Enfisema subcutáneo como complicación de procedimientos de cirugía oral. Avería del instrumental utilizado / Subcutaneous emphisema after surgical third molar extraction: medical instruments failure

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Impact of HLA-DRB1 allele polymorphisms on control of HIV infection in a Peruvian MSM cohort.

Associations between HLA class II polymorphisms and HIV control were assessed in a Peruvian MSM cohort. Among 233 treatment naïve HIV+ individuals, DRB1*13:02 was linked to elevated viral loads (P = .044) while DRB1*12:01 showed significantly lower viral set points (P = .015) and restricted a dominant T cell response to HIV Gag p24 (P = .038). The present work contributes to a better knowledge of the Peruvian immunogenetics and supports the important role of HLA class II restricted T cells in HIV control.

Identification of Interleukin-27 (IL-27)/IL-27 Receptor Subunit Alpha as a Critical Immune Axis for In Vivo HIV Control.

Intact and broad immune cell effector functions and specific individual cytokines have been linked to HIV disease outcome, but their relative contribution to HIV control remains unclear. We asked whether the proteome of secreted cytokines and signaling factors in peripheral blood can be used to discover specific pathways critical for host viral control. A custom glass-based microarray, able to measure >600 plasma proteins involved in cell-to-cell communication, was used to measure plasma protein profiles in 96 HIV-infected, treatment-naive individuals with high (>50,000) or low (<10,000 HIV RNA copies/ml) viral loads. Univariate and regression model analysis demonstrate that plasma levels of soluble interleukin-27 (IL-27) are significantly elevated in individuals with high plasma viremia (P < 0.0001) and are positively correlated with proviral HIV-DNA copy numbers in peripheral blood mononuclear cells (PBMC) (Rho = 0.4011; P = 0.0027). Moreover, soluble IL-27 plasma levels are negatively associated with the breadth and magnitude of the total virus-specific T-cell responses and directly with plasma levels of molecules involved in Wnt/ß-catenin signaling. In addition to IL-27, gene expression levels of the specific IL-27 receptor (IL27RA) in PBMC correlated directly with both plasma viral load (Rho = 0.3531; P = 0.0218) and the proviral copy number in the peripheral blood as an indirect measure of partial viral reservoir (Rho = 0.4580; P = 0.0030). These results were validated in unrelated cohorts of early infected subjects as well as subjects before and after initiation of antiretroviral treatment, and they identify IL-27 and its specific receptor as a critical immune axis for the antiviral immune response and as robust correlates of viral load and proviral reservoir size in PBMC.IMPORTANCE The detailed knowledge of immune mechanisms that contribute to HIV control is a prerequisite for the design of effective treatment strategies to achieve HIV cure. Cells communicate with each other by secreting signaling proteins, and the blood is a key conduit for transporting such factors. Investigating the communication factors promoting effective immune responses and having potentially antiviral functions against HIV using a novel focused omics approach ("communicome") has the potential to significantly improve our knowledge of effective host immunity and accelerate the HIV cure agenda. Including 140 subjects with variable viral loads and measuring the plasma levels of >600 soluble proteins, our data highlight the importance of Th17 cells and Wnt/ß-catenin signaling in HIV control and especially identify the IL-27/IL-27 receptor subunit alpha (IL-27RA) axis as a predictor of plasma viral load and proviral copy number in the peripheral blood. These data may provide important guidance to therapeutic approaches in the HIV cure agenda.

Anterior pre-tensioned external fixator for pelvic fractures and dislocations. Initial clinical series.

In the treatment of unstable pelvic ring fractures, external fixators have the limitation of not adequately stabilizing the injured posterior elements. This article presents a novel and simple technique of temporary external fixation of the pelvic ring, able to produce compression of both the anterior and posterior pelvic elements. A curved flexible carbon-fiber rod is used, pre-tensioned before attachment to supra-acetabular Schanz screws. Although more extensive clinical experience is required, favorable preliminary results in a series of 13 patients with unstable pelvic fracture were encouraging: the aim of closing the posterior and anterior elements of the pelvic ring was achieved in all cases treated with this technique, and 12 patients survived. Radiological results were excellent in 3 cases and good in 9 cases. No major complications, such as secondary displacement, vertical re-displacement or deep infection, were observed. Mean operative time was 25min, compatible with emergency management.

