Increased TLR2 expression in patients with type 1 diabetes: evidenced risk of microalbuminuria

Objective: To study the activation of an inflammatory cascade through leukocyte mRNA expression of TLR2, TLR4, MyD88, and pro-inflammatory cytokines in individuals with childhood onset type 1 diabetes. Design and methods: Seventy-six type 1 diabetic patients and 100 normoglycemic subjects (NG) 6 to 20 years old were recruited. Type 1 diabetic patients (DM1) were considered to have good (DM1G) or poor (DM1P) glycemic control according to the values of glycated hemoglobin. TLR2, TLR4, MyD88, interleukin-1 beta (IL-1 beta), IL-6, and tumor necrosis factor alpha (TNF-alpha) mRNA expressions were measured in peripheral blood leukocytes (PBL) by real-time polymerase chain reaction (PCR). Urea, creatinine, albumin, and total protein serum levels were determined. Urinary albumin-to-creatinine ratio (ACR) was calculated. Results: DM1 and DM1P patients showed higher glycated hemoglobin (10 and 11%, respectively) and serum glucose concentrations (208 and 226 mg/ dL, respectively) compared to NG (Glycated hemoglobin: 7% and glucose: 76 mg/ dL) (p < 0.05). PBL mRNA expressions of TLR2, MyD88, IL-1 beta, IL-6, and TNF-alpha were higher in DM1 and TLR2, IL-1 beta, and IL-6 expressions were higher in DMP1 compared to NG (p < 0.05). In DM1, serum albumin and total protein were lower, while serum urea and ACR were higher in comparison to NG (p < 0.05). However, these differences compared to NG were more pronounced in DM1P, which included nine individuals with microalbuminuria. Conclusions: Increased mRNA expression of TLR2, MyD88, and pro-inflammatory cytokines in leukocytes of patients with childhood onset type 1 diabetes indicates the development of a TLR2-mediated pro-inflammatory process, which may also be associated with an early inflammatory process in the kidney and the occurrence of microalbuminuria.

Cytoplasmic and extracellular expression of pharmaceutical-grade mycobacterial 65-kDa heat shock protein in Lactococcus lactis

Lactic acid bacteria (LAB) are an attractive and safe alternative for the expression of heterologous proteins, as they are nonpathogenic and endotoxin-free organisms. Lactococcus lactis, the LAB model organism, has been extensively employed in the biotechnology field for large-scale production of heterologous proteins, and its use as a "cell factory" has been widely studied. We have been particularly interested in the use of L. lactis for production of heat shock proteins (HSPs), which reportedly play important roles in the initiation of innate and adaptive immune responses. However, this activity has been questioned, as LPS contamination appears to be responsible for most, if not all, immunostimulatory activity of HSPs. In order to study the effect of pure HSPs on the immune system, we constructed recombinant L. lactis strains able to produce and properly address the Mycobacterium leprae 65-kDa HSP (Hsp65) to the cytoplasm or to the extracellular medium, using a xylose-induced expression system. Approximately 7 mg/L recombinant Hsp65 was secreted. Degradation products related to lactococcal HtrA activity were not observed, and the Limulus amebocyte lysate assay demonstrated that the amount of LPS in the recombinant Hsp65 preparations was 10-100 times lower than the permitted levels established by the U. S. Food and Drug Administration. These new L. lactis strains will allow investigation of the effects of M. leprae Hsp65 without the interference of LPS; consequently, they have potential for a variety of biotechnological, medical and therapeutic applications.

