Some state space models of HIV pathogenesis under treatment by anti-viral drugs in HIV-infected individuals

In this paper we have extended the model of HIV pathogenesis under treatment by anti-viral drugs given by Perelson et al. [A.S. Perelson et al., Science 271 (1999) 1582] to a stochastic model. By using this stochastic model as the stochastic system model, we have developed a state space model for the HIV pathogenesis under treatment by anti-viral drugs. In this state space model, the observation model is a statistical model based on the observed numbers of RNA virus copies over different times. For this model we have developed procedures for estimating and predicting the numbers of infectious free HIV and non-infectious free HIV as well as the numbers of different types of T cells through extended Kalman filter method. As an illustration, we have applied the method of this paper to the data of patient Nos. 104, 105 and 107 given by Perelson et al. [A.S. Perelson et al., Science 271 (1999) 1582] under treatment by Ritonavir. For these individuals, it is shown that within two weeks since treatment, most of the free HIV are non-infectious, indicating the usefulness of the treatment. Furthermore, the Kalman filter method revealed a much stronger effect of the treatment within the first 10 to 20 h than that predicted by the deterministic model.     

Treatment of psoriasis by using Hijamah: A case report

Hijamah (a well-known Prophetic complimentary treatment) has been used for centuries to treat various human diseases. It is considered that this traditional treatment (also known as wet cupping) has the potential to treat many kinds of diseases. It is performed by creating a vacuum on the skin by using a cup to collect the stagnant blood in that particular area. The vacuum at the end is released by removing the cup. Superficial skin scarification is then made to draw the blood stagnation out of the body. This technique needs to be performed in aseptic conditions by a well trained Hijamah-physician. Prophet Muhammad (PBUH) had described Hijamah as the best treatment humans can have. This novel treatment methodology has been successfully used as cure for numerous diseases including skin diseases. In this case report, we discuss about the application of this method in the treatment of psoriasis (an autoimmune skin disease). Results illustrated that with Hijamah, disease can not only be controlled but can be brought to a nearly complete remission.     

Diagnosis of Vater's papilla cancer and its combination treatment and radiotherapy

The paper considers the problems of enhancing the efficiency of diagnosis and treatment of Vater's papilla cancer complicated by jaundice, by maximally realizing the capacities of instrumental studies and by improving the procedures of combination treatment and radiotherapy for this disease. The achieved treatment results show it expedient to use combination treatment and, if radical surgery is contraindicated, radiotherapy for Vater's papilla cancer.     

TREATMENT OF GENITO-URINARY TUBERCULOSIS WITH STREPTOMYCIN AND SYNERGISTIC DRUGS

The use of newer drugs in the treatment of genito-urinary tuberculosis is usually auxiliary to accepted surgical and medical procedures. The treatment of choice is removal of the tuberculous focus by surgical methods whenever this can be achieved. Risk of tuberculous complications of surgical operation may be greatly reduced by the use of these drugs. There is also a significant place for such treatment when disease is too far advanced to permit surgical removal. Under these conditions, the principal result is one of palliation only in many circumstances. The drugs of choice at this time are a combination of streptomycin and para-aminosalicylic acid (PAS) and the treatment is frequently more prolonged than in the case of tuberculosis of other organs.     

Repair by human cells of adenovirus-2 damaged by psoralen plus near ultraviolet light treatment.

Adenovirus-2 is damaged by treatment with psoralen plus near-ultraviolet (UV) light is shown by reduced ability to infect human fibroblasts. The apparent sensitivity of the virus to this treatment depended upon the strain of cells used. The virus was 3-4 times more sensitive to the treatment when infecting xeroderma pigmentosum (XP complementation groups A or D) fibroblasts than when infecting normal fibroblasts. DNA extracted from virus preparations that had undergone such treatment was analyzed for treatment-induced crosslinks by gel electrophoresis and sedimentation in alkaline sucrose gradients. The fraction of adenovirus DNA molecules remaining non-crosslinked after treatment was found to correlate with the survival of the virus in normal fibroblasts. This result showed that the psoralen plus near-UV treatment gave rise to non-crosslink lesions (presumably psoralen-DNA mono-adducts), that were repairable by normal but not by XP fibroblasts, and suggested the possibility that normal fibroblasts cannot repair this type of crosslink in the DNA of an infecting adenovirion.     

