An Assessment of HIV-Infected Patients Dying in Care for Deceased Organ Donation in a United States Urban Center.

Organ transplantation is an acceptable option for human immunodeficiency virus (HIV)-infected patients with end-stage kidney or liver disease. With worse outcomes on the waitlist, HIV-infected patients may actually be disproportionately affected by the organ shortage in the United States. One potential solution is the use of HIV-infected deceased donors (HIVDD), recently legalized by the HIV Organ Policy Equity (HOPE) Act. This is the first analysis of patient-specific data from potential HIVDD, retrospectively examining charts of HIV-infected patients dying in care at six HIV clinics in Philadelphia, Pennsylvania from January 1, 2009 to June 30, 2014. Our data suggest that there are four to five potential HIVDD dying in Philadelphia annually who might yield two to three kidneys and three to five livers for transplant. Extrapolated nationally, this would approximate 356 potential HIVDD yielding 192 kidneys and 247 livers annually. However, several donor risk indices raise concerns about the quality of kidneys that could be recovered from HIVDD as a result of older donor age and comorbidities. On the other hand, livers from these potential HIVDD are of similar quality to HIV-negative donors dying locally, although there is a high prevalence of positive hepatitis C antibody.

Travel distance to HIV medical care: a geographic analysis of weighted survey data from the Medical Monitoring Project in Philadelphia, PA.

Decisions regarding where patients access HIV care are not well understood. The purpose of this analysis was to examine differences in travel distance to care among persons receiving care in Philadelphia. A multi-stage sampling design was utilized to identify 400 potential participants. 65 % (260/400) agreed to be interviewed. Participants were asked questions about medical care, supportive services, and geographic location. Distances were calculated between residence and care location. 46.3 % travelled more than three miles beyond the nearest facility. Uninsured travelled further (6.9 miles, 95 % CI 3.9-9.8) than persons with public insurance (3.3 miles, 2.9-3.6). In multivariate analyses, no insurance (20/260) was associated with increased distance (p = 0.0005) and Hispanic ethnicity was associated with decreased distance (p = 0.0462). Persons without insurance travel further but insurance status alone does not explain the variability in distance travelled to care. In Philadelphia, Hispanic populations, and providers that may be most accessible to them, are spatially contained.

Flow cytometric detection of CD10 (cALLA) on peripheral blood B lymphocytes of neonates.

CD10 (cALLA) was detected on the surface of CD19-positive circulating lymphocytes in the peripheral blood of 32/50 neonates tested. These cells are presumed to represent immature B cells, commonly referred to as haematogones, previously undescribed in peripheral blood. The CD10+/CD19+ cells expressed lower levels of CD22 consistent with these cells being immature B lymphocytes. The presence of CD10+/CD19+ cells in the blood was not significantly correlated with a leucoerythroblastic picture, adjusted gestational age, or the presence in blood smears of medium-to-large lymphocytes with an immature appearance that morphologically resembled classic bone-marrow haematogones.

Expression and function of the complement membrane attack complex inhibitor protectin (CD59) in human prostate cancer.

Protectin (CD59) inhibits homologous complement-mediated cytolysis by preventing formation of the membrane attack complex at the point of insertion and polymerization of C9 into cell membranes. The present study investigated the expression and function of CD59 on human prostatic tumor cells in situ and on 5 human prostate cell lines in vitro originating from either metastatic tumors or benign prostate hypertrophy epithelial cells. Immunohistochemical staining of prostate carcinoma tissue with monoclonal antibody (MAb) MEM43 revealed weak to moderately strong expression of CD59 by prostate glandular epithelial cells. Flow cytometry with MEM43 demonstrated that the 5 prostate cell lines expressed different relative quantities of CD59. Indirect immunofluorescence analysis revealed uniform membrane staining of DU145 and PC3 cell lines with no membranous granularity in the staining pattern. Western immunoblots with MAb BRIC 229 showed that PC3 and DU145 cells express CD59 with a m.w. of 18-25 kDa. Treatment of DU 145 and PC3 cells with phosphatidylinositol-specific phospholipase C caused a significant decrease of CD59 expression indicating that the CD59 expressed by prostate cancer cells is anchored to the cell membrane via a glycosylphosphatidylinositol (GPI) linkage. PC3 and DU145 cells were completely resistant to human complement-mediated cytolysis but became sensitive to killing in the presence of the CD59-neutralizing MAb YTH53.1. We conclude that malignant and benign human prostate cells express CD59 that is GPI-linked to the cell surface and that CD59 may regulate the immunological response to cancerous prostate cells by protecting the cells from the cytolytic activity of complement.

