Physiological responses to parental separation and a strange situation are related to parental care received in juvenile Goeldi's monkeys (Callimico goeldii)

The relationship between parental care received and physiological and behavioral responses to parental separation, isolation, and reunion was investigated in seven juvenile Goeldi's monkeys living in their family groups. Physiological responses were measured noninvasively: the hypothalamic–pituitary–adrenal axis via urinary cortisol output and the autonomic nervous system via piloerection on the tail. Parent–infant aggression demonstrated high intergroup variation and predicted: (a) an increase in urinary cortisol output, r_s = 0.86, p = 0.04, and duration of piloerection, r_s = 0.71, p = 0.08, at initial separation–isolation; (b) adaptation of piloerection, r_s = −0.89, p = 0.03, to repeated separation–isolation. Juvenile Goeldi's monkeys that had received high parental aggression were more physiologically responsive to separation; they also sought more contact with their mothers at reunion, r_s = 0.93, p = 0.02. We propose that these data are consistent with the hypothesis that high emotional reactivity is related to insecure attachment to aggressive parents in this New World primate. © 1998 John Wiley & Sons, Inc. Dev Psychobiol 33: 21–31, 1998     

The differential release of eosinophil granule proteins. Studies on patients with acute bacterial and viral infections

Background: Harlier in vitro studies have suggested that the eosinophil may release its granule proteins selectively depending on the stimulus to which the cell is exposed. Objective: The object of the present study was to study the question of selective release in vivo by means of serum measurements of the two eosinophil granule proteins eosinophil cationic protein (ECP) and eosinophil peroxidase (EPO) in acute infections. Methods: Fourty-six subjects with acute infections were studied before treatment, 20 with bacterial infections and 26 with viral infections. Serum ECP, EPO and MPO were measured by specific RIA. Results: In acute bacterial infections ECP, but not EPO. was significantly raised in serum (P < 0.0001) compared with non-infected healthy subjects. In acute bacterial infections ECP was significantly correlated to the levels of the neutrophil marker myeloperoxidase (MPO) (r_s= 0.96, P < 0.0001) but not to EPO. In acute viral infections neither ECP nor EPO were on average raised. However, almost 20% the patients had elevated levels of both proteins. In the viral infections the serum-levels of ECP and EPO were correlated (r_s= 0.63, P < 0.001), but no correlation was found with MPO Conclusion: It is concluded that eosinophils are activated during acute bacterial infections and that this activation results in the preferential mobilisation of ECP. The simultaneous assay of the two eosinophil proteins, ECP and EPO. may give new insight into the role of the eosinophil in disease.     

Biomechanical and neuromuscular comparison of single- and multi-planar jump tests and a side-cutting maneuver: Implications for ACL injury risk assessment

BackgroundNon-contact anterior cruciate ligament (ACL) injuries are a major problem among adolescent female soccer and handball players. Therefore, the aim of this study was to examine if known biomechanical and neuromuscular ACL injury risk factors obtained from single-planar jump-landings and multi-planar side-jumps can resemble the demands of side-cutting maneuvers, a known high-risk ACL injury movement for this population.MethodsTwenty-four female soccer and handball players (mean ± SD: age: 17 ± 1 year; height: 172 ± 66 cm; mass: 67 ± 9 kg) performed a series of functional tasks including two single-planar jump-landings, two multi-planar side-jumps and a sports-specific side-cutting maneuver on their dominant leg. Frontal and sagittal plane knee and hip joint kinematics and kinetics were calculated from three-dimensional motion analysis, whereas hamstring and quadriceps muscle pre-activity levels were measured with surface electromyography.ResultsThe sports-specific side-cut was distinguished by more knee flexion at initial contact, greater abduction angles and external knee abduction moments, higher biceps femoris and semitendinosus muscle pre-activity levels than both the single-planar jump-landings and multi-planar side-jumps (p < .05). Whilst, poor-to-strong spearman rank correlation coefficients inconsistently were found for the biomechanical and neuromuscular ACL injury risk factors explored between the side-cut and the single-planar jump-landings (r_s = 0.01–0.78) and multi-planar side-jumps (r_s = 0.03–0.88) respectively.ConclusionSingle-planar jump-landings and multi-planar side-jumps should be used with caution to test for non-contact ACL injury risk factors in adolescent female soccer and handball players, because they do not mimic the biomechanical nor neuromuscular demands of the most frequent injury situation.     

