Biomedical subjects

N Martinet

Publications and source records attributed to N Martinet.

At least 19 recordsLinked to original sources

PubMed2006

[Capacity and performance: ambulatory monitoring under controlled and real-life conditions].

OBJECTIVES: To determine the value of ambulatory monitoring in assessing human gait. To describe the sensors, the parameters and the ambulatory devices. MATERIALS AND METHODS: Literature review and practical experience about techniques, principles, objectives and limits. RESULTS: Accelerometry is the main technique for ambulatory monitoring because of its reliability, pertinence of signals and software developed for interpretation. Simultaneous monitoring of heart rate response is clinically relevant. Pedometers and actimeters can answer precise clinical questions about amount of walking activity. CONCLUSION: Ambulatory monitoring during long periods (one day or more) is important, especially for rehabilitation medicine because it measures the actual patient activity performed and participation. The simultaneous monitoring of environmental conditions of activity should improve the interpretation of the data collected.

Humans↗

PubMed2006

[Optoelectronic gait analysis after metatarsophalangeal arthrodesis of the hallux: fifteen cases].

PURPOSE OF THE STUDY: Degeneration of the metatarsophalangeal joint of the hallux is a frequent secondary lesion of the first ray subsequent to hallux valgus. Different surgical techniques have been proposed for cure, including metatarsophalangeal arthrodesis. Joint fusion relieves pain but sacrifices joint motion. The purpose of this work was to assess changes observed in gait after metatarsophalangeal arthrodesis of the hallux using a three-dimensional optoelectronic system. MATERIAL AND METHODS: Gait analysis was performed with a Vicon 3D system with five cameras and two AMTI force platforms in twelve patients who had undergone metatarsophalangeal arthrodesis more than six months earlier. The kinetic and kinematic curves and ground reaction forces were analyzed. Changes in the gait cycle and any compensations observed in the talocrural and interphalangeal joints were noted in the three dimensions. Wilcoxon test for paired series was applied for the statistical analysis. RESULTS: The general gait parameters and kinetic and kinematic values were not modified (excepting a non-significant decline in maximal dorsiflexion of the ankle joint). There was a significant decrease in propulsion force in the anteroposterior and vertical planes, with significantly later heal lift-off and systematic displacement of ground reaction forces anterior to the metatarsophalangeal joint on the arthrodesis side. Reflectors positioned on the distal extremity of the hallux demonstrated that the essential part of compensation occurred at the level of the interphalangeal joint. DISCUSSION: Gait analysis after tibiotalar arthrodesis has been widely reported in the literature. The consequence of joint fusion on the rear foot and/or the torsion couple have also been studied. However, to our knowledge, there has been only one report using a different methodology devoted to metatarsophalaneal arthrodesis of the hallux. In this study, only step length and interphalangeal moment as well as ankle force were found to be decreased. Function of the interphalangeal joint was not assessed. The Vicon system enabled an adapted study of gait after metatarsophalangeal arthrodesis. This method offers several perspectives: study of the effect of the position of the arthrodesis in the sagittal plane on gait, changes over time in interphalangeal joint motion, or consequences of fusion on walking up and down stairs. CONCLUSION: Metatarsophalangeal arthrodesis of the hallux does not modify general gait parameters nor the kinetic and kinematic values. Compensation is achieved via the interphalangeal joint.

Aged↗

PubMed2005

[Evaluation of amputees].

