Non-Hodgkin Lymphomas of the Oral Cavity in AIDS Patients in a Reference Hospital of Infectious Diseases in Argentina: Report of Eleven Cases and Review of the Literature

Introduction

Extranodal non-Hodgkin lymphoma (NHL) were commonly described in AIDS patients and are related with an atypical morphology and aggressive clinical course.

Materials and Methods

In this single institutional study we evaluated the epidemiological, clinical, immunological, virological, histopathological and the outcome of eleven HIV/AIDS patients with oral cavity lymphomas (OCL).

Results

Nine were males and seven intravenous drug abusers. The median of age was 33 years and the median of CD4 T cell counts at the time of diagnosis was 97 cell/µL. The majority of tumors presented as large and ulcerated masses involving the gingiva, the palate and the jaw. Six of these tumors were diffuse large B-cell lymphomas (DLBCL); three were Burkitt’s lymphomas and the final case was a plasmablastic lymphoma. An association with Epstein-Barr virus (EBV) was found in three of the ten tested cases by in situ hybridization (EBER 1 and 2 probes) and immunohistochemistry (LMP-1). Human herpes virus-8 (HHV-8) was detected by polymerase chain reaction (PCR) in only one neoplasm. Six patients died without specific treatment; four received chemotherapy and highly active antiretroviral therapy (HAART) and three of them presented a prolonged survival.

Discussion

Combination of HAART and chemotherapy should modify the poor prognosis of AIDS patients with OCL.     

The short peritoneal equilibration test in pediatric peritoneal dialysis

The peritoneal equilibration test (PET) is the gold standard method for defining peritoneal membrane permeability and for prescribing peritoneal dialysis (PD) therapy on an individual basis. However, it is laborious, consumes nursing time, and requires many hours to be performed. Therefore, several authors have attempted to validate a short PET protocol, with controversial results. To evaluate the concordance between the 2-h (short) and 4-h (classical) peritoneal equilibrium test, a prospective observational protocol was applied in three PD centers (Mexico, Chile, and Uruguay) between July 1, 2008 and July 31 2009. PET protocol: the night prior to the test, each patient received five exchanges, 1 h each, at the same glucose concentration as previously used. Afterwards, a 2.5% glucose dialysis solution was used for a dwell time of 4 h. Exchange fill volume was 1,100 ml/m² body surface area. The next morning, the 4-h dwell was drained, and Dianeal 2.5% was infused. Three dialysate samples at 0, 2, and 4 h were obtained. A single blood sample was obtained at 120 min. Creatinine D/P and glucose D/D₀ ratios were calculated at hours 0, 2, and 4. Patients were categorized as low, low average, high average, or high transporters according creat D/P and gluc D/D₀ results. Pearson and Kappa test were used for numerical and categorical correlations, respectively, and p?<?0.05 was considered significant. Eighty-seven PET studies were evaluated in 74 patients, 33 males, age 11.1?±?5.05 years old. A positive linear correlation of 92% between 2 and 4-h creat D/P and 80% between 2 and 4-h gluc D/D₀ (p?<?0.001) was founded. The Kappa test showed a significant concordance between creat D/P and gluc D/D₀ categories at 2 and 4 h (p?<?0.001). When analyzing cut-off-value categories, creat D/P was founded to be lower and gluc D/D₀ higher than other experiences. This multicentric prospective study strongly suggests that PET obtained at 2 h and 4 h, based on either creatinine or glucose transport, provides identical characterization of peritoneal membrane transport capacity in PD children.     

Photosensitizer delivery to vulnerable atherosclerotic plaque: comparison of macrophage-targeted conjugate versus free chlorin(e6)

We have previously shown that a conjugate (MA-ce6) between maleylated serum albumin and the photosensitizer chlorin(e6) (ce6) is targeted in vitro to macrophages via class A scavenger receptors. We now report on the ability of this conjugate to localize in macrophage-rich atherosclerotic plaques in vivo. Both the conjugate and the free photosensitizer ce6 are studied after injection into New Zealand White rabbits that are rendered atherosclerotic by a combination of aortic endothelial injury and cholesterol feeding into normal rabbits. Rabbits are sacrificed at 6 and 24 h after injection and intravascular fluorescence spectroscopy is carried out by fiber-based fluorimetry in intact blood-filled arteries. Surface spectrofluorimetry of numbered excised aortic segments together with injured and normal iliac arteries is carried out, and quantified ce6 content by subsequent extraction and quantitative fluorescence determination of the arterial segments and also of nontarget organs. There is good agreement between the various techniques for quantifying ce6 localization, and high contrast between arteries from atherosclerotic and normal rabbits is obtained. Fluorescence correlates with the highest burden of plaque in the aorta and the injured iliac artery. The highest accumulation in plaques is obtained using MA-ce6 at 24 h. Free ce6 gives better accumulation at 6 h compared to 24 h. The liver, spleen, lung, and gall bladder have the highest uptake in nontarget organs. Macrophage-targeted photosensitizer conjugates may have applications in both detecting and treating inflamed vulnerable plaque.     

