Identifying Spatial Variation Along the HIV Care Continuum: The Role of Distance to Care on Retention and Viral Suppression.

Distance to HIV care may be associated with retention in care (RIC) and viral suppression (VS). RIC (≥ 2 HIV visits or labs ≥ 90 days apart in 12 months), prescribed antiretroviral therapy (ART), VS (< 200 copies/mL at last visit) and distance to care were estimated among 3623 DC Cohort participants receiving HIV care in 13 outpatient clinics in Washington, DC in 2015. Logistic regression models and geospatial statistics were computed. RIC was 73%; 97% were on ART, among whom 77% had VS. ZIP code-level clusters of low RIC and high VS were found in Northwest DC, and low VS in Southeast DC. Those traveling ≥ 5 miles had 30% lower RIC (adjusted odds ratio (aOR) 0.71, 95% CI 0.58, 0.86) and lower VS (OR 0.70, 95% CI 0.52, 0.94). Geospatial clustering of RIC and VS was observed, and distance may be a barrier to optimal HIV care outcomes.

P2X7 purinergic receptors participate in the expression and extinction processes of contextual fear conditioning memory in mice.

The purinergic system consists of two large receptor families - P2X and P2Y. Both are activated by adenosine triphosphate (ATP), although presenting different functions. These receptors are present in several brain regions, including those involved in emotion and stress-related behaviors. Hence, they seem to participate in fear- and anxiety-related responses. However, few studies have investigated the purinergic system in threatening situations, as observed in contextual fear conditioning (CFC). Therefore, this study investigated the involvement of purinergic receptors in the expression and extinction of aversive memories. C57Bl/6 background mice were submitted to the CFC protocol. Wildtype (WT) mice received i.p. injection of either a nonselective P2 receptor (P2R) antagonist, P178 (10 or 30 mg/kg); a selective P2X7 receptor (P2X7R) antagonist, A438079 (10 mg/kg); a selective P2Y1 receptor (P2Y1R) antagonist, MRS2179 (10 mg/kg); or vehicle 10 min prior to or immediately after the extinction session. Additionally, P2X7R KO mice were tested in the CFC protocol. After P2R antagonist treatment, contextual fear recall increased, while acquisition of extinction was impaired. Similar results were observed with the selective P2X7R antagonist, but not with the selective P2Y1R antagonist. Interestingly, P2X7R KO mice showed increased contextual fear recall, associated with impaired acquisition of extinction, in accordance with pharmacologic P2X7R antagonism. Our results suggest that specific pharmacological or genetic blockade of P2X7R promotes anxiogenic-like effects, along with deficits in extinction learning. Thus, these receptors could present an alternative treatment of stress-related psychiatric disorders.

Adverse birth outcomes associated with Zika virus exposure during pregnancy in São José do Rio Preto, Brazil.

OBJECTIVES: We aimed to report the first 54 cases of pregnant women infected by Zika virus (ZIKV) and their virologic and clinical outcomes, as well as their newborns' outcomes, in 2016, after the emergence of ZIKV in dengue-endemic areas of São Paulo, Brazil. METHODS: This descriptive study was performed from February to October 2016 on 54 quantitative real-time PCR ZIKV-positive pregnant women identified by the public health authority of São José do Rio Preto, São Paulo, Brazil. The women were followed and had clinical and epidemiologic data collected before and after birth. Adverse outcomes in newborns were analysed and reported. Urine or blood samples from newborns were collected to identify ZIKV infection by reverse transcription PCR (RT-PCR). RESULTS: A total of 216 acute Zika-suspected pregnant women were identified, and 54 had the diagnosis confirmed by RT-PCR. None of the 54 women miscarried. Among the 54 newborns, 15 exhibited adverse outcomes at birth. The highest number of ZIKV infections occurred during the second and third trimesters. No cases of microcephaly were reported, though a broad clinical spectrum of outcomes, including lenticulostriate vasculopathy, subependymal cysts, and auditory and ophthalmologic disorders, were identified. ZIKV RNA was detected in 18 of 51 newborns tested and in eight of 15 newborns with adverse outcomes. CONCLUSIONS: Although other studies have associated many newborn outcomes to ZIKV infection during pregnancy, these same adverse outcomes were rare or nonexistent in this study. The clinical presentation the newborns we studied was mild compared to other reports, suggesting that there is significant heterogeneity in congenital Zika infection.

