Resumen La cirugía desempeña un papel insustituible en la prevención, diagnóstico, estadificación, reconstrucción y rehabilitación en el tratamiento global del cáncer. Sin embargo, es difícil que cirujanos y personal de enfermería tengan en cuenta todos los aspectos de la gestión de la medicación, como el impacto de la cirugía en la función física del paciente y la complejidad del tratamiento antitumoral con sus comorbilidades. Los servicios de atención farmacéutica que anteriormente prestaban los farmacéuticos en oncología se centraban más en aspectos de la medicina interna, y no ampliamente en el ámbito quirúrgico. En la actualidad, el modo de trabajo farmacéutico en la cirugía oncológica aún no está definido en China, y existe una necesidad de mejorar la gestión de la medicación de todo el proceso asistencial. En 2015, la Asociación Farmacéutica de GuangDong propuso la creación del rol de farmacéutico quirúrgico en China y posteriormente creó su puesto de trabajo. En 2021, la Asociación Farmacéutica de GuangDong estableció una nueva disciplina denominada “farmacia quirúrgica”, que es el área de conocimiento de los farmacéuticos quirúrgicos, y también intentó diferenciar la farmacia quirúrgica en distintas subáreas, como la farmacia quirúrgica oncológica. Este artículo presenta el modo de trabajo de los farmacéuticos quirúrgicos en China, que proporciona servicios de atención farmacéutica en el periodo perioperatorio de los pacientes incorporando los distintos aspectos del tratamiento antitumoral, control de infecciones, anestesia, anticoagulación, control de la presión arterial y la glucosa en sangre, nutrición y tratamiento del dolor, con el objetivo de mejorar la calidad de vida de los pacientes.

Abstract Surgery plays an irreplaceable role in the prevention, diagnosis, staging, reconstruction, and rehabilitation in the overall management of cancer. Nevertheless, it is difficult for surgeons and nurses to take into account the details of medication management, considering the impact of surgery on the patient’s physical function and the complexity of anti-tumor treatment with comorbidity. The pharmaceutical care services previously provided by pharmacists in oncology focus more on the internal medicine system, not widely the surgical field. At present, the pharmaceutical working mode in oncology surgery has not well been formed around China, and the whole process medication management needs to be improved. In 2015, the GuangDong Pharmaceutical Association came up with the concept of surgical pharmacist in China and subsequently created its position. In 2021, the GuangDong Pharmaceutical Association established a new discipline termed “surgical pharmacy”, which is the knowledge system of surgical pharmacists, and also tried to differentiate surgical pharmacy into diverse areas, such as oncology surgical pharmacy. This article introduced a working mode of surgical pharmacists in China that providing pharmaceutical care services in perioperative period around anti-tumor, anti-infection, anesthesia, anticoagulation, blood pressure, blood glucose, nutrition, and pain management, to improve quality of life for patients.

ABSTRACT Purpose: To investigate the underlying mechanism of hepatic sinusoidal obstruction syndrome (HSOS) induced by Gynura segetum by measuring autophagy in mouse models. Methods: The model group was administered G. segetum (30 g/kg/d) by gavage, while the normal control group was administered an equal volume of saline daily for five weeks. Serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), hepatic histopathological examinations, and Masson staining were performed to evaluate liver injury. Liver intercellular adhesion molecule-1 (ICAM-1) and P-selectin were evaluated by immunohistochemistry. Hepatocellular apoptosis was assessed using the terminal deoxynucleotidyl transferase dUTP nick-end labeling (TUNEL) assay. Protein expression levels of autophagy markers were measured using Western blot analysis. Results: Gynura segetum was found to significantly induce liver injury compared with control mice, as evidenced by the increase of serum transaminases, a decrease in triglyceride levels, and histopathological changes in mice. Gynura segetum remarkably induced hepatocellular apoptosis and upregulated the expressions of ICAM-1 and P-selectin and also downregulated the protein expression levels of LC3, Atg12 and cytoplasmic polyadenylation element binding protein. Conclusions: Our results suggested that G. segetum induced liver injury with HSOS, and it was partly due to its ability to impair the autophagy pathway.