The medial amygdaloid nucleus is involved in the cardiovascular pathway activated by noradrenaline into the lateral septal area of rats

We have previously reported that noradrenaline (NA) microinjected into the lateral septal area (LSA) caused pressor and bradicardic responses that were mediated by vasopressin release into the circulation through the paraventricular nucleus of hypothalamus (PVN). Although PVN is the final structure involved in the cardiovascular responses caused by NA in the LSA, there is no evidence of direct connections between these areas, suggesting that some structures could be links in this pathway. In the present study, we verified the effect of reversible synaptic inactivation of the medial amygdaloid nucleus (MeA), bed nucleus of stria terminalis (BNST) or diagonal band of Broca (DBB) with Cobalt Chloride (CoCl2) on the cardiovascular response to NA microinjection into the LSA of unanesthetized rats. Male Wistar rats had guide cannulae implanted into the LSA and the MeA, BNST or DBB for drug administration, and a femoral catheter for blood pressure and heart rate recordings. Local microinjection of CoCl2 (1 mm in 100 nL) into the MeA significantly reduced the pressor and bradycardic responses caused by NA microinjection (21 nmol in 200 nL) into the LSA. In contrast, microinjection of CoCl2 into the BNST or DBB did not change the cardiovascular responses to NA into the LSA. The results indicate that synapses within the MeA, but not in BNST or DBB, are involved in the cardiovascular pathway activated by NA microinjection into the LSA.

Genotoxic and mutagenic effects of erythrosine B, a xanthene food dye, on HepG2 cells

Erythrosine (ErB) is a xanthene and an US Food and Drug Administration approved dye used in foods, drugs and cosmetics. Although its utilization is permitted, ErB is described as inhibitor of enzymes and protein-protein interactions and is toxic to pituitary and spermatogenesis processes. However, the genotoxicity and mutagenicity of ErB is inconclusive in the literature. This study aimed to analyze the genotoxicity of this dye using the alkaline comet assay and is the first investigation to evaluate ErB mutagenicity using the cytokinesis block micronucleus cytome (CBMN-Cyt) assay in HepG2 cells. These cells were chosen because they produce phase I and phase II enzymes that can mimic in vivo metabolism. The cells were treated with seven concentrations (0.1-70.0 mu g mL(-1)) of ErB, and the results showed genotoxicity at the two highest concentrations and mutagenicity at six concentrations. Furthermore, as micronuclei result from clastogenic and aneugenic processes, while comet assay is often considered more sensitive and detects DNA single strain breaks, we suggest that an aneugenic is responsible for the observed damage. Although ErB is approved for use in the food, cosmetic and pharmaceutical industries, it must be used carefully because it damages the DNA structure. (C) 2012 Elsevier Ltd. All rights reserved.

In vivo evaluation of a metronidazole-containing gel for the adjuvant treatment of chronic periodontitis: preliminary results

The present study developed an experimental metronidazole-based gel and evaluated its efficacy for the adjuvant treatment of chronic periodontitis. Sixteen patients were randomly allocated into two groups of eight subjects according to the following proposed treatments: (1) scaling and root planing (active control) or (2) scaling and root planing and direct periodontal intrapocket application of 15% metronidazole-based gel in two sites (a parts per thousand yen5 mm in depth) (experimental group). Potential changes in the subgingival microbiota were assessed using a DNA Checkerboard method at three proposed times: baseline and following 7 or 30 days of drug administration. High-performance liquid chromatography (HPLC) monitored metronidazole concentrations in the crevicular fluid during treatment. The metronidazole experimental group presented lower bacterial counts than the control group at the three evaluated times (p < 0.01 for baseline, p < 0.001 for 7 or 30 days) when the target species were analyzed as a pool of bacteria. Samples revealed significantly lower counts 7 days after drug administration compared with baseline or after 30 days (p < 0.05). HPLC analysis detected gel 1 h after application. The metronidazole-based gel significantly decreased the total bacterial count at the three evaluated times. Periodontopathogenic species were not different after gel administration.

Sviluppo di tecniche di analisi ifenate per la quantificazione di biomarcatori di esposizione a tossici ambientali: gli acidi mercapturici