Circulating red cells usually remain of host origin after bone marrow transplantation for severe combined immunodeficiency.

BACKGROUND: Patients with severe combined immunodeficiency (SCID) treated with allogeneic bone marrow transplantation often receive a milder conditioning regimen than patients who undergo transplantation for hematologic malignancy, and they regularly retain circulating white cells of host origin. The origin of circulating red cells following successful bone marrow transplantation to treat SCID is not known. STUDY DESIGN AND METHODS: Review of the medical records identified all patients with SCID who underwent ABO-mismatched bone marrow transplantation at the University of California, San Francisco, between 1982 and 1994. The ABO and Rh phenotype at >6 months after transplantation was determined for all successful transplants by review of the medical record or the taking of a fresh blood sample for analysis. Patient-conditioning and donor bone marrow-preparative regimens were reviewed to assess their possible influence on the red cell phenotype after successful bone marrow transplantation. RESULTS: Nine of 35 SCID patients who underwent successful transplantation received marrow from ABO-mismatched donors. Eight of the nine patients had only host red cells circulating at 6 to 84 months after transplantation, while one patient had only donor red cells circulating at 48 months after transplantation. None of the patients had circulating red cells of both host and donor origin. Conditioning regimens included cyclophosphamide and antithymocyte globulin for all nine patients; only three patients also received total body irradiation. Seven of the nine patients received related-donor, HLA-mismatched bone marrow, and two patients received HLA-identical bone marrow; eight patients received T-cell-depleted bone marrow. The one patient whose red cell phenotype converted to that of the donor received T-cell-depleted, haploidentical marrow, and the preparative regimen included chemotherapy and total body irradiation. CONCLUSION: SCID patients successfully treated with allogeneic bone marrow transplantation typically fail to show circulating red cells of donor phenotype; this finding is in contrast to the universal presence of circulating donor red cells following successful bone marrow transplantation to treat hematologic malignancies and other diseases. The milder conditioning regimens typically given to patients with SCID, along with T-cell depletion and HLA mismatching, may play a role in this different outcome. It is not known whether the inability to find circulating red cells of donor origin is due to a failure to engraft donor pluripotent stem cells or a failure of engrafted donor stem cells to differentiate along the erythroid lineage.

Immunocytochemical assay for androgen receptors in prostate cancer: a prospective study of 63 cases with long-term follow-up.

BACKGROUND: Numerous problems are associated with biochemical androgen receptor (AR) assay performance and interpretation in prostatic cancer. The purpose of this study was to determine if a novel immunocytochemical AR assay performed on intact tissue sections would prove useful in prognosticating endocrine response and survival. METHODS: A prospective study was done on 63 prostatic carcinomas maintained in liquid nitrogen for over a decade. The study used the peroxidase-antiperoxidase system and a polyclonal anti-AR antibody. RESULTS: Marked tissue and cellular heterogeneity of nuclear AR was apparent. A cut-off of 10% AR-positive cells maximized assay prognostic efficiency. Frequency of positivity was 48% and correlated significantly with endocrine response (p = 0.03), time to progression (p = 0.0016), and survival (p = 0.02), but not with grade, stage, or ethnicity. CONCLUSIONS: This AR assay could be prognostically useful in the clinical management of prostate cancer and is suitable for use in the community hospital laboratory.

Benign schwannoma of the retroperitoneal space: case report.

