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Biomedical subjects

J Y Mary

Publications and source records attributed to J Y Mary.

At least 19 recordsLinked to original sources
PubMed1995

Improved cytogenetics in multiple myeloma: a study of 151 patients including 117 patients at diagnosis.

Between December 1990 and January 1994, bone marrow (BM) samples from 151 patients with multiple myeloma (MM), including 117 patients evaluated at diagnosis, were collected for cytogenetic analysis. A total of 129 patients had assessable metaphases (100 patients at diagnosis). Cytogenetic studies were performed on BM cells after longterm cultures (6 days) with stimulation of cultures by granulocyte-macrophage colony-stimulating factor (GM-CSF), GM-CSF plus interleukin (IL)-6, IL-3 plus IL-6, or GM-CSF plus IL-3 plus IL-6 to improve myeloma cell growth, and 91 patients had an additional unstimulated culture. Sixty-six patients (51%) had cytogenetic abnormalities, including 47 of 100 patients at diagnosis (47%) and 17 of 24 patients at relapse (71%; P = .04). The aberration rate increased with stage (P = .007), BM plasmacytosis (P = .003), beta 2 microglobulin level (P = .001), C-reactive protein (CRP) level (P = .001), and Ki-67 (P = .007). The abnormality detection rate was higher in stimulated than unstimulated cultures, and the difference was statistically significant (P < .01). Hyperdiploidy was observed in 39 patients (30% of patients with an assessable karyotype) and hypodiploidy in 19 patients (15%). Among numeric changes, gains predominantly involved chromosomes 3, 5, 7, 9, 11, 15, 19 and losses, chromosomes 8, 13, 14, and X. The most frequent loss was loss of chromosome 13, observed in 22 patients (15%), including 18 patients at diagnosis (12%). We observed frequent structural changes of chromosomes 1 (15%) and 14 (10%) but also a 5% incidence of 19q13 abnormality and two patients with translocation t(1;16)(p11;p11). By using the proportional hazard univariate model, patients with abnormal karyotypes were demonstrated to have 2.5-fold greater chance of death than patients with normal karyotypes (P < .014). Despite a multivariate approach with the same model, the respective roles of karyotype abnormality, age, stage, and beta 2 microglobulin level could not be clearly ascertained. From these results we conclude that cytogenetic analysis using stimulation of cultures by cytokine(s) may be a promising method to identify about 50% of cytogenetic abnormalities in patients with newly diagnosed MM. Cytogenetic analysis may help to define a high-risk population that would benefit from intensive therapeutic approaches.

Adult↗
PubMed1995

Soluble interleukin-2 receptor in Crohn's disease. Assessment of disease activity and prediction of relapse.

In Crohn's disease, the activity of the disease is difficult to evaluate and the evolution of the disease is difficult to predict. The soluble interleukin-2 receptor serum level has been reported to correlate with clinical activity of the disease and with mucosal immune activation. We compared serum soluble interleukin-2 receptor to classical inflammatory markers and other immune parameters in the assessment of clinical disease activity and prediction of relapse in patients with Crohn's disease. Soluble interleukin-2 receptor serum levels correlated well with the Crohn's disease activity index, and multivariate analysis showed that this correlation was independent of the other inflammatory and immune markers. The correlation was not greater, However, than that between some inflammatory markers, such as ESR, and Crohn's disease activity index. Longitudinal follow-up showed that a high soluble interleukin-2 receptor serum level was highly predictive of relapse. Multivariate analysis showed that the soluble interleukin-2 recepteur serum level was complementary to other inflammatory and clinical markers in the prediction of relapse of disease. We conclude that soluble interleukin-2 receptor is of use in monitoring Crohn's disease, particularly in prediction of relapse.

Adolescent↗
PubMed1995

Risk factors for fatal diarrhoea among dehydrated malnourished children in a Madagascar hospital.