A single episode of high intensity sound inhibits long-term potentiation in the hippocampus of rats.

Exposure to loud sounds has become increasingly common. The most common consequences of loud sound exposure are deafness and tinnitus, but emotional and cognitive problems are also associated with loud sound exposure. Loud sounds can activate the hipothalamic-pituitary-adrenal axis resulting in the secretion of corticosterone, which affects hippocampal synaptic plasticity. Previously we have shown that long-term exposure to short episodes of high intensity sound inhibited hippocampal long-term potentiation (LTP) without affecting spatial learning and memory. Here we aimed to study the impact of short term loud sound exposure on hippocampal synaptic plasticity and function. We found that a single minute of 110 dB sound inhibits hippocampal Schaffer-CA1 LTP for 24 hours. This effect did not occur with an 80-dB sound exposure, was not correlated with corticosterone secretion and was also observed in the perforant-dentate gyrus synapse. We found that despite the deficit in the LTP these animals presented normal spatial learning and memory and fear conditioning. We conclude that a single episode of high-intensity sound impairs hippocampal LTP, without impairing memory and learning. Our results show that the hippocampus is very responsive to loud sounds which can have a potential, but not yet identified, impact on its function.

The Endocannabinoid System and Anxiety.

The medical properties of Cannabis sativa is known for centuries. Since the discovery and characterization of the endogenous cannabinoid system, several studies have evaluated how cannabinoid compounds and, particularly, how the modulation of the endocannabinoid (eCB) system influences a wide range of functions, from metabolic to mental disorders. Cannabinoids and eCB system often exert opposite effects on several functions, such as anxiety. Although the mechanisms are not completely understood, evidence points to different factors influencing those effects. In this chapter, the recent advances in research about the relationship between eCB system and anxiety disorders in humans, as well as in animal models, will be discussed. The recent data addressing modulation of the eCBs in specific brain areas, such as the medial prefrontal cortex, amygdaloid complex, bed nucleus of stria terminalis, hippocampus, and dorsal periaqueductal gray, will be summarized. Finally, data from animal models addressing the mechanisms through which the eCB system modulates anxiety-related behavior dependent on stressful situations, such as the involvement of different receptors, distinct eCBs, modulation of neurotransmitters release, HPA axis and immune system activation, and plastic mechanisms, will also be discussed.

Zika Virus Infection and Solid Organ Transplantation: A New Challenge.

Public health concerns exist surrounding the epidemic of the Zika virus (ZIKV) and the rapid growth of transplantation in developing countries, including endemic zones of active arbovirus transmission, as well as travel to such regions by potential organ donors and recipients. Few data exist regarding the clinical characteristics of ZIKV infection in immunocompromised hosts. Laboratory screening protocols for transplantation to differentiate ZIKV infections from other endemic viral diseases and for the detection of possible donor-derived infection have not been stated. The diagnosis of ZIKV infection remains a challenge, fueled by the lack of standardized commercially available diagnostic tests and validated reference diagnostic laboratories, as well as the limited duration of ZIKV viremia. In this small series, ZIKV infection in renal and liver recipients presented without rash, conjunctivitis, or neurological symptoms, and with abnormal graft function, thrombocytopenia, and bacterial superinfection. We report the first case series of ZIKV infection in solid organ recipients, with a description of clinical and laboratory features and therapeutic management.

Isolation and Characterization of Madariaga Virus from a Horse in Paraíba State, Brazil.