ABSTRACT Objective This study aimed to present the impact of age and gender on thyroid hormone levels in a large Chinese population with sufficient iodine intake. Subjects and methods A total of 83643 individuals were included and were stratified by age and gender. The median, 2.5th and 97.5th of thyrotropin (TSH), free triiodothyronine (FT3), free thyroxine (FT4) and FT3/FT4 ratio were calculated for both genders for every decade from 18 to over 80 years. TSH, FT3, FT4, FT3/FT4 distribution in each age group was evaluated for females and males using smoothing splines in the generalized additive models (GAM). TSH concentrations were compared in the different age groups in gender. Results In the over 80s age group, the TSH level (median: 2.57 mIU/L, 2.5th-97.5th: 0.86-7.56 mIU/L) was significantly higher than other age groups, irrespective to gender (P<0.001). Females had a higher TSH value than males in all age groups (P<0.001). Results of the smoothing curves showed that TSH increased with age, FT3 concentration was higher in males than in females and the tendency of the FT3/FT4 ratio was basically similar to that of FT3. TSH concentration in the 50s age group (median 2.48 mIU/L for females versus 2.00 mIU/L for males) was significantly higher than that in the 30s age group (median 2.18 mIU/L for females versus median 1.85 mIU/L for males). Conclusions In accord with increasing TSH values during aging, females and older adults have lower FT3 values and lower FT3/FT4 ratios, while the FT4 values remain stable.

Resumo Fundamentos: A influência da anatomia da veia pulmonar (VP) na criocinética durante a ablação por criobalão (CB) não está clara. Objetivo: Investigar a relação entre a anatomia da VP e a criocinética durante a ablação com CB para fibrilação atrial (FA). Métodos: sessenta pacientes consecutivos foram matriculados. Foram avaliados em imagens de tomografia computadorizada multidetectora (TCMD) pré-procedimento a anatomia da VP, incluindo diâmetros dos óstios (longo, curto e corrigido), relação entre diâmetros curtos e longos, forma do óstio (redondo, oval, triangular e estreito) e padrão de drenagem (típico, com tronco comum, antro comum, ramo ostial e VP supranumerária). Os parâmetros criocinéticos [tempo de congelamento de balão de 0 a -30ºC (TCB), temperatura do nadir do balão (TNB) e tempo de aquecimento do balão de -30 a + 15ºC (TAB)] foram registrados durante o procedimento. Todos os valores de p são bicaudais, com valores de p < 0,05 considerados estatisticamente significativos. Resultados: o ciclo de congelamento foi realizado 606 vezes. Correlação negativa moderada foi documentada entre o TNB e o diâmetro VP corrigido (r = - 0,51, p < 0,001) ao usar CBs de 23 mm e correlação negativa leve (r = - 0,32, p = 0,001) foi encontrada ao usar 28- mm CBs. A análise de regressão logística multivariada revelou que o diâmetro corrigido do óstio da VP (OR, 1,4; p = 0,004) previu um TNB < -51ºC ao usar CB de 23 mm, enquanto a forma oval do óstio VP (OR, 0,3; p = 0,033) e as localizações da VP (VP inferior: OR, 0,04; p = 0,005; VP superior direito: OR, 4,3; p = 0,025) previram TNB < -51ºC ao usar CBs de 28 mm. Conclusões: A TCMD pode fornecer uma avaliação precisa da anatomia da VP antes da ablação por CB. A anatomia da VP está associada à criocinética durante a ablação.

