Thymidine-analog and multi-nucleoside resistance mutations are observed in both zidovudine-naive and zidovudine-experienced subjects with viremia after treatment with stavudine-containing regimens

OBJECTIVE

The type and frequency of mutations in the human immunodeficiency virus type 1 (HIV-1) reverse transcriptase coding region observed in virus from antiretroviral therapy (ART)-experienced, zidovudine (ZDV)-naive subjects receiving stavudine (d4T)-based therapies were compared with mutations observed in virus from ART-experienced subjects with previous ZDV exposure.

METHODS

Plasma HIV-1 RNA was isolated from 67 ART-experienced subjects. Reverse transcriptase mutations were assessed by sequencing polymerase chain reaction products.

RESULTS

Thirty-four subjects (51%) were ZDV-experienced (Z(exp)) and 33 (49%) were ZDV-naive and d4T-experienced (d(exp)Z(naive)). Human immunodeficiency virus type 1 from 16 of 33 (48%) d(exp)Z(naive) subjects and from 16 of 34 (47%) Z(exp) subjects had thymidine analog mutations (TAMs). Multi-nucleoside resistance (MNR) mutations were observed in virus from 5 of 33 (15%) d(exp)Z(naive) subjects and 3 of 34 (9%) Z(exp) subjects. At least one TAM or MNR mutation was identified in 18 of 33 (55%) of the former and in 19 of 34 (56%) of the latter group.

CONCLUSIONS

These results confirm recent reports that TAMs and MNR mutations can arise in subjects receiving d4T-based therapy who are naive with respect to ZDV.

Antiretroviral activity and safety of abacavir in combination with selected HIV-1 protease inhibitors in therapy-naive HIV-1-infected adults

OBJECTIVE

To assess antiretroviral efficacy and safety of abacavir in combination with selected HIV-1 protease inhibitors.

DESIGN

A 48-week, open-label study.

MATERIALS AND METHODS

Eighty-two antiretroviral naive HIV-1-infected adults (CD4 cell count > or = 100 cells/mm3, plasma HIV-1 RNA > or = 5,000 copies/ml) were randomly assigned to receive abacavir (300 mg twice daily) in combination with standard doses of one of five protease inhibitors: indinavir, saquinavir soft-gel, ritonavir, nelfinavir or amprenavir. Adults who met protocol-defined switch criteria at or after week 8 could modify their randomized therapy. Antiretroviral activity was assessed by the proportion of subjects with plasma HIV-1 RNA < or = 400 and < or = 50 copies/ml, and by changes in plasma HIV-1 RNA levels and CD4 cell counts. Safety was assessed by monitoring clinical adverse events and laboratory abnormalities.

RESULTS

At week 48, the proportion of subjects in the indinavir, saquinavir, ritonavir, nelfinavir and amprenavir groups with plasma HIV-1 RNA < or = 400 copies/ml was 53, 50, 50, 41 and 56%, respectively, and the proportion with HIV-1 RNA < or = 50 copies/ml was 47, 56, 50, 47, and 44%, respectively (by intent-to-treat analysis). Median reductions from baseline in plasma HIV-1 RNA for each group ranged from 1.7 to 2.4 log10 copies/ml. The median CD4 cell count increase from baseline was 195, 131, 116, 136 and 259 cells/mm3 in the indinavir, saquinavir, ritonavir, nelfinavir, and amprenavir groups, respectively. Overall, the most common adverse events attributed to study drugs were diarrhoea, nausea, malaise/fatigue, headache and perioral paresthesia. The frequency of treatment-limiting adverse events did not differ between groups.

CONCLUSIONS

Abacavir is safe and effective when used in combination with a protease inhibitor.

