prescribers (demographic, specialty, workload) and neighbourhoods (medical density, complaints filed for environmental noise). Analyses were stratified by the deprivation level of the census block of residence to control for the confounding effects of neighbourhood socio-economic status. RESULTS: The ZINB model showed a small but significant increase in the risk of purchasing higher numbers of anxiolytics-hypnotics for Ln greater than 55 dB(A) only in the low deprivation stratum. CONCLUSION: We found some evidence that potential exposure to night-time road traffic noise might affect individual use of anxiolytics-hypnotics. Further research based on strictly individual approaches is warranted to assess exposure to road traffic noise more precisely and reliably than allowed by noise propagation prediction models.

Interlaboratory reproducibility of Etest amphotericin B and caspofungin yeast susceptibility testing and comparison with the CLSI method.

This study aimed to assess the interlaboratory reproducibility at four university hospital laboratories in the southeast region of France of the Etest technique for the determination of caspofungin (CAS) and amphotericin B (AMB) MICs and to compare it to the CLSI broth microdilution reference method. Consecutive clinical yeast isolates (n = 198) were included in the study. AMB and CAS MICs were read at 24 and 48 h. Interlaboratory reproducibility was estimated by using (i) an intraclass correlation coefficient (ICC), (ii) essential agreement (EA), and (iii) categorical agreement (CA). For Etest interlaboratory reproducibility for CAS, ICCs were 0.80 (95% confidence interval [CI], 0.76 to 0.84) and 0.81 (95% CI, 0.77 to 0.85) at 24 and 48 h, respectively. For AMB, the ICCs were 0.51 (95% CI, 0.43 to 0.58) and 0.69 (95% CI, 0.63 to 0.74) at 24 and 48 h, respectively. At 48 h, the between-center EAs ranged from 94.4 to 99.0% for both antifungals. For the comparison of the CLSI method and the Etest, the between-technique ICCs were 0.69 (95% CI, 0.63 to 0.74) and 0.62 (95% CI, 0.55 to 0.68) for CAS and AMB, respectively. The EAs ranged from 76.5 to 98.5% for CAS and from 90.3 to 97.4% for AMB according to the centers. CAs ranged from 87.9% to 91.4%, with four very major errors for 2 strains (1 Candida albicans strain and 1 Candida krusei strain), for CAS and from 97.5 to 99.5%, with four major errors, for AMB. In conclusion, the Etest showed a good interlaboratory reproducibility and a good correlation with the CLSI technique. It is well suited for the routine clinical laboratory and can thus be used to monitor clinical yeast isolates' in vitro susceptibilities in this setting.

[Mucoepidermoid carcinomas of salivary glands: prognostic significance of immunohistochemistry. A study of 49 cases]. / Carcinomes muco-épidermoïdes des glandes salivaires : valeur pronostique de l'immuno-histochimie. A propos de 49 cas.

INTRODUCTION: Mucoepidermoid carcinoma (MEC) is considered as the most common malignant salivary gland tumor. Its prognosis is dominated by the presence of high-grade forms involving life-threatening. The aim of our study was to evaluate the usefulness of immunohistochemistry to identify the most aggressive forms and allow better discrimination between low grade, intermediate grade and high grade tumors. MATERIALS AND METHODS: This was a retrospective study of 49 cases of mucoepidermoid carcinomas of salivary glands. Two immunohistochemical markers have mainly been studied: a marker of proliferation (Ki-67) and a growth factor receptor (EGFR). Additional analyzes were performed with other markers (p53, ACE, bcl2, CD 117 and her2). Statistical analysis investigated the existence of a correlation between the presence of these factors and the histopathological grade on one hand and survival of patients on the other hand. RESULTS: Regarding the results of immunohistochemical Ki-67 and EGFR, it was observed a better survival rate when the immunostaining was less than 10%. The expression of Ki-67 and EGFR was correlated with the histological grade, but did not, in our study, allow discrimination between low-grade, intermediate grade and high grade. Our results are consistent with data of the literature, including Ki-67, which appears to be a useful but not powerful marker of prognosis of MEC. Other markers studied (p53, ACE, bcl2, CD 117 and her2) showed no contributory results. CONCLUSION: The prognosis of MEC is appreciated satisfactorily following histological criteria: histological grade, surgical margins, perineural invasion or vascular emboli. The integration of immunohistochemistry in a therapeutic algorithm could be particularly useful for the challenging assessment of prognosis of intermediate grades.

Auxological evaluation in patients with a 22q11.2 microdeletion syndrome: normal prevalence of obesity and neonatal length and gender influence on body mass index evolution.