Madariaga virus (MADV), the new species designation for the South American isolates of eastern equine encephalitis virus (EEEV), is genetically divergent and substantially different in ecology and pathogenesis from North American EEEV strains. We isolated and characterized a MADV isolate obtained from a horse in Brazil. Our results support previous phylogenetic studies showing there are three genetically distinct MADV lineages. The MADV isolate from Paraíba State belongs to the South American lineage III and is closely related to Peruvian, Colombian and Venezuelan isolates.

Modulation of defensive behavior by Transient Receptor Potential Vanilloid Type-1 (TRPV1) channels.

The Transient Receptor Potential Vanilloid Type-1 (TRPV1) was first characterized in primary afferent fibers as a receptor for capsaicin (the pungent ingredient of chili peppers). Later on, this cation-permeable ion channel was also described in the central nervous system, where its main putative endogenous ligand is N-arachidonoyl ethanolamide (an endocannabinoid, also known as anandamide). Recent results employing genetic, pharmacological and histochemical techniques indicate that TRPV1 tonically modulate anxiety, fear and panic responses in brain regions related to defensive responses, such as the dorsal periaqueductal gray, the hippocampus and the medial prefrontal cortex. Genetic deletion or antagonism of this ion channel induces anxiolytic-like effects in several animal models. The main mechanism responsible for TRPV1-mediated effects on anxiety seems to involve facilitation of glutamatergic neurotransmission. In addition, there is evidence for interactions with other neurotransmitter systems, such as nitric oxide and endocannabinoids.

Cannabinoid type 1 receptors and transient receptor potential vanilloid type 1 channels in fear and anxiety-two sides of one coin?

The transient receptor potential vanilloid type 1 channel (TRPV1; originally vanilloid receptor VR1) is activated in peripheral terminals of nociceptive fibers by noxious heat, low pH, and natural products such as capsaicin, the pungent ingredient of red-hot chilli peppers. Evidence has been accumulating that TRPV1 is expressed also in the brain, where it seems to be involved in antinociception, locomotor control, and regulation of affective behaviors. This ion channel might be activated by arachidonoyl ethanolamide (anandamide), the endogenous agonist of the cannabinoid type 1 (CB(1)) receptor. However, while CB(1) activation leads to a decrease in intracellular calcium and attenuation of synaptic transmission, anandamide binding to TRPV1 results in elevated calcium levels and potentiated synaptic transmission. This suggests a tripartite regulatory system with antagonistic effects of CB(1) and TRPV1, which are tied together by the same endogenous ligand. Such a system may have important implication for the modulation of behavioral responses. The present commentary elaborates on this interplay between CB(1) receptors and TRPV1 channels in the context of fear- and anxiety-related behaviors.

Antiaversive effects of cannabinoids: is the periaqueductal gray involved?

Cannabinoids play an important role in activity-dependent changes in synaptic activity and can interfere in several brain functions, including responses to aversive stimuli. The regions responsible for their effects, however, are still unclear. Cannabinoid type 1 (CB1) receptors are widely distributed in the central nervous system and are present in the periaqueductal gray (PAG), a midbrain structure closely involved in responses related to aversive states. Accordingly, exposure to stressful stimuli increases endocannabinoid (eCB) levels in the PAG, and local administration of CB1 agonists or drugs that facilitate eCB-mediated neurotransmission produces antinociceptive and antiaversive effects. To investigate if these drugs would also interfere in animal models that are sensitive to anxiolytic drugs, we verified the responses to intra-PAG injection of CB1 agonists in rats submitted to the elevated plus-maze, the Vogel punished licking test, or contextual aversive conditioning model. The drugs induced anxiolytic-like effects in all tests. The same was observed with the transient receptor potential vanilloid type 1 (TRPV1) antagonist capsazepine and with cannabidiol, a nonpsychotomimetic phytocannabinoid that produces anxiolytic-like effects after systemic administration in humans and laboratory animals. These results, therefore, suggest that the PAG could be an important site for the antiaversive effects of cannabinoids.

