Prenatal care: missed opportunity for HBV prevention in women of childbearing age in rural Senegal

Background

Perinatal transmission of hepatitis B virus (HBV) constitutes an important risk in highly endemic countries including Senegal. Although the prevalence of chronic HBV infection is estimated at 11% in this country, specific data on women of childbearing age are sorely lacking. We described in this study the prevalence of the HBV antigen (HbsAg) in women of childbearing age in rural Senegal, as well as general knowledge on HBV and hepatitis B status awareness.

Methods

A cross-sectional study including HBV screening was conducted at home in the rural Niakhar area. Chronic HBV infection was determined through HBsAg detection using dried blood spots. Socio-demographic and behavioral data were collected through standardized face-to-face questionnaires. The analyzes included 368 women aged 15-49 (67% married; 65% with at least 1 child) enrolled from October 2018 to March 2019.

Results

Preliminary results show that 49 women (13%) had positive HBsAg. Only 68 women (18%) have already heard about HBV. Among them, 53% knew that there exists an HBV vaccine and 78%, 75% and 67% correctly answered that HBV can be transmitted through blood contact, childbirth and sexual intercourse, respectively.

Among the 233 (63%) women who had already given birth, 76% had attended at least 4 antenatal care sessions and 74% had given birth in a healthcare facility for their last pregnancy. However, only 1% reported to have already been screened for HBV. Main reasons reported for not having been screened were having never heard about this test (80%) and not having been offered screening during antenatal care sessions (10%).

Conclusions

General knowledge and awareness of HBV status are particularly low in women of childbearing age living in rural Senegal, despite high antenatal care sessions attendance. Given the high prevalence of chronic HBV infection found in this population, it is urgent to ensure systematic HVB screening and to provide adequate information to women during pregnancy.

Key messages

The prevalence of chronic HBV is high in women of childbearing age in Senegal. National recommendations for women attending antenatal care sessions should include HBV screening and counselling.

Untreated alcohol use disorder in people who inject drugs: a major barrier to HCV treatment uptake

Aims

Although people who inject drugs (PWID) are the core at-risk population in the hepatitis C (HCV) epidemic in industrialized countries, few initiate treatment. Alcohol use disorder (AUD), common within this population, has been identified as a barrier to HCV treatment uptake in the general population. We investigated whether the arrival of new and well-tolerated HCV treatments (direct-acting antivirals: DAA) has improved HCV treatment uptake in French PWID compared with former treatments (pegylated interferon-based treatments: Peg-IFN).

Methods

Analyses were based on exhaustive care delivery data collected between 2012 and 2016 (study period) in the French national healthcare reimbursement database. Chronic HCV-infected individuals who received opioid agonist therapy (OAT) at least once during the study period were included. Separate analyses were performed for 2012-2013 (Peg-IFN era, 19,700 patients) and 2014-2016 (DAA era, 22,545 patients). Using discrete-time Cox proportional hazards models, we tested for associations between AUD (i.e. AUD-related long-term illness status, diagnosis coding during hospitalization or AUD pharmacological treatment) and first HCV treatment delivery, after adjusting for gender, age, complementary universal health cover, liver disease severity and type of OAT received.

Results

Incidence rate of HCV treatment uptake per 100 person-years [95% confidence interval] was 6.56 [6.30-6.84] and 5.70 [5.51-5.89], for Peg-IFN-based treatment (2012-2013) and DAA (2014-2016), respectively. After multiple adjustment, people with AUD not receiving related medication had 30% and 14% lower Peg-IFN-based treatment and DAA uptake, respectively, than those without AUD (hazard ratio [95%CI]: 0.70 [0.62-0.80] and 0.86 [0.78-0.94]). No difference was observed between those treated for AUD and those without AUD.

Conclusions

Despite the benefits of DAA, untreated AUD is still a major barrier to HCV treatment access for PWID in France.

Key messages

AUD is still a barrier to HCV treatment for French PWID. DAA availability improved HCV treatment uptake for PWID with AUD.

Hepatitis B vaccination status and vaccine immune response among children in rural Senegal

Background

Hepatitis B vaccination during childhood is key to reduce the prevalence of Hepatitis B virus (HBV) infection. In Senegal, a highly endemic country, the three-dose hepatitis B vaccine and the birth dose vaccine were introduced in the Expanded Programme on Immunization (EPI) in 2004 and 2016 respectively. This study aimed to determine chronic HBV infection prevalence, hepatitis B vaccination status and vaccine immunity among children in Senegal.

Methods

A cross-sectional study including HBV screening was conducted at home among children aged 6 months to 15 years (i.e. born after the introduction of the HBV vaccine in the EPI) in the rural zone of Niakhar. Dried Blood Spot (DBS) samples were collected for the detection of HBsAg, anti-HBc Ab and anti-HBs Ab using chemoluminescence. Vaccination status was assessed using information on vaccination cards. Detectable vaccine immunity was defined with an adjusted DBS threshold of DOI≥0.36 IU/mL (corresponding to 10 IU/mL in venous blood sampling).

Results

Between October and December 2018, 455 children were enrolled. Preliminary results show that 7/455 (1.5%) had been in contact with HBV (positive anti-HBc Ab) and 5/455 (1.1%) had chronic HBV infection (positive HBsAg).

Only 161/455 (35.4%) children had a vaccination card available. Among those, 150/161 (93.2%) received at least 3 doses of hepatitis B vaccine, of which 83/150 (55.3%) had detectable vaccine immunity. The proportion of children with detectable vaccine immunity was significantly higher in children <5 years than in children aged 5-9 and 10-15 (72.3% versus 47.3%, p = 0.006 and 72.3% versus 14.3%, p < 0.001).

