Peanut allergy: is maternal transmission of antigens during pregnancy and breastfeeding a risk factor?

BACKGROUND

Peanut allergy is an important public health problem in western countries. However, the risk factors associated with this allergy remain uncertain.

OBJECTIVE

To determine whether the consumption of peanuts during pregnancy and breastfeeding is a risk factor for peanut allergy in infants.

METHODS

We enrolled 403 infants in a case-control study. The cases were infants aged 18 months or less with a diagnosis of peanut allergy based on a history of clinical reaction after exposure to peanuts and the presence of peanut-specific immunoglobulin E. Controls were age-matched infants with no known clinical history or signs of atopic disease. The mothers of the children filled out a detailed questionnaire about maternal diet during pregnancy and breastfeeding, the infant's diet, the presence of peanut products in the infant's environment, and family history of atopy.

RESULTS

The mean (SD) age of cases was 1.23 (0.03) years. The groups were comparable in terms of the rate and duration of breastfeeding. However, the reported consumption of peanuts during pregnancy and breastfeeding was higher in the case group and associated with an increased risk of peanut allergy in offspring (odds ratio [OR], 4.22 [95% confidence interval [CI], 1.57-11.30 and OR, 2.28 [95% CI, 1.31-3.97] for pregnancy and breastfeeding, respectively). Overall, the infants with peanut allergy did not seem to be more exposed to peanut products in their environment than the controls.

CONCLUSION

Early exposure to peanut allergens, whether in utero or through human breast milk, seems to increase the risk of developing peanut allergy.

Expression of CD133 and poor outcome in neuroblastoma associated with chemoresistance mediated by AKT pathway

10007

Background: Neuroblastoma is a frequent childhood cancer with very heterogeneous prognosis. Recent studies showed that CD133 expression is an independent prognostic marker for low survival in several cancers like medulloblastoma. The aim of our study is to determine the prognostic value of CD133 expression in a large population of neuroblastoma and to determine the chemoresistance of neuroblasts expressing CD133. Methods: 280 tumor samples of neuroblastoma were screened for CD133 expression. Patients had a median follow-up of 7.15 years. One hundred eighteen patients were under one year of age with a median age of 27 months. There were 67 stage 1, 46 stage 2, 43 stage 3, 99 stage 4, and 25 stage 4S. The association of CD133 expression with relapse and survival were determined through univariate and multivariate analysis. Sensitivity of purified CD133+ neuroblasts isolated from 2 human neuroblastoma cell lines (SKNSH and NB10) to doxorubicin, vincristine and cisplatin was evaluated in vitro, as single agents or in combination with LY294002, a AKT inhibitor. Results: CD133 was expressed in 95 of 280 tumors (33%). There was a significant association between CD133 expression and the following poor prognosis co-variates: age (p<0.0001), INSS stage (p<0.0001), MYCN amplification (p<0.0001). Patients with a CD133+ tumor had a three year event-free and overall survival of 43±5% and 51±5%, respectively, as compared to patients with a CD133- tumor with 88±2% (P<0.001) and 95±2% (p<0.001). In a multivariate model, CD133 expression was independently associated with a decreased overall survival (p = 0.003) in the entire cohort. In vitro purified CD133+ neuroblasts were significantly resistant to chemotherapy as compared to their CD133- cells counterpart, but not in presence of the AKT inhibitor. In vitro treatment of unsorted neuroblasts with the three anticancer drugs significantly enriched the CD133+ subpopulation but not in presence of the AKT inhibitor. CD133plus; significantly expressed higher levels of activated proteins in the AKT pathway than CD133−. Conclusions: CD133 is independently associated with a worse outcome in patents with neuroblastoma. This prognosis factor is associated with in vitro resistance to chemotherapy involving activation of the AKT pathway.

No significant financial relationships to disclose.

Acute effect of nut consumption on plasma total polyphenols, antioxidant capacity and lipid peroxidation

BACKGROUND

Nuts have been shown to have beneficial effects on human health due to the healthy fat content; however, the effect of antioxidants (i.e. polyphenols) in nuts have not been fully investigated. The present study aimed to assess the immediate effect of a polyphenol-rich meal (75% of energy from nuts: walnuts or almonds) and a polyphenol-free meal on plasma polyphenol content, antioxidant capacity and lipid peroxidation in healthy volunteers.

