Co-receptor signaling in the pathogenesis of neuroHIV.

The HIV co-receptors, CCR5 and CXCR4, are necessary for HIV entry into target cells, interacting with the HIV envelope protein, gp120, to initiate several signaling cascades thought to be important to the entry process. Co-receptor signaling may also promote the development of neuroHIV by contributing to both persistent neuroinflammation and indirect neurotoxicity. But despite the critical importance of CXCR4 and CCR5 signaling to HIV pathogenesis, there is only one therapeutic (the CCR5 inhibitor Maraviroc) that targets these receptors. Moreover, our understanding of co-receptor signaling in the specific context of neuroHIV is relatively poor. Research into co-receptor signaling has largely stalled in the past decade, possibly owing to the complexity of the signaling cascades and functions mediated by these receptors. Examining the many signaling pathways triggered by co-receptor activation has been challenging due to the lack of specific molecular tools targeting many of the proteins involved in these pathways and the wide array of model systems used across these experiments. Studies examining the impact of co-receptor signaling on HIV neuropathogenesis often show activation of multiple overlapping pathways by similar stimuli, leading to contradictory data on the effects of co-receptor activation. To address this, we will broadly review HIV infection and neuropathogenesis, examine different co-receptor mediated signaling pathways and functions, then discuss the HIV mediated signaling and the differences between activation induced by HIV and cognate ligands. We will assess the specific effects of co-receptor activation on neuropathogenesis, focusing on neuroinflammation. We will also explore how the use of substances of abuse, which are highly prevalent in people living with HIV, can exacerbate the neuropathogenic effects of co-receptor signaling. Finally, we will discuss the current state of therapeutics targeting co-receptors, highlighting challenges the field has faced and areas in which research into co-receptor signaling would yield the most therapeutic benefit in the context of HIV infection. This discussion will provide a comprehensive overview of what is known and what remains to be explored in regard to co-receptor signaling and HIV infection, and will emphasize the potential value of HIV co-receptors as a target for future therapeutic development.

Pancreatic cystic tumors.

Cystic tumors of the pancreas are less frequent than other tumors in neoplastic pancreatic pathology, but in recent years the literature has reported an increasing number. After the first report by Becourt in 1830, cystic tumors were classified into 2 different types by Compagno and Oertel in 1978: benign tumors with glycogen-rich cells and mucinous cystic neoplasms with overt and latent malignancy. The WHO classification of exocrine tumors of the pancreas, published in 1996, is based on the histopathological features of the epithelial wall, which are the main factor in differential diagnosis with cystic lesions of the pancreas. Thanks to the knowledge acquired up to now, a surgical procedure is not always required because the therapeutic choice is conditioned by the correct classification of this heterogeneous group of tumors. Clinical signs are not really useful in the clinical work up, most patients have no symptoms and when clinical signs are present, they may help us to pinpoint the organ of origin but never to identify the type of pathology. In the last few years, the great improvement in imaging has enabled us not only to discriminate cystic from solid lesions, but also to identify the features of the lesions and label them preoperatively. More invasive diagnostic procedures such as fine needle aspiration and intracystic fluid tumor marker level are not really useful because they are not sensitive and the cystic wall can show different degrees of dysplasia and de-epithelialization. These are the reasons for sending the entire specimen to pathology. Good cooperation between surgeons, pathologists, radiologists and gastroenterologists is mandatory to increase the chances of making a proper diagnosis. Therefore, we must analyze all the information we have, such as age, sex, clinical history, location of the tumor and radiological features, in order to avoid the mistake of treating a cystic neoplasm as a benign lesion or as a pseudocyst, as described in the literature. Except for inoperable cases due to the critical condition of the patient or non-resectable lesions, surgical treatment differs with the diagnosis. Cystic tumors of the pancreas, therefore, are a heterogeneous group of tumors, with a real problem regarding differential diagnosis between neoplastic and inflammatory lesions. Even with a proper work up, some perplexity may remain about the nature of the lesion and in these cases the surgical procedure has a therapeutic value as well as playing a diagnostic role. The role of surgery is central in the treatment of these tumors because it could be curative when complete resection is possible. In this way, the lack of good therapeutic results with chemotherapy and radiotherapy force the surgeon to go ahead with the procedure. Intraductal papillary mucinous neoplasms represent a new and, from the epidemiological point of view, important chapter in the world of cystic tumors. The margin of resection is important and the surgeon has to be aware that in order to have a curative resection, total pancreatectomy is sometimes required. In the last few years the therapeutic approach has changed thanks to new knowledge of the biological behavior of these tumors. In fact, from a surgical approach in all cases, we are now discussing the possibility of a follow-up not only for asymptomatic serous cystadenomas but also for the little branch side intraductal papillary mucinous neoplasms (IPMNs) in critical patients. A follow-up could be planned even for solid pseudopapillary tumors but it seems risky to leave untreated big tumors in young patients without a certain diagnosis and with so few studies reported in the literature.

