Neutralizing antibody responses in acute human immunodeficiency virus type 1 subtype C infection.

The study of the evolution and specificities of neutralizing antibodies during the course of human immunodeficiency virus type 1 (HIV-1) infection may be important in the discovery of possible targets for vaccine design. In this study, we assessed the autologous and heterologous neutralization responses of 14 HIV-1 subtype C-infected individuals, using envelope clones obtained within the first 2 months postinfection. Our data show that potent but relatively strain-specific neutralizing antibodies develop within 3 to 12 months of HIV-1 infection. The magnitude of this response was associated with shorter V1-to-V5 envelope lengths and fewer glycosylation sites, particularly in the V1-V2 region. Anti-MPER antibodies were detected in 4 of 14 individuals within a year of infection, while antibodies to CD4-induced (CD4i) epitopes developed to high titers in 12 participants, in most cases before the development of autologous neutralizing antibodies. However, neither anti-MPER nor anti-CD4i antibody specificity conferred neutralization breadth. These data provide insights into the kinetics, potency, breadth, and epitope specificity of neutralizing antibody responses in acute HIV-1 subtype C infection.

Phenotypic characterization of HIV type 1 isolates from Ghana.

Viral isolates from 27 HIV-1-infected patients in Ghana, most of whom were symptomatic, were characterized for coreceptor usage using MT-2 and U87.CD4 cells. Irrespective of clinical status, most infections were caused by CCR5-tropic viruses although three CXCR4-tropic viruses were also found. Genotyping was performed by sequencing the gp41 region. Seven viruses clustered with subtype G reference strains, while the remaining 20 viruses clustered within the subtype A reference viruses. Most subtype A isolates clustered loosely with the CRF02_AG viruses and are described as CRF02_AG-like. The V3 loop was sequenced in selected isolates including all isolates capable of using CXCR4. The V3 region of CXCR4-using viruses contained genetic traits characteristic of CXCR4-using subtype B and C viruses, such as increased charge, the presence of positively charged residues at positions 11 and 25, and loss of a predicted glycosylation site. This study supports previous work showing that CRF02_AG is responsible for most HIV-1 infections in Ghana at this time. The predominance of CCR5-using viruses, even in symptomatic patients, suggests that CCR5-blocking strategies may be useful for prevention and treatment of HIV-1 infections in Ghana.

Long-term Paparella II grommet use in the management of persistent childhood otitis media: a 5-year follow-up study.

A comprehensive 5-year follow-up study of Paparella grommet use in UK. Study group consists of children previously treated with short-term grommets and with persistent glue ear. Mean functional period was 3.73 years with 52% being retainde for the full 5 year duration of the study. Infection and perforation rates increased with the duration of grommet in-situ and this was especially marked after 36 months. We advise the elective removal of these long-term grommets after 3 years of function to reduce compication rate.

Detection of laryngeal carcinoma and epithelial hyperplastic laryngeal lesions via a rapid-access dysphonia clinic.

Recent government initiatives in the UK have focused on streamlining oncology services by reducing waiting times between urgent referral, assessment and treatment of patients with possible cancer. The performance of the Quick Early Diagnosis Dysphonia Clinic of the Queen Elizabeth Hospital, Birmingham, between May 1997 and April 2001 was reviewed. Of 721 patients reviewed, 123 (17 per cent) had clinically suspicious laryngeal lesions. Thirteen cases of epithelial hyperplastic laryngeal lesions and 27 laryngeal malignancies were diagnosed. There was no statistical link between early cancer detection and assessment within two weeks of referral. However, rapid-access clinics for dysphonia serve an important role in the reassurance and multidisciplinary management of patients with persistent hoarseness. Greater financial commitments are necessary to achieve compliance with objectives for a maximum two-week wait for patients with suspected laryngeal malignancy.

Gunshot injuries to the temporal bone.

The current incidence of missile injury to the temporal bone (MITB) is very low in the United Kingdom. However, the increasing frequency of firearm violence in Britain suggests a greater risk of occurrence. This, along with the devastating potential sequelae of MITB (facial palsy, dead ear, intracranial damage, major vascular injury and cosmetic disfigurement), requires otolaryngologists to be conversant with all aspects of their management. The risk of major complications is much higher with MITB than with temporal bone injury following blunt trauma, and surgical management is, therefore, much more common. We present one such case, and review the literature outlining the pathogenesis, clinical features, and recommended management.