We report a case of retroperitoneal benign schwannoma involving the left femoral and obturator nerves. The difficulties of diagnosis are discussed and the potential complications of tumor removal are described.

Pharmacokinetics and pharmacodynamics of doxacurium in young and elderly patients during isoflurane anesthesia.

Preliminary disposition studies of the investigational, long-acting muscle relaxant doxacurium chloride (Nuromax) have demonstrated dual elimination by renal and hepatobiliary pathways, as well as slow hydrolysis by plasma cholinesterase. The present study compares the kinetics and dynamics of doxacurium in eight ASA physical status I or II elderly patients (67-72 yr of age) and eight ASA I or II young patients (22-49 yr of age). After institutionally approved written informed consent, kinetic and dynamic measurements were made after a 25-micrograms/kg bolus injection of doxacurium during 1.25 MAC nitrous oxide/oxygen/isoflurane anesthesia. Maximum twitch depression was similar in older patients (96.4% +/- 1.3%) to that in the young patients (96.6% +/- 1.8%). The time to achieve this level of block was significantly longer in the elderly than in the young (11.2 +/- 1.1 min versus 7.7 +/- 1.0 min, respectively). Recovery times to twitch heights of 5% and 25% of control tended to be prolonged and were more variable in the elderly (82.6 +/- 17.2 and 97.1 +/- 20.1 min, respectively) than in the young (54.8 +/- 9 and 67.5 +/- 8.2 min, respectively). Elimination half-life (96 +/- 20 min) and clearance (2.47 +/- 0.69 mL.kg-1.min-1) in the elderly patients were not statistically different from values found in the younger group. Volume of distribution at steady state in the elderly (220 +/- 80.2 mL/kg) was significantly larger than in the young (150 +/- 40.0 mL/kg).(ABSTRACT TRUNCATED AT 250 WORDS)

K+-evoked [3H]-5-HT release from rat frontal cortex slices: the effect of 5-HT agonists and antagonists.

The pharmacological characteristics of a pre-junctional 5-HT autoreceptor have been studied by following the Ca2+-dependent, K+-evoked release of [3H]-5-HT from preloaded rat frontal cortex slices. Added 5-HT, in the presence of the 5-HT uptake inhibitor chlorimipramine, caused a dose related inhibition of the K+-evoked release of [3H]-5-HT in this system as did the 5-HT analogues 5-methoxytryptamine, N-methyltryptamine, 5-methoxy-NN'-dimethyltryptamine, N-methyl 5-hydroxytryptamine and tryptamine. The inhibitory effect of 1 microM 5-HT on the K+-evoked release of [3H]-5-HT was reversed in a dose-related manner by the 5-HT antagonist drug, methiothepin (pA10 value 6.7). At a concentration of 1 microM, the 5-HT antagonists drugs cinanserin and mianserin produced a small but significant reversal of the 5-HT induced inhibition of K+-evoked [3H]-5-HT release, but methysergide, metergoline and cyproheptadine were completely without effect at this concentration. The results are interpreted as evidence for a pre-junctional autoreceptor for 5-HT in the frontal cortex of the rat with a different pharmacological specificity for 5-HT antagonists from previously studied 5-HT receptors.

Evaluation of blood pressure during early alcohol withdrawal.

Ninety-five patients undergoing early alcohol withdrawal were observed for a five-day period in a non-hospital facility to evaluate the natural history of blood pressure change during this period. Patients under 30 years old developed a significant increase in systolic pressure on the second abstinent day, decreasing a mean of 10 mm Hg by the fourth abstinent day. With increasing age there was a progressively smaller rise in systolic pressure. Multivariate analysis showed a history of hypertension, delirium tremens, seizures, initial pulse, race, and sex not to be predictive of blood pressure change. Diastolic pressure was unaffected. Etiology of this difference requires further study. There were no hypertensive complications in this group. Patients undergoing early withdrawal need not be treated for changes in blood pressure without evidence of end organ damage or severe hypertension.