001) and 0.9 kg (IQR –0.51 to +2.34 kg) in the

darunavir/r triple-therapy group (P = 0.001), with no significant difference find more between the groups (P = 0.40; Fig. 3). Overall, patients gained a median of 6.3% (IQR –5.4 to +25.0%) and 12.5% (IQR –1.9 to +28.0%) trunk fat, respectively, in the monotherapy and triple-therapy groups. An increase in trunk fat of > 20% over 96 weeks was observed in 37% of patients (22 of 59) in the darunavir/r monotherapy arm and in 34% of patients (24 of 70) in the darunavir/r triple-therapy arm. In contrast to fat tissue modification, no significant change in the squelettic mass index (SMI) was observed in either group during the study period. Linear regression analyses by ITT were performed to assess baseline factors associated click here with the changes in limb fat and trunk fat at weeks 48 and 96. In the multivariate analysis, no baseline variable, such as prior antiretroviral regimen (PI-containing regimen vs. non-PI-containing regimen), NRTI association or body composition, was significantly associated with limb or abdominal modification as measured by DEXA. A significant median change in body weight was observed between baseline and week 96, with a weight gain of +2.0 kg (IQR –1.0 to +4.0 kg) (P < 0.001) in the darunavir/r monotherapy group and +0.5 kg (IQR –2.50 to +3.0 kg) (not significant) in the darunavir/r triple-therapy group, with a significant difference between the two

groups by week 96 (P = 0.012). Significant median changes in body mass index and waist circumference were also found within the two arms, but there were no significant differences between the arms in body mass index or thoracic, waist, hip or thigh circumference. Table 2 summarizes changes in metabolic parameters from baseline to week 96. No significant changes were observed within and between treatment groups with regard to total cholesterol, HDL cholesterol and LDL cholesterol. The only significant difference was increased glucose levels in the darunavir/r

monotherapy arm (median +4.0 mg/dL; IQR –4.0 to +7.0 mg/dL) compared with the darunavir/r triple-therapy group (median –2.0 mg/dl; IQR –5.0 to +4.0 mg/dL) (P = 0.012). However, blood glucose level remained < 126 mg/dL in all patients except learn more for one in the darunavir/r monotherapy arm. Bone mineral density of the lumbar spine and both hips was evaluated at week 96 in 87 patients: 50 from the triple-therapy group and 37 from the monotherapy group. Overall, osteoporosis was observed in 11 of 87 patients (12%) and osteopenia in 32 of 87 patients (37%), with no difference between groups. Serum 25-hydroxyvitamin D, PTH, calcium and phosphate levels were similar in the two groups, with median levels of 22 ng/ml (IQR +16 to +28) for 25-hydroxyvitamin D, 47.3 pg/ml (IQR +35.7 to +63.5) for PTH, 2.3 mmol/L (IQR +2.3 to +2.4) for calcium, and 1.0 mmol/L (IQR +0.8 to +1.1) for phosphate.

“
“Previous studies in HIV-infected populations have yielded conflicting results on the effect of antiretroviral therapy (ART) on cognition. Our objective was to investigate the effect of several years of ART with stable

find more central nervous system penetration effectiveness (CPE) score on neuropsychological performance in HIV-infected individuals. We analysed a clinical cohort of HIV-infected patients who initiated ART between June 2003 and December 2006 and maintained stable CPE scores. Patients were evaluated with a short neuropsychological battery. Using linear regression, we examined the relationship between results of cognitive tests and CPE scores in all patients. Patients were divided into three similarly sized groups (CPE ≤ 1, CPE between 1.5 and 2.5, and CPE ≥ 2.5). We found that ART with high CPE scores was associated with poorer executive performances in HIV-1-infected patients. These results suggest that cognitive performance in treated HIV-infected patients could be influenced by ART. “
“To investigate the presence of hepatitis B virus (HBV) DNA and hepatitis C virus (HCV) RNA in HIV-infected patients initiating antiretroviral therapy in Cameroon. Baseline

blood samples from 169 patients were tested retrospectively for hepatitis B surface antigens (HBsAg), anti-hepatitis B core (anti-HBc), anti-HCV and – if HBsAg or anti-HCV result was positive or indeterminate – for HBV DNA or HCV RNA, selleckchem respectively, using the Cobas Ampliprep/Cobas TaqMan quantitative assay (Roche Diagnostics GmbH, Mannheim, Germany). HBV DNA was detected in 14 of the 18 patients with positive or indeterminate HBsAg results [8.3% of the total study population, 95% confidence interval (CI) 4.6–13.5]. The median