Conclusions

Preliminary results suggest a low prevalence of HBV chronic infection among children born after the introduction of HBV vaccination in Senegal. However, detectable vaccine immunity rapidly decreases with age among vaccinated children, signalling a need for further studies on the immune response to HBV vaccination in this context.

Key messages

HBV chronic infection is low among children born after the introduction of HBV vaccination in Senegal. Further studies on the immune response to HBV vaccination in this context are needed.

Process design for wastewater treatment: catalytic ozonation of organic pollutants

Emerging micropollutants have been recently the target of interest for their potential harmful effects in the environment and their resistance to conventional water treatments. Catalytic ozonation is an advanced oxidation process consisting of the formation of highly reactive radicals from the decomposition of ozone promoted by a catalyst. Nanocarbon materials have been shown to be effective catalysts for this process, either in powder form or grown on the surface of a monolithic structure. In this work, carbon nanofibers grown on the surface of a cordierite honeycomb monolith are tested as catalyst for the ozonation of five selected micropollutants: atrazine (ATZ), bezafibrate, erythromycin, metolachlor, and nonylphenol. The process is tested both in laboratorial and real conditions. Later on, ATZ was selected as a target pollutant to further investigate the role of the catalytic material. It is shown that the inclusion of a catalyst improves the mineralization degree compared to single ozonation.

Industrial wastewater re-use: closure of water cycle in the main water consuming industries--the example of paper mills

Paper mill, chemistry, textile and food processing industries are high water consumers. Within the framework of the European project Aquafit4Use, the possibility to close the on-site water loop is studied. The aim is to find new technologies or innovative treatment trains to produce water that is 'fit for use' in the industrial process; an example of a paper mill is given. Laboratory-scale tests on nine technologies were carried out to determine the best suitable treatment train: anaerobic process (already on site) --> aerobic process (already on site) --> Flexible Fibre Filter Module --> softening --> nanofiltration --> evapoconcentration or ozonation on nanofiltration (NF) concentrate. This treatment train is currently compared on site at pilot scale to another treatment train including some modifications on the existing on-site biological treatment: anaerobic process --> softening --> membrane bioreactor --> nanofiltration --> evapoconcentration or ozonation of NF concentrate.

Electrochemical treatment of wastewater polluted by nitrate: selective reduction to N2 on boron-doped diamond cathode

Electrochemical tests of nitrate reduction on Boron-Doped Diamond cathode are investigated through a Design of Experiments (DOE) method. The results show good reduction of nitrate into almost exclusively N2. In the studied domain, the best experimental conditions are high initial nitrate content, low acidic pH values and low working current densities. The application of DOE conclusions on an agro-industrial wastewater gives really satisfying results: final nitrate contents lower than 50 mg/L without nitrite or ammonium formation, and with low energy consumption (under 25 kWh/kgNO3).

Linking diatom community structure to pesticide input as evaluated through a spatial contamination potential (Phytopixal): a case study in the Neste river system (South-West France)

A large-scale field survey was undertaken in the Neste system (South-West France) to investigate the impact of pesticide inputs on the structure of riverine benthic diatom communities. A total of 18 sites in the "Coteaux de Gascogne" study area were sampled during periods of pesticide use over two consecutive years (2005-2006). The typology of the diatoms collected was determined using artificial neural networks generating patterns in diatom community composition that indicated the species influenced by pesticide inputs, combined with organic pollution. Small, pioneer species of the Achnanthales group were more frequent in the pesticide-contaminated assemblages, whereas slower colonizers were more often found in the sites where disturbance was lower. The Phytopixal approach, a means to assess the spatial contamination potential, provided valuable information about pesticide exposure and was a successful means of discriminating diatom assemblages, suggesting that a global estimate of pesticide pollution risk, although rough, would be more appropriate and more representative than sporadic pesticide analyses.

Sensitivity of freshwater periphytic diatoms to agricultural herbicides

The biomonitoring of pesticide pollution in streams and rivers using algae such as diatoms remains difficult. The responses of diatom communities to toxic stress in stream water are disturbed by the variations of environmental parameters. In this study, periphytic algae collected in situ were exposed under controlled conditions to two major herbicides used in French agriculture (isoproturon and s-metolachlor). Three exposure regimes were tested: 5 and 30 microg L(-1) for 6 days and 30 microg L(-1) for 3 days followed by a recovery period of 3 days. The algal biomasses were assessed from pigment concentrations (chlorophyll a and c) and from live cell density. The highest concentration (30 microg L(-1)) of isoproturon inhibited the biomass increase statistically significantly. In periphyton exposed to 5 and 30 microg L(-1) of s-metolachlor, chlorophyll c concentration and live cell density were also statistically significantly lower than in the control. Periphyton left to recover after reduced exposure duration (3 days) showed higher growth rates after treatment with s-metolachlor than with isoproturon. Taxonomic identifications showed that species like Melosira varians, Nitzschia dissipata and Cocconeis placentula were not affected by the herbicide exposure. Other species like Eolimna minima and Navicula reichardtiana were more sensitive. Studying diatoms according to their trophic mode showed that facultative heterotroph species were statistically significantly favoured by isoproturon exposure at the highest concentration. Results obtained with s-metolachlor exposure showed a disturbance of cell multiplication rather than that of photosynthesis. These results suggest that photosynthesis inhibitors like isoproturon favour species able to survive when the autotroph mode is inhibited.

[Epidermolysis bullosa acquisita of childhood]

BACKGROUND

Epidermolysis bullosa acquisita (EBA) is a subepidermal autoimmune blistering disease characterized immunologically by autoantibodies to type VII collagen. Its occurrence in childhood is rare. Thirty-five cases have been described to date in the literature.