Pharmacogenomics of Type I interferon therapy: a survey of response-modifying genes

Interferon-beta (IFN-beta) is routinely prescribed as an immunomodulatory treatment for multiple sclerosis (MS), but is associated with variable clinical efficacy. Ideally an early predictor of response status would allow more rational provision of this therapy. Both pharmacogenomic and expression analysis have highlighted IFN-beta regulated genes which may influence treatment efficacy. In this review we have summarized and discussed the main genes identified by these studies in MS patients, and supplemented this with data from similar studies of Type I IFN treatment in hepatitis.     

Survey of general practitioners' treatment of the discharging ear

The prescribing habits of all (401) general practitioners in the North Staffordshire health district for the treatment of otorrhoea was ascertained by questionnaire; 301 (75%) responded. Of those, 198 (66%) would not give topical treatment when the tympanic membrane was perforated. Only 41 (14%) would give topical treatment in cases of discharging grommets. Although there is a theoretical risk of ototoxicity to aminoglycosides in topical preparations, this is the most effective medical treatment and is the standard teaching advocated in specialist textbooks and practised by otolaryngologists.The results of the survey suggest that there is undue concern about possible ototoxicity and a degree of confusion in the management of this common clinical condition.     

Percutaneous treatment of benign biliary strictures and biliary manometric perfusion test

BACKGROUND: Benign biliary strictures are usually treated surgically or endoscopically. When these strictures are not accessible by endoscope or when open repair is not possible, percutaneous dilatation treatment is indicated. The efficacy of treatment is usually evaluated by clinical trial which includes leaving a small non-functional catheter in situ and following liver function tests. The evaluation may be effectively done by the biliary manometric perfusion test. AIM: The aim of this paper is to emphasize the importance of percutaneous dilatation treatment of benign biliary strictures with focus on the role of the biliary manometric perfusion test and its future prospects. METHODS AND RESULTS: Based on the literature and our own experience, this article gives a short overview of percutaneous treatment of benign biliary strictures, indications, techniques, complications and results. The treatment of these strictures has an overall success rate between 60 to 90%. This article also explains the biliary manometric test, the technique and its importance in evaluation of treatment success. CONCLUSION: Benign biliary strictures of the hepatic duct junction or bilio-enteric anastomosis are difficult to treat surgically and are endoscopically inaccessible. Percutaneous treatment by balloon dilatation and long term external-internal drainage is feasible in the majority of these patients. It is minimally invasive, safe and effective. The evaluation of the treatment success may be more effectively done by the manometric perfusion test. It is easy, reliable, less time-consuming giving immediate results, and relatively safe.     

Optimized recirculation survival of mouse carrier erythrocytes.

Carrier mouse erythrocytes prepared by a hypotonic dialysis technique and reinjected into mice have a 24 hour survival of approximately 50%. Twenty-four hour survival can be improved substantially to 74% by removing the more fragile erythrocytes by a hypotonic wash treatment. The mean cell volume of the carriers prepared by this modification is significantly (p less than 0.01) different from cells prepared by the standard method with a isotonic wash treatment. Carriers prepared by the hypotonic treatment wash modification exhibit a different 50% hemolytic value (15% difference) from isotonically prepared carriers, and normal erythrocytes. Carrier-erythrocytes removed from mice 24 hour post-injection exhibit an osmotic profile that is independent of the treatment. Carriers were also prepared by another modification of the encapsulation procedure and held in a permeable state overnight before resealing and annealing. Carriers prepared in this manner showed a much lower 24 hour survival (13%).     

Pain control by ionizing radiation of bone metastasis

Pain treatment due to cancer is a large fraction of the care in a radiotherapy department. While radiation treatment is very effective in reducing pain, the pathophysiology of bone metastases remains very complex. Reducing the number of tumour cells by radiation will reduce the pressure in bone marrow, but the very rapid response to radiation treatment seen in some patients is probably related to the presence of highly radiosensitive inflammatory cells. In this review we give an overview of the pathophysiological mechanisms which lead to pain associated with bone metastasis and the impact of radiation treatment and other treatments on this mechanism.     

