Raltegravir can be used safely in HIV-1-infected patients treated with warfarin

Drug co-administration often affects the patient response to warfarin through various mechanisms. We describe here five HIV-1-infected patients on treatment with warfarin in whom the use of raltegravir was associated with a favourable outcome.

Single-molecule study of the CUG repeat-MBNL1 interaction and its inhibition by small molecules

Effective drug discovery and optimization can be accelerated by techniques capable of deconvoluting the complexities often present in targeted biological systems. We report a single-molecule approach to study the binding of an alternative splicing regulator, muscleblind-like 1 protein (MBNL1), to (CUG)n = 4,6 and the effect of small molecules on this interaction. Expanded CUG repeats (CUG(exp)) are the causative agent of myotonic dystrophy type 1 by sequestering MBNL1. MBNL1 is able to bind to the (CUG)n-inhibitor complex, indicating that the inhibition is not a straightforward competitive process. A simple ligand, highly selective for CUG(exp), was used to design a new dimeric ligand that binds to (CUG)n almost 50-fold more tightly and is more effective in destabilizing MBNL1-(CUG)4. The single-molecule method and the analysis framework might be extended to the study of other biomolecular interactions.

Morphological and topological transformation of membrane vesicles

Liposomes are micro-compartments made of lipid bilayer membranes withcharacteristics quite similar to those of biological membranes. To formartificial cell-like structures, we generated liposomes that containedsubunit proteins of cytoskeletons: tubulin or actin. Spherical liposomeswere transformed into bipolar or cell-like shapes by mechanical forcesgenerated by the polymerization of encapsulated subunits of microtubules.Disk- or dumbbell-shaped liposomes were developed by the polymerizationof encapsulated actin. Dynamic processes of morphological transformationsof liposomes were visualized by high intensity dark-field lightmicroscopy.Topological changes, such as fusion and division of membrane vesicles,play an essential role in cellular activities. To investigate themechanism of these processes, we visualized in real time the liposomesundergoing topological transformation. A variety of novel topologicaltransformations were found, including the opening-up of liposomes and thedirect expulsion of inner vesicles.

A cross-sectional population-based study on senile dementia in a rural city

All residents aged 65 or over in a rural city (n=5340) were studied with a self-administered questionnaire on psychiatric symptoms, physical health status, medical history, and environmental factors. After the screening, the clinical diagnosis of senile dementia was made by psychiatrists. The overall prevalence was 4.0% among responders staying at home (201/4969). The prevalence increased with age for both males and females and tended to be higher for females than males. The multilogistic analysis of the above variables showed that in the cerebrovascular type, stroke and inactive physical status might be risk factors for both gender groups. For the Alzheimer's type, age and inactive physical status might be risk factors. For overall dementia, age, stroke, and inactive physical status might be risk factors.

Formation of NaCl-type monodeuteride LaD by the disproportionation reaction of LaD2

Previous x-ray diffraction measurements revealed the pressure-induced decomposition of an fcc LaH2.3 into H-rich and H-poor fcc phases around 11 GPa. The present neutron diffraction measurements on LaD2 confirm the formation of NaCl-type LaD as a counterpart of the D-rich LaD2+δ by disproportionation. First-principles enthalpy and lattice dynamic calculations demonstrate that the NaCl-type LaH is stabilized at high pressures and can be recovered at ambient conditions. Finding the NaCl-type LaH will pave the way for investigations on the site-dependent nature of hydrogen-metal interactions.

Fluid overload deteriorate chylothorax: evaluation in a canine model

No conservative treatments for chylothorax have yet been established, and surgical ligation of the thoracic duct is required in many cases. In the present study, we investigated the management of body fluid in a canine chylothorax model. Twelve beagle dogs were divided evenly into three groups: A, B, and C. Under general anesthesia, the thoracic duct was cut and opened, and the amount of lymph fluid leakage was measured. Intravenous extracellular fluid infusion was started at 5mL/kg/h for the first 2h, and then between 2 and 4h, the infusion rate was increased to 10 mL/kg/h in group A and to 20mL/kg/h in group B. During the first 2h after cutting the thoracic duct, the mean lymph fluid leakage rates in groups A, B, and C were 0.466, 0.635, and 0.575 mL/kg/h, respectively. The rates of leakage did not differ significantly among the groups. Between 2 and 4h, the mean rates of leakage were 0.750, 1.43, and 0.544mL/kg/h, respectively, being significantly higher in groups A and B than in group C. The amount of lymph fluid ascending the thoracic duct correlates with the amount of intravenous fluid infusion. For the management of chylothorax, it is important to avoid fluid overload.

