European guidelines on the clinical management of HIV-1 tropism testing.

Viral tropism is the ability of viruses to enter and infect specific host cells and is based on the ability of viruses to bind to receptors on those cells. Testing for HIV tropism is recommended before prescribing a chemokine receptor blocker. In most European countries, HIV tropism is identified with tropism phenotype testing. New data support genotype analysis of the HIV third hypervariable loop (V3) for the identification of tropism. The European Consensus Group on clinical management of tropism testing was established to make recommendations to clinicians and clinical virologists. The panel recommends HIV-tropism testing for the following groups: drug-naive patients in whom toxic effects are anticipated or for whom few treatment options are available; patients who have poor tolerability to or toxic effects from current treatment or who have CNS pathology; and patients for whom therapy has failed and a change in treatment is considered. In general, an enhanced sensitivity Trofile assay and V3 population genotyping are the recommended methods. Genotypic methods are anticipated to be used more frequently in the clinical setting because of their greater accessibility, lower cost, and faster turnaround time than other methods. For the interpretation of V3 loop genotyping, clinically validated systems should be used when possible. Laboratories doing HIV tropism tests should have adequate quality assurance measures. Similarly, close collaboration between HIV clinicians and virologists is needed to ensure adequate diagnostic and treatment decisions.

Plerixafor with and without chemotherapy in poor mobilizers: results from the German compassionate use program.

The CXCR4-inhibitor plerixafor mobilizes hematopoietic stem cells amplifying the effects of granulocyte-CSF (G-CSF). Before approval plerixafor was used in a compassionate use program (CUP) for patients who failed a previous mobilization. In the German CUP 60 patients from 23 centers (median age 56.5 years (2-75)) were given 240 µg/kg plerixafor SC 9-11 h before apheresis. A total of 78.3% (47/60) received G-CSF for 4 days before plerixafor administration; 76.6% of those (36/47) yielded at least 2.0 × 10(6) CD34(+) cells/µL. The median cell yield was 3.35 × 10(6) CD34+ cells/kg (0-29.53). Nine patients received plerixafor alone or with G-CSF for less than 4 days mobilizing a median of 3.30 × 10(6) CD34+ cells/kg (1.6-5.6). There was no significant difference between G-CSF application for 4 days and for a shorter period of time (P=0.157). A total of 47 patients received plerixafor plus G-CSF combined with chemotherapy yielding a median of 3.28 × 10(6) CD34+ cells/kg (0-24.79). In all, 40 of 60 patients (66.7%) proceeded to transplantation, and achieved a timely and stable engraftment. Side effects were rare and manageable. In conclusion, mobilization with plerixafor in poor mobilizers is safe and results in a sufficient stem cell harvest in the majority of patients.

Digit ratio (2D:4D) predicts sporting success among female fencers independent from physical, experience, and personality factors.

Research particularly focusing on male athletes and popular sports (running and soccer) suggests associations of lower (masculinized) second-to-fourth digit ratio (2D:4D), a putative marker of prenatal androgen action, with better sports performance. Studies focusing on women, non-mainstream sports, or controlling for covariates relevant for sporting success are still sparse. This study examined associations between 2D:4D and performance of both male and female athletes active in fencing (a non-mainstream sport dominated by male participants), while controlling for covariates. National fencing rankings and 2D:4D of 58 male and 41 female Austrian tournament fencers (mean age 24 years) were correlated. Among female, but not male, fencers, lower 2D:4D was related to better national fencing rankings. 2D:4D still accounted for incremental variance (12%) in fencing success, when the effects of salient performance factors (age, body mass index, years of fencing, training intensity, and the personality variables achievement, control, harm avoidance, and social potency) were controlled for (totaling 35% attributable variance). Athletes active in the most aggressive form (the sabre) had lower 2D:4D than those active in the other forms (épée and foil fencing). Sporting success in adult life might be partly prenatally programmed via long-lasting extragenital effects of testosterone.

Demonstration of UVB-induced synthesis of 1 alpha,25-dihydroxyvitamin D3 (calcitriol) in human skin by microdialysis.