HBV viral load was 2.47 × 107 IU/mL [interquartile range (IQR) 3680–1.59 × 108; range 270 to >2.2 × 108]. Twenty-one patients (12.4%, 95% CI 7.9–18.4) were found with HCV RNA (all with positive HCV serology). The median HCV viral load was 928 000 IU/mL (IQR 178 400–2.06 × 106; range 640–5.5 × 106). No patient was co-infected with HBV and HCV. In multivariate analysis, HCV co-infection was associated with greater age [≥45 years vs. <45 years, odds ratio (OR) 11.89, 95% CI 3.49–40.55, P<0.001] and Arachidonate 15-lipoxygenase abnormal serum alanine aminotransferase level [≥1.25 × upper limit of normal (ULN) vs. <1.25 × ULN, OR 7.81, 95% CI 1.54–39.66, P=0.01]; HBV co-infection was associated with abnormal serum aspartate aminotransferase level (OR 4.33, 95% CI 1.32–14.17, P=0.02). These high rates of active HBV and HCV co-infections in HIV-positive Cameroonian patients requiring antiretroviral therapy underline the need to promote: (i) screening for HBV and HCV before treatment initiation; (ii) accessibility to tenofovir (especially in HBV-endemic African countries); and (iii) accessibility to treatment for HBV and HCV infections.

“
“Previous studies in HIV-infected populations have yielded conflicting results on the effect of antiretroviral therapy (ART) on cognition. Our objective was to investigate the effect of several years of ART with stable

mTOR inhibitor central nervous system penetration effectiveness (CPE) score on neuropsychological performance in HIV-infected individuals. We analysed a clinical cohort of HIV-infected patients who initiated ART between June 2003 and December 2006 and maintained stable CPE scores. Patients were evaluated with a short neuropsychological battery. Using linear regression, we examined the relationship between results of cognitive tests and CPE scores in all patients. Patients were divided into three similarly sized groups (CPE ≤ 1, CPE between 1.5 and 2.5, and CPE ≥ 2.5). We found that ART with high CPE scores was associated with poorer executive performances in HIV-1-infected patients. These results suggest that cognitive performance in treated HIV-infected patients could be influenced by ART. “
“To investigate the presence of hepatitis B virus (HBV) DNA and hepatitis C virus (HCV) RNA in HIV-infected patients initiating antiretroviral therapy in Cameroon. Baseline

blood samples from 169 patients were tested retrospectively for hepatitis B surface antigens (HBsAg), anti-hepatitis B core (anti-HBc), anti-HCV and – if HBsAg or anti-HCV result was positive or indeterminate – for HBV DNA or HCV RNA, Caspase inhibitor review respectively, using the Cobas Ampliprep/Cobas TaqMan quantitative assay (Roche Diagnostics GmbH, Mannheim, Germany). HBV DNA was detected in 14 of the 18 patients with positive or indeterminate HBsAg results [8.3% of the total study population, 95% confidence interval (CI) 4.6–13.5]. The median

HBV viral load was 2.47 × 107 IU/mL [interquartile range (IQR) 3680–1.59 × 108; range 270 to >2.2 × 108]. Twenty-one patients (12.4%, 95% CI 7.9–18.4) were found with HCV RNA (all with positive HCV serology). The median HCV viral load was 928 000 IU/mL (IQR 178 400–2.06 × 106; range 640–5.5 × 106). No patient was co-infected with HBV and HCV. In multivariate analysis, HCV co-infection was associated with greater age [≥45 years vs. <45 years, odds ratio (OR) 11.89, 95% CI 3.49–40.55, P<0.001] and cAMP abnormal serum alanine aminotransferase level [≥1.25 × upper limit of normal (ULN) vs. <1.25 × ULN, OR 7.81, 95% CI 1.54–39.66, P=0.01]; HBV co-infection was associated with abnormal serum aspartate aminotransferase level (OR 4.33, 95% CI 1.32–14.17, P=0.02). These high rates of active HBV and HCV co-infections in HIV-positive Cameroonian patients requiring antiretroviral therapy underline the need to promote: (i) screening for HBV and HCV before treatment initiation; (ii) accessibility to tenofovir (especially in HBV-endemic African countries); and (iii) accessibility to treatment for HBV and HCV infections.

