Improved metabolic profile after switch to darunavir/ritonavir in HIV positive patients previously on protease inhibitor therapy

Metabolic abnormalities associated with cumulative exposure to antiretroviral therapy have been linked to an increased risk of myocardial infarction in HIV positive individuals. The aim of this study was to evaluate whether the switch from lopinavir/ritonavir (LPV/r) or fosamprenavir/ritonavir (FPV/r) to darunavir/ritonavir (DRV/r) is able to improve the lipid profile. A total of 13 Caucasian subjects (7 from LPV/r and 6 from FPV/r) were enrolled in the study and received DRV/r at the dose of 800/100 mg, without change in their NRTI backbone. Viro‐immunological parameters, triglycerides (TGs), total cholesterol (TCh), high‐density lipoprotein (HDL) and low‐density lipoprotein (LDL) cholesterol, fasting glucose, HOMA‐IR, indexes of hepatic and renal functionality, microalbuminuria and cystatin C were measured at baseline (T0), 3 months (T3), 6 months (T6), and 12 months (T12). The switch to DRV/r reduced levels of TCh, LDL, and TGs at T3. Similar improvements were confirmed further at T6 and at T12. A 14% increase in CD4+ count cells (P < 0.05) was observed. Serum cystatin C values showed a statistically significant decrease. After 12 months of switching to DRV/r from LPV/r or FPV/r, patients infected with HIV with TGs above 200 mg/dl, showed a 49% decrease in TGs, along with a 16% reduction of LDL and 19% reduction of TCh. Switching to DRV/r also improved immunological parameters, such as CD4+ cells count and cystatin C plasmatic levels, which may translate into a reduction of the cardiovascular risk. In conclusion, a switch to DRV/r should be considered in those HIV positive patients undergoing antiretroviral therapy, who also present abnormal lipid profiles. J. Med. Virol. 85:755–759, 2013. © 2013 Wiley Periodicals, Inc.     

The distally-based radial fasciosubcutaneous flap for soft tissue cover of the flexor aspect of the wrist.

The distally-based radial forearm fasciosubcutaneous flap is based on the distal perforators of the radial artery. We used it in a particularly difficult case involving loss of soft tissue at the wrist with exposure of tendons and nerves after an operation to section the transverse carpal ligament for carpal tunnel syndrome complicated by a chronic fistula.     

The usefulness of flow cytometric CD10 detection in the differential diagnosis of peripheral T-cell lymphomas

We studied the histologic and multiparameter flow cytometry (MFC) features of 12 cases of angioimmunoblastic T-cell lymphoma (AITL), 13 of mature T-cell lymphoma, and 25 control cases of reactive lymphoid hyperplasia to evaluate the role of CD10 in the differential diagnosis of peripheral T-cell lymphomas (PTCLs). A characteristic immunophenotypic profile (CD2+/CD4+) with recurrent phenotypic aberrancies (eg, CD3 and CD7 loss) was identified in most AITL cases; MFC documented CD10 coexpression on T cells in 10 (83%). Mature T-cell lymphoma showed a more heterogeneous altered immunophenotypic pattern, and 2 cases of PTCL, unspecified, had clear evidence of aberrant CD10 expression on T cells. A small physiologic CD3+/CD4+/CD10+ T-cell population was detected by MFC in all control cases tested (range, 0.28%-4.71%), suggesting that a normal subset of peripheral CD10+ T cells exists. CD10 was a highly sensitive but incompletely specific phenotypic marker for diagnosing AITL; the differential diagnosis of PTCL, unspecified, must be related with traditional histologic features. A small number of CD10+ T cells in reactive lymph nodes suggests that this subpopulation may be the normal counterpart of neoplastic T cells in AITL. The biologic role of CD10+ T cells should be studied further.     

Gaseous metabolism of the chicken embryo and hatchling during post-hypoxic recovery

In neonatal mammals, the drop in oxygen consumption (VO2) during moderate degrees of hypoxia is a manifestation of metabolic depression, and occurs without anaerobic energy compensation. We examined the possibility that embryos also respond to hypoxia with a similar hypometabolic response, by measuring the extent of the O2 debt during post-hypoxic recovery. In chicken embryos at incubation days 11 (E11) and 16 (E16), and hatchlings on the day of hatching (H1), VO2 and carbon dioxide production (VCO2) were measured with an open flow system. The protocol consisted of 1h in air, followed by 40 min in hypoxia (either 17% or 11% O2) and additional 45 min of post-hypoxic recovery. VO2 dropped in hypoxia, more with 11% than 17% O2, and more the younger the animal. During post-hypoxic recovery VO2 returned to, but did not exceed, the pre-hypoxic level, indicating that no O2 debt was contracted during hypoxia. In H1, the changes of VCO2 during hypoxia and post-hypoxia matched those of VO2. Differently, in the embryos, the changes in VCO2 during hypoxia and post-hypoxic recovery were minimal. This phenomenon is explained by changes in the large CO2 stores of the eggs, which buffer the changes in CO2 output of aerobic origin. We conclude that in the chicken embryo and hatchling the energetic shortfall during the hypoxic decrease in VO2 is not compensated by anaerobic energy supply, and represents a phenomenon of metabolic depression.     

Correlation between oncological family history and clinical outcome in a large monocentric cohort of pediatric patients with rhabdomyosarcoma

International Journal of Clinical Oncology - Rhabdomyosarcoma (RMS), an aggressive soft tissue sarcoma of the skeletal muscle generally affecting children and adolescents, shows extensive...     

Cardiac autonomic activity during daytime nap in young adults

The current study investigated both sympathetic and vagal autonomic patterns during a daytime sleep in 25 healthy adults (23.2 ± 2.4 years). Pre‐ejection period (PEP; related inversely to beta‐adrenergic sympathetic activity), the interval between consecutive R‐waves (RR) and frequency‐domain heart rate variability (HRV) were computed during pre‐nap wakefulness and undisturbed sleep stages. Results showed sleep‐related changes in RR and HRV measures, whereas PEP decreased significantly from pre‐nap to sleep, showing no differences across sleep stages. Moreover, pre‐nap PEP and HFnu (the normalized unit of the high‐frequency component of HRV) were associated negatively with sleep latency and wake after sleep onset. These results indicate a marked autonomic output reduction during daytime sleep, with different stage‐dependent fluctuations for sympathetic and vagal activity. Importantly, pre‐nap autonomic activity seems to modulate subsequent sleep quality.