Osseointegrated dental implants in patients with intellectual disability: a pilot study.

PURPOSE: The objective of this study was to investigate if intellectual disability (ID) itself constitutes an absolute contraindication to oral rehabilitation with osseointegrated implants, or if adequately selected patients can benefit from this dental treatment technique. METHOD: We report a series of eight patients with non-syndromic ID and no associated neuromuscular disorders, craniofacial abnormalities, or serious systemic complications, in whom oral rehabilitation was performed using implant-supported prostheses, with a follow-up of one to three years. RESULTS: A total of 18 titanium implants were inserted and nine implant-supported prostheses were constructed. Follow-up examination showed that although the majority of implants presented a degree of peri-implant mucositis, all were osseointegrated and the prostheses were functional. CONCLUSIONS: Although there is very little literature on this subject, the results of this pilot study allow us to suggest that osseointegrated oral implants could constitute a therapeutic option for patients with ID. The success of oral rehabilitation depends fundamentally on appropriate patient selection. IMPLICATIONS FOR REHABILITATION: • Apart from the obvious difficulties related to eating and communication, edentulism is of great cosmetic importance in patients with ID in terms of social acceptance. • It has been suggested that patients with ID do not receive the same level of dental treatment as the general population. • The results of this pilot study allow us to suggest that osseointegrated oral implants could constitute a therapeutic option for patients with ID.

Chemokines and other cytokines in human immunodeficiency virus type 1 (HIV-1) infection

Las citocinas, las quimiocinas y sus receptors son probablementelos principales factores del huésped que influyen en la patogénesisdel VIH-1 in vivo. La infección por el VIH-1 estimula laproducción de citocinas y quimiocinas en una gran variedad detipos celulares. Estos factores pueden inducir o inhibir la replicaciónviral. Además, algunos receptores de quimiocinas actúancomo co-receptores necesarios para la entrada viral en la célula,y el nivel de disponibilidad de dichos co-receptores determina lasusceptibilidad de la infección. Tanto las citocinas como las quimiocinasmodulan la expresión de los co-receptores.En esta revisión, describimos la importancia de la distribuciónde las quimiocinas y de sus receptores en la infección primariay en la posterior evolución de la enfermedad; también describimosel efecto de las citocinas más relevantes en la replicaciónviral y en la regulación de la homeostasis inmunitaria. Finalmente,discutimos el uso de las citocinas y las quimiocinas como agentesterapéuticos

Cytokines, chemokines and their receptors are important factorsthat influence the pathogenesis of HIV-1 in vivo. HIV-1 infectionstimulates the production of cytokines and chemokines froma great variety of cell types, which may either induce or inhibitviral replication. Furthermore, chemokine receptors act as viralco-receptors for viral entry into cells. Co-receptor expression andco-receptor availability are important determinants of the susceptibilityto infection. Cytokines and chemokines modulate coreceptorexpression and thus influence HIV pathogenesis.In this review, we describe the importance of the distributionof chemokines and their receptors in the primary infection and inthe later evolution of the disease, as well as the effect of relevantcytokines in viral replication and in the regulation of immune cellhomeostasis. Finally, we also discuss the use of cytokines and chemokinesas therapeutic agents

Chemokines and other cytokines in human immunodeficiency virus type 1 (HIV-1) infection

Las citocinas, las quimiocinas y sus receptors son probablemente los principales factores del huésped que influyen en la patogénesis del VIH-1 in vivo. La infección por el VIH-1 estimula la producción de citocinas y quimiocinas en una gran variedad de tipos celulares. Estos factores pueden inducir o inhibir la replicación viral. Además, algunos receptores de quimiocinas actúan como co-receptores necesarios para la entrada viral en la célula,y el nivel de disponibilidad de dichos co-receptores determina la susceptibilidad de la infección. Tanto las citocinas como las quimiocinasmodulan la expresión de los co-receptores.En esta revisión, describimos la importancia de la distribución de las quimiocinas y de sus receptores en la infección primaria y en la posterior evolución de la enfermedad; también describimos el efecto de las citocinas más relevantes en la replicación viral y en la regulación de la homeostasis inmunitaria. Finalmente,discutimos el uso de las citocinas y las quimiocinas como agentes terapéuticos (AU)

