Lymphoma associated antigen (LAA)--a unique biomarker for lymphomas.

A lymphoma associated antigen (LAA) isolated from pooled lymph nodes of confirmed Hodgkin's and non-Hodgkin's lymphomas has been purified and characterized. Using a xenogenic rabbit anti-serum, enzyme-linked immunosorbent assay (ELISA) and RIA were developed for LAA. LAA was detected in the sera of all confirmed lymphomas, the test being negative for normals, for patients with benign lymphadenitis and various other types of cancers. Except for a very few false positive results, no false negative was observed. LAA was identified in urine, CSF, saliva and gastric juice of a few lymphoma patients, and the test proved to be of diagnostic potential, as for a few patients it had a lead time of a few months over the histological diagnosis. In order to render the LAA test more precise and specific, monoclonal antibodies were generated by both in vitro and in vivo immunization procedures. Seven monoclonals were generated, viz. 7D6, 7D2, 7G2, 7C5, 6G2, 23B7 and 23G11, which exhibited cytoplasmic staining of frozen sections of malignant lymphoid tissues of B cell derived non-Hodgkin's lymphomas. Two of these monoclonal antibodies, 7D6 and 23B7, revealed strong cytoplasmic staining of frozen sections, impression smears and cytospin specimens of B cell non-Hodgkin's lymphomas. The reactivity was very weak or negative for T cell lymphomas. The test was negative for Hodgkin's disease and controls. These results were confirmed by dot blotting, immunoprecipitation and immunofluorescence study. By ELISA with a sensitivity of 15 ng/ml, serum LAA levels for lymphomas were in the range 72-1250 ng/ml. LAA could not be detected in the sera of normals and controls.(ABSTRACT TRUNCATED AT 250 WORDS)     

Maternal behavior,milk ejection,and plasma hormones in Hatano high- and low-avoidance rats

Hatano high- and low-avoidance (in a two-way active avoidance task) animals (HAA and LAA, respectively) were successfully selected from a Sprague-Dawley rat population. Pup growth of both strains was dependent on the maternal strain in a cross-fostering study. To determine whether there are strain-specific differences between HAA and LAA in maternal care, both strains of dams were subjected to a test battery as measured by nest building, home cage behavior, pup retrieval, and milk ejection tests. In addition, changes in plasma concentrations of lactotropic and corticotropic hormones such as prolactin, ACTH, and corticosterone were examined during lactation. The test battery indicated that the dams of both strains built good nests and spent an identical amount of time with their offspring. However, LAA dams showed a prolonged latency time for pup retrieval and often left pups outside the nest until the end of the test period. LAA dams also showed a decreased amount of milk ejection, whereas no strain differences were observed in milk ejection after oxytocin treatment. During lactation, a lesser increase in plasma concentrations of prolactin and a greater increase in ACTH were found in LAA dams. There were no differences between the two strains in plasma concentrations of corticosterone. These results clearly demonstrated decreases in maternal behavior and milk ejection in LAA as compared to HAA dams. The present results also suggest that maternal motivation and mechanisms responsible for maternal hormones related to suckling are involved in the degree of pup growth.     

The provocation test in children with cow-milk protein and gluten intolerance: evaluation of the clinical response and lesions in the mucous membrane of the small intestine

Provocation test (re-introduction of the noxious protein) was carried out in two groups of patients: (a) with intolerance to the cow-milk proteins (41 children) treated with milk-free diet for 6-24 months, and (b) with gluten intolerance (26 children) treated with gluten-free diet for 6-36 months. The following parameters were compared: type and frequency of the clinical symptoms seen in these patients prior to the introduction of allergen-free diet. Moreover, the type of observed morphological changes in the small intestine mucosa following provocation test were analysed in the groups of 7 patients. A two-year elimination of milk from the diet produces milk tolerance in about 61% patients; clinical symptoms in the remaining children are diversified. Re-introduction of gluten with the diet (provocation test) produces recurrence of gluten intolerance in 96% of children treated with gluten-free diet for 2-3 years. Recurrence of the disease was accompanied by the atrophy of the intestinal villi.     