PATIENTS AND METHODS

We report the case of an 8-year-old girl presenting blistering lesions on the cheeks, extremities and limb extension areas. The diagnosis of EBA was confirmed by histology, direct immunofluorescence of a perilesional skin biopsy specimen, indirect immunofluorescence on salt-split skin substrate and direct electron microscopy. The patient was controlled clinically under treatment with dapsone alone.

DISCUSSION

This 36th childhood case of EBA presented typical clinical features, a similar prognosis and comparable treatment response to other paediatric cases. Clinical presentation is inflammatory and affects the face. As in our case, in childhood, prognosis is often better than in adults without the need for immunosuppressive agents.

Intestinal loop lengthening: early treatment of vanishing bowel

Bianchi's procedure experience for short bowel syndrome in children is positive. This technique is generally performed after the first year of life. Here the authors propose a case of gastroschisis with prenatal spontaneous closure of abdominal defect and vanishing gut presenting as intestinal atresia, absence of ileo-cecal valve, and residual short intestinal dilatation, treated by early gut lengthening (ILP).

Herbicide effects on freshwater benthic diatoms: induction of nucleus alterations and silica cell wall abnormalities

Benthic diatoms are well known bio-indicators of river pollution by nutrients (nitrogen and phosphorus). Biological indexes, based on diatom sensitivity for non-toxic pollution, have been developed to assess the water quality. Nevertheless, they are not reliable tools to detect pollution by pesticides. Many authors have suggested that toxic agents, like pesticides, induce abnormalities of the diatom cell wall (frustule). High abnormal frustule abundances have been reported in natural diatom communities sampled in streams contaminated by pesticides. However, no direct link was found between the abundances of abnormal frustules in these communities and the pesticide concentrations in stream water. In the present study, a freshwater benthic diatom community, isolated from natural biofilm and cultured under controlled conditions, was treated with a known genotoxic herbicide, maleic hydrazide (MH). Cells were exposed to three concentrations of MH (5x10(-6), 10(-6), 10(-7)M) for 6h followed by a 24h-recovery time. After MH treatments, nucleus alterations were observed: abnormal nucleus location, micronucleus, multinuclear cell or disruption of the nuclear membrane. A dose-dependent increase of nuclear alterations was observed. The difference between the control (9.65 nuclear alterations per 1000 cells observed (9.65 per thousand), S.D.=4.23) and the highest concentrations (29.40 per thousand, S.D.=8.49 for 10(-6)M and 35.96 per thousand, S.D.=3.71 for 5x10(-6)M) was statistically significant (Tukey test, P<0.05). Diatoms also exhibited frustules with deformed morphology and abnormal ornamentation. Significantly increased abundances of abnormal frustules were observed for the highest concentrations (10(-6) and 5x10(-6)M; Tukey test, P<0.05). These two parameters tended to increase together (Pearson correlation=0.702, P<0.05). The results suggest that the induction of abnormal frustules could be associated with the genotoxic effects of MH. The alterations observed could be related to the effects of MH on the synthesis of the proteins involved in frustule formation or in the regulation of the cytoskeleton of the diatom cells.

Long-term survey of heavy-metal pollution, biofilm contamination and diatom community structure in the Riou Mort watershed, South-West France

In a metal-polluted stream in the Riou Mort watershed in SW France, periphytic biofilm was analyzed for diatom cell densities and taxonomic composition, dry weight and metal bio-accumulation (cadmium and zinc). Periphytic diatom communities were affected by the metal but displayed induced tolerance, seen through structural impact (dominance of small, adnate species) as well as morphological abnormalities particularly in the genera Ulnaria and Fragilaria. Species assemblages were characterized by taxa known to occur in metal-polluted environments, and shifts in the community structure expressed seasonal patterns: high numbers of Eolimna minima, Nitzschia palea and Pinnularia parvulissima were recorded in Summer and Autumn, whereas the species Surirella brebissonii, Achnanthidium minutissimum, Navicula lanceolata and Surirella angusta were dominant in Winter and Spring. Commonly used indices such as the Shannon diversity index and Specific Pollution Sensitivity Index reflected the level of pollution and suggest seasonal periodicity, the lowest diversities being observed in Summer.

Zero Liquid Discharge approach in plating industry: treatment of degreasing effluents by electrocoagulation and anodic oxidation

Degreasing waste effluents issued from a surface treatment plant were treated by electrochemical techniques in an attempt to reduce COD so that clean water can be returned to the rinse bath. Electrocoagulation, both with iron and aluminium anodes, and anodic oxidation with boron doped diamond (BDD) anodes were tested. In the electrocoagulation tests, the nature of the anodes did not impact significantly the reduction of COD. Electrocoagulation showed good COD removal rates, superior to 80%, but it was not able to reduce COD down to low levels. Anodic oxidation was able to reduce COD down to discharge limits; the oxidation efficiency was superior to 50%. Economical calculations show that anodic oxidation is best used as a polishing step after electrocoagulation. The bulk of the COD would be reduced by electrocoagulation and, then, anodic oxidation would reduce COD below discharge limits. The maximum treatable flow is somewhat hindered by the small sizes of current BDD installation but it would reach 600 m(3)/year if anodic oxidation is coupled with electrocoagulation, the operational cost being 2.90 Euros /m(3).

Typology of diatom communities and the influence of hydro-ecoregions: a study on the French hydrosystem scale

By comparing diatom communities in natural and disturbed sites, indicators for different types and levels of anthropogenic disturbance can be found. As a first step, this study aims to describe the different natural and disturbed community types found throughout the French hydrosystem. 836 diatom samples were analysed with an unsupervised neural network, the self-organising-map, a well accepted method for community ordination. 11 different communities were identified, 5 corresponding to non-impacted or slightly impacted conditions and representing the diatom natural variability of our dataset. These 5 communities corresponded to 5 different hydro-ecoregions, i.e. 5 river types with similar geological context and range in altitude. The 6 other communities were typical of rivers under anthropogenic pressure. The influence of natural conditions within the hydro-ecoregions was overwhelmed by the nature and the intensity of the pollution at the sampling stations. This work was done in the context of the application and enforcement of the Water Framework Directive.