AIMS: To evaluate auxological parameters in children and adults with a 22q11.2 microdeletion syndrome (22q11.2 DS) and to compare prevalence of obesity to that in the French general population. METHODS: 102 patients with 22q11.2 DS (49 males, 53 females) were recruited from birth to adulthood through a reference center in southern France. RESULTS: Mean BMI Z score and mean height were normal (0.07 ± 1.49 SD, -0.87 ± 1.36 SDS, respectively). 16.1% of patients were overweight (including obese), 57% out of them being born small for gestational age for length versus 25% of non-overweight patients. During infancy, BMI increased in girls (+0.89 SD Z score). Childhood: 14.7% were overweight, prevalence similar to that of the in French children population. Adulthood: 19.2% were overweight. BMI Z scores were inversely correlated with neonatal length (p = 0.026) and female sex (p = 0.032) but positively associated with neonatal weight (p = 0.036). From analysis of neonatal data, 22q11.2 DS newborns were significantly shorter with regard to their weight (p < 0.01), even though mean neonatal measures were above -2 SDS. CONCLUSIONS: Our study did not find a higher prevalence of overweight in 22q11.2 DS to that in the French population. The BMI Z score was inversely correlated with neonatal length and female gender but positively associated with neonatal weight.

Pituitary stalk interruption syndrome in 83 patients: novel HESX1 mutation and severe hormonal prognosis in malformative forms.

BACKGROUND: Pituitary stalk interruption syndrome (PSIS) is a particular entity in the population of patients with hypopituitarism. Only rare cases have a known genetic cause. OBJECTIVES: i) To compare subgroups with or without extra-pituitary malformations (EPM) in a cohort of PSIS patients to identify predictive factors of evolution, ii) to determine the incidence of mutations of the known pituitary transcription factor genes in PSIS. Study design We analyzed features of 83 PSIS patients from 80 pedigrees and screened HESX1, LHX4, OTX2, and SOX3 genes. RESULTS: PSIS had a male predominance and was rarely familial (5%). Pituitary hypoplasia was observed only in the group with EPM. Multiple hormone deficits were observed significantly more often with versus without EPM (87.5 vs 69.5% respectively). Posterior pituitary location along the stalk was a significant protective factor regarding severity of hormonal phenotype. A novel HESX1 causative mutation was found in a consanguineous family, and two LHX4 mutations were present in familial PSIS. CONCLUSION: PSIS patients with EPM had a more severe hormonal disorder and pituitary imaging status, suggesting an antenatal origin. HESX1 or LHX4 mutations accounted for <5% of cases and were found in consanguineous or familial cases.

Noble gas (argon and xenon)-saturated cold storage solutions reduce ischemia-reperfusion injury in a rat model of renal transplantation.

BACKGROUND: Following kidney transplantation, ischemia-reperfusion injury contributes to adverse outcomes. The purpose of this study was to determine whether a cold-storage solution saturated with noble gas (xenon or argon) could limit ischemia-reperfusion injury following cold ischemia. METHODS: Sixty Wistar rats were randomly allocated to 4 experimental groups. Kidneys were harvested and then stored for 6 h before transplantation in cold-storage solution (Celsior®) saturated with either air, nitrogen, xenon or argon. A syngenic orthotopic transplantation was performed. Renal function was determined on days 7 and 14 after transplantation. Transplanted kidneys were removed on day 14 for histological and immunohistochemical analyses. RESULTS: Creatinine clearance was significantly higher and urinary albumin significantly lower in the argon and xenon groups than in the other groups at days 7 and 14. These effects were considerably more pronounced for argon than for xenon. In addition, kidneys stored with argon, and to a lesser extent those stored with xenon, displayed preserved renal architecture as well as higher CD-10 and little active caspase-3 expression compared to other groups. CONCLUSION: Argon- or xenon-satured cold-storage solution preserved renal architecture and function following transplantation by reducing ischemia-reperfusion injury.

Demography and diffusion in epidemics: malaria and black death spread.

The classical models of epidemics dynamics by Ross and McKendrick have to be revisited in order to incorporate elements coming from the demography (fecundity, mortality and migration) both of host and vector populations and from the diffusion and mutation of infectious agents. The classical approach is indeed dealing with populations supposed to be constant during the epidemic wave, but the presently observed pandemics show duration of their spread during years imposing to take into account the host and vector population changes as well as the transient or permanent migration and diffusion of hosts (susceptible or infected), as well as vectors and infectious agents. Two examples are presented, one concerning the malaria in Mali and the other the plague at the middle-age.

Cytomegalovirus risk factors in renal transplantation with modern immunosuppression.