Human biomonitoring (HBM) is an ideal tool for evaluating toxicant exposure in health risk assessment. Chemical substances or their metabolites related to environmental pollutants can be detected as biomarkers of exposure using a wide variety of biological fluids. Individual exposure to aromatic hydrocarbon compounds (benzene, toluene, and o-xylene –“BTX”) were analysed with a liquid chromatography coupled to electrospray ionisation-mass spectrometry (μHPLC-ESI-MS/MS) method for the simultaneous quantitative detection of the BTX exposure biomarker SPMA, SBMA and o-MBMA in human urine. Urinary S-phenylmercapturic acid (SPMA) is a biomarker proposed by the American Conference of Governmental Industrial Hygienists (ACGIH) for assessing occupational exposure to benzene (Biological Exposure Index of 25 microg/g creatinine). Urinary S-benzylmercapturic (SBMA) and o-methyl S-benzyl mercapturic acid (o-MBMA) are specific toluene and o-xylene metabolites of glutathione detoxicant pathways, proposed as reliable biomarkers of exposure. To this aim a pre-treatment of the urine with solid phase extraction (SPE) and an evaporation step were necessary to concentrate the mercapturic acids before instrumental analysis. A liquid chromatography separation was carried out with a reversed phase capillary column (Synergi 4u Max-RP) using a binary gradient composed of an acquous solution of formic acid 0.07% v/v and methanol. The mercapturic acids were determinated by negative-ion-mass spectrometry and the data were corrected using isotope-labelled analogs as internal standards. The analytical method follows U.S. Food and Drug Administration guidance and was applied to assess exposure to BTX in a group of 396 traffic wardens. The association between biomarker results and individual factors, such as age, sex and tobacco smoke were also investigated. The present work also included improvements in the methods used by modifying various chromatographic parameters and experimental procedures. A partial validation was conducted to evaluate LOD, precision, accuracy, recovery as well as matrix effects. Higher sensitivity will be possible in future biological monitoring programmes, allowing evaluation of very low level of BTX human exposure. Keywords: Human biomonitoring, aromatic hydrocarbons, biomarker of exposure, HPLC-MS/MS.

Sintesi, modifica e caratterizzazione di polimeri da fonti rinnovabili

Gli argomenti trattati all’interno di questa tesi di dottorato riguardano la sintesi e la modifica di polimeri ottenuti a partire da fonti rinnovabili. L’acido polilattico (PLA) è stato modificato per ottenere film estensibili per uso alimentare. La scelta del materiale si è basata sull’analisi del suo ciclo di vita e perché è riconosciuto come sicuro per l’utilizzo nel campo alimentare. Le formulazioni testate, a base di PLA, sono state preparate con l’aggiunta di una serie di additivi utilizzati per migliorare le proprietà meccaniche del materiale. La lavorazione è stata eseguita mediante estrusione, ottenendo dei pellet a composizione omogenea successivamente lavorati nell’estrusore a bolla, modalità industriale di produzione dei film estensibili. È stata poi effettuata la sintesi diretta di nuovi poliesteri insaturi a base di dimetil succinato e 1,6-esandiolo. L’insaturazione della catena è stata ottenuta mediante l’uso, durante la sintesi, di derivati dell’olio di ricino, l’acido ricinoleico e il suo derivato insaturo metil undecenoato. Un’altra molecola insatura utilizzata è stata il citronellolo, scelto tra i terpeni. I polimeri così ottenuti sono stati modificati tramite reazioni radicaliche indotte con radiazioni UV utilizzando sostanze antibatteriche (sale 3-esadecil-1-vinilimidazolo bromuro) al fine di ottenere materiali con attività biocida a lungo termine e senza rilascio. Si è proceduto inoltre alla polimerizzazione reversibile di monomeri furanici con oli vegetali utilizzando una strategia di tipo double click. Si è partiti dalla sintesi di monomeri derivanti da oli vegetali contenenti eterocicli furanici attaccati mediante addizione tiol-enica (prima reazione click chemistry) e si è proseguito con la loro successiva polimerizzazione attraverso una reazione di tipo Diels-Alder con molecole con gruppi maleimmidici (seconda reazione click chemistry). I polimeri così ottenuti sono materiali potenzialmente auto-riparanti, grazie alla possibilità di spostare l’equilibrio verso i prodotti o i reagenti semplicemente variando le condizioni di temperatura.