Bilateral cortical blindness: an unusual complication following unilateral neck dissection.

We present the case of a 50-year-old man who developed bilateral cortical blindness and confusion following a seemingly uneventful right-sided radical neck dissection. Computed tomography (CT) scans confirmed bilateral occipital lobe infarctions. To our knowledge, there are no previously documented reports of this clinical event following head and neck surgical procedures. Although this is a rare occurrence, otolaryngologists should be aware of this potential post-operative complication. The possible aetiologies of this condition are discussed.

Atypical lipoma of the tongue.

We report an atypical lipoma arising in the tongue of a 43-year-old man who presented with an indolent dorsal lingual swelling. Atypical lipomas contain multivacoulated lipoblasts, which distinguishes them from benign lipomas. The superficial location in this case distinguishes this tumour from well-differentiated liposarcoma, which is biologically similar in lacking the propensity for metastasis. The superficial location of atypical lipoma allows a complete resection, which is often not possible for the deep-seated counterpart. Atypical lipoma and well-differentiated liposarcoma, if left in situ, may undergo transition to de-differentiated liposarcoma. Atypical lipoma should be completely excised with a cuff of normal tissue in order to prevent repeated local recurrence and the possibility of de-differentiation.

Relevance of commercial diagnostic tests to detection of enteric adenovirus infections in South Africa.

The prevalence of enteric adenoviruses detected by an in-house enzyme-linked immunosorbent assay (the RIVM-ELISA) ranged from 13 to 38%, and subgroup F adenoviruses comprised 86%. All subgroup F adenoviruses reacted with both RIVM anti-adenovirus type 40 (Ad40) and anti-adenovirus type 41 (Ad41) monoclonal antibodies but were not detected by Adenoclone Type 40/41 enzyme immunoassay (EIA). The correlation between the Biotrin EIA and RIVM-ELISA results was low (26%). Immunospecific tests suggest that a significant proportion of enteric adenoviruses, possibly comprising previously unidentified or emerging types, are not detected by commercial diagnostic tests in South Africa.

The influence of flooring on standing balance among older persons.

This study investigated the effects of flooring on balance during quiet standing in healthy young and older participants. Seven flooring conditions were examined, including a hard tile floor and combinations of low-pile and high-pile carpet with urethane foam and rubber padding. The resulting floors provided a variety of compliant surfaces, ranging from very soft to hard. Participants stood during three separate visual conditions: eyes open, eyes closed, and looking at a moving visual surround. Three measures of postural sway were calculated using center of pressure recordings during the trails. The results showed that the amplitude of sway was higher in the older than in the younger participants, particularly in the moving visual surround condition. Flooring compliance was found to have an effect on sway during moving visual environments, with the largest effects found among the older participants. Softer floors increased the amount of sway in the older participants. These results suggest that floor compliance influences standing postural stability in older people, particularly in destabilizing visual environments.

Senior market tough to crack. MacNeal Health Network, Berwyn, IL.

Seniors, often thought of as a stodgy, conservative market, actually constitute one of the most vibrant, diverse age groups of all. Here's how people who have discovered the secrets of the mature market use that diversity to their advantage.

Center takes hard line with press. The missing infant incident at Columbia Trident Medical Center.

When the body of a stillborn infant went missing from the Columbia Trident morgue, the press pounced. The hospital was accused of everything from neglect to a police-protected cover-up. Reporters stopped patients in the parking lot to ask them if they felt safe. Others used the incident to question Columbia's proposed merger with the local university medical center. In response, Columbia Trident initiated a strict policy that prohibits the press from showing up unannounced and stridently protects the rights of patients and employees. The case provokes questions about the role of public relations professionals in an age of sensationalism. When is withholding information justified and when is it an obstruction of justified inquiry? How far is too far for the press?

IDS proves benefits with report card.

Everyone says integrated delivery reduces costs while improving quality, but The Health Alliance of Greater Cincinnati sets out to prove it. Its data-filled report for payers takes seriously the new trend in report card marketing.

Making it in a 'saturated' market. How the Spence Center wins women's hearts with grass-roots marketing.

