The cardiomyopathy of cystic fibrosis: a modern form of Keshan disease.

Introduction: We conducted a study to determine the prevalence of structural heart disease in patients with CF, the characteristics of a cardiomyopathy not previously described in this population, and its possible relationship with nutritional deficiencies in CF. Methods: We studied 3 CMP CF patients referred for heart-lung transplantation and a prospective series of 120 adult CF patients. All patients underwent a clinical examination, blood tests including levels of vitamins and trace elements, and echocardiography with evaluation of myocardial strain. Cardiac magnetic resonance imaging (CMR) was performed in patients with CMP and in a control group. Histopathological study was performed on hearts obtained in transplant or necropsy. Results: We found a prevalence of 10% (CI 4.6%-15.4%) of left ventricular (LV) dysfunction in the prospective cohort. Myocardial strain parameters were already altered in CF patients with otherwise normal hearts. Histopathological examination of 4 hearts from CF CMP patients showed a unique histological pattern of multifocal myocardial fibrosis similar to Keshan disease. Four of the five CF CMP patients undergoing CMR showed late gadolinium uptake, with a characteristic patchy pattern in 3 cases (p < 0.001 vs. CF controls). Selenium deficiency (Se < 60 µg/L) was associated with more severe LV dysfunction, higher prevalence of CF CMP, higher NTproBNP levels, and more severe pulmonary and digestive involvement. Conclusion: 10% of adults with CF showed significant cardiac involvement, with histological and imaging features resembling Keshan disease. Selenium deficiency was associated with the presence and severity of LV dysfunction in these patients.

Relation among Oxygen Stoichiometry, Structure, and Co Valence and Spin State in Single-Layer La2-xAxCoO4±Î´ (A = Ca, Sr) Perovskites.

We have investigated the role of oxygen stoichiometry and structural properties in the modulation of Co valence and spin state in single-layer La2-xAxCoO4±Î´ (A = Sr, Ca; 0 ≤ x ≤ 1) perovskites as well as the interplay between their local structural properties and the magnetic and charge-ordering phenomena. We show the results of high angular resolution powder X-ray diffraction and Co K-edge X-ray absorption and emission spectroscopy experiments on polycrystalline and single-crystal samples. The different doping-induced changes in the Co valence and spin state by Ca (or Sr) substitution can be understood in terms of the evolving oxygen stoichiometry. For Ca doping, the interstitial oxygen excess around the La/Ca atoms in underdoped samples is rapidly lost upon increasing the Ca content. The creation of oxygen vacancies leads to the stabilization of a mixed-valence Co2.5+ independently of the Ca content. In contrast, Sr substitution leads to almost stoichiometric samples and a lower oxygen vacancy concentration, which allows higher mixed-valence states for Co up to Co2.9+. The Co mixed-valence state along the two series is fluctuating between two valence states, Co2.4+ as in La2CoO4.2 and Co2.9+ as in LaSrCoO3.91, that become periodically ordered for the charge-ordered phases around the half-doping. The X-ray emission derived spin states agree well with the Co fluctuating mixed-valence state derived from X-ray absorption spectroscopy on consideration of a distribution of high-spin Co2+ and low-spin Co3+. Furthermore, there is no quenching of the orbital contribution for the high-spin Co2+, as concluded from a comparison with macroscopic magnetization measurements. Doping holes are mainly located in the ab plane and have a strong oxygen 2p character. The major lattice distortions, which are different for Sr and Ca doping, occur along the c axis, where changes in the oxygen stoichiometry take place. Moreover, charge-order transitions are clearly shown from the anomalous increase of the c lattice parameter with an increase in the temperature above 500 K but there is no signature for a temperature-dependent spin-state transition.

Maintenance of virologic efficacy and decrease in levels of ß2-microglobulin, soluble CD40L and soluble CD14 after switching previously treated HIV-infected patients to an NRTI-sparing dual therapy.