Effects of the dopamine D2 agonist, quinpirole, on time and number processing in rats

In Experiment 1, rats were trained to discriminate discrete sound sequences that varied in time or number. On time trials, the number of sounds was held constant at 4 and the duration of the sound sequence was either 2 or 8 s. On number trials, the duration of the sound sequence was held constant at 4 s, and the number of sounds was either 2 or 8. Psychophysical functions for time and number were obtained by presenting unreinforced sequences of intermediate duration or number. In agreement with previous research, sensitivity to variation in time was greater than variation in number. Rats received injections of the specific D2 agonist, quinpirole (0.08 mg/kg), or saline. Quinpirole significantly attenuated control by both time and number, but it did not increase behavioral estimates of time or number. In Experiment 2, rats were given different dosages of quinpirole (0.02, 0.04 or 0.06 mg/kg). The steepness of the psychophysical functions for both time and number was reduced in a dose-related fashion without any evidence of an increase in the estimation of time or number. The similarity of the effect of quinpirole on both time and number processing is consistent with the idea that the same internal mechanism is used for timing and counting. However, it is not consistent with the idea that D2 dopamine agonists selectively increase the rate of the internal clock, which is assumed to underlie performance in a temporal bisection procedure. Quinpirole (at doses between 0.02 and 0.08 mg/kg) reduces sensitivity to time and number in a bisection procedure without altering the speed of the internal clock.

Utilization of Alzheimer's disease community resources by Asian-Americans in California

Alzheimer's disease is as prevalent among Asian ethnic minority groups as among Caucasians. We explored Asian groups' utilization of available Alzheimer's disease services in California, using a uniquely large sample of Asian-Americans. The Minimum Uniform Dataset includes data from nine California Alzheimer's Disease Diagnostic and Treatment Centers. Of the 9,451 cases included in the Minimum Utilizable Dataset, 4.2% were Asian (primarily Chinese), 0.8% Filipino, 0.3% Pacific Islander, and 75.9% Caucasian. In comparison to their numbers within the nine California countries served, Asian ethnic elders were underrepresented in enrollment by approximately 50%, except at one center where all staff were bilingual. The centers referred a significantly greater proportion of Asian than Caucasian patients for financial help (47.8 vs. 7.4%, P < 0.001), case management (47.8 vs. 22.3%, P < 0.001), and to Alzheimer's disease day care (41.3 vs. 28.4%, P < 0.05). A significantly greater proportion of Asian caregivers received referrals to caregiver resource centers (32.6 vs. 61.3%, P < 0.001) and financial help (29.6 vs. 4.7%, P < 0.001). A smaller proportion of Asian patients received referrals to home health services than Caucasians (4.3 vs. 14.9%, P < 0.05). Filipino patients were also referred more frequently to financial assistance than Caucasians (P < 0.05). Asians and Pacific Islanders under-enroll at centers specializing in AD care. Bilingual staff at centers specializing in dementia care, training for community physicians who treat these patients, and establishment of caregiver support groups within Asian and Pacific Islander communities may enhance the enrollment of these elders. AD care centers in areas supporting Asian and Filipino families may need to concentrate resources on providing financial assistance in case management.

Viral genetic heterogeneity in HIV-1-infected individuals is associated with increasing use of HAART and higher viremia

OBJECTIVE

To assess the correlation between the outgrowth of mutant viruses (viral genetic heterogeneity), highly active antiretroviral therapy (HAART), and plasma HIV-1 RNA in a population-based observational cohort study.

DESIGN

The study population consisted of 42 HIV-1-infected individuals receiving at least two nucleotide reverse transcriptase (RT) inhibitors and one or more protease inhibitors at study entry. There were no restrictions on antiretroviral therapy after enrollment.

METHODS

Plasma samples were obtained from subjects at baseline, at therapy changes, and at quarterly intervals for quantitation of HIV-1 RNA levels and for sequence determination of the entire protease coding region and the first 235 codons of the reverse transcriptase coding region. Data were analyzed using the generalized estimating equation method for longitudinal data and using linear regression analysis.

RESULTS

With increased time on HAART there were significant increases in the number of total HIV-1 mutations in the regions sequenced (P = 0.010). There were significant correlations between the increases in the plasma HIV-1 RNA levels and the numbers of total mutations and reverse transcriptase mutations (P = 0.007 and 0.021, respectively).

CONCLUSIONS

The number of HIV-1 mutations increased over time. Failure of HAART in this study population was correlated with outgrowth of virus with numerous mutations in the reverse transcriptase and protease coding regions. Phenotypic results correlated with genotypic results, showing decreased susceptibility to antiretrovirals over time in the majority of this population during HAART. Both synonymous and non-synonymous mutations were observed, with a higher incidence of non-synonymous mutations occurring at codons associated with drug resistance.