Radiobiological considerations in combining doses from external beam radiotherapy and brachytherapy for cervical cancer

The recommended radio-therapeutic treatment for cervix cancer consists of a first phase of external beam radiotherapy (EBRT) plus a second phase of brachytherapy (BT), the combined treatment being delivered within 8 weeks.In order to assess a comprehensive dosimetry of the whole treatment, it is necessary to take into account that these two phases are characterized by different spatial and temporal dosimetric distributions, which complicates the task of the summation of the two contributions, EBRT and BT. Radiobiology allows to tackle this issue pragmatically by means of the LQ model and, in fact, this is the usual tool currently in use for this matter.In this work, we describe the rationale behind the summation of the dosimetric contributions of the two phases of the treatment, EBRT and BT, for cervix cancer, as carried out with the LQ model.Besides, we address, from a radiobiological point of view, several important considerations regarding the use of the LQ model for this task. One of them is the analysis of the effect of the overall treatment time in the result of the global treatment. Another important question considered is related to the fact that the capacity of LQ to predict the treatment outcomes is deteriorated when the dose per fraction of the radiotherapic scheme exceeds 6–10 Gy, which is a typical brachytherapy fractionation. Finally, we analyze the influence of the uncertainty and the variability of the main parameters utilized in the LQ model formulation in the assessment of the global dosimetry.     

Radiotherapy in the treatment of Graves ophthalmopathy—to do it or not?

To the objective of this study is to evaluate the role and toxicity of radiotherapy in the treatment of Graves ophthalmopathy. In the years 2000–2003, 121 patients with malignant exophthalmos were treated with radiotherapy of the retrobulbar area to the total dose of 20 Gy in ten fractions with a 6 MeV photon beam. The treatment was performed by the team of the Clinic of Oncology of the Jagiellonian University Medical College in Cracow. The radiotherapy was preceded by intravenous steroid therapy: methylprednisolone acetate administered at the dose of 2 g/week for four consecutive weeks. The highest efficacy, expressed as improvement of all ocular symptoms, was observed for the combined treatment. Female and non-diabetic patients responded positively to the combined treatment. Radiotherapy combined with steroid therapy in the treatment of Graves ophthalmopathy seems to be an effective treatment for strictly defined indications. In the treatment of Graves–Basedow disease, radiotherapy is a well-tolerated treatment modality. Diabetes is a factor that worsens prognosis in Graves ophthalmopathy and female sex is a favourable factor for this condition.     

Is infertility a disease and does it matter?

Claims about whether or not infertility is a disease are sometimes invoked to defend or criticize the provision of state‐funded treatment for infertility. In this paper, I suggest that this strategy is problematic. By exploring infertility through key approaches to disease in the philosophy of medicine, I show that there are deep theoretical disagreements regarding what subtypes of infertility qualify as diseases. Given that infertility’s disease status remains unclear, one cannot uncontroversially justify or undermine its claim to medical treatment by claiming that it is or is not a disease. Instead of focusing on disease status, a preferable strategy to approach the debate about state‐funded treatment is to explicitly address the specific ethical considerations raised by infertility. I show how this alternative strategy can be supported by a recent theoretical framework in the philosophy of medicine which avoids the problems associated with the concepts of health and disease.     

Emergy required for the complete treatment of municipal wastewater

The continuous increase of human pressure on the environment and the concomitant pollution threat call for more complete and efficient environmental protection systems. Wastewater treatment plants are a technological response to the accumulation of pollution that occurs during the human-dominated phases of water cycle. In recent years, thanks to significant improvements in sewage treatment methodology, a number of upgrades have been assessed to improve the efficiency and functionality of treatment systems. Nonetheless, this activity requires large material and energy consumptions that have to be carefully accounted for when evaluating the efficiency of the process. In this work we present an emergy approach to the evaluation of a wastewater treatment plant located along the Ligurian coast (NW Mediterranean Sea). Besides the evaluation of the water treatment plant system, a preliminary assessment of the environmental costs in terms of natural fluxes required for the treatment process was performed. In fact, at the end of the treatment discharged water is still loaded with substances that have to be adsorbed by the receiving natural system. The work done by nature assimilating this load is generally considered as free while it is counted as a further cost in the total emergy budget of the water purification process.     

Studies on the low molecular weight RNA associated with 28S ribosomal RNA from Crotalus durissus terrificus liver.

A low molecular weight RNA was released from the purified rattlesnake 28 S RNA by brief heat treatment as well as by treatment with 80% dimethylsulfoxide or formamide. The sedimentation coeficient of this low molecular weight RNA was found to be 5.5 S, corresponding to a nucleotide number of 140 and a molecular weight of 46 000. It was also observed that 5.5S RNA is present in equimolar ratio to 5 S rRNA. Heat treatment of the purified 60 S ribosomal subunit also released the 5.5 S RNA. The possibility that this low molecular weight RNA is located on the surface of the large ribosomal subunit is discussed.     