Sicurezza dei prodotti alimentari e la responsabilità civile nell'Unione europea e negli Stati Uniti: tecniche a confronto

Le profonde trasformazioni che hanno interessato l’industria alimentare, unitamente alle accresciute capacità delle scienze mediche ed epidemiologiche di individuare nessi causali tra il consumo di determinate sostanze e l’insorgere di patologie, hanno imposto al legislatore di intervenire nella materia della c.d. sicurezza alimentare mettendo in atto sistemi articolati e complessi tesi a tutelare la salute dei consociati. Quest’ultimo obiettivo viene perseguito, da un lato, mediante disposizioni di natura pubblicistica e di carattere preventivo e, dall’altro lato, dallo strumento della responsabilità civile. Le due prospettive di tutela della salute delle persone costituiscono parti distinte ma al tempo stesso fortemente integrate in una logica unitaria. Questa prospettiva emerge chiaramente nel sistema statunitense: in quel ordinamento la disciplina pubblicistica della sicurezza degli alimenti – definita dalla Food and Drug Administration – costituisce un punto di riferimento imprescindibile anche quando si tratta di stabilire se un prodotto alimentare è difettoso e se, di conseguenza, il produttore è chiamato a risarcire i danni che scaturiscono dal suo utilizzo. L’efficace sinergia che si instaura tra la dimensione pubblicistica del c.d. Public Enforcement e quella risarcitoria (Private Enforcement) viene ulteriormente valorizzata dalla presenza di efficaci strumenti di tutela collettiva tra i quali la class action assume una importanza fondamentale. Proprio muovendo dall’analisi del sistema statunitense, l’indagine si appunta in un primo momento sull’individuazione delle lacune e delle criticità che caratterizzano il sistema nazionale e, più in generale quello comunitario. In un secondo momento l’attenzione si focalizza sull’individuazione di soluzioni interpretative e de iure condendo che, anche ispirandosi agli strumenti di tutela propri del diritto statunitense, contribuiscano a rendere maggiormente efficace la sinergia tra regole preventive sulla sicurezza alimentare e regole risarcitorie in materia di responsabilità del produttore.

Serumfreie Collagen-Monolayer- und Sandwich-Kulturen primärer Hepatozyten als ein wertvolles Modell zur Detektion von Toxizität und Arzneimittelwechselwirkungen in vitro

In dieser Arbeit wurden Zellkulturen primärer Hepatozyten von Ratte und Mensch hinsichtlich ihrer Eignung untersucht Speziesunterschiede der toxischen Wirkung und des Metabolismus von Substanzen darzustellen und inwieweit die in vitro-Ergebnisse in vivo vergleichbar bzw. übertragbar sind. Des Weiteren wurde ein Zellkulturmodell entwickelt, das eine Kultivierung von primären Hepatozyten aus Ratte, Mensch und Maus über einen Zeitraum von mindestens einer bis zwei Wochen erlaubt.rnrnDie Zellkulturen primärer Hepatozyten von Ratte und Mensch zeigten deutliche Unterschiede in der substanzinduzierten Veränderung der Genexpression nach Behandlung mit den, vor allem für den Menschen, lebertoxischen Substanzen Diclofenac und Troglitazon. Diese Unterschiede traten hauptsächlich in der Induktion fremdstoffmetabolisierender Enzyme sowie deren transkriptionsregulierenden Kernrezeptoren in den humanen Hepatozyten auf. Ebenso war eine verstärkte Stressantwort zu beobachten.rnDeutliche Speziesunterschiede konnten ebenso in der Wirkung der Arzneimittelentwicklungssubstanz EMD 392949 auf die Aktivität bzw. Genexpression von Cytochrom P450 Enzymen sowie deren Regulatoren nachgewiesen werden. Des Weiteren konnte hier eine sehr gute Übereinstimmung der Ergebnisse aus den Zellkulturen primärer Ratten- bzw. Humanhepatozyten mit jenen aus in vivo-Experimenten mit Ratten bzw. Affen (Macaca fascicularis) beobachtet werden, was die Aussagekraft der Primärkulturen verdeutlichte.rnDie große Übereinstimmung zwischen Enzymaktivität und Genexpression in der Induktion fremdstoffmetabolisierender Enzyme konnte durch die Behandlung mit einer Reihe speziesspezifischer Induktoren in Zellkulturen primärer Ratten- bzw. Humanhepatozyten bestätigt werden; vor allem nach dem von der amerikanischen Arzneimittelzulassungsbehörde (FDA, Food and Drug Administartion) vorgeschlagenen Bewertungsschema zur Untersuchung der CYP-Induktion.rnrnDie Lebensdauer sowie der Differenzierungsgrad von primären Hepatozyten in Kultur sind stark abhängig von den Zellkulturbedingungen. Durch diese Arbeit konnte gezeigt werden, dass spezifische Eigenschaften von Rattenleberzellen durch Kultivierung in einem Sandwich aus zwei hydratisierten Collagengelschichten und unter serumfreien Bedingungen für einen Zeitraum von mindestens zwei Wochen aufrechterhalten werden können. Dieses Kulturmodel konnte auf Primärhepatozyten von Mensch und Maus übertragen werden und erweitert die möglichen Anwendungen hin zu einer Behandlung über einen längeren Zeitraum und der Untersuchung von subchronischen Effekten.rn