Maximizing learning outcomes by videotaping nursing students' interactions with a standardized patient.

1. Videotaping is a beneficial instructional methodology to help undergraduate students develop awareness of their strengths and opportunities for growth in therapeutic interactional skills. 2. Educational interventions with undergraduate students provide an opportunity to involve doctoral students in vital instruction, research, and knowledge dissemination through publication and presentation. 3. Allowing novice nurses to view their interactional skills with a simulated patient can reduce the anxiety they experience in first therapeutic encounters with assigned patients. 4. Continuous quality improvement in educational methodology is dependent on listening carefully to students who have invaluable feedback to offer and making appropriate correction as indicated.

A review of forgiveness literature with implications for nursing practice.

This article describes clinical practice where forgiveness is a central patient/family issue. In this case, the professional nurses learned substantively from the family about the tragic consequences of forgiveness withheld and the transformative nature of forgiveness extended. The concept of forgiveness is defined and forgiveness as a primary, secondary, and tertiary intervention is considered. Implications for professional practice are developed. Practical forgiveness-based assessment questions are included. A review of instrumentation from other disciplines measuring interpersonal dimensions of forgiveness is offered. Significant aspects of the process of forgiveness are elucidated and opportunities for forgiveness-related nursing research are identified.

Community service-learning in an undergraduate psychiatric mental health nursing course.

This article reports the outcomes of a descriptive study of service-learning undertaken in a Psychiatric and Mental Health Nursing Course at Virginia Commonwealth University. Following a review of the service-learning (S-L) literature, study questions are presented. The S-L intervention is presented, as are characteristics of learners and sites where S-L was conducted. Gains for all stakeholders and lessons learned are reported.

Developing staff nurse experts in nursing diagnosis-based care planning.

In this article, the authors describe the Program to Increase Nursing Knowledge and Facilitate the Utilization of Nursing Diagnosis (PINK FUND) undertaken at the Medical College of Virginia Hospitals. The program prepared unit-based nurses to be facilitators for nursing diagnosis-based care planning. Major curriculum threads included theory of nursing diagnosis, planned change, and adult learning. Instructors modeled innovative instructional methodologies for participants. Program planners vigorously marketed the program to nurses within the institution. The program succeeded in preparing nurses to use the nursing process to deliver planned care. The program description will serve as a potential model for staff development educators seeking to increase staff competence in nursing care planning and documentation.

HIV/AIDS clients' satisfaction with selected aspects of clinic nursing services.

The authors report findings from a semistructured interview study of a random sample of adult clients (N = 20) receiving care in the infectious disease clinic at a large university-affiliated state-supported teaching hospital. Clients were asked to respond to items designed to measure their satisfaction with nursing and social work services at the ID Clinic. Over all, the clients interviewed reported relative satisfaction with services received; however, clients offered substantive suggestions for continuing quality improvement.