Rapid HIV type 1 testing of women presenting in late pregnancy with unknown HIV status in Lima, Peru

We studied the feasibility and acceptability of HIV-1 testing using rapid serological assays in pregnant women presenting in late pregnancy without prior HIV-1 testing. Pregnant women presenting to the emergency room at the Instituto Materno-Perinatal in Lima, Peru, were offered on-site rapid HIV-1 testing. Consenting women were provided HIV counseling and had samples taken for rapid detection of antibodies in the blood and oral secretions. Women testing HIV-1 seropositive by one or both assays were offered standard HIV obstetrical care including antiretrovirals. Between October 2000 and August 2001, 3543 women were tested for HIV-1 antibodies through the rapid testing protocol. Twenty-seven women tested positive by one or both assays. Standard EIA results were negative for two of the 27 women and EIA results were not available for an additional three women. Seventeen of the 19 women (89%) for whom delivery information is available received antiretroviral therapy prior to delivery. Eighty percent of the women treated with nevirapine received the drug at least 1 hr prior to delivery. Study personnel reported problems with performing the rapid assays for less than 1% of the samples and the majority of the women did not express a preference for either the oral fluid or blood sample collection. While HIV-1 testing early in pregnancy is preferable, rapid HIV-1 testing in late pregnancy or at delivery is feasible, acceptable to most women, and allows for timely intervention to reduce maternal-child transmission.     

The chemotherapy of lymphoblastic lymphoma

Thirty-two patients treated on consecutive Southwest Oncology Group (SWOG) protocols for malignant lymphoma were subsequently diagnosed as having lymphoblastic lymphoma. Combination chemistry, usually adriamycin-based, produced complete responses (CR) in 17 patients (53%). Median survival was 15 mo. Patients achieving a CR survival significantly longer than patients with partial or no response (p < 0.01). Ten of 24 patients not receiving central nervous system (CNS) prophylaxis developed leptomeningeal lymphoma while none of the seven patients who received prophylactic intrathecal cytosine arabinoside or methotrexate developed CNS lymphoma (p = 0.04). Implications of these results for planning future treatment programs of lymphoblastic lymphoma are discussed.     

Asialo-von Willebrand factor inhibits platelet adherence to human arterial subendothelium: discrepancy between ristocetin cofactor activity and primary hemostatic function

Platelet adherence at high wall shear rates requires plasma von Willebrand factor (vWF). Clinically, the ristocetin cofactor (RCof) activity is the only widely available assay for vWF function. When purified vWF is treated with neuraminidase to yield asialo-vWF (AS- vWF), its RCof activity is increased by 20% to 40%. AS-vWF binds to normal human platelets independently of ristocetin and induces platelet aggregation in the presence of fibrinogen. To determine whether AS-vWF also shows an enhanced capacity to support platelet adherence to subendothelium, we used the Baumgartner technique. Intact vWF, AS-vWF, or AS-vWF treated with beta-galactosidase (asialo, agalacto-vWF; AS,AG- vWF) was added to normal citrated whole blood before perfusion over human umbilical artery segments (wall shear rate, 2,600 sec-1). Four micrograms per milliliter AS-vWF caused a 69% reduction in total platelet adherence compared with citrated whole blood (P less than .001), and 4 micrograms/mL AS,AG-vWF led to a 48% reduction (P less than .005). With 4 micrograms/mL intact vWF, the platelet adherence values were not significantly different from the controls. No significant differences in subendothelial platelet thrombi or postperfusion platelet counts were evident among any of the groups. In reconstituted afibrinogenemic perfusates, 4 micrograms/mL AS-vWF caused a 42% reduction in platelet adherence (P less than .05). Thus, AS-vWF is a potent inhibitor of platelet adherence, despite its enhanced RCof specific activity. Abnormalities in vWF carbohydrate may play a role in impaired primary hemostasis in some patients with von Willebrand's disease.     

Nitric oxide interactions with cobalamins: biochemical and functional consequences

Nitric oxide (NO) is a paramagnetic gas that has been implicated in a wide range of biologic functions. The common pathway to evoke the functional response frequently involves the formation of an iron- nitrosyl complex in a target (heme) protein. In this study, we report on the interactions between NO and cobalt-containing vitamin B12 derivatives. Absorption spectroscopy showed that of the four Co(III) derivatives (cyanocobalamin [CN-Cbl], aquocobalamin [H2O-Cbl], adenosylcobalamin [Ado-Cbl], and methylcobalamin [MeCbl]), only the H2O- Cbl combined with NO. In addition, electron paramagnetic resonance spectroscopy of H2O-Cbl preparations showed the presence of a small amount of Cob-(II)alamin that was capable of combining with NO. The Co(III)-NO complex was very stable, but could transfer its NO moiety to hemoglobin (Hb). The transfer was accompanied by a reduction of the Co(III) to Co(II), indicating that NO+ (nitrosonium) was the leaving group. In accordance with this, the NO did not combine with the Hb Fe(II)-heme, but most likely with the Hb cysteine-thiolate. Similarly, the Co(III)-NO complex was capable of transferring its NO to glutathione. Ado-Cbl and Me-Cbl were susceptible to photolysis, but CN- Cbl and H2O-Cbl were not. The homolytic cleavage of the Co(III)-Ado or Co(III)-Me bond resulted in the reduction of the metal. When photolysis was performed in the presence of NO, formation of NO-Co(II) was observed. Co(II)-nitrosyl oxidized slowly to form Co(III)-nitrosyl. The capability of aquocobalamin to combine with NO had functional consequences. We found that nitrosylcobalamin had diminished ability to serve as a cofactor for the enzyme methionine synthase, and that aquocobalamin could quench NO-mediated inhibition of cell proliferation. Our in vitro studies therefore suggest that interactions between NO and cobalamins may have important consequences in vivo.     