METHODS

Thirteen subjects participated in a randomized, crossover, intervention study. After an overnight fast, walnuts, almonds or a control meal in the form of smoothies were consumed by study subjects. Each subject participated on three occasions, 1 week apart, consuming one of the smoothies each time. Blood samples were obtained at fasting and then at intervals up to 3.5 h after consumption of the smoothies.

RESULTS

There was a significant increase in plasma polyphenol concentration following both nut meals, with peak concentrations being achieved at 90 min, and with a walnut meal having a more sustained higher concentration than an almond meal. The plasma total antioxidant capacity reached its highest point at 150 min postconsumption of the nut meals, and was higher after the almond compared to walnut meal. A gradual significant (P < 0.05) reduction in the susceptibility of plasma to lipid peroxidation was observed 90 min after ingestion of the nut meals. No changes were observed following consumption of control meal.

CONCLUSIONS

Consumption of both nuts increased plasma polyphenol concentrations, increased the total antioxidant capacity and reduced plasma lipid peroxidation.

Acute effect of nut consumption on plasma total polyphenols, antioxidant capacity and lipid peroxidation

BACKGROUND

Nuts have been shown to have beneficial effects on human health due to the healthy fat content; however, the effect of antioxidants (i.e. polyphenols) in nuts have not been fully investigated. The present study aimed to assess the immediate effect of a polyphenol-rich meal (75% of energy from nuts: walnuts or almonds) and a polyphenol-free meal on plasma polyphenol content, antioxidant capacity and lipid peroxidation in healthy volunteers.

METHODS

Thirteen subjects participated in a randomized, crossover, intervention study. After an overnight fast, walnuts, almonds or a control meal in the form of smoothies were consumed by study subjects. Each subject participated on three occasions, 1 week apart, consuming one of the smoothies each time. Blood samples were obtained at fasting and then at intervals up to 3.5 h after consumption of the smoothies.

RESULTS

There was a significant increase in plasma polyphenol concentration following both nut meals, with peak concentrations being achieved at 90 min, and with a walnut meal having a more sustained higher concentration than an almond meal. The plasma total antioxidant capacity reached its highest point at 150 min postconsumption of the nut meals, and was higher after the almond compared to walnut meal. A gradual significant (P < 0.05) reduction in the susceptibility of plasma to lipid peroxidation was observed 90 min after ingestion of the nut meals. No changes were observed following consumption of control meal.

CONCLUSIONS

Consumption of both nuts increased plasma polyphenol concentrations, increased the total antioxidant capacity and reduced plasma lipid peroxidation.

Randomized clinical trial of post-operative radiotherapy versus concomitant carboplatin and radiotherapy for head and neck cancers with lymph node involvement

BACKGROUND AND PURPOSE

Post-operative radiotherapy is indicated for the treatment of head and neck cancers. In vitro, chemotherapy potentiates the cytotoxic effects of radiation. We report the results of a randomized trial testing post-operative radiotherapy alone versus concomitant carboplatin and radiotherapy for head and neck cancers with lymph node involvement.

MATERIALS AND METHODS

The study involved patients undergoing curative-intent surgery for head and neck cancers with histological evidence of lymph node involvement. Patients were randomly assigned to receive radiotherapy alone (54-72Gy, 30-40 fractions, 6-8 weeks) or identical treatment plus concomitant Carboplatin (50mg/m(2) administered by IV infusion twice weekly).

RESULTS

Between February 1994 and June 2002, 144 patients were included. With a median follow-up of 106 months (95% confidence interval (CI) [92-119]), the 2-year rate of loco-regional control was 73% (95% CI: 0.61-0.84) in the combined treatment group and 68% (95% CI: 0.57-0.80) in the radiotherapy group (p=0.26). Overall survival did not differ significantly between groups (hazard ratio for death, 1.05; 95% CI: 0.69-1.60; p=0.81).

CONCLUSIONS

Twice-weekly administration of carboplatin concomitant to post-operative radiotherapy did not improve local control or overall survival rates in this population of patients with node-positive head and neck cancers.

[Management of gynecomastia induced by bicalutamide]

Adjuvant bicalutamide monotherapy after radical prostatectomy improves the overall survival in patients with locally advanced prostate cancer. The main adverse event of the nonsteroidal antiandrogen is the development of gynecomastia against which prophylactic breast irradiation can be administered. Therapeutic local radiotherapy using a very small number of fractions is a well-tolerated management option. Symptom improvement is observed in about half of the patients. Radiotherapy-related adverse effects are often mild (erythema, skin irritation) and transient. Tamoxifen has been also shown to be effective in prevention and treatment of gynecomastia induced by adjuvant therapy by bicalutamide in two-third of patients. Long-term safety of this prophylactic and therapeutic approach needs to be investigated through appropriate trials. Further evaluation of the optimal dose and duration of treatment with tamoxifen in this setting is required.