This study aims to explore the opinions of nurses and carers within care homes on the relevance and acceptability of individualised medication administration guides for patients with dysphagia (PWD). 72 Care homes with nursing in East Anglia were invited to take part in this research and a purposively selected sample of 11 were accepted. Participant staff who administered medication to

(PWD) in care homes was included and 15 semi structured interviews with nurses and carers conducted by a research pharmacist specialising in the administration of medication to PWD. A semi-structured question list was used to identify the profession- and experience-based Alectinib cell line opinions of the participants

on whether and how far they found the I-MAG useful and their reasons for their responses. The interviews were coded and analysed. The thematic analysis drew on grounded theory principles and theory generated was then applied to improve content and procedures relating to I-MAGs. Thematic analysis indicated ways in which the I-MAGs could help standardise current practice in the administration of medication to PWD. Aspects of using the guides was also seen as increasing the nurses’ clinical confidence in their practice in ways which could improve the care received by PWD by decreasing the medicines administration error rate. I-MAGs are likely to optimise the time involved in the drug rounds but they would require regular UK-371804 datasheet updates from the community pharmacist. Pharmacist-led training on the use of the guides would also be expected by the participants before implementing such guides. The implementation of I-MAGs in care homes by community pharmacists is a complex intervention

that would also involve other healthcare professionals such us Speech and Language therapists and GPs as well as the care DCLK1 home nurses. These guides offer an opportunity for community pharmacist to enhance their role in the care homes and to improve communication between healthcare professionals. Although patients with swallowing difficulties may benefit from this intervention, appropriate health outcome measures to determine this should be identified. This study is limited to the views of our participants and further research is needed to examine the effects of implementing the I-MAG and its acceptability by other healthcare professionals. 1. Wright D. Medication administration in nursing homes. Nursing standard. 2002; 16: 33–38. 2. Serrano Santos JM, Poland F, Kelly J, Wright D. Drug administration guides in dysphagia. Nursing Times. 2012; 108: 15–17.

[1] Leptospirosis is now considered an emerging disease in travelers. On July 1, 2011, two Australian male tourists aged 25 and 26 years were admitted to the emergency department of the Careggi Hospital, Florence, Italy, reporting a 1-week history of fever with sudden onset of headache, myalgia, nausea, vomiting, and diarrhea. They had

no significant past medical or surgical history and they had recently traveled from Venice to Florence. At the time of admission they showed similar clinical signs and symptoms, mainly jaundice, conjunctival hyperemia, and muscle tenderness. Routine hematological and biochemical profiles were similar (Table 1). In both cases laboratory findings evidenced acute renal failure and hepatic impairment. Vital signs were normal. On auscultation, the heart sounds had no abnormalities PI3K Inhibitor Library research buy and air entry was equal on both lungs with occasional scattered wheezing. Results of neurological examination were normal. Electrocardiogram, abdominal ultrasound, and X-ray of the chest revealed no abnormalities. Asked about recent exposure to animals, mud, or potentially contaminated freshwater sources, the young tourists mentioned they had settled at a campsite near Venice 2 weeks earlier; because of the heat, they had both immersed their feet in the waters of a Venice canal close to Rialto Bridge. One of them had also swum in it for less than a minute without

any protection for the conjunctiva.

No skin lesions or trauma were observed at the time of possible infection, nor any swallowing of the canal water. The common selleckchem history of exposure to possible contaminated water, along with hepatic and renal impairment, suggested the diagnosis of leptospirosis. However, blood and urine specimens were collected for culture and polymerase chain reaction Dolichyl-phosphate-mannose-protein mannosyltransferase (PCR) was also evaluated. Serum samples were tested by the microscopic agglutination test (MAT). Intravenous ceftriaxone (2 g every 24 h) was empirically administered.[2] Adequate fluids and a diuretic infusion were also started. Both patients required daily hemodialysis for 5 days as a result of the severe renal injury. Blood and urine cultures had no growth. The PCR result was positive for leptospiral DNA in the urine of both patients. First collected serum sample results (approximately the tenth day of disease) were positive by MAT in both subjects with titers to serovars icterohaemorrhagiae of 1 : 1,600 and serovars copenhageni of 1 : 200 (serogroup icterohaemorrhagiae). Serovars icterohaemorrhagiae and copenhageni are commonly associated with rats as reservoir hosts.[3] Ten days later, the titer of 1 : 1,600 was confirmed in the first subject, while that of 1 : 200 of the other attained 1 : 3,200 (Table 1). The clinical picture progressively improved, restoring normal function of liver and kidney, and they were discharged after 2 weeks.

