Surgical Performance During Laparoscopic Radical Nephrectomy Is Improved With Training in a Porcine Model

Background and Purpose: Becoming proficient in laparoscopic surgery is dependent on the acquisition of specialized skills that can only be obtained from specific training. This training could be achieved in various ways using inanimate models, animal models, or live patient surgery-each with its own pros and cons. Currently, there are substantial data that support the benefits of animal model training in the initial learning of laparoscopy. Nevertheless, whether these benefits extent themselves to moderately experienced surgeons is uncertain. The purpose of this study was to determine if training using a porcine model results in a quantifiable gain in laparoscopic skills for moderately experienced laparoscopic surgeons. Materials and Methods: Six urologists with some laparoscopic experience were asked to perform a radical nephrectomy weekly for 10 weeks in a porcine model. The procedures were recorded, and surgical performance was assessed by two experienced laparoscopic surgeons using a previously published surgical performance assessment tool. The obtained data were then submitted to statistical analysis. Results: With training, blood loss was reduced approximately 45% when comparing the averages of the first and last surgical procedures (P = 0.006). Depth perception showed an improvement close to 35% (P = 0.041), and dexterity showed an improvement close to 25% (P = 0.011). Total operative time showed trends of improvement, although it was not significant (P = 0.158). Autonomy, efficiency, and tissue handling were the only aspects that did not show any noteworthy change (P = 0.202, P = 0.677, and P = 0.456, respectively). Conclusions: These findings suggest that there are quantifiable gains in laparoscopic skills obtained from training in an animal model. Our results suggest that these benefits also extend to more advanced stages of the learning curve, but it is unclear how far along the learning curve training with animal models provides a clear benefit for the performance of laparoscopic procedures. Future studies are necessary to confirm these findings and better understand the impact of this learning tool on surgical practice.

Anti-Atherogenic Effects of a Phenol-Rich Fraction from Brazilian Red Wine (Vitis labrusca L.) in Hypercholesterolemic Low-Density Lipoprotein Receptor Knockout Mice

Moderate wine intake (i.e., 1-2 glasses of wine a day) is associated with a reduced risk of morbidity and mortality from cardiovascular disease. The aim of this study was to evaluate the anti-atherosclerotic effects of a nonalcoholic ethyl acetate fraction (EAF) from a South Brazilian red wine obtained from Vitis labrusca grapes. Experiments were carried out on low-density lipoprotein (LDL) receptor knockout (LDLr-/-) mice, which were subjected to a hypercholesterolemic diet and treated with doses of EAF (3, 10, and 30 mg/kg) for 12 weeks. At the end of the treatment, the level of plasma lipids, the vascular reactivity, and the atherosclerotic lesions were evaluated. Our results demonstrated that the treatment with EAF at 3 mg/kg significantly decreased total cholesterol, triglycerides, and LDL plus very low-density lipoprotein levels compared with control hypercholesterolemic mice. The treatment of mice with EAF at 3 mg/kg also preserved the vasodilatation induced by acetylcholine on isolated thoracic aorta from hypercholesterolemic LDLr-/- mice. This result is in agreement with the degree of lipid deposit on arteries. Taken together, the results show for the first time that the lowest concentration of an EAF obtained from a red wine produced in southern Brazil significantly reduced the progression of atherosclerosis in mice.

Somatic Mosaic Activating Mutations in PIK3CA Cause CLOVES Syndrome

Congenital lipomatous overgrowth with vascular, epidermal, and skeletal anomalies (CLOVES) is a sporadically occurring, nonhereditary disorder characterized by asymmetric somatic hypertrophy and anomalies in multiple organs. We hypothesized that CLOVES syndrome would be caused by a somatic mutation arising during early embryonic development. Therefore, we employed massively parallel sequencing to search for somatic mosaic mutations in fresh, frozen, or fixed archival tissue from six affected individuals. We identified mutations in PIK3CA in all six individuals, and mutant allele frequencies ranged from 3% to 30% in affected tissue from multiple embryonic lineages. Interestingly, these same mutations have been identified in cancer cells, in which they increase phosphoinositide-3-kinase activity. We conclude that CLOVES is caused by postzygotic activating mutations in PIK3CA. The application of similar sequencing strategies will probably identify additional genetic causes for sporadically occurring, nonheritable malformations.