Left Atrial Appendage Morphology in Patients with Suspected Cardiogenic Stroke without Known Atrial Fibrillation

The left atrial appendage (LAA) is the typical origin for intracardiac thrombus formation. Whether LAA morphology is associated with increased stroke/TIA risk is controversial and, if it does, which morphological type most predisposes to thrombus formation. We assessed LAA morphology in stroke patients with cryptogenic or suspected cardiogenic etiology and in age- and gender-matched healthy controls. LAA morphology and volume were analyzed by cardiac computed tomography in 111 patients (74 males; mean age 60 ± 11 years) with acute ischemic stroke of cryptogenic or suspected cardiogenic etiology other than known atrial fibrillation (AF). A subgroup of 40 patients was compared to an age- and gender-matched control group of 40 healthy individuals (21 males in each; mean age 54 ± 9 years). LAA was classified into four morphology types (Cactus, ChickenWing, WindSock, CauliFlower) modified with a quantitative qualifier. The proportions of LAA morphology types in the main stroke group, matched stroke subgroup, and control group were as follows: Cactus (9.0%, 5.0%, 20.0%), ChickenWing (23.4%, 37.5%, 10.0%), WindSock (47.7%, 35.0%, 67.5%), and CauliFlower (19.8%, 22.5%, 2.5%). The distribution of morphology types differed significantly (P<0.001) between the matched stroke subgroup and control group. The proportion of single-lobed LAA was significantly higher (P<0.001) in the matched stroke subgroup (55%) than the control group (6%). LAA volumes were significantly larger (P<0.001) in both stroke study groups compared to controls patients. To conclude, LAA morphology differed significantly between stroke patients and controls, and single-lobed LAAs were overrepresented and LAA volume was larger in patients with acute ischemic stroke of cryptogenic or suspected cardiogenic etiology.     

谷红联合尼莫地平在小血管病性认知障碍与大动脉粥样硬化性认知障碍中的疗效分析

摘要 目的：谷红联合尼莫地平对小血管病性认知障碍与大动脉粥样硬化性认知障碍进行治疗,考察对两种类型血管性认知障碍的疗效。方法：以2017年-2019年12月就诊于我院血管性认知功能障碍(vascular cognitive impairment,VCI)患者为研究对象,大动脉粥样硬化型(large artery atherosclerotic,LAA)204例,为LAA组,小血管性(small vessel disease,SVD)226例,为SVD组,所有患者均给予基础治疗,在此基础上,LAA组和SVD组均进行谷红注射液和尼莫地平联合治疗,以临床疗效、认知功能评分以及不良反应情况为考察指标,考察谷红联合尼莫地平对两种类型血管性认知障碍的治疗效果。结果：经过谷红注射液联合尼莫地平的治疗,LAA组和SVD组均取得了较好的疗效,LAA组总有效率为90.20%,SVD组总有效率为88.05％,两组总有效率比较,无显著差异（P＞0.05）;治疗前两组患者的蒙特利尔认知量表(Montreal Cognitive Assessment,MoCA)评分和简易精神状态量表(Mini-Mental State Exam,MMSE)评分均无统计学差异(P>0.05);治疗后,LAA组和SVD组患者的MOCA评分和MMSE评分均显著的改善（P<0.05）,其中LAA组MOCA评分由19.31±5.45提升至22.31±6.21,MMSE评分由21.45±5.91提升至25.23±3.21,SVD组MOCA评分由19.28±4.01提升至22.88±5.73,MMSE评分由21.30±7.76提升至25.08±6.19,但两组间各项评分无显著差异（P>0.05）;治疗期间LAA组和SVD组均未出现严重不良反应,共有7例患者出现轻度头部胀痛、面部潮红等,其中LAA 组3（1.47 %）例,SVD组4（1.96 %）例,两组间比较无显著差异（P＞0.05）。结论：谷红注射液联合尼莫地平治疗小血管病性认知障碍与大动脉粥样硬化性认知障碍,均能显著缓解患者认知功能障碍症状,临床疗效显著,无严重不良反应,有一定的推广价值。     

Incidence and predictors of left atrial thrombus in patients with atrial fibrillation prior to ablation in the real world of China