Novel strategies are necessary to decrease inflammatory parameters in successfully treated HIV-infected patients. Our aim was to evaluate the maintenance of viral suppression and potential changes in inflammatory, immune-activation and coagulation biomarkers in virologically suppressed HIV-infected patients switched to a nucleoside reverse transcriptase inhibitor-sparing (NRTI) and maraviroc (MVC)-containing combined antiretroviral therapy (cART). Fifty-eight HIV-infected patients were observed after their treatment regimens were changed to MVC 150mg/once daily plus ritonavir-boosted protease inhibitor therapy. Activation-, inflammation- and coagulation-associated biomarkers and mitochondrial (mt)DNA were analyzed after a median of 24weeks of follow-up. We observed that after changing to an NRTI-sparing regimen, 96.6% of HIV-patients on viral suppressive cART maintained viral suppression and their CD4+ T cell counts did not change significantly (median of 31weeks of follow-up). This cART switch reduced soluble CD40 ligand (p=0.002), beta-2 microglobulin (p=0.025), and soluble CD14 (p=0.009) in patients with higher baseline levels of these inflammation biomarkers after a median of 24weeks of follow-up. The results of our study show that changing to NRTI-sparing dual therapy decreased the levels of inflammatory biomarkers and maintained the immune-virologic efficacy. The potential benefits of this regimen warrant further investigation to uncover the association of this therapy with the potential decrease in the morbidity and mortality of HIV-infected patients from non-AIDS-defining illnesses.

Long-term suppressive combined antiretroviral treatment does not normalize the serum level of soluble CD14.

Levels of soluble CD14 (sCD14) were longitudinally measured in 85 human immunodeficiency virus (HIV)-infected subjects during long-term receipt of suppressive combined antiretroviral therapy (cART) and compared to those in young and elderly HIV-negative control subjects. cART did not normalize sCD14 levels; rather, the HIV-infected group displayed a significantly higher sCD14 level at baseline (ie, before cART initiation), 1 year after cART initiation, and 5 years after cART initiation, compared with both control groups. Furthermore, the baseline CD4(+) T-cell count was inversely associated with the baseline sCD14 level. Our results point to the necessity of complementary therapies to treat the activated/inflamed status associated with chronic HIV infection and to the benefits of early initiation of cART.

Effect of maraviroc on HIV disease progression-related biomarkers.

The potential effect of blocking the CCR5 receptor on HIV disease progression biomarkers is not well understood. We showed that an 8-day maraviroc (MVC) monotherapy clinical test (MCT) can be used in selecting patients to receive MVC-containing combined antiretroviral therapy (cART). Using this MCT model, we assessed the effect of MVC on several HIV disease progression biomarkers during the MCT (MVC-specific effect) and following short-term (12-week) cART. We compared 45 patients on MVC monotherapy with a control group of 25 patients on MVC-sparing cART. We found that MVC did not modify any biomarkers in patients that had no virological response after the MCT. MVC-specific effects in patients with virological responses included increased CD8(+) T-cell activation and senescence levels, preservation of an increase in soluble CD14 (sCD14), and a decrease in D dimer levels. After 12 weeks, MVC-containing cART increased CD8(+) T-cell counts and preserved CD4(+) T-cell senescence levels compared with MVC-sparing cART. Moreover, there was a decrease in sCD14 levels in patients that received MVC-containing cART. In conclusion, effects compatible with CD8(+) T-cell redistribution in peripheral blood were observed after MVC therapy. However, MVC was associated with a favorable profile in HIV disease progression biomarkers only in patients with a virological response. These results support a potential clinical benefit of a therapy which includes MVC in HIV-infected patients.

Patients on a combined antiretroviral therapy after maraviroc clinical test show no immunovirological impairment.

The maraviroc clinical test (MCT) is a clinical approach to establish the indication of maraviroc treatment. In this study, we analysed the long-term outcome of patients receiving a combined antiretroviral therapy (cART) selected according to MCT results. Ninety-two consecutive HIV-infected patients underwent MCT. A virological response (<40 HIV-RNA copies/ml after 24 weeks) was observed in 76/92 patients (82.6%). These patients (n=76) were included in a time to treatment failure analysis; after a mean follow-up period of 88 weeks, treatment failure was confirmed in 14 patients (18.4%). Tropism switch during MCT was observed in 3/35 patients (8.6%); these patients experienced excellent long-term outcome on cART. In conclusion, MCT should be considered as an additional method before CCR5-antagonists prescription.