OBJECTIVE: To examine mortality risk factors during rehydration among 6-35 month malnourished children with diarrhoea. DESIGN: Data collected prospectively during a clinical trial comparing two oral rehydration solutions (ORS). SETTING: Paediatric ward. SUBJECTS: Study children had either a weight-for-age Z-score below -2 or a weight-for-height below 70% of NCHS median. All had diarrhoea for < 5 days. 150 were enrolled and two were excluded for intercurrent infection. INTERVENTION: Children were randomly allocated to receiving 100 ml/kg of standard or rice-based ORS during the 6h following admission. Then they received 420 kJ/kg/day of high energy milk, progressively increased to 840 kJ/kg/day. RESULTS: Mortality rate was 16% and with no difference by ORS group. In univariate analysis, the risk of dying (mean odds ratio; 95% confidence interval) was significantly higher among girls (3.5; 1.4-8.9), in non-breast-fed children (3.7; 1.4-9.6) and in children with a low weight-for-height (5.1; 1.9-14.1). Low weight, moderate or severe dehydration, low plasma specific gravity or total plasma protein and longer duration of diarrhoea before inclusion also were significant risk factors. In multivariate logistic analysis, only absence of breast-feeding was associated with a higher risk of dying among girls with a low weight-for-height. Among them, eight out of nine died, compared to 15 out of 139 for other children. CONCLUSION: Breast-feedings protected severely malnourished girls against death from diarrhoea even when dehydration was corrected. Mechanisms underlying this selective effect are poorly understood.

Breast Feeding↗
PubMed1994

A classification after radical cystectomy of patients with bladder cancer associated with schistosomiasis.

The aim of this study was to classify the bilharzial bladder cancer patients after radical cystectomy into several prognostic strata with increasing risk of recurrence. 310 patients through the period 1977-1983 at the National Cancer Institute of Cairo were systematically analysed for 12 variables evaluated after radical cystectomy. Eight factors were shown to have a significant influence on the recurrence-free survival curve after radical cystectomy namely: tumour stage, size, grade and location in the bladder, lymph node involvement, metastasis, renal insufficiency and urinary diversion. Using the proportional hazard model, five factors were significantly related to a lower recurrence-free survival, one major prognostic factor, tumour grade (G2 or G3) (relative risk estimate of 5.5), and four minor prognostic factors (relative risk estimates around 2), namely tumour diameter greater than 5 cm, anterior or trigonal location of the tumour, tumour stage (T3 or T4) and presence of renal insufficiency before surgery. Four prognostic strata have been defined in relation to the presence of these prognostic factors. This classification was validated on a second sample of 122 patients by comparing for each prognostic stratum, the recurrence-free survival curve observed on this sample and the corresponding predicted curve by Cox model. No statistically significant difference could be detected. This classification of bladder cancer patients appears to be adequate for bilharzial bladder cancer patients after radical cystectomy, at least in the conditions they presented and were treated for at the NIC in Cairo.

Adult↗
PubMed1994

Correlations between clinical activity, endoscopic severity, and biological parameters in colonic or ileocolonic Crohn's disease. A prospective multicentre study of 121 cases. The Groupe d'Etudes Thérapeutiques des Affections Inflammatoires Digestives.

The relationships between clinical activity, endoscopic severity, and biological parameters in Crohn's disease have not been thoroughly investigated and a link was therefore sought between these three elements. The following parameters were determined simultaneously in 121 consecutive patients with colonic or ileocolonic Crohn's disease: Crohn's disease activity index, Crohn's disease endoscopic index of severity, and serum albumin, alpha 2-globulin, alpha 1-antitrypsin, orosomucoid, C reactive protein, erythrocyte sedimentation rate, platelets, lymphocyte and polymorphonuclear cell counts, haematocrit, and faecal alpha 1-antitrypsin concentration. The distribution of these parameters was studied and transformation was used so that data matched the normal distribution closely. A weak but significant correlation (r = 0.32; p < 0.001) was found between clinical and endoscopic indices in the whole group of patients and this correlation seemed to be homogenous in various patient subgroups (clinically quiescent or active disease, pure colonic disease, untreated patients). Endoscopic or clinical indices were also found to be weakly linked with biological parameters (r < 0.50). Stepwise linear regression identified C reactive protein as predictive of the clinical index, and, successively, alpha 2-globulin, erythrocyte sedimentation rate, faecal alpha 1-antitrypsin, serum orosomucoid, and alpha 1-antitrypsin as predictive of the endoscopic index. Both predictions were poor--the biological variables accounting for only 22 and 44% respectively of the clinical and endoscopic index variations. In conclusion, Crohn's disease clinical activity seems to be virtually independent of the severity of the mucosal lesions and biological activity.