Validation of biomarkers for impact evaluation of aqueous industrial waste in mesocosms

The use of exposure biomarkers in measuring the impact of aqueous waste holds promise because such tools have short response times, are flexible in use and may give an indication about the type of pollution. However, their ecological significance has not yet been demonstrated. It is necessary to validate these responses under controlled conditions before using such biomarkers for biomonitoring. The TotalFinaElf company has developed a pilot scheme incorporating such controlled conditions. This pilot is a dynamic open mesocosm (16 channels 40 m in length supplied with river water). The research programme currently carried out in the "Pilot Rivers" aims at validating biochemical parameters (components of phases I and II (de)toxication metabolism and propionylcholinesterase activity), measured in a fresh water bivalve Corbicula fluminea as a biomarker of water quality. The comparison between biomarker responses and community ones (reference) gives information about the precocity and sensitivity of these biomarker responses. Pure substances (trichloroethylene (TCE), cadmium (CD) and anthracenic oil (AO)) have been injected during one month. Biomarker responses are as sensitive as the most sensitive community response in the presence of CD and AO. With TCE, community responses are more sensitive. Precocity of biomarker response is observed only in the presence of CD.

Impacts of Cd and Zn on the development of periphytic diatom communities in artificial streams located along a river pollution gradient

Many field and experimental studies have been conducted to reveal modifications of periphytic diatom communities under metal pollution, but most of the approaches presented drawbacks: variability of environmental factors for field studies and lack of representativity for experimental ones. An original approach that allows growth of periphytic communities under conditions more controlled than in the field and more realistic than experimental investigations was developed to try conclusions being drawn on the real impact of metallic pollution. Artificial streams were placed on the river bank at three sites along the pollution gradient (Cd/Zn) of the River Lot (SW France): reference (upstream pollution discharge), slightly polluted (around 1.5 microg Cd x L(-1) and 50 microg Zn x L(-1)), and polluted (around 6 microg Cd x L(-1) and 400 microg Zn x L(-1)) sites. Structural characteristics of diatom communities growing in these artificial streams, on glass substrates, and under homogenized current velocity and water depth were compared after four durations (1, 2, 3, and 4 weeks) to study effects of metal on first steps of community development. Marked perturbations of diatom community development were observed overall in the polluted site: after 1 week, early biofilms differed already by taxonomic composition; after 4 weeks, cell density was significantly lower than in the reference site and taxonomic composition was very different. These results, generated by a methodology intermediate between field and experimental approaches, compare well with literature findings based on more traditional approaches, strongly attesting that metallic pollution affects diatom community architecture and induce rising of abnormal cells.

Diatom analysis in victim's tissues as an indicator of the site of drowning

The diagnosis of drowning is one of the most difficult in forensic pathology and previously we proposed criteria for a positive tissue analysis according to the qualitative and quantitative diatom investigations. In the positive cases, we studied the reliability of determining the site of drowning by comparing the diatom taxa found in the lung samples with those of the water samples or in the absence of these samples with the results of the water diatom monitoring programme set up in our region. In this study, we present two series of cases, the first is one of 20 corpses who died from accidental or suicidal drowning with known drowning site, and the second of 20 corpses for which the drowning site was unknown. The results showed that a concordance of the abundance of the diatom taxa in tissues compared to the site of drowning and their distribution relative to one another was 65% in the group where the site of drowning was known and 35% in the other group. The concordance of the individual distribution in the lungs of water diatom taxa may be an interesting method to guide the investigations for determining the site of drowning. The two limiting factors are the concentration of diatoms in the lungs and the development of a river monitoring programme in the district of the study.

Intraepithelial lymphocytes from villus tip and crypt portions of the murine small intestine show distinct characteristics

BACKGROUND & AIMS

Intraepithelial lymphocytes (IELs) are located between epithelial cells that are thought to display unique features and functions at the small intestinal villus tip and crypt levels. We have addressed whether the spatial differences in the intestinal epithelium extend to IELs and subsequent cross-talk between IELs and epithelial cells.

METHODS

IELs were isolated from villus tip and crypt portions of mouse small intestine and then compared for spontaneous cytokine production and responsiveness to interleukin (IL)-2 and/or IL-7.

RESULTS

No difference was observed between number of beta IELs in villus tips and crypts, whereas a trend toward increased frequencies of IELs bearing the gamma delta form of T-cell receptor was noted in villus tips. Interestingly, the number of beta IELs producing interferon gamma and IL-5 was significantly reduced in the cells from crypts compared with villus tips. Furthermore, villus tip beta IELs exhibited higher responses to stimulation signals provided by IL-2 and/or IL-7 than their crypt counterpart. Such functional differences were not observed with gamma delta IELs from the two intestinal sites.

CONCLUSIONS

Distinct molecular cross-talk between IELs and epithelial cells occurs in intestinal villus tips and crypts.

Case-control study of the risk factors for age related macular degeneration. France-DMLA Study Group

AIM

A case-control study was initiated to determine the risk factors for the development of age related macular degeneration (AMD).