A New View of the Things We Use: Using Purchasing Data to Predict Common Mixture Exposures

Open in a separate window

Humans are exposed to a multitude of chemicals,1 typically in mixtures. Testing substances individually using traditional methods can be time consuming and cost prohibitive;2 the number of possible chemical combinations makes this type of testing unrealistic for mixtures.3 To circumvent these challenges, scientists at the U.S. Environmental Protection Agency (EPA) used a data-driven approach to identify and prioritize relevant chemical combinations, as reported recently in Environmental Health Perspectives.3Open in a separate windowBy identifying patterns in purchasing data, investigators can estimate common ingredient combinations that consumers are exposed to in the products they use regularly. Knowledge of common co-exposures could help direct experimental toxicology assessments. Image: © iStock/Prostock-Studio.Other efforts to identify high-priority co-exposures have not captured the full spectrum of chemical combinations because of either the lack of ingredient information or insufficient purchase and use data.2^,4^,5 “This study is unique because of the way we were able to integrate multiple data sets to improve our overall understanding of human exposure,” says Zachary Stanfield, a postdoctoral researcher at the U.S. EPA and first author of the study.Stanfield and colleagues matched consumer purchasing data from a marketing database compiled in 2012 with ingredient data obtained from the U.S. EPA’s Chemical and Product Database.6 The combined data streams included approximately 2.4 million purchases by about 53,000 households of 31,000 products. Using frequent item set mining,7 a well-established method for identifying patterns in behavior, the group sifted through the extremely high number of theoretical chemical combinations to identify the truly relevant ones.“Our findings show that, from a risk standpoint, we don’t need to concern ourselves with all possible chemical combinations,” notes Kristin Isaacs, senior author of the study. “This ‘top-down’ approach can supplement others that ‘look under the lamppost’ at specific chemicals.”“This is an important start,” says Julia Brody, executive director of the Silent Spring Institute. “It creates a resource so we can evaluate the combined effects on health [of specific chemicals].” She notes that products’ ingredient data were incomplete and calls for additional ingredient disclosure. “In the U.S., manufacturers can use ingredients without testing first for effects on health, and they don’t have to list all the ingredients on product labels, so we’re always playing catch-up to understand how [products] affect people’s health,” she explains. Brody was not involved in the study.The study revealed exposure variations across demographic groups. Focused analysis comparing predominant purchases and demographic patterns showed several distinct patterns. For example, chemical mixtures most frequently encountered by households with children, households headed by women of color, and lower-income households diverged from those encountered by the rest of the study households.“This suggests a need for further study of the product chemical combinations, such as from hair products used by Black women, that may be contributing to health inequalities,” says Brody. More in-depth studies should look at the factors underlying differences in purchasing behavior within households and communities—for example, how choice, brand, or product availability influences chemical mixture exposures. Brody says information like this can better inform public health policy aimed at eliminating racial inequities in environmental health.     

Stress testing and troponin in unstable coronary syndromes: the status trial-clinical outcomes and resource use

Cardiac troponins are markers used to diagnose acute myocardial infarction, but their value in guiding management in low- to intermediate-risk patients is not well established. Using a randomized design, the authors compared a strategy using stress testing with blinded troponins vs a troponin I-guided strategy for risk stratification and management of 241 patients with intermediate-risk unstable angina. Fewer stress-tested patients required coronary care unit admission and repeat hospitalization for acute coronary syndrome, at a lower cost. There was no significant difference in rates of death and myocardial infarction due to acute coronary syndrome at 6 months' follow-up. For patients with intermediate-risk acute coronary syndrome, stress testing is as safe as, and more cost-effective than, a troponin I-guided strategy. Patients with marginal troponin I elevations can safely undergo stress testing. Further studies combining stress testing and a troponin I-guided strategy are warranted.     

The Iroquois homeodomain proteins are required to specify body wall identity in Drosophila

The Iroquois complex (Iro-C) homeodomain proteins allow cells at the proximal part of the Drosophila imaginal wing disc to form mesothoracic body wall (notum). Cells lacking these proteins form wing hinge structures instead (tegula and axillary sclerites). Moreover, the mutant cells impose on neighboring wild-type cells more distal developmental fates, like lateral notum or wing hinge. These findings support a tergal phylogenetic origin for the most proximal part of the wing and provide evidence for a novel pattern organizing center at the border between the apposed notum (Iro-C-expressing) and hinge (Iro-C-nonexpressing) cells. This border is not a cell lineage restriction boundary.     

Asymptomatic Becker muscular dystrophy in a family with a multiexon deletion

We report a Becker muscular dystrophy (BMD) family with one 5‐year‐old affected patient and a 69‐year‐old asymptomatic grandfather. Dystrophin gene multiplex polymerase chain reaction and multiplex ligation‐dependant probe amplification analysis showed that both males carried an in‐frame deletion of exons 45–55. Segregation analysis revealed two additional asymptomatic boys in this family. Our finding supports previous predictions that exons 45–55 are the optimal multiexon skipping target in antisense gene therapy to transform the severe Duchenne muscular dystrophy into the milder BMD, or even asymptomatic, phenotype. Muscle Nerve, 2008