BackgroundThe present study was to evaluate the value of CHADS2 and CHA2DS2VASC scores on predicting left atrial (LA) or left atrial appendage (LAA) thrombus in atrial fibrillation (AF) patients prior to ablation in the real world of China.Methods and resultsA total of 397 patients with non-valvular AF were analyzed to determine the relationship between CHADS2 and CHA2DS2VASC scores and LA/LAA thrombus identified on transesophageal echocardiography prior to radiofrequency ablation(RFA). LA/LAA thrombus was present in 38 patients (9.6%). There was a strong association between higher CHADS2 score or CHA2DS2VASC score and LA/LAA thrombus. No thrombus was identified in patients with CHA2DS2VASC score of 0 regardless of anticoagulation status. However, LA/LAA thrombus was detected in 2.9% patients with CHADS2 score of 0 without adequate anticoagulation, while no thrombus was present in the patients with CHADS2 score of 0 with adequate anticoagulation. Univariate analysis showed that heart failure (LVEF＜50%), LA≥40 mm, diabetes mellitus, previous stroke or TIA, CAD, hypertension, inadequate anticoagulation therapy, CHADS2 score of ≥2 and CHA2DS2VASC score of ≥2 were significantly associated with LA/LAA thrombus. Multivariable Cox regression analysis demonstrated that CHA2DS2VASC score of ≥2 (p = 0.02) and previous stroke or TIA (p = 0.04) were independently associated with LA/LAA thrombus regardless of anticoagulation status. ROC curve analysis showed that higher CHADS2 score and CHA2DS2VASC score could be similarly used to predict the presence of LA thrombus.ConclusionsBoth higher CHA2DS2VASC and CHADS2 scores were associated with LA/LAA thrombus in non-valvular AF patients prior to ablation. Although CHA2DS2VASC score and CHADS2 score had similar value to predict LA/LAA thrombus, CHA2DS2VASc score was better to identify low-risk patients for LA/LAA thrombus than CHADS2 score without anticoagulation. There will be a possibility of performing AF ablation or cardioversion in patients with a CHA2DS2VASC of 0 without TEE or anticoagulation therapy. The safety need to be verified by more multicentre randomized controlled clinical trails.     

Amphiphilic Erythromycin-Lipoamino Acid Ion Pairs: Characterization and <Emphasis Type="Italic">In Vitro</Emphasis> Microbiological Evaluation

A series of amphiphilic ion pairs of erythromycin (ERY) with lipoamino acids (LAAs) were produced. The ion pairs were prepared by evaporation of a water/ethanol co-solution of the drug and LAA bearing an alkyl side chain of 10–16 carbon atoms. For the sake of comparison, equimolar physical mixtures were prepared by triturating ERY and the LAA in the absence of any solvent. FTIR spectroscopy confirmed the structure of ion pairs, while differential scanning calorimetry and powder X-ray diffractometry were used to assess the formation of new saline species. The solubility pattern of the coevaporates in different aqueous and organic solvents confirmed their amphiphilic properties. ERY–LAA ion pairs were submitted to an in vitro microbiological assay against different bacterial strains, both susceptible and resistant to macrolides. The presence of the LAA moiety was shown not altering the antibacterial spectrum of activity of the drug. These results can be the basis for a further evaluation of ERY–LAA ion pairs as a mean to improve the penetration of the drug inside bacterial cells and to optimize the loading of ERY in lipid-based nanocarriers.     

Flurbiprofen derivatives in Alzheimer's disease: synthesis, pharmacokinetic and biological assessment of lipoamino acid prodrugs

Flurbiprofen (FLU) lipophilic prodrugs with lipoamino acids (LAA) 6a- e were synthesized for brain delivery. Chemical and plasmatic stability of prodrugs 6a- e as well as pharmacokinetic distribution studies for the prodrugs 6b and 6d were carried out. FLU prodrugs 6a- e were compared to the parent drug for their ability to inhibit binding of [F-18]FDDNP to in vitro formed beta-amyloid protein (Abeta fibrils). FLU-LAA conjugates showed a typical prodrug stability profile, being stable in PBS at pH 7.4 and releasing the active drug in plasma. Compound 6d yielded a slow accumulation of FLU in the brain. In the in vitro inhibition assay, all prodrugs except for the prodrug with the longest alkyl side chain ( 6e) were effective as inhibitors of [F-18]FDDNP binding to Abeta fibrils with EC50 values in the 10-300 nM range. The different brain accumulation kinetics shown by FLU and its LAA conjugate 6d suggested a possible slow-releasing activity of FLU by these prodrugs in the brain or a differential pharmacological effect deserving further, detailed studies on their biodistribution and pharmacological profile.     

