Immunologic responses of HIV-1-infected study subjects to immunization with a mixture of peptide protein derivative-V3 loop peptide conjugates

V3 loop peptide sequences from several HIV-1 strains were covalently linked to purified protein derivative (PPD) of Mycobacterium tuberculosis. A mixture of PPD conjugates of V3 loop peptides from six different strains of HIV-1 induced a stronger antibody response than a single V3 peptide-conjugate administered to guinea pigs and humans. Sera from animals immunized with a PPD-six peptide-PPD conjugate neutralized multiple primary-isolate strains of HIV-1. Potent immune responses were noted only when animals were primed with bacillus Calmette-Guerin (BCG), PPD was covalently bound to the peptides, and PPD was used as the carrier protein. Based on these animal studies, an immunogen consisting of PPD-conjugated V3 loop peptides from five HIV-1 strains was tested in 7 HIV-1 seropositive PPD skin test positive study subjects. Vaccinees exhibited over time a uniform increase in neutralizing antibodies for both laboratory adapted and primary isolates of HIV-1, including strains from multiple clades. In 3 patients with baseline viral loads between 8000 and 12,000 RNA copies/ml, the viral load declined in 2 patients to <400 copies/ml and in 1 patient to 1200 copies/ml without concurrent administration of highly active antiretroviral therapy (HAART).

HIV type 1 infection of human fetal bone marrow cells induces apoptotic changes in hematopoietic precursor cells and suppresses their in vitro differentiation and capacity to engraft SCID mice

To investigate the mechanism of HIV-1-induced hematopoietic abnormalities, we examined the effect of HIV-1 infection on the in vitro and in vivo behavior of precursor cells obtained from human fetal bone marrow (HFBM). After infection with the monocyte-tropic isolate HIV-1(ADA), HFBM cells displayed a significant decrease in their subsequent in vitro production of precursor cell colonies and a marked impairment in their engraftment of the bone marrow of irradiated SCID mice. By injecting retrovirally tagged, purified human CD34+ cells into HIV-1(ADA)-infected or uninfected human thymic tissue implanted in SCID mice, we demonstrated that HIV-1 infection also inhibited the in vivo differentiation of CD34+ cells into T cells. To determine the mechanism by which HIV-1 suppressed hematopoietic activity, we investigated whether HIV-1 infection induced apoptotic cell death in hematopoietic cells. Multiparameter flow cytometry with FITC-labeled annexin V and propidium iodide demonstrated that infection of the HFBM with monocyte-tropic, but not T cell line-tropic HIV-1, stimulated apoptosis in the CD34+ hematopoietic precursor population. The presence of a TNF-alpha inhibitor during exposure of the HFBM cells to HIV-1 substantially reduced the level of apoptosis of CD34+ cells and significantly decreased the repression of in vitro colony formation induced by HIV-1. However, inhibition of TNF-alpha during HFBM cell culture with HIV-1 did not restore their capacity to engraft SCID mice. Taken together, these results indicated that HIV-1 suppression of human hematopoietic cell maturation is a multifactoral phenomenon, a crucial element of which may be HIV-1-induced apoptosis of precursor cells mediated by TNF-alpha production.

Simultaneous analysis of individual and aggregate responses in psychometric data using multilevel modeling

Psychometric data on risk perceptions are often collected using the method developed by Slovic, Fischhoff, and Lichtenstein, where an array of risk issues are evaluated with respect to a number of risk characteristics, such as how dreadful, catastrophic or involuntary exposure to each risk is. The analysis of these data has often been carried out at an aggregate level, where mean scores for all respondents are compared between risk issues. However, this approach may conceal important variation between individuals, and individual analyses have also been performed for single risk issues. This paper presents a new methodological approach using a technique called multilevel modelling for analysing individual and aggregated responses simultaneously, to produce unconditional and unbiased results at both individual and aggregate levels of the data. Two examples are given using previously published data sets on risk perceptions collected by the authors, and results between the traditional and new approaches compared. The discussion focuses on the implications of and possibilities provided by the new methodology.

Multilevel modelling of the geographical distributions of diseases

"Multilevel modelling is used on problems arising from the analysis of spatially distributed health data. We use three applications to demonstrate the use of multilevel modelling in this area. The first concerns small area all-cause mortality rates from Glasgow where spatial autocorrelation between residuals is examined. The second analysis is of prostate cancer cases in Scottish counties where we use a range of models to examine whether the incidence is higher in more rural areas. The third develops a multiple-cause model in which deaths from cancer and cardiovascular disease in Glasgow are examined simultaneously in a spatial model. We discuss some of the issues surrounding the use of complex spatial models and the potential for future developments."