The identity of Sertularia reptans Linnaeus, 1758 (Bryozoa, Candidae)

This paper includes a reassessment of Scrupocellaria reptans (Linnaeus, 1758) (basionym Sertularia reptans), the lectotype of which is selected and figured from among herbarium-sheet specimens held at the Linnean Society of London. Material previously assigned to S. reptans was examined, providing morphological characteristics to distinguish Scrupocellaria ellisi n. sp. Scrupocellaria reptans has a geographically limited distribution in the United Kingdom, while S. ellisi is more widespread in the North Sea, Northeast Atlantic, Adriatic and Tasmania.

Functional Polymorphism Located in MMP-9 Gene Promoter Is Strongly Associated with Obesity

The adipose tissue expansion is accompanied by remodeling of extracellular matrix performed by matrix metalloproteinases (MMPs). Higher plasma and tissue MMP-9 levels are found in obese; therefore, we evaluated if the functional C-1562T polymorphism (rs3918242) located in promoter region of the MMP-9 gene is associated with obesity in women. We studied 112 lean and 114 obese women. Plasma MMP-9 and tissue inhibitor of MMP-9 (TIMP)-1 were measured using enzyme-linked immunosorbent assay. We found different genotype frequencies between lean and obese women (p = 0.008), prevailing T-allele in obese (2.3-fold). However, although obese women present higher levels of plasma MMP-9, lack of modulation by the polymorphism was found (all p > 0.05). Our findings suggest that C-1562T polymorphism may contribute to pathogenetic mechanisms involved in the development of obesity in women.

Conjugated Linoleic Acid Combined with Physical Activity Reduces Body Fat Accumulation But Does Not Modify Lean Body Mass in Male and Female Wistar Rats

Several biological and clinical studies have suggested that conjugated linoleic acid (CLA) prevents body fat accumulation and increases lean body mass. CLA is available as a concentrated dietary supplement and is purported to provide the aforementioned benefits for people who perform physical activity. This study was conducted to evaluate the effect of a CLA-supplemented diet combined with physical activity on the body composition of Wistar rats. Two groups of Wistar rats of both sexes, between 45 and 60 days old, were fed a diet containing 5.5% soybean oil (control group) or a CLA-supplemented diet (0.5% CLA and 5.0% soybean oil) (test group). Half the rats in both groups were assigned to exercise by running on a treadmill. The biochemical and anatomical body compositions were analyzed. In both groups, CLA had no effect on the dietary consumption or the weight of the liver, heart, and lungs. However, it did influence the overall weight gain of exercised male rats and the chemical and anatomical body composition in exercised and sedentary rats of both sexes. The results confirm that a CLA-supplemented diet with and without physical activity reduced body fat accumulation in rats of both sexes. However, there is no evidence of an increase in the lean body mass of the exercised rats.

Characterization of Primary Isolates of HIV Type 1 CRF28_BF, CRF29_BF, and Unique BF Recombinants Circulating in Sao Paulo, Brazil

We report for the first time the genetic and biological characterization of 10 HIV-1 primary isolates representing CRF28_BF and CRF29_BF together with additional unique BF recombinant forms (URFs) obtained by PBMC cocultivation. Recombination is an important factor promoting the increase in the genetic diversity of HIV-1. Notably, more than 20% of HIV-1 sequences worldwide were recombinants. Several recombinant viruses were reported in Brazil, and six circulating recombinant forms (CRFs) have been identified (CRF28_BF, CRF29_BF, CRF31_BC, CRF39_BF, CRF40_BF, and CRF46_BF). CRF28_BF and CRF29_BF were found to infect almost 30% of the patients in Sao Paulo State. The near full-length genomes of these 10 primary isolates were amplified by nested PCR in three overlapping segments, purified, and sequenced. Three samples were related to CRF28_BF, three to CRF29_BF, and four were unique recombinant forms (URFs), as determined by their breakpoint profile determined with the jpHMM program. Additionally, the coreceptor usage of these isolates was investigated in vitro using GHOST assays, which revealed three dual-tropic (X4/R5) viruses, four lymphotropic (X4) viruses, and three macrophage-tropic (R5) viruses with different V3-loop motifs, which challenges the notion that GWGR-carrying viruses are macrophage-tropic only. In sum, we report a much-anticipated well-characterized panel of viruses representing CRF28_BF, CRF29_BF, and URFs from Sao Paulo State, Brazil.