Illicit drug use related attendances at accident and emergency services in Aberdeen: a prospective six month survey

OBJECTIVE

To quantify and examine the nature of known illicit drug related attendances at the Accident and Emergency Department of Aberdeen Royal Hospital over a six month period.

DESIGN

A structured questionnaire was completed by Accident and Emergency staff.

SETTING

The Accident and Emergency Department of Aberdeen Royal Hospital.

SUBJECTS

All patients presenting at the Accident and Emergency Department as a result of known illicit drug use between November 1996 to April 1997 inclusive.

RESULTS

One hundred and fifty seven subjects presented at Accident and Emergency during the six month period. Peak attendance was between 18.00 and 21.00 hours. Twenty seven percent of patients chose to visit Accident and Emergency rather than their own general practitioner. Thirty seven percent had no involvement with any health care professional regarding their drug use. Heroin was used by 62% of cases of which the majority (94.9%) had injected and stimulants such as amphetamine and ecstasy were used by a large proportion of cases. Only 4.5% of subjects admitted to not using clean equipment yet 15% admitted to have loaned equipment (to someone else) and 22% of subjects had injecting related problems. Thirteen percent of subjects were considered unco-operative by staff. Fifty four percent of subjects required admission to a ward and ten patients (6%) died.

CONCLUSION

Heroin continues to be the main drug causing major health problems. Harm reduction messages are not adequately reaching/or being taken up by drug users given the high proportion with injecting related problems and those being prepared to lend needles. The receptive attitude amongst subjects highlighted the opportunity for patient education as well as giving contact addresses of relevant organisations.

Deletions in the beta3-beta4 hairpin loop of HIV-1 reverse transcriptase are observed in HIV-1 isolated from subjects during long-term antiretroviral therapy

OBJECTIVES

To examine the effect of in-frame deletions in human immunodeficiency virus type 1 (HIV-1) reverse transcriptase (RT) on plasma viremia and phenotypic resistance to antiretroviral drugs.

STUDY DESIGN/METHODS

Plasma HIV-1 RNA was isolated from 168 antiretroviral therapy-experienced subjects for quantification of plasma viremia, RT sequence analysis, and phenotypic resistance assays.

RESULTS

Four patients were found to harbor HIV-1 strains possessing in-frame, 3-nucleotide deletions at RT codons 67, 69, and 70. In these subjects, phenotypic resistance and high plasma viremia were observed only in a background of multiple resistance mutations. A recombinant virus engineered with an in-frame deletion of RT codon 67 did not have increased resistance to nucleoside reverse transcriptase inhibitors (NRTIs).

CONCLUSIONS

Selection for deletions within the beta3-beta4 hairpin loop of the HIV-1 RT is an uncommon event most likely to occur in subjects with long-term antiretroviral experience. The codon 67 deletion does not appear to cause increased phenotypic resistance or increased viremia in the absence of concomitant RT mutations.

In vitro fertilization outcomes after intracytoplasmic sperm injection with fresh or frozen-thawed testicular spermatozoa

OBJECTIVE

To compare the outcomes of intracytoplasmic sperm injection (ICSI) and in vitro fertilization (IVF) with fresh and cryopreserved testicular spermatozoa in patients with obstructive and nonobstructive azoospermia.

DESIGN

Retrospective analysis of consecutive ICSI cycles.

SETTING

Large urban reproductive medicine program.

PATIENT(S)

Twenty-nine patients with obstructive and nonobstructive azoospermia undergoing testicular sperm extraction for a total of 46 IVF-ICSI cycles (12 fresh, 34 frozen).

INTERVENTION(S)

Testicular sperm extraction, cryopreservation, and IVF-ICSI with fresh or frozen-thawed spermatozoa.

MAIN OUTCOME MEASURE(S)

Fertilization rates, embryo cleavage rates, embryo implantation rates, clinical pregnancy rates per cycle and per embryo transfer, and delivery and spontaneous abortion rates.

RESULT(S)

No statistically significant differences were noted in any of the parameters examined between IVF-ICSI cycles from fresh or frozen-thawed testicular spermatozoa. Fertilization rates were 56% with fresh vs. 61% with frozen-thawed testicular sperm, cleavage rates 92% vs. 95%, implantation rates 26% vs. 17%, clinical pregnancy rates per cycle 33% vs. 41%, and pregnancy rates per embryo transfer 33% vs. 45%, respectively. Delivery rates were 75% with fresh vs. 69.2% with frozen-thawed testicular sperm, and spontaneous abortion rates 25% and 30.8%, respectively.

