The functional-morphological characteristics of alcohol-induced pathology as dependent on the nature of the intoxication and its nootropil correction in an experiment

The response of hematological system, carbohydrate metabolism and pathomorphologic alterations in the viscera were studied for four weeks on the model of chronic alcoholization in conditions of hydrolytic alcohol production. It is shown that maximal deviations of all the parameters in white conventional rats occur after receiving a combined ethanol dose in inhalation of a mixture of methanol and furfurol vapour. Less manifest pathology was revealed in simultaneous introduction of nootropil solution. Thus, functional-morphologic changes in alcoholic intoxication in unfavourable environment are reversible in purposeful application of drugs with neurometabolic effect.     

Broadly cross-reactive HIV-1-neutralizing human monoclonal Fab selected for binding to gp120-CD4-CCR5 complexes

HIV-1 entry into cells involves formation of a complex between gp120 of the viral envelope glycoprotein (Env), a receptor (CD4), and a coreceptor, typically CCR5. Here we provide evidence that purified gp120(JR-FL)-CD4-CCR5 complexes exhibit an epitope recognized by a Fab (X5) obtained by selection of a phage display library from a seropositive donor with a relatively high broadly neutralizing serum antibody titer against an immobilized form of the trimolecular complex. X5 bound with high (nM) affinity to a variety of Envs, including primary isolates from different clades and Envs with deleted variable loops (V1, -2, -3). Its binding was significantly increased by CD4 and slightly enhanced by CCR5. X5 inhibited infection of peripheral blood mononuclear cells by a selection of representative HIV-1 primary isolates from clades A, B, C, D, E, F, and G with an efficiency comparable to that of the broadly neutralizing antibody IgG1 b12. Furthermore, X5 inhibited cell fusion mediated by Envs from R5, X4, and R5X4 viruses. Of the five broadly cross-reactive HIV-1-neutralizing human monoclonal antibodies known to date, X5 is the only one that exhibits increased binding to gp120 complexed with receptors. These findings suggest that X5 could possibly be used as entry inhibitor alone or in combination with other antiretroviral drugs for the treatment of HIV-1-infected individuals, provide evidence for the existence of conserved receptor-inducible gp120 epitopes that can serve as targets for potent broadly cross-reactive neutralizing antibodies in HIV-1-infected patients, and have important conceptual and practical implications for the development of vaccines and inhibitors.     

The impact of route of delivery and presentation on twin neonatal and infant mortality: a population-based study in the USA, 1995–97

Objective: We examined whether the route of delivery for near-term (???34 weeks' gestation) twins, as candidates for vaginal delivery, affected neonatal and infant mortality rates. We further evaluated whether these mortality rates were modified by fetal presentation.

Methods: A population-based retrospective cohort study based on the matched multiple births data in the USA (1995–97) was performed. Analyses were restricted to non-malformed liveborn twins delivered at ??34 weeks' gestation. Twins with breech–breech and breech–vertex presentations were excluded, since they are not candidates for vaginal delivery. Neonatal mortality rates (death within the first 27 days) and post-neonatal mortality rates (death between 28 and 365 days) per 1000 twin live births, by route of delivery and fetal presentation, were derived. The associations between neonatal mortality, post-neonatal mortality and the route of delivery for vertex–breech versus vertex–vertex presentations were expressed based on relative risks (RR) and 95% confidence intervals (CI) derived from logistic regression models based on the method of generalized estimating equations.

Results: Of the 177?622 twins analyzed, 87% (n?=?154?531) presented as vertex-vertex. Fifty-five per cent (n?=?97?692) of twins were both delivered vaginally, 41% (n?=?72?825) were both delivered by Cesarean section and, of the remaining 4% (n?=?7105), the first twin was delivered vaginally and the second by Cesarean section. Twins with vertex–breech presentations delivered by Cesarean–cesarean sections, as well as those with vertex–vertex presentations delivered vaginally, had the lowest neonatal mortality rate (1.6 per 1000 live births). The highest neonatal mortality rate in the vertex–breech pairs occurred with vaginal–Cesarean deliveries (2.7 per 1000 live births). Among twins with vertex–vertex presentations, twins delivered via the vaginal–Cesarean route experienced the highest neonatal mortality (3.8 per 1000 live births). The RR for neonatal mortality in this group was 2.24 (95% CI 1.35, 3.72) compared with twins both delivered vaginally.

Conclusion: Route of delivery and fetal presentation both confer an impact on twin infant mortality rates. Strategies to reduce discordant routes in complicated vaginal deliveries may lead to improved neonatal survival.     

Stroke in pregnant and postpartum women

Ischemic infarcts and hemorrhages are uncommon but dangerous complications of pregnancy. Their etiology is related to physiological changes during pregnancy. The majority of strokes are seen in the third trimester and postpartum and are etiologically related to three conditions: reversible cerebral vasoconstriction syndrome, preeclampsia/eclampsia and cerebral venous thrombosis. The first two conditions are etiologically connected and can lead to ischemic and hemorrhagic events, whereas cerebral sinus thrombosis is mainly related to hypercoagulation and causes venous infarcts and brain hemorrhages. MRI and CT scans are safe to use for diagnosis of stroke in pregnancy, although use of iodine-based contrast may affect thyroid function of the neonate. Management of stroke in pregnancy is specific to cause and depends on management of blood pressure and delivery in preeclampsia/eclampsia, expected management or calcium channel blockers in reversible cerebral vasoconstriction syndrome, and anticoagulation for cerebral sinus thrombosis.     

Predictive models for diabetes patients in Medicaid

Predictive modeling can be used to identify persons who are at increased risk for adverse health outcomes. We used demographic, medical, and pharmacy claims data to create a gender-specific model for fee-for-service Medicaid based on 2 states' data that can assist with the identification of persons with an elevated future risk of hospitalization, elevated claims expense, or death. Depending on age and the outcome of interest, the area under the receiver operating characteristic curve for this predictive modeling tool across 2 states' diabetes populations ranged from 0.608 to 0.834. We conclude that this analysis yielded a level of accuracy comparable to other predictive models that can be used to target patient enrollment in population-based care management.     

Transluminal balloon angioplasty as a method of choice in treatment of critical ischemia of lower extremities

The authors analyzed results of treatment of 127 patients. A new direction in the endovascular treatment of critical ischemia of the lower extremities is substantiated on the basis of a combination of methods of subintimal and intraluminal angioplasty. For the first time all the patients with critical ischemia of lower extremities, and having no irreversible changes of the extremity requiring amputation at the level of the low leg or femur, must be considered as good candidates for translumbar balloon angioplasty.