INTRODUCTION: Review of the literature about evaluation of amputees. MATERIALS AND METHODS: A search of the Medline and Reedoc databases with the key words lower limb amputee, upper limb amputee, evaluation of lower limb amputee, evaluation of upper limb amputee, survey of lower limb amputee, survey of upper limb and the same words in French for reports on the evaluation of amputees. RESULTS: Evaluations of amputees differ according to the level of amputation (lower or upper limb) and age (adult or child). They concern standing balance, walking (lower limb) and the mono- or bimanual prehensile capacities with or without prostheses in daily living activities and leisure (upper limb) as well as quality of life, personal satisfaction, psychological impact and, in particular, coping strategies. DISCUSSION: For lower-limb amputees, tools to evaluate include scales of deambulation, of which few are valid in French, and global scales (on locomotor capacities, quality of life and satisfaction), which have been recently validated, but only one of them is valid in French. For upper-limb amputees, specific and valid tools are not available for adults; however, for children some functional capacity scales in daily activities have been validated and take into account psychomotor development. None of these tools are valid in French, and their use is scattered and limited to validation studies. CONCLUSION: Only a few tools to evaluate amputees are valid in French for adults, and they concern lower-limb amputees only. Validating some of these tools in French is necessary.

Activities of Daily Living↗

PubMed2004

[Clinical and three-dimensional kinematic features of the upper limb after replantation of the hand].

INTRODUCTION: Functional assessments of hand replantation after traumatic amputation are considered as good although frequent deficits of long fingers mobility and hand sensitiveness occur. AIMS: To evaluate the capability of handling and the compensatory mechanisms involved in handling. METHODS: Prospective study in eight right-handed males who had distal amputation of the left upper limb with hand replantation for more than two years. Eight males with paired age and handedness served as control. Skin sensitiveness (thread test), mobility (TAM), functional capability (Box and Blocks test, 400 points test) and occupational outcome were assessed. Three-dimensional analysis (opto-electronic device) of the motion of the trunk and the upper limbs (arm, forearm, hand) was made during a pointing and gripping-shifting maneuver and the time of the related phases was measured (dynamometric cube device). Correlation between clinical assessments and three-dimensional analysis were tested. RESULTS: Patients with replantation had a remarkable recovery of the absolute and relative times of the various phases of the handling maneuver. Only the gripping phase was significantly prolonged in patients, this result was correlated with the deficit in motor function and sensitiveness of the replanted hand. The visual control was higher because of the lack of superficial and deep sensitiveness. Compensatory mechanisms involved a lateral shift of the replanted limb segments, probably attributed to the lateral shift of the trunk. CONCLUSION: Patient with a replanted hand develops a homogenesis displacement of the trunk and the pectoral girdle to compensate the shortening and the reduction in active mobility of the hand. This compensatory mechanism, observed in a small scale in healthy too, is efficient with respect to the handling phases.

Activities of Daily Living↗

PubMed2002

Functional asymmetries of the lower limbs. A comparison between clinical assessment of laterality, isokinetic evaluation and electrogoniometric monitoring of knees during walking.

We used bilateral electrogoniometric gait monitoring of the knees to demonstrate the existence of an angular asymmetry between the two legs in healthy subjects. We also searched for correlations between this asymmetry and handedness, footedness and ocular laterality and isokinetic strength of the flexor-extensor muscles of the two knees. Among the 40 subjects studied, 25 (62.5%) showed an asymmetric maximal knee flexion: the difference being superior or equal to 5 degrees between the knees. There was no correlation between this asymmetry and the lateralities studied. We termed this type of asymmetry 'angular preponderance' to differentiate it from the laterality defined by clinical tests. Isokinetic strength of the knee flexors and extensors was correlated with the gender and speed, but not with side or laterality. Appropriate interpretation of lower limb examination should take into consideration angular gait asymmetry in the healthy subject.

Adult↗

PubMed2002

Nottingham Health Profile: reliability in a sample of 542 subjects with major amputation of one or several limbs.

The reliability of a generic health-related quality of life measure was assessed for subjects with major amputation of one or several limbs. The Nottingham Health Profile was sent a first time to 1011 limb amputees, and a second time to the 542 respondents to the first inquiry. The intraclass correlation coefficient (ICC) between the answers to each survey was highest for the categories of distress caused by pain (ICC = 0.83), emotional reactions (ICC = 0.83) and mobility (ICC = 0.81). It was found satisfactory for energy level (ICC = 0.75), sleep (ICC = 0.75) and social isolation (ICC = 0.64). It is concluded that the NHP is a reliable health related quality of life measure for amputees.