Cytokines, chemokines and their receptors are important factors that influence the pathogenesis of HIV-1 in vivo. HIV-1 infection stimulates the production of cytokines and chemokines froma great variety of cell types, which may either induce or inhibit viral replication. Furthermore, chemokine receptors act as viralco-receptors for viral entry into cells. Co-receptor expression and co-receptor availability are important determinants of the susceptibilityto infection. Cytokines and chemokines modulate coreceptor expression and thus influence HIV pathogenesis. In this review, we describe the importance of the distribution of chemokines and their receptors in the primary infection and in the later evolution of the disease, as well as the effect of relevant cytokines in viral replication and in the regulation of immune cellhomeostasis. Finally, we also discuss the use of cytokines and chemokinesas therapeutic agents (AU)

CXCR4 and SDF-1 expression in B-cell chronic lymphocytic leukemia and stage of the disease.

The pathogenesis of B-cell chronic lymphocytic leukemia (B-CLL) has been linked to an overexpression of the chemokine receptor CXCR4 and increased in vitro functional response to its natural ligand CXCL12 (SDF-1). The CXCR4/SDF-1 system appears to be important for tissue localization and increased survival of B-CLL cells. The aim of our study was to examine if CXCR4 expression and SDF-1 blood levels were correlated to clinical and pathological stage of B-CLL. Flow cytometry and enzyme-linked immunosorbent assay (ELISA) techniques were used to determine CXCR4 expression and SDF-1 plasma levels, respectively, in a cohort of 51 patients diagnosed with B-CLL to correlate these measurements with several parameters that define the clinical stage of the disease. We confirmed that CXCR4 was consistently expressed on circulating B-CLL cells with a fluorescence intensity that was five-fold greater than in cells from healthy volunteers. There was a correlation between CXCR4 expression and leukocyte count ( r: 0.55, p<0.01), and CD19(+)/CD5(+ )cells ( r: 0.63, p<0.01). Interestingly, the group of B-CLL patients showed lower SDF-1 plasma levels compared to the control group. However, there was no correlation between CXCR4 or SDF-1 expression and the clinical stage of disease or the pattern of bone marrow infiltration. The results obtained suggest that other factors, and not only alteration in the SDF-1/CXCR4 chemokine system, must account for marrow infiltration of neoplastic cells observed in B-CLL and that CXCR4 could be involved in other features that exhibit malignant B cells, such as increased survival, rather than in their homing or migration to the bone marrow.

Interleukin-7 in plasma correlates with CD4 T-cell depletion and may be associated with emergence of syncytium-inducing variants in human immunodeficiency virus type 1-positive individuals.

Human immunodeficiency virus type 1 (HIV-1) primary infection is characterized by the use of CCR5 as a coreceptor for viral entry, which is associated with the non-syncytium-inducing (NSI) phenotype in lymphoid cells. Syncytium-inducing (SI) variants of HIV-1 appear in advanced stages of HIV-1 infection and are characterized by the use of CXCR4 as a coreceptor. The emergence of SI variants is accompanied by a rapid decrease in the number of T cells. However, it is unclear why SI variants emerge and what factors trigger the evolution of HIV from R5 to X4 variants. Interleukin-7 (IL-7), a cytokine produced by stromal cells of the thymus and bone marrow and by keratin, is known to play a key role in T-cell development. We evaluated IL-7 levels in plasma of healthy donors and HIV-positive patients and found significantly higher levels in HIV-positive patients. There was a negative correlation between circulating IL-7 levels and CD4(+) T-cell count in HIV-positive patients (r = -0.621; P < 0.001), suggesting that IL-7 may be involved in HIV-induced T-cell depletion and disease progression. IL-7 levels were higher in individuals who harbored SI variants and who had progressed to having CD4 cell counts of lower than 200 cells/microl than in individuals with NSI variants at a similar stage of disease. IL-7 induced T-cell proliferation and up-regulated CXCR4 expression in peripheral blood mononuclear cells in vitro. Taken together, our results suggest a role for IL-7 in the maintenance of T-cell regeneration and depletion by HIV in infected individuals and a possible relationship between IL-7 levels and the emergence of SI variants.

Stromal-cell-derived factor 1 prevents the emergence of the syncytium-inducing phenotype of HIV-1 in vivo.