Heterogeneity of penetrance in familial amyloid polyneuropathy,ATTR Val30Met,in the Swedish population

Transthyretin (TTR) familial amyloid polyneuropathies (FAP) are autosomal dominant devastating afflictions. They were first described in Portugal, later in Japan and Sweden and are now recognized worldwide. The TTR Val30Met mutation is the most common, and depending on the geographic origin, a wide variation in age at onset of the disease is observed. In Europe, northern Sweden is the second most prevalent area of the disease, and a late age of onset of 56 years has been reported. The present study aims to estimate the penetrance in TTR Val30Met Swedish families. Genealogical investigations, clinical data and genotyping were obtained in 77 TTR-Val30Met Swedish families. The penetrance in Val30Met carriers and variation within the endemic area, according to gender and transmitting parents were calculated by a newly developed bias-free method. The penetrance estimates were low, i.e. 1.7% and 22% at age 30 and 60 years, respectively, and far from complete (69%) by age 90 years. Differences between Piteå and Skellefteå regions were observed. Moreover, penetrance was significantly higher when the mutation was inherited from the mother than from the father. The low penetrance observed in TTR FAP kindreds and its variations is important information for the genetic counseling and treatment of Swedish FAP patients and their families.     

Comparative in vitro analysis of different hematopoietic cell populations from human cord blood: in search of the best option for clinically oriented ex vivo cell expansion

BACKGROUND: Ex vivo expansion of hematopoietic stem and progenitor cells has become a priority in the experimental hematology arena. In this study we have obtained different hematopoietic cell populations from umbilical cord blood and simultaneously assessed their proliferation and expansion kinetics. Our main goal was to determine which one of these cell populations would be more suitable for clinical‐grade ex vivo expansion. STUDY DESIGN AND METHODS: By using immunomagnetic‐negative selection and cell sorting, five cell populations were obtained: unseparated mononuclear cells (MNCs; I); two lineage‐negative cell populations, one enriched for CD34+ CD38+ cells (II) and the other enriched for CD34+ CD38? cells (III); and two CD34+ cell fractions purified by fluorescence‐activated cell sorting, one containing CD34+ CD38+ cells (IV) and the other containing CD34+ CD38? cells (V). The kinetics of such populations were analyzed in both relative and absolute terms. RESULTS: No expansion was observed in Population I; in contrast, significant increments in the numbers of both progenitor and stem cells were observed in cultures of Populations II to V. Population V (reaching 12,800‐fold increase in total cells; 1280‐fold increase in CD34+ cells; 490‐fold increase in colony‐forming cells; and 12‐fold increase in long‐term culture–initiating cells) showed the highest proliferation and expansion potentials. CONCLUSION: Our study suggests that the cell fraction containing greater than 98% CD34+ CD38? cells would be the ideal one for large‐scale ex vivo expansion; however, based on our data, it seems that, except for MNCs, all other cell populations could also be used as input cell fractions.     

薄层色谱溶剂系统的最优化方法

本文以模糊聚类分析法对81种常用溶剂进行分类,并根据最相邻原理从中优选出二十种色谱分析常用溶剂。再据此结果,以均匀设计试验法和最优化方法——单纯形法为手段,进行溶剂系统的最优化设计。并提出一个改良的色谱优化函数。经初步验证,这是一种比较有效与实用的系统化方法,尚未见国内外报道。本法不仅适用于薄层色谱,也适用于纸色谱及柱型液相色谱。     

Interactions between depression and borderline personality disorder. A pilot study

Although many nosologists advocate the autonomy of borderline personality disorder (BPD), its heterogeneity led to demands that it be absorbed into the affective disorder spectrum. This study attempted to determine if (a) BPD and affective disorders overlapped and (b) if BPD characteristics were differentially associated with specific Axis I, DSM-III diagnoses. Forty-three BPD inpatients were rated retrospectively on 29 variables, including BPD characteristics from Gunderson's diagnostic interview for borderlines (DIB). chi 2 analyses were performed for each of 28 variables in 56 contingency tables whose independent variables were dysthymia/other Axis I diagnoses or depression/no depression. BPD inpatients with dysthymia had more impaired occupational functioning and greater use of splitting. Also, depressed BPDs were in general more dependent, empty and bored, and suicidal.     

Spontaneous bacterial peritonitis in fulminant hepatic failure

Ascites may be associated with fulminant hepatic failure (FHF), but spontaneous bacterial peritonitis (SBP) is an extremely rare complication. We report on two patients with FHF who developed SBP. One patient died and the other recovered.