Multi-level repeated measures growth modelling using extended spline functions

This paper explores the fitting of multi-level models to growth data over a wide age range using a new class of extended spline models. These extend conventional splines based on a '+' function representation by allowing variable order functions and by including fractional polynomial terms. The work focuses on modelling human growth in height and head circumference with example data sets. The procedures can be used with covariates and for comparing population parameters.

Decreased susceptibility of peripheral blood mononuclear cells from individuals heterozygous for a mutant CCR5 allele to HIV infection

OBJECTIVE

Individuals homozygous for a deletion in the CCR5 gene (CCR5delta32/CCR5delta32) are resistant to HIV infection, indicating that this particular chemokine receptor plays a crucial role in the initiation of in vivo HIV infection. We investigated the effect of the heterozygote genotype (CCR5/CCR5delta32) on susceptibility of peripheral blood mononuclear cells (PBMC) to HIV infection.

DESIGN

Sensitivity to HIV infection of PBMC from volunteers with either the CCR5/CCR5, CCR5/CCR5delta32, or CCR5delta32/CCR5delta32 genotypes was examined by challenging their PBMCs with serial titers of HIV isolates with different cellular tropisms. The genotype of the PBMCs was correlated with the lowest viral inoculum required to initiate productive infection with either three M-tropic HIV-1 isolates, (92RW009A, HIV-1ada, and HIV-1(59)), one dual-tropic HIV-1 isolate (92BR021), or two T-tropic HIV-1 isolates (92UG021 and 92UG029).

RESULTS

PBMCs from the CCR5/CCR5delta32 group required a significantly higher inoculum (p value from .036 to .003) to become infected with these three M-tropic HIV-1 isolates than did PBMC from the CCR5/CCR5 group, but became infected after exposure to an inoculum of T-tropic HIV-1 isolates that was comparable to that which infected PBMCs from the CCR5/CCR5 individuals.

CONCLUSIONS

The decreased susceptibility of PBMCs from individuals heterozygous for the CCR5 deletion to HIV infection by M-tropic HIV-1 isolates may provide a mechanistic explanation for the delayed progression of disease in some CCR5/CCR5delta32 individuals.

Legal abortion in Denmark during the past 25 years: aspects of public health and ethics

Since October 1, 1973, Denmark has granted its permanent residents the right to legal abortion up to the end of the 12th week of gestation. In the beginning of the period of legal abortion, the numbers of induced abortions per year were high, although they decreased during the 1980s and 1990s. Probably, information campaigns concerning the use of contraception have had some effect. Abortion figures are, however, of interest of studied as rates of abortion, i.e. numbers per 1000 women of fertile age or as age-related rates of abortion. Aspects of legal abortion comprise various topics. One of these is the ethical questions for physicians and nurses, and also for the entire population in a country with legal, and free, abortion to a certain limit. Some central ethical questions are discussed, and it is stated that we cannot perform abortion if we grant the fetus the same moral status as an adult human being.

AAEM case report 32: nerve injury associated with hip arthroplasty

Hip Arthroplasty to alleviate pain related to arthritic degeneration has become one of the most common orthopedic procedures performed. As the elderly population expands, the number of such procedures can be expected to continue to increase. An electrodiagnostic evaluation can aid in localization, help identify the mechanism of injury, and be used as a tool to identify the nature and severity of the nerve pathology. Electrodiagnosis can also be used to generate a prognosis for recovery from nerve damage following hip surgery.

thy/liv-SCID-hu mice: a system for investigating the in vivo effects of multidrug therapy on plasma viremia and human immunodeficiency virus replication in lymphoid tissues

Modified, human immunodeficiency virus (HIV)-inoculated thy/liv-SCID-hu mice were used to evaluate the in vivo efficacy of antiretroviral drugs. Ritonavir treatment alone initially suppressed plasma viremia, but the viremia recurred with the appearance of ritonavir-resistant HIV isolates. Multidrug therapy suppressed plasma HIV RNA to undetectable levels; however, plasma viremia returned after therapy was stopped, showing that the therapy did not completely suppress HIV infection in the thymic implant. When thy/liv-SCID-hu mice were treated with a combination of zidovudine, lamivudine, and ritonavir immediately after inoculation with HIV, cocultures of the thymic implants remained negative for HIV even 1 month after therapy was discontinued, suggesting that acute treatment can prevent the establishment of HIV infection. Thus, these modified thy/liv-SCID-hu mice should prove to be a useful system for evaluating the effectiveness of different antiretroviral therapies on acute and chronic HIV infection.