Comparison of Serum and Cell-Specific Cytokines in Humans

Cytokines function at the cellular, microenvironmental level, but human cytokine assessment is most commonly done at the macro level, by measuring serum cytokines. The relationships between serum and cellular cytokines, if there are any, are undefined. In a study of hospitalized patients in Malawi, we compared cytometrically assessed, cell-specific cytokine data to serum interleukin 2 (IL-2), IL-4, IL-6, IL-8, IL-10, gamma interferon (IFN-γ), and tumor necrosis factor alpha (TNF-α) levels in 16 children and 71 (IL-2, -4, -6, -10) or 159 (IL-8, IFN-γ, and TNF-α) adults, using Wilcoxon rank sum tests and Pearson's (r_p) and Spearman's (r_s) rank correlations. For the entire study group, correlations between identical serum and cellular cytokines mainly involved IL-8 and IFN-γ, were few, and were weakly positive (r < 0.40). Blood culture-positive persons had the most and strongest correlations, including those between serum IL-2 levels and the percentages of lymphocytes spontaneously making IL-2 (r_s = +0.74), serum IL-8 levels and the percentages of lymphocytes spontaneously making IL-8 (r_p = +0.66), and serum IL-10 levels and the percentages of CD8⁺ T cells making TNF-α (r_p = +0.89). Human immunodeficiency virus (HIV)-positive persons had the next largest number of correlations, including several serum IL-8 level correlations, correlation of serum IL-10 levels with the percentages of lymphocytes producing induced IL-10 (r_s = +0.36), and correlation of serum IFN-γ levels and the percentages of lymphocytes spontaneously making both IL-6 and IFN-γ in the same cell (r_p = +0.59). HIV-negative, malaria smear-positive, and pediatric patients had few significant correlations; for the second and third of these subgroups, serum IL-8 level was correlated with the percentage of CD8⁻ T cells producing induced IL-8 (r_s = +0.40 and r_s = +0.56, respectively). Thus, the strength of associations between serum and cellular cytokines varied with the presence or absence of bloodstream infection, HIV status, and perhaps other factors we did not assess. These results strongly suggest that serum cytokines at best only weakly reflect peripheral blood cell cytokine production and balances.     

Quantitative analysis of hyperpolarized 129Xe ventilation imaging in healthy volunteers and subjects with chronic obstructive pulmonary disease

In this study, hyperpolarized ¹²⁹Xe MR ventilation and ¹H anatomical images were obtained from three subject groups: young healthy volunteers (HVs), subjects with chronic obstructive pulmonary disease (COPD) and age‐matched controls (AMCs). Ventilation images were quantified by two methods: an expert reader‐based ventilation defect score percentage (VDS%) and a semi‐automated segmentation‐based ventilation defect percentage (VDP). Reader‐based values were assigned by two experienced radiologists and resolved by consensus. In the semi‐automated analysis, ¹H anatomical images and ¹²⁹Xe ventilation images were both segmented following registration to obtain the thoracic cavity volume and ventilated volume, respectively, which were then expressed as a ratio to obtain the VDP. Ventilation images were also characterized by generating signal intensity histograms from voxels within the thoracic cavity volume, and heterogeneity was analyzed using the coefficient of variation (CV). The reader‐based VDS% correlated strongly with the semi‐automatically generated VDP (r = 0.97, p < 0.0001) and with CV (r = 0.82, p < 0.0001). Both ¹²⁹Xe ventilation defect scoring metrics readily separated the three groups from one another and correlated significantly with the forced expiratory volume in 1 s (FEV₁) (VDS%: r = –0.78, p = 0.0002; VDP: r = –0.79, p = 0.0003; CV: r = –0.66, p = 0.0059) and other pulmonary function tests. In the healthy subject groups (HVs and AMCs), the prevalence of ventilation defects also increased with age (VDS%: r = 0.61, p = 0.0002; VDP: r = 0.63, p = 0.0002). Moreover, ventilation histograms and their associated CVs distinguished between subjects with COPD with similar ventilation defect scores, but visibly different ventilation patterns. Copyright © 2012 John Wiley & Sons, Ltd.     

