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Regulatory T (Treg) cells comprise different functional subsets with different CCR5 expression. Treg homeostasis is disrupted by HIV but the effect of treatment has barely been explored. In a longitudinal design, we compared the effect of a maraviroc-containing (n = 9) or sparing (n = 12) therapy in antiretroviral-naive HIV-positive participants on peripheral FoxP3(low) CD45RA(+) (nTreg), FoxP3(high) CD45RA(-) (eTreg) and FoxP3(low) CD45RA(-) (non-Treg) cells. Maraviroc significantly reduced all subsets in the short-term and, except for nTreg cells, also normalized them in the long-term. The correlation between eTreg cells and CD4 counts, lost before treatment, was only restored by maraviroc. The differential effect of maraviroc on Treg subsets contributes to understanding its immunomodulatory effects.

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OBJECTIVES: To determine the mean stay (MS) of patients with pulmonary embolism (PE) in a thrombosis unit (TU) with a short stay unit (SSU) in a tertiary hospital. To compare the data collected with those of other hospitals in the same region, of other regions (Autonomous Communities [AACC]), and within the same hospital in the year before the SSU opened. MATERIAL AND METHODS: A descriptive retrospective observational study that included patients with a diagnosis of PE in the University Hospital Virgen de la Arrixaca (HCUVA) in 2012. These data were classified by hospital department, and used for calculating the mean stay. This was then compared with that of other hospitals in our region, with the rest of the regions, and with the data in 2007 (the last year without a TU). RESULTS: A total of 113patients with PE were included, 60 (53%) in the TU with an MS of 4.39, in Oncology, 7.45, and Internal Medicine (IM), 15.38days. There were no deaths in the TU and only 3 (5%) readmissions. Published data showed that the MS in all hospitals in our region was 8.25, 5.18 in our hospital, and higher in the rest of hospitals. The best AACC was the Basque Country with an MS of 6.85days. In 2007, there were 70patients with PE in the HCUVA, 34 (49%) in IM, with an MS of 8.50, Oncology 11 (31%) with an MS 9.64, and Chest Diseases 3 (4.3%) with an MS 19days, and with an overall mortality of 11% and a rate of readmissions in IM of 6%. CONCLUSION: The mean stay for a PE in the SSU of a TU was lower than in the rest of the hospital departments, lower than the rest hospitals of our region, lower than the rest of the regions, and lower than any department of our hospital before the SSU existed, without increasing the readmission or mortality rate.

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The purpose of this study was to test the hypothesis that decreasing liver perfusion in rabbits results in an increase in thermal lesion size and that these effects can be accurately monitored using magnetic resonance imaging (MRI). We additionally tested the hypothesis that the increase in thermal lesion size would depend on the particular vessel or vessels occluded (hepatic artery, portal vein, or both). Using an Institutional Animal Care and Use Committee approved protocol, 20 New Zealand white rabbits were randomly assigned to four treatment groups (five in each group): control and ligation of portal vein (PV), hepatic artery (HA), or both PV and HA (HAPV). Surgical ligation of the appropriate vessel was performed under general anesthesia. Immediately after ligation, the rabbits were placed in a 0.2-T open MR system, and an 18-G copper radiofrequency (RF) electrode with a 2-cm exposed tip was inserted into the liver. RF was applied for 10 minutes with the tip temperature maintained at 90 degrees +/- 2 degrees C. Before and after ablation, perfusion data were obtained for 90 seconds using 30 3-second sequential single oblique-slice fast imaging with steady-state progression (FISP) acquisitions after injection of gadolinium-diethylene triamine pentaacetic acid (Gd-DTPA) via the inferior vena cava. Postablation scanning included axial and oblique turbo spin-echo (TSE) T2-weighted (T2w), STIR, and Gd-enhanced T1w sequences. Lesion size was determined perpendicular to the RF electrode using software calipers on the imager. The rabbits were sacrificed after completion of the post-therapy scans, and their livers were harvested for histologic analysis. The liver showed a mean increase in signal amplitude (SA) of 76% 24 seconds after Gd contrast injection in the control group. After contrast injection, the SA increased to a mean of only 66% in the group with ligated hepatic arteries, with no difference in the time to peak compared with the control group. No significant SA increase over baseline could be found in the groups with ligated PV or ligated PV and HA. T2-weighted images demonstrated the highest lesion-to-liver contrast-to-noise ratios (CNRs; mean -5.5) on postprocedure images, followed by STIR images (mean -2.2) in the control group. The lesions were poorly delineated on the Gd-enhanced images. Average maximum lesion sizes (mean +/- 95% confidence interval) were 22 +/- 4.3 mm after ligation of PV, 22 +/- 2.6 mm after ligation of both PV and HA, 14 +/- 2.0 mm after ligation of HA, and 13 +/- 1.9 mm in the control group. We accept the hypothesis that the diameter of the region of coagulation necrosis achieved by standardized RF ablation in the liver increases with reduced organ perfusion and that this effect can be accurately monitored using MRI. The major factor influencing the size of the coagulation area is the portal venous flow. Occlusion of the hepatic artery alone does not significantly increase lesion size. T2w sequences are best suited for postprocedure imaging due to the high lesion-to-liver CNR in rabbits with normal hepatic perfusion. J. Magn. Reson. Imaging 2001;13:57-63.

