Impact of lack of knowledge on risk perception and protective practices of home nurses handling antineoplastic drugs.

Introduction: Health care workers handling antineoplastic drugs (ADs) are at risk of carcinogenic, mutagenic and reproductive toxic risks (CMR). The aim of this study was to assess the impact of the lack of knowledge (K) on risk perception (P) and on protective practices (PP) related to the handling of home-based chemotherapy (HC) by home nurses. Methods: This study was conducted in Normandy among home nurses. A questionnaire was developed to explore the K, P and PP related to handling ADs by home nurses working with four different providers from two hospitals. Results: Among the 28 home nurses included, 25.93% had received initial training on the specific treatment of ADs, 48.15% scored below average on risk management K, 52.00% scored below average on personal PP. Conclusion: This study reveals the importance of adapted and regular training on the handling of ADs. It will help develop a climate of safety and reinforce adherence to wearing personal protective equipment to protect health care workers from contamination.

Impact of low- and high-risk operators handling irinotecan on the blood contamination of health care workers in oncology day care units.

INTRODUCTION: Health care workers handling antineoplastic drugs (ADs) are at risk of mutagenicity and adverse reproductive effects. Despite protective equipment and AD handling guidelines, AD levels are still detected in caregivers in oncology units. This study attempted to assess blood contamination by irinotecan and its metabolites in all health care workers in oncology day hospital units according to activities specific to each employment category. METHODS: The study was performed at two different hospitals: a university hospital and a comprehensive cancer centre. Forty-four participants were categorized according to their daily activity as a high-risk operator (29 nurses/ward aides and 5 cleaning staff) and a low-risk operator (7 doctors and 3 secretaries). The collected blood samples were subjected to UHPLC-MS/MS. The plasma and red blood cell (RBC) levels of irinotecan and its metabolites (SN-38; APC) were determined using a validated analytical method detection test. RESULTS: Two hundred sixty-four assay results were collected (132 plasma results and 132 RBC results). The comparison between low- and high-risk operator-contaminated workers was not significant (18.33% positive results in low-risk operators vs. 25.98% positive results in high-risk operators; P = 0.22). This homogeneity showed overall contamination within the unit. Positive results were obtained in 21.43% of physicians, 11.11% of secretaries, 25.86% of nurses/ward aides and 26.67% of cleaning staff. These results could be explained by the lack or failure of personal and collective protective equipment. A lack of protection and inadequate decontamination procedures can result in surface contamination. CONCLUSIONS: This study evaluated blood contamination with irinotecan and its metabolites in health care workers from day hospital care units. Among the 24.24% of contaminations observed in care units, the difference between low- and high-risk operator contamination was not significant (P = 0.22). The impact on blood contamination found is the same between low- and high-risk caregivers. This implies that the protective precautions associated with the handling of anticancer drugs must therefore be followed by all staff, including those believed to be at low risk of exposure.

Does equipment change impact blood contamination with irinotecan and its two major metabolites in a centralized cytotoxic pharmacy unit?

BACKGROUND: Antineoplastic drugs exposure is a major problem for caregivers' health. The aim of this study is to assess blood contamination with irinotecan and its two metabolites in a centralized pharmacy unit for cytotoxic drug preparations workers before and after protective equipment changes. METHODS: The study took place in a university hospital centralized pharmacy unit for cytotoxic drug and was performed in two parts, before (Round 1: R1) and after equipment changes (Round 2: R2). Collection of pharmacy staff blood samples was performed in UHPLC-MS/MS. Plasma and red blood cell irinotecan and its metabolites (SN38; APC) were determined with a validated analytical method detection test. RESULTS: A total of 15/36 (41.6%) assays were positive in R1 and 16/72 (22.2%) in R2 with a significant decrease between periods (P = 0.035). For plasma dosages, no difference between the two periods was found (P = 0.71); respectively 4/18 (22.2%) assays were positive in R1 and 6/36 (16.6%) in R2. For red blood cells dosages, a significant decrease between periods was found (P = 0.01); respectively 11/18 (61%) were positive in R1 and 10/36 (27.8%) in R2. CONCLUSIONS: These dosages make it possible to have the very first evaluation for plasma and red blood cell contamination with irinotecan and its metabolites in the context of equipment changes, both at individual and collective levels. This work would help to protect health workers from the potential risks represented by these molecules, especially by revealing a contamination of workers in order to objectify the results of exposure.