Recent literature has described the emergence of a multidrug-resistant USA-300 strain

that has accumulated genes conferring resistance not only to beta-lactams, but also to fluoroquinolones, tetracyclines, macrolides, clindamycin and mupirocin [17]. These strains appear to be common among MSM, with an overall prevalence of 26 cases per 100 000 persons in MSM in one study where MSM status was identified as a risk factor for multidrug-resistant USA-300 strain, independent of HIV status [18]. Smad family Of all MRSA infections among our MSM population, only one (5.3%) was a multidrug-resistant isolate, and it was not a USA-300. According to our definition of multidrug resistance (resistance buy GSK458 to more than two classes of antimicrobials other than beta-lactams) we had a total of eight multidrug-resistant isolates,

five of which were USA-300. Our study had several limitations. Not all patients seen in our ID clinic undergo MRSA surveillance cultures, not all isolates were available for PFGE, and complete antibiotic susceptibilities were not reported for each isolate. Additionally, although ART use within the previous year was documented, patient compliance was not assessed in our study. Unlike previous findings, our multivariate analysis did not show an increased risk of MRSA colonization or infection among injecting drug users, MSM or patients with prior incarceration. This may be explained

by our patient population, our sample size, or underreporting of homosexual activity and IDU. In summary, MRSA infection, and specifically USA-300 CA-MRSA infection, occurs in HIV-infected patients. As previously demonstrated, prior antibiotic exposure and a CD4 count <200 cells/μL proved to be independent risks for colonization or infection with MRSA in our study population. Most interesting was our novel finding that HIV-infected patients who received ART in the past year had a significantly decreased risk of MRSA colonization or infection. Further studies are warranted to determine whether HIV-infected patients with recurrent MRSA infections should be considered for earlier selleck products initiation of ART or offered decolonization. “
“The aim of the study was to determine the prevalence and risk factors for HIV-associated fatigue in the era of highly active antiretroviral therapy (HAART). A cross-sectional survey of 100 stable HIV-infected out-patients was carried out. Severity of fatigue was measured using the Fatigue Impact Scale (FIS). Symptoms of orthostatic intolerance (dysautonomia) were evaluated using the Orthostatic Grading Scale (OGS). Data for HIV-infected patients were compared with those for 166 uninfected controls and 74 patients with chronic fatigue syndrome (CFS)/myalgic encephalomyelitis (encephalopathy) (ME).

, 2006); it is assumed that the malate generated inside any Fluorouracil cell line of these organelles can be transported into the cytosol. Opposed to T. brucei, the insect stage of T. cruzi can only produce malate inside the glycosome and the mitochondrion, as in this parasite the cytosolic malate dehydrogenase (MDH) is replaced by an aromatic 2-hydroxyacid dehydrogenase that is unable to catalyze the reduction of oxaloacetate into malate (Cazzulo Franke et al., 1999). Besides, the expression of the glycosomal and mitochondrial MDHs is developmentally regulated in the American trypanosome, the glycosomal isozyme being downregulated in T. cruzi amastigotes. By contrast, the mitochondrial MDH (mMDH)

is expressed throughout the whole life cycle of parasite, and at the protein level the enzyme seems to be more abundant in amastigotes. Also, the mitochondrial aspartate aminotransferase is expressed in all T. cruzi stages, but appeared to be more

abundant in the intracellular amastigotes (Marciano et al., 2008). Although in T. cruzi amastigotes, l-aspartate is transaminated into oxaloacetate in the mitochondrion and the cytosol, the latter is converted into malate only through the action of mMDH. As the malate produced in the mitochondrion can be easily exported into the cytosol, this metabolite can serve as a substrate for both the mitochondrial and the cytosolic MEs. In summary, in T. cruzi the cytosolic level of malate is determined by the metabolic activity within EPZ6438 the mitochondrion. This hypothesis fits in well with early reports that postulated that in T. cruzi,