Mice transgenic for human CD4 and CCR5 are susceptible to HIV infection

HIV entry into human cells is mediated by CD4 acting in concert with one of several members of the chemokine receptor superfamily. The resistance to HIV infection observed in individuals with defective CCR5 alleles indicated that this particular chemokine receptor plays a crucial role in the initiation of in vivo HIV infection. Expression of human CD4 transgene does not render mice susceptible to HIV infection because of structural differences between human and mouse CCR5. To ascertain whether expression of human CD4 and CCR5 is sufficient to make murine T lymphocytes susceptible to HIV infection, the lck promoter was used to direct the T cell-specific expression of human CD4 and CCR5 in transgenic mice. Peripheral blood mononuclear cells and splenocytes isolated from these mice expressed human CD4 and CCR5 and were infectible with selected M-tropic HIV isolates. After in vivo inoculation, HIV-infected cells were detected by DNA PCR in the spleen and lymph nodes of these transgenic mice, but HIV could not be cultured from these cells. This indicated that although transgenic expression of human CD4 and CCR5 permitted entry of HIV into the mouse cells, significant HIV infection was prevented by other blocks to HIV replication present in mouse cells. In addition to providing in vivo verification for the important role of CCR5 in T lymphocyte HIV infection, these transgenic mice represent a new in vivo model for understanding HIV pathogenesis by delineating species-specific cellular factors required for productive in vivo HIV infection. These mice should also prove useful for the assessment of potential therapeutic and preventative modalities, particularly vaccines.

Multi-level models for longitudinal growth norms

Multi-level models for estimating conditional and unconditional longitudinal growth norms are presented. The procedure involves transforming the original growth measurements to Normality and modelling these with a two-level random coefficient model. Growth norms for any desired time interval and function can be derived. Height and weight data are used for illustration.

Thy/Liv-SCID-Hu mice implanted with human intestine: an in vivo model for investigation of mucosal transmission of HIV

Mucosal transmission is a major route by which individuals become infected with HIV. Investigation into the mechanism by which mucosal transmission of HIV occurs would be greatly facilitated by the development of a small animal model infectible with HIV by the mucosal route. We have previously described a SCID-hu mouse model, in which human thymic and liver tissues are implanted under both kidney capsules (thy/liv-SCID-hu mice), which are populated in the periphery with high numbers of human T cells and that develop disseminated HIV-1 infection after intraperitoneal injection. To expand further the usefulness of the thy/liv-SCID-hu mouse as a model for studying mucosal transmission of HIV, thy/liv-SCID-hu mice were subcutaneously implanted with human intestinal tissue in a manner that maintained the lumen. Four months later, the histological appearance of the implanted intestine resembled that of normal human bowel tissue and the lamina propria was populated with human T cells. Six weeks after introduction of HIV into the lumen of the intestinal implant, the mice developed disseminated HIV infection. Scattered HIV-infected cells were detected in the lamina propria of the implant, indicating that HIV infection in these mice was mediated by transmission of the virus across the mucosa of the human intestinal implant. Thus, our modified thy/liv-SCID-hu mice transplanted with human bowel tissue should provide a novel model for investigating mucosal transmission of HIV.

Predicting who will choose a family medicine residency

PURPOSE

To create and evaluate a screening instrument and a revised interview format for use in the selection of family medicine residents at the McGill University Faculty of Medicine.

METHOD

The screening tool consisted of two sections an assessment of academic performance (the TASS) and an evaluation of applicants' generalist versus specialist orientation (the GSSS); each applicant's file was assessed by two raters. The revised interview included specific questions and scenarios related to family medicine. All three parts were tested on 143 applicants from outside the region of Quebec in 1994-95. The results on both parts of the screening tool and the interview were compared with the students' first choices of residency and then were compared with the performances of the 24 accepted into the program as reflected in their first six-month summative evaluation forms. Data were analyzed through several statistical methods.

RESULTS

Only the GSSS accurately predicted the applicants' first choices (for agreement between both raters: sensitivity, 81%; specificity, 70%; accuracy, 78%). No significant association was found when comparing matching applicants' scores obtained during the selection process with their scores on the six-month evaluation forms.

