Antiretroviral adherence interventions: a review of current literature and ongoing studies

Adherence has proven to be Achilles' heel of antiretroviral therapy. To achieve the nearly perfect adherence apparently necessary for optimal effects, individuals often require assistance. In this review, we examine antiretroviral therapy adherence intervention studies and reviews published through January 2003 as well as abstracts of ongoing National Institutes of Health-funded research projects aimed at enhancing antiretroviral therapy adherence. The 21 published studies we located utilized 4 intervention strategies: cognitive-behavioral, behavioral, directly observed therapy, and affective. Most of these were pilot or feasibility studies. However, the 4 randomized controlled trials conducted with adequate methologic rigor suggest some promising yet preliminary effects of a pharmacist-led individualized intervention, a cognitive-behavioral educational intervention based on self-efficacy theory, and cue-dose training when combined with monetary reinforcement. The 39 ongoing federally funded studies offer superior methodologic sophistication and include some innovative strategies, such as the use of handheld devices, two-way pagers, and alarmed medication vials, along with enhancement of social and emotional support.     

Nonmurine animal models of food allergy

Food allergy can present as immediate hypersensitivity [manifestations mediated by immunoglobulin (Ig)E], delayed-type hypersensitivity (reactions associated with specific T lymphocytes), and inflammatory reactions caused by immune complexes. For reasons of ethics and efficacy, investigations in humans to determine sensitization and allergic responses of IgE production to innocuous food proteins are not feasible. Therefore, animal models are used a) to bypass the innate tendency to develop tolerance to food proteins and induce specific IgE antibody of sufficient avidity/affinity to cause sensitization and upon reexposure to induce an allergic response, b) to predict allergenicity of novel proteins using characteristics of known food allergens, and c) to treat food allergy by using immunotherapeutic strategies to alleviate life-threatening reactions. The predominant hypothesis for IgE-mediated food allergy is that there is an adverse reaction to exogenous food proteins or food protein fragments, which escape lumen hydrolysis, and in a polarized helper T cell subset 2 (Th2) environment, immunoglobulin class switching to allergen-specific IgE is generated in the immune system of the gastrointestinal-associated lymphoid tissues. Traditionally, the immunologic characterization and toxicologic studies of small laboratory animals have provided the basis for development of animal models of food allergy; however, the natural allergic response in large animals, which closely mimic allergic diseases in humans, can also be useful as models for investigations involving food allergy.     

Three treatments for chronic venous insufficiency: escin, hydroxyethylrutoside, and Daflon

Escin, hydroxyethylrutoside (HR), and Daflon have been shown to be safe and effective for the treatment of chronic venous insufficiency (CVI). They seem to work differently than compression therapy, suggesting that they would usefully augment this therapy. All three phlebotonics attenuate the drop in adenosine triphosphate in venous endothelial cells during hypoxia. This attenuates (1) the inflammation response, (2) the attraction of neutrophils, (3) damage to the veins, and (4) the release of growth factors. These factors otherwise would perpetuate venous insufficiency and contribute to varicose veins. Additional independent effects that would be useful for the treatment of CVI are that they reduce permeability and fragility; HR, Daflon, and perhaps escin increase venous tone; escin inhibits hyaluronidase; Daflon and probably HR are attracted to the veins. With regard to similarity, no differences in effect have been established among these phlebotonics.     

Surgical treatment for scoliosis extending to main thoracic spine by keyvertebral-screws technique （KVST）

Objective ：To introduce a key-vertebral-screws technique （KVST） in the surgical treatment of scoliosis extending to main thoracic levels, and to find the role of fulcrum bending in predicting the result of surgical treatment for scoliosis by this technique. Methods： Seventeen consecutive patients with scoliosis extending to main thoracic spine, who underwent pure posterior fusion without anterior or posterior release by KVST between January 2004 and July 2005 were evaluated for fulcrum bending flexibility, surgical correction rate, fulcrum bending correction index （FBCI） in main thoracic curves. Universal Spine System （USS） instrumentation was used in 15 cases, Monarch in another 2 cases. The severity of the curves was measured by Cobb＇s method using RadWork 6.0 software. Preoperative standing AP radiographs, preoperative fulcrum bending anterioposterior （AP） radiographs, postoperative standing AP radiographs, and most recent follow-up standing AP radiographs for spine were measured and recorded. All the data were analyzed with two-sample paired t-test by Origin 7.0 software. Results： Infection and neurological complications were not noted. No major complications were found. Just one case had some axial back pain, which got a full recovery from physiotherapy for 2 weeks. In the X-ray, there was an average correction of 71.5 % of the fused main thoracic curves, which had no significant lose of correction in final follow-up. For the whole fused main thoracic curves, the fulcrum bending flexibility were lower to operation correction rate （P=0. 013）. The average FBCI was 123%. From the data, the more rigid curves （especially fulcrum bending flexibility 〈50%）, the more correction rate operation could get, compared with fulcrum bending flexibility. Conclusion： （1） KVST is a good method in the surgical treatment of thoracic scoliosis, which can get satisfying result with lower medical cost. （2） Fulcrum bending flexibility is lower than operative correction rate by KVST in main     