Appropriate use of antifungals: impact of an antifungal stewardship program on the clinical outcome of candidaemia in a French University Hospital.

OBJECTIVES: The objective of this study was to compare clinical outcomes of patients with candidaemia before and after implementation of an antifungal stewardship program (AFSP). METHODS: This study included all consecutive cases of candidaemia identified from January 2012 to December 2015 in a French University Hospital. Data were collected retrospectively for a period of 2 years before implementation of the AFSP, and prospectively for 2 years after. All cases were reviewed by a multidisciplinary panel of experts including infectiologists, a microbiologist and pharmacists to have a complete follow-up of patients. RESULTS: 33 and 37 patients were finally included in the first and second period, respectively. The sites of entry of the candidaemia cases studied were as follows: intraabdominal in 29 cases (41.4%), central venous catheter 21 (30.0%), other or unknown: 20 (28.6%). Infectiologist consultations increased from 36.4 to 86.5% between the two periods with a significative impact on daily blood cultures which were more frequently performed in the second period (p = 0.04), and the use of echinocandins which was more frequent in the second period (97.1% of cases vs 78.8%, p = 0.03). The 3-month mortality rate declined from 36.4% in the first period to 27.0% in the second period (p = 0.4). CONCLUSIONS: Despite the insufficient number of candidaemia cases and the presence of other unmodifiable risk factors of mortality which did not allow us to show a significant effect on the 3-month mortality, AFSP had a significant effect on daily blood cultures and echinocandin use as first-line therapy.

[Prevalence of Helicobacter pylori detected by real-time PCR in the subgingival plaque of patients with chronic periodontitis]. / Prévalence d'helicobacter pylori détecté par PCR en temps réel dans la plaque sous-gingivale des patients atteints de parodontite chronique.

BACKGROUND: Helicobacter pylori plays a significant role in gastric disease. The aim of the present pilot study was to evaluate the prevalence of H. pylori detected by real-time polymerase chain reaction (real-time PCR) in the sub-gingival plaque of chronic periodontitis patients and to determine periodontopathogens profile of positive sites at H. pylori. METHODOLOGY: 109 subgingival samples collected from 17 subjects with chronic periodontitis were studied. The DNA was extracted from the oral samples and analyzed for the presence of H. pylori by real-time PCR (LightCycler) using 16S rRNA#120 primers which targeted the 16S rRNA gene. DNA from H. pylori DSM 4867 was used as a positive control. Seven bacteria implicated in chronic periodontitis were selected to explore the presence of these periodontopathic species in the oral positive sites for H. pylori. RESULTS: 16 of 109 samples (14.7%) were positives of H. pylori. All the positives sites were also positives to Fusobacterium nucleatum and Eikenella corrodens, 62.5% to Porphyromonas gingivalis, 31.25% to Treponema denticola, 25% to Prevotella intermedia, 12.5% to Aggregatibacter actinomycetemcomitans and 6.25% to Tannerella forsythia. CONCLUSIONS: H. pylori may be present in the subgingival plaque samples of patients with chronic periodontitis who are resident in a developing country. F. nucleatum and E. corrodens could coaggregate with H. pylori in the subgingival dental plaque.

Effect of a prospective audit with intervention and feedback on Clostridioides difficile infection management.