METHODS

Study participants, who were all white, aged 50-85 years, and were recruited from private ophthalmology practices. Each practitioner enrolled patients with bilateral AMD, who were then matched with controls for sex and age. Environmental factors and systemic and ocular histories were screened. All patients had bilateral red-free fundus photographs and fluorescein angiography. Photographs were classified into pigment epithelium alterations, drusen, geographic atrophy, and exudative AMD. Statistical analysis included the identification of risk factors for AMD. A multivariate analysis was performed at the end of the study. Analysis included the entire study population and was carried out for each stage of AMD.

RESULTS

1844 controls were compared with 1844 patients with AMD. Mean age was 71 years for controls and 72 for cases. Logistic regression identified six major risk factors for AMD (whole population): arterial hypertension (odds ratio (OR) = 1.28), coronary disease (OR = 1.31), hyperopia (OR = 1.33), light coloured irises (OR = 1.22), and lens opacities or previous cataract surgery (OR = 1.55). The significance of vascular risk factors was increased for late stages of AMD, especially the atrophic forms (coronary disease, OR = 3.19).

CONCLUSIONS

This large case-control study confirms some of the risk factors previously identified and may contribute to the determination of methods for prevention of AMD.

A novel alkaline phosphatase-based isolation method allows characterization of intraepithelial lymphocytes from villi tip and crypt regions of murine small intestine

The isolation of intestinal intraepithelial lymphocytes (IEL) is a major prerequisite for the investigation of cellular and molecular cross-talk in the intestinal mucosa. Since intestinal epithelial cells exhibit distinct functional features at the villi tip and crypt levels, such differences could extend to IEL. We developed a mechanical procedure for isolation of IEL from these distinct epithelial sites to test our hypothesis. Cells isolated from the intestinal epithelium by sequential incubations under stirring were segregated based upon their alkaline phosphatase (AP) activity since villi tip and crypt fractions expressed high and low AP activity, respectively. IEL preparations obtained after a further purification step in Percoll gradient contained > 90% Integrin alpha IEL chain+, CD3+ T cells, and no Ig+ cells. Villi tip IEL preparations possessed increased numbers of low density IEL when compared to crypt IEL, suggesting that distinct IEL-epithelial cell interactions occur at the intestinal villi tip and crypt levels.

Spontaneously hypertensive rat: cholera toxin converts suppression to immunity through a Th2 cell-IL-4 pathway

The spontaneously hypertensive rat (SHR) exhibits a number of T cell dysfunctions that develop concurrently with elevated blood pressure. Studies have shown a mitogen-induced lymphocyte suppression mediated in part by the production of interferon-gamma (IFN-gamma), which stimulated NO production by macrophages. To assess whether this immune suppression is reversible, SHR were immunized with diphtheria toxoid (DT) with or without cholera toxin (CT) as adjuvant. SHR immunized with DT only displayed weak serum immunoglobulin G (IgG) anti-DT titers, tenfold less than similarly treated normotensive Wistar-Kyoto rats (WKYR). SHR CD4+ T cells failed to proliferate upon in vitro stimulation with DT. In contrast, SHR coimmunized with DT and CT showed serum IgG antibody titers similar to WKYR and Brown Norway rats. Coimmunization with CT rescued SHR CD4+ T cells from suppression and supported DT- or B subunit of CT-specific proliferative responses, and these cells produced more interleukin-4 (IL-4) than IFN-gamma, and anti-IFN-gamma antibody treatment enhanced IL-4 production. Exogenous IL-4 increased the proliferation of antigen-specific CD4+ T cells, whereas IFN-gamma was inhibitory. This study shows that the adjuvant CT induces T helper 2-type responses, reversing the T cell dysfunction in the SHR.

Logistic regression model of fotemustine toxicity combining independent phase II studies

BACKGROUND

To optimize fotemustine chemotherapy, the authors considered how to combine independent Phase II trials to predict the risk of first occurrence of severe toxicity as a function of initial patient characteristics.

METHODS

Clinical data from six Phase II trials were collected. Of the 478 patients enrolled 442 (male/female, 259/183; age range, 15-81 years) were evaluable for toxicity (1384 cycles of chemotherapy), including 221 with malignant malignant melanomas, 138 with primary brain tumors, 29 with lung carcinomas, 8 with head and neck carcinomas, and 46 with miscellaneous cancers. The influence of age, sex, performance status, type of tumor, number and location of metastases, and previous treatment by chemotherapy and/or radiotherapy was studied. The logistic regression method was applied to predict occurrence of leukopenia, thrombocytopenia, anemia, digestive tract, and/or hepatic toxicity.

RESULTS

Univariate analysis showed that predictive factors for hematologic toxicity were age (> 50 years), type of tumor (brain < melanoma < others), number of metastatic sites (> 3), location of metastases (nonvisceral), and previous chemotherapy. Performance status and previous radiotherapy did not affect the toxicity of fotemustine Nausea and vomiting were predictable based on the type of tumor (head and neck < lung < brain < melanoma < others), the number of metastatic sites (> three) and visceral metastases. Hepatic disorders occurred preferentially in patients with hepatic metastases and more than three metastatic sites. Individual risk of hematologic and hepatic toxicity for patients with melanoma and primary brain tumors was predicted using logistic regression models.

CONCLUSIONS

By combining clinical data from independent Phase II trials, the logistic model developed could predict the probability of fotemustine hematologic and hepatic toxicity.

Continuous river monitoring of the diatoms in the diagnosis of drowning

The diagnosis of drowning is one of the most difficult in forensic pathology. Diatom analysis has been proposed to provide supportive evidence of drowning but the reliability and applicability of quantitative and qualitative diatom analysis in the diagnosis of drowning is still disputed in the literature. In order to further examine such cases, the authors report the development of a water monitoring system based on algae performed each month at three aquatic locations where drowning victims are frequently found. Water samples and stones were taken from the surface and from the bed of the river. This protocol was performed during 1993 with analyses both on water samples and human tissue samples (30 bodies). The diatom profile of the drowning sites was compared with the tissue analysis. The extraction of diatoms from the tissues was performed with an enzymatic digestion method using Proteinase K. Results indicate that the monitoring of river diatom populations is an accurate method of generating profiles of the river flora, which can then be compared with the diatom genera found in tissues.