Genetic Variants in Matrix Metalloproteinase-9 Gene Modify Metalloproteinase-9 Levels in Black Subjects

Altered matrix metalloproteinases (MMPs) levels are involved in cardiovascular diseases and increased MMP-9 levels enhance the cardiovascular risk in apparently healthy subjects. We investigated the effects of MMP-9 gene polymorphisms and haplotypes on the circulating MMP-9 levels in healthy black subjects and the effects of an MMP-2 polymorphism on the plasma MMP-2 concentrations. We studied 190 healthy subjects, nonsmokers, self-reported as blacks (18-63 years). Genotypes for the MMP-2 C-1306T polymorphism and the MMP-9 C-1562T, 90(CA)(14-24) and Q279R polymorphisms (rs243865, rs3918242, rs2234681, and rs17576, respectively) were determined by TaqMan (R) Allele Discrimination assay and real-time polymerase chain reaction or restriction fragment length polymorphism. Alleles for the 90(CA)(14-24) polymorphism were grouped as low (L) when there were < 21 and high (H) when there were >= 21 CA repeats. The plasma levels of MMP-2 and MMP-9 were determined by gelatin zymography. The software PHASE 2.1 was used to estimate the haplotypes frequencies. Although we found no effects of the MMP-9 C-1562T or the Q279R polymorphisms on MMP-9 levels, higher MMP-9 levels were associated with the HH genotype for the -90(CA)(14-24) polymorphism compared with the HL or LL genotypes. Lower MMP-9 levels were found in carriers of the CRL haplotype (combining the C, R, and L alleles for the MMP-9 polymorphisms) compared with the CRH haplotype. Consistent with this finding, the CRL haplotype was more commonly found in subjects with low MMP-9 levels. The MMP-2 C-1306T polymorphism had no effects on the plasma MMP-2 levels. Our results show that MMP-9 genetic variations modify MMP-9 levels in black subjects and may offer biochemical evidence implicating MMP-9 in the pathogenesis of cardiovascular diseases in blacks.

Florística e fitossociologia em parcelas permanentes da Mata Atlântica do sudeste do Brasil ao longo de um gradiente altitudinal