Predictors of AIDS-Defining Events Among Advanced Naïve Patients After HAART

Abstract

Background: Baseline and follow–up predictors of new AIDS-defining events or death (ADE/death) among patients who started HAART late in their disease history have rarely been assessed simultaneously. Method: ADE and mortality rates were assessed using Cox regression analyses. Variables were tested for prediction of ADE/death within the first 3 months of therapy and from month 3, thereafter. Results: 751 HIV–infected patients with <200 CD4+/mm³ before HAART were followed for a median of 49 months. 207 new ADE occurred (7.06 [6.16–8.10] per 100 patient-years). ADE/deaths clustered within the first 3 months of treatment (106/207, 51%). Higher CD4+ T-cell counts during the follow–up (per log_e cells/mm³: hazard ratio [HR] 0.51; 0.41–0.64; p < .001) and use of antiretroviral therapy (HR 0.38; 95% CI 0.21–0.69; p = .001) appeared to protect from ADE/death after month 3. Conversely, increasing follow–up with HIV RNA >400 copies/mL correlated with ADE/death (per month: HR 1.09; 95% CI 1.06-1.12; p = .001). Use of boosted protease inhibitors as first-line HAART and HCV-seropositivity were additional risk factors. Baseline CD4+ T-cell count and HIV RNA had a predominant impact in the first 3 months after HAART initiation. Conclusion: A careful monitoring of patients with low CD4+ is particularly necessary during the first few months of HAART. Length and extent of viral replication during the follow-up appeared to induce a significantly higher risk of HIV disease progression afterwards, implying that new drugs and new strategies aimed at ensuring long-term suppression of HIV RNA are of outstanding importance.     

Inflammatory mediators in exhaled breath condensate and peripheral blood of healthy donors and stable COPD patients

Objective: The aim of this work was to compare matrix metalloproteinase-9 and -12, tissue inhibitor of metalloproteinase-1 and -4, and neutrophil elastase in exhaled breath condensate (EBC) and peripheral blood of patients with COPD.

Methods: Peripheral blood and EBC samples from COPD patients and healthy donors were collected. In serum and EBC, MMP-9, MMP-12, NE, TIMP-1, and TIMP-4 proteins were detected by ELISA. The mRNA expression levels of MMP-9, MMP-12, NE, TIMP-1, and TIMP-4 in peripheral blood mononuclear cells (PBMCs) were analyzed by qRT-PCR.

Results: The protein levels of MMP-9 (p=.034) and MMP-12 (p=.041) in the EBC of COPD smokers were higher than those of COPD never-smokers. The concentrations of TIMP-1 (p=.072) and TIMP-4 (p=.084) in the EBC of COPD smokers were higher than those of COPD never-smokers; however, the difference was not statistically significant. MMP-9 (r=–0.78, p<.0001) and TIMP-1 (r=–0.71, p<.0001) levels in EBC were significantly negatively correlated with pulmonary function FEV₁%pred. The protein levels of MMP-12 (r=–0.37, p=.034) and TIMP-4 (r=–0.34, p=.041) were also negatively correlated with FEV1%pred. The expression of MMP-9, MMP-12, NE, TIMP-1, and TIMP-4 in PBMCs and serum of COPD smokers were significantly higher than those of control never-smokers (p<.05).