Abstract Background: The influence of pulmonary vein (PV) anatomy on cryo kinetics during cryoballoon (CB) ablation is unclear. Objective: To investigate the relationship between PV anatomy and cryo kinetics during CB ablation for atrial fibrillation (AF). Methods: Sixty consecutive patients were enrolled. PV anatomy, including ostial diameters (long, short and corrected), ratio between short and long diameters, ostium shape (round, oval, triangular, and narrow), and drainage pattern (typical, with common trunk, common antrum, ostial branch and supernumerary PV) were evaluated on multi-detector computed tomography (MDCT) images pre-procedure. Cryo kinetics parameters [balloon freeze time from 0 to -30ºC (BFT), balloon nadir temperature (BNT) and balloon warming time from -30 to +15ºC (BWT)] were recorded during procedure. All p values are two-sided, with values of p < 0.05 considered to be statistically significant. Results: 606 times of freezing cycle were accomplished. Moderate negative correlation was documented between BNT and corrected PV diameter (r = -0.51, p < 0.001) when using 23-mm CBs, and mild negative correlation (r = - 0.32, p = 0.001) was found when using 28-mm CBs. Multivariate logistic regression analysis revealed that PV corrected ostial diameter (OR, 1.4; p = 0.004) predicted a BNT < -51ºC when using 23-mm CBs, while PV ostium oval shape (OR, 0.3; p = 0.033) and PV locations (left inferior PV: OR, 0.04; p = 0.005; right superior PV: OR, 4.3; p = 0.025) predicted BNT < -51ºC when using 28-mm CBs. Conclusions: MDCT can provide PV anatomy accurate evaluation prior CB ablation. PV anatomy is associated with cryo kinetics during ablation.

Abstract Local administration of toll-like receptor 9 (TLR9), agonist cytidine-phosphate-guanosine oligodeoxynucleotide (CpG ODNs), and CD40 ligand (CD40L) can decrease ligature-induced periodontal inflammation and bone loss in wild type (WT) mouse. Objective: This study aimed to explore whether such effect is dependent on TLR9 signaling. Material and Methods: Purified spleen B cells isolated from WT C57BL/6J mice and TLR9 knockout (KO) mice were cultured for 48 hours under the following conditions: CD40L, CpG+CD40L, CpG at low, medium and high doses. We determined B cell numbers using a hemocytometer at 24 h and 48 h. Percentages of CD1dhiCD5+ B cells were detected by flow cytometry. Interleukin-10 (IL-10) mRNA expression and protein secretion were measured by quantitative real-time polymerase chain reaction (qRT-PCR) and by ELISA, respectively. The silk ligature was tied around the maxillary second molars for 14 days, during which the CpG+CD40L mixture or PBS was injected into palatal gingiva on days 3, 6, and 9. Results: For both WT and TLR9 KO mice, CpG significantly induced B cell proliferation, increased IL-10 mRNA expression and protein secretion of IL-10 but reduced CD1dhiCD5+ B cells population; local injection of CpG+CD40L mixture significantly decreased alveolar bone loss and the number of TRAP-positive cells adjacent to the alveolar bone surface, and significantly increased the gingival mRNA expression of IL-10 and decreased RANKL and IFN-γ mRNA expression. Conclusions: These results indicated that CpG plus CD40L decreased periodontal inflammation and alveolar bone loss in a TLR9-independent manner in ligature-induced experimental periodontitis.

Nonketotic hyperglycinemia is an extremely rare autosomal recessively inherited glycine encephalopathy caused by a deficiency in the mitochondrial glycine cleavage system, which leads to severe clinical symptoms. Nonketotic hyperglycinemia is characterized by complex and diverse phenotypes, such as hypotonia, seizures, cognitive impairment, developmental delays and myoclonic jerks that may lead to apnea and even death. Here we report a 1-year-old boy with myoclonic seizures, hypotonia and coma; he had elevated plasma and cerebrospinal fluid glycine levels, and cerebrospinal fluid/plasma glycine ratio was 0.24. Two novel heterozygous mutations confirm the diagnosis of nonketotic hyperglycinemia. One is a missense mutation c.2516A>G (p.Y839C) and the other one is a splicing mutation c.2457+2T>A in the GLDC gene.