Adolescent↗
PubMed1992

Automatic search for model to simulate the differentiation of T lymphocytes within the thymus.

The differentiation of T Lymphocytes within the thymus is an important biological phenomenon during which these cell acquire their functions to further control the immune system. Numerous experiments under various conditions have been devised to understand the different mechanisms involved in this complex process. Nevertheless, interpretation of these experiments lead to still contradictory debatable hypotheses. Modelisation of this process through classical simulation methods cannot be envisaged because they are not adapted to modifications of the model structure, which is the point of interest. For these reasons, we proposed a new approach of automatic search for model. The program consists of four independent connected modules: The generator produces model, based on the rationale of formal grammars. Protocol and experimental data are stored in a set of experiments. The simulator using a protocol and a model provides simulated results. Finally, the supervisor by comparing simulated results and experimental data, adapts the model parameters to increase their fit and either chooses a new experiment to explore, or modifies the model structure. Change of the model structure is performed among still unexplored models according to their "promise" level, which is iteratively evaluated relatively to previously explored models through a proposed model distance. The generator is written in Prolog and the other modules in C++. The architecture of the program allows us to modify or complete a module without changing anything in the other modules. As a consequence, the proposed modeling approach conceived to study T lymphocyte differentiation within the thymus remains independent of this biological phenomenon and can be applied to other biological problems.

Cell Differentiation↗
PubMed1992

[Clinical consequences of replacing milk with yogurt in persistent infantile diarrhea].

Persistent diarrhea is an episode of diarrhea that begins acutely but lasts longer than expected for this usually self-limited disease. Treatment of this ill-defined syndrome is not well standardized but immediate intervention is required to minimize the risk of malnutrition with its various consequences. This randomized clinical trial was undertaken to evaluate the clinical efficacy of substituting yogurt for milk, as the only treatment. After a one to two-day observation period during which a standard milk diet was given, 78 children aged 3 to 36 months with confirmed persistent diarrhea of more than 15 days but less than one month duration and negative tests for fecal blood were fed either milk (infant formula) or yogurt (infant formula fermented with Lactobacillus bulgaricus and Streptococcus thermophilus). At inclusion both groups were comparable for age, nutritional status, diarrhea, and lactose hydrogen breath test results. Clinical treatment failure (weight loss greater than 5% in one day or persistent diarrhea after 5 days) was significantly less common in children fed yogurt (15 +/- 6%) than in children fed milk (45 +/- 8%). The beneficial effects of feeding yogurt were apparent within 48 hours in 67 +/- 8% of infants. In conclusion, these data confirm the clinical efficacy of substituting yogurt for milk in young children with persistent diarrhea. They also suggest that yogurt may be a good alternative for the initial treatment of persistent diarrhea.

Algeria↗
PubMed1991

Clonogenic leukemic progenitor cells in acute myelocytic leukemia are highly sensitive to cryopreservation: possible purging effect for autologous bone marrow transplantation.

