Improvement of lipoatrophy by switching from efavirenz to lopinavir/ritonavir.

OBJECTIVE: To assess whether changes in antiretroviral drugs other than thymidine nucleoside reverse transcriptase inhibitors (NRTI) may have a body fat impact in HIV-infected patients with lipoatrophy. METHODS: Ninety-six-week phase IV, open-label, multicentre, pilot randomized trial. HIV-infected patients with moderate/severe lipoatrophy at one or more body sites despite long-term thymidine NRTI-free therapy were randomized to continue their efavirenz (EFV)-based antiretroviral regimen or to switch from EFV to lopinavir/ritonavir (LPV/r). The primary endpoint was the absolute change in limb fat mass measured by dual X-ray absorptiometry from baseline to 96 weeks. Changes in other body fat measurements, subjective perception of lipoatrophy, subcutaneous fat gene expression and plasma lipids were also assessed. RESULTS: Thirty-three patients (73% men, median age 52 years) were recruited. At 96 weeks, absolute limb fat mass increased in the LPV/r arm vs. the EFV arm (estimated difference +1082.1 g; 95% CI +63.7 to +2103.5; P = 0.04); this difference remained significant after adjustment by gender, age, fat mass, body mass index and CD4 cell count at baseline. Subjective lipoatrophy perception scores also improved in the LPV/r arm relative to the EFV arm. Adipogenesis, glucose and lipid metabolism, and mitochondrial gene expression increased in the LPV/r arm compared with the EFV arm at 96 weeks. HDL cholesterol decreased in the LPV/r arm relative to the EFV arm. CONCLUSIONS: Switching from EFV to LPV/r in HIV-infected patients with lipoatrophy may offer further limb fat gain beyond thymidine NRTI discontinuation, although this strategy decreased plasma HDL cholesterol and caused changes in subcutaneous fat gene expression that may be associated with increased insulin resistance.

Differential subcutaneous adipose tissue gene expression patterns in a randomized clinical trial of efavirenz or lopinavir-ritonavir in antiretroviral-naive patients.

Gene expression studies of subcutaneous adipose tissue may help to better understand the mechanisms behind body fat changes in HIV-infected patients who initiate antiretroviral therapy (ART). Here, we evaluated early changes in adipose tissue gene expression and their relationship to fat changes in ART-naive HIV-infected patients randomly assigned to initiate therapy with emtricitabine/tenofovir plus efavirenz (EFV) or ritonavir-boosted lopinavir (LPV/r). Patients had abdominal subcutaneous adipose tissue biopsies at baseline and week 16 and dual-energy-X-ray absorptiometry at baseline and weeks 16 and 48. mRNA changes of 11 genes involved in adipogenesis, lipid and glucose metabolism, mitochondrial energy, and inflammation were assessed through reverse transcription-quantitative PCR (RT-qPCR). Additionally, correlations between gene expression changes and fat changes were evaluated. Fat increased preferentially in the trunk with EFV and in the limbs with LPV/r (P < 0.05). After 16 weeks of exposure to the drug regimen, transcripts of CEBP/A, ADIPOQ, GLUT4, LPL, and COXIV were significantly down-regulated in the EFV arm compared to the LPV/r arm (P < 0.05). Significant correlations were observed between LPL expression change and trunk fat change at week 16 in both arms and between CEBP/A or COXIV change and trunk fat change at the same time point only in the EFV arm and not in the LPV/r arm. When combined with emtricitabine/tenofovir as standard backbone therapy, EFV and LPV/r induced differential early expression of genes involved in adipogenesis and energy metabolism. Moreover, these mRNA expression changes correlated with trunk fat change in the EFV arm. (This was a substudy of a randomized clinical trial [LIPOTAR study] registered at ClinicalTrials.gov under identifier NCT00759070.).

The converging epidemics of mood-altering-drug use, HIV, HCV, and partner violence: a conundrum for methadone maintenance treatment.