Este trabalho resume os dados de florística e fitossociologia de 11, das 14 parcelas de 1 ha, alocadas ao longo do gradiente altitudinal da Serra do Mar, São Paulo, Brasil. As parcelas começam na cota 10 m (Floresta de Restinga da Praia da Fazenda, município de Ubatuba) e estão distribuídas até a cota 1100 m (Floresta Ombrófila Densa Montana da Trilha do rio Itamambuca, município de São Luis do Paraitinga) abrangendo os Núcleos Picinguaba e Santa Virgínia do Parque Estadual da Serra do Mar. Na Restinga o solo é Neossolo Quartzarênico francamente arenoso, enquanto que na encosta o solo é um Cambisolo Háplico Distrófico argilo-arenoso, sendo que todas as parcelas apresentaram solo ácido (pH 3 – 4) com alta diluição de nutrientes e alta saturação de alumínio. Na Restinga e no sopé da encosta o clima é Tropical/Subtropical Úmido (Af/Cfa), sem estação seca, com precipitação média anual superior a 2.200 mm e temperatura média anual de 22 °C. Subindo a encosta mantêm-se a média de precipitação, mas há um gradativo resfriamento, de forma que a 1.100 m o clima é Subtropical Úmido (Cfa/Cfb), sem estação seca, com temperatura média anual de 17 °C. Destaca-se ainda que, quase diariamente, a parte superior da encosta, geralmente acima de 400 m, é coberta por uma densa neblina. Nas 14 parcelas foram marcados, medidos e amostrados 21.733 indivíduos com DAP ≥ 4,8 cm, incluindo árvores, palmeiras e fetos arborescentes. O número médio de indivíduos amostrados nas 14 parcelas foi de 1.264 ind.ha–1 (± 218 EP de 95%). Dentro dos parâmetros considerados predominaram as árvores (71% FOD Montana a 90% na Restinga), seguidas de palmeiras (10% na Restinga a 25% na FOD Montana) e fetos arborescentes (0% na Restinga a 4% na FOD Montana). Neste aspecto destaca-se a FOD Terras Baixas Exploradas com apenas 1,8% de palmeiras e surpreendentes 10% de fetos arborescentes. O dossel é irregular, com altura variando de 7 a 9 m, raramente as árvores emergentes chegam a 18 m, e a irregularidade do dossel permite a entrada de luz suficiente para o desenvolvimento de centenas de espécies epífitas. Com exceção da FOD Montana, onde o número de mortos foi superior a 5% dos indivíduos amostrados, nas demais fitofisionomias este valor ficou abaixo de 2,5%. Nas 11 parcelas onde foi realizado o estudo florístico foram encontradas 562 espécies distribuídas em 195 gêneros e 68 famílias. Apenas sete espécies – Euterpe edulis Mart. (Arecaceae), Calyptranthes lucida Mart. ex DC. e Marlierea tomentosa Cambess (ambas Myrtaceae), Guapira opposita (Vell.) Reitz (Nyctaginaceae), Cupania oblongifolia Mart. (Sapindaceae) e as Urticaceae Cecropia glaziovii Snethl. e Coussapoa microcarpa (Schott) Rizzini – ocorreram da Floresta de Restinga à FOD Montana, enquanto outras 12 espécies só não ocorreram na Floresta de Restinga. As famílias com o maior número de espécies são Myrtaceae (133 spp), Fabaceae (47 spp), 125 Fitossociologia em parcelas permanentes de Mata Atlântica http://www.biotaneotropica.org.br/v12n1/pt/abstract?article+bn01812012012 http://www.biotaneotropica.org.br Biota Neotrop., vol. 12, no. 1 Introdução A Mata Atlântica sensu lato (Joly et al. 1999) é a segunda maior floresta tropical do continente americano (Tabarelli et al. 2005). A maior parte dos Sistemas de Classificação da vegetação brasileira reconhece que no Domínio Atlântico (sensu Ab’Saber 1977) esse bioma pode ser dividido em dois grandes grupos: a Floresta Ombrófila Densa, típica da região costeira e das escarpas serranas com alta pluviosidade (Mata Atlântica – MA – sensu stricto), e a Floresta Estacional Semidecidual, que ocorre no interior, onde a pluviosidade, além de menor, é sazonal. Na região costeira podem ocorrer também Manguezais (Schaeffer-Novelli 2000), ao longo da foz de rios de médio e grande porte, e as Restingas (Scarano 2009), crescendo sobre a planície costeira do quaternário. No topo das montanhas, geralmente acima de 1500 m, estão os Campos de Altitude (Ribeiro & Freitas 2010). Em 2002, a Fundação SOS Mata Atlântica em parceria com o INPE (Instituto..., 2002) realizaram um levantamento que indica que há apenas 7,6% da cobertura original da Mata Atlântica (s.l.). Mais recentemente Ribeiro et al. (2009) refinaram a estimativa incluindo fragmentos menores, que não haviam sido contabilizados, e concluíram que resta algo entre 11,4 e 16% da área original. Mesmo com esta fragmentação, o mosaico da Floresta Atlântica brasileira possui um dos maiores níveis de endemismos do mundo (Myers et al. 2000) e cerca da metade desses remanescentes de grande extensão estão protegidos na forma de Unidades de Conservação (Galindo & Câmara 2005). Entre os dois centros de endemismo reconhecidos para a MA (Fiaschi & Pirani 2009), o bloco das regiões sudeste/sul é o que conserva elementos da porção sul de Gondwana (Sanmartin & Ronquist 2004), tido como a formação florestal mais antiga do Brasil (Colombo & Joly 2010). Segundo Hirota (2003), parte dos remanescentes de MA está no estado de São Paulo, onde cerca de 80% de sua área era coberta por florestas (Victor 1977) genericamente enquadradas como Mata Atlântica “sensu lato” (Joly et al. 1999). Dados de Kronka et al. (2005) mostram que no estado restam apenas 12% de área de mata e menos do que 5% são efetivamente florestas nativas pouco antropizadas. Nos 500 anos de fragmentação e degradação das formações naturais, foram poupadas apenas as regiões serranas, principalmente a fachada da Serra do Mar, por serem impróprias para práticas agrícolas. Usando o sistema fisionômico-ecológico de classificação da vegetação brasileira adotado pelo IBGE (Veloso et al. 1991), a Floresta Ombrófila Densa, na área de domínio da Mata Atlântica, foi subdividida em quatro faciações ordenadas segundo a hierarquia topográfica, que refletem fisionomias de acordo com as variações das faixas altimétricas e latitudinais. No estado de São Paulo, na latitude entre 16 e 24 °S temos: 1) Floresta Ombrófila Densa das Terras Baixas - 5 a 50 m de altitude; 2) Floresta Ombrófila Densa Submontana – no sopé da Serra do Mar, com cotas de altitude variando entre 50 e 500 m; 3) Floresta Ombrófila Densa Montana – recobrindo a encosta da Serra do Mar propriamente dita, em altitudes que variam de 500 a 1.200 m; 4) Floresta Ombrófila Densa Altimontana – ocorrendo no topo da Serra do Mar, acima dos limites estabelecidos para a formação montana, onde a vegetação praticamente deixa de ser arbórea, pois predominam os campos de altitude. Nas últimas três décadas muita informação vem sendo acumulada sobre a composição florística e a estrutura do estrato arbóreo dos remanescentes florestais do estado, conforme mostram as revisões de Oliveira-Filho & Fontes (2000) e Scudeller et al. (2001). Em florestas tropicais este tipo de informação, assim como dados sobre a riqueza de espécies, reflete não só fatores evolutivos e biogeográficos, como também o histórico de perturbação, natural ou antrópica, das respectivas áreas (Gentry 1992, Hubbell & Foster 1986). A síntese dessas informações tem permitido a definição de unidades fitogeográficas com diferentes padrões de riqueza de espécies e apontam para uma diferenciação, entre as florestas paulistas, no sentido leste/oeste (Salis et al. 1995, Torres et al. 1997, Santos et al. 1998). Segundo Bakker et al. (1996) um método adequado para acompanhar e avaliar as mudanças na composição das espécies e dinâmica da floresta ao longo do tempo é por meio de parcelas permanentes (em inglês Permanent Sample Plots –PSPs). Essa metodologia tem sido amplamente utilizada em estudos de longa duração em florestas tropicais, pois permite avaliar a composição e a estrutura florestal e monitorar sua mudança no tempo (Dallmeier 1992, Condit 1995, Sheil 1995, Malhi et al. 2002, Lewis et al. 2004). Permite avaliar também as consequências para a floresta de problemas como o aquecimento global e a poluição atmosférica (Bakker et al. 1996). No Brasil os projetos/programas que utilizam a metodologia de Parcelas Permanentes tiveram origem, praticamente, com o Projeto Rubiaceae (49) e Lauraceae (49) ao longo de todo gradiente da FOD e Monimiaceae (21) especificamente nas parcelas da FOD Montana. Em termos de número de indivíduos as famílias mais importantes foram Arecaceae, Rubiaceae, Myrtaceae, Sapotaceae, Lauraceae e na FOD Montana, Monimiaceae. Somente na parcela F, onde ocorreu exploração de madeira entre 1960 e 1985, a abundância de palmeiras foi substituída pelas Cyatheaceae. O gradiente estudado apresenta um pico da diversidade e riqueza nas altitudes intermediárias (300 a 400 m) ao longo da encosta (índice de Shannon-Weiner - H’ - variando de 3,96 a 4,48 nats.indivíduo–1). Diversas explicações para este resultado são apresentadas neste trabalho, incluindo o fato dessas altitudes estarem nos limites das expansões e retrações das diferentes fitofisionomias da FOD Atlântica durante as flutuações climáticas do Pleistoceno. Os dados aqui apresentados demonstram a extraordinária riqueza de espécies arbóreas da Floresta Ombrófila Densa Atlântica dos Núcleos Picinguaba e Santa Virgínia do Parque Estadual da Serra do Mar, reforçando a importância de sua conservação ao longo de todo o gradiente altitudinal. A diversidade desta floresta justifica também o investimento de longo prazo, através de parcelas permanentes, para compreender sua dinâmica e funcionamento, bem como monitorar o impacto das mudanças climáticas nessa vegetação.