The intrinsic AML-CFU sensitivity to cryopreservation was investigated. We compared the recovery of AML-CFU with six different freezing techniques in five myelocytic leukemic (AML) patients to the recovery of normal progenitors (CFU-GM and BFU-E) from control marrows. The recovery for AML-CFU (9.3% +/- 3.1, SE) was significantly lower (p less than 0.001) than for normal CFU-GM (48.4% +/- 4.6) and BFU-E (46.2% +/- 5.0). Moreover, the cloning efficiency of frozen AML-CFU was significantly reduced in 4/5 cases (p less than 0.001), as compared to fresh samples, while it was unaltered in 3/4 normal controls. There were no significant differences between the six freezing techniques, indicating that they are equally efficient for normal progenitors and inefficient for leukemic progenitors. These results indicate that human leukemic progenitors are more sensitive to cryopreservation than normal CFU-GM and BFU-E. These findings suggest that cryopreservation per se may have a purging effect in the context of autologous bone marrow transplantation for acute myelocytic leukemia in complete remission.

Bone Marrow Transplantation↗
PubMed1990

Epidemiology of aplastic anemia in France: a prospective multicentric study. The French Cooperative Group for Epidemiological Study of Aplastic Anemia.

Incidence rates of aplastic anemia (AA) are rare among defined populations. Since June, 1984, a cooperative group, including 83 University medical centers throughout metropolitan France, prospectively recorded new cases of AA and followed them up. Inclusion criteria were: at least two depressed blood cell lineages (hemoglobin less than or equal to 10 g/100 mL and reticulocytes less than or equal to 50 x 10(9)/L, granulocytes less than or equal to 1.5 x 10(9)/L, platelets less than or equal to 100 x 10(9)/L) and a bone marrow biopsy compatible with the disease. Between May, 1984, and April, 1987, 292 cases were recorded. After exclusion of constitutional disease, 27 patients did not satisfy the inclusion criteria with relation to either bone marrow or blood evaluations and seven patients were initially misdiagnosed (shown in the follow-up), leaving 250 confirmed AA cases in the register. The annual incidence in France appeared to be about 1.5 per million inhabitants. The sex ratio of AA cases was similar to that of the population. In men, two peaks of incidence were observed: one between 15 and 30 years and one after 60 years. In women, the only peak was observed after 60 years. An excess of cases was observed in small towns but not in rural areas. About two of every three cases had severe AA, with a possible excess in younger cases. Based on a minimum follow-up of 1 year for 238 patients, the fatality rate was estimated at 17% at 3 months after diagnosis and at 34% at 1 year. Among 243 suspected etiologies reported by the physicians, 74% were declared idiopathic, 13% presumably associated to drug toxicity, and 5% related to hepatitis. AA appears to be a rare and severe disease in metropolitan France, often of unknown origin, a fact that emphasizes the necessity of controlled etiologic studies.

Adolescent↗
PubMed1990

Clinical, biological, and endoscopic picture of attacks of Crohn's disease. Evolution on prednisolone. Groupe d'Etude Thérapeutique des Affections Inflammatoires Digestives.

One hundred forty-two patients with active colonic or ileocolonic Crohn's disease were included in a multicenter prospective study. Data collection included 28 clinical, biological, and endoscopic items; the latter were recorded according to a standardized colonoscopic protocol; a previously validated endoscopic index of severity was calculated. Oral prednisolone (1 mg/kg body wt per day) was started and maintained until clinical remission and for at least 3 and at most 7 wk. A second clinical biological and endoscopic evaluation was then performed. At initial colonoscopy, mucosal lesions were, by decreasing order of frequency, superficial ulcerations, deep ulcerations, mucosal edema, erythema, pseudopolyps, aphthoid ulcers, ulcerated stenosis, and nonulcerated stenosis (93%, 74%, 48%, 44%, 41%, 35%, 10%, 8%, and 2% of cases, respectively). No correlation was found between the clinical activity index and any of the endoscopical data (lesion frequency and surface, endoscopic severity index). Ninety-two percent of patients underwent clinical remission within 7 wk of treatment. None of the 28 clinical biological and endoscopical items collected just before treatment could predict clinical response to steroids. Only 38 of the 131 patients in clinical remission were also in endoscopic remission. In conclusion, (a) the description and severity of colonoscopic lesions in active Crohn's disease have been quantified; (b) no correlation exists between clinical severity and nature, surface, or severity of endoscopic lesions; (c) Oral prednisolone (1 mg/kg body wt per day) induces a clinical remission in 92% of patients within 7 wk; (d) resistance to steroids cannot be predicted from the data collected before treatment onset; and (e) only 29% of patients in clinical remission also achieve endoscopic remission.