CONCLUSION(S)

No differences were found in IVF-ICSI outcomes between cryopreserved and fresh testicular sperm. In addition, cryopreservation provides several advantages for the patients and reproductive team.

Severe B cell hyperplasia and autoimmune disease in TALL-1 transgenic mice

TALL-1/Blys/BAFF is a member of the tumor necrosis factor (TNF) ligand superfamily that is functionally involved in B cell proliferation. Here, we describe B cell hyperplasia and autoimmune lupus-like changes in transgenic mice expressing TALL-1 under the control of a beta-actin promoter. The TALL-1 transgenic mice showed severe enlargement of spleen, lymph nodes, and Peyer's patches because of an increased number of B220+ cells. The transgenic mice also had hypergammaglobulinemia contributed by elevations of serum IgM, IgG, IgA, and IgE. In addition, a phenotype similar to autoimmune lupus-like disease was also seen in TALL-1 transgenic mice, characterized by the presence of autoantibodies to nuclear antigens and immune complex deposits in the kidney. Prolonged survival and hyperactivity of transgenic B cells may contribute to the autoimmune lupus-like phenotype in these animals. Our studies further confirm TALL-1 as a stimulator of B cells that affect Ig production. Thus, TALL-1 may be a primary mediator in B cell-associated autoimmune diseases.

Angiopoietin-1 protects the adult vasculature against plasma leakage

Pathological increases in vascular leakage lead to edema and swelling, causing serious problems in brain tumors, in diabetic retinopathy, after strokes, during sepsis and also in inflammatory conditions such as rheumatoid arthritis and asthma. Although many agents and disease processes increase vascular leakage, no known agent specifically makes vessels resistant to leaking. Vascular endothelial growth factor (VEGF) and the angiopoietins function together during vascular development, with VEGF acting early during vessel formation, and angiopoietin-1 acting later during vessel remodeling, maturation and stabilization. Although VEGF was initially called vascular permeability factor, there has been less focus on its permeability actions and more effort devoted to its involvement in vessel growth and applications in ischemia and cancer. Recent transgenic approaches have confirmed the profound permeability effects of VEGF (refs. 12-14), and have shown that transgenic angiopoietin-1 acts reciprocally as an anti-permeability factor when provided chronically during vessel formation, although it also profoundly affects vascular morphology when thus delivered. To be useful clinically, angiopoietin-1 would have to inhibit leakage when acutely administered to adult vessels, and this action would have to be uncoupled from its profound angiogenic capabilities. Here we show that acute administration of angiopoietin-1 does indeed protect adult vasculature from leaking, countering the potentially lethal actions of VEGF and inflammatory agents.

Rapid detection of the HIV type 1 reverse transcriptase codon T215Y by reverse transcription-polymerase chain reaction with fluorogenic probes

Early detection of viral mutations, particularly those mutations associated with cross-resistance to antiretroviral drugs, is critical both for understanding the mechanism of drug resistance and for the clinical management of patients infected with HIV-1. One of the frequently observed mutations in the HIV-1 reverse transcriptase (RT)-coding region is ACC --> TAC at codon 215, resulting in a change of wild-type threonine (T) to tyrosine (Y); this mutation has been associated with decreased phenotypic susceptibility to zidovudine (ZDV). We describe a technique for the detection of the T215Y mutation using reverse transcription-polymerase chain reaction (RT-PCR) amplification of viral sequences and a 5' nuclease assay requiring fluorogenic probes. In addition to detecting the presence of the ACC --> TAC mutation at codon 215, this assay provides an increased ability to detect low levels of mutant species in a mixed population, relative to conventional sequencing. Further advantages of this technique include the rapid and high-throughput nature of the assay, the accuracy of the assay relative to conventional DNA sequencing, and the convenience of combining RT-PCR virus amplification with the allelic discrimination assay, without the need for purification of PCR products.