La hiperglicinemia no cetósica es una encefalopatía por glicina autosómica recesiva y hereditaria sumamente rara, causada por una deficiencia en el sistema enzimatico de división de la glicina mitocondrial, que provoca síntomas clínicos graves. La hiperglicinemia no cetósica se caracteriza por fenotipos diversos y complejos, por ejemplo, hipotonía, convulsiones, deterioro cognitivo, retrasos del desarrollo y espasmos mioclónicos que podrían causar apnea e incluso la muerte. En este artículo, presentamos el caso de un niño de 1 año con convulsiones mioclónicas, hipotonía y coma, con aumento de la concentración de glicina en el plasma y el líquido cefalorraquídeo y con un índice de glicina en líquido cefalorraquídeo/plasma de 0,24. Existen dos mutaciones heterocigotas novedosas que confirman el diagnóstico de hiperglicinemia no cetósica. Una es una mutación de aminoácido, c.2516A>G (p.Y839C), y la otra es una mutación en los sitios de corte y empalme, c.2457+2T>A, en el gen GLDC.

Abstract: Bullous pemphigoid is a blistering autoimmune disease characterized by two hemidesmosomal proteins (anti-BP180 and 230). Pemphigus, by contrast, is characterized by two autoantibodies (anti-desmoglein 1 and 3). Coexistence of autoantibodies of bullous pemphigoid and pemphigus in a patient is rare. A 25-year-old male patient was admitted to our hospital, reporting a 3-month history of multiple papules, vesicles, and erosions over an extensive erythema on the entire body. Laboratory tests showed high levels of serum IgE, anti-BP180 antibodies, and anti-desmoglein 1 and 3. Histopathologic and immunopathologic features were characterized by bullous pemphigoid. No improvement was seen with systemic corticosteroid therapy, however, pulse corticosteriod therapy combined with methylprednisolone, immunosuppressants, immunomodulators, and plasmapheresis led to the recovery of his condition with numerous milia.

Abstract Based on dynamic direct tensile tests, splitting tests and spalling tests, it is found that the experimental tensile strength of concrete-like materials greatly increases with loading-rate. This kind of dynamic tensile strength enhancement may be caused by the combination influence of the inertia effect, real rate effect and end friction effect (here the end friction effect is only existed in splitting and spalling tests). To further investigate the influence degree of real rate effect for concrete-like materials in dynamic tensile tests, this paper conducts systematically dynamic tensile experiments, viz. dynamic direct tensile tests, splitting tests and spalling tests. At the same time, numerical dynamic tensile tests are employed to analyze the mechanical characteristics of concrete-like materials. A hydrostatic pressure dependent model, the Drucker-Prager constitutive model, is used for concrete-like material specimens, which can consider the influence of inertia effect. In the numerical model, the specimen is set to be rate-independent, thus the predicted dynamic tensile strength of specimens is free of the real rate effect. The end friction effect is also taken into account in the numerical analysis of dynamic splitting and spalling tests. It is found that the dynamic tensile strength of concrete-like materials in numerical simulations does not varies obviously with the loading-rate, indicating that the inertia effect and end friction effect have little contributions to the dynamic tensile strength enhancement of concrete-like materials. Therefore, the real rate effect dominates the dynamic tensile strength enhancement of concrete-like materials in laboratory tests, but the inertia effect and end friction effect do not.