Conclusions: Exhaled MMP-9, MMP-12, TIMP-1, and TIMP-4 levels increased in stable COPD patients and were negatively correlated with FEV1%pred, which suggests the usefulness of their measurement in EBC for the monitoring of airway inflammation. However, to better assess their diagnostic or prognostic value, larger studies are necessary.     

Factors Influencing Gestational Age-Adjusted Birthweight in a National Series of 600 Newborns from Mothers with HIV

Abstract

Background: Few studies have assessed the determinants of birthweight in newborns from HIV-positive mothers in analyses that adjusted for different gestational age at delivery. Method: We calculated gestational age-adjusted birthweight Z-score values in a national series of 600 newborns from women with HIV and in 600 newborns from HIV-negative women matched for gender and gestational age. The determinants of Z-score values in newborns from HIV-positive mothers were assessed in univariate and multivariate regression analyses. Results: Compared to newborns from HIV-negative women, newborns from HIV-positive women had significantly lower absolute birthweight (2799 vs. 2887 g; p = .007) and birthweight Z score (?0.430 vs. ?0.222; p < .001). Among newborns from mothers with HIV, the maternal characteristics associated with significantly lower Z-score values in univariate analyses were recent substance use (Z-score difference [ZSD] 0.612, 95% CI 0.359?0.864, p < .001), smoking >10 cigarettes/day (ZSD 0.323, 95% CI 0.129?0.518, p = .001), absence of pregnancies in the past (ZSD 0.200, 95% CI 0.050?0.349, p = .009), no antiretroviral treatment in the past (ZSD 0.186, 95% CI 0.044?0.327, p = .010), and Caucasian ethnicity compared to Hispanic (ZSD 0.248, 95% CI 0.022?0.475, p = .032). Body mass index (BMI) at conception and maternal glycemia levels during pregnancy were also significantly related to birthweight Z scores. Glycemia, BMI, and recent substance use maintained a significant association with Z-score values in multivariate analyses. In the multivariate analysis, the only factors significantly associated with Z-score values below the 10th percentile were recent substance use (adjusted odds ratio [AOR] 3.17, 95% CI 1.15?8.74) and smoking (AOR 2.26, 95% CI 1.13?4.49). Discussion: We identified several factors associated with gestational age-adjusted birthweight in newborns from women with HIV. Smoking and substance use have a significant negative impact on intrauterine growth, which adds to an independent HIV-related effect on birthweight. Prevention and information on this issue should be reinforced in women with HIV of childbearing age to reduce the risk of negative outcomes in their offspring.     

Is there any association between leptin levels and bone mineral density in haemophiliac men?

Introduction

Conflicting data exist regarding the role of leptin in bone metabolism. The purpose of the present study was to investigate serum leptin concentrations in male patients with haemophilia A and B, a disease known to be associated with low bone mass.

Material and methods

Eighty-one male patients, aged 45.4 ±15 years, were screened. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry (DXA) in lumbar spine (LS), femoral neck (FN) and total hip (TH).

Results

Low bone mass was diagnosed in 20 patients (24.7%). Serum leptin concentrations were strongly associated with body weight (r _s = 0.457, p = 0.0001) and body mass index (BMI) (r _s = 0.491, p = 0.0001). In unadjusted analysis leptin was inversely associated with BMD in LS (r _s = –0.255, p = 0.023), but not in FN and TH (r _s = –0.205, p = 0.068 and r _s = –0.191, p = 0.090, respectively). However, after adjusting for BMI and body weight, leptin was inversely associated with BMD in FN (F _1,76 = 7.727, p = 0.007, β = –0.371, ΔR ² = 0.089) and TH (F _1,76 = 4.533, p = 0.036, β = –0.290, ΔR ² = 0.054), but not in LS (F _1,75 = 2.076, p = 0.154, β = –0.202, ΔR ² = 0.026). No association was found between age, presence of HBV, HCV or HIV infection or alkaline phosphatase and leptin levels.

Conclusions

Our study showed a negative association between circulating leptin levels and bone mass in males, independently of body weight and BMI.     