Cyclosporin versus tacrolimus as primary immunosuppressant after liver transplantation: a meta-analysis

A systematic review of randomized clinical trials (RCT) was undertaken to evaluate the beneficial and harmful effects of immunosuppression with cyclosporin versus tacrolimus for liver transplanted patients. MEDLINE, EMBASE, Cochrane Central and Hepato-Biliary Group Controlled Trials Registers were searched. Using fixed and random effects model, relative risk (RR), values <1 favoring tacrolimus, with 95% confidence intervals (CI) were calculated. Of 717 potentially relevant references, 16 RCTs were eligible for inclusion. Mortality and graft loss at 1 year were significantly reduced in tacrolimus-treated recipients (Death: RR 0.85, 95% CI 0.73-0.99; graft loss: RR 0.73, 95% CI 0.61-0.86). Tacrolimus reduced the number of recipients with acute rejection (RR 0.81, 95% CI 0.75-0.88) and steroid-resistant rejection (RR 0.54, 95% CI 0.47-0.74) in the first year. Lymphoproliferative disorder or dialysis rates were not different but more de novo diabetes (RR 1.38, 95% CI 1.01-1.86) occurred with tacrolimus. More patients stopped cyclosporin than tacrolimus (RR 0.57, 95% CI 0.49-0.66). Treating 100 recipients with tacrolimus instead of cyclosporin would avoid rejection and steroid-resistant rejection in nine and seven patients respectively, graft loss and death in five and two patients respectively, but four additional patients would develop diabetes after liver transplantation.

Cyclosporin versus tacrolimus as primary immunosuppressant after liver transplantation: a meta-analysis

A systematic review of randomized clinical trials (RCT) was undertaken to evaluate the beneficial and harmful effects of immunosuppression with cyclosporin versus tacrolimus for liver transplanted patients. MEDLINE, EMBASE, Cochrane Central and Hepato-Biliary Group Controlled Trials Registers were searched. Using fixed and random effects model, relative risk (RR), values <1 favoring tacrolimus, with 95% confidence intervals (CI) were calculated. Of 717 potentially relevant references, 16 RCTs were eligible for inclusion. Mortality and graft loss at 1 year were significantly reduced in tacrolimus-treated recipients (Death: RR 0.85, 95% CI 0.73-0.99; graft loss: RR 0.73, 95% CI 0.61-0.86). Tacrolimus reduced the number of recipients with acute rejection (RR 0.81, 95% CI 0.75-0.88) and steroid-resistant rejection (RR 0.54, 95% CI 0.47-0.74) in the first year. Lymphoproliferative disorder or dialysis rates were not different but more de novo diabetes (RR 1.38, 95% CI 1.01-1.86) occurred with tacrolimus. More patients stopped cyclosporin than tacrolimus (RR 0.57, 95% CI 0.49-0.66). Treating 100 recipients with tacrolimus instead of cyclosporin would avoid rejection and steroid-resistant rejection in nine and seven patients respectively, graft loss and death in five and two patients respectively, but four additional patients would develop diabetes after liver transplantation.

Rituximab therapy for childhood-onset systemic lupus erythematosus

OBJECTIVE

To describe the safety and efficacy of rituximab in the treatment of childhood-onset systemic lupus erythematosus (SLE).

STUDY DESIGN

We conducted a French multicenter retrospective study of childhood-onset SLE treated with rituximab.

RESULTS

Eleven girls with severe SLE, including 8 girls with class IV or V lupus nephritis, 2 girls with severe autoimmune cytopenia, and 1 girl with antiprothrombin antibody with severe hemorrhage, were treated with rituximab. The mean age at onset of rituximab treatment was 13.9 years. Patients received 2 to 12 intravenous infusions of rituximab (350-450 mg/m2/infusion), with corticosteroids. Six patients also received different standard immunosuppressive agents, including Cyclophosphamide (2 patients). Remission was achieved in 6 of 8 patients with lupus nephritis and in the 2 patients with autoimmune cytopenia. Steroid therapy was tapered in 5 patients who responded to treatment, and low-dose prednisone treatment was maintained in 1 patient. The mean follow-up period was 13.2 months (range, 6-26 months), and remission lasted in all who patients who responded to treatment, except 1 patient who was successfully retreated with a second course of rituximab. Anti-double-stranded DNA antibody levels decreased in 6 of 11 patients, and anticardiolipin antibody levels decreased in 3 of 4 patients. Severe adverse events developed in 5 patients. Effective depletion of peripheral blood B cells was observed in 7 of 8 patients who were examined, and this paralleled the remission.