Redox Control of 20S Proteasome Gating

The proteasome is the primary contributor in intracellular proteolysis. Oxidized or unstructured proteins can be degraded via a ubiquitin-and ATP-independent process by the free 20S proteasome (20SPT). The mechanism by which these proteins enter the catalytic chamber is not understood thus far, although the 20SPT gating conformation is considered to be an important barrier to allowing proteins free entrance. We have previously shown that S-glutathiolation of the 20SPT is a post-translational modification affecting the proteasomal activities. Aims: The goal of this work was to investigate the mechanism that regulates 20SPT activity, which includes the identification of the Cys residues prone to S-glutathiolation. Results: Modulation of 20SPT activity by proteasome gating is at least partially due to the S-glutathiolation of specific Cys residues. The gate was open when the 20SPT was S-glutathiolated, whereas following treatment with high concentrations of dithiothreitol, the gate was closed. S-glutathiolated 20SPT was more effective at degrading both oxidized and partially unfolded proteins than its reduced form. Only 2 out of 28 Cys were observed to be S-glutathiolated in the proteasomal alpha 5 subunit of yeast cells grown to the stationary phase in glucose-containing medium. Innovation: We demonstrate a redox post-translational regulatory mechanism controlling 20SPT activity. Conclusion: S-glutathiolation is a post-translational modification that triggers gate opening and thereby activates the proteolytic activities of free 20SPT. This process appears to be an important regulatory mechanism to intensify the removal of oxidized or unstructured proteins in stressful situations by a process independent of ubiquitination and ATP consumption. Antioxid. Redox Signal. 16, 1183-1194.

Treatment of Nuclear-Donor Cells or Cloned Zygotes with Chromatin-Modifying Agents Increases Histone Acetylation But Does Not Improve Full-Term Development of Cloned Cattle

Although somatic cell nuclear transfer (SCNT) is a promising tool, its potential use is hampered by the high mortality rates during the development to term of cloned offspring. Abnormal epigenetic reprogramming of donor nuclei after SCNT is thought to be the main cause of this low efficiency. We hypothesized that chromatin-modifying agents (CMAs) targeting chromatin acetylation and DNA methylation could alter the chromatin configuration and turn them more amenable to reprogramming. Thus, bovine fibroblasts were treated with 5-aza-2'-deoxycytidine (AZA) plus trichostatin (TSA) or hydralazine (HH) plus valproic acid (VPA) whereas, in another trial, cloned bovine zygotes were treated with TSA. The treatment of fibroblasts with either AZA + TSA or HH + VPA increased histone acetylation, but did not affect the level of DNA methylation. However, treatment with HH + VPA decreased cellular viability and proliferation. The use of these cells as nuclear donors showed no positive effect on pre- and postimplantation development. Regarding the treatment of cloned zygotes with TSA, treated one-cell embryos showed an increase in the acetylation patterns, but not in the level of DNA methylation. Moreover, this treatment revealed no positive effect on pre- and postimplantation development. This work provides evidence the treatment of either nuclear donor cells or cloned zygotes with CMAs has no positive effect on pre- and postimplantation development of cloned cattle.

Glucose Control in Acute Myocardial Infarction: A Pilot Randomized Study Controlled by Continuous Glucose Monitoring System Comparing the Use of Insulin Glargine with Standard of Care

Background: This pilot study aimed to verify if glycemic control can be achieved in type 2 diabetes patients after acute myocardial infarction (AMI), using insulin glargine (iGlar) associated with regular insulin (iReg), compared with the standard intensive care unit protocol, which uses continuous insulin intravenous delivery followed by NPH insulin and iReg (St. Care). Patients and Methods: Patients (n = 20) within 24 h of AMI were randomized to iGlar or St. Care. Therapy was guided exclusively by capillary blood glucose (CBG), but glucometric parameters were also analyzed by blinded continuous glucose monitoring system (CGMS). Results: Mean glycemia was 141 +/- 39 mg/dL for St. Care and 132 +/- 42 mg/dL for iGlar by CBG or 138 +/- 35 mg/dL for St. Care and 129 +/- 34 mg/dL for iGlar by CGMS. Percentage of time in range (80-180 mg/dL) by CGMS was 73 +/- 18% for iGlar and 77 +/- 11% for St. Care. No severe hypoglycemia (<= 40 mg/dL) was detected by CBG, but CGMS indicated 11 (St. Care) and seven (iGlar) excursions in four subjects from each group, mostly in sulfonylurea users (six of eight patients). Conclusions: This pilot study suggests that equivalent glycemic control without increase in severe hyperglycemia may be achieved using iGlar with background iReg. Data outputs were controlled by both CBG and CGMS measurements in a real-life setting to ensure reliability. Based on CGMS measurements, there were significant numbers of glycemic excursions outside of the target range. However, this was not detected by CBG. In addition, the data indicate that previous use of sulfonylurea may be a potential major risk factor for severe hypoglycemia irrespective of the type of insulin treatment.