Cutaneous vitamin D(3) (VD(3)) is generated by UVB-induced photolysis of 7-dehydrocholesterol (7-DHC). VD(3) then undergoes sequential hydroxylation to calcidiol (25-OHD(3)) in the liver and to hormonally active calcitriol (1 alpha,25-(OH)(2)D(3)) in the kidney. Recently, we have described the epidermal VD(3) metabolic pathway by demonstrating the autochthonous formation of calcitriol in cultured keratinocytes. In this study we sought to determine whether photolysis of 7-DHC induced by irradiation of human skin with monochromatic UVB at 300 nm results in epidermal synthesis of calcitriol in vivo. Using a microdialysis technique we demonstrated that UVB irradiation results in a dose- and time-dependent increase in the calcitriol concentration in the extracellular fluid of UVB-irradiated skin. Topical treatment of skin with an ointment containing 2% ketoconazole immediately after irradiation suppressed UVB-induced intraepidermal calcitriol synthesis. This study demonstrates for the first time UVB-triggered synthesis of calcitriol in human skin in vivo. The link between UVB irradiation and synthesis of calcitriol in the skin may be of great importance for regulation of biological processes such as cell growth, differentiation, apoptosis and immunological reactions.

Age-associated changes in integral cholesterol and cholesterol sulfate concentrations in human scalp hair and finger nail clippings.

In contrast to surface lipids originating from the sebaceous glands, membrane-forming integral lipids occur in keratinized tissues of skin, and skin appendages like fingernail plates or scalp hair. After removal of lipids of sebaceous origin by exhaustive solvent extraction, lyophilizing and hydrolyzing fingernail plate and scalp hair samples, fractions of integral cholesterol (CH) and cholesterol sulfate (CS) were quantified using gas chromatography. We studied these bound lipids and the serum lipids of 70 healthy subjects, aged 20.1 to 92.0 years. We observed higher amounts of CS in hair clippings of men than of women (775+/-241 vs 662+/-239 nmol/g hair, respectively). The highest amounts of CS were found in men with serum LDL-CH > 4.14 mmol/L; this subgroup also showed the highest CH values in fingernail clippings (2293+/-621 nmol/g nail). However, analysis of integral lipids of hair and fingernail plate clippings had little significance in detecting hypercholesterolemia in normal persons. An increase in integral CH levels in fingernail clippings with donor age was noted, independently of variations in serum CH or LDL-CH. This correlation proved to be significant in men (R=0.43), but not in women (R=0.38). In contrast, in women but not in men we found donor age correlated with internal CH of hair samples (R=0.43) and with CS of nail plates (R=-0.59), independently of serum CH or LDL-CH variations. This age-dependent decrease in CS levels might explain the previously observed higher incidence of brittle nails in women. Obviously, the metabolism of internal lipids CH and CS in fingernail and scalp hair differs between genders, and shows age-associated changes.

[Heparin-induced thrombocytopenia with unfractionated heparin. A prospective study of inpatient treatment of internal medicine patients]. / Heparin-induzierte Thrombozytopenien unter nichtfraktioniertem Heparin. Eine prospektive Studie bei stationär behandelten internistischen Patienten.

AIM: To investigate the influence of unfractionated heparin on heparin-induced thrombocytopenia (HIT) type II. PATIENTS AND METHOD: In 162 patients with internal diseases treated therapeutically of prophylactically with unfractionated heparin (heparin sodium, heparin calcium), we carried out a prospective study to determine the incidence of HIT type I and II. 55.6% of the patients were female (n = 90) with an average age of 76.5 years (range: 25 to 96 years) and 44.4% male (n = 72) with an average age of 67.5 years (range: 17 to 93 years). A platelet count was taken regularly before the start of heparin treatment, on the first day of treatment and then every second day from day 5 to 20. Whenever HIT II was suspected, an HIPA test was performed. RESULT: Type I HIT occurred in 10%, type II in 3% of the cases. Two of the 5 patients with type II developed severe thrombotic complications. CONCLUSION: In view of the high incidence of HIT, regular platelet counts should always be carried out in patients receiving heparin treatment.

HIV and AIDS in Germany.

AIDS: While Germany is still classified as a pattern I country under the World Health Organization (WHO) standards, meaning most new HIV infections occur in populations at risk, trends within this broad classification are slowly changing. Both the proportion and the absolute number of women reported as newly infected have increased, and account for 20 percent of all new infections. The annual number of new infections among gay men has stabilized at close to 1,000, or 55 percent of all new infections. Immigrants and refugees from endemic areas in Asia and Africa now comprise 17 percent of all newly reported infections. In addition, the country's policy of making new drugs available to Germans immediately after they are approved anywhere else in the world has created a healthcare system in which patients have access to a broad array of exciting new treatments, but little professional advice on treatment strategies or safety precautions. Thus, medical professionals must work to remain abreast of new developments in treatment. Meanwhile, organizations that have been set up to help people live with HIV face increased economic difficulties as new treatments lower morbidity rates.^ieng

[Fumaria officinalis (fumitory)--clinical applications]. / Fumaria officinalis (Echter Erdrauch)--klinische Anwendung.