BACKGROUND: Accumulating evidence suggests that partner violence may be associated with HIV risk behavior and drug use among women in methadone maintenance treatment programs (MMTPs), yet the mechanisms linking these overlapping problems remain unclear. The main purpose of this qualitative study is to explore in detail how drug-related activities and HIV risk behavior occur in the context of a recent episode of partner violence among women in MMTPs. METHOD: We conducted and analyzed in-depth interviews with 31 women who reported having experienced physical or sexual violence by an intimate partner during the past year. Guided by existing research, feminist theory and trauma theory, we constructed a set of questions which were designed to explore multiple ways in which drug-related activities or HIV risk behavior may be linked directly or indirectly to the recent event. To examine the extent and significance of the woman sand/or her partner s drug-related activities or sexual HIV risk issues occurring immediately before, during and/or after the most recent event, we adapted a series of techniques for thematic analysis of qualitative data. RESULTS: Of the 31 women who reported recent events: 83.8 % (n=26) recalled recent events in which there was some drug-involvement; 40% (n=13) indicated that both she and her partner were involved in drug-related activities during the most recent event of partner abuse; 35% (n=11) reported that the partner was drug-involved; and only two women (6.4%) indicated that they alone had been drug-involved. One-fifth (19.3%, n=6) of the women indicated that they had used drugs immediately after the event because they were upset or in physical pain. One-fifth of the women (n=6) reported that they had coerced, unprotected sex during or after the most recent incident. CONCLUSIONS: The multiple ways in which the use of mood-altering drugs are related to partner violence and the occurrence of coerced, unprotected sex underscore the need to design specific interventions for preventing drug relapse, and HIV and HCV infection among abused women in MMTPs. Treatment and policy implications of study findings are discussed.

[Penile and urethral lesion caused by metallic ring. Reconstruction with radial free flap]. / Lesión peneana y uretral por anillo metálico. Reconstrucción con colgajo radial libre.

We report a case of a man with a severe penile injure caused by a metallic ring placed in the penile shaft for 48 hours, it coursed with partial urethral section and ischemia of the whole penile skin and dartos. It was solved with surgical excision of all death tissue and posterior reconstruction using a forearm free flap, the vascular supply came from epigastric vessels, we used hair-free skin from forearm for the urethroplasty. Ethetic and functional results obtained are successful.

An electropalatographic study of alveolar and palatal consonants in Catalan and Italian.

Electropalatographic data for Catalan and Italian reported in this paper reveal the existence of two categories of palatal consonants, namely, alveolopalatals ([n], [lambda]) and palatals proper ([j]). All these consonants are produced with a single place of articulation and thus are not good candidates for complex segments involving a tongue front articulator and a tongue dorsum articulator. A higher degree of coupling between the primary articulator and other tongue regions for alveolopalatals and palatals than for alveolar [n] accounts for a reduced sensitivity to coarticulatory effects for the former vs. the latter. Alveolar-palatal correlations reported in this study support the notion of relative independence between different tongue articulators for non-dorsal vs. dorsal consonants. Differences in articulation and coarticulation were found for Italian vs. Catalan. In comparison with their Catalan counterparts, Italian shows the following properties: Consonants are more anterior, [n] allows less coarticulation at the alveolar zone (in line with the laminal nature of the consonant), and long alveolopalatals exhibit more contact and less coarticulation at the front palatal zone.

Cortical tibial bone graft for nasal augmentation: donor site short scar.

The nose is the central part of the face and the most prominent facial feature. Augmentation rhinoplasty is one of the most exciting and arduous techniques for plastic surgeon and patient. Fourteen cases of augmentation rhinoplasty with cortical tibial bone graft are presented. An endonasal approach was used in 13 cases and an open approach in one case, with a donor site short scar (1.5 cm) in every case. The average follow up was 2 years and no significant bone resorption was observed. No remarkable complications or complications requiring surgery were noted during the follow up. The cosmetics results have been gratifying.

Hip and buttock implants to enhance the feminine contour for patients with HIV.

The antiretroviral therapy for patients with human immunodeficiency virus (HIV) causes lipodystrophy, or a change in the distribution of body. Treatment for the facial changes is well addressed and covered in the recent literature, but female patients also report changes in their buttocks and lower limbs. There is no treatment for the lower limb deformity, but plastic surgeons can do something for the buttock. The authors propose a classification for the deformities of these patients and a new solution to improve the contour of this area and to reduce the social impact of deformity on women with HIV. This consists of placing two silicone implants, in the buttock and on the hip, to give a rounder appearance. The authors think that hip implants may be indicated also for gender reassignment surgery and for women with masculine features.

Co-articulatory variability and articulatory-acoustic correlations for consonants.

This paper is an investigation of articulatory-acoustic correlations differing in degree of articulatory constraint. Data on F2 and on dorsopalatal contact (electropalatographic, EPG) were collected for the sequences /iCi/ and /aC./ with seven Catalan consonants differing in place and manner of articulation (velarised /l/, /n/, /n/, /s/, /f/, /l/, /p/). These consonants are characterised by different degrees of tongue dorsum constraint depending on their production requirements (dorsals > non-dorsals, fricatives > non-fricatives, etc.). The results showed an inverse relationship between vowel-dependent coarticulation and the degree of consonant-dependent articulatory constraint. F2 and dorsopalatal contact size were found to be positively correlated across consonants and speakers, and across consonants for each individual speaker. Correlation values were much lower for each consonant across speakers. These findings are discussed in the light of the acoustic theory of speech production and possible clinical applications are suggested.

