Antibody seronegative human T-lymphotropic virus type III (HTLV-III)- infected patients with acquired immunodeficiency syndrome or related disorders

The human T-lymphotropic virus type III (HTLV-III) is the primary cause of the acquired immunodeficiency syndrome (AIDS) and related disorders (ARC). Prior studies have reported that nearly all symptomatic patients with AIDS or ARC manifest antibody to HTLV-III. This observation has engendered efforts to screen for HTLV-III, especially prior to blood donation, with assays for antibody to HTLV-III. We report the first two cases, one with AIDS and one with ARC, that are HTLV-III virus positive but antibody negative. Accurate diagnosis of HTLV-III infection in some cases may require direct virus culture or tests for antigen. In addition, lack of HTLV-III antibody may indicate an atypical clinical course of AIDS.     

Abnormalities of the executive control network in multiple sclerosis phenotypes: An fMRI effective connectivity study

The Stroop interference task is a cognitively demanding task of executive control, a cognitive ability that is often impaired in patients with multiple sclerosis (MS). The aim of this study was to compare effective connectivity patterns within a network of brain regions involved in the Stroop task performance between MS patients with three disease clinical phenotypes [relapsing‐remitting (RRMS), benign (BMS), and secondary progressive (SPMS)] and healthy subjects. Effective connectivity analysis was performed on Stroop task data using a novel method based on causal Bayes networks. Compared with controls, MS phenotypes were slower at performing the task and had reduced performance accuracy during incongruent trials that required increased cognitive control. MS phenotypes also exhibited connectivity abnormalities reflected as weaker shared connections, presence of extra connections (i.e., connections absent in the HC connectivity pattern), connection reversal, and loss. In SPMS and the BMS groups but not in the RRMS group, extra connections were associated with deficits in the Stroop task performance. In the BMS group, the response time associated with correct responses during the congruent condition showed a positive correlation with the left posterior parietal → dorsal anterior cingulate connection. In the SPMS group, performance accuracy during the congruent condition showed a negative correlation with the right insula → left insula connection. No associations between extra connections and behavioral performance measures were observed in the RRMS group. These results suggest that, depending on the phenotype, patients with MS use different strategies when cognitive control demands are high and rely on different network connections. Hum Brain Mapp, 37:2293–2304, 2016. © 2016 Wiley Periodicals, Inc.     

Selective release of cytokines,chemokines, and growth factors by minced skin in vitro supports the effectiveness of autologous minced micrografts technique for chronic ulcer repair

A new effective surgical procedure to repair chronic ulcers called minced micrografts technique has been recently reported. The technique consists in spreading a finely minced skin sample upon the wound bed. In this study, we investigate the in vitro release of cytokines (interleukin‐6, tumor necrosis factor‐α, interleukin‐1α, and granulocyte‐colony stimulating factor), chemokines (monocyte chemoattractant protein‐1 and growth‐related oncogene‐α), and growth factors (platelet‐derived growth factor, basic fibroblast growth factor, vascular endothelial growth factor, hepatocyte growth factor, and nerve growth factor) by minced (referred to as the minced sample) vs. not minced (referred to as the whole sample) human skin biopsy samples from the same donor. Factor release in the culture medium at different time points was detected using a multiplexed protein assay. The minced sample, which could behave like the skin fragments used in vivo in the autologous minced micrografts technique, expressed higher levels of tumor necrosis factor‐α, interleukin‐1α, platelet‐derived growth factor, and basic fibroblast growth factor, and lower levels of interleukin‐6, monocyte chemoattractant protein‐1, growth related oncogene‐α, and vascular endothelial growth factor compared with the whole sample. In conclusion, mincing of healthy skin may allow appropriate regulation of the inflammatory phase of wound healing and could induce overexpression of some growth factors, which facilitates the proliferative phase of healing.     

Predicting local failure after radical cystectomy in patients with bladder cancer: Implications for the selection of candidates at adjuvant radiation therapy

Objective

To evaluate incidence and predictors of local failure (LF) after radical cystectomy (RC) due to bladder cancer.

Bridge to durable left ventricular assist device for refractory cardiogenic shock

Objective

The role of short-term mechanical circulatory support has increased in patients with refractory cardiogenic shock. However, limited data exist on the outcomes of a bridge to a durable left ventricular assist device strategy using short-term mechanical circulatory support.

Natural history of hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is a slowly growing tumor, whose natural history is not completely known. Since the hepatocarcinogenetic process may evolve for years in a stepwise fashion from premalignant to overt HCC, detection of early, better treatable tumors is made possible by surveillance of patients at risk. A 6-month interval surveillance with ultrasound is considered cost-effective, generally leading to the identification of a single < 3 cm tumor in 50-70% of the patients at risk. For greater than 2 cm tumors, demonstration of arterial hypervascularization of the node by sonovue US, triphasic spiral CT or MRI is diagnostic for HCC. The diagnosis of a less than 2 cm in diameter tumor may be more difficult due to the risk of false negative diagnoses with contrast imaging technique (50% of the cases) caused by immature arterial vascularization of the small nodules. Prognosis largely depends on the evolutionary stage at which HCC is detected, i.e. a size and number of HCC nodes, vascular invasiveness and degree of liver impairment. The multinodular pattern of HCC, representing one third of all early cancers, heralds poor prognosis, especially for patients not fitting the Milan criteria for liver transplantation. The best prognosis is for a single, less than 5 cm node in compensated cirrhosis without vascular invasion, since this tumor is amenable to both liver transplantation and hepatic resection which may confer long-term survival Better survivals of cirrhotic patients with a recently identified tumors reflect the application of accurate criteria for tumor staging and stringent criteria for curative treatments. However, ageing of the patients, deterioration of liver function during surveillance, occurrence of multinodular tumors and limited access to liver transplantation may hamper surveillance programs effectiveness.