Adult↗
PubMed1990

Effect of feeding yogurt versus milk in children with persistent diarrhea.

Although the pathophysiology of persistent diarrhea in children remains unclear, it has been suggested that it may be related to the composition of the food ingested. Since lactase deficiency and cow's milk protein intolerance are often identified in children with persistent diarrhea, replacement of milk with yogurt should be beneficial. We, therefore, compared the clinical outcome of children (aged 3-36 months) with persistent diarrhea randomly assigned to receive either milk or yogurt for 5 days. Preliminary results on 45 of the 100 children indicated clinical failure, which was determined after a 5% loss of body weight per day or the persistence of diarrhea after 5 days, in only 14% of the children fed yogurt compared to 42% of those fed milk (p less than 0.05). These preliminary results strongly suggest a clinical advantage of feeding yogurt rather than milk in children with persistent diarrhea.

Child, Preschool↗
PubMed1990

Expansion by folinic acid of the peripheral blood progenitor pool after chemotherapy: its use in autografting in acute leukaemia.

We have tested folinic acid (FA) for ability to increase peripheral blood stem cells (PBSC) after chemotherapeutic aplasia in acute leukaemia. Five adult patients (four AML, one ALL) entered the study, each patient underwent two series of three leukapheresis, the first following induction chemotherapy and the second following the first course of consolidation. The first leukapheresis of each series was done when the white blood cell count reached 10(9)/l with subsequent leukapheresis every other day. Folinic acid (Lederle Laboratories, France) was administered at a dose of 50 mg (i.v.) per day, 15 days from initiation of chemotherapy and continuing through the third leukapheresis of the series (days 25-30). PBSC were collected on a Haemonetics V50 cell separator. In these five cases we observed an increased yield of both colony-forming units, granulocyte macrophage (CFU-GM) and burst forming units-erythroid (BFU-E) expressed per ml of cytapheresis product: CFU-GM x 18, BFU-E x 3 and if expressed per 10(4)/kg of body weight: CFU-GM x 30, BFU-E x 3 (CFU-GM P less than 0.05, BFU-E less than 0.01). Long-term blood culture (LTSC) from FA stimulated leukapheresis, in an attempt to quantitate the most primitive stem cells, demonstrated that this expansion of the PBSC was sustained in time. We found by means of LTSC that FA did not stimulate CFU-L from patients with AML (two cases tested). Finally two AML patients were grafted with FA-PBSC after Cytotoxan and total body irradiation (TBI). Haematopoietic reconstitution was rapid complete and sustained in time in both patients. This indication for folinic acid should be further studied with or as an alternative to haematopoietic growth factors.

Adult↗
PubMed1990

Is P50 the most representative P(SO2) to evaluate HbO2 affinity?

Off-line computer assistance allowed a correct visualization of the actual data included in any experimental whole oxygen-hemoglobin association curve. The affinity of hemoglobin for oxygen (characterized by the successive PO2 corresponding to any saturation value: P(SO2)), the shape of the association curve (Hill's curve and Hill's numbers) and the Bohr coefficients all along the oxygenation process, were determined with great accuracy. Results agreed with literature values obtained for successive steps of oxygenation. A batch of 78 computerized curves was divided into 3 groups (normal: NL, right deviated: RD and left deviated: LD) to which the principal component (P.C.) method was applied. It was therefore possible not only to study correlations between any curve summarized by its P.C. and any external variable but also to define for any association curve, whatever its eventual shift, the most representative value of P(SO2). For all mixed groups, the most significant parameter would be P44. If the characterization of the HbO2 dissociation curve is to be represented by a single point, then it should be P48 for the NL curves, P52 for the LD group, and P24 for the RD group. Then, the common use of P50 appeared to be illegitimate and inadequate for the right shifted curves, a very frequent circumstance in clinical practice.