The reverse transcriptase codon 69 insertion is observed in nucleoside reverse transcriptase inhibitor-experienced HIV-1-infected individuals, including those without prior or concurrent zidovudine therapy

OBJECTIVES

This study was undertaken to examine 6-bp insertions following codon 69 in the reverse transcriptase (RT) coding region of human immunodeficiency virus type 1 (HIV-1) mutations in terms of incidence, presence of additional RT mutations, phenotypic drug resistance, HIV-1 RNA levels, and antiretroviral treatment history.

STUDY DESIGN/METHODS

A retrospective study of 121 nucleoside reverse transcriptase inhibitor (NRTI)-experienced subjects infected with HIV-1 was performed. Methods included quantitation of HIV-1 RNA levels, genotypic analyses of the RT and protease coding regions, and determination of phenotypic drug resistance.

RESULTS

A 6-bp insertion following RT codon 69 was observed in viral isolates from 4 subjects. Two subjects had a history of zidovudine (ZDV)-based therapy, and two subjects had a history of stavudine (D4T)-based therapy without prior exposure to ZDV. The T69S mutation and the 6-bp insertion following RT codon 69 were the only RT mutations observed in the 2 subjects with a history of D4T-based therapy.

CONCLUSIONS

Six-basepair insertions occurred in virus from 4 of 121 (3%) NRTI-experienced subjects, including those without prior ZDV treatment, and was observed in the absence of the T215Y mutation. There was no apparent correlation between insertion incidence and HIV-1 viremia.

Changes in attractiveness of elected, rejected, and precluded alternatives: a comparison of happy and unhappy individuals

In 3 studies the authors compared the responses of self-rated happy and unhappy students in situations involving choice. In Study 1, high school seniors evaluated colleges after applying for admission and then later after making their selections. Happy students tended to be more satisfied than unhappy ones with the colleges they ultimately chose and those they ultimately rejected, and they more sharply devalued the colleges that rejected them. Studies 2 and 3 dealt with postdecisional consequences of less consequential decisions about fancy desserts. In Study 2, unhappy participants sharply derogated the desserts they rejected or were denied, relative to those selected by or for them, whereas happy participants showed no such derogation. These group differences, moreover, proved to be largely independent of self-esteem and optimism. The design of Study 3 helped explicate underlying mechanisms by inducing both groups to distract themselves or to self-reflect. Doing so eliminated all group differences. Implications of the results for the link between cognitive processes and hedonic consequences are discussed.

Changes in attractiveness of elected, rejected, and precluded alternatives: a comparison of happy and unhappy individuals

In 3 studies the authors compared the responses of self-rated happy and unhappy students in situations involving choice. In Study 1, high school seniors evaluated colleges after applying for admission and then later after making their selections. Happy students tended to be more satisfied than unhappy ones with the colleges they ultimately chose and those they ultimately rejected, and they more sharply devalued the colleges that rejected them. Studies 2 and 3 dealt with postdecisional consequences of less consequential decisions about fancy desserts. In Study 2, unhappy participants sharply derogated the desserts they rejected or were denied, relative to those selected by or for them, whereas happy participants showed no such derogation. These group differences, moreover, proved to be largely independent of self-esteem and optimism. The design of Study 3 helped explicate underlying mechanisms by inducing both groups to distract themselves or to self-reflect. Doing so eliminated all group differences. Implications of the results for the link between cognitive processes and hedonic consequences are discussed.

Progress's Pilgrim: a critical narrative of research in progress

There is increasing interest in the use of stories to develop nursing and health care practice. This paper reports on how we used story to understand and develop research on nursing practice. Story (or narrative) and science can be seen as distinct but complementary paradigms. We have found that a story framework can help researchers to reflect on a process of social scientific investigation, and to consider how to 'go on' in that process. In a study on 'Community psychiatric nurses' empowerment of people with enduring mental disorders in the community: involving users to develop services' we have encountered a number of interesting and challenging issues related to design and use of methods. We present these issues within a framework of story analysis, focusing on issues related to empowerment. This analysis draws on Burke's 'pentad' of story elements as a framework for narrative analysis. We present the elements of the 'story of the study-as-funded' and as it was carried out through the pilot stage, and outline the story of developments in the main study. 'Trouble' in a story centres on a problematic 'ratio' of story elements. The 'trouble' at this stage in the progress of our study relates to lack of fit between some parts of the instruments (the methods) and the goal (empowerment), and to the status of the CPNs as actors or agents. Narrative analysis sensitizes us to these issues of 'trouble' and provides a means of addressing them. Like John Bunyan's Pilgrim, we have learned through our progress; unlike Pilgrim, we know not our end.