Regulation of mucosal and systemic antibody responses by T helper cell subsets, macrophages, and derived cytokines following oral immunization with live recombinant Salmonella

We have assessed regulatory Th cell and cytokine responses in mice after oral immunization with recombinant Salmonella (BRD 847) expressing fragment C of tetanus toxoid, since little information is available to explain how these vectors induce mucosal IgA responses. A single dose of BRD 847 elicited serum IgG2a and mucosal IgA anti-tetanus toxoid Ab responses. To assess Th1-and Th2-type responses, CD4+ T cells from Peyer's patches and spleen were restimulated in vitro, and cytokine-specific ELISPOT, ELISA, and reverse transcriptase-PCR assays were used to assess cytokine patterns. CD4+ T cells produced IFN-gamma and IL-2 as well as IL-10, but not IL-4 or IL-5. Although IL-6 was elevated, further purification of cells from in vitro cultures into CD4+ Mac-1- T cells and Mac-1+ CD4- cells revealed that only the latter cell population had consistently elevated IL-6 gene expression, whereas both sorted populations exhibited increased IFN-gamma and IL-10 gene expression. Thus, orally administered recombinant Salmonella expressing fragment C of tetanus toxoid elicited dominant Ag-specific Th1-type responses together with Th2-type cells producing IL-10 in both mucosal and systemic tissues. Macrophages producing IL-6 were also evident. Our results are consistent with the suggestion that Ag-specific Th1 cells and their derived cytokines, IFN-gamma and IL-2, and Th2-derived IL-10 together with IL-6 produced by macrophages provide important signals for the development of mucosal IgA and serum IgG subclass responses in the absence of preferential expression of Th2 cytokines IL-4 and IL-5.

Regulation of mucosal and systemic antibody responses by T helper cell subsets, macrophages, and derived cytokines following oral immunization with live recombinant Salmonella

We have assessed regulatory Th cell and cytokine responses in mice after oral immunization with recombinant Salmonella (BRD 847) expressing fragment C of tetanus toxoid, since little information is available to explain how these vectors induce mucosal IgA responses. A single dose of BRD 847 elicited serum IgG2a and mucosal IgA anti-tetanus toxoid Ab responses. To assess Th1-and Th2-type responses, CD4+ T cells from Peyer's patches and spleen were restimulated in vitro, and cytokine-specific ELISPOT, ELISA, and reverse transcriptase-PCR assays were used to assess cytokine patterns. CD4+ T cells produced IFN-gamma and IL-2 as well as IL-10, but not IL-4 or IL-5. Although IL-6 was elevated, further purification of cells from in vitro cultures into CD4+ Mac-1- T cells and Mac-1+ CD4- cells revealed that only the latter cell population had consistently elevated IL-6 gene expression, whereas both sorted populations exhibited increased IFN-gamma and IL-10 gene expression. Thus, orally administered recombinant Salmonella expressing fragment C of tetanus toxoid elicited dominant Ag-specific Th1-type responses together with Th2-type cells producing IL-10 in both mucosal and systemic tissues. Macrophages producing IL-6 were also evident. Our results are consistent with the suggestion that Ag-specific Th1 cells and their derived cytokines, IFN-gamma and IL-2, and Th2-derived IL-10 together with IL-6 produced by macrophages provide important signals for the development of mucosal IgA and serum IgG subclass responses in the absence of preferential expression of Th2 cytokines IL-4 and IL-5.

Effects of the phenylurea herbicide isoproturon on periphytic diatom communities in freshwater indoor microcosms

The toxic effects of the phenylurea herbicide Isoproturon -IPU: (3-(4-isopropylphenyl)-1, 1-dimethylurea)-were studied on the colonization of periphytic diatom communities, within indoor microcosms consisting of a mixed biotope (water column and natural sediment) and two biological species-rooted macrophyte cuttings (Elodea densa) and benthic bivalve molluscs (Corbicula fluminea). The periphyton, essentially composed of diatoms, was collected on artificial substrata (glass slides) in the upper layers of the water column, after two periods of exposure (34 and 71 days). IPU was initially added in the water or in the sediment compartment, at two nominal concentrations (L1 and L2 levels) for each contamination source-5 and 20 microg litre(-1) and 100 and 400 microg kg(-1) in sediment (w/w) respectively. The effects of IPU on the density and community structure of periphytic diatoms are described. A marked reduction in the diatom density was observed after 34 days exposure to the lower concentration of IPU in the water (5 microg litre(-1)). For the L2 levels, the very small number of live cells present did not permit quantification of the diatom density. After 71 days, recovery in community parameters occurred for the two contamination levels of the sediment and water column sources. Samples collected in the experimental units contaminated with the L2 levels were dominated by heterotrophic and smaller diatom species, such as Sellaphora seminulum. Data treatment based on factorial discriminant analysis enabled us to distinguish the different contamination conditions, with only 11 species from the 130 taxa identified.

