Search

We have developed a new system for the production of autologous platelet-rich plasma and red blood cell concentrates to be used in autologous transfusion support of cardiac surgery patients. In 15 operations no homologous blood products were required. Costs were diminished since with the same harness it was possible to carry out the intraoperative blood salvage and concentrate the erythrocytes contained in the oxygenator and its lines. Indirect costs were also reduced since no infective complication was observed due to homologous blood products.

To determine the effect of highly active antiretroviral therapy (HAART) on high-risk human papillomavirus (HR-HPV) infections and related cervical lesions, the virologic and cytologic markers of HPV infection were prospectively studied in 163 human immunodeficiency virus (HIV)‐infected women, including 27 untreated, 62 treated with reverse transcriptase inhibitors, and 74 treated with HAART. A high prevalence of both infections with HR-HPV types (68%) and squamous intraepithelial lesions (SILs; low grade, 20.2%; high grade, 6.2%) was observed. The risks of infection and disease were inversely correlated with CD4 cell counts (P p .015 and , respectively). During the observation period (mean, 15.4 months; range, 6‐24 P p .022 months), CD4 cell counts increased significantly only in subjects receiving HAART (P ! ). Persistence of HR-HPV infection and progression of SILs were comparable in the 3 .001 groups. These results indicate that, even in the era of HAART, HIV-infected women should be monitored carefully for the emergence of high-grade SILs and cervical cancer.

The paper reports on a systematic survey of the literature around the manifold theme of workarounds in CSCW and in so doing presents a range of definitions that focus on different aspects of this phenomenon. We also report a case study in a large hospital where we discussed with some key users the opportunity of a tool that could promote awareness of existing workarounds, as a way to provide feedback on the actual use of an IT application in a bottom-up fashion. This case study led to the design of a simple process annotation tool, where users could distinguish between different kinds of workarounds: either as misalignments with respect to the organization procedures, or circumventions of the technology supporting them, or both.

This prospective study evaluated the effect of long-term highly active antiretroviral therapy (HAART) on human papillomavirus-related cervical disease in clinically stable HIV-positive women on unchanged therapy and those switching to HAART because of virological worsening. Only the clinically stable (P= 0.00004) and HAART-treated women in the same group (P= 0.0009) showed a reduction in lesions, thus suggesting that strict preventative regimens for invasive lesions are also needed in the HAART era.

The chapter discusses the role of simple and lightweight Web-based systems in promoting a different approach to the externalization of practice-related knowledge within communities of professionals. This approach exploits common online questionnaire systems to collect the preferences of large numbers of domain experts to interesting paradigmatic work cases and proposes a statistically sound evaluation of these responses to evaluate the agreement reached within the community. We tested this approach in a case study that involved a large international medical association, that we chose as an example of a large and highly distributed community of expert professionals; in this study we challenged more than 1,000 surgeons about some border-line clinical cases where tacit notions based on lifelong practice and situated experiences coexist (and sometimes clash) with scientific evidences drawn from the specialistic literature. We make the point that a sound evaluation of the collective agreement is a necessary precondition to use such lean Web-based tools in bottom-up knowledge elicitation initiatives. To this aim, existing measures of agreement and survey-related heuristics can be exploited to get a more precise picture of the "opinion of the many" in collective settings like communities of practice. © Springer-Verlag London 2012.

Background. GB virus C, a positive-stranded RNA virus, is classified in the family Flaviviridae. It is currently believed that persistent infection occurs in 25-50% of infected individuals, however, it still remains an "orphan" virus in search of a role in human pathology. Molecular epidemiological studies have demonstrated that GBV-C infection is present in about 1-1.4% of the healthy population in developed countries, that it shares routes of transmission with HIV and HCV and that the prevalence of GBV-C in these populations is higher than in blood donors. On the basis of the sequence variation among the isolates, GBV-C is classified into at least four major genotypes. Preliminary evidence has suggested that GBV-C is a lymphotropic virus that replicates mainly in the spleen and bone marrow. Recently, several reports have investigated the possible beneficial effect of GBV-C co-infection on HIV disease progression to AIDS, reduced mortality in HIV infected individuals and lower HIV viral loads, not leading to a definitive conclusion yet. Aim. To investigate the role of GBV virus C co-infection in two different subsets of HIV-infected patients, and to evaluate the prevalence of GBV-C genotypes in Northern Italy. Methods. A total of 86 HIV positive patients were examined for GBV-C viremia (years after HIV sera conversion: 12 +/- 5). Control population (Group A): 46 patients (mean age 42 years) with 500 CD4/ml for at least 8 years and never treated with HAART. After extraction of viral RNA from plasma samples, amplification of a highly conserved region of 5'UTR was performed by nested RT-PCR. All positive samples were genotyped by sequencing, alignment with published sequences and phylogenetic analysis. CD4 cell count, HIV plasma levels were also evaluated. Results. 9 out of 46 (19.56%) in Group A and 15 out of 40 (37.5%) in Group B had detectable GBV-C viremia (p=0.064, OR 2.47, percent confidence interval 0.94 to 6.51). No statistical difference was observed when disease stage was evaluated between the two groups. In Group B, after regression analysis for CD4 cell count decrease over the period observed, no significant difference was detected between GBV-C positive and negative patients. No significant difference was observed in Group B in HIV viremia and CD4 cell count at time of GBV-C detection between GBV-C infected patients and GBV-C negative patients. All Italian patients were genotype 2, the only African patient carried GBV-C genotype 1. Conclusions. Although previous results suggest that GBV-C virus may be a favorable marker for long term non progression of HIV disease, whether it plays a direct anti-HIV role or just takes advantage of non progessors' higher CD4 cell count to replicate more efficiently, still remains to be answered. Follow up of untreated patients and further evaluation of virological interactions, between the viruses and the host immune system, will be helpful to shed some light on these observations, offering new prognostic and eventually therapeutical tools for the management of HIV patients.

Genotypic testing includes several steps (RNA purification, RT-PCR amplification, DNA sequencing, sequence editing and analysis) that should be individually controlled. In our laboratory, we have added to this step-by-step internal control a final phylogenetic quality control: this is performed every time a sequence is obtained from a patient previously subjected to the same test. Each sequence with this characteristic is routinely compared with sequences from previous samples of the same patient by multiple alignment and a neighbor-joining tree by using Kimura two-parameter method is constructed. To validate the quality control procedure, we have aligned and calculated the mean similarity of the reverse transcriptase (first 984 nucleotides) and protease (whole gene) sequences from 30 patients whose virus was completely wild-type for both reverse transcriptase and protease. In the same tree, we have added the sequences obtained from 5 out of the 30 patients, tested at a second time point. The wild type sequences have shown a mean inter-sample divergence of 2.9%, and all the sequence pairs from individual patients clustered together in the tree constructed with the nucleotide sequences, while the tree constructed with the inferred aminoacid sequences did not always permit to cluster the sequences from the same patients. This indicates that: 1) the phylogenetic analysis of nucleic acid sequences can be useful to rule out sample mix-up; 2) the belonging of a sequence to each individual patient can efficiently be assessed also in the cases of extreme divergence in terms of drug resistance mutations.