Background Clostridioides difficile infections are associated with morbidity and mortality in several countries. Their increasing incidence and frequent recurrence make them an urgent public health threat. The lack of adherence to international treatment guidelines for Clostridioides difficile infections is a proven mortality risk factor. Objective To evaluate long-term prescribers' adherence to recommendations on the management of Clostridioides difficile infections and its impact on clinical outcomes after an educational and Clostridioides difficile-prospective audit with intervention and feedback period. Setting All patients admitted to a 1500-bed university hospital with positive Clostridioides difficile tests identified were included. Methods Data were collected retrospectively over a baseline period (May-November 2014) and prospectively over a Clostridioides difficile-prospective audit with intervention and feedback period (November 2015-May 2016) and an observation period (November 2017-September 2018). All Clostridioides difficile cases were reviewed by a Clostridioides difficile-prospective audit with intervention and feedback team composed of pharmacists, an infectious diseases specialist and a microbiologist to obtain a complete overview of patient records in each area of expertise. Main outcome measures Percentage of conformity to the protocol, percentage of recovery at 10 days and percentage of relapse, as well as Clostridioides difficile incidence and percentage of Fidaxomicin use. Results A total of 183 patients were included over the three periods. A significant improvement in conformity to the local protocol was observed between the intervention period (23.9%) and the observation period (67.3%) (P < 10-3). Fidaxomicin prescriptions increased significantly (P = 0.006). Clinical outcomes improved significantly with an increase in the percentage of recovery at 10 days (P = 0.001) and a decrease in the percentage of relapse (P = 0.016). The Clostridioides difficile incidence rate improved significantly to 1.3 per 10,000 patient-days during the observation period. Conclusion This study shows the lasting effect of an educational and Clostridioides difficile-prospective audit with intervention and feedback period on prescribers' adherence to recommendations and a significant impact on clinical outcomes.

[Evaluation of the need for periodontal treatment in prisons near Dakar, Senegal]. / Evaluation des besoins de traitements parodontaux chez les détenus de la région de Dakar (Sénegal).

INTRODUCTION: Oral diseases qualify as major public health problems due to their high prevalence and incidence. They usually affect poor and marginal segments of the population. This study focused on the prison population that is characterized by poor living conditions and malnutrition. The aim of study was to assess the need for periodontal care in prisoners serving time in the Dakar region of Senegal. METHODS: This cross-sectional study included 375 prisoners serving in three facilities, i.e. the penal camp, Liberte VI prison for women, and Rufisque prison for women. Data were collected using a modified WHO information sheet. The community periodontal index of treatment needs (CPITN) was used for scoring. Statistical analysis with stratification by sex and age was performed and tests were considered as significant for p < or = 0.05. RESULTS: There were 335 men (89.3%) and 40 women (10.7%) with a sex ratio of 8.3. Mean age was 35 years +/- 11.5 (range, 16-88). Mean prison time was 39.29 months +/- 17.73. The proportion of prisoners needing periodontal treatment increased gradually according to prison time with significant differences (p < 0.05) even after stratification. CONCLUSION: Better management taking into account the environment and prison time would reduce the need for periodontal treatment in prisons in Dakar.

[Periodontal status of Senegalese patients with Sjögren's syndrome. A case control study at the Service of Internal Medicine]. / Santé parodontale et syndrome de Gougerot Sjögren. Etude cas-témoins au service de médecine interne.

The aim of this study is to compare the periodontal status of patients with Gougerot-Sjögren syndrome (GSS) to healthy subjects in order to investigate the relation between periodontal disease and GSS. To achieve this aim, one hundred and three patients, among whom 36 with primary GSS and 67 with secondary GSS, were selected and compared with one hundred and three (103) control subjects. The hygiene level was evaluated with Silness and Löe plaque index (PI) and inflammation level with Löe and Silness gingival index (GI). Probing depth and clinical attachment loss was measured with Williams periodontal probe. Mean plaque indices were identical for both groups (1.27 +/- 0.1 versus 1.22 +/- 0.1, p = 0.67). Compared with control subjects, the inflammation index scores were significantly higher among SSG patients (IG = 1.1 +/- 0.1 versus 0.44 +/- 0.2, p < 0,001). The logistical regression model applied to the whole sample showed that patients with GSS had a higher risk of developing periodontal disease (IG : OR 5.508, state 95% CI [1.66-9.60] ; PP : OR = 4.51 95% CI [1.692-12.024]). A training program for GSS patients seems essential, in order to manage the deleterious effects of defective oral-dental ground. It would allow convincing patients about the interest of prevention through regular surveillance and care.

