Assessment of liver fibrosis and associated risk factors in HIV-infected individuals using transient elastography and serum biomarkers.

BACKGROUND: Liver fibrosis in human immunodeficiency virus (HIV)-infected individuals is mostly attributable to co-infection with hepatitis B or C. The impact of other risk factors, including prolonged exposure to combined antiretroviral therapy (cART) is poorly understood. Our aim was to determine the prevalence of liver fibrosis and associated risk factors in HIV-infected individuals based on non-invasive fibrosis assessment using transient elastography (TE) and serum biomarkers (Fibrotest [FT]). METHODS: In 202 consecutive HIV-infected individuals (159 men; mean age 47 ± 9 years; 35 with hepatitis-C-virus [HCV] co-infection), TE and FT were performed. Repeat TE examinations were conducted 1 and 2 years after study inclusion. RESULTS: Significant liver fibrosis was present in 16% and 29% of patients, respectively, when assessed by TE (≥ 7.1 kPa) and FT (> 0.48). A combination of TE and FT predicted significant fibrosis in 8% of all patients (31% in HIV/HCV co-infected and 3% in HIV mono-infected individuals). Chronic ALT, AST and γ-GT elevation was present in 29%, 20% and 51% of all cART-exposed patients and in 19%, 8% and 45.5% of HIV mono-infected individuals. Overall, factors independently associated with significant fibrosis as assessed by TE (OR, 95% CI) were co-infection with HCV (7.29, 1.95-27.34), chronic AST (6.58, 1.30-33.25) and γ-GT (5.17, 1.56-17.08) elevation and time on dideoxynucleoside therapy (1.01, 1.00-1.02). In 68 HIV mono-infected individuals who had repeat TE examinations, TE values did not differ significantly during a median follow-up time of 24 months (median intra-patient changes at last TE examination relative to baseline: -0.2 kPa, p = 0.20). CONCLUSIONS: Chronic elevation of liver enzymes was observed in up to 45.5% of HIV mono-infected patients on cART. However, only a small subset had significant fibrosis as predicted by TE and FT. There was no evidence for fibrosis progression during follow-up TE examinations.

Micellar transitions in the aqueous solutions of a surfactant-like ionic liquid: 1-butyl-3-methylimidazolium octylsulfate.

We have observed dual transitions in various physical properties while investigating the surfactant-like behavior of the ionic liquid (IL) 1-butyl-3-methylimidazolium octylsulfate [C(4)mim][C(8)SO(4)] in aqueous media. Interestingly, in conductivity measurements, it was found that the second transition, which is comparatively weak in pure water, can be modulated and tuned to the desired concentration without affecting the first transition by the addition of a suitable electrolyte. Using an array of techniques, such as conductivity, ultrasonics, TEM, cryo-TEM, DLS, (1)H NMR and 2D (1)H-(1)H NOESY, it has been revealed that the first transition corresponds to the anionic aggregation with imidazolium cations adsorbed as counterions, and the second transition corresponds to the restructuring of the initially formed aggregates in a way that the alkyl chain of the imidazolium cation is incorporated towards the micellar core, leading to a unique mixed micelle-type structure in a single IL system.

Data on three-year zooplankton monitoring in ditches of the apple orchard region of Altes Land, Germany.

The data presented in this article are related to the research article 'Chemical and biological monitoring of the load of plant protection products and of zoocoenoses in ditches of the orchard region Altes Land' (Süß et al., 2006), which is only available in the German language. The zooplankton data presented here were acquired from four ditches (three ditches were located in apple orchards, and one ditch was located in a grassland region) between 2001 and 2003 (Lorenz & Müller, 2018). This article describes the methods used to determine zooplankton species in the samples. The field data set is publicly available at the OpenAgrar repository under (Lorenz & Müller, 2018). It is related to the field data set of Lorenz et al. (2018) where pesticide monitoring data from the same ditches and time period were presented.

Evolution of resistance mutations during low-level viral replication in HIV-1-infected patients treated with zidovudine/lamivudine/abacavir as a first-line regimen.