Predictors of Virological Response to Atazanavir in Protease Inhibitor-Experienced Patients

Abstract

Background: Atazanavir (ATV) is the latest approved HIV protease inhibitor (PI). Even though it is very convenient (only two capsules once a day), concerns have risen about its potency. Method: The clinical performance of ATV 400 mg once a day was examined in all PI-experienced patients who were included in the ATV expanded access program conducted in a single institution. The predictive value of baseline drug resistance HIV genotypes, ATV plasma trough levels, and the genotypic inhibitory quotient (GIQ) on the virological response at week 24 was assessed. Results: Data from 92 patients were analyzed. ATV was prescribed as part of a rescue intervention (45%), a simplification strategy (11%), or an attempt to ameliorate hyperlipidemias (23%) or other toxicities (16%). Tenofovir (TDF) was concomitantly used with ATV in 78% of patients. None received ritonavir boosting. In patients with detectable viremia at baseline (65%), the median HIV RNA drop was 0.7 logs. The median ATV C_min was 0.12 μg/mL (IQR, 0.05-0.22 μg/mL), which is clearly above the IC₉₀ (90% inhibitory concentration) for ATV in wild-type viruses. The virological response did not correlate significantly with ATV C_min. The median number of protease resistance mutations was lower in patients showing virological response than in nonresponders (1 vs. 5; p = .07). A higher HIV RNA drop was associated with a higher GIQ (p = .02; β = –5.4; 95% CI, –10 to –1). Only 4 patients (4%) discontinued treatment due to ATV-related toxicities (hyperbilirubinemia in 1). Bilirubin levels were associated with ATV plasma concentrations (p = .05; β = 3.2; 95% CI, –0.1 to 6.5). The rate of hypertriglyceridemia and hypercholesterolemia declined significantly with respect to baseline. Conclusion: ATV is relatively safe and provides significant virological response in PI-experienced patients, mainly among those with a low number of protease resistance mutations. The GIQ predicts accurately the virological response in patients receiving ATV. Hyperbilirubinemia is associated with higher ATV plasma levels.     

Hospice nurse identification of comfortable and difficult discussion topics: Associations among self-perceived communication effectiveness,nursing stress,life events,and burnout

ObjectiveTo assess hospice nurses’ self-perceived communication effectiveness, identify comfortable and difficult discussion topics, and explore associations between self-perceived communication effectiveness, burnout, nursing stress, and life events.Methods181 nurses completed self-report measures, then listed comfortable and/or difficult patient and caregiver discussion topics.ResultsNurses were generally experienced (median 9 years, range <1–46 as a registered nurse; median 3 years, range <1–23 as a hospice nurse), reporting overall Effective/Very Effective communication skills (85.6%); 70% desired more communication training. As nursing stress increased perceived overall communication effectiveness decreased (r_s = ?0.198; p 0.012). As burnout increased overall effectiveness (r_s = ?0.233; p 0.002) and effectiveness with difficult topics (r_s = ?0.225; p 0.003) decreased. Content analysis revealed 9 categories considered both comfortable and difficult to discuss; contextual comments provided fuller explanation (e.g. providing general information on the Dying Process was comfortable, discussing Dying process during patient death was difficult). Seven additional categories (e.g. Denial) were deemed uniquely difficult.ConclusionHospice nurses perceive themselves as effective communicators, yet want additional training. Perceived communication effectiveness is associated with burnout and stress.Practice implicationsCommunication training that focuses on contextually grounded topics identified by participants may optimize communication between hospice nurses, patients and caregivers.     