[Identification of Epstein-Barr virus in nasopharyngeal carcinomas in Argentina. Its relation with p53 and the determination of proliferation indices]. / Identificación del virus Epstein-Barr en carcinomas nasofaríngeos en Argentina. Su relación con p53 y determinación de índices de proliferación.

Thirty-seven nasopharyngeal carcinomas were studied obtaining the tissue from nasopharyngeal biopsies that were formalin fixed and paraffin embedded. The patients were born in Argentina, 23 men and 14 women with a mean age of 50 years. Histologically the tumors were classified as queratinizing squamous cell carcinomas, 1 case (2%); non-queratinizing squamous cell carcinomas, 15 cases (41%) and undifferentiated carcinomas, 21 cases (57%). The proliferating index (PI) was determined using monoclonal antibodies against PCNA and Ki-67 (MIB-1), resulting in 26% for PCNA and 17% for Ki-67 while no differences were found comparing PI with histological type and cases with clinical stage III and IV. The PI was of 2% in the 3 cases with clinical stage II. Immunostains for p53 were positive in 30 out of the 37 cases with no differences between the histological types, exception made for the queratinizing carcinoma which was negative. With a cut off point of 7% in the 12 cases with follow up, two groups were found with a mean survival of 35 and 12 months, a finding that was not statistically significant. Epstein-Barr virus was detected by PCR using the paraffin embedded material in 31 out of the 37 cases: 21 were undifferentiated carcinomas and 15 non-queratinizing squamous cell carcinomas; the queratinizing squamous cell carcinoma was negative. These results, published for the first time in samples from Argentinian patients are similar to those found in areas of high and low incidence of nasopharyngeal carcinomas and can be of clinical use in determining the nasopharyngeal origin of a cervical metastatic lymph node of an unknown primary.

Differential modulation of protein kinase C isozymes in rat parotid acinar cells. Relation to amylase secretion.

We investigated the expression, distribution, and activation parameters of protein kinase C (PKC) isozymes in isolated rat parotid acinar cells. By analyzing cellular extracts by western blot analysis and for isozyme-specific RNA, the Ca(2+)-independent PKC-delta, -epsilon, and -zeta were detected in the cytosolic, particulate (plasma membrane), and nuclear fractions of unstimulated cells, whereas the Ca(2+)-dependent PKC-alpha was confined to the cytosolic and particulate fractions. The expressed isozymes showed distinct responses to phorbol 12-myristate 13-acetate (PMA), thymeleatoxin, and cell surface receptor agonists with respect to translocation from cytosol to particulate fraction and nucleus, as well as sensitivity to down-regulation caused by prolonged exposure to PMA (3-20 hr). The marked susceptibility to down-regulation displayed by PKC-alpha and -delta was accompanied by an enhanced secretory response to norepinephrine as compared with control cells. Further, the selective PKC inhibitors Ro 31-8220 and CGP 41,251 also produced a concentration-dependent enhancement of norepinephrine-induced amylase secretion. Our findings suggest that PKC-alpha or -delta plays a negative modulatory role, rather than an obligatory role, in amylase secretion. Also, the localization and redistribution of PKC-epsilon and -delta to the nucleus by PKC activators imply that one or both of these isozymes may regulate such processes as cellular proliferation and/or differentiation.

Ventricular tachycardia during exercise testing as a predictor of sudden death in patients with chronic chagasic cardiomyopathy and ventricular arrhythmias.