Structural distortion, charge modulation and local anisotropies in magnetite below the Verwey transition using resonant X-ray scattering.

The pattern of charge modulations and local anisotropies below the Verwey transition has been determined and quantified in high-quality Fe(3)O(4) single crystals and thin films grown on MgO by using resonant X-ray scattering at the Fe K-edge. The energy, polarization and azimuthal angle dependencies of an extensive set of reflections with potential sensitivity to charge or local anisotropy orderings have been analyzed to explore their origins. A charge disproportion on octahedral B sites of 0.20 ± 0.05 e(-) with [0 0 1] and [1 1 0] cubic periodicities has been confirmed, while no significant charge disproportion has been obtained with [0 0 1/2] cubic periodicity. Additional charge modulations in the monoclinic a-b plane are also present. In addition, the occurrence of new forbidden (1, 1, 0) and (0, 0, 2n + 1/2) cubic reflections that arise from the anisotropy of the local structure around different tetrahedral and octahedral Fe atoms is shown. This complex pattern of weak charge modulations and local anisotropies is fully compatible with the low-temperature crystal structure refined in the non-polar C2/c space group and disproves any bimodal charge disproportion of the octahedral Fe atoms.

Reexamination of the temperature dependences of resonant reflections in highly stoichiometric magnetite.

We have studied the temperature dependences of the so-called charge and orbital ordering reflections in the neighborhood of the Verwey transition by means of resonant x-ray scattering at the Fe K and L edges on a high purity single crystal of magnetite. Contrary to recently published results [J. E. Lorenzo, Phys. Rev. Lett. 101, 226401 (2008)10.1103/PhysRevLett.101.226401], we show that all the reflections studied disappear simultaneously at the Verwey transition for both edges, on and off resonance. This means that there is no correlation between the Verwey (123.5 K) and the spin-reorientation (130 K) transitions and that the resonant reflections are driven by the lattice distortions.

Maturation and germination of oak somatic embryos originated from leaf and stem explants: RAPD markers for genetic analysis of regenerants.

Experiments were performed to determine the influence of maturation medium carbohydrate content on the rates of germination and plantlet conversion (root and shoot growth) of somatic embryos from four embryogenic lines derived from leaf or internode explants of Quercus robur L. seedlings. The conversion rate was favoured by high carbohydrate content as long as the maturation medium contained at least 2% sucrose, which was necessary for healthy embryo development. Given this, sorbitol and mannitol favoured the conversion rate more efficiently than sucrose, the highest rate, 32%, being achieved by medium with 6% sorbitol and 3% sucrose. Maturation treatment did not affect the root or shoot lengths of converted embryos. In supplementary experiments, 2 weeks of gibberellic acid treatment between maturation and germination treatments did not improve germination rates, but did reduce root length and the number of leaves per regenerated plantlet. In the four embryogenic lines tested, plant recovery rate was enhanced by inclusion of benzyladenine into the germination medium following culture of the embryos on maturation medium with 6% sorbitol and 2-3% sucrose. In embryogenic systems it is important to assess the uniformity of the regenerants. Random amplified polymorphic DNA (RAPD) analysis using 32 arbitrary oligonucleotide primers was performed to study variability in DNA sequences within and between four embryogenic lines. No intraclonal nor interclonal polymorphism was detected between embryogenic lines originating from different types of explant from the same seedling, but every one of the primers detected enough polymorphism among clones originating from different plants to allow these three origins to be distinguished. No differences in DNA sequences between regenerated plantlets and their somatic embryos of origin were detected, but a nodular callus line that had lost its embryogenic capacity was found to be mutant with respect to three other clones originating from the same plantlet. This study shows that high carbohydrate levels in the maturation medium significantly increase plant conversion of oak somatic embryos, which exhibit no variation in DNA sequences when proliferated by secondary embryogenesis.