Nitrimidazine Compared with Metronidazole in the Treatment of Vaginal Trichomoniasis

A new substituted nitroimidazole, nitrimidazine (Naxogin), is compared with the established drug, metronidazole (Flagyl), for the treatment of vaginal trichomoniasis in a randomized double-blind trial. Nitrimidazine cured 39 (68%) out of 57 patients and showed no undesirable effects other than nausea in one patient. Metronidazole cured 51 (89%) out of 57 patients and also caused nausea in one patient; this cure rate corresponds with that previously reported in other trials. In the recommended dosage nitrimidazine is inferior to metronidazole, but is sufficiently effective to be useful in cases of intolerance to metronidazole.     

Is there an alternative treatment for patients intolerant to antiplatelet therapy if percutaneous left atrial appendage closure is considered?

Introduction

Left atrial appendage (LAA) closure has become of major interest for patients with atrial fibrillation intolerant to oral anticoagulation therapy (OAC). Patients with a contraindication to both OAC and antiplatelet therapy are not eligible for percutaneous LAA closure. We aimed to find an alternative treatment for these specific patients.

Methods

From March 2014 until December 2015 five patients were referred for percutaneous LAA closure. Alternative treatment was necessary due to an absolute contraindication to OAC and antiplatelet therapy (n = 4) or after previous failed percutaneous device implantation (n = 1). A stand-alone full thoracoscopic closure of the LAA using the Atriclip PRO device (AtriCure Inc., Dayton, OH, USA) was performed under guidance of transoesophageal echocardiography (TEE). After three months all patients underwent a computed tomography scan. Mean follow-up was 7.2 months [range 4.5–9.8 months].

Results

All procedures were achieved without the occurrence of complications. Complete LAA closure was obtained in all patients without any residual flow confirmed by TEE. Postoperative computed tomography confirmed persisting adequate clip positioning with complete LAA closure and absence of intracardial thrombi. During follow-up no thromboembolic events occurred.

Conclusion

For atrial fibrillation patients with an absolute contraindication to OAC and antiplatelet therapy a stand-alone, minimally invasive thoracoscopic closure of the LAA is a safe and feasible alternative treatment. This might be a solution to avoid serious bleeding complications while eliminating the thromboembolic risk originating from the LAA in patients who are not eligible for percutaneous LAA closure.

     

Left Atrial Appendage Volume Increased in More Than Half of Patients with Cryptogenic Stroke

Background

Ischemic strokes without a well-defined etiology are labeled as cryptogenic, and account for 30–40% of strokes in stroke registries. The left atrial appendage (LAA) is the most typical origin for intracardiac thrombus formation when associated with atrial fibrillation. Here, we examined whether increased LAA volume detected with cardiac computed tomography (cCT) constitutes a risk factor in cryptogenic stroke patients.

Methods

This study included 82 stroke/TIA patients (57 males; mean age, 58 years) with a diagnosis of cryptogenic stroke after extensive radiological and cardiological investigations. Cases were classified using the TOAST criteria modified by European Association of Echocardiography recommendations for defining cardiac sources of embolism. Forty age- and gender-matched control subjects without cardiovascular diseases were selected for pair-wise comparisons (21 males; mean age, 54 years). LAA volume adjusted for body surface area was measured three dimensionally by tracing the LAA borders on electrocardiogram-gated CT slices.

Results

In control subjects, mean LAA volume was 3.4±1.1 mL/m². Mean+2SD, which was considered the upper limit for normal LAA volume was 5.6 mL/m². In paired Student t-test between the patient group and matched controls, LAA volume was 67% larger in cryptogenic stroke/TIA patients (5.7±2.0 mL/m² vs. 3.4±1.1 mL/m²; P<0.001). Forty-five (55%) patients with cryptogenic stroke/TIA had enlarged LAA.

Conclusion

LAA is significantly enlarged in more than half of patients with cryptogenic stroke/TIA. LAA thrombosis may contribute to the pathogenesis of stroke in patients considered to have cryptogenic stroke after conventional evaluation.     