OBJECTIVE: To verify the prognostic value of exercise induced ventricular arrhythmias in patients with chagasic cardiomyopathy. METHODS: 69 consecutive patients (37 male, 32 female; age range 21-67 years) with chronic chagasic cardiomyopathy and ventricular arrhythmias (more than 10 ventricular premature complexes per hour) were evaluated during treadmill exercise testing, using the Bruce protocol. Protocol end points were peak heart rate or presence of sustained ventricular tachycardia. MAIN OUTCOME MEASURE: Sudden cardiac death. RESULTS: 44 patients (group I) developed ventricular tachycardia during exercise testing (five sustained and 39 non-sustained), and 25 did not (group II). After a follow up of 24 (SD 15) months sudden cardiac death occurred in seven patients in group I and in none in group II (P < 0.05). CONCLUSIONS: Ventricular tachycardia on exercise testing is significantly associated with sudden cardiac death in patients with chronic chagasic cardiomyopathy and ventricular arrhythmias.

Estesioneuroblastomas: estudio clínico-patológico, inmunohistoquímico y de ploidía nuclear / Esthesioneuroblastomas: clinico-pathological, immunohistochemical and nuclear ploidy study

Se presentaron 9 casos de estesioneuroblastomas (ENB), 5 varones y 4 mujeres cuyas edades promedio fueron 39 y 55 años respectivamente. Todos presentaban masas polipoides, friables, ubicadas a nivel de nariz y/o senos paranasales. El tratamiento consistió en 8 resecciones quirúrgicas locales, considerándose irresecable uno de los casos. Histológicamente los tumores se hallaban constituidos por células redondas, pequeñas y uniformes dispuestas en planchas y nidos con una matriz fibrilar de fondo, identificándose en un caso pseudorosetas de Homer-Wright. Los estudios inmunohistoquímicos fueron positivos para: enolasa neuronoespecífica (9); proteína S-100 (8); sinaptofisina (7); cromogranina (6); neurofilamentos (6); anticuerpo 013 (4); citoqueratina (1); proteína gliofibrilar ácida (1) y negativos para desmina y CD 45. La determinación del antígeno nuclear de proliferación celular mostró una actividad proliferativa baja en 6 casos (0 a 20 por ciento), y alta en los restantes 3(30 a 50 por ciento). El análisis de ADN reveló 3 tumores diploides y 6 aneuroploides. Un paciente falleció (tumor irresecable y diploide), y los restantes 8 se hallan vivos con seguimientos de 6 meses a 22 años. Se demostró la utilidad de un panel de anticuerpos en el diagnóstico de ENB y el posible valor pronóstico adverso de los histogramas diploides

Estesioneuroblastomas: estudio clínico-patológico, inmunohistoquímico y de ploidía nuclear / Esthesioneuroblastomas: clinico-pathological, immunohistochemical and nuclear ploidy study

Se presentaron 9 casos de estesioneuroblastomas (ENB), 5 varones y 4 mujeres cuyas edades promedio fueron 39 y 55 años respectivamente. Todos presentaban masas polipoides, friables, ubicadas a nivel de nariz y/o senos paranasales. El tratamiento consistió en 8 resecciones quirúrgicas locales, considerándose irresecable uno de los casos. Histológicamente los tumores se hallaban constituidos por células redondas, pequeñas y uniformes dispuestas en planchas y nidos con una matriz fibrilar de fondo, identificándose en un caso pseudorosetas de Homer-Wright. Los estudios inmunohistoquímicos fueron positivos para: enolasa neuronoespecífica (9); proteína S-100 (8); sinaptofisina (7); cromogranina (6); neurofilamentos (6); anticuerpo 013 (4); citoqueratina (1); proteína gliofibrilar ácida (1) y negativos para desmina y CD 45. La determinación del antígeno nuclear de proliferación celular mostró una actividad proliferativa baja en 6 casos (0 a 20 por ciento), y alta en los restantes 3(30 a 50 por ciento). El análisis de ADN reveló 3 tumores diploides y 6 aneuroploides. Un paciente falleció (tumor irresecable y diploide), y los restantes 8 se hallan vivos con seguimientos de 6 meses a 22 años. Se demostró la utilidad de un panel de anticuerpos en el diagnóstico de ENB y el posible valor pronóstico adverso de los histogramas diploides (AU)

[Esthesioneuroblastomas. Clinico-pathological, immunohistochemical and nuclear ploidy study]. / Estesioneuroblastomas. Estudio clínico-patológico, immunohistoquímico y de ploidía nuclear.