Efficacy and Safety of Ritonavir-Boosted and Unboosted Atazanavir Among Antiretroviral-Naïve Patients

Abstract

Purpose: Evaluate responses and safety of ritonavir-boosted atazanavir (“boosted atazanavir”) compared to unboosted atazanavir among antiretroviral-naïve patients in the clinical managed care setting. Method: Observational cohort analysis of atazanavir use (comparing ritonavir-boosted to non-boosted) at Kaiser Permanente and Group Health Cooperative from 2003 to 2006. Antiretroviral-naïve patients initiating atazanavir were followed through 52 weeks of treatment. Results: 443 patients were prescribed atazanavir (69 non-boosted; 15.5%). Boosted and non-boosted atazanavir groups were similar with respect to gender and age. Boosted atazanavir use was associated with greater odds achieving HIV RNA <400 c/mL (odds ratio [OR] = 3.24, p = .008), greater decrease in HIV RNA (?0.37 log₁₀/mL, p = .03), greater increase in CD4 T-cell count (+59 cells/μL, p = .01), and greater increase in total bilirubin (+1.21 mg/dL as opposed to +0.56 mg/dL, p ? .001). There were no statistically significant differences for glucose, liver transaminases, total cholesterol, or LDL cholesterol elevations. There were greater odds of maximal viral control when atazanavir was combined with tenofovir or zidovudine in combination with lamivudine (or emtricitabine). Conclusions: Ritonavir-boosted atazanavir is associated with greater virologic control and immune response through 52 weeks compared to non-boosted atazanavir, without greater risk of adverse events except elevated bilirubin. Thus, ritonavir-boosted atazanavir is the preferred method of prescribing atazanavir.     

Lipid accumulation product (LAP) is related to androgenicity and cardiovascular risk factors in postmenopausal women

Objectives

To investigate whether lipid accumulation product (LAP) is related to androgen and sex hormone binding globulin (SHBG) levels and to cardiovascular risk factors in postmenopausal women with no evidence of established cardiovascular disease.

Study design

Cross-sectional study.

Main outcome measures

LAP (waist-58 × triglycerides [nmol/L]), LAP ≥ arbitrary cutoff point of 34.5, serum testosterone, SHBG, ultrasensitive C-reactive protein (us-CRP).

Results

Forty-nine women (mean age 55 ± 5 years; median amenorrhea time 5.5 years [3–8]) were studied: 14% had the metabolic syndrome and 24.5% were hypertensive. Compared with LAP < 34.5, LAP ≥ 34.5 (n = 29, 59%) was associated with higher testosterone (p = 0.021) and free androgen index (FAI) (p = 0.003) and lower SHBG levels (p = 0.013). Us-CRP (p = 0.012), total cholesterol (p = 0.041), glucose (p = 0.020) and homeostasis model assessment (HOMA) (p = 0.019) were higher, and high-density lipoprotein cholesterol (HDL-C) (p = 0.001) was lower with LAP ≥ 34.5. LAP was positively correlated with total testosterone (r = 0.349, p = 0.014), FAI (rs = 0.470, p = 0.001), us-CRP (r = 0.315, p = 0.042), systolic (r = 0.318, p = 0.028) and diastolic (r = 0.327, p = 0.023) blood pressure, total cholesterol (r = 0.498, p < 0.001) and glucose (rs = 0.319, p = 0.026). LAP was negatively correlated with SHBG (rs = −0.430, p = 0.003) and HDL-C (r = −0.319, p = 0.026).

Conclusions

LAP index seems to be associated with androgens and SHBG and with cardiovascular risk factors in postmenopausal women. Also, LAP seems to be a suitable method to screen for cardiovascular risk in postmenopause.     

Health-Related Quality of Life in Individuals Infected with HIV in the Era of HAART