Adult↗

PubMed2002

Upregulation of nerve growth factor expression by human airway smooth muscle cells in inflammatory conditions.

Recent studies have suggested that nerve growth factor (NGF) may play a role in inflammation and bronchial hyperresponsiveness in asthma. Neither the types of cells that produce NGF in the human airways nor the effect of inflammation on NGF expression are clear. The two-fold aim of the present study was to determine whether airway smooth muscle produces NGF in vitro, and, if so, whether the pro-inflammatory cytokine interleukin-1beta (IL-1beta) affects this expression. Human airway smooth muscle cells in culture were incubated in the presence or absence of IL-1beta. NGF production was measured by enzyme-linked immunosorbent assay. NGF messenger ribonucleic acid (mRNA) was measured using a specific real-time fluorescent polymerase chain reaction technique, and expressed in relation to glyceraldehyde-3-phosphate dehydrogenase (GAPDH) mRNA levels. Human airway smooth muscle cells in vitro expressed NGF constitutively (21.4+/-7.8 pg x mL(-1); 14.6+/-5.4 pg NGF complementary deoxyribonucleic acid (cDNA) x pg GAPDH cDNA(-1) (mean+/-SEM)). Stimulation with IL-1beta (0.1-30 U x mL(-1)) for 24 h induced a dose-dependent increase in NGF production (22.1 pg x mL(-1) at 10 U x mL(-1); p<0.05). The IL-1beta (10 U x mL(-1))-induced increase in NGF expression was time-dependent. It was highest for NGF protein at 10 h (1.6-fold increase over control; p<0.001) and for NGF mRNA at 2.5 h (2.4-fold increase over control; p<0.05). In conclusion, the present study clearly shows that the human airway smooth muscle cell is a source of nerve growth factor, the expression of which is upregulated in inflammatory conditions, mimicked in vitro by the addition of interleukin-1beta.

Asthma↗

PubMed2001

Expression and function of proteinase-activated receptor 2 in human bronchial smooth muscle.

Trypsin and mast cell tryptase cleave proteinase-activated receptor 2 (PAR2) to induce alterations in contraction of airway smooth muscle that have been implicated in asthma in experimental animals. Although tryptase inhibitors are under development for treatment of asthma, little is known about the localization and function of PAR2 in human airways. We detected PAR2 expression in primary cultures of human airway smooth muscle cells using reverse transcriptase/polymerase chain reaction (RT-PCR) and immunofluorescence. The PAR2 agonists trypsin, tryptase, and an activating peptide (SLIGKV-NH2) stimulated calcium mobilization in these cells. PAR2 agonists strongly desensitized responses to a second challenge of trypsin and SLIGKV-NH2, but not to thrombin, indicating that they activate a receptor distinct from the thrombin receptors. Immunoreactive PAR2 was detected in smooth muscle, epithelium, glands, and endothelium of human bronchi. Trypsin, SLIGKV-NH2, and tryptase stimulated contraction of isolated human bronchi. Contraction was increased by removal of the epithelium and diminished by indomethacin. Thus, PAR2 is expressed by human bronchial smooth muscle where its activation mobilizes intracellular Ca2+ and induces contraction. These results are consistent with the hypothesis that PAR2 agonists, including tryptase, induce bronchoconstriction of human airway by stimulating smooth muscle contraction. PAR2 antagonists may be useful drugs to prevent bronchoconstriction.

Bronchi↗

PubMed2001

Down-regulation of peroxisome proliferator-activated receptor-gamma gene expression by sphingomyelins.