OBJECTIVE: Long-term evaluation of viral evolution in patients who continued first-line therapy with zidovudine/lamivudine/abacavir (Trizivir [TZV]) in the presence of low-level viral replication and assessment of the impact of mutational patterns selected under TZV on viral load (VL), CD4+ T-cell count (CD4) and subsequent therapeutic options. DESIGN: Analysis of viral evolution based on genotypic resistance tests (GRT) from samples collected during non-suppressive first-line therapy with TZV. METHODS: Patients from the Frankfurt HIV cohort with at least 3 months uninterrupted first-line therapy with TZV in whom VL and CD4 measurements were performed at baseline and at follow up were identified. Criteria for virological failure (VF) were two consecutive VL >400 copies/ml. GRTs were required at baseline, VF and last visit (LV). RESULTS: Initially, 23/119 patients were classified as VF; 4/23 were lost to follow up. Median time to VF was 48 weeks. Because of the observed virological and immunological benefit, patients continued TZV for a median of 87 weeks despite detectable viraemia. Median CD4 increase and VL reduction at LV were 120 cells/mm3 and 317,100 copies/ml, respectively, compared to baseline. After 54 weeks of treatment with detectable VL, three mutational patterns were observed: Group A (n=4) characterized by M184V without further regimen-associated mutations, group B (n=9) by M184V accompanied by one to three thymidine analogue mutations (TAMs), and group C (n=6) by M184V and four to six TAMs. No virological or CD4 parameters correlated with these patterns. Group A remained unchanged, thus preserving activity of most nucleoside analogues (NA). However, in the majority of patients (groups B and C) accumulation of mutations at different rates was observed, leading to a sequential loss of NA options. CONCLUSIONS: Continuous treatment with TZV in the presence of viral replication is associated with a stepwise accumulation of resistance mutations. M184V was present in all cases, not followed by further selection of TAMs in a small, unpredictable subgroup of patients. However, in the majority of patients selection of M184V was associated with accumulation of TAMs at different rates leading to a substantial loss of active NAs, despite continuous virological and immunological benefit when compared with baseline.

Comparison of selective AT1-receptor blockade versus ACE inhibition for restenosis prophylaxis in patients with peripheral occlusive arterial disease after stent angioplasty: a randomized, controlled, proof-of-concept study.

Different components of the renin-angiotensin system (RAS) have been demonstrated in atherosclerotic plaques. However, the involvement of the RAS in the complex process of in-stent restenosis is not yet clear. In this prospective, randomized, double-blind, controlled proof-of-concept study, we compared the 2 different pharmacological approaches, selective AT(1)-receptor-blockade with candesartan vs ACE inhibition with quinapril to reduce in-stent restenosis after stent angioplasty of the superficial femoral artery. Twenty-two hypertensive patients with stage IIb peripheral occlusive arterial disease and severe claudication who had been successfully treated with percutaneous transluminal angioplasty (PTA) and stent implantation were randomly assigned to receive daily doses of either candesartan (32 mg) or quinapril (20 mg). Primary end point was restenosis 6 months after intervention, assessed by angiography. Secondary end points were pain-free walking distance, determined by treadmill ergometry; determination of crurobrachial indices; and intima-media thickness (IMT). At 6 months, the rate of restenosis on angiography was 34% in the candesartan group and 71% in the quinapril group (P = .043). Relevant restenosis was found in 3 patients (27%) in the candesartan group and in 7 patients (64%) in the quinapril group. Patients in the candesartan group were able to walk farther on a treadmill (increase: 135 m +/- 20 m) compared with patients in the quinapril group (increase: 83 m +/- 21 m). The IMT at the stent edge was not significantly different in the 2 groups (candesartan: 1.9 mm +/- 0.5 mm; quinapril: 2.0 mm +/- 0.3 mm). This study revealed significant benefit of a pharmacological restenosis regimen using the AT(1)-receptor antagonist candesartan in patients with severe atherosclerosis after superficial femoral artery stenting compared with treatment with the ACE inhibitor quinapril. Further prospective studies in patients are required to confirm these results.

Linear precoding based on polynomial expansion: reducing complexity in massive MIMO.

Massive multiple-input multiple-output (MIMO) techniques have the potential to bring tremendous improvements in spectral efficiency to future communication systems. Counterintuitively, the practical issues of having uncertain channel knowledge, high propagation losses, and implementing optimal non-linear precoding are solved more or less automatically by enlarging system dimensions. However, the computational precoding complexity grows with the system dimensions. For example, the close-to-optimal and relatively "antenna-efficient" regularized zero-forcing (RZF) precoding is very complicated to implement in practice, since it requires fast inversions of large matrices in every coherence period. Motivated by the high performance of RZF, we propose to replace the matrix inversion and multiplication by a truncated polynomial expansion (TPE), thereby obtaining the new TPE precoding scheme which is more suitable for real-time hardware implementation and significantly reduces the delay to the first transmitted symbol. The degree of the matrix polynomial can be adapted to the available hardware resources and enables smooth transition between simple maximum ratio transmission and more advanced RZF. By deriving new random matrix results, we obtain a deterministic expression for the asymptotic signal-to-interference-and-noise ratio (SINR) achieved by TPE precoding in massive MIMO systems. Furthermore, we provide a closed-form expression for the polynomial coefficients that maximizes this SINR. To maintain a fixed per-user rate loss as compared to RZF, the polynomial degree does not need to scale with the system, but it should be increased with the quality of the channel knowledge and the signal-to-noise ratio.