CONCLUSION

The GSSS may prove useful as a tool in the review of applicants' files. More studies are needed to reevaluate the use of the interview in the selection process and to help determine whether any selection instrument can accurately predict applicants' subsequent performances in a residency.

Human immunodeficiency virus type 1 infection of mature CD3hiCD8+ thymocytes

Although CD4+ cells are the primary targets of human immunodeficiency virus type 1 (HIV-1) infection, earlier reports have suggested that intrathymic infection of CD8+ cells may occur. However, it was unclear whether HIV-1-infected CD8+ thymocytes were truly mature single-positive (SP) cells. In the present study, SCID mice implanted with human fetal thymus and liver tissues (SCID-hu mice) were infected with three primary isolates of HIV-1 and infected thymocytes were analyzed to assess maturational status. After intra-implant or intraperitoneal injection with HIV-1, thymocytes were sorted by three-color flow cytometric analysis into mature populations of CD3hiCD4+ and CD3hiCD8+ SP cells of > 99% purity (< 0.3% CD4-containing cells in the CD8+ population). The presence of HIV-1 provirus in the sorted thymocyte populations was determined by quantitative PCR. A fraction of mature CD3hiCD8+ thymocytes contained HIV-1 proviral DNA, and evidence of viral mRNA transcription in these cells was demonstrated by in situ hybridization. In contrast, when uninfected CD3hiCD8+ thymocytes were cocultured with HIV-1-infected CD4+ thymocytes, no evidence of productive HIV-1 infection was detected. Thus, HIV-1 infection of CD8+ thymocytes in the SCID-hu mouse does not occur by direct contact with the virus. Rather, cell surface CD4 is required; therefore, precursor cells are the likely primary target of HIV-1 infection in the thymus. During ontogeny, some of these infected cells continue their differentiation into mature CD8+ SP thymocytes that contain proviral DNA and express viral RNA.

Saquinavir-mediated inhibition of human immunodeficiency virus (HIV) infection in SCID mice implanted with human fetal thymus and liver tissue: an in vivo model for evaluating the effect of drug therapy on HIV infection in lymphoid tissues

Treatment with protease inhibitors alone or in combination with inhibitors of reverse transcriptase potently suppresses levels of human immunodeficiency virus (HIV) RNA in plasma and thereby may significantly delay the progression of HIV-mediated disease. To investigate the effect of treatment with the protease inhibitor saquinavir on HIV replication in the lymphoid tissues, we used a SCID-hu mouse model that we developed, in which human thymic and liver tissues (hu-thy/liv) were implanted under both kidney capsules in SCID mice (thy/liv-SCID-hu mice). These mice are populated in the periphery with large numbers of human T cells and develop disseminated HIV infection after intraimplant injection. thy/liv-SCID-hu mice with established HIV infection that were treated for 1 month with saquinavir had a significantly lower viral load present in the implanted hu-thy/liv and mouse spleen than did the untreated HIV-infected thy/liv-SCID-hu mice. To examine the capacity of acute treatment with saquinavir to prevent HIV infection, some thy/liv-SCID-hu mice were inoculated with HIV and then immediately started on saquinavir. Although treated mice had markedly lower viral loads in the thy/liv implants and spleens, HIV infection was not completely prevented. Thus, the effect of antiviral therapy on HIV infection in the major site of HIV replication, the lymphoid tissues, can be readily evaluated in our thy/liv-SCID-hu mice. These mice should prove to be a useful model for determining the in vivo effectiveness of different therapeutic interventions on acute and chronic HIV infection.

Faculty advisor program for family medicine residents

PROBLEM BEING ADDRESSED

In response to the accreditation guidelines of the College of Family Physicians of Canada's (CFPC) Task Force on Intraining Evaluation, the Department of Family Medicine at McGill University implemented a faculty advisor program on July 1, 1993.

OBJECTIVE OF PROGRAM

In addition to meeting the requirements of the CFPC, the faculty advisor program was developed to foster communication between residents and faculty, increase opportunities for feedback, promote self-directed learning, and personalize the educational experience of trainees.

MAIN COMPONENTS OF PROGRAM

Residents were assigned an advisor. They were expected to meet their advisors monthly to discuss educational objectives, performance, career planning, and any problems. Educational plans were to be completed at each meeting.

CONCLUSIONS

Feedback from advisors and residents has been positive, with both groups expressing overall satisfaction with the program. The faculty advisor program will continue but will be modified to address problems identified and better meet the needs of faculty and residents.