We recently demonstrated that the sphingomyelin (SM) content of adipocyte membranes was negatively correlated with the expression of peroxisome proliferator-activated receptor-gamma (PPARgamma) in the subcutaneous adipose tissue of obese women with variable degrees of insulin resistance. We have now investigated whether SM really does have an impact on the expression of PPARgamma in 3T3-F442A adipocytes. Adding SM to the culture medium for 24 h caused a significant increase in SM content of adipocyte membranes and an acyl chain length-dependent decrease in the levels of PPARgamma mRNA and protein. The longer the acyl chain of the fatty acid of SM, the greater was the decrease in PPARgamma. These data suggest that the nature of the fatty acid is important in the regulation of PPARgamma by the SM pathway.

3T3 Cells↗

PubMed2001

[Classification and mechanisms of body perceptions in the amputees].

OBJECTIVE: Amputees can experience several types of physical illusions and phantom limb phenomenon. The objective was to establish a synthetic classification of theses perceptions. METHOD: Prospective study in 75 amputees (group 1: amputation (n = 60), group 2: congenital defect). The subjects were asked first to report their perceptions spontaneously and then to detail the perception, if exist, of the missing limb: form recognition, posture, movement, reminiscence of a lost limb. RESULTS: Different types of perception were described besides the perception of the real state : normal, deformed or commemorative phantom limb and illusion of a normal body. DISCUSSION: Whatever the model (i.e.: neuro-matrix) which support the construction of the scheme and the body image, the representations related to identified perceptions, use various innate, autobiographic and identity frames of references as well as instantaneous peripheral information, treated by reorganized cerebral structures. Each type of perception is related to a particular representation pattern. CONCLUSION: This approach, in accordance with the literature, offers a better understanding of the differences between amelic and amputated subjects and of their perception of any prosthetic equipment.

Amputees↗

PubMed2001

[MRI and leg stump neuroma].

OBJECTIVE: To describe RMI aspects of leg stump neuroma and to evaluate RMI scan interest for neuroma diagnosis and management. POPULATION AND METHOD: During a 2 years period, 224 amputated patients consulting for pain or prostetics problems were studied. In 10 cases, a characteristic pain leads to neurona diagnosis. This is described as a sensation of ascending or descending electric shock induced by the stimulation of an identified point with a reproducible topography. In all these cases, RMI scans were performed. In thirty two other cases, a RMI scan was performed to confirm a pathology (bursitis, bone abnormality) or in order to establish an etiologic diagnosis. Twelve neuromas were diagnosed. RESULTS: RMI scan showed a neuroma in the ten cases with a clinical suspicion and two asymptomatic neuromas were diagnosed out of the 32 patients without clinical suspicion. Medium delay between amputation and neuroma diagnosis is 11,6 year. In six cases, staking was modified and in six other cases, surgery was necessary. In aIl cases, clinical manifestations disappeared. Vanous RMI aspects ofneuromas are described and illustrated. Neuroma is observed on the extremity of a nerve that have a wavy aspect on its top. The neuroma is an oblong structure, with clear limits. There is an hyposignal with Ti sequence and variable signal with T2 and after gadolinium injection. DISCUSSION: RMI scan is a good way to diagnose amputee neuroma. It makes it possible to demonstrate the pathological character of the neuroma. It has to be performed when a neuroma is suspected. It enables to confirm the diagnosis and establish the exact topography and anatomic connection. Mechanical strains role as a factor of discovering the neuroma is discussed because of the concomitant evolution of associated lesions (bursitis, bone edema). Surgical repair takes place after correcting abnormal mechanical strains.

Amputation, Surgical↗

PubMed2001

[Georges Gilles of Tourette, pioneer of gait analysis in the nervous system diseases].

