Both heparin 5,000 units subcutaneously every 8 hours and enoxaparin 40 mg subcutaneously once daily provide highly effective and safe prophylaxis for patients undergoing colorectal surgery. However, given the current differences in cost, prophylaxis with low-dose heparin remains the preferred method at present.

No abstract

We conclude that CD103 defines a discrete and stable subset of human CD8+ CTL and that CD103 expression by such cells is initiated and maintained by bioactive TGF-beta. These data point to the existence of a human effector subset that is uniquely specialized for the destruction of the graft epithelium.

Human immunodeficiency virus (HIV) type 1 infection requires functional interactions of the viral surface (gp120) glycoprotein with cell surface CD4 and a chemokine coreceptor (usually CCR5 or CXCR4) and of the viral transmembrane (gp41) glycoprotein with the target cell membrane. Extensive genetic variability, generally in gp120 and the gp41 ectodomain, can result in altered coreceptor use, fusion kinetics, and neutralization sensitivity. Here we describe an R5 HIV variant that, in contrast to its parental virus, infects T-cell lines expressing low levels of cell surface CCR5. This correlated with an ability to infect cells in the absence of CD4, increased sensitivity to a neutralizing antibody recognizing the coreceptor binding site of gp120, and increased resistance to the fusion inhibitor T-20. Surprisingly, these properties were determined by alterations in gp41, including the cytoplasmic tail, a region not previously shown to influence coreceptor use. These data indicate that HIV infection of cells with limiting levels of cell surface CCR5 can be facilitated by gp41 sequences that are not exposed on the envelope ectodomain yet induce allosteric changes in gp120 that facilitate exposure of the CCR5 binding site.Human immunodeficiency virus type 1 (HIV-1) enters cells by membrane fusion mediated by its envelope (Env) glycoproteins (51). The Env proteins are synthesized as a 160-kDa precursor that is cleaved by a host protease to yield the surface gp120 (SU) and the transmembrane gp41 (TM) glycoprotein subunits. The functional Env structure is a trimer, with the gp120 subunits anchored on the virion surface by noncovalent interactions with the gp41 trimer. The gp120 binds first to CD4 and subsequently to a chemokine receptor/coreceptor (generally CCR5 or CXCR4). The gp41 then interacts with the target cell membrane through its N-terminal fusion domain, promoting lipid mixing and viral entry. An unusual feature of gp41 is its long cytoplasmic domain (CD) or tail of approximately 150 amino acids (aa), in contrast to the TM proteins of other retroviruses, such as avian and murine oncoretroviruses, which have a shorter CD (typically 20 to 30 aa).The HIV gp41 CD region includes a number of domains, the exact functions of which are not well understood. The CD includes one or more palmitoylated cysteines, which may mediate localization of the Env to lipid rafts (4, 55). A tyrosinebased (Yxx⌽) motif in the membrane-proximal region of the CD mediates binding to components of clathrin-associated adaptor complexes, which are involved in trafficking and endocytosis (3,5,7,48,56), and also targets Env to the basolateral membrane in polarized cells, resulting in basolateral budding (38, 49). The CD forms three highly conserved amphipathic ␣-helices, termed lentiviral lytic peptides (LLPs), that have been implicated in interactions that decrease the stability of lipid bilayers, causing pore formation and mediating T-cell death (11,12,22,33,42,43,62). The CD also contains two regions that closely resemble those found in calm...

Bupivacaine injection may be useful for reducing pain and associated symptoms long enough to tolerate a trip home from the outpatient department but does not show a sustained effect.

Sexual functioning is often neglected in the care of HIV-infected patients. Little information exists about the relationship between hormonal factors, psychological factors, medication, HIV disease stage and sexual functioning among persons with HIV disease. In this study, 50 HIV+ men completed the Derogatis Sexual Functioning Inventory (DSFI), and had serum hormonal assays drawn (testosterone, thyroid function test, leuteinizing hormone, prolactin and oestradiol). Although all the subjects reported some degree of sexual dysfunction, persons with symptomatic HIV/AIDS reported more negative mood, lower sexual satisfaction scores and worse body image than persons with asymptomatic HIV. Persons with asymptomatic HIV also tended to have normal testosterone levels compared with persons with symptomatic HIV/AIDS. No relationship was found between medications and low testosterone, although numbers were small. These results suggest that sexual dysfunction is prevalent among persons with HIV disease, is more common as patients become symptomatic and progress to AIDS and that both physiological (low testosterone) and psychological issues play a role.

No abstract

Background:To perform complete resection of locally advanced and recurrent rectal carcinoma, total pelvic exenteration (TPE) may be attempted. We identified disease-related outcomes and prognostic factors. Methods:We conducted a single-centre review of patients who underwent TPE for rectal carcinoma over a 10-year period. Results:We included 28 patients in our study. After a median follow-up of 35 months, 53.6% of patients were alive with no evidence of disease. The 3-year actuarial disease-free and overall survival rates were 52.2% and 75.1%, respectively. On univariate analysis, recurrent disease, preoperative body mass index greater than 30 and lymphatic invasion were poor prognostic factors for disease-free survival, and only lymphatic invasion predicted overall survival. Additionally, multivariate analysis identified lymphatic invasion as an independent poor prognostic factor for disease-free survival in this patient population with locally advanced and recurrent rectal carcinoma. Conclusion:Despite the significant morbidity, TPE can provide long-term survival in patients with rectal carcinoma. Additionally, lymphatic invasion on final pathology was an independent prognostic factor for disease-free survival.Contexte : Pour pratiquer une résection complète du cancer du rectum avancé au stade local et récidivant, on peut tenter une exentération pelvienne totale (EPT). Nous avons déterminé des résultats liés à la maladie et des facteurs de pronostic. Méthodes :Nous avons procédé à une étude unicentrique portant sur des patients qui ont subi une EPT pour un cancer du rectum au cours d'une période de 10 ans.