Shorter Survival of SDF1-3′A/3′A Homozygotes Linked to CD4+ T Cell Decrease in Advanced Human Immunodeficiency Virus Type 1 Infection

The SDF-1 3′A allelic polymorphism has been reported to influence either positively or negatively the progression of human immunodeficiency virus type 1 (HIV-1) disease. Therefore, the SDF-1 genotype of 729 HIV-1-infected individuals pooled from 3 distinct cohorts was determined. A statistically nonsignificant association between the SDF1-3′A/3′A genotype and accelerated disease progression was evident among seroconverters (n = 319), but a striking correlation of decreased survival after either diagnosis of AIDS according to the 1993 definition or loss of CD4+ T cell counts <200 was observed. The relative hazards for SDF1-3′A/3′A homozygotes, compared with heterozygotes and wild-type homozygotes were 2.16 (P = .0047), for time from diagnosis according to the 1993 Centers for Disease Control and Prevention AIDS case definition (AIDS-'93) to death, and 3.43 (P = .0001), for time from CD4+ T cells <200 to death. Because no difference in survival was observed after diagnosis according to AIDS-'87, the association of the SDF1-3′A/3′A genotype with the accelerated progression of late-stage HIV-1 disease appears to be explained for the most part by the loss of CD4+ T lymphocyte

Performance evaluation of positive regulators for population control

This paper deals with real time control of age-structured populations described by Leslie models with positive inputs. The classical industrial and pole-assignment regulators are adapted to this class of positive systems and their performance is evaluated through simulation. The influence of noise on cost and robustness of the controlled system and the role of the information structure are discussed in some detail

Limit cycles and Hopf bifurcations in a Kolmogorov type system

The paper is devoted to the study of a class of Kolmogorov type systems which can be used to represent the dynamic behaviour of prey and predators. The model is an extension of the classical prey-predator model since it allows intra-specific competition for the predator's species. The analysis shows that the system can only have Kolmogorov's two modes of behaviour: a globally stable equilibrium or a globally stable limit cycle. Moreover, the transition from one of these two modes to the other is a non-catastrophic Hopf bifurcation which can be specified analytically

Participation in multi-criteria decisions: a software tool and a case study

The paper describes AMACI, a software prototype supporting the decision process in the choice among alternatives. AMACI has been designed in the context of environmental assessment, considering participation essential to elicit interests and judgment parameters of the different groups involved in the decision. Therefore, the software makes possible a clear and transparent communication and supports the active involvement of the stakeholders. The main features of AMACI are the following: it provides a framework for the description of a decision problem and structures the decision making process for each decision-maker with the integrated use of trees and matrices; it makes use of the classical multiattribute decision analysis, including tools to define utility functions; it computes the ranking of the alternatives; it helps a group of decision-makers in dealing with uncertainty and in managing the possible conflict. AMACI has been used to perform the Strategic Environmental Assessment of the local planning process of the Municipality of Trezzo sull’Adda (Italy). The main steps of the procedure and the use of AMACI are briefly described: identification of stakeholders (public, relevant authorities); definition of alternatives; identification of the evaluation criteria; elicitation of the decision-maker preferences; estimation of the effects of the alternatives; comparison between alternatives; sensitivity analysis

The Italian version of the Coma Recovery Scale-Revised (CRS-R)

We present, in the appendix, the Italian version of the Coma Recovery Scale-Revised (CRS-R), a reliable tool that can distinguish patients in the minimally conscious state from those in a vegetative state. The CRS-R consists of 29 hierarchically organised items divided into 6 subscales addressing auditory, visual, motor, oromotor, communication, and arousal processes. The translation procedure, designed to ensure the development of an Italian version of the CRS-R that mirrors the structure and content of the original, was the following: three translations of the scale were concurrently completed by authors from the groups involved in the study; a selected version underwent back translation to detect errors in translation and to ensure that there was no misinterpretation of administration and scoring guidelines; a consensus meeting was held to agree on a fully comprehensible and accurate Italian translation that was consistent with the original English text; the authors of the original version were consulted for additional assistance with translation when consensus could not be reached; a final back translation was done based on the agreed Italian version The Italian version of the scale is now available for use in clinical practice and in studies designed to investigate its psychometric properties; this will help in the coordination of multicentre studies to assess its reliabilit

Decompensated Cirrhosis as Presentation of LKM1/LC1 Positive Type 2 Autoimmune Hepatitis in Adulthood. A Rare Clinical Entity of Difficult Management

Background: Autoimmune hepatitis (AIH) is a chronic and aggressive liver disease that rapidly evolves into cirrhosis and end-stage liver disease if not timely diagnosed and treated with immunosuppressive therapy. AIH is classified into type 1 and type 2 according to the autoantibody pattern, with smooth muscle antibodies and/or antinuclear antibodies as serological markers of AIH-1, while antiliver cytosol antibody type 1 and/or antiliver/kidney microsomal antibody type 1 characterize type 2 AIH, which mainly affects children, including infants, and adolescents. Case Summary: We describe a case of type 2 AIH, clinically onset in a 34-year-old woman with decompensated cirrhosis. Only a thorough analysis of the autoantibody profile allowed for a diagnosis of an AIH-2 evolved into cirrhosis. The patient received a moderate corticosteroid therapy without achieving optimal disease control. We discuss the controversial decision of whether or not to treat the patient with immunosuppressive therapy, which should be balanced with the potential risk of infectious and other complications. A review of the literature on the management of patients with autoimmune cirrhosis is also presented. Conclusions: AIH-2 can be clinically onset in adult patients with cirrhosis and its complications, without being preceded by major clinical signs. Due to the difficult management of cirrhosis with immunosuppressive treatments, a patient-tailored strategy with a case-by-case approach is needed to prevent major complications such as infections, potentially precluding liver transplantation the only curative therapy