Electropalatographic data collected with and without a face mask.

This study investigates the extent to which the use of a face mask conveys linguopalatal contact changes during speech production. Electropalatographic data from five Catalan speakers were collected for different consonants, i.e., the alveolar stop [n], the alveolopalatal stop [n] and the palatal approximant [j], in the sequences [iCi] and [aCe]. Results for [n] indicate more closure retraction in the mask versus nonmask condition occurring presumably when the mask is pressed forcefully against the face in front of the mouth. The use of the mask for [n] and [j] causes an increase in dorsopalatal contact, which reflects most likely a strategy of articulatory and/or perceptual compensation.

An electropalatographic and acoustic study of temporal coarticulation for Catalan dark/l/ and German clear/l/.

Electropalatographic and F2 frequency data in /VlV/ sequences reveal more prominent C-to-V effects for Catalan dark /l/ than for German clear /l/, more so in the /i/ context than in the /a/ context, which is in agreement with the existence of high lingual requirements on the formation of two constriction places for dark /l/. German clear /l/ exerts a similar amount of F2 displacement on both vowels which may be indicative of the tongue dorsum being directed towards a target position; this is also suggested by dorsopalatal contact and formant frequency data showing less vowel-dependent variability than clear /l/ in other languages though more so than Catalan dark /l/. Salient anticipatory requirements for the implementation of /l/ in the two languages block V1-dependent carryover effects to a large extent which results in more prominent vocalic anticipation than vocalic carryover. This directionality trend in vocalic coarticulation is more obvious for Catalan dark /l/ than for German clear /l/ (in agreement with the former consonantal variety requiring more anticipation than the latter) and opposes German /l/ to clear /l/ in other languages (i.e., the less constrained /l/ variety of Spanish may favor vocalic carryover over vocalic anticipation in VCV sequences).

HIV risks of men in methadone maintenance treatment programs who abuse their intimate partners: a forgotten issue.

Accumulating findings suggest a relationship between partner violence and HIV risk among women, however, this issue has yet to be adequately researched among men. This study examines the relationship between perpetrating intimate partner violence and HIV risk behavior among a sample of men in methadone maintenance treatment programs (MMTPs). Data were collected on 273 sexually active men, who were recruited from four inner-city MMTP clinics. More than a third of the sample reported perpetrating intimate physical abuse and 15% reported severe physical abuse in the past 12 months. Results from multiple logistic regression analyses indicate that after adjusting for demographic, poverty, and drug-use factors, men who abused an intimate partner were almost 4 times more likely to have more than one intimate partner, almost 3 times more likely to have unprotected anal sex, and 2.6 times more likely to have sex with a drug-injecting sexual partner than their counterparts. This study showed that men who perpetrated partner violence were at higher risk for HIV transmission. HIV prevention interventions need to consider the complex relationship between partner violence and HIV risk.

Forehead flag flap.

We present a modification of the Okada and Maruyama's flap for forehead reconstruction, based solely on the supratrochlear vessels. The flap is raised extra-periosteally but in the area of the pedicle the periosteum is included in the flap to protect the vessels. The flap is advanced and rotated to cover full thickness defects on the contralateral hemi-forehead, like a flag on its flagpole. We have treated six patients with large malignant tumours of the forehead which required excision including the periosteum. The flap survived in all cases and no necrosis was observed in any. The main advantage of this flap is that it is relatively straightforward to raise, being a good solution in selected cases (elderly patients). The main disadvantages of this flap are that the supraorbital nerve is sacrificed and some distortion of the eyebrows occurs.

Lesión peneana y uretral por anillo metálico. Reconstrucción con colgajo radial libre / Penile and urethral injury by methalic ring. Reconstruction using a forearm free flap

Se describe el caso de un paciente con lesión peneana grave ocasionada por un anillo metálico alojado durante 48 horas en la base peneana que cursó con sección parcial de uretra peneana y necrosis isquémica de la práctica totalidad del recubrimiento cutáneo del pene y dartos. Fue solucionado mediante una exéresis quirúrgica de todo el tejido necrótico en una primera instancia y posterior reconstrucción utilizando un colgajo radial anastomosado a los vasos epigástricos caudales, utilizando piel lampiña de la cara anterior del antebrazo en la uretroplastia. Los resultados estéticos y funcionales que se obtienen son exitosos (AU)