CONCLUSION

Rituximab may be an effective co-therapy; however, further investigations are required because severe adverse events occurred in 45% of the patients in this study.

Initial presentation of childhood-onset systemic lupus erythematosus: a French multicenter study

OBJECTIVE

To describe the clinical and laboratory manifestations of childhood-onset systemic lupus erythematosus (SLE) at presentation.

STUDY DESIGN

This retrospective French multicenter study involved 155 patients in whom SLE developed before the age of 16 years. Mean patient age at onset was 11.5 +/- 2.5 years (range, 1.5-16 years). The female to male ratio was 4.5.

RESULTS

The most common initial manifestations were hematologic (72%), cutaneous (70%), musculoskeletal (64%), renal (50%), and fever (58%). Thirty-two percent of children had atypical symptoms, mainly including abdominal involvement in 26 patients, which lead to negative laparotomy results for presumed appendicitis. Severe renal, neurologic, hematologic, abdominal, cardiac, pulmonary, thrombotic, and/or cutaneous manifestations occurred within the first month after the diagnosis in 40% of patients. The mean erythrocyte sedimentation rate was 72 +/- 29 mm/h, and the mean C-reactive protein value 22 +/- 21 mg/L. Antinuclear antibodies an, anti-double stranded DNA antibodies, and low C3 or C4 level were retrieved in 97%, 93%, and 78 % of patients, respectively.

CONCLUSION

Initial manifestations of childhood-onset SLE are diverse and often severe. The diagnosis of SLE should be promptly considered in any febrile adolescent with unexplained organ involvement, especially when associated with an increased erythrocyte sedimentation rate.

Thermocoagulation percutanée scannoguidée de l’ostéome ostéoïde

PURPOSE OF THE STUDY

Progress in medical imaging has improved recognition and management of osteoid osteoma. The purpose of this study was to assess the efficacy of computed tomography (CT)-guided percutaneous thermal ablation and discuss the advantages and disadvantages.

MATERIAL AND METHODS

We reviewed retrospectively 33 consecutive patients with osteoid osteoma who had undergone CT-guided radiofrequency ablation. The diagnosis was established on the basis of the clinical presentation and pathognomonic radiographic findings (CT and bone scintigram) without histological proof. We recorded patient age and gender, tumor location, clinical signs and duration, imaging findings, duration of the ablation procedure, type of anesthesia, hospital stay, and complications. We evaluated their effect on final outcome.

RESULTS

Weight-bearing was possible in all patients with a lesion of the lower limb a few hours after surgery. Patients resumed their normal activities in 24-48 hours. Pain resolved immediately after radiofrequency ablation in 26 patients and limping, when present, disappeared within 24 hours. At mean follow-up of 34 months (minimum 12 months) there was one case of recurrent pain. Clinical cure was confirmed by CT and bone scintigraphy in twelve patients.

DISCUSSION AND CONCLUSION

This precise and minimally invasive method is an effective and safe way to reduce healthcare expenditures. It can be recommended as the primary treatment for osteoid osteoma.

Lupus érythémateux disséminé chez l'enfant : recommandations concernant les examens à effectuer lors de l'évaluation initiale et du suivi

Childhood-onset systemic lupus erythematosus (SLE) is often severe and has a serious long-term morbidity. Pediatric guidelines about its management do not exist. The French study group of childhood-onset SLE proposes recommendations about the investigation which are needed at diagnosis and during follow-up of SLE, in order to adjust the treatment according to the severity of the disease and to avoid unnecessary investigations.