Severe combined immunodeficiency mice engrafted with human T cells, B cells, and myeloid cells after transplantation with human fetal bone marrow or liver cells and implanted with human fetal thymus: a model for studying human gene therapy

To develop an in vivo model wherein human hematopoiesis occurs, we transplanted severe combined immunodeficiency (SCID) mice with either human fetal bone marrow (HFBM) or human fetal liver (HFL). After transplantation of SCID mice with cultured HFBM (BM-SCID-hu mice) or HFL cells (Liv-SCID-hu mice), significant engraftment of the mouse bone marrow (BM) and population of the peripheral blood with human leukocytes was detected. Human colony-forming unit-granulocyte macrophage and burst forming unit-erythroid were detected in the BM of the BM-SCID-hu and Liv-SCID-hu mice up to 8 months after transplantation. When the HFBM or HFL cells were transduced with a retroviral vector before transplantation, integrated retroviral sequences were detected in human precursor cells present in the SCID mouse BM and in leukocytes circulating in the peripheral blood (PB) up to 7 months after transplantation. The PB of the BM-SCID-hu mice also became populated with human T cells after implantation with human thymic tissue, which provided a human microenvironment wherein human pre-T cells from the BM could mature. When the HFBM was retrovirally transduced before transplantation, integrated retrovirus was detected in sorted CD4+CD8+ double positive and CD4+ single positive cells from the thymic implant and CD4+ cells from the PB. Taken together, these data indicated that the BM of our BM-SCID-hu and Liv-SCID-hu mice became engrafted with retrovirally transduced human hematopoietic precursors that undergo the normal human hematopoietic program and populate the mouse PB with human cells containing integrated retroviral sequences. In addition to being a model for studying in vivo human hematopoiesis, these mice should also prove to be a useful model for investigating in vivo gene therapy using human stem/precursor cells.

Environmental awareness and level-dependent hearing protection devices

OBJECTIVE

The effect of level-dependent hearing protection devices (HPDs) on subjects' ability to identify real-life environmental sounds was investigated.

DESIGN

Eighteen subjects with no hunting experience attempted to identify sounds (crow, duck, turkey, deer, owl, goose, and person) recorded at various distances in the presence of the SoundScope and Sonic II level-dependent HPDs as well as in an open ear condition. Knowles Electronic's Manikin for Auditory Research was employed in making the experimental recordings. The Sonic II accomplishes level-dependent attenuation via a passive mechanism, whereas the SoundScope employs active circuitry that attenuates loud sounds while providing a small amount of high frequency amplification for soft sounds. Both devices are commercially available and are advertised for hunters/shooters. Sound identification scores (SISs) were determined for each condition.

RESULTS

Mean SISs differed significantly among the three earplug conditions, collapsed over type of sound and distance, with the best SIS obtained under the open ear condition (96.43%) and the worst under the Sonic II condition (84.13%). Further analysis revealed that the listening conditions differed significantly only at the 100 yard distance.

CONCLUSIONS

Auditory awareness was not maintained by either device investigated during the 100 yard condition. However, auditory awareness was maintained by both devices at a distance of 75 yards or closer. These devices may be appropriate for use in certain hunting/shooting situations depending on several factors including type of game being hunted, environment, and shooting range of the weapon. Further support also is provided for the usage of level-dependent HPDs during recreational shooting activities (i.e., at a shooting range).

Interaction among preschoolers with and without disabilities: effects of across-the-day peer intervention

We examined the effects of a peer-mediated intervention package that taught typically developing children to be more aware of communicative attempts to classmates with disabilities, to use a small set of facilitative strategies ("Stay, play, talk"), and to distribute strategy use across the school day. A multiple baseline design across subjects was instituted with two cohorts of preschool children. Following baseline observations, a total of 8 target children with moderate development disabilities were eventually paired with trained peers who received "buddy training." One trained peer were taught facilitative strategies and encouraged to use them during classroom activities, consistent improvements in social interaction on the part of the trained peers and target children were demonstrated. Similar or more frequent interactions were demonstrated when trained peers were reassigned to different target children during generalization probes. In addition, treatment effects were revealed when comparing sequential analyses applied to the specific communicative behaviors across experimental conditions, in changes in target children's sociometric ratings, and in social validity judgments of videotapes from before and after treatment. This peer intervention approach has promise for improving the communicative interaction and social integration of children with disabilities attending inclusive preschools.