[Periodontal conditions in young sickle cell anemia Senegalese patients]. / Etat parodontal du jeune sénégalais drépanocytaire homozygote.

INTRODUCTION: The oral cavity holds a complex microbial flora including periodontal pathogens. The infectious complications are common in sickle cell anaemia, which reaches 1% of the population in Senegal. The objective of this study is to assess periodontal conditions in young Senegalese sickle cell anaemics. PATIENTS AND METHODS: A sample of 82 subjects aged between 15 and 34 years with mean at 25.2 years +/- 4.6 was made up, including 35 homozygous and 47 non homozygous. Plaque index, gingival index and papillary bleeding index, tooth mobility and clinical attachment loss were assessed. Partial correlation between periodontal indexes and haemoglobin and hematocrit controlling for plaque index was performed. RESULTS: No significant statistical differences were found for periodontal indexes and clinical attachment loss between the two groups, even if homozygous show higher values. Periodontitis is less frequent in homozygous and odd ratio show protective effect of sickle cell anaemia (OR = 0.381, IC at 95% = [0.130; 1.1 18]). Tooth mobility is significantly increased in homozygous with mean at 1.0 +/- 0.8 versus 0.5 +/- 0.4 in control group (p = 0.000). Partial correlation show significant negative association between haematocrit and papillary bleeding index in homozygous (p = 0.045). CONCLUSIONS: The hypothesis that sickle cell anaemia can affect periodontal conditions and worsen periodontal diseases is to be considered even if it has not been proved as risk factor. Increased tooth mobility could be marker of periodontal risk in homozygous.

[Periodontal status in a sample of Senegalese women using hormonal contraception]. / Etat parodontal d'une population de femmes Sénégalaises sous contraception hormonale.

Hormonal contraception is based on the use of synthetic hormones containing variable doses of oestrogen and progesterone making it possible to avoid pregnancy in a temporary and reversible way. The objective of this study is to evaluate the periodontal status of a sample of Senegalese women under hormonal contraceptive. One hundred women using contraception since at least 6 month were paired on the age, the socio-economic profile and oral hygiene with a control group. Oral hygiene (plaque index (PI) of Silness and Löe), the inflammation (gingival index (GI) of Löe and Silness), probing depth and clinical attachment loss were recorded. With equal hygiene, the scores of the gingival index were significantly higher among women under contraceptive (p < 0.001). Inflammation was significantly more marked for the women who used contraception in injectable form compared to the control group (p < 0.001). Probing depth (3.01 +/- 0.04) and clinical attachment loss (3.19 +/- 0.08) were significantly more important among women under contraceptive (p < 0.001). The women under contraceptive seem to set up a group at risk for developing a periodontal disease, it is thus necessary to systematise periodontal appraisal before and during contraceptive use period.

[Periodontal status and diabetes: evaluation of 80 patients with diabetes mellitus in Conakry Teaching Hospital]. / Evaluation de l'etat parodontal au cours au diabète : a propos de 80 patients au CHU Donka de Conakry.

INTRODUCTION: Dental and periodontal diseases are frequent in diabetics. Few studies were carried out on oral pathologies of the diabetics in Africa. The objective of this study was to assess periodontal conditions in a population of diabetics followed in a hospital environment by comparing them with non diabetics. PATIENTS AND METHOD: In a cross-sectional study realized from January to April 1999, 80 diabetic patients followed in the Service of Endocrinology were compared to 35 non-diabetic patients, chosen among the patients attending in the Service of Internal medicine of the Donka Teaching Hospital in Conakry in the same period. Both groups were compared according to the simplified oral hygiene index (OHIS) and community periodontal index of treatment needs (CPITN). RESULTS: There was no difference between diabetics and nondiabetics according to the OHIS. Diabetics CPITN index was higher compared to non-diabetics (p = 0.019). In diabetics, scores of CPITN increase significantly with duration of diabetes mellitus (p = 0.019). Also correlation was found between OHIS and the duration of diabetes. Glycemic control was significantly correlated with OHIS (p < 0.001) and CIPTN (p < 0.001). CONCLUSION: Diabetic patients have more periodontal treatment need than controls. Better collaboration between diabetologist and odontostomatologist is needed to preserve the oral health of diabetics.