Fumaria officinalis-fumitory or earth smoke-is a medicinal plant which has long had a role to play in empirical medicine in numerous countries. A review of the literature, however, reveals very few studies that support its use for dermatological indications (milk crust, eczema, scabies, etc.) or as a diuretic or laxative. This contrasts with its use to treat functional diseases of the biliary system. Although no placebo-controlled studies have been done, a number of empirical reports, clinical case reports and animal experimental studies have been published. Accordingly, in Germany, Fumaria officinalis is approved for the indication "colicky pain affecting the gallbladder and biliary system, together with the gastrointestinal tract".

[Tardive congenital glaucoma in the case of brothers]. / Glaucom congenital cu debut tardiv în cadrul unei fratrii.

The case of a family is presented, in which mother had been operated 5 years ago for tardive congenital glaucoma, in a very advanced stage. At that moment, the examination of the eldest son had not revealed modifications of the visual acuity, eye fundus and intraocular pressure. After 5 years, the examination of the 5 children revealed tardive congenital glaucoma in a very advanced stage at the first son and in a manifest stage at the second. The obvious conclusion is to emphasize the importance of the careful periodical examination for all the descendents of a patient with congenital glaucoma.

Immunologic and antiviral therapy in herpetic keratitis.

A group of 113 patients with herpetic keratitis who were administered besides the classical therapy (local and general) immunologic and antiviral treatments was studied. The following Romanian non-toxic preparations were used: "SRE Immunostimulent", "Moroxidin" chlorhydrate and "Antiherpin". The control group including 120 patients received a classical treatment and the first signs of recovery appeared after 30 days; in 32% of the patients recurrences, were recorded during the first year. The recovery of the patients included in the experimental lot (113) consisted in the disappearance of congestive phenomena after 3-4 days; recurrences occurred in 14% of the patients after 1, 2 or even 4 years, especially in those who received an incomplete treatment.

[The eye manifestations in phosphorus-calcium metabolic disorders]. / Manifestari oculare în tulburarile metabolismului fosfo-calcic.

The investigation of a number of 286 patients having disorders of binocular seeing shows a very frequent association of these to spasmophilia, especially for persons of feminine sex during their third or fourth decades of life. The medicamentous treatment of spasmophilia has ameliorated the disturbing binocular seeings, which had appeared again after stopping the treatment for a long time. The authors recommend the cover-test end the examination using Maddox's experiment for tracing rapidly out the binocular seeing disturbings. In order to stimulate the movements of the ocular globe in an reverse sense to the deviation formed by the oculomotor existed lack of poise, it had been used the prescription of classes with prisms assembled conversely to the classic rules, having the indication of wearing them for 3-4 hours a day.

[The treatment of posttraumatic endophthalmia]. / Consideratii asupra tratamentului endoftalmiei posttraumatice.

Starting from a case of endophthalmitis secondary to a stung plague, the authors show the present treatment trends in this ophthalmic disease. The paper also reports on the importance of intravitreous administration of antibiotics associated or not with vitrectomy, corticotherapy, and other adjuvant treatments and on the possible complications induced by this new therapeutic trend.

[Benign prostatic hyperplasia]. / Benigne Prostatahyperplasie (BPH).

More than 40% of men, aged 50 years and more, develop a benign prostatic hyperplasia. There is some evidence that a disturbance of the testosterone and estrogene metabolism within the prostate is involved in the pathogenesis. In relation to the symptoms, either a conservative therapy or a surgical treatment and resection of the prostate is performed. Retrograde ejaculation is a frequent consequence of surgical treatment.

[Cryosurgery of the healthy rat liver]. / Kryochirurgie an der gesunden Rattenleber.

Cryosurgical treatment was applied to normal liver tissue of 13 clinically intact rats, with a view to investigating effects of freezing temperatures upon normal liver tissue. The animals were sacrificed after different intervals from surgery, and their liver tissue was macroscopically and histologically examined. Major postoperative complications were not observed but for one animal which died of wound healing disorder. The method seems to be suitable also for treatment of liver cell carcinoma or liver metastases.

[Animal experiment studies of cryosurgical treatment of DS sarcomas and Morris hepatomas implanted in the liver]. / Tierexperimentelle Untersuchungen über die kryochirurgische Behandlung von in die Leber implantierten DS-Sarkomen und Morris- Hepatomen.

Cryosurgical treatment was applied to solid liver tumours of rats with a view to studying the effects of freezing temperatures upon liver carcinoma. Such treatment was applied to twelve rats to which carcinomas, 0.5 cm to 3.0 cm in size, had been implanted. Cryosurgical treatment was successful in one case. Many of the animals died of complications which resulted from freezing of surrounding organs, such as stomach or greater liver vessels.