Late acute failure of well-HLA-matched renal allografts with capillary congestion and arteriolar thrombi

Seventeen cases of a histologically and clinically unusual renal acute dysfunction in kidney recipients, individualized among a population of 1378, are reported. The basic histological lesion was a huge capillary congestion, associated with capillary and arteriolar thromboses or parenchymal necrosis in most patients, and contrasting with the absence of the classical features of acute cellular rejection, i.e., tubulitis, glomerulitis, edema, and infiltrate. The corresponding clinical history was characterized by its early timing in the course of transplantation (< 3 months), its sudden occurrence in patients usually having good transplant function, leading to end-stage renal failure in a few days, and its resolution under rejection treatment. The occurrence of this syndrome was significantly linked with a good HLA matching: 13 of the 17 recipients were HLA-DR matched (P < 0.0001). The etiology of this syndrome remains unknown. There was no evidence for graft vessel thrombosis. Because of some histological similarities, the usual causes of the hemolytic uremic syndrome, including bacterial and viral infections or cyclosporine arteriolopathy, were discussed. Acute vascular rejection was suspected, but the cross-match was negative on T lymphocytes in all cases and anti-HLA class I and II antibodies were not found to develop at the time of transplant dysfunction, except in 1 patient, in whom the detected anti-DR antibodies were not directed at the kidney donor. Anti-human umbilical vein endothelial cell antibodies, detected in an antibody-dependent cellular cytotoxicity assay, were present in 6 patients (of the 14 tested) at the onset of renal failure, but they were either absent (n = 3) or already present at the time of transplantation (n = 5) in the other 8 patients. Therefore, reliable arguments are lacking to conclude that this acute transplant dysfunction is an acute vascular rejection and its strong association with HLA matching has, as yet, no satisfactory explanation.

Mucosal adjuvant effect of cholera toxin in mice results from induction of T helper 2 (Th2) cells and IL-4

Despite pathophysiologic effects including diarrhea, cholera toxin (CT) is a potent mucosal immunogen and adjuvant. We investigated the influence of CT on T helper (Th)-type 1 (Th1) and Th2 cell-regulated Ag-specific B cell isotype and IgG subclass Ab responses elicited when the toxin was co-administered orally with different protein Ags. When mice were orally immunized with tetanus toxoid (TT) and CT as adjuvant, this regimen induced TT-specific secretory IgA responses in the gastrointestinal tract as well as serum IgG, including IgG1 and IgG2b subclasses, and IgA responses. This oral regimen also induced TT- and CT-B-specific IgE responses. In addition, CT also elicited adjuvant effects for Ag-specific IgG1, IgE, and IgA responses when two other protein Ags, OVA and hen egg white lysozyme, were given by the oral route. Quantitative reverse transcriptase-PCR was performed to assess levels of mRNA for Th1 (IFN-gamma) and Th2 (IL-4) cytokine expression in TT-stimulated CD4+ T cell cultures. Both Peyer's patches and splenic CD4+ T cells expressed markedly increased levels of IL-4-specific message, but did not result in changes in IFN-gamma mRNA expression. To determine whether the route of immunization influenced IgE responses, mice were immunized s.c. with TT and CT as adjuvant. Significant increases in total and TT-specific IgE Abs were induced when CT was co-administered. Taken together, these results show that CT acts as a mucosal adjuvant to enhance Th2-type responses and in particular, the IL-4 produced results in a characteristic Ab isotype pattern associated with this cytokine.

Mucosal adjuvant effect of cholera toxin in mice results from induction of T helper 2 (Th2) cells and IL-4

Despite pathophysiologic effects including diarrhea, cholera toxin (CT) is a potent mucosal immunogen and adjuvant. We investigated the influence of CT on T helper (Th)-type 1 (Th1) and Th2 cell-regulated Ag-specific B cell isotype and IgG subclass Ab responses elicited when the toxin was co-administered orally with different protein Ags. When mice were orally immunized with tetanus toxoid (TT) and CT as adjuvant, this regimen induced TT-specific secretory IgA responses in the gastrointestinal tract as well as serum IgG, including IgG1 and IgG2b subclasses, and IgA responses. This oral regimen also induced TT- and CT-B-specific IgE responses. In addition, CT also elicited adjuvant effects for Ag-specific IgG1, IgE, and IgA responses when two other protein Ags, OVA and hen egg white lysozyme, were given by the oral route. Quantitative reverse transcriptase-PCR was performed to assess levels of mRNA for Th1 (IFN-gamma) and Th2 (IL-4) cytokine expression in TT-stimulated CD4+ T cell cultures. Both Peyer's patches and splenic CD4+ T cells expressed markedly increased levels of IL-4-specific message, but did not result in changes in IFN-gamma mRNA expression. To determine whether the route of immunization influenced IgE responses, mice were immunized s.c. with TT and CT as adjuvant. Significant increases in total and TT-specific IgE Abs were induced when CT was co-administered. Taken together, these results show that CT acts as a mucosal adjuvant to enhance Th2-type responses and in particular, the IL-4 produced results in a characteristic Ab isotype pattern associated with this cytokine.

Le genre Gomphoneis (Bacillariophyta) : un nouveau modèle d'organisation du cingulum

The valvar structure and the cingulum arrangement of a diatom related to the Gomphoneis herculeana – Gomphoneis minuta complex were investigated in electron and light microscopy. Ultrastructural features include striae composed of double rows of areolae, apical pore fields composed of pores structurally differentiated from the areolae and the presence of an axial siliceous plate responsible for longitudinal lines visible in light microscopy. The pars interior of the valvocopula looks like a marginal lamina of silica. A new model of organization for the cingulum, quite different from the classical model, is proposed. The valvocopula is a closed band with a connective septum at both the head and the footpole. The copulae, each of them with a connective septum, are open bands, with their openings at opposite poles. All septa possess on the advalvar face a projecting lamina that fits under the pseudosepta of the valve or the septum of a girdle band. The first two copulae are directly connected with the opposite septa of the valvocopula. The third copula is attached to the first copula and the fourth to the second. Key words: Bacillariophyta, Gomphoneis, valve, model, cingulum.