[Treatment of localized gingival hypertrophy induced by orthodontic appliances using modified Widman flap. A case report]. / Traitement de l'hypertrophie gingivale localisée associée au port de dispositifs orthodontiques par lambeau de Widman modifié. Rapport de cas.

Gingival enlargement is a condition that commonly develops during orthodontic treatment. Orthodontic appliances are irritation and retention plaque factors holding up oral hygiene and control of gingival inflammation. This case-report shows localized gingival hypertrophy in young Senegalese female undergoing orthodontic treatment with fixed appliances. Modified Widman flap associated with osseous recontouring have led to morphological conditions of gingiva allowing better plaque control and orthodontic treatment going on. Comfort and controlled haemostasis after periodontal surgery make this procedure a good choice for treatment of gingival hypertrophy. Collaboration between orthodontist and periodontist is required for successful therapeutic.

[Gingival hypertrophy during orthodontic treatment: contribution of external bevel gingivectomy. Case report]. / L'hypertrophie gingivale au cours du traitement orthodontique: apport de la gingivectomie à biseau externe. Rapport de cas.

Gingival enlargement is a condition that commonly develops during orthodontic treatment. Orthodontic appliances are irritation and retention plaque factors holding up oral hygiene and control of gingival inflammation. Two cases of gingival hypertrophy in young Senegalese females undergoing orthodontic treatment with fixed appliances are described and treated by gingivectomy. This surgical procedure have led to morphological conditions of gingiva allowing better plaque control and the orthodontic treatment going on. Periodical controls in child and adolescent are required for healthy periodontium during orthodontic therapy. Collaboration between orthodontist and periodontist is one of the most important keys to successful treatment.

[Influence of orthodontic anomalies on periodontal condition]. / Influence des anomalies orthodontiques sur l'état parodontal.

INTRODUCTION: Three main reasons are routinely cited to justify the provision of orthodontic treatment: improvement of facial and dental aesthetics and of dental health and function. However, association between malocclusions and periodontal condition is still controversial. The aim of the present study was to further investigate the correlation between certain orthodontic anomalies and periodontal condition. MATERIALS AND METHOD: One hundred and one subjects were included in this study. Information regarding oral hygiene habits and accessibility to professional oral health care were obtained from each subject. Malocclusions were assessed with the Indice of Orthodontc Treatment Need (IOTN) and the Index of Complexity, Outcome and Need (ICON) and periodontal with the Community Periodontal Index for Treatment Need (CPITN). Spearman Rank correlation order was used to test for any association between malocclusions and periodontal condition. Significance was set at the 5% level. RESULTS: Contact point displacements (malpositions) are positively and significantly correlated to CPITN in the mandibular arch. There was also significant negative correlation between spacing and CPITN in the maxilla. Openbite and overjet assessed by IOTN have a significant positive correlation with the periodontal condition as assessed by the CPITN. In contrast no correlation was found with dental crossbite (IOTN and ICON). At last, there was significant correlation between overbite and periodontal condition. CONCLUSION: Significant correlations were found between malocclusions and periodontal condition. Within the limitation of this study one can suggest that malocclusions are risk marker for periodontal diseases. However, this study by virtue of its protocol cannot allow us to makeany inference about a cause/effect relationship between malocclusions and periodontal condition.

[Surgical and Orthodontic Treatment of Impacted Canines: A Clinical Report]. / Prise en charge chirurgicale et orthodontique de canines incluses : rapport d'une observation clinique.

