Antiretroviral therapy for HIV infection in 1996. Recommendations of an international panel. International AIDS Society-USA

We report on a retrospective study evaluating infectious morbidity associated with totally implantable venous access devices (TIVAD) (Port-A-Cath) in HIV-infected patients. This study of 84 consecutive HIV-infected patients requiring 89 TIVAD between January 1990 and October 1993 was performed in the Department of Infectious Diseases H?pital de l'Institut Pasteur, Paris, France. The total number of catheter days was 11,595. Eighteen of 89 patients with TIVAD (20%) were infected, causing 25 infectious events (25/89: 28%) among 17 different patients (17/84: 20%). The infection rate was 0.22 per 100 catheter days. Mean onset of infection was 82 days. Twenty microorganisms were isolated: Staphylococcus aureus in eight cases (40%), coagulase-negative Staphylococcus in six cases (30%), Streptococcus D faecalis in one case; Gram-negative bacilli were found in five cases (25%). All patients received an intravenous antibiotherapy combined with a local lock treatment in eight cases. Nine TIVAD removals were performed. One death was related to the TIVAD infection. No additional predisposing factor for infection was identified other than the implied condition of the HIV infection. The population and material in this study were homogeneous. The TIVAD infection rate was comparable to other published reports. Prospective evaluation comparing tunneled catheter and TIVAD in HIV-infected patients is needed.     

Ligand-induced conformational change in transferrins: crystal structure of the open form of the N-terminal half-molecule of human transferrin

Serum transferrin binds ferric ions in the bloodstream and transports them to cells, where they are released in a process involving receptor-mediated endocytosis. Iron release is believed to be pH dependent and is coupled with a large conformational change. To help define the steps in iron release, we have determined the three-dimensional structure of the iron-free (apo) form of the recombinant N-lobe half-molecule of human serum transferrin (ApoTfN) by X-ray crystallography. Two crystal forms were obtained, form 1 with four molecules in the asymmetric unit and form 2 with two molecules in the asymmetric unit. The structures of both forms were determined by molecular replacement and were refined at 2.2 and 3.2 A resolution, respectively. Final R-factors were 0.203 (free R = 0. 292) for form 1 and 0.217 (free R = 0.312) for form 2. All six copies of the ApoTfN structure are essentially identical. Comparison with the holo form (FeTfN) shows that a large rigid-body domain movement of 63 degrees has occurred in ApoTfN, to give an open binding cleft. The extent of domain opening is the same as in the N-lobe of human lactoferrin, showing that it depends on internal constraints that are conserved in both proteins, and that it is unaffected by the presence or absence of the C-lobe. Although the conformational change is primarily a rigid-body motion, several local adjustments occur. In particular, two iron ligands, Asp 63 and His 249, change conformation to form salt bridges, with Lys 296 and Glu 83, respectively, in the binding cleft of the apo protein. Both salt bridges would have to break for iron coordination to occur. Most importantly, the structure, determined at a pH (5.3) that is close to the pH of physiological iron release, indicates that protonation of His 249 is a key step in iron release.     

Computed tomography-guided central venous catheter placement in a patient with superior vena cava and inferior vena cava occlusion

Erythropoietin (EPO) is a glycoprotein hormone produced principally by the kidney and is the major stimulus for erythropoiesis. Recombinant human EPO has now been biosynthesized and is available for clinical use, particularly in patients with renal failure. EPO has been reported to be effective in treating anaemia due to chronic renal failure. It has been used in pregnancy to correct anaemia following renal transplantation with graft dysfunction. We report here the case of a post-renal transplant patient who became pregnant and developed severe anaemia which was not related to iron, B12, or folate deficiency. Her anaemia was successfully treated with EPO with no evidence of rejection or significant graft dysfunction following therapy. She tolerated EPO very well, and there was a successful outcome of the pregnancy. This case has encouraged us to conclude that EPO has a useful role in the treatment of anaemia in pregnant women following renal transplantation.     

BMP-2/-4 and Wnt-8 cooperatively pattern the Xenopus mesoderm

An improved and efficient refolding system for a single-chain antibody fragment (scFv) from inclusion bodies expressed in Escherichia coli was developed. Stepwise removal of denaturing reagent and controlled addition of oxidizing reagent were found to be the most effective conditions to achieve for almost complete recovery of functional monomeric scFv from inclusion bodies. Adding L-arginine to the refolding solution also increased the yield of refolded functional scFv. The single-chain Fv fragments of both a mouse anti-lysozyme monoclonal antibody, HyHEL10, and a human monoclonal antibody against the D antigen of the Rh blood group, D10, in solubilized inclusion bodies could be refolded under these conditions with yields of up to 95%. The refolding procedures developed in this study will contribute to providing a stable supply of large amounts of human single-chain Fv fragments.     

Transition to adulthood of female garment-factory workers in Bangladesh

This article examines data from a study on garment-factory workers in Bangladesh to explore the implications of work for the early socialization of young women. For the first time, large numbers of young Bangladeshi women are being given an alternative to lives in which they move directly from childhood to adulthood through early marriage and childbearing. Employment creates a period of transition in contrast to the abrupt assumption of adult roles at very young ages that marriage and childbearing mandate. This longer transition creates a period of adolescence for young women working in the garment sector that is shown to have strong implications for the women's long-term reproductive health.     

The identification and measurement of quality dimensions in health care: focus group interview results

The identification and measurement of service quality are critical factors that are responsible for customer satisfaction. This article identifies 11 attributes that define quality of care and patient satisfaction and reveals various gaps among the patient, physician, and administrator groups in the perceived importance of those dimensions. Managerial implications for patient-focused health care are discussed.     

Prospects of immunotropic therapy of traumatic uveitis

Traditional corticosteroid and antiinflammatory therapy should be supplemented with new immunocorrective drugs in patients with traumatic uveitis and ocular subatrophy. Immunotherapy is a pathogenetically justified and perspective trend in multiple-modality treatment of patients with injuries to the organ of vision. The authors validate the use of immunocorrectors utilized in general transplantology for preventing rejection crisis. Immunostimulants or immunosuppresants can be added to treatment protocols for patients with traumatic uveitis, depending on the changes in the patient's immune status. New immunotropic drugs affecting all components of immunity are needed.