Relapse of Intravenous Drug Use Triggered by Enfuvirtide, a Parenteral Antiretroviral Medication

Fuzeon (R) (enfuvirtide; Hoffmann-LaRoche, Nutley, NJ) is a parenteral medication prescribed to antiretroviral-experienced HIV patients. Clinicians are frequently concerned when prescribing enfuvirtide to former drug addicts because of the risk of triggering relapse, however, no previous report has described this adverse event. We describe two HIV-infected patients, previously abstinent from injection drug use, who experienced relapse or near-relapse situations after starting treatment with enfuvirtide. Along with the concerns related to adherence and to injection site reactions, clinicians who prescribe enfuvirtide should consider and discuss the risk of triggering relapse among former or recovering drug addicts.

Duodenal stenting for malignant gastric outlet obstruction: Prospective study

AIM: To evaluate the results of duodenal stenting for palliation of gastroduodenal malignant obstruction by using a gastric outlet obstruction score (GOOS). METHODS: A prospective, non-randomized study was performed at a tertiary center between August 2005 and April 2010. Patients were eligible if they had malignant gastric outlet obstruction (GOO) and were not candidates for surgical treatment. Medical history and patient demographics were collected at baseline. Scheduled interviews were made on the day of the procedure and 15, 30, 90 and 180 d later or unscheduled as necessary. RESULTS: Fifteen patients (6 male, 9 female; median age 61 years) with GOO who had undergone duodenal stenting were evaluated. Ten patients had metastasis at baseline (66.6%) and 14 were unable to accept oral intake (93.33%), including 7 patients who were using a feeding tube. Laboratory data showed biliary obstruction in eight cases (53.33%); all were submitted to biliary drainage. Two patients developed obstructive symptoms due to tumor ingrowth after 30 d and another due to tumor overgrowth after 180 d. Two cases of stent migration occurred. A good response to treatment was observed, with a mean time of approximately 1 d (19 h) until toleration of a liquid diet and slightly more than 2 d for both soft solids (51 h) and a solid food/normal diet (55 h). The mean time to first failure to maintain liquid intake (GODS >= 1) was 93 d. During follow-up, the mean time to first failure to maintain the previously achieved GODS of 2-3 (solid/semi-solid food), considered technical failure, was 71 d. On the basis of oral intake a GODS is defined: 0 for no oral intake; 1 for liquids only; 2 for soft solids only; 3 for low-residue or full diet. CONCLUSION: Enteral stenting to alleviate gastroduodenal malignant obstruction improves quality of life in patients with limited life expectancy, which can be evaluated by using a GOO scoring system. (C) 2012 Baishideng. All rights reserved.

Tax Gene Characterization of Human T-Lymphotropic Virus Type 1 Strains from Brazilian HIV-Coinfected Patients

The tax gene of human T-lymphotropic virus type 1 (HTLV-1) diverges among isolates according to geographic regions and has been classified into two genotypes: taxA and taxB. In Brazil, taxA is the most prevalent genotype in symptomatic and asymptomatic carriers. Few studies have been conducted in HIV-infected patients. The present study characterized the tax gene (1059 bp) in 13 Brazilian HIV-1/HTLV-1-coinfected patients from the south and southeast regions. The results confirmed the transcontinental HTLV-1 subgroup A of the Cosmopolitan subtype and showed high nucleotide similarity both among Brazilian sequences and in relation to the ATK prototype (99.5% and 99.2%, respectively). Six nucleotide substitutions were highly conserved among isolates, ranging from 76.9% to 100%: C7401T, T7914C, C7920T, C7982T, G8231A, and A8367C. The presence of the Brazilian molecular signature of genotype taxA was confirmed in all of the isolates, and they clustered into two Latin American clusters, which confirms the double introduction of HTLV-1 in Brazil.