In a correlative study, the mean plasma level of the chemokine stromal-cell-derived factor 1 (SDF-1) was lower in subjects with syncytium-inducing (SI) than in subjects with non-syncytium-inducing (NSI) HIV isolates, regardless of the CD4 cell count or when compared with HIV-negative individuals. Individuals with high SDF-1 had an 81% probability of having an NSI virus phenotype compared with individuals with lower SDF-1. Increased expression of SDF-1 may help explain why the more pathogenic SI HIV-1 variants do not appear in some individuals.

Characteristics of nitric oxide-induced apoptosis and its target cells in mitogen-stimulated peripheral blood mononuclear cells from HIV+ subjects.

The phenomenon of apoptosis observed in lymphoid cells from HIV+ subjects is an important factor contributing to their massive depletion. Several studies have identified nitric oxide (NO) as one of the molecules involved in the apoptosis phenomenon observed during HIV infection. It has been shown that HIV-derived gp120 enhances NO synthesis in cultured cells from HIV+ individuals. Therefore, we tested the potential of two nitric oxide synthase (NOS) inhibitors with different mechanisms of action as preventive agents of in vitro apoptosis, in peripheral blood mononuclear cells (PBMC) from HIV+ subjects. PBMC isolated from these patients always showed higher apoptosis levels than normal subjects, a fact that correlated with overproduction of NO and with reduction of mitochondrial transmembrane potential in these cells. We identified the CD8+ T lymphocyte sub-population as the major apoptosis target in PBMC cultures. Treatment with NO inhibitors N(G)-monomethyl-L-arginine (L-NMMA) and dexamethasone (DEX) inhibited spontaneous and mitogen-induced apoptosis, while reducing mitochondrial alterations in PBMC from both normal (30%) and HIV+ (70%) subjects. The development of apoptosis in target cells correlated with their mitochondrial transmembrane potential impairment and with increased expression of Fas (CD95) molecules. These results offer additional alternatives for the manipulation of cellular depletion in HIV disease.

Cyclin levels during TNF-alpha-induced apoptosis in HIV-infected cells.

Cyclins are cell cycle regulatory proteins. We compared the concurrent kinetics of apoptosis and cyclin expression between HIV-infected cells (J1.1), and uninfected Jurkat cells. Cells were cultured with TNF-alpha and harvested at 24, 48 and 72 hr to examine cyclin expression and DNA content. We found a decline in the levels of the mitotic B cyclin in Jurkat cells (16 to 2%, 48 hr), while in J1.1 cells it was observed in cyclin E (60 to 37%, 72 hr). Because cyclin B is mitotic, results suggest that Jurkat cells undergo apoptosis at G2, while J1.1 cells enter mitosis and then die by apoptosis, as no changes in cyclin B or DNA content at G2M were observed. G1 cyclin E decline in J1.1 cells also suggests that they die after entering mitosis. Based on differences in the cyclins involved, it seems that HIV-1 manipulates the cell cycle to protect J1.1 cells from apoptosis induction at G2, a critical cell cycle phase for HIV replication. Thus, cyclins are useful to characterize points in the cell cycle at which apoptosis is induced, and could become excellent tools to evaluate mechanisms of action of antiretroviral drugs in the cell cycle of HIV-infected cells.

Cardiac pacemakers in the transplanted heart: short term with the biatrial anastomosis and unnecessary with the bicaval anastomosis.

Sinus node dysfunction occurs commonly after orthotopic heart transplantation and may be caused by surgical trauma, ischemia to the sinus node, rejection, drug therapy and increasing donor age. In the past, using the standard biatrial technique described originally by Lower and Shumway, many series have reported permanent pacing in more than 10% of patients. Unlike sinus node dysfunction in nontransplanted patients, which typically worsens with time, sinus node dysfunction in the transplanted heart usually improves over a period of weeks to months. Delaying the implantation of a permanent pacemaker may render it unnecessary. The development of the bicaval technique for implantation of the donor heart appears to have decreased even further or even eliminated the need for early permanent pacing. Because sinus node dysfunction in the transplanted heart does not predict subsequent development of atrioventricular (AV) node dysfunction, rate-responsive atrial pacing should be used in the majority of cases. Even after appropriate pacing for sinus node dysfunction, the sinus node may recover and permanent pacing may be discontinued. AV conduction abnormalities are far less common and generally occur late after transplantation. Dual-chamber pacing is required and permanent pacing should be continued indefinitely.