Georges Gilles de la Tourette's contribution to neurology goes beyond the description of the neurological disorder named after him. On December 28, 1885, he defended his doctoral thesis devoted to "gait in the diseases of the nervous system, studied by the method of imprints". In collaboration with Albert Londe, he worked for two years in Charcot's department on "a simple method applicable to both healthy and unhealthy patients", establishing the scientific and modern basis of functional exploration of human gait. The purpose was to "record the modifications of the gait and to fix them permanently, using suitable devises to guarantee not only rigorous comparison, but also to prevent observers, making use of the same method, from disputing or canceling the results completely independent of the experimenter himself". Georges Gilles de la Tourette defined the various characteristic parameters and provided the normal reference values in males and females, determining the physiological asymmetry of steps. He described spastic gait, shaking palsy, and locomotor ataxia. He distinguished between disorders of nervous control and related joint diseases. He also classified gait disorders occurring during hemiplegia. Modern development of kinetic, kinematic and biomechanical studies is a good illustration of the current relevancy of Gilles de la Tourette's contribution.

France↗

PubMed2001

[Chemoprevention perspectives for bronchial cancer].

Lung cancer, with a high incidence and a 14% survival rate at 5 years is the leading cause of death in France. Because of past and present smoking habits in the French population and the lack of real expectations for significant therapeutic progress within a short or mid-term delay, the only reasonable way to try to limit the predictable hecatomb in the next 2 decades is to reduce exposure to the main risk factors (tobacco smoke, asbestos.), implement an early and effective (radiographic and/or endoscopic) screening system, and/or determine an active chemoprevention scheme. The principle of chemoprevention is based on the fundamental concept that since lung cancer develops through several stages, subjects exposed to risk factors could be given a compound or compounds counteracting the deleterious effect of carcinogenic substances on DNA and/or blocking the subsequent cascade of molecular events. Two families of products have been considered as potential chemoprevention agents: antioxidants (selenium, beta-caroten, vitamin E, and N-acetyl-cystein) and vitamin A and its analogs. Unfortunately, despite promising experimental data, large-scale clinical trials have not evidenced any protective effect of these compounds that have even been observed to produce opposing effects. To date, no chemopreventive substance can be reasonable proposed for subjects at risk. Due to the lack of proof of the efficacy of the different screening systems proposed, the only preventive action with proven efficacy is to limit exposure to risk factors. All health care givers must actively participate in the fight against active and passive smoking.

Antioxidants↗

PubMed2001

[Illusions of body normality in amputees and paraplegic patients].

Phantom limbs in amputees, or body illusion in hemiplegics, have been the subject of wide ranging descriptions. The detected abnormalities involve morphological, postural and/or kinetic features. The aim of this prospective study carried out in 25 amputees and 10 adult paraplegics was to describe the typology of these perceptions. Data were collected from free and semi-directive investigations before and after caloric vestibular stimulation. Amputees and paraplegics perceived normal, deformed and painful body phantom segments, reffered perceptions and "normal limbs" which took on the request posture considering the general body position (illusion of body normality). This perception corresponds to an image of the body, such as it should be and not such as it is. In amputees, the limb follows the movements of the prothesis. These perceptions conform quite well reality so that the loss of the paralyzed limb is not perceived as a missing limb. This illusion of body normality should be distinguished from the normal phantom limb, characterized by a stronger perception of the lost limb compared with the other. In both amputees and paraplegics, vestibular stimulation can generate or modify phantoms limbs or body illusion and can abolish painful phantom limbs. The neuromatrix, which rebuilds body representations, could get its information from reorganized cortical areas (instantaneous body image), autobiographical engrams (painful phantoms limbs), or innate engrams (identity body schema) that, via congruence mechanisms, could be identified as a somatic reference, particularly for motor programming. This interpretation is compatible with current knowledge and suggests how amputees can easily use a prothesis.

Adult↗

PubMed2000

Retinoic acid receptor and retinoid X receptor alterations in lung cancer precursor lesions.