Computers↗
PubMed1990

Inhibition of human bone marrow progenitors by the synthetic tetrapeptide AcSDKP.

The purpose of this work was to study the effects of a tetrapeptide, acetyl-N-Ser-Asp-Lys-Pro (AcSDKP), an inhibitor of spleen colony-forming unit (CFU-S) entry into DNA synthesis, on human progenitor cells. Normal human mononuclear cells were incubated with concentrations of the synthetic tetrapeptide ranging from 10(-12) to 10(-7) M for 1.5 and 24 h and then plated in methylcellulose in the presence of human placenta-conditioned medium and recombinant human erythropoietin. The proportion of progenitors in DNA synthesis was determined by the thymidine suicide assay. Incubation with AcSDKP for 24 h leads to a significant inhibition of granulocyte-macrophage colony-forming unit (CFU-GM) and erythroid burst-forming unit (BFU-E) growth and in some cases of erythroid colony-forming unit (CFU-E) growth. The inhibition, which was never greater than 50%, was obtained with 10(-10)-10(-9) M AcSDKP, whereas no effect was seen at higher concentrations. The percentage of CFU-GM, BFU-E, and CFU-E in DNA synthesis was significantly reduced in five consecutive patients after incubation of cells for 24 h with inhibitory doses of the peptide, indicating that it is active on cycling cells. Therefore, these studies provide the first evidence that the tetrapeptide AcSDKP, originally obtained from bovine marrow and now chemically synthesized, is able to inhibit the in vitro growth of human progenitors and to decrease their proportion in cell cycle.

Amino Acid Sequence↗
PubMed1990

[Leukocyte differential of the Coulter VCS. Evaluation and modalities of use in comparison with the Coulter STKR and manual count].

The Coulter VCS is a flow cytometer which performs, from a 100 microliter blood sample, a full five-part differential by assessing the volume (V), high frequency conductivity (C) and laser light scatter (S) on each white cell counted. The authors evaluated the Coulter VCS and compared its results with those of the Coulter STKR (three-part differential) and of the manual count. Reproducibility (ten replicate analyses on six different normal samples) was studied by the three methods and showed coefficients of variation closed to the manufacturer's specifications except for monocytes. The correlation coefficients obtained from 345 normal samples were the following: VCS/manual count: 0.97 for neutrophils, 0.70 for eosinophils, 0.97 for lymphocytes and 0.57 for monocytes; VCS/STKR: 0.99 for granulocytes, 0.99 for lymphocytes and 0.70 for monocytes. Comparisons of means displayed statistical differences for some cell categories but without clinical consequences. The flag analysis of 313 abnormal samples showed a false positive rate of 3.1 p. cent for the VCS and 1.8 p. cent for the STKR, the false negative rate was 2.1 p. cent for the VCS and 3.6 p. cent for the STKR. Starting from total blood count parameters, the authors propose guidelines for appropriate use of the different leucocyte differential methods.

Algorithms↗
PubMed1989

Incubation time for AIDS from French transfusion-associated cases.

Although incubation time is a key parameter of the epidemiology of AIDS, statistical estimates based on transfusion-associated AIDS cases have, up to now, used only the single dataset provided by the AIDS program of the Centers for Disease Control (CDC) in Atlanta. Using a new dataset provided by the Direction Générale de la Santé (DGS), of the French Ministry of Health1, we estimate the mean incubation time for AIDS (median in brackets) to be 5.3 years (5.3 years) with a 90% confidence interval ranging from 4.4 to 8.9 years (4.4 to 8.8 years), when a Weibull distribution is postulated for incubation time. The previously encountered problem of very large confidence intervals (range larger than 100 years), is not observed, indicating that an accurate estimate for mean incubation time will be obtainable in the near future.

Acquired Immunodeficiency Syndrome↗