Plasma HIV-1 RNA decline within the first two weeks of treatment is comparable for nevirapine, efavirenz, or both drugs combined and is not predictive of long-term virologic efficacy: A 2NN substudy

BACKGROUND: The initial rate of plasma HIV-1 RNA (pVL) decline has been proposed as a marker of early efficacy of antiretroviral therapy (ART) and a possible predictor of late efficacy. We compared the rate of pVL decline in patients starting ART with nevirapine (NVP), efavirenz (EFV), or both drugs combined in addition to lamivudine (3TC) and stavudine (d4T). METHODS: Analysis of the viral decay constant (VDc) during the first 2 weeks of treatment in patients enrolled in the 2NN study who remained on allocated treatment. RESULTS: The median VDc (log10 copies per day, [interquartile range]) was similar for NVP (0.30 [0.25-0.36], EFV (0.31 [0.27-0.37]), and NVP + EFV (0.30 [0.27-0.36]). Patients with a baseline pVL >100,000 copies/mL were 8.7 (95% confidence interval [CI]: 6.2-12.3) times more likely to have a VDc >75th percentile. A high VDc was not associated with plasma drug concentration or with a decreased risk of virologic failure at week 48 after the start of therapy (hazard ratio = 0.8, 95% CI: 0.6-1.2). CONCLUSION: NVP, EFV, or NVP + EFV in combination with 3TC and d4T show similar rates of pVL decline during the first 2 weeks of treatment. The VDc with these regimens is not predictive of late virologic efficacy.     

Marked hypocalcemia after tocolytic magnesium sulphate therapy

Symptomatic hypocalcemia has been reported infrequently in association with magnesium sulfate (MgSO (4)) tocolytic therapy. We report a 38-year-old woman who presented in preterm labor at 24 3/7 weeks. Twenty hours after starting MgSO (4), she developed chest pain. Studies revealed therapeutic serum Mg level, total serum calcium (Ca) = 5.5 mg/dL, 24-hour urine Ca = 763.9 mg, and low serum uric acid and phosphate levels. All studies corrected day 1 postpartum; urine Ca level corrected on day 2. Even short courses of MgSO (4) can result in severe hypocalcemia, raising the question of whether Ca levels should be routinely monitored.     

干细胞移植治疗时间窗与临床疗效的荟萃分析

目的:探讨寻找干细胞移植治疗急性心肌梗死的最佳移植治疗时间,指导临床应用,提高临床疗效。方法:应用计算机检索medline2000-01/2006-05文章,检索词为:"stem cell transplantation and/or acute myocardialinfarction(AMI)and/or chronic heart failure or ischemic cardiomyopathy",限定文章语言种类为English;同时计算机检索中国期刊全文数据库,相同时间的文章,检索词:"干细胞移植治疗,干细胞移植与急性心肌梗死,干细胞移植治疗与心力衰竭或慢性缺血性心肌病",限定文章语言种类为中文。共检索到300余篇与主题有关的文献,其中12篇有价值的文章见参考文献。移植时间取平均值,并按射血分数值和P值进行列表、作图。对干细胞移植时间与射血分数值之间的关系进行分析。结果:在急性心肌梗死后2～5d和9d以后进行干细胞移植治疗疗效较24h内及6～8d为好。结论:干细胞移植治疗急性心肌梗死的移植时间与临床疗效之间可能存在一定的相关性。经冠脉注入干细胞比经静脉或经心内膜下注入可以更好地改善左室功能,但还需要进一步的临床资料证实。     

Understanding the biology of angiogenesis: review of the most important molecular mechanisms

Angiogenesis is an important process for forming new blood vessels. It is fundamental in many biological processes including development, reproduction and wound repair. Under these conditions, angiogenesis is a highly regulated process. Numerous inducers of angiogenesis have been identified, including the members of the vascular endothelial growth factor family, angiopoietins, transforming growth factors, platelet-derived growth factor, tumor necrosis factor-alpha, interleukins and members of the fibroblast growth factor family. Vascular endothelial growth factor-A is the most potent pro-angiogenic protein described to date. It induces proliferation, sprouting and tube formation of endothelial cells. Angiogenesis is therefore a putative target for therapy. The potential application of different angiogenesis inhibitors is currently under intense clinical investigation. A better understanding of the biology of angiogenesis may reveal new targets for treating many diseases that are associated with this complex process. In this review, we summarize the most important molecular mechanisms mediating angiogenesis.