Percutaneous left atrial appendage closure for stroke prevention in atrial fibrillation

Background

Percutaneous left atrial appendage (LAA) closure can be an alternative to coumadin treatment in patients with atrial fibrillation (AF) at high risk for thromboembolic events and/or bleeding complications. We report the initial experience with this new technique.

Methods

Patients were eligible if they had AF with a high stroke risk (CHADS₂ score >1), and/or contraindication for coumadin therapy. The procedure was performed under general anaesthesia, using biplane fluoroscopy and (3D) transoesophageal echocardiography (TEE) guidance. Patients were discharged on coumadin until a TEE was repeated at 45 days after closure to evaluate LAA occlusion. If LAA occlusion was achieved, oral anticoagulation was discontinued and aspirin started.

Results

Percutaneous LAA closure was performed in 10 patients (50% male, age 61.6 ± 9.6 years). The median CHADS₂ score was 3 (range 2–4), median CHA₂DS₂-VASc score 3.5 (range 2–6) and HAS-BLED score 1.5 (range 1–4). Nine patients had a history of stroke and 2 patients had a history of major bleeding while on coumadin. Concomitant pulmonary vein isolation was performed in 9 patients. The device was successfully placed in all patients within a median of 56 min (38–137 min). Asymptomatic catheter thrombus occurred in one patient. At 45-day follow-up, no thromboembolic events occurred, TEE showed minimal residual flow in the LAA in three patients. In one patient the LAA device was dislocated, requiring successful percutaneous retrieval.

Conclusion

Device closure of the LAA may provide an alternative strategy to chronic coumadin therapy in patients with AF and high risk of stroke and/or bleeding complications using coumadin.     

Effect of linoleic acid-albumin in the culture medium on freezing sensitivity of in vitro-produced bovine morulae

The objective of this study was to improve the survival of in vitro-produced bovine morulae after cry opreservation. In Experiment 1, presumptive zygotes at 20 h post-insemination (hpi) were cultured in a mixture of modified synthetic oviduct fluid (m-SOF)/0.3% BSA and m-SOF/0.3% linoleic acid-albumin from bovine serum (LAA) at 39.0 degrees C in 5% O2, 5% CO2 and 90% N2 (final LAA concentration: 0, 0.01, 0.03, 0.1 or 0.3%). Morulae harvested at 138 hpi were frozen and thawed in m-PBS/0.3% BSA containing 1.5 M ethylene glycol and were cultured for 96 h in m-SOF/10% FBS to assess further development. The post-thaw survival of morulae derived from culture in 0.1% LAA (60%, P < 0.01) and in 0.03% LAA (55%, P < 0.05) was higher than that in 0% LAA (32%). Lowering the LAA concentration below 0.1% resulted in similar rates of morula development as in m-SOF/0.3% BSA. In Experiment 2, zygotes were cultured in m-SOF/0.1% LAA from 20 to 90 hpi and/or from 90 to 138 hpi. Post-thaw survival of morulae that had been exposed to LAA from 20 to 90 hpi (39%) or from 90 to 138 hpi (56%) was higher than that of morulae cultured without LAA from 20 to 138 hpi (12%, P < 0.02). These survival rates were lower than that of morulae cultured with LAA over a period of 20 to 138 hpi (76%, P < 0.001). The results indicate that cell-free culture of IVM/IVF bovine zygotes in m-SOF supplemented with LAA produces morula-stage embryos relatively tolerant to the process of freezing and thawing.     

Primed lymphocyte test in dogs: Restimulation by non-DLA-D determinants and failure to detect lymphoma associated antigens

The primed lymphocyte test (PLT) has been adapted to the dog and utilized in histocompatibility typing and in an attempt to detect lymphoma associated antigens (LAA) in dogs with spontaneously occurring lymphoma. After primary culture lasting 12–14 days, primed lymphocytes could be stimulated by the priming cells to undergo blastogenesis within 2–4 days of secondary culture. Dogs sharing defined DLA-D determinants always showed cross-reactivity in PLT, but dogs showing cross-reactivity in PLT did not necessarily share DLA-D determinants defined by homozygous typing cells. After using two variations of the test, no evidence for reactivity of presumed LAA in the PLT could be found.     