Prozessanalytische Technologien "PAT" zur Optimierung von Wirbelschichtgranulationsprozessen

In der Herstellung fester Darreichungsformen umfasst die Granulierung einen komplexen Teilprozess mit hoher Relevanz für die Qualität des pharmazeutischen Produktes. Die Wirbelschichtgranulierung ist ein spezielles Granulierverfahren, welches die Teilprozesse Mischen, Agglomerieren und Trocknen in einem Gerät vereint. Durch die Kombination mehrerer Prozessstufen unterliegt gerade dieses Verfahren besonderen Anforderungen an ein umfassendes Prozessverständnis. Durch die konsequente Verfolgung des PAT- Ansatzes, welcher im Jahre 2004 durch die amerikanische Zulassungsbehörde (FDA) als Guideline veröffentlicht wurde, wurde der Grundstein für eine kontinuierliche Prozessverbesserung durch erhöhtes Prozessverständnis, für Qualitätserhöhung und Kostenreduktion gegeben. Die vorliegende Arbeit befasste sich mit der Optimierung der Wirbelschicht-Granulationsprozesse von zwei prozesssensiblen Arzneistoffformulierungen, unter Verwendung von PAT. rnFür die Enalapril- Formulierung, einer niedrig dosierten und hochaktiven Arzneistoffrezeptur, wurde herausgefunden, dass durch eine feinere Zerstäubung der Granulierflüssigkeit deutlich größere Granulatkörnchen erhalten werden. Eine Erhöhung der MassRatio verringert die Tröpfchengröße, dies führt zu größeren Granulaten. Sollen Enalapril- Granulate mit einem gewünschten D50-Kornverteilung zwischen 100 und 140 um hergestellt werden, dann muss die MassRatio auf hohem Niveau eingestellt werden. Sollen Enalapril- Granulate mit einem D50- Wert zwischen 80 und 120µm erhalten werden, so muss die MassRatio auf niedrigem Niveau eingestellt sein. Anhand der durchgeführten Untersuchungen konnte gezeigt werden, dass die MassRatio ein wichtiger Parameter ist und zur Steuerung der Partikelgröße der Enalapril- Granulate eingesetzt werden kann; unter der Voraussetzung dass alle anderen Prozessparameter konstant gehalten werden.rnDie Betrachtung der Schnittmengenplots gibt die Möglichkeit geeignete Einstellungen der Prozessparameter bzw. Einflussgrößen zu bestimmen, welche dann zu den gewünschten Granulat- und Tabletteneigenschaften führen. Anhand der Lage und der Größe der Schnittmenge können die Grenzen der Prozessparameter zur Herstellung der Enalapril- Granulate bestimmt werden. Werden die Grenzen bzw. der „Design Space“ der Prozessparameter eingehalten, kann eine hochwertige Produktqualität garantiert werden. rnUm qualitativ hochwertige Enalapril Tabletten mit der gewählten Formulierung herzustellen, sollte die Enalapril- Granulation mit folgenden Prozessparametern durchgeführt werden: niedrige Sprührate, hoher MassRatio, einer Zulufttemperatur von mindestens > 50 °C und einer effektiven Zuluftmenge < 180 Nm³/h. Wird hingegen eine Sprührate von 45 g/min und eine mittlere MassRatio von 4.54 eingestellt, so muss die effektive Zuluftmenge mindestens 200 Nm³/h und die Zulufttemperatur mindestens 60 °C betragen, um eine vorhersagbar hohe Tablettenqualität zu erhalten. Qualität wird in das Arzneimittel bereits während der Herstellung implementiert, indem die Prozessparameter bei der Enalapril- Granulierung innerhalb des „Design Space“ gehalten werden.rnFür die Metformin- Formulierung, einer hoch dosierten aber wenig aktiven Arzneistoffrezeptur wurde herausgefunden, dass sich der Wachstumsmechanismus des Feinanteils der Metformin- Granulate von dem Wachstumsmechanismus der D50- und D90- Kornverteilung unterscheidet. Der Wachstumsmechanismus der Granulate ist abhängig von der Partikelbenetzung durch die versprühten Flüssigkeitströpfchen und vom Größenverhältnis von Partikel zu Sprühtröpfchen. Der Einfluss der MassRatio ist für die D10- Kornverteilung der Granulate vernachlässigbar klein. rnMit Hilfe der Störgrößen- Untersuchungen konnte eine Regeleffizienz der Prozessparameter für eine niedrig dosierte (Enalapril)- und eine hoch dosierte (Metformin) Arzneistoffformulierung erarbeitet werden, wodurch eine weitgehende Automatisierung zur Verringerung von Fehlerquellen durch Nachregelung der Störgrößen ermöglicht wird. Es ergibt sich für die gesamte Prozesskette ein in sich geschlossener PAT- Ansatz. Die Prozessparameter Sprührate und Zuluftmenge erwiesen sich als am besten geeignet. Die Nachregelung mit dem Parameter Zulufttemperatur erwies sich als träge. rnFerner wurden in der Arbeit Herstellverfahren für Granulate und Tabletten für zwei prozesssensible Wirkstoffe entwickelt. Die Robustheit der Herstellverfahren gegenüber Störgrößen konnte demonstriert werden, wodurch die Voraussetzungen für eine Echtzeitfreigabe gemäß dem PAT- Gedanken geschaffen sind. Die Kontrolle der Qualität des Produkts findet nicht am Ende der Produktions- Prozesskette statt, sondern die Kontrolle wird bereits während des Prozesses durchgeführt und basiert auf einem besseren Verständnis des Produktes und des Prozesses. Außerdem wurde durch die konsequente Verfolgung des PAT- Ansatzes die Möglichkeit zur kontinuierlichen Prozessverbesserung, zur Qualitätserhöhung und Kostenreduktion gegeben und damit das ganzheitliche Ziel des PAT- Gedankens erreicht und verwirklicht.rn