Abstract

Purpose: To compare health-related quality of life (HR-QOL) in individuals infected with HIV to general population levels and to assess the relationship between HR-QOL and markers of disease progression in the era of highly active antiretroviral therapy (HAART). Method: This was a cross-sectional questionnaire-based study. This study included 154 individuals at least 18 years old with HIV who either were attending a London hospital or were visited by a community team in Brighton. Study participants were asked to complete two HR-QOL questionnaires. This study used HR-QOL, as measured using the Medical Outcome Study HIV Health Survey (MOS-HIV) and EuroQoL self-report (EQ-5D) questionnaires, as the main outcome measure. Responses on the EQ-5D were compared with a published general population data set. The relationships between scores on the MOS-HIV and EQ-5D questionnaires and a number of independent variables including CD4 count and viral load were also assessed. Results: Each analysis was based on the results of at least 128 questionnaires. The mean MOS-HIV mental and physical component scores were 43.2 (SD = 12.2) and 41.8 (SD = 13.2), respectively. After adjusting for differences in age and gender, it was shown that individuals with HIV reported significantly lower EQ-5D_utility ( p = .0001) and EQ-5D_VAS ( p = .0001) compared with the general population. However, further analysis revealed few significant associations between markers of disease progression and HR-QOL. Conclusion: Individuals with HIV generally recorded significantly lower HR-QOL compared with the general population. Thus, prevention of further transmissions of the virus is still likely to prevent significant morbidity losses in addition to mortality losses, despite the availability of HAART. However, disease progression as measured is not clearly related to further reductions in HR-QOL.     

Impact of a Selenium Chemoprevention Clinical Trial on Hospital Admissions of HIV-Infected Participants

Abstract

Purpose: To evaluate the impact of selenium chemoprevention (200μg/day) on hospitalizations in HIV-positive individuals. Method: Data were obtained from 186 HIV+ men and women participating in a randomized, double-blind, placebo-controlled selenium clinical trial (1998-2000). Supplements were dispensed monthly, and clinical evaluations were conducted every 6 months. Inpatient hospitalizations, hospitalization costs, and rates of hospitalization were determined 2 years before and during the trial. Results: At enrollment, no significant differences in CD4 cell counts or viral burden were observed between the two study arms. Fewer placebo-treated participants were using antiretrovirals (p < .05). The total number of hospitalizations declined from 157 before the trial to 103 during the 2 year study. A marked decrease in total admission rates (RR = 0.38; p = .002) and percent of hospitalizations due to infection/100 patients for those receiving selenium was observed (p = .01). As a result, the cost for hospitalization decreased 58% in the selenium group, compared to a 30% decrease in the placebo group (p = .001). In the final analyses, selenium therapy continued to be a significant independent factor associated with lower risk of hospitalization (p = .001). Conclusion: Selenium supplementation appears to be a beneficial adjuvant treatment to decrease hospitalizations as well as the cost of caring for HIV-1--infected patients.     

Allergic rhinitis to grass pollen: Measurement of inflammatory mediators of mast cell and eosinophils in native nasal fluid lavage and in serum out of and during pollen season

Background: In allergic rhinitis, mast cells, activated by cross-linking of allergen to mast cell–bound specific IgE, release both vasoactive mediators related to the early nasal symptoms and chemotactic mediators that attract inflammatory cells, such as eosinophils, related to the late-phase response. Objective: We have analyzed, during and out of pollen season, in blood and nasal fluid from patients allergic to grass pollen, histamine and tryptase to monitor the early phase markers and eosinophil and eosinophil cationic protein (ECP) to monitor the late phase. Methods: Twenty patients were enrolled in the study. As a control, we studied 10 nonatopic subjects. Mediators and eosinophils were assessed in blood and nasal fluid. Histamine was tested only in nasal fluid. Results: During pollen season, tryptase but not histamine increased in nasal fluids from patients (2.96 vs 0.22 U/ml, p = 0.001) and correlated with symptom scores (r_s = 0.63, p = 0.003). Tryptase was not detected in serum. Eosinophils increased in nasal cytology (17.0% vs 2.0%, p = 0.001) and in the blood (26.5 vs 12.7 × 10⁶ L, p = 0.001) from patients, but they did not correlate with symptom scores. ECP increased only in the nasal lavage (16.33 vs 1.30 ng/ml, p = 0.001) and correlated with symptom scores (r_s = 0.53, p = 0.016). Conclusions: Both ECP and tryptase increase in nasal secretion in natural disease. Therefore the measurement of tryptase and ECP levels in nasal fluid might be a useful clinical test for monitoring disease activity and the effects of therapeutic agents. (J Allergy Clin Immunol 1997;100:832-7.)