MMP-9基因多态性与缺血性脑卒中发病及预后的相关性研究

目的:研究基质金属蛋白酶9(MMP-9)基因多态性与缺血性脑卒中(IS)发病及预后的相关性,为IS的防治提供新的理论依据。方法:选取治疗的IS患者100例,根据TOAST分型标准分为大动脉粥样硬化型(LAA)组41例,小动脉阻塞型(SAO)组59例,并选取健康体检者40例作为对照组,采用PCR-RFLP法检测各组MMP-9基因C1562T、R279Q多态性,并对IS患者进行3个月的随访,采用Logistic回归分析C1562T、R279Q多态性与IS患者预后的相关性。结果:LAA组、SAO组MMP-9基因C1562T位点T等位基因、C/T+T/T基因型频数均高于对照组,差异有统计学意义(P0.05),LAA组、SAO组C1562T位点C等位基因、C/C基因型频数及R279Q位点等位基因和基因型频数与对照组比较差异无统计学意义(P0.05);Logistic回归分析显示,MMP-9各型别基因与预后无明显相关性(P0.05)。结论:MMP-9基因C1562T的T等位基因是IS发病的穿易感基因之一,但MMP-9基因多态性与IS患者的预后并无明显相关性。     

Increase in the Incidence of Allergy to Prosthetic Materials and Local Anesthetics: Immunophysiology and Laboratory Diagnostics of Intolerance

Combined analysis of drug sensitivity in vitro and in vivo is necessary for reliable diagnosis of the intolerance to prosthetic materials and local anesthetics as an intrinsic allergic reaction, especially in the cases of generally weak allergic reactions. Changes in peroxidase release from granulocytes in response to a corresponding substance is an effective in vitro test, and the provocative mucosal-gingival test (MGT) is used in vivo. During the past decade, a growth was observed in the population developing allergies to prosthetic materials and local anesthetics, which is expressed in an increased number of patients with intolerance to these materials against the background of increasing hyperresponsiveness to the drugs which have usually been tolerated well, as well as an increased proportion of patients with a polyvalent allergy to many prosthetic materials and anesthetics. At the same time, the amount of weak responses to drugs in the in vitro test has increased. Some of these patients exhibit a pathologic response to the given drug, which can be detected using the MGT. In most cases, polyvalent allergies to prosthetic materials or anesthetics and a pathological response accompanied by a weak in vitro reaction are found in patients with bronchial asthma and other chronic allergies, chronic candidosis of the oral cavity, and chronic Helicobacter and Giardia lamblia infections.     

Factors affecting cryosurvival of nuclear-transferred bovine and swamp buffalo blastocysts: effects of hatching stage, linoleic acid-albumin in IVC medium and Ficoll supplementation to vitrification solution

The objective was to determine whether the hatching stage of cattle and swamp buffalo somatic cell nuclear-transferred (SCNT) blastocysts affected cryosurvival after vitrification, and whether addition of linoleic acid-albumin (LAA) to the IVC medium and Ficoll to the vitrification solution improves cryosurvival. Fused couplets were activated with ethanol and cycloheximide-cytochalasin D (day 0), and were allowed to develop in the presence of 0.3% BSA or 0.1% LAA+0.2% BSA. Hatching blastocysts were harvested at day 7.0 (cattle) or day 6.5 (buffalo), and classified into one of three categories, according to the ratio of extruding embryonic diameter from zona to embryonic diameter inside the zona. The blastocysts were vitrified in 20% DMSO+20% ethylene glycol+0.5M sucrose, with or without 10% Ficoll in TCM199+20% FBS, using Cryotop as a cryodevice. The post-thaw survival of the blastocysts was assessed by in vitro culture for 24h. In cattle, when the LAA-supplemented IVC medium and the Ficoll-free vitrification solution were used, cryosurvival of the early-hatching blastocysts (77%) was not different from those of middle- and late-hatching blastocysts (74 and 80%, respectively). Inclusion of Ficoll in the vitrification solution did not improve the cryosurvival of SCNT blastocysts (54 to 68%). Early-hatching SCNT blastocysts produced in the absence of LAA were sensitive to the vitrification procedure (cryosurvival 56%; P<0.05 versus 80% in the late-hatching blastocysts). The full-term developmental potential of SCNT blastocysts was proven only in the non-vitrified control group. In buffalo, the mean cryosurvival of hatching SCNT blastocysts produced with LAA (89%) was not different from that of those produced without LAA (87%). In conclusion, bovine SCNT blastocysts, regardless of their hatching stage, were relatively resistant to vitrification by the ultra-rapid cooling procedure when the blastocysts were produced in the presence of LAA. Furthermore, swamp buffalo SCNT blastocysts were more tolerant of vitrification than bovine SCNT blastocysts.     