American Society of Hematology/American Society of Clinical Oncology clinical practice guideline update on the use of epoetin and darbepoetin in adult patients with cancer

Purpose: To update American Society of Hematology/American Society of Clinical Oncology recommendations for use of erythropoiesis-stimulating agents (ESAs) in patients with cancer. Methods: An Update Committee reviewed data published between January 2007 and January 2010. MEDLINE and the Cochrane Library were searched. Results: The literature search yielded one new individual patient data analysis and four literature-based meta-analyses, two systematic reviews, and 13 publications reporting new results from randomized controlled trials not included in prior or new reviews. Recommendations: For patients undergoing myelosuppressive chemotherapy who have a hemoglobin (Hb) level less than 10 g/dL, the Update Committee recommends that clinicians discuss potential harms (eg, thromboembolism, shorter survival) and benefits (eg, decreased transfusions) of ESAs and compare these with potential harms (eg, serious infections, immune-mediated adverse reactions) and benefits (eg, rapid Hb improvement) of RBC transfusions. Individual preferences for assumed risk should contribute to shared decisions on managing chemotherapy-induced anemia. The Committee cautions against ESA use under other circumstances. If used, ESAs should be administered at the lowest dose possible and should increase Hb to the lowest concentration possible to avoid transfusions. Available evidence does not identify Hb levels 10 g/dL either as thresholds for initiating treatment or as targets for ESA therapy. Starting doses and dose modifications after response or nonresponse should follow US Food and Drug Administration-approved labeling. ESAs should be discontinued after 6 to 8 weeks in nonresponders. ESAs should be avoided in patients with cancer not receiving concurrent chemotherapy, except for those with lower risk myelodysplastic syndromes. Caution should be exercised when using ESAs with chemotherapeutic agents in diseases associated with increased risk of thromboembolic complications. Table 1 lists detailed recommendations.