Impaction of tooth can be defined as a failure of a tooth to emerge usually due to insufficient space or the presence of a supernumerary tooth blocking its path of eruption. Impaction of the canines deserves particular attention due to their importance regarding occlusal stability and aesthetic. A case of a young girl who presented with an impaction of both upper canines and the lower left canine is reported here. Good therapeutic results have been obtained after 18 month of treatment with a multidisciplinary team involving oral surgeons, periodontists and orthodontists.

[Evaluation of gingival condition in homozygous children and adolescents with sickle cell anemia in Senegal]. / Evaluation de l'etat gingival chez l'enfant et l'adolescent drepanocytaires homozygotes au Senegal.

Sickle cell anaemia is an inherited disorder of haemoglobin synthesis leading to haemolytic anaemia. It touches more than 50 million people in the world and 10% of the population in Senegal. Only the homozygous form is symptomatic and appears by painful crises of vaso-occlusive type. There is a lack of works carried out or published in Senegal about potential link between periodontal conditions and sickle-cell anaemia. The main objective of this study is to assess the gingival conditions in Senegalese children and adolescents homozygous sickle cell anaemic. Secondary, the gingival state is correlated with oral hygiene and rate of reticulocytes to determine their relationship. Fifty homozygous attending the Albert Royer Paediatric Hospital of Dakar and unscathed of other systemic pathologies, were examined. The patients are old between 3 and 16 years with an average age 9.4 years +/- 3.8. The gingival state is assessed by measurement of the gingival index (GI) and index of sulculary bleeding (SBI). Partial correlation is performed between the two indexes and average of reticulocytes. The gingival index mean is 1.7 +/- 0.6 and 66% of the patients present a severe inflammation, which is more frequent in the age bracket from 3 to 12 years. The SBI mean is 1 +/- 1.1 and 68% of the patients present gingival bleeding, which is moderate to severe in 18%, with a greater frequency in the age bracket from 13 to 16 years. Strong correlation is found between plaque index, GI and SBI. Damage of gingival state seems not to be linked to the high average of reticulocytes controlling for oral hygiene. Children and adolescent homozygous have an inflammatory periodontium associated to poor oral hygiene, which highlights their needs in periodontal treatments. Early tracking and preventive treatment of periodontal diseases during systematic oral visits must be required.

LDL and acetyl-LDL inhibit the NK activity and are taken up by CD56+ lymphocytes.

The effect of LDL and modified LDL (acetyl-LDL) was studied on human natural killer cell-mediated cytotoxicity against K562 cells. Incubation for 24 h of peripheral blood lymphocytes (PBL) with a high concentration (200 micrograms/ml) of LDL decreased the NK activity in some donors. After acetylation of the LDL protein (apoB), the modified-LDL systematically inhibited the NK function of PBL in a time- and dose-dependent manner. Inhibition mediated by acetyl-LDL (AcLDL) was significantly greater than that of LDL, indicating that the apoB modification can mediate the inhibition of the NK function. AcLDL also inhibited the NK activity of peripheral blood mononuclear cells, suggesting that, under our experimental conditions, monocytes are not efficient enough to protect NK cells against the adverse effects of modified-LDL. With a cytofluorimetric analysis, the internalization of acetyl-LDL by PBL was demonstrated and was only 3-4 times lower than LDL internalization in lymphocytes. It appeared to be time, temperature and dose dependent, saturable and different from the internalization mediated by the known scavenger receptors. Finally, CD14- CD3+ lymphocytes and CD14- CD56+ lymphocytes were able to internalize AcLDL in the same way. Our results suggest that in some in vivo circumstances, when the LDL concentration and/or the modified-LDL/LDL ratio increase in tissues, lipoproteins are internalized by NK cells and also can induce adverse effects on the NK function.

Electric field-mediated glycophorin insertion in cell membrane is a localized event.