Nine cases of esthesioneuroblastoma were studied; 5 males and 4 females, ages ranging from 13 to 75 years (mean 46). All had polypoid masses located in the nasal cavity and/or paranasal sinuses: 8 cases had a surgical resection and 1 a biopsy due to an unresectable tumor. Histologically, all were cellular tumors composed of small round cells growing in sheets or nests with a fibrillary background. Immunohistochemical studies showed positivity for neuron-specific enolase (9/9), S-100 protein (8/9), synaptophysin (7/9), chromogranin (6/9), neurofilaments (6/9), 013 (4/9), GFAP (1/9), cytokeratin (1/9), and negativity for desmina and CD 45. PCNA index showed three tumors with high proliferative activity (30-50%) and low in 6 cases (0-20%). DNA analysis revealed three diploid and six aneuploid tumors. One patient with an unresectable tumor died and the remaining 8 are alive with a mean follow up of 83 months (6 months to 22 years). We emphasize the utility of several antibodies in the diagnosis of esthesioneuroblastoma, the predominance of aneuploid tumors and the possible unfavorable prognostic value of diploid histograms.

Estesioneuroblastomas. Estudio clínico-patológico, immunohistoquímico y de ploidía nuclear. / [Esthesioneuroblastomas. Clinico-pathological, immunohistochemical and nuclear ploidy study]

Nine cases of esthesioneuroblastoma were studied; 5 males and 4 females, ages ranging from 13 to 75 years (mean 46). All had polypoid masses located in the nasal cavity and/or paranasal sinuses: 8 cases had a surgical resection and 1 a biopsy due to an unresectable tumor. Histologically, all were cellular tumors composed of small round cells growing in sheets or nests with a fibrillary background. Immunohistochemical studies showed positivity for neuron-specific enolase (9/9), S-100 protein (8/9), synaptophysin (7/9), chromogranin (6/9), neurofilaments (6/9), 013 (4/9), GFAP (1/9), cytokeratin (1/9), and negativity for desmina and CD 45. PCNA index showed three tumors with high proliferative activity (30-50

) and low in 6 cases (0-20

). DNA analysis revealed three diploid and six aneuploid tumors. One patient with an unresectable tumor died and the remaining 8 are alive with a mean follow up of 83 months (6 months to 22 years). We emphasize the utility of several antibodies in the diagnosis of esthesioneuroblastoma, the predominance of aneuploid tumors and the possible unfavorable prognostic value of diploid histograms.

Translocation of the alpha-isozyme of protein kinase C during stimulation of rat parotid acinar cells by phorbol ester and carbachol.

Protein kinase C activity was detected in the cytosolic fraction of quiescent parotid acinar cells; the particulate fraction contained a much smaller proportion of the enzyme. Protein kinase C activity was increased in the membrane fraction and decreased in the cytosol after exposure of intact cells to phorbol 12-myristate 13-acetate (PMA) or the muscarinic-receptor agonist carbachol. The effect of PMA was potentiated by a subthreshold concentration of ionomycin. Immunoblot analysis with anti-protein kinase C antibodies revealed that the protein kinase C-alpha isoform is expressed in rat parotid cells. Other Ca(2+)-dependent isoforms were not detected. Further, agonist stimulation caused the redistribution of protein kinase C-alpha from cytosol to a membrane fraction. Agonists may promote parotid acinar cell activity, including amylase secretion, by increasing the affinity of protein kinase C-alpha for the membrane fraction, presumably via a rise in Ca2+ and diacylglycerol derived from polyphosphoinositide hydrolysis.