OBJECTIVE: The aim of this study was to determine the efficacy of 252Californium neutron intracavitary brachytherapy using a two-channel Y applicator combined with external beam radiotherapy for the treatment of endometrial cancer. METHODS: Thirty-one patients with stage I-III endometrial cancer were recruited for this study. The stage I patients received only 252Californium neutron intracavitary brachytherapy with a two-channel applicator. The stage II and III patients received both 252Californium neutron intracavitary brachytherapy using a two-channel applicator and parallel-opposed whole pelvic radiotherapy. RESULTS: The five-year local control rate was 80.6% (25/31), the overall survival rate was 51.6% (16/31), and the disease-free survival rate was 54.8% (17/31). The incidence of serious late complications was 12.9% (4/31). CONCLUSIONS: 252Californium neutron intracavitary brachytherapy using a two-channel applicator combined with external beam radiotherapy was effective for treating endometrial cancer and the incidence of serious late complications related to this combination was within an acceptable range.

Functional properties and antioxidative activity of a protein hydrolysate prepared from Acanthogobius hasta processing by-product protein during solid-state fermentation with Aspergillus oryzae were investigated. Overall, protease activity increased with the degree of hydrolysis (DH) decreased during solid-state fermentation. All the protein hydrolysate had excellent solubility, possessed interfacial properties, and varying degrees of antioxidant activity which were governed by their concentrations and DH, molecular weight distribution and amino acid composition. After 5 days fermentation, the DH of the protein hydrolysate was 31.23%. The protein hydrolysate had the highest total hydrophobic amino acid content, the highest DPPH scavenging activity, reducing power, and the chelating activity. The radical-scavenging activity of the hydrolysates at 6 mg/mL was 78.6%. The reducing power of protein hydrolysate at the range of 0-6 mg/mL was lower than that of BHA at the range of 0-60 µg/mL, while the chelating activity of APs was similar to that of BHA at the range of 0-60 µg/mL. Moreover, the protein hydrolysate showed good emulsifying and foaming properties over a wide pH range from 2 to 12. Therefore, solid state fermentation provided a suitable and low-cost method for converting Acanthogobius hasta processing by-product protein into antioxidant protein hydrolysates.

Immunoglobulin light chain amyloidosis is the most common acquired systemic amyloidosis. Its presentation is often insidious and progressive, which may delay diagnosis. The authors describe a rare case of immunoglobulin light chain amyloidosis in a 34-year-old man with scleroderma-like manifestation substantiated by multifarious laboratory investigations and the histopathologic feature of involved skin lesions stained with Congo red and crystal violet. This helps to maintain a high clinical suspicion of the disease when confronting similar skin presentation.

In this study we focused on the development of Cabernet Sauvignon grapes and investigated changes in the activity of alcohol dehydrogenase (ADH) and hydroperoxide lyase (HPL) in different tissues. We sampled grape skin at four, six, seven, eight, nine, 10, 12, 14 and 16 weeks after anthesis; developing flowers when blooming at 0%, 5%, 50%, and 90%; and leaves at two and four weeks before anthesis and at two, four, six, eight, nine, and 10 weeks after anthesis. We also examined the type and fluctuation of volatile contents. ADH activity increased with the development of flowers and grape skins, which led to the increasing of types and concentration of alcohols. Low levels of 9-HPL led to low concentrations of C9 compounds. According to this paper, C6 compounds became abundant with the development of grape berries, while the activity of 13-HPL kept at a low level in the flowers and grape skins. There might have been a high level of 13-HPL activity from the end of flowering until fruit setting that we did not detect. Furthermore, similar C6 and C5 compounds were detected across all tissues, including hexanal, (E)-2-hexenal, (Z)-3-hexenal, (Z)-2-penten-1-ol, (Z)-3-hexen-1-ol, 1-hexanol and 3-hexen-1-ol. Generally speaking, the concentrations of C6 and C5 compounds could be used as the criterion of maturation of the three grape tissues.

This paper presents the experimental results of recycled aggregate concrete (RAC) specimens prepared with five different amount of recycled coarse aggregate (RCA) [i.e. 0, 25%, 50%, 75% and 100%] subjected to compressive loading based on split Hopkinson pressure bar tests. Strain-rate effects on dynamic compressive strength and critical strain of recycled aggregate concrete were studied. Results show that impact properties of recycled aggregate concrete exhibit strong strain-rate dependency, and increase approximately linearly with strain-rate. The transition point from low strain-rate sensitivity to high sensitivity decreases with the increase of matrix strength.