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BACKGROUND: Cerebrovascular disease is the leading cause of death in Portugal and carotid disease is responsible for 20 to 50% of strokes. As dyslipidaemias and alcoholism are frequent problems in our country, we planned to examine the relationship of alcohol consumption and carotid disease in dyslipidaemic patients, a subject that has never been specifically studied, as far as we know. METHODS: We studied 102 dyslipidaemic patients, 38 females and 64 males. We used the following classification for echo-doppler results; grade 0--normal; grade 1--intimal-medial thickening (> or = 1 mm); grade 2--one plaque; grade 3--two or more plaques; grade 4--haemodynamic disturbance. We measured several biochemical and clinical parameters, including declared alcohol consumption. RESULTS: In a stepwise regression we found that age had the highest correlation with carotid atherosclerosis, followed by alcohol consumption. Visually we noticed a J-curve between alcohol consumption and carotid atherosclerosis, that we confirmed with a polynomial regression (r = 0.318, p = 0.0114). Carotid atherosclerosis increased only with levels of alcohol consumption over 60 g/day, in spite of even lower levels of alcohol consumption being associated with lower HDL-C and higher triglycerides compared to abstainers. Apo(a) significantly decreased with levels of alcohol consumption over 60 g/day. CONCLUSIONS: In spite of inducing a more severe dyslipidaemia, a low to moderate alcohol consumption may not be contraindicated in dyslipidaemic patients, with some of the protective effects of alcohol probably counterbalancing the worse lipid profile.

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Triglyceride atherogenicity is still a matter of controversy for reasons related to their biological and epidemiological characteristics. The authors discuss and review several of these problems, as well as the metabolic relationship of triglycerides and HDL-cholesterol, data indicating a strong influence of triglycerides on cardiovascular risk, mechanisms mediating the pathogenicity of triglycerides, and some questions of drug treatment of hypertriglyceridemias.

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OBJECTIVES: 1) To find the reasons for PC professionals' anxiety when going about their normal work. 2) To check whether training and experience affect the assessment of the reasons of Family Doctors for anxiety. DESIGN: A descriptive study using a questionnaire. SETTING: PC health centres with second-year family and community medicine (FCM) residents from the Murcia Teaching Unit. PARTICIPANTS: All second-year FCM residents from the Teaching Unit (28) in December 1995 and their tutors. MEASUREMENTS: Open questionnaire based on three points: Causes of anxiety in on-demand consultations; causes of anxiety in scheduled consultations; other reasons for anxiety connected with the Health Centre. RESULTS: The three most anxiety-producing causes in relation to each question were: a) on-demand consultation: residents (R)--unfinishable consultations, lack of time, clinical problems; tutors (T)--unfinishable consultations, a lot of patients waiting outside, manipulative patients. b) Scheduled consultation: R--clinical problems, consultation too long, difficulties in reaching a solution; T--consultation too long, patients without an appointment and interruptions in the middle of the consultation. c) Other reasons for anxiety: R--not being off the day after being on call, having to do research work, and emergency calls; T--emergency calls, research work and temperature problems. CONCLUSIONS: Clinical problems are the causes of anxiety with the greatest difference between tutors and residents. Regulated training in the health centre and professional experience seem to act positively on some of the causes of anxiety.

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OBJECTIVES: To find the causes of worry in second-year family and community medicine (FCM) residents on their arrival at health centres. DESIGN: A descriptive study. A survey with 4 questions on difficulties found in the on-demand clinic, in consultations by appointment, other causes of anxiety and problems foreseen a priori. SETTING: Health centres in the Murcia Region with second-year FCM residents. PARTICIPANTS: All the second-year FCM residents (28) on their arrival at health centres in November, 1995. RESULTS: The three points of most concern to residents were: 1. On-demand clinic: unfinishable consultations, lack of time and clinical problems. 2. Consultations by appointment: clinical problems, over-long consultations and difficulties in resolving the consultations. 3. Other causes of anxiety: not having the day off after being on call, research work and emergencies. 4. Problems foreseen a priori: a lot of patients in a short time, not creating problems for the tutor and unemployment at the end of the residency. CONCLUSIONS: The short time to attend each patient and clinical problems are what cause most difficulty. This was the first time the difficulties residents had to integrate into Health Centres were surveyed. The initiative was greatly appreciated by them.

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A new method for oxalate determination in urine is described. It neither requires precipitation nor previous extraction of oxalate and is free from the interferences often found with analyses of urine samples. The method is not time consuming and is suited to routine work.

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