Smoking prevention will decrease lung cancer incidence in time. However, early detection would improve lung cancer prognosis in subjects at risk provided that specific markers could be identified. We previously reported that retinoic acid receptor (RAR) and retinoid X receptor (RXR) expression was altered in lung tumors. RAR-beta gene status could be derived from corresponding allelotyping and immunohistochemistry data. We now report the continued study on lung cancer precursor lesions. Fluorescence PCR-based assays were used for allelotyping at the RAR/RXR loci of: (a) 66 lung precursor lesions found at the free resection margins of 41 patients undergoing surgery for lung cancer (+ 31 paired tumors); and (b) bronchial cells also found at the free resection margins from 16 current and 8 never smokers operated on for noncancerous diseases. Three microsatellites located at 3p14-21 and 9p21 were also used for interwork comparison. Immunohistochemistry was additionally performed to evaluate P53 and RAR-beta expression in precursor lesions. Chi2 tests showed significant differences (P < 0.05) when comparing the results obtained from never smokers, smokers, squamous metaplasia, dysplasia + in situ carcinoma, and tumors. Microsatellite changes occurred frequently in all samples, but without specificity for any group (P < 0.08-0.52). They were globally correlated with tobacco exposure (P < 0.04), for which the RAR-gamma marker appeared as a preferential target (P < 0.004). Few reparation error phenotypes were observed, mostly at the RXR-alpha and RXR-gamma markers for which combined changes were also linearly increasing from never smokers to dysplasia + in situ carcinoma (P < 0.05 and P < 0.03). RAR-beta marker losses also increased from the first to the last group studied (P < 0.01), with a concomitant decrease in RAR-beta protein expression and correlated p53 increased immunoreactivity (P < 0.02). Losses at 3p14, 3p21, and P16 were frequent, but no significant differences between groups could be found. Unexpectedly, high constitutive homozygosity was observed near the RAR-alpha locus in squamous cell lung cancer cases. RARs/RXRs form homodimers or heterodimers involved in ligand binding. Their added alterations could result in a state of functional vitamin A deficiency in the affected bronchial cells. Further deletion events drawn from a limited repertoire of specific regions such as 3p14-21 and 9p21 could subsequently drive the deficient cells to invasive carcinoma.

Alleles↗

PubMed2000

Serum level of soluble tumour necrosis factor receptor II (75 kDa) indicates inflammatory activity of sarcoidosis.

OBJECTIVES: Tumour necrosis factor alpha (TNFalpha) is a key cytokine involved in granuloma formation of sarcoidosis. Since soluble TNF receptors (sTNF-R) are known to inhibit TNF effects, we were interested in whether they are elevated in the serum of sarcoidosis patients. METHODS: We determined serum levels of sTNF-R I (55 kDa) and sTNF-R II (75 kDa) in 49 patients with sarcoidosis and 22 controls. The clinical course of the disease was re-evaluated in a follow-up after (mean +/- SE) 6.8 +/- 6.6 months. RESULTS: sTNF-R I (3.1 +/- 1.1 ng mL-1, P < 0.05) and sTNF-R II (5.5 +/- 2.7 ng mL-1, P < 0.0005) were significantly elevated in sarcoidosis compared with controls (2.4 +/- 0.7 and 3.0 +/- 1.3 ng mL-1, respectively). Interestingly, both sTNF receptors were significantly higher in the serum of patients with active compared with inactive sarcoidosis (P < 0.005 and P < 0.0005, respectively). Furthermore, serum sTNF-R II levels were significantly higher in sarcoidosis patients with advanced radiological types II and III. In 10 patients, serum sTNF-R levels were obtained before and after systemic corticosteroid therapy and we observed a significant decrease of sTNF-R II (P < 0.02), whereas sTNF-R I levels were not reduced significantly. CONCLUSIONS: Both types of sTNF receptors are elevated in the serum of sarcoidosis patients with active disease, but only the sTNF-R II seems to be useful for monitoring the inflammatory activity of the disease.

Adrenal Cortex Hormones↗

PubMed2000

Imaging of the painful lower limb stump.