Comparison of zotarolimus-eluting and everolimus-eluting coronary stents

New-generation coronary stents that release zotarolimus or everolimus have been shown to reduce the risk of restenosis. However, it is unclear whether there are differences in efficacy and safety between the two types of stents on the basis of prospectively adjudicated end points endorsed by the Food and Drug Administration.

Outcomes of patients on dual-boosted PI regimens: experience of the Swiss HIV cohort study

Dual-boosted protease inhibitors (DBPI) are an option for salvage therapy for HIV-1 resistant patients. Patients receiving a DBPI in the Swiss HIV Cohort Study between January1996 and March 2007 were studied. Outcomes of interest were viral suppression at 24 weeks. 295 patients (72.5%) were on DBPI for over 6 months. The median duration was 2.2 years. Of 287 patients who had HIV-RNA >400?copies/ml at the start of the regimen, 184 (64.1%) were ever suppressed while on DBPI and 156 (54.4%) were suppressed within 24 weeks. The median time to suppression was 101 days (95% confidence interval 90-125 days). The median number of past regimens was 6 (IQR, 3-8). The main reasons for discontinuing the regimen were patient's wish (48.3%), treatment failure (22.5%), and toxicity (15.8%). Acquisition of HIV through intravenous drug use and the use of lopinavir in combination with saquinavir or atazanavir were associated with an increased likelihood of suppression within 6 months. Patients on DBPI are heavily treatment experienced. Viral suppression within 6 months was achieved in more than half of the patients. There may be a place for DBPI regimens in settings where more expensive alternates are not available.

Diagnosis and treatment of iron-deficiency anaemia during pregnancy and postpartum

Iron-deficiency anaemia during pregnancy and postpartum occurs frequently and may lead to severe maternal and foetal complications. New treatment regimens include intravenous iron administration in particular clinical situations. The aim of the study was to determine optimal diagnostic and therapeutic approaches to iron-deficiency anaemia during pregnancy and postpartum.

Microneurography in rats: a minimally invasive method to record single C-fiber action potentials from peripheral nerves in vivo

Microneurography is a method suitable for recording intraneural single or multiunit action potentials in conscious subjects. Microneurography has rarely been applied to animal experiments, where more invasive methods, like the teased fiber recording technique, are widely used. We have tested the feasibility of microneurographic recordings from the peripheral nerves of rats. Tungsten microelectrodes were inserted into the sciatic nerve at mid-thigh level. Single or multiunit action potentials evoked by regular electrical stimulation were recorded, digitized and displayed as a raster plot of latencies. The method allows unambiguous recording and recognition of single C-fiber action potentials from an in vivo preparation, with minimal disruption of the nerve being recorded. Multiple C-fibers can be recorded simultaneously for several hours, and if the animal is allowed to recover, repeated recording sessions can be obtained from the same nerve at the same level over a period of weeks or months. Also, single C units can be functionally identified by their changes in latency to natural stimuli, and insensitive units can be recognized as 'silent' nociceptors or sympathetic efferents by their distinctive profiles of activity-dependent slowing during repetitive electrical stimulation, or by the effect on spontaneous efferent activity of a proximal anesthetic block. Moreover, information about the biophysical properties of C axons can be obtained from their latency recovery cycles. Finally, we show that this preparation is potentially suitable for the study of C-fiber behavior in models of neuropathies and nerve lesions, both under resting conditions and in response to drug administration.