HIV quasispecies dynamics during pro-active treatment switching: impact on multi-drug resistance and resistance archiving in latent reservoirs

The human immunodeficiency virus (HIV) can be suppressed by highly active anti-retroviral therapy (HAART) in the majority of infected patients. Nevertheless, treatment interruptions inevitably result in viral rebounds from persistent, latently infected cells, necessitating lifelong treatment. Virological failure due to resistance development is a frequent event and the major threat to treatment success. Currently, it is recommended to change treatment after the confirmation of virological failure. However, at the moment virological failure is detected, drug resistant mutants already replicate in great numbers. They infect numerous cells, many of which will turn into latently infected cells. This pool of cells represents an archive of resistance, which has the potential of limiting future treatment options. The objective of this study was to design a treatment strategy for treatment-naive patients that decreases the likelihood of early treatment failure and preserves future treatment options. We propose to apply a single, pro-active treatment switch, following a period of treatment with an induction regimen. The main goal of the induction regimen is to decrease the abundance of randomly generated mutants that confer resistance to the maintenance regimen, thereby increasing subsequent treatment success. Treatment is switched before the overgrowth and archiving of mutant strains that carry resistance against the induction regimen and would limit its future re-use. In silico modelling shows that an optimal trade-off is achieved by switching treatment at days after the initiation of antiviral therapy. Evaluation of the proposed treatment strategy demonstrated significant improvements in terms of resistance archiving and virological response, as compared to conventional HAART. While continuous pro-active treatment alternation improved the clinical outcome in a randomized trial, our results indicate that a similar improvement might also be reached after a single pro-active treatment switch. The clinical validity of this finding, however, remains to be shown by a corresponding trial.     

Hyperthermia can enhance the initiation of DNA synthesis stimulated by growth factors in Swiss mouse 3T3 cells

Confluent quiescent Swiss mouse 3T3 cells can be stimulated to initiate DNA synthesis and to divide by epidermal growth factor (EGF) and prostaglandin F2 alpha (PGF2 alpha), two mitogens of unrelated structure. Heat treatment at 46 degrees C for up to 20 min of confluent quiescent cells, which has no mitogenic effect, can enhance the stimulatory effect of suboptimal concentrations of EGF or PGF2 alpha on the initiation of DNA synthesis. Furthermore, insulin, which is not mitogenic in these cells, enhances the effect of these mitogens, but this effect is not further enhanced by heat treatment. Likewise the combination of EGF and PGF2 alpha is synergistic on DNA synthesis, and this effect is also not enhanced by the heat treatment. Incubation at 46 degrees C for longer than 20 min was inhibitory in all cases. These results suggest that heat treatment induces events which affect the regulation of the initiation of DNA synthesis in a manner depending on the duration of the heat treatment and the stimulation of the cells.     

Immune responses induced by intranasal imiquimod and implications for therapeutics in rhinovirus infections

Notwithstanding the progress recently made in immunology and virology, there is yet no effective, specific treatment for the common cold. Symptomatic treatment is minimally effective. An anecdotal report of rapid clearing of the common cold of recent onset after intranasal application of imiquimod in several subjects by one of the authors, made us test the hypothesis that this treatment works through the secretion of interferon by the nasal mucosa. We decided to do an animal study in primates (Indian Macaca Mulata): 5 treatment and 3 control animals were used. Imiquimod or placebo was massaged into the nares of the animals and periodic samples of post-nasal fluid were taken and measurements for Interferon alpha (IFNalpha) and Tumor Necrosis Factor alpha (TNFalpha) were made by ELISA methods, and kinetic studies. mRNA IFNalpha was also isolated and analyzed by quantitative competitive RT-PCR. The internal standard was constructed to be complementary to and compete with oligonucleotide primers and for amplification of target sequences. One intranasal application of imiquimod rapidly (1-4 Hours) induced high levels of mRNA for IFNalpha, and minimal levels in the control animals. Rapid induction of INFalpha, and proportional increase of TNFalpha sustained for 4 and 6 hours respectively were noted. No adverse reactions to treatment were found in macaques during this short period of intranasal imiquimod usage (except in one macaque with a short period of lacrimation). No animal had cytotoxic effects when examined at 6 hr, 12 hr, 24 hr or 48 hr, except one animal, which had an episode of lacrimation for 6 hr post treatment. Thus both safety and efficacy of short treatment with imiquimod is proven in this animal model. Proof of principle for intranasal treatment of the common cold with imiquimod is shown. We think that this work will encourage a number of double blind clinical trials to confirm the effectiveness of the intranasal treatment of the common cold with imiquimod.