Impact of HLA matching on outcome of hematopoietic stem cell transplantation in children with inherited diseases: a single-center comparative analysis of genoidentical, haploidentical or unrelated donors

SUMMARY

Hematological inherited diseases can be cured by hematopoietic stem cell transplantation (HSCT) from an human leukocyte antigen (HLA)-identical sibling donor (MSD), but the outcome of unrelated donors (URD) or haploidentical donors (HMD) has been a cause of concern. In all, 94 children affected with inherited diseases underwent HSCT at a single center using MSD (group A, n=31), URD (group B, n=23) or HMD (group C, n=40). There was no difference in the rate of engraftment or in the incidence of grades III-IV acute graft-versus-host disease (GVHD) between the groups. Survival rate was 80.6% in group A, 62.5% in group B and 47.5% in group C (P=0.023). In group B, survival rate was 73.7% in the subgroup with zero or one class I mismatch, and 25% in the subgroup with two or more class I mismatches (P=0.04). In group C, survival rate was 83.3% in the 9/10-identical subgroup, 64.3% in the seven or 8/10 subgroup, and 25% in the five or 6/10 subgroup (P=0.0007). Thus, engraftment, incidence of GVHD and survival are similar in recipients of grafts from MSD, URD with 0-1 class I-mismatch, or HMD with at least 7/10 HLA matches. The low success of HSCT using more disparate donors suggests reserving them for patients with very poor prognosis.

Multimodal therapy with intravenous biweekly leucovorin, 5-fluorouracil and irinotecan combined with hepatic arterial infusion pirarubicin in non-resectable hepatic metastases from colorectal cancer (a European Association for Research in Oncology trial)

BACKGROUND

The purpose of this study was to evaluate the tolerance and efficacy of combining i.v. irinotecan, 5-fluorouracil (5-FU) and leucovorin (LV) with hepatic arterial infusion (HAI) of pirarubicin in non-resectable liver metastases from colorectal cancer.

PATIENTS AND METHODS

Thirty-one patients were included in a phase II trial with i.v. irinotecan/5-FU/LV administered every 2 weeks, combined with HAI pirarubicin 60 mg/m(2) on day 1 every 4 weeks. In most cases HAI was administered via a percutaneous catheter.

RESULTS

The main grade 3/4 toxicity was neutropenia, encountered in 78% of the patients. When all patients were considered in the analysis, tumour response rate was 15 out of 31 [48%; 95% confidence interval (CI) 32% to 65%]. Liver resection was made possible in 11 patients (35%; 95% CI 21% to 53%). There were no toxic death. Median overall survival was 20.5 months, and median progression-free survival was 9.1 months. In patients with completely resected metastases, median overall survival was not reached and median progression-free survival was 20.2 months.

CONCLUSION

The multimodality approach used in the present study was well-tolerated and yielded dramatic responses. An aggressive approach combining i.v. and HAI chemotherapy deserves further investigation.

Meta-analysis of the effect of structured exercise training on cardiorespiratory fitness in Type 2 diabetes mellitus

AIMS/HYPOTHESIS

Low cardiorespiratory fitness is a powerful and independent predictor of mortality in people with diabetes. Several studies have examined the effects of exercise on cardiorespiratory fitness in Type 2 diabetic individuals. However, these studies had relatively small sample sizes and highly variable results. Therefore the aim of this study was to systematically review and quantify the effects of exercise on cardiorespiratory fitness in Type 2 diabetic individuals.

METHODS

MEDLINE, EMBASE, and four other databases were searched up to March 2002 for randomized, controlled trials evaluating effects of structured aerobic exercise interventions of 8 weeks or more on cardiorespiratory fitness in adults with Type 2 diabetes. Cardiorespiratory fitness was defined as maximal oxygen uptake (VO(2max)) during a maximal exercise test.

RESULTS

Seven studies, presenting data for nine randomized trials comparing exercise and control groups (overall n=266), met the inclusion criteria. Mean exercise characteristics were as follows: 3.4 sessions per week, 49 min per session for 20 weeks. Exercise intensity ranged from 50% to 75% of VO(2max). There was an 11.8% increase in VO(2max) in the exercise group and a 1.0% decrease in the control group (post intervention standardized mean difference =0.53, p<0.003). Studies with higher exercise intensities tended to produce larger improvements in VO(2max). Exercise intensity predicted post-intervention weighted mean difference in HbA(1c) (r=-0.91, p=0.002) to a larger extent than did exercise volume (r=-0.46, p=0.26).

CONCLUSIONS/INTERPRETATION

Regular exercise has a statistically and clinically significant effect on VO(2max) in Type 2 diabetic individuals. Higher intensity exercise could have additional benefits on cardiorespiratory fitness and HbA(1c).

[Childhood-onset systemic lupus erythematosus]

Systemic Lupus Erythematosus (SLE) remains a challenging autoimmune disease in term of etiology, pathogenesis and treatment. It is estimated that 10-17% of lupus patients present before the age of 16. SLE in children appears to have more severe organ involvement than in adults. The outcome of childhood SLE has improved during the last decade, but the morbidity remains high.