Several postoperative complications associated with pain may develop in the stump of an amputated lower limb. Clinical findings are often nonspecific; however, radiologic evaluation, especially with magnetic resonance (MR) imaging, is useful in the early diagnosis of these complications, thereby helping minimize physical disability with its psychologic and socioeconomic implications. Conventional radiography can demonstrate evidence of osseous origins of pain (eg, aggressive bone edge, heterotopic ossification, osteomyelitis) and should be the first imaging study performed after clinical examination. Videofluoroscopy can help evaluate improper prosthetic fit by demonstrating abnormal residual limb motion, piston action, rolling of soft tissues, and abnormal angle between the limb axis and the prosthesis during gait. Ultrasonography can demonstrate inflammatory changes in the stump as well as soft-tissue fluid collections. However, MR imaging is the modality of choice when clinical and other imaging findings are indeterminate. Because of its high spatial and contrast resolution, MR imaging can demonstrate subtle inflammatory changes, fluid collections, cancers, neuromas, and subtle traumatic bone lesions. Knowledge of various surgical and rehabilitation techniques is required for accurate diagnosis of complications associated with stump pain. Correct diagnosis allows choice of the most appropriate therapy, which may involve treating the stump, remodeling the prosthesis, or both.

Amputation Stumps↗

PubMed2000

Predictive survival markers in patients with surgically resected non-small cell lung carcinoma.

Among patients with resected non-small cell lung carcinoma, about 50% will present a tumor recurrence. Thus, it would be of major importance to be able to predict and try to prevent these relapses by an active chemotherapy and/or radiotherapy. In an attempt to answer this question, the tumors of 227 patients with a surgically resected non-small cell lung carcinoma were evaluated as follows: tumors were classified as squamous cell carcinoma (n = 132) or adenocarcinoma (n = 95), and tumor differentiation was evaluated for each type. Then, all tumors were classified in respect to their pathological TNM staging (WHO) and screened by immunohistochemistry for the detection of the expression of the following antigens: Bcl-2, A+B+H blood group antigens, c-erb-b2, p53, and Pan-Ras antigens. Furthermore, adenocarcinomas were screened for the presence of point mutations in Ki-Ras codons 1-31. Finally, the patient blood group was defined, and patient survival was analyzed using nonparametric tests and proportional hazard Cox models. Using Kaplan-Meier survival curves, disease pathological TNM staging was shown to be a strong predictive factor of survival for both squamous cell carcinoma and adenocarcinoma. Patients with squamous cell carcinoma experienced fewer relapses than those with adenocarcinoma (42% versus 63%; P = 0.0002) and had a significantly better survival. All evaluated antigens were more often present in squamous cell carcinoma than in adenocarcinoma except for Pan-Ras (three times more frequent in adenocarcinoma). In patients with squamous cell carcinoma, only tumor staging had a significant prognosis value (P = 0.01). In patients with lung adenocarcinoma, a well-differentiated tumor (P = 0.009) as well as a positive Bcl-2 staining (P = 0.009) and an A+B+H antigen tumor staining (P = 0.024) were associated with a better survival. In contrast, patients with a stage I or II disease and a p53-positive tumor staining and patients with the O blood group (P = 0.01) had a shorter survival. Interestingly, no relation with patient survival was related to c-erb-b2 and Pan-Ras staining. Finally, 12 point mutations were found out of 81 tumors (15%) evaluated for Ki-Ras codons 1-31; they involved codon 12 but also 8, 14, and 15 without any relationship to survival. In respect to lung adenocarcinoma, using Cox proportional hazard models stratified on tumor staging, the following markers were shown to be related to survival: (a) Independent markers of longer survival (ie., high histological degree of tumor differentiation and positive Bcl-2 and A+B+H blood group antigen expression by tumor cells); and (b) Independent markers of shorter survival (i.e., O blood group for all patients and p53 tumor staining in patients with stage I and II diseases). This study suggests that, in patients who undergo surgery for lung adenocarcinoma, the presence or absence of these criteria could be used to define a subset of patients who may benefit from a more specific follow-up.

ABO Blood-Group System↗