The Spence Centers, full-service, independent clinics for women, depend on grass-roots outreach to cultivate customers and build brand equity. The Centers have garnered national and international press coverage and made enough friends to open a fourth operation.

Cheshire Medical Center puts wellness on the Web, with a marketing-savvy physician and cute babies.

Cheshire Medical Center is devoted to wellness. Unlike many, its physician-designed web site reflects its mission and works hand-in-hand with its other marketing communications. Patients love the easy access to information about seminars and prescription drugs, but regional antagonists might soon provide compelling competition.

Patients unhappy, AHA/Picker say.

The American Hospital Association and The Picker Institute say Americans want more information and empowerment from their providers. Fully one-third of those surveyed by the organizations say they have problems getting answers to important health-related questions. Marketers need to reconsider their own assessments of patient satisfaction and get patients more information. CHESS, a computerized information-distribution package, provides one elegant--and cost-saving--example.

Cascade blue derivatives: water soluble, reactive, blue emission dyes evaluated as fluorescent labels and tracers.

Fluorescent dyes based on the pyrenyloxytrisulfonic acid (Cascade Blue) structure were prepared and evaluated. The dyes contain functional groups that react with amines, thiols, acids, aldehydes, and ketones, forming covalently bonded, fluorescent derivatives of molecules with broad biological interest. Reactive groups in the Cascade Blue dyes include carboxylic acids and activated esters, amines, hydrazides, alcohols, photoaffinity reagents, acrylamides, and haloacetamides. The dyes exhibited absorption maxima at 374-378 nm and 399-403 nm, with extinction coefficients in the range of 1.9 x 10(4)-2.4 x 10(4) M-1cm-1 and 2.3 x 10(4)-3.0 x 10(4) M-1cm-1, respectively. Emission maxima ranged from 422-430 nm. The spectral properties of the fluorescent dyes are sufficiently different from fluorescein to permit simultaneous use of both dyes with minimum spectral interference. The Cascade Blue derivatives have narrower spectral bandwidths and smaller Stokes' shifts than other reactive dyes with similar spectral properties, do not show appreciable sensitivity to pH, have higher solubilities in aqueous solution, and have good to excellent quantum yields. Cascade Blue conjugates of a number of histochemically and biologically useful molecules were prepared, including dextrans, albumins, Fc receptor binding proteins, antibodies, lectins, membrane receptor binding proteins, and biotin binding proteins, as well as biological particles and bacteria. Cascade Blue conjugates of secondary and tertiary labels yielded specific fluorescence localization in the indirect immunofluorescent staining of human epithelial cell (HEp-2) nuclei.

Dihydrotetramethylrosamine: a long wavelength, fluorogenic peroxidase substrate evaluated in vitro and in a model phagocyte.

Dihydrotetramethylrosamine, a fluorogenic substrate for peroxidase, and its fluorescent oxidation product, tetramethylrosamine chloride, were evaluated. The substrate is colorless and nonfluorescent while the oxidized dye absorbs at 550 nm and emits at 574 nm in both methanol and water. In vitro assays demonstrated that the substrate was oxidized to the fluorophore by horseradish peroxidase in the presence of hydrogen peroxide. In vivo uptake and oxidation of the substrate by Amoeba proteus was characterized by the initial appearance of fluorescent phagocytic vacuoles with subsequent localization in vesicular organelles the size and shape of protozoan mitochondria. Similar staining patterns occurred in cells incubated with substrate, oxidized rosamine or rhodamine 123, a known mitochondrial stain.

Vasoactive characteristics of calcitonin in coronary and hepatic circulations.

Although parathyroid hormone (PTH) has been shown to possess potent vasodilator and hypotensive properties, little information is available on the cardiovascular effects of the other major calcium-regulating peptide hormone, calcitonin. In the present studies we examined the possibility that calcitonin may be vasoactive in the coronary and hepatic circulations. In anaesthetized open-chest or open-abdomen dogs, salmon calcitonin (sCT) (0.0001-10 IU/kg), PTH-(1-34) or adenosine were injected intra-arterially via the left circumflex or common hepatic artery. Flow probes were placed proximal to the injection sites to determine blood flow rates before and after injections. The results showed that sCT was vasoactive in the dog, eliciting opposite effects on basal flow in the coronary (vasoconstriction) and hepatic (vasodilatation) circulations, but augmenting PTH-induced vasodilatation in both regions.