Purified soluble glycophorin, an intrinsic protein, can be back 'electroinserted' in the membrane of Chinese hamster ovary cells by submitting the cell/protein mixture to short electric field pulses. Previous studies showed that this complex between pulsed cells and proteins, which is detected only when the cell membrane is electropermeabilized, was very stable. This strongly suggested that the protein was indeed inserted in the membrane. The basic processes involved in this phenomena are studied in the present work. The association is observed at the single cell level by means of videoimmunofluorescence. Electric field-mediated insertion occurs firstly in a limited patch of the cell surface, which size is in agreement with the prediction of Electropermeabilization theory. A free diffusion of the inserted proteins then follows on the cell surface. The diffusion coefficient is computed to be less than 10(-10) cm2/s as observed for transmembranous proteins. This slow process gives an homogeneous distribution of the inserted protein.

Study of LDL and acetylated LDL endocytosis by mononuclear cells in HIV infection.

Activated lymphocytes have a high level of low density lipoprotein (LDL) uptake as compared to resting lymphocytes, whereas scavenger receptors for acetylated LDL (Ac-LDL) are expressed on limited number of immune cells, i.e., monocytes/macrophages. The endocytosis of LDL and Ac-LDL by mononuclear cells was studied during in vitro and in vivo HIV infection, in order to use LDL and Ac-LDL as carriers of antiviral and/or immunomodulatory drugs towards lymphocytes and monocytes. The uptake of LDL and Ac-LDL was analyzed by cytofluorimetry. LDL endocytosis in PHA/IL2-activated lymphocytes was higher than in resting lymphocytes. In vitro HIV infection of PHA/IL2-activated lymphocytes did not alter the high LDL endocytosis in lymphocytes. CD4+ and CD8+ cells. In a group of 12 symptomatic patients there was no alteration of LDL endocytosis in lymphocytes, CD4 and CD8 lymphocytes. In another group of 23 individuals, the Ac-LDL endocytosis mediated by CD14+ monocytes was unaltered in asymptomatic patients (n = 6) and in some symptomatic patients (n = 6, CD14+ cells > 100/mm3). On the contrary, in other symptomatic patients (n = 11, CD14+ cells < 100/mm3), the number of Ac-LDL+ CD14+ cells decreased, whereas their efficiency of Ac-LDL endocytosis increased as compared to those of other HIV+ patients. In conclusion, the use of lipoproteins as carriers to increase the drug delivery to CD4+ lymphocytes and to CD14+ monocytes can be envisaged, since: (i) the LDL endocytosis was not impaired in CD4 lymphocytes of HIV+ patients, and (ii) the Ac-LDL uptake by monocytes was altered only in some patients of stage IV.

Chronic vascular rejection: histologic comparison between two murine experimental models.

BACKGROUND: We previously developed an experimental model to study chronic vascular rejection (CVR) in mice, the orthotopic aortic allograft. More recently we performed human arterial grafts into SCID/Beige mice reconstituted with human spleen cells. We report herein the differences in CVR lesions. MATERIAL AND METHODS: In the first model, recipient mice were C57BL/6 (H-2b), and donor mice were DBA/2 (H-2d). In the second model, terminal branches of the human superior mesenteric artery were transplanted into SCID/Beige mice in the infrarenal aorta. Human immune reconstitution was achieved by a single intraperitoneal injection of 30 x 10(6) human spleen cells. The presence of human lymphocytes and IgG was verified weekly. In both models, the vascular grafts were inserted in the infrarenal aortic position using the sleeve technique. The transplanted mice were sacrificed at 35 days after the operation. The grafts were analyzed by histology and morphometry. The mean intimal thickening was calculated based on transverse sections at 0.1-mm intervals. RESULTS: Typical CVR lesions developed with neointimal thickening, T-cell infiltration, and smooth muscle cell (SMC) proliferation in both models. In the mouse aortic model, disappearance of SMC in the media was noted in contrast to human arterial transplants, where the media remained intact. CONCLUSION: Other groups have noted that arteries conserve their media in clinical organ transplants. From this point of view, the lesions in the second experimental model (human arteries) better reflect the pathology of CVR in clinical transplantation than the murine aortic transplant model.