Quality of cryopreserved testicular sperm in patients with obstructive and nonobstructive azoospermia

PURPOSE

Sperm retrieved by testicular sperm extraction is routinely used to attempt pregnancy by in vitro fertilization-intracytoplasmic sperm injection. We evaluated the efficacy of cryopreserving testicular sperm collected by testicular sperm extraction at diagnostic biopsy.

MATERIALS AND METHODS

A total of 73 men with obstructive and 42 with nonobstructive azoospermia underwent testicular sperm extraction at diagnostic biopsy. Sperm was retrieved and cryopreserved in all cases of obstruction and in 15 of nonobstructive azoospermia cases. Before freezing we determined sperm count, motility, morphology and viability, and after thawing we assessed sperm motility and viability. In 17 couples a total of 20 cycles of in vitro fertilization-intracytoplasmic sperm injection were performed and fertilization, cleavage and pregnancy rates were determined in cases of obstruction and nonobstruction.

RESULTS

Sperm count and morphology were lower in the testicular biopsies of men with nonobstructive versus obstructive azoospermia. Motility was low or absent in all testicular sperm extraction specimens. Importantly, pre-freeze (63%) and post-thaw (31%) viability was the same in both patient groups. After in vitro fertilization-intracytoplasmic sperm injection using frozen and thawed testicular sperm the fertilization, cleavage, implantation and clinical pregnancy rates were 60, 86, 16 and 50%, respectively. Using cryopreserved sperm we observed no differences in outcome of any in vitro fertilization-intracytoplasmic sperm injection procedure in patients with obstructive versus nonobstructive azoospermia.

CONCLUSIONS

Cryopreservation of testicular sperm provides enough good quality sperm after thawing to result in excellent in vitro fertilization-intracytoplasmic sperm injection outcomes. Cryopreservation does not adversely affect intracytoplasmic sperm injection outcomes, including pregnancy rate. Therefore, we recommend routine testicular sperm extraction and cryopreservation of sperm at testicular biopsy.

A novel isoform of the mitochondrial outer membrane protein VDAC3 via alternative splicing of a 3-base exon. Functional characteristics and subcellular localization

Voltage-dependent anion channels (VDACs) are pore-forming proteins found in the outer mitochondrial membrane of all eucaryotes. VDACs are the major pathway for metabolites through the outer mitochondrial membrane and, in mammals, bind several cytosolic carbohydrate kinases. Whereas yeast contain a single VDAC (YVDAC), to date three isoforms have been described in the mouse that constitute a gene family. We have observed an additional isoform of VDAC3 that appears to be generated via the tissue-specific alternative splicing of a 3-base exon (ATG). The exon is predicted to introduce a methionine 39 amino acids downstream of the amino terminus of the polypeptide. Between exons 3 and 4 is an intronic sequence that potentially encodes the exon, with flanking splice enhancer elements. Expression of this alternative form in the mouse is limited to brain, heart, and skeletal muscle. Complementation of YVDAC-deficient yeast by the two isoforms and with other sequence variants of VDAC3 suggests this residue is an important modulator of VDAC3 function. In transfected mammalian cells both isoforms localize to mitochondria. A similar variant is present in humans.

A comparison of social phobia outcome measures in cognitive-behavioral group therapy

This article reports the effects of a cognitive-behavioral group therapy program for social phobia (N = 25 outpatients) on several psychometric measures. It is the first study to simultaneously examine three newer and promising social-phobia measures: the Social Phobia Scale (SPS) and accompanying Social Interaction Anxiety Scale (SIAS), the Social Phobia and Anxiety Inventory (SPAI), and the Liebowitz Social Anxiety Scale (LSAS). More traditional measures of social phobia were also included, along with measures of anxious and depressed mood. Among the newer scales, the SPAI and SPS/SIAS were found to have good sensitivity to treatment. There was limited support for the LSAS. Intercorrelations among all of the outcome measures are presented both before and after cognitive-behavioral therapy. Strengths and weakness of each of the newer social-phobia measures are discussed.