Induction of elastin expression in vascular endothelial cells relates to hepatoportal sclerosis in idiopathic portal hypertension: possible link to serum anti-endothelial cell antibodies

Hepatoportal sclerosis accompanied by dense elastic fibre deposition is generally regarded as the primary lesion in the development of idiopathic portal hypertension (IPH). This study was performed to clarify the mechanism of elastic fibre deposition in the peripheral portal tracts of IPH liver in relation to serum anti-endothelial cell antibodies (AECA). In-vitro experiments were performed using human dermal microvascular endothelial cells (HMVEC) and patients' sera. The presence of serum AECA was assayed by a cell-based enzyme-linked immunosorbent assay (ELISA) using HMVEC. Immunohistochemical analysis of elastin was performed using liver tissue sections of IPH patients. IPH sera contained one or more AECA that could bind to the vascular endothelial cells of the peripheral portal tracts of the liver. When the value of AECA greater than the mean ± 2 standard deviations of healthy controls was regarded as positive, the positive detection rate of either immunoglobulin (Ig)G, IgA or IgM AECA in IPH sera was 30% (10 of 33 cases). IPH sera induced the expression of elastin in HMVEC, which appeared to be associated with the presence of AECA. Apoptosis was also induced in HMVEC by the stimulation with IPH sera. In vivo, elastin expression was observed in the endothelial cells of the peripheral portal tracts of IPH livers in a proportion of cases. The disease pathogenesis of IPH seems to be heterogeneous, and this study elucidated a possible contribution of the induction of elastin expression in the portal vessels to hepatoportal sclerosis of IPH, which might be linked to serum AECA as a causative factor.

Sharps injuries among nurses in a Thai regional hospital: prevalence and risk factors

BACKGROUND

Sharps injuries (SIs) are one of the most serious occupational accidents among nurses due to the possible severe consequences, such as the transmission of infectious diseases and inducing of mental impairment.

OBJECTIVE

To discover the prevalence of SIs among nurses in a regional hospital in Thailand and to identify factors associated with SIs.

METHODS

A cross-sectional study was conducted in 2011. Stratified random sampling was used to select the respondents, with wards as the strata and the number of nurses selected proportional to the size of the ward nurse population. 261 self-administered questionnaires were distributed to nurses who used needles, syringes or other sharp medical equipment in their work. Data were analyzed using chi-square tests, correlation analysis and multiple logistic regression analysis.

RESULTS

The prevalence of SIs for the previous 12 months was 55.5% among the 250 nurses who returned a completed questionnaire. Of these, 91.1% were with blood. Needles (52.8%) were the main cause of SIs. The reporting rate of SIs to the hospital was 23.8%. SIs had a significant association with each of marital status, work duration, work department, attitude regarding SI prevention, and preventive management. Using multiple logistic regression analysis, attitude was found to be the strongest predictor of SIs when adjusted for other factors. Nurses who had negative attitudes towards prevention of SIs were nearly two times more likely to have SIs than those with positive attitudes (adjusted odds ratio = 1.86; 95% CI: 1.03-3.38).

CONCLUSION

The study showed a high prevalence of SIs, but a low reporting rate. This suggests the reporting system requires simplification and also should include a quick response management component. Promoting positive attitudes to SI prevention, and improving the reporting system would reduce SIs.

Usefulness of an original self-completed questionnaire for screening of cancer-related mental disorder in patients with newly diagnosed early breast cancer

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Background: Cancer-related mental disorder reduces (e.g., depression and anxiety disorder) not only treatment compliance but also compromises the quality of life of the patient. However, psychiatric intervention at the cancer notification has been barely performed in Japan because Japanese people traditionally tend to have a prejudice against psychiatric consultation and about sexual activity. In order to provide more effective treatment for breast cancer patients, it is necessary to treat cancer-related mental disorder in Japan.

Methods: Based on Self-rating Depression Scale, Hamilton's Rating Scale for Depression and Beck Depression Inventory, the questionnaires were modified for Japanese patients by psychiatrists and clinical psychologists of our hospital. We asked newly diagnosed breast cancer patients an original self-completed questionnaire regarding the depression and anxiety disorder between January 2010 and March 2011. This questionnaire consists of 14 questions about depression and anxiety disorder without questions of sexual activity, which has two points each question (maximum total points were 28). We recommended the psychiatric interference by a psychiatrist and the clinical psychologist to all patients with more than 14 points in this questionnaire.

Results: We obtained data from 116 patients. No patient refused to answer the questionnaire. 23 patients had higher than 14 points in this questionnaire. Of 23 patients, 9 patients received psychiatric intervention without medication, and four patients received psychotropic medications. Based on the results, we avoided the administration of anticancer agent by intravenous infusion in three patients who had higher than 14 points in the questionnaire. Multivariate analysis revealed that unmarried status is associated with a significantly higher score (OR 16.1; p = 0.013).

Conclusions: Our data suggest that our original self-completed questionnaire is useful for the screening of the cancer-related mental disorder in order to provide appropriate therapy to newly diagnosed breast cancer patients.

Emergence of raltegravir-resistant HIV-1 in the central nervous system

Integrase inhibitor-resistant HIV-1 was detected in the cerebrospinal fluid, but not in the plasma of a 42-year-old man with HIV encephalopathy treated with a raltegravir (RAL)-containing regimen. Raltegravir resistance may develop in the central nervous system when the virus is already multi-drug resistant because of different penetration into cerebrospinal fluid of individual antiretroviral agents.