An efficient DNA extraction method was developed for peanut seed, where only 3-5 mg cotyledonary tissue was enough for more than 50 PCR reactions with a reaction volume of 15 μl. Both low copy number and high copy number DNA sequences were successfully amplified. Processing one seed sample only took about half an hour. Sampling had no significant effects on germination and development. The DNA extraction method makes it possible to identify transformants and conduct molecular marker studies prior to sowing, and thus may greatly hasten research progress.

OBJECTIVE: We assessed the impact of breastfeeding by women infected with human immunodeficiency virus (HIV)-1 on their morbidity and risk of mortality and on the mortality of their children. METHODS: We analysed longitudinal data from two previous randomized clinical trials of mother-to-child transmission of HIV conducted between April 2000 and March 2003 in the Republic of Malawi, Africa. Mothers infected with HIV, and their newborns, were enrolled at the time of their child's birth; they then returned for follow-up visits when the child was aged 1 week, 6-8 weeks and then 3, 6, 9, 15, 18, 21 and 24 months. Patterns of breastfeeding (classified as exclusive, mixed or no breastfeeding), maternal morbidity and mortality, and mortality among their children were assessed at each visit. Descriptive and multivariate analyses were performed to determine the association between breastfeeding and maternal and infant outcomes. FINDINGS: A total of 2000 women infected with HIV were enrolled in the original studies. During the 2 years after birth, 44 (2.2%) mothers and 310 (15.5%) children died. (Multiple births were excluded.) The median duration of breastfeeding was 18 months (interquartile range (IQR) = 9.0-22.5), exclusive breastfeeding 2 months (IQR = 2-3) and mixed feeding 12 months (IQR = 6-18). Breastfeeding patterns were not significantly associated with maternal mortality or morbidity after adjusting for maternal viral load and other covariates. Breastfeeding was associated with reduced mortality among infants and children: the adjusted hazard ratio for overall breastfeeding was 0.44 (95% confidence interval (CI) = 0.28-0.70), for mixed feeding 0.45 (95% CI = 0.28-0.71) and for exclusive breastfeeding 0.40 (95% CI = 0.22-0.72). These protective effects were seen both in infants who were infected with HIV and those who were not. CONCLUSION: Breastfeeding by women infected with HIV was not associated with mortality or morbidity; it was associated with highly significant reductions in mortality among their children.

OBJETIVO: Evaluamos los efectos de la lactancia materna entre las mujeres infectadas por el virus de la inmunodeficiencia humana (VIH-1) en su morbilidad y su riesgo de mortalidad y en la mortalidad de sus hijos. MÉTODOS: Analizamos datos longitudinales de dos ensayos clínicos aleatorizados previos sobre la transmisión del VIH de la madre al niño realizados entre abril de 2000 y marzo de 2003 en la República de Malawi, África. Las madres infectadas por el VIH y sus recién nacidos entraron a participar en el estudio al nacer su hijo; luego regresaban para realizar visitas de seguimiento cuando el niño tenía 1 semana, 6-8 semanas, y 3, 6, 9, 15, 18, 21 y 24 meses. En cada visita se determinaba el tipo de lactancia materna (exclusiva, mixta, o no amamantamiento), la morbilidad y mortalidad maternas, y la mortalidad entre sus hijos. Se realizaron análisis descriptivos y multifactoriales para determinar la relación entre la lactancia materna y los resultados maternos e infantiles. RESULTADOS: Un total de 2000 mujeres infectadas por el VIH participaron en los estudios originales. Durante los 2 años posteriores al nacimiento murieron 44 madres (2,2%) y 310 niños (15,5%). (Se excluyeron los partos múltiples.) La duración mediana de la lactancia materna fue de 18 meses (intervalo intercuartílico (II) = 9,0 - 22,5), la de la lactancia materna exclusiva, de 2 meses (II = 2 - 3), y la de la alimentación mixta, de 12 meses (II = 6 -18). El tipo de lactancia materna no influyó de forma significativa en la mortalidad y la morbilidad maternas después de ajustar en función de la carga viral materna y de otras covariables. La lactancia materna se asoció a una reducción de la mortalidad entre los lactantes y los niños: el cociente de riesgos instantáneos (hazard ratio) ajustado para la lactancia materna en general fue de 0,44 (intervalo de confianza (IC) del 95% = 0,28 - 0,70); para la alimentación mixta, de 0,45 (IC95% = 0,28 - 0,71); y para la lactancia materna exclusiva, de 0,40 (IC95% = 0,22 - 0,72). Estos efectos protectores se observaron tanto entre los lactantes que estaban infectados por el VIH como entre los que no lo estaban. CONCLUSIÓN: La lactancia materna entre las mujeres infectadas por el VIH no se asoció a diferencias de la mortalidad o la morbilidad, pero sí a una disminución muy importante de la mortalidad entre sus hijos.