Four drug-HAART in primary HIV-1 infection: clinical benefits and virologic parameters

BACKGROUND: From a theoretical standpoint, primary HIV infection (PHI) represents a great chance to modify the natural history of the disease. In this study we purposed a four drugs regimen with zidovudine, lamivudine, ritonavir and saquinavir to treat aggressively the infection and achieve a complete immune reconstitution. METHODS: This is an Italian multicentric open label study. Adult patients with PHI were eligible for the study if they met at least one clinical criterion and one laboratory criterion of the following. Clinical criteria: Signs and symptoms of acute retroviral syndrome within the past 70 days, exposure to HIV-1 within the last 3 months, a preceding negative antibody test within the past 6 months. Laboratory criteria: Detectable p24 antigen with neutralization in serum; detectable HIV-RNA in plasma; indeterminate Western blot test with negative or low positive value HIV antibody in ELISA test. RESULTS: Since April 1997 to April 1999 40 patients with PHI have been enrolled; 80% of this cohort referred symptoms related to acute antiretroviral syndrome. Treatment has been withdrawn in 17 patients (12 for intolerance, 3 for toxicity and 2 for failure). At baseline the mean CD4+ T cells count and CD4/CD8 ratio were 537 (range 55-1287) and 0.58 (range 0.1-1.03) and the mean plasma HIV-RNA level was 5.9 log copies/ml (range 3-7.15). Plasmatic HIV-1 RNA levels of all patients dropped below 200 copies/ml in 68% of patients at week 12, 81% at week 24, 93% after 12 months and 100% after 18 months. Immunological parameters have been improved and have achieved normal range since 6th month. CONCLUSIONS: A rapid virologic suppression and immunological reconstitution are associated with PHI therapy. However early treatment should be weighted against the potential disadvantages such as immediate adverse events (intolerance and drug toxicity) and long term manifestation (metabolic disorders).     

Concomitant epicardial left atrial appendage ligation and left atrial ablation of atrial fibrillation: Safety,feasibility and outcome

IntroductionWe present initial results of patients undergoing a combined procedure of epicardial LAA ligation in addition to left atrial ablation for AF.Methods9 patients were included for additional use of LARIAT as an individual treatment approach for AF. First an epicardial LAA ligation was performed, in the same procedure left atrial ablations consisting of PVI and additional substrate based modifying ablations were performed. Follow–up at 3 months and 12 months was performed.ResultsThere was only 1 minor procedural complication (11%) involving epicardial bleeding and 2 late adverse events of pericardial tamponade and stroke. At the final follow-up (median 20 months) 7 patients were in stable sinus rhythm (78%) and 2 pts had reduced AF burden.ConclusionConcomitant epicardial LAA ligation and ablation is feasible in selected patients with a reasonable risk profile. More prospective data are required to validate the safety and efficacy.     

Human immunodeficiency virus and drug misuse: the Edinburgh experience.

During 1985 many drug abusers who lived in Edinburgh were found to be infected with the human immunodeficiency virus (HIV). As a result an alternative counselling and screening clinic for testing for antibodies to HIV was established for use by drug abusers. Four hundred and forty one patients were counselled in the first year, and over 60% were either drug abusers or their sexual contacts. One hundred and fourteen (26%) patients were positive for HIV antibody, and 100 (88%) of these were current or former drug abusers. The HIV seropositivity rate in drug abusers was 52% but was only 7% in their sexual contacts. Services were provided for these people as well as counselling before and after the test. The cost of this counselling service for the first year was 27,000 pounds or 61.22 pounds per patient. The unexpected mobility of 23% of the Edinburgh drug abusers, particularly to other areas of Britain, suggests that similar services need to be set up elsewhere.