BACKGROUND: Immunosuppressive regimens have lowered the rate of kidney rejection, but with increasing immunodeficiency-related complications. New cytomegalovirus (CMV) prophylaxis also has become available. The impact of these 2 developments on CMV diseases has not been well evaluated. We conducted a randomized trial comparing a drug regimen common in the 1980s, cyclosporin A (CsA) with azathioprine (Aza), with a drug combination used most today, tacrolimus (Tac) with mycophenolate mofetil (MMF), and we analyzed CMV risk factors in kidney transplant patients. METHODS: The 300 patients included in the trial underwent the same universal prophylaxis and preemptive therapy. CMV events and risk factors were prospectively recorded. RESULTS: With preventive and preemptive strategies combined for 3 months, CMV replication was detected in 32.6% and CMV disease in 18.1% of patients. Multivariate analysis on risk factors for CMV disease were CMV donor (D)/recipient (R) matching and first month renal function (risk ratio [95% confidence interval]: 1.02 [1.01; 1.04]; P=0.011), but not the immunosuppressive regimen (P=0.35). The D+/R- combination increased the risk of CMV disease by a factor of 9 (P<0.0001) when compared with D-/R- status, and a factor of 3.5 (P<0.0001) when compared with all CMV-positive recipients. Despite the 50% rate of CMV disease in the D+/R- group, no asymptomatic CMV replication was detected with the preemptive strategy. CONCLUSIONS: With modern immunosuppression, a sequential quadritherapy with Tac/MMF, and a 3-month CMV prevention strategy, the risk for CMV disease remains close to that with CsA/Aza. A CMV-negative recipient transplanted from a CMV-positive donor (D+/R-) remains a major risk factor, calling for better CMV prophylaxis or matching in negative recipients. Preemptive strategy thus appeared inefficient for this high-risk group. Transplant recipients with altered renal function should also be considered at risk.

Specific adipocytokines profiles in patients with hyperactive and/or binge/purge form of anorexia nervosa.

OBJECTIVE: The aim of our study was to determine whether eating behaviors and/or physical activity level may explain contradicting results in adipocytokines levels in anorexia nervosa (AN). SUBJECTS/METHODS: Fasting levels of circulating adipocytokines (adiponectin, resistin and leptin), insulin, glucose, C-reactive protein, cytokines (tumor necrosis factor-alpha and interleukin (IL)-1beta), body composition and resting energy expenditure were measured in 24 women AN patients and 14 women controls. These parameters were compared according to AN subtypes: 15 patients with restrictive (R-AN) form versus 9 patients with binge/purge (BP-AN) form; 15 patients with hyperactive (H-AN) form versus 9 patients with nonhyperactive (NH-AN) form. RESULTS: BP-AN patients had significantly higher serum adiponectin levels compared with R-AN patients (P<0.05), and H-AN patients had higher serum leptin and lower serum resistin levels compared with NH-AN patients (P<0.05 for both). CONCLUSIONS: Our study shows specific adipocytokines profiles depending on the subtype of AN: restrictive versus binge/purge and hyperactive versus Nonhyperactive forms. We suggest that these biological signatures could interfere with the outcome of the disease.

[Carcinologic outcomes after radical prostatectomy in 81 high-risk patients]. / Résultats carcinologiques de la prostatectomie totale chez 81 patients à haut risque.

OBJECTIVES: To evaluate carcinologic outcomes and biologic recurrence (BR) factor after radical prostatectomy (RP) for high-risk (HR) prostate cancer. MATERIAL AND METHODS: Between 1996 and 2006, 81 consecutives RP (65 with standard lymphadenectomy) have been done by a single surgeon for HR cancer according to d'Amico classification. No patient received neo-adjuvant therapy. Minimum follow-up required was 2 years. The BR was defined by two consecutives PSA greater than 0.2 ng/ml. Forty patients required immediate adjuvant therapy. Thirty for patients required secondary therapy. A multivariate analysis have been done for the following factors: age at RP, TNM stage, pre- and postoperative PSA, Gleason score, number of positive core biopsy, number of HR factor, positive surgical margin and immediate adjuvant therapy. RESULTS: Mean age was 64 years. Median follow-up was 71 month. Forty-nine patients was pT3 (60.5 %), seven was pN+(8.7 %) and 40 had positive surgical margin (49.4 %). The 5 years biological recurrence free survival rate was 42 %. The Gleason score (p=0.003, RR=1.688, IC=1.193-2.387), the preoperative PSA (p=0.001, RR=1.06, IC=1.032-1.089) and the number of positive core biopsy (p=0.006, RR=5.316, IC=1.605-17.607) were significant independent prognostic factors for the BR. The number of HR factor, positive surgical margin and immediate adjuvant therapy were not significant independent prognostic factors for the BR. CONCLUSIONS: At 5 years, RP in HR prostate cancer allowed carcinologic control without BR in 34 patients (42 %). This result was not influenced by the number of HR factor, surgical positive margin and immediate adjuvant therapy.