Extracorporeal whole body hyperthermia treatments for HIV infection and AIDS.

Whole body hyperthermia therapy (WBHT) is the elevation of the core body temperature to 42 degrees C. In vitro studies have confirmed that 42 degrees C is cytocidal for virally infected lymphocytes, and even more effective when heating is repeated 4 days later. The safety and efficacy of two successive sessions of WBHT (4 days apart) was evaluated in 30 patients with AIDS (not on protease inhibitors), randomized to: 1) untreated controls, 2) low temperature WBHT for 1 hour at 40 degrees C and repeated 96 hours later, and 3) high temperature WBHT for 1 hour at 42 degrees C and repeated 96 hours later. The sorbent suspension in the ThermoChem System (HemoCleanse, West Lafayette, IN) system automatically controlled blood phosphate, calcium, and other electrolyte concentrations during WBHT. In 1 year of follow-up after WBHT, there were positive effects of the therapy on frequency of AIDS defining events, Karnofsky score, and weight maintenance. However, effects on plasma HIV RNA and CD4 counts were transient. Two successive WBHT treatments were performed in four patients who were on protease inhibitor/triple drug therapy, but had suboptimal response. In follow-up for 6 months, plasma HIV RNA and CD4 improved after WBHT, and the patients remained clinically well. This WBHT may have specific advantages in patients with suboptimal response to protease inhibitor therapy.

What do family members expect from the family physician of a deceased loved one?

BACKGROUND AND OBJECTIVES: This study examined what actions are expected from a family physician by the family members of a deceased patient immediately following the death of the patient. METHODS: Those listed as next of kin on the charts of deceased patients of a suburban family practice residency were asked to complete a questionnaire about their expectations of their family member's family physician after the death. RESULTS: Expectation of the surveyed actions was surprisingly low, with attendance at the funeral the least expected, followed closely by acknowledgment of the anniversary of the family member's death. Nearly half of the respondents expected a telephone call shortly after the death, while close to one third expected the physician to ask about their emotional well-being at their next visit. CONCLUSIONS: The results suggest that family members do not expect or rarely expect any action from their family member's family physician after the death. However, comments received with the survey indicate that any gesture of sympathy or show of concern from the family physician was greatly appreciated by the survivors.

Effect of whole-body hyperthermia on AIDS patients with Kaposi's sarcoma: a pilot study.

The safety and possible efficacy of extracorporeal whole-body hyperthermia (WBHT) were evaluated in the first FDA-approved feasibility study of WBHT in persons with AIDS. Six gay men, aged 20-50 years, CDC class C-3, underwent 1 h of WBHT at either 40 degrees C or 42 degrees C, employing a system that minimizes the physiological and biochemical changes that occur during WBHT. All subjects had Kaposi's sarcoma (KS), were free of opportunistic infections, and had significant elevations of plasma HIV RNA. During the treatment, there were no adverse side effects and all subjects tolerated WBHT without problems. KS lesions partially regressed immediately following WBHT in all subjects but returned to pretreatment status in five of six patients at 1 week. In subjects treated at 40 degrees C, CD4 counts decreased during the 8-week follow-up period; they remained unchanged, however, following 42 degrees C WBHT. Viral load remained unchanged following WBHT in subjects treated at 40 degrees C. Treatment at 42 degrees C resulted in an immediate reduction in HIV RNA that was not sustained at 1 week post-WBHT. We conclude that WBHT is safe in subjects with advanced HIV disease and that it may have a role in treating HIV infection. A larger controlled trial involving two treatments in less immunocompromised subjects is currently in progress to test this hypothesis.

Modeling human operators using neural networks.

Often in the process industries, human operators rather than mathematically based advanced algorithms are used to achieve product control. Typically, if there are three shifts of operators per day, one shift achieves superior control. If the expertise of the best operator can be captured easily and economically and made available to the other operators, significant economic benefits would accrue. This paper discusses a methodology that uses artificial neural networks for capturing the knowledge of process operators. For many operator tasks, only readily available information obtained from a process control computer is required. Once a converged network is available, a stripping technique can be employed to simplify the net and to gain knowledge about what a good operator is doing compared to a poor one. It is felt that the proposed approach is superior to traditional expert system techniques employing knowledge extraction approaches.