Medical ethics education in Colombia.

This paper discusses some basic concepts in the teaching of Medical Ethics. The development of these concepts is directed towards their application in practical and clinical settings. The appendix describes how an education program has been devised and introduced in Columbia.

Partial necrosis of the neck of the talus treated with arthroscopy.

An unusual case of an area of necrosis on the talar neck of a girl with a 2-year history of gradually increasing pain following an ankle sprain is presented. Initial radiographs were normal but follow-up radiography showed irregularity in the anterior talar neck. A definitive diagnosis was made by magnetic resonance imaging. Arthroscopic removal of a necrotic fragment from the anterior talar neck that was impinging on the tibia relieved her symptoms. Two years after the operation the patient has normal radiographs and full activity.

The Catholic physician and the teachings of Roman Catholicism.

The relationship between Catholic physicians and the teaching authority of the Church is inquired into through an exploration of the special relationship which exists between medicine and religion. Evolution of the relationship between Church subject and Church authority, with a view to a correct interpretation of the relationship between the Catholic physician and the Church, is characterized by the healthy, moderate autonomy recognized by the Second Vatican Council.

Decreased levels of TNF-beta in cultured PBLs from HIV+ patients occur concomitantly to increased apoptosis and impaired PWM-induced proliferation and dehydrogenase activity.

The occurrence of apoptosis in cultured blood cells from HIV+ patients is well-documented. However, the relationship of this process to cytokine production is still undefined. We measured the production of TNF-beta by mitogen-stimulated PBLs from 33 HIV+ patients, while simultaneously assessing their development of apoptosis, dehydrogenase activity and proliferative responses to PWM and PHA; Only 3/33 patients had less than 30% apoptosis in PWM cultures (average value = 19.6%); patients were grouped in accordance with their having low (31-40%; average 34.8%), intermediate (41-50%, average 45.7%) or high levels (over 51%, average 53.6%) of apoptosis. Our results indicate that there is a quantitative correlation between the different degrees of apoptosis and the impaired production of TNF-beta, and support the hypothesis that PBLs from all HIV+ patients have defective immunological functions. In addition, our results show that TNF-beta production correlates with a stage classification of patients which reflects their PBL status of apoptosis, proliferative response to PWM and dehydrogenase activity in vitro.

Why do cells die in HIV infection? Potential mechanisms inducing programmed cell death/apoptosis.

This work reviews the suggested mechanisms which result in programmed cell death in human HIV infection. Here we present state-of-the-art scientific information related to the newly rediscovered phenomenon of Apoptosis, and to its biological relevance in the pathogenesis of HIV disease. General features of this phenomenon are reviewed, as well as available evidence for its occurrence and possible role in AIDS pathogenesis. A complex series of cellular and molecular events leading to cellular apoptosis are also reviewed and discussed. They include events which take place at the cell membrane level and those which occur at the intramembrane level and cytoplasmic locations, which result from the immunological activation of affected cells. Cellular events which follow and occur within the mitochondrial space and at the nuclear level are also discussed. The biological significance of all these phenomena is summarized in a theoretical scheme, which attempts to integrate all cellular events leading a primed cell into its HIV-induced programmed death.

Multifunctional immunological monitoring of HIV positive patients: a novel staging system.

A tri-functional in vitro evaluation has been utilized to analyze peripheral blood mononuclear cells (BMNC) from HIV-infected patients, which allows for the classification of these individuals into convenient stages, according to the number of in vitro parameters affected. The classifying functional parameters are: the mitochondrial metabolic activity of freshly isolated BMNC, measured by an MTT reduction assay, the detection of apoptosis in 72 hour cultures of these cells assessed by propidium iodide staining and dual parametric flow cytometric analysis, and their proliferative response to pokeweed mitogen. Our results indicate that HIV-infected patients at different stages of their clinical disease, can present dysfunctions in one, two or three of the above-mentioned parameters. Based on these results, patients can be classified into four newly-described stages which are Stage 0, including uninfected controls and all patients with unaffected parameters, and Stages 1, 2 and 3, including patients having one, two or all three parameters affected, respectively. This type of immunological evaluation and classification of HIV-infected patients has the potential of becoming a predictive tool in the longitudinal follow-up of their HIV infection.