amino acids are actively metabolized in the mitochondrion, generating the precursors needed for energy production as well as the intermediates required for metabolic processes that occur in the cytosol (Tielens & Van Hellemond, 1998). This work was performed with grants from Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Universidad de Buenos Aires (UBA, B-094) and Agencia Nacional de Promoción Científica y Tecnológica (Argentina). C.N. and J.J.C. are members of the HSP90 Research Career from CONICET, A.E.L. is supported by a fellowship from CONICET and D.A.M. by a fellowship from the Universidad Nacional de General San Martin. Fig. S1. Sequence alignment of MEs from Trypanosoma cruzi and Trypanosoma brucei with selected orthologues from higher eukaryotes linked to NAD and NADP coenzymes. Putative malic enzymes from trypanosomes were aligned with Homo sapiens mitochondrial NAD-dependent malic enzyme (MAOM_HUMAN, Genebank accession number P23368) and pigeon cytosolic NADP-dependent malic enzyme (MAOX_COLLI, Genebank accession number P40927) using ClustalX default settings. T. brucei putative MEs (TbME1, Gene ID Tb11.02.3130 and TbME2, Gene ID Tb11.02.3120), T. cruzi putative MEs (TcME1a, Gene ID Tc00.1047053505183.20, TcME1b, Gene ID Tc00.1047053508647.270, TcME2a, Gene ID Tc00.

Performance was assessed for both ‘physical’ line bisection using a newly developed Landmark variant task and for ‘mental’ line bisection using number pairs. The effects for number line bisection were lateralized – left but not right cerebellar rTMS increased rightward errors, whereas for physical line bisection rTMS to either hemisphere did not affect performance. Effects due to neck muscle contraction and changes in eye position were ruled out

with appropriate control stimulation sites, and eye-tracking. check details The results confirm the role of the cerebellum in spatial judgement, and, for the first time, demonstrate direct cerebellar involvement in the generation of the midline in ‘imaginal’ (number) space. The difference between number line and physical line bisection effects is discussed with find more reference to pre-existing models of cerebellar hemispheric specialization and functional topography. “
“Axon collateral projections to various lobules of the cerebellar cortex are thought to contribute to the coordination of neuronal activities among different parts of the cerebellum. Even though lobules I/II and IX/X of the cerebellar vermis are located at the opposite poles in the anterior–posterior axis, they have been shown to receive dense vestibular mossy fiber projections. For climbing fibers, there is also a mirror-image-like organisation in their axonal collaterals between the anterior and

posterior cerebellar cortex. However, the detailed organisation of mossy and climbing fiber collateral afferents to lobules I/II and IX/X is still unclear. Here, we carried out a double-labeling study with two retrograde tracers (FluoroGold and MicroRuby) in lobules I/II and IX/X. We examined labeled cells in the vestibular nuclei and inferior olive. We found a low percentage of double-labeled neurons in Astemizole the vestibular nuclei (2.1 ± 0.9% of tracer-labeled neurons in this brain region), and a higher percentage of double-labeled neurons in the inferior

olive (6.5 ± 1.9%), especially in its four small nuclei (18.5 ± 8.0%; including the β nucleus, dorsal cap of Kooy, ventrolateral outgrowth, and dorsomedial cell column), which are relevant for vestibular function. These results provide strong anatomical evidence for coordinated information processing in lobules I/II and IX/X for vestibular control. “
“The current study aimed to investigate the effect of histamine-3 (H3) receptors, expressed in the tuberomammillary nucleus (TMN) of the hypothalamus and in the prefrontal cortex (PFC), on histamine neurotransmission in the rat brain. The firing activity of histamine neurons in the TMN was measured using in vivo extracellular single-unit electrophysiology, under propofol anesthesia. Extracellular histamine levels were determined using the dual (PFC and TMN) probe microdialysis, in freely-moving animals. Histamine levels in dialysates were determined using high-performance liquid chromatography (HPLC) and fluorescence detection.