OBJECTIF: Nous avons évalué l'influence de l'allaitement au sein sur la morbidité et le risque de mortalité des mères porteuses du virus de l'immunodéficience humaine (VIH-1) ainsi que sur la mortalité de leurs enfants. MÉTHODES: Nous avons étudié les données longitudinales tirées de deux essais cliniques randomisés portant sur la transmission du VIH de la mère à l'enfant qui avaient été effectués entre avril 2000 et mars 2003 en République du Malawi (Afrique). Le recrutement des mères porteuses du VIH et de leurs nouveau-nés a été effectué lors de la naissance de leur enfant ; on les a ensuite revues pour des visites de suivi lorsque leur enfant a atteint l'âge de 1 semaine, 6-8 semaines puis 3, 6, 9,15, 18, 21 et 24 mois. A chaque fois, le mode d'allaitement (au sein exclusivement, mixte ou pas d'allaitement au sein), la morbidité et la mortalité maternelle ainsi que la mortalité des enfants ont été notés. On a procédé à des analyses descriptives et à des analyses à variables multivariées pour déterminer l'association entre l'allaitement au sein et l'état de santé de la mère et de l'enfant. RÉSULTATS: Au total, 2000 femmes contaminées par le VIH ont été recrutées pour les études initiales. Au cours des deux années suivant la naissance, 44 mères (2,2 %) et 310 enfants (15,5 %) sont décédés. (on n'a pas pris en compte les naissances multiples). La durée médiane de l'allaitement était de 18 mois (intervalle interquartile (IQR) = 9,0 -22,5); celle de l'allaitement exclusivement au sein de 2 mois (IQR = 2-3) et celle de l'allaitement mixte de 12 mois (IQR = 6-18). On n'a pas relevé d'association significative entre le mode d'allaitement et la morbidité ou la mortalité maternelle après correction pour tenir compte de la charge virale maternelle et des autres covariables. Chez les nourrissons et les enfants plus âgés, l'allaitement au sein était associé à une réduction de la mortalité : le rapport des risques ajusté pour l'allaitement au sein en général était égal à 0,44 (intervalle de confiance à 95 % : 0,28 - 0,70) ; il était de 0,45 pour l'allaitement mixte (IC à 95 % : 0,28 - 0,71) et de 0,40 pour l'allaitement exclusivement au sein (IC à 95 % : 0,22 - 0,72). Ces effets protecteurs ont été observés chez les enfants infectés par le VIH comme chez ceux qui ne l'étaient pas. CONCLUSION: Chez les femmes infectées par le VIH, il n'y avait aucune association entre l'allaitement au sein et la morbidité ou la mortalité. Chez leurs enfants en revanche, il était associé à une réduction très significative de la mortalité.