Application of a simple enzymatic digestion method for diatom detection in the diagnosis of drowning in putrified corpses by diatom analysis

The reliability and applicability of quantitative and qualitative diatom analysis by an enzymatic digestion method in the diagnosis of drowning of putrified bodies has been evaluated. The authors report the analysis of water and organ samples of 12 immersion cases using light microscopy. This study included control organ samples from the bodies of persons who died from causes other than drowning. Organ samples were treated by both chemical and enzymatic methods, the first one using concentrated nitric acid and the second proteinase K. Diatoms were present in most organ samples of the immersed corpses; no diatoms could be found in the control samples. Our experience was that the enzymatic method seemed to be more convenient in terms of rapidity, safety and environmental protection than chemical digestion. The number of diatoms recovered with both methods was similar. Qualitative and quantitative analysis of both water and organ samples of immersion cases supported the diagnosis of death by drowning in 41.6% of the putrified cases studied. The authors suggest that diatom analysis using enzymatic digestion of organs can be used as a criterion for positive diagnosis of drowning in cases involving putrified bodies.

Identification of C-terminal peptides of bovine beta-casein that enhance proliferation of rat lymphocytes

A casein polypeptidic fraction, obtained from a pepsin-chymosin digestion of caseins, showed a mitogenic effect on primed lymph node (LN) cells and unprimed spleen cells of rats. A biologically active C-terminal sequence of bovine beta-casein (residues 192-209) was characterized. The corresponding synthetic peptide had a stimulatory effect on primed LN cells but failed to enhance proliferation of spleen cells. We prepared two chymosin digests (PA and PB) of bovine beta-casein which contained, respectively, 80% and 95% of the sequence including residues 193-209. They induced a significant proliferative response in both LN and spleen cells. It is therefore possible that other active peptides in the PA preparation may be involved in mitogenic activity.

Impaired prolactin secretion and body fat distribution in obesity

Human obesity shows clustering within families. The hypothesis for the presence of a major gene or genes acting in human obesity is supported by recent evidence from studies of obesity in adoptees and their biological parents and siblings. The heterogeneity of obesity may be demonstrated by the shape of fat distribution and the prolactin response to insulin hypoglycaemia. Fat distribution has been shown to have a genetic background whereas a primary disorder of hypothalamic function is suspected in obese women who show an impaired prolactin response to insulin-induced hypoglycaemia. We have investigated the possible association between fat distribution and hypothalamic function in 23 extremely obese, nondiabetic premenopausal women who have been characterized using their absolute body weight, body mass index (BMI), fat distribution (expressed as waist to hip ratio), fasting insulin, basal prolactin and prolactin response to hypoglycaemia. Fasting insulin values showed a significant correlation (P less than 0.05, R = 0.604) with increasing waist to hip ratio (upper body segment obesity), whereas the graded prolactin response to hypoglycaemia of the obese women showed a negative association with increasing upper body segment obesity (P less than 0.05; R = -0.446). No relationship was observed between fasting insulin and the prolactin response to hypoglycaemia. We suggest that this previously unrecognized association of an impaired prolactin response to hypoglycaemia and upper body segment fatness may be useful for the investigation of the genetics of obesity.

Effect of systemic and orally administered iota-carrageenan on ovalbumin-specific antibody response in the rat

Iota-carrageenans are high molecular weight polygalactans commonly used in the food industry. Their immunomodulating effects were examined on the reaginic and IgG ovalbumin-specific responses after systemic or oral administration to Brown Norway rats. Intraperitoneal injection of ovalbumin with either iota-carrageenan or alum induced both a reaginic and IgG response. Reaginic antibodies were detected in the primary response with alum, but only in the secondary response with iota-carrageenan. Oral tolerance to ovalbumin was similarly induced whether the protein was given alone or admixed in solution with iota-carrageenan. These results confirmed the systemic adjuvant action of iota-carrageenan described earlier, and showed that this effect did not take place when orally administered.

Ampicillin inactivation in the caecum of axenic, gnotoxenic and conventional lambs: interaction with resistant or sensitive Escherichia coli

The fate of orally administered ampicillin was studied in axenic lambs, in gnotoxenic lambs given a complex microflora and a mixture of ampicillin resistant and/or sensitive strains of Escherichia coli, and in conventional lambs. In axenic lambs or animals with a sensitive microflora, antibiotic concentrations of 500-1600 micrograms ml-1 were detected in the intestine, and most of the ampicillin passed through the small intestine and entered the large intestine, within 12-15 h of administration. These antibiotic concentrations were sufficient to decrease the numbers of ampicillin-sensitive E. coli from 10(8)-10(9) bacteria ml-1 to about 10(5)-10(6) bacteria ml-1 by 8 h after ampicillin administration. Second and third doses of antibiotic had no further effect on the bacterial count. Administration of ampicillin to animals hosting ampicillin-resistant E. coli resulted in a significant inactivation of the antibiotic in the intestine. As might be expected there was little reduction in the numbers of these organisms. These results are similar to those observed in conventional lambs hosting resistant E. coli as the dominant colibacillary flora.

[In vitro interaction between an ampicillin-colistin combination and ampicillin-resistant Escherichia coli]

In this work, the authors studied in vitro potential interactions between bacteria and antibiotics. Colistin and ampicillin were introduced to ampicillin-resistant Escherichia coli and ampicillin activity was measured. Two layers of agar media were used. The lower layer contained E. coli and colistin. The superficial layer was sown with indicating bacteria (ampicillin-sensitive Proteus mirabilis). Ampicillin activity was evaluated on the upper layer with impregnated disks. By this technique, it was ascertained that ampicillin degradation increased with colistin concentration. In this case, colistin may favour interactions of intracellular beta-lactamases on ampicillin.