When is the best time for psychotherapeutic intervention following autologous peripheral blood stem cell transplantation?

Background and objective:  

To compare the impact of (A) an earlier (months 1 to 6 after PBSCT) vs. (B) a later (months 6 to 12) individualised psychodynamic short-time psychotherapy on health related quality of life.     

Mice are not little rats: species differences in a one-day water maze task

The present study examined species differences in spatial and non-spatial memory in the Morris water maze. Male Wistar rats and C57BL/6 mice were tested in a one-day water maze task in which spatial learning, retention, and non-spatial learning were assessed within 3 h. Rats and mice appeared to use different strategies for locating the hidden escape platform. Whereas rats evinced a clear spatial strategy, mice appeared to rely less on spatial cues and more on alternative non-spatial strategies. The sensitivity of this behavioral protocol to subtle species differences highlights the potential use of this one-day water maze task as a tool for evaluating rapidly learning and memory in rodents.     

Uterine sarcomas: A clinicopathologic study, 1965–1981

Forty-six cases diagnosed as uterine sarcoma from 1965 to 1981 were analyzed. Using mitotic count, 7 of 21 leiomyosarcomas (LMS) were redesignated leiomyomas and all are NED. The actuarial survival rates for the 38 considered sarcomas were 55 and 27% at 2 and 5 years. (The 22 patients eligible for 5-year follow-up had a 27% absolute survival, with 3 of 22 NED.) Fourteen LMS patients had a superior 5-year actuarial survival (42%) than 18 malignant mixed mesodermal (MMM) patients (15%), but the difference disappears when only patients under 70 are considered. Stage and age were the most important prognostic indicators. Complete surgical resection was essential for long-term survival. Six resected patients given adjuvant chemotherapy (mostly VAC) had an improved actuarial survival (61 vs 15% for the 23 resected patients not receiving chemotherapy). Seventy percent of 23 recurrences occurred within 2 years and average survival post-recurrence was 7.6 months. Survival post-recurrence for 8 patients was not improved by chemotherapy. Seventy-eight percent of recurrences had a distal component, with lung being the most common site.     

Perceptions of Control in Children with Externalizing and Mixed Behavior Disorders

Examined the differences in the perception of control in 67 school-age children with externalizing and children with both externalizing and internalizing behavior problems. The results indicated that children with externalizing behavior and mixed behavior could be differentiated by their perception of control. Specifically, children with externalizing behavior endorsed a significantly stronger unknown locus of control than children in the mixed behavior group. Findings suggest that when behavior groups are clearly defined, neither external nor internal locus of control is the dominant style. Implications for the findings are discussed.     

Clotting factor V activity in plasma cryoproteins

Plasma cryoprecipitates containing considerable quantities of clotting factor V were observed in five patients. The unusual factor V activity was not associated with significant amounts of cryofibrinogen. Clinically, the symptoms were not distinguishable from those of other cryopathies. The abnormality did not lead to a deficiency of factor V in the circulating blood nor to a haemorrhagic diathesis.     

Extracorporeal shockwave lithotripsy in childhood

ESWL is a non invasive method for treatment of renal and ureteral stones. This method offers the advantage that all radiopositive renal stones irrespectively of their actual location in the collecting system and the free parts of the ureter can be localized and treated. Between March 1985 and December 1986 in 14 children, aged 2 to 14 years, with renal and ureteral calculi this method was performed. Further should be referred to the fact that two children with complete staghorn calculi were successfully treated by ESWL monotherapy. There was no morbidity and no undue side effects. 12/14 children (= 85%) were free of stones within the first three months following ESWL.