e. in a fetal medicine unit) has been considered. The evidence from prospective reports of first trimester ART exposure to the APR [7] does not support the need for increased surveillance with the most commonly prescribed therapies (listed in Appendix 4), although with newer medication the knowledge base is inevitably limited. APR reports on the frequency and nature of birth defects and ART are updated every 6 months (http://www.apregistry.com/). 7.1.2 The combined screening test for trisomy 21 is recommended as this has the best sensitivity and specificity and will minimize the number

of women who may need invasive testing. Grading: 2C Clinical Veliparib Guidance 62 (CG62) [12] also recommends that all women should be offered screening for trisomy 21. The most effective screening is with the combined test at 11 + 0 to 13 + 6 weeks’ gestation. This includes maternal age, nuchal translucency, βHCG and pregnancy-associated plasma protein A. In the general population this has a detection rate of 92.6% with a false positive rate of 5.2% [13]. For women who present too late for the combined test, the most clinically and cost-effective serum

screening test (triple or quadruple test) should be offered between 15 + 0 and 20 + 0 weeks [12]. However, significantly increased levels of βHCG, α-fetoprotein and lower levels of UE3 (the elements of the selleck products ‘triple test’) have been observed in the HIV-positive population [[14][[15][#[16]]Ent]211] while a reduction in βHCG in patients treated with PI-based [17] or with NNRTI-based HAART has been reported. As Down’s syndrome is associated with increased βHCG, theoretically, HIV infection per se may increase the false-positive rate in women and thus increase the number of invasive tests offered compared with the uninfected population. Pregnancy-associated plasma protein A and nuchal Calpain translucency are unaltered by HIV infection or ART [18] and are thus the preferred screening modality. 7.1.3 Invasive prenatal diagnostic testing should not

be performed until after HIV status of the mother is known and should be ideally deferred until HIV VL has been adequately suppressed. Grading: 1C Limited data suggest amniocentesis is safe in women on HAART. There are minimal data on other forms of prenatal invasive testing. All clinicians performing a prenatal invasive test should know the woman’s HIV status, and if necessary delay the invasive test until the HIV result is available. Where possible, amniocentesis should be deferred until VL is <50 HIV RNA copies/mL. The fetal medicine team should discuss management with an HIV physician if the woman is HIV positive and has a detectable VL. 7.1.4 If not on treatment and the invasive diagnostic test procedure cannot be delayed until viral suppression is complete, it is recommended that women should commence HAART to include raltegravir and be given a single dose of nevirapine 2–4 h before the procedure.

g. a monophyletic group of Phlebia strains was characterized by its similar ability to degrade recalcitrant organopollutants (Kamei et al., 2005). In the same way, molecular clustering of isolates of Aspergillus niger aggregate group could be related to their ability to produce various

types of feruloyl esterases, enzymes involved in the biodegradation process of the cell-wall polymers (Giraud et al., 2007). In conclusion, the analysis of the three genomic fragments, www.selleckchem.com/products/ch5424802.html corresponding to rRNA, β-tubulin and lac3-1 gene regions, with respect to Pycnoporus species, could provide effective, essential molecular tools for the routine identification and comparison of strains in laboratory culture conditions. For the first time, the laccase gene lac3-1 was used to infer the phylogeny of Pycnoporus species and could highlight enzyme functional diversity associated with biogeographical origin.

Special attention was given to the closely related species P. sanguineus and P. coccineus, which display very similar characters but are geographically discontinuous populations, indicating that biogeography has played a strong role in determining evolutionary units in the genus Pycnoporus. The current defining of species in basidiomycetes is still frequently delicate and should combine molecular tools with classic selleck compound morphological data and mating-type experiments. The authors thank Prof K.A. To from the University of Hanoi and Dr M. Coussot of the Centre International de Recherche Agronomique pour le Développement (CIRAD, France) for specimens of P. sanguineus from Vietnam and French New Caledonia, respectively. The authors also are grateful to Prof. Regis Courtecuisse (Université de Lille II, France) who provided the expertise in identification of Pycnoporus species collected on the French territories. The authors also sincerely thank Dr Stéphane Welti for valuable suggestions and Dr Jean-Guy Berrin for practical

assistance. This work was supported financially by the Commission of the European Communities, Galeterone specifically the BIORENEW project (NMP2-CT-2006-026456 ‘White biotechnology for added value products from renewable plant polymers: design of tailor-made biocatalysts and new industrial bioprocesses’). “
“The use of the Gram-positive bacterium Lactococcus lactis in recombinant protein production has several advantages, including the organism’s long history of safe use in food production and the fact that it does not produce endotoxins. Furthermore the current non-dairy L. lactis production strains contain few proteases and can secrete stable recombinant protein to the growth medium. The P170 expression system used for recombinant protein production in L. lactis utilizes an inducible promoter, P170, which is up-regulated as lactate accumulates in the growth medium. We have optimised the components of the expression system, including improved promoter strength, signal peptides and isolation of production strains with increased productivity.